OB/PEDS HESI COMBO
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. -
VERIFIED ANSWER 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 - VERIFIED ANSWER 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. -
VERIFIED ANSWER 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 - VERIFIED ANSWER 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. - VERIFIED ANSWER 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. - VERIFIED ANSWER
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 - VERIFIED ANSWER 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 - VERIFIED ANSWER 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 - VERIFIED ANSWER 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 - VERIFIED ANSWER A. choking, coughing, and cyanosis
(A) includes the "3 C's" of esophageal atresia caused by the overflow of secretions into the trachea.
(B) is characteristic of pyloric stenosis in the infant. (C) could be due to prematurity or sepsis, and
grunting is a sign of respiratory distress. (D) is characteristic of a diaphragmatic hernia.
Which behavior would the nurse expect a two-year-old child to exhibit?
A. build a house with blocks
B. ride a tricycle
C. display possessiveness of toys
D. look at a picture book for 15 minutes - VERIFIED ANSWER C. display possessiveness of toys
Two-year old children are egocentric and unable to share with other children. (A, B, and D) are
behaviors of a preschooler.
the mother of a preschool-aged client asks the nurse if it is all right to administer Pepto Bismal to her
son when he 'has a tummy ache." After reminding the mother to check the label of all OTC drugs for
the presence of aspirin, which instruction should the nurse include when replying to this mother's
question?
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. -
VERIFIED ANSWER 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 - VERIFIED ANSWER 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. -
VERIFIED ANSWER 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 - VERIFIED ANSWER 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. - VERIFIED ANSWER 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. - VERIFIED ANSWER
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 - VERIFIED ANSWER 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 - VERIFIED ANSWER 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 - VERIFIED ANSWER 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 - VERIFIED ANSWER A. choking, coughing, and cyanosis
(A) includes the "3 C's" of esophageal atresia caused by the overflow of secretions into the trachea.
(B) is characteristic of pyloric stenosis in the infant. (C) could be due to prematurity or sepsis, and
grunting is a sign of respiratory distress. (D) is characteristic of a diaphragmatic hernia.
Which behavior would the nurse expect a two-year-old child to exhibit?
A. build a house with blocks
B. ride a tricycle
C. display possessiveness of toys
D. look at a picture book for 15 minutes - VERIFIED ANSWER C. display possessiveness of toys
Two-year old children are egocentric and unable to share with other children. (A, B, and D) are
behaviors of a preschooler.
the mother of a preschool-aged client asks the nurse if it is all right to administer Pepto Bismal to her
son when he 'has a tummy ache." After reminding the mother to check the label of all OTC drugs for
the presence of aspirin, which instruction should the nurse include when replying to this mother's
question?
