HESI LPN
Pediatric HESI Test Bank
1. What is an early sign of congestive heart failure that the nurse should recognize?
- A. tachypnea
- B. bradycardia
- C. inability to sweat
- D. increased urinary output
Correct answer: A
Rationale: Tachypnea is an early sign of congestive heart failure that nurses should recognize. Tachypnea refers to rapid breathing, which can be an indication of the body's attempt to compensate for decreased cardiac output in congestive heart failure. Bradycardia (choice B) is a slow heart rate and is not typically associated with congestive heart failure. Inability to sweat (choice C) and increased urinary output (choice D) are not specific early signs of congestive heart failure and are not typically recognized as such.
2. What nursing action should the nurse implement for a 3-hour-old male infant who presents with cyanotic hands and feet, an axillary temperature of 96.5°F (35.8°C), a respiratory rate of 40 breaths per minute, and a heart rate of 165 beats per minute?
- A. Administer oxygen by mouth at 2L/min
- B. Gradually warm the infant under a radiant heat source
- C. Notify the pediatrician of the infant's vital signs
- D. Perform a heel-stick to maintain blood glucose levels
Correct answer: B
Rationale: The correct nursing action is to gradually warm the infant under a radiant heat source. The infant is presenting with signs of cold stress, indicated by cyanotic extremities and a low body temperature. Gradual warming is crucial to stabilize the infant's temperature and prevent further complications. Administering oxygen, notifying the pediatrician, or performing a heel-stick are not the priority actions in this scenario and may not address the immediate need to raise the infant's body temperature.
3. A client with a fractured femur is in Buck's traction. The nurse should assess for which of the following complications?
- A. Foot drop
- B. Urinary retention
- C. Constipation
- D. Muscle spasms
Correct answer: A
Rationale: Corrected Rationale: Foot drop is a potential complication of prolonged immobility and improper positioning in traction. In Buck's traction, the lower extremity is suspended to immobilize and align the fractured femur. Prolonged suspension of the leg in traction can lead to nerve damage, specifically to the common peroneal nerve, resulting in foot drop. Urinary retention, constipation, and muscle spasms are not directly associated with Buck's traction and a fractured femur.
4. What role does a community health nurse play in disaster management?
- A. Providing direct patient care
- B. Conducting research on disaster impacts
- C. Coordinating emergency response efforts
- D. Developing new healthcare policies
Correct answer: C
Rationale: Community health nurses are primarily responsible for coordinating emergency response efforts during disasters. This involves organizing and implementing strategies to address the health needs of the community in crisis situations. Providing direct patient care (Choice A) is often carried out by other healthcare professionals such as doctors and paramedics during disasters. Conducting research on disaster impacts (Choice B) is important for understanding the effects of disasters but is not the primary role of a community health nurse. Developing new healthcare policies (Choice D) is typically the responsibility of policymakers and public health officials rather than community health nurses.
5. What is the smallest amount of a nutrient that, when consumed over a prolonged period, maintains a specific function?
- A. nutrient allowance
- B. nutrient requirement
- C. nutrient tolerable limit
- D. nutrient adequate intake
Correct answer: B
Rationale: The correct answer is 'B: nutrient requirement.' The nutrient requirement refers to the smallest amount of a nutrient that, when consumed over a prolonged period, maintains a specific function in the body. This amount ensures the body's optimal functioning and health. Choice A, 'nutrient allowance,' is incorrect as it does not specifically refer to the minimum amount needed for bodily functions but rather suggests a broader term. Choice C, 'nutrient tolerable limit,' is incorrect as it pertains to the maximum amount of a nutrient that can be consumed without adverse effects. Choice D, 'nutrient adequate intake,' is incorrect as it refers to the recommended average daily intake level of a nutrient to meet the requirements of most healthy individuals.