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PediatricsHESI
2023
A
6-month-old
infant
with
congestive
heart
failure
(CHF)
is
receiving
digoxin
elixir.
Which
observation
by
the
nurse
warrants
immediate
intervention?
Apical
heart
rate
of
60.
Sweating
across
the
forehead.
Doesn't
suck
well.
Respiratory
rate
of
30
breaths
per
minute.
-
ANSApical
heart
rate
of
60.
A
heart
rate
of
60
(A)
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
to
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)
is
within
normal
limits
for
an
infant.
The
nurse
is
teaching
the
parents
of
a
5-year-old
with
cystic
fibrosis
about
respiratory
treatments.
Which
statement
indicates
to
the
nurse
that
the
parents
understand?
Perform
postural
drainage
before
starting
aerosol
therapy.
Give
respiratory
treatments
when
the
child
is
coughing
a
lot.
Administer
aerosol
therapy
followed
by
postural
drainage
before
meals.
Ensure
respiratory
therapy
is
done
daily
during
any
respiratory
infection.
-
ANSAdminister
aerosol
therapy
followed
by
postural
drainage
before
meals.
Postural
drainage
for
a
child
with
cystic
fibrosis
is
most
effective
when
performed
after
nebulization
and
before
meals
(C)
or
at
least
1
hour
after
eating
to
prevent
nausea
and
vomiting.
Postural
drainage
uses
gravity
to
promote
mucous
removal
after
nebulization
(A)
treatments
which
open
the
airways.
Pulmonary
toileting
or
respiratory
treatments
should
be
given
3
to
4
times
daily,
not
episodically
(B
and
D).
A
female
teenager
is
taking
oral
tetracycline
HCL
(Achromycin
V)
for
acne
vulgaris.
What
is
the
most
important
instruction
for
the
nurse
to
include
in
this
client's
teaching
plan?
Use
sunscreen
when
lying
by
the
pool.
Cleanse
the
skin
at
least
4
times
a
day.
Take
the
medication
with
a
glass
of
milk.
Menstrual
periods
may
become
irregular.
-
ANSUse
sunscreen
when
lying
by
the
pool.
Photosensitivity
is
a
common
side
effect
of
tetracycline
HCL
(Achromycin
V)
therapy.
Severe
sunburn
can
occur
with
minimal
sun
exposure
and
clients
should
be
instructed
to
avoid
sunlight
and
to
use
sunscreen
(A).
(B
and
D)
are
not
related
to
tetracycline
HCL
(Achromycin
V)
therapy.
(C)
should
be
avoided
because
dairy
products
interfere
with
the
absorption
of
tetracyclines.
What
preoperative
nursing
intervention
should
be
included
in
the
plan
of
care
for
an
infant
with
pyloric
stenosis? Monitor
for
signs
of
metabolic
acidosis.
Estimate
the
quantity
of
diarrhea
stools.
Place
in
a
supine
position
after
feeding.
Observe
for
projectile
vomiting.
-
ANSObserve
for
projectile
vomiting.
Projectile
vomiting
(D),
which
contributes
to
metabolic
alkalosis
(A),
is
the
classic
sign
of
pyloric
stenosis.
(B)
is
not
indicated.
(C)
is
dangerous,
due
to
the
potential
for
aspiration
with
frequent
vomiting.
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?
Stop
the
flow
of
unoxygenated
blood
into
systemic
circulation.
Increase
the
flow
of
unoxygenated
blood
to
the
lungs.
Prevent
the
return
of
oxygenated
blood
to
the
lungs.
Reduce
peripheral
tissue
hypoxia
and
nailbed
clubbing
-
ANSPrevent
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
(C).
VSDs
are
acyanotic
defects,
which
means
that
no
unoxygenated
blood
enters
the
systemic
circulation
(A
and
B).
(D)
is
common
with
Tetrology
of
Fallot,
which
is
a
cyanotic
defect.
A
3-week-old
newborn
is
brought
to
the
clinic
for
follow-up
after
a
home
birth.
The
mother
reports
that
her
child
bottle
feeds
for
5
minutes
only
and
then
falls
asleep.
The
nurse
auscultates
a
loud
murmur
characteristic
of
a
ventricular
septal
defect
(VSD),
and
finds
the
newborn
is
acyanotic
with
a
respiratory
rate
of
64
breaths
per
minute.
What
instruction
should
the
nurse
provide
the
mother
to
ensure
the
infant
is
receiving
adequate
intake?
(Select
all
that
apply.)
A.
Monitor
the
the
infant's
weight
and
number
of
wet
diapers
per
day.
B.
Increase
the
infant's
intake
per
feeding
by
1
to
2
ounces
per
week.
C.
Mix
the
dose
of
prophylactic
antibiotic
in
a
full
bottle
of
formula.
D.
Allow
the
infant
to
rest
and
refeed
on
demand
or
every
2
hours.
E.
Use
a
softer
nipple
or
increase
the
size
of
the
nipple
opening.
-
ANSA.
Monitor
the
the
infant's
weight
and
number
of
wet
diapers
per
day.
B.
Increase
the
infant's
intake
per
feeding
by
1
to
2
ounces
per
week.
D.
Allow
the
infant
to
rest
and
refeed
on
demand
or
every
2
hours.
E.
Use
a
softer
nipple
or
increase
the
size
of
the
nipple
opening.
