HESI FINAL Reviewed Test With Correct
AnswerHESI FINAL Reviewed Test With Correct
AnswerHESI FINAL Reviewed Test With Correct
AnswerHESI FINAL Reviewed Test With Correct
AnswerHESI FINAL Reviewed Test With Correct
Answer
A 12-month-old is admitted with a respiratory infection and possible pneumonia. He is
placed in a mist tent with oxygen. Which nursing intervention has the greatest priority?
A. Give small frequent feedings of fluids
B. Accurately chart assessed breath sounds
C. Have a bulb syringe readily available to remove secretions
D. Encourage older siblings to visit - CORRECT ANSWERS-Correct Answer: C
The child already has a respiratory infection and pneumonia, his airway could become
compromised with the secretions.
A 14-year-old female client tells the nurse that she is concerned about the acne she has
recently developed. Which recommendation should the nurse provide?
A. Remove all blackheads and follow with an alcohol scrub
B. Use medical cosmetics only to help hide the blemishes
C. Wash the hair and skin frequently with soap and hot water
D. Encourage her to see a dermatologist as soon as possible - CORRECT ANSWERS-
Correct Answer: C
Washing the hair and skin frequently removes oils and debris from the skin, which help
prevent and treat acne.
A 16-year old boy is brought to the E.D. with a crushed leg after falling off a horse. His
last tetanus toxoid booster was received at 8-years old. Which action should the nurse
take?
A. Dispense a tetanus antitoxin
B. Prepare human tetanus immune globulin
,C. Administer tetanus toxoid booster
D. Delay the tetanus toxoid booster - CORRECT ANSWERS-Correct Answer: C
Toxoid booster should be administered every 10 years or with traumatic injury that is
contaminated with dirt, feces, soil, or saliva
A 2-year-old child with Downs Syndrome is brought to the clinic for his regular physical
exam. The nurse knows which problem is frequently associated with DS
A. Congenital heart disease
B. Fragile X chromosome
C. Trisomy 13
D. Pyloric Stenosis - CORRECT ANSWERS-Correct Answer: A
The most common associated condition associated with DS. (B&C) involve
abnormalities with chromosomes but are not associated with DS
A 2-year-old child with trisomy 21 (Down syndrome) is brought to the clinic for a routine
evaluation. Which assessment finding suggests the presence of a common complication
often experienced by those with Down syndrome?
A. Presence of a systolic murmur
B. New onset of patchy alopecia
C. Complaints of long bone pain
D. Recent projectile vomiting - CORRECT ANSWERS-Correct Answer: A
Congenital heart disease occurs in 40% to 50% of children with trisomy 21 (Down
syndrome). Defects of the atrial or ventricular septum that create systolic murmurs are
the most common heart defects associated with this congenital anomaly. Options B, C,
and D are not recognized as common complications of trisomy 21.
A 2-year-old with gastroesophageal reflux disease has developed a fear of eating. What
instruction should the RN include in the parent's teaching plan?
A. Invite other children home to share meals
B. Accept that he will eat when he is hungry
C. Reward the child with a nap after eating
D. Consistently follow a set meal-time routine - CORRECT ANSWERS-Correct Answer:
D
A 2-year-old is comforted by consistency.
A 3-month-old develops oral thrush. Which pharmacological agent should the RN
administer?
A. Nystatin
,B. Nitrofurantoin
C. Norfloxacin
D. Neomycin sulfate - CORRECT ANSWERS-Correct Answer: A
Nystatin is an oral antiifungal. Duh.
A 3-month-old infant returns from surgery with elbow restraints and a Logan bow over a
cleft lip suture line. Which intervention should the nurse implement to maintain suture
line integrity during the initial postoperative period?
A. Place the infant upright in an infant seat position.
B. Provide mittens with the use of elbow restraints.
C. Use soft rubber catheters for nasal suctioning.
D. Apply water-soluble lubricant to the suture line. - CORRECT ANSWERS-Correct
Answer: A
The use of an infant seat simulates a supine position with the head elevated and also
prevents aspiration. Prone positioning should be avoided to prevent disruption of the
protective Logan bow and prevent the infant from rubbing the face on the bed surface.
