ATI > RN

Exam Review

Ati nur 223a sect 4 pediatrics final proctored exam

We are excited to announce the release of a NEW VERSION OF THE SYSTEM! To benefit from the latest features, improvements, and component updates, please switch to the new system as soon as possible.
Visit Latest Version  

Total Questions : 93

Showing 10 questions, Sign in for more
Question 1:
Emergency Department - 0900: • Two-year-old toddler brought in by parents due to concerns about child’s breathing. • Parents report child has a history of asthma and woke up today with a bad asthma attack. • Parents state child has had a runny nose and occasional cough for 2 days and has not been eating or drinking well. • Child is restless and crying intermittently while clinging to parent. • Appears ill with flushed face. • Large amount of clear thick nasal drainage from bilateral nares and marked nasal flaring noted. • Oral mucosa pink and slightly dry. • Moderate to severe suprasternal and substernal retractions. • Bilateral wheezes in upper lobes throughout inspiration and expiration. • Diminished breath sounds in bilateral bases. • Frequent dry hacking cough when crying. Pediatric Unit - 1200: • Two-year-old toddler admitted from the emergency department due to exacerbation of asthma. • Child currently asleep in parent’s arms but rouses easily when touched. • Oral mucosa pink and moist. • No nasal flaring noted. • Mid substernal retractions noted. • Mild bilateral expiratory wheezes auscultated in upper lobes with breath sounds diminished in bilateral bases. • No cough noted. • O2 at 2 L/min via nasal cannula.
0900: • Temperature: 38.3°C (100.9°F) • Heart rate: 130 bpm • Respiratory rate: 40 breaths/min • Oxygen saturation: 88% on room air 1200: • Temperature: 37.8°C (100.0°F) • Heart rate: 120 bpm • Respiratory rate: 32 breaths/min • Oxygen saturation: 94% on 2 L/min O2 via nasal cannula
0900: • Child appears ill with flushed face. • Large amount of clear thick nasal drainage from bilateral nares. • Marked nasal flaring noted. • Oral mucosa pink and slightly dry. • Moderate to severe suprasternal and substernal retractions. • Bilateral wheezes in upper lobes throughout inspiration and expiration. • Diminished breath sounds in bilateral bases. • Frequent dry hacking cough when crying. 1200: • Child currently asleep in parent’s arms but rouses easily when touched. • Oral mucosa pink and moist. • No nasal flaring noted. • Mid substernal retractions noted. • Mild bilateral expiratory wheezes auscultated in upper lobes with breath sounds diminished in bilateral bases. • No cough noted.
• Chest X-ray: Hyperinflation of lungs, no focal consolidation. • Blood gas analysis: pH 7.35 (7.35-7.45), PaCO2 45 mmHg (35-45 mmHg), PaO2 60 mmHg (80-100 mmHg), HCO3 24 mEq/L (22-26 mEq/L). 1200: • Chest X-ray: No significant change from previous. • Blood gas analysis: pH 7.38 (7.35-7.45), PaCO2 42 mmHg (35-45 mmHg), PaO2 75 mmHg (80-100 mmHg), HCO3 24 mEq/L (22-26 mEq/L).
0900: • Albuterol nebulizer treatment every 4 hours. • Prednisolone 2 mg/kg/day PO divided into two doses. • Oxygen therapy at 2 L/min via nasal cannula. • IV fluids at maintenance rate. 1200: • Continue Albuterol nebulizer treatment every 4 hours. • Continue Prednisolone 2 mg/kg/day PO divided into two doses. • Continue oxygen therapy at 2 L/min via nasal cannula. • Continue IV fluids at maintenance rate.

A nurse is caring for a 2-year-old toddler in the pediatric unit who was admitted from the emergency department due to concerns about the child’s breathing.

Exhibits

Which of the following findings should the nurse on the pediatric unit identify as an indication that the treatment plan is effective? (Select all that apply)

Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 2:

Client presents to the ED with guardian. Client reports that they began having pain around their “belly button” the previous evening around 2100. Reports that pain is now in right lower quadrant and became worse earlier this morning. Reports nausea. Abdomen soft with tenderness to palpation in right lower quadrant. Bowel sounds positive in all four quadrants. Verbalizes increase in pain when right hip is flexed and rotated internally. Rates pain as 6 on a 0 to 10 pain scale. Notified provider of client’s arrival and assessment data. Prescriptions received.

• Temperature: 37.7°C (99.9°F) • Pulse rate: 98/min, strong and regular • Respiratory rate: 22/min • Blood pressure: 124/64 mm Hg • Oxygen saturation: 99% on room air

• CBC and C-Reactive Protein drawn and sent to lab

Client continues to report right lower quadrant pain, now rated as 7 on a 0 to 10 pain scale. Reports increased nausea and has vomited once. Abdomen remains soft with increased tenderness in the right lower quadrant. Bowel sounds remain positive in all four quadrants. Client appears more uncomfortable and is guarding the right lower quadrant. Notified provider of client’s status and updated assessment data.

• Temperature: 38.1°C (100.6°F) • Pulse rate: 102/min, strong and regular • Respiratory rate: 24/min • Blood pressure: 126/68 mm Hg • Oxygen saturation: 98% on room air

• WBC count: 22,000/mm³ (5,000 to 10,000/mm³) • RBC count: 4.5 million/mm³ (4.0 to 5.5 million/mm³) • Hgb: 14 g/dL (9.5 to 14 g/dL) • Hct: 44% (30% to 40%) • Platelets: 350,000/mm³ (150,000 to 400,000/mm³) • C-Reactive Protein: 11.8 mg/dL (less than 1.0 mg/dL)

A nurse in the emergency department (ED) is caring for a 13-year-old client who presented with right lower quadrant abdominal pain, nausea, and fever.

