HESI RN
RN HESI Pediatrics Exam 2 Questions
Extract:
Question 1 of 5
The nurse is assessing a 6-month-old infant. Which response requires further evaluation by the nurse?
Correct Answer: D
Rationale: The startle (Moro) reflex typically disappears by 3-6 months. Its presence at 6 months suggests possible neurological delay, warranting further evaluation. Peek-a-boo, doubled birth weight, and sound localization are normal milestones for a 6-month-old.
Question 2 of 5
An infant born 2 days ago has not passed a meconium stool and begins to vomit bilious secretions. Which action should the nurse take first?
Correct Answer: B
Rationale: No meconium and bilious vomiting suggest a possible intestinal obstruction. Measuring abdominal circumference assesses for distension, guiding further evaluation. IV supplies, manometry, and urine output are secondary.
Question 3 of 5
During a follow-up clinic visit, a mother tells the nurse that her 5-month-old son who had surgical correction for tetralogy of Fallot (TOF) has rapid breathing, often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held and his growth is in the expected range. Which intervention should the nurse implement?
Correct Answer: B
Rationale: Rapid breathing and feeding difficulties post-TOF repair suggest possible cardiac or respiratory issues. Auscultating heart and lungs assesses for abnormalities, guiding further evaluation. FTT evaluation, inducing cyanosis, or ECG are less immediate.
Question 4 of 5
An 8-year-old girl with precocious sexual development is being treated medically with injections of luteinizing hormone-releasing hormone (LHRH) to regulate the pituitary gland. Which statement by the parents indicates that they understand the treatment?
Correct Answer: B
Rationale: LHRH therapy aims to delay precocious puberty, allowing the child to develop at a pace similar to peers. The statement about sexual maturity differences disappearing reflects understanding that the treatment is temporary and effective in aligning development with age-appropriate norms.
Question 5 of 5
The nurse is preparing to administer medications for an eight-month-old infant with heart failure. The infant has a blood pressure of 114/66 mm Hg, apical pulse of 88 beats/minute, and respirations of 30 breaths/minute. Which medication should the nurse withhold until the health care provider is notified?
Correct Answer: A
Rationale: Digoxin requires an apical pulse >90-110 bpm in infants to avoid toxicity. At 88 bpm, the nurse should withhold it and notify the provider. Other medications lack pulse-related contraindications.