Review ATI RN Paediatric nursing 2023

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ATI RN Paediatric nursing 2023

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Total Questions : 55

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Question 1:

School-age child admitted, diagnosed with cystic fibrosis at 3 months of age, has experienced failure to thrive, and has chronic obstructive pulmonary disease. The child presents with wheezing, rhonchi, paroxysmal cough, and dyspnea. The parent reports large, frothy, foul-smelling stools. The child has deficient levels of vitamin A, D, E, and K.
Barrel-shaped chest

Clubbing of the fingers bilaterally

Respiratory rate 40/min with wheezing and rhonchi noted bilaterally, dyspnea, and paroxysmal cough
Vital Signs

Temperature 38.4° C (101.1° F) Heart rate 100/min Respiratory rate 40/min
Blood pressure 100/57 mm Hg

Sputum culture positive for Pseudomonas aeruginosa
Stool analysis positive for presence of fat and enzymes
Chest x-ray indicates obstructive emphysema WBC count 20,000/mm3 (5,000 to 10,000/mm3)

A nurse is caring for a school-age child who has cystic fibrosis.

Exhibits

A nurse is reviewing the child's medical record. Which of the following medications should the nurse expect the provider to prescribe or reconcile from the child's home medication list?
Select all that apply.

A. Water-soluble vitamins B. Acetaminophen C. Dornase alfa D. Meperidine E. Pancreatic lipase

Answer and Explanation

Choice A:

Deficient levels of vitamins A, D, E, and K indicate malabsorption, necessitating supplementation with water-soluble vitamins to address nutritional deficiencies.

Choice B:

Acetaminophen is an analgesic and antipyretic that has no effect on the underlying cause of cystic fibrosis.

Choice C:

Dornase alfa (Pulmozyme) is a recombinant human deoxyribonuclease enzyme used in the management of cystic fibrosis to improve pulmonary function by reducing the viscosity of mucus in the airways.

Choice D:

Meperidine is an opioid analgesic that can cause respiratory depression and increase the risk of pulmonary complications.

Choice E:

Children with cystic fibrosis often have pancreatic insufficiency, leading to malabsorption of fats and fat-soluble vitamins. Pancreatic lipase supplements are necessary to aid in the digestion of fats.

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Question 2:

A 15-year-old adolescent is admitted for a vaso-occlusive crisis. The parent reports that the adolescent has a low-grade fever and has vomited for 3 days. The adolescent reports having right- sided and low back pain. They also report hands and right knee are painful and swollen. The client reports pain as 8 on a scale of 0 to 10.

Temperature 37.8° C (100° F)
Heart rate 100/min
Blood pressure 110/72 mm Hg
Respiratory rate 20/min
Oxygen saturation 95% on room air

Awake, alert, and oriented x 3
Yellow sclera of eyes noted bilaterally
Right upper quadrant tender to palpation
Hands painful to touch and swollen bilaterally
Right knee is swollen, warm to palpation, and the client reports pain as 8 on a scale of 0 to 10.
Client is tearful and grimacing during the examination.

A nurse is caring for an adolescent who is admitted with a vaso-occlusive crisis.

Exhibits

The nurse is planning care for the adolescent. Select the 5 interventions the nurse should include.

A. Instruct the parent to ensure the pneumococcal vaccine is current. B. Administer folic acid as prescribed. C. Monitor oxygen saturation continuously. D. Place the client on strict bed rest. E. Apply cold compresses to the affected joints. F. Administer meperidine IV for pain. G. Restrict oral intake. H. Give oral hydroxyurea.

Answer and Explanation

Choice A:

Instructing the parent to ensure the pneumococcal vaccine is current is not an immediate priority for the client's care and should be done as part of routine health maintenance.

Choice B:

Folic acid supplementation may be part of the overall management of sickle cell disease, but it is not a priority intervention during a vaso-occlusive crisis.

Choice C:

Vaso-occlusive crises can lead to tissue hypoxia due to impaired blood flow.Continuous monitoring of oxygen saturation helps in assessing tissue perfusion and detecting hypoxemia early.

Choice D:

Placing the client on strict bed rest can increase the risk of thrombosis and impair circulation.

