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Ati pn paediatrics nursing 2023
Total Questions : 61
Showing 10 questions, Sign in for more0730:
Adolescent presented with new onset shortness of breath, fatigue, and cough. Adolescent is
receiving treatment for osteosarcoma. Prescriptions received for chest x-ray and laboratory testing.
0830:
Provider discussed results of laboratory tests and chest x-ray with adolescent's parent outside of adolescent's room. Parent tearful and states, "I don't want my child to know that the cancer has spread to their lungs."
0730:
- Blood pressure 110/72 mm Hg
- Heart rate 80/min
- Respiratory rate 22/min
- Temperature 38.2° C (100.8° F)
- SaO2 95% on room air
Complete the following sentence by using the lists of options.
The nurse identifies the parent is having difficulty discussing the metastasis of the cancer with their adolescent. The nurse should
Explanation
Rationale for Correct Choices:
- Consult the child life specialist for guidance: A child life specialist is trained to help children and adolescents cope with serious illness and stressful medical information. They can support both the adolescent and the parent in age-appropriate communication about difficult topics like cancer metastasis.
- Reinforce teaching to the parent regarding the adolescent’s potential emotional responses: Adolescents are capable of understanding complex medical information and may experience a range of emotional responses, including fear, anger, or sadness. Supporting the parent with education helps them feel better equipped to navigate this challenging conversation.
Rationale for Incorrect Choices:
- Instruct the parent to withhold the test results from their adolescent: Withholding such significant information can damage trust and emotional processing. Adolescents benefit from honest, age-appropriate communication, especially about their health.
- Encourage the parent to hide their emotions from their adolescent: Hiding emotions can lead to emotional disconnect. Showing genuine emotions in a supportive manner helps model healthy coping and strengthens emotional bonds.
- Discourage the parent from discussing the possibility of death with their adolescent: It is important for families to have open conversations about the illness trajectory, including death if appropriate. Avoiding the topic may leave the adolescent confused and unsupported.
- Collaborate with the RN to initiate a referral for admission to hospice care: While hospice may be appropriate later, the priority at this moment is supporting communication and addressing the parent’s emotional needs, not immediately shifting to end-of-life planning.
Day 1, 2200:
Child has been admitted to the pediatric unit for observation following tonsillectomy. Parents report child has history of chronic pharyngitis. Child is drowsy, but responsive to verbal stimuli. Respirations even, nonlabored. Heat rate regular. No bleeding noted. Child rates pain as a 3 out of 10 on the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Head of bed elevated.
Day 2, 0800:
Child is alert and awake, clears throat often. Small amount of bleeding noted in the posterior pharynx. Breath sounds clear bilaterally. Abdomen soft, nondistended, nontender. Skin dry. Child rates pain as a 3 out of 10 on the FLACC scale.
0830:
Parent reports child has vomited bright red emesis.
Day 2, 0800:
- Temperature 36.2° C (97.2° F)
- Heart rate 120/min
- Respiratory rate 26/min
- Blood pressure 94/74 mm Hg
Day 2, 0800:
WBC 7,500 mm (5,000 to 10,000/mm3)
Hemoglobin 8.8 g/dL (9.5 to 14 g/dL)
Hematocrit 29% (30% to 40%)
Clear liquids, advance diet as tolerated.
A nurse is assisting with planning care for a school-age child on the pediatric unit.
Complete the following sentence by using the lists of options.
The nurse should plan to
Explanation
Rationale for Correct Choices:
- Inspect the child's oropharynx: The child has bright red emesis and a history of frequent throat clearing, with visible bleeding in the posterior pharynx. This raises concern for post-tonsillectomy hemorrhage, a serious complication. Immediate inspection of the oropharynx helps assess the severity and source of the bleeding.
- Obtaining a set of vital signs: After confirming bleeding, it is crucial to assess hemodynamic stability. The child’s heart rate is elevated (120/min) and hemoglobin is low (8.8 g/dL), suggesting possible blood loss. Repeat vital signs will help determine the urgency of medical intervention.
Rationale for Incorrect Choices:
- Offer the child a red popsicle: Red-colored foods or drinks are contraindicated post-tonsillectomy because they can be mistaken for blood in vomit or secretions. This could delay recognizing true hemorrhage.
