HESI PN Obstetrics/Maternity Practice Exam, Pediatrics HESI PN Review, Hesi Peds, PN HESI Peds, Peds & Maternity HESI, HESI Maternity/Pediatric Remediation

A primigravida at 33-weeks gestation is admitted after being involved in a motor vehicle collision (MVC). The client has no complaints of abdominal pain and no evidence of vaginal bleeding. Which action should the practical nurse (PN) anticipate implementing for the client?

Obtain a biophysical profile.

Which intervention should the practical nurse (PN) provide a neonate during hospitalization?

Offer the neonate a pacifier between feedings.

A father expresses concern that his 3-day-old infant looks "yellow." Which information should the practical nurse (PN) provide?

Physiologic jaundice occurs from a normal reduction in red blood cells.

The practical nurse (PN) is reviewing the informational packets with a client who is at risk for preeclampsia. Which information is most important for the PN reinforce with the client?

Notify the clinic if any vision changes are experienced.

Which information should the practical nurse (PN) provide the parents about the purpose of instilling erythromycin (llotycin) ophthalmic ointment in the newborn's eyes.

Prophylactic treatment for gonorrheal and chlamydia infection.

Which client should the practical nurse (PN) closely monitor for severe after pains?

A multigravida who is breastfeeding.

A primiparous client asks the practical nurse (PN) how much her newborn baby should sleep every day. What information should the PN provide?

A newborn sleeps most of the day and gradually will have increasing periods of wakefulness.

Which physiological cause(s) for constipation during pregnancy should the practical nurse (PN) explain to a client in the first trimester? (Select all that apply.)

A. Displacement of the colon. E. Decrease in peristalsis.

A client is 5 weeks pregnant call the clinic to report that her home pregnancy test is positive. She asks what she should be concerned about during the weeks before her first visit. Which signs and symptoms should the practical nurse (PN) tell the client to report immediately to the healthcare provider? (select all that apply)

A. Vaginal bleeding D. Membrane rupture E. Severe headaches

A child who is admitted with acute abdominal pain and possible appendicitis. Which action should the practical nurse (PN) implement for the child's abdominal discomfort? a) assist the child to any position of comfort. b) give a saline enema to cleanse the bowel c) lay a heating pad on the abdomen d) place the bed in trendelenburg

Answer: A Rationale: Abdominal pain is a common childhood complaint, but this child should be assisted to any position of comfort (A) that relieves the pain. (B and D) are contraindicated with possible appendicitis and increase the risk of ruptured appendix. If the appendix should rupture, (C) increases the spread of the infection.

Which of Freud's psychosexual development stages occurs during a toddler's growth and development? a) anal b) oral c) genital d) phallic

Answer: A Rationale: According to Freud's theory, the anal stage (A_, 1-3 years of age, focuses on toilet training and learning to delay immediate gratification. Oral gratification(B) occurs from birth to one year of age. (C) The stage of genital awareness & exploration. (D) The stage of sexual identity and expression in adolescence.

The practical nurse (PN) is monitoring a child who is manifesting signs of shock after a motor vehicle collision. Which finding is most important for the PN to report to the charge nurse? a) narrowing pulse pressure b) irritability c) apprehension d) thirst

Answer: A Rationale: As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs of decompensated shock become pronounced, such as tachycardia and narrowing pulse pressure (A) (the difference between systolic and diastolic blood pressure), which should be reported immediately. (B,C, and D) are not as significant as (A).

The practical nurse (PN) is monitoring a child who is manifesting signs of shock after a motor vehicle collision. Which finding is most important for the PN to report to the charge nurse? a) narrowing pulse pressure b) apprehension c) irritability d) thirst

Answer: A Rationale: As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs of decompensated shock become pronounced, such as tachycardia and narrowing pulse pressure (A). (The difference between systolic and diastolic blood pressure), which should be reported immediately. (B,C, and D) are not as significant as (A).

The mother of a male newborn calls the clinic to inquire about the formation of a yellow crust over her son's circumcision area. What information should the practical nurse (PN) provide? a) do not remove the yellow crust from the site b) stop using petroleum around the head of the penis c) bring him into the clinic d) tightly fasten the diaper

Answer: A Rationale: Crust formation is part of the healing process and should be removed (A). (C) is not indicated at this time. The diaper should be fastened loosely, not tightly (D) which can place pressure on the incision site. (B) assists in the healing process and should not be discontinued.

The PN is checking the musculoskeletal system of a one month old infant during a well child visit. Which finding should the PN report to the healthcare provider? a) one leg is shorter than the other. b) 2 skin folds on the back of each thigh c) broadening & flattening of the buttocks d) hypotonicity of the leg muscles

Answer: A Rationale: Developmental hip dysplasia, subluxation or discoloration, either partial or complete, is a common orthopedic deformity where the head of the femur is partly or completely displaced as a result of a shallow hip socket (acetabulum). Hip dysplasia causes the leg on the affected side to appear shorter (A) than the leg on the unaffected side. (D) is a sign of a neurologic problem, not hip dysplasia. The skin folds of the thigh are deeper and often asymmetrical, not (B), and the best indicator of hip dysplasia is femur shortening. (C) is not a sign of hip dysplasia.

A child is admitted for observation following a closed head injury. Which assessment is most essential for the practical nues (PN) to monitor for an early sign of a worsening condition? a) level of consciousness b) posturing c) focal neurologic signs d) vital signs

Answer: A Rationale: Following a head injury, determining a change in the child's LOC (A) provides the first indication that a progression of the injury is possible. (C) is a symptom of advanced neurologic insult. Alterations in consciousness appear earlier than alterations of (B and D).

