1200 HESI QUESTIONS PEDIATRICS EXAM VERSION B

1200 HESI QUESTIONS PEDIATRICS EXAM VERSION BPediatrics Exam - Version B 1.The nurse is preparing to catheterize an 8-year-old child. Before starting the procedure, which action should the nurse take first? A. Obtain the parent's cooperation before initiating the procedure. B. Explain to the child and the parents that the procedure needs to be done. C. After talking with the parents about the procedure, ask them to leave the room. D. Provide the child with privacy by conducting the procedure in the treatment room. An 8-year-old uses concrete operational thought (Piaget), can cooperate, and should be included in the plan of care (B). (A) is indicated for a pre-school aged child, and does not acknowledge the school-aged child's cognitive ability. (C and D) may be needed, but should occur after (B). Points Earned: 0/1 Correct Answer: B You r Response: D 2. Which neurological test should the nurse implement to assess cerebellar function in a 5-year-old with symptoms of hyperactivity? A. Finger-to-nose. B. Quadriceps reflex. C. Two-point discrimination. D. Ability to follow directions. The cerebellum controls balance and coordination and is significant in children with symptoms of hyperactivity or learning difficulty, so difficulty in performing a finger-to-nose test (A) indicates poor sense of position (especially with the eyes closed) and incoordination (especially with the eyes opened). Superficial reflexes (B), sensory discrimination (C), and ability to follow directions (D) are aspects of a neurologic examination but do not test cerebellar function. 2 | P a g ePoints Earned: 0/1 Correct Answer: A Your Response: C 3. An infant with developmental dysplasia of the hip is placed in a Pavlik harness. What instructions should the nurse include in a teaching plan for the parents? A. Apply lotion or powder to minimize skin irritation. B. Put clothing over harness for maximum effectiveness. Check for red areas under the straps three times a day. . D.Use a thin absorbent disposable diaper over the harness. The Pavlik harness, which maintains the hips in abduction, is the most widely used device for developmental dysplasia of the hip. An infant who continuously wears a Pavlik harness is at risk for skin breakdown, so parents should be instructed to check two to three times a day for red areas under clothing and harness straps (C). Lotions and powders (A) can cake or irritate the skin and should be avoided. To avoid direct contact with the skin, clothing and diapers should be placed under the straps (B and D). Points Earned: 1/1 Correct Answer: C Your Response: C 4.Which research finding provides evidence-based practice for an infant's risk for sudden infant death syndrome (SIDS)? A. Breastfeeding reduces the risk for and the incidence of SIDS. B. Infants should be positioned supine or supported laterally to sleep. C. The prone position should be used when an infant sleeps after feeding. D. The peak incidence occurs between the ages of 1 and 2 months. Research has shown that placing babies on their backs for sleep reduces the risk of SIDS (B). Although breastfeeding is recommended to boost neonatal immunity, (A) is unrelated to SIDS. A population-based study found the prone sleep position (C) was associated with twice (2.4% odds ratio) the rate of SIDS compared with infants placed nonprone to sleep. SIDS remains the third leading cause of death in children between the ages of 1 month and 1 year, not (D). Points Earned: 0/1 Correct Answer: B Your Response: D 5. During the well-child assessment of an 18-month-old male toddler, the nurse determines the child does not walk while holding on to furniture but prefers to crawl, rarely speaks, has a flat affect, and is small for his age. Which nursing diagnosis should the nurse formulate? 3 | P a g eA. Alteration in nutrition. B. Alteration in parenting. C. Delayed growth and development. D. Alteration in health maintenance. This child does not demonstrate gross motor or psychosocial skills typical of an 18-month- old toddler, which best supports delayed growth and development (C). Additional information about the child's growth parameters is needed to support (A, B, or D). Points Earned: 0/1 Correct Answer: C Your Response: A 6. A 4-year-old boy is brought to the emergency department by his parent, who reports that the child has been pointing at his stomach and saying, "It hurts so bad." Which pain- assessment tool should the nurse use? A. Descriptor Scale. B. Brief Pain Inventory. C. A numeric rating scale. D. Wong-Baker FACES Scale. A pain rating scale using pictures, such as the Wong-Baker FACES Scale (D), allows the child to choose a facial expression that shows how much hurt you have now and should be used for a preschool-aged child. (A, B, and C) are used for older children who are able to conceptualize pain using a number or descriptive narratives. Points Earned: 0/1 Corre ct Answ er: D Your Resp onse: 7. The parents of a child with Asperger's disorder asks the nurse to explain the differences between Asperger's and autism. Which information should the nurse share with the parents about Asperger's disorder that is not characteristic in autism? A. Obsession with moving objects. B. Repetitive patterns of behavior. C Age-appropriate language development. . 