HESI Pediatric Complete Guide

HESI Pediatric Complete Guide When taking the health history of a child, the nurse know what which finding is an early indication of hypothyroidism in children? Ans- Cessation of growth in a child that had been normal The nurse received a lab report stating a child w/ asthma has theophyline level of 15 mcg/dl. What action will the nurse take? Ans- Hold the next dose of theophylline a.i. Therapeutic levels of theophylline is 10-10 mcg/dl, so the child's level is w/in the therapeutic rage. Surgery is being delayed for an infant with undescended testes. In collaboration w/ the health care provider and the family, which prescription should the nurse anticipapte? Ans- trial of human chorionic gonadotrophic hormone a.i A trial of HCG may aid in testicular descent, but does not replace surgical repair for true undescended testes. (cryptorchidism: may be found in the inguinal canal due to exaggerated creamasteric reflex Which menu selection by a child w/ celiac disease indicates to the nurse that the child understands necessary dietary considerations? Ans- a. Oven baked potato chips & cola a.i. Celiac disease causes an intolerance to the protein gluten found in oats, rye, wheat, and barley. The child should avoid any produces containing these indredients to avoid symptoms such as diarrhea. The mother of a 2-year-old boy consults the nurse about her son's increased temper tantrums. The mother states, "yesterday he threw a fit in the grocery store, and I did not know what to do. I was so embarrassed. What can I do if this occurs again?" Which recommendation is best for the nurse to provide this mother? Ans- a. Walk away from him and ignore the behavior a.i. The best approach for a toddler is to ignor the attention-seeking behavior. The parents should be somewhat nearby, w/in view of the child but should avoid reinforcing the behavior in any way. Tantrums can sometimes be avoided by talking to the child before the situation occurs Which restraint should be used for a toddler after a cleft palate repair? Ans- a. Elbow a.i. Elbow restraints prevent children from bending their arms and brining their hands to the oral surgical site, (A) restrains the hands but the child can bend and bring their head to their ands. (B) is used during procedures (mummy). (D)-jacket, restrains the body torso and is not appropriate The mother of a 4-year-old child asks the nurse what she can do to help her other children cope with their sibling's hospitalizations. Which is the best response that the nurse should offer? Ans- a. Encourage the mother to have the children visit the hospitalized sibling. a.i. Needs of a sibling will be better met with facture information and contact w/ the ill child, so siblings visitation should be encouraged (D). Parents are experts on their children and should determine when their children are old enough to visit. (A) in the hospital/ Separation fr. a family & home (B) may intensify fear & anxiety (suggest that the child visit a grandmother until the sibling returns home. Children may have difficulty expressing questions (C) ask the mother if the child asks when the sibling will be discharged, so the support of parents & other caregivers are needed to help alleviate their fears. The nurse is giving preoperative instruction 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? Ans- a. I understand that I will be in a body cast and I will show you how you taught me to turn a.i. Outcome of learning is best demonstrated when the client not only verbalizes an understand, but can also provide a return demonstration During administration of a blood transfusion, a child complains of chills, headache, and nausea. Which action should the nurse implement? Ans- a. Stop the infusion immediately and notify the healthcare provider a.i. The child is exhibiting signs of a reaction to the blood transfusion. The blood transfusion should be stopped immediately and the healthcare provider notified ©. After the transfusion is discontinused, IV access should be maintained. (A) w/ fluids that do not introduce any more cellular products. (B & D) place the child @ risk for further blood reactions The clinic nurse is taking the hx for a new 6-month-old client. The mother reports that she took a great deal of aspirin while pregnant. Which assessment should the nurse obtain? Ans- a. Type of reaction to loud noises a.i. Ototoxicity diminishes hear acuity and causes symptoms of tinnitus and vertigo in older children who can express subjective symptoms, so assessing the infant's reation to loud noises (A) helps to determine an infant's risk for hearing deficit r/t to a hx of the mother taking ototoxic drug, such