2025 Hesi RN Pediatrics Exam 60 Questions and Answers (2025) (Verified Answers)

1. A child is to receive phenytoin (Dilantin) 100 mg IV for seizure prophylaxis. Which intervention is appropriate when administering this drug? 1. Mix it in dextrose 5% in water and give over 1 hour. 2. Administer no faster than 2 mg/kg/min. 3. Do not use an inline fi lter. 4. Monitor temperature prior to and after administration. - 2 (1. Mix intravenous doses in normal saline as mixtures precipitate with dextrose 5% in water. 2. Phenytoin (Dilantin) should be given slowly (1-2 mg/kg/min) via pump. Rapid infusion may cause hypotension, arrhythmias, and circulatory collapse. 3. An inline filter is recommended. 4. Continuous monitoring of electrocardiogram, blood pressure, and respiratory status is essential because of potential side effects.) 2. The parent of a child who is being discharged from the clinic wants to know if there is a difference between Advil and ibuprofen, saying, "I can buy ibuprofen over the counter at a cheaper price than Advil." What is the nurse ' s best response? 1. "Advil and ibuprofen are two different drugs with similar effects." 2. "There is no difference between the two medications, so you should use whichever one is cheaper." 3. "Similarities exist between the drugs, but you need to consult the health-care provider about the specifi c order." 4. "Ibuprofen is usually cheaper, so you should use it." - 3 (1. This does not answer the parent ' s question. 2. This is not a true statement because Advil is enteric coated, and not all ibuprofens are enteric coated. 3. This response answers the question and tells the parent the physician is the only one who can change a name brand to a generic drug. 4. The nurse should not make that judgment. The physician should be consulted.) 3. What time would the nurse most likely see signs and symptoms of hypoglycemia after administering NPH insulin at 0730? 1. 0930 to 1030. 2. 1130 to 1430. 3. 1130 to 1930. 4. 1530 to 1930. - 3 (1. Peak time for regular insulin is 2 to 3 hours. 2. Peak time for Semilente insulin is 4 to 7 hours. 3. Peak time for NPH insulin is 4 to 12 hours. 4. Peak time for Lente insulin is 8 to 12 hours.) 4. Morphine sulfate (Duramorph) 2 mg IV q2h prn for pain is ordered for a 12-yearold who has had abdominal surgery. Which is the most appropriate nursing action? 1. Administer the morphine sulfate (Duramorph) using a syringe pump over 1 hour. 2. Encourage the child to use incentive spirometer every hour during the day and when awake at night. 3. Ask the health-care provider to change the medication to meperidine (Demerol). 4. Administer the morphine sulfate (Duramorph) with Benadryl (diphenhydramine) to prevent itching. - 2 (1. Giving morphine sulfate (Duramorph) over 1 hour takes too long to relieve the pain. It can be given by slow IV push. 2. Because morphine sulfate (Duramorph) can depress respirations and the child has just had abdominal surgery, deep breathing should be encouraged. 3. Meperidine (Demerol) is not used in children because of the risk of induced seizures. 4. One of the side effects of morphine sulfate (Duramorph) is itching, and diphenhydramine (Benadryl) is a good medication to give as needed in case of itching. It should not be given together with the morphine sulfate (Duramorph).) The parent of a child who is being treated for Haemophilus influenzae meningitis tells the nurse that the family is being treated prophylactically with rifampin (Rifadin). Which should the nurse include in teaching about this medication? 1. "The drug will change the color of the urine to orange-red, and it will cause staining." 2. "Adverse effects of the drug may cause urinary retention." 3. "The drug is given to treat meningitis." 4. "You will need to continue taking the drug for 7 days." - 1 (1. Rifampin (Rifadin) causes an orange-red discoloration of body fluids, including urine. Knowledge of this can decrease anxiety when such discoloration occurs. 2. Urinary retention is not a side effect. Rifampin (Rifadin) is metabolized in the liver and should be used with caution in clients with elevated liver enzymes. 3. The drug is ordered prophylactically to guard against developing meningitis. 4. The drug is given for 2 days as prophylactic treatment.) 6. A 2-year-old child has been prescribed amoxicillin (Amoxil) bid for treatment of pharyngitis. Which statement indicates that the parent knows how to give the medication? 1. "If I miss giving my child a dose at breakfast, I will double up on the dose at night." 2. "I will give the medication at breakfast and dinner." 3. "I know that amoxicillin (Amoxil) is a pill, but sometimes my child will not take it." 4. "I will continue giving the amoxicillin (Amoxil) for 10 days even after my child is better." - 4 (1. Missed doses should be given as soon as possible and not doubled with the next dose. 2. Doses of antibiotics should be taken at regular intervals over 24 hours without interrupting sleep to maintain maximum blood levels. 