HESI Exit RN V4
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1. 1. The nurse is caring for a pre-adolescent client in skeletal Dunlop traction.
Which nursing intervention is appropriate for this child?
A) Make certain the child is maintained in correct body alignment.
B) Be sure the traction weights touch the end of the bed.
C) Adjust the head and foot of the bed for the child's comfort
D) Release the traction for 15-20 minutes every 6 hours PRN.: A: Make certain
the child is maintained in correct body alignment.
2. 2. The nurse is assessing a healthy child at the 2 year check up. Which of the
following should the nurse report immediately to the health care provider?
A) Height and weight percentiles vary widely
B) Growth pattern appears to have slowed
C) Recumbent and standing height are different
D) Short term weight changes are uneven: A: Height and weight percentiles vary
widely
3. 3. The parents of a 2 year-old child report that he has been holding his breath
whenever he has temper tantrums. What is the best action by the nurse?
A) Teach the parents how to perform cardiopulmonary resuscitation
B) Recommend that the parents give in when he holds his breath to prevent
anoxia
C) Advise the parents to ignore breath holding because breathing will begin
as a reflex
D) Instruct the parents on how to reason with the child about possible harmful
effects: C: Advise the parents to ignore breath holding because breathing will begin
as a reflex
4. 4. The nurse is assessing a client in the emergency room. Which statement
suggests that the problem is acute angina?
A) "My pain is deep in my chest behind my sternum."
B) "When I sit up the pain gets worse."
C) "As I take a deep breath the pain gets worse."
D) "The pain is right here in my stomach area.": A: "My pain is deep in my chest
behind my sternum."
5. 5. The nurse is assessing the mental status of a client admitted with possible
organic brain disorder. Which of these questions will best assess the function
of the client's recent memory?
A) "Name the year." "What season is this?" (pause for answer after each
, HESI Exit RN V4
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question)
B) "Subtract 7 from 100 and then subtract 7 from that." (pause for answer)
"Now continue to subtract 7 from the new number."
C) "I am going to say the names of three things and I want you to repeat them
after me: blue, ball, pen."
D) "What is this on my wrist?" (point to your watch) Then ask, "What is the
purpose of it?": C: "I am going to say the names of three things and I want you to
repeat them after me: blue, ball, pen."
6. 6. In planning care for a 6 month-old infant, what must the nurse provide to
assist in the development of trust?
A) Food
B) Warmth
C) Security
D) Comfort: C: Security
7. 7. A nurse has just received a medication order which is not legible. Which
statement best reflects assertive communication?
A) "I cannot give this medication as it is written. I have no idea of what you
mean."
B) "Would you please clarify what you have written so I am sure I am reading
it correctly?"
C) "I am having difficulty reading your handwriting. It would save me time if
you would be more careful."
D) "Please print in the future so I do not have to spend extra time attempting
to read your writing.": B) "Would you please clarify what you have written so I am
sure I am reading it correctly?"
8. 8. What is the most important consideration when teaching parents how to
reduce risks in the home?
A) Age and knowledge level of the parents
B) Proximity to emergency services
C) Number of children in the home
D) Age of children in the home: D: Age of children in the home
9. 9. A 35 year-old client with sickle cell crisis is talking on the telephone but
stops as the nurse enters the room to request something for pain. The nurse
should
A) Administer a placebo
, HESI Exit RN V4
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B) Encourage increased fluid intake
C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control: C: Administer the pre-
scribed analgesia
10. 10. While caring for a toddler with croup, which initial sign of croup requires
the nurse's immediate attention?
A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions: A: Respiratory rate of 30
11. 11. A client is admitted with low T3 and T4 levels and an elevated TSH
level. On initial assessment, the nurse would anticipate which of the following
assessment findings?
A) Lethargy
B) Heat intolerance
C) Diarrhea
D) Skin eruptions: A: Lethargy
12. 12. The emergency room nurse admits a child who experienced a seizure
at school. The father comments that this is the first occurrence, and denies
any family history of epilepsy. What is the best response by the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures.": B: "The seizure may or
may not mean your child has epilepsy."
13. 13. Alcohol and drug abuse impairs judgment and increases risk taking
behavior. What nursing diagnosis best applies?
