PEDIATRICS - HESI PRACTICE EXAM WITH CORRECT SOLUTIONS

PEDIATRICS - HESI PRACTICE EXAM WITH CORRECT SOLUTIONSThe nurse is giving preoperative instructions to a 14-year old female client who is scheduled for surgery to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken place? A. I will read all the literature you gave me before surgery. B. I have had surgery before when I broke my wrist in a bike accident, so I know what to expect. C. All the things people have told me will help me take care of my back. D. I understand that I will be in a body cast and I will show you how you taught me to turn. D. I understand that I will be in a body cast and I will show you how you taught me to turn. Outcome of learning is best demonstrated when the client not only verbalizes an understanding, but also can provide a return demonstration. A 14-year old may or may not follow through with reading material and there is no way of measuring that way of learning. Have a previous surgery may help the client understand the surgical process, but wrist surgery is very different from spinal surgery and emergency surgery is different than elective surgery. In (C), the client may be saying what the nurse wants to hear, without expressing any real understanding of what to do after surgery. To take the vital signs of a 4-month old child, which order will give the most accurate results? A. Respiratory rate, heart rate, then rectal temperature B. Heart rate, rectal temperature, then respiratory rate. C. Rectal temperature, heart rate, then respiratory rate D. Rectal temperature, respiratory rate, then heart rate A. Respiratory rate, heart rate, then rectal temperature The respiratory rate should be taken first in infants, since touching them or performing unpleasant procedures usually makes them cry, elevating the heart rate and making respirations difficult to count. Rectal temperature is the most invasive procedure, and is mot likely to precipitate crying, so should be done last. During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not movable. What action should the nurse take next? A. No action required, as this is an expected finding for a school-aged child B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately. C. Send a note home advising the parents to have the child evaluated by a healthcare provider as soon as possible. d. Call the parents and have them take the child home from school for the rest of the day. B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately. More information is needed to interpret these findings. The tympanic membrane is normally pearly gray, not bulging, and moves when the client blows against resistance or a small puff of air is blown into the ear canal. Since this child's findings are not completely normal, further assessment of history and related signs and symptoms is indicated for accurate interpretation of the findings. (A), (C), and (D) are inappropriate actions based on the data obtained from the otoscope examination. Which restraint should be used for a toddler after a cleft palate repair? A. clove hitch B. Mummy C. elbow D. jacket C. elbow Elbow restraints Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical site. A clove hitch restrains the hands, but the child can bend and bring their head to their hands. A mummy restraint is used during procedures. A jacket restraint restrains the body torso and is not appropriate. What preoperative nursing intervention should be included in the plan of care for an infant with pyloric stenosis? A. Monitor for signs of metabolic acidosis. B. estimate the quantity of diarrhea stools. C. place in a supine position after feeding D. observe for projectile vomiting. D. observe for projectile vomiting. Projectile vomiting which contributes to metabolic alkalosis, is the classic sign of pyloric stenosis. Estimating the quantity of diarrhea stools is not indicated. Placing the child in a supine position is dangerous due to the potential for aspiration with frequent vomiting. A six-month-old returns from surgery with elbow restraints in place. What nursing care should be included when caring for any restrained child? A. keep restraints on at all times. B. remove restraints one at a time and provide range of motion exercises C. Remove all restraints simultaneously and provide lay activities D. renew the healthcare provider's prescription for restraints every 72 hours. B. remove restraints one at a time and provide range of motion exercises Removing restraints one at a time is safer than removing all of them at once. The child needs to exercise and should not be kept in restraints at all times. The renewal of the healthcare provider's prescription varies with hospitals and it does not really answer the question. A 2-year old child with Down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated with Down syndrome? A. congenital heart disease B. fragile x-chromosome C. trisomy 13 D. pyloric stenosis A. congenital heart disease Congenital heart disease is the most common associated defect in children with Down syndrome. Trisomy 13 my have seemed possible since Down syndrome is a trisomal chromosomal abnormality o chromosome 21. Fragile x-chromosome is a sex-linked abnormality also causing mental retardation. Pyloric stenosis is not associated with Down syndrome. When assessing a child with asthma, the nurse should expect intercostal retractions during A. inspiration B. coughing C. apneic episodes D. expiration A. inspiration Intercostal retractions result from respiratory effort to draw air into restricted airways. When planning the care for a child who has had a cleft lip repair, the nurse knows that crying should be minimized because it A. increases salivation B. increases the respiratory