3. Attempting to have the child take it whole could cause the child to aspirate. 4. A full course of the antibiotic must be taken to decrease the risk of resistance to the antibiotic or recurrence of the infection.) 7. A nurse is caring for a child who is receiving amphotericin B IV daily for a fungal infection. Prior to starting the therapy, which should the nurse review? 1. Aspartate aminotransferase and alanine aminotransferase serum levels. 2. Serum amphotericin level. 3. Serum protein and sodium levels. 4. Blood urea, nitrogen, and creatinine levels. - 4 (7. 1. Liver damage is not associated with amphotericin therapy. 2. Serum levels of the drug are not done. 3. The drug should not cause a change in sodium or protein levels. 4. The drug tends to be nephrotoxic. Elevation of blood urea, nitrogen, and creatinine levels indicates renal damage. If these levels are elevated, the healthcare provider must be notified to determine if the drug must be withheld for the day.) 8. Which toxicity is specific to gentamicin (Garamycin)? 1. Hepatatoxicity. 2. Ototoxicity. 3. Myocardial toxicity. 4. Neurotoxicity. - 2 (1. Hepatic and neurological toxicities are more common in fluoroquinolones. 2. Nephrotoxicity and ototoxicity are the most significant adverse effects. 3. Myocardial toxicity is not a common reaction. 4. Hepatic and neurological toxicities are more common in fluoroquinolones.) 9. A nurse is administrating vancomycin intravenously and sets the pump to infuse the medication over 90 minutes. Which adverse reaction is the nurse trying to prevent? 1. Vomiting. 2. Headache. 3. Flushing of the face, neck, and chest. 4. Hypertension. - 3 (1. Vomiting is a side effect but is not related to the rate of infusion. 2. Headache is not related to the rate of infusion. 3. "Red man syndrome" or "red neck syndrome" is flushing of the face, neck, and upper chest associated with too rapid an infusion of vancomycin. This can be prevented with infusing the vancomycin over 90 to 120 minutes and pretreating the patient with diphenhydramine (Benadryl) prior to the infusion. 4. Hypotension with shock can result from a histamine release from rapid infusion.) 10. The parents of an 8-year-old come to the clinic and ask the nurse if their child should receive growth hormone to boost short stature. Which is the nurse's best response? 1. "Growth hormone only works if the child has short bones." 2. "Can your child remember to take the pills every day?" 3. "Test results are required before growth hormone can be started in children." 4. "How tall do you think your child should be?" - 3 (1. This response does not answer the parents' question. 2. Growth hormone is available as a parenteral medication and is given intramuscularly or subcutaneously. 3. Growth hormone is approved for use only in children to treat a documented lack of growth hormone. 4. The nurse must fi rst answer the parents' question about growth hormone. TEST-TAKING HINT: Recall the reason) 11. A child has been receiving prednisone for the past 3 weeks, and the parent wants to stop the medication. What is the nurse ' s best response? 1. "There is no problem in stopping the medication since the child ' s symptoms are gone." 2. "It is dangerous for steroids to be stopped suddenly." 3. "Your child may develop severe psychological symptoms when prednisone is stopped suddenly." 4. "Stopping the prednisone will require blood work." - 2 (1. Abrupt withdrawal can cause severe side effects. 2. Abrupt cessation of long-term steroid therapy can cause acute adrenal insufficiency that could lead to death. Long-term steroid use can cause shrinkage of the adrenal glands, which decreases the production of the hormone. 3. Central nervous system symptoms such as confusion and psychosis are adverse effects of steroids. 4. Gradual tapering of the dosages will prevent severe side effects and no blood work is required.) 12. A child who has been diagnosed with hypothyroidism is started on levothyroxine (Synthroid). Which should be included in the nurse ' s teaching plan? 1. The child will have more energy the next day after starting the medication. 2. Optimal effectiveness of the medication may not occur for several weeks. 3. The medication should be taken once a day at any time. 4. The medication should be taken with milk. - 2 (1. The energy level takes much longer than 1 day to increase. 2. After starting therapy, peak levels of the drug may not be expected for many weeks to months. Clients need to know this to prevent them from stopping the medication because they think it is not working. 3. The drug works best when taken on an empty stomach; the patient should select a time each day when the stomach is empty. In children, just prior to bed may be the best time, as most children do not eat prior to bedtime. 4. The drug works best when taken on an empty stomach. Taking it with milk is contraindicated.) 13. Which should the nurse include in the discharge teaching plan for a child beginning growth hormone therapy? 1. The child is expected to grow 3 to 5 inches during the first year of treatment. 