HESI Pediatric (N158) Exam

The correct answer is B: A viral infection.

Explanation:

In infants, asthma is most commonly triggered by viral infections, particularly those caused by respiratory syncytial virus (RSV) and other respiratory viruses like rhinovirus. These infections can cause inflammation and narrowing of the airways, which may lead to asthma-like symptoms or exacerbate existing asthma in young children.

Why the other options are incorrect:

A. Medications:

While certain medications, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), can trigger asthma exacerbations in some individuals, medications are not typically the primary trigger for asthma in infants. The most common triggers in infants are viral infections and environmental factors.

C. Exposure to cold air:

Cold air can be a trigger for asthma in some children, especially in those with established asthma, but it is not the primary trigger for infants. In infants, viral infections are more commonly the cause of respiratory symptoms that may be mistaken for asthma.

D. Allergy to dust or dust mites:

Allergic triggers such as dust or dust mites are more common in older children and adults with asthma. While environmental allergens can trigger asthma, infants are more likely to experience asthma-like symptoms due to viral infections rather than allergies to dust or dust mites in the early years.

Summary:

In infants, asthma-like symptoms are most often triggered by viral infections, such as RSV, rather than environmental allergens or cold air. This makes viral respiratory infections the most common trigger for asthma in this age group.

The correct answer is B: Wanting to please the parent helps motivate the child to use the toilet.

Explanation:

Toilet training is a major developmental milestone during the toddler years, and a child’s desire to gain approval from parents plays a significant motivational role. Around the age of 2, toddlers begin to show signs of autonomy while still being strongly influenced by the reactions and encouragement of caregivers. The desire to please parents can positively reinforce toilet training efforts when paired with patience and support.

Why the other options are incorrect:

A. Bladder training is usually accomplished before bowel training:

This is incorrect; in fact, bowel training typically comes first. Children usually become aware of the urge to have a bowel movement before they can reliably control bladder function.

C. Watching older siblings use the toilet confuses the child:

This is not true. Modeling behavior is actually helpful. Watching siblings or parents use the toilet can encourage learning by providing a visual example of what is expected.

D. Children must be forced to sit on the toilet when first learning:

Forcing a child to sit on the toilet can lead to negative associations and resistance. Toilet training should be approached with patience and positivity, allowing the child to participate willingly and at their own pace.

Summary:

The motivation to please caregivers is a powerful and developmentally appropriate factor in successful toilet training. Positive reinforcement and readiness cues should guide the process, not force or unrealistic expectations.

The correct answer is A: 1 year

Explanation:

Abdominal thrusts (the Heimlich maneuver) are recommended for children older than 1 year who are experiencing airway obstruction. For infants under 1 year, back blows and chest thrusts are recommended instead of abdominal thrusts. The reason for this difference is the child's smaller size and fragile abdominal area; abdominal thrusts could cause injury in infants. However, for children older than 1 year, abdominal thrusts are considered the most effective technique for relieving airway obstruction caused by a foreign body.

Why the other options are incorrect:

B. 4 years:

While abdominal thrusts are definitely appropriate for children older than 1 year, there is no requirement to wait until 4 years. The recommendation is for children over 1 year, not specifically 4 years.

C. 8 years:

This is not correct because abdominal thrusts can be used in children older than 1 year. The age of 8 years is not relevant in this case. The recommended age is simply over 1 year.

D. 12 years:

There is no requirement to wait until a child is 12 years old for abdominal thrusts. The guideline is for children over 1 year old, regardless of whether they are younger or older than 12.

Summary:

Abdominal thrusts (the Heimlich maneuver) are recommended for children older than 1 year who are experiencing airway obstruction. For infants under 1 year, other techniques like back blows and chest thrusts are used.

The correct answer is A: Give her planned, frequent, and nutritious snacks.

Explanation:

It is common for toddlers to have small appetites and to prefer frequent snacks rather than eating large meals. To ensure they get proper nutrition, it’s important to offer nutritious snacks between meals. These snacks should be planned and balanced, so they help meet the child’s nutritional needs without spoiling their appetite for meals. Providing structured snacks at consistent times helps the child maintain energy levels and supports healthy growth.

Why the other options are incorrect:

B. Offer rewards for eating at mealtimes:

While some parents may be tempted to use rewards for eating, it is generally better to avoid turning eating into a battleground. Positive reinforcement can be used, but meals should not be associated with pressure or rewards. This could lead to emotional eating patterns or unhealthy associations with food.