rate C. leads to vomiting D. stresses the suture line D. stresses the suture line Prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance of a cleft lip repair. Although crying also causes increased salivation, increased respiratory rate and may lead to vomiting, these conditions do not create a problem for the child with a cleft lip repair. A full-term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that the infant may have an esophageal atresia. Which symptoms is this newborn likely to have exhibited? A. choking, coughing, and cyanosis B. projectile vomiting and cyanosis C. apneic spells and grunting D. scaphoid abdomen and anorexia A. choking, coughing, and cyanosis (A) includes the "3 C's" of esophageal atresia caused by the overflow of secretions into the trachea. (B) is characteristic of pyloric stenosis in the infant. (C) could be due to prematurity or sepsis, and grunting is a sign of respiratory distress. (D) is characteristic of a diaphragmatic hernia. Which behavior would the nurse expect a two-year-old child to exhibit? A. build a house with blocks B. ride a tricycle C. display possessiveness of toys D. look at a picture book for 15 minutes C. display possessiveness of toys Two-year old children are egocentric and unable to share with other children. (A, B, and D) are behaviors of a preschooler. the mother of a preschool-aged client asks the nurse if it is all right to administer Pepto Bismal to her son when he 'has a tummy ache." After reminding the mother to check the label of all OTC drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question? A. if the child's tongue darkness, discontinue the Pepto Bismal immediately B. do not give if the child has chickenpox, the flu, or any other viral illness. C. avoid the use of Pepto Bismal until the child is at least 16 years old. D. Pepto Bismal may cause a rebound hyperactivity, worsening the "tummy-ache." B. do not give if the child has chickenpox, the flu, or any other viral illness. Pepto Bismal contains aspirin and there is the potential of Reye's syndrome. A dark tongue is a common effect of Pepto Bismal and does not warrant discontinuation. Pepto Bismal can be used by children. Pepto Bismal does not cause rebound hyperactivity, which is a complication of antacids containing calcium. The nurse observes a 4-year old boy in a daycare setting. Which behavior should the nurse consider normal for this client? A. Has a temper tantrum when told he must share his toys. B. plays by himself most of the day C. demonstrates aggressiveness by boasting when telling a story D. Begins to cry and is fearful when separated from his parents. C. demonstrates aggressiveness by boasting when telling a story Four-year old children are aggressive in their behavior and enjoy "tale telling". Behaviors in (A and D) are typical of toddlers. The play of a preschooler is cooperative, so playing alone is not typical. A burned child is brought to the emergency room. In estimating the percentage of the body burned, the nurse uses a modified "Rule of Nines." Which part of a child's body is calculated as a larger percentage of total body surface than an adult? A. head and neck B. arms and chest C. legs and abdomen D. back and abdomen A. head and neck A child's head and neck are proportionately larger to their body than an adults. The standard "Rule of Nine's" is inaccurate for determining burned body surface areas with children and must be modified for use with children. Specially designed charts for children are commonly used to determine body surface area involvement (B, C and D) are not proportionately different. 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? A. pass the information on in the report B. notify the healthcare provider because the value is high C. repeat the lab study because the value is too high. D. hold the next dose of theophylline A. pass the information on in the report The therapeutic level of theophylline is 10-20 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. (B, C, and D) would be inappropriate actions in view of the laboratory finding. A 12-month old boy is admitted with a respiratory infection and possible pneumonia. He is placed in a mist tent with oxygen. Which nursing intervention has the greatest priority for this infant? A. give small, frequent feedings of fluids B. accurately chart observations regarding breath sounds C. have a bulb syringe readily available to remove secretions D. encourage older siblings to visit C. have a bulb syringe readily available to remove secretions A patient airway has the highest priority. Humidification will liquefy the nasal secretions thereby increasing the amount of secretions and making (C) the highest priority. (A) maintains hydration and prevents, but an open airway has the highest priority. (B) is important for evaluations of therapy. When asked "priority" questions, remember Maslow. Physical needs usually have a higher priority than psychosocial needs. An open airway is the highest physiological need 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. A. weighing diapers B. assessing fontanels C. checking skin turgor D. observing mucous membranes for moisture B. assessing fontanels All of these interventions evaluate fluid status in infants. But, now old is this child? Posterior fontanel closes at 2 months and anterior fontanels close by 18 months of age. Remember normal growth and development A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician prescribed dextrose 5% and 0.25% normal saline with 2 mEq KCI/100 mL to be infused at 25mL/hr. Prior to initiating the infusion, the nurse should obtain which assessment finding? A. frequency of emesis is the last 8 hours B. serum BUN and creatinine levels C. current blood sugar level D. appearance of the stool B. serum BUN and creatinine levels Regardless of a client's age, adequate renal function must be present before adding potassium to IV fluids. (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. 