HESI RN
Pediatric HESI
1. What is the recommended analgesia for preparing a school-age child for a lumbar puncture (LP)?
- A. Ondansetron (Zofran) 4 mg / 5 ml PO TID.
- B. Codeine 10 mg PO 30 minutes before the procedure.
- C. A transdermal fentanyl (Duragesic) patch immediately before the procedure.
- D. EMLA (eutectic mixtures of local anesthetics) 2.5 hours before the procedure.
Correct answer: D
Rationale: For a lumbar puncture in a school-age child, EMLA cream should be applied 2.5 hours before the procedure. EMLA is commonly used to numb the skin, reducing pain and discomfort for the child during the procedure. Choices A, B, and C are incorrect because ondansetron is an antiemetic, codeine is an opioid analgesic that may not be suitable for children, and transdermal fentanyl is a strong opioid that is not typically used for local anesthesia in children undergoing lumbar puncture.
2. A 6-month-old female is scheduled to receive diphtheria, tetanus toxoid, and acellular pertussis vaccine (DTaP) and IPV (inactivated poliovirus vaccine) immunizations. She is recovering from a cold but is otherwise healthy and afebrile. Her 5-year-old sister is receiving chemotherapy. Which considerations should the nurse make for this situation?
- A. DTaP and IPV can be safely given to the infant at the scheduled time.
- B. DTaP and IPV are contraindicated because the infant has a cold.
- C. IPV is contraindicated because her sister is immunocompromised.
- D. DTaP is contraindicated because her sister is immunocompromised.
Correct answer: A
Rationale: DTaP and IPV can be safely administered to a child with a mild illness like a cold, even if there is an immunocompromised family member, as these vaccines do not contain live viruses. It is important to ensure that the child is otherwise healthy and afebrile before administering the vaccines. The presence of a cold is not a contraindication for receiving DTaP and IPV vaccines. Choice A is correct because the infant can receive both vaccines as scheduled. Choice B is incorrect as having a cold does not contraindicate DTaP and IPV administration. Choice C is incorrect because IPV is not contraindicated due to the sister's immunocompromised status. Choice D is incorrect as both DTaP and IPV can be given in this scenario.
3. A 3-year-old child is brought to the clinic by the parents who are concerned that the child is not yet potty trained. What is the nurse’s best response?
- A. Most children are potty trained by this age, so you should not be concerned
- B. Every child develops at their own pace. Let’s discuss some strategies to help
- C. Your child may need to be evaluated for developmental delays
- D. It’s best to force your child to use the potty to encourage training
Correct answer: B
Rationale: The correct answer is B because it is important to acknowledge that children develop at different rates. By offering support and discussing strategies for potty training, the nurse can provide the necessary guidance without causing unnecessary concern or pressure on the parents. Choice A is incorrect because it dismisses the parents' concerns. Choice C is incorrect because jumping to the conclusion of developmental delays without further assessment or discussion can cause undue anxiety. Choice D is incorrect because forcing a child to use the potty can lead to resistance and negative associations with potty training.
4. The nurse is caring for a 4-year-old child who has been diagnosed with measles. Which intervention should the nurse implement to prevent the spread of infection?
- A. Administer antipyretics as prescribed
- B. Place the child in airborne isolation
- C. Encourage fluid intake
- D. Teach the parents about hand hygiene
Correct answer: B
Rationale: Measles is an airborne infection, so placing the child in airborne isolation is crucial to prevent the spread of the virus to others. Airborne isolation precautions help contain infectious respiratory droplets and reduce the risk of transmission to healthcare workers, other patients, and visitors. Administering antipyretics, encouraging fluid intake, and teaching parents about hand hygiene are important aspects of care but do not directly address the prevention of the spread of measles, which requires airborne precautions.
5. Which nursing diagnosis is a priority for a 4-year-old child diagnosed with nephrotic syndrome?
- A. Impaired urinary elimination.
- B. Risk for infection.
- C. Fluid volume excess.
- D. Risk for impaired skin integrity.
Correct answer: C
Rationale: In a child with nephrotic syndrome, fluid volume excess is a priority nursing diagnosis due to the risk of edema and related complications. This patient may experience significant fluid retention, leading to edema, hypertension, and potential respiratory distress. Monitoring and managing fluid volume excess are crucial in preventing further complications and supporting the child's health during nephrotic syndrome. The other options are not the priority in this case. Impaired urinary elimination is not typically a primary concern in nephrotic syndrome. While infection is a risk due to compromised immunity, fluid volume excess poses a more immediate threat to the child's health. Risk for impaired skin integrity may be a concern secondary to edema, but addressing fluid volume excess takes precedence.
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