HESI Pediatric (N158) Exam

The correct answer is C: Education for safety and potential hazards.

Explanation:

During the preschool years, children are developing a sense of independence and curiosity, which often leads to increased risk of injury. The best approach to injury prevention during this time is to educate the child and caregivers about safety and potential hazards. This includes teaching preschoolers about things like traffic safety, fire safety, and the dangers of certain objects or behaviors. Education at this stage helps children understand why certain behaviors are unsafe and empowers them to make safer choices.

Why the other options are incorrect:

A. Constant vigilance and protection:

While vigilance and supervision are important, it’s not realistic or effective to provide constant protection. Children need to learn to assess risks and make decisions on their own, so education is a more practical and long-term solution than constant supervision.

B. Punishment for unsafe behaviors:

Punishing children for unsafe behaviors does not teach them about why the behavior is unsafe or how to avoid it. Positive reinforcement and education are much more effective in helping children learn to make better decisions regarding safety.

D. Limitation of physical activities:

Preschool children need opportunities for physical activity to develop motor skills, coordination, and overall health. Limiting physical activities as a form of injury prevention would hinder their growth and development. Instead, it's more effective to focus on teaching safe practices during physical activities.

Summary:

The most effective approach to injury prevention during the preschool period is to focus on education about safety and potential hazards, which helps children understand risks and make safer decisions as they grow.

The correct answer is C: Toddlers are capable of building a tower of blocks.

Explanation:

At 18 months, toddlers are in the early stages of developing their fine motor skills and hand-eye coordination. They are capable of stacking a small number of blocks (usually 2–3), though they may still need assistance. By 18 months, children are beginning to engage in simple constructive play, such as stacking and arranging objects. This is a typical and developmentally appropriate activity at this age.

Why the other options are incorrect:

A. Blocks at this age are used primarily for throwing:

While toddlers may explore blocks by throwing them, this is not their primary use at this stage. By 18 months, children start using blocks for stacking and building, which are appropriate cognitive and motor activities.

B. Toddlers are too young to imitate the behavior of others:

Toddlers are actually able to imitate behaviors by 18 months. They often mimic adult actions and can learn from demonstrations, such as watching a parent stack blocks.

D. Toddlers are too young to build a tower of blocks:

This is inaccurate. At 18 months, toddlers are capable of building simple towers with blocks, although they may only be able to stack a few before the tower topples.

Summary:

At 18 months, toddlers are beginning to engage in simple stacking activities with blocks, and they can build small towers, making it a typical developmental milestone for their age.

The correct answer is C: My child will not need a dental checkup until his permanent teeth come in.

Explanation:

This statement indicates a misunderstanding of appropriate dental care for toddlers. The American Academy of Pediatric Dentistry recommends that children have their first dental visit by age 1 or within 6 months of the first tooth erupting. Early dental visits help with preventive care, establish a dental home, and allow for early identification of any issues.

Why the other options are correct and do not indicate a need for further teaching:

A. We use well water so I give my toddler fluoride supplements.

Well water typically lacks fluoride, so providing fluoride supplements (as prescribed by a healthcare provider) is an appropriate measure to protect dental health.

B. My toddler brushes his teeth with my help.

Toddlers lack the fine motor skills to effectively brush their teeth on their own. Parental assistance is essential, making this a correct and encouraged practice.

D. I use a small nylon bristle brush for my toddler's teeth.

A small, soft nylon-bristle toothbrush is appropriate for toddlers and ensures gentle but effective cleaning of their teeth.

Summary:

The belief that a toddler doesn’t need a dental checkup until permanent teeth come in is incorrect and indicates a need for further education on early dental care and prevention.

The correct answer is C: Eat the same food as the rest of the family.

Explanation:

At 12 months, many children begin to transition from breastfeeding or formula to eating solid foods and may start eating a wider variety of foods, often including the same foods as the rest of the family, although they may still prefer softer or mashed textures. This is a typical developmental milestone as toddlers are moving toward eating more independently.

Why the other options are incorrect:

A. Use a spoon adeptly:

At 12 months, most children are just beginning to experiment with utensils like spoons, but they are usually not adept at using them. They may try to scoop food but often lack the fine motor control to use a spoon with precision.

B. Relinquish the bottle voluntarily:

At 12 months, some children may start to show interest in transitioning from a bottle to a cup, but not all will voluntarily relinquish the bottle at this age. The transition is gradual and typically continues through the second year of life.

D. Reject all solid foods in preference to the bottle:

By 12 months, most children are more interested in solid foods and may gradually move away from preferring the bottle, although some children may still have a strong attachment to it for comfort. It is uncommon for a 12-month-old to reject all solid foods in favor of the bottle.

Summary:

At 12 months, most children begin to demonstrate the ability to eat a variety of foods, including the same foods as their family, though they are still in the process of transitioning to a more varied and independent diet.

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 a D: Answer is:Varicella zoster immune globulin (VZIG)

Explanation:

Varicella zoster immune globulin (VZIG) is given to high-risk children who have been exposed to chickenpox (varicella) to prevent the development of the disease or reduce its severity. It is most commonly administered to children with compromised immune systems, newborns, and pregnant women who have not had chickenpox or the varicella vaccine. VZIG provides passive immunity by supplying antibodies against the varicella virus.

Why the other options are incorrect:

A. Acyclovir:

Acyclovir is an antiviral medication used to treat chickenpox in those who are already infected, not to prevent infection after exposure. It helps reduce the severity and duration of symptoms, but it is not given prophylactically after exposure.

