NSG 222 HESI FINAL EXAM NEWEST ACTUAL EXAM COMPLETE 300
QUESTIONS AND CORRECT DETAILED ANSWERS/NEWEST UPDATE!!!
Question 1
A 2-year-old child consistently yells "NO!" during attempts at toilet training. According to
Erikson’s psychosocial stages, the nurse interprets this behavior as a sign of which crisis?
A) Trust vs. Mistrust
B) Initiative vs. Guilt
C) Industry vs. Inferiority
D) Autonomy vs. Shame and Doubt
E) Identity vs. Role Confusion
Correct Answer: D) autonomy vs shame and doubt
Rationale: Toddlers (ages 1–3 years) are in the stage of Autonomy vs. Shame and Doubt.
The hallmark of this stage is the development of independence and self-control. The
"negativism" characterized by saying "no" and resisting demands is a normal part of
asserting autonomy and testing boundaries during this developmental period.
Question 2
A 2-year-old child is admitted to the hospital with juvenile rheumatoid arthritis (JRA). During
the assessment, which finding should the nurse prioritize as a sign of disease activity?
A) Increased irritability and insistence on being carried
B) Sudden onset of a productive cough
C) Recent history of weight gain
D) Preference for playing with building blocks
E) Requesting a specific flavor of juice
Correct Answer: A) increased irritability and the child's insistence to be carried out
Rationale: In young children who may not be able to verbalize specific joint pain,
"irritable" behavior and a refusal to walk (insisting on being carried) are primary
indicators of the joint pain and stiffness associated with JRA. This reflects the child’s
physical discomfort and limited mobility.
Question 3
A toddler hospitalized for mild dehydration becomes distressed when the mother leaves for work.
Which immediate behavior is the most developmentally appropriate response for this age group?
A) Silently withdrawing under a blanket
B) Loudly crying and kicking both legs
C) Quietly playing with a puzzle
D) Sucking the thumb and rocking in a corner
E) Engaging in cooperative play with other children
Correct Answer: B) loudly crying and kicking both legs
Rationale: This behavior represents the "protest" phase of separation anxiety, which is
common in toddlers. During this phase, the child reacts aggressively to the loss of the
caregiver with loud crying, screaming, and physical resistance to the departure.
, 2
Question 4
A mother asks the nurse to explain hypospadias in her newborn son. The nurse should define this
congenital anomaly as:
A) An opening of the urethral meatus on the ventral (underside) of the glans penis
B) One or both testes failing to descend into the scrotal sac
C) An opening of the urethral meatus on the dorsal (top) of the penis
D) The extrusion of the urinary bladder through the abdominal wall
E) The narrowing of the foreskin preventing retraction
Correct Answer: A) it is a congenital anomaly in which the actual opening of the urethra
meatus is below the normal placement on the glans penis
Rationale: Hypospadias is a condition where the urethral opening is located on the ventral
surface (underside) of the penis rather than the tip. This is a common congenital
malformation that requires surgical correction, usually before the child reaches school age.
Question 5
A child with cystic fibrosis (CF) is learning the "huff" maneuver. What explanation should the
nurse provide regarding the purpose of this breathing technique?
A) To increase the oxygen saturation of the blood
B) To prolong the time of inspiration
C) To move air through the upper lobes only
D) To mobilize secretions so they can be easily coughed out
E) To strengthen the diaphragm muscle
Correct Answer: D) "this type of breathing is used to mobilize secretions so that they can be
easily coughed out"
Rationale: The "huff" maneuver is a forced expiratory technique that helps move mucus
from the small, peripheral airways to the larger, central airways. For CF patients with
thick, tenacious mucus, this maneuver is essential for effective airway clearance and
preventing infection.
Question 6
A nurse is instructing the parent of a child with cystic fibrosis (CF) about dietary needs. Which
diet is most appropriate for this patient?
