Pediatric HESI Test Bank

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At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. After determining that delivery is not imminent, you begin transport. While en route, the mother tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. What is your most appropriate first action?

  • A. allow the head to deliver and check for the location of the cord
  • B. advise your partner to stop the ambulance and assist with the delivery
  • C. tell the mother to take short, quick breaths until you arrive at the hospital
  • D. prepare the mother for an emergency delivery and open the obstetrics kit
Correct Answer: B

Rationale: The correct action in this scenario is to advise your partner to stop the ambulance and assist with the delivery. When the mother feels the urge to push and you see the baby's head bulging from the vagina, it indicates an imminent delivery. Stopping the ambulance allows for a safer environment for the delivery of the baby and ensures that immediate assistance can be provided to both the mother and the newborn. Allowing the head to deliver before checking for the cord (Choice A) may delay necessary interventions in case of complications. Instructing the mother to take short, quick breaths (Choice C) is not appropriate when the baby's head is already visible. Preparing for an emergency delivery and opening the obstetrics kit (Choice D) is important but should come after stopping the ambulance and assisting with the imminent birth.

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Which cardiac defects are associated with tetralogy of Fallot?

  • A. Right ventricular hypertrophy, atrial and ventricular defects, and mitral valve stenosis
  • B. Origin of the aorta from the right ventricle and of the pulmonary artery from the left ventricle
  • C. Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta
  • D. Altered connection between the pulmonary artery and the aorta, right ventricular hypertrophy, and an atrial septal defect
Correct Answer: C

Rationale: Tetralogy of Fallot is characterized by a combination of four specific cardiac defects: right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta. Choice A is incorrect as it includes mitral valve stenosis, which is not typically part of tetralogy of Fallot. Choice B describes transposition of the great arteries rather than tetralogy of Fallot. Choice D includes an atrial septal defect, which is not part of the classic presentation of tetralogy of Fallot.

After surgery to correct hypertrophic pyloric stenosis (HPS) in a 3-week-old infant who had been formula-fed, which postoperative feeding order is appropriate?

  • A. Thickened formula 24 hours after surgery
  • B. Withholding feedings for the first 24 hours
  • C. Regular formula feeding within 24 hours after surgery
  • D. Additional glucose feedings as desired after the first 24 hours
Correct Answer: C

Rationale: After surgery for hypertrophic pyloric stenosis (HPS), it is appropriate to resume regular formula feeding within 24 hours postoperatively to promote recovery. Choice A, thickened formula after surgery, may be too heavy for the infant's digestive system at this early stage. Withholding feedings for the first 24 hours (Choice B) is not recommended as early feeding helps with recovery. Additional glucose feedings (Choice D) are not necessary and may not provide the balanced nutrition required after surgery.

When caring for a child diagnosed with bronchiolitis, what is the priority nursing intervention?

  • A. Administering bronchodilators
  • B. Providing respiratory therapy
  • C. Monitoring oxygen saturation
  • D. Encouraging fluid intake
Correct Answer: B

Rationale: The priority nursing intervention for a child with bronchiolitis is providing respiratory therapy. This intervention aims to maintain airway patency, optimize oxygenation, and support effective breathing. Administering bronchodilators, though important, may not be the initial priority as respiratory therapy takes precedence in ensuring adequate oxygenation and ventilation. Monitoring oxygen saturation is crucial but is usually part of the ongoing assessment following the initiation of respiratory therapy. Encouraging fluid intake is essential for hydration but is not the priority intervention when addressing the respiratory distress associated with bronchiolitis.

What is an essential nursing action when caring for a young child with severe diarrhea?

  • A. Maintain the IV.
  • B. Take daily weights.
  • C. Replace the lost calories.
  • D. Promote perianal skin integrity.
Correct Answer: D

Rationale: Promoting perianal skin integrity is crucial when caring for a young child with severe diarrhea to prevent skin breakdown from the irritation caused by frequent bowel movements. Maintaining the IV (Choice A) may be important for hydration but is not directly related to managing skin integrity. Taking daily weights (Choice B) is important for monitoring fluid balance but does not address the immediate need to prevent skin breakdown. While replacing lost calories (Choice C) is important, it is not the priority when a child is experiencing severe diarrhea and skin integrity is at risk.

Before starting kindergarten, the child should receive boosters of which primary immunizations to ensure ongoing protection?

  • A. IPV, HepB, Td.
  • B. DTaP, HepB, Td.
  • C. MMR, DTaP, Hib.
  • D. DTaP, IPV, MMR.
Correct Answer: D

Rationale: Before starting kindergarten, the child should receive boosters of DTaP, IPV, and MMR. DTaP provides protection against diphtheria, tetanus, and pertussis, IPV protects against polio, and MMR immunization covers measles, mumps, and rubella. These boosters are essential to maintain immunity and protect the child from these diseases as they enter school. Choices A, B, and C are incorrect because they do not include the recommended boosters for kindergarten entry and may leave the child susceptible to certain infections.

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