SAUNDERS HESI PEDS
EXAM 1
The nurse is monitoring a child with burns during treatment for burn shock. Which
assessment provides the most accurate guide to determine the adequacy of fluid
resuscitation?
1. Skin turgor
2. Level of edema at burn site
3. Adequacy of capillary filling
4. Amount of fluid tolerated in 24 hours - CORRECT ANSWER-3
Parameters such as vital signs (especially heart rate), urinary output volume, adequacy
of capillary filling, and state of sensorium determine adequacy of fluid resuscitation.
Although options 1, 2, and 4 may provide some information related to fluid volume, in a
burn injury, and from the options provided, adequacy of capillary filling is most accurate.
The mother of a 3-year-old child arrives at a clinic and tells the nurse that the child has
been scratching the skin continuously and has developed a rash. The nurse assesses
the child and suspects the presence of scabies. The nurse bases this suspicion on
which finding noted on assessment of the child's skin?
1. Fine grayish red lines
2. Purple-colored lesions
3. Thick, honey-colored crusts
4. Clusters of fluid-filled vesicles - CORRECT ANSWER-1
Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch
mite). Scabies appears as burrows or fine, grayish red, threadlike lines. They may be
difficult to see if they are obscured by excoriation and inflammation. Purple-colored
lesions may indicate various disorders, including systemic conditions. Thick, honey-
colored crusts are characteristic of impetigo or secondary infection in eczema. Clusters
of fluid-filled vesicles are seen in herpesvirus infection.
Permethrin is prescribed for a child with a diagnosis of scabies. The nurse should give
which instruction to the parents regarding the use of this treatment?
1. Apply the lotion to areas of the rash only.
2. Apply the lotion and leave it on for 6 hours.
3. Avoid putting clothes on the child over the lotion.
4. Apply the lotion to cool, dry skin at least 30 minutes after bathing - CORRECT
ANSWER-4
,Permethrin is massaged thoroughly and gently into all skin surfaces (not just the areas
that have the rash) from the head to the soles of the feet. Care should be taken to avoid
contact with the eyes. The lotion should not be applied until at least 30 minutes after
bathing and should be applied only to cool, dry skin. The lotion should be kept on for 8
to 14 hours, and then the child should be given a bath. The child should be clothed
during the 8 to 14 hours of treatment contact time.
The school nurse has provided an instructional session about impetigo to parents of the
children attending the school. Which statement, if made by a parent, indicates a need
for further instruction?
1. "It is extremely contagious."
2. "It is most common in humid weather."
3. "Lesions most often are located on the arms and chest."
4. "It might show up in an area of broken skin, such as an insect bite." - CORRECT
ANSWER-3
Impetigo is a contagious bacterial infection of the skin caused by β-hemolytic
streptococci or staphylococci, or both. Impetigo is most common during hot, humid
summer months. Impetigo may begin in an area of broken skin, such as an insect bite
or atopic dermatitis. Impetigo is extremely contagious. Lesions usually are located
around the mouth and nose, but may be present on the hands and extremities.
The clinic nurse is reviewing the health care provider's prescription for a child who has
been diagnosed with scabies. Lindane has been prescribed for the child. The nurse
questions the prescription if which is noted in the child's record?
1. The child is 18 months old.
2. The child is being bottle-fed.
3. A sibling is using lindane for the treatment of scabies.
4. The child has a history of frequent respiratory infections - CORRECT ANSWER-1
Lindane is a pediculicide product that may be prescribed to treat scabies. It is
contraindicated for children younger than 2 years because they have more permeable
skin, and high systemic absorption may occur, placing the children at risk for central
nervous system toxicity and seizures. Lindane also is used with caution in children
between the ages of 2 and 10 years. Siblings and other household members should be
treated simultaneously. Options 2 and 4 are unrelated to the use of lindane. Lindane is
not recommended for use by a breast-feeding woman because the medication is
secreted into breast milk
A topical corticosteroid is prescribed by the health care provider for a child with atopic
dermatitis (eczema). Which instruction should the nurse give the parent about applying
the cream?