Exhibits

The nurse has notified the provider of the client’s 0800 assessment data and lab results. Which of the following prescriptions should the nurse anticipate?

Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 3:

(0700 hrs)

 

  • Temperature: 36.7°C (98.0°F)
  • Pulse rate: 114/min
  • Respiratory rate: 30/min
  • Blood pressure: 92/66 mm Hg
  • Oxygen saturation: 90%

(0700 hrs)

 

  • Furosemide 40 mg IV every 6 hr. Administered at 0600.
  • Digoxin 250 mcg IV now. Administered at 0600.

 

(0700 hrs)

  • Jugular vein distention noted.
  • Lower extremity edema 2+ bilaterally.
  • Extremities cool with decreased skin pigmentation.
  • Peripheral pulses weak bilaterally.
  • Lung sounds with wheezing noted throughout.

(0700 hrs)

  • Chest X-ray: Cardiomegaly noted.
  • Echocardiogram: Left ventricular hypertrophy, mitral valve stenosis.
  • BNP: 1200 pg/mL (Reference range: <100 pg/mL)

Based on the information provided, what is the most appropriate initial nursing action?

Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 4:
• Diagnosis: Bilateral pneumonia • Past medical history: Cystic fibrosis • Plan: Aggressive airway clearance therapy, intravenous antibiotic therapy
• 0700 hrs: Caregiver reports child has had increased coughing, fatigue, and a poor appetite for the past several days. Wheezing and rhonchi auscultated bilaterally. Respirations labored with accessory muscle use. Frequent cough productive with thick, yellow blood-streaked sputum. Dyspnea noted with activity. Child reports “a bit of a stomachache” and rates the discomfort as 3 on a scale of 0 to 10. Abdomen soft and non-tender to palpation. Active bowel sounds auscultated. • 0900 hrs: Respirations rapid with accessory muscle use. Dyspnea noted while at rest. Frequent cough. Thick yellow sputum expectorated following airway clearance therapy. Child reports chest discomfort as 4 on a scale of 0 to 10. Child consumes approximately 50% of meals. Denies abdominal pain. Passed three large, frothy, foul-smelling stools.
• 0700 hrs: o Oral temperature: 39.1°C (102.4°F) o Heart rate: 116/min o Respiratory rate: 32/min o Blood pressure: 102/60 mm Hg o Oxygen saturation: 95% on room air • 0900 hrs: o Oral temperature: 38.1°C (100.6°F) o Heart rate: 128/min o Respiratory rate: 32/min o Blood pressure: 88/48 mm Hg o Oxygen saturation: 88% on room air
• 0900 hrs: o Chest X-ray: Bilateral infiltrates consistent with pneumonia o Complete Blood Count (CBC):  WBC: 15,000/mm³ (Reference range: 4,500-11,000/mm³)  Hemoglobin: 11 g/dL (Reference range: 12-16 g/dL)  Platelets: 250,000/mm³ (Reference range: 150,000-450,000/mm³)

A nurse is caring for a school-age child in the hospital.

Exhibits

Which of the following assessment findings should the nurse report to the provider? (Select all that apply)

Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 5:
(0700 hrs) • Temperature: 39°C (102.2°F) • Heart rate: 148/min • Respiratory rate: 42/min • Blood pressure: 87/44 mm Hg • SpO2: 89% on room air
(0700 hrs) • The toddler presents with a high fever, cough, and difficulty breathing. • The mother reports that the child has been irritable and not eating well for the past two days. • The child is observed to have nasal flaring and intercostal retractions. • Breath sounds are diminished with wheezing heard bilaterally. • The child is restless and crying intermittently. • The mother denies any known allergies or recent travel. • The child has a history of frequent upper respiratory infections.
(0700 hrs) • Rapid RSV antibody test: Positive (per nasal swab) • Blood culture: Pending • Hgb: 10 g/dL (9.5 to 14 g/dL) • Hct: 40% (30% to 40%) • WBC: 10,000/mm³ (5,000 to 10,000/mm³) • Platelets: 230,000/mm³ (150,000 to 400,000/mm³) • Glucose: 82 mg/dL (60 to 100 mg/dL) • BUN: 18 mg/dL (5 to 18 mg/dL)
(0700 hrs) • Albuterol 2.5 mg via nebulizer now. May repeat every 20 min for 1 hr as needed for wheezing and retractions. • Oxygen 2 L/min via nasal cannula.

A nurse is caring for a 2-year-old male toddler in the emergency department.

Exhibits

Which of the following findings should the nurse identify as an indication that the treatment plan is effective? (Select all that apply.)

Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 6:
A child is admitted with a suspected diagnosis of Wilms tumor.
The nurse should place a sign with which of the following warnings over the child’s bed?
Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 7:
The nurse would teach the mother of a boy with Tetralogy of Fallot that if the child suddenly becomes cyanotic and dyspneic, the mother should:
Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 8:
A 3-month-old is admitted with severe diarrhea.
Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information, the nurse documents that the infant has:
Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 9:
When planning care for children, the nurse knows that which factor has the largest impact but is not able to be altered to influence the growth and development of children?
Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments
Question 10:
A nurse is planning care for a 6-year-old child who has bacterial meningitis.
Which of the following nursing interventions is unnecessary in the client’s plan of care?


Answer and Explanation
A
Your comment is awaiting moderation.
This field cannot be empty!!
0 Pulse Checks
No comments

Sign Up or Login to view all the 93 Questions on this Exam

Join over 100,000+ nursing students using Naxlex’s science-backend flashcards, practice tests and expert solutions to improve their grades and reach their goals.

Sign Up Now
learning

Join Naxlex Nursing for nursing questions & guides! Sign Up Now