1200 HESI QUESTIONS PEDIATRICS EXAM VERSION B 404 PAGES

1200 HESI QUESTIONS PEDIATRICS EXAM VERSION B 404 PAGES

Pediatrics Exam - Version B
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Points Awarded 22
Points Missed 68
Percentage 24%
1. The nurse is preparing to catheterize an 8-year-old child. Before starting the procedure, which action should the nurse take first?
A. Obtain the parent's cooperation before initiating the procedure.
B. Explain to the child and the parents that the procedure needs to be done.
C. After talking with the parents about the procedure, ask them to leave the room.
D. Provide the child with privacy by conducting the procedure in the treatment room.
An 8-year-old uses concrete operational thought (Piaget), can cooperate, and should be included
in the plan of care (B). (A) is indicated for a pre-school aged child, and does not acknowledge
the school-aged child's cognitive ability. (C and D) may be needed, but should occur after (B).
Points Earned: 0/1
Correct Answer: B
Your Response: D
2. Which neurological test should the nurse implement to assess cerebellar function in a 5-year-old with symptoms of hyperactivity?
A. Finger-to-nose.
B. Quadriceps reflex.
C. Two-point discrimination.
D. Ability to follow directions.
The cerebellum controls balance and coordination and is significant in children with symptoms
of hyperactivity or learning difficulty, so difficulty in performing a finger-to-nose test (A)
indicates poor sense of position (especially with the eyes closed) and incoordination (especially
with the eyes opened). Superficial reflexes (B), sensory discrimination (C), and ability to follow
directions (D) are aspects of a neurologic examination but do not test cerebellar function.
Points Earned: 0/1
Correct Answer: A
Your Response: C
3. An infant with developmental dysplasia of the hip is placed in a Pavlik harness. What instructions should the nurse include in a teaching plan for the parents?
A. Apply lotion or powder to minimize skin irritation.
B. Put clothing over harness for maximum effectiveness.
. Check for red areas under the straps three times a day.
D. Use a thin absorbent disposable diaper over the harness.
The Pavlik harness, which maintains the hips in abduction, is the most widely used device for
developmental dysplasia of the hip. An infant who continuously wears a Pavlik harness is at risk
for skin breakdown, so parents should be instructed to check two to three times a day for red
areas under clothing and harness straps (C). Lotions and powders (A) can cake or irritate the skin
and should be avoided. To avoid direct contact with the skin, clothing and diapers should be
placed under the straps (B and D).
Points Earned: 1/1
Correct Answer: C
Your Response: C
4. Which research finding provides evidence-based practice for an infant's risk for sudden infant death syndrome (SIDS)?
A. Breastfeeding reduces the risk for and the incidence of SIDS.
B. Infants should be positioned supine or supported laterally to sleep.
C. The prone position should be used when an infant sleeps after feeding.
D. The peak incidence occurs between the ages of 1 and 2 months.
Research has shown that placing babies on their backs for sleep reduces the risk of SIDS (B).
Although breastfeeding is recommended to boost neonatal immunity, (A) is unrelated to SIDS. A
population-based study found the prone sleep position (C) was associated with twice (2.4% odds
ratio) the rate of SIDS compared with infants placed nonprone to sleep. SIDS remains the third
leading cause of death in children between the ages of 1 month and 1 year, not (D).
Points Earned: 0/1
Correct Answer: B
Your Response: D
5. During the well-child assessment of an 18-month-old male toddler, the nurse determines the child does not walk while holding on to furniture but prefers to
crawl, rarely speaks, has a flat affect, and is small for his age. Which nursing diagnosis should the nurse formulate?
A. Alteration in nutrition.
B. Alteration in parenting.
C. Delayed growth and development.
D. Alteration in health maintenance.
This child does not demonstrate gross motor or psychosocial skills typical of an 18-month-old
toddler, which best supports delayed growth and development (C). Additional information about
the child's growth parameters is needed to support (A, B, or D).
Points Earned: 0/1
Correct Answer: C
Your Response: A
6. A 4-year-old boy is brought to the emergency department by his parent, who reports that the child has been pointing at his stomach and saying, "It hurts so bad."
Which pain-assessment tool should the nurse use?
A. Descriptor Scale.
B. Brief Pain Inventory.
C. A numeric rating scale.
D. Wong-Baker FACES Scale.
A pain rating scale using pictures, such as the Wong-Baker FACES Scale (D), allows the child to
choose a facial expression that shows how much hurt you have now and should be used for a preschool-
aged child. (A, B, and C) are used for older children who are able to conceptualize pain
using a number or descriptive narratives.