4 | P a g eD.Stereotypic movements and speech patterns. Communication is not delayed in Asperger's disorder (C), but impaired communication with delays of spoken language is characteristic of autism. Asperger's disorder has many characteristics also found in autistic disorder, such as self-injurious behavior, behaviors that lead to social impairment (A), and restrictive, repetitive forms of behaviors (B and D). Points Earned: 0/1 Correct Answer: C Your Response: C 8. The nurse notices that the hem of a skirt on a pre-adolescent girl is uneven when she comes to the clinic. What procedure should the nurse follow to examine the girl for scoliosis? (Arrange the examination process from first on top to last on the bottom.) A. Ask the girl to remove her shirt but leave on her bra or swimsuit top. B. Examine for scapular prominence. C. Look for asymmetry in the hip area. D. Instruct the girl to bend at the waist so back is parallel to the floor. To screen for scoliosis, the girl should first be asked to remove her shirt, wear her bra, or wear a swimsuit top. Then, as she stands erect, observe for asymmetry of the shoulders, back and hips while standing behind the girl. Next, ask her to bend forward so that the back is parallel to the floor, and finally observe from the side and the back, noting asymmetry or prominence of the rib cage and scapulae. Points Earned: 0/4 Correct Answer: A:1, B:4, C:2, D:3 Your Response: A:-, B:-, C:-, D:- 9. The parents of a 14-year-old girl tell the nurse that their daughter dresses as a tomboy and plays baseball one day and the next day dresses in feminine clothes and becomes a teenage drama queen. What information should the nurse use to respond to the parents? A. Teenagers need a strong role mode to emulate. B. Adolescents try on different roles while seeking their identity. C. Such erratic behavior needs further investigation. D. Fourteen-year-olds often try to please parents with their role choices. As teenagers seek their own identity, they try on different roles to see if they fit (B). Although role models (A) are important, they do not explain the adolescent's exploration for self- identity. Such behaviors seem erratic, but are normal adolescent experiences that needs no further investigation (C). (D) does not provide the best explanation. 5 | P a g ePoints Earned: 0/1 Correct Answer: B Your Response: D 10. A 2-year-old is receiving care in the emergency department (ED) for a deep laceration on the head. What action should the nurse implement to facilitate the child's cooperation? A. Allow the child to hold a favorite toy or blanket. B. Direct the parents to remain outside the treatment room. C. Keep the child physically restrained during nursing care. D. Let the child decide whether to sit up or lie down for procedures. Allowing a child to hold a favorite toy or blanket (A) provides familiarity and comfort which should facilitate the child's cooperation during treatment. Parents should remain with the child, not (B), to calm and reassure a child who may perceive the ED environment as threatening. A toddler needs autonomy and may not respond well to restriction, such as restraints (C), which should be limited or removed as soon as safety permits. (D) should not be offered to a toddler who is not capable of understanding a position (D) that might be needed during a treatment or procedure. Points Earned: 0/1 Correct Answer: A Your Response: B 11. A 4-year-old is brought to the emergency room for a laceration on the right foot. What action should the nurse implement to help the child in coping with the emergency room experience? A. Avoid the use of bandages to keep wounds open to air. B. Remind the preschooler how big children should act. C. Give the child some time after explaining procedures. D. Avoid using jargon, such as shot, when giving care. Using positive terms and avoiding words that have frightening connotations (D) assist the preschool-age child in coping with an emergency room experience. Bandages (A) are important to preschool-aged children because this age group often believe bandages stop their insides from leaking out. Children need to feel comfortable expressing their fears and feelings and should not be shamed into cooperation by referencing expected big children behaviors (B). Preschool-age children should be told about procedures immediately before they are performed (C), which minimizes the time a child fantasies about the treatment, which causes increased anxiety. Points Earned: 0/1 Correct Answer: D Your Response: B 6 | P a g e12. A 6-year-old child is admitted in the emergency department with a systolic blood pressure of 58 mm Hg. What action should the nurse take first? A. Comfort the child. B. Assess responsiveness. C. Alert the healthcare provider. D. Initiate IV fluid replacement. The lower limit for systolic blood pressure for a child older than 1 year of age is 70 mm Hg plus 2 times the child's age in years, so the healthcare provider should be notified (C) of the child's hypotension, and although comforting measures should be provided (A), physiological needs should be met first. Assessing the child's responsiveness is a component of a neurologic assessment, but asystolic blood pressure of 58 mm Hg is a late sign of shock in children and requires immediate intervention (B). The healthcare provider's prescriptions, including IV fluids (D), should be obtained to address shock. Points Earned: 0/1 Correct Answer: C Your Response: D 13. A child is brought to the emergency department with sweating, chills, and snake fang-like puncture marks on the calf. What action should