A) Low calorie, low fat
B) Low calorie, high protein
C) High calorie, high protein
D) High calorie, restricted fat
E) Gluten-free, low sodium
Correct Answer: C) high calorie, high protein diet
Rationale: Children with CF have increased metabolic demands due to chronic respiratory
infections and malabsorption caused by pancreatic enzyme deficiency. They require a high-
, 3
calorie, high-protein diet (and usually unrestricted fat with enzyme replacement) to
maintain growth and weight.
Question 7
When implementing a respiratory regimen for a child with cystic fibrosis, what is the correct
sequence of interventions?
A) Postural drainage followed by breathing exercises
B) Breathing exercises followed by postural drainage
C) Postural drainage 30 minutes before a meal
D) Breathing exercises performed only at bedtime
E) Administering pancreatic enzymes followed by postural drainage
Correct Answer: A) perform the postural drainage, then the breathing exercises
Rationale: Postural drainage (chest physiotherapy) is used to loosen and move secretions
toward the central airways. Performing breathing exercises (like the huff maneuver)
immediately afterward helps the child expel those loosened secretions effectively.
Question 8
A sweat test is performed on a child suspected of having cystic fibrosis (CF). Which result would
the nurse identify as a diagnostic indicator of the disease?
A) Sweat sodium less than 40 mEq/L
B) Sweat potassium less than 40 mEq/L
C) Sweat chloride less than 10 mEq/L
D) Sweat sodium greater than 60 mEq/L
E) Sweat sodium exactly 20 mEq/L
Correct Answer: D) a sweat sodium concentration greater than 60 mEq/L
Rationale: The gold standard for diagnosing CF is the pilocarpine iontophoresis sweat test.
A sweat chloride or sodium concentration greater than 60 mEq/L is diagnostic of CF in
children, as the defective CFTR protein prevents the reabsorption of salt in the sweat ducts.
Question 9
The nurse is instructing a mother on how to administer methylphenidate (Ritalin) to her child
with ADHD. What is the optimal timing for the doses?
A) At bedtime and upon waking
B) Before breakfast and before the noontime meal
C) After the evening meal and at midnight
D) Once daily at 3:00 PM
E) Only on days when the child has school exams
Correct Answer: B) before breakfast and before the noontime meal
Rationale: Methylphenidate is a central nervous system stimulant. It should be given about
30 minutes before meals to maximize absorption. Most importantly, it should not be given
late in the day to prevent the common side effect of insomnia.
, 4
Question 10
A mother of a 10-year-old with ADHD confirms she understands the administration of
methylphenidate (Ritalin) when she states:
A) "I will give it at 8:00 PM to help him sleep."
B) "I will give it after he eats his biggest meal."
C) "I will give it at breakfast and lunch to prevent insomnia."
D) "I will give it with extra water to protect his kidneys."
E) "I will only give it when his teacher calls with a complaint."
Correct Answer: C) I will give my child the medication at breakfast and lunch to prevent
insomnia
Rationale: Because stimulants can cause significant sleep disturbances, the last dose of the
day should be administered no later than 4:00 PM. Giving the medication earlier in the day
ensures the therapeutic effect is present during school hours while minimizing nighttime
restlessness.
Question 11
Which statement by a parent of a child taking methylphenidate (Ritalin) indicates a need for
further instruction?
A) "I will keep the bottle away from heat and tightly capped."
B) "I will inform the school nurse about the medication."
C) "I will give the medication at noon."
D) "I should avoid giving the medication on weekends to provide a 'drug holiday'."
Correct Answer: D) I should avoid giving the medications on Saturdays and Sundays to
provide a medication holiday
Rationale: While "drug holidays" (stopping the medication during non-school times) are
sometimes used to assess the need for continued therapy or to minimize growth
suppression, they should only be done under the direct supervision of a healthcare
provider. The parent should not independently decide to skip doses on weekends.
Question 12
A client with diplopia (double vision) is prescribed an eye patch. How should the nurse instruct
the client to use the patch?
A) Wear the patch continuously, alternating eyes each day
B) Wear it only when driving a vehicle
C) Apply the patch to the stronger eye only
D) Wear it for one hour on and one hour off
E) Use the patch only during the night while sleeping
Correct Answer: A) wear the patch continuously, alternating eyes each day
Rationale: For diplopia, patching one eye helps the brain process a single image. Alternating
QUESTIONS AND CORRECT DETAILED ANSWERS/NEWEST UPDATE!!!