Points Earned: 0/1
Correct Answer: D
Your Response:
7. The parents of a child with Asperger's disorder asks the nurse to explain the differences between Asperger's and autism. Which information should the nurse
share with the parents about Asperger's disorder that is not characteristic in autism?
A. Obsession with moving objects.
B. Repetitive patterns of behavior.
C.
Age-appropriate language development.
D. Stereotypic movements and speech patterns.
Communication is not delayed in Asperger's disorder (C), but impaired communication with
delays of spoken language is characteristic of autism. Asperger's disorder has many
characteristics also found in autistic disorder, such as self-injurious behavior, behaviors that lead
to social impairment (A), and restrictive, repetitive forms of behaviors (B and D).
Points Earned: 0/1
Correct Answer: C
Your Response: C
8. The nurse notices that the hem of a skirt on a pre-adolescent girl is uneven when she comes to the clinic. What procedure should the nurse follow to examine the
girl for scoliosis? (Arrange the examination process from first on top to last on the bottom.)
A. Ask the girl to remove her shirt but leave on her bra or swimsuit top.
B. Examine for scapular prominence.
C. Look for asymmetry in the hip area.
D. Instruct the girl to bend at the waist so back is parallel to the floor.
To screen for scoliosis, the girl should first be asked to remove her shirt, wear her bra, or wear a
swimsuit top. Then, as she stands erect, observe for asymmetry of the shoulders, back and hips
while standing behind the girl. Next, ask her to bend forward so that the back is parallel to the
floor, and finally observe from the side and the back, noting asymmetry or prominence of the rib
cage and scapulae.
Points Earned: 0/4
Correct Answer: A:1, B:4, C:2, D:3
Your Response: A:-, B:-, C:-, D:-
9. The parents of a 14-year-old girl tell the nurse that their daughter dresses as a tomboy and plays baseball one day and the next day dresses in feminine clothes
and becomes a teenage drama queen. What information should the nurse use to respond to the parents?
A. Teenagers need a strong role mode to emulate.
B. Adolescents try on different roles while seeking their identity.
C. Such erratic behavior needs further investigation.
D. Fourteen-year-olds often try to please parents with their role choices.
As teenagers seek their own identity, they try on different roles to see if they fit (B). Although
role models (A) are important, they do not explain the adolescent's exploration for self-identity.
Such behaviors seem erratic, but are normal adolescent experiences that needs no further
investigation (C). (D) does not provide the best explanation.
Points Earned: 0/1
Correct Answer: B
Your Response: D
10. A 2-year-old is receiving care in the emergency department (ED) for a deep laceration on the head. What action should the nurse implement to facilitate
the child's cooperation?
A. Allow the child to hold a favorite toy or blanket.
B. Direct the parents to remain outside the treatment room.
C. Keep the child physically restrained during nursing care.
D. Let the child decide whether to sit up or lie down for procedures.
Allowing a child to hold a favorite toy or blanket (A) provides familiarity and comfort which
should facilitate the child's cooperation during treatment. Parents should remain with the child,
not (B), to calm and reassure a child who may perceive the ED environment as threatening. A
toddler needs autonomy and may not respond well to restriction, such as restraints (C), which
should be limited or removed as soon as safety permits. (D) should not be offered to a toddler
who is not capable of understanding a position (D) that might be needed during a treatment or
procedure.
Points Earned: 0/1
Correct Answer: A
Your Response: B
11. A 4-year-old is brought to the emergency room for a laceration on the right foot. What action should the nurse implement to help the child in coping
with the emergency room experience?
A. Avoid the use of bandages to keep wounds open to air.
B. Remind the preschooler how big children should act.
C. Give the child some time after explaining procedures.
D. Avoid using jargon, such as shot, when giving care.
Using positive terms and avoiding words that have frightening connotations (D) assist the
preschool-age child in coping with an emergency room experience. Bandages (A) are important
to preschool-aged children because this age group often believe bandages stop their insides from
leaking out. Children need to feel comfortable expressing their fears and feelings and should not
be shamed into cooperation by referencing expected big children behaviors (B). Preschool-age
children should be told about procedures immediately before they are performed (C), which
minimizes the time a child fantasies about the treatment, which causes increased anxiety.
