Hesi 2020 PN (Graded A+) LATEST UPDATE

Hesi 2020 PN 1. RN is caring for a 3-y/o child who is 2 hours postop from a cardiac catheterization via the right femoral artery. Which assessment finding is an indication of arterial obstruction? • BP trend is downward & pulse is rapid & irregular. • Right foot is cool to touch & appears pale & blanched. • Pulse distal to femoral artery is weaker on left foot than right. • Pressure dressing at right femoral area is moist & oozing blood. 2. Following a motor vehicle collision, a 3-y/o girl has a spica cast applied. Which toy is best for RN for this 3 y/o child? • Duck that squeaks. • Fashion doll & clothes. • Set of cloth & hand puppets. • Hand held video game. 3. An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which action should RN implement first? • Administer morphine sulphate. • Start IV fluids. • Place the infant in a knee-chest position. • Provide 100% oxygen by face mask. 4. Child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. RN determines that the increased respiratory rate is a compensatory mechanism for which acid base alteration? • Metabolic alkalosis. • Respiratory acidosis. • Respiratory alkalosis. • Metabolic acidosis. 5. 7 years old is admitted to hospital with persistent vomiting & a nasogastric tube attached to low intermittent suction is applied. Which finding is most important for RN to report to Dr? • Gastric output of 100 mL in the last 8 hours. • Shift intake of 640 mL IV fluids plus 30 mL PO ice chips. • Serum potassium of 3.0 mg/dL. • Serum pH of 7.45. 6. RN is evaluating diet teaching for Pt who has nontropical sprue (celiac disease). Choosing which food indicates effective teaching? • Creamed corn. • Pancakes. • Rye crackers. • Cooked oatmeal. 7. During a well-baby check, RN hides a block under baby’s blanket & baby looks for block. Which normal growth & development milestone is baby developing? • Separation anxiety. • Associative play. • Object prehension. • Object permanence. 8. The RN is measuring the frontal occipital circumference (FOC) of a 3-months old infant, & notes that the FOC has increased 5 inches since birth & the child’s head appears large in relation to body size. Which action is most important for RN to take next? • Measure the infant’s head-to-toe length. • Palpate the anterior fontanel for tension & bulging. • Observe the infant for sunken eyes. • Plot the measurement on the infant’s growth chart. 9. The RN is preparing 10 year old with accelerated forehead for suturing. Both parents & 12 y/o sibling are at the child’s bedside. Which instruction best supports family? • While waiting for Dr, only one visitor may stay with the child. • All of you should leave while Dr sutures the child’s forehead. • It is best if sibling goes to waiting room until suturing is completed. • Please decide who will stay when Dr begins suturing. 10.RN is planning for a 5-month old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake & decrease vomiting, what instructions should RN provide this mother? • Give small amounts of baby food with each feeding. • Thicken formula with cereal for each feeding. • Dilute the childs formula with equal parts of water. • Offer 10% dextrose in water between most feedings. 11.While teaching a parenting class to new parents RN describes the needs of infants & toddlers regarding discipline & limit setting. What is the most important reason for implementing such parenting behaviors? A. Children need help in developing social skills. B. This age child fears loss of self control. C. They provide the child with a sense of security. D. Children must to learn to deal with authority. 12.Parents of newborn infant with hypospadia are concerned about when surgical correction should occur. What info should RN provide? • Repair should be done by 1 month to prevent bladder infection. • To form proper urethra repair, it should be done after sexual maturity • Repairs typically should be done before child is potty trained. • Delaying the repair until school age reduces castration fears. 13.Which drink choice on hot day indicates to RN that a teenager with sickle cell understands dietary consideration related to disease? • Milkshake. • Iced tea. • Diet cola. • Lemonade. 14.RN is assessing an infant with diarrhea & lethargy. Which finding should RN identify that is consistent with early dehydration? • Tachycardia. • Bradycardia. • Dry mucous membrane. • Increased skin turgor. 15.While auscultating the lung sounds of 5 y/o Chinese boy who recently completed antibiotic therapy for pneumonia, RN notices symmetrical, round, bruise-like blemishes on his chest. What action is best for RN to take? • Identify the antibiotic used to treat the pneumonia. • Inquire about the use of alternative methods of treatment. • Ask the parents if the child has been in a recent accident. • Report suspected child abuse to the authorities. 