HESI MILESTONE 2 EXAM | 100%
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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 parents?
- Correct Answer - This is an inherited X-linked recessive
disorder, which primarily affects male children in the family
A 4-year-old boy was recently diagnosed with Duchenne muscular
dystrophy (DMD). Which characteristic of the disease is most
important for the nurse to focus on during the initial teaching?
- Correct Answer - Lower legs become progressively weaker,
causing waddling, unsteady gait
Duchenne muscular dystrophy
,- Correct Answer - Duchenne muscular dystrophy appears in
early childhood (ages 3 to 5 years) (children appear normal at
birth until signs and symptoms of the disease manifest).
By the age of 9 to 11 years old, the child loses the ability to walk
independently.
Life expectancy generally in the third decade
Febrile seizures teaching
- Correct Answer - febrile seizures: reassure parents febrile
seizures will go away use seizure precautions, call 911 if lasts
more than 5 minutes
The nurse is caring for an infant who was recently diagnosed with
a congenital heart defect. Which assessment finding is most
important for the nurse to report to the healthcare provider?
- Correct Answer - Weight gain of 2.2 lbs (1kg) in last 48 hours
Which of the following should the nurse expect to note as a
frequent complication for a child with congenital heart disease?
- Correct Answer - Susceptibility to respiratory infection
,In making the initial assessment of a 2-hour-old infant, which
finding should lead the nurse to suspect a congenital heart
defect?
- Correct Answer - Diminished femoral pulses
RSV distress
- Correct Answer - RSV: Private room, not airborne - transferred
via hand (no mask is needed) - Standard precautions. Cool mist
via tent.
Do not expose other children to RSV, it is very contagious even
without direct contact
Look for nasal flaring
Pyloric stenosis symptoms
- Correct Answer - olive shaped mass may be visible
Mass in the upper right abdominal quadrant, shaped like an olive.
S/s:- RUQ sausage shaped mass
- vomiting/ Note Degree of forcefulness of vomiting episodes
, - bloody mucus stool
fever
weight loss
The 6-week-old infant diagnosed with pyloric stenosis has
recently developed projectile vomiting. Which assessment finding
indicates to the nurse that the infant is becoming dehydrated?
- Correct Answer - Weak cry without any tears.
The nurse is assessing an infant with pyloric stenosis. Which
pathophysiological mechanism is the most likely consequence of
this infant's clinical picture?
- Correct Answer - metabolic alkalosis (from the forceful
vomiting)
The nurse is preparing a child with an intussusception for a
prescribed barium enema. What is the main purpose of
conducting this procedure prior to surgical intervention?
- Correct Answer - Reduce the invaginated bowel segment.
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