HESI RN Pediatrics Practice Test

HESI RN Pediatrics HESI RN Pediatrics A PRACTICE TEST 1. To take the vital signs of a 4monthold child, which order provides 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. 2. A 16yearold 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? A. Dispense a tetanus antitoxin. B. Prepare human tetanus immune globulin. C. Administer tetanus toxoid booster. D. Delay the tetanus toxoid booster until due. Correct Correct 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). Awarded 1.0 points out of 1.0 possible points. 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 (C). (A, B, and D) are not indicated. Awarded 1.0 points out of 1.0 possible points. 3. The mother of a 6monthold asks the nurse when her baby will get the first measles, mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control, which response is accurate? A. 3 to 6 months. B. 12 to 15 months. C. 18 to 24 months. D. 4 to 6 years. 4. A 2yearold 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. Correct Correct The first measles, mumps, and rubella (MMR) vaccine should be given no sooner than 12 months of age, and ideally between 12 and 15 months of age (B). (A) should not receive the MMR vaccine due to the presence of maternal antibodies. MMR is not routinely administered at (C), but other immunizations, such as DTaP and Hepatitis B may be given at that time. The second dose of MMR is routinely administered at (D), provided that at least 4 weeks have elapsed since the first dose, and if both doses were administered beginning at or after 12 months. Awarded 1.0 points out of 1.0 possible points. Congenital heart disease (A) is the most common associated defect in children with Down syndrome. (C) might have seemed possible since Down syndrome is a trisomal chromosomal abnormality of chromosome 21. (B) is a sexlinked abnormality also causing mental retardation. (D) is not associated with Down syndrome. Awarded 1.0 points out of 1.0 possible points. 5. A 14yearold female client tells the nurse that she is concerned about the acne she has recently developed. Which recommendation should the nurse provide? A. Remove all blackheads and follow with an alcohol scrub. B. Use medicated cosmetics only to help hide the blemishes. C. Wash the hair and skin frequently with soap and hot water. D. Encourage her to see a dermatologist as soon as possible. 6. The nurse is caring for a 12yearold with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication? A. Poor skin turgor resulting from dehydration. B. Changes in level of consciousness. C. Premature aging as the disease progresses. D. Severe edema from an excess of water and sodium. Correct Incorrect Correct Incorrect Washing the hair and skin with soap and hot water (C) removes oil and debris from the skin and helps prevent and treat acne. Oily skin is especially bothersome during adolescence when hormones cause enlargement of sebaceous glands and increased glandular secretions which predispose the teenager to acne. (A) is contraindicated. Cosmetics ("medicated" or not) should be used sparingly to avoid further blocking sebaceous gland ducts (B). (D) might be indicated at a later time, if healthcare recommendations are not successful. Awarded 0.0 points out of 1.0 possible points. 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. Awarded 0.0 points out of 1.0 possible points. 7. A threemonth old boy weighing 10 lbs 15 oz has an axillary temperature of 98.9° F. The nurse determines the daily caloric need for this child is approximately A. 400 calories per day. B. 500 calories per day. C. 600 calories per day. D. 700 calories per day. 8. A 6yearold is admitted to the pediatric unit after falling off a bicycle. Which intervention should the nurse implement to assist the child's adjustment to hospitalization? A. Explain hospital schedules to the child, such as mealtimes. Correct Correct 10 lbs 15 oz = 10.9 lbs. Convert lbs to kg by dividing pounds by 2.2; 10.9/2.2 = 4.954 kg, rounded to 5 kg. An infant requires 108 calories/kg/day (108 × 5 = 540 calories/day). However, this infant requires 10% more calories because he has one degree temperature elevation. 10% of 540 is 54 and 540 + 54 = 594. This infant will require approximately 600 calories/day. Tough question! You know that 400 calories are too few and 700 are too much, and a temperature elevation necessitates consumption of more calories, so choose the higher of the two choices left! Awarded 1.0 points out of 1.0 possible points. B. Use terms, such as "honey" and "dear," to show a caring attitude. C. Provide a list of rules that limits visitation of siblings in the hospital. D. Orient the parents to the hospital unit and refreshment areas. 9. 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? A. Slowly pour hydrogen peroxide over the open wound. B. Apply ice to the area before rinsing with cold water. C. Wash the wound gently with mild soap and water. D. Gently cleanse with a sterile pad using povidoneiodine. 10. 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. Esti mat e the involvement of the schoolaged child incorporates the child's sense of initiate and cooperation. Awarded 1.0 points out of 1.0 possible points. Correct Incorrect Altered daily schedules and loss of rituals are upsetting to children and increase separation anxiety, and active sensitivity to the needs of children can minimize the negative effects of hospitalization. Explaining the hospital schedules (A) and establishing an individual schedule familiarizes the child to the hospital environment and decreases anxiety. (B) depersonalizes the child who should be addressed by name. Family and sibling visitation should be recommended and encouraged without limitation (C). Although (D) should be implemented, the direct A small, superficial laceration to the skin should be washed gently with mild soap and water (C) for several minutes, followed by thorough rinsing. (A and D) are antiseptics that can be traumatic (painful) when cleaning fresh, open wounds. Applying ice (B) may reduce or prevent further edema, but the wound should be washed with mild soap and water first. Awarded 0.0 points out of 1.0 possible points. q u a n t i t y o f d i a r r h e a s t o o l s . C. P l a c e i n a s u p i n e p o s i t i o n a f t e r f e e d i ng. D. Observe for projectile vomiting. ID: Correct Projectile vomiting (D), which contributes to metabolic alkalosis (A), is the classic sign of pyloric stenosis. (B) is not indicated. (C) is dangerous, due to the potential for aspiration with frequent vomiting. Awarded 1.0 points out of 1.0 possible points.