A toddler with a chronic illness that requires frequent hospitalization is likely to experience which psychosocial developmental problem? a) interference with the development of autonomy b) distortion of differentiation of self from parent c) delayed language, fine motor, and self care skill d) fixation with the feelings of inadequacy

Answer: A Rationale: Frequent hospitalization for a toddler with a chronic illness may experience interference with the development of autonomy (A), which is a major psychosocial task of the age group 1-3 years of age. Achieving other psychosocial development tasks can be impeded during the stages of school age (B), infancy (C), and preschool age children (D).

A 2 year old child who is hospitalized has become withdrawn and quiet on the fourth day after admission. The parent expresses concern about this change in behavior. Which explanation should the practical nurse (PN) provide? The child is a) Experiencing the despair stage of separation b) Detaching emotionally from the family c) Protesting the separation from the parents d) Adjusting to hospitalization

Answer: A Rationale: In the despair stage of separation (A), the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic. Toddlers do not readily "adjust" to hospitalization (D) and separation from caregivers. During the detachment stage (B) which occurs after prolonged separation, the child becomes interested in the environment and begins to play. In the protest stage (C), the child is likely to cry and resist care by others, and is inconsolable.

A child is prescribed radiographs of the hand and wrist. The child's parent asks the practical nurse (PN) the purpose of this procedure. What finding should the PN explain is provided by the diagnostic study? a) skeletal age b) linear growth c) external proportions d) neurologic maturation

Answer: A Rationale: Skeletal age (A) can be determined with radiologic examinations that analysis carpal bones maturity and degree of ossification, which is most useful for determining skeletal age before 6 years of age. (B, C, and D) do not describe the correct rationale for this procedure.

The practical nurse (PN) identifies an increased frequency of otitis media (OM) is children who are coming to the clinic. Based on this finding, which age group should the PN monitor a child for signs and symptoms of OM? a) toddler b) preschooler c) school ager d) adolescent

Answer: A Rationale: Infants and toddlers (A) are most prone to otitis media due to the anatomical structure of the eustachian tube that allows fluid and microbial entry into the middle ear. (B, C, and D) are most susceptible to acute infectious diseases acquired through environmental transmission from daycare or school settings.

Which nonfood item is the most common cause of respiratory arrest in young children? a) latex balloons b) broken rattles c) buttons d) pacifiers

Answer: A Rationale: Nonfood items cause the majority of choking deaths in young children. Latex balloons (A), whether partially inflated, uninflated, or popped, are the leading cause of pediatric choking that leads to aspiration of small objects (A,B, and D) because they experience the environment by placing objects in the mouth, but (A) is the leading cause of death causing respiratory obstruction and arrest.

A 3 year old male child who has been toilet trained has had several urinary "accidents" since hospital admission. What action should the practical nuse (PN) implement? a) provide the child with frequent opportunities to urinate b) inform the parent that the child will need to be retrained c) determine how the long the child has been toilet trained d) place a bedpan on the bedside table for the child to use

Answer: A Rationale: Offering choices and allowing the child to make a decision increases the child's sense of control. Asking the child frequently if he has to go to the bathroom (A) helps reduce the incidents of accidental urinations. Regression to previous behaviors is common during hospitalization, even when the child has been practicing the skill successfully (B). A 3 year old child is not developmentally able to use a bedpan independently (D). Relearning a skill such as toilet training, contributes to the child's stress and should not be attempted during hospitalization.

Which physiological difference is present in a 3 month old infant that affects oral drug absorption rates? a) variable pancreatic enzyme activity b) more acidic gastric secretions c) more rapid peristaltic activity d) an accelerated gastric emptying rate

Answer: A Rationale: Pancreatic enzyme activity (A) is variable in infants for the first 3 months of life as the Gi system matures. The gastric secretions of infants are less acidic than those of older children or adults, not (B). Intestinal motility and gastric emptying rate tend to be slower in infants, not (C and D).

Which finding should the practical nurse confirm with the parents of an infant who is admitted with possible intussusception? a) red currant jelly stools b) clay colored stools c) constant abdominal pain d) projectile vomiting after meals

Answer: A Rationale: Red currant jelly stools (A) is a sign of intussusception, which causes a mixture of stool, mucous, and blood as the intestines telescopes inside itself. (D) is associated with pyloric stenosis. (B) is consistent with biliary obstruction. Infants with intussusception usually have periods of severe pain followed by intervals in which they appear comfortable, not (C).

A 6 year old who had a tonsillectomy 12 hours ago is complaining of thirst. What should the practical nurse (PN) offer? a) popsicle b) lemonade c) orange juice d) chocolate milk

Answer: A Rationale: Small amounts of clear liquids without red dyes should be offered to the child. Popsicles (A) are cold and help soothe a dry throat. Citrus drinks (B and C) are acidic and irritate the operative site in the posterior oropharynx. Milk (D) thickens oral mucus which makes swallowing more difficult and causes coughing.

When reviewing the dietary guidelines for a child with nephrotic syndrome, which diet should the practical nurse reinforce with the parents? a) low sodium b) high protein c) low fat d) high carbohydrate

Answer: A Anasarca, generalized edema associated with nephrotic syndrome, indicates that fluid retention should be managed with a diet that is low in sodium (A). (B, C, and D) are not dietary recommendations in the management of nephrosis.

What age appropriate play activity should the PN suggest to the parents of a 7 month old infant to encourage visual stimulation? a) play peek a boo b) show how to clasp hands c) play pat a cake d) imitate animal sounds

Answer: A Infant stimulation is as important for psychological growth as food is for physical growth. By 6 months-1 year, play is a very important part of an infant's day and involves sensorimotor skills. Infants are very personable and enjoy playing games such as peek a boo, an activity for visual stimulation (A). (B) is an appropriate activity at 7 months for kinetic stimulation. (C) is more appropriate for auditory stimulation for infants 9-12 months old. (D) is an age appropriate activity at 7 months for auditory stimulation.

