1
HESI RN PROCTORED EXAM /ACTUAL EXAM vr vr vr vr vr
QUESTIONS AND WELL ELABORATED vr vr vr vr
ANSWERS/NEWEST/A+ GRADE vr vr
1. The nurse is caring for a pre-adolescent client in skeletal Dunloptraction.
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Which nursing intervention is appropriate for this child?
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A) Make certain the child is maintained in correct body alignment.
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B) Be sure the traction weights touch the end of the bed.
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C) Adjust the head and foot of the bed for the child's comfort
vr vr vr vr vr vr vr vr vr vr vr
D) Release the traction for 15-20 minutes every6 hours PRN. vr vr vr vr vr vr vr vr vr
✓ A: Make certain the child is maintained in correct body alignment.
vr vr vr vr vr vr vr vr vr vr
2. The nurse is assessing a healthy child at the 2 year check up. Which of
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
the following should the nurse report immediately to thehealth care
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provider?
vr
A) Height and weight percentiles varywidely vr vr vr vr vr
B) Growth pattern appears to have slowed vr vr vr vr vr
C) Recumbent and standing height are different vr vr vr vr vr
D) Shortterm weight changes are uneven
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✓ A: Height and weight percentiles vary widely
vr vr vr vr vr vr
3. The parents of a 2 year-old child report that he has been holdinghis
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breath whenever he has temper tantrums. What is the best action by the
vr vr vr vr vr vr vr vr vr vr vr vr vr
nurse?
vr
A) Teach the parents how to perform cardiopulmonary
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resuscitation
vr
B) Recommend that the parents give in when he holds his breath toprevent vr vr vr vr vr vr vr vr vr vr vr vr
anoxia
vr
C) Advise the parents to ignore breath holding because breathingwill
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begin as a reflex
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D) Instruct the parents on how to reason with the child aboutpossible
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harmful effects
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✓ C: Advise the parents to ignore breath holding because breathingwill
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begin as a reflex
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4. The nurse is assessing a client in the emergencyroom. Which
vr vr vr vr vr vr vr vr vr vr
statement suggests that the problem is acute angina?
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A) "My pain is deep in mychest behind mysternum."
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B) "When I sit up the pain gets worse." vr vr vr vr vr vr vr
,2
C) "As I take a deep breath the pain gets worse."
vr vr vr vr vr vr vr vr vr
D) "The pain is right here in my stomach area." vr vr vr vr vr vr vr vr
✓ A: "My pain is deep in my chest behind my sternum."
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5. The nurse is assessing the mental status of a client admitted with
vr vr vr vr vr vr vr vr vr vr vr
possible organic brain disorder. Which of thesequestions willbest assess
vr vr vr vr vr vr vr vr vr vr vr
the function of the client's recent memory?
vr vr vr vr vr vr vr
A) "Name the year." "What season is this?" (pause for answer aftereach vr vr vr vr vr vr vr vr vr vr vr
question)
vr
B) "Subtract 7 from 100 and then subtract 7 from that." (pause foranswer) vr vr vr vr vr vr vr vr vr vr vr vr
"Now continue to subtract 7 from the new number."
vr vr vr vr vr vr vr vr vr
C) "I am going to saythe names of three things and I want you torepeat
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them after me: blue, ball, pen."
vr vr vr vr vr vr
D) "What is this on mywrist?" (point to your watch) Then ask,"What is
vr vr vr vr vr vr vr vr vr vr vr vr vr
the purpose of it?"
vr vr vr vr
✓ C: "I am going to say the names of three things and I want you to
vr vr vr vr vr vr vr vr vr vr vr vr vr vr vr
repeat them after me: blue, ball, pen."
vr vr vr vr vr vr vr
6. In planning care for a 6 month-old infant, what must the nurseprovide
vr vr vr vr vr vr vr vr vr vr vr vr
to assist in the development of trust?
vr vr vr vr vr vr vr
A) Food
B) Warmth
C) Security
D) Comfort
✓ C: Security vr
7. A nurse has just received a medication order which is not legible.Which
vr vr vr vr vr vr vr vr vr vr vr vr
statement best reflects assertive communication?
vr vr vr vr vr
A) "I cannot give this medication as it is written. I have no idea ofwhat you
vr vr vr vr vr vr vr vr vr vr vr vr vr vr vr
mean."
