Peds HESI Exam 3

During feedings, a newborn has difficulty sucking and swallowing and tires easily. Which physiologic process would the nurse consider when assessing this infant?

Difficulty when feeding may be an early indication of a heart defect.

Which behavior is important to avoid in 5 mo who had heart surgery to repair defect associated with tet of fallot?

Straining at stool

Which adverse effect would a nurse monitor for when caring for a patient receiving furosemide to relieve edema?

Hypokalemia

Which activity would the nurse sugggest to the paren of a child which sickle cell anemia who tells the nurse that the family is going camping by a lake in the mountains this summer? A. Swimming in the lake B. Soccer with the family C. Climbing the mountain trails D. Motorboat rides around the lake

Motorboat rides around the lake

Which physical examination finding would the nurse expect when assessing an infant with ventricular septal defect?

Murmur at left sternal boarder

Which deviations from the normal range would make the nurse suspect that there might be a problem during physical assessment of a newborn infant?

Expiratory bruit, persistent heart rate of 180 or more, apneic episodes that last longer than 20 seconds

Which S/S would nurse expect when assessing 4 yo with newly diagnosed ALL?

Anorexia, petechiae

Heart failure develops in 4 month old infant with congenital heart defect, the infant exhibits marked dyspnea at rest. Which assessment finding would the nursing expect in this infant?

Bilateral crackles

Which clinical finding would the nurse expect when assessing an infant with tetralogy of fallot?

Clubbing of fingers

Comparing DMSA and BAL for treatment of lead poisoning. Which reflect accurate comparisons?

DMSA is oral while BAL is IM, both are given in repeated doses over several days

To assess the status of circulation to the foot, which site would the nurse monitor for a pulse?

Dorsalis pedis artery, posterior tibial artery

The nurse is caring for a toddler receiving chelation therapy and IV deferoxamine. Which assessment finding would be most concerned about?

Facial flushing

Which method would the nurse use to measure temp of 4 year old with leukemia who also has mucositis?

Infrared tympanic, temporal artery

Which clinical finding would the nurse expect when assessing a 4 year old with suspected mucocutaneous lymph node syndrome (Kawasaki disease)?

Insidious onset of low grade fever.

Before administration of IVIG which action will the nurse take?

Obtain consent for blood product administration, start IV line

A child with Kawasaki disease is in pain caused by desquamating rash. Which would the nurse identify as best short term goal for this child?

Pain will be maintained at a level 3.

Which intervention would the nurse avoid in an infant with a congenital heart defect after cardiac cath?

Performing range of motion exercises

Which essential education would the nurse provide the parents of a 4 year old after nephrectomy for Wilms tumor? A. Prepare for kidney transplant B. Restrict intake of sodium C. Maintain fluid restrictions D. Recognize signs of UTI

Recognize signs of UTI

Which factors would nurse consider when preparing to measure the temp of a preschool age child with leukemia who is undergoing chemo?

Rectal temperatures are too upsetting for age group, oral temperatures are accurate in children with leukemia, rectal temps are avoided to reduce risk of rectal trauma

Intervention to include in plan of care for toddler whose lead level is 18mcg?

Repeat lab tests at 1 month and then every 3-4 months

Which assessment finding in a 5 month old infant would the nurse report to the health care provider? A. Heart rate of 100 bpm B. Blood pressure of 75/48 C. Respiratory rate of 70 breaths per minute D. Temperature of 99.5

Respiratory rate of 70 breaths per minute.

Infant admitted to PICU after open heart surgery for repair of ventricular septal defect. List assessment in order of priority.

Respiratory status, IV catheter, operative site, heart rate, urinary output

Which common concern of most parents of children with sickle cell anemia would the nurse address at a family education conference? A. Finding special school facilities B. Planning to move to a more therapeutic climate C. Choosing effective birth control measures D. Sharing feelings regarding transmission of the disorder

Sharing feelings regarding the transmission of the disorder

The nurse assesses a newborn and observes central cyanosis. Which type of congenital heart defect usually results in central cyanosis?