A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem: A: Risk for injury
14. 14. The nurse is caring for a 10 month-old infant who is has oxygen via
mask. It is important for the nurse to maintain patency of which of these
areas?
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A) Mouth
B) Nasal passages
C) Back of throat
D) Bronchials: B: Nasal passages
15. 15. The nurse is providing instructions for a client with pneumonia. What
is the most important information to convey to the client?
A) "Take at least 2 weeks off from work."
B) "You will need another chest x-ray in 6 weeks."
C) "Take your temperature every day."
D) "Complete all of the antibiotic even if your findings decrease.": D: "Complete
all of the antibiotic even if your findings decrease."
16. 16. When counseling a 6 year old who is experiencing enuresis, what must
the nurse understand about the pathophysiological basis of this disorder?
A) Has no clear etiology
B) May be associated with sleep phobia
C) Has a definite genetic link
D) Is a sign of willful misbehavior: A: Has no clear etiology
17. 17. The nurse is discussing negativism with the parents of a 30 month-old
child. How should the nurse tell the parents to best respond to this behavior?
A) Reprimand the child and give a 15 minute "time out"
B) Maintain a permissive attitude for this behavior
C) Use patience and a sense of humor to deal with this behavior
D) Assert authority over the child through limit setting: C: Use patience and a
sense of humor to deal with this behavior
18. 18. The nurse is talking by telephone with a parent of a 4 year-old child who
has chickenpox. Which of the following demonstrates appropriate teaching by
the nurse?
A) Chewable aspirin is the preferred analgesic
B) Topical cortisone ointment relieves itching
C) Papules, vesicles, and crusts will be present at one time
D) The illness is only contagious prior to lesion eruption: C: Papules, vesicles,
and crusts will be present at one time
19. 19. The nurse is assigned to a client who has heart failure . During the
morning rounds the nurse sees the client develop sudden anxiety, diaphore-
sis and dyspnea. The nurse auscultates, crackles bilaterally. Which nursing
Study online at https://quizlet.com/_c8ksxq
1. 1. The nurse is caring for a pre-adolescent client in skeletal Dunlop traction.
Which nursing intervention is appropriate for this child?
A) Make certain the child is maintained in correct body alignment.
B) Be sure the traction weights touch the end of the bed.
C) Adjust the head and foot of the bed for the child's comfort
D) Release the traction for 15-20 minutes every 6 hours PRN.: A: Make certain
the child is maintained in correct body alignment.
2. 2. The nurse is assessing a healthy child at the 2 year check up. Which of the
following should the nurse report immediately to the health care provider?
A) Height and weight percentiles vary widely
B) Growth pattern appears to have slowed
C) Recumbent and standing height are different
D) Short term weight changes are uneven: A: Height and weight percentiles vary
widely
3. 3. The parents of a 2 year-old child report that he has been holding his breath
whenever he has temper tantrums. What is the best action by the nurse?
A) Teach the parents how to perform cardiopulmonary resuscitation
B) Recommend that the parents give in when he holds his breath to prevent
anoxia
C) Advise the parents to ignore breath holding because breathing will begin
as a reflex
D) Instruct the parents on how to reason with the child about possible harmful
effects: C: Advise the parents to ignore breath holding because breathing will begin
as a reflex
4. 4. The nurse is assessing a client in the emergency room. Which statement
suggests that the problem is acute angina?
A) "My pain is deep in my chest behind my sternum."
B) "When I sit up the pain gets worse."
C) "As I take a deep breath the pain gets worse."
D) "The pain is right here in my stomach area.": A: "My pain is deep in my chest
behind my sternum."
5. 5. The nurse is assessing the mental status of a client admitted with possible
organic brain disorder. Which of these questions will best assess the function
of the client's recent memory?
A) "Name the year." "What season is this?" (pause for answer after each
, HESI Exit RN V4
Study online at https://quizlet.com/_c8ksxq
question)
B) "Subtract 7 from 100 and then subtract 7 from that." (pause for answer)
"Now continue to subtract 7 from the new number."
C) "I am going to say the names of three things and I want you to repeat them
after me: blue, ball, pen."
