OB/Peds HESI Practice Questions

OB/Peds HESI Practice Questions The RN is monitoring an infant with CHD closely for SSx of HF. The RN should assess the infant for which early sign of HF? 1.Pallor 2.Cough 3.Tachycardia 4.Slow and shallow breathing Ans- 3. tachycardia RATIONALE: HF is the inability of the heart to pump a sufficient amt of blood to meet the O2 and metabolic needs of the body. The early SSx of HF include tachycardia, tachypnea, profuse scalp sweating, fatigue & irritability, sudden weight gain, and resp distress. A cough may occur in HF as a result of mucosal swelling & irritation, but is not an early sign. Pallor may be noted in an infant w/ HF, but is not an early sign. The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1.Immunoglobulin 2.Red blood cell count 3.White blood cell count 4.Anti-streptolysin O titer Ans- 4. anti-streptolysin O titer RATIONALE: Rheumatic fever is an inflammatory autoimmune disease that affects the CT of the heart, joints, skin (SQ tissues), BV, and CNS. A Dx of rheumatic fever is confirmed by the presence of 2 major manifestations or 1 major and 2 minor manifestations from the Jones criteria. In addition, evidence of a recent strep infection is confirmed by a + anti-streptolysin O titer, streptozyme assay, or anti-DNase B assay. On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1.Cracked lips 2.Normal appearance 3.Conjunctival hyperemia 4.Desquamation of the skin Ans- 3. conjunctival hyperemia RATIONALE: Kawasaki disease, aka mucocutaneous lymph node syndrome, is an acute systemic inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thromobocytosis occur. In the convalescent stage, the child appears normal, but SSx of inflammation may be present The mother of a child being discharged after heart surgery asks the nurse when the child will be able to return to school. Which is the most appropriate response to the mother? 1."The child may return to school in 1 week." 2."The child will not be able to return to school during this academic year." 3."The child may return to school in 1 week but needs to go half-days for the first 2 weeks." 4."The child may return to school in 3 weeks but needs to go half-days for the first few days." Ans- 4. "The child may return to school in 3 weeks but needs to go half-days for the 1st few days" RATIONALE: After heart surgery, the child may be able to return to school in 3 weeks but needs to go half-days for the 1st few days. The mother also should be told that the child cannot participate in PE for 2 months. Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of the child is a registered nurse and asks the nurse why the child needs the medication. What is the most appropriate response to the mother about the action of the medication? 1.Prevents blue (tet) spells 2.Maintains adequate cardiac output 3.Maintains an adequate hormonal level 4.Maintains the position of the great arteries Ans- 2. maintains adequate CO RATIONALE: A child with transposition of the great arteries may receive prostaglandin E1 temporarily to increased blood mixing if systemic and pulmonary mixing is inadequate to maintain adequate CO. The nurse is assessing a newborn with heart failure before administering the prescribed digoxin. In reviewing the laboratory data, the nurse notes that the newborn has a digoxin blood level of 1.6 ng/mL (2.05 mmol/L) and an apical heart rate of 90 beats/min. The mother also tells the nurse that the newborn just vomited her formula. Which intervention should the nurse take? 1.Retake the apical pulse. 2.Administer the medication. 3.Withhold the medication for 1 hour. 4.Withhold the medication and notify the health care provider. Ans- 4. withhold the med and notify HCP RATIONALE: The apical pulse rate for a newborn is 120-160 bpm. The therapeutic dig level is 0.5-0.8. Bc the apical rate is low and the dig blood level is elevated, indicating toxicity, the RN would withhold the med and notify the HCP The nurse is preparing to administer digoxin to an infant with heart failure. Before administering the medication, the nurse double-checks the dose, counts the apical heart rate for 1 full minute, and obtains a rate of 80 beats/minute. Based on this finding, which is the appropriate nursing action? 1.Withhold the medication. 2.Administer the medication. 3.Check the blood pressure and then administer the medication. 4.Check the respiratory rate and then administer the medication. Ans- 1. withhold the med RATIONALE: Dig is a cardiac glycoside that is used to treat HF. A primary concern is dig toxicity, and the RN needs to monitor closely for SSx of toxicity and monitor dig blood levels. The med is effective within a narrow therapeutic dig range (0.5-0.8). Safety in administration is achieved by double checking the dose and counting the apical HR for 1 full minute. The apical HR for an infant is 90-130 bpm. If the HR is less than 90 bpm in an infant, the RN would withhold the dose and contact the HCP. The nurse is creating a plan of care for a child admitted with a diagnosis of Kawasaki disease. In developing the initial plan of care, the nurse should include monitoring the child for signs of which condition? 1. Bleeding 2. Heart failure 3. Failure to thrive 4. Decreased tolerance to stimulation Ans- 2. HF RATIONALE: Nursing care initially centers on observing for SSx of HF. The RN monitors for increased RR, increased HR, dyspnea, crackles, and abdominal distension The day care nurse is observing a 2-year-old child and suspects that the child may have strabismus. Which observation made by the nurse indicates the presence of this condition? 1.The child has difficulty hearing. 2.The child consistently tilts the head to see. 3.The child does not respond when spoken to. 4.The child consistently turns the head to hear. Ans- 2. the child consistently tilts the head to see RATIONALE: Strabismus is a condition in which the eyes are not aligned bc of lack of coordination of the extraocular muscles. The RN may suspect strabismus in a child when the child c/o of freq HA, squints, or tilts the head to see. Other manifestations include crossed eyes, closing one eye to see, diplopia, photophobia, loss of binocular vision, or impairment of depth perception. A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all that apply. 1.Provide a soft diet. 2.Position the child on the left side. 3.Administer an antihistamine twice daily. 4.Irrigate the right ear with normal saline every 8 hours. 5.Administer ibuprofen for fever every 4 hours as prescribed and as needed. 