PEDS HESI FINAL EXAM PRACTICE TEST QUESTIONS
WITH DETAILED ANSWERS WITH RATIONALE
The nurse is assessing the neurovascular status of a child in Russell's traction. Which finding should the
nurse report to the healthcare provider?
Pale bluish coloration of the toes.
Rationale:
Russell's skin traction is used for fractures of the femur in young children and adolescents whose growth
plates remain open and is applied to the lower leg using moleskin and elastic wrap bandages, which can
compress the peroneal nerve and arteries that supply the foot. Assessment of adequate circulation,
movement, and sensation of the toes and skin distal to the application is made to identify compromised
blood flow, so cyanosis of the toes should be reported immediately.
The nurse is teaching the parents of a 5-year-old child with cystic fibrosis about respiratory treatments.
Which statement indicates to the nurse that the parents understand?
Administer aerosol therapy followed by postural drainage before meals.
Rationale:
Postural drainage for a child with cystic fibrosis is most effective when performed after nebulization and
one hour before meals and/or at least 2 hours after eating to prevent nausea and vomiting and potential
aspiration. Postural drainage uses gravity to promote mucous removal after the nebulization treatments
has liquefied the secretions, therefore helps open the airways. Pulmonary toileting or respiratory
treatments should be given 3 to 4 times daily.
,A 16-year-old is brought to the Emergency Center with a crushed leg after falling off a horse. The
adolescent's last tetanus toxoid booster was received eight years ago. What action should the nurse
take?
Administer tetanus toxoid booster.
Rationale:
After the completion of the initial tetanus immunization schedule, the recommended booster for an
adolescent or adult is every ten years or less if a traumatic injury occurs that is contaminated by dirt,
feces, soil, or saliva, such as puncture or crushing injuries, avulsions, wounds from missiles, burns, or
frostbite. The adolescent's injury is considered a contaminated wound requiring prophylactic therapy, so
the tetanus toxoid booster should be administered.
A 2-year-old child recently diagnosed with hemophilia A is discharged home. What information should
the nurse include in a teaching plan about home care?
Apply pressure and ice for bleeding while elevating and resting the extremity.
Rationale:
Hemophilia, a blood disorder, causes joint bleeding which is treated with rest, ice, compression, and
elevation (RICE).
A child falls on the playground and is brought to the school nurse with a small laceration on the forearm.
Which action should the nurse implement first?
Wash the wound gently with mild soap and water.
Rationale:
A small, superficial laceration to the skin should be washed gently with mild soap and water for several
minutes, followed by thorough rinsing. Washing the superficial laceration will help prevent an infection
and/or tetanus. Hydrogen peroxide should be avoided because it can irritate the already injured tissue.
,A burned child is brought to the emergency room. In estimating the percentage of the body burned, the
nurse uses a modified "Rule of Nines." Which part of a child's body is calculated as a larger percentage
of total body surface than an adult's?
Head and neck.
Rationale:
A child's head and neck are proportionately larger to their body than an adult's. The standard "Rule of
Nines" is inaccurate for determining burned body surface areas with children, and must be modified for
use with children. Specially designed charts for children are commonly used to determine body surface
area involvement.
When discussing discipline with the mother of a 4-year-old child, the nurse should include which
guideline?
Parental control should be consistent.
Rationale:
Discipline should be a positive and necessary component of childrearing that is started in infancy and
should teach socially acceptable behavior, help children protect themselves from danger, and channel
undesirable behavior into constructive activity. Misbehavior may result from inconsistent rules or
messages, so parental attention should be clear, reasonable, and consistent. The most important aspect
of parenting is being consistent when raising a child, so it helps them to establish structure and
boundaries. Structure and boundaries that are consistently followed through will help a child feel more
secure and less anxious than no boundaries or consistency.
A 3-month-old infant develops oral thrush. Which pharmacologic agent should the nurse plan to
administer for treatment of this disorder?
Nystatin (Mycostatin).
Rationale:
Nystatin (Mycostatin) is an antifungal drug that is effective in treating thrush, an oral fungal infection.
, Which growth and development characteristic should the nurse consider when monitoring the effects of
a topical medication for an infant?
A thin stratum corneum that increases topical absorption.
Rationale:
Infants have a thin outer skin layer (stratum corneum), so the nurse should monitor the infant for a
prompt onset and response to the application of topical medication.
A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which
behavior?
Concern for body integrity.
Rationale:
The preschooler's major stressor is concern for his body integrity. He fears that his "insides will leak
out." A child undergoing surgery to his genitalia is even more concerned about body integrity.
A child with a penetrating eye injury comes to the school clinic. What action should the nurse
implement?
Apply a Fox shield to the affected eye and any type of patch to the other eye.
Rationale:
The treatment for a penetrating eye injury is not to remove or manipulate the impaled object, but to
apply a Fox shield over the eye, if available (not a regular eye patch) and place an eye patch over the
unaffected eye to prevent bilateral eye movement. The child should be transported to the emergency
department immediately. If a Fox shield is not available, then tape in place a paper cup over the eye and
object.
