HESI Pediatric (N158) Exam

The correct answer is B: Stammering

Explanation:

Stammering, or stuttering, can occur in preschool children as they learn to use more complex speech patterns and vocabulary. It's a common and temporary occurrence in preschool-age children as their language skills develop. Stammering is often seen when children are excited or trying to express complex thoughts, and it usually resolves on its own by age 5 or 6.

Why the other options are incorrect:

A. Lisp:

A lisp is an articulation error where "s" sounds are pronounced incorrectly. While it can be common in younger children, especially those under age 5, it is not a normal or typical feature of preschool language development in general. A lisp may require intervention if it persists beyond the early years.

C. Echolalia:

While echolalia (repeating words or phrases) is a normal part of language development in younger children (typically under age 3), by the time children reach the preschool years, they are usually starting to use language meaningfully and independently. Echolalia should be less common by the age of 4-5.

D. Repetition without meaning:

Repetition without meaning is not typical in preschool-age language development. Children at this age are starting to understand and use language in context. Repetitive speech usually has a purpose, like practicing pronunciation or learning new words.

Summary:

Stammering is a normal and temporary characteristic of language development in preschool-age children and often resolves as they continue to refine their communication skills.

The correct answer is A: Asthma.

Explanation:

The combination of a chronic, nonproductive cough and diffuse wheezing that is heard during the expiratory phase of respiration is characteristic of asthma. In asthma, the airways are hyperreactive and can become narrowed and inflamed, leading to wheezing, especially during expiration when the airways are constricted. The nonproductive cough is also typical in asthma as the inflammation and airway narrowing do not result in the production of sputum.

Why the other options are incorrect:

B. Pneumonia:

Pneumonia typically presents with symptoms like fever, productive cough, tachypnea, and localized crackles or rales upon auscultation, rather than diffuse wheezing. Pneumonia often leads to a productive cough with mucus or pus, unlike the nonproductive cough seen in asthma.

C. Bronchiolitis:

Bronchiolitis, often caused by RSV (respiratory syncytial virus), typically affects infants and presents with wheezing, rapid breathing, and nasal congestion, but it is more common in the younger population (under age 2) and is usually accompanied by increased work of breathing and retractions. It can cause wheezing, but it typically presents more acutely and with a history of a viral infection, rather than the chronic nature of the symptoms seen in asthma.

D. Foreign body in the trachea:

A foreign body aspiration usually presents with sudden onset of wheezing, often localized to one side, or a coughing fit following the aspiration. It is typically accompanied by unilateral wheezing and acute respiratory distress, rather than the chronic, diffuse wheezing seen in asthma.

Summary:

The child’s symptoms of a chronic, nonproductive cough and diffuse wheezing during the expiratory phase are most consistent with asthma, a condition where airway constriction and inflammation cause wheezing and coughing, especially during expiration

The correct answer is A: Before chest physiotherapy (CPT)

Explanation:

Aerosolized bronchodilator medications should be administered before chest physiotherapy (CPT) in children with cystic fibrosis (CF). The purpose of the bronchodilator is to open the airways and help the child breathe more easily by relaxing the muscles around the airways. This allows the chest physiotherapy (which includes techniques like percussion and vibration to help loosen mucus) to be more effective in clearing mucus from the lungs. Administering the bronchodilator first ensures the airways are more open, improving the effectiveness of CPT.

Why the other options are incorrect:

B. After CPT:

Administering bronchodilators after CPT is not recommended, as the airways are not optimally open to help with mucus clearance. The bronchodilator should be given beforehand to maximize the effectiveness of chest physiotherapy.

C. Before receiving 100% oxygen:

While oxygen therapy is important for CF patients, it is not directly related to the timing of bronchodilator administration. The bronchodilator should be given before CPT, regardless of oxygen administration, to ensure the airways are open for better mucus clearance.

D. After receiving 100% oxygen:

The bronchodilator should not be delayed until after oxygen therapy. Oxygen can help improve oxygenation, but bronchodilators are best administered before CPT to prepare the airways for effective mucus clearance.

