EVOLVE HESI PEDS PRACTICE EXAM
QUESTIONS WITH CORRECT
ANSWERS
As part of the physical assessment of children, the nurse observes and palpates the
fontanels. Which child's fontanel finding should be reported to the healthcare
provider?
A 6-month-old with failure to thrive that has a closed anterior fontanel.
A 24-month-old with gastroenteritis that has a closed posterior fontanel.
A 2-month-old with chickenpox that has an open posterior fontanel.
A 28-month-old with hydrocephalus that has an open anterior fontanel. - ANSWER-
A 6-month-old with failure to thrive that has a closed anterior fontanel.
At six months of age the anterior fontanel should be open, and it should not be
closed until approximately 18 months of age. (B and C) are normal findings. A child
with hydrocephalus may have a delayed closing of the fontanel (D).
The nurse receives a lab report stating a child with asthma has a theophylline level
of 15 mcg/dl. What action will the nurse take?
Pass the information on in the report.
Notify the healthcare provider because the value is high.
Repeat the lab study because the value is too high.
Hold the next dose of theophylline. - ANSWER-Pass the information on in the
report.
The therapeutic level of theophylline is 10 to 20 mcg/dl, so the child's level is within
the therapeutic range. This information evaluates the prescribed therapy and should
be communicated in the nurse's report (A). (B, C, and D) would be inappropriate
actions in view of the laboratory finding.
The nurse is having difficulty communicating with a hospitalized 6-year-old child.
Which approach by the nurse is most helpful in establishing communication?
Engage the child through drawing pictures.
Suggest that the parent read a book to the child.
Provide paper and pencil for the child to keep a diary.
Ask the parent if the child is always uncommunicative. - ANSWER-Engage the child
through drawing pictures.
Drawing pictures (A) is a valuable form of non-verbal communication. As the nurse
and child look at the drawings, a verbal story can be told that projects the child's
thinking. (B) may distract the child, but does not establish communication with the
nurse. (C) is useful for an older child who is able to write. (D) is important, but
engaging the child is more effective in establishing communication patterns.
The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). This child should be carefully assessed for which complication?
Poor skin turgor resulting from dehydration.
, Changes in level of consciousness.
Premature aging as the disease progresses.
Severe edema from an excess of water and sodium. - ANSWER-Changes in level of
consciousness.
The child must be monitored for signs and symptoms of hyponatremia, which creates
secondary central nervous system alterations such as changes in level of
consciousness, seizure, and coma (B). Fluid overload occurs with SIADH, not (A)
(which occurs with diabetes insipidus). (C) is caused by hypersecretion of growth
hormone, not SIADH. (D) is not found in children with SIADH because edema is
caused by an excess of both water and sodium.
The nurse is assigning care for a 4-year-old child with otitis media and is concerned
about the child's increasing temperature over the past 24 hours. When planning care
for this child, it is important for the nurse to consider that
A. Only an RN should be assigned to monitor this child's temperature. Incorrect
B. A tympanic measurement of temperature will provide the most accurate reading.
C. The licensed practical nurse should be instructed to obtain rectal temperatures on
this child.
D. The healthcare provider should be asked to prescribe the method for
measurement of the child's temperatures. - ANSWER-B. A tympanic measurement
of temperature will provide the most accurate reading.
(B) A tympanic membrane sensor is an excellent site because both the eardrum and
hypothalamus (temperature-regulating center) are perfused by the same circulation.
The sensor is unaffected by cerumen and the presence of suppurative or
unsuppurative otitis media does not effect measurement. RULE OF THUMB: for
management--sterile procedures should be assigned to licensed personnel.
Management skills will be tested on the NCLEX! An RN is not required (A). Rectal
temperature measurement (C) is less accurate because of the possibility of stool in
the rectum. (D) is unnecessary.
A 3-year-old boy is brought to the emergency room because he swallowed an entire
bottle of children's vitamin pills. Which intervention should the nurse implement first?
Insert N/G tube for gastric lavage.
Determine the child's pulse and respirations.
Assess the child's level of consciousness.
Administer an IV D5/0.25 NS as prescribed. - ANSWER-Determine the child's pulse
and respirations.
The most important principle in dealing with a poisoning is to treat the child first, not
the poison. Initiate immediate life support measures with assessment of vital signs
(B), in particular, respirations. Inserting an airway or initiating mechanical ventilation
may be necessary. Assessment and identification of the poison should occur prior to
(A). (C and D) should occur after assessing the airway.
To take the vital signs of a 4-month-old child, which order provides the most accurate
results?
Respiratory rate, heart rate, then rectal temperature.
Heart rate, rectal temperature, then respiratory rate.
