Evolve HESI Practice Questions and Answers Latest 2022 Already Graded A

Evolve HESI Practice Questions and Answers Latest 2022 Already Graded A A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervent ...

Evolve HESI Practice Questions and Answers Latest 2022 Already Graded A A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervention? Apical heart rate of 60. Sweating across the forehead. Doesn't suck well. Respiratory rate of 30 breaths per minute. Correct Answer-Apical heart rate of 60. A heart rate of 60 (A) is much lower than normal for a 6-month-old and warrants immediate intervention. The normal heart rate for a 6-month-old is 80 to 150 BPM when awake, and a rate of 70 while sleeping is considered within normal limits. (B and C) are expected symptoms of heart failure in an infant. (D) is within normal limits for an infant. The nurse is teaching the parents of a 5-year-old with cystic fibrosis about respiratory treatments. Which statement indicates to the nurse that the parents understand? Perform postural drainage before starting aerosol therapy. Give respiratory treatments when the child is coughing a lot. Administer aerosol therapy followed by postural drainage before meals. Ensure respiratory therapy is done daily during any respiratory infection. Correct Answer-Administer aerosol therapy followed by postural drainage before meals. Postural drainage for a child with cystic fibrosis is most effective when performed after nebulization and before meals (C) or at least 1 hour after eating to prevent nausea and vomiting. Postural drainage uses gravity to promote mucous removal after nebulization (A) treatments which open the airways. Pulmonary toileting or respiratory treatments should be given 3 to 4 times daily, not episodically (B and D). A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most important instruction for the nurse to include in this client's teaching plan? Use sunscreen when lying by the pool.Cleanse the skin at least 4 times a day. Take the medication with a glass of milk. Menstrual periods may become irregular. Correct Answer-Use sunscreen when lying by the pool. Photosensitivity is a common side effect of tetracycline HCL (Achromycin V) therapy. Severe sunburn can occur with minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen (A). (B and D) are not related to tetracycline HCL (Achromycin V) therapy. (C) should be avoided because dairy products interfere with the absorption of tetracyclines. What preoperative nursing intervention should be included in the plan of care for an infant with pyloric stenosis? Monitor for signs of metabolic acidosis. Estimate the quantity of diarrhea stools. Place in a supine position after feeding. Observe for projectile vomiting. Correct Answer-Observe for projectile vomiting. Projectile vomiting (D), which contributes to metabolic alkalosis (A), is the classic sign of pyloric stenosis. (B) is not indicated. (C) is dangerous, due to the potential for aspiration with frequent vomiting. An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The nurse recognizes that surgical correction is designed to achieve which outcome? Stop the flow of unoxygenated blood into systemic circulation. Increase the flow of unoxygenated blood to the lungs. Prevent the return of oxygenated blood to the lungs. Reduce peripheral tissue hypoxia and nailbed clubbing Correct Answer-Prevent the return of oxygenated blood to the lungs. Closure of VSDs stops oxygenated blood from being shunted from the left ventricle to the right ventricle (C). VSDs are acyanotic defects, which means that no unoxygenated blood enters the systemic circulation (A and B). (D) is common with Tetrology of Fallot, which is a cyanotic defect.A 3-week-old newborn is brought to the clinic for follow-up after a home birth. The mother reports that her child bottle feeds for 5 minutes only and then falls asleep. The nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD), and finds the newborn is acyanotic with a respiratory rate of 64 breaths per minute. What instruction should the nurse provide the mother to ensure the infant is receiving adequate intake? (Select all that apply.) A. Monitor the the infant's weight and number of wet diapers per day. B. Increase the infant's intake per feeding by 1 to 2 ounces per week. C. Mix the dose of prophylactic antibiotic in a full bottle of formula. D. Allow the infant to rest and refeed on demand or every 2 hours. E. Use a softer nipple or increase the size of the nipple opening. Correct Answer-A. Monitor the the infant's weight and number of wet diapers per day. B. Increase the infant's intake per feeding by 1 to 2 ounces per week. D. Allow the infant to rest and refeed on demand or every 2 hours. E. Use a softer nipple or increase the size of the nipple opening. Antibiotic prophylaxis is recommended for infants with VSDs, but should not be mixed in a bottle of formula (C) because it is difficult to ensure that the total dose is consumed. They should be monitored for weight gain and at least 6 wet diapers per day (A). A one-month old infant should ingest 2 to 4 ounces of formula per feeding and progress to about 30 ounces per day by 4- months of age (B) Preoperative nursing care for a child with Wilms' tumor should include which intervention? Gently percuss the abdomen for evidence of trapped air. Observe the abdomen for any noticeable discolorations. Apply cold compresses to the abdomen to reduce edema. Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN." Correct Answer-Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN." Prevention of abdominal palpation (D) minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis. (A) is unnecessary, and this action could traumatize the tumor in the same manner as palpation. (B and C) are incorrect since the abdomen is not discolored and cold compresses are not indicated.At 8 a.m. the unlicensed assistive personnel (UAP) informs the charge nurse that a female adolescent client with acute glomerulonephritis has a blood pressure of 210/110. The 4 a.m. blood pressure reading was 170/88. The client reports to the UAP that she is upset because her boyfriend did not visit last night. What action should the nurse take first? Give the client her 9 a.m. prescription for an oral diuretic early. Administer PRN prescription of nifedipine (Procardia) sublingually. Notify the healthcare provider and inform the nursing supervisor of the client's condition. Attempt to calm the client and retake the blood pressure in thirty minutes. Correct Answer-Administer PRN prescription of nifedipine (Procardia) sublingually. Sublingual Procardia (B) lowers blood pressure very quickly, and this should be done first. (A) may also be done, but oral diuretics do not work as rapidly as the sublingual antihypertensive. When notifying the healthcare provider, the first thing he/she will want to know is if the PRN antihypertensive has been administered (C). (D) does not consider the seriousness of this finding. The nurse should stay with the client until the blood pressure is reduced. The nurse is assessing an 8-month-old child who has a medical diagnosis of Tetrology of Fallot. Which symptom is this client most likely to exhibit? Bradycardia. Machinery murmur. Weak pedal pulses. Clubbed fingers. Correct Answer-Clubbed fingers. Tetrology of Fallot, a cyanotic heart defect, causes clubbing of fingers and toes (D) due to tissue hypoxia. Tachycardia, not (A), is a manifestation of congenital heart disease. (B) is a classic sign of ventricular septal defect. (C) is characteristic of coarctation of the aorta. Surgery is being delayed for an infant with undescended testes. In collaboration with the healthcare provider and the family, which prescription should the nurse anticipate? A trial of adrenocorticotrophic hormone injections. Frequent stimulation of the cremasteric reflex. A trial of human chorionic gonadotrophic hormone.Frequent warm baths to gently dilate the scrotal area. Correct Answer-A trial of human chorionic gonadotrophic hormone. A trial of HCG (human chorionic gonadotrophic hormone) (C) may aid in testicular descent, but does not replace surgical repair for true undescended testes. Undescended testes (cryptorchidism) may be found in the inguinal canal due to exaggerated cremasteric reflex. (A) is not indicated. Stimulation of the cremasteric reflex causes the testes to ascend rather than descend in the scrotum (B). (D) may relax the cremasteric muscle, but may not cause the testes to descend. A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which behavior? Ability to communicate verbally. Response to separation from family. Concern for body integrity. Socialization with other children. Correct Answer-Concern for body integrity. The preschooler's major stressor is concern for his body integrity (C). He fears that his "insides will leak out." A child undergoing surgery to his genitalia is even more concerned about body integrity. The preschooler is quite verbal, so comprehension of the words he uses or hears may be inaccurate, while his imagination and fears may fantasize the reality (A). (B) is a concern for all children, but of most concern to the toddler. (D) is not a prime concern in this situation. A six-month-old returns from surgery with elbow restraints in place. What nursing care should be included when caring for any restrained child? Keep restraints on at all times. Remove restraints one at a time and provide range of motion exercises. Remove all restraints simultaneously and provide play activities. Renew the healthcare provider's prescription for restraints every 72 hours. Correct Answer-Remove restraints one at a time and provide range of motion exercises. Removing restraints one at a time (B) is safer than removing all of them at once (C). The child needs to exercise and should not be kept in restraints at all times (A). The renewal of the healthcare provider's prescription varies with hospitals (D), and it does not really answer the question.All of the following interventions can be used to evaluate the effectiveness of nursing and medical interventions used to treat diarrhea. Which intervention is least useful in the nurse's evaluation of a 20- month-old child? Weighing diapers. Assessing fontanels. Checking skin turgor. Observing mucous membranes for moisture. Correct Answer-Assessing fontanels. All of these interventions evaluate fluid status in infants. But, how old is this child? Posterior fontanel closes at 2 months and anterior fontanel closes by 18 months of age (B)! Remember normal growth and development! As part of the physical assessment of children, the nurse observes and palpates the fontanels. Which child's fontanel finding should be reported to the healthcare provider? A 6-month-old with failure to thrive that has a closed anterior fontanel. A 24-month-old with gastroenteritis that has a closed posterior fontanel. A 2-month-old with chickenpox that has an