Summary:

The correct timing for administering aerosolized bronchodilators in children with cystic fibrosis is before chest physiotherapy (CPT) to open the airways and enhance the effectiveness of the therapy. Therefore, A. Before chest physiotherapy (CPT) is the correct answer.

The correct answer is B: Measles (rubeola)

Explanation:

Koplik's spots are small, white spots with a blueish-white center that appear on the buccal mucosa (inside the cheeks) and are a characteristic early sign of measles (rubeola). These spots typically appear 2-4 days before the measles rash and are considered a classic diagnostic feature of measles. The presence of Koplik's spots can help differentiate measles from other similar viral infections.

Why the other options are incorrect:

A. Rubella:

Rubella (also known as German measles) does not feature Koplik's spots. Rubella is typically characterized by a rash that starts on the face and spreads down, but it does not have the same distinctive oral spots as seen in measles.

C. Chickenpox (varicella):

Chickenpox presents with vesicular lesions on the skin but does not involve Koplik's spots. The rash starts on the trunk and then spreads to the face and limbs. Koplik's spots are not associated with varicella.

D. Exanthema subitum (roseola):

Roseola, caused by the human herpesvirus 6 (HHV-6), typically involves a sudden high fever followed by a rash that appears after the fever breaks. There are no Koplik's spots in roseola.

Summary:

Koplik's spots are a hallmark of measles (rubeola) and appear in the mouth before the measles rash develops. These spots are not seen in rubella, chickenpox, or roseola.

The correct answer is A: This is normal behavior for the child's age.

Explanation:

The behaviors described—saying “no” frequently, rapid mood changes, expressions of anger followed by the desire for comfort—are typical of toddlers, especially around 18 months. This stage of development is marked by the struggle for autonomy versus shame and doubt (Erikson), where toddlers are learning to assert themselves, make choices, and express independence. Saying “no” is one of the first and most common ways toddlers exert control. Mood swings are also normal as emotional regulation is still developing, and shifting from anger to seeking comfort from a parent is part of learning to manage big feelings.

Why the other options are incorrect:

B. This is unusual behavior for the child's age:

This behavior is actually quite typical for toddlers. Labeling it as unusual may lead to unnecessary concern or intervention.

C. The child is not effectively coping with stress:

While the child may be experiencing frustration, the behavior described is developmentally appropriate and not a sign of poor coping. Emotional outbursts and seeking comfort are normal toddler responses.

D. The child is showing the need for more attention:

Although toddlers do need attention, this behavior is not necessarily a sign of unmet emotional needs but rather part of normal emotional and social development.

Summary:

At 18 months, saying “no,” showing mood swings, and displaying a mix of independence and need for reassurance are all normal developmental behaviors. They reflect the toddler’s efforts to assert autonomy while still relying on the caregiver for emotional support.

The correct answer is D: Sinusitis

Explanation:

The symptoms described—cold-like symptoms lasting over two weeks, a headache, nasal congestion with purulent (yellow or green) nasal drainage, facial tenderness, and a cough worsening during sleep—are characteristic of sinusitis. Sinusitis is an inflammation or infection of the sinuses, often resulting from a viral upper respiratory infection that progresses to a bacterial infection. The purulent drainage and facial tenderness are key indicators that the infection has likely spread to the sinuses. Additionally, the cough worsening at night is commonly due to postnasal drip, where mucus from the sinuses drips down the back of the throat, irritating the airway.

Why the other options are incorrect:

A. Allergic rhinitis:

Allergic rhinitis, also known as hay fever, typically involves symptoms like sneezing, itching, and clear nasal drainage, along with nasal congestion, but it does not usually cause purulent drainage or facial tenderness. The symptoms described in the question are more consistent with an infection rather than an allergic response.

B. Bronchitis:

Bronchitis is characterized by inflammation of the bronchial tubes and is typically associated with a productive cough and mucus production. However, bronchitis doesn't usually present with nasal congestion, purulent nasal drainage, or facial tenderness, which are more indicative of sinus involvement.

C. Asthma:

Asthma involves wheezing, shortness of breath, chest tightness, and a cough, but it doesn't typically cause nasal congestion, purulent drainage, or facial tenderness. Asthma symptoms may be triggered by allergens or respiratory infections, but the presence of facial tenderness and sinus-related symptoms points more to sinusitis.

