a nurse is reviewing the clinical records of infants and children with cardiac disorders who developed heart failure what did the nurse determine is t
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Nursing Elites

HESI LPN

Pediatric HESI 2023

1. A healthcare professional is reviewing the clinical records of infants and children with cardiac disorders who developed heart failure. What did the healthcare professional determine is the last sign of heart failure?

Correct answer: C

Rationale: Peripheral edema is often the last sign of heart failure in infants and children as it indicates significant fluid retention and circulatory compromise. Tachypnea (Choice A) and tachycardia (Choice B) are early signs of heart failure due to the body's compensatory mechanisms. Periorbital edema (Choice D) can occur in heart failure but is not typically the last sign; it is more commonly associated with renal or hepatic dysfunction.

2. A newborn is diagnosed with metatarsus adductus. The parents ask the nurse how this occurred. Which response by the nurse would be most appropriate?

Correct answer: B

Rationale: Metatarsus adductus is a condition characterized by the inward turning of the front part of the foot. It is often caused by the baby's position in the womb, leading to the foot adopting this position. Choice A is incorrect because metatarsus adductus is primarily related to positioning in utero rather than a genetic defect. Choice C is incorrect as there is an understanding of the common cause of this condition. Choice D is incorrect because metatarsus adductus specifically refers to a foot deformity, not a hip deformity.

3. A healthcare professional is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the professional integrates knowledge that bone growth occurs primarily in which area?

Correct answer: B

Rationale: Bone growth primarily occurs in the epiphysis, which is the area where growth plates are located. The epiphysis is responsible for longitudinal bone growth. The growth plate, also known as the physis, is the cartilaginous region in the metaphysis where bone growth occurs. The metaphysis is the area between the epiphysis and diaphysis where bone lengthening occurs, but it is not the primary site of bone growth. Therefore, choices A, C, and D are incorrect.

4. What is the nurse’s priority intervention when preparing for admission of a child with acute laryngotracheobronchitis?

Correct answer: C

Rationale: The correct answer is to place a tracheotomy set at the bedside. Acute laryngotracheobronchitis can cause airway obstruction, which may require an emergency tracheotomy. Having the tracheotomy set readily available ensures quick access in case of respiratory distress. Padding the side rails of the crib, arranging for a quiet, cool room, and obtaining a recliner for a parent are important aspects of care but are not the priority when managing a potentially life-threatening airway emergency.

5. A child with acute lymphoblastic leukemia (ALL) is hospitalized for treatment. What is the priority nursing intervention?

Correct answer: B

Rationale: The priority nursing intervention for a child hospitalized for acute lymphoblastic leukemia (ALL) is preventing infection. Children with ALL have compromised immune systems, making them highly vulnerable to infections. Preventing infections through strict aseptic techniques, isolation precautions, and proper hygiene is crucial to safeguard the child's health. Administering antibiotics (choice A) may be necessary if an infection occurs, but the primary focus should be on infection prevention. While providing nutritional support (choice C) is important, preventing infection takes precedence due to its direct impact on the child's survival. Managing pain (choice D) is essential for the child's comfort but is not the priority over preventing life-threatening infections in this scenario.

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