a nurse is providing discharge instructions to the parents of a 2 month old infant who was treated for pyloric stenosis which statement by the parents
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Nursing Elites

HESI RN

HESI Practice Test Pediatrics

1. A parent of a 2-month-old infant, who was treated for pyloric stenosis, is receiving discharge instructions from a healthcare provider. Which statement by the parent indicates a need for further teaching?

Correct answer: C

Rationale: Placing infants on their stomach after feeding increases the risk of sudden infant death syndrome (SIDS). It is important to educate parents to always place infants on their back to sleep to reduce this risk.

2. A 6-year-old child with sickle cell anemia presents to the emergency department with severe pain in the legs and abdomen. The child is crying and states that the pain is unbearable. What is the nurse’s priority action?

Correct answer: B

Rationale: In a sickle cell crisis, pain management is a priority to alleviate the child's suffering. Administering the prescribed pain medication is crucial to address the severe pain experienced by the child. Warm compresses, encouraging fluid intake, and monitoring oxygen saturation are important interventions but should follow the priority of pain management in this situation.

3. A 2-year-old child is admitted with severe dehydration due to gastroenteritis. Which assessment finding indicates that the child's condition is improving?

Correct answer: C

Rationale: Increased urine output is a positive sign indicating that the child's hydration status is improving. It suggests that the kidneys are functioning more effectively and able to excrete urine, which is a crucial indicator of improved hydration levels in a dehydrated patient. Decreased heart rate (Choice A) can be a sign of possible shock. A sunken fontanelle (Choice B) is a sign of dehydration. Dry mucous membranes (Choice D) are also indicative of dehydration.

4. A 3-year-old with a congenital heart defect has had a steady decrease in heart rate, now at 76 bpm from 110 bpm four hours ago. Which additional finding should be reported immediately to a healthcare provider?

Correct answer: D

Rationale: A significant drop in heart rate and blood pressure should be reported immediately as it may indicate worsening of the congenital heart defect. The blood pressure of 70/40 is dangerously low and requires immediate attention to prevent further complications. Oxygen saturation of 94% is within an acceptable range and does not indicate immediate danger. A respiratory rate of 25 breaths/minute is slightly elevated but not a critical finding. Urine output of 20 mL/hr is low but may not be the most concerning finding in this scenario compared to the drop in blood pressure.

5. A 2-year-old is admitted to the hospital with possible encephalitis, and a lumbar puncture is scheduled. Which information should the nurse provide this child concerning the procedure?

Correct answer: A

Rationale: The correct answer is A. Describing the side-lying, knees to chest position that must be assumed during the lumbar puncture procedure is essential as it helps the child understand what to expect, promotes cooperation, and reduces anxiety. This position is necessary for the procedure to be performed safely and effectively. Choice B is incorrect because mentioning loud clicking noises may increase the child's anxiety. Choice C is incorrect because there may be restrictions on activity after the procedure, depending on individual cases. Choice D is also incorrect as it provides information about fluid intake restrictions that are not directly related to the procedure itself.

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