Pediatrics HESI 2023

Correct Answer: B

Rationale: The primary purpose of a lumbar puncture is to obtain a sample of cerebrospinal fluid for analysis. This sample helps in diagnosing conditions such as meningitis by evaluating the presence of pathogens or abnormalities in the cerebrospinal fluid. Measuring the pressure of cerebrospinal fluid (Choice A) is not the main objective of a lumbar puncture, although it can be done during the procedure. Relieving intracranial pressure (Choice C) is not the direct purpose of a lumbar puncture, as other interventions are typically used for this purpose. Assessing the presence of infection in the spinal fluid (Choice D) is related to the overall goal of obtaining a sample for analysis, making it a secondary outcome of the procedure.

Correct Answer: D

Rationale: Retractions and the use of accessory respiratory muscles can be signs of respiratory distress, which may indicate trauma such as shaken baby syndrome (SBS). Shaken baby syndrome can result in brain injury and respiratory compromise, leading to breathing difficulties. Choices A, B, and C are less likely to be associated with SBS. Birth before 32 weeks' gestation is more related to prematurity rather than SBS. The lack of stridor and adventitious breath sounds, as well as previous episodes of apnea lasting 10 to 15 seconds, are not specific indicators of SBS.

Correct Answer: B

Rationale: The correct answer is B: Tissue oxygen needs. Polycythemia occurs as the body's response to chronic hypoxia by increasing RBC production to enhance oxygen delivery. In tetralogy of Fallot, a congenital heart defect, the heart's structure causes reduced oxygen levels in the blood. This chronic hypoxia stimulates the bone marrow to produce more red blood cells, leading to an elevated RBC count. Choice A is incorrect as low blood pressure is not directly related to polycythemia in this context. Choice C, diminished iron level, is not the cause of polycythemia in tetralogy of Fallot. Choice D, hypertrophic cardiac muscle, is not the primary cause of the elevated RBC count in this case.

Correct Answer: A

Rationale: The priority nursing action when a child with a suspected fracture is brought to the emergency department is to immobilize the affected limb. Immobilization helps prevent further injury until a fracture is confirmed or ruled out. Applying ice or elevating the limb can wait until after immobilization has been achieved. Checking the child's neurovascular status is important but is not the priority action in this situation.

Correct Answer: D

Rationale: The Resiliency model of family stress, adjustment, and adaptation is the appropriate theory in this scenario. This model focuses on identifying risks and protective factors that help families achieve positive outcomes despite challenges. Duvall's developmental theory primarily focuses on family life cycle stages, Friedman's structural functional theory emphasizes the interdependence of family members, and Von Bertalanffy's general system theory applied to families looks at the family as a dynamic system. These theories do not specifically address the concept of resilience and adaptation in the face of stressors like homelessness.