1200 HESI QUESTIONS PEDIATRICS EXAM VERSION B
1 | P a g ePediatrics Exam - Version B
1.The nurse is preparing to catheterize an 8-year-old child. Before
... [Show More] starting the procedure,
which action should the nurse take first?
A. Obtain the parent's cooperation before initiating the procedure.
B. Explain to the child and the parents that the procedure needs to be done.
C. After talking with the parents about the procedure, ask them to leave the room.
D. Provide the child with privacy by conducting the procedure in the treatment room.
An 8-year-old uses concrete operational thought (Piaget), can cooperate, and should be
included in the plan of care (B). (A) is indicated for a pre-school aged child, and does not
acknowledge the school-aged child's cognitive ability. (C and D) may be needed, but
should occur after (B).
Points Earned: 0/1
Correct Answer: B
You
r Response: D
2.
Which neurological test should the nurse implement to assess cerebellar
function in a 5-year-old with symptoms ofhyperactivity?
A. Finger-to-nose.
B. Quadriceps reflex.
C. Two-point discrimination.
D. Ability to follow directions.
The cerebellum controls balance and coordination and is significant in children with
symptoms of hyperactivity or learning difficulty, so difficulty in performing a finger-to-
nose test (A) indicates poor sense of position (especially with the eyes closed) and
incoordination (especially with the eyes opened). Superficial reflexes (B), sensory
discrimination (C), and ability to follow directions (D) are aspects of a neurologic
examination but do not test cerebellar function.
Points Earned: 0/1
Correct Answer: A
2 | P a g eYour Response: C
3.
An infant with developmental dysplasia ofthe hip is placed in a Pavlik harness. What
instructions should the nurse include in a teaching plan for the parents?
A. Apply lotion or powder to minimize skin irritation.
B. Put clothing over harness for maximum effectiveness.
Check for red areas under the straps three times a day.
.
D.Use a thin absorbent disposable diaper over the harness.
The Pavlik harness, which maintains the hips in abduction, is the most widely used device
for developmental dysplasia of the hip. An infant who continuously wears a Pavlik harness
is at risk for skin breakdown, so parents should be instructed to check two to three times
a day for red areas under clothing and harness straps (C). Lotions and powders (A) can
cake or irritate the skin and should be avoided. To avoid direct contact with the skin,
clothing and diapers should be placed under the straps (B and D).
Points Earned: 1/1
Correct Answer: C
Your Response: C
4.Which research finding provides evidence-based practice for an infant's risk for sudden
infant death syndrome (SIDS)?
A. Breastfeeding reduces the risk for and the incidence ofSIDS.
B. Infants should be positioned supine or supported laterally to sleep.
C. The prone position should be used when an infant sleeps after feeding.
D. The peak incidence occurs between the ages of1 and 2 months.
Research has shown that placing babies on their backs for sleep reduces the risk of SIDS
(B). Although breastfeeding is recommended to boost neonatal immunity, (A) is unrelated
to SIDS. A population-based study found the prone sleep position (C) was associated with
twice (2.4% odds ratio) the rate of SIDS compared with infants placed nonprone to sleep.
SIDS remains the third leading cause of death in children between the ages of 1 month
and 1 year, not (D).
Points Earned: 0/1
Correct Answer: B
Your Response: D
5. During the well-child assessment ofan 18-month-old male toddler, the nurse determines
the child does not walk while holding on to furniture but prefers to crawl, rarely speaks,
has a flat affect, and is small for his age. Which nursing diagnosis should the nurse
formulate?
A. Alteration in nutrition.
B. Alteration in parenting.
C. Delayed growth and development.
3 | P a g eD. Alteration in health maintenance.
This child does not demonstrate gross motor or psychosocial skills typical of an 18-month-
old toddler, which best supports delayed growth and development (C). Additional
information about the child's growth parameters is needed to support (A, B, or D).
