Pediatric's HESI Comp Book
A 12 year old with type 1 diabetes mellitus complains of abdominal pain and has experienced
increased thirst during the previous 24 hours. What action should the practical nurse implement
first?
a. Obtain blood for a complete blood count (CBC) test.
b. Initiate D10W at 50 mL/hour IV.
c. Test urine for ketones and glucose.
d. Assess temperature and blood pressure. - ANS-c. Test urine for ketones and glucose.
Rationale:
This child is exhibiting signs of impending diabetic ketoacidosis (DKA), so the child's urine
should be tested for ketones and glucose to assess for DKA.
A 12-year-old child has been experiencing right lower quadrant abdominal pain and acute
appendicitis has been diagnosed. The child rates the pain level as an 8 on the 0-10 scale. An
hour later, the child says the pain suddenly went away. The nurse contacts the health care
provider for which reason?
a. To report the pain has been relieved
b. To inform the on call surgical team that surgery will not be needed
c. To inform the health care provider that the pain abruptly stopped, indicating possible rupture
d. To ask if liquids can be prescribed by mouth and to ask to change the intravenous antibiotics
to be given orally - ANS-c. To inform the health care provider that the pain abruptly stopped,
indicating possible rupture
Rationale:
A person experiencing a ruptured appendix will experience an abrupt relief of pain. The nurse is
contacting the health care provider because this indicates surgery will be necessary very quickly
to prevent peritonitis and sepsis. The nurse is not notifying the health care provider to report
pain relief, or to notify the surgical team that surgery is not needed. The child will be kept NPO
(nothing by mouth status), until the surgeon prescribes fluids after surgery. The child should not
be given fluids by mouth prior to surgery, because this could contribute to aspiration.
A 15-year-old male with a mild cognitive deficit who is hospitalized for minor surgery tells a
female practical nurse (PN), "Wow, you have big ones." Which response is best for the PN to
make?
a. "Do you really think so?"
b. "That language is not permitted."
c. "You should not speak to me like that, such language offends me."
d. "I'll notify your parents if you continue to talk that way." - ANS-b. "That language is not
permitted."
Rationale:
Limit setting is necessary for inappropriate behavior or suggestive interaction. Sets limits without
threatening or degrading the client.
,A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred
injection site to administer this immunization?
a. Dorsal gluteal
b. Vastus lateralis
c. Ventral gluteal
d. Deltoid - ANS-b. Vastus lateralis
Rationale:
The preferred intramuscular site for children younger than 2 years of age is the vastus lateralis.
A 2-year-old child developed a fever of 103.4° F (39.7° C) and was rushed to the emergency
department when the child developed febrile seizures. After the child was stabilized, the health
care provider diagnosed otitis media in the child. The concerned caregivers ask the nurse how
this can be prevented from happening again. The nurse should reinforce which instructions?
a. Contact the child's health care provider if the child starts pulling at the ear.
b. If the child develops an elevated temperature, bathe the child in cold water.
c. Give the child a bottle to take while in the supine position to relieve the pain.
d. Use children's chewable baby aspirin if the child's temperature is over 102° F (38.9° C). -
ANS-a. Contact the child's health care provider if the child starts pulling at the ear.
The parents should be taught to contact the health care provider if the child begins to pull at the
ears, an early sign of otitis media. Treating otitis media early can reduce the risk of a high
temperature and a resulting febrile seizure. If the child develops an elevated temperature, the
child should be bathed in tepid water, not cold water or rubbing alcohol. Taking a bottle in the
supine position is not recommended because this increases the risk of developing otitis media.
Children should be given acetaminophen as prescribed for pain and fever. Aspirin is not
recommended in children due to the risk of Reyes syndrome, a serious neurological disorder.
Unfortunately, pleasantly flavored children's chewable aspirin is sometimes described or labeled
as "baby aspirin."
A 2-year-old child had tympanostomy ventilating tubes inserted into both tympanic membranes
(TMs) 1 week earlier. During a postoperative clinic visit, the practical nurse (PN) notes that the
child has a purulent discharge from the right ear, and the mother explains that the toddler has
had a cold for 3 days. What action should the PN plan to implement?
a. Collect a specimen of the otorrhea for culture.
b. Refer the child for audiologic screening tests.
c. Administer prescribed antibiotics.
d. Perform an otoscopic exam for TM tube placement. - ANS-a. Collect a specimen of the
otorrhea for culture.
Rationale:
The presence of the purulent drainage indicates that the middle ear is draining a new infectious
process, and a specimen of the otorrhea should be collected for culture. Tympanostomy tubes
are surgically placed to manage otitis media with effusion (OME) to provide mechanical
drainage of fluid and to equalize pressure within the middle ear. Chronic OME can impede TM
and ossicle function, necessitating hearing screening. The immediate problem, however, is
infection.
