HESI Comprehensive Exam: Structured for Success
with Expert Questions & Solutions from Top-Tier
Universities
The nurse is explaining the diagnosis of congenital diaphragmatic hernia (CDH) related to a
left posterolateral defect (also called Bochdalek hernia) to a postpartum client. What body
system does the nurse emphasize is the system most at risk for problems?
Respiratory system
Genitourinary system
Musculoskeletal system
Gastrointestinal system - CORRECT ANS- -Respiratory system
Rationale: With a congenital diaphragmatic hernia, abdominal contents herniate through
an opening in the diaphragm. If caused by a left posterolateral defect, the respiratory
system is most at risk for problems. This serious defect requires prompt recognition
(usually in utero) and aggressive treatment to reduce its high mortality. Intestines and other
abdominal structures, such as the liver, can enter the thoracic cavity, compressing the
lung. Lung hypoplasia may occur on the affected side and to a lesser degree on the
contralateral side. Ventilation is further compromised by hypoplasia and compression of
the lung, including the airways and blood vessels. In addition to the anatomic defect,
pulmonary hypoplasia and pulmonary hypertension have also been recently recognized as
components in the pathology of CDH.
A nurse is performing an assessment of a newborn with a diagnosis of esophageal atresia
(EA) and tracheoesophageal fistula (TEF). Which findings does the nurse expect to note in
the infant? Select all that apply.
Drooling
Wheezing
,Hiccuping
Short periods of apnea
Excessive oral secretions
Bowel sounds over the chest - CORRECT ANS- -Drooling
Excessive oral secretions
Rationale: EA with or without TEF results in excessive oral secretions, drooling, and feeding
intolerance. EA and TEF, the most life-threatening anomalies of the esophagus, often occur
together, although they may occur singly. EA is a congenital anomaly in which the
esophagus ends in a blind pouch or narrows into a thin cord, thereby failing to form a
continuous passageway to the stomach. TEF is an abnormal connection between the
esophagus and trachea. When fed, the infant may swallow but will then cough and gag and
return the fluid through the nose and mouth. Bowel sounds over the chest is a clinical
manifestation associated with congenital diaphragmatic hernia. Hiccuping and spitting up
after a meal are clinical manifestations of gastroesophageal reflux. Coughing, wheezing,
and short periods of apnea are clinical manifestations of hiatal hernia.
A nurse is reviewing the medical record of an infant in whom hypertrophic pyloric stenosis
(HPS) is suspected. Which characteristics associated with the disorder does the nurse
expect to see documented in the infant's medical record? Select all that apply.
Weight loss
Facial edema
Metabolic acidosis
Projectile vomiting
Distended upper abdomen - CORRECT ANS- -Weight loss
Projectile vomiting
Distended upper abdomen
, Rationale: HPS occurs when the circular muscle of the pylorus becomes thickened,
causing constriction of the pylorus and obstruction of the gastric outlet. Clinical
manifestations include projectile vomiting, a hungry infant who eagerly accepts a second
feeding after the vomiting episode, weight loss, signs/symptoms of dehydration, and a
distended upper abdomen. A readily palpable olive-shaped mass in the epigastrium just to
the right of the umbilicus is noted, and gastric peristaltic waves, moving from left to right
across the epigastrium, are visible. Laboratory findings include metabolic alkalosis, a
result of the vomiting that occurs in this disorder. Facial edema and metabolic acidosis do
not occur in this disorder.
The nurse is assessing a client who has a history of Prinzmetal's angina. The nurse knows
that what type of medication is given to treat this condition?
Inotropes
Beta blockers
ACE inhibitors
Calcium channel blockers - CORRECT ANS- -Calcium channel blockers
Rationale: Prinzmetal's, or variant, angina is prolonged and severe and occurs at the same
time each day, most often at rest. The treatment of choice is usually a calcium channel
blocker. Calcium channel blockers relax and dilate the vascular smooth muscle, thus
relieving the coronary artery spasm in variant angina. Inotropes, beta blockers, and
angiotensin-converting enzyme (ACE) inhibitors are not given to treat this disorder.
Methylergonovine is prescribed for a client to control postpartum bleeding. Which action
does the nurse take before administering the medication?