vr
B) "Would you please clarifywhat you have written so I am sure Iam vr vr vr vr vr vr vr vr vr vr vr vr vr
reading it correctly?"
vr vr vr
C) "I am having difficultyreading your handwriting. It would saveme time if
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you would be more careful."
vr vr vr vr vr
D) "Please print in the future so I do not have to spend extra time vr vr vr vr vr vr vr vr vr vr vr vr vr
attempting to read your writing."
vr vr vr vr vr
✓ B) "Would you please clarify what you have written so I am sure Iam
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
reading it correctly?" vr vr vr
8. What is the most important consideration when teaching parentshow to
vr vr vr vr vr vr vr vr vr vr
reduce risks in the home?
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A) Age and knowledge level of the parents
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B) Proximityto emergencyservices r
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,3
C) Number of children in the home vr vr vr vr vr
D) Age of children in the homevr vr vr vr vr
✓ D: Age of children in the home vr vr vr vr vr vr
9. A 35 year-old client with sickle cell crisis is talking on the
vr vr vr vr vr vr vr vr vr vr vr
telephone but stops as the nurse enters the room to request
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something for pain. The nurse should
vr vr vr vr vr vr
A) Administera placebo vr vr
B) Encourageincreased fluidintake vr vr vr
C) Administertheprescribedanalgesia vr vr vr
D) Recommend relaxation exercisesfor pain control vr vr vr vr vr
✓ C: Administertheprescribed analgesia vr vr vr vr
✓
10. While caring for a toddler with croup, which initial sign of crouprequires
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the nurse's immediate attention?
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A) Respiratoryrate of 42 vr vr vr
B) Lethargyfor the past hour vr vr vr vr
C) Apical pulse of 54 vr vr vr
D) Coughingupcopious secretions vr vr vr
✓ A: Respiratory rate of 30 vr vr vr vr
11. A client is admitted with low T3 and T4 levels and an elevated TSH
vr vr vr vr vr vr vr vr vr vr vr vr vr
level. On initial assessment, the nursewould anticipatewhichof the
vr vr vr vr vr vr vr vr vr vr vr
following assessment findings?
vr vr vr
A) Lethargy
B) Heatintolerance vr
C) Diarrhea
D) Skin eruptions vr
✓ A: Lethargy vr
12. The emergency room nurse admits a child who experienced a
vr vr vr vr vr vr vr vr vr
seizure at school. The father comments that this is the first occurrence,
vr vr vr vr vr vr vr vr vr vr vr vr
and denies anyfamily historyof epilepsy. What is thebest response by the
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
nurse?
vr
A) "Do not worry. Epilepsycan be treated with medications."
vr vr vr vr vr vr vr vr
B) "The seizure mayor maynot mean your child has epilepsy."
vr vr vr vr vr vr vr vr vr vr
C) "Since thiswas the first convulsion, it maynot happen again."
vr vr vr vr vr vr vr vr vr vr
D) "Longterm treatment will prevent futureseizures."vr vr vr vr vr vr
✓ B: "The seizure may or may not mean your child has epilepsy."
vr vr vr vr vr vr vr vr vr vr vr
13. Alcohol and drug abuse impairs judgment and increases risktaking vr vr vr vr vr vr vr vr vr
behavior. What nursing diagnosis best applies?
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, A) Risk for injury vr vr
4
B) Riskforknowledge deficit vr vr vr
C) Alteredthoughtprocess vr vr
D) Disturbanceinself-esteem vr vr
✓ A: Risk for injury vr vr vr
14. The nurse is caring for a 10 month-old infant who is has oxygen via
vr vr vr vr vr vr vr vr vr vr vr vr vr
mask. It is important for the nurse to maintain patency of which of these
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
areas?
vr
A) Mouth
B) Nasal passages vr
C) Back of throat vr vr
D) Bronchials
✓ B: Nasalpassages vr vr
15. The nurse is providing instructions for a client with pneumonia. What is
vr vr vr vr vr vr vr vr vr vr vr
the most important information to convey to the client?
vr vr vr vr vr vr vr vr vr
A) "Take at least 2 weeks off from work." vr vr vr vr vr vr vr
B) "Youwill need another chest x-rayin 6 weeks." vr vr vr vr vr vr vr vr
C) "Takeyour temperature everyday." vr vr vr vr
D) "Completeall of the antibiotic evenif your findings decrease." vr vr vr vr vr vr vr vr vr
✓ D:"Complete all of the antibiotic even if your findings decrease."
