the nurse is assessing a 3 month old infant who had a pylorotomy yesterday this child should be medicated for pain based on which findings the nurse is assessing a 3 month old infant who had a pylorotomy yesterday this child should be medicated for pain based on which findings
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HESI LPN

HESI CAT Exam 2024

1. The nurse is assessing a 3-month-old infant who had a pylorotomy yesterday. This child should be medicated for pain based on which finding?

Correct answer: A

Rationale: In infants, restlessness can be a significant indicator of discomfort or pain, necessitating appropriate pain management. While choices B, C, and D can also be associated with pain, restlessness is a more general and reliable indicator in this scenario. A clenched fist might indicate pain or distress, but it is not as specific as restlessness in assessing pain in infants. Increased pulse rate and respiratory rate can be influenced by various factors other than pain, making them less reliable indicators of pain in this context.

2. A client with a diagnosis of generalized anxiety disorder is prescribed hydroxyzine. The nurse should instruct the client that this medication may have which potential side effect?

Correct answer: A

Rationale: The correct answer is A: Drowsiness. Hydroxyzine is known to cause drowsiness, so clients should be advised to avoid activities like driving until they understand how the medication affects them. Choices B, C, and D are incorrect because dry mouth, nausea, and headache are not commonly associated with hydroxyzine use. It is crucial for the client to be aware of the potential drowsiness to ensure their safety and well-being while taking this medication.

3. The client is being instructed on the correct technique for using... what to provide the client?

Correct answer: B

Rationale: The correct technique for using an inhaler for allergic rhinitis involves holding one nostril closed while spraying the other nostril to ensure proper delivery of the medication. This technique helps direct the medication into the nasal passages for optimal effectiveness. Choice A is incorrect as it refers to an incorrect technique for inhaler use. Choice C is incorrect as shaking the inhaler is often necessary to ensure proper mixing of the medication. Choice D is incorrect as the timing of inhaler use is typically based on individual preferences or healthcare provider recommendations, not specifically tied to the morning.

4. A weight reduction regimen calls for a daily intake of 1400 kilocalories, which includes 30 grams of fat. What percentage of the total energy is contributed by fat?

Correct answer: C

Rationale: To calculate the percentage of total energy contributed by fat, first determine the energy from fat by multiplying the fat amount (30g) by the energy density of fat (9 kcal/g), which equals 270 kcal. Then, divide the energy from fat (270 kcal) by the total energy intake (1400 kcal) and multiply by 100 to find the percentage: (270 kcal / 1400 kcal) * 100 = 19.29% ≈ 19.00%. Therefore, fat contributes approximately 19% of the total energy in the diet. Choice A (8.50%) is too low, while choices B (15.00%) and D (25.50%) are incorrect calculations based on the given information.

5. .A 7-month-old girl is to be catheterized to obtain a sterile urine specimen. One of the infant’s parents expresses fear that this procedure may traumatize the baby psychologically. How should the nurse provide reassurance?

Correct answer: D

Rationale: While catheterization can be uncomfortable, it does not typically result in long-term psychological harm, and obtaining a sterile specimen is important for accurate diagnosis.

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