Points Earned: 0/1
Correct Answer: C
Your Response: A
6. A 4-year-old boy is brought to the emergency department by his parent, who reports
that the child has been pointing at his stomach and saying, "It hurts so bad." Which
pain-assessment tool should the nurse use?
A. Descriptor Scale.
B. BriefPain Inventory.
C. A numeric rating scale.
D. Wong-Baker FACES Scale.
A pain rating scale using pictures, such as the Wong-Baker FACES Scale (D), allows the
child to choose a facial expression that shows how much hurt you have now and should be
used for a preschool-aged child. (A, B, and C) are used for older children who are able to
conceptualize pain using a number or descriptive narratives.
Points Earned: 0/1
Correc
t
Answ
er: D
Your
Respo
nse:
7. The parents ofa child with Asperger's disorder asks the nurse to explain the
differences between Asperger's and autism. Which information should the nurse
share with the parents about Asperger's disorder that is not characteristic in autism?
A. Obsession with moving objects.
B. Repetitive patterns ofbehavior.
C
Age-appropriate language development.
.
D.Stereotypic movements and speech patterns.
Communication is not delayed in Asperger's disorder (C), but impaired communication
with delays of spoken language is characteristic of autism. Asperger's disorder has many
4 | P a g echaracteristics also found in autistic disorder, such as self-injurious behavior, behaviors
that lead to social impairment (A), and restrictive, repetitive forms of behaviors (B and D).
Points Earned: 0/1
Correct Answer: C
Your Response: C
8. The nurse notices that the hem ofa skirt on a pre-adolescent girl is uneven when
she comes to the clinic. What procedure should the nurse follow to examine the girl
for scoliosis? (Arrange the examination process from first on top to last on the
bottom.)
A. Ask the girl to remove her shirt but leave on her bra or swimsuit top.
B. Examine for scapular prominence.
C. Look for asymmetry in the hip area.
D. Instruct the girl to bend at the waist so back is parallel to the floor.
To screen for scoliosis, the girl should first be asked to remove her shirt, wear her bra, or
wear a swimsuit top. Then, as she stands erect, observe for asymmetry of the shoulders,
back and hips while standing behind the girl. Next, ask her to bend forward so that the
back is parallel to the floor, and finally observe from the side and the back, noting
asymmetry or prominence of the rib cage and scapulae.
Points Earned: 0/4
Correct Answer: A:1, B:4, C:2,
D:3
Your Response: A:-, B:-, C:-, D:-
9. The parents ofa 14-year-old girl tell the nurse that their daughter dresses as a
tomboy and plays baseball one day and the next day dresses in feminine clothes
and becomes a teenage drama queen. What information should the nurse use to
respond to the parents?
A. Teenagers need a strong role mode to emulate.
B. Adolescents try on different roles while seeking their identity.
C. Such erratic behavior needs further investigation.
D. Fourteen-year-olds often try to please parents with their role choices.
As teenagers seek their own identity, they try on different roles to see if they fit (B).
Although role models (A) are important, they do not explain the adolescent's exploration
for self-identity. Such behaviors seem erratic, but are normal adolescent experiences that
needs no further investigation (C). (D) does not provide the best explanation.
Points Earned: 0/1
Correct Answer: B
Your Response: D
5 | P a g e10. A 2-year-old is receiving care in the emergency department (ED) for a deep
laceration on the head. What action should the nurse implement to facilitate the
child's cooperation?
A. Allow the child to hold a favorite toy or blanket.
B. Direct the parents to remain outside the treatment room.
C. Keep the child physically restrained during nursing care.
D. Let the child decide whether to sit up or lie down for procedures.
Allowing a child to hold a favorite toy or blanket (A) provides familiarity and comfort
which should facilitate the child's cooperation during treatment. Parents should remain
with the child, not (B), to calm and reassure a child who may perceive the ED environment
as threatening. A toddler needs autonomy and may not respond well to restriction, such as
restraints (C), which should be limited or removed as soon as safety permits. (D) should
not be offered to a toddler who is not capable of understanding a position (D) that might
be needed during a treatment or
procedure.
