OB/Peds HESI Practice Questions
The RN is monitoring an infant with CHD closely for SSx of HF. The RN should assess the infant
for which early sign of HF?
1.Pallor
2.Cough
3.Tachycardia
4.Slow and shallow breathing - ANS3. tachycardia
RATIONALE:
HF is the inability of the heart to pump a sufficient amt of blood to meet the O2 and metabolic
needs of the body. The early SSx of HF include tachycardia, tachypnea, profuse scalp sweating,
fatigue & irritability, sudden weight gain, and resp distress. A cough may occur in HF as a result
of mucosal swelling & irritation, but is not an early sign. Pallor may be noted in an infant w/ HF,
but is not an early sign.
The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic
fever, knowing that which laboratory study would assist in confirming the diagnosis?
1.Immunoglobulin
2.Red blood cell count
3.White blood cell count
4.Anti-streptolysin O titer - ANS4. anti-streptolysin O titer
RATIONALE:
Rheumatic fever is an inflammatory autoimmune disease that affects the CT of the heart, joints,
skin (SQ tissues), BV, and CNS. A Dx of rheumatic fever is confirmed by the presence of 2
major manifestations or 1 major and 2 minor manifestations from the Jones criteria. In addition,
evidence of a recent strep infection is confirmed by a + anti-streptolysin O titer, streptozyme
assay, or anti-DNase B assay.
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse
expects to note which clinical manifestation of the acute stage of the disease?
1.Cracked lips
2.Normal appearance
3.Conjunctival hyperemia
4.Desquamation of the skin - ANS3. conjunctival hyperemia
RATIONALE:
,Kawasaki disease, aka mucocutaneous lymph node syndrome, is an acute systemic
inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red
throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute
stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes,
joint pain, cardiac manifestations, and thromobocytosis occur. In the convalescent stage, the
child appears normal, but SSx of inflammation may be present
The mother of a child being discharged after heart surgery asks the nurse when the child will be
able to return to school. Which is the most appropriate response to the mother?
1."The child may return to school in 1 week."
2."The child will not be able to return to school during this academic year."
3."The child may return to school in 1 week but needs to go half-days for the first 2 weeks."
4."The child may return to school in 3 weeks but needs to go half-days for the first few days." -
ANS4. "The child may return to school in 3 weeks but needs to go half-days for the 1st few
days"
RATIONALE:
After heart surgery, the child may be able to return to school in 3 weeks but needs to go
half-days for the 1st few days. The mother also should be told that the child cannot participate in
PE for 2 months.
Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of
the child is a registered nurse and asks the nurse why the child needs the medication. What is
the most appropriate response to the mother about the action of the medication?
1.Prevents blue (tet) spells
2.Maintains adequate cardiac output
3.Maintains an adequate hormonal level
4.Maintains the position of the great arteries - ANS2. maintains adequate CO
RATIONALE:
A child with transposition of the great arteries may receive prostaglandin E1 temporarily to
increased blood mixing if systemic and pulmonary mixing is inadequate to maintain adequate
CO.
The nurse is assessing a newborn with heart failure before administering the prescribed digoxin.
In reviewing the laboratory data, the nurse notes that the newborn has a digoxin blood level of
1.6 ng/mL (2.05 mmol/L) and an apical heart rate of 90 beats/min. The mother also tells the
nurse that the newborn just vomited her formula. Which intervention should the nurse take?
1.Retake the apical pulse.
2.Administer the medication.
3.Withhold the medication for 1 hour.
, 4.Withhold the medication and notify the health care provider. - ANS4. withhold the med and
notify HCP
RATIONALE:
The apical pulse rate for a newborn is 120-160 bpm. The therapeutic dig level is 0.5-0.8. Bc the
apical rate is low and the dig blood level is elevated, indicating toxicity, the RN would withhold
the med and notify the HCP
The nurse is preparing to administer digoxin to an infant with heart failure. Before administering
the medication, the nurse double-checks the dose, counts the apical heart rate for 1 full minute,
and obtains a rate of 80 beats/minute. Based on this finding, which is the appropriate nursing
action?
1.Withhold the medication.
2.Administer the medication.
3.Check the blood pressure and then administer the medication.
4.Check the respiratory rate and then administer the medication. - ANS1. withhold the med
RATIONALE:
Dig is a cardiac glycoside that is used to treat HF. A primary concern is dig toxicity, and the RN
needs to monitor closely for SSx of toxicity and monitor dig blood levels. The med is effective
within a narrow therapeutic dig range (0.5-0.8). Safety in administration is achieved by double
checking the dose and counting the apical HR for 1 full minute. The apical HR for an infant is
90-130 bpm. If the HR is less than 90 bpm in an infant, the RN would withhold the dose and
contact the HCP.
The nurse is creating a plan of care for a child admitted with a diagnosis of Kawasaki disease.
In developing the initial plan of care, the nurse should include monitoring the child for signs of
which condition?
1.
Bleeding
2.
Heart failure
3.
Failure to thrive
4.
Decreased tolerance to stimulation - ANS2. HF
RATIONALE:
Nursing care initially centers on observing for SSx of HF. The RN monitors for increased RR,
increased HR, dyspnea, crackles, and abdominal distension
The RN is monitoring an infant with CHD closely for SSx of HF. The RN should assess the infant
for which early sign of HF?