The practical nurse (PN) is caring a 6 year old who is hospitalized with asthma. Which developmentally correct activity should the PN provide the child? a) an audio cassette and player b) crayons and a coloring book c) a ball to throw into a basket d) a 1000 piece jigsaw puzzle

Answer: B Painting, drawing, playing computer games, and modeling allow children to practice and improve newly refined skills, so crayons and a coloring book (B) are an age appropriate activity for a 6 year old child who is hospitalized with asthma. A 1000 piece puzzle (D) requires conceptualization of a bigger picture, which a 6 year old may not be able to conceptualize. Throwing a soft foam ball (C) around the room stresses the oxygen demand for the child with acute asthma and poses a safety issue with equipment in a hospital room if unsupervised. An audio cassette play (A) may not provide the best diversion for a 6 year old.

The practical nurse is caring for a 6 year old girl who had surgery 12 hours ago. The child tells the PN that she does not have pain but a few minutes later, tells her parents that she does. What child development concept is relevant to this situation? a) inconsistency in pain reporting suggests that pain not present b) a child may have pain yet deny its presence to the nurse c) truthful reporting of pain should occur by this age d) children use pain experiences to manipulate their parents

Answer: B Rationale: A child may fear receiving an injection for pain or may believe that pain is a deserved punishment for some misdeed, so the pain is denied (D) when the nurse asks the child, who then readily admits having pain to a parent. This behavior should not be interpreted as (C) but as a valid indication of pain. (A and C) are incorrect interpretations of this behavior.

A male adolescent who is newly diagnosed with a seizure disorder receives a prescription for an anticonvulsant. Which statement indicates the client is at risk for non-compliance with life-long medication management? a) i will take the pills at home so others will not see me b) my friends will think i am a freak if i take these pills c) i don't want my parents monitoring my medications d) i hope i will be able to drive while taking these pills

Answer: B Rationale: Adolescents are concerned with being normal, so the statement indicating his fear that his peer group will not accept him places the adolescence at risk for noncompliance (B). The ability to drive an automobile (D), maintaining independence (C), and privacy (A) are common tasks of adolescence, which should not hinder compliance.

The practical nurse (PN) is observing a group of children at a day care center to determine whether children are achieving developmental milestones. Which activity should the PN identify as typical for a 2 year old child's cognitive development? a) has a vocabulary of about 1000 words b) uses short sentences to express self c) initiates play with other children d) recognizes right and wrong

Answer: B Rationale: Although children develop at different rates, a 2 year old typically uses short sentences to express independence and control (B) and has a vocabulary of up to 300 words, not (A). At the age of 2 years, a toddler is developing negativism without understanding the concepts of right and wrong (D). A 2 year old engages in solitary play and parallel play but does not initiate or cooperative with other children (C) in play, which begins with socialization of the preschool child.

During a well child visit, the mother of an infant states, "I will probably not have my baby immunized because I am concerned about the risk of a severe reaction." Which response should the PN provide? a) have you talked with other parents about this decision b) no immunization poses a greater risk for your child c) you are making a mistake d) it' is your decision

Answer: B Rationale: Although immunizations have caused reported adverse reactions in a small number of cases, an infant who is not immunized is at greater risk of developing complications from childhood diseases than from the vaccines (B). (A,C, and D) ignore the PN's responsibility to inform parents about the risks to children who are not immunized.

The practical nurse (PN) is talking with a group of elementary students about bicycle safety. Which information should the PN provide? a) wearing protective gear on a bicycle is a voluntary measure b) children should wear a bicycle helmet when riding a bicycle c) bicycle injuries involve a collision with an automobile d) riding double is allowed if the bicycle has an extra large seat

Answer: B Rationale: Bicycle accidents that result in head injuries are a common, accidental cause of morbidity and mortality, so bicycle safety and some state laws mandate that children should wear a protective helmet (B). (A, C, and D) do not provide accurate information.

A primigravida client asks the practical nurse (PN). "How will i know that I will be going into labor soon?" Which sign should the PN provide that is a common sign?

Burst of energy.

The practical nurse (PN) arrives at the playgrounds and sees a school-aged boy who has eaten something he is allergic to and is demonstrating a stridor. Which action should the PN implement first? a) ask if the child is alone b) call for an ambulance c) mov the child to a different environment d) determine what the child has eaten

Answer: B Rationale: Food allergy hypersensitivity can cause an anaphylactic reaction that can occur shortly after ingestion (5-30 minutes) or exposure to an allergen, and manifest with hives, rash, flushing, asthmatic episode, or airway compromise, such as stridor. The first action is to call for an ambulance (B) immediately, since the condition may progress and become life-threatening. (A,C, and D) do not have the same priority of (B).

The mother of a 9 month old male infant is concerned because he cries whenever she leaves him with a sitter. What is the best response for the practical nurse (PN) to provide? a) "Have you noticed whether your baby is teething?" b) "Crying when you leave him in a healthy sign of attachment." c) "Consider taking the baby to the doctor because he may be ill." d) "You could consider leaving the infant more often so he can adjust."

Answer: B Rationale: Healthy attachment is manifested by stranger anxiety in late infancy (B). Pain from teething expressed by the infant's cries does not occur only when the mother leaves the infant with another person (A). The PN should evaluate the infant's developmental needs (C) before suggesting the infant may be ill. An infant who manifests stranger anxiety is best supported by the mother if the infant is left for shorter periods of time, not (D).

When reviewing the adverse effects of the DTap (diphtheria, tetanus, and acellular pertussis) vaccine with parents whose child is being immunized, what side effect should the practical nurse convey as most common? a) persistent crying and hyperpyrexia b) local erythema and edema at injection site c) vomiting and dehydration d) seizures and hypo-responsive episodes

Answer: B Rationale: Mild side effects of the DTaP vaccine that resolve in 24-48 hours after administration include mild fever, redness and swelling at the injection site (B), fussiness, & a slight decrease in appetite. Serious side effects (A and D) usually occur after 48 hours of administration and manifest signs of encephalopathy, which include persistent, inconsolable crying, fever of 104.8F, seizures, & hypotonic hypo-responsive episodes. (C) is not an expected reaction.