as aspirin, while pregnancy (B,C,D are not assoc w/ the exposure to aspirin in utero The mother of a preschool aged child asks the nurse if it is all right to administer Pepto Bismol to her son when he has a "tummy ache" After reminding the mother to check the label of all OTC drugs for the presence of aspirin, which instruction should the nurse include when replying to this mother's question? Ans- a. Do not give if the child has chickenpox, the flu, or any other viral illness a.i. Pepto Bismol contains aspirin and there is the potential of Reye's syndrome (B). (a) is a common effect of peptobismol and does not warrant discontinuation. Pepto Bismol can be used by children (C). Pepto Bismol does not cause rebound hyperacidity (D) complication of antacids containing calcium A 3 moth old infant develops oral thrush. Which pharmacologic agent should the nurse plan to administer for treatment of this disorder? Ans- a. Nystatin (Mycostatin) a.i. Nystatin (mycostatin) (A) is an antifungal drug that is effective in treating thrush, an oral fungal infection The nurse is developing a plan of care for a 3 yr old who is scheduled for a cardiac catherization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement? Ans- a. C-give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there a.i. Familizaring the child and mother w/ the department will help decrease anxiety of the child and mother (who may have more anxiety than the child). Three is a difficult age to undergo a procedure that requires cooperation. Restraints and possible sedation may be required A 3 yr old boy is brought to the ER because he swallowed an entire bottle of children's vitamin pills. Which intervention should the nurse implement first? Ans- a. B-determine the child's pulse and respirations a.i. The most important principle in dealing w/ a poisoning is to treat the child first, not the poison. Initiate immediate life support measures w/ assessment of VS (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 & D after assessing the airway.) A 4- year- old girl continues to interrupt her mother during a routine clinic visit. The mother appears irritated w/ the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information? Ans- a. A- children need to retian a sense of initiative w/o impinging on the rights and privileges others a.i. Children aged 3-6 are in Erickson's initiative vs. guilt stage, which is characterized by vigorous, intrusive behavior, enterprise, and strong imagination. At this age, children develop a conscience and must learn to retain a sense of initiative w/o impinging on the rights of others The nurse is planning the care of a 2 year old w/ severe eczema on the face, next, and scalp fr. scratching the affected areas. Which nursing intervention is most effective in preventing further excoriation due to the purities? Ans- a. C- place elbow restraints on the child's arms. a.i. Elbow restraints prevent arm flexion and scratching of involved area, but do not inhibit use of the nads for play activities. Others can be removed easily a 6- year old admitted to the pediatric unit after falling of a bicycle. Which intervention should the nurse implement to assist the child's adjustments to hospitalization? Ans- a.Explain hospital schedules to the child, such as mealtimes. 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. A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most important instruction for the nurse to include in this client's teaching plan? Ans- a. A- Use sunscreen when lying by the pool a.i. Photosensitivity is a common side effect of tetracycline HCL (AchromycinV) therapy. Severe sunburn can occur w/ minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen The nurse is caring for a 12 year-old w/ Syndrome of Inappropriate Antidiuretic Hormone (SIADH). This child should be carefully assessed for which complication? Ans- a. B- changes in LOC a.i. The child must be monitored for S/S of hypontremia, which creates secondary central nervous system alterations such as changes in LOC, seizure coma. A child falls on the playground and is brought to the school nurse w/ a small lacreration on the forearm. Which action should the nurse implement first? Ans- a. C-Wash the wound gently w/ mild soap and water a.i. A small, superficial laceration to the skin should be washed gently w/ mild soap and water for several minutes, followed by thorough rinsing. A 6-month-old infant w/ congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervention? Ans- a. A- Apical heart rate of 60 a.i. A heart rate of 60 is much lower than normal for a 6-month old and warrants immediate intervention. The normal heart rate for a 6 month old is 