HESI RN PEDIATRICS NG QUESTIONS&ANSWERS THIS DOCUMENT CONTAINS NEXT GEN QUESTIONS WITH CASE STUDIES 2023

HESI RN PEDIATRICS NG QUESTIONS&ANSWERS THIS DOCUMENT CONTAINS NEXT GEN QUESTIONS WITH CASE STUDIES 2023 1. An 8-year-old boy is admitted to the hospital with a diagnosis of sickle cell crisis and pneumonia. He complains of pain in his legs and abdomen, wheezing, and pain in his chest. He has a history of asthma, epilepsy, and is allergic to peanuts,tomatoes, and aspirin. He is 40 inches tall and weighs 55 pounds. Vital signs are: T 102 degrees F, BP 90/66, P 112, R 30. Chest X-ray confirms right upper lobe pneumonia, and a throat culture is positive for Group A streptococcus. His ordersinclude the following: Bed rest Diet as tolerated, encouragePOfluids Fluid bolusD5½NS at 20 mL/kg over1 hr followed by IV D5½NS at 110 mL/hr Morphine sulfate 0.075 mg/kg/h IV Penicillin G 100,000 units/kg/day divided doses q6h. Add to in 100 mL D5W and infuse over 1 hr Methylprednisolone 1mg/kg IM now,then 1 mg/kg PO in the morning FloventHFA (fluticasonepropionate) inhalation aerosol2puffs bid Folicacid 1 mg po daily Depakene (valproic acid) 30mg/kg PO bid Tylenol (acetaminophen) 12mg/kg POq4h prn fortemp over101 Montelukast 5mg PO qhs Albuterol 2mgPO tid A. Calculate the child’s 24-hourfluidrequirement. - (100 x 10) + (50 x 10) + (20 x 35) = 1000 + 500 + 700 = 2200 - The child’s 24-hourfluid requirementis 2200 mL. B. The firstthing the nurse will do isset up the IV fluids. a) Calculate the amount of IV fluids the child will receive in the bolus - 25 kg x 20 mL/kg = 500 mL b) What rate will the nurse set the pump at inmL/hr to infuse the bolus? - The nurse willsetthe pump to 500 mL perhour. C. What rate will the nurse set the pump to infuse the penicillinG? - 100,000 units x 25 kg = 2,500,000 units/kg/day - 2,500,000 units/kg/daydivided by 4= 625,000 units/kg perdose - The nurse willsetthe pump to infuse 100 mL an hour. D. The recommended doseformorphine is 0.05-0.1mg/kg IV q4h. Isthe prescribed dose safe? - Yes, the prescribed dose is safe because it is 0.075 mg/kg/h IV, which is between 0.05 and 0.1 mg/kg. E. Methylprednisolone comes in a single dose vial in the concentration 40 mg/mL. How many mL of methylprednisolonewill the nurse administerforthe IM dose? - 1 mg/kg x 25 kg = 25 mg/kg/day - 25 mg / 40 mg = 0.625 mL – 0.6 mL - The nurse will administer 0.6mL F. Regarding the valproicacid: a) Selectthe correct label for valproicacid and write it below. - 250 mg b) Howmany capsules ofthismedicationwill the nurse administer? - 30 mg/kg x 25 mg = 750 mg - 750 mg / 250 mg = 3 - The nurse will administer 3capsules G. The folicacid is available in 1mg tablets. Howmanymicrogramsisthe child receiving perday? - The child isreceiving 1,000 mcg in the 1 mg tablet H. Regarding the montelukast: a) Selectthe correctlabel formontelukast and write it below. - Montelukast 5mg tablets b) How many tablets ofthis medication will the nurse administer? - The nurse will administer 1tablet H. The Tylenol available islabeled 160 mg/5 mL.How manymL will the nurse administer? - Tylenol (acetaminophen) 12mg/kg PO q4h prn for temp over101 = 12 mg/kg x 25 kg = 300 mg - 300 mg x 5mL / 160 mg = 9.375 mL – 9.4 mL - The nurse will administer 9.4mL I. Albuterolsulfate comesin 2mg/5mL syrup. How manymL will the nurse administer daily? - The nurse will administer 15mL daily. J. The strength ofthe Floventis 44 mcg/inhalation. Howmanymcg isthe child receiving perday? - The child isreceiving 2pumps perday - 44 mcg x 2 pumps = 88 mcg perdose - 88 mcg x 2 = 176 mcg perday 2. The nurse is developing the plan of care for a hospitalized child with von Willebrand disease. What priority nursing intervention should be included in this child’s plan of care? Guard against bleeding injuries 3. How should then nurse instructthe parents of a4-month-old with seborrheicdermatitis(cradle cap) to shampoo the child’s hair? use a soft brush and gently scrub the area 4. The motherof a one-month-old callsthe clinic to report that the back of her infant’s head isflat.How should the nurse respond? Position the infant on the stomach occasionallywhen awakeand active 5. A 7-year-old child is admitted to the hospital with acute glomerulonephritis (AGN). When obtaining the nursing history which finding should the nurse expectto obtain? A recentstrep throatinfection 6. In assessing a10-year-old newly diagnosed with osteomyelitis,which information ismostforthe nurse to obtain? recentrecurrence of infection 7. A mother brings her 8-month-old baby boy to the clinic because he has been vomiting and had diarrhea forthe last 3 days. Which assessment ismore important for the nurse to make? Measure the infant's pulse. 