, A 2-year-old child who is hospitalized with an acute upper respiratory infection (URI) is crying
uncontrollably because her mother went to the cafeteria for lunch. Which action should the
practical nurse implement?
a. Distract the child with a favorite toy.
b. Tell the child that her mother will return.
c. Take the child to the cafeteria.
d. Calm the child with a dietary treat. - ANS-a. Distract the child with a favorite toy.
Rationale:
The best action is to refocus the child's attention by distracting with a favorite toy.
A 3 day infant has had surgery to reconstruct the anus due to an anorectal malformation noted
at birth. The nurse will implement which aspect of postoperative care?
a. Assess the child's temperature rectally every 4 hours.
b. Position the child side-lying prone with the hips elevated.
c. Inform the parents toilet training should begin on schedule.
d. Passing stools in the urine is expected to occur after surgery. - ANS-b. Position the child
side-lying prone with the hips elevated.
Rationale:
The child should be positioned in the side-lying prone position with the hips elevated to
decrease pressure on the perineal sutures. No rectal temperatures should be taken
postoperatively, because this could disrupt the sutures. Toilet training is frequently delayed and
full continence may not be achieved. It is not normal for the child to pass stools in the urine
A 5-year-old children tells the practical nurse (PN) that she "needs a Band-Aid" when she has
an injection. Which action is best for the PN to take?
a. Show her that the bleeding has already stopped.
b. Explain why a Band-Aid is not needed.
c. Ask her why she wants a Band-Aid.
d. Apply a Band-Aid over the injection site - ANS-d. Apply a Band-Aid over the injection site.
Rationale:
Preschool children sometimes think that any hole (e.g., an injection or incision) made in their
bodies allow their "insides to leak out," so applying a Band-Aid over the hole prevents this from
occurring.
A 6-year-old child arrives to the urgent care center with symptoms of an asthma exacerbation.
The child's oxygen saturation is 90%, the pulse is 120 beats/min, and the respiratory rate 32 per
minute. The nurse should prepare for which priority intervention?
a. Administration of a long-acting bronchodilator
b. Monitoring for signs of an infection masked by steroid use
c. Administration of oxygen and subcutaneous injection of epinephrine
d. Reviewing with the caregivers the possible triggers for an exacerbation of asthma - ANS-c.
Administration of oxygen and subcutaneous injection of epinephrine
Rationale:
The priority of care for an acute asthma attack is oxygen administration and administration of
epinephrine, which is a rapid-acting bronchodilator. After the acute attack has subsided, and the
child's respiratory status is stable, the nurse can anticipate administration of a long-acting
bronchodilator. Monitoring for signs of an infection is important, but the immediate priority is
A 12 year old with type 1 diabetes mellitus complains of abdominal pain and has experienced
increased thirst during the previous 24 hours. What action should the practical nurse implement
first?
a. Obtain blood for a complete blood count (CBC) test.
b. Initiate D10W at 50 mL/hour IV.
c. Test urine for ketones and glucose.
d. Assess temperature and blood pressure. - ANS-c. Test urine for ketones and glucose.
Rationale:
This child is exhibiting signs of impending diabetic ketoacidosis (DKA), so the child's urine
should be tested for ketones and glucose to assess for DKA.
A 12-year-old child has been experiencing right lower quadrant abdominal pain and acute
appendicitis has been diagnosed. The child rates the pain level as an 8 on the 0-10 scale. An
hour later, the child says the pain suddenly went away. The nurse contacts the health care
provider for which reason?
a. To report the pain has been relieved
b. To inform the on call surgical team that surgery will not be needed
c. To inform the health care provider that the pain abruptly stopped, indicating possible rupture
d. To ask if liquids can be prescribed by mouth and to ask to change the intravenous antibiotics
to be given orally - ANS-c. To inform the health care provider that the pain abruptly stopped,
indicating possible rupture
Rationale:
A person experiencing a ruptured appendix will experience an abrupt relief of pain. The nurse is
contacting the health care provider because this indicates surgery will be necessary very quickly
to prevent peritonitis and sepsis. The nurse is not notifying the health care provider to report
pain relief, or to notify the surgical team that surgery is not needed. The child will be kept NPO
(nothing by mouth status), until the surgeon prescribes fluids after surgery. The child should not
be given fluids by mouth prior to surgery, because this could contribute to aspiration.
A 15-year-old male with a mild cognitive deficit who is hospitalized for minor surgery tells a
female practical nurse (PN), "Wow, you have big ones." Which response is best for the PN to
make?
a. "Do you really think so?"
b. "That language is not permitted."
c. "You should not speak to me like that, such language offends me."
d. "I'll notify your parents if you continue to talk that way." - ANS-b. "That language is not
permitted."
Rationale:
Limit setting is necessary for inappropriate behavior or suggestive interaction. Sets limits without
threatening or degrading the client.
,A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred
injection site to administer this immunization?
a. Dorsal gluteal
b. Vastus lateralis
c. Ventral gluteal
d. Deltoid - ANS-b. Vastus lateralis
Rationale:
The preferred intramuscular site for children younger than 2 years of age is the vastus lateralis.