the nurse implement after the type of snake is identified? A. Secure the antivenin. B. Ambulate the child. C. Apply a tourniquet to the leg. D. Reassure the child and parent. Antivenin is essential to the child's survival because the child is showing signs of envenomation (A). When a bite or envenomation is located on an extremity, the extremity should be immobilized, so ambulating the child (B) is contraindicated by the venom circulation increases with the exercise. The use of a tourniquet is not recommended (C). Envenomation is a potentially life-threatening condition, so false reassurance is not helpful (D). Points Earned: 0/1 Correct Answer: A Your Response: C 14. Which finding should the nurse in the emergency department identify as an indicator that a 3-year-old child has been mistreated? A. The toddler does not remember how the injury occurred. B. The parents are extremely calm in the emergency room. C. The injury sustained is highly unusual for 3-year-old children. D. The child was doing something unsafe when the injury occurred. 7 | P a g eAn injury that is highly unusual or inconsistent with the age and condition of the child should raise suspicion of child abuse (C). A 3-year-old child's attention span and interruption of events are consistent with a child's reliability as a historian or not remembering what happened (A) when the injury occurred. Culture, ethnicity, individual experiences and psychological makeup can influence parental reactions to a child who has been injured, so (B) alone is insufficient to deduce child abuse. Additional information should be obtained to determine whether the parents are negligent in the care of the child (D). Points Earned: 0/1 Correct Answer: C Your Response: D 15. A crying toddler has a blood pressure measurement of 120/70 mm Hg. What action should the nurse implement? A. Notify the healthcare provider of the measurement. B. Quiet the child and retake the blood pressure. C. Ask the parent if the child has a history of hypertension. D. Document the finding and recheck in 4 hours. When a child is crying, intra-thoracic and abdominal pressures increase and are reflected in an elevation of systemic blood pressure, so the nurse should quiet the child before retaking the blood pressure (B). (A) is not necessary until accurate readings are obtained. (C) is not necessary. An accurate pressure reading should be obtained before implementing (D). Points Earned: 1/1 Correct Answer: B Your Response: B 16. What should the nurse assess last when examining a 5-year-old child? A. Heart. B. Lungs. C. Throat. D. Abdomen. Examination of the mouth, throat, and perineum is considered to be more invasive than other parts of a physical examination, so invasive procedures, such as (C), should be left to the end of the examination for a preschooler. Assessment of (A, B, and D) is not considered as invasive or frightening to the child as (C). Points Earned: 1/1 Correct Answer: C Your Response: C 8 | P a g e17. A 15-year-old girl tells the school nurse that she wants to have a baby. How should the nurse respond? A. "Will you be able to support the baby?" B. "Do you have plans to continue school?" C. "Have you talked with your parents about this?" D. "Can you tell me how your life will be if you have an infant?" Developing a dialogue with the teen is important, and by using open-ended questions the nurse will encourage communication and explanation. Asking the teenager to describe how the infant will affect her life (D) directs the teen to consider real life experiences and allows the nurse to assess the teen's perception and reality orientation. (A, B, and C) do not facilitate communication and may terminate the communication. Points Earned: 0/1 Correct Answer: D Your Response: C 18. The nurse is caring for a 9-year-old male child who frequently speaks about sex and uses correct sexual vocabulary. What action should the nurse implement with this child? A. Ask the child whether he was sexually abused. B. Ascertain what the child understands about sex. C. Inquire where the child got this important information. D. Involve the child in teaching sex information to peers. School-age children often use correct sexual vocabulary, and yet have no real understanding of what the words mean, so (B) provides clarification of the child's concepts used in conversation. Direct questions about sexual abuse (A) may frighten the child and more information is needed to make the assumption of sexual abuse. Asking the child about his source of information (C) is not as relevant as what the child understands about sex. (D) is not an option. Points Earned: 0/1 Correct Answer: B Your Response: A 19. A mother brings her 6-month-old infant to the clinic for a well-baby routine exam. Which vaccine(s) should the nurse verify the infant has received? (Select all that apply.) A. Meningococcal polysaccharide vaccine (MPSV4). B. Haemophilus influenzae type b conjugate vaccine (Hib). C. Inactivated poliovirus vaccine (IPV). D. Hepatitis B virus vaccine (HepB). E. Diphtheria, tetanus toxoids, and acellular pertussis (DTaP). 9 | P a g eF. Measles, mumps, and rubella vaccine (MMR). (B, C, D, and E) should be administered prior to 6 months of age. (A) is administered after 24months of age. (F) is administered at 12-months of age. Points Earned: 1/4 Correct Answer: B, C, D, E Your Response: D 20. While assessing the apical pulse of a 13-year-old, the nurse determines that the rate is 88 beats/minute