HESI PN106 Fundamentals of Nursing 44047 Fall 2025 at Nightingale College
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Free HESI PN106 Fundamentals of Nursing 44047 Fall 2025 at Nightingale College Questions
The practical nurse (PN) is preparing to provide mouth care to a client who is dependent and requires total care. Which action should the PN include?
- A. Position thumb and index finger in mouth to help keep open.
- B. Turn the client on the side before providing mouth care.
- C. Obtain a stiff-bristled brush to ensure thorough cleansing.
- D. Apply sterile gloves prior to beginning the procedure.
Explanation
Turning the client on their side before providing mouth care is essential to prevent aspiration, especially in a client who is dependent and unable to manage their own airway. This position allows any fluids or secretions to drain from the mouth and reduces the risk of choking or aspiration into the lungs. It is a standard practice to provide safer mouth care for clients with total care needs.
While performing a physical assessment on a client with chronic obstructive pulmonary disease (COPD), the practical nurse (PN) determines that the client's respiratory rate is 30 breaths/minute. When the PN begins to assess the client's range of motion (ROM), which is the best plan to implement?
- A. Limit ROM assessment to the lower extremities only.
- B. Ask the client to perform flexion and extension of arms 5 times.
- C. Observe the client performing lateral flexion of the waist.
- D. Defer ROM assessment because of the respiratory rate.
Explanation
A respiratory rate of 30 breaths per minute is elevated and may indicate that the client is experiencing respiratory distress or fatigue. Performing physical activities, such as range of motion exercises, could exacerbate the client's breathing difficulty. Therefore, the best course of action is to defer the ROM assessment until the client’s respiratory status improves or stabilizes. The PN should prioritize the client’s breathing and ensure that they are not overexerting themselves.
An unlicensed assistive personnel (UAP) is preparing to assist with the personal hygiene of a client receiving oxygen per nasal cannula. While reviewing client care with the UAP, which instruction related to the oxygen therapy should the practical nurse (PN) include?
- A. Use a soft hairbrush and avoid chemical hair products.
- B. Restrict fluids to reduce risk for aspiration.
- C. Apply a gait belt before ambulation.
- D. Keep the oral cavity and mucous membranes moistened.
Explanation
Clients receiving oxygen therapy via a nasal cannula are at risk for dryness of the oral cavity and mucous membranes. The PN should instruct the UAP to keep the oral cavity and mucous membranes moistened by encouraging the client to drink fluids or using a humidifier if indicated. This helps to alleviate discomfort and prevent complications such as dryness, irritation, or infections.
The client is a 42-year-old female who had a cholecystectomy. Patient Data Nurses' Notes0900 Returned to room from postanesthesia care unit (PACU). Situation-background-assessment-recommendation (SBAR) communication reveals the client has had no urine output during the anesthesia recovery period. Last void was 8 hours ago. Client positioned in bed. Warm blanket applied for comfort. IV fluids infusing. 1045 Client requesting pain medication and informs has the urge to void. Wishes to use bedpan. Voided 75 mL. 1130 Client reporting continues to have the urge to void and feels "wet". Placed on bedpan. Voided 50 mL. Bladder focused assessment. Palpated and feels full. Bladder scanner applied and revealed 600 mL residual urine. The practical nurse (PN) is planning care for the client. Which condition the client is most likely experiencing, two actions the PN should take to address that condition, and two parameters the PN should monitor to assess the client's progress.
- A. Condition: Urinary Retention Actions to Take: ●Insert an indwelling urinary catheter ●Increase the IV fluid rate Parameters to Monitor: ●Residual urine ●Amount of urine output
- B. Condition: Overflow Urinary Incontinence Actions to Take: ●Request a prescription for a straight catheter ●Assist the client to the bathroom for voiding Parameters to Monitor: ●Frequency of voiding ●IV fluid intake
- C. Condition: Functional Urinary Incontinence Actions to Take: ●Insert an indwelling urinary catheter ●Request a prescription for straight catheter Parameters to Monitor: ●Pain medication effects ●Frequency of voiding
- D. Condition: Urinary Tract Obstruction Actions to Take: ●Increase the IV fluid rate ●Request a prescription for a straight catheter Parameters to Monitor: ●Residual urine ●Pain medication effects
Explanation
Urinary retention is the most likely condition based on the client's symptoms: absence of urine output, the urge to void, and a full bladder with a significant amount of residual urine. Inserting an indwelling catheter will help relieve the retention, and increasing the IV fluids will help promote urine production. Monitoring residual urine and urine output will be crucial to assess progress.
A client has a prescription for NPH insulin 25 units before breakfast and insulin aspart before meals and at bedtime per sliding scale. The sliding scale parameters are: ●0 units for finger stick glucose less than 170 mg/dL ●5 units for finger stick glucose 171 to 219 mg/dL ●10 units for finger stick glucose 220 to 269 mg/dL ●15 units for finger stick glucose 270 to 300 mg/dL Call healthcare provider (HCP) for finger stick glucose greater than 300 mg/dL. The client's 0730 finger stick glucose is 271 mg/dL. What is the total amount of insulin this client should receive? (Enter numeric value only.)
