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PEDS HESI Final Exam
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PEDS HESI Final ExamAn infant with developmental dysplasia of the hip is placed in a Pavlik harness. Which 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 the harness for maximum effectiveness.
c-Check for red areas under the straps two to three times a day.
d-Use a thin absorbent disposable diaper over the harness. - ANS c. 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. To avoid direct contact with the skin, clothing and diapers should be placed under the straps.
The nurse calculates a 4 mL dose of prescribed digoxin to a 9-month-old infant. Which action should
the nurse implement?
a Mix the dose with juice to disguise its taste.
b Suspect a dosage error and do not give the dose.
c Check the infant's heart rate and administer the dose by placing it to the back and side of the
mouth.
d Check the infant's heart rate and administer the dose by letting the infant suck it through a nipple.
- ANS b, Digoxin's narrow margin of safety for an infant should not exceed 1 mL (50 mcg) in one
dose. The nurse's calculation indicates a dosage error and should not be given. Digoxin is given
without mixing with any other fluids or foods because the infant may refuse to consume the total
amount, which results in an inaccurate drug dose. Generally, pediatric digoxin elixir is available as
0.05 mg/mL. Great care must be taken in dosage calculation and should be double-checked with
another nurse prior to administration.
***A 12yo m tells the nurse that he is happy to be taking GH cuz now he can grow to be as tall, best
for the nurse to provide?
a "You must remember that this treatment regimen is not always effective."
,b "Although being tall is important to you, remember there are far more important characteristics
than height."
c You will grow with this medicine, and are likely to be taller than anyone in your family."
d "Being taller is important to you and taking your injections will help achieve that goal." - ANS d, It is
important to validate his feelings and reinforce the fact that injections are the only way he can get
the medication and achieve growth in height. He will have to take injections three times a week for
years.
1****4 yo after corrective surgery for scoliosis. In the immediate postoperative period, the nurse
should include which action in this client's plan of care? (Select all that apply.)
a Record intake and output every 8 hours.
b Elevate the head of the bed 30 degrees.
c Assess bowel sounds every 4 hours.
d Initiate a logrolling schedule every 2 hours.
e Ambulate for 5 minutes, 12 hours postoperative.
f Give morphine sulfate, 2 mg IV every 4 hours PRN. - ANS a,d,f, Recording intake and output and
assessing bowel sounds are critical when determining if the body systems are recovering from the
effects of anesthesia. Using a logrolling technique to turn the client maintains spinal alignment
postoperatively and prevents complications of immobility. Since this is a painful surgery, the nurse
should maintain pain control as prescribed. The pain associated is not just due to the incisions of
surgery, but also to the manipulation and placement of the spinal hardware and muscular pain as
the involved muscles adjust to the corrective realignment of the spine. Following corrective surgery
for scoliosis, a client should be immobilized without spinal flexion for 24 to 48 hours, and then
ambulated by the physical therapist.
****The parents of an adolescent male with Ewing sarcoma ask the nurse what is the most
significant factor contributing to their son's prognosis. Which factor should the nurse include when
answering the parent's concern?
a Age of onset.
b Gender of child.
c Appearance on x-ray.
d Degree of metastasis. - ANS d Ewing sarcoma is the second most common malignant bone tumor
of children. Prognosis is most significantly related to the degree of metastasis during the early
course of the disease.
***A 6-year-old child is brought to the emergency department with a systolic blood pressure of 58
mmHg. What action should the nurse take first?
, a Comfort the child.
b Assess responsiveness.
c Alert the healthcare provider.
d Initiate IV fluid replacement. - ANS c the lower limit for systolic blood pressure for a child older
than 1 year of age is 70 mmHg plus 2 times the child's age in years. The healthcare provider should
be notified immediately of the child's hypotension and anticipate a prescription for IV fluids.
****The parents of a toddler brought well-child visit tell the nurse that the child becomes upset if
even the smallest things change in the environment. What info should the nurse provide ?
a A child is insecure because trust is not fostered and developed during infancy.
b A toddler should be exposed to different routines to promote adapting to new experiences.
c Children of this age are comfortable with ritualism and display global thinking.
d Objects should be frequently moved in the env to teach - ANS c A 2-year-old is ritualistic and wants
consistency and routine. Changes in the toddler's environment or schedule is upsetting. Another
mark of the toddlers' sensitivity to change is global thinking. When there is a change in one small
part of the environment, such as a minor shift in room arrangement, or changes in the whole
environment, the 2-year-old's composure disintegrates.
A child with a penetrating eye injury comes to the school clinic. Which action should the nurse
implement?
a Remove the object impaled in the eye and then apply a regular eye patch.
b Place an ice bag over the eye until the healthcare provider is seen.
c Irrigate the affected eye copiously with a cool sterile saline solution.
d Apply a Fox shield to the affected eye and any type of patch to the other eye. - ANS d The
treatment for a penetrating eye injury is not to remove or manipulate the impaled object, but to
apply a Fox shield over the eye, if available (not a regular eye patch). Place an eye patch over the
unaffected eye to prevent bilateral eye movement. The child should be transported to the
emergency department immediately. If a Fox shield is not available, tape a paper cup over the eye
and object.
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 percentiles. 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.
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