HESI LPN
Pediatric HESI Test Bank Questions
Question 1 of 5
The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion?
Correct Answer: B
Rationale: Upright positioning is the most appropriate intervention to promote maximum chest expansion in a child with Duchenne muscular dystrophy. By keeping the child in an upright position, lung expansion is maximized, which improves breathing efficiency. Deep-breathing exercises may help with overall lung function but do not directly promote chest expansion. Coughing and chest percussion are more related to airway clearance and do not specifically address maximizing chest expansion.
Question 2 of 5
The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis?
Correct Answer: A
Rationale: The correct answer is A: Risk for impaired skin integrity due to cast and location. When caring for a child with a long-leg hip spica cast, the priority nursing diagnosis is the risk for impaired skin integrity. This is because the child's limited mobility and the pressure from the cast can lead to skin breakdown and complications. Choice B is incorrect as while education is essential, it is not the priority when immediate physical risks are present. Choice C is incorrect because while immobility can impact development, the immediate concern is preventing complications from the cast. Choice D is incorrect as it focuses on self-care deficits rather than the physical risk of skin integrity issues.
Question 3 of 5
What is an essential nursing action when caring for a young child with severe diarrhea?
Correct Answer: D
Rationale: Promoting perianal skin integrity is crucial when caring for a young child with severe diarrhea to prevent skin breakdown from the irritation caused by frequent bowel movements. Maintaining the IV (Choice A) may be important for hydration but is not directly related to managing skin integrity. Taking daily weights (Choice B) is important for monitoring fluid balance but does not address the immediate need to prevent skin breakdown. While replacing lost calories (Choice C) is important, it is not the priority when a child is experiencing severe diarrhea and skin integrity is at risk.
Question 4 of 5
The parents of a child who is scheduled for open-heart surgery ask why their child must be subjected to chest tubes after surgery. What should the nurse consider before responding in language the parents will understand?
Correct Answer: B
Rationale: Chest tubes are necessary after open-heart surgery to facilitate the drainage of air and fluid from the chest cavity. These tubes help prevent complications such as pneumothorax (accumulation of air in the pleural space) or cardiac tamponade (build-up of fluid in the pericardial sac), which can be serious postoperative issues. Options A, C, and D are incorrect because chest tubes are primarily used for draining purposes and not for increasing tidal volumes, maintaining positive intrapleural pressure, or regulating pressure on the pericardium and chest wall.
Question 5 of 5
An instructor is developing a plan for a class of nursing students on various skin disorders. When describing urticaria, what would the instructor include?
Correct Answer: B
Rationale: The correct answer is B. Urticaria is a type I hypersensitivity reaction, not type IV. When triggered, histamine release leads to vasodilation, causing characteristic wheals. Wheals are typically followed by erythema. The rash in urticaria is pruritic and does blanch with pressure, unlike the nonpruritic rash described in choice D. Therefore, the most appropriate description of urticaria includes histamine release and vasodilation, as stated in choice B.