Points Earned: 0/1
Correct Answer: A
Your Response: B
11. A 4-year-old is brought to the emergency room for a laceration on the right foot.
What action should the nurse implement to help the child in coping with the
emergency room experience?
A. Avoid the use ofbandages to keep wounds open to air.
B. Remind the preschooler how big children should act.
C. Give the child some time after explaining procedures.
D. Avoid using jargon, such as shot, when giving care.
Using positive terms and avoiding words that have frightening connotations (D) assist the
preschool-age child in coping with an emergency room experience. Bandages (A) are
important to preschool-aged children because this age group often believe bandages stop
their insides from leaking out. Children need to feel comfortable expressing their fears and
feelings and should not be shamed into cooperation by referencing expected big children
behaviors (B). Preschool-age children should be told about procedures immediately before
they are performed (C), which minimizes the time a child fantasies about the treatment,
which causes increased anxiety.
Points Earned: 0/1
Correct Answer: D
Your Response: B
12. A 6-year-old child is admitted in the emergency department with a systolic blood
pressure of58 mm Hg. What action should the nurse take first?
A. Comfort the child.
B. Assess responsiveness.
C. Alert the healthcare provider.
6 | P a g eD. Initiate IV fluid replacement.
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 (C)
of the child's hypotension, and although comforting measures should be provided (A),
physiological needs should be met first. Assessing the child's responsiveness is a
component of a neurologic assessment, but asystolic blood pressure of 58 mm Hg is a late
sign of shock in children and requires immediate intervention (B). The healthcare
provider's prescriptions, including IV fluids (D), should be obtained to address shock.
Points Earned: 0/1
Correct Answer: C
Your Response: D
13. A child is brought to the emergency department with sweating, chills, and snake
fang-like puncture marks on the calf. What action should the nurse implement
after the type ofsnake is identified?
A. Secure the antivenin.
B. Ambulate the child.
C. Apply a tourniquet to the leg.
D. Reassure the child and parent.
Antivenin is essential to the child's survival because the child is showing signs of
envenomation
(A). When a bite or envenomation is located on an extremity, the extremity should be
immobilized, so ambulating the child (B) is contraindicated by the venom circulation
increases with the exercise. The use of a tourniquet is not recommended (C).
Envenomation is a potentially life-threatening condition, so false reassurance is not helpful
(D).
Points Earned: 0/1
Correct Answer: A
Your Response: C
14. Which finding should the nurse in the emergency department identify as an
indicator that a 3-year-old child has been mistreated?
A. The toddler does not remember how the injury occurred.
B. The parents are extremely calm in the emergency room.
C. The injury sustained is highly unusual for 3-year-old children.
D. The child was doing something unsafe when the injury occurred.
An injury that is highly unusual or inconsistent with the age and condition of the child
should raise suspicion of child abuse (C). A 3-year-old child's attention span and
interruption of events are consistent with a child's reliability as a historian or not
remembering what happened (A) when the injury occurred. Culture, ethnicity, individual
experiences and psychological makeup can influence parental reactions to a child who has
been injured, so (B) alone is insufficient to deduce child abuse. Additional information
should be obtained to determine whether the parents are negligent in the care of the child
(D).
7 | P a g ePoints Earned: 0/1
Correct Answer: C
Your Response: D
15. A crying toddler has a blood pressure measurement of120/70 mm Hg. What
action should the nurse implement?
A. Notify the healthcare provider ofthe measurement.
B. Quiet the child and retake the blood pressure.
C. Ask the parent ifthe child has a history ofhypertension.
D. Document the finding and recheck in 4 hours.
When a child is crying, intra-thoracic and abdominal pressures increase and are reflected
in an elevation of systemic blood pressure, so the nurse should quiet the child before
retaking the blood pressure (B). (A) is not necessary until accurate readings are obtained.
(C) is not necessary. An accurate pressure reading should be obtained before
implementing (D).
