PEDIATRICS - HESI PRACTICE EXAM
The nurse is giving preoperative instructions to a 14-year old female client who is
scheduled for surgery to correct a spinal curvature. Which statement by the client
best demonstrates that learning has taken place?
A. I will read all the literature you gave me before surgery.
B. I have had surgery before when I broke my wrist in a bike accident, so I know
what to expect.
C. All the things people have told me will help me take care of my back.
D. I understand that I will be in a body cast and I will show you how you taught
me to turn.
(ANS - D. I understand that I will be in a body cast and I will show you how you
taught me to turn.
Outcome of learning is best demonstrated when the client not only verbalizes an
understanding, but also can provide a return demonstration. A 14-year old may or
may not follow through with reading material and there is no way of measuring
that way of learning. Have a previous surgery may help the client understand the
surgical process, but wrist surgery is very different from spinal surgery and
emergency surgery is different than elective surgery. In (C), the client may be
saying what the nurse wants to hear, without expressing any real understanding of
what to do after surgery.
To take the vital signs of a 4-month old child, which order will give 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
(ANS - A. Respiratory rate, heart rate, then rectal temperature
The respiratory rate should be taken first in infants, since touching them or
performing unpleasant procedures usually makes them cry, elevating the heart rate
,and making respirations difficult to count. Rectal temperature is the most invasive
procedure, and is mot likely to precipitate crying, so should be done last.
During routine screening at a school clinic, an otoscope examination of a child's
ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not
movable. What action should the nurse take next?
A. No action required, as this is an expected finding for a school-aged child
B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.
C. Send a note home advising the parents to have the child evaluated by a
healthcare provider as soon as possible.
d. Call the parents and have them take the child home from school for the rest of
the day.
(ANS - B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.
More information is needed to interpret these findings. The tympanic membrane is
normally pearly gray, not bulging, and moves when the client blows against
resistance or a small puff of air is blown into the ear canal. Since this child's
findings are not completely normal, further assessment of history and related signs
and symptoms is indicated for accurate interpretation of the findings. (A), (C), and
(D) are inappropriate actions based on the data obtained from the otoscope
examination.
Which restraint should be used for a toddler after a cleft palate repair?
A. clove hitch
B. Mummy
C. elbow
D. jacket
(ANS - C. elbow
Elbow restraints
Elbow restraints prevent children from bending their arms and bringing their hands
to the oral surgical site. A clove hitch restrains the hands, but the child can bend
and bring their head to their hands. A mummy restraint is used during procedures.
A jacket restraint restrains the body torso and is not appropriate.
,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. estimate the quantity of diarrhea stools.
C. place in a supine position after feeding
D. observe for projectile vomiting.
(ANS - D. observe for projectile vomiting.
Projectile vomiting which contributes to metabolic alkalosis, is the classic sign of
pyloric stenosis. Estimating the quantity of diarrhea stools is not indicated. Placing
the child in a supine position is dangerous due to the potential for aspiration with
frequent vomiting.
A six-month-old returns from surgery with elbow restraints in place. What nursing
care should be included when caring for any restrained child?
A. keep restraints on at all times.
B. remove restraints one at a time and provide range of motion exercises
C. Remove all restraints simultaneously and provide lay activities
D. renew the healthcare provider's prescription for restraints every 72 hours.
(ANS - B. remove restraints one at a time and provide range of motion exercises
Removing restraints one at a time is safer than removing all of them at once. The
child needs to exercise and should not be kept in restraints at all times. The
renewal of the healthcare provider's prescription varies with hospitals and it does
not really answer the question.
A 2-year old 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
(ANS - A. congenital heart disease
, Congenital heart disease is the most common associated defect in children with
Down syndrome. Trisomy 13 my have seemed possible since Down syndrome is a
trisomal chromosomal abnormality o chromosome 21. Fragile x-chromosome is a
sex-linked abnormality also causing mental retardation. Pyloric stenosis is not
associated with Down syndrome.
When assessing a child with asthma, the nurse should expect intercostal retractions
during
A. inspiration
B. coughing
C. apneic episodes
D. expiration
(ANS - A. inspiration
Intercostal retractions result from respiratory effort to draw air into restricted
airways.
When planning the care for a child who has had a cleft lip repair, the nurse knows
that crying should be minimized because it
A. increases salivation
B. increases the respiratory rate
C. leads to vomiting
D. stresses the suture line
(ANS - D. stresses the suture line
Prevention of stress on the lip suture line is essential for optimum healing and the
cosmetic appearance of a cleft lip repair. Although crying also causes increased
salivation, increased respiratory rate and may lead to vomiting, these conditions do
not create a problem for the child with a cleft lip repair.
A full-term infant is admitted to the newborn nursery. After careful assessment, the
nurse suspects that the infant may have an esophageal atresia. Which symptoms is
this newborn likely to have exhibited?
