Download PEDS HESI EXAM QUESTIONS, ANSWERS AND EXPLANATIONS and more Exams Nursing in PDF only on Docsity!
PEDS HESI EXAM QUESTIONS,
ANSWERS AND EXPLANATIONS
The RN is monitoring an infant with CHD closely for SSx of HF. The RN should assess the infant for which early sign of HF? 1.Pallor 2.Cough 3.Tachycardia 4.Slow and shallow breathing - Correct answer 3. tachycardia RATIONALE: HF is the inability of the heart to pump a sufficient amt of blood to meet the O2 and metabolic needs of the body. The early SSx of HF include tachycardia, tachypnea, profuse scalp sweating, fatigue & irritability, sudden weight gain, and resp distress. A cough may occur in HF as a result of mucosal swelling & irritation, but is not an early sign. Pallor may be noted in an infant w/ HF, but is not an early sign. The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1.Immunoglobulin 2.Red blood cell count 3.White blood cell count 4.Anti-streptolysin O titer - Correct answer 4. anti-streptolysin O titer RATIONALE: Rheumatic fever is an inflammatory autoimmune disease that affects the CT of the heart, joints, skin (SQ tissues), BV, and CNS. A Dx of rheumatic fever is confirmed by the presence of 2 major manifestations or 1 major and 2 minor manifestations from the Jones criteria. In addition, evidence of a recent strep infection is confirmed by a + anti-streptolysin O titer, streptozyme assay, or anti-DNase B assay.
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1.Cracked lips 2.Normal appearance 3.Conjunctival hyperemia 4.Desquamation of the skin - Correct answer 3. conjunctival hyperemia RATIONALE: Kawasaki disease, aka mucocutaneous lymph node syndrome, is an acute systemic inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thromobocytosis occur. In the convalescent stage, the child appears normal, but SSx of inflammation may be present The mother of a child being discharged after heart surgery asks the nurse when the child will be able to return to school. Which is the most appropriate response to the mother? 1."The child may return to school in 1 week." 2."The child will not be able to return to school during this academic year." 3."The child may return to school in 1 week but needs to go half-days for the first 2 weeks." 4."The child may return to school in 3 weeks but needs to go half-days for the first few days." - Correct answer 4. "The child may return to school in 3 weeks but needs to go half-days for the 1st few days" RATIONALE: After heart surgery, the child may be able to return to school in 3 weeks but needs to go half-days for the 1st few days. The mother also should be told that the child cannot participate in PE for 2 months. Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of the child is a registered nurse and asks the nurse
3.Check the blood pressure and then administer the medication. 4.Check the respiratory rate and then administer the medication. - Correct answer 1. withhold the med RATIONALE: Dig is a cardiac glycoside that is used to treat HF. A primary concern is dig toxicity, and the RN needs to monitor closely for SSx of toxicity and monitor dig blood levels. The med is effective within a narrow therapeutic dig range (0.5-0.8). Safety in administration is achieved by double checking the dose and counting the apical HR for 1 full minute. The apical HR for an infant is 90-130 bpm. If the HR is less than 90 bpm in an infant, the RN would withhold the dose and contact the HCP. The nurse is creating a plan of care for a child admitted with a diagnosis of Kawasaki disease. In developing the initial plan of care, the nurse should include monitoring the child for signs of which condition?
