Pediatric HESI
Which between-meal snack should a nurse tell the parents of a preschooler with a urinary tract infection to offer their child? 1 Skim milk 2 Fresh fruit 3 Hard candy 4 Cream soup
1 A high-protein, high-carbohydrate snack provides additional nutrients to combat an infection and a fever. Also, fluid helps flush the urinary tract. Fruit does not provide the protein needed for the healing process. Candy provides empty calories. A cream soup is too heavy for a between-meal snack and does not provide the needed protein.
The nurse notes that a 6-month-old infant is startled by a loud noise but does not turn in the direction of the sound. How should the nurse interpret this response? 1 As evidence of hearing loss 2 As an effect of vision deficits 3 As developmentally appropriate 4 As evidence of a low-normal hearing range
1 By 3 to 4 months of age an infant should localize sound by looking in the direction of the sound. The nurse's observation does not provide information about the infant's ability to see. This response indicates that the infant's hearing is not developmentally appropriate. Low-normal hearing range is not within the norm for this age group.
The nurse is teaching a group of parents of toddlers in the daycare center about accident prevention. The nurse determines that more teaching is needed when one parent states what? 1 "I'll keep medications in a kitchen cabinet." 2 "I'll put baby gates at the top and bottom of the stairs." 3 "I'll have my daughter in a regular bed by the time she's 2½." 4 "I'll buy my son shoes that close with Velcro instead of laces."
1 The kitchen cabinet is not a safe place for medications; toddlers are curious and are capable of climbing and opening cabinets. They must be protected from dangerous areas such as stairs. Secured gates at the top and bottom of stairs provide a barrier. At a height of 36 inches (91.4 centimeters) a toddler is ready to use a bed; the average toddler reaches this height at age 2½. Shoes with Velcro can be secured without the need for shoelaces, which may become untied and pose a risk for falls.
A registered nurse is teaching a nursing student about the use of activated charcoal as a method of gastrointestinal decontamination in preschoolers who have ingested poison. Which statements should be included in the teaching? Select all that apply. 1 "Use of activated charcoal may cause constipation and intestinal obstruction." 2 "Activated charcoal should always be administered through a nasogastric tube." 3 "Activated charcoal should be administered within 30 minutes of the poison ingestion." 4 "Activated charcoal should be mixed with small amounts of chocolate milk or fruit syrup." 5 "Activated charcoal may be used in children who have ingested large amounts of quinine."
1, 4, 5 Activated charcoal can be used for gastrointestinal decontamination in preschoolers who have ingested poison. However, its use may cause constipation and intestinal obstruction. To increase the child's acceptance of activated charcoal, the nurse should mix the activated charcoal with small amounts of chocolate milk or fruit syrup before administering the medication to the child. Children who have ingested large amounts of quinine can be administered activated charcoal. A nasogastric tube may be required to administer activated charcoal in small children; however, the nurse may serve activated charcoal mixed with chocolate milk or fruit syrup through a straw. Activated charcoal should be administered within one hour, not 30 minutes, of the poison ingestion.
A nurse in the pediatric clinic is performing a physical assessment of a 15-month-old toddler. What finding indicates that a disorder may be present? 1 The anterior fontanel is still palpable. 2 The liver is palpated 3 cm below the costal margin. 3 Abdominal movements are visible with respiration. 4 An apical pulse rate of 104 beats/min is auscultated.
2 A 15-month-old child's liver should be palpable 1 to 2 cm below the right costal margin. The anterior fontanel closes completely around 18 months of age. Abdominal or diaphragmatic breathing is expected in children younger than 7 years. A pulse rate of 104 beats/min is within the expected range (100 to 110 beats/min) for a 15-month-old child.
What should the nurse include in the teaching plan for parents of an infant with phenylketonuria (PKU)? 1 Testing for PKU is done immediately after birth. 2 Cognitive impairment occurs if PKU is untreated. 3 Treatment for PKU includes lifelong medications. 4 PKU is transmitted by an autosomal dominant gene.
2 In PKU, the absence of the hepatic enzyme phenylalanine hydroxylase prevents metabolism (hydroxylation to tyrosine) of the amino acid phenylalanine. The increased fluid level of phenylalanine in the body and the alternate metabolic by-products (phenylketones) are associated with severe cognitive impairment if PKU is not identified and treated early. Testing for PKU cannot be done until after several days of milk ingestion. Medications are not part of therapy for PKU. PKU is transmitted by an autosomal recessive gene.
A nurse inserts a nasogastric tube before an infant is to receive a tube feeding. What action should the nurse take when the infant begins to cough and gag? 1 Auscultating for breath sounds 2 Removing the tube, then reinserting it 3 Administering the tube feeding slowly 4 Observing the infant for circumoral cyanosis
2 The infant's response indicates that the tube may be in the trachea rather than the stomach. The tube should be removed, reinserted, and verified for its placement before the feeding is started. Auscultating for breath sounds does not provide information about the placement of the tube. The tube should be removed immediately; it is unsafe to assess the infant for additional signs of respiratory distress. It is unsafe to administer the feeding until placement in the stomach has been confirmed.
A 9-year-old child has the diagnosis of type 1 diabetes. What intervention should be included in the school nurse's plan of care for this child? 1 Limiting fluid intake during school hours 2 Asking the child each day what was eaten for breakfast 3 Considering the presence of diabetes but treating the child similarly to other children 4 Checking several times a day for injuries because of participation in the physical education program
3 It is important to be aware of the disorder and to have documentation, but it is more important that the child be treated in the same way as other children. Restricting fluids can cause physical problems; fluid should not be restricted. Asking a child what he or she had for breakfast each day is unnecessary and will cause undue attention to the problem. Overprotection or overattention can be detrimental to a child's development.