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. B. 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. B. a tympanic measurement of temperature will provide the most accurate reading 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 affect 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 to do this. Rectal temperature management is less accurate because of the possibility of stool in the rectum. It is unnecessary to contacted the healthcare provider. 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? A. bradycardia B. machinery murmur C. weak pedal pulses D. clubbed fingers D. clubbed fingers Tetrology of Fallot, a cyanotic heart defect, causes clubbing of fingers and toes due to tissue hypoxia. Tachycardia not bradycardia is a manifestation of congenital heart disease. Machinery murmur is a classic sign of ventricular septal defect. Weak pedal pulses are characteristic of coarctation of the aorta 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. A 5-month old with failure to thrive that has a closed anterior fontanel B. a 24-month old with gastroenteritis that has a closed posterior fontanel. C. A 2-month old with chickenpox that has an open posterior fontanel. D. A 28-month old with hydrocephalus that has an open anterior fontanel. A. A 5-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 hydrocphalus may have a delayed closing of the fontanel. A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which behavior? A. ability to communicate verbally B. response to separation from family C. concern for body integrity D. socialization with other children C. concern for body integrity The preschooler's major stressor is concern for his body integrity. 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. (B) is a concern for all children, but of most concern to the toddler. (D) is not a prime concern in this situation. 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? A. stop the flow of unoxygenated blood into systemic circulation B. increase the flow of unoxygenated blood to the lungs. C. prevent the return of oxygenated blood to the lungs. D. reduce peripheral tissue hypoxia and nailbed clubbing. C. 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. VSDs are acyanotic defects, which means that no unoxygenated blood enters the systemic circulation. (D) is common with Tetrology of Fallot, which is a cyanotic defect. A three-month old boy weighing 10 lbs, 15 oz has an axillary temperature of 98.9 degrees F. The nurse determines the daily caloric need for this child is approximately: A. 400 cal/day B. 500 cal/day C. 600 cal/day D. 700 cal/day C. 600 cal/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 cal/kg/day (108 x 5 = 540 cal/day). However this infant requires 10% more calories because he has one degree temperature elevation. 10% of 540 is 54 and 54 + 540 = 594. This infant will require approximately 600 calories/day. Remember that a temperature elevation necessitates consumption of more calories. The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about prevention of accidental poisonings. It is most important for the nurse to include which instructions? A. tell children they should not taste anything but food B. store all toxic agents and medicines in locked cabinets. C. Provide special play areas in the house and restrict play in other areas. D. punish children i they open cabinets that contain household chemicals. B. store all toxic agents and medicines in locked cabinets. A 6-month old infant with congestive heart failure (CHF) is receiving digoxin elixer. Which observation by the nurse warrants immediate intervention? A. apical heart rate of 60. B. sweating across the forehead C. doesn't suck well D. respiratory rate of 30 breaths/minute A. apical heart rate of 60. A heart rate of 60 is much lower than normal for a 6-month old and warrants immediate intervention. the normal heart rate for a 6-month old is 80-150 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) normal limits for an infant. At 8am, 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 4am BP 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? A. give the client her 9am prescription for an oral diuretic early. B. administer PRN prescription of nifedipine (Procardia) sublingually. C. notify the healthcare provider and inform the nursing supervisor of the client's condition D. attempt to calm the client and retake the BP in 30 minutes. B. administer PRN prescription of nifedipine (Procardia) sublingually. Sublingual Procardia lowers BP 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. (D) does not consider the seriousness of this finding. The nurse should stay with the client until the BP is reduced. A premature newborn girl, born 24 hours ago, is diagnosed with a patent ductus arteriosus (PDA) and placed under an oxygen hood at 35%. The parents visit the nursery and ask to hold her. Which response should the nurse provide to the parents? A. Studies have shown that handling a sick newborn is not good for the baby and upsets the parents. B. the oxygen hood is holding the baby's oxygen level just at the point which is needed. You may stroke and talk to her. C. Since your baby has been doing well under oxygen for 24 hours, I can let you hold the baby without oxygen. D. You can hold the baby with the oxygen blowing on the baby's face since the level is very close to room air. B. the oxygen hood is holding the baby's oxygen level just at the point which is needed. You may stroke and talk to her. The baby is at 35% which is much more than room air (21%) and at this time the baby should not be moved from under the hood. the nurse should offer the parents an alternative such as to stroke and reassure the infant. Holding sick babies benefits the infant and the parents, but the first consideration now has to be the infant's oxygenation. The nurse should not take the baby out from under the hood without a prescription from the healthcare provider, as this could severely compromise the infant. A PO2 of 35% cannot be readily achieved with "blow by" oxygen. 