HESI RN
HESI Pediatric Practice Exam
1. A 10-year-old girl who has had type 1 diabetes mellitus (DM) for the past two years tells the nurse that she would like to use a pump instead of insulin injections to manage her diabetes. Which assessment of the girl is most important for the nurse to obtain?
- A. Understanding of the quality control process used to troubleshoot the pump
- B. Interpretation of fingerstick glucose levels that influence diet selections
- C. Knowledge of her glycosylated hemoglobin A1c levels for the past year
- D. Ability to perform the pump for basal insulin with mealtime boluses
Correct answer: A
Rationale: In a patient transitioning to an insulin pump, understanding the quality control process to troubleshoot the pump is crucial for ensuring proper and safe management of diabetes. This knowledge enables the individual to identify and address any issues that may arise with the pump, helping maintain optimal glycemic control and prevent complications. Choices B, C, and D, although important in diabetes management, are not as critical as ensuring the correct understanding of troubleshooting the pump, which directly impacts the girl's ability to effectively use the pump for insulin delivery.
2. A mother brings her 3-week-old infant to the clinic because the baby vomits after eating and always seems hungry. Further assessment indicates that the infant’s vomiting is projectile, and the child seems listless. Which additional assessment finding indicates the possibility of a life-threatening complication?
- A. Irregular palpable pulse
- B. Hyperactive bowel sounds
- C. Underweight for age
- D. Crying without tears
Correct answer: D
Rationale: In this scenario, the infant presenting with vomiting, lethargy, and projectile vomiting indicates a potential serious condition. Crying without tears is a sign of dehydration, a critical condition that can lead to life-threatening complications in infants. Dehydration can rapidly worsen an infant's condition, making prompt intervention crucial to prevent further complications. Irregular palpable pulse (Choice A) could indicate a cardiovascular issue but is less immediately life-threatening in this context. Hyperactive bowel sounds (Choice B) are more indicative of gastrointestinal issues rather than a life-threatening complication. Underweight for age (Choice C) may be concerning for growth-related issues but does not directly indicate a life-threatening complication like dehydration does.
3. The mother of a one-month-old calls the clinic to report that the back of her infant's head is flat. How should the nurse respond?
- A. Turn the infant on the left side braced against the crib when sleeping.
- B. Prop the infant in a sitting position with a cushion when not sleeping.
- C. Place a small pillow under the infant's head while lying on the back.
- D. Position the infant on the stomach occasionally when awake and active.
Correct answer: D
Rationale: Positioning the infant on the stomach occasionally when awake and active can help prevent flat spots on the head. This position allows for more natural movement and prevents prolonged pressure on one area of the head, reducing the risk of developing a flat spot. Turning the infant on the left side braced against the crib when sleeping (choice A) is not recommended as it does not address the issue of flat spots. Propping the infant in a sitting position with a cushion when not sleeping (choice B) may increase the risk of falls and is not suitable for a one-month-old. Placing a small pillow under the infant's head while lying on the back (choice C) should be avoided due to the risk of suffocation and sudden infant death syndrome (SIDS).
4. When should oral hygiene practices start for an infant according to the American Dental Association guidelines?
- A. There is no need to begin until after all of the child's baby teeth are in.
- B. You don't have to worry about that until your child can handle a toothbrush.
- C. You can begin now using toothpaste on a gauze pad and wiping the gums.
- D. Begin wiping the teeth with a washcloth and water when the first tooth appears.
Correct answer: D
Rationale: According to the American Dental Association guidelines, oral hygiene practices should start as soon as the first tooth appears. At this stage, using a soft cloth and water to clean the infant's gums and teeth is recommended to establish good oral hygiene habits early on and prevent dental issues. Choice A is incorrect as waiting until all baby teeth are in is too late for starting oral hygiene practices. Choice B is incorrect as it is essential to start oral hygiene before the child can handle a toothbrush. Choice C is incorrect as using toothpaste on a gauze pad is not recommended for infants with emerging teeth.
5. The nurse is assessing a 4-year-old child who is brought to the clinic for a routine checkup. The child’s parent reports that the child has been more irritable and less active over the past week. The nurse notes a petechial rash on the child’s trunk and extremities. What should the nurse do first?
- A. Ask the parent about recent exposure to contagious diseases
- B. Review the child’s immunization record
- C. Measure the child’s temperature
- D. Notify the healthcare provider immediately
Correct answer: D
Rationale: In this scenario, the child's presentation with irritability, decreased activity, and a petechial rash raises concern for a serious condition like meningitis. Petechial rash can be indicative of meningitis or other critical illnesses. Therefore, the nurse's priority should be to notify the healthcare provider immediately to ensure prompt evaluation and appropriate management. Asking about recent exposure to contagious diseases may be relevant later but is not the most urgent action. Reviewing the child's immunization record and measuring the temperature can provide valuable information but should not take precedence over the need to address the potential serious condition indicated by the petechial rash.
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