Question 1
A 2-year-old child consistently yells "NO!" during attempts at toilet training. According to
Erikson’s psychosocial stages, the nurse interprets this behavior as a sign of which crisis?
A) Trust vs. Mistrust
B) Initiative vs. Guilt
C) Industry vs. Inferiority
D) Autonomy vs. Shame and Doubt
E) Identity vs. Role Confusion
Correct Answer: D) autonomy vs shame and doubt
Rationale: Toddlers (ages 1–3 years) are in the stage of Autonomy vs. Shame and Doubt.
The hallmark of this stage is the development of independence and self-control. The
"negativism" characterized by saying "no" and resisting demands is a normal part of
asserting autonomy and testing boundaries during this developmental period.
Question 2
A 2-year-old child is admitted to the hospital with juvenile rheumatoid arthritis (JRA). During
the assessment, which finding should the nurse prioritize as a sign of disease activity?
A) Increased irritability and insistence on being carried
B) Sudden onset of a productive cough
C) Recent history of weight gain
D) Preference for playing with building blocks
E) Requesting a specific flavor of juice
Correct Answer: A) increased irritability and the child's insistence to be carried out
Rationale: In young children who may not be able to verbalize specific joint pain,
"irritable" behavior and a refusal to walk (insisting on being carried) are primary
indicators of the joint pain and stiffness associated with JRA. This reflects the child’s
physical discomfort and limited mobility.
Question 3
A toddler hospitalized for mild dehydration becomes distressed when the mother leaves for work.
Which immediate behavior is the most developmentally appropriate response for this age group?
A) Silently withdrawing under a blanket
B) Loudly crying and kicking both legs
C) Quietly playing with a puzzle
D) Sucking the thumb and rocking in a corner
E) Engaging in cooperative play with other children
Correct Answer: B) loudly crying and kicking both legs
Rationale: This behavior represents the "protest" phase of separation anxiety, which is
common in toddlers. During this phase, the child reacts aggressively to the loss of the
caregiver with loud crying, screaming, and physical resistance to the departure.
, 2
Question 4
A mother asks the nurse to explain hypospadias in her newborn son. The nurse should define this
congenital anomaly as:
A) An opening of the urethral meatus on the ventral (underside) of the glans penis
B) One or both testes failing to descend into the scrotal sac
C) An opening of the urethral meatus on the dorsal (top) of the penis
D) The extrusion of the urinary bladder through the abdominal wall
E) The narrowing of the foreskin preventing retraction
Correct Answer: A) it is a congenital anomaly in which the actual opening of the urethra
meatus is below the normal placement on the glans penis
Rationale: Hypospadias is a condition where the urethral opening is located on the ventral
surface (underside) of the penis rather than the tip. This is a common congenital
malformation that requires surgical correction, usually before the child reaches school age.
Question 5
A child with cystic fibrosis (CF) is learning the "huff" maneuver. What explanation should the
nurse provide regarding the purpose of this breathing technique?
A) To increase the oxygen saturation of the blood
B) To prolong the time of inspiration
C) To move air through the upper lobes only
D) To mobilize secretions so they can be easily coughed out
E) To strengthen the diaphragm muscle
Correct Answer: D) "this type of breathing is used to mobilize secretions so that they can be
easily coughed out"
Rationale: The "huff" maneuver is a forced expiratory technique that helps move mucus
from the small, peripheral airways to the larger, central airways. For CF patients with
thick, tenacious mucus, this maneuver is essential for effective airway clearance and
preventing infection.
Question 6
A nurse is instructing the parent of a child with cystic fibrosis (CF) about dietary needs. Which
diet is most appropriate for this patient?
A) Low calorie, low fat
B) Low calorie, high protein
C) High calorie, high protein
D) High calorie, restricted fat
E) Gluten-free, low sodium
Correct Answer: C) high calorie, high protein diet
Rationale: Children with CF have increased metabolic demands due to chronic respiratory
infections and malabsorption caused by pancreatic enzyme deficiency. They require a high-
, 3
calorie, high-protein diet (and usually unrestricted fat with enzyme replacement) to
maintain growth and weight.