16.A child with acute lymphocytic leukemia (ALL) receiving chemo via subclavian IV infusion, has oral temp of 103 degrees. In assessing IV site, RN determines there are no signs of infection at site. Which intervention is most important for RN to do? • Obtain specimen for blood cultures. • Assess the CBC. • Monitor the oral temperature every hour. • Administer acetaminophen as prescribed. 17.A child who weights 25 kg is receiving IV ampicillin 300 mg/kg/24 hours in equally divided doses every 4 hours. How many mg should RN administer to the child for each dose? 1875mg 18.RN is caring for infant scheduled for reduction of intussusceptions. The day before scheduled procedure, infant passes a soft-formed brown stool. Which intervention should RN do? • Instruct the parents that the infant needs to be NPO. • Notify healthcare provider of the passage of brown stool. • Obtain a stool specimen for laboratory analysis. • Ask the parents about recent changes in the infant’s diet. 19.The mother of a 4-month old asks RN for advice in preventing diaper rash. What suggestion should RN provide? • At diaper change generously powder the baby’s diaper area with talcum powder to promote dryness. • Wash the diaper area every 2 hours with soap & water to help prevent skin breakdown. • Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change. • Place a cloth diaper inside the disposable diaper for overnight periods when increased wearing time is likely. 20.Which statement by school aged Pt going to summer camp indicates best understanding of the mode of transmission of Lyme disease? • I’ll cover my mouth with wet cloth if too much dust blowing. • Cuts & scrapes need to be washed out & covered right away. • I’m not going to swim where water is standing still or feels too hot. • I’ll wear long sleeves & pants while hiking around the pond. 21.RN is evaluating thyroid therapy used to treat 5 month old with hypothyroidism. Which behavior indicates tx has been effective? • Laughs readily, turns from back to side. • Has strong Moro & tonic neck reflexes. • Keeps fists clenched, opens hands when grasping an object. • Can lift head, but not chest when lying on abdomen. 22.The HR for a 3 y/o with a congenital heart defect has steadily decreased over the last few hours, now it’s 76 bpm, the previous reading 4 hours ago was 110 bpm. Which additional finding should be reported immediately to a healthcare provider? • Oxygen saturation 94%. • RR of 25 breaths/minute. • Urine output 20 mL/hr. • BP 70/40. 23.2 y/o is admitted to hospital with possible encephalitis & lumbar puncture is scheduled. Which info should RN provide this child? • Describe the side-lying, knees to chest position that must be assumed during the procedure. • Tell the child to expect loud clicking noises during the procedure that may be slightly annoying. • Reassure the child that there will be no restrictions on activity after the procedure is completed. • Explain that fluids cannot be taken for 8 hours before the procedure & for 4 hours after procedure. 24. the parents of a 3 y/o boy who has Duchenne muscular dystrophy (DMD) ask “how can our son have this disease? We are wondering if we should have any more children” What information should RN provide these parents? • This is an inherited X-linked recessive disorder, which primarly affects male children in the family • The male infant had a viral infection that went unnoticed & iuntreated, so mucle damage was incurred • The XXXX muscle groups of males can be impacted by a lack of the protein dystrophyn in the mother • Birth trauma with a breech vaginal birth causes damage to the spinal cord, thus weakening the muscles 25.RN finds a 6 month old infant unresponsive & calls for help. After opening the airway & finding the XXXX the infant is still no breathing. Which action should RN take? A. Palpate femoral pulse & check for regularity B. Deliver cycles of 30 chest compressions & 2 breaths C. Give two breath that makes the chest rise D. Feel the carotid pulse & check for adequate breathing 26.A 3 y/o with HIV infection is staying with a foster family who is caring for 3 other foster children in their home. When one of the children acquires pertussis, the foster mother calls the clinic & asks RN what she should do. Which action should RN take first? A. Remove the child who has HIV from the foster home B. Report exposure of the child with HIV to the health department C. Place the chuld who has HIV in reverse isolation D. Review immunization documentation of child who has HIV 27.A 16 y/o female student with a history of asthma controlled with both an oral antihistamine & an albuterol (Provenfil) metere-dose inhaler (MDI) comes to school RN. The student complains she cannot