PEDIATRIC'S HESI COMP BOOK EXAM
QUESTIONS WITH VERIFIED
ANSWERS
A full-term infant is admitted to the newborn nursery. During the initial PO feeding,
the practical nurse (PN) observes the infant for possible tracheal esophageal atresia.
Which symptoms are likely to be exhibited during the feeding if this condition is
present?
a. Choking, coughing, and cyanosis
b. Projectile vomiting and cyanosis
c. Apneic spells and grunting
d. Scaphoid abdomen and anorexia - ANSWER-a. Choking, coughing, and cyanosis
Rationale:
Choking, coughing, and cyanosis are the "3 Cs" of esophageal atresia caused by the
overflow of secretions into the trachea.
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
- ANSWER-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 oxygen administration and use of
a rapid-acting bronchodilator. Education regarding asthma triggers is also crucial, but
should take place after the child is stable.
An infant is born with a ventricular septal defect (VSD), and surgery is planned to
correct the defect. The practical nurse (PN) should understand that the surgical
correction is designed to achieve which hemodynamic outcome?
a. Stop the flow of unoxygenated blood into systemic circulation.
b. Increase the flow of unoxygenated blood to the lungs.
c. Prevent the return of oxygenated blood to the lungs.
d. Reduce peripheral tissue hypoxia and nail bed clubbing. - ANSWER-c. Prevent
the return of oxygenated blood to the lungs.
Rationale:
Closure of the VSD will stop shunting of oxygenated blood from the left ventricle
(higher pressure) to the right ventricle.
,The parents of a 1-year-old child, who was recently diagnosed with hypospadias,
state that they plan to delay the corrective surgery to see if the child will outgrow the
problem. What information is best for the practical nurse (PN) to provide to these
parents?
a. The prognosis will worsen if surgery is delayed.
b. Some children do outgrow this type of problem and waiting may be beneficial.
c. Regardless of the decision, the staff is available to assist with the process.
d. Discuss the child's diagnosis with the health care provider for additional
information and clarity. - ANSWER-d. Discuss the child's diagnosis with the health
care provider for additional information and clarity.
Rationale:
The PN should first ensure that the parents have adequate and correct information.
Hypospadias is a congenital anomaly resulting in an abnormally located urethral
meatus. Surgical correction is usually done early in childhood, which is considered
the best time for the child to face surgery with the fewest fears.
The practical nurse(PN) in the clinic receives a phone call from the mother of a 6
year old child with a newly applied cast for a fracture of the femur. The master
reports that the child Is in pain and is crying and that child's foot appears swollen and
blue. Which should be the nurse's instruction to the mother?
a. Ask the child to use crutches for mobility.
b. Apply ice to the site of the fracture
c. Bring the child immediately to the clinic
d. Administer the prescribed pain medication - ANSWER-c. Bring the child
immediately to the clinic.
Rationale:
Because the child is exhibiting indications of impaired circulation (pain and
cyanosis), the child is having altered peripheral tissue perfusion. The PN should
instruct the mother to bring the child into the clinic or emergency room immediately
for evaluation.
While examining a 6 year old visiting the clinic for fever and a rash, the practical
nurse (PN) notices several elevated 1- to 3-mm white spots on the buccal mucosa.
What other signs should the PN expect this child to exhibit?
a. Pruritic vesicular skin eruptions on trunk
b. Honey-colored crusted exudate from ruptured skin vesicles
c. Irregular red macular rash in the perianal area
d. Red blotchy macular rash on the face and neck - ANSWER-d. Red blotchy
macular rash on the face and neck
Rationale:
Elevated white spots on the oral mucosa of a child are likely Koplik's spots and are
indicative of rubeola. They are accompanied by a red blotchy rash that starts on the
face and spreads to the neck, the trunk, and the rest of the body.
The practical nurse (PN) has reviewed signs and symptoms of congestive heart
failure with the parents of a 2-year-old child with a congenital heart defect. The nurse
realizes the education has been effective if the parents identify which behavior as
most important for the parents to report to the health care provider?
a. Sits or squats frequently when playing outdoors.
b. Exhibits a sudden and unexplained weight gain.
