HESI RN PEDIATRIC EXAM STUDY GUIDE

Which client requires immediate intervention by the RN? • A child with cystic fibrosis who is constipated. • A toddler with chicken pox who is scratching, • A child with acute renal failure and hyperkalemia. • An adolescent with a migraine and photophobia. A 7 year old male is referred to the school clinic because he fainted on the playground. His height is 3 feet, 7 inches (107.5 cm), he weighs 55 pounds (25 kilograms), and his body mass index (BMI) is 20.9. Which assessment finding is most important for the RN to address? • He consumed2 bottles of water in 30 minutes prior to fainting. • Since age 3 he has experienced exercise induced asthma. • Reports drinking 3-4 high calorie, carbonated beverages daily. • The child’s father has a history of fainting when exercising. The RN of a 6 year old girl is concerned about her child’s obesity. The child’s weight plots at the 75th percentile, and height at the 25th percentile. The child’s body mass index (BMI) is at the 85th percentile for age and gender. Which interventions should the RN implement? (Select All That Apply) • Explain that the child is likely to grow into her weight. • Determine the child’s usual physical activity pattern. • Obtain the child’s 3- day diet history based on the mothers input. • Inquire as to whether or not the school has a physical education program. • Tell the mother that girls hit their growth spurt before boys so eating more is expected. (B, C, and D) are correct. The child’s growth parameters, particularly her BMI, indicate that she is overweight. (B and D) assess for the child’s level of activity, which should be evaluated and increased if possible. (C) Provides information about the quantity and quality of the child’s dietary intake, which is information that is needed to create an individualized diet teaching plan. (A) Does not consider the serious health and psychological consequences associated with childhood obesity. Girls do not hit their growth spurt before boys in preadolescence, but this child is only 6 years of age and the child’s obesity should not be negated because of this growth and development expectation. (e) A toddler with hemophilia is being discharged from the hospital. Which teaching should the RN include in the discharge instructions to the mother? • Apply padding on the sharp corners of the furniture. • Prevent the client from running inside the house. • Give an 81 mg tablet of aspirin for pain relief. • Use a soft bristle toothbrush from frequent cleaning. The RN is examining an infant for possible cryptorchidism. Which examine technique should be used? • Place the infant in a side lying position to facilitate the exam. • Hold the penis and extract the foreskin gently. • Cleanse the penis with an antiseptic-soaked pad. • Place the infant in a warm room and use a calm approach. An infant who has been diagnosed with a tracheoesophageal fistula (TEF). What nursing intervention is indicated for this infant prior to surgical repair? • Provide frequent sips of liquid. • Give isotonic enemas as prescribed. • Maintain nothing by mouth status. • Prepare the infant for a barium enema. An adolescent with non- Hodgkin’s lymphoma (NHL) is complaining of a sore mouth two days after beginning chemotherapy. What activity should the RN implement? • Encourage large meals during steroid and chemotherapy. • Provide lemon glycerin swabs and dilute peroxide oral rinses. • Recommend fluids using citrus juices and drinking with a straw. • Frequent use of saline oral rinses and a soft sponge toothbrush. A child with acute laryngotracheobronchitis (croup) received epinephrine 2 hours ago in the emergency room, and now is being prepared for discharge to go home. The RN should instruct the parents to take which action if the child’s uncontrolled coughing reoccurs? • Call for emergency transportation to the hospital. • Increase the fluid intake to liquefy the secretions. • Administer a dose of the prescribed cough medicine. • Sit with the child in the bathroom with hot steam. Moist, warm air (D) promotes bronchodilation, which helps relieve spasms that cause the coughing. If the symptoms continue or worsen, the child may need to be transported to the hospital (A). Fluids will thin the secretions (B) and cough medicine (C) may decrease cough, but neither of these interventions decrease swelling or dilate the airway to improve breathing. The RN is performing a routine examination of a 6-month old infant at the community health clinic. Records indicate that the child weighed 3 kg at birth. The clinic uses lbs to describe weight. When assessing this child, approximately what weight, in lbs, should the RN consider to be within normal range for this child? • 15 to 18 lbs. • 12 to 15 lbs. • 9 to 11.5 lbs. • 6 to 7.5 lbs. Birth weight should at least be double at this time. When developing a teaching plan for an adolescent male who was recently diagnosed with Type 1 Diabetes Mellitus, the RN should instruct the client to eat a source of sugar if which symptom occurs? • Excessive thirst. • Racing pulse. • Profuse perspiration. • Seeing spots. Tachycardia is one of the symptoms of hypoglycemia. A breast feeding mother returns to work when her infant is 5 months old. She is having difficulty pumping enough milk to mete her infant’s dietary requirements. Which suggestion should the RN provide to this mother? • Mix infants formula with breast milk. • Supplement with an iron-rich formula. • Introduce baby food for one meal daily. • Offer a follow-up transitional formula. The RN is evaluating the effects of thyroid therapy used to treat a 5 month old with hypothyroidism. Which behavior indicates that the treatment has been effective? • Keeps fists clenched, opens hands when grasping an object. • Has strong Moro and tonic neck reflexes. • Can lift head, but not chest when lying on abdomen. • Laughs readily, turns from back to side. The RN is assessing an infant with aortic stenosis and identifies bilateral fine crackles in both lung fields. Which additional finding should the RN expect to obtain? • Vigorous feeding and sanitation. • Hemiplegia. • Fever. • Hypotension and tachycardia. A child with possible Duchenne muscular dystrophy (MD) undergoes an electro-myelogram (EMG). Following the procedure, the child’s parents tell the RN that the child is complaining of sore muscles. How should the RN respond? • Explain that muscle aches and pain are commonly experienced by children with this form of muscular dystrophy. • Advise the parents that children with chronic diseases may seek attention by reporting pain or other unpleasant symptoms. • Encourage the parents to monitors the child’s body temperature for the next 24 hours and report a rise above 101 degree F. • Offer reassurance that muscle soreness following this procedure is temporary and does not indicate a problem. ...................................................................................................CONTINUE.