PEDIATRICS HESI PRACTICE EXAM
(EVOLVE) QUESTIONS WITH VERIFIED
ANSWERS
An 8-year-old boy who was recently diagnosed with diabetes mellitus is admitted to
the intensive care unit with diabetic ketoacidosis (DKA). Which nursing action has
the highest priority?
a. Place on a cardiac monitor.
b. Initiate an intravenous infusion.
c. Collect a specimen for serum electrolytes.
d. Obtain fingerstick glucose. - ANSWER-b. Initiate an intravenous infusion.
The priority for a child with DKA, an emergency life-threatening situation, is to obtain
venous access for administration of fluids, electrolytes, and insulin. The child should
be placed on a cardiac monitor and have serum electrolytes and glucose levels
obtained, but not before initiating venous access.
The nurse is collecting a blood sample from a newborn for a phenylketonuria (PKU)
screening test. When should the nurse obtain the blood sample?
a. At birth from cord blood.
b. Fourteen days after birth.
c. Before oral feedings are initiated.
d. After ingestion of a source of protein. - ANSWER-d. After ingestion of a source of
protein.
PKU is a genetic disease caused by the absence of the enzyme needed to
metabolize the essential amino acid phenylalanine. The Guthrie blood test is used
for early detection of this condition in order to prevent mental retardation as a result
of this disease. The blood sample should be collected between 1 to 7 days after
birth, with fresh heel blood only, and no sooner than 24 hours after the infant has
ingested a source of protein (breast milk or infant formula). Premature infants and/or
sick neonates who haven't been introduce to breast milk or formula due to medical
reasons will have the PKU test taken after they are able to ingest breast milk or
formula regardless of method of delivery (nippling or gavage fed).
What is the best action for the nurse to take when initiating contact with a toddler for
the first time?
a. Ask the toddler to point to where it hurts.
b. Tell the child your name and that you are the nurse.
c. Call the child by name while picking up the toddler.
d. Kneel in front of the toddler and speak softly. - ANSWER-d. Kneel in front of the
toddler and speak softly.
,The toddler perceives the nurse as a stranger. A more positive interaction occurs
when the toddler perceives the meeting in a nonthreatening way. Placing oneself at
the toddler's eye level and speaking softly can be less threatening for the child.
The nurse calculates a 4 mL dose of prescribed digoxin to a 9-month-old infant.
Which action should the nurse implement?
a. Mix the dose with juice to disguise its taste.
b. Suspect a dosage error and do not give the dose.
c. Check the infant's heart rate and administer the dose by placing it to the back and
side of the mouth.
d. Check the infant's heart rate and administer the dose by letting the infant suck it
through a nipple. - ANSWER-b. Suspect a dosage error and do not give the dose
Digoxin's narrow margin of safety for an infant should not exceed 1 mL (50 mcg) in
one dose. The nurse's calculation indicates a dosage error and should not be given.
Digoxin is given without mixing with any other fluids or foods because the infant may
refuse to consume the total amount, which results in an inaccurate drug dose.
Generally, pediatric digoxin elixir is available as 0.05 mg/mL. Great care must be
taken in dosage calculation and should be double-checked with another nurse prior
to administration.
A 14-year-old returns to the pediatric unit after corrective surgery for scoliosis. In the
immediate postoperative period, the nurse should include which action in this client's
plan of care? (Select all that apply.)
a. Record intake and output every 8 hours.
b. Elevate the head of the bed 30 degrees.
c. Assess bowel sounds every 4 hours.
d. Initiate a logrolling schedule every 2 hours.
e. Ambulate for 5 minutes, 12 hours postoperative.
f. Give morphine sulfate, 2 mg IV every 4 hours PRN. - ANSWER-a. Record intake
and output every 8 hours.
c. Assess bowel sounds every 4 hours.
d. Initiate a logrolling schedule every 2 hours.
f. Give morphine sulfate, 2 mg IV every 4 hours PRN.
Recording intake and output and assessing bowel sounds are critical when
determining if the body systems are recovering from the effects of anesthesia. Using
a logrolling technique to turn the client maintains spinal alignment postoperatively
and prevents complications of immobility. Since this is a painful surgery, the nurse
should maintain pain control as prescribed. The pain associated is not just due to the
incisions of surgery, but also to the manipulation and placement of the spinal
hardware and muscular pain as the involved muscles adjust to the corrective
realignment of the spine. Following corrective surgery for scoliosis, a client should be
immobilized without spinal flexion for 24 to 48 hours, and then ambulated by the
physical therapist.
