a mother of a toddler who is hospitalized with mil
c it is a congenital anomaly in which the actual
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HESI Pediatric
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Voorbeeld van de inhoud
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HESI
Version
2
"A
mother
tells
the
nurse
that
her
child
does
not
want
anything
to
do
with
toilet
training
and
yells
"NO!"
consistently
when
she
tries
to
toilet
train.
The
child
is
2
years
old.
According
to
Erikson,
the
nurse
interprets
that
the
child
is
experiencing
which
psychosocial
crisis?"
a.
autonomy
vs
shame
and
doubt
b.
initiative
vs
guilt
c.
industry
vs
inferiority
d.
trust
vs
mistrust
-
ANSAutonomy
vs
shame
and
doubt
A
2-year-old
child
is
admitted
to
the
hospital
with
juvenile
rheumatoid
arthritis
(JRA).
During
the
focused
assessment,
the
nurse
makes
it
a
priority
to
note
the
presence
of
which
of
the
following?"
a.
increased
irritability
and
the
child's
insistence
to
be
carried
out
b.
complaints
of
joint
stiffness
c.
history
of
daily
temperature
elevations
d.
description
of
how
difficult
it
is
to
move
around
after
periods
of
inactivity
-
ANSincreased
irritability
and
the
child's
insistence
to
be
carried
out
A
mother
of
a
toddler
who
is
hospitalized
with
mild
dehydration
must
leave
her
child
to
go
to
work.
Which
behavior
would
the
nurse
expect
to
observe
in
the
toddler
immediately
after
the
mother's
departure?
a.
silently
curled
in
bed
with
a
blanket
b.
loudly
crying
and
kicking
both
legs
c.
playing
quietly
with
a
favorite
toy
d.
sucking
thumb
and
rocking
back
and
forth
-
ANSloudly
crying
and
kicking
both
legs
"A
newborn
infant
is
diagnosed
with
hypospadias,
and
the
mother
asks
the
nurse
about
the
disorder.
The
nurse
bases
the
response
on
which
of
the
following?"
a.
it
is
a
congenital
anomaly
in
which
the
actual
opening
of
the
urethra
meatus
is
below
the
normal
placement
on
the
glans
penis
b.
it
occurs
when
one
or
both
testes
fail
to
descend
through
the
inguinal
canal
into
the
scrotal
sac
c.
it
is
a
congenital
anomaly
in
which
the
actual
opening
of
the
urethral
meatus
is
dorsal
to
the
urethral
opening
d.
it
is
a
congential
anomaly
characterized
by
the
extrusion
of
the
urinary
bladder
to
the
outside
of
the
body
-
ANSit
is
a
congenital
anomaly
in
which
the
actual
opening
of
the
urethra
meatus
is
below
the
normal
placement
on
the
glans
penis A
home
care
nurse
is
providing
instructions
to
a
child
with
cystic
fibrosis
about
how
to
perform
the
"huff"
maneuver;
the
child
asks
the
nurse
about
the
purpose
of
this
type
of
breathing.
The
nurse
makes
which
response
to
the
child?
a.
"this
type
of
breathing
is
used
to
mobilize
secretions
so
that
they
can
be
easily
coughed
out"
b.
"this
type
of
breathing
prolongs
inspiration
time"
c.
"this
type
of
breathing
moves
air
out
of
the
lower
lungs"
d.
"this
type
of
breathing
moves
air
through
the
lungs"
-
ANS"this
type
of
breathing
is
used
to
mobilize
secretions
so
that
they
can
be
easily
coughed
out"
A
home
care
nurse
is
instructing
the
mother
of
a
child
with
cystic
fibrosis
(CF)
about
the
appropriate
dietary
measures.
The
nurse
tells
the
mother
that
the
child
needs
to
consume
a:
a.
low
calorie,
low
fat
diet
b.
high
calorie,
high
protein
diet
c.
low
calorie,
low
protein
diet
d.
high
calorie,
restricted
fat
-
ANShigh
calorie,
high
protein
diet
Breathing
exercises
and
postural
drainage
is
prescribed
for
a
child
with
cystic
fibrosis.
A
nurse
implements
these
procedures
by
telling
the
child
to:
a.
perform
the
postural
drainage,
then
the
breathing
exercises
b.
perform
the
breathing
exercises,
then
the
postural
drainage
c.
schedule
the
procedures
so
they
are
4
hours
apart
d.
perform
postural
drainage
in
the
morning
and
breathing
exercises
in
the
evening
-
ANSperform
the
postural
drainage,
then
the
breathing
exercises
A
nurse
is
reviewing
the
results
of
a
sweat
test
performed
on
a
child
with
cystic
fibrosis
(CF).
