PEDIATRICS HESI 2025 LATEST AND UPDATED EXAM

A 15-month-old is admitted to the pediatric unit with a history of a recent upper respiratory infection. Which symptom is consistent with the diagnosis of laryngotracheobronchitis (croup)? Select all that apply. 1.Reported inspiratory stridor which is worse at night. 2.Suprasternal retractions are present upon examination. 3.The toddler has a barking, seal-like, harsh cough. 4.Lung sounds have inspiratory wheezing. 5.Lung sounds with crackles in the bases bilaterally. - 1,2,3 A four-year-old is presented to the urgent care center with a history of a sudden onset of a severe sore throat. He began drooling and has difficulty swallowing. The temperature is 102.2F (39.0C). Lung sounds are clear and there is no cough. The child is very anxious and flushed and is leaning forward in a tripod position. Based on these symptoms, the nurse anticipates a diagnosis of: 1.Acute Asthma Attack 2.Laryngotracheomalacia 3.Acute laryngotracheobronchitis (Croup) 4.Acute Epiglottitis - 4 Which should the nurse expect to be included in the treatment of the client experiencing acute asthma symptoms? Select all that apply. 1.Bronchodilators 2.Corticosteroids 3.Oxygen 4.Montelukast (Singular) 5.Immediate Intubation - 1, 2, 3 The nurse understands that in a child with cystic fibrosis (CF) which vitamin absorption is impaired? Select all that apply. 1.A 2.B 3.C 4.D 5.E - 1, 3, 4, 5 Which indicates the earliest sign of hemorrhage in a child who has just had a tonsillectomy? 1.Frequent swallowing 2.Labored respirations 3.Tachypnea stridor 4.Dark brown emesis - 1 A child with chronic otitis media has bilateral myringotomy tubes placed. Which statement would indicate that the parent understands education about myringotomy tubes? 1."The tubes have to be surgically removed in 9 months or so." 2."The tubes were placed to equalize pressure." 3."These tubes won't affect my child being able to go swimming in the summer." 4."My child will still need to be on Amoxicillin prophylactically for six months." - 2 The nurse should instruct the parent whose child is diagnosed with respiratory syncytial virus (RSV) to notify the healthcare provider for which issue? Select all that apply. 1.The child is not eating 2.There is a decrease in wet diapers 3.There is increased work of breathing 4.The child develops yellow drainage from the nose 5.Only when the child wheezes - 1, 2, 3 Which are signs and symptoms of respiratory distress in a two-monthold? Select all that apply. 1.Nasal flaring 2.Intercostal retractions 3.Coughing 4.Bronchovesicular lung sounds 5.Grunting - 1, 2, 5 You are teaching a family with a child who has cystic fibrosis (CF) about chest physiotherapy treatment (CPT). Which of the following teaching points are correct to include? SATA 1.It should be performed three to four times a day. 2.It may cause bronchospasm. 3.It is all right to percuss over the spine or internal organs. 4.When manually percussing you should use a cupped hand. 5.CPT can be done at any time including after eating. - 1, 2, 4 Which child does the nurse anticipate to be most at risk for being hospitalized for respiratory syncytial virus (RSV)? 1.A three-month-old who was born at 30 weeks gestation 2.A 18-month-old with a tracheostomy 3.A four-year-old with a ventricular septal defect (VSD) 4.A five-year-old who was term but has never received any immunizations - 1 The nursing student asks the nurse about genetic implications related to cystic fibrosis (CF). How should the nurse respond? 1."It is inherited as an autosomal dominant trait." 2."It is a genetic defect found primarily in non-Caucasian people." 3."If it is present in a child, both parents are carriers of the defective gene." 4."There is a 50% chance the siblings of an affected child will also be affected." - 3 what is the gold standard test in cystic fibrosis - sweat test A measurement of the maximum flow of air that can be forcefully exhaled in 1 second, a key measurement of pulmonary function - Peak expiratory flow rate provides an objective method of evaluating the presence and degree of lung dz, as well as the response of therapy - Pulmonary Function Test (PFT) cessation of breathing for more than 20 sec or for a shorter period of time when associated w/ hypoxemia or bradycardia - apnea a medical emergency that can result in respiratory failure and death if untreated - status asthmaticus involves stimulating the production of sweat w/ a special device, collecting sweat and measuring the sweat electrolytes. Used in the diagnosis of cystic fibrosis - sweat chloride test inability of the respiratory apparatus to maintain adequate oxygenation of the blood w/ or