The mother of a 9 month old girl provides the PN information about her daughter's diet. Which statement by the mother may indicate why the infant has been diagnosed with iron deficiency anemia? a) she doesn't like to eat peaches or pears b) she has been on whole milk for 7 months c) she almost never drinks sugar water d) she likes to chew on bread as a snack

Answer: B Rationale: Since cow's milk lacks iron, zinc, & vitamin E, which are necessary for a 9 month old infant's growth & development (B) indicates a possible etiology for the anemia. (A, C, and D) are not r/t the etiology of iron deficiency anemia.

The practical nurse (PN) is caring for a school aged male child who is having problems adjusting to a new school. Which action should the PN recommend to the parents that may foster their child's developmental task of industry. a) identify failures immediately for feedback from the child and his peers b) structure the tasks in the home environment and recreational settings c) decrease their expectations of home tasks and school success d) ask the child what the child wants to achieve in his new school

Answer: B Rationale: Structuring the environment (B) provides opportunities to solve increasingly more complex problems, which enhances self-confidence and promotes a sense of mastery. (C) is not as important as structuring the environment so that the child is successful. (D) Does not promote a sense of achievement or mastery. Sharing failures with the child's peers (A) for feedback reinforces the child's feelings of failure.

Using Freud's theory, the practical nurse should expect a 2 year old boy to demonstrate the behaviors of which stage? a) phallic b) anal c) latency d) oral

Answer: B Rationale: The anal phase (B) defines the behaviors of a toddler, ages 1-3 years, who begins to develop sphincter control and the ability to control the release of feces. Success in this stage results in a sense of autonomy. The oral phase (D), ages birth to 1 year, is the stage of learning to relate to others without excessive jealously, dependency, and the development of trust and sense of self-reliance. Phallic phase (A), ages 3-7 years, is an age r/t formation of an identity focuses on sexuality or the genitalia. Success in this stage results in mastery over internal processes and impulses. Latency, ages 7 years to puberty, is a stage of development where one's attention is turned toward learning and successful achieving the ability to delay gratification.

A mother asks the practical nurse (PN), "When will I know if my daughter has entered puberty?" Which finding should the PN tell the mother to observe for with the onset of puberty? a) mood swings b) growth of pubic hair c) heterosexual interest d) menarche

Answer: B Rationale: The onset of puberty in girls is observed with the development of secondary sex characteristics, such as breast development and the growth of pubic hair (B). (A,C, and D) are not consistently found with pubescence.

Which statement by a mother indicates that her 5 month old infant girl is ready for solid food? a) i find that my baby really has to be encouraged to eat. b) my baby has started to sit up without any support c) when i give my baby solid foods she has difficulty getting it to the back of her throat to swallow d) i am surprised that my baby only weights 11 pounds. I expected her to have gained more weight.

Answer: B Rationale: Voluntary skeletal muscular activities, such as sitting (B) and involuntary activities such as absence of the protrusion reflex, are indicators of neuromuscular development. (A and C) indicate that the infant is not interested in starting solid foods. The ability to manipulate foods to the back of the throat is a sign that the infant is ready to manage solid foods, not (D).

The practical nurse (PN) is caring for a 6 year old girl who had surgery 12 hours ago. The child tells the PN that she does not have pain but a few minutes later, tells her parents that she does. What child development concept is relevant to this situation? a) inconsistency in pain reporting suggests that pain is not present b) truthful reporting of pain should occur by this age c) a child may have pain yet deny its presence to the nurse d) children use pain experiences to manipulate their parents

Answer: C Rationale: A child may fear receiving an injection for pain or may believe that pain is a deserved punishment for some misdeed, so the pain is denied (C) when the nurse asks the child, who then readily admits having pain to a parent. This behavior should not be interpreted as (D) but as a valid indication of pain. (A and B) are incorrect interpretations of this behavior.

Which preoperative action is most important for the practical nurse (PN) to implement for a newborn with meningomyelocele? a) document vital signs b) prevent skin breakdown c) minimize the risk for infection d) monitor neurologic functioning

Answer: C Rationale: A meningomyelocele provides a direct entry for bacteria into the central nervous system, leading to meningitis. Measures that protect the integrity of the meningomyelocele sac and infection control measures should be implemented to minimize the risk of infection (C). (A,B, and D) should be implemented but do not have the priority of (C).

The mother of a child with croup is having barking, coughing episodes calls the clinic for assistance. What action should the practical nurse (PN) recommend that the mother implement first? a) take the child outside in the cool air b) bring the child directly to the emergency room c) sit with the child in bathroom with a hot shower running d) have the child drink plenty of fluids

Answer: C Rationale: Croup (laryngotracheobronchitis) is a viral infection that causes a "barking" cough and varying degrees of inspiratory stridor, which often responds to a high humidity environment. Most children can be managed at home using the stream from a hot shower in a closed bathroom (C) which often stops laryngeal spasm. Increasing the child's fluid intake is important (D), but not a priority at this time.Although exposure to cold air (A) also relieves stridor, parents should be encouraged to use mist humidifier in the child's room. (B) is not necessary unless the child is having increasingly difficulty breathing that may lead to a compromised airway.

The practical nurse (PN) is interviewing a 10 year old girl about school and her extracurricular activities. She responds, "I like school. I play the flute in the school band, and I take tennis lessons." Based on Erikson's psychosocial theory, the PN identifies that this child is in what stage of development? a) identity b) intimacy c) industry d) initiative

Answer: C Rationale: Erikson's stage of industry (C) for a school aged child is demonstrated by successful participation in new skills and peer activities, such as sports and band. (A, B, and D) are achieved in other age groups.