Points Earned: 1/1
Correct Answer: B
Your Response: B
16. What should the nurse assess last when examining a 5-year-old child?
A. Heart.
B. Lungs.
C. Throat.
D. Abdomen.
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 (C), should be left to
the end of the examination for a preschooler. Assessment of (A, B, and D) is not
considered as invasive or frightening to the child as (C).
Points Earned: 1/1
Correct Answer: C
Your Response: C
17. A 15-year-old girl tells the school nurse that she wants to have a baby. How should
the nurse respond?
A. "Will you be able to support the baby?"
B. "Do you have plans to continue school?"
C. "Have you talked with your parents about this?"
D. "Can you tell me how your life will be ifyou have an infant?"
8 | P a g eDeveloping a dialogue with the teen is important, and by using open-ended questions the
nurse will encourage communication and explanation. Asking the teenager to describe
how the infant will affect her life (D) directs the teen to consider real life experiences and
allows the nurse to assess the teen's perception and reality orientation. (A, B, and C) do
not facilitate communication and may terminate the communication.
Points Earned: 0/1
Correct Answer: D
Your Response: C
18. The nurse is caring for a 9-year-old male child who frequently speaks about sex
and uses correct sexual vocabulary. What action should the nurse implement with
this child?
A. Ask the child whether he was sexually abused.
B. Ascertain what the child understands about sex.
C. Inquire where the child got this important information.
D. Involve the child in teaching sex information to peers.
School-age children often use correct sexual vocabulary, and yet have no real
understanding of what the words mean, so (B) provides clarification of the child's
concepts used in conversation. Direct questions about sexual abuse (A) may frighten the
child and more information is needed to make the assumption of sexual abuse. Asking the
child about his source of information (C) is not as relevant as what the child understands
about sex. (D) is not an option.
Points Earned: 0/1
Correct Answer: B
Your Response: A
19. 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.)
A. Meningococcal polysaccharide vaccine (MPSV4).
B. Haemophilus influenzae type b conjugate vaccine (Hib).
C. Inactivated poliovirus vaccine (IPV).
D. Hepatitis B virus vaccine (HepB).
E. Diphtheria, tetanus toxoids, and acellular pertussis (DTaP).
F. Measles, mumps, and rubella vaccine (MMR).
(B, C, D, and E) should be administered prior to 6 months of age. (A) is administered after
24months of age. (F) is administered at 12-months of age.
Points Earned: 1/4
Correct Answer: B, C,
D, E
Your Response: D
9 | P a g e20. While assessing the apical pulse ofa 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?
A. Continue the cardiac examination.
B. Inquire about daily caffeine intake.
C. Re-assess the apical pulse in 15 minutes.
D. Schedule a consultation with a cardiologist.
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 (A). This finding is not related to caffeine intake (B). (C and D) are
not indicated because the heart rate is within the normal range.
Points Earned: 0/1
Correct Answer: A
Your Response: B
21. The nurse reviews the complete blood count (CBC) findings ofan adolescent with
acute myelogenous leukemia (AML). The hemoglobin is 13.8 g/dl, hematocrit is
36.7%, white blood cell count is 8,200 mm3, and platelet count is 115,000 mm3.
Based on these findings, what is the priority nursing diagnosis for this client's plan
ofcare?
A. Impaired gas exchange.
B. Risk for infection.
C. Risk for injury.
D. Risk for activity intolerance.
A client with AML is at risk for anemia, neutropenia, and thrombocytopenia. These CBC
findings indicate that the platelet count is low (normal 250,000 to 400,000 mm3), which
places this client at an increased risk for injury (C), usually manifested as bruising or
bleeding. There is no evidence of impaired gas exchange (A) due to respiratory
compromise, risk of infection (B) due to neutropenia, or risk for activity intolerance (D)
secondary to anemia and fatigue.
Points Earned: 1/1
Correct Answer: C
Your Response: C
22. The parents ofa child with hemophilia A ask the nurse about their probability of
having another child with hemophilia A. Which information is the basis for the
nurse's response? (Select all that apply.)