B. Vitamin A:

Vitamin A has been studied for its potential benefits in reducing the severity of chickenpox, but it is not a preventive measure for high-risk children exposed to the varicella virus. It may help with immune function, but it is not used for post-exposure prevention.

C. Diphenhydramine hydrochloride:

Diphenhydramine is an antihistamine used to manage itching and allergic reactions, but it does not prevent or treat chickenpox. It can be used to relieve symptoms once a person has the infection, but it is not a preventive measure after exposure.

Summary:

Varicella zoster immune globulin (VZIG) is the appropriate treatment for high-risk children who have been exposed to chickenpox. It helps prevent or reduce the severity of the disease by providing passive immunity.

The correct answer is B: Parent to stabilize the chin with one hand and brush with the other.

Explanation:

At a toddler's age, they typically do not have the dexterity to effectively clean all surfaces of their teeth, and they also may not have the attention span or understanding to brush thoroughly. Therefore, it’s important for the parent to assist with brushing by stabilizing the child’s chin and using the other hand to brush the teeth properly. This ensures that all surfaces are cleaned effectively, including hard-to-reach areas like the back teeth.

Why the other options are incorrect:

A. Child to brush regularly with toothpaste of his or her choice:

While it’s important for toddlers to begin learning how to brush, they lack the coordination and skill to brush effectively at this age. A parent should assist and supervise brushing until the child can do it more independently (usually around age 6 or 7).

C. Parent to brush the mandibular occlusive surfaces, leaving the rest for the child:

While it’s important for the parent to help, leaving the rest for the child can result in ineffective cleaning. Toddlers often cannot reach all areas of their teeth, including the sides and back. The parent should assist with brushing all surfaces to ensure thorough cleaning.

D. Parent to brush the front labial surfaces, leaving the rest for the child:

Similarly to option C, leaving any surfaces for the child to clean is not effective, as toddlers often struggle with brushing all the surfaces of their teeth. The parent should help brush all areas to ensure a complete cleaning.

Summary:

The most effective way to clean a toddler's teeth is for the parent to stabilize the child's chin with one hand and use the other to brush all surfaces of the teeth, ensuring thorough cleaning and good dental hygiene.

Correct answer D: Normal growth curve of a breast-fed infant.

Explanation:

D. Normal growth curve of a breast-fed infant.

The infant's weight and height percentiles are within normal limits for a breastfed infant. In general, infants' growth patterns should be interpreted in the context of their individual growth curves. A 4-month-old breastfed infant at the 80th percentile for weight and 75th percentile for height is growing well and appropriately, with these percentiles indicating that the infant's growth is consistent and healthy. Breastfed infants typically have growth patterns that are somewhat different from formula-fed infants, but these percentiles fall within the normal range for a breastfed baby.

Why the Other Options Are Incorrect:

A. Milk allergy.

There is no evidence in the scenario to suggest that the infant is showing signs of a milk allergy, such as rash, vomiting, diarrhea, or blood in the stool. The normal growth percentiles suggest no immediate concerns regarding feeding or digestion.

B. Failure to thrive.

Failure to thrive is characterized by a significant decrease in weight, height, and/or head circumference that falls below the 5th percentile for age. The infant in this case is in the 80th percentile for weight and the 75th percentile for height, indicating that the infant is growing and gaining weight appropriately, which rules out failure to thrive.

C. Inadequate milk supply in mother.

The infant's growth is within normal limits, which suggests that the breastfeeding is sufficient for the infant's needs. Signs of inadequate milk supply typically include poor weight gain or failure to thrive, neither of which is present in this scenario.

Summary:

The correct answer is D. Normal growth curve of a breast-fed infant, as the infant's growth measurements are within the normal range for a 4-month-old breastfed child. The other options, including milk allergy, failure to thrive, and inadequate milk supply, do not apply based on the provided growth percentiles.

The correct answer is D: Vitamins A, D, E, and K

Explanation:

Children with cystic fibrosis (CF) have difficulty absorbing fat-soluble vitamins (A, D, E, and K) due to pancreatic insufficiency, which impairs the digestion of fats. As a result, they are often prescribed supplements of these vitamins to ensure they receive adequate amounts for proper growth and immune function.

Vitamin A is important for vision and immune health.

Vitamin D is necessary for bone health and calcium absorption.

Vitamin E acts as an antioxidant.

Vitamin K is essential for blood clotting.

Why the other options are incorrect:

A. Vitamin C and calcium:

Although calcium and vitamin C are important for overall health, they are not specifically required as supplements for CF in the same way as vitamins A, D, E, and K. Children with CF are more at risk for deficiencies in fat-soluble vitamins, so those are the priority in supplementation.

B. Vitamins B6 and B12:

Vitamins B6 and B12 are important for metabolism and red blood cell formation, but they are water-soluble vitamins and are usually less of a concern for deficiency in CF compared to fat-soluble vitamins.

C. Magnesium:

Magnesium is essential for muscle function and bone health, but it is not a primary concern in CF as compared to vitamins A, D, E, and K. While magnesium levels should be monitored, it is not generally the focus for supplementation in CF care.

Summary:

Children with cystic fibrosis need supplements of vitamins A, D, E, and K due to malabsorption caused by pancreatic insufficiency. These vitamins are critical for maintaining healthy vision, immune function, bones, and blood clotting.