Which statement made by a toddler-age client during a health maintenance visit is an example of centration? 1 "That chair is mean; it made me fall." 2 "I want that cup of juice because it has more." 3 "I don't like to eat that because it is green; green is yucky." 4 "My grandpa died because he yelled at me for making a mess."
3 Not wanting to eat a food because it is green is an example of centration. The toddler statement about the chair being mean is an example of animism. The response related to the grandpa is an example of magical thinking. Wanting another cup of juice because it appears to have more, even though both have the same volume, is an example of lack of conservation.
What does a nurse recognize as the most serious complication of meningitis in young children? 1 Epilepsy 2 Blindness 3 Peripheral circulatory collapse 4 Communicating hydrocephalus
3 Peripheral circulatory collapse (Waterhouse-Friderichsen syndrome) is a serious complication of meningococcal meningitis caused by bilateral adrenal hemorrhage. The resultant acute adrenocortical insufficiency causes profound shock, petechiae, ecchymotic lesions, vomiting, prostration, and hypotension. Although epilepsy or blindness may occur, neither condition is as serious a complication as peripheral circulatory collapse. Similarly, although hydrocephalus may occur, it is rare and not as serious as peripheral circulatory collapse.
A preschooler who has undergone adenoidectomy arrives at the healthcare provider's office for a follow-up visit. What other adaptations to the surgery should the nurse assess in addition to hearing? Select all that apply. 1 Swallowing 2 Visual deficits 3 Sense of taste 4 Sense of smell 5 Speech sounds
3, 4, 5 Adenoids can obstruct nasal breathing, interfering with the sense of taste. After surgery the sense of taste should improve. Disrupted nasal breathing also interferes with the sense of smell. After surgery the sense of smell should improve. Obstructed nasal breathing causes speech to have the typical adenoid sound; after surgery the quality of speech should improve. Swallowing should not be affected because this ability is not related to the surgical area. Vision is not affected by adenoidectomy.
Where will a preschool-aged child admitted with Reye syndrome most likely be placed? 1 In an isolation room 2 On a presurgical unit 3 On the pediatric floor 4 In the intensive care unit
4 A child with Reye syndrome is critically ill and needs the constant supervision that is available in an intensive care unit. Reye syndrome is not contagious. Surgery is not required for children with Reye syndrome. A general pediatric unit does not offer the continued assessment and intensive interventions that are necessary for a child with Reye syndrome.
Which statement by the nurse is accurate and appropriate to the parents of a toddler-age client who has never been to the dentist? 1 "You should continue to work with your child regarding brushing and flossing habits." 2 "You should schedule an appointment for a thorough cleaning and a full set of x-rays." 3 "It is best that you wait until your child is more cooperative prior to making an appointment." 4 "It is a good idea to let your child go with you for a dental visit prior to scheduling one for your child."
4 Initial visits to the dentist should be nontraumatizing. Modeling, in which the child observes procedures performed on the parent or a cooperative sibling, is the most appropriate recommendation from the nurse at this time. While it is important for the parents to continuing working with their toddler in regards to brushing and flossing habits, this does not address the child not going to the dentist. Since the first visit to the dentist should be nontraumatizing, the first visit should include looking at the equipment and a brief examination. Delaying a dental visit until the child is more cooperative places him or her at risk for dental caries.
While discussing immunizations with the nurse, the parent of a 7-month-old boy states, "You know, my son doesn't sit up by himself yet. Shouldn't he be able to do this by now?" How should the nurse respond? 1 "He may need a little encouragement. How have you tried to help him sit up?" 2 "Most babies do sit up by this time. Have you discussed this with the pediatrician?" 3 "Don't worry that he's not sitting up yet. Some babies take longer to develop this skill." 4 "Many babies don't sit up until they're 8 months old. Let's watch what he does when I sit him up."
4 Most infants by 6 months of age can remain in the sitting position when placed there; however, they do not sit up by themselves until 8 months. This response involves the parent in the assessment of the infant's capabilities. Stating that the child may just need encouragement questions the parent's ability to assist the child and demeans the infant. Indicating that most babies are sitting up by this age is erroneous; many healthy infants do not sit steadily without support until 8 months of age. Telling the parent not to worry cuts off communication and offers no directions to the parent, who obviously is worried.
A parent tells the nurse, "Our 2½-year-old child only uses two-word phrases when talking, and we can only understood our child maybe a quarter of the time. We're really concerned." What should the nurse consider before responding? 1 This is expected for the child's age. 2 This is advanced beyond the age of 2½ years. 3 This is evidence of an overall developmental delay. 4 This seems to be slow language development for a 2½-year-old.
4 This child's language development is slower than that expected of a 2½-year-old. At 2 years of age children usually use two- and three-word phrases and can be understood 65% of the time. Children with advanced language development at 2 years of age will combine three or four words in a phrase and will be understood 65% to 100% of the time. Additional data are needed about other developmental skills before a conclusion that this is evidence of overall developmental delay can be justified.
A 4½-year-old child is admitted to the pediatric unit in preparation for surgery. What psychologic responses to hospitalization does the nurse anticipate from this preschooler? Select all that apply. Incorrect1 Sadness about leaving playmates Incorrect2 Confusion about why surgery is needed 3 Anxiety regarding parental abandonment Correct4 Fearfulness regarding intrusive procedures Correct5 Misgivings about being punished for
4, 5 Preschoolers are developing a concept of their bodies and its boundaries and are more threatened by intrusive procedures than are children in other age groups. Preschoolers are developing a conscience and frequently inappropriately associate occurrences as punishment for perceived misbehavior. Friends are important to school-aged children and adolescents because they need approval and feedback from their peers. Preschoolers are able to understand simple explanations that dispel confusion. Feelings of abandonment are more appropriate for a toddler.
