PEDIATRICS - HESI PRACTICE EXAM

As part of the physical assessment of children, the nurse observes and palpates the fontanels. Which child's fontanel finding should be reported to the healthcare provider?

A. A 5-month old with failure to thrive that has a closed anterior fontanel

A 3-month old infant develops oral thrush. Which pharmacologic agent should the nurse plan to administer for treatment of this disorder?

A. Nystantin (Mycostatin)

To take the vital signs of a 4-month old child, which order will give the most accurate results?

A. Respiratory rate, heart rate, then rectal temperature

The nurse reviews the latest laboratory results for a child who received chemotherapy last week and identifies a reduced neutrophil count. Which nursing diagnosis has the highest priority for this child?

A. risk for infection

The clinic nurse is taking the history for a new 6 month old client. The mother reports that she took a great deal of aspirin while pregnant. Which assessment should the nurse obtain?

A. type of reaction to loud noises

Which growth and development characteristic should the nurse consider when monitoring the effects of a topical medication for an infant?

B. a thin stratum corneum that increases topical absorption

The nurse is assigning care for a 4-year old child with otitis media and is concerned about the child's increasing temperature over the past 24 hours. When planning care for this child, it is important for the nurse to consider that:

B. a tympanic measurement of temperature will provide the most accurate reading

At 8am, the unlicensed assistive personnel (UAP) informs the charge nurse that a female adolescent client with acute glomerulonephritis has a blood pressure of 210/110. The 4am BP reading was 170/88. The client reports to the UAP that she is upset because her boyfriend did not visit last night. What action should the nurse take?

B. administer PRN prescription of nifedipine (Procardia) sublingually.

a 14-year old female client tells the nurse that she is concerned about the acne she has recently developed. Which recommendation should the nurse provide?

C. Wash the hair and skin frequently with soap and hot water

Surgery is being delayed for an infant with undescended testes. In collaboration with the healthcare provider and the family, which prescription should the nurse anticipate?

C. a trial of human chorionic gonadotrophic hormone

A 16 year old is brought to the emergency department with a crushed leg after falling off a horse. the adolescent's last tetanus toxoid booster was received eight year ago. What action should the nurse take?

C. administer tetanus toxoid booster

A hospitalized 16-year old male refuses all visits from his classmates because he is concerned about his distorted appearance. To increase the client's social interaction, what intervention is best for the nurse to initiate?

C. arrange for an internet connection in the client's room for email communication

In developing a teaching plan for a 5 year old child with diabetes, which component of diabetic management should the nurse plan for the child to manage first?

C. process of glucose testing

During administration of a blood transfusion, a child complains of chills, headache and nausea. Which action should the nurse implement?

C. stop the infusion immediately and notify the healthcare provider

A child falls on the playground and is brought to the school nurse with a small laceration on the forearm. Which action should the nurse implement first?

C. wash the wound gently with mild soap and water

The mother of a 2-year old boy consults the nurse about her son's increased tempter tantrums. The mother states, "Yesterday he threw a fit in the grocery store, and I did not know what to do. I was embarrassed. What can I do if this occurs again?" Which recommendation is best for the nurse to provide this mother?

D. walk away from him and ignore the behavior

The nurse is giving a liquid iron preparation to a 3 year old child. Which technique should the nurse implement to engage the child's cooperation?

A. use a colorful straw

To assess the effectiveness of an analgesic administered to a 4 year old, what intervention is best for the nurse to implement?

A. use a happy face/sad face pain scale

During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not movable. What action should the nurse take next?

B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.

A 3-year old boy is brought to the emergency room because he swallowed an entire bottle of children's vitamin pills. Which intervention should the nurse implement first?

B. determine the child's pulse and respirations

the mother of a preschool-aged client asks the nurse if it is all right to administer Pepto Bismal to her son when he 'has a tummy ache." After reminding the mother to check the label of all OTC drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question?

B. do not give if the child has chickenpox, the flu, or any other viral illness.

During discharge teaching of a child with juvenile rheumatoid arthritis, the nurse should stress to the parents the importance of obtaining which diagnostic testing?

B. eye exam

The nurse is planning care for school aged children at a community care center. Which activity is best for the children?

B. playing follow-the-leader

A nurse provides the parents with information on health maintenance for their child with sickle cell disease. Which information reflected by the parents indicates understanding of the child's care?

B. plenty of fluids should be consumed daily

A six-month-old returns from surgery with elbow restraints in place. What nursing care should be included when caring for any restrained child?

B. remove restraints one at a time and provide range of motion exercises

A 3 year old client with sickle cell anemia is admitted to the Emergency Department with abdominal pain. The nurse palpates an enlarged liver, an x-ray reveals an enlarged spleen, and a CBC reveals anemia. these findings indicate which type of crisis?

B. sequestration

A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician prescribed dextrose 5% and 0.25% normal saline with 2 mEq KCI/100 mL to be infused at 25mL/hr. Prior to initiating the infusion, the nurse should obtain which assessment finding?

B. serum BUN and creatinine levels

The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about prevention of accidental poisonings. It is most important for the nurse to include which instructions?