Bleeding
Heart failure
Failure to thrive
Decreased tolerance to stimulation - Correct answer 2. HF RATIONALE: Nursing care initially centers on observing for SSx of HF. The RN monitors for increased RR, increased HR, dyspnea, crackles, and abdominal distension The day care nurse is observing a 2-year-old child and suspects that the child may have strabismus. Which observation made by the nurse indicates the presence of this condition? 1.The child has difficulty hearing. 2.The child consistently tilts the head to see. 3.The child does not respond when spoken to. 4.The child consistently turns the head to hear. - Correct answer 2. the child consistently tilts the head to see
RATIONALE:
Strabismus is a condition in which the eyes are not aligned bc of lack of coordination of the extraocular muscles. The RN may suspect strabismus in a child when the child c/o of freq HA, squints, or tilts the head to see. Other manifestations include crossed eyes, closing one eye to see, diplopia, photophobia, loss of binocular vision, or impairment of depth perception. A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all that apply. 1.Provide a soft diet. 2.Position the child on the left side. 3.Administer an antihistamine twice daily. 4.Irrigate the right ear with normal saline every 8 hours. 5.Administer ibuprofen for fever every 4 hours as prescribed and as needed. 6.Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy. - Correct answer 1. provide soft diet
- administer ibuprofen for fever q4h as Rx'd and PRN
- instruct the parents about the need to administer the Rx'd abx for the full course of therapy RATIONALE: Acute OM is an inflammatory d/o caused by an infection of the middle ear. The child often has fever, pain, loss of appetite, and possible ear drainage. The child is also irritable and lethargic and may roll the head or pull on the or rub the affected ear. Otoscopic exam may reveal a red, opaque, bulging, and immobile tympanic membrane. Hearing loss may be noted particularly in chronic OM. The child's fever should be treated with ibuprofen. The child is positioned on his/her affected side to facilitate drainage. A soft diet is recommended during the acute stage to avoid pain that can occur w/ chewing. Abx are Rx'd to treat the bacterial infection and should be administered for the full Rx'd course. The ear should not be irrigated with NS bc it can exacerbate the inflammation further. Antihistamines are not usually recommended as part of the therapy
suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1.Incessant crying 2.Coughing at nighttime 3.Choking with feedings 4.Severe projectile vomiting - Correct answer 3. choking w/ feedings RATIONALE: In esophageal atresia and tracheoesophageal fistula, the esophagus terminates b4 it reaches the stomach, ending in a blind pouch, and a fistula is present that forms an unnatural connection w/ the trachea. Any child who exhibits the "3 C's" (coughing & choking w/ feedings & unexplained cyanosis) should be suspected to have tracheoesophageal fistula A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely for which problem? 1.Diarrhea 2.Metabolic acidosis 3.Metabolic alkalosis 4.Hyperactive bowel sounds - Correct answer 3. metabolic alkalosis RATIONALE: Vomiting causes the loss of HCl acid and subsequent metabolic alkalosis. Metabolic acidosis would occur in a child experiencing diarrhea bc of the loss of bicarb. Diarrhea might or might not accompany vomiting. Hyperactive BS are not r/t vomiting The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with this disorder? 1.Bile-stained fecal emesis 2.The passage of currant jelly-like stools 3.Failure to pass meconium stool in the first 24 hours after birth 4.Sausage-shaped mass palpated in the upper right abdominal quadrant - Correct answer 3. failure to pass meconium stool in 1st 24 hours after birth
RATIONALE:
Imperforate anus is the incomplete development or absence of the anus in its normal position in the perineum. During the newborn assessment, this defect should be ID'd easily on sight. However, a rectal thermometer or tube may be necessary to determine the patency if meconium is not passed in the 1st 24 hours after birth. Other assessment findings include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum. The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which sign of this disorder documented? 1.Watery diarrhea 2.Ribbon-like stools 3.Profuse projectile vomiting 4.Bright red blood and mucus in the stools - Correct answer 4. bright red blood and mucus in the stools RATIONALE: Intussusception is a telescoping of 1 portion of the bowel into another. The condition results in an obstruction to the passage of intestinal content. A child w/ intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present, but it is not projectile. Bright red blood and mucus are passed thru the rectum and commonly are described as currant jelly-like stools. Which interventions should the nurse include when creating a care plan for a child with hepatitis? Select all that apply. 1.Providing a low-fat, well-balanced diet 2.Teaching the child effective hand-washing techniques 3.Scheduling playtime in the playroom with other children 4.Notifying the health care provider (HCP) if jaundice is present 5.Instructing the parents to avoid administering medications unless prescribed 6.Arranging for indefinite home schooling because the child will not be able to return to school - Correct answer 1. providing a low-fat, well balanced diet
4.Cleft-lip repair is usually performed between 6 months and 2 years. - Correct answer 3. 1st weeks of life RATIONALE: Cleft lip repair is usually performed during the 1st few weeks of life. Early repair may improve bonding and makes feeding much easier. Revisions may be required at a later age. A 1-year-old child is diagnosed with intussusception, and the mother of the child asks the student nurse to describe the disorder. Which statement by the student nurse indicates correct understanding of this disorder?
"It is an acute bowel obstruction."
"It is a condition that causes an acute inflammatory process in the bowel."
"It is a condition in which a distal segment of the bowel prolapses into a proximal segment of the bowel."