C. Avoid snacks so she is hungry at mealtimes:

Completely avoiding snacks can lead to a child feeling too hungry and may cause them to become overly irritable, which can actually reduce their willingness to eat. It’s better to provide healthy snacks at set times to prevent the child from becoming excessively hungry between meals.

D. Explain to her in a firm manner what is expected of her:

While it’s important to establish healthy eating habits, explaining the expectations firmly might be ineffective for toddlers at this stage. Toddlers are still learning how to regulate their behaviors, and they respond better to structure and routine than to verbal explanations alone. Instead of focusing on firmness, it's better to establish a consistent and flexible mealtime routine.

Summary:

The best approach is to offer planned, nutritious snacks that help meet the toddler’s nutritional needs and maintain a healthy eating routine. This approach encourages balanced eating habits and avoids power struggles related to mealtime.

Correct answer C: Maintain a temperature controlled, high-humidity atmosphere.

Explanation:

C. Maintain a temperature controlled, high-humidity atmosphere.

Low-birth-weight (LBW) infants are at an increased risk of hypothermia due to their limited ability to regulate body temperature. A neutral thermal environment (NTE) helps maintain the infant’s body temperature within a safe range without requiring excessive metabolic energy. This is achieved by maintaining a controlled, warm environment with high humidity, which reduces heat loss through evaporation and helps keep the infant warm. This approach is essential for preventing further complications associated with temperature instability, such as hypoglycemia or respiratory distress.

Why the Other Options Are Incorrect:

A. Use wool blankets for covers.

Wool blankets are not ideal for maintaining a neutral thermal environment for LBW infants. Wool can cause temperature fluctuations because it does not retain heat evenly, and it may not provide adequate insulation in a controlled environment. The use of materials that promote a consistent, moderate temperature is preferable.

B. Avoid using disposable diapers.

This is not a necessary action for providing a neutral thermal environment. Disposable diapers are commonly used and do not significantly affect the infant's ability to maintain a neutral thermal environment. In fact, some disposable diapers are designed to maintain dryness and comfort, which can contribute to thermal regulation.

D. Continue cool oxygenation via a hood.

Cool oxygenation via a hood is not appropriate for maintaining a neutral thermal environment. In fact, this would further lower the infant's body temperature, as cool air can lead to heat loss. The goal is to maintain a warm environment, not to cool the infant, which can cause thermal instability.

Summary:

The correct answer is C. Maintain a temperature controlled, high-humidity atmosphere, as this is the most effective way to ensure a neutral thermal environment for LBW infants. The other options do not directly contribute to maintaining a safe and stable temperature for the infant.

The correct answer is D: Periodically for children who reside in high-prevalence regions.

Explanation:

The Mantoux tuberculin skin test (TST) is used to detect latent tuberculosis infection (LTBI). Skin testing is recommended periodically for children who are at higher risk of exposure to tuberculosis, particularly those who live in or travel to high-prevalence areas, or who have close contact with someone known to have active tuberculosis. Routine annual testing for all children is not recommended unless they are in a high-risk category.

Why the other options are incorrect:

A. Every year for all children older than 2 years:

Routine annual testing for all children over 2 years is not recommended. The Mantoux test is typically performed based on risk factors, such as exposure to high-risk populations or living in areas with higher tuberculosis rates, not as a routine screening for all children.

B. Every year for all children older than 10 years:

Routine yearly testing for all children over 10 years is also not recommended. As with younger children, testing should be based on risk factors for tuberculosis exposure, not on age alone.

C. Every 2 years for all children starting at age 1 year:

There is no guideline that recommends testing every 2 years for all children starting at age 1. Skin testing should be risk-based, performed periodically for those at risk of tuberculosis exposure, rather than on a set schedule for all children.

Summary:

Skin testing for tuberculosis (the Mantoux test) is recommended periodically for children who reside in high-prevalence regions or have other risk factors for exposure, rather than being performed annually or at regular intervals for all children. This ensures testing is focused on those most at risk for tuberculosis infection.

The correct answer is D: A feeling of fullness in the ear.

Explanation:

Chronic otitis media with effusion (OME) is characterized by fluid accumulation in the middle ear without signs of acute infection (such as fever or pain). A key distinguishing feature of OME is the feeling of fullness or "blocked ear" sensation due to the fluid behind the eardrum. Unlike acute otitis media (AOM), OME does not typically present with severe pain, fever, or nausea. The fluid accumulation can lead to hearing issues, but it's usually not associated with the intense pain or systemic symptoms seen in AOM.