Shunting of blood from right to left

In which position would the nurse place a 4 year old child during the immediate postoperative period after cardiac catheterization? A. Semi fowler B. Trendelenurg C. Supine with bed flat D. Side-lying with knees flexed

Supine with bed flat

Which assessment finding would indicate improvement in a 4 month old infant admitted to the pediatric unit with diagnosis of congestive heart failure? A. Decreased tremors B. Increased hours of sleep C. Weight loss during next 2 days D. More rapid heart rate within 2 days

Weight loss during next 2 days

A preterm infant is started on digoxin and furosemide for persistent patent ductus arteriosus. Which nursing assessment provides best indication of the effectiveness of the furosemide? A. Pedal edema in reduced B. Digoxin toxicity is prevented C. Fontanels appear depressed D. Urine output exceeds fluid intake

Urine output exceeds fluid intake.

A parent asks the nurse "the doctor said that my baby has something called pulmonic stenosis. What does that mean?" Which response by the nurse is best?

What else did the doctor say?

Toddler is found to have coarctation of aorta. Which finding would the nurse expect when taking the child's vital signs?

Weak femoral pulse

An 11 year old is found to have ALL and HCP discusses diagnosis and treatment with child and family. Which age appropriate behavior would the nurse expect from child regarding diagnosis? A. Expressing anger by being insolent B. Saying that when people die they go to heaven C. Being afraid to go to sleep D. Telling nurse that death is punishment for not being good

Expressing anger by being insolent

Which response would nurse provide to parent of 4 year old with newly diagnosed ALL who expresses confusion over care plan? A. There are support groups B. New treatment protocols have been shown to have excellent results C. Let me get you the phone number for Leukemia society D. Maybe you could talk to your HCP about a second opinion

Maybe you could talk to your HCP about a second opinion

Intervention for 4 month old with tetralogy of fallot and heart failure?

Providing small, frequent feedings

Which factors contribute to the frequency of iron poisoning in toddlers?

Widespread availability, resemblance of iron tablets to candy, lack of parental awareness, packaging of large quantities in containers

Which action would promote psychological adjustment and early function after teenager with diagnosed osteoscramona has amputated leg? A. Allow to change first dressing B. Help adjust to prosthesis C. Assign to room with another adolescent D. Have patient meet with member of cancer survivor org.

Help adjust to temporary prosthesis

Which finding would the nurse expect when assessing a child with congenital cardiac malformation that causes right to left shunting of blood through the heart?

Increased Hct

For which reason would the nurse advise a parent to avoid cows milk in 7 month old?

Increases risk of allergies, poor source of vitamins and iron, too concentrated for kidneys to manage

Which manifestation in a client with heart failure indicates digoxin toxicity?

Nausea, yellow vision, irregular pulse

Which treatment would the nurse anticipate when caring for a preschooler with Kawasaki disease?

Administering IVIG as prescribed

Which education would the nurse provide the parent of a hospitalized 3 year old undergoing chemo who is asking for fried chicken? A. Fried foods might cause nausea and vomiting B. Any food that is requested should be offered because the child needs calories C. The coatings on fried foods may irritate the child mouth and cause bleeding D. Foods from outside should not be brought to the unit because of the potential for infection.

Any food that is requested should be offered because the child needs calories

Which nursing action will best evaluate the effectiveness of the furosemide in managing a client with heart failure and acute pulmonary edema? A. Performing daily weights B. Auscultate breath sounds C. Monitoring intake and output D. Assessing for dependent edema

Auscultate breath sounds

Which health conditions are associated with lead poisoning in preschooler?

Brain damage and growth retardation

Which medication would then nurse conclude is the cause of a decreased heart rate in a patient recieving a cardiac glycoside, diuretic and ACE inhibitor? A. Diuretic B. Vasodilator C. ACE inhibitor D. Cardiac glycoside

Cardiac glycoside

Which information about self care would nurse include when teaching adolescent undergoing chemo for bone cancer and has stomatitis as result of chemo?

Clean teeth with swab, drink fluids through straw, avoid foods served at extremes of temperatures

During the physical assessment of a newborn, the nurse palpates the infants femoral pulse, which cardiac anomaly is the nurse trying to detect?

