2024 PN EXAM HESI Practice

In infants with hydrocephalus, the early signs of ventricular shunt malfunction are: a) A high-pitched cry, colic, and pupillary changes b) A tense fontanelle, vomiting, and irritability c) Anorexia, and changes in pulse and respiration d) Headaches, lethargy, and a loss of appetite - correct answersA tense fontanelle, vomiting, and irritability -These symptoms show increased intracranial pressure. Changes in heart rate and respiration would be a late sign. The other choices are not indicative of ICP. A pediatric ED nurse, who is caring for a 12-year-old patient with septic shock, perceives a potential complication of fluid resuscitation upon noting: a) A heart rate of 50 beats/minute b) A temperature of 102-degrees-F c) Complaints of leg pain d) Rales and rhonchi by auscultation - correct answersRales and rhonchi by auscultation -Pulmonary edema should be monitored for closely as in septic shock, fluids can third space and leak into the lungs causing hypoxia and respiratory distress. The patient should receive additional fluids less rapidly and the practitioner may choose to move on to vasopressor therapy. Which initial question directed to the parent assists the pediatric nurse in obtaining a patient's health history? a) "Are your child's immunizations up to date?" b) "Is your child allergic to anything?" c) "What bring you here today?" d) "What is the child's problem?" - correct answers"What brings you here today?" -SAMPLE history starts out by asking about Signs and Symptoms, then Allergies, Medications, Past history, Last food or drink consumed, and Events leading up to the illness or chief complaint. Asking why they are here will give the RN a broad idea which they may then focus on and get more specific information. An adolescent, with chronic asthma, who has been hospitalized several times during the winter with severe asthmatic exacerbations confides, "I wish I could stay here in the hospital because every time that I go home, I get sick again!" The pediatric nurse's best response is: a) "I think that you should consider participating on a swim team to improve your pulmonary function." b) "Let's talk about preventing and managing your asthma on a daily basis at home." c) "Why don't I speak with your parents about what they are doing at home to help control your asthma?" d) "Your insurance company does not pay for any additional days of hospitalization that are not medically necessary." - correct answers"Let's talk about preventing and managing your asthma on a daily basis at home." After receiving an immunization for diphtheria, tetanus, and pertussis, a child develops swelling and tenderness at the injection site, a low-grade fever, and malaise. The pediatric ED nurse informs the child's parents that: a) The reaction is severe enough that they should bring the child to an emergency department b) They should delay future immunizations until the child is seen by an allergist c) This is a mild reaction, and teaches them how to manage it d) This is an appropriate reaction, and instructs them to do nothing - correct answersThis is a mild reaction, and teaches them how to manage it. -A severe reaction would present as Anaphylaxis. An appropriate reaction would be mild warmth over the site. This reaction is moderate and can be managed with Tylenol and Benadryl. An 8-year-old is being evaluated in the ER for suspected appendicitis. The physician has then lie on their left side and extend the hip, eliciting pain in the RLQ. What is this test called? a) Kernig's sign b) Rovsing's Sign c) Brudzinski's Sign d) Psoas Sign - correct answersPsoas Sign -Kernig's and Bruszinski's signs are used to evaluate for Meningitis. Rovsing's sign also is a test for appendicitis, but is done by applying deep palpation to the RLQ, causing pain. A 10-year-old is accidentally shot in the forearm by a small caliber firearm. The wound enters the dorsum of the forearm and exits on the ventral side. The patient is ambulatory and has minor pain at the site. What test is likely needed for evaluation of the injury? a) CT scan of arm b) MRI of arm c) Arteriogram d) Ultrasound of arm - correct answersArteriogram -An arteriogram is needed to assess the vascular supply in the arm after a gunshot would to ensure that no injury to the ulnar and radial artery has occurred. A 5-year-old girl has a fever, headache, and complaints of a stiff neck. The physician suspects bacterial meningitis. What is the best test culture site to detect the bacteria? a) Lumbar puncture b) Clean catch urine c) Nasal swab d) Blood culture - correct answersLumbar puncture -Lumbar puncture is the method of choice for detecting the bacteria causing bacterial meningitis and sending a sample for culture, as meningitis infects the meninges and bacteria is present in the cerebrospinal fluid. A 14-year-old boy with leukemia is receiving an IV infusion of packed red blood cells. The client reports that he is feeling anxious and short of breath even though his respiratory rate is 24. What should the nurse do in this situation? a) Give a dose of diphenhydramine b) Give a dose of acetaminophin c) Stop infusion and notify physician d) Give a dose of ibuprofen - correct answersStop infusion and notify physician -Anxiety and the sensation of breathlessness are signs of possible anaphylactic shock, a reaction to the packed red blood cells, so the nurse should stop the infusion immediately and notify the physician.