B. store all toxic agents and medicines in locked cabinets.

Which class of antiinfective drugs is contraindicated for use in children under 8 years of age?

B. tetracyclines

A premature newborn girl, born 24 hours ago, is diagnosed with a patent ductus arteriosus (PDA) and placed under an oxygen hood at 35%. The parents visit the nursery and ask to hold her. Which response should the nurse provide to the parents?

B. the oxygen hood is holding the baby's oxygen level just at the point which is needed. You may stroke and talk to her.

The nurse assigning care for a 5-year old with otitis media is concerned about the child's increasing temperature over the past 24 hours. Which statement is accurate and should be considered when planning care for the remainder of the shift?

B. tympanic and oral temperatures are equally accurate

Which action by the nurse is most helpful in communicating with a preschool-aged child?

B. use a doll to play and communicate

The nurse is teaching a mother to give 4 mL of liquid antibiotic to a 10 month old infant. Which statement by the parent indicates a need for further teaching?

B. using a teaspoon will help me measure this correctly.

The nurse is developing a plan of care for a 3-year old who is scheduled for a cardiac catheterization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement?

C. give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there.

A 12-month old boy is admitted with a respiratory infection and possible pneumonia. He is placed in a mist tent with oxygen. Which nursing intervention has the greatest priority for this infant?

C. have a bulb syringe readily available to remove secretions

The nurse is assessing a 2-year old. What behavior indicates that the child's language development is within normal limits?

C. is capable of making a three word sentence

The nurse must prevent a 2-year old with severe eczema on the face, neck and scalp from scratching the affected areas. Which nursing intervention is most effective in preventing further excoriation due to the pruritis?

C. place elbow restraints on the child's arms

An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The nurse recognizes that surgical correction is designed to achieve which outcome?

C. prevent the return of oxygenated blood to the lungs.

When evaluating the effectiveness of interventions to improve the nutritional status of an infant with gastro-esophageal reflux, which intervention is most important for the nurse to implement?

A. record weight daily

A 17 year old male student reports to the school clinic one morning for a scheduled health exam. He tells the nurse that he just finished football practice and is on his way to class. The nurse assesses his vital signs: temperature 100F, pulse 80, respirations 20, and BP 122/82. What is the best action for the nurse to take?

A. tell the student to proceed directly to his regularly scheduled class.

A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most important instruction for the nurse to include in this client's teaching plan?

A. Use sunscreen when lying by the pool.

A 6-month old infant with congestive heart failure (CHF) is receiving digoxin elixer. Which observation by the nurse warrants immediate intervention?

A. apical heart rate of 60.

A 4-year old boy was admitted to the emergency room with a fractured right ulna and a short arm cast was applied. When preparing the parents to take the child home, which discharge instruction has the highest priority?

A. call the healthcare provider immediately if his nail beds appear blue.

Which measurements should be used to accurately calculate a pediatric medication dosage? (Select all that apply) A. child's height and weight B. adult dosage of medication C. body surface area of child D. average adult's body surface area E. average pediatric dosage of medication F. nomogram determined mathematical constant.

A. child's height and weight C. body surface area of child F. nomogram determined mathematical constant.

A full-term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that the infant may have an esophageal atresia. Which symptoms is this newborn likely to have exhibited?

A. choking, coughing, and cyanosis

The mother of a 6-month old asks the nurse when her baby will get the first measles, mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control, which response is accurate?

B. 12-15 months

A 6-month old boy and his mother are at the healthcare provider's office for a well-baby checkup and routine immunizations. the healthcare provider recommends to the mother that the child receive an influenza vaccine. What medications should the nurse plan to administer today?

B. All the immunizations with the influenza vaccine given at a separate site from any other injection.

The nurse is assessing a 13-year old girl with suspected hyperthyroidism. Which question is most important for the nurse to ask her during the admission interview?

B. Are you experiencing any type of nervousness?

A three-month old boy weighing 10 lbs, 15 oz has an axillary temperature of 98.9 degrees F. The nurse determines the daily caloric need for this child is approximately:

C. 600 cal/day 10 lbs, 15 oz = 10.9 lbs. Convert lbs to kg by dividing pounds by 2.2 (10.9/2.2) = 4.954 kg rounded to 5 kg. an infant requires 108 cal/kg/day (108 x 5 = 540 cal/day). However this infant requires 10% more calories because he has one degree temperature elevation. 10% of 540 is 54 and 54 + 540 = 594. This infant will require approximately 600 calories/day. Remember that a temperature elevation necessitates consumption of more calories.

The nurse is teaching the parents of a 5 year old with cystic fibrosis about respiratory treatments. Which statement indicates to the nurse that the parents understand?

C. Administer aerosol therapy followed by postural drainage before meals

A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which behavior?

C. concern for body integrity

The nurse observes a 4-year old boy in a daycare setting. Which behavior should the nurse consider normal for this client?

C. demonstrates aggressiveness by boasting when telling a story

Which behavior would the nurse expect a two-year-old child to exhibit?

C. display possessiveness of toys

Which restraint should be used for a toddler after a cleft palate repair?