A. Autosomal dominance occurs with this disorder.
B. Sons offemale carriers have a 50% chance ofinheriting hemophilia.
C. Men with hemophilia have sons who also manifest the disease.
10 | P a g eD. The disease occurs in daughters ofmen with hemophilia.
E. Hemophilia is an X-linked recessive disorder.
Correct choices are (B and E). Hemophilia is an inherited disease that manifests in male
children whose mother is a carrier. With each pregnancy there is a 50% chance that a
male child will inherit the defective gene and manifest hemophilia A (B), which is an X-
linked recessive disorder (E). (A) is descriptive of a rare type of hemophilia, known as von
Willebrand's disease. Hemophilia is inherited by male offspring of female carriers (C).
Daughters (D) do not manifest the disease, but have a 50% chance of being a carrier.
Points Earned: 0/2
Correct Answer: B, E
Your Response: A, B, C
23.What is a priority nursing diagnosis for a child in the subacute stage ofKawasaki
disease?
A. Alterations in skin integrity.
B. High risk for altered tissue perfusion, cardiopulmonary.
C. Risk for imbalanced body temperature, hyperthermia.
D. High risk for fluid volume deficit.
Kawasaki's disease (KD) is an acute systemic vasculitis that places the child at risk for
coronary artery aneurysm, which is most likely to occur during the subacute phase,
resulting in reduced cardiac output (B). Kawasaki disease causes rashes and
desquamation of the hands and feet (A), but this is not as life-threatening as cardiac
involvement. Insensible fluid loss from fever (C) and reduced fluid intake due to oral
lesions may alter fluid balance and place the child at risk for fluid volume deficit (D), but
these issues are not as critical as possible changes in tissue perfusion.
Points Earned: 1/1
Correct Answer: B
Your Response: B
25. The nurse is developing the plan ofcare for a school-aged boy with a chronic
disability. The child frequently cries about being different from his siblings and
wants others to do things for him that he is capable ofdoing for himself. To assist
the family in coping with this child's chronic illness, which intervention is most
important for the nurse to implement?
A. Recommend the use ofconsistent discipline and reward for acceptable behavior.
B. Encourage the parents to role model ways to act when one is disappointed.
C. Suggest that all the children are included in family decision making.
D. Evaluate the proper use ofequipment that is provided to improve the child's
lifestyle.
Focusing on the child, and not the condition, is essential in assisting the child to adapt to a
chronic disability or illness. Consistent family rules (A) should be used with a chronically
ill child, such as setting boundaries for acceptable behavior, requiring participation in
household activities, and fulfilling school responsibilities. (B, C, and D) may be worthwhile
11 | P a g einterventions, but do not have the priority of providing the child with consistent
expectations of acceptable behavior.
Points Earned: 0/1
Correct Answer: A
Your Response: B
26. A man who was recently diagnosed with Huntington's disease asks the nurse ifhis
adolescent son should be tested for the disease. What response is best for the nurse
to provide?
A. Autosomal dominant disorders, such as Huntington's, cannot be inherited from
the parent.
B. Testing is needed because there is a 50 percent risk ofpassing the gene to each
offspring.
C. Genetic counseling should be provided to ensure an informed decision by the
family.
D. Positive genetic testing may contribute to insurance discrimination that denies
coverage.
Huntington's disease, a progressively incapacitating, fatal neuromuscular disease, is an
autosomal dominant inherited disease that has a 50% risk of developing in each child of
those who have the disorder. The risk of autosomal dominant inheritance should be
explained and emphasized (B). (A) is inaccurate. Although the basic tenet of genetic
counseling is to provide families with facts to assist them in making informed decisions
(C), the basic laws of inheritance should be explained to direct the client to counseling. (D)
provides information that does not address the client's question, and might be considered
judgmental.
Points Earned: 0/1
Correct Answer: B
Your Response: A
27. A mother is crying as she holds and rocks her child with tetanus who is having
muscular spasms and crying. After administering diazepam (Valium) to the child,
what action should the nurse implement?