vr vr vr vr vr vr vr vr vr vr
16. When counseling a 6 year old who is experiencing enuresis,what vr vr vr vr vr vr vr vr vr vr
must the nurse understand about the pathophysiological basis of this
vr vr vr vr vr vr vr vr vr vr
disorder?
vr
A) Has no clear etiology vr vr vr
B) Maybe associated with sleep phobia vr vr vr vr vr
C) Has a definite genetic link vr vr vr vr
D) Is a sign ofwillful misbehavior
vr vr vr vr vr
✓ A: Has no clear etiology vr vr vr vr
17. The nurse is discussing negativism with the parents of a 30month-
vr vr vr vr vr vr vr vr vr vr vr
old child. How should the nurse tell the parents to best respond to this
vr vr vr vr vr vr vr vr vr vr vr vr vr
behavior?
vr
A) Reprimand the child and give a 15 minute "time out" vr vr vr vr vr vr vr vr vr
B) Maintainapermissive attitude for thisbehavior vr vr vr vr vr vr
C) Use patience and a sense of humor to deal with this behavior
vr vr vr vr vr vr vr vr vr vr vr
D) Assert authorityover the child through limit setting vr vr vr vr vr vr vr
✓ C: Use patience and a sense of humor to deal with this behavior
vr vr vr vr vr vr vr vr vr vr vr vr
18. The nurse is talking by telephone with a parent of a 4 year-oldchild who
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
has chickenpox. Which of the following demonstrates appropriate
vr vr vr vr vr vr vr vr
HESI RN PROCTORED EXAM /ACTUAL EXAM vr vr vr vr vr
QUESTIONS AND WELL ELABORATED vr vr vr vr
ANSWERS/NEWEST/A+ GRADE vr vr
1. The nurse is caring for a pre-adolescent client in skeletal Dunloptraction.
vr vr vr vr vr vr vr vr vr vr vr
Which nursing intervention is appropriate for this child?
vr vr vr vr vr vr vr vr
A) Make certain the child is maintained in correct body alignment.
vr vr vr vr vr vr vr vr vr
B) Be sure the traction weights touch the end of the bed.
vr vr vr vr vr vr vr vr vr vr
C) Adjust the head and foot of the bed for the child's comfort
vr vr vr vr vr vr vr vr vr vr vr
D) Release the traction for 15-20 minutes every6 hours PRN. vr vr vr vr vr vr vr vr vr
✓ A: Make certain the child is maintained in correct body alignment.
vr vr vr vr vr vr vr vr vr vr
2. The nurse is assessing a healthy child at the 2 year check up. Which of
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
the following should the nurse report immediately to thehealth care
vr vr vr vr vr vr vr vr vr vr vr
provider?
vr
A) Height and weight percentiles varywidely vr vr vr vr vr
B) Growth pattern appears to have slowed vr vr vr vr vr
C) Recumbent and standing height are different vr vr vr vr vr
D) Shortterm weight changes are uneven
vr vr vr vr vr
✓ A: Height and weight percentiles vary widely
vr vr vr vr vr vr
3. The parents of a 2 year-old child report that he has been holdinghis
vr vr vr vr vr vr vr vr vr vr vr vr vr
breath whenever he has temper tantrums. What is the best action by the
vr vr vr vr vr vr vr vr vr vr vr vr vr
nurse?
vr
A) Teach the parents how to perform cardiopulmonary
vr vr vr vr vr vr
resuscitation
vr
B) Recommend that the parents give in when he holds his breath toprevent vr vr vr vr vr vr vr vr vr vr vr vr
anoxia
vr
C) Advise the parents to ignore breath holding because breathingwill
vr vr vr vr vr vr vr vr vr
begin as a reflex
vr vr vr vr
D) Instruct the parents on how to reason with the child aboutpossible
vr vr vr vr vr vr vr vr vr vr vr
harmful effects
vr vr
✓ C: Advise the parents to ignore breath holding because breathingwill
vr vr vr vr vr vr vr vr vr vr
begin as a reflex
vr vr vr vr
4. The nurse is assessing a client in the emergencyroom. Which
vr vr vr vr vr vr vr vr vr vr
statement suggests that the problem is acute angina?
vr vr vr vr vr vr vr vr
A) "My pain is deep in mychest behind mysternum."