D) "What is this on my wrist?" (point to your watch) Then ask, "What is the
purpose of it?": C: "I am going to say the names of three things and I want you to
repeat them after me: blue, ball, pen."
6. 6. In planning care for a 6 month-old infant, what must the nurse provide to
assist in the development of trust?
A) Food
B) Warmth
C) Security
D) Comfort: C: Security
7. 7. A nurse has just received a medication order which is not legible. Which
statement best reflects assertive communication?
A) "I cannot give this medication as it is written. I have no idea of what you
mean."
B) "Would you please clarify what you have written so I am sure I am reading
it correctly?"
C) "I am having difficulty reading your handwriting. It would save me time if
you would be more careful."
D) "Please print in the future so I do not have to spend extra time attempting
to read your writing.": B) "Would you please clarify what you have written so I am
sure I am reading it correctly?"
8. 8. What is the most important consideration when teaching parents how to
reduce risks in the home?
A) Age and knowledge level of the parents
B) Proximity to emergency services
C) Number of children in the home
D) Age of children in the home: D: Age of children in the home
9. 9. A 35 year-old client with sickle cell crisis is talking on the telephone but
stops as the nurse enters the room to request something for pain. The nurse
should
A) Administer a placebo
, HESI Exit RN V4
Study online at https://quizlet.com/_c8ksxq
B) Encourage increased fluid intake
C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control: C: Administer the pre-
scribed analgesia
10. 10. While caring for a toddler with croup, which initial sign of croup requires
the nurse's immediate attention?
A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions: A: Respiratory rate of 30
11. 11. A client is admitted with low T3 and T4 levels and an elevated TSH
level. On initial assessment, the nurse would anticipate which of the following
assessment findings?
A) Lethargy
B) Heat intolerance
C) Diarrhea
D) Skin eruptions: A: Lethargy
12. 12. The emergency room nurse admits a child who experienced a seizure
at school. The father comments that this is the first occurrence, and denies
any family history of epilepsy. What is the best response by the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures.": B: "The seizure may or
may not mean your child has epilepsy."
13. 13. Alcohol and drug abuse impairs judgment and increases risk taking
behavior. What nursing diagnosis best applies?
A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem: A: Risk for injury
14. 14. The nurse is caring for a 10 month-old infant who is has oxygen via
mask. It is important for the nurse to maintain patency of which of these
areas?
, HESI Exit RN V4
Study online at https://quizlet.com/_c8ksxq
A) Mouth
B) Nasal passages
C) Back of throat
D) Bronchials: B: Nasal passages
15. 15. The nurse is providing instructions for a client with pneumonia. What
is the most important information to convey to the client?
A) "Take at least 2 weeks off from work."
B) "You will need another chest x-ray in 6 weeks."
C) "Take your temperature every day."
D) "Complete all of the antibiotic even if your findings decrease.": D: "Complete
all of the antibiotic even if your findings decrease."
16. 16. When counseling a 6 year old who is experiencing enuresis, what must
the nurse understand about the pathophysiological basis of this disorder?
A) Has no clear etiology
B) May be associated with sleep phobia
C) Has a definite genetic link
D) Is a sign of willful misbehavior: A: Has no clear etiology
17. 17. The nurse is discussing negativism with the parents of a 30 month-old
child. How should the nurse tell the parents to best respond to this behavior?
A) Reprimand the child and give a 15 minute "time out"
B) Maintain a permissive attitude for this behavior
C) Use patience and a sense of humor to deal with this behavior
D) Assert authority over the child through limit setting: C: Use patience and a
sense of humor to deal with this behavior
18. 18. The nurse is talking by telephone with a parent of a 4 year-old child who
has chickenpox. Which of the following demonstrates appropriate teaching by
the nurse?
A) Chewable aspirin is the preferred analgesic
B) Topical cortisone ointment relieves itching
C) Papules, vesicles, and crusts will be present at one time
D) The illness is only contagious prior to lesion eruption: C: Papules, vesicles,
and crusts will be present at one time
19. 19. The nurse is assigned to a client who has heart failure . During the
morning rounds the nurse sees the client develop sudden anxiety, diaphore-
sis and dyspnea. The nurse auscultates, crackles bilaterally. Which nursing