, Rectal temperature, heart rate, then respiratory rate.
Rectal temperature, respiratory rate, then heart rate. - ANSWER-Respiratory rate,
heart rate, then rectal temperature.
The respiratory rate should be taken first (A) in infants, since touching them or
performing unpleasant procedures usually makes them cry, elevating the heart rate
and making respirations difficult to count (B). Rectal temperature is the most invasive
procedure, and is most likely to precipitate crying, so should be done last (C and D).
The parents of a 3-week-old infant report that the child eats well but vomits after
each feeding. What information is most important for the nurse to obtain?
Description of vomiting episodes in past 24 hours.
Number of wet diapers in last 24 hours.
Feeding and sleep schedule.
Amount of formula consumed during the past 24 hours. - ANSWER-Description of
vomiting episodes in past 24 hours.
A description of the vomiting episodes (A) will assist the nurse in determining the
reason for the symptoms, which may be helpful in developing a plan of care for this
infant. (B and C) provide related information but are not as helpful as (A). (D) may be
related to the vomiting, but the nurse should first obtain a better description of the
vomiting episodes.
A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician
prescribes dextrose 5% and 0.25% normal saline with 2 mEq KCl/100 ml to be
infused at 25 ml/hour. Prior to initiating the infusion, the nurse should obtain which
assessment finding?
Frequency of emesis in the last 8 hours.
Serum BUN and creatinine levels.
Current blood sugar level.
Appearance of the stool. - ANSWER-Serum BUN and creatinine levels.
Regardless of a client's age, adequate renal function must be present before adding
potassium to IV fluids (B). (A) is important in determining the need for fluid
replacement. (C) is not indicated. (D) is useful information, but will not impact
administration of the prescribed IV solution.
Which finding in a 19-year-old female client should trigger further assessment by the
nurse?
Menstruation has not occurred.
Reports no tetanus immunization since childhood.
Denies having any wisdom teeth.
History of painful, inward growth on bottom of foot. - ANSWER-Menstruation has not
occurred.
Menstruation is an expected secondary sex characteristic that occurs with
pubescence and typically occurs by age 18, so (A) should prompt further
investigation to determine the cause of this primary amenorrhea. Children receive
tetanus as part of the DPT childhood immunization series, and a booster is not
typically given until age 16 (B). Wisdom teeth are the third molar teeth of the
QUESTIONS WITH CORRECT
ANSWERS
As part of the physical assessment of children, the nurse observes and palpates the
fontanels. Which child's fontanel finding should be reported to the healthcare
provider?
A 6-month-old with failure to thrive that has a closed anterior fontanel.
A 24-month-old with gastroenteritis that has a closed posterior fontanel.
A 2-month-old with chickenpox that has an open posterior fontanel.
A 28-month-old with hydrocephalus that has an open anterior fontanel. - ANSWER-
A 6-month-old with failure to thrive that has a closed anterior fontanel.
At six months of age the anterior fontanel should be open, and it should not be
closed until approximately 18 months of age. (B and C) are normal findings. A child
with hydrocephalus may have a delayed closing of the fontanel (D).
The nurse receives a lab report stating a child with asthma has a theophylline level
of 15 mcg/dl. What action will the nurse take?
Pass the information on in the report.
Notify the healthcare provider because the value is high.
Repeat the lab study because the value is too high.
Hold the next dose of theophylline. - ANSWER-Pass the information on in the
report.
The therapeutic level of theophylline is 10 to 20 mcg/dl, so the child's level is within
the therapeutic range. This information evaluates the prescribed therapy and should
be communicated in the nurse's report (A). (B, C, and D) would be inappropriate
actions in view of the laboratory finding.
The nurse is having difficulty communicating with a hospitalized 6-year-old child.
Which approach by the nurse is most helpful in establishing communication?
Engage the child through drawing pictures.
Suggest that the parent read a book to the child.
Provide paper and pencil for the child to keep a diary.
Ask the parent if the child is always uncommunicative. - ANSWER-Engage the child
through drawing pictures.
Drawing pictures (A) is a valuable form of non-verbal communication. As the nurse
and child look at the drawings, a verbal story can be told that projects the child's
thinking. (B) may distract the child, but does not establish communication with the
nurse. (C) is useful for an older child who is able to write. (D) is important, but
engaging the child is more effective in establishing communication patterns.
The nurse is caring for a 12-year-old with Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). This child should be carefully assessed for which complication?
Poor skin turgor resulting from dehydration.
, Changes in level of consciousness.
Premature aging as the disease progresses.
Severe edema from an excess of water and sodium. - ANSWER-Changes in level of
consciousness.
