HESI PEDIATRICS
(Resources of detail solutions and Complete Exam Questions Answers)
1. When caring for a child with congenital heart disease and polycythemia, which nursing action has the highest
priority?
A. Administering oxygen therapy continuously
B. Restricting fluids as ordered
C. Maintaining adequate hydration
D. Maintaining digoxin levels
Rationale:
The key word in this question is polycythemia. Hydration decreases blood viscosity and the risk for thrombus
formation, the most common complication of polycythemia. Options A and D are nursing interventions for
the cardiac client but do not treat polycythemia. Fluid intake should be increased, not restricted.
2. The nurse is preparing a teaching plan for the mother of a child who has been diagnosed with celiac
disease. Choosing which lunch will be within the therapeutic management of a child with celiac disease?
A. Turkey salad, milk, and oatmeal cookies
B. Baked chicken, coleslaw, soda, and frozen fruit dessert
C. Tuna salad sandwich on whole wheat bread, milk, and ice cream
D. Turkey sandwich on rye bread, orange juice, and fresh fruit
Rationale:
A child with celiac disease is managed on a gluten-free diet, which eliminates food products containing oats, wheat,
rye, or barley.
3. A 7-month-old male infant diagnosed with spastic cerebral palsy is seen by the nurse in the clinic. Which
statement by the parent warrants immediate intervention by the nurse?
A. “My son often chokes while I am feeding him.”
B. “Is it normal for my child’s legs to cross each other?”
C. “He gets stiff when I pull him up to a sitting position.”
D. “My 4-year-old son is jealous of his little brother.”
Rationale:
Airway obstruction is always a priority when caring for any client. Options B and C are characteristics of spastic
cerebral palsy and may involve one or both sides. These children have difficulty with fine motor skills, and attempts
at motion increase abnormal postures. Option D is an expected behavior and may need to be addressed, but it is not
a priority over choking.
4. A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. During the
initial nursing assessment, which symptoms will this child most likely exhibit? (Select all that apply.)
A. Bone pain
B. Tremors
C. Nystagmus
D. Abdominal distention
E. Pallor
Rationale:
Options A and E list the most common presenting symptoms of leukemia. Leukemic cells invade the bone marrow,
gradually causing a weakening of the bone and a tendency toward pathologic fractures. As leukemic cells invade the
periosteum, increasing pressure causes severe pain and anemia results from decreased erythrocytes, causing pallor.
Options B and C could be associated with central nervous system disorders. Option D commonly occurs in children
but is not specific for leukemia.
5. The nurse is caring for a child with intussusception who is scheduled for a barium enema prior to a
surgical procedure. Which action should the nurse take first?
A. Evacuate the bowel of impacted feces.
, B. Administer magnesium sulfate.
C. Place the child on a clear liquid diet.
D. Assess the stool for white color.
Rationale:
Intussusception, an invagination or telescoping of one portion of the intestine into another, causes intestinal
obstruction in children (usually occurs between 3 months and 5 years of age). Nonsurgical treatment is attempted
with hydrostatic pressure created by barium instillation, which often reduces the area of bowel intussusception. In
preparation for a barium enema, the client should first be placed on a clear liquid diet for the entire day; then
magnesium sulfate is administered for bowel evacuation. A barium enema is likely to cause option A. After the
enema, white stool may be seen as the body naturally removes any remaining barium.
6. The nurse should teach the parents of a child with a cyanotic heart defect to perform which action when
a hypercyanotic spell occurs?
A. Place the child’s head flat, with the knees on pillows above the
level of the heart.
B. Have the child lie on the right side, with the head elevated on one
pillow.
C. Allow the child to assume a knee-chest position, with the head
and chest slightly elevated.
D. Encourage the child to sit up at a 45-degree angle, drink cold water,
and take deep breaths.
Rationale:
Assuming a knee-chest position with the head and chest slightly elevated will help restore hemodynamic
equilibrium. Options A and B are incorrect positions and may hinder the child’s condition. Option D may cause
chest pain or a vasovagal response, with resulting hypotension.
7. The nurse is teaching the parents of a 2-year-old child with a congenital heart defect about signs and symptoms
of congestive heart failure. Which information about the child is 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
Rationale:
Sudden and unexplained weight gain can indicate fluid retention and is a sign of congestive heart failure. Option A is
used by the child to reduce chronic hypoxia, especially during exercise. Option C is common; 2-year-olds are not
expected to be toilet-trained. Option D is normal.
8. Prophylactic antibiotics are prescribed for a child who has mitral valve damage. The nurse should advise
the parents to give the antibiotics prior to which occurrence?
A. Adjustment of orthodontic appliances or braces
B. Loss of deciduous teeth (baby teeth)
C. Urinary catheterization
D. Insect bites
Rationale:
Prophylactic antibiotics are usually prescribed prior to any invasive procedure for children who have valvular
damage. Of the choices listed, only urinary catheterization is an invasive procedure. Options A, B, and D are not
invasive and do not require administration of prophylactic antibiotics.
9. A 7-month-old infant with a rotavirus causing severe diarrhea is admitted for treatment. Which action should
the nurse take first?
