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pediatric hesi part 1 exam questions and answers
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pediatric hesi part 1 exam questions andanswers
A 2-year-old child with trisomy 21 (Down syndrome) is brought to the clinic for a routine
evaluation. Which assessment finding suggests the presence of a common complication
often experienced by those with Down syndrome? - Answer -Presence of a systolic
murmur
Rationale: Congenital heart disease occurs in 40% to 50% of children with trisomy 21
(Down syndrome). Defects of the atrial or ventricular septum that create systolic
murmurs are the most common heart defects associated with this congenital anomaly.
Which preoperative nursing intervention should be included in the plan of care for an
infant with pyloric stenosis? - Answer -Observe for projectile vomiting.
Rationale: Projectile vomiting (D), the classic sign of pyloric stenosis, contributes to
metabolic alkalosis.
A 6-month-old male infant is admitted to the postanesthesia care unit with elbow
restraints in place. He has an endotracheal tube and is ventilator-dependent but will be
extubated soon following recovery from anesthesia. Which nursing intervention should
be included in this child's plan of care? - Answer -Remove restraints one at a time and
provide range-of-motion exercises.
Rationale: Removing restraints one at a time is safer than simultaneously. The infant
should have the restrained extremities assessed frequently for signs of neurologic or
vascular impairment, and range-of-motion exercises should be performed with these
assessments. Under no circumstances should restraints be applied to the client
continuously. Documentation of assessment findings regarding the restrained
extremities must occur much more frequently than every 72 hours; however, the reason
for using restraints must be justified and should be stated in the medical record.
The nurse notes that a 16-year-old male client is refusing visits from his classmates.
Further assessment reveals that he is concerned about his edematous facial features.
Based on these assessment findings, the nurse should plan interventions related to
which nursing diagnosis? - Answer -Social isolation
Rationale: Peer acceptance and body image are significant issues in the growth and
development of adolescents. The answer addresses the problem of a lack of contact
with peers stemming from his desire to protect his ego.
,Ampicillin, 75 mg/kg, is prescribed for a 22-lb child. It is available in a solution that
contains 250 mg/5 mL. How many milliliters should the nurse administer in one dose? -
Answer -15
Rationale: Take 22lbs / 2.2 = 10kg
10kg X 75mg/kg = 750mg
750/250 mg = 3mg X 5mL = 15
A child comes to the school nurse complaining of itching. Further assessment reveals
that the child has impetigo. What action should the nurse take? - Answer -Send the
child home with the parents to see the health care provider before returning to school.
Rationale: Impetigo is a staphylococcal infection and is transmitted by person-to-person
contact. The child should be sent home with a note to the parents explaining the
condition
The nurse observes a 4-year-old boy in a day care setting. Which behavior should the
nurse expect this child to exhibit? - Answer -Boasts aggressively when telling a story
Rationale: Four-year-old children are aggressive in their behavior and enjoy telling tales
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.
Based on these findings, what action should the nurse take? - Answer -Ask if the child
has had a cold, runny nose, or any ear pain lately.
Rationale: The tympanic membrane is normally pearly gray, not bulging, and moves
when a client blows against resistance or when a small puff of air is blown into the ear
canal. Because these findings are not completely normal, further assessment of history
and related signs and symptoms are needed to interpret the findings accurately.
Following the administration of immunizations to a 6-month-old girl, the nurse provides
the family with home care instructions. Which statement by the mother indicates that
further teaching is needed? - Answer -"I will give her a baby aspirin every 4 hours as
needed for fever."
Rationale: Although fever may occur, non-aspirin-containing medications should be
used because of the risk of Reye's syndrome
A 7-month-old infant with a rotavirus causing severe diarrhea is admitted for treatment.
Which intervention should the nurse implement first? - Answer -Insert an intravenous
(IV) line and begin IV fluids.
Rationale: An infant with severe diarrhea is at high risk for dehydration, so the nurse's
priority is to initiate IV fluids
The nurse is preparing a child with an intussusception for a prescribed barium enema.
What is the main purpose of conducting this procedure prior to surgical intervention? -
Answer -Reduce the invaginated bowel segment.
Rationale: Intussusception, an invagination or telescoping of one portion of the intestine
into another, causes intestinal obstruction in children (usually occurs between 3 months
and 5 years of age). Nonsurgical treatment is attempted with hydrostatic pressure
,created by barium instillation, which often reduces the area of bowel intussusception,
thereby negating the need for surgical intervention.
