HESI Pediatrics Practice Questions - Answered with Rationales

HESI Pediatrics Practice Questions - Answered with Rationales Which growth and development characteristic should the nurse consider when monitoring the effects of a topical medication for an infant? A thin stratum corne ...

HESI Pediatrics Practice Questions - Answered with Rationales Which growth and development characteristic should the nurse consider when monitoring the effects of a topical medication for an infant? A thin stratum corneum that increases topical absorption. Rationale: Infants have a thin outer skin layer (stratum corneum), so the nurse should monitor the infant for a prompt onset and response to the application of topical medication. A preschool-age child who is hospitalized for hypospadias repair is most strongly influenced by which behavior? Concern for body integrity. Rationale: The preschooler's major stressor is concern for his body integrity. He fears that his "insides will leak out." A child undergoing surgery to his genitalia is even more concerned about body integrity. A child with a penetrating eye injury comes to the school clinic. What action should the nurse implement? Apply a Fox shield to the affected eye and any type of patch to the other eye. Rationale: The treatment for a penetrating eye injury is not to remove or manipulate the impaled object, but to apply a Fox shield over the eye, if available (not a regular eye patch) and place an eye patch over the unaffected eye to prevent bilateral eye movement. The child should be transported to the emergency department immediately. If a Fox shield is not available, then tape in place a paper cup over the eye and object. A mother brings her 6-month-old infant to the clinic for a well-baby routine exam. Which vaccine(s) should the nurse verify the infant has received? (Select all that apply.) 1. Inactivated poliovirus vaccine (IPV). 2. Diphtheria, tetanus toxoids, and acellular pertussis (DTaP). Rationale: According to the CDC guidelines for immunizations, a six-month-old infant should have received doses 1 & 2 of Hib, IPV, HepB, and DTap. A 6-year-old child is admitted to the emergency department with a systolic blood pressure of 58 mm Hg. What action should the nurse take first? Alert the healthcare provider. Rationale: The lower limit for systolic blood pressure for a child older than 1 year of age is 70 mm Hg plus 2 times the child's age in years, so the healthcare provider should be notified immediately of the child's hypotension and anticipate a prescription for IV fluids. The nurse determines the daily caloric need for a six-month old weighs 15 pounds. Considering an infant requires 108 calories/kg/day, how many calories should the infant be provided throughout the day? (Round at the end of the calculation to the nearest whole number.) 735 calories per day. Rationale: An infant requires 108 calories/kg/day (108 x 6.81= 736 calories/day). Convert pounds to kilograms (kg): 15 pounds / 2.2 pounds per kg = 6.81 kg 108 calories x 6.81 = 735.48 = 735 calories / 24 hours What sign of malignant hyperthermia should the nurse assess for during the perioperative period in a child receiving general anesthesia? Tachypnea. Rationale: Malignant hyperthermia, a potentially fatal autosomal genetic myopathy, can cause a change in vital signs that demands immediate attention in the perioperative period when these individuals are exposed to anesthetic agents. Early symptoms of the disorder include tachycardia and tachyarrhythmia, tachypnea, hypercarbia, and metabolic and respiratory acidosis. An elevated temperature is a late sign of the disorder. A mother expresses concern to the nurse about the behavior of her 15-year-old adolescent who is frequently finding fault and criticizing her. What information should the nurse provide? Teens create psychological distance from parents in order to separate from them. Rationale: Although a mutually respectful parent-adolescent relationship is important, an adolescent may use critical and fault-finding behavior as a mechanism to separate from the parent. Between the ages 15-17 years old, adolescents tend to have conflicts with their parents as they struggle with issues of independence and control as they mature towards late adolescence of 18-20 years old. A mother tells the nurse that her children are asking questions about divorce, but one male child tells her that he is sorry that he caused the divorce of the parents. Which age group is most likely to experience feelings of punishment or responsibility for the divorce of parents? 