, A 5-year-old child who is one day postoperative has bilateral eye patches in place
and should be out of bed. Which nursing intervention should be implemented first
before leaving the bedside?
a. Speak to the child when entering the room.
b. Allow the child to assist in eating.
c. Orient the child to the immediate surroundings.
d. Allow the parents to stay in the room with the child. - ANSWER-c. Orient the child
to the immediate surroundings.
When sighted children temporarily lose their vision, many aspects of the environment
becomes bewildering and frightening. To minimize the effects of temporary loss of
vision, the child should be oriented immediately to the surroundings and should be
told about the nurse's actions and any experiences that are felt or heard during
procedures. The child and family should be reassured throughout every phase of
treatment and encouraged to be independent (with assistance) in self-care activities
such as eating and bathing.
The nurse observes the interactions of a 2-year-old child who says, "No" even when
"Yes" is what the child really wants to say. The parent says to the nurse,
"We are such positive people. Why is our child so negative?" How should the nurse
respond?
a. A 2-year-old often acts in the opposite way to get attention.
b. A child at this age is testing the limits of the parent's patience.
c. The toddler is exhibiting an example of ritualistic behavior.
d. The child is trying to assert autonomy through negativism. - ANSWER-d. The child
is trying to assert autonomy through negativism.
As a toddler tests autonomy and ego boundaries, sometimes they clash with
parental restrictions and respond with recital of prompts that parents often say. "No"
is a favorite repeated word and is the child's way of exploring autonomy through
negativism.
When administering a gavage feeding to a school-age child, which action should the
nurse implement?
a. Administer feedings over 5 to 10 minutes.
b. Position the child on the right side after administering the feeding.
c. Check the placement of the tube by inserting 20 mL of sterile water.
d. Lubricate the tip of the feeding tube with petroleum jelly to facilitate passage. -
ANSWER-b. Position the child on the right side after administering the feeding.
The child should be positioned on the right side with the head of the bed elevated 30
degrees after administering the feeding to facilitate gastric emptying and prevent
gastric reflux. Gavage feedings should be given to allow slow gastric filling over 15 to
30 minutes.
While assessing the apical pulse of a 13-year-old, the nurse determines that the rate
is 88 beats/minute, and the rhythm is irregular. The heart rate is phasic with
(EVOLVE) QUESTIONS WITH VERIFIED
ANSWERS
An 8-year-old boy who was recently diagnosed with diabetes mellitus is admitted to
the intensive care unit with diabetic ketoacidosis (DKA). Which nursing action has
the highest priority?
a. Place on a cardiac monitor.
b. Initiate an intravenous infusion.
c. Collect a specimen for serum electrolytes.
d. Obtain fingerstick glucose. - ANSWER-b. Initiate an intravenous infusion.
The priority for a child with DKA, an emergency life-threatening situation, is to obtain
venous access for administration of fluids, electrolytes, and insulin. The child should
be placed on a cardiac monitor and have serum electrolytes and glucose levels
obtained, but not before initiating venous access.
The nurse is collecting a blood sample from a newborn for a phenylketonuria (PKU)
screening test. When should the nurse obtain the blood sample?
a. At birth from cord blood.
b. Fourteen days after birth.
c. Before oral feedings are initiated.
d. After ingestion of a source of protein. - ANSWER-d. After ingestion of a source of
protein.
PKU is a genetic disease caused by the absence of the enzyme needed to
metabolize the essential amino acid phenylalanine. The Guthrie blood test is used
for early detection of this condition in order to prevent mental retardation as a result
of this disease. The blood sample should be collected between 1 to 7 days after
birth, with fresh heel blood only, and no sooner than 24 hours after the infant has
ingested a source of protein (breast milk or infant formula). Premature infants and/or
sick neonates who haven't been introduce to breast milk or formula due to medical
reasons will have the PKU test taken after they are able to ingest breast milk or
formula regardless of method of delivery (nippling or gavage fed).
What is the best action for the nurse to take when initiating contact with a toddler for
the first time?
a. Ask the toddler to point to where it hurts.
b. Tell the child your name and that you are the nurse.
c. Call the child by name while picking up the toddler.
d. Kneel in front of the toddler and speak softly. - ANSWER-d. Kneel in front of the
toddler and speak softly.
,The toddler perceives the nurse as a stranger. A more positive interaction occurs
when the toddler perceives the meeting in a nonthreatening way. Placing oneself at
the toddler's eye level and speaking softly can be less threatening for the child.