1. Apply the cream over the entire body.
,2. Apply a thick layer of cream to affected areas only.
3. Avoid cleansing the area before application of the cream.
4. Apply a thin layer of cream and rub it into the area thoroughly. - CORRECT
ANSWER-4
Atopic dermatitis is a superficial inflammatory process involving primarily the epidermis.
A topical corticosteroid may be prescribed and should be applied sparingly (thin layer)
and rubbed into the area thoroughly. The affected area should be cleaned gently before
application. A topical corticosteroid should not be applied over extensive areas.
Systemic absorption is more likely to occur with extensive application.
The school nurse is performing pediculosis capitis (head lice) assessments. Which
assessment finding indicates that a child has a "positive" head check?
1. Maculopapular lesions behind the ears
2. Lesions in the scalp that extend to the hairline or neck
3. White flaky particles throughout the entire scalp region
4. White sacs attached to the hair shafts in the occipital area - CORRECT ANSWER-4
Pediculosis capitis is an infestation of the hair and scalp with lice. The nits are visible
and attached firmly to the hair shaft near the scalp. The occiput is an area in which nits
can be seen. Maculopapular lesions behind the ears or lesions that extend to the
hairline or neck are indicative of an infectious process, not pediculosis. White flaky
particles are indicative of dandruff.
The nurse caring for a child who sustained a burn injury plans care based on which
pediatric considerations associated with this injury? (SELECT ALL THAT APPLY.)
1. Scarring is less severe in a child than in an adult.
2. A delay in growth may occur after a burn injury.
3. An immature immune system presents an increased risk of infection for infants and
young children.
4. Fluid resuscitation is unnecessary unless the burned area is more than 25% of the
total body surface area.
5. The lower proportion of body fluid to body mass in a child increases the risk of
cardiovascular problems.
6. Infants and young children are at increased risk for protein and calorie deficiency
because they have smaller muscle mass and less body fat than adults. - CORRECT
ANSWER-2, 3, 6
Pediatric considerations in the care of a burn victim include the following: Scarring is
more severe in a child than in an adult. A delay in growth may occur after a burn injury.
An immature immune system presents an increased risk of infection for infants and
young children. The higher proportion of body fluid to body mass in a child increases the
risk of cardiovascular problems. Burns involving more than 10% of total body surface
area require some form of fluid resuscitation. Infants and young children are at
, increased risk for protein and calorie deficiencies because they have smaller muscle
mass and less body fat than adults
The nurse analyzes the laboratory results of a child with hemophilia. The nurse
understands that which result will most likely be abnormal in this child?
Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific
coagulation proteins. Results of tests that measure platelet function are normal; results
of tests that measure clotting factor function may be abnormal. Abnormal laboratory
results in hemophilia indicate a prolonged partial thromboplastin time. The platelet
count, hemoglobin level, and hematocrit level are normal in hemophilia.
The nurse is providing home care instructions to the parents of a 10-year-old child with
hemophilia. Which sport activity should the nurse suggest for this child?
1. Soccer
2. Basketball
3. Swimming
4. Field hockey - CORRECT ANSWER-3
Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific
coagulation proteins. Children with hemophilia need to avoid contact sports and to take
precautions such as wearing elbow and knee pads and helmets with other sports. The
safe activity for them is swimming.
The nursing student is presenting a clinical conference and discusses the cause of β-
thalassemia. The nursing student informs the group that a child at greatest risk of
developing this disorder is which of these?
1. A child of Mexican descent
2. A child of Mediterranean descent
3. A child whose intake of iron is extremely poor
4. A breast-fed child of a mother with chronic anemia - CORRECT ANSWER-2
β-Thalassemia is an autosomal recessive disorder characterized by the reduced
production of 1 of the globin chains in the synthesis of hemoglobin (both parents must
be carriers to produce a child with β-thalassemia major). This disorder is found primarily
in individuals of Mediterranean descent. Options 1, 3, and 4 are incorrect.
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