HESI RN EVOLVE Pediatrics Practice Exam
The nurse is giving preoperative instructions to a 14-year old female client who is scheduled for surgery
to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken
place?
A. I will read all the literature you gave me before surgery.
B. I have had surgery before when I broke my wrist in a bike accident, so I know what to expect.
C. All the things people have told me will help me take care of my back.
D. I understand that I will be in a body cast and I will show you how you taught me to turn.
D. I understand that I will be in a body cast and I will show you how you taught me to turn.
Outcome of learning is best demonstrated when the client not only verbalizes an understanding, but
also can provide a return demonstration. A 14-year old may or may not follow through with reading
material and there is no way of measuring that way of learning. Have a previous surgery may help the
client understand the surgical process, but wrist surgery is very different from spinal surgery and
emergency surgery is different than elective surgery. In (C), the client may be saying what the nurse
wants to hear, without expressing any real understanding of what to do after surgery.
To take the vital signs of a 4-month old child, which order will give the most accurate results?
A. Respiratory rate, heart rate, then rectal temperature
B. Heart rate, rectal temperature, then respiratory rate.
C. Rectal temperature, heart rate, then respiratory rate
D. Rectal temperature, respiratory rate, then heart rate
A. Respiratory rate, heart rate, then rectal temperature
The respiratory rate should be taken first in infants, since touching them or performing unpleasant
procedures usually makes them cry, elevating the heart rate and making respirations difficult to count.
Rectal temperature is the most invasive procedure, and is mot likely to precipitate crying, so should be
done last.
During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic
membrane that is pearly gray, slightly bulging, and not movable. What action should the nurse take
next?
,A. No action required, as this is an expected finding for a school-aged child
B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.
C. Send a note home advising the parents to have the child evaluated by a healthcare provider as soon
as possible.
d. Call the parents and have them take the child home from school for the rest of the day.
B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.
More information is needed to interpret these findings. The tympanic membrane is normally pearly
gray, not bulging, and moves when the client blows against resistance or a small puff of air is blown into
the ear canal. Since this child's findings are not completely normal, further assessment of history and
related signs and symptoms is indicated for accurate interpretation of the findings. (A), (C), and (D) are
inappropriate actions based on the data obtained from the otoscope examination.
Which restraint should be used for a toddler after a cleft palate repair?
A. clove hitch
B. Mummy
C. elbow
D. jacket
C. elbow
Elbow restraints
Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical
site. A clove hitch restrains the hands, but the child can bend and bring their head to their hands. A
mummy restraint is used during procedures. A jacket restraint restrains the body torso and is not
appropriate.
What preoperative nursing intervention should be included in the plan of care for an infant with pyloric
stenosis?
A. Monitor for signs of metabolic acidosis.
B. estimate the quantity of diarrhea stools.
C. place in a supine position after feeding
,D. observe for projectile vomiting.
D. observe for projectile vomiting.
Projectile vomiting which contributes to metabolic alkalosis, is the classic sign of pyloric stenosis.
Estimating the quantity of diarrhea stools is not indicated. Placing the child in a supine position is
dangerous due to the potential for aspiration with frequent vomiting.
A six-month-old returns from surgery with elbow restraints in place. What nursing care should be
included when caring for any restrained child?
A. keep restraints on at all times.
B. remove restraints one at a time and provide range of motion exercises
C. Remove all restraints simultaneously and provide lay activities
D. renew the healthcare provider's prescription for restraints every 72 hours.
B. remove restraints one at a time and provide range of motion exercises
Removing restraints one at a time is safer than removing all of them at once. The child needs to exercise
and should not be kept in restraints at all times. The renewal of the healthcare provider's prescription
varies with hospitals and it does not really answer the question.
A 2-year old child with Down syndrome is brought to the clinic for his regular physical examination. The
nurse knows which problem is frequently associated with Down syndrome?
A. congenital heart disease
B. fragile x-chromosome
C. trisomy 13
D. pyloric stenosis
A. congenital heart disease
Congenital heart disease is the most common associated defect in children with Down syndrome.
Trisomy 13 my have seemed possible since Down syndrome is a trisomal chromosomal abnormality o
chromosome 21. Fragile x-chromosome is a sex-linked abnormality also causing mental retardation.
Pyloric stenosis is not associated with Down syndrome.
, When assessing a child with asthma, the nurse should expect intercostal retractions during
A. inspiration
B. coughing
C. apneic episodes
D. expiration
A. inspiration
Intercostal retractions result from respiratory effort to draw air into restricted airways.
When planning the care for a child who has had a cleft lip repair, the nurse knows that crying should be
minimized because it
A. increases salivation
B. increases the respiratory rate
C. leads to vomiting
D. stresses the suture line
D. stresses the suture line
Prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance
of a cleft lip repair. Although crying also causes increased salivation, increased respiratory rate and may
lead to vomiting, these conditions do not create a problem for the child with a cleft lip repair.
A full-term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that
the infant may have an esophageal atresia. Which symptoms is this newborn likely to have exhibited?
A. choking, coughing, and cyanosis
B. projectile vomiting and cyanosis
C. apneic spells and grunting
D. scaphoid abdomen and anorexia
A. choking, coughing, and cyanosis
The nurse is giving preoperative instructions to a 14-year old female client who is scheduled for surgery
to correct a spinal curvature. Which statement by the client best demonstrates that learning has taken
place?
