INET HESI RN V4 ACTUAL PROCTORED
EXAM (VERIFIED ANSWERS) |ALREADY
GRADED A+
• The nurse is caring for a pre-adolescent client in skeletal Dunlop
traction. Which nursing intervention is appropriate for this child?
• Make certain the child is maintained in correct body alignment.
• Be sure the traction weights touch the end of the bed.
• Adjust the head and foot of the bed for the child's comfort
• Release the traction for 15-20 minutes every 6 hours PRN.
• A: Make certain the child is maintained in correct body alignment.
• 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?
• Height and weight percentiles vary widely
• Growth pattern appears to have slowed
• Recumbent and standing height are different
• Short term weight changes are uneven
• A: Height and weight percentiles vary widely
• 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?
• Teach the parents how to perform cardiopulmonary
resuscitation
• Recommend that the parents give in when he holds his breath to
prevent anoxia
• Advise the parents to ignore breath holding because breathing
will begin as a reflex
• 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
• The nurse is assessing a client in the emergency room. Which
statement suggests that the problem is acute angina?
• "My pain is deep in my chest behind my sternum."
• "When I sit up the pain gets worse."
• "As I take a deep breath the pain gets worse."
• "The pain is right here in my stomach area."
• A: "My pain is deep in my chest behind my sternum."
• 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?
• "Name the year." "What season is this?" (pause for answer after
each question)
• "Subtract 7 from 100 and then subtract 7 from that." (pause for
answer) "Now continue to subtract 7 from the new number."
• "I am going to say the names of three things and I want you to
repeat them after me: blue, ball, pen."
• "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."
• In planning care for a 6 month-old infant, what must the nurse
provide to assist in the development of trust?
• Food
• Warmth
• Security
• Comfort
• C: Security
• A nurse has just received a medication order which is not legible.
Which statement best reflects assertive communication?
,• "I cannot give this medication as it is written. I have no idea of
what you mean."
• "Would you please clarify what you have written so I am sure I
am reading it correctly?"
• "I am having difficulty reading your handwriting. It would save
me time if you would be more careful."
• "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?"
• What is the most important consideration when teaching parents
how to reduce risks in the home?
• Age and knowledge level of the parents
• Proximity to emergency services
• Number of children in the home
• Age of children in the home
• D: Age of children in the home
• 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
• Administer a placebo
• Encourage increased fluid intake
• Administer the prescribed analgesia
• Recommend relaxation exercises for pain control
• C: Administer the prescribed analgesia
• While caring for a toddler with croup, which initial sign of croup
requires the nurse's immediate attention?
• Respiratory rate of 42
• Lethargy for the past hour
• Apical pulse of 54
• Coughing up copious secretions
• A: Respiratory rate of 30
, • 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?
• Lethargy
• Heat intolerance
• Diarrhea
• Skin eruptions
• A: Lethargy
• 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?
• "Do not worry. Epilepsy can be treated with medications."
• "The seizure may or may not mean your child has epilepsy."
• "Since this was the first convulsion, it may not happen again."
• "Long term treatment will prevent future seizures."
• B: "The seizure may or may not mean your child has epilepsy."
• Alcohol and drug abuse impairs judgment and increases risk
taking behavior. What nursing diagnosis best applies?
• Risk for injury
• Risk for knowledge deficit
• Altered thought process
• Disturbance in self-esteem
• A: Risk for injury
• 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?
• Mouth
• Nasal passages
• Back of throat
EXAM (VERIFIED ANSWERS) |ALREADY
GRADED A+
• The nurse is caring for a pre-adolescent client in skeletal Dunlop
traction. Which nursing intervention is appropriate for this child?
• Make certain the child is maintained in correct body alignment.
• Be sure the traction weights touch the end of the bed.
• Adjust the head and foot of the bed for the child's comfort
• Release the traction for 15-20 minutes every 6 hours PRN.
• A: Make certain the child is maintained in correct body alignment.
• 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?
• Height and weight percentiles vary widely
• Growth pattern appears to have slowed
• Recumbent and standing height are different
• Short term weight changes are uneven
• A: Height and weight percentiles vary widely
• 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?
• Teach the parents how to perform cardiopulmonary
resuscitation
• Recommend that the parents give in when he holds his breath to
prevent anoxia
• Advise the parents to ignore breath holding because breathing
will begin as a reflex
• 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
• The nurse is assessing a client in the emergency room. Which
statement suggests that the problem is acute angina?
• "My pain is deep in my chest behind my sternum."
• "When I sit up the pain gets worse."
• "As I take a deep breath the pain gets worse."
• "The pain is right here in my stomach area."
• A: "My pain is deep in my chest behind my sternum."
• 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?
• "Name the year." "What season is this?" (pause for answer after
each question)
• "Subtract 7 from 100 and then subtract 7 from that." (pause for
answer) "Now continue to subtract 7 from the new number."
• "I am going to say the names of three things and I want you to
repeat them after me: blue, ball, pen."
• "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."
• In planning care for a 6 month-old infant, what must the nurse
provide to assist in the development of trust?
• Food
• Warmth
• Security
• Comfort
• C: Security
• A nurse has just received a medication order which is not legible.
Which statement best reflects assertive communication?
,• "I cannot give this medication as it is written. I have no idea of
what you mean."
• "Would you please clarify what you have written so I am sure I
am reading it correctly?"
• "I am having difficulty reading your handwriting. It would save
me time if you would be more careful."
• "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?"
• What is the most important consideration when teaching parents
how to reduce risks in the home?
• Age and knowledge level of the parents
• Proximity to emergency services
• Number of children in the home
• Age of children in the home
• D: Age of children in the home
• 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
• Administer a placebo
• Encourage increased fluid intake
• Administer the prescribed analgesia
• Recommend relaxation exercises for pain control
• C: Administer the prescribed analgesia
• While caring for a toddler with croup, which initial sign of croup
requires the nurse's immediate attention?
• Respiratory rate of 42
• Lethargy for the past hour
• Apical pulse of 54
• Coughing up copious secretions
• A: Respiratory rate of 30
, • 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?
• Lethargy
• Heat intolerance
• Diarrhea
• Skin eruptions
• A: Lethargy
• 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?
• "Do not worry. Epilepsy can be treated with medications."
• "The seizure may or may not mean your child has epilepsy."
• "Since this was the first convulsion, it may not happen again."
• "Long term treatment will prevent future seizures."
• B: "The seizure may or may not mean your child has epilepsy."
• Alcohol and drug abuse impairs judgment and increases risk
taking behavior. What nursing diagnosis best applies?
• Risk for injury
• Risk for knowledge deficit
• Altered thought process
• Disturbance in self-esteem
• A: Risk for injury
• 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?
• Mouth
• Nasal passages
• Back of throat
