HESI LPN
Pediatrics HESI 2023
1. What should the nurse include in the care plan for a 6-month-old infant admitted with a diagnosis of respiratory syncytial virus (RSV)?
- A. Provide small, frequent feedings
- B. Administer antibiotics
- C. Maintain strict isolation
- D. Elevate the head of the bed
Correct answer: D
Rationale: Elevating the head of the bed is crucial in the care plan for an infant with RSV as it helps improve breathing by facilitating better airflow and drainage of secretions. This position can also enhance comfort and reduce respiratory distress. Providing small, frequent feedings (Choice A) is generally beneficial for infants but is not specific to managing RSV. Administering antibiotics (Choice B) is not indicated for RSV as it is caused by a virus, and antibiotics are ineffective against viral infections. Maintaining strict isolation (Choice C) is important to prevent the spread of contagious infections but is not a direct intervention for improving the infant's respiratory status in RSV.
2. When caring for a neonate with a suspected tracheoesophageal fistula, what nursing care should be included?
- A. Elevating the head and not giving anything by mouth
- B. Elevating the head at all times
- C. Administering glucose water only during feedings
- D. Avoiding suctioning unless the infant is cyanotic
Correct answer: A
Rationale: When caring for a neonate with a suspected tracheoesophageal fistula, it is essential to elevate the head and avoid giving anything by mouth. Elevating the head helps prevent aspiration, and withholding oral intake reduces the risk of complications like aspiration pneumonia. Elevating the head at all times (choice B) is overly restrictive and unnecessary. Administering glucose water only during feedings (choice C) is not recommended as it can still lead to aspiration. Avoiding suctioning unless the infant is cyanotic (choice D) is incorrect because maintaining airway patency may require suctioning, irrespective of cyanosis, in a neonate with a suspected tracheoesophageal fistula.
3. A child with a diagnosis of bronchiolitis is admitted to the hospital. What is the most important nursing intervention?
- A. Administering bronchodilators
- B. Providing respiratory therapy
- C. Monitoring oxygen saturation
- D. Encouraging fluid intake
Correct answer: B
Rationale: The most important nursing intervention for a child with bronchiolitis is providing respiratory therapy. This intervention helps to maintain airway patency and improve breathing, which are crucial in managing bronchiolitis. Administering bronchodilators (Choice A) may be a part of the treatment plan but is not the most important intervention. Monitoring oxygen saturation (Choice C) is important but falls secondary to providing direct respiratory support. Encouraging fluid intake (Choice D) is also essential but does not address the immediate respiratory needs of the child with bronchiolitis.
4. A 5-year-old child is diagnosed with acute glomerulonephritis. What is a key assessment the nurse should perform?
- A. Monitor blood glucose levels
- B. Monitor respiratory rate
- C. Monitor urine output
- D. Monitor for signs of infection
Correct answer: C
Rationale: In a child diagnosed with acute glomerulonephritis, monitoring urine output is a crucial assessment. Acute glomerulonephritis affects the kidneys, leading to decreased urine output due to impaired kidney function. Monitoring urine output helps assess renal perfusion, fluid status, and kidney function. This assessment is essential in determining the effectiveness of treatment and identifying complications. Monitoring blood glucose levels (Choice A) is not directly related to acute glomerulonephritis. Respiratory rate (Choice B) may be important in other conditions but is not a key assessment for acute glomerulonephritis. Monitoring for signs of infection (Choice D) is important in general, but it is not specific to the primary issue of impaired kidney function in acute glomerulonephritis.
5. A nurse plans to talk to the parents of a toddler about toilet training. What should the nurse explain is the most important factor in the process of toilet training?
- A. Parents’ attitude towards it
- B. Child’s motivation to remain dry
- C. Child’s ability to sit independently on the toilet
- D. Parents’ commitment to work on the toilet training
Correct answer: D
Rationale: The most crucial factor in successful toilet training is the parents' commitment to consistently work with their child. While parents' attitude and willingness are important, the key is their dedication to the process. The child's motivation and ability are also significant but rely heavily on parental guidance and support. Therefore, the correct choice is the parents' commitment to work on toilet training.
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