Pediatrics A HESI RN Case Studies With Practice Test {correct answers with explained Rationales}

Pediatrics A To take the vital signs of a 4­month­old child, which order provides the most accurate ID: results? A. Respiratory rate, heart rate, then rectal temperature. Correct B. Heart rate, rectal temperature, then respiratory rate. C. Rectal temperature, heart rate, then respiratory rate. D. Rectal temperature, respiratory rate, then heart rate. The respiratory rate should be taken first (A) in infants, since touching them or performing unpleasant procedures usually makes them cry, elevating the heart rate and making respirations difficult to count (B). Rectal temperature is the most invasive procedure, and is most likely to precipitate crying, so should be done last (C and D). Awarded 1.0 points out of 1.0 possible points. 1. A 16­year­old is brought to the Emergency Center with a crushed leg after falling off a ID: horse. The adolescent's last tetanus toxoid booster was received eight years ago. What action should the nurse take? A. Dispense a tetanus antitoxin. B. Prepare human tetanus immune globulin. C. Administer tetanus toxoid booster. Correct D. Delay the tetanus toxoid booster until due. After the completion of the initial tetanus immunization schedule, the recommended booster for an adolescent or adult is every ten years or less if a traumatic injury occurs that is contaminated by dirt, feces, soil, or saliva, such as puncture or crushing injuries, avulsions, wounds from missiles, burns, or frostbite. The adolescent's injury is considered a contaminated wound requiring prophylactic therapy, so the tetanus toxoid booster should be administered (C). (A, B, and D) are not indicated. Awarded 1.0 points out of 1.0 possible points. 2. The mother of a 6­month­old asks the nurse when her baby will get the first measles, ID: mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control, which response is accurate? A. 3 to 6 months. B. 12 to 15 months. Correct C. 18 to 24 months. D. 4 to 6 years. The first measles, mumps, and rubella (MMR) vaccine should be given no sooner than 12 months of age, and ideally between 12 and 15 months of age (B). (A) should not receive the MMR vaccine due to the presence of maternal antibodies. MMR is not routinely administered at (C), but other immunizations, such as DTaP and Hepatitis B may be given at that time. The second dose of MMR is routinely administered at (D), provided that at least 4 weeks have elapsed since the first dose, and if both doses were administered beginning at or after 12 months. Awarded 1.0 points out of 1.0 possible points. 3. A 2­year­old child with Down syndrome is brought to the clinic for his regular physical ID: examination. The nurse knows which problem is frequently associated with Down syndrome? A. Congenital heart disease. Correct B. Fragile X chromosome. C. Trisomy 13. D. Pyloric stenosis. Congenital heart disease (A) is the most common associated defect in children with Down syndrome. (C) might have seemed possible since Down syndrome is a trisomal chromosomal abnormality of chromosome 21. (B) is a sex­linked abnormality also causing mental retardation. (D) is not associated with Down syndrome. Awarded 1.0 points out of 1.0 possible points. 4. A 14­year­old female client tells the nurse that she is concerned about the acne she has ID: recently developed. Which recommendation should the nurse provide? A. Remove all blackheads and follow with an alcohol scrub. B. Use medicated cosmetics only to help hide the blemishes. C. Wash the hair and skin frequently with soap and hot water. Correct D. Encourage her to see a dermatologist as soon as possible. Incorrect Washing the hair and skin with soap and hot water (C) removes oil and debris from the skin and helps prevent and treat acne. Oily skin is especially bothersome during adolescence when hormones cause enlargement of sebaceous glands and increased glandular secretions which predispose the teenager to acne. (A) is contraindicated. Cosmetics ("medicated" or not) should be used sparingly to avoid further blocking sebaceous gland ducts (B). (D) might be indicated at a later time, if healthcare recommendations are not successful. Awarded 0.0 points out of 1.0 possible points. 5. The nurse is caring for a 12­year­old with Syndrome of Inappropriate Antidiuretic ID: Hormone (SIADH). This child should be carefully assessed for which complication? A. Poor skin turgor resulting from dehydration. B. Changes in level of consciousness. Correct C. Premature aging as the disease progresses. D. Severe edema from an excess of water and sodium. Incorrect The child must be monitored for signs and symptoms of hyponatremia, which creates secondary central nervous system alterations such as changes in level of consciousness, seizure, and coma (B). Fluid overload occurs with SIADH, not (A) (which occurs with diabetes insipidus). (C) is caused by hypersecretion of growth hormone, not SIADH. (D) is not found in children with SIADH because edema is caused by an excess of both water and sodium. Awarded 0.0 points out of 1.0 possible points. 6. A three­month old boy weighing 10 lbs 15 oz has an axillary