w/out carbon dioxide retention - respiratory failure a serious obstructive inflammatory process in the upper airway may see absence of a cough but drooling and agitation - acute epiglottitis in general applies to 2 conditions: increased work of breathing w/ near normal gas exchange function or the inability to maintain normal blood gas tensions that develops from carbon dioxide retention w/ subsequent hypoxemia and acidosis - respiratory insuffuecuency upper airway infection characterized by hoarseness and a barking cough - croup earliest manifestation of cystic fibrosis where the small intestine is blocked w/ thick meconium in the newborn - meconium ileus the child insists on sitting upright and leaning foward w/ the chin thrust out, mouth open and tongue protruding to facilitate breathing - tripod irritants such as house dust mites, tobacco smoke, mold or pets - allergens a serious possibly life-threatening obstructive inflammatory process of the upper trachea w/ features of croup and epiglottitis - bacterial tracheitis considered to be the corner stone treatment for children and adolescents w/ cystic fibrosis - airway clearance therapies The nurse in the emergency department (ED) is assessing a school-age child with a new ventriculoperitoneal (VP) shunt. The child is being seen for lethargy, irritability, vomiting, severe headache, and a fever of 102.4°. What initial action should the nurse expect would be taken? 1.An admission to the hospital for IV fluids and monitoring 2.Give mannitol for increased intracranial pressure. 3.Obtain a CT scan of the brain with X-rays of the chest and abdomen. 4.A surgical intervention for hydrocephalus - 3 A nurse in the emergency department (ED) is assessing a pre-school age client who had a febrile seizure at home. The parent is very concerned and asks the nurse if this is very serious. How should the nurse respond? 1."Yes, the child is likely to get brain damage when a fever gets too high." 2."Generally they are not. But it is best to treat a fever when it starts." 3."No, they don't cause any issues." 4."Yes, you should consider this a medical emergency any time something like this occurs." - 2 The nurse is doing post-procedure education with a school-age child after a lumbar puncture. What factor is important for the nurse to emphasize? 1.The child will be NPO for 6 hours post-procedure. 2.The child will need to lay flat for 4 to 24 hours. 3.The child will need hourly vital signs for the first 6 hours postprocedure. 4.The child will need to be assessed for adequate urinary elimination within 4 hours post-procedure. - 2 The nurse is assigned an adolescent client with newly diagnosed meningitis and is going in the client's room to hang the antibiotics. What personal protective equipment (PPE) should the nurse put on? 1.Gown and gloves 2.Gown, mask, and gloves 3.Gown, goggles, mask, and gloves 4.Gloves - 2 A mother is talking to the nurse and is concerned that her infant will get meningitis and die like her cousin's child did many years ago. The mother asks the nurse, "What is the best way I can protect my child?" How should the nurse respond? 1."There is no way to prevent it, unfortunately, but you must be quick to respond to any symptoms." 2."You should avoid taking your baby anywhere." 3."Many strains are vaccine-preventable, so getting all your vaccinations is a good start." 4."Keep your baby away from anyone who is sick." - 3 The nurse is reviewing the plan of care for an adolescent child with cerebral palsy. Which treatment modalities would the nurse expect? Select all that apply. 1.Speech therapy 2.Physical therapy 3.Respiratory therapy 4.Occupational therapy 5.Educational therapy - 1, 2, 4, 5 The nurse is performing a home assessment on a preschool-age child. The nurse notices that when in a squatting position, the child has to use his hands and arms to "walk up" his own body, pushing as he goes, in order to stand. What condition should the nurse investigate further? 1.Cerebral palsy 2.Muscular dystrophy 3.Myasthenia gravis 4.Guillain-Barré - 2 A school-age child is diagnosed with meningitis. What should the nurse expect to assess in this client? Select all that apply. 1.Stiff neck 2.Photosensitivity 3.Severe headache 4.Lower extremity weakness 5.Elevated body temperature - 1, 2, 3, 5 A toddler is scheduled for a routine wellness examination. What should the nurse do before beginning the assessment? 1.Encourage the parent to hold the child. 2.Ask the child to state his or her name and age. 3.Allow the child to manipulate the stethoscope. 