Coarctation of the aorta

Which finding would the nurse recognize as common among infants with symptomatic cardiac malformations? A. Mental retardation B. Inherited genetic disorders C. Delayed physical growth D. Clubbing of fingertips

Delayed physical growth

Which intervention os used by a nurse caring for an adolescent child with sickle cell anemia? A. Teach how to limit sickling episodes B. Prep for occasional blood transfusions C. Educate about prophylactic medications D. Explaining to child how excess oxygen causes sickling

Teach how to limit sickling episodes

Which nursing care would the nurse provide an 8 month old infant with tet of fallot?

prevention of increased respiratory effort to promote oxygenation

Which symptoms would the nurse expect in a 3 year old with mild iron deficiency anemia and fatigue? A. Cold clammy skin B. Increased pulse rate C. Increased blood pressure D. Cyanosis of nail beds

Increased pulse rate

Which early sign of heart failure would the nurse recognize in an infant who has congenital heart defect with left to right shunting of blood? A. Cyanosis B. Restlessness C. Decreased heart rate D. Increased respiratory rate

Increased respiratory rate

Which treatment would the nurse anticipate when caring for an infant with heart failure? A. Open heart surgery B. Cardiac stress test C. Aggressive IV fluids D. Medications that are prescribed for both children and adults

Medications that are prescribed for both children and adults.

In which way does a sequestration crisis differ from a painful episode in a child with sickle cell? A. Peripheral ischemia occurs along with pain B. Blood volume decreases and signs of shock apnea C. RBC production diminishes with severe anemia D. Destruction of RBC is accelerated and jaundice becomes evident

Blood volume decreases as signs of shock appear

Which adverse effect would a nurse monitor for when caring for a patient with hypertension who is prescribed metoprolol? A. Hirsutism B. Bradycardia C. Restlessness D. Angina

Bradycardia

The parent of a child who has undergone open heart surgery is informed that their child is in the post anesthesia care unit and is stable. The parent is crying and openly expressing their worries and fears. Which is the best response by the nurse? A. Reassuring them their their child is doing well B. Allow them to continue to express their feelings C. Bring them to recovery area for sever minutes D. Encourage them to go to the coffee shop before returning

Bringing them to the recovery area for several minutes.

Which description would the nurse provide the parents of an infant who are asking about what a patent ductus arteriosus is?

Connection between the pulmonary artery and aorta

Which nursing intervention is most important in care of an infant with iron deficiency anemia?

Conserve energy, protect from infection, teach parents about nutrition, telling parents to offer small frequent feedings

2 year old diagnosed with tetralogy of fallot is hospitalized and seen squatting in play room. What action does the nurse take?

Continue to observe

Which clinical indicator is the nurse most likely to identify when taking admission history of patient with right ventricular failure?

Edema, ascites

Which action by the nurse would be therapeutic after obtaining the consent of adolescent who is concerned about body after amputation? A. Encourage peers to visit B. Keep lower body covered C. Place in room by self D. Limit visitors to family

Encourage peers to visit

Which parent education would the nurse provide as a rational for gavage feedings in an infant with congestive heart failure?

Energy that would have been expended on suckling is conserved

The nurse is assessing a newborn with suspected retention of fetal structure that will result in a congenital heart defect. Which fetal structures should undergo change after birth?

Foramen ovale and ductus arteriosus

Which action described a therapeutic effect of atenolol? A. Heart rate decreases B. Blood pressure increases C. Bronchospasm is relieved D. Pulse ox improves

Heart rate decreases

Which would the nurse consider the major characteristic of cardiac malformation associated with left to right shunting?

Increased blood flow to the lungs

Which eduction would the nurse teach the parent of an infant with a cardiac defect about an early sign of heart failure? A. Slowed respiration B. Increased heart rate C. Distended neck veins D. Increased urine output

Increased heart rate

Which information would the nurse include when teaching a group of parents about the developmental needs of adolescence?

Increased needs for calories, needs to consume iron in diet on daily basis, better guided by physiological age than chronological age

Which nursing action is important when a health care provider prescribes enalapril for a patient? A. Assess for hypokalemia B. Monitor for adverse effects on renal function C. Monitor clients blood pressure during therapy D. Assess for hypoglycemia

Monitor blood pressure during therapy

Which action would the nurse to take when assessing an infant on digoxin who has an apical pulse of 88 bpm? A. Notify the health care provider immediately B. Tell mother to continue giving digoxin C. Expect health care provider to lower the dose D. Ask mother whether this is the usual heart rate

Notify the health care provider immediately.