8. Jesus is the first-born son of Roberto and Marie Valez. The parents are very excited about the birth of their new son. They have brought Jesus into their nurse practitioner today for his first examination 3 days after his birth. Jesus was 7 lbs 2 oz at birth and 19 in. His Apgar scores were 8 and 9. There were no complications with his mother’s pregnancy or his delivery. Jesus’ parents have noticed that he has lost some weight since coming home.Marie is breastfeeding Jesus and is concerned that she is doing somethingwrong. They also have severalquestions about Jesus. (LearningObjectives 1and 4) a. What can the nurse practitionertell Marie regarding her concerns aboutJesus’ weightloss? The practitioner should educate the family member regarding to newborns will lose up to 10% of their birth weight by 3 to 4 days of age. “ this is due to fluid shifts, loss of meconium, and limited intake , especially in infants who are breastfed” ( ATI, p.15). The nurse practitioner can assure the family members to not worry and continue with breast feeding method and the infant’s weight will be regained. b.What questionsshould the nurse practitioner ask regarding Jesus’ nutrition, and whatinformation can he orshe offertoMarie regarding breastfeeding? The nurse should ask the mother if she breast feeding her newborn. Ask the mother if she has any experience with pumping and supplemental feedings. What are the family members’ thought on supplementing with formula during breastfeeding? Breastmilk is the ideal food for infants to both nourish them and protect them from illness. Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for the first 6 months of life. Gradual introduction of solid foods in the second half of the first year should complement the breast milk diet. Continued breastfeeding is recommended throughout the first year and thereafter aslong asismutually desired. c. What anticipatory guidance can the nurse practitionerofferto Roberto and Marie regarding Jesus’ growth and development overthe next severalweeks? Inform family’s member that their infant will gain approximately 1.5lbs per month during the first 5 months of life and double birth weight at 5 months. The infant could also grow 1in per month on the first 6 months of life. Head circumference will be approximately 2cm per month during the first 3 months. At 1 month the infant will able to demonstrates head lag and has a strong grasp reflex. 9. A mother brings her 2-year-old son to the clinic because he has been crying and pulling on his earlobe for the past 12 hours. The child's oral temperature is 101.2 F. Which intervention should the nurse implement? Ask the motherifthe child has had a runny nose 10. During a follow-up clinical visit a mother tells the nurse that her 5-month-old son who had surgical correction for Tetralogy of Fallot has rapid breathing,often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held and his growth is in the expected range. Which intervention should the nurse implement? Auscultate heart and lungs while infantis held. 11. An adolescent'smother callsthe primaryHCP's officeto inquire aboutthe results of herdaughter's serum test results that were drawn last week. Since it is the teenager's 18th birthday, how should the nurse respond to thismother's inquiry? Explain thatthe information cannot be releasedwithoutthe 18-yearold’s permission 12. Albumin 25% IV is prescribed for a child with nephrotic syndrome. Which assessmentfinding indicates to the nurse thatthe medication is having the desired effect? Reduction of edema 13. Donnie has brought his 4-year-old son, Isaac, to the pediatric free clinic for a kindergarten physical. Isaac is the older of two children of Donnie and Mary Smith. Donnie is employed as a farrier but his work does not provide insurance and he has come to a nurse-operated free clinic. Donnie shares that Isaac enjoys spending time with his father when he is working with the horses, but he is concerned that Isaac has an imaginary friend named “Tackle.”On physical examination, Isaac is 39 inches tall and weighs 35 lbs.Donnie is aman of average height(5’9” with a slim build). Donnie is concerned that Isaacmay be too small forhis age.