2. The parents must measure the child ' s weight and height weekly. 3. The child will need to continue the therapy until he or she is 21 years old. 4. There are no side effects from taking growth hormones. - 1 (1. The expected growth rate with growth hormone therapy is 3 to 5 inches in the first year. 2. Height and weight are measured monthly. 3. Growth hormone is discontinued when optimal adult height is attained and fusion of the epiphyseal plates has occurred. 4. Side effects include glucose intolerance, hypothyroidism, adrenocorticotropic hormone deficiency, hypercalciuria, renal calculi, gastrointestinal) 14. The onset of Humalog insulin is: 1. 10 to 15 minutes. 2. 30 minutes to 1 hour. 3. 1 to 2 hours. 4. 2 to 4 hours. - 1 (1. Humalog insulin is rapid-acting and has an onset of 10 to 15 minutes. 2. Regular insulin has an onset of 30 minutes to 1 hour. 3. NPH insulin has an onset of 1 to 2 hours and is intermediateacting. 4. Ultralente insulin has an onset of 2 to 6 hours and is a longacting insulin.) 15. Which should the nurse include in the teaching plan for a child started on metoclopramide (Reglan)? 1. The drug increases gastrointestinal motility. 2. The drug decreases tone in the lower esophageal sphincter. 3. The drug prevents diarrhea. 4. The drug induces the release of acetylcholine. - 1 (1. Metoclopramide (Reglan) is a gastrointestinal stimulant that increases motility of the gastrointestinal tract, shortens gastric emptying time, and reduces the risk of the esophagus being exposed to gastric content. 2. Decreased tone in the esophageal sphincter increases the risk of gastric contents being regurgitated upward into the esophagus. 3. There can be an increase in diarrhea because of the increase in gastrointestinal motility. 4. Methyl scopolamine blocks effects of acetylcholine and relaxes sooth muscles.) 16. The nurse will monitor a child on high-dose prednisone for: 1. Diabetes. 2. Deep vein thrombosis. 3. Nephrotoxicity. 4. Hepatotoxicity. - 1 (1. One of the side effects of high-dose steroids can be diabetes mellitus. The child needs to be evaluated so that prompt treatment can be initiated. The diabetes is self-limiting and after the steroids are discontinued should no longer be present. Other side effects include mood changes, hirsutism, trunk obesity, thin extremities, gastric bleeding, poor wound healing, hypertension, immunosuppression, insomnia, and increased appetite. 2. This is not a side effect of steroids. Deep vein thrombosis is related to clotting abnormalities. 3. This is not a side effect of steroids. 4. This is not a side effect of steroids. TEST-TAKING HINT: Review side effects) 17. A nurse is administering cyclophosphamide (Cytoxan) to a child with leukemia. Which action by the nurse would be appropriate? 1. Monitoring serum potassium levels. 2. Checking for hematuria. 3. Obtaining daily weights. 4. Obtaining neurological checks every 4 hours. - 2 (1. There should not be a change in potassium level, as the drug does not cause potassium loss. 2. Hemorrhagic cystitis is a major side effect of cyclophosphamide (Cytoxan); checking the urine for blood is an appropriate intervention. 3. Weights are obtained daily with clients receiving chemotherapy because of nausea and vomiting. 4. There are no central nervous system side effects with cyclophosphamide (Cytoxan).) 18. A nurse is giving ifosfamide (Ifex) as chemotherapy for a child who has leukemia. Mixed in with the ifosfamide (Ifex) is mesna (Mesnex). Mesna is given for which reason? 1. As combination chemotherapy. 2. As an antiarrhythmic. 3. To prevent hemorrhagic cystitis. 4. To increase absorption of the chemotherapy. - 3 (1. Mesna (Mesnex) is not a chemotherapeutic agent. 2. Mesna (Mesnex) does not prevent arrhythmias. 3. Mesna (Mesnex) is a detoxifying agent used as a protectant against hemorrhagic cystitis induced by ifosfamide (Ifex) and cyclophosphamide (Cytoxan). 4. There is no medication that increases absorption of chemotherapy.) 19. Which should a nurse anticipate be prescribed in chelation therapy for a child receiving frequent blood transfusions? 1. Dalteparin sodium (Fragmin). 2. Deferoxamine (Desferal). 3. Diclofenac (Voltaren). 4. Diltiazem (Cardizem). - 2 (1. Dalteparin sodium (Fragmin) is an anticoagulant used as prophylaxis for postoperative deep vein thrombosis. 2. Deferoxamine (Desferal) is an antidote for acute iron toxicity. 3. Diclofenac (Voltaren) is an anti-inflammatory drug. 4. Diltiazem (Cardizem) is an antianginal agent for chronic stable angina.) 20. Why is filgrastim (Neupogen) given to a child who has received chemotherapy? 1. Reduce fatigue level. 2. Prevent infection. 3. Reduce nausea and vomiting. 4. Increase mobilization of stem cells. - 4 (1. Chemotherapy may cause anemia, which can compound the feeling of fatigue rather than reduce fatigue. 2. The drug does not prevent infection, but it does increase the number of neutrophils. 3. The drug may cause nausea and vomiting rather than reduce it. 4. The drug mobilizes stem cells to produce neutrophils.)