Points Earned: 0/1
Correct Answer: D
Your Response: B
12. A 6-year-old child is admitted in the emergency department with a systolic blood pressure of 58 mm Hg. What action should the nurse take first?
A. Comfort the child.
B. Assess responsiveness.
C. Alert the healthcare provider.
D. Initiate IV fluid replacement.
The lower limit for systolic blood pressure for a child older than 1 year of age is 70 mm Hg plus
2 times the child's age in years, so the healthcare provider should be notified (C) of the child's
hypotension, and although comforting measures should be provided (A), physiological needs
should be met first. Assessing the child's responsiveness is a component of a neurologic
assessment, but asystolic blood pressure of 58 mm Hg is a late sign of shock in children and
requires immediate intervention (B). The healthcare provider's prescriptions, including IV fluids
(D), should be obtained to address shock.
Points Earned: 0/1
Correct Answer: C
Your Response: D
13. A child is brought to the emergency department with sweating, chills, and snake fang-like puncture marks on the calf. What action should the nurse
implement after the type of snake is identified?
A. Secure the antivenin.
B. Ambulate the child.
C. Apply a tourniquet to the leg.
D. Reassure the child and parent.
Antivenin is essential to the child's survival because the child is showing signs of envenomation
(A). When a bite or envenomation is located on an extremity, the extremity should be
immobilized, so ambulating the child (B) is contraindicated by the venom circulation increases
with the exercise. The use of a tourniquet is not recommended (C). Envenomation is a potentially
life-threatening condition, so false reassurance is not helpful (D).
Points Earned: 0/1
Correct Answer: A
Your Response: C
14. Which finding should the nurse in the emergency department identify as an indicator that a 3-year-old child has been mistreated?
A. The toddler does not remember how the injury occurred.
B. The parents are extremely calm in the emergency room.
C. The injury sustained is highly unusual for 3-year-old children.
D. The child was doing something unsafe when the injury occurred.
An injury that is highly unusual or inconsistent with the age and condition of the child should
raise suspicion of child abuse (C). A 3-year-old child's attention span and interruption of events
are consistent with a child's reliability as a historian or not remembering what happened (A)
when the injury occurred. Culture, ethnicity, individual experiences and psychological makeup
can influence parental reactions to a child who has been injured, so (B) alone is insufficient to
deduce child abuse. Additional information should be obtained to determine whether the parents
are negligent in the care of the child (D).
Points Earned: 0/1
Correct Answer: C
Your Response: D
15. A crying toddler has a blood pressure measurement of 120/70 mm Hg. What action should the nurse implement?
A. Notify the healthcare provider of the measurement.
B. Quiet the child and retake the blood pressure.
C. Ask the parent if the child has a history of hypertension.
D. Document the finding and recheck in 4 hours.
When a child is crying, intra-thoracic and abdominal pressures increase and are reflected in an
elevation of systemic blood pressure, so the nurse should quiet the child before retaking the
blood pressure (B). (A) is not necessary until accurate readings are obtained. (C) is not necessary.
An accurate pressure reading should be obtained before implementing (D).
Points Earned: 1/1
Correct Answer: B
Your Response: B
16. What should the nurse assess last when examining a 5-year-old child?
A. Heart.
B. Lungs.
C. Throat.
D. Abdomen.
Examination of the mouth, throat, and perineum is considered to be more invasive than other
parts of a physical examination, so invasive procedures, such as (C), should be left to the end of
the examination for a preschooler. Assessment of (A, B, and D) is not considered as invasive or
frightening to the child as (C).
Points Earned: 1/1
Correct Answer: C
Your Response: C
17. A 15-year-old girl tells the school nurse that she wants to have a baby. How should the nurse respond?
A. "Will you be able to support the baby?"
B. "Do you have plans to continue school?"
C. "Have you talked with your parents about this?"
D. "Can you tell me how your life will be if you have an infant?"
Developing a dialogue with the teen is important, and by using open-ended questions the nurse
will encourage communication and explanation. Asking the teenager to describe how the infant
will affect her life (D) directs the teen to consider real life experiences and allows the nurse to
assess the teen's perception and reality orientation. (A, B, and C) do not facilitate communication
and may terminate the communication.
Points Earned: 0/1
Correct Answer: D
Your Response: C
18. The nurse is caring for a 9-year-old male child who frequently speaks about sex and uses correct sexual vocabulary. What action should the nurse
implement with this child?
