Pediatrics HESI 2023

Correct Answer: B

Rationale: The correct answer is B: Tissue oxygen needs. Polycythemia occurs in response to chronic hypoxia, leading the body to increase red blood cell production to enhance oxygen delivery. In tetralogy of Fallot, a congenital heart defect that results in reduced oxygen levels in the blood, the body compensates by producing more red blood cells. Choice A is incorrect as low tissue oxygen needs would not trigger polycythemia. Choice C, diminished iron levels, is not the cause of polycythemia in this case. Choice D, hypertrophic cardiac muscle, is unrelated to the pathophysiology of polycythemia in tetralogy of Fallot.

Correct Answer: D

Rationale: Retractions and the use of accessory respiratory muscles are signs of respiratory distress in infants. These clinical manifestations can be associated with trauma, such as shaken baby syndrome (SBS), which can lead to severe head injuries and respiratory compromise. Birth before 32 weeks' gestation (Choice A) is more related to prematurity complications rather than SBS. The absence of stridor and adventitious breath sounds (Choice B) may not be specific indicators of SBS. Previous episodes of apnea lasting 10 to 15 seconds (Choice C) alone may not be as concerning as the presence of retractions and use of accessory muscles in the context of a distressed infant.

Correct Answer: C

Rationale: The priority nursing action after corrective surgery for hypertrophic pyloric stenosis (HPS) is to assess the IV site for infiltration. This is crucial as it ensures proper fluid administration and prevents complications such as phlebitis or infiltration-related tissue damage. Applying restraints (Choice A) would not be appropriate in this situation as it is not related to the immediate post-operative care of an infant with an IV infusion. Administering a mild sedative (Choice B) is not indicated as the primary concern post-surgery is monitoring the IV site and the infant's response to the surgery. Attaching the nasogastric tube to wall suction (Choice D) is not the priority at this time, as assessing the IV site takes precedence to prevent potential complications.

Correct Answer: C

Rationale: The priority nursing action after a corrective surgery for hypertrophic pyloric stenosis (HPS) is to assess the IV site for infiltration. This is crucial to ensure proper fluid administration and prevent complications such as extravasation or infiltration. Applying restraints (Choice A) is not indicated in this scenario and can compromise the infant's comfort and safety. Administering a mild sedative (Choice B) is not necessary and should only be done based on specific clinical indications. Attaching the nasogastric tube to wall suction (Choice D) may be important for certain conditions but is not the priority immediately post-surgery; assessing the IV site is more urgent to prevent potential complications related to IV therapy.

Correct Answer: C

Rationale: Soaking the area in warm water is the most appropriate instruction for a child who is having their cast removed. This method helps to gently remove dead skin without causing irritation. Applying petroleum jelly to dry skin (Choice A) is not recommended as it may not effectively aid in the removal of dead skin. Rubbing the skin vigorously (Choice B) can lead to skin irritation and should be avoided. Washing the skin with diluted peroxide and water (Choice D) may be too harsh, causing unnecessary irritation to the skin post-cast removal.