(LearningObjectives 1) a. What can the nurse communicate to Isaac’sfather about his physical growth? The nurse should educate family member for a typical 4 year old child average weight is 16.5 kg (36.5 lbs) and height at 103 cm ( 40.5 in). Base on the physical assessment the nurse should be able explain to the parent that their child is a bit below the national average but still in an expected range. The nurse should assess furtherinto the nutritional intakeof Isaac to determine if any deficient occur. b.What can the nurse teach Isaac’s father about his cognitive and psychosocialdevelopment? The nurse should teach the father of 4year old child is in preparation stage of cognitive development in which a child islearning language and able to symbolically to representthings. During this stage, children’sthinking is egocentric and centered, and they can’t yet achieve conversation. Magical thinking is a characteristic during this phrase and which itmay explain Isaac’simaginary friend. In termof psychosocial, a 4-year-old child became actively in learning and interacting with people around, explore their interpersonal skills through initiating activities. Children begin to plan activities, make upgames, and initiate activities with others. If given this opportunity, children develop a sense of initiative and feel secure in their ability to lead others and make decisions. Guild occurs when child is misbehaved or not able to accomplish the task. c. What can the nurse teach Isaac’s father about hismoral development? The nurse should inform the father regarding to a behavior of a 4 year old child is determined by consequences. The individual will obey to avoid punishment 14. A 3-month-old withmyelomeningocele and atonicbladderis catheterized every 4hoursto prevent urinary retention. The home health nurse notesthat the child has developed episodes of sneezing, urticaria, watery eyes, and a rash in the diaper area. What action ismost important for the nurse to take? Change to latex-freegloves when handling infant 15. The nurse is examining an infant for possible cryptorchidism. Which exam technique should be used? Place the infantin a warmroom and use a calm approach 16. In caring for an clientwith acute epiglottitis, which nursing action takes priority? Prepare forendotracheal intubation 17. A toddler with hemophilia is being discharged from the hospital. Which teaching should the nurse include in the discharge instructionsto the mother? Apply padding on the sharp corners ofthe furniture 18. Three-year-old C.E. is admitted to the emergency department (ED) fast track clinic. Her mother tells the nurse that C.E. has had a low-grade fever for 2 days and is complaining frequently of ear pain and a sore throat. C.E.’s mother also notes that C.E. has been coughing and is a little hoarse. C.E.’s mother states that C.E.’s appetite has been “off,” but she has been drinking and using the bathroom as usual. As you get C.E.settled in the exam room, you suspect C.E.may have otitismedia (OM). 1. What routine information regarding risk factors for OM would you want to obtain from C.E.’s mother? Has your child had a cold or ear infection recently? Does your child get URIs frequently? Is your child exposed to cigarette smoke?Does your child attend daycare?Does your child have any allergies? 2. C.E.’smother asks, “Why does C. keep getting earinfections? Isthere something Ishould do?” Explain the etiology of earinfections. Ear infections occur when a bacterial or viral infection affects the middle ear. The etiology of OM is unknown, but it may occur because of blocked Eustachian tubes, which results in negative pressure. Because the Eustachian tubes may be malfunctioning, this causes accumulation of secretion in the ears. The two infections that precipitate OM are RSV and influenza. Risk factors include being exposed to cigarette smoke, attending daycare and having a history of allergies. 