1.Pallor
2.Cough
3.Tachycardia
4.Slow and shallow breathing - ANS3. tachycardia
RATIONALE:
HF is the inability of the heart to pump a sufficient amt of blood to meet the O2 and metabolic
needs of the body. The early SSx of HF include tachycardia, tachypnea, profuse scalp sweating,
fatigue & irritability, sudden weight gain, and resp distress. A cough may occur in HF as a result
of mucosal swelling & irritation, but is not an early sign. Pallor may be noted in an infant w/ HF,
but is not an early sign.
The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic
fever, knowing that which laboratory study would assist in confirming the diagnosis?
1.Immunoglobulin
2.Red blood cell count
3.White blood cell count
4.Anti-streptolysin O titer - ANS4. anti-streptolysin O titer
RATIONALE:
Rheumatic fever is an inflammatory autoimmune disease that affects the CT of the heart, joints,
skin (SQ tissues), BV, and CNS. A Dx of rheumatic fever is confirmed by the presence of 2
major manifestations or 1 major and 2 minor manifestations from the Jones criteria. In addition,
evidence of a recent strep infection is confirmed by a + anti-streptolysin O titer, streptozyme
assay, or anti-DNase B assay.
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse
expects to note which clinical manifestation of the acute stage of the disease?
1.Cracked lips
2.Normal appearance
3.Conjunctival hyperemia
4.Desquamation of the skin - ANS3. conjunctival hyperemia
RATIONALE:
,Kawasaki disease, aka mucocutaneous lymph node syndrome, is an acute systemic
inflammatory illness. In the acute stage, the child has a fever, conjunctival hyperemia, red
throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute
stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes,
joint pain, cardiac manifestations, and thromobocytosis occur. In the convalescent stage, the
child appears normal, but SSx of inflammation may be present
The mother of a child being discharged after heart surgery asks the nurse when the child will be
able to return to school. Which is the most appropriate response to the mother?
1."The child may return to school in 1 week."
2."The child will not be able to return to school during this academic year."
3."The child may return to school in 1 week but needs to go half-days for the first 2 weeks."
4."The child may return to school in 3 weeks but needs to go half-days for the first few days." -
ANS4. "The child may return to school in 3 weeks but needs to go half-days for the 1st few
days"
RATIONALE:
After heart surgery, the child may be able to return to school in 3 weeks but needs to go
half-days for the 1st few days. The mother also should be told that the child cannot participate in
PE for 2 months.
Prostaglandin E1 is prescribed for a child with transposition of the great arteries. The mother of
the child is a registered nurse and asks the nurse why the child needs the medication. What is
the most appropriate response to the mother about the action of the medication?
1.Prevents blue (tet) spells
2.Maintains adequate cardiac output
3.Maintains an adequate hormonal level
4.Maintains the position of the great arteries - ANS2. maintains adequate CO
RATIONALE:
A child with transposition of the great arteries may receive prostaglandin E1 temporarily to
increased blood mixing if systemic and pulmonary mixing is inadequate to maintain adequate
CO.
The nurse is assessing a newborn with heart failure before administering the prescribed digoxin.
In reviewing the laboratory data, the nurse notes that the newborn has a digoxin blood level of
1.6 ng/mL (2.05 mmol/L) and an apical heart rate of 90 beats/min. The mother also tells the
nurse that the newborn just vomited her formula. Which intervention should the nurse take?
1.Retake the apical pulse.
2.Administer the medication.
3.Withhold the medication for 1 hour.
, 4.Withhold the medication and notify the health care provider. - ANS4. withhold the med and
notify HCP
RATIONALE:
The apical pulse rate for a newborn is 120-160 bpm. The therapeutic dig level is 0.5-0.8. Bc the
apical rate is low and the dig blood level is elevated, indicating toxicity, the RN would withhold
the med and notify the HCP
The nurse is preparing to administer digoxin to an infant with heart failure. Before administering
the medication, the nurse double-checks the dose, counts the apical heart rate for 1 full minute,
and obtains a rate of 80 beats/minute. Based on this finding, which is the appropriate nursing
action?
1.Withhold the medication.
2.Administer the medication.
3.Check the blood pressure and then administer the medication.
4.Check the respiratory rate and then administer the medication. - ANS1. withhold the med
RATIONALE:
Dig is a cardiac glycoside that is used to treat HF. A primary concern is dig toxicity, and the RN
needs to monitor closely for SSx of toxicity and monitor dig blood levels. The med is effective
within a narrow therapeutic dig range (0.5-0.8). Safety in administration is achieved by double
checking the dose and counting the apical HR for 1 full minute. The apical HR for an infant is
90-130 bpm. If the HR is less than 90 bpm in an infant, the RN would withhold the dose and
contact the HCP.
The nurse is creating a plan of care for a child admitted with a diagnosis of Kawasaki disease.
In developing the initial plan of care, the nurse should include monitoring the child for signs of
which condition?
1.
Bleeding
2.
Heart failure
3.
Failure to thrive
4.
Decreased tolerance to stimulation - ANS2. HF
RATIONALE:
Nursing care initially centers on observing for SSx of HF. The RN monitors for increased RR,
increased HR, dyspnea, crackles, and abdominal distension
