a nurse is providing care to a child with a diagnosis of sickle cell anemia what is the priority nursing intervention
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Nursing Elites

HESI LPN

Pediatric HESI 2024

1. When caring for a child diagnosed with sickle cell anemia, what is the priority nursing intervention?

Correct answer: A

Rationale: The priority nursing intervention when caring for a child with sickle cell anemia is administering pain medication. Pain management is crucial in sickle cell anemia due to vaso-occlusive crises that can cause severe pain. While ensuring adequate hydration, providing nutritional support, and monitoring vital signs are important aspects of care for a child with sickle cell anemia, addressing the pain with appropriate medication takes precedence to alleviate the child's suffering and improve their quality of life.

2. During postoperative care for a child who has had a tonsillectomy, what is an important nursing intervention?

Correct answer: C

Rationale: Administering antibiotics is crucial post-tonsillectomy to prevent infection, as the surgical site is susceptible to bacterial growth. Encouraging deep breathing exercises can also be beneficial for lung expansion and preventing respiratory complications. However, administering antibiotics takes precedence as it directly addresses the risk of infection. Encouraging the child to eat may not be appropriate immediately post-tonsillectomy due to the risk of throat irritation and potential discomfort. Applying ice to the throat is typically not recommended after a tonsillectomy, as it may constrict blood vessels and hinder the healing process.

3. When assessing a child with suspected bacterial meningitis, what clinical manifestation is the nurse likely to observe?

Correct answer: B

Rationale: The correct answer is B: High fever. In bacterial meningitis, a high fever is a common clinical manifestation due to the body's inflammatory response to the infection. While photophobia (choice A) is also a common symptom in meningitis, it is not as specific as a high fever. Rash (choice C) is more commonly associated with viral infections or other conditions, rather than bacterial meningitis. Nasal congestion (choice D) is not a typical clinical manifestation of bacterial meningitis and is more commonly seen in respiratory infections. Therefore, when assessing a child with suspected bacterial meningitis, the nurse is most likely to observe a high fever as a key clinical manifestation.

4. The nurse is teaching a parent group about the reasons for adhering to the immunization schedule. What complication of mumps is important for adolescents to avoid?

Correct answer: A

Rationale: The correct answer is A: Sterility. Mumps can lead to serious complications such as sterility, especially in adolescent males. Vaccination is essential to prevent this potential outcome. Hypopituitarism (Choice B) is not a typical complication of mumps. Choices C and D, decrease in libido and decrease in androgens, are not directly associated with mumps complications, particularly in the context of adolescents.

5. How should a nurse prepare a 15-month-old child diagnosed with hydrocephalus for a computed tomography (CT) scan?

Correct answer: D

Rationale: Preparing a toddler for a CT scan involves providing a simple explanation of the procedure to help reduce anxiety and fear. Shaving the child's head is unnecessary for a CT scan and may increase distress. Starting an IV infusion or administering sedatives may not be appropriate or necessary for all pediatric patients undergoing CT scans, especially if the child can cooperate without these interventions.

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