sleep at night, feels shaky & her heart feels like it is “beating a mile per minute” Which info is most important for RN to obtain? • When she last took the antihistamine • When her last Asthma attack occurred • Duration of most asthmas attacks • How often the MDI is used daily 28.RN is assessing a child for neurological soft signs, which finding is most likely demonstrated in the child’s behavior? • Inability to move tongue in a direction • Presence of vertigo • Poor coordination & sense of position • Loss of visual acuity 29.RN is assessing infant with pyloric stenosis. Which patho physiological mechanism is most likely consequence of this infant’s clinical picture? • Metabolic alkalosis • Respiratory acidosis • Metabolic acidosis • Respiratory Alkalosis 30.A 4 month-old girl is brought to the clinic by her mother because she has had a cold for 2 o 3 days & woke up this morning with a hacking cough & difficulty breathing. Which additional assessment finding should alert RN that the child is in acute respiratory distress? • Bilateral bronchial breath sounds • Diaphragmatic respiration • A resting respiratory rate of 35 breathe per minute • Flaring of the nares 31.2 y/o boy begins to cry when the mother starts to leave. What is RN’s best response in this situation? Let me read the book to you. 32.A two y/o child with heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin) RN obtains an apical heart rate of 128 bpm. What action should RN implement? • Determine the pulse deficit • Administer the scheduled dose • calculate the safe dose range • review the serum digoxin level 33.A child with leukemia is admitted for Chemotherapy & the nursing diagnosis “altered nutrition, less those body requirements related to anorexia, nausea & vomiting” is identified. Which intervention RN included in this child plan of care? • Encourage a variety of large portions of food at every meal • Allow the child to eat any food desired & tolerated • Recommended eating the food as sibling eat at home • Restrict food brought form fast food restaurants 34.a 6 y/o who has asthma is demonstrating a prolonged expiratory phase & wheezing & has a35% of personal best peak expiratory flow rate (PEFR) based on these finding, actions should RN take first? • Administer a prescribed bronchodilator • Encourage the child to cough & deep breath • Report findings to the heath care provider • Determine what triggers precipitated this attack 35.RN plans to administer 10 mcg/kg of digoxin elixir as a loading dose to child who weights 55lbs. Digoxin is available as elixir of 50 mcg/ml. How many ml of digoxin elixir should RN administer to this child? 5ml 36.RN observes a mother giving her 11 month-old ferrous sulfate, followed by two ounces of orange juice. What should RN do next? • Suggest placing their on drops in orange juice & feed infant • Tell mother to follow iron drops with formula instead of OJ • instruct mother to feed infant nothing in next 30 min after iron • Give positive feedback about the way she gave sulfate 37.Which nursing intervention is most important to include in the plan of care for a child with acute glomerulonephritis A. encourage fluid intake • Promote complete bedrest • weight the child daily • administer vitamin supplements 38.During a well baby visit the parents explain that a soft bulge appears in the groin of their 4 month old son when he cries or strain stooling. The infant is schedule for surgical repair of the inguinal; hernia in two weeks. The parent should be instructed to take which measure if the hernia becomes incarcerated prior to the surgery? • Use rectal thermometer for straining on stool • Gently manipulate the hernia for reduction • Offer oral electrolyte fluids for comfort • Give acetaminophen or aspirin for crying 39.A 16 y/o male Pt who has been treated in the past for a seizure disorder is admitted to the hospital. Immediately after admission he begins to have a grand mal seizure. Which action should RN take? • Obtain assistance in holding him to prevent injury • Observe him carefully • Call a CODE • Place a padded tongue blade between the teeth 40.The mother of a 9 month old who was diagnosed with respiratory syncytial virus yesterday calls the clinic to inquire if it will be all right to take her infant to the first b-day party of a friend’s child the following day. What response should RN provide this mother? • The child will not longer be contagious, no need to take any further precaution • Make sure there are not children under age of 6 months around infected child • The child can be around other children but should wear mask at all times • Do not expose other children to RSV. It is very contagious even without direct contact 41.When screening a 5 y/o for strabism, what action should RN take A. Have child identify colored