A. Ask the child whether he was sexually abused.
B. Ascertain what the child understands about sex.
C. Inquire where the child got this important information.
D. Involve the child in teaching sex information to peers.
School-age children often use correct sexual vocabulary, and yet have no real understanding of
what the words mean, so (B) provides clarification of the child's concepts used in conversation.
Direct questions about sexual abuse (A) may frighten the child and more information is needed
to make the assumption of sexual abuse. Asking the child about his source of information (C) is
not as relevant as what the child understands about sex. (D) is not an option.
Points Earned: 0/1
Correct Answer: B
Your Response: A
19. A mother brings her 6-month-old infant to the clinic for a well-baby routine exam. Which vaccine(s) should the nurse verify the infant has received?
(Select all that apply.)
A. Meningococcal polysaccharide vaccine (MPSV4).
B. Haemophilus influenzae type b conjugate vaccine (Hib).
C. Inactivated poliovirus vaccine (IPV).
D. Hepatitis B virus vaccine (HepB).
E. Diphtheria, tetanus toxoids, and acellular pertussis (DTaP).
F. Measles, mumps, and rubella vaccine (MMR).
(B, C, D, and E) should be administered prior to 6 months of age. (A) is administered after 24-
months of age. (F) is administered at 12-months of age.
Points Earned: 1/4
Correct Answer: B, C, D, E
Your Response: D
20. While assessing the apical pulse of a 13-year-old, the nurse determines that the rate is 88 beats/minute, and the rhythm is irregular. The heart rate is
phasic with respirations, increasing during inspiration and decreasing with expiration. What action should the nurse take?
A. Continue the cardiac examination.
B. Inquire about daily caffeine intake.
C. Re-assess the apical pulse in 15 minutes.
D. Schedule a consultation with a cardiologist.
Sinus arrhythmia is characterized by phasic irregularity of the heart rate that occurs with changes
in intrathoracic pressure during respiration and is a common phenomenon during childhood and
adolescence. No intervention is required, and the nurse should continue with the cardiac exam
(A). This finding is not related to caffeine intake (B). (C and D) are not indicated because the
heart rate is within the normal range.
Points Earned: 0/1
Correct Answer: A
Your Response: B
21. The nurse reviews the complete blood count (CBC) findings of an adolescent with acute myelogenous leukemia (AML). The hemoglobin is 13.8 g/dl,
hematocrit is 36.7%, white blood cell count is 8,200 mm3, and platelet count is 115,000 mm3. Based on these findings, what is the priority nursing
diagnosis for this client's plan of care?
A. Impaired gas exchange.
B. Risk for infection.
C. Risk for injury.
D. Risk for activity intolerance.
A client with AML is at risk for anemia, neutropenia, and thrombocytopenia. These CBC
findings indicate that the platelet count is low (normal 250,000 to 400,000 mm3), which places
this client at an increased risk for injury (C), usually manifested as bruising or bleeding. There is
no evidence of impaired gas exchange (A) due to respiratory compromise, risk of infection (B)
due to neutropenia, or risk for activity intolerance (D) secondary to anemia and fatigue.
Points Earned: 1/1
Correct Answer: C
Your Response: C
22. The parents of a child with hemophilia A ask the nurse about their probability of having another child with hemophilia A. Which information is the
basis for the nurse's response? (Select all that apply.)
A. Autosomal dominance occurs with this disorder.
B. Sons of female carriers have a 50% chance of inheriting hemophilia.
C. Men with hemophilia have sons who also manifest the disease.
D. The disease occurs in daughters of men with hemophilia.
E. Hemophilia is an X-linked recessive disorder.
Correct choices are (B and E). Hemophilia is an inherited disease that manifests in male children
whose mother is a carrier. With each pregnancy there is a 50% chance that a male child will
inherit the defective gene and manifest hemophilia A (B), which is an X-linked recessive
disorder (E). (A) is descriptive of a rare type of hemophilia, known as von Willebrand's disease.
Hemophilia is inherited by male offspring of female carriers (C). Daughters (D) do not manifest
the disease, but have a 50% chance of being a carrier.
Points Earned: 0/2
Correct Answer: B, E
Your Response: A, B, C
23. What is a priority nursing diagnosis for a child in the subacute stage of Kawasaki disease?
A. Alterations in skin integrity.
B. High risk for altered tissue perfusion, cardiopulmonary.
C. Risk for imbalanced body temperature, hyperthermia.
D. High risk for fluid volume deficit.
Kawasaki's disease (KD) is an acute systemic vasculitis that places the child at risk for coronary
artery aneurysm, which is most likely to occur during the subacute phase, resulting in reduced
cardiac output (B). Kawasaki disease causes rashes and desquamation of the hands and feet (A),
but this is not as life-threatening as cardiac involvement. Insensible fluid loss from fever (C) and
reduced fluid intake due to oral lesions may alter fluid balance and place the child at risk for
fluid volume deficit (D), but these issues are not as critical as possible changes in tissue
perfusion.