WITH DETAILED ANSWERS WITH RATIONALE
The nurse is assessing the neurovascular status of a child in Russell's traction. Which finding should the
nurse report to the healthcare provider?
Pale bluish coloration of the toes.
Rationale:
Russell's skin traction is used for fractures of the femur in young children and adolescents whose growth
plates remain open and is applied to the lower leg using moleskin and elastic wrap bandages, which can
compress the peroneal nerve and arteries that supply the foot. Assessment of adequate circulation,
movement, and sensation of the toes and skin distal to the application is made to identify compromised
blood flow, so cyanosis of the toes should be reported immediately.
The nurse is teaching the parents of a 5-year-old child with cystic fibrosis about respiratory treatments.
Which statement indicates to the nurse that the parents understand?
Administer aerosol therapy followed by postural drainage before meals.
Rationale:
Postural drainage for a child with cystic fibrosis is most effective when performed after nebulization and
one hour before meals and/or at least 2 hours after eating to prevent nausea and vomiting and potential
aspiration. Postural drainage uses gravity to promote mucous removal after the nebulization treatments
has liquefied the secretions, therefore helps open the airways. Pulmonary toileting or respiratory
treatments should be given 3 to 4 times daily.
,A 16-year-old is brought to the Emergency Center with a crushed leg after falling off a horse. The
adolescent's last tetanus toxoid booster was received eight years ago. What action should the nurse
take?
Administer tetanus toxoid booster.
Rationale:
After the completion of the initial tetanus immunization schedule, the recommended booster for an
adolescent or adult is every ten years or less if a traumatic injury occurs that is contaminated by dirt,
feces, soil, or saliva, such as puncture or crushing injuries, avulsions, wounds from missiles, burns, or
frostbite. The adolescent's injury is considered a contaminated wound requiring prophylactic therapy, so
the tetanus toxoid booster should be administered.
A 2-year-old child recently diagnosed with hemophilia A is discharged home. What information should
the nurse include in a teaching plan about home care?
Apply pressure and ice for bleeding while elevating and resting the extremity.
Rationale:
Hemophilia, a blood disorder, causes joint bleeding which is treated with rest, ice, compression, and
elevation (RICE).
A child falls on the playground and is brought to the school nurse with a small laceration on the forearm.
Which action should the nurse implement first?
Wash the wound gently with mild soap and water.
Rationale:
A small, superficial laceration to the skin should be washed gently with mild soap and water for several
minutes, followed by thorough rinsing. Washing the superficial laceration will help prevent an infection
and/or tetanus. Hydrogen peroxide should be avoided because it can irritate the already injured tissue.
,A burned child is brought to the emergency room. In estimating the percentage of the body burned, the
nurse uses a modified "Rule of Nines." Which part of a child's body is calculated as a larger percentage
of total body surface than an adult's?
Head and neck.
Rationale:
A child's head and neck are proportionately larger to their body than an adult's. The standard "Rule of
Nines" is inaccurate for determining burned body surface areas with children, and must be modified for
use with children. Specially designed charts for children are commonly used to determine body surface
area involvement.
When discussing discipline with the mother of a 4-year-old child, the nurse should include which
guideline?
Parental control should be consistent.
Rationale:
Discipline should be a positive and necessary component of childrearing that is started in infancy and
should teach socially acceptable behavior, help children protect themselves from danger, and channel
undesirable behavior into constructive activity. Misbehavior may result from inconsistent rules or
messages, so parental attention should be clear, reasonable, and consistent. The most important aspect
of parenting is being consistent when raising a child, so it helps them to establish structure and
boundaries. Structure and boundaries that are consistently followed through will help a child feel more
secure and less anxious than no boundaries or consistency.
A 3-month-old infant develops oral thrush. Which pharmacologic agent should the nurse plan to
administer for treatment of this disorder?
Nystatin (Mycostatin).
Rationale:
Nystatin (Mycostatin) is an antifungal drug that is effective in treating thrush, an oral fungal infection.
, Which growth and development characteristic should the nurse consider when monitoring the effects of
a topical medication for an infant?
A thin stratum corneum that increases topical absorption.
Rationale:
Infants have a thin outer skin layer (stratum corneum), so the nurse should monitor the infant for a
prompt onset and response to the application of topical medication.
A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which
behavior?
Concern for body integrity.
Rationale:
The preschooler's major stressor is concern for his body integrity. He fears that his "insides will leak
out." A child undergoing surgery to his genitalia is even more concerned about body integrity.
A child with a penetrating eye injury comes to the school clinic. What action should the nurse
implement?
Apply a Fox shield to the affected eye and any type of patch to the other eye.
Rationale:
The treatment for a penetrating eye injury is not to remove or manipulate the impaled object, but to
apply a Fox shield over the eye, if available (not a regular eye patch) and place an eye patch over the
unaffected eye to prevent bilateral eye movement. The child should be transported to the emergency
department immediately. If a Fox shield is not available, then tape in place a paper cup over the eye and
object.
