Pediatrics HESI 2023

HESI LPN

1. The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include?

A. Getting cervical radiographs between 3 and 5 years of age
B. Adhering to the special dietary needs of the child
C. Getting an echocardiogram before 3 months of age
D. Monitoring for symptoms of respiratory infection

Correct answer: B

Rationale: The correct answer is B. While special dietary needs may be important for a child with Down syndrome, they are typically not the primary concern for a 1-month-old. The nurse would be least likely to focus on this aspect as immediate issues such as monitoring for congenital heart defects (echocardiogram), cervical spine abnormalities (radiographs), and respiratory infections are more critical in the early months. Adhering to dietary needs is important, but it is usually addressed as the child grows older and is not the priority during the infant stage.

2. The nurse is assessing a 4-year-old client. Which finding suggests to the nurse this child may have a genetic disorder?

A. The inquiry determines the child had feeding problems.
B. The child weighs 40 lb (18.2 kg) and is 40 in (101.6 cm) in height.
C. The child has low-set ears with lobe creases.
D. The child can hop on one foot but cannot skip.

Correct answer: C

Rationale: Low-set ears with lobe creases are often associated with genetic disorders, such as Down syndrome, and can indicate underlying chromosomal abnormalities. This physical characteristic is a common feature seen in various genetic syndromes. The other choices, including feeding problems, weight and height measurements, and motor skills, are not typically specific indicators of genetic disorders in the absence of other associated features.

3. A child with a diagnosis of leukemia is receiving chemotherapy. What is the most important nursing intervention?

A. Monitor for signs of infection
B. Monitor for signs of bleeding
C. Monitor for signs of dehydration
D. Monitor for signs of pain

Correct answer: A

Rationale: The correct answer is to monitor for signs of infection. When a child is undergoing chemotherapy, their immune system is compromised, making them more susceptible to infections. Monitoring for signs of infection is crucial to promptly identify and treat any potential infections. Choices B, C, and D are incorrect because although monitoring for bleeding, dehydration, and pain are important aspects of care, the priority for a child receiving chemotherapy is to prevent and detect infections due to their increased vulnerability.

4. A nurse is teaching the parents of a child with a diagnosis of type 1 diabetes mellitus about blood glucose monitoring. What should the nurse emphasize?

A. Checking blood glucose levels before meals and at bedtime
B. Using a lancet device to obtain blood samples
C. Using urine test strips for monitoring
D. Recognizing signs of hypoglycemia

Correct answer: A

Rationale: Checking blood glucose levels before meals and at bedtime is essential in managing type 1 diabetes mellitus as it helps in monitoring blood sugar levels at different times of the day and adjusting insulin doses accordingly. Option B about using a lancet device to obtain blood samples is a technique rather than an emphasis on monitoring frequency. Option C suggesting the use of urine test strips is incorrect as urine test strips are not recommended for accurate real-time monitoring of blood glucose levels in type 1 diabetes. Option D, recognizing signs of hypoglycemia, is important but not the primary emphasis when educating about blood glucose monitoring.

5. A 1-week-old infant has been in the pediatric unit for 18 hours following placement of a spica cast. The nurse observes a respiratory rate of fewer than 24 breaths/min. No other changes are noted. Because the infant is apparently well, the nurse does not report or document the slow respiratory rate. Several hours later, the infant experiences severe respiratory distress, and emergency care is necessary. What should be considered if legal action is taken?

A. Most infants have slow respirations when they are uncomfortable.
B. The respiratory rates of young infants are irregular, so a drop in rate is unimportant.
C. Vital signs that are outside the expected parameters are significant and should be documented.
D. The respiratory tract of young infants is underdeveloped, and their respiratory rate is not significant.

Correct answer: C

Rationale: In this scenario, the nurse failed to report or document the slow respiratory rate of the infant, which later led to severe respiratory distress. It is crucial to understand that any vital signs outside the expected range in an infant should be documented and reported promptly. This documentation is vital for monitoring the infant's condition, identifying potential issues, and ensuring timely intervention if needed. Choices A, B, and D are incorrect because they downplay the significance of abnormal vital signs and fail to emphasize the importance of documentation and reporting in infant care.