Summary:

The symptoms of headache, nasal congestion with purulent drainage, facial tenderness, and a cough that worsens at night are classic signs of sinusitis. This condition often develops after a viral upper respiratory infection and can be exacerbated by bacterial infection, leading to the characteristic signs and symptoms.

The correct answer is A: There is heightened airway reactivity.

Explanation:

Bronchial asthma is characterized by increased airway reactivity, meaning that the airways are more likely to constrict in response to triggers such as allergens, cold air, or respiratory infections. This heightened reactivity leads to bronchoconstriction, inflammation, and excess mucus production, which cause the hallmark symptoms of asthma, such as wheezing, shortness of breath, chest tightness, and coughing. This characteristic is the most accurate and descriptive feature of asthma.

Why the other options are incorrect:

B. There is decreased resistance in the airway:

This is incorrect. In asthma, there is increased airway resistance due to bronchoconstriction, inflammation, and mucus production, not decreased resistance. This increased resistance leads to difficulty in breathing and airflow limitation.

C. The single cause of asthma is an allergic hypersensitivity:

While allergic hypersensitivity is a common trigger for asthma, it is not the single cause. Asthma can be triggered by a variety of factors, including environmental pollutants, infections, exercise, and cold air. Genetic predisposition and environmental factors play significant roles in the development of asthma.

D. It is inherited:

Asthma can have a genetic component, but it is not solely inherited. Family history plays a role in susceptibility, but environmental factors and other triggers also contribute to the development of asthma.

Summary:

The most accurate description of bronchial asthma is that there is heightened airway reactivity, leading to airway narrowing and breathing difficulties. Therefore, the correct answer is A. There is heightened airway reactivity.

The correct answer is A: 5 mm

Explanation:

For individuals who are HIV positive, a 5 mm or greater induration is considered a positive result on the tuberculin skin test (TST). This is because people with HIV have a weakened immune system, and they are at higher risk for developing active tuberculosis (TB), even with smaller amounts of exposure. The threshold for a positive result is lower in immunocompromised individuals compared to healthy individuals, where a larger induration (10 mm or more) would be needed to indicate a positive test.

Why the other options are incorrect:

B. 10 mm:

A 10 mm induration is generally considered positive for individuals without HIV or other risk factors (such as recent TB exposure). However, for HIV-positive individuals, a 5 mm induration is considered positive.

C. 15 mm:

A 15 mm induration is typically considered positive for individuals who are at low risk for TB, such as healthy adults with no known risk factors. This size is too large for an HIV-positive individual, where a 5 mm induration is the threshold.

D. 20 mm:

A 20 mm induration is definitely positive, but it is much larger than the threshold required for a positive result in an HIV-positive person. A 5 mm induration is sufficient to indicate a positive result for someone with HIV.

Summary:

For an adolescent who is HIV-positive, a 5 mm or greater induration is considered positive for tuberculosis on the tuberculin skin test. Therefore, the correct answer is A. 5 mm.

The correct answer is C: The parent's interactions and responsiveness to the child

Explanation:

Parental interaction and responsiveness are key predictors of a child’s readiness for kindergarten. Children thrive cognitively, emotionally, and socially when their caregivers are responsive, supportive, and engaged in their development. These interactions help build language skills, emotional regulation, self-confidence, and a positive attitude toward learning—critical skills for school success.

Why the other options are incorrect:

A. The child's ability to sit still:

While self-regulation and attention span are important, expecting a young child to sit still for extended periods is unrealistic. Readiness involves more than this single skill and depends heavily on emotional and social development fostered at home.

B. The child's sense of learned helplessness:

Learned helplessness is a negative outcome, not a factor in readiness. It reflects a belief that one’s actions have no effect on outcomes and is associated with low self-esteem and poor problem-solving. The goal is to foster independence, not helplessness.

D. Attending a preschool program:

Although preschool can offer structured learning and social interaction, it is not the most critical factor. A nurturing and stimulating home environment with responsive parenting plays a more substantial role in early school readiness.

Summary:

The quality of parent-child interactions—specifically how responsive and supportive the parent is—plays the most crucial role in preparing a child for kindergarten.