- Place the child in a supine position: Supine positioning can increase the risk of aspiration of blood. The child should be positioned upright or side-lying to promote drainage and reduce aspiration risk.
- Requesting a prescription for codeine: Codeine is not recommended in children post-tonsillectomy due to the risk of respiratory depression. It is contraindicated for pediatric pain control in this context.
- Encouraging the child to cough and deep breathe: Coughing may aggravate bleeding in a post-tonsillectomy patient and should be avoided when active hemorrhage is suspected.
Cystic fibrosis
Blood streaked sputum
0900:
- Tympanic temperature 37.7° C (99.9° F)
- Heart rate 130/min
- Respiratory rate 36/min
- Blood pressure 110/65 mm Hg
- Oxygen saturation 92% on 2 L oxygen via nasal cannula
1300:
- Tympanic temperature 37.5° C (99.5° F)
- Heart rate 130/min
- Respiratory rate 32/min.
- Blood pressure 100/60 mm Hg
- Oxygen saturation 95% on 2 L oxygen via nasal cannula
Chest x-ray shows infiltrate and an increased anteroposterior diameter
WBC count 22,000/mm3 (5,000 to 10,000/mm3)
A nurse is assisting with the care of a 15-year-old adolescent who has Streptococcus pneumonia.
The nurse is collecting data on the adolescent 24 hr later. How should the nurse interpret the findings?
For each finding, click to specify whether the finding is unrelated to the admitting diagnosis, an indication of potential improvement, or an indication of potential worsening condition.
Explanation
Rationale:
- Hemoptysis 300 mL: Large-volume hemoptysis in cystic fibrosis can indicate significant airway inflammation or erosion of pulmonary blood vessels. Haemoptysis indicates worsening condition possibly due to progression or complications of pneumonia.
- Barrel chest: Barrel chest is a chronic manifestation of cystic fibrosis due to long-standing air trapping and hyperinflation. It is not an acute indicator of pneumonia severity or progression.
- WBC count 17,000/mm³: The WBC count has decreased from 22,000 to 17,000, suggesting a positive response to antibiotic therapy and resolving infection, although it remains elevated.
- Oxygen saturation 95% on 1 L: The adolescent was previously on 2 L oxygen and is now maintaining adequate saturation (95%) on 1 L, which shows improved respiratory function.
- Steatorrhea: Steatorrhea is associated with pancreatic insufficiency in cystic fibrosis but is not directly related to pneumonia or the current pulmonary infection.
- Respiratory rate 32/min: A persistently elevated respiratory rate indicates ongoing tachypnea and respiratory distress, which can suggest that pulmonary function is still compromised despite some other improving signs.
1000:
Toddler presents to emergency department. Guardian reports toddler has vomited twice when eating and has had sudden onset of episodes of drawing their knees to their chest and a high-pitched cry. Between episodes, toddler appears comfortable and plays as usual. Toddler has been sleeping more and is irritable after eating. Guardian reports a decrease in the urine frequency and amount.
1030:
Guardian calls nurse to the room to report toddler's bowel movement looks "like red jelly."
1000:
- Temperature 36.7° C (98.0° F)
- Heart rate 145/min
- Respiratory rate 25/min
- Blood pressure 90/48 mm Hg
- SaO2 98% on room air
A nurse in an emergency department is assisting with the care of a 2-year-old toddler.
Complete the diagram by dragging from the choices below to specify what condition the toddler is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the toddler's progress.
Explanation
Rationale for Correct Answers:
- Intussusception: The toddler shows hallmark signs of intussusception, including intermittent abdominal pain with leg-drawing, high-pitched crying, vomiting, lethargy, and currant jelly stools. These features strongly suggest bowel telescoping and justify this diagnosis.
- Palpate the toddler's abdomen for a mass in the right upper quadrant: A sausage-shaped mass in the right upper quadrant is a classic physical finding in intussusception. Palpating for this mass supports diagnostic confirmation and helps identify severity or progression.
- Reinforce teaching with the guardian about hydrostatic reduction: Hydrostatic reduction using air or contrast enema is the first-line treatment for stable children with intussusception. The nurse should prepare the guardian for this procedure by explaining what it involves, its purpose and the potential outcomes and need for further intervention if it's unsuccessful.
- Stool consistency: Monitoring stool consistency is critical as improvement or normalization suggests successful resolution of the intussusception. Red, jelly-like stools are a key indicator of ongoing bowel compromise.
