HESI RN
HESI Pediatrics Practice Exam
1. The healthcare provider is evaluating the effects of thyroid therapy used to treat a 5-month-old with hypothyroidism. Which behavior indicates that the treatment has been effective?
- A. Laughs readily, turns from back to side.
- B. Has strong Moro and tonic neck reflexes.
- C. Keeps fists clenched, opens hands when grasping an object.
- D. Can lift head, but not chest when lying on abdomen.
Correct answer: A
Rationale: In infants, laughing readily and turning from back to side are indicative of normal development. These behaviors indicate that the thyroid therapy is effective, as they suggest the baby is achieving age-appropriate milestones. A 5-month-old infant should be able to laugh readily and turn from back to side, showing progress in motor and social development. Choices B, C, and D describe behaviors that are not specific to the expected developmental milestones of a 5-month-old. Strong Moro and tonic neck reflexes, clenched fists, and limited ability to lift the chest when lying on the abdomen are not necessarily indicative of the effectiveness of thyroid therapy for hypothyroidism.
2. Which of the following is included in a pelvic examination?
- A. Inspection of internal genitalia
- B. Inspection of the cervix and vaginal wall
- C. Palpation of the vagina and vaginal cervix by digital examination
- D. Rectal examination
Correct answer: B
Rationale: The correct answer is B. A pelvic examination involves the inspection of the cervix and vaginal wall. This is typically done to assess the health of the reproductive organs and screen for any abnormalities. Choices A, C, and D are incorrect because while palpation and digital examination may be part of a pelvic exam, the specific focus on the cervix and vaginal wall is a key component that distinguishes it from other types of examinations.
3. Discuss the anatomical/physiological changes in pregnancy under the following: Uterus
- A. The uterus softens in the anterior midline, becomes flexible at the uterocervical junction, blood vasculature increases in size and number, and hypertrophy of myometrial cells occurs.
- B. The uterus decreases in size during pregnancy and remains rigid.
- C. The uterus size remains unchanged, and no changes occur in the blood vasculature.
- D. Uterus becomes more rigid and hypertrophies.
Correct answer: A
Rationale: During pregnancy, the uterus undergoes various anatomical and physiological changes. The correct answer, Choice A, accurately describes these changes. The uterus softens in the anterior midline, becomes flexible at the uterocervical junction, experiences an increase in blood vasculature size and number, and myometrial cells hypertrophy. This softening and increased vascularity are essential for accommodating the growing fetus and facilitating delivery. Choices B, C, and D are incorrect because they do not reflect the typical changes that occur in the uterus during pregnancy. The uterus does not decrease in size, remain unchanged in size, become more rigid, or hypertrophy without the described softening and vascular changes.
4. A client who is in hospice care complains of increasing amounts of pain. The healthcare provider prescribes an analgesic every four hours as needed. Which action should the nurse implement?
- A. Give analgesics on an around-the-clock schedule for pain management.
- B. Administer analgesic medication only when the pain becomes severe.
- C. Provide medication to keep the client comfortable without inducing sedation.
- D. Allow brief medication-free periods to promote comfort during daily activities.
Correct answer: A
Rationale: The most effective pain management strategy in hospice care involves administering analgesics on an around-the-clock schedule (A) to maintain pain control. Waiting until pain is severe before administering medication (B) is not ideal as it may lead to inadequate pain relief. While providing comfort is crucial in hospice care, sedation that prevents the client from interacting and experiencing their remaining time should be minimized. Therefore, keeping the client comfortable without excessive sedation (C) is preferred. Allowing for some periods without medication (D) may be appropriate but should not compromise the client's comfort and pain control.
5. A client is receiving a continuous infusion of normal saline at 125 ml/hour post abdominal surgery. The client is drowsy and complaining of constant abdominal pain and a headache. Urine output is 800 ml over the past 24 hours with a central venous pressure of 15 mmHg. The nurse notes respiratory crackles and bounding central pulse. Vital signs: temperature 101.2 F (38.4 C), heart rate 96 beats/minute, respiration 24 breaths/minute, and blood pressure of 160/90 mmHg. Which intervention should the nurse implement first?
- A. Calculate total intake and output for the last 24 hours.
- B. Administer a PRN dose of acetaminophen.
- C. Decrease IV fluids to a keep vein open (KVO) rate.
- D. Review the last administration of IV pain medication.
Correct answer: C
Rationale: In this scenario, the client is showing signs of fluid volume excess, such as drowsiness, abdominal pain, headache, crackles in the lungs, bounding pulse, and elevated blood pressure. Decreasing the IV fluids to a keep vein open (KVO) rate is crucial to prevent further fluid overload. This intervention helps in balancing fluid intake and output to prevent complications associated with fluid volume excess. Calculating total intake and output (Choice A) may be necessary but not the immediate priority in managing fluid overload. Administering acetaminophen (Choice B) may help with managing the fever but does not address the underlying issue of fluid overload. Reviewing the last administration of IV pain medication (Choice D) is not the priority in this situation where fluid overload is a concern.