A. Lay the child down and ask the mother to stay near the child in the crib.
B. Encourage the mother to take a break and leave the room to stop crying.
C. Keep all light sources offand close the window blinds to the room.
D. Use calm, reassurance and understanding to comfort the mother.
Controlling environmental stimulation such as noise, light, or tactile stimuli helps reduce
CNS irritability related to acute tetanus. The mother should be instructed to minimize
handling of the child during episodes of muscle spasticity and to stay calmly near the child
(A). The mother's presence with the child provides security and support, so (B) is not
indicated. Reducing external stimuli (C) may have some effect in reducing the child's
distress, but light tends to be less irritating than vibratory or auditory stimuli and is
essential for careful observation. Although a calm, reassuring manner and sympathetic
12 | P a g eunderstanding (D) can help reduce the mother's anxiety, the most comforting measure for
the child is the presence of the mother.
Points Earned: 0/1
Correct Answer: A
Your Response: C
27. Which clinical finding should the nurse expect a child with nephrosis to exhibit?
A. Elevated blood pressure.
B. Blood-tinged urine.
C. Elevated temperature.
D. Urine protein 3+ to 4+.
In nephrosis, renal tubules become permeable to proteins, causing massive proteinuria
(D). (A and B) are characteristic of acute glomerulonephritis. Infection, indicated by (C), is
not the cause of nephrosis, but may occur secondary to immunosuppressive therapy.
Points Earned: 0/1
Correct Answer: D
Your Response: B
28. 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?
A. Teach the parents about interventions for failure to thrive syndrome.
B. Compare this weight with previous weights recorded in the child's record.
C. Evaluate the parent's body build in relation to the infant's weight.
D. Obtain a 24-hour nutritional history before making any conclusions.
Evaluation of weight using a growth chart requires comparison of consistency of current
weight with previous weight measurements (B). The infant is defined as having a failure
to thrive (A) if height or weight falls below the 3rd percentile. It is worthwhile to evaluate
(C), but first the nurse should review the infant's record to determine the weight history.
(D) is important, but does not have the priority of (B).
Points Earned: 0/1
Correct Answer: B
Your Response: D
29. 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 ofhis
friends. What response is best for the nurse to provide?
A. You must remember that this treatment regimen is not always effective.
B. Although being tall is important to you, remember there are far more important
characteristics than height.
13 | P a g eC. You will grow with this medicine, and are likely to be taller than anyone in your family.
D. Being taller is important to you and taking your injections will help achieve that goal.
It is important to validate his feelings (D) and reinforce the fact that injections are the only way he can get the medication. He will have to take injections three times a week for years. (A) is unnecessarily negative and not indicated at this time. It is important to this child how tall he is, and (B) belittles these feelings. While heredity plays an important role in the height this child will achieve, (C) is not true; this child will probably still be shorter than he would have been had he not had this problem. Points Earned: 0/1
Correct Answer: D Your Response: A
30. A 3-year-old boy is brought to the emergency room because ofa possible diazepam (Valium) overdose. He is lethargic and confused, and his vital signs are: pulse rate 100 beats/minute, respiratory rate 20 breaths/minute, and blood pressure 70/30. Which nursing intervention has the highest priority?
A. Insert an orogastric tube for gastric lavage. B. Prepare a set-up for an endotracheal intubation. C. Draw blood for stat chemistries and blood gases. D. Insert a Foley catheter to monitor renal functioning.
Diazepam causes respiratory depression, so preparation for intubation (B) to protect the airway is the priority intervention at this time. (A) may be necessary, but the child is lethargic and confused, with a lowered respiratory rate, so (B) takes priority. (C and D) are interventions that should be implemented, but they are both secondary to ensuring an open airway.
Points Earned: 0/1
Correct Answer: B Your Response: C
31. The nurse is developing a plan ofcare for a newborn with a colostomy due to anal agenesis, and the infant has had three loose stools since surgery yesterday. Which nursing diagnosis has the highest priority? [Show Less]