Which first aid action should the practical nurse implement for a child who has sustained a second degree thermal burn? a) apply petroleum jelly to the burned skin b) apply ice to the burned area c) immerse the burned area in cold water d) break any blisters that are present

Answer: C Rationale: First aid treatment of a second degree thermal burn is immersion of the burned area in cold water (C) to halt the burning process. (A, B, and D) are not indicated due tot he risk of increased skin damage or infection.

Which information is most important for the PN to reinforce with an adolescent who has hepatitis A about preventing the spread of hepatitis in the home? a) wash the adolescent's dishes separately b) ensure that all family members wash their hands before eating c) prevent the adolescent from preparing food d) encourage the adolescent to wear a mask over the nose and mouth

Answer: C Rationale: Hepatitis A is spread through fecal oral contamination, so the chance of contaminating others is best reduced when the client does not participate in any food prep (C). Although (B) is always recommended, the adolescent is an infectious reservoir and should refrain from family meal prep during the period of communicability. (A and D) are not necessary.

The mother of a young child with Type 1 diabetes mellitus (DM) who needs insulin injections at home tells the practical nurse (PN) that she is afraid she does not know what to do properly. Which action is most important for the PN implement to decrease the mother's apprehension? a) have the mother verbalize the importance of follow up care b) help the mother devise a schedule for rotating the injections c) observe the mother while she administers an insulin injection d) review the side effects of insulin with the mother

Answer: C Rationale: Observing the mother's ability to give the insulin injection (C) provides an opportunity to reinforce information & provide validation to increase the mother's confidence and relieve apprehension about caring for her child with DM. (A, B, and D) are of less priority than (C).

After reinforcing information to treat a sprained ankle, what statement by the adolescent indicates tot he PN that further instruction is needed? a) keep the leg elevated when sitting b) put an ice pack on the ankle, alternating 30 minutes on & 30 minutes off c) apply warm compresses to the ankle for the first 24 hours d) wrap the ankle in an elastic bandage for support

Answer: C Rationale: The "RICE" treatment (rest, ice, compression, & elevation) should be implemented for a sprain. Warm compresses (C) reflects the need for further instruction because heat causes vasodilation which can increase fluid accumulation in the injured area and increase swelling. (A, B, and D) reflect correct understanding of the treatment protocol.

Which play activity should the practical nurse (PN) provide a hospitalized 6 month old infant? a) push and pull toys b) ball rolling and hide and seek game c) supervised water play d) pat a cake and peek a boo

Answer: D Rationale: 6 month old enjoy playing pat a cake and peek a boo (D). 12 month old infants enjoy (A). 4 months old infants enjoy (C). 9 month olds enjoy (B).

A 3 year old boy with cerebral palsy (CP) has difficulty swallowing, cannot hold a utensil, and is slightly underweight for his height. Which action should the practical nurse implement when feeding this child? a) put the child in a well-supported semi-reclining position b) offer a specialized formula per tube feeding c) place the child in a sitting position with the neck hyperextended d) stabilize the child's jaw with the caregiver's hand

Answer: D Rationale: A child with CP should be fed in an upright, eating position, and manual stability of the oral mechanisms during swallowing should be provided to minimize the risk of aspiration. Hold the child's jaw (D) from the side or front of the face assists with head control, correction of the neck and trunk hyperextension, and jaw stabilization. (A, B, and C) are not indicated.

What information should the practical nurse (PN) reinforce with the parents of a 3 month old infant about liquid medication administration? a) pour the medication into a small cup and allow the infant to drink it b) place the medication in a nipple and have infant suck the nipple c) administer the medication with a dropper to the back of the infant's tongue d) use an oral syringe to place the medication in the side of the infant's mouth

Answer: D Rationale: An oral syringe is a useful device for measuring small quantities of medications for infants. The syringe is placed in the side of the mouth. (B) increases the amount of air the infant swallows, which cause excessive gas. (B and D) increase the risk for aspiration.

A 3 year old boy cries, kicks, and clings to his father when the parents try to leave the hospital room. The parents express their concern to the practical nurse (PN). What response should the PN provide? a) "It is not helpful for parents to stay with children during hospitalization." b) "Your child's behavior indicates a need for a psychological consultation." c) "You can avoid this if you wait to leave after your child falls asleep." d) "Your child is showing a normal response to the stress of hospitalization."

Answer: D Rationale: The child is exhibiting a healthy attachment to the father (D). Leaving while your child is asleep creates mistrust in the child (C). To minimize the child's stress hospital policy often require someone to stay with their child during hospitalization, not (A). The child's behavior represents the protest stage of separation and does not represent maladaptive behavior (B).

An adolescent female who comes to the school clinic is reluctant to confide her concerns to the practical nurse (PN). The PN tells the teen that confidentiality and privacy are maintained unless a life-threatening situation arises. Which principal supports the PN's response? a) disclosures from the adolescent should be kept confidential b) minor adolescents should not be encouraged to disclose private concerns c) the adolescent should be encouraged to seek help outside of the school clinic d) honest information ensures establishing a trusting relationship

Answer: D Rationale: Critical elements in establishing trusting relationships include active listening, responding to the adolescent's emotions, and ensuring confidentiality and privacy, but situations that pose a life-threatening situation for the adolescent must be reported. Minor-aged adolescents have the right to confidential communication with providers unless the client is being abused or a life-threatening situation is evident. Honesty (D) is vital in the development of trust between an adolescent and a health professional. (A,B, and C) do not provide immediate intervention for the adolescent's concerns about self integrity and safety.

What action should the practical nurse (PN) implement when caring for a dying child and the family? a) Provide adequate oral intake on a regular schedule b) Organize care to minimize contact that interrupts rests c) Allow family to give basic care when the child is alert d) Tell family to continue talking to the child until time of death

Answer: D Rationale: Families should be encouraged to talk to the child because the sense of hearing is acute until death (D), and verbal communication and physical touch provide comfort for both the family and child. When a child is dying, comfort is based on measures that respond to the child's requests beyond a regular schedule for fluids (A). Nursing care should minimize disruptions but not contact (B). family involvement in the basic care of the child should continue throughout the child's dying process, not only when the child is alert (C).