19. The nurse is administering an oral medication to a reluctant preschool-age boy. Which intervention should the nurse implement? Use straightforward approach with the child 20. The nurse is planning care for a newborn infant scheduled for a cardiac catheterization. Which occurrence posesthe greatest risk for this child? Acute hemorrhage fromthe entry site ofthe catheter afterthe procedure 21. A mother brings her 2-year-old son to the clinic because he has been crying and pulling on his earlobe forthe past 12 hours. The child's oral temperature is 101.2 F (38 C). Which intervention should the nurse implement? Ask the mother if the child has had a runny nose 22. Steve Shell has broughtin his 9-month-daughter Emily forherwellness examination and immunizations. Steve is a single father raising his daughter after Emily’s mother was killed in a motor vehicle accident (MVA). Steve is doing a great job of raising Emily by himself, but he still has some concerns about his abilities as a father. He has several questions for the nurse practitioner. The nurse practitioner’s examination of Emily is unremarkable and she is growing and developing as expected. a. What should the nurse practitioner include when teaching Steve about promoting healthy eating habits and appropriate sleep and rest? The nurse practitioner need to educate Steve on the importance of making sure the child has a healthy and balance diet easily accessible in the house so the child can develop a healthy habit. There should be no distraction during meal or sleep time. Make time a family time. TV’s should be turned off during meal, encourage the child not to rush through meals, encourage drinking water with meals. Bedtime should be set and consistent. Sleep time should be uninterrupted. Steve can read to the child before bed. Encourage more reading and less electronics use. b.What can the nurse practitioner offer Steve regarding promoting appropriate discipline with Emily? Steve needs to provide safety for the baby. Chemical and anything harmful should be put in a locked cabinet or hard to reach places. He needs to provide play areas with boundaries. Be consistent with rules and making shore rules are obeyed. Good behavior need to be praised and bad need to be punished. 23. The teacher notifies the school nurse that a child's nose is bleeding for no apparent reason. What action should the nurse implementfirst? Pinch the nose using thumb and fingerfor10 minutes 24. A hospitalized child stiffens and stars to seize as the nurse enters the room. What actions should the nurse take? (Select all apply) • Turn clientto the side if possible • Pad side rails with availablepillows and blankets • Monitorduration and progress ofthe seizure 25. A 6-year-old child is diagnosed with rheumatic fever and demonstrates associated chorea (sudden aimlessmovements of the arms and legs). Which information should the nurse provide to the parents? The chorea or movements are temporary and willeventually disappear 26. A 9-year-old boy is diagnosed with diabetesmellitus Type 1. Which stage of Erikson'stheory of psychosocial developmentis the nurse addressing when teaching this client about insulin injections? Industry 27. The nurse is assessing an 8-month-old who has a cough, axillary temperature of 100 F, and rhinorrhea. What information ismostimportant forthe nurse to obtain from this child's mother? Immunization status ofthe infant 28. A breast-feeding mother returns to work when her infant is 5 months old. She is having difficulty pumping enoughmilk tomeet her infant's dietary requirements. Which suggestion should the nurse provide to this mother? Supplement with an iron-rich formula 29. A child with possibleDuchennemusculardystrophy (DMD) undergoes an electromyogram(EMG). Following the procedure, the child's parentstellthe nurse that the child is complaining ofsore muscle. How should the nurserespond? Offer reassurance that muscle soreness following these procedures is temporary and does not indicate a problem 30. The heart rate for a 3-year-old with a congenital heart defect has steadily decreased over the last few hours and is now at 76 beats/minute; the previous reading 4 hours ago was 110 beats/minute. Which additional clinical finding should be reported immediately to the healthcare provider? Blood pressure of 70/40 31. An infant with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which action should the nurse implement first? Place the infantin a kneechest position 32. When caring for a child sickle cell disease, the