a) A high-pitched cry, colic, and pupillary changes
b) A tense fontanelle, vomiting, and irritability
c) Anorexia, and changes in pulse and respiration
d) Headaches, lethargy, and a loss of appetite - correct answersA tense fontanelle, vomiting, and
irritability
-These symptoms show increased...
Pediatric HESI Practice
In infants with hydrocephalus, the early signs of ventricular shunt malfunction are:
a) A high-pitched cry, colic, and pupillary changes
b) A tense fontanelle, vomiting, and irritability
c) Anorexia, and changes in pulse and respiration
d) Headaches, lethargy, and a loss of appetite - correct answersA tense fontanelle, vomiting, and
irritability
-These symptoms show increased intracranial pressure. Changes in heart rate and respiration would be
a late sign. The other choices are not indicative of ICP.
A pediatric ED nurse, who is caring for a 12-year-old patient with septic shock, perceives a potential
complication of fluid resuscitation upon noting:
a) A heart rate of 50 beats/minute
b) A temperature of 102-degrees-F
c) Complaints of leg pain
d) Rales and rhonchi by auscultation - correct answersRales and rhonchi by auscultation
-Pulmonary edema should be monitored for closely as in septic shock, fluids can third space and leak
into the lungs causing hypoxia and respiratory distress. The patient should receive additional fluids less
rapidly and the practitioner may choose to move on to vasopressor therapy.
Which initial question directed to the parent assists the pediatric nurse in obtaining a patient's health
history?
a) "Are your child's immunizations up to date?"
b) "Is your child allergic to anything?"
c) "What bring you here today?"
d) "What is the child's problem?" - correct answers"What brings you here today?"
-SAMPLE history starts out by asking about Signs and Symptoms, then Allergies, Medications, Past
history, Last food or drink consumed, and Events leading up to the illness or chief complaint. Asking why
they are here will give the RN a broad idea which they may then focus on and get more specific
information.
An adolescent, with chronic asthma, who has been hospitalized several times during the winter with
severe asthmatic exacerbations confides, "I wish I could stay here in the hospital because every time
that I go home, I get sick again!" The pediatric nurse's best response is:
a) "I think that you should consider participating on a swim team to improve your pulmonary function."
b) "Let's talk about preventing and managing your asthma on a daily basis at home."
c) "Why don't I speak with your parents about what they are doing at home to help control your
asthma?"
d) "Your insurance company does not pay for any additional days of hospitalization that are not
medically necessary." - correct answers"Let's talk about preventing and managing your asthma on a
daily basis at home."
,After receiving an immunization for diphtheria, tetanus, and pertussis, a child develops swelling and
tenderness at the injection site, a low-grade fever, and malaise. The pediatric ED nurse informs the
child's parents that:
a) The reaction is severe enough that they should bring the child to an emergency department
b) They should delay future immunizations until the child is seen by an allergist
c) This is a mild reaction, and teaches them how to manage it
d) This is an appropriate reaction, and instructs them to do nothing - correct answersThis is a mild
reaction, and teaches them how to manage it.
-A severe reaction would present as Anaphylaxis. An appropriate reaction would be mild warmth over
the site. This reaction is moderate and can be managed with Tylenol and Benadryl.
An 8-year-old is being evaluated in the ER for suspected appendicitis. The physician has then lie on their
left side and extend the hip, eliciting pain in the RLQ. What is this test called?
a) Kernig's sign
b) Rovsing's Sign
c) Brudzinski's Sign
d) Psoas Sign - correct answersPsoas Sign
-Kernig's and Bruszinski's signs are used to evaluate for Meningitis. Rovsing's sign also is a test for
appendicitis, but is done by applying deep palpation to the RLQ, causing pain.
A 10-year-old is accidentally shot in the forearm by a small caliber firearm. The wound enters the
dorsum of the forearm and exits on the ventral side. The patient is ambulatory and has minor pain at the
site. What test is likely needed for evaluation of the injury?
a) CT scan of arm
b) MRI of arm
c) Arteriogram
d) Ultrasound of arm - correct answersArteriogram
-An arteriogram is needed to assess the vascular supply in the arm after a gunshot would to ensure that
no injury to the ulnar and radial artery has occurred.
A 5-year-old girl has a fever, headache, and complaints of a stiff neck. The physician suspects bacterial
meningitis. What is the best test culture site to detect the bacteria?
a) Lumbar puncture
b) Clean catch urine
c) Nasal swab
d) Blood culture - correct answersLumbar puncture
-Lumbar puncture is the method of choice for detecting the bacteria causing bacterial meningitis and
sending a sample for culture, as meningitis infects the meninges and bacteria is present in the
cerebrospinal fluid.
A 14-year-old boy with leukemia is receiving an IV infusion of packed red blood cells. The client reports
that he is feeling anxious and short of breath even though his respiratory rate is 24. What should the
nurse do in this situation?
a) Give a dose of diphenhydramine
b) Give a dose of acetaminophin
c) Stop infusion and notify physician
d) Give a dose of ibuprofen - correct answersStop infusion and notify physician
, -Anxiety and the sensation of breathlessness are signs of possible anaphylactic shock, a reaction to the
packed red blood cells, so the nurse should stop the infusion immediately and notify the physician.
A patient is experiencing dizziness, shortness of breath, lightheadedness, and nausea caused by
encephalitis. Which of the following descriptions most accurately describes the patient's condition?
a) Metabolic acidosis
b) Respiratory alkalosis
c) Metabolic alkalosis
d) Respiratory acidosis - correct answersRespiratory alkalosis
-Respiratory alkalosis results from hyperventilation, during which extra CO2 is excreted, causing a
decrease in carbonic acid (H2CO3) concentration in the plasma. Symptoms include tachycardia,
arrhythmias, lightheadedness, nausea, and vomiting
The parents of a child, age 6, who will begin school in the fall ask the nurse for anticipatory guidance.
The nurse should explain that a child of this age:
a) Still depends on the parents
b) Rebels against scheduled activities
c) Is highly sensitive to criticism
d) Loves to tattle - correct answersIs highly sensitive to criticism
-In a 6-year-old child, a precarious sense of self causes overreaction to criticism and a sense of
inferiority. By age 6, most children no longer depend on the parents for daily tasks and love the routine
of a schedule. Tattling is more common at age 4 to 5, by age 6, the child wants to make friends and be a
friend.
While preparing to discharge an 8-month-old infant who is recovering from gastroenteritis and
dehydration, the nurse teaches the parents about their infant's dietary and fluid requirements. The
nurse should include which other topic in the teaching session?
a) Nursery schools
b) Toilet training
c) Safety guidelines
d) Preparation for surgery - correct answersSafety guidelines
-The nurse always should reinforce safety guidelines when teaching parents how to care for their child.
By giving anticipatory guidance the nurse can help prevent many accidental injuries. For parents of a 9-
month-old infant, it is too early to discuss nursery schools or toilet training. Because surgery is not used
for gastroenteritis, this topic is inappropriate.
Nurse Betina should begin screening for lead poisoning when a child reaches which age?
a) 6 months
b) 12 months
c) 18 months
d) 24 months - correct answers18 months
-The nurse should start screening a child for leading poisoning at age 18 months and perform repeat
screening at age 24, 30, and 36 months. High-risk infants, such as premature infants and formula-fed
infants not receiving iron supplementation, should be screened for iron-deficiency anemia at 6 months.
Regular dental visits should begin at age 24 months.
When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to
see which of the following?
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