The practical nurse (PN) collects information about infant growth and development milestones for infants who come to the clinic for a well child visit. Which findings should the PN document as normal infant growth and development? a) maternal iron stores persist during the first 12 months of life b) anterior fontanel closes by 6 to 10 months of age c) binocularity is well established by 8 months of age d) birth weight double by age 5 months and triples by 1 year

Answer: D Rationale: Infants gain approximately 1.5 pounds/month until age 5 to 6 months, when the birth weight doubles, and by 1 year of age, the birth weight usually triples (D). The anterior fontanel closes by 12 to 18 months of age, with the average being 14 months, not (B). Binocularity begins to develop by 6 weeks of age and should be well established by age 4 months, not (C). Maternally derived iron stores ares present for the first 5 to 6 months and gradually diminish, which results in an expected lowered hemoglobin levels toward the end of the first 6 months (A).

A 4 year old girl is brought to the emergent care center with a frog like croaking sound on inspiration. She is having difficulty breathing and has her chin trust forward with her mouth open. She is drooling, agitated, and insists on sitting upright. What action should the PN take? a) Auscultate the lungs and make preparations for placing the child in a mist tent. b) Examine the oral pharynx and report to the HCP c) make the child lie down on the stretcher & rest quietly c) notify the HCP & prep for immediate intubation of tracheotomy

Answer: D Rationale: The child is exhibiting signs of acute epiglottis, a serious obstructive, inflammatory process that can rapidly progress to severe respiratory distress, which requires immediate intubation or tracheotomy (D) by the HCP to secure the airway. (A, B, and C) are contraindicated.

The practical nurse (PN) is preparing to administer an intramuscular immunization to a 6 month old infant. What site should the PN select? a) dorsogluteal b) ventrogluteal c) deltoid d) vastus lateralis

Answer: D Rationale: The vastus lateralis (D) has minimal nerves or blood vessels and is the best site for intramuscular (IM) injections in children younger than 3 years of age. The deltoid muscle (C) is a small muscle mass that accommodates small volumes, less than 0.5 mL, and is not recommended for IM use in young children. The gluteal muscles (A and B) are used as an injection site in children whose musculature develops after walking.

Which response should the PN provide a school age child who asks to talk with a dying sister? a) touch provides tactile presence of others if she does not responds to words b) talk loudly to ensure the dying client hears & recognizes others voices c) sitting close offers the dying person the sensation of others presence d) although the dying client may not response, she cna still hear what is said

Answer: D Rationale: There is evidence that hearing acuity remains during the dying process, so talking to a dying client is important both for the client the family (D). (A) os unnecessary. Although, (B and C) provide additional actions, hearing (D) remains an intact sensory perceptions through unconsciousness and the dying process.

Which action is best for the practical nurse (PN) to implement to help a 7 year old child cope with a lengthy course of IV antibiotics therapy? a) give the child stickers for cooperative behavior b) arrange for the child to go to the playroom daily c) ask the child to draw a picture about himself d) allow the child to participate in injection play

Answer: D Supervised injection play (D) is an effective coping strategy for a school aged child who is receiving extended IV therapy, or any other therapy involving syringes and needles. Rewards, such as stickers (A) may enhance cooperative behavior but do not address coping with painful treatments. The hospitalized child should have opportunities for play each day, if his condition warrants, but free play (B) does not have any specific therapeutic purpose in preparing for painful experiences. (C) may not elicit the child's feeling about IV treatment.

A mother who is preparing for discharge begins asking the practical nurse (PN) questions about bottle feeding her infant. What information should the PN reinforce?

Burp the newborn periodically during the feeding.

Which medication is prescribed for the prevention of ophthalmia neonatorum?

Erythromycin (iilotycin)

The practical nurse (PN) palpates the anterior fontanel of a 14 month old toddler and finds that it is closed. What action should thePN implement? a) refer the toddler for a developmental evaluation b) perform a focused neurological examination c) report premature cranial suture closure to the healthcare provider d) document the normal finding for the 14 month old toddler

Answer: D The anterior fontanel normally closes between 12 and 18 months of age, so this finding should be documented as a normal finding for the 14 month old toddler (D). (A, B, and C) are unnecessary.

A multiparous client's membranes rupture after 8 hours of labor. which action should the practical nurse implement at this time?

Assess the fetal heart rate (FHR) and pattern.

The practical nurse (PN) palpates fundal height at the umbilicus of a multiparous client who has just given birth to an 8-pound boy when dark red blood comes from the client's vagina. What action is most important for the PN to implement?

Continue to massage the fundus until firm.

The practical nurse (PN) is discussing aspects of newborn hygiene with the new parents as they prepare for discharge. Which information should the PN provide?

Create a draft-free environment when bathing the baby.

An 11-year-old boy is admitted after being hit in the head with a baseball during a Little League game. Which subject is most important for the practical nurse to explore during history taking? A. Inspection of wound for lacerations and bleeding. B. Description of the character and quality of pain. C. Independent observer's account of the event. D. The level of consciousness exhibited after the injury.

D. The level of consciousness exhibited after the injury. Rationale:The priority concern when taking the history involving a head injury is to determine the level of consciousness following the injury.

A primigravida client who is at 39-weeks gestation arrives at the clinic and tells the practical nurse (PN) she is having contractions every 5 minutes. The healthcare provider determines she is dilated 3 cm and in early labor. What action should the practical nurse (PN) implement when the client groans with each contraction?

Demonstrate simple relaxation measures.