4.Watch the child play with an age-appropriate toy. - 4 The nurse, caring for a school-age client recovering from a ventriculoperitoneal (VP) shunt implant, completes an assessment and immediately notifies the healthcare provider. Which assessment finding caused the nurse to be concerned? 1.Poor appetite 2.Blood pressure 110/70 mm Hg 3.Pain level 4 on a scale from 1 to 10 4.Blood tinged spot on the pillowcase encircled by a lighter ring - 4 A 5-year-old client is being tested for muscular dystrophy. Which type of this disorder should the nurse expect the client to perform Gowers' sign? 1.Becker muscular dystrophy 2.Acquired muscular dystrophy 3.Duchenne muscular dystrophy 4.Facioscapulohumeral muscular dystrophy - 3 A preschool-age client begins to experience a tonic-clonic seizure. What action should the nurse take first? 1.Apply oxygen. 2.Support the head. 3.Position the client on the side. 4.Place a padded tongue blade in the mouth. - 3 A school-age client who has been on bed rest for several days becomes dizzy when moving to a sitting position. What type of hypotension should the nurse document in this client's medical record? 1.Cardiac 2.Vasovagal 3.Orthostatic 4.Psychogenic - 3 The parent of a school-age child who is recovering from a concussion that took place several weeks ago reports the child fell off a bicycle and hit the head again. What direction should the nurse provide to the parent? 1.Place on bed rest. 2.Monitor for orientation. 3.Take to the nearest medical facility. 4.Provide an over-the-counter analgesic. - 3 A 5-year-old client has been experiencing seizure activity for the last 20 minutes. What medication should the nurse prepare to administer to this client? 1.Diazepam 2.Clonazepam 3.Ethosuximide 4.Carbamazepine - 1 The nurse is assessing motor skills of a preschool-age child. What method would best accomplish this goal? 1.Ask the parent what the child is able to do. 2.Offer age-appropriate toys to see if the child manipulates the toy appropriately. 3.Ask the child questions to determine the level of capability. 4.Give the child a physical exam. - 2 The nurse is doing health promotion education with a group of young women. Because of the risk of neural tube defects, the nurse should stress the importance of taking which supplement daily while of childbearing age? 1.Calcium 2.Magnesium 3.Folic acid 4.Iron - 3 The nurse is assessing a full-term newborn infant and notes the lack of a Moro reflex. What should this finding represent to the nurse? 1.A birth defect 2.A normal finding 3.An impairment of the central nervous system 4.A dysfunction of the neuromuscular junction - 3 The nurse is providing education to a family who recently delivered a child with a myelomeningocele and the parents ask, "What issues can this cause?" How should the nurse respond? 1."This can cause paralysis of the legs, flaccid muscles, and problems with control of the bowel and bladder." 2."This can cause progressive muscle deterioration and mild mental delays." 3."This can cause spastic muscles, which can prompt difficulty with ambulation and cognitive deficits." 4."This can cause problems with mental abilities, a lack of coordination, and uncoordinated, jerky body movements - 1 The nurse is assessing an infant for hydrocephalus. What signs and symptoms should the nurse identify to support this potential diagnosis? Select all that apply. 1.Rapid increase in head circumference or an unusually large head size 2.Bulging fontanel with crying 3.Vomiting 4.A high-pitched, shrill cry 5.Sunsetting eyes - 1, 3, 4, 5 A nurse is providing anticipatory guidance to a parent of an adolescent about injury prevention. Which statement, when made by the parent, indicates they understand the teaching? 1."I will make sure that my teen sits in a booster seat in the car." 2."I will keep all medications out of reach." 3."I will make sure that my teen does not stay up past 10pm every night." 4."I will have ongoing conversations with my teen about rules they will need to follow when they begin to drive." - 4 A nurse is providing care to a 14-year-old adolescent post-operatively. What is most significant in planning care for this child? 1.A child this age will miss being in school the most 2.A child this age will only want to be with their parents while in hospital 3.A child this age will be concerned about privacy 4.A child this age is learning to be independent with activities - 3 A nurse is caring for a 17-year-old male in the outpatient clinic and takes his vital signs. His blood pressure (BP) reads 112/72 mm/Hg. What is the best nursing action based on these results? 1.This is an average reading for this age range. The nurse should record the BP reading and continue with the assessment. 2.This blood pressure is too high for this age range and the client should be evaluated by the physician. 