Points Earned: 1/1
Correct Answer: B
Your Response: B
24. The nurse is developing the plan of care for a school-aged boy with a chronic disability. The child frequently cries about being different from his siblings
and wants others to do things for him that he is capable of doing for himself. To assist the family in coping with this child's chronic illness, which
intervention is most important for the nurse to implement?
A. Recommend the use of consistent discipline and reward for acceptable behavior.
B. Encourage the parents to role model ways to act when one is disappointed.
C. Suggest that all the children are included in family decision making.
D. Evaluate the proper use of equipment that is provided to improve the child's lifestyle.
Focusing on the child, and not the condition, is essential in assisting the child to adapt to a
chronic disability or illness. Consistent family rules (A) should be used with a chronically ill
child, such as setting boundaries for acceptable behavior, requiring participation in household
activities, and fulfilling school responsibilities. (B, C, and D) may be worthwhile interventions,
but do not have the priority of providing the child with consistent expectations of acceptable
behavior.
Points Earned: 0/1
Correct Answer: A
Your Response: B
25. A man who was recently diagnosed with Huntington's disease asks the nurse if his adolescent son should be tested for the disease. What response is
best for the nurse to provide?
A. Autosomal dominant disorders, such as Huntington's, cannot be inherited from the parent.
B. Testing is needed because there is a 50 percent risk of passing the gene to each offspring.
C. Genetic counseling should be provided to ensure an informed decision by the family.
D. Positive genetic testing may contribute to insurance discrimination that denies coverage.
Huntington's disease, a progressively incapacitating, fatal neuromuscular disease, is an
autosomal dominant inherited disease that has a 50% risk of developing in each child of those
who have the disorder. The risk of autosomal dominant inheritance should be explained and
emphasized (B). (A) is inaccurate. Although the basic tenet of genetic counseling is to provide
families with facts to assist them in making informed decisions (C), the basic laws of inheritance
should be explained to direct the client to counseling. (D) provides information that does not
address the client's question, and might be considered judgmental.
Points Earned: 0/1
Correct Answer: B
Your Response: A
26. A mother is crying as she holds and rocks her child with tetanus who is having muscular spasms and crying. After administering diazepam (Valium) to
the child, what action should the nurse implement?
A. Lay the child down and ask the mother to stay near the child in the crib.
B. Encourage the mother to take a break and leave the room to stop crying.
C. Keep all light sources off and close the window blinds to the room.
D. Use calm, reassurance and understanding to comfort the mother.
Controlling environmental stimulation such as noise, light, or tactile stimuli helps reduce CNS
irritability related to acute tetanus. The mother should be instructed to minimize handling of the
child during episodes of muscle spasticity and to stay calmly near the child (A). The mother's
presence with the child provides security and support, so (B) is not indicated. Reducing external
stimuli (C) may have some effect in reducing the child's distress, but light tends to be less
irritating than vibratory or auditory stimuli and is essential for careful observation. Although a
calm, reassuring manner and sympathetic understanding (D) can help reduce the mother's
anxiety, the most comforting measure for the child is the presence of the mother.
Points Earned: 0/1
Correct Answer: A
Your Response: C
27. Which clinical finding should the nurse expect a child with nephrosis to exhibit?
A. Elevated blood pressure.
B. Blood-tinged urine.
C. Elevated temperature.
D. Urine protein 3+ to 4+.
In nephrosis, renal tubules become permeable to proteins, causing massive proteinuria (D). (A
and B) are characteristic of acute glomerulonephritis. Infection, indicated by (C), is not the cause
of nephrosis, but may occur secondary to immunosuppressive therapy.
Points Earned: 0/1
Correct Answer: D
Your Response: B
28. When plotting a 20-week-old infant's weight on a standardized growth chart, the nurse determines that the child's weight is between the 2nd and 3rd
percentile. Based on this finding, which action should the nurse take?
A. Teach the parents about interventions for failure to thrive syndrome.
B. Compare this weight with previous weights recorded in the child's record.
C. Evaluate the parent's body build in relation to the infant's weight.
D.