A 14-week gestational client, who weighed 125 pounds before pregnancy, comes into the health clinic for a prenatal appointment. The client's weight today is 129 pounds. What action should the practical nurse (PN) implement?

Document the finding in the medical record.

The practical nurse (PN) quickly moves the crib of a male newborn and notices that his legs flex. arms fan out, and then return toward his midline. What action should the PN implement?

Document the newborn demonstrates a Moro reflex.

A 3-day-old newborn who weighed 7 pounds, 8 ounces at birth is breast feeding and now weighs 6 pound and 15 ounces. Which action should the practical nurse take?

Document the weight loss

The practical nurse (PN) is assessing a client 2 hours after a vaginal delivery of a 7-pound 3-ounce newborn and determines the client's bladder is distended. Which additional finding should the PN report to the charge nurse?

Excessive bleeding on the perineal pad.

What is the most important action by the practical nurse (PN) in preventing neonatal infection?

Hand washing.

Which strategy should the practical nurse (PN) implement to prevent a puerperal infection for a client during the first postpartum week?

Implement strict medical and aseptic technique.

The mother asks the practical nurse (PN) what her infant may need if the phenylketonuria(PKU) test is positive. What type of treatment should the PN tell the mother will be required?

Lifelong dietary management.

A young adult female comes to the health clinic to confirm a positive home pregnancy test. After determining the client's last menstrual period (LMP) as August 5, what expected date of birth (EDB) should the practical nurse (PN) calculate?

May 12

An infant who weight 4550 grams is delivered using forceps-assisted vaginal delivery. What action is most important for the practical nurse (PN) to implement?

Monitor for signs of hypoglycemia.

a client who took iron supplements during pregnancy delivers and infant by cesarean section. On the second postpartum day, the client reports having a constipated stool that is greenish-black in color. Which action should the practical nurse (PN) implement?

Record color and consistency of the stool.

Which client is a candidate for the administration of human immune globulin (RhoGam) after delivery?

The Rh-negative mother who delivers a Rh-positive baby.

The practical nurse (PN) places a newborn who is 4 hours old with an axillary temperature of 97.2 F under the radiant heat warmer. Which rationale supports the PN's action?

The newborn's thin layer of subcutaneous fat provides poor insulation.

After repeating the vital signs for a newborn who is 4 hours old, the practical nurse (PN) obtains an axillary temperature of 97.2 F and places the newborn under a radiant heat warmer. Which additional finding should the PN observe in the newborn?

Tremors of the hands during crying.

Which finding for a 2-week-old infant should the practical nurse (PN) report to the healthcare provider?

Yellowish tinge around the eyes.

A short arm cast is applied to a child with a fractured right ulna. The practical nurse (PN) is preparing the parents with home instructions and should reinforce that the parents follow which discharge instruction? a. Call the health care provider immediately if the nail beds appear "blue" or "empty." b. Check the child's ability to move his fingers without pain hourly for the first 48 hours. c. Elevate the arm above the heart for the first 24 hours. d. Monitor temperature every 4 hours for the next 2 days and call if an elevation is noted.

a. Call the health care provider immediately if the nail beds appear "blue" or "empty." Rationale:Cyanosis indicates impaired circulation to the fingers and should be reported immediately.

The parents of a 7-month-old infant with spastic cerebral palsy bring him to the pediatric clinic. Which symptom reported by the parents warrants immediate intervention by the practical nurse (PN)? a. Choking while being fed. b. The child's legs continually cross each other. c. Child gets stiff when shifting to a sitting position. d. Older sibling is jealous of the younger sibling.

a. Choking while being fed. Rationale:Aspiration is a priority when caring for an infant with cerebral palsy and dysphagia.

A full-term infant is admitted to the newborn nursery. During the initial PO feeding, the practical nurse (PN) observes the infant for possible tracheal esophageal atresia. Which symptoms are likely to be exhibited during the feeding if this condition is present? a. Choking, coughing, and cyanosis b. Projectile vomiting and cyanosis c. Apneic spells and grunting d. Scaphoid abdomen and anorexia

a. Choking, coughing, and cyanosis Rationale:Choking, coughing, and cyanosis are the "3 Cs" of esophageal atresia caused by the overflow of secretions into the trachea.

A 2-year-old child had tympanostomy ventilating tubes inserted into both tympanic membranes (TMs) 1 week earlier. During a postoperative clinic visit, the practical nurse (PN) notes that the child has a purulent discharge from the right ear, and the mother explains that the toddler has had a cold for 3 days. What action should the PN plan to implement? a. Collect a specimen of the otorrhea for culture. b. Refer the child for audiologic screening tests. c. Administer prescribed antibiotics. d. Perform an otoscopic exam for TM tube placement.

a. Collect a specimen of the otorrhea for culture. Rationale:The presence of the purulent drainage indicates that the middle ear is draining a new infectious process, and a specimen of the otorrhea should be collected for culture. Tympanostomy tubes are surgically placed to manage otitis media with effusion (OME) to provide mechanical drainage of fluid and to equalize pressure within the middle ear. Chronic OME can impede TM and ossicle function, necessitating hearing screening. The immediate problem, however, is infection.

A 2-year-old child who is hospitalized with an acute upper respiratory infection (URI) is crying uncontrollably because her mother went to the cafeteria for lunch. Which action should the practical nurse implement? a. Distract the child with a favorite toy. b. Tell the child that her mother will return. c. Take the child to the cafeteria. d. Calm the child with a dietary treat.

a. Distract the child with a favorite toy. Rationale:The best action is to refocus the child's attention by distracting with a favorite toy.

The practical nurse (PN) is assessing a child with asthma for retractions during respirations. When should the PN recognize the absence or presence of intercostal retractions? a. Inspiration b. Coughing c. Apneic episodes d. Expiration

a. Inspiration Rationale:Intercostal retractions result during the respiratory effort to draw air into restricted airways.