C. elbow restraints

A 15 year old girl tells the school nurse that all of her friends have started their periods and she feels abnormal because she has not. Which response is best for the nurse to provide?

C. explain that menarche varies and occurs between the ages of 12 and 18 years.

The nurse is giving preoperative instructions to a 14-year old female client who is scheduled for surgery to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken place?

D. I understand that I will be in a body cast and I will show you how you taught me to turn.

Preoperative nursing care for a child with Wilm's tumor should include which intervention?

D. Put a sign on the bed reading, "DO NOT PALPATE ABDOMEN."

A 2 year old child recently diagnosed with hemophilia A is discharged home. What information should the nurse include in a teaching plan about home care?

D. apply pressure and ice for bleeding while elevating and resting the extremity.

A child is rescued from a burning house and brought to the emergency room with partial-thickness burns on the face and chest. Which action should the nurse implement first?

D. assess the child's respiratory status

When taking the health history of a child, the nurse knows that which finding is an early indication of hypothyroidism in children?

D. cessation of growth in a child that had been normal.

The nurse is assessing an 8-month old child who has a medical diagnosis of Tetrology of Fallot. Which symptom is this client most likely to exhibit?

D. clubbed fingers

A 2-year old with gastro-esophageal reflux has developed a fear of eating. What instruction should the nurse include in the parents' teaching plan?

D. consistently follow a set mealtime routine.

The nurse receives a lab report stating a child with asthma has a theophylline level of 15 mcg/dl. What action will the nurse take?

A. pass the information on in the report

The nurse is teaching a 12-year old male adolescent and his family about taking injections of growth hormone for idiopathic hypopituitarism. Which adverse symptoms, commonly associated with growth hormone therapy should the nurse plan to describe to the child and his family?

A. polyuria and polydipsia

A four-year old girl continues to interrupt her mother during a routine clinic visit. the mother appears irritated with the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information?

A. children need to retain a sense of initiative without impinging on the rights and privileges of others.

A 2-year old child with Down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated with Down syndrome?

A. congenital heart disease

The parents of a 3-week old infant report that the child eats well but vomits after each feeding. what information is most important for the nurse to obtain?

A. description of vomiting episodes in the past 24 hours

The nurse is having difficulty communicating with a hospitalized 6 year old child. Which approach by the nurse is the most helpful in establishing communication?

A. engage the child through drawing pictures

A 6 year old is admitted to the pediatric unit after falling off a bicycle. Which intervention should the nurse implement to assist the child's adjustment to hospitalization?

A. explain hospital schedules to the child, such as mealtimes.

A burned child is brought to the emergency room. In estimating the percentage of the body burned, the nurse uses a modified "Rule of Nines." Which part of a child's body is calculated as a larger percentage of total body surface than an adult?

A. head and neck

When assessing a child with asthma, the nurse should expect intercostal retractions during

A. inspiration

Which finding in a 19 year old female client should trigger further assessment by the nurse?

A. menstruation has not occurred

A 3 week old newborn is brought to the clinic for follow after a home birth. the mother reports that her child bottle feeds for 5 minutes only and then falls asleep. the nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD) and finds the newborn is acyanotic with a respiratory rate of 64 breaths per minute. What instruction should the nurse provide the mother to ensure the infant is receiving adequate intake? (select all that apply)

A. monitor the infant's weight and number of wet diapers per day. B. increase the infant's intake per feeding by 1-2 ounces per week D. allow the infant to rest and refeed on demand on every 2 hours E. use a softer nipple or increase the size of the nipple opening

Which menu selection by a child with celiac disease indicates to the nurse that the child understands necessary dietary considerations?

A. oven-baked potato chips and cola.

The nurse is assessing the neurovascular status of a child in Russell's traction. Which finding should the nurse report to the healthcare provider?

A. pale bluish coloration of the toes

When discussing discipline with the mother of a 4 year old child, the nurse should include which guideline?

A. parental control should be consistent

All of the following interventions can be used to evaluate the effectiveness of nursing and medical interventions used to treat diarrhea. Which intervention is least useful in the nurse's evaluation of a 20-month-old child.

B. assessing fontanels

The nurse is caring for a 12-year old with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication?

B. changes in LOC

The vital signs of a 4 year old child with polyuria are BP 80/40, pulse 118, and respirations 24. the child's pedal pulses are present with a volume of +1 and no edema is observed. What action should the nurse implement first?

B. start an IV infusion of normal saline

The mother of a 4 year old child asks the nurse what she can do to help her other children cope with their sibling's repeated hospitalizations. Which is the best response that the nurse should offer?

D. encourage the mother to have the children visit the hospitalized sibling.

What preoperative nursing intervention should be included in the plan of care for an infant with pyloric stenosis?

D. observe for projectile vomiting.

An 18-month old is admitted to the hospital with possible Hirschsprung's disease. When obtaining a nursing history, the nurse asks about bowel habits. What describes the disease?

D. ribbon-like and brown

A child with cystic fibrosis is having stools that float and are foul smelling. Which descriptive term should the nurse use to document the finding?

D. steatorrhea

When planning the care for a child who has had a cleft lip repair, the nurse knows that crying should be minimized because it

D. stresses the suture line