Which plan of care would the nurse implement for an infant admitted to the pediatric unit with the diagnosis of heart failure? A. Increase the infants fluid intake B. Position infant flat on back C. Offer small, frequent feedings D. Measure infants head circumference

Offer the infant small, frequent feedings.

In which position would the nurse place a 5 week infant who has difficulty breathing and feeding related to a suspected congenital heart defect?

Side lying with upper body eleveated

Cardiac cath in child with ventricular septal defect serves which purpose?

Identifies the specific location of the defect

Which statement by and adolescent with hemophilia indicates a need for further teaching? A. Ill use the straight razor B. I plan on trying out for the swim team C. If i injury a joint, ill keep it still D. If i get a little scratch, i can apply gentle pressure

Ill use a straight razor

Which concern when caring for a patient prescribed furosemide 40mg daily in conjunction with digoxin would prompt the nurse to ask the HCP about potassium supplements? A. Digoxin causes significant potassium depletion B. Liver destroys potassium as digoxin is detoxified C. LASIK's requires adequate serum potassium to promote diuresis D. Digoxin toxicity occurs rapidly in presence of hypokalemia

Digoxin toxicity occurs rapidly in presence of hypokalemia

According to development norms for a 5 year old child, the nurse would hold digoxin if apical heart rate falls before which?

70 bpm

normal toddler blood pressure

95/65

Which finding would the preop nurse expect when assessing a child before repair of ventricular septal defect?

Bilateral lung sounds with rales and rhonchi

The weight of a 3 month old infant with tet of fallot has declined from 25th percentile to 5th. Which mechanism would the nurse suspect is the reason for inadequate weight gain?

Inadequate oxygen perfusion leading to activity intolerance resulting in diminished energy to nurse

Which position would the nurse place an infant with tetralogy of fallot who begins to cry and exhibits worsening cyanosis and dyspnea?

Knee-chest

normal adolescent blood pressure

110/65 mm Hg

Which criteria of Kawasaki disease is essential to confirm diagnosis?

A combination of signs

Which clinical manifestation would nurse expect in 3 year old with Wilma tumor? A. Periorbital edema B. Projectile vomiting C. Abdominal swelling D. Low grade temp

Abdominal swelling

Child admitted with tentative diagnoses of ALL. What early signs and symptoms would nurse expect?

Anorexia, limb pain, splenomegaly

Which adverse hemodynamic effect typically occurs when a patient develops tachycardia?

Decreased ventricular filling time, lower cardiac output, weaker pulse quality

Which assessment finding would the nurse expect when a client is diagnosed with left sided congested heart failure?

Dyspnea, crackles and frequent cough

Which feeding education would the nurse provide the parent of a 2 month old infant with diagnosis of heart failure?

Feed slowly while allowing for adequate rest periods.

Which factor would be a major concern to 15 year old who is undergoing chemo for leukemia? A. Missing time at school B. Limiting social activities C. Being dependent while enjoying sick role D. Feeling different regarding changes in body image

Feeling different regarding changes in body image

An infant with congenital heart defect is in heart failure and is recieving daily weight measurements. Which complications of heart failure would daily weights help monitor? A. Renal failure B. Fluid retention C. Digitalis toxicity D. Protein malnutrition

Fluid retention

Which parent education would the nurse provide to decreased the workload of a babies heart for an infant with cardiac defect?

How to organize care to support periods of rest

Why would the nurse advise the patient who takes furosemide and digoxin for heart failure to drink a glass of orange juice every day? A. Maintain potassium level B. Preventing increased sodium level C. Limiting the medications synergistic effects D. Correct associated dehydration

Maintain potassium level

Which action would the nurse take after the child has a cardiac catheterization procedure? A. Early ambulation B. Monitor site for bleeding C. Restricting fluids until blood pressure has stabilized D. Comparing blood pressure readings in lower extremities

Monitor site for bleeding

Which would the nurse expect to see when reviewing the results of a CBC for infant with tetralogy of Fallot?

Polycythemia

A child with sickle cell anemia is admitted to the unit with vasoocclusive crisis. Which intervention would be implemented after the pain is under constrol?

Rehydration and O2 therapy

When encouraging a patient to seek testing and treatment for strep pharyngitis, which complication will the nurse discuss?

