HESI LPN
Pediatrics HESI 2023
1. The parents of a 2-year-old child tell the nurse that they are having difficulty disciplining their child. What is the nurse’s most appropriate response?
- A. “This is a difficult age that your child is going through right now.”
- B. “Tell me more about your difficulty. I’m not sure what you mean by this.”
- C. “It’s important to be consistent with toddlers when they need disciplining.”
- D. “I can understand what you mean. That’s why this age is called the terrible twos.”
Correct answer: C
Rationale: The most appropriate response for the nurse is to emphasize the importance of consistency in discipline when dealing with toddlers. Toddlers are at an age where they are learning boundaries and acceptable behaviors. By being consistent, parents can help their child understand what is expected of them and establish a sense of structure and routine. Choices A, B, and D do not provide constructive advice or guidance on how to address the issue of disciplining a 2-year-old. Choice A merely acknowledges the age without providing guidance, choice B seeks more information without offering support, and choice D labels the age without offering practical advice on discipline.
2. A client with fluid volume excess has gained 6.6 pounds. The nurse recognizes that this is equivalent to what volume of fluid?
- A. Two liters.
- B. Three liters.
- C. Four liters.
- D. Five liters.
Correct answer: B
Rationale: A weight gain of 6.6 pounds is approximately equivalent to 3 liters of fluid. It is important to remember that 1 liter of fluid is equal to 1 kg, which is approximately 2.2 pounds. Therefore, when the client gains 6.6 pounds, it translates to 3 liters of fluid. Choices A, C, and D are incorrect as they do not align with the conversion rate of 1 liter of fluid to 2.2 pounds.
3. A 16-year-old female client returns to the clinic because she is pregnant for the third time by a new boyfriend. Which vaccine should the nurse plan to administer?
- A. MMR
- B. Hepatitis B
- C. Human papillomavirus
- D. Pneumococcal
Correct answer: B
Rationale: The correct answer is B, Hepatitis B. The Hepatitis B vaccine is crucial for pregnant women to prevent transmission of the virus to the baby during childbirth. Option A, MMR (Measles, Mumps, Rubella) vaccine, is not indicated during pregnancy. Option C, Human papillomavirus vaccine, is recommended for prevention of HPV infections but is not specifically indicated during pregnancy. Option D, Pneumococcal vaccine, is important for certain populations but is not the priority vaccine for a pregnant woman in this scenario.
4. The nurse is receiving a report for a laboring client who arrived in the emergency center with ruptured membranes that the client did not recognize. Which is the priority nursing action to implement when the client is admitted to the labor and delivery suite?
- A. Begin a pad count
- B. Prepare to start an IV
- C. Take the client's temperature
- D. Monitor amniotic fluid for meconium
Correct answer: C
Rationale: The priority nursing action when a client with ruptured membranes is admitted to the labor and delivery suite is to take the client's temperature. This is crucial to assess for infection, especially when the duration of membrane rupture is unknown. Beginning a pad count, preparing to start an IV, and monitoring amniotic fluid for meconium are important actions but are not as immediate or critical as assessing for infection through temperature measurement.
5. To prevent keratitis in an unconscious client, where should the nurse apply moisturizing ointment?
- A. Finger and toenail quicks
- B. Eyes
- C. Perianal area
- D. External ear canals
Correct answer: B
Rationale: The correct answer is B: Eyes. Applying moisturizing ointment to the eyes helps prevent keratitis, a condition that can occur due to inadequate blinking in unconscious clients, leading to corneal dryness and potential damage. Choices A, C, and D are incorrect as moisturizing ointment should not be applied to finger and toenail quicks, perianal area, or external ear canals to prevent keratitis.