vr vr vr vr vr vr vr vr vr
B) "When I sit up the pain gets worse." vr vr vr vr vr vr vr
,2
C) "As I take a deep breath the pain gets worse."
vr vr vr vr vr vr vr vr vr
D) "The pain is right here in my stomach area." vr vr vr vr vr vr vr vr
✓ A: "My pain is deep in my chest behind my sternum."
vr vr vr vr vr vr vr vr vr vr
5. The nurse is assessing the mental status of a client admitted with
vr vr vr vr vr vr vr vr vr vr vr
possible organic brain disorder. Which of thesequestions willbest assess
vr vr vr vr vr vr vr vr vr vr vr
the function of the client's recent memory?
vr vr vr vr vr vr vr
A) "Name the year." "What season is this?" (pause for answer aftereach vr vr vr vr vr vr vr vr vr vr vr
question)
vr
B) "Subtract 7 from 100 and then subtract 7 from that." (pause foranswer) vr vr vr vr vr vr vr vr vr vr vr vr
"Now continue to subtract 7 from the new number."
vr vr vr vr vr vr vr vr vr
C) "I am going to saythe names of three things and I want you torepeat
vr vr vr vr vr vr vr vr vr vr vr vr vr vr vr
them after me: blue, ball, pen."
vr vr vr vr vr vr
D) "What is this on mywrist?" (point to your watch) Then ask,"What is
vr vr vr vr vr vr vr vr vr vr vr vr vr
the purpose of it?"
vr vr vr vr
✓ C: "I am going to say the names of three things and I want you to
vr vr vr vr vr vr vr vr vr vr vr vr vr vr vr
repeat them after me: blue, ball, pen."
vr vr vr vr vr vr vr
6. In planning care for a 6 month-old infant, what must the nurseprovide
vr vr vr vr vr vr vr vr vr vr vr vr
to assist in the development of trust?
vr vr vr vr vr vr vr
A) Food
B) Warmth
C) Security
D) Comfort
✓ C: Security vr
7. A nurse has just received a medication order which is not legible.Which
vr vr vr vr vr vr vr vr vr vr vr vr
statement best reflects assertive communication?
vr vr vr vr vr
A) "I cannot give this medication as it is written. I have no idea ofwhat you
vr vr vr vr vr vr vr vr vr vr vr vr vr vr vr
mean."
vr
B) "Would you please clarifywhat you have written so I am sure Iam vr vr vr vr vr vr vr vr vr vr vr vr vr
reading it correctly?"
vr vr vr
C) "I am having difficultyreading your handwriting. It would saveme time if
vr vr vr vr vr vr vr vr vr vr vr vr
you would be more careful."
vr vr vr vr vr
D) "Please print in the future so I do not have to spend extra time vr vr vr vr vr vr vr vr vr vr vr vr vr
attempting to read your writing."
vr vr vr vr vr
✓ B) "Would you please clarify what you have written so I am sure Iam
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
reading it correctly?" vr vr vr
8. What is the most important consideration when teaching parentshow to
vr vr vr vr vr vr vr vr vr vr
reduce risks in the home?
vr vr vr vr vr
A) Age and knowledge level of the parents
vr vr vr vr vr vr
B) Proximityto emergencyservices r
v vr vr
,3
C) Number of children in the home vr vr vr vr vr
D) Age of children in the homevr vr vr vr vr
✓ D: Age of children in the home vr vr vr vr vr vr
9. A 35 year-old client with sickle cell crisis is talking on the
vr vr vr vr vr vr vr vr vr vr vr
telephone but stops as the nurse enters the room to request
vr vr vr vr vr vr vr vr vr vr vr
something for pain. The nurse should
vr vr vr vr vr vr
A) Administera placebo vr vr
B) Encourageincreased fluidintake vr vr vr
C) Administertheprescribedanalgesia vr vr vr
D) Recommend relaxation exercisesfor pain control vr vr vr vr vr
✓ C: Administertheprescribed analgesia vr vr vr vr
✓
10. While caring for a toddler with croup, which initial sign of crouprequires
vr vr vr vr vr vr vr vr vr vr vr vr
the nurse's immediate attention?