nurse knows that the child will most likely exhibit which sign when experiencing a sickle cell crisis? Pain 33. The parents of a 4 week-old infant phone the pediatric clinic to report that their infant eats well but vomits after each feeding. To differentiatebetween normal regurgitation and pyloric stenosis, which information is most important for the nurse to obtain? Degree of forcefulness of vomiting episodes 34. Donnie has brought his 4-year-old son, Isaac, to the pediatric free clinic for a kindergarten physical. Isaac is the older of two children of Donnie and Mary Smith. Donnie is employed as a farrier but his work does not provide insurance and he has come to a nurse-operated free clinic. Donnie shares that Isaac enjoys spending time with his father when he is working with the horses, but he is concerned that Isaac has an imaginary friend named “Tackle.”On physical examination, Isaac is 39 inches tall and weighs 35 lbs.Donnie is aman of average height(5’9” with a slim build). Donnie is concerned that Isaacmay be too small forhis age a. What can the nurse communicate to Isaac’sfather about his physical growth? Kids in the age of Isaac are still physical, though at times they learn in a manner that is less hectic and a more focused way than when they were younger. Such a kid would average a gain of about 2 kg in weight and about 2-3 inches height per year. On average, a 4 year old kid like Isaac should weight around 40 pounds (lbs) in weight and have a height of around 40 inches. Thus, Isaac is really normal in matters of both weight and height in relation to his age. The father is tall person with less weight as told in the case which seems less exaggerated in the kid. Donnie should not be worried as long as the child gets all the required care and attention to ensure he retains a good health condition. b.What can the nurse teach Isaac’s father about his cognitive and psychosocialdevelopment? Donnie should know that at such an age of 4 years of age, Isaac is trying to assert their power and contol over the issues at his disposal by simply directing ply and other social interactions which is normal. This is basically the third stage in psychosocial development which entails. Isaac is trying to do things by himself without having to rely on the father, and this is the reason behind what seems to be an imaginary friendship between Isaac and the "tackle". In regards to cognitive development, it is good for Donnie to understand the essence of Isaac's acquisition of ability to reason and solve problems. On the side of Donnie, havin three children for a period of four years alsomay affectthe child's development. The father has no security in terms of insurance for the children and the work that he does is not permanent. Thus, it is essential for Donnie to plan the life of Isaac as early so that he may not end up stating besides him when he should be in a day care or a learning institution. For Isaac and any other kid, he has generated the interest in horses since this is what he has seen the father do and he thinks and feels happy thatwhatthe father doesis good. C. What can the nurse teach Isaac’s father about hismoral development Simply, it is good for any parent to teach and train their kids as early as the age of Isaac. What he ventures into doing and trying may end up shaping his future life. Whatever is not supposed to be done by the child, there should be ways of main the child know it is not good. Isaac needs support from the parents in terms of living and maintain moral values in life. Staying besides Donnie all the times may end up interfering with the moral uprightness of Isaac. This is because, Donnie is busy working on horses and might have less time to train and keep the child in touch. Isaac should have good time with the mother, forseveral reasonsthat Isaac needsto have both parents besides him 35. A 12-year-old is admitted to the hospital with possible encephalitis, and a lumbar puncture is schedule. Which information should the nurse provide concerning to this procedure? Describe the side-lying, knee to the chest positionthatmust be assumed during the procedure 36. A child who has been vomiting for3 days is admitted for correction of fluid and electrolyte imbalances. What acid base imbalance isthis child likely to exhibit? Metabolic alkalosis 37. Several children at a day camp return from playing in a tick-infested field. What action should the camp nurse take first? Observe the children'sskin for attached ticks. 