Pediatric Hesi Multiple Choice

A child with pertussis is receiving azithromycin IV. Which intervention is most important for the nurse to include in this child’s plan of care? A. B. C. D. Assess for abdominal pain and vomiting Obtain vital signs at onset of fluid overload Monitor vital signs for facial swelling and urticaria Change IV site dressing q 3 days and prn A nine-week-old infant is scheduled for a cleft lip repair. Which information is most important for the nurse to convey to the surgeon before transporting the infant to the surgical suite? A. B. C. D. Weight gain of 2 pounds since birth Red blood cell count of 2.3 million Urine specific gravity is 1.011 White blood cell count of 10,000 Normal levelsDofDRBCsDat birth range from 5.1 to 5.3 million/mm3Dfor termDnewbornsDand 4.6 to 5.3 million/mm3Dfor premature neonates.D A 10-year-old girl who has had type 1 diabetes for the past two years tells the nurse that she would like to use a pump instead of insulin injections to manage her diabetes. Which assessment of the girl is most important for the nurse to obtain? A. Knowledge of her hemoglobin A1c levels for the last year B. Interpretation of fingerstick glucose levels that influence diet C. Understanding of quality control process to troubleshoot the pump D. Ability to program the pump for basal insulin and mealtime boluses Which toy is most appropriate for a 10-year-old child with rheumatic fever who is on strict bedrest? A. Doctor kit B. Play dough C. Punching bag D. Checkers- easy to keep clean E. When administering indomethacin to a premature infant who has patent ductus arteriosus, the nurse should anticipate which outcome? A. Increased respiratory effort B. Increased number of red blood cells C. Decreased urinary output D. Decreased cardiac murmur The parents of a 3-year-old boy who has Duchenne muscular dystrophy ask, “How can our son have this disease? We are wondering if we should have any more children.” What information should the nurse provide to these parents? A. Birth trauma with a breech vaginal birth causes damage to the spinal cord, thus weakening muscles. B. The male infant had a viral infection that went unnoticed and untreated, so muscle damage occurred. C. The striated muscle groups in males can be impacted by a lack of the protein dystrophin in their mothers. D. This is an inherited X-linked recessive disorder, which primarily affects male children in the family. The nurse is performing a routine assessment of a 3-year-old at a community health center. Which behavior by the child should alert the nurse to request a follow-up for a possible autistic spectrum disorder? A. Has a history of temper tantrums B. Strokes the hair of a hand-held doll C. Shows indifference to verbal stimuli D. Performs odd repetitive behaviors A toddler is hospitalized with Kawasaki’s disease. Pharmacological management includes aspirin therapy. What is the benefit of the aspirin? A. Minimize vascular inflammation B. Reduce joint swelling C. Manage irritability D. Control high fever A hospitalized adolescent female demands that her mother stay with her. The mother tells the nurse that she cannot understand her daughter acting this way. What response is best for the nurse to provide? A. “Try not to reward her manipulation” B. “It is likely she is regressing to an earlier age” C. “Possibly, she is lonely for her friends” D. “She is probably feeling insecure” A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) and high levels of thyroid stimulating hormone (TSH). What is the best explanation for this finding? A. High thyroxine levels normally occur in breastfeeding infants B. The thyroid gland does not produce normal levels of thyroxine for several weeks after birth C. The thyroxine level is low because the TSH is high D. The TSH is high because of the low production of T4 by the thyroid Several children at a day camp return from playing in a tick infested field. What action should the camp nurse take first? A. Observe the children for attached ticks B. Encourage the children to lie down and rest quietly C. Ask the children if they were using tick repellent D. Assess the children for the presence of the bull’s eye rash A school age male is brought to the school nurse after he was thrown off his bicycle into a pine tree. The child’s face and arms are covered in embedded pine bark. He has copious tearing and complains that there is ‘stuff in his eyes’. What action should the nurse implement? A. B. C. D. Patch both eyes and send him to the family ophthalmologist Instill pain-relieving eye drops into each eye and keep the head elevated Use sterile tweezers to