4 years. Rationale: Divorce constitutes a major disruption for children of all ages. Behaviors and feelings differ based on children's developmental stages and cover a wide spectrum, with overlap between stages. A preschool-aged child often feels frightened, confused, and may blame themselves for the divorce, or feel it is their personal punishment. A 12-year-old male client tells the nurse that he is happy to be taking growth hormones because now he can expect to grow and be just as tall as all of his friends. What response is best for the nurse to provide? "Being taller is important to you and taking your injections will help achieve that goal." Rationale: It is important to validate his feelings and reinforce the fact that injections are the only way he can get the medication and achieve growth in height. He will have to take injections three times a week for years. A newborn who is breastfeeding is diagnosed with galactosemia. What action should the nurse implement? Stop the infant breastfeeding. Rationale: Galactosemia is a rare genetic disorder that involves an inborn error of carbohydrate metabolism in which a hepatic enzyme, galactokinase, involved in the conversion of galactose to glucose is absent. Treatment consists of eliminating all lactose-containing foods, including breast milk, so the infant should stop breastfeeding. Soy protein formula is the feeding of choice during infancy. The nurse is instructing an adolescent with bulimia and a low potassium level about the risk for complications. Which medical problem should be the focus of the nurse's instruction to this client? Cardiac arrhythmias. Rationale: An adolescent with bulimia who purges by frequent self-induced vomiting, diuretic or laxative abuse can experience potassium depletion, which increases the risk for cardiac arrhythmias. What should the nurse assess last when examining a 5-year-old child? Throat. Rationale: Examination of the mouth, throat, and perineum is considered to be more invasive than other parts of a physical examination, so invasive procedures, such as examination of the throat, should be left to the end of the examination for a preschooler. While assessing the apical pulse of a 13-year-old, the nurse determines that the rate is 88 beats/minute, and the rhythm is irregular. The heart rate is phasic with respirations, increasing during inspiration and decreasing with expiration. What action should the nurse take? Continue the cardiac examination. Rationale: Sinus arrhythmia is characterized by phasic irregularity of the heart rate that occurs with changes in intrathoracic pressure during respiration and is a common phenomenon during childhood and adolescence. No intervention is required, and the nurse should continue with the cardiac exam. An 8-year-old boy who is recently diagnosed with diabetes mellitus is admitted to the intensive care unit with diabetic ketoacidosis (DKA). Which nursing action has the highest priority? Initiate an intravenous infusion. Rationale The priority for a child with DKA, an emergency life-threatening situation, is to obtain venous access for administration of fluids, electrolytes, and insulin. The child should be placed on a cardiac monitor and have serum electrolytes and glucose levels obtained, but not before initiating venous access. The low-birth-weight (LBW) infant requires a neutral thermal environment. What action should the nurse implement? Maintain a high-humidity atmosphere. Rationale: A neutral thermal environment with high humidity provides adequate warmth so the LBW infant can maintain a normal core temperature with minimum oxygen consumption and calorie expenditure. LBW infants are especially vulnerable to temperature instability due to they are usually premature and neurologically have difficulty maintaining their temperature and their skin has not mature enough to provide the adequate protection from heat and water-loss. A high-humidity atmosphere in an incubator contributes to body homeostasis by reducing evaporative heat loss and insensible water loss. A nurse who is working in the Poison Control Center receives a telephone call from a parent of a 16-month old child who drank 2 ounces of acetaminophen (Children's Tylenol) elixir. What action should the nurse recommend to the parent? Transport to emergency center for gastric decontamination. Rationale: Each 5 ml of Children's Tylenol Elixir contains 160 mg of acetaminophen, and this child has ingested twice the maximum recommended 24-hour dose, which can cause acetaminophen toxicity. The parent should transport the child to the emergency center for gastrointestinal decontamination and the possible administration of the antidote, acetylcysteine. Overdosing of Tylenol can cause serious liver damage. When plotting a 20-week-old infant's weight on a standardized growth chart, the nurse determines that the child's weight is between the 2nd and 3rd percentile. Based on this finding, which action should the nurse take?