The
nurse
would
expect
to
note
which
finding?
a.
a
sweat
sodium
concentration
less
than
40
mEq/L
b.
a
sweat
potassium
concentration
less
than
40
mEq/L
c.
a
sweat
potassium
concentration
greater
than
40
mEq/L
d.
a
sweat
sodium
concentration
greater
than
60
mEq/L
-
ANSa
sweat
sodium
concentration
greater
than
60
mEq/L
Methylphenidate
(Ritalin)
is
prescribed
for
a
child
with
a
diagnosis
of
attention
deficit
hyperactivity
disorder
(ADHD).
The
nurse
provides
instructions
to
the
mother
regarding
the
administration
of
the
medication
and
tells
the
mother
to
administer
the
medication:
a.
before
dinner
and
at
bedtime
b.
before
breakfast
and
before
the
noontime
meal
c.
in
the
morning
after
breakfast
and
at
bedtime
d.
at
the
noontime
and
evening
meals
-
ANSbefore
breakfast
and
before
the
noontime
meal
"Methylphenidate
hydrochloride
(Ritalin)
is
prescribed
for
a
10-year-old
child
diagnosed
with
attention
deficit
hyperactivity
disorder,
and
the
nurse
provides
instructions
to
the
mother
about
administration
of
the
medication.
The
nurse
determines
that
the
mother
understands
the
instructions
when
the
mother
states:" a.
I
will
give
my
child
the
medication
at
bedtime
so
that
he
will
be
rested
and
alert
for
school
the
next
day
b.
I
will
give
my
child
the
medication
after
meals
to
obtain
the
full
effects
of
the
medication
c.
I
will
give
my
child
the
medication
at
breakfast
and
lunch
to
prevent
insomnia
d.
I
will
give
my
child
the
medication
with
water
to
prevent
kidney
damage
-
ANSI
will
give
my
child
the
medication
at
breakfast
and
lunch
to
prevent
insomnia
Methylphenidate
(Ritalin)
is
prescribed
for
a
child
with
attention
deficit
hyperactivity
disorder
(ADHD).
The
nurse
provides
instructions
to
the
mother
regarding
the
administration
of
the
medication.
Which
statement
by
the
mother
would
indicate
a
need
for
further
instructions?
a.
I
will
administer
the
medication
with
the
noontime
meal
b.
I
will
keep
the
medication
tightly
capped
and
away
from
direct
heat
c.
I
should
inform
the
school
nurse
that
my
child
is
taking
this
medication
d.
I
should
avoid
giving
the
medications
on
Saturdays
and
Sundays
to
provide
a
medication
holiday
-
ANSI
should
avoid
giving
the
medications
on
Saturdays
and
Sundays
to
provide
a
medication
holiday
A
client
with
diplopia
has
been
given
an
eye
patch
to
promote
better
vision
and
prevent
injury.
The
nurse
teaches
the
client
to
do
which
of
the
following
as
part
of
correct
use
of
this
item?
a.
wear
the
patch
continuously,
alternating
eyes
each
day
b.
wear
the
patch
continuously,
alternating
eyes
each
week
c.
use
the
patch
only
when
vision
is
exceptionally
blurry
d.
put
the
patch
on
for
an
hour,
and
then
take
it
off
for
an
hour
-
ANSwear
the
patch
continuously,
alternating
eyes
each
day
A
student
nurse
examines
an
Asian
American
infant's
eyes
and
notes
that
the
infant's
eyes
are
crossed.
The
registered
nurse
asks
the
student
to
interpret
the
finding.
Which
statement
by
the
student
indicates
an
understanding
of
this
assessment
finding?
a.
it
probably
isn't
strabismus
but
appears
that
way
because
of
the
child;s
ethnic
background
b.
you
will
want
to
call
the
pediatrician
immediately
because
this
could
lead
to
detached
retina
c.
it
probably
is
strabismus
because
the
baby's
mother
has
abused
tranquilizers
d.
strabismus
isn't
life
threatening
but
it
requires
surgery
in
the
first
2
months
to
prevent
the
crossed
eyes
from
being
a
life
long
condition
-
ANSit
probably
isn't
strabismus
but
appears
that
way
because
of
the
child;s
ethnic
background
A
nurse
notes
that
a
client's
eyes
are
continuously
moving
back
and
forth
within
the
eye
sockets.
The
nurse
documents
in
the
medical
record
that
the
client
has:
a.
ataxia
b.
nystagmus
c.
pronator
drift
d.
hyperreflexia
-
ANSnystagmus
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