3.The nurse should provide education about nutritional interventions that will lower BP. 4.The nurse should refer the client for a cardiology appointment. - 1 What is a priority nursing assessment to use for the adolescent? 1.Blood pressure screening 2.Diabetes screening 3.Anthropomorphic measurements 4.Assessing adolescent's health, education, activity, sexuality, and safety - 4 Which of the following assessment findings during a routine well child exam is most concerning? 1.Leukorrhea in a 12-year-old Hispanic female 2.Breast development in a 7-year-old Caucasian female 3.Breast tenderness in a 10-year-old African American female 4.Irregular menstrual cycles in an 11-year-old Asian female - 2 A nurse is caring for an adolescent in the acute care setting. The nurse knows which term means obtaining agreement from the adolescent regarding the plan of care? 1.Consent 2.Health Care Proxy 3.Assent 4.Dissent - 3 A 6-month-infant is hospitalized for a fever. What are important considerations for the infant's nursing care on the pediatric unit? Select all that apply. 1.Encourage the parents to room in. 2.Ask the parents to leave the room for the physical examination. 3.Tell the parents to go home at night and the nurse will check on the infant 4.Encourage the caregiver to leave the infant's toys at home. 5.Educate the parents that the infant may regress - 1, 5 The pediatric nurse uses play with providing care with a 3-month-old infant. What important concepts will the nurse be mindful about when playing with an infant? Select all that apply. 1.Place on their stomachs for supervised play times. 2.Use musical toys for sensory stimulation. 3.Select any dully color toys. 4.Read a story to the infant in a soothing voice. 5.Put stuffed animals in the crib so the infant can play. - 1, 2, 4 The nurse is discussing safe toy selection for a 13-month-old child with the parents. Which examples stated by the parents would be appropriate? Select all that apply. 1.A ride on animal car 2.A mobile with colorful animals and lights 3.A tricycle with large wheels 4.Marbles of various colors 5.A shape sorter with various blocks - 1, 3, 5 The nurse is reviewing developmental stages when caring of a nine-yearold hospitalized client. Using Erikson's developmental stages, what are the best interventions? Select all that apply. 1.Encourage continuation of schoolwork. 2.Provide information on sexuality. 3.Help the child adjust to limitations. 4.Name objects and provide simple explanations. 5.Give clear instructions about treatments and interventions. - 1, 3, 5 The nurse is preparing to teach a 10-year-old client about their Type I Diabetes. What is the best format to teach the child? 1.Show a video and ask them if they have any questions. 2.Lead the discussion through a picture book. 3.Demonstrate correct use of supplies and equipment. Allow for questions. 4.Sign them up for a web tutorial. - 3 The nurse is working triage in the emergency department. She is about to perform a pain assessment on a seven-year-old client. Which statement shows the best age appropriate assessment? 1."Does it hurt a little or a lot?" 2."Can you point to the face that shows how much pain you are in?" 3."On a scale of 1 through 10, 10 being the worst pain ever, can you tell me what number your pain is at?" 4.The client is sleeping so the nurse determines pain during FLACC scale. - 2 According to Piaget, a school-age child (age 7-11) is in a phase of concrete operation. Which information does the nurse understand to be describing this stage? 1.Can think of one idea at a time 2.Thought process more coherent and logical 3.Is egocentric 4.Thinks abstractly and rationally - 2 Which skills would the nurse assessing appropriate developmental skills expect to see for a 2 year old? Select all that apply. 1.Climbing up and down stairs 2.Turning a door knob 3.Having conversations using two to three sentences 4.Following simple instructions 5.Demonstrating separation anxiety - 1, 2, 4, 5 The nurse is educating the parents of a three-week-old infant being admitted for colic. What teaching interventions are included for the parents? Select all that apply. 1.Reinforce that intestinal gas is not a reflection of the caregiving skills. 2.Swaddle the infant during the crying times. 3.Educate the parents that the colic can persist for 12 months. 4.White noise may cause the infant to be fussier. 5.Limit the infant's time with a pacifier. - 1, 2 A nurse is caring for a toddler on an inpatient unit. Which developmental milestones should be expected at this stage by the nurse? Select all that apply. 