, c. Is not completely toilet trained and has some "accidents."
d. Demonstrates irritation and fatigue 1 hour before bedtime. - ANSWER-b. Exhibits
a sudden and unexplained weight gain.
Rationale:
Sudden and unexplained weight gain can indicate fluid retention and is a sign of
congestive heart failure.
A newborn who has mild transitional (positional) clubfeet is placed in bilateral casts
in an overcorrected valgus (outward) position. What is the primary issue the practical
nurse should review with the parents during discharge teaching?
a. Prevent cast soiling and maintain the cast's edge by petaling.
b. Observe for skin and circulation compromise from the cast.
c. Manipulate the cast surfaces with the palms of the hands.
d. Support and elevate both legs on pillows continuously. - ANSWER-b. Observe for
skin and circulation compromise from the cast.
Rationale:
Reinforcing information with parents about their role in care and about vigilant
observation for potential problems of the infant at home such as skin and circulation
compromise is the most important nursing intervention
The nurse has reinforced instructions for a child who has been hospitalized with a
sickle cell crisis. The nurse realizes the instruction has been effective if the parents
make which statements?(Select all that apply.)
a. "if my child's joints are swollen and painful, I should apply ice."
b. "My child keeps wetting the bed, so I should restrict fluid intake."
c. "I will ask the physical education teacher allow extra fluid intake while exercising."
d. "If my child is having a crisis, morphine intravenously is likely going to be
necessary."
e. "If we are planning any trips, we need to make sure we do not travel to any high
altitudes." - ANSWER-c. "I will ask the physical education teacher allow extra fluid
intake while exercising."
d. "If my child is having a crisis, morphine intravenously is likely going to be
necessary."
e. "If we are planning any trips, we need to make sure we do not travel to any high
altitudes."
Rationale:
A child with sickle cell disease should have additional fluids while exercising. During
a crisis, parenteral morphine is likely necessary. The child should not travel to high
altitude areas, due to decreased oxygenation. If the child's joints are painful, warmth,
not ice packs, should be applied. Even though bedwetting is occurring, additional
fluids are still necessary to treat and prevent a crisis.
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
QUESTIONS WITH VERIFIED
ANSWERS
A full-term infant is admitted to the newborn nursery. During the initial PO feeding,
the practical nurse (PN) observes the infant for possible tracheal esophageal atresia.
Which symptoms are likely to be exhibited during the feeding if this condition is
present?
a. Choking, coughing, and cyanosis
b. Projectile vomiting and cyanosis
c. Apneic spells and grunting
d. Scaphoid abdomen and anorexia - ANSWER-a. Choking, coughing, and cyanosis
Rationale:
Choking, coughing, and cyanosis are the "3 Cs" of esophageal atresia caused by the
overflow of secretions into the trachea.
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
- ANSWER-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 oxygen administration and use of
a rapid-acting bronchodilator. Education regarding asthma triggers is also crucial, but
should take place after the child is stable.
An infant is born with a ventricular septal defect (VSD), and surgery is planned to
correct the defect. The practical nurse (PN) should understand that the surgical
correction is designed to achieve which hemodynamic outcome?
a. Stop the flow of unoxygenated blood into systemic circulation.
b. Increase the flow of unoxygenated blood to the lungs.
c. Prevent the return of oxygenated blood to the lungs.
d. Reduce peripheral tissue hypoxia and nail bed clubbing. - ANSWER-c. Prevent
the return of oxygenated blood to the lungs.
Rationale:
Closure of the VSD will stop shunting of oxygenated blood from the left ventricle
(higher pressure) to the right ventricle.
,The parents of a 1-year-old child, who was recently diagnosed with hypospadias,
state that they plan to delay the corrective surgery to see if the child will outgrow the
problem. What information is best for the practical nurse (PN) to provide to these
parents?
a. The prognosis will worsen if surgery is delayed.
b. Some children do outgrow this type of problem and waiting may be beneficial.
c. Regardless of the decision, the staff is available to assist with the process.
d. Discuss the child's diagnosis with the health care provider for additional
information and clarity. - ANSWER-d. Discuss the child's diagnosis with the health
care provider for additional information and clarity.