A 15-year-old male with mild mental retardation who is hospitalized for minor surgery tells a female practical nurse (PN), "Wow, you have big ones." Which response is best for the PN to make? a. "Do you really think so?" b. "That language is not permitted." c. "You should nt speak to me like that, such language offends me." d. "Ill notify your parents if you continue to talk that way."

b. "That language is not permitted." Rationale:Limit setting is necessary for inappropriate behavior or suggestive interaction. Sets limits without threatening or degrading the client.

Which action should the practical nurse (PN) implement first when obtaining the tympanic temperature of a 2-year-old child? a. Point the thermometer probe tip anteriorly. b. Remove drainage from the external auditory meatus. c. Apply the probe cover to the electronic thermometer. d. Ask the mother to help stabilize the child's head.

c. Apply the probe cover to the electronic thermometer. Rationale:Before a tympanic temperature is obtained, the equipment should be prepared for use without manipulating the electronic thermometer in front of the child, so a clean probe cover should be applied first.

The practical nurse (PN) is caring for a toddler who is admitted for cleft palate repair. Which type of restraint should the PN prepare to apply in the postoperative period? a. Wrist b. Mummy c. Elbow d. Jacket

c. Elbow Rationale:Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical site.

The practical nurse (PN) is caring for a child with an acute respiratory condition. When the PN is monitoring for impending respiratory distress, what sign is the child likely to exhibit first? a. Cyanosis b. Sternal retraction c. Restlessness d. Crowing respiration

c. Restlessness Rationale:Restlessness is an early sign of hypoxemia.

What is the most important information for the practical nurse (PN) to review with a 12-year-old who is receiving long-term and rescue medications for routine management of asthma? a. Drink a large amount of cold fluids after exercising to restore hydration. b. Avoid swimming, which increases the need for oxygen while underwater. c. Use albuterol for prevention of exercise-induced bronchospasm. d. Keep a prescription for a premeasured dose of epinephrine available.

c. Use albuterol for prevention of exercise-induced bronchospasm. Rationale:When used before exercise, the beta-adrenergic agonist albuterol can prevent an asthma attack.

A high-school graduate with attention deficit hyperactivity disorder (ADHD) presents to the family health care provider for a precollege physical and tells the practical nurse (PN), "I don't want to take my amphetamine-dextroamphetamine in college." How should the PN respond? a. "There are other medications you can use for ADHD." b. "Your ADHD probably won't be a problem in college." c. "What will happen if you stop your Adderall?" d. "What are your concerns about continuing Adderall?"

d. "What are your concerns about continuing Adderall?" Rationale:It is important to understand the client's concerns about taking amphetamine-dextroamphetamine before making a judgment about his future use of the drug.

A mother phones the clinic because her 6-year-old child has been taking prescribed antibiotics for 7 of the previous 10 days and continues to cough. She also reports that the cough is worsening and is nonproductive. What information should the practical nurse (PN) provide to this mother? a. Watch the child a few more days and see if the cough begins to produce sputum. b. Complete the full 10-day course of antibiotics and reevaluate the cough then. c. Give the child plenty of fluids and an over-the-counter cough suppressant. d. Bring the child to the clinic today for an examination related to the cough.

d. Bring the child to the clinic today for an examination related to the cough. Rationale:The child should be evaluated as soon as possible for pneumonia. Antibiotics usually improve symptoms during the first few days of treatment but should be continued for the full prescribed course. A continued cough after 7 days of antibiotic treatment may indicate an infectious process in the lower lungs, which could cause a nonproductive cough. Children with pneumonia can deteriorate unexpectedly and rapidly and can become seriously ill with no sputum production.

The practical nurse (PN) is assessing an 8-month-old who has a medical diagnosis of tetralogy of Fallot. The child demonstrates cyanosis with crying and exertion. Which other symptom is this infant most likely to exhibit? a. Bradycardia b. Squatting posture c. Weak pedal pulses d. Clubbed fingers

d. Clubbed fingers Rationale:Tetralogy of Fallot, a cyanotic heart defect, causes clubbing of fingers and toes resulting from tissue hypoxia.

A 5-year-old tells the practical nurse (PN) that she "needs a Band-Aid" when she has an injection. Which action is best for the PN to take? a. Show her that the bleeding has already stopped. b. Explain why a Band-Aid is not needed. c. Ask her why she wants a Band-Aid. d. Apply a Band-Aid over the injection site.

d. Crowing respiration Rationale:Preschool children sometimes think that any hole (e.g., an injection or incision) made in their bodies allows their "insides to leak out," so applying a Band-Aid over the hole prevents this from occurring.

Which intervention should the practical nurse implement when a child cannot swallow prescribed tablets? a. Give the tablets with a very cold beverage of the child's choice. b. Put intact tablets in 1 tablespoon of corn syrup. c. Place the crushed tablet in a gelatin capsule and give with food. d. Crush tablets to a fine powder and mix with a small amount of soft food.

d. Crush tablets to a fine powder and mix with a small amount of soft food. Rationale:For children who have difficulty swallowing tablets, crushing the prescribed dose of tablets (except sustained-released capsules and enteric-coated medications) into a fine powder and mixing in a small amount of applesauce, yogurt, or pudding helps the child swallow the medication.

A child with nephrotic syndrome is receiving prednisone. The practical nurse (PN) reviews breakfast foods at a fast food restaurant with the child's mother. Which selections indicate that the mother understands the dietary guidelines necessary for her child? a. French toast sticks and orange juice b. Sausage-egg muffin and grape juice c. Canadian bacon slices and hot chocolate d. Toasted oat cereal and low-fat milk

d. Toasted oat cereal and low-fat milk Rationale:A child receiving a corticosteroid for nephrotic syndrome should follow a low-sodium, low-fat, and low-sugar diet. Based on these guidelines, the best breakfast choice is toasted oat cereal and low-fat milk.