Question 7
When implementing a respiratory regimen for a child with cystic fibrosis, what is the correct
sequence of interventions?
A) Postural drainage followed by breathing exercises
B) Breathing exercises followed by postural drainage
C) Postural drainage 30 minutes before a meal
D) Breathing exercises performed only at bedtime
E) Administering pancreatic enzymes followed by postural drainage
Correct Answer: A) perform the postural drainage, then the breathing exercises
Rationale: Postural drainage (chest physiotherapy) is used to loosen and move secretions
toward the central airways. Performing breathing exercises (like the huff maneuver)
immediately afterward helps the child expel those loosened secretions effectively.
Question 8
A sweat test is performed on a child suspected of having cystic fibrosis (CF). Which result would
the nurse identify as a diagnostic indicator of the disease?
A) Sweat sodium less than 40 mEq/L
B) Sweat potassium less than 40 mEq/L
C) Sweat chloride less than 10 mEq/L
D) Sweat sodium greater than 60 mEq/L
E) Sweat sodium exactly 20 mEq/L
Correct Answer: D) a sweat sodium concentration greater than 60 mEq/L
Rationale: The gold standard for diagnosing CF is the pilocarpine iontophoresis sweat test.
A sweat chloride or sodium concentration greater than 60 mEq/L is diagnostic of CF in
children, as the defective CFTR protein prevents the reabsorption of salt in the sweat ducts.
Question 9
The nurse is instructing a mother on how to administer methylphenidate (Ritalin) to her child
with ADHD. What is the optimal timing for the doses?
A) At bedtime and upon waking
B) Before breakfast and before the noontime meal
C) After the evening meal and at midnight
D) Once daily at 3:00 PM
E) Only on days when the child has school exams
Correct Answer: B) before breakfast and before the noontime meal
Rationale: Methylphenidate is a central nervous system stimulant. It should be given about
30 minutes before meals to maximize absorption. Most importantly, it should not be given
late in the day to prevent the common side effect of insomnia.
, 4
Question 10
A mother of a 10-year-old with ADHD confirms she understands the administration of
methylphenidate (Ritalin) when she states:
A) "I will give it at 8:00 PM to help him sleep."
B) "I will give it after he eats his biggest meal."
C) "I will give it at breakfast and lunch to prevent insomnia."
D) "I will give it with extra water to protect his kidneys."
E) "I will only give it when his teacher calls with a complaint."
Correct Answer: C) I will give my child the medication at breakfast and lunch to prevent
insomnia
Rationale: Because stimulants can cause significant sleep disturbances, the last dose of the
day should be administered no later than 4:00 PM. Giving the medication earlier in the day
ensures the therapeutic effect is present during school hours while minimizing nighttime
restlessness.
Question 11
Which statement by a parent of a child taking methylphenidate (Ritalin) indicates a need for
further instruction?
A) "I will keep the bottle away from heat and tightly capped."
B) "I will inform the school nurse about the medication."
C) "I will give the medication at noon."
D) "I should avoid giving the medication on weekends to provide a 'drug holiday'."
Correct Answer: D) I should avoid giving the medications on Saturdays and Sundays to
provide a medication holiday
Rationale: While "drug holidays" (stopping the medication during non-school times) are
sometimes used to assess the need for continued therapy or to minimize growth
suppression, they should only be done under the direct supervision of a healthcare
provider. The parent should not independently decide to skip doses on weekends.
Question 12
A client with diplopia (double vision) is prescribed an eye patch. How should the nurse instruct
the client to use the patch?
A) Wear the patch continuously, alternating eyes each day
B) Wear it only when driving a vehicle
C) Apply the patch to the stronger eye only
D) Wear it for one hour on and one hour off
E) Use the patch only during the night while sleeping
Correct Answer: A) wear the patch continuously, alternating eyes each day
Rationale: For diplopia, patching one eye helps the brain process a single image. Alternating