- Abdominal pain: Recurrent or worsening abdominal pain may indicate failed reduction or complications such as bowel perforation. Tracking this symptom helps guide timely escalation of care.
Rationale for Incorrect Choices:
- Celiac disease: Celiac disease typically presents with chronic diarrhea, abdominal bloating, and failure to thrive, not acute episodes of pain with red jelly stools. It is a chronic autoimmune condition, not an acute surgical emergency.
- Gastroesophageal reflux: GERD in toddlers may cause vomiting or irritability, but it does not produce currant jelly stools, intermittent severe pain, or palpable abdominal masses. These findings are inconsistent with reflux.
- Gastroenteritis: Gastroenteritis can cause vomiting and diarrhea, but the absence of fever, presence of severe intermittent pain, and blood-mucus stools are not characteristic. It also would not cause a sausage-shaped mass.
- Obtain a prescription for blood transglutaminase antibody testing: This test screens for celiac disease and is unrelated to intussusception. It does not aid in diagnosing or managing the acute symptoms presented in this toddler.
- Request a prescription for a fat-soluble vitamin supplement: Fat-soluble vitamins are given in chronic conditions like cystic fibrosis or celiac disease. They play no role in the emergency management of intussusception.
- Prepare the toddler for an upper endoscopy with possible biopsy: An upper endoscopy is used for evaluating upper GI issues such as celiac disease or esophagitis, not for intussusception. It would not visualize the area involved in this condition.
- Sleep pattern: Although the toddler has been sleeping more, this is not a primary monitoring parameter for recovery from intussusception. It is nonspecific and less useful than other direct indicators of GI status.
- Bone mineral density: Bone density is not relevant in acute gastrointestinal conditions. It is more applicable in chronic malnutrition or metabolic bone disorders.
- Urine specific gravity: While hydration is important, urine specific gravity is not the primary marker for monitoring resolution of intussusception. Stool and pain are more direct indicators of clinical progress.
Infant admitted with fever, irritability, and poor feeding for the past 48 hours. Parent reports that the infant has a history of an allergic reaction to cephalosporins, specifically cefdinir (rash and facial swelling). The infant appears fussy but consolable, with decreased appetite noted since yesterday. No vomiting or diarrhea reported.
Past Medical History: Term birth, normal growth and development
Immunizations: Up to date
Feeding: Formula-fed
Medications: None regularly
- Temperature: 38.9 °C (102 °F)
- Heart Rate: 162 bpm
- Respiratory Rate: 42/min
- Blood Pressure: 86/54 mmHg
- SpOâ‚‚: 97% on room air
WBC count 21,000/mm3 (6,200 to 17,000/mm3)
Potassium 6 mEq/L (4.1 to 5.3 mEq/L)
Hct 30% (35% to 50%)
Hgb 8.2 g/dL (10 to 17 g/dL)
A nurse is preparing to administer medications to a 5-month-old infant.
Drag 1 medication and 1 infant finding to fill in each blank in the following sentence.
The nurse should clarify the prescription
Explanation
Ceftriaxone is a third-generation cephalosporin antibiotic. The infant has a documented allergy to cephalosporins (rash and facial swelling), which puts them at risk for anaphylaxis or serious allergic reactions if given ceftriaxone. Therefore, this medication must be clarified and withheld unless ruled safe by the provider and pharmacy, which is highly unlikely given the allergy.
Allergy: The most critical finding is the infant’s allergy to cephalosporins. Administering ceftriaxone inthis context could result in a life-threatening hypersensitivity reaction.
A nurse is reinforcing teaching about nutritional needs of preschoolers with a group of parents. Which of the following foods should the nurse recommend as a source of complete protein?
A nurse is contributing to the plan of care for a toddler who is receiving intermittent enteral feedings. Which of the following interventions should the nurse include?
A nurse is contributing to the plan of care for a school-age child who is being admitted for diabetic ketoacidosis. Which of the following interventions should the nurse recommend?
A nurse is caring for a toddler whose guardian reports multiple episodes of diarrhea. The provider suspects Clostridium difficile. Which of the following actions should the nurse take?
A nurse is reinforcing teaching with the parents of a 2-year-old toddler about age-appropriate play activities. Which of the following activities should the nurse recommend?
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