Rationale:
The PN should first ensure that the parents have adequate and correct information.
Hypospadias is a congenital anomaly resulting in an abnormally located urethral
meatus. Surgical correction is usually done early in childhood, which is considered
the best time for the child to face surgery with the fewest fears.
The practical nurse(PN) in the clinic receives a phone call from the mother of a 6
year old child with a newly applied cast for a fracture of the femur. The master
reports that the child Is in pain and is crying and that child's foot appears swollen and
blue. Which should be the nurse's instruction to the mother?
a. Ask the child to use crutches for mobility.
b. Apply ice to the site of the fracture
c. Bring the child immediately to the clinic
d. Administer the prescribed pain medication - ANSWER-c. Bring the child
immediately to the clinic.
Rationale:
Because the child is exhibiting indications of impaired circulation (pain and
cyanosis), the child is having altered peripheral tissue perfusion. The PN should
instruct the mother to bring the child into the clinic or emergency room immediately
for evaluation.
While examining a 6 year old visiting the clinic for fever and a rash, the practical
nurse (PN) notices several elevated 1- to 3-mm white spots on the buccal mucosa.
What other signs should the PN expect this child to exhibit?
a. Pruritic vesicular skin eruptions on trunk
b. Honey-colored crusted exudate from ruptured skin vesicles
c. Irregular red macular rash in the perianal area
d. Red blotchy macular rash on the face and neck - ANSWER-d. Red blotchy
macular rash on the face and neck
Rationale:
Elevated white spots on the oral mucosa of a child are likely Koplik's spots and are
indicative of rubeola. They are accompanied by a red blotchy rash that starts on the
face and spreads to the neck, the trunk, and the rest of the body.
The practical nurse (PN) has reviewed signs and symptoms of congestive heart
failure with the parents of a 2-year-old child with a congenital heart defect. The nurse
realizes the education has been effective if the parents identify which behavior as
most important for the parents to report to the health care provider?
a. Sits or squats frequently when playing outdoors.
b. Exhibits a sudden and unexplained weight gain.
, c. Is not completely toilet trained and has some "accidents."
d. Demonstrates irritation and fatigue 1 hour before bedtime. - ANSWER-b. Exhibits
a sudden and unexplained weight gain.
Rationale:
Sudden and unexplained weight gain can indicate fluid retention and is a sign of
congestive heart failure.
A newborn who has mild transitional (positional) clubfeet is placed in bilateral casts
in an overcorrected valgus (outward) position. What is the primary issue the practical
nurse should review with the parents during discharge teaching?
a. Prevent cast soiling and maintain the cast's edge by petaling.
b. Observe for skin and circulation compromise from the cast.
c. Manipulate the cast surfaces with the palms of the hands.
d. Support and elevate both legs on pillows continuously. - ANSWER-b. Observe for
skin and circulation compromise from the cast.
Rationale:
Reinforcing information with parents about their role in care and about vigilant
observation for potential problems of the infant at home such as skin and circulation
compromise is the most important nursing intervention
The nurse has reinforced instructions for a child who has been hospitalized with a
sickle cell crisis. The nurse realizes the instruction has been effective if the parents
make which statements?(Select all that apply.)
a. "if my child's joints are swollen and painful, I should apply ice."
b. "My child keeps wetting the bed, so I should restrict fluid intake."
c. "I will ask the physical education teacher allow extra fluid intake while exercising."
d. "If my child is having a crisis, morphine intravenously is likely going to be
necessary."
e. "If we are planning any trips, we need to make sure we do not travel to any high
altitudes." - ANSWER-c. "I will ask the physical education teacher allow extra fluid
intake while exercising."
d. "If my child is having a crisis, morphine intravenously is likely going to be
necessary."
e. "If we are planning any trips, we need to make sure we do not travel to any high
altitudes."
Rationale:
A child with sickle cell disease should have additional fluids while exercising. During
a crisis, parenteral morphine is likely necessary. The child should not travel to high
altitude areas, due to decreased oxygenation. If the child's joints are painful, warmth,
not ice packs, should be applied. Even though bedwetting is occurring, additional
fluids are still necessary to treat and prevent a crisis.
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