Antibiotic
prophylaxis
is
recommended
for
infants
with
VSDs,
but
should
not
be
mixed
in
a
bottle
of
formula
(C)
because
it
is
difficult
to
ensure
that
the
total
dose
is
consumed.
They
should
be
monitored
for
weight
gain
and
at
least
6
wet
diapers
per
day
(A).
A
one-month
old
infant
should
ingest
2
to
4
ounces
of
formula
per
feeding
and
progress
to
about
30
ounces
per
day
by
4-months
of
age
(B) Preoperative
nursing
care
for
a
child
with
Wilms'
tumor
should
include
which
intervention?
Gently
percuss
the
abdomen
for
evidence
of
trapped
air.
Observe
the
abdomen
for
any
noticeable
discolorations.
Apply
cold
compresses
to
the
abdomen
to
reduce
edema.
Put
a
sign
on
the
bed
reading,
"DO
NOT
PALPATE
ABDOMEN."
-
ANSPut
a
sign
on
the
bed
reading,
"DO
NOT
PALPATE
ABDOMEN."
Prevention
of
abdominal
palpation
(D)
minimizes
the
risk
of
rupturing
the
encapsulated
tumor
and
subsequent
metastasis.
(A)
is
unnecessary,
and
this
action
could
traumatize
the
tumor
in
the
same
manner
as
palpation.
(B
and
C)
are
incorrect
since
the
abdomen
is
not
discolored
and
cold
compresses
are
not
indicated.
At
8
a.m.
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
4
a.m.
blood
pressure
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
first?
Give
the
client
her
9
a.m.
prescription
for
an
oral
diuretic
early.
Administer
PRN
prescription
of
nifedipine
(Procardia)
sublingually.
Notify
the
healthcare
provider
and
inform
the
nursing
supervisor
of
the
client's
condition.
Attempt
to
calm
the
client
and
retake
the
blood
pressure
in
thirty
minutes.
-
ANSAdminister
PRN
prescription
of
nifedipine
(Procardia)
sublingually.
Sublingual
Procardia
(B)
lowers
blood
pressure
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
(C).
(D)
does
not
consider
the
seriousness
of
this
finding.
The
nurse
should
stay
with
the
client
until
the
blood
pressure
is
reduced.
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?
Bradycardia.
Machinery
murmur.
Weak
pedal
pulses.
Clubbed
fingers.
-
ANSClubbed
fingers.
Tetrology
of
Fallot,
a
cyanotic
heart
defect,
causes
clubbing
of
fingers
and
toes
(D)
due
to
tissue
hypoxia.
Tachycardia,
not
(A),
is
a
manifestation
of
congenital
heart
disease.
(B)
is
a
classic
sign
of
ventricular
septal
defect.
(C)
is
characteristic
of
coarctation
of
the
aorta.
Surgery
is
being
delayed
for
an
infant
with
undescended
testes.
In
collaboration
with
the
healthcare
provider
and
the
family,
which
prescription
should
the
nurse
anticipate?
A
trial
of
adrenocorticotrophic
hormone
injections.
Frequent
stimulation
of
the
cremasteric
reflex. A
trial
of
human
chorionic
gonadotrophic
hormone.
Frequent
warm
baths
to
gently
dilate
the
scrotal
area.
-
ANSA
trial
of
human
chorionic
gonadotrophic
hormone.
A
trial
of
HCG
(human
chorionic
gonadotrophic
hormone)
(C)
may
aid
in
testicular
descent,
but
does
not
replace
surgical
repair
for
true
undescended
testes.
Undescended
testes
(cryptorchidism)
may
be
found
in
the
inguinal
canal
due
to
exaggerated
cremasteric
reflex.
(A)
is
not
indicated.
Stimulation
of
the
cremasteric
reflex
causes
the
testes
to
ascend
rather
than
descend
in
the
scrotum
(B).
(D)
may
relax
the
cremasteric
muscle,
but
may
not
cause
the
testes
to
descend.
A
preschool-age
child
who
is
hospitalized
for
hypospadias
repair
is
most
strongly
influenced
by
which
behavior?
Ability
to
communicate
verbally.
Response
to
separation
from
family.
Concern
for
body
integrity.
Socialization
with
other
children.
-
ANSConcern
for
body
integrity.
The
preschooler's
major
stressor
is
concern
for
his
body
integrity
(C).
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
(A).
(B)
is
a
concern
for
all
children,
but
of
most
concern
to
the
toddler.
(D)
is
not
a
prime
concern
in
this
situation.
A
six-month-old
returns
from
surgery
with
elbow
restraints
in
place.
What
nursing
care
should
be
included
when
caring
for
any
restrained
child?
Keep
restraints
on
at
all
times.
Remove
restraints
one
at
a
time
and
provide
range
of
motion
exercises.
Remove
all
restraints
simultaneously
and
provide
play
activities.
Renew
the
healthcare
provider's
prescription
for
restraints
every
72
hours.
-
ANSRemove
restraints
one
at
a
time
and
provide
range
of
motion
exercises.
Removing
restraints
one
at
a
time
(B)
is
safer
than
removing
all
of
them
at
once
(C).
The
child
needs
to
exercise
and
should
not
be
kept
in
restraints
at
all
times
(A).
The
renewal
of
the
healthcare
provider's
prescription
varies
with
hospitals
(D),
and
it
does
not
really
answer
the
question.
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?
Weighing
diapers.
Assessing
fontanels.
Checking
skin
turgor.
Observing
mucous
membranes
for
moisture.
-
ANSAssessing
fontanels.
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