vr vr vr vr
A) Respiratoryrate of 42 vr vr vr
B) Lethargyfor the past hour vr vr vr vr
C) Apical pulse of 54 vr vr vr
D) Coughingupcopious secretions vr vr vr
✓ A: Respiratory rate of 30 vr vr vr vr
11. A client is admitted with low T3 and T4 levels and an elevated TSH
vr vr vr vr vr vr vr vr vr vr vr vr vr
level. On initial assessment, the nursewould anticipatewhichof the
vr vr vr vr vr vr vr vr vr vr vr
following assessment findings?
vr vr vr
A) Lethargy
B) Heatintolerance vr
C) Diarrhea
D) Skin eruptions vr
✓ A: Lethargy vr
12. The emergency room nurse admits a child who experienced a
vr vr vr vr vr vr vr vr vr
seizure at school. The father comments that this is the first occurrence,
vr vr vr vr vr vr vr vr vr vr vr vr
and denies anyfamily historyof epilepsy. What is thebest response by the
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
nurse?
vr
A) "Do not worry. Epilepsycan be treated with medications."
vr vr vr vr vr vr vr vr
B) "The seizure mayor maynot mean your child has epilepsy."
vr vr vr vr vr vr vr vr vr vr
C) "Since thiswas the first convulsion, it maynot happen again."
vr vr vr vr vr vr vr vr vr vr
D) "Longterm treatment will prevent futureseizures."vr vr vr vr vr vr
✓ B: "The seizure may or may not mean your child has epilepsy."
vr vr vr vr vr vr vr vr vr vr vr
13. Alcohol and drug abuse impairs judgment and increases risktaking vr vr vr vr vr vr vr vr vr
behavior. What nursing diagnosis best applies?
vr vr vr vr vr vr
, A) Risk for injury vr vr
4
B) Riskforknowledge deficit vr vr vr
C) Alteredthoughtprocess vr vr
D) Disturbanceinself-esteem vr vr
✓ A: Risk for injury vr vr vr
14. The nurse is caring for a 10 month-old infant who is has oxygen via
vr vr vr vr vr vr vr vr vr vr vr vr vr
mask. It is important for the nurse to maintain patency of which of these
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
areas?
vr
A) Mouth
B) Nasal passages vr
C) Back of throat vr vr
D) Bronchials
✓ B: Nasalpassages vr vr
15. The nurse is providing instructions for a client with pneumonia. What is
vr vr vr vr vr vr vr vr vr vr vr
the most important information to convey to the client?
vr vr vr vr vr vr vr vr vr
A) "Take at least 2 weeks off from work." vr vr vr vr vr vr vr
B) "Youwill need another chest x-rayin 6 weeks." vr vr vr vr vr vr vr vr
C) "Takeyour temperature everyday." vr vr vr vr
D) "Completeall of the antibiotic evenif your findings decrease." vr vr vr vr vr vr vr vr vr
✓ D:"Complete all of the antibiotic even if your findings decrease."
vr vr vr vr vr vr vr vr vr vr
16. When counseling a 6 year old who is experiencing enuresis,what vr vr vr vr vr vr vr vr vr vr
must the nurse understand about the pathophysiological basis of this
vr vr vr vr vr vr vr vr vr vr
disorder?
vr
A) Has no clear etiology vr vr vr
B) Maybe associated with sleep phobia vr vr vr vr vr
C) Has a definite genetic link vr vr vr vr
D) Is a sign ofwillful misbehavior
vr vr vr vr vr
✓ A: Has no clear etiology vr vr vr vr
17. The nurse is discussing negativism with the parents of a 30month-
vr vr vr vr vr vr vr vr vr vr vr
old child. How should the nurse tell the parents to best respond to this
vr vr vr vr vr vr vr vr vr vr vr vr vr
behavior?
vr
A) Reprimand the child and give a 15 minute "time out" vr vr vr vr vr vr vr vr vr
B) Maintainapermissive attitude for thisbehavior vr vr vr vr vr vr
C) Use patience and a sense of humor to deal with this behavior
vr vr vr vr vr vr vr vr vr vr vr
D) Assert authorityover the child through limit setting vr vr vr vr vr vr vr
✓ C: Use patience and a sense of humor to deal with this behavior
vr vr vr vr vr vr vr vr vr vr vr vr
18. The nurse is talking by telephone with a parent of a 4 year-oldchild who
vr vr vr vr vr vr vr vr vr vr vr vr vr vr
has chickenpox. Which of the following demonstrates appropriate
vr vr vr vr vr vr vr vr