"It is a condition in which a proximal segment of the bowel prolapses into a distal segment of the bowel." - Correct answer 4. it is a condition in which the proximal segment of the bowel prolapses into a distal segment of the bowel A 3-year-old child is seen in the health care clinic, and a diagnosis of encopresis is made. The nurse expects to provide teaching about which client problem? 1.Odor 2.Nausea 3.Malaise 4.Diarrhea - Correct answer 1. odor RATIONALE: Encopresis is the repeated voluntary or involuntary passage of feces of normal or near-normal consistency in places not appropriate for that purpose according to the individual's own sociocultural setting. SSx include evidence of soiled clothing, scratching or rubbing the anal area bc of
irritation, fecal odor w/o apparent awareness by the child, and social withdrawal The nurse has been assigned to care for a neonate just delivered who has gastroschisis. Which concern should the nurse address in the client's plan of care? 1.Infection 2.Poor body image 3.Decreased urinary elimination 4.Cracking oral mucous membranes - Correct answer 1. infection RATIONALE: Gastroschisis occurs when the bowel herniates thru a defect in the abdominal wall to the right of the umbilical cord. There is no membrane covering the exposed bowel. Surgical repair will be done ASAP bc of the risk of infection in the unprotected bowel. Therefore, the greatest risk immediately after delivery is infection. Bc the pt is a neonate, poor body image is not an immediate problem. The nurse is developing a plan of care for an infant after surgical intervention for imperforate anus. The nurse should include in the plan that which position is the most appropriate one for the infant in the postoperative period? 1.Prone position 2.Supine with no head elevation 3.Side-lying with the legs extended 4.Supine with the head elevated 45 degrees - Correct answer 1. prone position RATIONALE: The appropriate position following surgical intervention for an imperforate anus is a side lying position w/ the legs flexed or a prone position to keep the hips elevated. These positions will reduce edema and pressure on the surgical site An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder?
2.Monitor the blood pressure. 3.Reposition the infant frequently. 4.Aspirate the NG tube every 5 to 10 minutes. - Correct answer 4. aspirate the NGT q5-10min RATIONALE: Esophageal atresia w/ tracheoesophageal fistula represents a critical neonatal surgical emergency. While the infant is awaiting transfer to surgery, management centers on prevention of aspiration. The infant is kept supine or prone w/ the HOB elevated to decrease the chance that gastric secretions will enter the lungs. IVF are essential. An NGT must be in place and aspirated q5-10min to keep the proximal pouch clear of secretions. Monitoring the temp and BP are standard nursing interventions A mother brings her child to the well-child clinic and expresses concern to the nurse because the child has been playing with another child diagnosed with hepatitis. The nurse prepares to perform an assessment on the child, knowing that which finding would be of least concern for hepatitis?
Jaundice
Hepatomegaly
Dark-colored, frothy urine
Left upper abdominal quadrant pain - Correct answer 4. LUQ pain RATIONALE: Assessment findings in a child w/ hepatitis include RUQ tenderness and hepatomegaly. The stools will be pale and clay colored, and urine will be dark and frothy. Jaundice may present and will be best assessed in the sclera, nail beds, and mucous membranes The nurse is reviewing the laboratory results for an infant with suspected hypertrophic pyloric stenosis. What should the nurse expect to note as the most likely finding in this infant? 1.Metabolic acidosis 2.Metabolic alkalosis
3.Respiratory acidosis 4.Respiratory alkalosis - Correct answer 2. metabolic alkalosis RATIONALE: Lab findings in an infant w/ hypertrophic pyloric stenosis include metabolic alkalosis as a result of the vomiting that occurs in this d/o. Additional findings include decreased serum K and Na levels, increased pH and bicarb levels, and decreased Cl level. A 12-year-old girl is admitted to the hospital with suspected appendicitis. What nursing interventions should be implemented preoperatively? 1.Applying a heating pad for 5-minute intervals as prescribed 2.Administering acetaminophen as needed for pain, as prescribed 3.Placing the adolescent in a fetal position, side-lying with legs drawn up to chest 4.Inserting a nasogastric tube and attaching it to low intermittent suction; measuring drainage as prescribed - Correct answer 3. placing the adolescent in a fetal position, side lying w/ legs drawn up to chest RATIONALE: A pt w/ appendicitis is more comfortable when lying in what is traditionally known as the fetal position, w/ legs drawn up toward the chest. This flexed positioning assists in decreasing the pain that comes w/ appendicitis by decreasing the pressure on the abdominal area. A heating pad can lead to a ruptured appendix. Pain meds are not given to the pt bc they mask the SSx that accompany a ruptured appendix. A NGT may be necessary post- op for gastric decompression, or pre-op if perforation occurs. A preschooler with a history of cleft palate repair comes to the clinic for a routine well-child checkup. To determine if this child is experiencing a long- term effect of cleft palate, which question should the nurse ask? 1."Was the child recently treated for pneumonia?" 2."Does the child play with an imaginary friend?" 3."Is the child unresponsive when given directions?" 4."Has the child had any difficulty swallowing food?" - Correct answer 3. "Is the child unresponsive when given directions?" RATIONALE:
Elevated hemoglobin level
Decreased reticulocyte count
Elevated red blood cell count
Red blood cells that are microcytic and hypochromic - Correct answer 4. RBCs that are microcytic and hypochromic RATIONALE: In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hgb in RBCs. The results of a CBC in children w/ iron deficiency anemia show decreased hgb levels and microcytic and hypochromic RBCs. The RBC count is decreased. The reticulocyte count is usually normal or slightly elevated The nurse is caring for a child with a diagnosis of hemophilia, and hemarthrosis is suspected because the child is complaining of pain in the joints. Which measure should the nurse expect to be prescribed for the child?
