Exam (elaborations)
HESI Pediatrics Exam 2024/2025 Questions With Completed & Verified Solutions.
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HESI Pediatrics Exam 2024/2025 Questions With Completed & Verified Solutions.
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HESI PediatricsA child has been treated in the emergency department for a fractured distal radius. The nurse
has reinforced instructions for care of the cast at home. The nurse realizes additional instruction
is needed if the caregiver makes which comments? (Select all that apply.)
a. "It is normal for the child to not be able to move the fingers very well after the cast is applied."
b. "If my child is itching under the cast, I can use sterile cotton tipped applicators under the cast
to scratch it."
c. "If my child's arm is hurting so badly, and pain meds have not worked, I should bring the child
back to the emergency department."
d. "If my child's fingers begin to be cold or blue, I should try to wrap up his fingers in some warm
clothes."
e. "I will need to make sure the child does not get the cast wet, I can use plastic wrap around
the cast for bathing." - ANS a. "It is normal for the child to not be able to move the fingers very
well after the cast is applied."
b. "If my child is itching under the cast, I can use sterile cotton tipped applicators under the cast
to scratch it."
d. "If my child's fingers begin to be cold or blue, I should try to wrap up his fingers in some warm
cloths."
Rationale:
The parents should be educated that not being able to move the fingers after cast application
indicates possible compartment syndrome and potential damage to nerves and vessels of the
arm. Extreme pain not relieved by analgesics, or cold, blue fingers also indicate possible
compartment syndrome. If compartment syndrome is suspected, the nurse should contact the
health care provider immediately. The child should not insert any object under the cast because
this can cause an infection in the irritated skin area. Parents should be instructed to keep the
cast dry while bathing.
A 7-year-old child is diagnosed with a streptococcal infection of the throat (strept throat). The
parent asks the nurse "Why does my child need to take antibiotics? His sister had a sore throat
last month and all she took was acetaminophen and diphenhydramine." The nurse responds by
explaining that "strept throat" is associated with which complications? (Select all that apply.)
a. Rheumatic heart disease
b. Ventral septal defects
c. Complete heart block
d. Nephrotic syndrome
e. Acute glomerulonephritis
f. Vesicoureteral reflux - ANS a. Rheumatic heart disease
e. Acute glomerulonephritis
Rationale:
"Strept throat" is a serious streptococcal infection which can lead to serious complications such
as rheumatic heart disease and acute glomerulonephritis. Ventral septal defects are congenital.
,Complete heart block is a dysrhythmia not associated with strept throat. Nephrotic syndrome
often has an idiopathic causation. Vesicoureteral reflux is frequently congenital.
The practical nurse (PN) has reviewed signs and symptoms of congestive heart failure with the
parents of a 2-year-old child with a congenital heart defect. The nurse realizes the education
has been effective if the parents identify which behavior as most important for the parents to
report to the health care provider?
a. Sits or squats frequently when playing outdoors.
b. Exhibits a sudden and unexplained weight gain.
c. Is not completely toilet trained and has some "accidents."
d. Demonstrates irritation and fatigue 1 hour before bedtime. - ANS b. Exhibits a sudden and
unexplained weight gain.
Rationale:
Sudden and unexplained weight gain can indicate fluid retention and is a sign of congestive
heart failure.
The practical nurse (PN) is caring for a child with an acute respiratory condition. When the PN is
monitoring for impending respiratory distress, what sign is the child likely to exhibit first?
a. Cyanosis
b. Sternal retraction
c. Restlessness
d. Crowing respiration - ANS c. Restlessness
Rationale:
Restlessness is an early sign of hypoxemia.
A 3 day infant has had surgery to reconstruct the anus due to an anorectal malformation noted
at birth. The nurse will implement which aspect of postoperative care?
a. Assess the child's temperature rectally every 4 hours.
b. Position the child side-lying prone with the hips elevated.
c. Inform the parents toilet training should begin on schedule.
d. Passing stools in the urine is expected to occur after surgery. - ANS b. Position the child
side-lying prone with the hips elevated.
Rationale:
The child should be positioned in the side-lying prone position with the hips elevated to
decrease pressure on the perineal sutures. No rectal temperatures should be taken
postoperatively, because this could disrupt the sutures. Toilet training is frequently delayed and
full continence may not be achieved. It is not normal for the child to pass stools in the urine.
The health care provider prescribes amoxicillin 60 mg PO three times a day for a child who
weighs 13 pounds. The pediatric dosage range is 20 to 40 mg/kg/day in three equal doses.
What is the maximum dosage in 24 hours that should be given? (Fill in the blank.) - ANS
The practical nurse (PN) is caring for a child with Wilms' tumor. Which preoperative intervention
should the PN implement?
, a. Gently percuss the abdomen for evidence of trapped air.
b. Observe the abdomen for any noticeable discolorations.
c. Apply cold compresses to the abdomen to reduce edema.
d. Put a sign above the bed reading, "Do not palpate abdomen." - ANS d. Put a sign above the
bed reading, "Do not palpate abdomen."
Rationale:
Prevention of abdominal palpation minimizes the risk of rupturing the encapsulated tumor and
subsequent metastasis.
The practical nurse (PN) is taking the temperature of a 5-year-old child with otitis media. During
the previous 24 hours, the child's temperature readings have ranged from 101.2° F oral to 102°
F tympanic. Which statement accurately evaluates these findings and should be considered
when planning care for the remainder of the shift?
a. The PN should confer with the nursing staff about the temperature method to use.
b. A tympanic temperature and an oral temperature are equally accurate techniques in
evaluating the child's fever.
c. A rectal temperature should be taken q4h to evaluate effectively the clinical course of the
fever.
d. The pediatrician should be notified of the variances in the oral and tympanic readings. - ANS
b. A tympanic temperature and an oral temperature are equally accurate techniques in
evaluating the child's fever.
Rationale:
Tympanic readings obtained using proper technique correlated moderately to strongly with oral
temperatures in recent research studies. A tympanic membrane sensor approximates core
temperatures because the same circulation perfuses the hypothalamus and eardrum. The
sensor is unaffected by cerumen or the presence of suppurative or unsuppurative otitis media.
The nurse has reinforced instructions for a child who has been hospitalized with a sickle cell
crisis. The nurse realizes the instruction has been effective if the parents make which
statements? (Select all that apply.)
a. "If my child's joints are swollen and painful, I should apply ice."
b. "My child keeps wetting the bed, so I should restrict fluid intake."
c. "I will ask the physical education teacher allow extra fluid intake while exercising."
d. "If my child is having a crisis, morphine intravenously is likely going to be necessary."
e. "If we are planning any trips, we need to make sure we do not travel to any high altitudes." -
ANS c. "I will ask the physical education teacher allow extra fluid intake while exercising."
d. "If my child is having a crisis, morphine intravenously is likely going to be necessary."
e. "If we are planning any trips, we need to make sure we do not travel to any high altitudes."
Rationale:
A child with sickle cell disease should have additional fluids while exercising. During a crisis,
parenteral morphine is likely necessary. The child should not travel to high altitude areas, due to
decreased oxygenation. If the child's joints are painful, warmth, not ice packs, should be
applied. Even though bedwetting is occurring, additional fluids are still necessary to treat and
prevent a crisis.
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