Checking the episiotomy site
Palpating the client's bladder
Checking the client's blood pressure
with Expert Questions & Solutions from Top-Tier
Universities
The nurse is explaining the diagnosis of congenital diaphragmatic hernia (CDH) related to a
left posterolateral defect (also called Bochdalek hernia) to a postpartum client. What body
system does the nurse emphasize is the system most at risk for problems?
Respiratory system
Genitourinary system
Musculoskeletal system
Gastrointestinal system - CORRECT ANS- -Respiratory system
Rationale: With a congenital diaphragmatic hernia, abdominal contents herniate through
an opening in the diaphragm. If caused by a left posterolateral defect, the respiratory
system is most at risk for problems. This serious defect requires prompt recognition
(usually in utero) and aggressive treatment to reduce its high mortality. Intestines and other
abdominal structures, such as the liver, can enter the thoracic cavity, compressing the
lung. Lung hypoplasia may occur on the affected side and to a lesser degree on the
contralateral side. Ventilation is further compromised by hypoplasia and compression of
the lung, including the airways and blood vessels. In addition to the anatomic defect,
pulmonary hypoplasia and pulmonary hypertension have also been recently recognized as
components in the pathology of CDH.
A nurse is performing an assessment of a newborn with a diagnosis of esophageal atresia
(EA) and tracheoesophageal fistula (TEF). Which findings does the nurse expect to note in
the infant? Select all that apply.
Drooling
Wheezing
,Hiccuping
Short periods of apnea
Excessive oral secretions
Bowel sounds over the chest - CORRECT ANS- -Drooling
Excessive oral secretions
Rationale: EA with or without TEF results in excessive oral secretions, drooling, and feeding
intolerance. EA and TEF, the most life-threatening anomalies of the esophagus, often occur
together, although they may occur singly. EA is a congenital anomaly in which the
esophagus ends in a blind pouch or narrows into a thin cord, thereby failing to form a
continuous passageway to the stomach. TEF is an abnormal connection between the
esophagus and trachea. When fed, the infant may swallow but will then cough and gag and
return the fluid through the nose and mouth. Bowel sounds over the chest is a clinical
manifestation associated with congenital diaphragmatic hernia. Hiccuping and spitting up
after a meal are clinical manifestations of gastroesophageal reflux. Coughing, wheezing,
and short periods of apnea are clinical manifestations of hiatal hernia.
A nurse is reviewing the medical record of an infant in whom hypertrophic pyloric stenosis
(HPS) is suspected. Which characteristics associated with the disorder does the nurse
expect to see documented in the infant's medical record? Select all that apply.
Weight loss
Facial edema
Metabolic acidosis
Projectile vomiting
Distended upper abdomen - CORRECT ANS- -Weight loss
Projectile vomiting
Distended upper abdomen
, Rationale: HPS occurs when the circular muscle of the pylorus becomes thickened,
causing constriction of the pylorus and obstruction of the gastric outlet. Clinical
manifestations include projectile vomiting, a hungry infant who eagerly accepts a second
feeding after the vomiting episode, weight loss, signs/symptoms of dehydration, and a
distended upper abdomen. A readily palpable olive-shaped mass in the epigastrium just to
the right of the umbilicus is noted, and gastric peristaltic waves, moving from left to right
across the epigastrium, are visible. Laboratory findings include metabolic alkalosis, a
result of the vomiting that occurs in this disorder. Facial edema and metabolic acidosis do
not occur in this disorder.
The nurse is assessing a client who has a history of Prinzmetal's angina. The nurse knows
that what type of medication is given to treat this condition?
Inotropes
Beta blockers
ACE inhibitors
Calcium channel blockers - CORRECT ANS- -Calcium channel blockers
Rationale: Prinzmetal's, or variant, angina is prolonged and severe and occurs at the same
time each day, most often at rest. The treatment of choice is usually a calcium channel
blocker. Calcium channel blockers relax and dilate the vascular smooth muscle, thus
relieving the coronary artery spasm in variant angina. Inotropes, beta blockers, and
angiotensin-converting enzyme (ACE) inhibitors are not given to treat this disorder.
Methylergonovine is prescribed for a client to control postpartum bleeding. Which action
does the nurse take before administering the medication?
Checking the episiotomy site
Palpating the client's bladder
Checking the client's blood pressure