open posterior fontanel. A 28-month-old with hydrocephalus that has an open anterior fontanel. Correct Answer-A 6-month-old with failure to thrive that has a closed anterior fontanel. At six months of age the anterior fontanel should be open, and it should not be closed until approximately 18 months of age. (B and C) are normal findings. A child with hydrocephalus may have a delayed closing of the fontanel (D). The nurse receives a lab report stating a child with asthma has a theophylline level of 15 mcg/dl. What action will the nurse take? Pass the information on in the report. Notify the healthcare provider because the value is high. Repeat the lab study because the value is too high. Hold the next dose of theophylline. Correct Answer-Pass the information on in the report.The therapeutic level of theophylline is 10 to 20 mcg/dl, so the child's level is within the therapeutic range. This information evaluates the prescribed therapy and should be communicated in the nurse's report (A). (B, C, and D) would be inappropriate actions in view of the laboratory finding. The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which approach by the nurse is most helpful in establishing communication? Engage the child through drawing pictures. Suggest that the parent read a book to the child. Provide paper and pencil for the child to keep a diary. Ask the parent if the child is always uncommunicative. Correct Answer-Engage the child through drawing pictures. Drawing pictures (A) is a valuable form of non-verbal communication. As the nurse and child look at the drawings, a verbal story can be told that projects the child's thinking. (B) may distract the child, but does not establish communication with the nurse. (C) is useful for an older child who is able to write. (D) is important, but engaging the child is more effective in establishing communication patterns. The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication? Poor skin turgor resulting from dehydration. Changes in level of consciousness. Premature aging as the disease progresses. Severe edema from an excess of water and sodium. Correct Answer-Changes in level of consciousness. The child must be monitored for signs and symptoms of hyponatremia, which creates secondary central nervous system alterations such as changes in level of consciousness, seizure, and coma (B). Fluid overload occurs with SIADH, not (A) (which occurs with diabetes insipidus). (C) is caused by hypersecretion of growth hormone, not SIADH. (D) is not found in children with SIADH because edema is caused by an excess of both water and sodium. The nurse is assigning care for a 4-year-old child with otitis media and is concerned about the child's increasing temperature over the past 24 hours. When planning care for this child, it is important for the nurse to consider that A. Only an RN should be assigned to monitor this child's temperature. IncorrectB. A tympanic measurement of temperature will provide the most accurate reading. C. The licensed practical nurse should be instructed to obtain rectal temperatures on this child. D. The healthcare provider should be asked to prescribe the method for measurement of the child's temperatures. Correct Answer-B. A tympanic measurement of temperature will provide the most accurate reading. (B) A tympanic membrane sensor is an excellent site because both the eardrum and hypothalamus (temperature-regulating center) are perfused by the same circulation. The sensor is unaffected by cerumen and the presence of suppurative or unsuppurative otitis media does not effect measurement. RULE OF THUMB: for management--sterile procedures should be assigned to licensed personnel. Management skills will be tested on the NCLEX! An RN is not required (A). Rectal temperature measurement (C) is less accurate because of the possibility of stool in the rectum. (D) is unnecessary. A 3-year-old boy is brought to the emergency room because he swallowed an entire bottle of children's vitamin pills. Which intervention should the nurse implement first? Insert N/G tube for gastric lavage. Determine the child's pulse and respirations. Assess the child's level of consciousness. Administer an IV D5/0.25 NS as prescribed. Correct Answer-Determine the child's pulse and respirations. The most important principle in dealing with a poisoning is to treat the child first, not the poison. Initiate immediate life support measures with assessment of vital signs (B), in particular, respirations. Inserting an airway or initiating mechanical ventilation may be necessary. Assessment and identification of the poison should occur prior to (A). (C and D) should occur after assessing the airway. To take the vital signs of a 4-month-old child, which order provides the most accurate results? Respiratory rate, heart rate, then rectal temperature. Heart rate, rectal temperature, then respiratory rate. Rectal temperature, heart rate, then respiratory rate. Rectal temperature, respiratory rate, then heart rate. Correct Answer-Respiratory rate, heart rate, then rectal temperature.The respiratory rate should be taken first (A) in infants, since touching them or performing unpleasant procedures usually makes them cry, elevating the heart rate and making respirations difficult to count (B). Rectal temperature is the most invasive procedure, and is most likely to precipitate crying, so should be done last (C and D). The parents of a 3-week-old infant report that the child eats well