patterns on polychromatic cards B. Direct the child through 6 cardinal position of glaze C. Inspect the child for the setting sun sign D. Observe the child for blank, sunken eyes 42.RN is assessing a 6 month old infant. Which response requires further evaluation by RN? • Has doubled birth weight • Turn head to locate sound • Plays pick a boo • Demonstrate startle reflex 43.A child is brought to clinic complaining of fever & joins pain & is DX with rheumatic fever. When planning care for this child what is the goal of nursing care? • Reduce fever • Maintain fluid & electrolytes • Prevent cardiac damage • Maintain join mobility & function 44.RN working on pediatric unit takes two 8-y/o girls to the playroom. Which activity is best for RN to plan for these girls? • Selecting a board game • Playing Doctor & RN • Watching cartoon on TV • Coloring, cutting & pasting 45.RN is developing plan of care for hospitalized child with von Willebrand disease. What priority nursing intervention should be included in this child plan of care • Reduce exposure to infection • Eliminate contact with cold grafts (crafts? Is not legible) • Guard against bleeding injuries • Reduce contact with other children 46.How should RN instruct the parents of a 4 month old with seborrheic dermatitis (cradle cap) to shampoo the child’s hair? • Use a soft brush & gently scrub the area • B. Avoid scrubbing the scalp until the scales disappear • Avoid washing the child’s hair more than once a week • Use soap & water & avoid shampoos 47.Prior to discharge, the parents of a child with cystic fibrosis are demonstrating chest physiotherapy (CPT) that they will perform for their child at home. Which action requires intervention by RN? • Plan to perform CPT when the child awakens in the morning • A Copped hand is used when percussing the lung field • A bronchodilator is administered before starting CPT • Child is placed in supine position to begin percussion 48.When assessing the breath sounds of an 18 month old child who is crying, what action should RN take? • Document the assessment is not available because child is crying • Ask parents to quiet the child so breath sounds can be auscultated • Allow child to initially play with stethoscope & distract during auscultation • Auscultate & document breath sounds, noting that the child was crying at the time 49.The mother of a one month old calls the clinic to report that the back of her infant is flat. How should RN respond • Turn infant on the left side braced against the crib when sleeping • Prop the infant in a sitting position with a cushion when no sleeping • Place a small pillow under the infant’s head while lying on the back • Position infant on stomach occasionally when awake & active 50.Which nursing intervention is most important to assist in detecting hypopituitarism & hyperpituitarism in children • Carefully recording the height & weight of children to detect inappropriate growth • Performing head circumference measurements on infants under one year of age • Assessing for behavioral problems at home & school by interviewing the parents • Noting tracked wt gain without gain in height on growth chart 51.7 y/o admitted hospital with acute glomerulonephritis. When obtaining nursing history which finding should RN expect to obtain? • High blood cholesterol level on routine screening • Increased thirst & urination • A recent strep throat infection • A recent DPT immunization 52.RN plans to screen only the highest risk children for scoliosis. Which group of children should RN screen first • Girls between ages 10 & 14 • Boys between ages 10 & 14 • Boys & girls between 12 & 14 • Boys & girls between 8 & 12 53.In assessing a 10 y/o newly diagnosed with osteomyelitis, which information is most for RN to obtain • Recent recurrence of infections • Cultural heritage & belief • Family history of bone disorder • Occurrence of increased fluid intake 54.A 3 y/o boy in a daycare facility scratches his head frequently & RN confirms the presence if head lice. RN washes the child’s hair with permethrin (Nix) shampoo & call his parents. What instructions should RN provide to the parents about treatment of head lice? • Wash the child’s bed linens & clothing In hot soapy water • Dispose of the child’s brushes, comb’s & other hair accessories • Rewash the child’s hair following a 24 hour isolation period • Take the child to a hair salon for a shampoo & shorter haircut 55.RN on ped unit observes a distraught mother in the hallway scolding her 3 y/o son for wetting his pants. What initial action should RN take? A. Suggest that the mother consult a pediatric nephrologists B. Provide disposable training pants while calming the mother C. Refer the mother to a community parent education program D. Inform the mother that toilet training is slower for boys