Evolve HESI EXAM A+ GRADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ANSWERS

HESI EXAM ms




Exam Solution ms




EVOLVE HESI Preparation Case Studies Breathing Patte ms ms ms ms ms ms




rns 2026 A+ GRADE ASSURED COMPLETE SOLUTIONS
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AND VERIFIED ANSWERS (CEBA8) ms ms ms




QUESTION 1 ms




Respiration's are rapid and shallow. What technique should the nurse use to accuratel
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y evaluate the child's respiration's?
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ANSWER

Place hands against the back or chest and observe the rise and fall of the chest *Rationale -
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This technique allows the nurse to observe and count each ventilatory cycle, even when the respira
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tion's are shallow ms ms




QUESTION 2 ms




Because of the client's dyspnea, the nurse is concerned that they may need to receive
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oxygen. Which action should the nurse perform that would be most indicative of the n
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eed for supplemental oxygen?
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ANSWER

Measure oxygen saturation *Rationale -
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Oxygen saturation provides important data about the percentage of hemoglobin that is saturated wi
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th oxygen, a valuable reflection of the client's overall oxygenation
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QUESTION 3 ms




When auscultating breath sounds, the nurse should demonstrate and ask the child to
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perform which action? ms ms




ANSWER

Breathe deeply through the mouth *Rationale -
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The child should be instructed to breathe slowly and deeply through a slightly opened mouth to all
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ow best auscultation of breath sounds.
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, QUESTION 4 ms




The client's mother states that this is the third time in recent months she has brought
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her child to the ED with a cough and shortness of breath. The nurse asks the mother
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how many respiratory or other infections the child has had within the past year. What
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is the nurse's purpose for this question?
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ANSWER

To assess for a possible immune deficiency disorder. *Rational -
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By 5 years of age a child should have developed immunity to many types of infections. It they cont
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inue to have reccurent infections it may be a sign of immune deficiency which will need further inv
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estigation.



QUESTION 5 ms




To measure capillary refill, the nurse must first perform which action?
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ANSWER

Compress the nailbed of one finger until it blanches. *Rationale -
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To measure capillary refill, the nurse should first compress the client's nailbed, then note how man
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y seconds it takes for the return of normal color to the nailbed.
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QUESTION 6 ms




While the nurse is explaining this procedure (capillary refill), the client asks if it will
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hurt. Which response by the nurse is best?
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ANSWER

The clip feels like a clothespin squeezing your finger. *Rationale -
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This is an honest response to the child's question regarding pain and one that places the sensation
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they will feel in a context he can understand.
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QUESTION 7 ms




Prior to applying a nasal cannula in the ED, which action is most important for the nu
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rse to implement to ensure client safety?
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ANSWER

Determine that all electrical equipment in the room is functioning correctly and is properly grounde
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d. *Rationale - An electrical spark in the presence of oxygen can result in a serious fire.
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QUESTION 8 ms