A. Obtain a scale to weigh the infant’s diapers.
B. Instruct the mother to offer Pedialyte regularly.
(Resources of detail solutions and Complete Exam Questions Answers)
1. When caring for a child with congenital heart disease and polycythemia, which nursing action has the highest
priority?
A. Administering oxygen therapy continuously
B. Restricting fluids as ordered
C. Maintaining adequate hydration
D. Maintaining digoxin levels
Rationale:
The key word in this question is polycythemia. Hydration decreases blood viscosity and the risk for thrombus
formation, the most common complication of polycythemia. Options A and D are nursing interventions for
the cardiac client but do not treat polycythemia. Fluid intake should be increased, not restricted.
2. The nurse is preparing a teaching plan for the mother of a child who has been diagnosed with celiac
disease. Choosing which lunch will be within the therapeutic management of a child with celiac disease?
A. Turkey salad, milk, and oatmeal cookies
B. Baked chicken, coleslaw, soda, and frozen fruit dessert
C. Tuna salad sandwich on whole wheat bread, milk, and ice cream
D. Turkey sandwich on rye bread, orange juice, and fresh fruit
Rationale:
A child with celiac disease is managed on a gluten-free diet, which eliminates food products containing oats, wheat,
rye, or barley.
3. A 7-month-old male infant diagnosed with spastic cerebral palsy is seen by the nurse in the clinic. Which
statement by the parent warrants immediate intervention by the nurse?
A. “My son often chokes while I am feeding him.”
B. “Is it normal for my child’s legs to cross each other?”
C. “He gets stiff when I pull him up to a sitting position.”
D. “My 4-year-old son is jealous of his little brother.”
Rationale:
Airway obstruction is always a priority when caring for any client. Options B and C are characteristics of spastic
cerebral palsy and may involve one or both sides. These children have difficulty with fine motor skills, and attempts
at motion increase abnormal postures. Option D is an expected behavior and may need to be addressed, but it is not
a priority over choking.
4. A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic leukemia. During the
initial nursing assessment, which symptoms will this child most likely exhibit? (Select all that apply.)
A. Bone pain
B. Tremors
C. Nystagmus
D. Abdominal distention
E. Pallor
Rationale:
Options A and E list the most common presenting symptoms of leukemia. Leukemic cells invade the bone marrow,
gradually causing a weakening of the bone and a tendency toward pathologic fractures. As leukemic cells invade the
periosteum, increasing pressure causes severe pain and anemia results from decreased erythrocytes, causing pallor.
Options B and C could be associated with central nervous system disorders. Option D commonly occurs in children
but is not specific for leukemia.
5. The nurse is caring for a child with intussusception who is scheduled for a barium enema prior to a
surgical procedure. Which action should the nurse take first?
A. Evacuate the bowel of impacted feces.
, B. Administer magnesium sulfate.
C. Place the child on a clear liquid diet.
D. Assess the stool for white color.
Rationale:
Intussusception, an invagination or telescoping of one portion of the intestine into another, causes intestinal
obstruction in children (usually occurs between 3 months and 5 years of age). Nonsurgical treatment is attempted
with hydrostatic pressure created by barium instillation, which often reduces the area of bowel intussusception. In
preparation for a barium enema, the client should first be placed on a clear liquid diet for the entire day; then
magnesium sulfate is administered for bowel evacuation. A barium enema is likely to cause option A. After the
enema, white stool may be seen as the body naturally removes any remaining barium.
6. The nurse should teach the parents of a child with a cyanotic heart defect to perform which action when
a hypercyanotic spell occurs?
A. Place the child’s head flat, with the knees on pillows above the
level of the heart.
B. Have the child lie on the right side, with the head elevated on one
pillow.
C. Allow the child to assume a knee-chest position, with the head
and chest slightly elevated.
D. Encourage the child to sit up at a 45-degree angle, drink cold water,
and take deep breaths.
Rationale:
Assuming a knee-chest position with the head and chest slightly elevated will help restore hemodynamic
equilibrium. Options A and B are incorrect positions and may hinder the child’s condition. Option D may cause
chest pain or a vasovagal response, with resulting hypotension.
7. The nurse is teaching the parents of a 2-year-old child with a congenital heart defect about signs and symptoms
of congestive heart failure. Which information about the child is 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
Rationale:
Sudden and unexplained weight gain can indicate fluid retention and is a sign of congestive heart failure. Option A is
used by the child to reduce chronic hypoxia, especially during exercise. Option C is common; 2-year-olds are not
expected to be toilet-trained. Option D is normal.
8. Prophylactic antibiotics are prescribed for a child who has mitral valve damage. The nurse should advise
the parents to give the antibiotics prior to which occurrence?
A. Adjustment of orthodontic appliances or braces
B. Loss of deciduous teeth (baby teeth)
C. Urinary catheterization
D. Insect bites
Rationale:
Prophylactic antibiotics are usually prescribed prior to any invasive procedure for children who have valvular
damage. Of the choices listed, only urinary catheterization is an invasive procedure. Options A, B, and D are not
invasive and do not require administration of prophylactic antibiotics.
9. A 7-month-old infant with a rotavirus causing severe diarrhea is admitted for treatment. Which action should
the nurse take first?
A. Obtain a scale to weigh the infant’s diapers.
B. Instruct the mother to offer Pedialyte regularly.