Mittens are not necessary and decrease the ability to provide sensory comfort, such as
hand holding. Nasal suctioning should be avoided to prevent trauma or dislodging clots
at the surgical site. Water-soluble lubricant will dry the suture line and cause crusting,
which predisposes the suture line to poor healing and scarring.
A 3-month-old infant weighing 10 lb 15 oz has an axillary temperature of 98.9° F. What
caloric amount does this child need?
A. 400 calories/day
B. 500 calories/day
C. 600 calories/day
D. 700 calories/day - CORRECT ANSWERS-Correct Answer: C
An infant requires 108 calories/kg/day. The first step is to change 10 lb 15 oz to 10.9 lb.
Then convert pounds to kilograms by dividing pounds by 2.2, which is 10.9/2.2 = 4.954
kg, rounded to 5 kg. The second step is to multiply 108 calories/kg/day (108 × 5 = 540
calories/day). However, this infant requires 10% more calories because of the 1° F
temperature elevation. Ten percent of 540 (calories/day) is 54, and 540 + 54 = 594. This
infant will require approximately 600 calories/day. Options A, B, and D are incorrect.
A 3-week-old newborn is brought to a clinic for follow-up after a home birth. The child
bottle feeds for 5 minutes only then falls asleep. A loud murmur characteristic of
ventricular septal defect (VSD), and finds the newborn acyanotic with a RR of 64 bpm.
What instruction should be provided to ensure the newborn gets adequate fluid intake?
(Select all that apply).
A. Monitor the infant's weight and number of wet diapers per day
, B. Increase the infant's intake per feeding by 1-2 ounces per week
C. Mix the dose of prophylactic antibiotic with formula in whole bottle
D. Allow the infant to rest and refeed on demand or every 2 hours
E. Use a softer nipple or increase the size of the nipple opening - CORRECT
ANSWERS-Correct Answer: A, B, D & E
Infants with VSD fatigue quickly and ingest inadequate amounts. A one-month old infant
should ingest 2-4 ounces of formula per feeding to about 30 ounces per day for a 4-
month old. The infant should eat every 2 hours to allow for adequate rest in between
meals. A larger nipple/nipple size helps to reduce the effort of sucking
A 3-year-old boy is brought to the emergency room after swallowing an entire bottle of
multi-vitamins. Which intervention should RN implement first?
A. Inert NG tube for gastric lavage
B. Determine the child's pulse and respirations
C. Assess the child's level of consciousness
D. Administer IV D5NS as prescribed - CORRECT ANSWERS-Correct Answer: B
Assessing the airway is the first intervention (respirations)
A 3-year-old client with sickle cell anemia is admitted to the Emergency Department
with abdominal pain. The nurse palpates an enlarged liver, an x-ray reveals an enlarged
spleen, and a CBC reveals anemia. These findings indicate which type of crisis?
A. Aplastic.
B. Sequestration.
C. Hyperhemolytic.
D. Vaso-occlusive. - CORRECT ANSWERS-Correct Answer: B
A sequestration crisis involves blood pooling in the spleen; S/S include abdominal pain
and anemia
A 41-week multigravida is receiving oxytocin (Pitocin) to augment labor. Contractions
are firm and occurring every 5 minutes, with a 30- to 40-second duration. The fetal heart
rate increases with each contraction and returns to baseline after the contraction. Which
action should the nurse implement?
A. Place a wedge under the client's left side.
B. Determine cervical dilation and effacement.
C. Administer 10 L of oxygen via facemask.
D. Increase the rate of the oxytocin (Pitocin) infusion. - CORRECT ANSWERS-Correct
Answer: D
The goal of labor augmentation is to produce firm contractions that occur every 2 to 3
minutes, with a duration of 60 to 70 seconds, and without evidence of fetal stress. FHR
accelerations are a normal response to contractions, so the oxytocin (Pitocin) infusion
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