- A. 25 units
- B. 30 units
- C. 35 units
- D. 40 units
Explanation
The total amount of insulin the client should receive includes both the scheduled NPH insulin and the insulin aspart based on the sliding scale. The NPH insulin is 25 units before breakfast. Since the client's finger stick glucose is 271 mg/dL, according to the sliding scale, the client should receive 15 units of insulin aspart. Therefore, the total amount of insulin is 25 units (NPH) + 15 units (insulin aspart) = 40 units.
The unlicensed assistive personnel (UAP) reports to the practical nurse (PN) that a resident of the long-term care facility being treated for bacterial conjunctivitis is reporting eye pain and photophobia. When passing by the client's room, the PN observes the UAP removing soiled gloves outside of the room. Which action should the PN take?
- A. Instruct how to clean and decontaminate the area.
- B. Clarify contact precautions guidelines with the UAP.
- C. Recommend using a non-alcohol foam for cleaning.
- D. Direct the UAP to dispose of personal protective equipment (PPE) in a red biohazard bag.
Explanation
The PN should clarify the contact precautions guidelines with the UAP. Bacterial conjunctivitis is a highly contagious condition, and it is essential for the UAP to follow proper infection control practices, including removing gloves and disposing of them inside the room. Ensuring the UAP understands the guidelines for contact precautions will help prevent the spread of infection within the facility and protect both staff and other residents.
Which information should the practical nurse (PN) include in a report of a client being admitted to the rehabilitation unit from the nursing home? Select all that apply.
- A. Admitting diagnosis.
- B. Nursing home care plan.
- C. Residency status.
- D. Current code status.
- E. Insurance coverage.
Explanation
Correct Answer Is:
A. Admitting diagnosis. B. Nursing home care plan. D. Current code status.
A. Admitting diagnosis: The PN should include the admitting diagnosis in the report to ensure that the healthcare team is aware of the reason for the client's admission to the rehabilitation unit. This helps guide the care plan and ensures appropriate treatment.
B. Nursing home care plan: The nursing home care plan is important for providing continuity of care. Including this information helps the rehabilitation team understand the client’s prior care needs, ongoing goals, and any specific interventions that may be necessary.
D. Current code status: Current code status is essential information for the rehabilitation team to know. It indicates the client's wishes regarding resuscitation or life-saving measures in the event of a medical emergency, and ensures that care is aligned with the client’s preferences.
An older Muslim woman with left hemiplegia caused by a stroke, is admitted to a long-term care facility. Which staff member should the practical nurse (PN) assign to care for this client?
- A. A middle-aged woman who speaks with an accent.
- B. A female student nurse who has back problems.
- C. An older male who has difficulty hearing female voices.
- D. A young male who avoids direct eye contact.
Explanation
In this scenario, cultural sensitivity is important. Muslim women often prefer care from female staff due to cultural and religious beliefs regarding modesty and gender roles. A middle-aged woman who speaks with an accent may still be the most appropriate choice, as long as she is capable of providing competent care. The accent should not be a barrier to care, and the key consideration here is the woman's gender, which aligns with the client's preferences.
The practical nurse (PN) is caring for a client who is postoperative and receiving supplemental oxygen at 2 L/minute via nasal cannula. The oxygen saturation is 89%. Which action should the PN implement?
- A. Remove nasal cannula
- B. Increase the oxygen to 3 L/minute.
- C. Verify placement of pulse oximeter.
- D. Switch to a nonrebreather mask.
Explanation
An oxygen saturation level of 89% is below the normal range (usually 92-100%), indicating that the client may not be receiving enough oxygen. A nonrebreather mask can deliver higher concentrations of oxygen compared to a nasal cannula, providing immediate and more effective oxygenation for clients with low oxygen saturation. The PN should switch to a nonrebreather mask to help increase the oxygen levels and improve the client’s saturation.
A male client who was treated for a draining, infected wound and placed on contact precautions while hospitalized is being discharged to his home where he lives with his wife and adolescent son. Which information should the practical nurse (PN) reinforce with the family?
- A. Use paper plates and disposable utensils for the client's meals and snacks.
- B. Require family members and visitors to wear a mask and gown when visiting the client.
- C. Have the client stay in a room separate from the family with the door closed.
- D. Place soiled dressings in a plastic bag that can be tightly secured for disposal.
Explanation
When a client is discharged after treatment for an infected wound, proper disposal of soiled dressings is essential to prevent the spread of infection. The PN should instruct the family to place soiled dressings in a plastic bag that can be tightly secured for disposal. This practice ensures that infectious material is contained and reduces the risk of transmission to others in the household. Proper disposal methods are part of standard infection control practices after contact precautions.
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