Rheumatic fever

Which information is important for the nurse to include in the teaching plan of a patient who will be taking furosemide and digoxin after discharge from the hospital? A. Maintenance of a low potassium diet B. Avoidance of foods high in cholesterol C. Signs and symptoms of digoxin therapy D. Importance of monitoring output

Signs and symptoms of digoxin toxicity.

A 6 month old infant has congenital right to left shunt defect of the heart. Which clinical finding would the nurse expect during physical examination and review of labs?

Tissue hypoxia and increased hct

The nurse is reviewing the labs of an infant with tetralogy of fallot and shows increased in RBC. Which would the nurse identify as the cause of polycythemia?

Tissue oxygen needs

Which education about rationale for cranial radiation would nurse provide parent of 3 year old who has acute lymphoblastic leukemia? A. Avoids need for chemo B. Reduces risk of systemic infection C. Limits metastasis to lymphatic system D. Treats central nervous system involvement

Treats central nervous system involvement

Which abnormalities are found in a tetralogy of fallot?

Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta

Which procedural description would the nurse provide the parents of an infant who has cardiac catheterization scheduled? A. It's and x-ray procedure that will allow us to visualize the size of your baby's heart B. It's a recording of the electrical activity of your baby's heart printed on graph paper C. It's an ultrasound procedure that produces pictures of the blood flow through your baby's heart D. A catheter will be inserted into a blood vessel in the babies groin and then threaded to the heart to confirm an anatomical abnormality.

A catheter will be inserted into a blood vessel in the babies groin and then threaded to the heart to confirm an anatomical abnormality.

Which nursing interventions promote safe administration of digoxin in a child diagnosed with heart failure?

Checking for compliance with patients medication regimen, monitor serum potassium and magnesium, calculate correct dosage form,prescribed amounts and prescription, monitor and record intake and output, heart rate, bp, daily weight and respirations regularly

Which rationale would the nurse understand for placing a chest tube after an infants open heart surgery?

Chest tubes facilitate drainage of air and fluid

Which discharge instruction would the nurse include for a child who has undergone a cardiac cath? A. Limit fluid intake for 3 days to prevent nausea B. Give sponge bath for 3 days to prevent infection C. Return to the clinic in 5 days to have pressure dressing removed D. Apply ice compresses every 20 minutes on first day to lessen edema

Give sponge baths for 3 days to prevent infection

Which patient understanding indicates the teaching about furosemide is understood?

I need to change positions slowly, i should eat more food that is high in potassium.

Parental statement regarding diet of 1 year old indicated needs for further education? A. I should limit intake of milk to 2-3 cups per day B. I should serve finger foods in small and reasonable amounts C. I can start supplementing with solids D. I should give low-fat or skim milk until 2 years

I should give low-fat or skin milk until 2

Need for further education about protecting preschooler from lead exposure?

I will use hot water for cooking, i will regularly vacuum hard surfaced floors or windowsills

Which finding would the nurse conclude is related to a child diagnosis of rheumatic heart disease?

Positive antistreptolysin titer

When a patient with a murmur reports gaining weight in spite of nausea and anorexia, which additional info would be priority to obtain?

Presence of cough and Exertional dyspnea

A child comes to the school nurse reporting a sore throat, and the nurse verifies that the child has a fever and a red, inflamed throat. Which illness is of most concern if the sore throat is not treated?

Rheumatic fever

In which part of the cardiac systems would the nurse expect an increase in pressure in a toddler with pulmonic stenosis?

Right ventricle

Which information would the nurse provide when teaching parents about nutritional needs of their 15 year old child?

Provide iron rich foods to the child, increase child's daily protein intake

Which intervention would the nurse implement for a 4 moth old with tetralogy of fallot and heart failure?

Provide small, frequent feedings

The clinic nurse receives a call from the parent of an infant prescribed digoxin, the parent reports they forgot whether they gave the morning dose. Which response by the nurse is most appropriate? A. Give the next dose immediately B. Wait 2 hours before giving the medication C. Skip this dose and give it at the next prescribed time D. Take the baby's pulse and give the medication if its more than 90 bpm

Skip this dose and give it at the next prescribed time.

Which therapeutic effect is associated with digoxin prescribed to a client with heart failure? A. Reduces edema B. Increases cardiac conduction C. Increases rate of ventricular contractions D. Slows and strengthens cardiac contractions

Slows and strengthens cardiac contractions.