6.Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy. Ans- 1. provide soft diet 5. administer ibuprofen for fever q4h as Rx'd and PRN 6. instruct the parents about the need to administer the Rx'd abx for the full course of therapy RATIONALE: Acute OM is an inflammatory d/o caused by an infection of the middle ear. The child often has fever, pain, loss of appetite, and possible ear drainage. The child is also irritable and lethargic and may roll the head or pull on the or rub the affected ear. Otoscopic exam may reveal a red, opaque, bulging, and immobile tympanic membrane. Hearing loss may be noted particularly in chronic OM. The child's fever should be treated with ibuprofen. The child is positioned on his/her affected side to facilitate drainage. A soft diet is recommended during the acute stage to avoid pain that can occur w/ chewing. Abx are Rx'd to treat the bacterial infection and should be administered for the full Rx'd course. The ear should not be irrigated with NS bc it can exacerbate the inflammation further. Antihistamines are not usually recommended as part of the therapy The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1.Diarrhea 2.Projectile vomiting 3.Regurgitation of feedings 4.Foul-smelling ribbon-like stools Ans- 4. foul-smelling ribbon-like stools RATIONALE: Hirschsprung's disease is a congenital anomaly aka congenital aganglionosis or aganglionic megacolon. It occurs as the result of an absence of ganglion cells in the rectum and other areas of the affected intestine. Chronic constipation beginning in the 1st month of life and resulting in pellet-like or ribbonlike stools that are foul smelling is a SSx of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a SSx. Bowel obstruction, especially in the neonatal period; abdominal pain and distension; and FTT are also SSx. An infant has just returned to the nursing unit after surgical repair of a cleft lip on the right side. The nurse should place the infant in which best position at this time? 1.Prone position 2.On the stomach 3.Left lateral position 4.Right lateral position Ans- 3. left lateral position RATIONALE: A cleft lip is a congenital anomaly that occurs as a result of failure of soft tissue or bone structure to fuse during embryonic development. After cleft lip repair, the RN avoids positioning an infant on the side of the repair or in the prone position bc these positions can cause rubbing of the surgical site on the mattress. The RN positions the infent on the side lateral to repair or on the back upright and positions the infant to prevent airway obstruction by secretions, blood, or the tongue. The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1.Incessant crying 2.Coughing at nighttime 3.Choking with feedings 4.Severe projectile vomiting Ans- 3. choking w/ feedings RATIONALE: In esophageal atresia and tracheoesophageal fistula, the esophagus terminates b4 it reaches the stomach, ending in a blind pouch, and a fistula is present that forms an unnatural connection w/ the trachea. Any child who exhibits the "3 C's" (coughing & choking w/ feedings & unexplained cyanosis) should be suspected to have tracheoesophageal fistula A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1.Diarrhea 2.Metabolic acidosis 3.Metabolic alkalosis 4.Hyperactive bowel sounds Ans- 3. metabolic alkalosis RATIONALE: Vomiting causes the loss of HCl acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea bc of the loss of bicarb. Diarrhea might or might not accompany vomiting. Hyperactive BS are not r/t vomiting The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? 1.Bile-stained fecal emesis 2.The passage of currant jelly-like stools 3.Failure to pass meconium stool in the first 24 hours after birth 4.Sausage-shaped mass palpated in the upper right abdominal quadrant Ans- 3. failure to pass meconium stool in 1st 24 hours after birth RATIONALE: Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. During the newborn assessment, this defect should be ID'd easily on sight. However, a rectal thermometer or tube may be necessary to determine the patency if meconium is not passed in the 1st 24 hours after birth. Other assessment findings include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum. The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1.Watery diarrhea 2.Ribbon-like stools 3.Profuse projectile vomiting 4.Bright red blood and mucus in the stools Ans- 4. bright red blood and mucus in the stools RATIONALE: Intussusception is a telescoping of 1 portion of the bowel into another. The condition results in an obstruction to the passage of intestinal content. A child w/ intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but it is not projectile. Bright red blood and mucus are passed thru the rectum and commonly are described as currant jelly-like stools. Which interventions should the nurse include when creating a care plan for a child with hepatitis? Select all that apply. 1.Providing a low-fat, well-balanced diet 2.Teaching the child effective hand-washing techniques 3.Scheduling playtime in the playroom with other children 4.Notifying the health care provider (HCP) if jaundice is present 5.Instructing the parents to avoid administering medications unless prescribed 6.Arranging for indefinite home schooling because the child will not be able to return to school Ans- 1. providing a low-fat, well balanced diet 2. teaching the child effective hand washing techniques 5. instructing the parents to avoid administering meds unless Rx'd RATIONALE: Hepatitis is an acute or chronic inflammation of the liver that may be caused by a virus, a med reaction, or another dz process. Bc hepatitis can be viral, standard precautions should be instituted in the hospital. The child should be discouraged from sharing toys, so playtime in the playroom w/ other kids is not part of the plan of care. The child will be allowed to return to school 1 wk after the onset of jaundice, so indefinite home schooling would not need to be arranged. Jaundice is an expectant finding w/ hepatitis and would not warrant notification of the HCP. Provision of a low-fat, well balanced diet is recommended. Parents are cautioned about administering any med to the child bc normal doses of many meds may become dangerous owing to the liver's inability to detoxify and excrete them. Hand washing is the most effective measure for control of hepatitis in any setting, and effective hand washing can prevent the immunocompromised child from contracting an opportunistic type of infection