A child with leukemia is being discharged after beginning chemotherapy. Which of the following
instructions will the nurse include when teaching the parents of this child?
a)provide a diet low in protein and high carbohydrates
b) avoid fresh vegetables that are not cooked or peeled
c) notify t...
Pediatric HESI practice
A child with leukemia is being discharged after beginning chemotherapy. Which of the following
instructions will the nurse include when teaching the parents of this child?
a)provide a diet low in protein and high carbohydrates
b) avoid fresh vegetables that are not cooked or peeled
c) notify the doctor if the child's temperature exceeds 101 F (39C)
d) increase the use of humidifiers throughout the house -correct answers Answer B
fresh fruits and vegetables harbor microorganisms, which can cause infections in immune-compromised
child. Fruits and vegetables should either be peeled or cooked. The physician should be notified of a
temperature above 100F, a diet low in protein is not indicated, and humidifiers harbor fungi in the water
containers.
A client with hemophilia has a very swollen knee after falling from bicycleriding. Which of the following
is the first nursing action?
a)initiate an IV site to begin administration of cryoprecipitate
b) type and cross-match for possible transfusion
c) monitor the client's vital signs for the first 5 minutes
d) apply ice pack and compression dressings to the knee -correct answers Answer D
rest, ice, compression, and elevation (RICE)are the immediate treatments to reduce the swelling and
bleeding into the joint. These are the priority actions for bleeding into the joint of a client with
hemophilia
A client and her husband are positive for the sickle cell trait. The client asks the nurse about chances of
her children having sickle cell disease. Which of the following is appropriate response by the nurse?
a)one of her children will have sickle cell disease
b) only the male children will be affected
c) each pregnancy carries a 25% chance of the child being affected
d) if she had four children, one of them would have the disease -correct answers Answer C
In autosomal recessive traits, both parents are carriers. There is a 25% chance with each pregnancy that
a child will have the disease.
An 8 year old child has been diagnosed to have iron deficiency anemia. Which ofthe following activities
is most appropriate for the child to decrease oxygen demands on the body?
a)Dancing
b) playing video games
c) reading a book
d) riding a bicycle -correct answers Answer C
reading a book is restful activity and can keep the child from becoming bored. Choices a, b, and d
require too much energy for a child with anemia and can increase oxygen demands on the body.
A 16 month old child diagnosed with Kawasaki Disease (KD) is very irritable,refuses to eat, and exhibits
peeling skin on the hands and feet. Which of the following would the nurse interpret as the priority?
,a)applying lotions to the hands and feet
b) offering foods the toddler likes
c) placing the toddler in a quiet environment
d) encouraging the parents to get some rest -correct answers Answer C
One of the characteristics of children with KD is irritability. They are often inconsolable.Placing the child
in a quiet environment may help quiet the child and reduce the workload of the heart. The child's
irritability takes priority over peeling of the skin.
A newborn's failure to pass meconium within the first 24 hours after birth may indicate which of the
following?
a.Hirschsprung disease
b. Celiac disease
c. Intussusception
d. Abdominal wall defect -correct answers Answer A
Failure to pass meconium within the first 24 hours after birth may be an indication of Hirschsprung
disease, a congenital anomaly resulting in mechanical obstruction due to inadequate motility in an
intestinal segment. Failure to pass meconium is not associated with celiac disease, intussusception, or
abdominal wall defect.
Which of the following should the nurse do first after noting that a child with Hirschsprung disease has a
fever and watery explosive diarrhea?
a. Notify the physician immediately
b. Administer antidiarrheal medications
c. Monitor child ever 30 minutes
d. Nothing, this is characteristic of Hirschsprung disease -correct answers Answer A
For the child with Hirschsprung disease, fever and explosive diarrhea indicate enterocolitis, a life-
threatening situation. Therefore, the physician should be notified immediately. Generally, because of
the intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to
treat Hirschsprung disease. The child is acutely ill and requires intervention, with monitoring more
frequently than every 30 minutes.Hirschsprung disease typically presents with chronic constipation.
When assessing a child for possible intussusception, which of the following would be least likely to
provide valuable information?
a.Stool inspection
b. Pain pattern
c. Family history
d. Abdominal palpation -correct answers Answer C
Because intussusception is not believed to have a familial tendency, obtaining a family history would
provide the least amount of information. Stool inspection, pain pattern, and abdominal palpation would
reveal possible indicators of intussusception. Current, jelly-like stools containing blood and mucus are an
indication of intussusception. Acute,episodic abdominal pain is characteristics of intussusception. A
sausage-shaped mass may be palpated in the right upper quadrant.
After teaching the parents of a preschooler who has undergone T and A(Tonsillectomy and
Adenoidectomy) about appropriate foods to give the child afterdischarge, which of the following, if
stated by the parents as appropriate foods, indicates successful teaching?
, a)meatloaf and uncooked carrots
b) pork and noodle casserole
c) cream of chicken soup and orange sherbet
d) hot dog and potato chips -correct answers Answer C
for the first few days after a T and A
(Tonsillectomy and Adenoidectomy)
, liquids and soft foods are best tolerated by the child while the throat is sore. Avoid hard and scratchy
foods until throat is healed.
A child diagnosed with tetralogy of fallot becomes upset, crying and thrashing around when a blood
specimen is obtained.The child's color becomes blue and respiratory rate increases to 44 bpm.Which of
the following actions would the nurse do first?
a)obtain an order for sedation for the child
b) assess for an irregular heart rate and rhythm
c) explain to the child that it will only hurt for a short time
d) place the child in knee-to-chest position -correct answers Answer D
the child is experiencing a "tet spell" or hypoxic episode.Therefore the nurse should place the child in a
knee-to-chest position. Flexing the legs reduces venous flow of
blood from lower extremities and reduces the volume of blood being shunted through the
interventricular septal defect and the overriding aorta in the child with tetralogy of fallot. As a result, the
blood then entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing
the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a
knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need
sedative. Once the child is in this position, the nurse may assess for an irregular heart rate and
rhythm.Explaining to the child that it will only hurt for a short time does nothing to alleviate hypoxia.
Which of the following would the nurse perform to help alleviate a child's joint pain associated with
rheumatic fever?
a)maintaining the joints in an extended position
b) applying gentle traction to the child's affected joints
c) supporting proper alignment with rolled pillows
d) using a bed cradle to avoid the weight of bed lines on the joints -correct answers Answer D
for a child with arthritis associated with rheumatic fever, the joints are usually so tender that even the
weight of bed linens can cause pain. Use of the bed cradle is recommended to help remove the weight
of the linens on painful joints. Joints need to be maintained in good alignment, not positioned
inextension, to ensure that they remain functional.Applying gentle traction to the joints is not
recommended because traction is usually used to relieve muscle spasms, not typically associated with
rheumatic fever. Supporting the body in good alignment and changing the client's position are
recommended, but these measures are not likely to relieve pain.
Which of the following health teachings regarding sickle cell crisis should be included by the nurse?
a) it results from altered metabolism and dehydration
b) tissue hypoxia and vascular occlusion cause the primary problems
c) increased bilirubin levels will cause hypertension
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