Why the other options are incorrect:

A. Fever as high as 40° C (104° F):

Fever is a common symptom in acute otitis media (AOM), which is an infection of the middle ear with bacterial or viral involvement. However, OME is a more chronic condition and typically does not present with fever. The absence of fever helps differentiate OME from AOM.

B. Severe pain in the ear:

Severe ear pain is characteristic of acute otitis media (AOM), which is caused by an active infection that often leads to pressure and inflammation in the middle ear. In contrast, OME is a non-infectious condition characterized by the presence of fluid, leading to a sensation of fullness or mild discomfort, but not severe pain.

C. Nausea and vomiting:

Nausea and vomiting can sometimes accompany AOM, especially in young children, but they are not characteristic of OME. OME typically does not cause systemic symptoms like nausea or vomiting.

Summary:

Chronic otitis media with effusion (OME) is most often characterized by a feeling of fullness in the ear due to fluid accumulation in the middle ear. It differs from acute otitis media (AOM), which typically involves fever, severe pain, and systemic symptoms like nausea and vomiting. OME is more associated with a chronic sensation of ear fullness rather than the acute symptoms of infection.

The correct answer is D: Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

Explanation:

Pancreatic enzymes are essential for children with cystic fibrosis (CF) because they help in the digestion and absorption of nutrients, particularly fats and proteins. Due to the pancreatic insufficiency characteristic of CF, the pancreas is unable to produce sufficient digestive enzymes, leading to poor nutrition, malabsorption, and issues such as steatorrhea (fatty stools). Administering pancreatic enzymes is essential to ensure adequate digestion and nutrient absorption.

Pancreatic enzymes should be taken with food, typically at the beginning of a meal or snack, to aid in the digestion of the food being consumed.

Enzymes can be swallowed whole or sprinkled on a small amount of food to make them easier for the child to ingest, especially for younger children who may have difficulty swallowing pills.

Why the other options are incorrect:

A. Do not administer pancreatic enzymes if the child is receiving antibiotics:

This statement is incorrect because there is no contraindication to administering pancreatic enzymes with antibiotics. In fact, many children with CF require both antibiotics (for respiratory infections) and pancreatic enzyme replacements for proper digestion. There is no significant interaction between these medications.

B. Decrease dose of pancreatic enzymes if the child is having frequent, bulky stools:

This is incorrect. Frequent, bulky stools are a sign that the child may not be receiving enough pancreatic enzymes. If a child with CF has inadequate enzyme dosing, the result can be malabsorption, leading to poor growth and nutritional status. The dose of pancreatic enzymes should be adjusted as needed based on the child's nutritional needs and stool characteristics, but the goal is to increase enzyme doses, not decrease them, if digestive issues persist.

C. Administer pancreatic enzymes between meals if at all possible:

This is incorrect. Pancreatic enzymes should not be administered between meals because they are needed during digestion. They should be taken with food to aid in the breakdown and absorption of nutrients. Administering them between meals would be ineffective, as they are meant to work while food is in the stomach and intestines.

Summary:

Pancreatic enzymes should be administered at the beginning of a meal or snack and can be swallowed whole or sprinkled on food to ensure optimal digestion. It is important to avoid administering them between meals, and the dose should be adjusted based on the child’s needs and stool consistency, particularly if digestive issues persist.

The correct answer is B: Decrease the number of lesions.

Explanation:

Acyclovir is an antiviral medication commonly used to treat chickenpox (varicella) in children. It works by reducing the severity and duration of the infection, particularly by decreasing the number of lesions and helping to reduce the intensity of symptoms. It may also reduce the risk of complications in children with weakened immune systems or those at higher risk for severe disease.

Why the other options are incorrect:

A. Minimize scarring:

While acyclovir may help reduce the severity of symptoms, it is not specifically aimed at minimizing scarring from chickenpox lesions. The goal is to reduce the number of lesions and prevent complications, rather than directly minimizing scarring.

C. Prevent aplastic anemia:

Acyclovir does not prevent aplastic anemia, which is a rare but serious condition where the bone marrow fails to produce enough blood cells. Acyclovir is used to manage chickenpox, but it does not address the prevention of aplastic anemia.

D. Prevent spread of the disease:

Acyclovir does not prevent the spread of chickenpox. Although it may reduce the severity and number of lesions, it does not stop the viral transmission. Chickenpox remains contagious, and isolation and precautionary measures are still necessary to prevent spreading the virus to others.

Summary:

Acyclovir is primarily given to children with chickenpox to decrease the number of lesions and reduce the severity of the illness, especially in high-risk cases. It is not intended to prevent scarring, aplastic anemia, or the spread of the disease.