A 2-year-old child developed a fever of 103.4° F (39.7° C) and was rushed to the emergency
department when the child developed febrile seizures. After the child was stabilized, the health
care provider diagnosed otitis media in the child. The concerned caregivers ask the nurse how
this can be prevented from happening again. The nurse should reinforce which instructions?
a. Contact the child's health care provider if the child starts pulling at the ear.
b. If the child develops an elevated temperature, bathe the child in cold water.
c. Give the child a bottle to take while in the supine position to relieve the pain.
d. Use children's chewable baby aspirin if the child's temperature is over 102° F (38.9° C). -
ANS-a. Contact the child's health care provider if the child starts pulling at the ear.
The parents should be taught to contact the health care provider if the child begins to pull at the
ears, an early sign of otitis media. Treating otitis media early can reduce the risk of a high
temperature and a resulting febrile seizure. If the child develops an elevated temperature, the
child should be bathed in tepid water, not cold water or rubbing alcohol. Taking a bottle in the
supine position is not recommended because this increases the risk of developing otitis media.
Children should be given acetaminophen as prescribed for pain and fever. Aspirin is not
recommended in children due to the risk of Reyes syndrome, a serious neurological disorder.
Unfortunately, pleasantly flavored children's chewable aspirin is sometimes described or labeled
as "baby aspirin."
A 2-year-old child had tympanostomy ventilating tubes inserted into both tympanic membranes
(TMs) 1 week earlier. During a postoperative clinic visit, the practical nurse (PN) notes that the
child has a purulent discharge from the right ear, and the mother explains that the toddler has
had a cold for 3 days. What action should the PN plan to implement?
a. Collect a specimen of the otorrhea for culture.
b. Refer the child for audiologic screening tests.
c. Administer prescribed antibiotics.
d. Perform an otoscopic exam for TM tube placement. - ANS-a. Collect a specimen of the
otorrhea for culture.
Rationale:
The presence of the purulent drainage indicates that the middle ear is draining a new infectious
process, and a specimen of the otorrhea should be collected for culture. Tympanostomy tubes
are surgically placed to manage otitis media with effusion (OME) to provide mechanical
drainage of fluid and to equalize pressure within the middle ear. Chronic OME can impede TM
and ossicle function, necessitating hearing screening. The immediate problem, however, is
infection.
, A 2-year-old child who is hospitalized with an acute upper respiratory infection (URI) is crying
uncontrollably because her mother went to the cafeteria for lunch. Which action should the
practical nurse implement?
a. Distract the child with a favorite toy.
b. Tell the child that her mother will return.
c. Take the child to the cafeteria.
d. Calm the child with a dietary treat. - ANS-a. Distract the child with a favorite toy.
Rationale:
The best action is to refocus the child's attention by distracting with a favorite toy.
A 3 day infant has had surgery to reconstruct the anus due to an anorectal malformation noted
at birth. The nurse will implement which aspect of postoperative care?
a. Assess the child's temperature rectally every 4 hours.
b. Position the child side-lying prone with the hips elevated.
c. Inform the parents toilet training should begin on schedule.
d. Passing stools in the urine is expected to occur after surgery. - ANS-b. Position the child
side-lying prone with the hips elevated.
Rationale:
The child should be positioned in the side-lying prone position with the hips elevated to
decrease pressure on the perineal sutures. No rectal temperatures should be taken
postoperatively, because this could disrupt the sutures. Toilet training is frequently delayed and
full continence may not be achieved. It is not normal for the child to pass stools in the urine
A 5-year-old children tells the practical nurse (PN) that she "needs a Band-Aid" when she has
an injection. Which action is best for the PN to take?
a. Show her that the bleeding has already stopped.
b. Explain why a Band-Aid is not needed.
c. Ask her why she wants a Band-Aid.
d. Apply a Band-Aid over the injection site - ANS-d. Apply a Band-Aid over the injection site.
Rationale:
Preschool children sometimes think that any hole (e.g., an injection or incision) made in their
bodies allow their "insides to leak out," so applying a Band-Aid over the hole prevents this from
occurring.
A 6-year-old child arrives to the urgent care center with symptoms of an asthma exacerbation.
The child's oxygen saturation is 90%, the pulse is 120 beats/min, and the respiratory rate 32 per
minute. The nurse should prepare for which priority intervention?
a. Administration of a long-acting bronchodilator
b. Monitoring for signs of an infection masked by steroid use
c. Administration of oxygen and subcutaneous injection of epinephrine
d. Reviewing with the caregivers the possible triggers for an exacerbation of asthma - ANS-c.
Administration of oxygen and subcutaneous injection of epinephrine
Rationale:
The priority of care for an acute asthma attack is oxygen administration and administration of
epinephrine, which is a rapid-acting bronchodilator. After the acute attack has subsided, and the
child's respiratory status is stable, the nurse can anticipate administration of a long-acting
bronchodilator. Monitoring for signs of an infection is important, but the immediate priority is