In making the initial assessment of a 2-hour-old infant, which finding should lead the
nurse to suspect a congenital heart defect? - Answer -Diminished femoral pulses
Rationale: Diminished femoral pulses (D) could indicate coarctation of the aorta.
Which assessment finding(s) should the nurse expect when caring for a child with cystic
fibrosis? (Select all that apply.) - Answer -Steatorrhea
Foul-smelling stools
Delayed growth
Pulmonary congestion
Which nursing intervention(s) is (are) therapeutic when caring for a hospitalized toddler?
(Select all that apply.) - Answer -Allow the toddler to choose a colored Band-Aid after an
injection & Give brief but simple explanations to the child before procedures.
Rationale: Giving the toddler a choice may increase autonomy in the hospitalized
setting. Brief but simple explanations are beneficial with the toddler. Separation from the
parent can cause emotional distress. Regression is expected, and bedwetting is not an
indication for a urinary catheter. The nurse should encourage age-appropriate toys to be
brought in from home.
The nurse should teach the parents of a child with a cyanotic heart defect to perform
which action when a hypercyanotic spell occurs? - Answer -Allow the child to assume a
knee-chest position, with the head and chest slightly elevated.
Rationale: Assuming a knee-chest position with the head and chest slightly elevated will
help restore hemodynamic equilibrium.
The nurse is conducting an initial admission assessment of a 12-month-old child in
celiac crisis. Which intervention is most important for the nurse to implement? - Answer
-Assess the child's mucous membranes and skin turgor
Rationale: An infant having a celiac crisis has severe diarrhea and is at high risk for fluid
volume deficit. The nurse should first assess for indications of fluid volume deficit
A woman whose first child died at 6 weeks of age because of sudden infant death
syndrome (SIDS) is being discharged following the birth of her second child. The mother
tells the nurse that she is fearful that this infant will also develop SIDS. Which response
is best for the nurse to provide this woman? - Answer -"The fear of losing another child
to SIDS is very realistic. Have you thought about what support you may need?"
Rationale: The most effective way to provide emotional support is to acknowledge what
clients may be feeling, be a sounding board for them so they can listen to themselves,
and allow them to discover their own solutions
A child with a permanent tracheostomy is confined to a wheelchair and is going to
school for the first time tomorrow. During the school day, which intervention should be
, implemented for this child? - Answer -Place suctioning supplies on the back of the
wheelchair when transporting.
Rationale: Suctioning supplies should always be readily available for use with any client
who has a tracheostomy.
A newborn female whose mother is HIV-positive is scheduled for the first follow-up
assessment with the nurse. If the child is HIV-positive, which initial symptom is she most
likely to exhibit? - Answer -Persistent cold
Rationale: Respiratory tract infections commonly occur in the pediatric population, but
the child with AIDS has a decreased ability to defend the body against these common
infections. Thus, the most typical presenting symptom of a child who contracted AIDS
through vertical transmission (i.e., from the mother during delivery) is a persistent cold
or respiratory infection
The nurse is preparing a health teaching program for parents of toddlers and
preschoolers and plans to include information about the prevention of accidental
poisonings. It is most important for the nurse to include which instruction? - Answer -
Store all toxic agents and medicines in locked cabinets.
Rationale: The only reliable way to prevent poisonings in young children is to make the
items inaccessible
A 7-month-old male infant diagnosed with spastic cerebral palsy is seen by the nurse in
the clinic. Which statement by the parent warrants immediate intervention by the nurse?
- Answer -"My son often chokes while I am feeding him."
Rationale: Airway obstruction is always a priority when caring for any client
Which intervention(s) should the nurse include in the teaching plan for the mother of a
6-year-old who is experiencing encopresis secondary to a fecal impaction? (Select all
that apply.) - Answer -Administer mineral oil daily.
Eliminate dairy products.
Initiate consistent toileting routine.
Rationale: Encopresis is fecal incontinence, usually as the result of recurring fecal
impaction and an enlarged rectum caused by chronic constipation. Encopresis is
managed through bowel retraining with mineral oil, eliminating dairy products, and
initiating a regular toileting routine. A high-fiber diet and increased daily fluids are
components of care for a child with encopresis.
A father of a 5-year-old boy calls the nurse to report that his son, who has had an upper
respiratory infection, is complaining of a headache, and his temperature has increased
to 103° F, taken rectally. Which intervention has the highest priority? - Answer -Tell the
parent to take the child to the emergency department.
Rationale: The child is exhibiting symptoms that may indicate possible meningitis, and
the parents should be encouraged to get immediate evaluation
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