1.Gross motor development milestones include learning to ride a bike. 2.Speech and language milestones include learning to put three or more words together to form a sentence. 3.Fine motor development milestones include learning to use a fine pincer grasp. 4.Fine motor development milestones include stacking 6 or more blocks on top of one another. 5.Cognitive development milestones include understanding the concept of object permanence. - 2, 4 The nurse is assessing a 6-year-old child. According to Piaget, what should the nurse expect to observe in the child at this stage? Select all that apply. 1.The child's thinking is influenced by fantasy. 2.The child understands the concept of time. 3.The child is able to think abstractly. 4.The child is able to think about things that are not in the present. 5.The child's language skills are fully developed. - 1, 4 The nurse is caring for a 7-year-old client and obtains these vital signs: temperature 98.2°F, pulse 90, respirations 22, and blood pressure 93/60. What will the nurse do next? 1.Cover the client with a warm blanket. 2.Document these normal vital signs. 3.Contact the healthcare provider regarding the low blood pressure. 4.Repeat the vital signs for accuracy. - 2 The 4-year-old sibling asks the nurse if she caused her brother to be sick because she "wanted him to go away." The nurse should recognize this as what? 1.Normal thinking for this age 2.A sign of potential abuse in the home 3.Concerning signs of emotional distress due to so much sibling anger 4.Highly developed language and thoughts for this age - 1 Which technique should the nurse use when assessing a preschooler in order to ensure child comfort and effective nursing care? 1.Allow the child to select which finger to put the pulse oximeter on. 2.Ask the child to sit on the examination bed. 3.Begin with the most invasive procedure first to get it out of the way. 4.Make sure the child is fully undressed before the examination begins. - 1 infants respond to nonverbal behaviors of adults like... (3) - 1. touch 2. sound 3. tone of voice infant is - birth - 1year toddler is - 1-3 years preschool age is - 3-6 years school age - 6-12years adolescence - 12-18years when should the child be double and triple birth weight - double = 5- 6mos triple = 1year when do teeth errupt - 6mos girls usually stop growing when - 2years after the start of menstration when does the main growth occur for teens - during puberty which can last 2-5years Piaget has 5 stages of what - cognitive development what are piagets 5 stages and the ages it goes with - 1. sensorimotor stage birth-2yo 2. preoperational 2-4yo 3. intuitive thought 4-7yo 4. concrete operation 7-11yo 5. formal operational 11yo-adulthood What is Piaget's sensorimotor stage? - birth - 2yo = child learns through motor and relex actions, and begins to understand that he or she is seperate from the environment and from others What is Piaget's preoperational stage - 2-7yo - egocentric - magical thinkers - language - thinking influenced by fantasy - undeveloped since of time what is Piage'ts concrete operational stage - 7-11yo - less self centered - coherent and logical - solves concrete problems - give opportunity to ask questions - increase in accommodation skills what is Piaget's formal operational stage - 11yo - adulthood - adaptable and flexible - thinks abstractly - brings cognition to its final form - can make rational judgments - capable of hypothetical and deductive reasoning what are Erikson's stages of ... - development theory trust vs mistrust is age - birth - 1yo - infancy Autonomy vs. Shame and Doubt is age - 1-3 yo - toddler initiative vs guilt is age - 3-6 yo - school age industry vs inferiority is age - 6-12 yo - school age identity vs role confusion is age - 12-19 yo - adolescent trust vs mistrust is - - learns to trust as needs are met - if needs are not met mistrust is learned - play is solitary autonomy vs shame and doubt is - - independent - "i'm a big kid now" - some control over body functions - if criticized for showing independence they will develop shame and doubt about their abilities - play is parallel initiative vs guilt - - conscience - learning right from wrong - if criticized for their actions, leads to guilt and lack of purpose - play is associative industry vs inferiority - - rule following - forming social relationships is important - pride in accomplishments - unable to be successful will lead to inferiority - play is cooperative identity vs role confusion - - changes in body are great - preoccupied w/ appearance and what others think - peers are very important - working on own identity - if unable to have meaningful definition of self may lead to role confusion