80-150 when awake, and a rate of 70 while sleeping is considered w/in normal limits. To assess the effectiveness of an analgesic administered to a 4-yr old, what intervention is best for the nurse to implement? Ans- a. A- use a happy-face/sad face pain scale. a.i. A 4 year old can readily identify w/ simple picures to show the nurse how he/she is feeling. Could be used to validate what the child is telling the nurse via the "faces" pain scale, but it is best to elicit the child's assessment of his/her pain level (C-assess for changes in the child's vs), may not accurately reflect the effectiveness of pain medication as they can also be affected by other variables, such as fear The nurse is assessing an 8 month old child who has a medical diagnosis of tetrology of Fallot. Which symptom is the client most likely to exhibit? Ans- a. D-clubbed fingers a.i. Tetrology of fallot, a cyanotic heart defect, causes clubbing of fingers and toes due to tissue hypoxia Which action by the nurse is most helpful in communicating w/ a preschool aged child? Ans- a. B- use a doll to play and communicate a.i. Communicating through play w/ a doll or other toy gives time for the child to feel comfortable w/ a stranger Preoperative nursing care for a child w/ Wilm's tumor should include which intervention? Ans- a. D-put a sign on the bed reading, "DO NOT PALPATE ABDOMEN" a.i. Prevention of abdominial palpation minimizes the risk of rupturing the encapsulated tumor and subsequent metastasis. The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about prevention of accidental poisonings. It is most important for the nurse to include which instruction? Ans- a. B- store all toxic agents and medicines in locked cabinets. a.i. The only reliable way to prevent poisoning in young children is to make them inaccessible The nurse observes a 4 yr old boy in a daycare setting. Which behavior would the nurse consider normal for this child? Ans- a. C- demonstrates aggressiveness by boasting when telling a story a.i. C- 4yr old children are aggressive in their behavior and enjoy "tale telling" A 2 yr old child w/ Down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated w/ Down syndrome? Ans- a. A- congenital heart disease a.i. Is the most common assoc w/ defect in children w/ Down Syndrome In developing a teaching plan for a 5 year old child w/ diabetes, which component of diabetic management should the nurse plan for the child to manage first? Ans- a. C-process of glucose testing a.i. Developmentally a 5 yr old has the cognitive and psychomotor skills to use a glucometer and to read the number (it is especially helpful if the nurse presents this activity as a game The nurse is assessing a 13 yr old girl w/ susptected hyperthyroidism. Which question is most important for the nurse to ask her during the admission interview? Ans- a. B-are you experiencing any type of nervousness? a.i. Assessing the client's physiological state upon admission is priority, and nervousness, apprehension, hyperexcitability, and palpitations are signs of hyperthyroidism, but assessing loss (even w/ a hearty appetite) (A) occurs in those w/ hyperthyroidism, but assessing the client's neurological state has a higher priority. Hormone replacement is not administered to a client who is already producing too much thyroid The mother of a 6 month old asks the nurse when her baby will get the first MMR vaccine. Based on the recommended childhood immunization schedule published by the CDC, which response is accurate? Ans- a. (b) the MMR vaccine should be given no sooner than 12 months of age, and ideally between 12 & 15 months of age. (a) 3-6 months should not receive the MMR vaccine due to the presence of maternal antibodies. MMR is not routinely administered @ 18-24, but others like dTaP and Hep B may be given at that time. A 16 y old is brought to the ER with a crushed leg after falling off a horse. The adolescent's last tetanus toxoid booster was received 8 ys ago. What action should the nurse take? Ans- a. C- administer the tetanus toxoid booster. a.i. After the completion of the initial tetanus immunization schedule, the recommended booster for an adolescent or adult if every 10 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 fr. 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 6 month old returns fr. surgery w/ elbow restraints in place. What nursing care should be included when caring for any restrained child? Ans- a. B- remove restraitnts one at a time and provide range of motion exercises a.i. Removing restraints one at a time (B) is safer than removing all of them at once. The child needs to exercise and should not be kept in restraints at all time