but vomits after each feeding. What information is most important for the nurse to obtain? Description of vomiting episodes in past 24 hours. Number of wet diapers in last 24 hours. Feeding and sleep schedule. Amount of formula consumed during the past 24 hours. Correct Answer-Description of vomiting episodes in past 24 hours. A description of the vomiting episodes (A) will assist the nurse in determining the reason for the symptoms, which may be helpful in developing a plan of care for this infant. (B and C) provide related information but are not as helpful as (A). (D) may be related to the vomiting, but the nurse should first obtain a better description of the vomiting episodes. A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician prescribes dextrose 5% and 0.25% normal saline with 2 mEq KCl/100 ml to be infused at 25 ml/hour. Prior to initiating the infusion, the nurse should obtain which assessment finding? Frequency of emesis in the last 8 hours. Serum BUN and creatinine levels. Current blood sugar level. Appearance of the stool. Correct Answer-Serum BUN and creatinine levels. Regardless of a client's age, adequate renal function must be present before adding potassium to IV fluids (B). (A) is important in determining the need for fluid replacement. (C) is not indicated. (D) is useful information, but will not impact administration of the prescribed IV solution. Which finding in a 19-year-old female client should trigger further assessment by the nurse? Menstruation has not occurred. Reports no tetanus immunization since childhood.Denies having any wisdom teeth. History of painful, inward growth on bottom of foot. Correct Answer-Menstruation has not occurred. Menstruation is an expected secondary sex characteristic that occurs with pubescence and typically occurs by age 18, so (A) should prompt further investigation to determine the cause of this primary amenorrhea. Children receive tetanus as part of the DPT childhood immunization series, and a booster is not typically given until age 16 (B). Wisdom teeth are the third molar teeth of the permanent dentition and are the last to erupt, so (C) is a normal finding. (D) describes a plantar surface wart, harmless but painful because of the pressure with walking or standing. The nurse is giving a liquid iron preparation to a 3-year-old child. Which technique should the nurse implement to engage the child's cooperation? Use a colorful straw. Mix the medication in water. Administer the medication using an oral syringe. Ask the pharmacy to provide an enteric tablet. Correct Answer-Use a colorful straw. A liquid iron preparation administered through a straw may help the child to accept the medication since young children consider drinking from a colorful straw fun (A). (B) may cause staining of the child's teeth. (C) is often used if the child is uncooperative. (D) is ineffective and should be requested from the healthcare provider. When evaluating the effectiveness of interventions to improve the nutritional status of an infant with gastro-esophageal reflux, which intervention is most important for the nurse to implement? Record weight daily. Assess for signs of anemia. Document sleeping patterns. Teach parenting skills. Correct Answer-Record weight daily. The most definitive measure of improved nutrition in an infant is obtaining the child's daily weight (A). (B, C, and D) may also be useful, but they are not as definitive as a daily weight measurement.A three-month old boy weighing 10 lbs 15 oz has an axillary temperature of 98.9° F. The nurse determines the daily caloric need for this child is approximately 400 calories per day. 500 calories per day. 600 calories per day. 700 calories per day. Correct Answer-600 calories per day. 10 lbs 15 oz = 10.9 lbs. Convert lbs to kg by dividing pounds by 2.2; 10.9/2.2 = 4.954 kg, rounded to 5 kg. An infant requires 108 calories/kg/day (108 × 5 = 540 calories/day). However, this infant requires 10% more calories because he has one degree temperature elevation. 10% of 540 is 54 and 540 + 54 = 594. This infant will require approximately 600 calories/day. Tough question! You know that 400 calories are too few and 700 are too much, and a temperature elevation necessitates consumption of more calories, so choose the higher of the two choices left! Which measurements should be used to accurately calculate a pediatric medication dosage? (Select all that apply.) Child's height and weight. Adult dosage of medication. Body surface area of child. Average adult's body surface area. Average pediatric dosage of medication. Nomogram determined mathematical constant. Correct Answer-Child's height and weight. Body surface area of child. Nomogram determined mathematical constant. Correct selections are (A, C, and F). The most accurate calculations of pediatric dosages use the child's height and weight (A). The child's BSA is calculated using the square root of weight in kg times height in cm divided by 3600 or the square root of weight in lb times height in inches divided by 3131 (C), then the child's BSA is multiplied by the recommended published dose per BSA. The nomogram (F) is used to plot the child's height and weight, and the point at which they intersect is the BSA mathematical constant used to calculate the child's dose. (B, D, and E) are not used to calculate pediatric dosages.The nurse is assessing a 2-year-old. What behavior indicates that the child's language development is within normal limits? Is