lift bark specks from the sclera of the eye Encourage the child to blink frequently to increase bilateral tearing of the eyes A two-week old infant is hospitalized for the surgical repair of an umbilical hernia. After returning to the postoperative neonatal unit, her respiratory rate and heart rate have increased during the last hour. Which intervention should the nurse implement? A. Administer a PRN analgesic B. Wrap the infant tightly and rock in a rocking chair C. Notify the healthcare provider D. Record the findings in the child’s record A male toddler is brought to the emergency center approximately three hours after swallowing tablets from his grandmother’s bottle of digoxin. What prescription should the nurse implement first? A. Give IV digoxin immune fab B. Administer activated charcoal orally C. Prepare for gastric lavage D. Obtain a 12-lead EKG A mother of a 3-year-old boy has just given birth to a baby girl. The little boy asks the nurse why is baby sister is eating mommy’s breast? How should the nurse respond? (select all that apply) A. B. C. D. E. Suggest that the baby can also drink from a bottle Remind him that his mother breastfed him too Reassure the boy that it does not hurt mommy Clarify that breastfeeding is his mother’s choice Explain that newborns get milk from their mothers like this A mother of a toddler reports to the nurse working in the pediatric clinic that her child has had a fever and sore throat for the past two days. The nurse observes several swollen red spots on the child’s body, a few a fluid filled blisters. What action should the nurse take? A. Obtain fluid culture from the blisters B. Implement transmission precautions C. Cover draining vesicles with a dressing D. Administer fever reducing salicylate Which nursing intervention is most important to assist in detecting hypopituitarism and hyperpituitarism in children A. Carefully recording the height and weight of children to detect inappropriate growth B. Performing head circumference measurements on infants under one year of age C. Assessing for behavioral problems at home and school by interviewing the parents D. Noting a tracked weight gain without a gain in height on a growth chart When assessing a newborn, the nurse includes which assessment for early signs of congenital hip dysplasia? A. Shortening of the leg on the unaffected side B. Limited adduction of the affected leg C. Depressed dance reflex D. Asymmetry of the gluteal folds A clinic nurse is assessing infants and toddlers for fine and gross motor development. Which child should the nurse refer to the healthcare provider for further follow up? A. An 18-month-old attempting to scribble on paper B. A 5-month-old with use of hand grasp in both hands C. A 3-year-old preferring to walk only on tip toes D. A 3-year-old with diminished Moro reflex A school age child is brought to the Emergency center with fever and joint pain and is diagnosed with rheumatic fever. Which explanation should the nurse provide to the parents regarding the cause of this condition? A. A previous bacterial infection causes a chronic condition that affects the heart valves B. An infection in the mitral valve results in a systemic infection that affects the heart valves C. The valves in the heart develop lesions that cause inflammation and scarring D. Scar tissue causes the leaflets in the heart valves to become rigid and closed A 2-year-old girl is brought to the clinic by her 17-year-old mother. When the nurse observes that the child is drinking sweetened soda from her bottle, what information should the nurse discuss with the mother? (select all that apply) A. Drinking soda is related to childhood obesity B. Toddlers should be drinking from a cup by age 2 C. Toddlers should be sleeping 10 hours a night D. A 2-year-old should be speaking in two-word phrases E. Dental caries are associated with drinking soda An infant is receiving digoxin for congestive heart failure. The apical heart rate is assessed at 80 beats/min. What intervention should the nurse implement? A. Call for a portable chest x-ray B. Obtain a therapeutic drug level C. Reassess the heart rate in 30 minutes D. Administer digoxin immune Fab stat- Sinus bradycardia (heart rate <90 to 110 beats/min in an infant) is an indication of digoxin toxicity, so assessment of the client's digoxin level has the highest priority. A newborn infant’s normal HR is 110 to 160 A 2-year-old child with trisomy 21 (Down syndrome) is brought to the clinic for a routine evaluation. Which assessment finding suggests the presence of a common complication often experienced by those with Down