Practice Question
An elderly client is 12-hours postoperative for a hernia repair and suddenly becomes agitated, staggers out into the corridor, and demands to be set free.After assisting the client back to bed and administering pain medication, which intervention is best for the practical nurse (PN) to implement?
Answer Choices:
Correct Answer:
Raise the side rails and notify the family to come and stay until the client is reoriented and cooperative
Rationale:
🛏️ The client’s behavior suggests postoperative delirium, which is common in older adults due to factors like anesthesia, pain, unfamiliar environment, or sleep disruption.
🛏️ Raising the side rails ensures safety without applying physical restraints, which should be avoided unless absolutely necessary.
🛏️ Notifying the family to come provides emotional support and may help calm and reorient the client through familiar presence and communication.
🛏️ This intervention promotes non-pharmacologic de-escalation, patient dignity, and encourages family involvement in care.
Want to practice more questions like this?
This question is from PN Hesi Exit-2025 Exam 1 which contains 72 questions.
More Questions from This Exam
The practical nurse (PN) is observing a newly hired PN who is preparing to administer a liquid medication via a client's feeding tube system as seen in the picture. What action should the PN take?
Answer Choices:
A client with obsessive-compulsive disorder (OCD) reports, "Thoughts stick in my mind and the rituals I use are stupid, but I cannot control them. People laugh at me, but they do not understand how awful it is. I am a burden to my family because I cannot hold a job. I do not know how much longer I can live this way." Which information is most important for the practical nurse (PN) to ask in response to the client's statements?
Answer Choices:
Which actions should the practical nurse (PN) include when assessing a client for signs and symptoms of fluid volume excess? (Select all that apply.)
Answer Choices:
The charge nurse brings a #18 urinary catheter with a 30 mL balloon to the practical nurse (PN) who is preparing to insert a catheter in a female client who weighs 50 kg. Which action should the PN take first?
Answer Choices:
The birth weight of an infant delivered by a woman with gestational diabetes is 10.1 pounds (4,581 grams). The infant is jitery and has a heel stick glucose level of 40 mg/dL (2.2 mmol/L) 30 minutes after birth. Based on this information, which intervention should the practical nurse (PN) implement first?Reference range:Blood glucose neonate: [30 to 60 mg/dL or 1.7 to 3.3 mmol/L]
Answer Choices:
Question Details
- Category: LPN Nursing Exam(s)
- Subcategory: LPN HESI Exit Exam(s)
- Domain: LPN HESI Exit-2025
- Answer Choices: 4