HESI PEDIATRICS Questions with Answers and Rationales

1. When caring for a child with congenital heart disease and polycythemia, which nursing action

has the highest priority?

A. Administering oxygen therapy continuously

B. Restricting fluids as ordered

C. Maintaining adequate hydration

D. Maintaining digoxin levels

Rationale:

The key word in this question is polycythemia. Hydration decreases blood viscosity and the risk

for thrombus formation, the most common complication of polycythemia. Options A and D are

nursing interventions for the cardiac client but do not treat polycythemia. Fluid intake should be

increased, not restricted.

2. The nurse is preparing a teaching plan for the mother of a child who has been diagnosed with

celiac disease. Choosing which lunch will be within the therapeutic management of a child with

celiac disease?

A. Turkey salad, milk, and oatmeal cookies

B. Baked chicken, coleslaw, soda, and frozen fruit dessert

C. Tuna salad sandwich on whole wheat bread, milk, and ice

cream

D. Turkey sandwich on rye bread, orange juice, and fresh

fruit

Rationale:

A child with celiac disease is managed on a gluten-free diet, which eliminates food products

containing oats, wheat, rye, or barley.

3. A 7-month-old male infant diagnosed with spastic cerebral palsy is seen by the nurse in the

clinic. Which statement by the parent warrants immediate intervention by the nurse?

A. “My son often chokes while I am feeding him.”

B. “Is it normal for my child’s legs to cross each other?”

C. “He gets stiff when I pull him up to a sitting position.”

D. “My 4-year-old son is jealous of his little brother.”

Rationale:

Airway obstruction is always a priority when caring for any client. Options B and C are

characteristics of spastic cerebral palsy and may involve one or both sides. These children have

difficulty with fine motor skills, and attempts at motion increase abnormal postures. Option D is

an expected behavior and may need to be addressed, but it is not a priority over choking.

4. A child is admitted to the hospital for confirmation of a diagnosis of acute lymphoblastic

leukemia. During the initial nursing assessment, which symptoms will this child most likely

exhibit? (Select all that apply.)

A. Bone pain

B. Tremors

C. Nystagmus

D. Abdominal distention

E. Pallor

Rationale:

Options A and E list the most common presenting symptoms of leukemia. Leukemic cells invade

the bone marrow, gradually causing a weakening of the bone and a tendency toward pathologic

fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain and

anemia results from decreased erythrocytes, causing pallor. Options B and C could be associated

with central nervous system disorders. Option D commonly occurs in children but is not specific

for leukemia.

5. The nurse is caring for a child with intussusception who is scheduled for a barium enema prior

to a surgical procedure. Which action should the nurse take first?

A. Evacuate the bowel of impacted feces.

B. Administer magnesium sulfate.

C. Place the child on a clear liquid diet.

D. Assess the stool for white color.

Rationale:

Intussusception, an invagination or telescoping of one portion of the intestine into another,

causes intestinal obstruction in children (usually occurs between 3 months and 5 years of age).

Nonsurgical treatment is attempted with hydrostatic pressure created by barium instillation,

which often reduces the area of bowel intussusception. In preparation for a barium enema, the

client should first be placed on a clear liquid diet for the entire day; then magnesium sulfate is

administered for bowel evacuation. A barium enema is likely to cause option A. After the enema,

white stool may be seen as the body naturally removes any remaining barium.

6. The nurse should teach the parents of a child with a cyanotic heart defect to perform which

action when a hypercyanotic spell occurs?

A. Place the child’s head flat, with the knees on pillows

above the level of the heart.

B. Have the child lie on the right side, with the head

elevated on one pillow.

C. Allow the child to assume a knee-chest position, with the

head and chest slightly elevated.

D. Encourage the child to sit up at a 45-degree angle, drink

cold water, and take deep breaths.

Rationale:

Assuming a knee-chest position with the head and chest slightly elevated will help restore

hemodynamic equilibrium. Options A and B are incorrect positions and may hinder the child’s

condition. Option D may cause chest pain or a vasovagal response, with resulting hypotension.

7. The nurse is teaching the parents of a 2-year-old child with a congenital heart defect about

signs and symptoms of congestive heart failure. Which information about the child is most

important for the parents to report to the health care provider?

A. Sits or squats frequently when playing outdoors

B. Exhibits a sudden and unexplained weight gain

C. Is not completely toilet-trained and has some accidents

D. Demonstrates irritation and fatigue 1 hour before bedtime

Rationale:

Sudden and unexplained weight gain can indicate fluid retention and is a sign of congestive heart

failure. Option A is used by the child to reduce chronic hypoxia, especially during exercise.

Option C is common; 2-year-olds are not expected to be toilet-trained. Option D is normal.

8. Prophylactic antibiotics are prescribed for a child who has mitral valve damage. The nurse

should advise the parents to give the antibiotics prior to which occurrence?

A. Adjustment of orthodontic appliances or braces

B. Loss of deciduous teeth (baby teeth)

C. Urinary catheterization

D. Insect bites

Rationale:

Prophylactic antibiotics are usually prescribed prior to any invasive procedure for children who

have valvular damage. Of the choices listed, only urinary catheterization is an invasive

procedure. Options A, B, and D are not invasive and do not require administration of

prophylactic antibiotics.

9. A 7-month-old infant with a rotavirus causing severe diarrhea is admitted for treatment.

Which action should the nurse take first?

A. Obtain a scale to weigh the infant’s diapers.

B. Instruct the mother to offer Pedialyte regularly.

C. Insert an intravenous (IV) line and begin IV fluids.

D. Obtain a stool specimen for analysis.

Rationale:

An infant with severe diarrhea is at high risk for dehydration, so the nurse’s priority is to initiate

IV fluids to rehydrate the infant. Options A, B, and D can then be implemented as needed.

10. The nurse admits a child to the intensive care unit with a possible diagnosis of Wilms tumor.

What is the most important safety precaution for child?

A. Maintain NPO status.

B. Limit visitors to the immediate family.

C. Place a do not palpate abdomen sign on head of bed.

D. Encourage ambulation in the pre-operative period.

Rationale:

Protect child from injury; place a sign on bed stating “no abdominal palpation” (to prevent

accidental fragmentation and dislodging into the abdominal cavity). The other option choices are

not relevant at this time