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? A. Reassure the parents that 3-year olds are cooperative and therefore are less likely to be anxious. B. Obtain a video film of a cardiac catheterization to show to the child prior to the procedure C. give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there. D. Obtain a cardiac catheter and demonstrate the procedure by pretending to put the catheter in a doll or stuffed animal. C. 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 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. At three, the child is too young to understand why this must be done. (B) is not indicated and (D) is not indicated because it is likely to be interpreted as painful. When taking the health history of a child, the nurse knows that which finding is an early indication of hypothyroidism in children? A. hyperactive behavioral traits B. delay in the eruption of permanent teeth C. slow sexual development but within normal range D. cessation of growth in a child that had been normal. D. cessation of growth in a child that had been normal. Since the thyroid gland is responsible for metabolism, cessation of growth which was previously within normal range, is the most common sign for hypothyroidism in children. The child with hypothyroidism is likely to be HYPOactive, not hyperactive. Although (B and C) may occur with hypothyroidism, they are late signs (not early indications) and are signs more often associated with a lack of growth hormone. The nurse is teaching a 12-year old male adolescent and his family about taking injections of growth hormone for idiopathic hypopituitarism. Which adverse symptoms, commonly associated with growth hormone therapy should the nurse plan to describe to the child and his family? A. polyuria and polydipsia B. lethargy and fatigue C. increased facial hair D. facial bone structure changes A. polyuria and polydipsia Signs and symptoms of diabetes or hyperglycemia need to be reported. those receiving growth hormone should be monitored to detect elevated blood sugars and glucose intolerance. Lethargy and fatigue are associated with any number of health alterations, but is not associated with the growth hormone therapy. Increased facial hair and facial bone structure changes are normal changes that occur with 12-year old males. 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? A. poor skin turgor resulting from dehydration B. changes in LOC C. premature aging as the disease progresses D. severe edema from an excess of water and sodium B. changes in LOC The child must be monitored for signs and symptoms of hyponatremia, which creates secondary CNS alterations, such as changes in LOC, seizure and coma. Fluid overload occurs with SIADH not dehydration (which occurs with diabetes insipidus). Premature aging is caused by hypersecretion of growth hormone, not SIADH. Severe edema is not found in children with SIADH because edema is caused by an excess of both water and sodium. A four-year old girl continues to interrupt her mother during a routine clinic visit. the mother appears irritated with the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information? A. children need to retain a sense of initiative without impinging on the rights and privileges of others. B. negative feelings of doubt and shame are characteristic of 4 year-old children C. Role conflict is a common problem of children this age. She is just wondering where she fits into society. D. At this age children compete and like to produce and carry through with tasks. She is just competing with her mother. A. children need to retain a sense of initiative without impinging on the rights and privileges of others. Children ages 3-6 are in Erikson's "Initiative vs. Guilt" stage, which is characterized by vigorous, intrusive behavior, enterprise, and strong imagination. At this age, children develop a conscience and must learn to retain a sense of initiative without impinging on the rights of others. (B) describes the "Autonomy vs. Shame and Doubt" stage (1-3 years). (C) describes an adolescent (12-18) "Identify vs. Role Confusion" stage. (D) describes a child 6-12 years of age in the "Industry vs. Inferiority" stage. a 14-year old female client tells the nurse that she is concerned about the acne she has recently developed. Which recommendation should the nurse provide? A. Remove all blackheads and follow with an alcohol scrub B. Use medicated cosmetics only to help hide the blemishes. C. Wash the hair and skin frequently with soap and hot water. D. Encourage her to see a dermatologist as soon as possible. C. Wash the hair and skin frequently with soap and hot water Washing the hair and skin with soap and hot water removes oil and debris from the skin and helps prevent and treat acne. Oily skin is especially bothersome during adolescence when hormones cause enlargement of sebaceous glands and increased glandular secretions which predispose the teenager to acne. (A) is contraindicated. Cosmetics ("medicated" or not) should be used sparingly to avoid further blocking of sebaceous gland ducts. (D) may be indicated at a later time, if healthcare recommendations are not successful.