syndrome? A. B. C. D. Presence of systolic murmur New onset of patchy alopecia Complaints of long bone pain Recent projectile vomiting Congenital heart disease occurs in 40% to 50% of children with trisomy 21 (Down syndrome). Defects of the atrial or ventricular septum that create systolic murmurs are the most common heart defects associated with this congenital anomaly. Options B, C, and D are not recognized as common complications of trisomy 21 Which assessment findings should the nurse expect when caring for a child with cystic fibrosis?D(Select all that apply.) A. Steatorrhea B. Obesity C. Foul smelling stools D. Delayed growth E. Pulmonary congestion A burned child is brought to the emergency department, and the nurse uses a modified rule of nines to estimate the percentage of the body burned. When calculating the percentage of burn, which parts of the child's body are proportionally larger than an adults? A. B. C. D. Head and neck Arms and chest Legs and abdomen Back and abdomen A) The standard rule of nines is inaccurate for determining burned body surface areas with children because a child's head and neck are proportionately larger than an adults. Specially designed charts are commonly used to measure the percentage of burn in children. Options B, C, and D are not proportionately different. In making the initial assessment of a 2-hour-old infant, which finding should lead the nurse to suspect a congenital heart defect? A. Irregular respirations and heart rate B. Gagging C. Blue hands and feet D. Diminished femoral pulses D) Diminished femoral pulses could indicate coarctation of the aorta. In the normal transition period, options A and B occur during the 4 to 6 hours after birth (second period of reactivity). Option C is a normal finding in the newborn. A nurse is preparing to end the shift and receives a laboratory report stating that a child with asthma has a theophylline level of 15 mcg/dL. Which action should the nurse take? A. B. C. D. Communicate the result to the oncoming nurse and document. Tell the oncoming nurse that the level is dangerously high. Ask the laboratory to redo the test because the result is faulty. Hold the next dose of theophylline based on this finding. A) The therapeutic level of theophylline is 10 to 20 mcg/dL, so the child's level is within the therapeutic range. This information evaluates the prescribed therapy and should be communicated in the nurse's report. Based on the laboratory finding, options B, C, and D are not indicated. A 3-month-old infant weighing 10 lb. 15 oz has an axillary temperature of 98.9° F. What caloric amount does this child need? A. 400 calories/day B. 500 calories/day C. 600 calories/day D. 700 calories/day C) An infant requires 108 calories/kg/day. The first step is to change 10 lb. 15 oz to 10.9 lb. Then convert pounds to kilograms by dividing pounds by 2.2, which is 10.9/2.2 = 4.954 kg, rounded to 5 kg. The second step is to multiply 108 calories/kg/day (108 × 5 = 540 calories/day). However, this infant requires 10% more calories because of the 1° F temperature elevation. Ten percent of 540 (calories/day) is 54, and 540 + 54 = 594. This infant will require approximately 600 calories/day. Options A, B, and D are incorrect. A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. During the initial nursing assessment, which symptoms will this child most likely exhibit? A. B. C. D. Bone pain, pallor Weakness, tremors Nystagmus, anorexia Fever, abdominal distention A) Option A lists the most common presenting symptoms of leukemia. Leukemic cells invade the bone marrow, gradually causing a weakening of the bone and a tendency toward pathologic fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain and anemia results from decreased erythrocytes, causing pallor. Options B and C could be associated with central nervous system disorders. Option D commonly occurs in children but is not specific for leukemia. An 18-month-old child returns to the unit following a cardiac catheterization with a cannulated femoral artery site. Which intervention should the nurse implement? A. Teach the parents how to ambulate the child in the room safely. B. Show the parents how to hold the child with the extremity extended. C. Restrain the child's lower extremities for a minimum of 4 hours. D. Place the child in a prone position to apply pressure to the site. B) The extremity should be extended to prevent trauma to the femoral catheterization site. Options A and D increase the risk for complications and are contraindicated. Option C is not necessary. Only the extremity that was catheterized requires immobilization The nurse is caring for