The child must be monitored for signs and symptoms of hyponatremia, which creates
secondary central nervous system alterations such as changes in level of
consciousness, seizure, and coma (B). Fluid overload occurs with SIADH, not (A)
(which occurs with diabetes insipidus). (C) is caused by hypersecretion of growth
hormone, not SIADH. (D) is not found in children with SIADH because edema is
caused by an excess of both water and sodium.
The nurse is assigning care for a 4-year-old child with otitis media and is concerned
about the child's increasing temperature over the past 24 hours. When planning care
for this child, it is important for the nurse to consider that
A. Only an RN should be assigned to monitor this child's temperature. Incorrect
B. A tympanic measurement of temperature will provide the most accurate reading.
C. The licensed practical nurse should be instructed to obtain rectal temperatures on
this child.
D. The healthcare provider should be asked to prescribe the method for
measurement of the child's temperatures. - ANSWER-B. A tympanic measurement
of temperature will provide the most accurate reading.
(B) A tympanic membrane sensor is an excellent site because both the eardrum and
hypothalamus (temperature-regulating center) are perfused by the same circulation.
The sensor is unaffected by cerumen and the presence of suppurative or
unsuppurative otitis media does not effect measurement. RULE OF THUMB: for
management--sterile procedures should be assigned to licensed personnel.
Management skills will be tested on the NCLEX! An RN is not required (A). Rectal
temperature measurement (C) is less accurate because of the possibility of stool in
the rectum. (D) is unnecessary.
A 3-year-old boy is brought to the emergency room because he swallowed an entire
bottle of children's vitamin pills. Which intervention should the nurse implement first?
Insert N/G tube for gastric lavage.
Determine the child's pulse and respirations.
Assess the child's level of consciousness.
Administer an IV D5/0.25 NS as prescribed. - ANSWER-Determine the child's pulse
and respirations.
The most important principle in dealing with a poisoning is to treat the child first, not
the poison. Initiate immediate life support measures with assessment of vital signs
(B), in particular, respirations. Inserting an airway or initiating mechanical ventilation
may be necessary. Assessment and identification of the poison should occur prior to
(A). (C and D) should occur after assessing the airway.
To take the vital signs of a 4-month-old child, which order provides the most accurate
results?
Respiratory rate, heart rate, then rectal temperature.
Heart rate, rectal temperature, then respiratory rate.
, Rectal temperature, heart rate, then respiratory rate.
Rectal temperature, respiratory rate, then heart rate. - ANSWER-Respiratory rate,
heart rate, then rectal temperature.
The respiratory rate should be taken first (A) in infants, since touching them or
performing unpleasant procedures usually makes them cry, elevating the heart rate
and making respirations difficult to count (B). Rectal temperature is the most invasive
procedure, and is most likely to precipitate crying, so should be done last (C and D).
The parents of a 3-week-old infant report that the child eats well but vomits after
each feeding. What information is most important for the nurse to obtain?
Description of vomiting episodes in past 24 hours.
Number of wet diapers in last 24 hours.
Feeding and sleep schedule.
Amount of formula consumed during the past 24 hours. - ANSWER-Description of
vomiting episodes in past 24 hours.
A description of the vomiting episodes (A) will assist the nurse in determining the
reason for the symptoms, which may be helpful in developing a plan of care for this
infant. (B and C) provide related information but are not as helpful as (A). (D) may be
related to the vomiting, but the nurse should first obtain a better description of the
vomiting episodes.
A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician
prescribes dextrose 5% and 0.25% normal saline with 2 mEq KCl/100 ml to be
infused at 25 ml/hour. Prior to initiating the infusion, the nurse should obtain which
assessment finding?
Frequency of emesis in the last 8 hours.
Serum BUN and creatinine levels.
Current blood sugar level.
Appearance of the stool. - ANSWER-Serum BUN and creatinine levels.
Regardless of a client's age, adequate renal function must be present before adding
potassium to IV fluids (B). (A) is important in determining the need for fluid
replacement. (C) is not indicated. (D) is useful information, but will not impact
administration of the prescribed IV solution.
Which finding in a 19-year-old female client should trigger further assessment by the
nurse?
Menstruation has not occurred.
Reports no tetanus immunization since childhood.
Denies having any wisdom teeth.
History of painful, inward growth on bottom of foot. - ANSWER-Menstruation has not
occurred.
Menstruation is an expected secondary sex characteristic that occurs with
pubescence and typically occurs by age 18, so (A) should prompt further
investigation to determine the cause of this primary amenorrhea. Children receive
tetanus as part of the DPT childhood immunization series, and a booster is not
typically given until age 16 (B). Wisdom teeth are the third molar teeth of the
