HESI LPN
HESI Leadership and Management Quizlet Questions
Question 1 of 5
A nurse in the emergency department is performing triage for a group of clients who were in a train crash. Which of the following clients should the nurse tag as emergent?
Correct Answer: C
Rationale: In a triage situation, an asymmetrical thorax suggests a potentially life-threatening condition such as a pneumothorax or hemothorax, requiring immediate attention. This client should be tagged as emergent. Periorbital ecchymosis and deep-partial thickness burns, while concerning, may not indicate an immediate life-threatening situation. An open fracture of the femur, although serious, can be prioritized after addressing emergent cases.
Question 2 of 5
A nurse at a long-term care facility is planning a fall prevention program for the residents. Which of the following interventions should the nurse include?
Correct Answer: D
Rationale: The correct answer is to implement rounds every 2 hours during the day to offer toileting. This intervention helps prevent falls by addressing the common cause of unassisted mobility, which is the need to use the bathroom. Choice A is incorrect as restraints should not be the first choice for fall prevention due to the risk of injury and loss of independence. Choice B is incorrect because all side rails up can lead to entrapment and should only be used based on individualized assessments. Choice C may not be feasible for all residents over 85 years old and does not directly address the risk of falls.
Question 3 of 5
A patient's serum potassium level is 2.2 mEq/L. Which nursing action is the highest priority for this patient?
Correct Answer: B
Rationale: The correct answer is to initiate cardiac monitoring. Severe hypokalemia can lead to life-threatening arrhythmias, making cardiac monitoring the priority to detect and manage any cardiac complications. Starting oxygen, seizure precautions, or bed rest are not the immediate priority actions for severe hypokalemia.
Question 4 of 5
Which atrioventricular heart block is also referred to as Mobitz II?
Correct Answer: B
Rationale: The correct answer is B. Second-degree atrioventricular heart block is also known as Mobitz II. In Mobitz II, some atrial impulses are blocked from reaching the ventricles, resulting in occasional dropped beats. Third-degree atrioventricular heart block is known as complete heart block, where no atrial impulses reach the ventricles. First-degree atrioventricular heart block is a condition where there is delayed conduction between the atria and ventricles but all atrial impulses are eventually conducted to the ventricles.
Question 5 of 5
Which manifestation should the nurse expect to assess in a patient with fluid volume deficit?
Correct Answer: D
Rationale: Orthostatic hypotension and flat neck veins are classic manifestations of fluid volume deficit. When the body loses fluid, blood volume decreases, leading to decreased venous return to the heart, resulting in orthostatic hypotension and flat neck veins. Choices A, B, and C are more indicative of other conditions such as dehydration, respiratory issues, or compensatory mechanisms in response to hypovolemia, respectively.