HESI RN
HESI Pediatric Practice Exam
1. A 2-week-old female infant is hospitalized for the surgical repair of an umbilical hernia. After returning to the postoperative neonatal unit, her RR and HR have increased during the last hour. Which intervention should the nurse implement?
- A. Notify the healthcare provider of these findings
- B. Administer a PRN analgesic as prescribed
- C. Document the findings in the infant's medical record
- D. Comfort the infant by swaddling and gently rocking
Correct answer: A
Rationale: In a postoperative neonatal setting, an increase in respiratory rate (RR) and heart rate (HR) in an infant could indicate pain or distress. It is crucial for the nurse to notify the healthcare provider promptly to assess the infant's condition and provide appropriate interventions. Prompt communication with the healthcare provider ensures timely evaluation and management of the infant's discomfort or distress, promoting optimal postoperative recovery and comfort. Administering analgesics without healthcare provider assessment could mask underlying issues, documenting findings alone does not address the immediate need for intervention, and comforting may not resolve the underlying cause of increased RR and HR.
2. A mother brings her school-aged daughter to the pediatric clinic for evaluation of her anti-epileptic medication regimen. What information should the nurse provide to the mother?
- A. The medication dose will be tapered over a period of 2 weeks when being discontinued
- B. If seizures return, multiple medications will be prescribed for another 2 years
- C. A dose of valproic acid (Depakote) should be available in the event of status epilepticus
- D. Phenytoin (Dilantin) and phenobarbital (Luminal) should be taken for life
Correct answer: A
Rationale: Antiepileptic drugs should not be abruptly stopped as it may lead to seizure recurrence. Tapering the medication over a period of 2 weeks helps to prevent withdrawal effects and minimize the risk of seizures. Choice B is incorrect because starting multiple medications for seizure recurrence is not the first-line approach. Choice C is incorrect because valproic acid is not the first-line medication given in the event of status epilepticus. Choice D is incorrect because antiepileptic medications are usually evaluated over time and adjusted based on the individual's response; it is not always necessary to take them for life.
3. The practical nurse is reinforcing education with the parents of a child prescribed iron supplements for iron-deficiency anemia. Which statement by the parents indicates they need further instruction?
- A. We will give the iron supplement with milk to reduce stomach upset.
- B. We should give the iron supplement with orange juice to improve absorption.
- C. The supplement may cause the stools to appear dark or black.
- D. We should store the iron supplements out of reach of children.
Correct answer: A
Rationale: Iron supplements should not be given with milk as calcium can interfere with iron absorption. Instead, it is recommended to give it with a source of vitamin C, such as orange juice, to enhance iron absorption. Giving iron supplements with milk may decrease the absorption of iron and should be avoided. Choice B is the correct method to improve iron absorption. Choice C is correct as iron supplements can cause dark or black stools due to unabsorbed iron. Choice D is also correct as iron supplements should always be stored out of reach of children to prevent accidental ingestion.
4. An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which action should the nurse implement first?
- A. Administer morphine sulfate.
- B. Start IV fluids.
- C. Place the infant in a knee-chest position.
- D. Provide 100% oxygen by face mask.
Correct answer: C
Rationale: In a situation where an infant with tetralogy of Fallot is acutely cyanotic and hyperpneic, the priority action should be to place the infant in a knee-chest position. This position helps increase systemic vascular resistance, improving pulmonary blood flow and subsequently ameliorating the cyanosis and hyperpnea. It is a non-invasive and effective intervention that can be promptly implemented by the nurse to address the immediate respiratory distress. Administering morphine sulfate (Choice A) is not the priority in this case as it may cause further respiratory depression. Starting IV fluids (Choice B) may not address the immediate cyanosis and hyperpnea. Providing 100% oxygen by face mask (Choice D) can help with oxygenation but may not be as effective as placing the infant in a knee-chest position to improve blood flow dynamics.
5. The infant scheduled for reduction of intussusception passes a soft-formed brown stool the day before the procedure. What intervention should the nurse implement?
- A. Instruct the parents that the infant needs to be NPO.
- B. Notify the healthcare provider of the passage of brown stool.
- C. Obtain a stool specimen for laboratory analysis.
- D. Ask the parents about recent changes in the infant's diet.
Correct answer: B
Rationale: Notifying the healthcare provider is crucial when an infant scheduled for intussusception reduction passes a soft-formed brown stool as it may indicate spontaneous reduction of the intussusception. The healthcare provider needs to be informed to assess if the procedure is still necessary or if further evaluation is required. Instructing the parents that the infant needs to be NPO (nothing by mouth) is not the immediate action required in this situation. Obtaining a stool specimen for laboratory analysis is not necessary as the soft-formed brown stool is likely a result of the intussusception spontaneously reducing. Asking about recent changes in the infant's diet is not the most appropriate action when brown stool is passed before the procedure for intussusception reduction.
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