A. choking, coughing, and cyanosis
The nurse is giving preoperative instructions to a 14-year old female client who is
scheduled for surgery to correct a spinal curvature. Which statement by the client
best demonstrates that learning has taken place?
A. I will read all the literature you gave me before surgery.
B. I have had surgery before when I broke my wrist in a bike accident, so I know
what to expect.
C. All the things people have told me will help me take care of my back.
D. I understand that I will be in a body cast and I will show you how you taught
me to turn.
(ANS - D. I understand that I will be in a body cast and I will show you how you
taught me to turn.
Outcome of learning is best demonstrated when the client not only verbalizes an
understanding, but also can provide a return demonstration. A 14-year old may or
may not follow through with reading material and there is no way of measuring
that way of learning. Have a previous surgery may help the client understand the
surgical process, but wrist surgery is very different from spinal surgery and
emergency surgery is different than elective surgery. In (C), the client may be
saying what the nurse wants to hear, without expressing any real understanding of
what to do after surgery.
To take the vital signs of a 4-month old child, which order will give 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
(ANS - A. Respiratory rate, heart rate, then rectal temperature
The respiratory rate should be taken first in infants, since touching them or
performing unpleasant procedures usually makes them cry, elevating the heart rate
,and making respirations difficult to count. Rectal temperature is the most invasive
procedure, and is mot likely to precipitate crying, so should be done last.
During routine screening at a school clinic, an otoscope examination of a child's
ear reveals a tympanic membrane that is pearly gray, slightly bulging, and not
movable. What action should the nurse take next?
A. No action required, as this is an expected finding for a school-aged child
B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.
C. Send a note home advising the parents to have the child evaluated by a
healthcare provider as soon as possible.
d. Call the parents and have them take the child home from school for the rest of
the day.
(ANS - B. Ask the child if he/she has had a cold, runny nose, or any ear pain lately.
More information is needed to interpret these findings. The tympanic membrane is
normally pearly gray, not bulging, and moves when the client blows against
resistance or a small puff of air is blown into the ear canal. Since this child's
findings are not completely normal, further assessment of history and related signs
and symptoms is indicated for accurate interpretation of the findings. (A), (C), and
(D) are inappropriate actions based on the data obtained from the otoscope
examination.
Which restraint should be used for a toddler after a cleft palate repair?
A. clove hitch
B. Mummy
C. elbow
D. jacket
(ANS - C. elbow
Elbow restraints
Elbow restraints prevent children from bending their arms and bringing their hands
to the oral surgical site. A clove hitch restrains the hands, but the child can bend
and bring their head to their hands. A mummy restraint is used during procedures.
A jacket restraint restrains the body torso and is not appropriate.
,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. estimate the quantity of diarrhea stools.
C. place in a supine position after feeding
D. observe for projectile vomiting.
(ANS - D. observe for projectile vomiting.
Projectile vomiting which contributes to metabolic alkalosis, is the classic sign of
pyloric stenosis. Estimating the quantity of diarrhea stools is not indicated. Placing
the child in a supine position is dangerous due to the potential for aspiration with
frequent vomiting.
A six-month-old returns from surgery with elbow restraints in place. What nursing
care should be included when caring for any restrained child?
A. keep restraints on at all times.
B. remove restraints one at a time and provide range of motion exercises
C. Remove all restraints simultaneously and provide lay activities
D. renew the healthcare provider's prescription for restraints every 72 hours.
(ANS - B. remove restraints one at a time and provide range of motion exercises
Removing restraints one at a time is safer than removing all of them at once. The
child needs to exercise and should not be kept in restraints at all times. The
renewal of the healthcare provider's prescription varies with hospitals and it does
not really answer the question.
A 2-year old 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
(ANS - A. congenital heart disease
, Congenital heart disease is the most common associated defect in children with
Down syndrome. Trisomy 13 my have seemed possible since Down syndrome is a
trisomal chromosomal abnormality o chromosome 21. Fragile x-chromosome is a
sex-linked abnormality also causing mental retardation. Pyloric stenosis is not
associated with Down syndrome.
When assessing a child with asthma, the nurse should expect intercostal retractions
during
A. inspiration
B. coughing
C. apneic episodes
D. expiration
(ANS - A. inspiration
Intercostal retractions result from respiratory effort to draw air into restricted
airways.
When planning the care for a child who has had a cleft lip repair, the nurse knows
that crying should be minimized because it
A. increases salivation
B. increases the respiratory rate
C. leads to vomiting
D. stresses the suture line
(ANS - D. stresses the suture line
Prevention of stress on the lip suture line is essential for optimum healing and the
cosmetic appearance of a cleft lip repair. Although crying also causes increased
salivation, increased respiratory rate and may lead to vomiting, these conditions do
not create a problem for the child with a cleft lip repair.
A full-term infant is admitted to the newborn nursery. After careful assessment, the
nurse suspects that the infant may have an esophageal atresia. Which symptoms is
this newborn likely to have exhibited?
A. choking, coughing, and cyanosis