a child with intussusception who is scheduled for a barium enema prior to a surgical procedure. Which action should the nurse take first? A. Evacuate the bowel of impacted feces B. Administer magnesium sulfate C. Place the child on a clear liquid diet D. Assess the stool for white color C) Intussusception, an invagination or telescoping of one portion of the intestine into another, causes intestinal obstruction in children (usually occurs between 3 months and 5 years of age). Nonsurgical treatment is attempted with hydrostatic pressure created by barium instillation, which often reduces the area of bowel intussusception. In preparation for a barium enema, the client should first be placed on a clear liquid diet for the entire day; then magnesium sulfate is administered for bowel evacuation. A barium enema is likely to cause option A. After the enema, white stool may be seen as the body naturally removes any remaining barium. The nurse is teaching an adolescent girl with scoliosis about a Milwaukee brace that her health care provider has prescribed. Which instruction should the nurse provide to this client? A. Remove the brace 1 hour each day for bathing only. B. Remove the brace only for back range-of-motion exercises. C. Wear the brace against the bare skin to ensure a good fit. D. Wearing the brace will cure the spinal curvature. A) The Milwaukee brace is designed to slow the progression in spinal curvature while the adolescent is growing. The brace should be worn 23 hours a day and removed a total of 1 hour a day for hygiene. There are no specific exercises for increasing the range of motion in the back that should be performed. A T shirt should be worn next to the body and the brace put on over the T shirt to protect the skin. The brace will not cure the spinal curvature but should slow the progression of the scoliosis. The nurse is preparing a teaching plan for the mother of a child who has been diagnosed with celiac disease. Choosing which lunch will be within the therapeutic management of a child with celiac disease? A. Turkey salad, milk, and oatmeal cookies B. Baked chicken, coleslaw, soda, and frozen fruit dessert C. Tuna salad sandwich on whole wheat bread, milk, and ice cream D. Turkey sandwich on rye bread, orange juice, and fresh fruit B) A child with celiac disease is managed on a gluten-free diet, which eliminates food products containing oats, wheat, rye, or barley. A 4-year-old child has cystic fibrosis. Which stage of Erikson theory of psychosocial development is the nurse addressing when teaching inhalation therapy? A. Autonomy B. Industry C. Trust D. Initiative D) Children 4 to 5 years of age are in the "Initiative vs. Guilt" stage of Erikson theory of psychosocial development. They enjoy being active and participating in role playing. "Autonomy vs. Shame and Doubt" occurs at 1 to 3 years of age. "Industry vs. Inferiority" occurs at 6 to 11 years; "Trust vs. Mistrust" occurs from birth to 1 year of age. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The nurse determines that the increased respiratory rate is a compensatory mechanism for which acid base alteration? Answer: Metabolic acidosis A 7-year-old is admitted to the hospital with persistent vomiting, and a nasogastric tube attached to low intermittent suction is applied. Which finding is most important for the nurse to report to the healthcare provide. A. Gastric output of 100 mL in the last 8 hours. B. Shift intake of 640 mL IV fluids plus 30 mL PO ice chips. C. Serum potassium of 3.0 mg/dL. D. Serum pH of 7.45. The nurse is evaluating diet teaching for a client who has nontropical sprue (celiac disease). Choosing which food indicates that the teaching has been effective? A. Creamed corn B. Pancakes C. Rye crackers D. Cooked oatmeal The nurse is assessing an infant with diarrhea and lethargy. Which finding should the nurse identify that is consistent with early dehydration? A. Tachycardia. B. Bradycardia. C. Dry mucous membrane. D. Increased skin turgor Remember this… If a child continues to go to the school nurse after the winter break at school, she might want to ask them what is going on at home. Always do a testicular exam on your patient in a warm environment. Do not forget that with epiglottitis, there will be ‘drooling’. If you see a child eating fertilizer you need to call poison control. If the nurse walks into a room when visiting hours are over and there are too many people present, she/he needs to ask which one is staying. For strabismus we need to do a 6-point cardinal gaze test. If a patient has hypospadias, it should be corrected before they start potty training.