Range-of-motion exercises to the affected joint
Application of a heating pad to the affected joint
Application of a bivalved cast for joint immobilization
Nonsteroidal antiinflammatory drugs for the pain - Correct answer 3. application of a bivalved cast for joint immobilization RATIONALE: In an acute period, immobilization of the joint would be Rx'd. ROM exercises during the acute period can increase the bleeding and would be avoided at this time. Heat will increase blood flow to the area, so it would promote increased bleeding to the area. NSAIDs can prolong bleeding time and would not be Rx'd to the child.
A child is brought to the emergency department after being accidentally struck in the lower back region with a baseball bat. When gathering assessment data, the nurse discovers that the child has hemophilia. The nurse should immediately assess for which data? 1.Slurred speech 2.Presence of hematuria 3.Complaints of headache 4.Change in respiratory rate - Correct answer 2. presence of hematuria RATIONALE: Bc the kidneys are located in the flank region of the body, trauma to the back area can cause hematuria, particularly in a child w/ hemophilia. The RN would be most concerned about the child's airway and RR if the child had sustained an injury to the neck region. Slurred speech and HA are associated w/ head trauma A 12-year-old child with newly diagnosed thalassemia is brought to the clinic exhibiting delayed sexual maturation, fatigue, anorexia, pallor, and complaints of headache. The child seems listless and small for age and has frontal bossing. What should the nurse expect to note on review of the results of the laboratory tests? 1.Macrocytosis and hyperchromia 2.Excessive red blood cell production 3.Excessive mature erythrocyte proliferation 4.Deficient production of functional hemoglobin - Correct answer 4. deficient production of functional hgb RATIONALE: Defective hgb is produced as a result of genetically deficient beta- polypeptide. This hgb is unstable, disintegrates, and damages the erythrocytes. Rapid destruction of the red cells stimulates rapid production of immature red cells, and the net gain is less than optimally functioning red cells. Iron from the RBC destruction is stored in the tissues, causing multiple problems. In thalassemia, immature erythrocytes proliferate, not mature ones. This is a progressive anemia. The nurse also would note microcytosis and hypochromia
RATIONALE:
Hemophilia is a lifelong hereditary blood disorder associated with deficiency of clotting factors. It is inherited in a recessive manner via a genetic defect on the X chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX. Blood product transfusion is not the Tx of choice over administering recombinant factors IV. A health care provider prescribes laboratory studies for an infant of a woman positive for human immunodeficiency virus (HIV). The nurse anticipates that which laboratory study will be prescribed for the infant? 1.Chest x-ray 2.Western blot 3.CD4+ cell count 4.p24 antigen assay - Correct answer 4. p24 antigen assay RATIONALE: Infants born to HIV+ mothers need to be screened for the HIV antigen. The detection of HIV in infants is confirmed by a p24 antigen assay, virus culture of HIV, or polymerase chain reaction. A Western blot test confirms the presence of HIV antibodies. The CD4+ cell count indicates how well the immune system is working. A CXR evaluates the presence of other manifestations of HIV infection, such as pneumonia A child is admitted to the pediatric unit with a diagnosis of acute stage Kawasaki disease. Which assessment findings by the nurse are characteristic of this disorder? Select all that apply. 1.Red throat 2.Cracking lips 3.Conjunctival hyperemia 4.Desquamation of the skin 5.Enlargement of the cervical lymph nodes - Correct answer 1. red throat
- conjuctival hyperemia
- enlargement of the cervical lymph nodes RATIONALE:
Kawasaki disease is known as mucocutaneous lymph node syndrome and is an acute systemic inflammatory disease. Assessment findings in the acute stage include fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. Desquamation of the skin, cracking lips, joint pain, cardiac manifestations, and thrombocytosis are characteristics of the subacute stage