able to name four colors. Can count five blocks. Is capable of making a three word sentence. Half of child's speech is understandable. Correct Answer-Half of child's speech is understandable. Between approximately 15 and 24 months of age, a child's speech is only half understandable (D). (A and B) usually occur between 3 and 5 years of age. (C) is usually accomplished by 18 months of age. The nurse reviews the latest laboratory results for a child who received chemotherapy last week and identifies a reduced neutrophil count. Which nursing diagnosis has the highest priority for this child? Risk for infection. Risk for hemorrhage. Altered skin integrity. Disturbance in body image. Correct Answer-Risk for infection. Chemotherapy (CT) suppresses phagocytotic neutrophils and places the child at risk for infection (A), which is the priority nursing diagnosis. (B, C, and D) may be related to the care of a child receiving CT are not related to neutropenia. A child falls on the playground and is brought to the school nurse with a small laceration on the forearm. Which action should the nurse implement first? Slowly pour hydrogen peroxide over the open wound. Apply ice to the area before rinsing with cold water. Wash the wound gently with mild soap and water. Gently cleanse with a sterile pad using povidone-iodine. Correct Answer-Wash the wound gently with mild soap and water. A small, superficial laceration to the skin should be washed gently with mild soap and water (C) for several minutes, followed by thorough rinsing. (A and D) are antiseptics that can be traumatic (painful)when cleaning fresh, open wounds. Applying ice (B) may reduce or prevent further edema, but the wound should be washed with mild soap and water first. The nurse observes a 4-year-old boy in a daycare setting. Which behavior would the nurse consider normal for this child? Has a temper tantrum when told he must share his toys. Plays by himself most of the day. Demonstrates aggressiveness by boasting when telling a story. Begins to cry and is fearful when separated from his parents. Correct Answer-Demonstrates aggressiveness by boasting when telling a story. Four-year-old children are aggressive in their behavior and enjoy "tale telling" (C). Behaviors in (A and D) are typical of toddlers. The play of a preschooler is cooperative, so playing alone (B) is not typical. The nurse is developing a plan of care for a 3-year-old who is scheduled for a cardiac catheterization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement? Reassure the parents that 3-year-olds are cooperative and therefore are less likely to be anxious. Obtain a video film of a cardiac catheterization to show to the child prior to the procedure. Give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there. Obtain a cardiac catheter and demonstrate the procedure by pretending to put the catheter in a doll or stuffed animal. Correct Answer-Give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there. Familiarizing the child and mother with the department (C) will help decrease anxiety of the child and mother (who may have more anxiety than the child). Three is a difficult age to undergo a procedure that requires cooperation. Restraints and possibly sedation may be required (A). At three, the child is too young to understand why this must be done, and (B) is not indicated. (D) is also not indicated because it is likely to be interpreted as painful. A 6-month-old boy and his mother are at the healthcare provider's office for a well-baby check-up and routine immunizations. The healthcare provider recommends to the mother that the child receive an influenza vaccine. What medications should the nurse plan to administer today?The routine immunizations and schedule another appointment to administer the influenza vaccine. Incorrect All the immunizations with the influenza vaccine given at a separate site from any other injection. The influenza vaccine and schedule another appointment to administer the immunizations. The influenza vaccine and the polio vaccine and schedule another appointment to administer the remaining immunizations. Correct Answer-All the immunizations with the influenza vaccine given at a separate site from any other injection. At 6-months of age, the routine immunizations include Hepatitis B, DTaP, Hib (Haemophilus influenza type b), PCV (Pneumococcal), IPV (inactivated poliovirus) and influenza. The influenza vaccine should be given at a separate site from any other injection (B). Scheduling a return visit (A, B, or C) increases the risk that the mother will not bring the child back for the immunizations. When discussing discipline with the mother of a 4-year-old child, the nurse should include which guideline? Parental control should be consistent. Children as young as 4 years rarely need reprimand or punishment. Withdrawal of approval is effective. Parents should enforce rigid rules to be followed without question. Correct Answer-Parental control should be consistent. Discipline should be a positive and necessary component of childrearing that is started in infancy and should teach socially acceptable behavior, help children protect themselves from danger, and channel undesirable behavior into constructive activity. Misbehavior may result from inconsistent rules or messages, so parental attention should be clear, reasonable, and consistent (A). (B and C) are not helpful to the child. Children need boundaries that are firm but not rigid (D)