38. An adolescent with pelvic inflammatory disease (PID) is admitted to the hospital after 14 days of taking levofloxacin (Levaquin) 500 mg orally once daily and metronidazole (Flagyl) 500 mg twice daily. She asksthe nurse, "Why do I have to be in the hospital? Why can'tI getmy treatment at home?"Which purpose should the nurse provide thatsupports and effective outcome? Administration of a supervised parenteral antibioticprotocol 39. Insulin therapy isinitiated for a12-year-old child who is admitted with diabetic ketoacidosis(DKA). Which action is most important for the nurse to include in the child's plan of care? Monitorserum glucose for adjustmentin infusion rate of Regularinsulin(Novolin R). 40. A 6-month-old, diagnosed with short bowelsyndrome, began enteral feedingsyesterday. To maintain normal growth and development ofthe child during this period, what action should the nurse include in the infant's plan of care? Give the infant a pacifierduring feeding 41. The nurse is evaluating diet teaching for a client who has nontropical sprue (celiac disease). Choosing which food indicatesthat the teaching has been effective? Rice 42. While teaching a parenting class to new parents the nurse describes the needs of infants and toddlersregarding disciplineand limit setting. Whatisthe most important reason for implementing such parenting behaviors? They provide the child with a sense ofsecurity 43. The mother of a 4-month-old asks the nurse for advice in preventing diaper rash. What suggestion should the nurse provide? Use a barrier cream, such as zinc oxide, which does not have to be completely removed with each diaper change. 44. A 3-year-old with HIV infection is staying with a foster family who is caring for 3 other foster children in their home. When one of the children acquires pertussis, the foster mother calls the clinic and asks the nurse what she should do. Which action should the nurse take first? Review the immunization documentation of the child who has HIV 45. A child with leukemia is admitted for Chemotherapy and the nursing diagnosis "altered nutrition, lessthose body requirementsrelated to anorexia, nausea and vomiting" is identified. Which intervention the nurse included in this child plan of care? Allow the child to eat any food desired and tolerated 46. Prior to discharge, the parents of a child with cystic fibrosis are demonstrating chest physiotherapy (CPT) thatthey will performfor their child athome. Which action? Percussion and postural drainage. 47. The nurse plans to screen only the highest risk children for scoliosis. Which group of children should the nurse screen first? Girls between ages 10and 14 48. A motherbrings her8mo. old baby boy to clinicbecause he has been vomiting and had diarrhea for last 3 days. Which assessment is mostimportant for nurse to make? Measure the infant's pulse 49. Nurse gets a call from a mother of a 10 y/o that just returned from camp with expanding circular red rash on arm. Mom asks what overthe counter product is safe to use. How should the nurse respond? Explain need for immediate exam 50. The nurse is caring for a 3-year-old child who is 2 hours postop from a cardiac catheterization via the rightfemoral artery. Which assessment finding is an indication of arterial obstruction? Rightfoot is cool to the touch and appears pale and blanched 51. An infantwith Tetralogy of Fallot becomes acutely cyanoticand hyperpneic. Which action shouldthe nurse implement first? Place the infantin a kneechest position 52. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The nurse determinesthat the increased respiratory rate is a compensatory mechanism for which acid base alteration? MetabolicAcidosis 53. Patient with diarrhea for 3 days – what does this cause? MetabolicAlkalosis 54. Which drink choice on a hot day indicates to the nurse that a teenager with sickle cell anemia understands dietary considerationsrelated to the disease? Lemonade 55. A nurse is caring for an infant who has hydrocephalus and ventriculoperitoneal shunt malfunction. Which of the following assessment findings indicates that the infant is experiencing increased intracranialpressure? Irritability