HESI PN EXIT V2 EXAM 1) The LPN/LVN is preparing to ambulate a postoperative client after cardiac surgery.
The nurse plans to do which to
... [Show More] enable the client to best tolerate the ambulation?
1. Provide the client with a walker.
2. Remove the telemetry equipment.
3. Encourage the client to cough and deep breathe.
4. Premedicate the client with an analgesic before ambulating.
Correct Answer: 4. Premedicate the client with an analgesic before ambulating.
2) A client is wearing a continuous cardiac monitor, which begins to alarm at the nurse's
station. The nurse sees no electrocardiographic complexes on the screen. The nurse
should do which first?
1. Call a code blue.
2. Call the health care provider.
3. Check the client status and lead placement.
4. Press the recorder button on the ECG console.
Correct Answer: 3. Check the client status and lead placement.
3) The LPN/LVN in a medical unit is caring for a client with heart failure. The client
suddenly develops extreme dyspnea, tachycardia, and lung crackles, and the nurse
suspects pulmonary edema. The nurse immediately notifies the registered nurse and
expects which interventions to be prescribed? Select all that apply.
1. Administering oxygen
2. Inserting a Foley catheter
3. Administering furosemide (Lasix)
4. Administering morphine sulfate intravenously
5. Transporting the client to the coronary care unit
6. Placing the client in a low-Fowler's side-lying position
Correct Answer:
1. Administering oxygen
2. Inserting a Foley catheter
3. Administering furosemide (Lasix)
4) The nurse is monitoring a client following cardioversion. Which observations should
be of highest priority to the nurse?
1. Blood pressure
2. Status of airway
3. Oxygen flow rate
4. Level of consciousness
Correct Answer: 2. Status of airway
5) The nurse is assisting in caring for the client immediately after insertion of a
permanent demand pacemaker via the right subclavian vein. The nurse prevents
dislodgement of the pacing catheter by implementing which intervention?
1. Limiting movement and abduction of the left arm
2. Limiting movement and abduction of the right arm
3. Assisting the client to get out of bed and ambulate with a walker
4. Having the physical therapist do active range of motion to the right arm
Correct Answer: 2. Limiting movement and abduction of the right arm
6) A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest
pain and shortness of breath, and the client is visibly anxious. The LPN/LVN
understands that a life-threatening complication of this condition is which?
1. Pneumonia
2. Pulmonary edema
3. Pulmonary embolism
4. Myocardial infarction
Correct Answer: 3. Pulmonary embolism
7) A 24-year-old man seeks medical attention for complaints of claudication in the arch
of the foot. The nurse also notes superficial thrombophlebitis of the lower leg. The nurse
should check the client for which next?
1. Smoking history
2. Recent exposure to allergens
3. History of recent insect bites
4. Familial tendency toward peripheral vascular disease
Correct Answer: 1. Smoking history
8) The nurse has reinforced instructions to the client with Raynaud's disease about selfmanagement
of the disease process. The nurse determines that the client needs further
teaching if the client states which?
1. "Smoking cessation is very important."
2. "Moving to a warmer climate should help."
3. "Sources of caffeine should be eliminated from the diet."
4. "Taking nifedipine (Procardia) as prescribed will decrease vessel spasm."
Correct Answer: 2. "Moving to a warmer climate should help."
9) A client with myocardial infarction suddenly becomes tachycardic, shows signs of air
hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath
sounds, expecting to hear which breath sounds bilaterally?
1. Rhonchi
2. Crackles
3. Wheezes
4. Diminished breath sounds
Correct Answer: 2. Crackles
10) The LPN/LVN is collecting data on a client with a diagnosis of right- sided heart
failure. The nurse should expect to note which specific characteristic of this condition?
1. Dyspnea
2. Hacking cough
3. Dependent edema
4. Crackles on lung auscultation
Correct Answer: 3. Dependent edema [Show Less]