The nurse calculates a 4 mL dose of prescribed digoxin to a 9-month-old infant.
Which action should the nurse implement?
a. Mix the dose with juice to disguise its taste.
b. Suspect a dosage error and do not give the dose.
c. Check the infant's heart rate and administer the dose by placing it to the back and
side of the mouth.
d. Check the infant's heart rate and administer the dose by letting the infant suck it
through a nipple. - ANSWER-b. Suspect a dosage error and do not give the dose
Digoxin's narrow margin of safety for an infant should not exceed 1 mL (50 mcg) in
one dose. The nurse's calculation indicates a dosage error and should not be given.
Digoxin is given without mixing with any other fluids or foods because the infant may
refuse to consume the total amount, which results in an inaccurate drug dose.
Generally, pediatric digoxin elixir is available as 0.05 mg/mL. Great care must be
taken in dosage calculation and should be double-checked with another nurse prior
to administration.
A 14-year-old returns to the pediatric unit after corrective surgery for scoliosis. In the
immediate postoperative period, the nurse should include which action in this client's
plan of care? (Select all that apply.)
a. Record intake and output every 8 hours.
b. Elevate the head of the bed 30 degrees.
c. Assess bowel sounds every 4 hours.
d. Initiate a logrolling schedule every 2 hours.
e. Ambulate for 5 minutes, 12 hours postoperative.
f. Give morphine sulfate, 2 mg IV every 4 hours PRN. - ANSWER-a. Record intake
and output every 8 hours.
c. Assess bowel sounds every 4 hours.
d. Initiate a logrolling schedule every 2 hours.
f. Give morphine sulfate, 2 mg IV every 4 hours PRN.
Recording intake and output and assessing bowel sounds are critical when
determining if the body systems are recovering from the effects of anesthesia. Using
a logrolling technique to turn the client maintains spinal alignment postoperatively
and prevents complications of immobility. Since this is a painful surgery, the nurse
should maintain pain control as prescribed. The pain associated is not just due to the
incisions of surgery, but also to the manipulation and placement of the spinal
hardware and muscular pain as the involved muscles adjust to the corrective
realignment of the spine. Following corrective surgery for scoliosis, a client should be
immobilized without spinal flexion for 24 to 48 hours, and then ambulated by the
physical therapist.
, A 5-year-old child who is one day postoperative has bilateral eye patches in place
and should be out of bed. Which nursing intervention should be implemented first
before leaving the bedside?
a. Speak to the child when entering the room.
b. Allow the child to assist in eating.
c. Orient the child to the immediate surroundings.
d. Allow the parents to stay in the room with the child. - ANSWER-c. Orient the child
to the immediate surroundings.
When sighted children temporarily lose their vision, many aspects of the environment
becomes bewildering and frightening. To minimize the effects of temporary loss of
vision, the child should be oriented immediately to the surroundings and should be
told about the nurse's actions and any experiences that are felt or heard during
procedures. The child and family should be reassured throughout every phase of
treatment and encouraged to be independent (with assistance) in self-care activities
such as eating and bathing.
The nurse observes the interactions of a 2-year-old child who says, "No" even when
"Yes" is what the child really wants to say. The parent says to the nurse,
"We are such positive people. Why is our child so negative?" How should the nurse
respond?
a. A 2-year-old often acts in the opposite way to get attention.
b. A child at this age is testing the limits of the parent's patience.
c. The toddler is exhibiting an example of ritualistic behavior.
d. The child is trying to assert autonomy through negativism. - ANSWER-d. The child
is trying to assert autonomy through negativism.
As a toddler tests autonomy and ego boundaries, sometimes they clash with
parental restrictions and respond with recital of prompts that parents often say. "No"
is a favorite repeated word and is the child's way of exploring autonomy through
negativism.
When administering a gavage feeding to a school-age child, which action should the
nurse implement?
a. Administer feedings over 5 to 10 minutes.
b. Position the child on the right side after administering the feeding.
c. Check the placement of the tube by inserting 20 mL of sterile water.
d. Lubricate the tip of the feeding tube with petroleum jelly to facilitate passage. -
ANSWER-b. Position the child on the right side after administering the feeding.
The child should be positioned on the right side with the head of the bed elevated 30
degrees after administering the feeding to facilitate gastric emptying and prevent
gastric reflux. Gavage feedings should be given to allow slow gastric filling over 15 to
30 minutes.
While assessing the apical pulse of a 13-year-old, the nurse determines that the rate
is 88 beats/minute, and the rhythm is irregular. The heart rate is phasic with
