Pediatrics - HESI : PN EXAM QUESTIONS AND ANSWERS 2022

Pediatrics - HESI : PN EXAM QUESTIONS AND ANSWERS 2022 A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? a. Dorsal gluteal b. Vastus lateralis c. Ventral gluteal d. Deltoid - CORRECT ANSWERb. Vastus lateralis Rationale: The preferred intramuscular site for children younger than 2 years of age is the vastus lateralis. A 2-year-old child developed a fever of 103.4° F (39.7° C) and was rushed to the emergency department when the child developed febrile seizures. After the child was stabilized, the health care provider diagnosed otitis media in the child. The concerned caregivers ask the nurse how this can be prevented from happening again. The nurse should reinforce which instructions? a. Contact the child's health care provider if the child starts pulling at the ear. b. If the child develops an elevated temperature, bathe the child in cold water. c. Give the child a bottle to take while in the supine position to relieve the pain. d. Use children's chewable baby aspirin if the child's temperature is over 102° F (38.9° C). - CORRECT ANSWERa. Contact the child's health care provider if the child starts pulling at the ear. Rationale: The parents should be taught to contact the health care provider if the child begins to pull at the ears, an early sign of otitis media. Treating otitis media early can reduce the risk of a high temperature and a resulting febrile seizure. If the child develops an elevated temperature, the child should be bathed in tepid water, not cold water or rubbing alcohol. Taking a bottle in the supine position is not recommended because this increases the risk of developing otitis media. Children should be given acetaminophen as prescribed for pain and fever. Aspirin is not recommended in children due to the risk of Reyes syndrome, a serious neurological disorder. Unfortunately, pleasantly flavored children's chewable aspirin is sometimes described or labeled as "baby aspirin." A 2-year-old child had tympanostomy ventilating tubes inserted into both tympanic membranes (TMs) 1 week earlier. During a postoperative clinic visit, the practical nurse (PN) notes that the child has a purulent discharge from the right ear, and the mother explains that the toddler has had a cold for 3 days. What action should the PN plan to implement? a. Collect a specimen of the otorrhea for culture. b. Refer the child for audiologic screening tests. c. Administer prescribed antibiotics. d. Perform an otoscopic exam for TM tube placement. - CORRECT ANSWERa. Collect a specimen of the otorrhea for culture. Rationale: The presence of the purulent drainage indicates that the middle ear is draining a new infectious process, and a specimen of the otorrhea should be collected for culture. Tympanostomy tubes are surgically placed to manage otitis media with effusion (OME) to provide mechanical drainage of fluid and to equalize pressure within the middle ear. Chronic OME can impede TM and ossicle function, necessitating hearing screening. The immediate problem, however, is infection. A 2-year-old child who is hospitalized with an acute upper respiratory infection (URI) is crying uncontrollably because her mother went to the cafeteria for lunch. Which action should the practical nurse implement? a. Distract the child with a favorite toy. b. Tell the child that her mother will return. c. Take the child to the cafeteria. d. Calm the child with a dietary treat. - CORRECT ANSWERA) Distract the child with a favorite toy. Rationale: The best action is to refocus the child's attention by distracting with a favorite toy. 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. - CORRECT ANSWERb. 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. A 5-year-old children tells the practical nurse (PN) that she "needs a Band-Aid" when she has an injection. Which action is best for the PN to take? a. Show her that the bleeding has already stopped. b. Explain why a Band-Aid is not needed. c. Ask her why she wants a Band-Aid. d. Apply a Band-Aid over the injection site. - CORRECT ANSWERD) Apply a Band-Aid over the injection site. Rationale: Preschool children sometimes think that any hole (e.g., an injection or incision) made in their bodies allow their "insides to leak out," so applying a Band-Aid over the hole prevents this from occurring. A 6-year-old child arrives to the urgent care center with symptoms of an asthma exacerbation. The child's oxygen saturation is 90%, the pulse is 120 beats/min, and the respiratory rate 32 per minute. The nurse should prepare for which priority intervention? a. Administration of a long-acting bronchodilator b. Monitoring for signs of an infection masked by steroid use c. Administration of oxygen and subcutaneous injection of epinephrine d. Reviewing with the caregivers the possible triggers for an exacerbation of asthma - CORRECT ANSWERc. Administration of oxygen and subcutaneous injection of epinephrine Rationale: The priority of care for an acute asthma attack is oxygen administration and administration of epinephrine, which is a rapid-acting bronchodilator. After the acute attack has subsided, and the child's respiratory status is stable, the nurse can anticipate administration of a long-acting bronchodilator. Monitoring for signs of an infection is important, but the immediate priority is oxygen administration and use of a rapid-acting bronchodilator. Education regarding asthma triggers is also crucial, but should take place after the child is stable. 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 - CORRECT ANSWERA) Rheumatic heart disease