A. I will read all the literature you gave me before surgery.
B. I have had surgery before when I broke my wrist in a bike accident, so I know what to expect.
C. All the things people have told me will help me take care of my back.
D. I understand that I will be in a body cast and I will show you how you taught me to turn.
D. I understand that I will be in a body cast and I will show you how you taught me to turn.
Outcome of learning is best demonstrated when the client not only verbalizes an understanding, but
also can provide a return demonstration. A 14-year old may or may not follow through with reading
material and there is no way of measuring that way of learning. Have a previous surgery may help the
client understand the surgical process, but wrist surgery is very different from spinal surgery and
emergency surgery is different than elective surgery. In (C), the client may be saying what the nurse
wants to hear, without expressing any real understanding of what to do after surgery.
To take the vital signs of a 4-month old child, which order will give the most accurate results?
A. Respiratory rate, heart rate, then rectal temperature
B. Heart rate, rectal temperature, then respiratory rate.
C. Rectal temperature, heart rate, then respiratory rate
D. Rectal temperature, respiratory rate, then heart rate
A. Respiratory rate, heart rate, then rectal temperature
The respiratory rate should be taken first in infants, since touching them or performing unpleasant
procedures usually makes them cry, elevating the heart rate and making respirations difficult to count.
Rectal temperature is the most invasive procedure, and is mot likely to precipitate crying, so should be
done last.
During routine screening at a school clinic, an otoscope examination of a child's ear reveals a tympanic
membrane that is pearly gray, slightly bulging, and not movable. What action should the nurse take
next?
,A. No action required, as this is an expected finding for a school-aged child
B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.
C. Send a note home advising the parents to have the child evaluated by a healthcare provider as soon
as possible.
d. Call the parents and have them take the child home from school for the rest of the day.
B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.
More information is needed to interpret these findings. The tympanic membrane is normally pearly
gray, not bulging, and moves when the client blows against resistance or a small puff of air is blown into
the ear canal. Since this child's findings are not completely normal, further assessment of history and
related signs and symptoms is indicated for accurate interpretation of the findings. (A), (C), and (D) are
inappropriate actions based on the data obtained from the otoscope examination.
Which restraint should be used for a toddler after a cleft palate repair?
A. clove hitch
B. Mummy
C. elbow
D. jacket
C. elbow
Elbow restraints
Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical
site. A clove hitch restrains the hands, but the child can bend and bring their head to their hands. A
mummy restraint is used during procedures. A jacket restraint restrains the body torso and is not
appropriate.
What preoperative nursing intervention should be included in the plan of care for an infant with pyloric
stenosis?
A. Monitor for signs of metabolic acidosis.
B. estimate the quantity of diarrhea stools.
C. place in a supine position after feeding
,D. observe for projectile vomiting.
D. observe for projectile vomiting.
Projectile vomiting which contributes to metabolic alkalosis, is the classic sign of pyloric stenosis.
Estimating the quantity of diarrhea stools is not indicated. Placing the child in a supine position is
dangerous due to the potential for aspiration with frequent vomiting.
A six-month-old returns from surgery with elbow restraints in place. What nursing care should be
included when caring for any restrained child?
A. keep restraints on at all times.
B. remove restraints one at a time and provide range of motion exercises
C. Remove all restraints simultaneously and provide lay activities
D. renew the healthcare provider's prescription for restraints every 72 hours.
B. remove restraints one at a time and provide range of motion exercises
Removing restraints one at a time is safer than removing all of them at once. The child needs to exercise
and should not be kept in restraints at all times. The renewal of the healthcare provider's prescription
varies with hospitals and it does not really answer the question.
A 2-year old child with Down syndrome is brought to the clinic for his regular physical examination. The
nurse knows which problem is frequently associated with Down syndrome?
A. congenital heart disease
B. fragile x-chromosome
C. trisomy 13
D. pyloric stenosis
A. congenital heart disease
Congenital heart disease is the most common associated defect in children with Down syndrome.
Trisomy 13 my have seemed possible since Down syndrome is a trisomal chromosomal abnormality o
chromosome 21. Fragile x-chromosome is a sex-linked abnormality also causing mental retardation.
Pyloric stenosis is not associated with Down syndrome.
, When assessing a child with asthma, the nurse should expect intercostal retractions during
A. inspiration
B. coughing
C. apneic episodes
D. expiration
A. inspiration
Intercostal retractions result from respiratory effort to draw air into restricted airways.
When planning the care for a child who has had a cleft lip repair, the nurse knows that crying should be
minimized because it
A. increases salivation
B. increases the respiratory rate
C. leads to vomiting
D. stresses the suture line
D. stresses the suture line
Prevention of stress on the lip suture line is essential for optimum healing and the cosmetic appearance
of a cleft lip repair. Although crying also causes increased salivation, increased respiratory rate and may
lead to vomiting, these conditions do not create a problem for the child with a cleft lip repair.
A full-term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that
the infant may have an esophageal atresia. Which symptoms is this newborn likely to have exhibited?
A. choking, coughing, and cyanosis
B. projectile vomiting and cyanosis
C. apneic spells and grunting
D. scaphoid abdomen and anorexia
A. choking, coughing, and cyanosis