Choice E:

Applying cold compresses to the affected joints is a non-pharmacological intervention that can reduce inflammation and pain in the joints affected by vaso-occlusion. Cold compresses can also constrict blood vessels and reduce blood flow to the area, which can prevent further sickling and tissue damage.

Choice F:

Meperidine (Demerol) is a potent opioid analgesic that can help alleviate severe pain associated with vaso-occlusive crises.

Choice G:

The nurse should not restrict oral intake, as hydration is important to prevent dehydration and further sickling.

Choice H:

Hydroxyurea is used to prevent vaso-occlusive crises in patients with sickle cell disease but is not typically administered during an acute crisis. This is a medication that reduces the frequency and severity of vaso-occlusive crises by increasing the production of fetal hemoglobin, which prevents sickling.

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Question 3:

A nurse is caring for a child who has disseminated intravascular coagulation. Which of the following laboratory findings should the nurse expect?

A. Decreased prothrombin time B. Increased Hgb level C. Increased RBC D. Decreased platelet count

Answer and Explanation

Choice A:

Disseminated intravascular coagulation (DIC) is associated with consumption of clotting factors, leading to prolonged clotting times, such as increased prothrombin time (PT) and activated partial thromboplastin time (aPTT), rather than decreased.

Choice B:

DIC does not typically cause an increase in hemoglobin (Hgb) levels; in fact, it may lead to anemia due to blood loss and consumption of clotting factors.

Choice C:

DIC does not typically cause an increase in red blood cell (RBC) count; if anything, it can lead to anemia due to blood loss.

Choice D:

DIC is characterized by widespread activation of coagulation, leading to consumption of platelets and decreased platelet count, which can result in bleeding tendencies.

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Question 4:

A nurse is caring for a group of clients. Which of the following findings should the nurse report to the provider?

A. An 18-month-old toddler who has a heart rate of 68/min B. A school-age child who has a rectal body temperature of 37.3° C (99.1° F) C. An adolescent who has a BP of 132/82 mm Hg D. A 3-month-old infant who has a respiratory rate of 30/min

Answer and Explanation

Choice A:

A toddler who has a heart rate of 68/min is likely to have bradycardia, a slow heart rate that can affect oxygen delivery. Bradycardia could be caused by hypoxia, hypothermia, or cardiac problems. The nurse should report this finding to the provider immediately.

Choice B:

This temperature is within the normal range, so it does not require reporting.

Choice C:

This blood pressure is within the normal range for an adolescent, so it does not require reporting.

Choice D:

The normal respiratory rate for a 3-month-old infant is 25 to 40/min.

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Monica: normal hr 88-156 bpm ~ 5mos ago

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Question 5:

A nurse is providing teaching about injury prevention to the parents of a toddler. Which of the following safety measures should the nurse include in the teaching?

A. Check clothing for loose buttons. B. Adjust the water heater temperature to 54° C (129.2° F). C. Place screens on all windows. D. Provide balloons for play.

Answer and Explanation

Choice A:

While it's important to ensure that clothing doesn't have small parts that could pose a choking hazard, loose buttons are not typically a significant safety concern.

Choice B:

Water heater temperature should be set to around 120°F (approximately 49°C) to prevent scalding burns, so adjusting it to 54°C (129.2°F) would pose a safety risk rather than prevent injury.

Choice C:

This is an important safety measure to prevent falls from windows, which can be a significant risk for toddlers.

Choice D:

Balloons pose a choking hazard for young children due to the risk of ingestion or aspiration, so they should not be provided as toys for toddlers.

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Question 6:

A nurse is providing discharge teaching to the guardian of a preschooler who had a tonsillectomy. Which of the following statements should the nurse include?

A. "Notify the provider if your child has dark brown blood between their teeth." B. "Encourage your child to drink liquids through a straw." C. "Notify the provider if your child is swallowing frequently." D. "Encourage your child to clear their throat as needed."

Answer and Explanation

Choice A:

Dark brown blood indicates old blood and is not a sign of active bleeding.

Choice B:

Drinking through a straw can increase the risk of bleeding after tonsillectomy, so it should be avoided.

Choice C:

Frequent swallowing may indicate discomfort or bleeding and should prompt notification of the healthcare provider.

Choice D:

Clearing the throat can also increase the risk of bleeding and should be discouraged after tonsillectomy.

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Question 7:

A nurse is providing teaching to the parent of a toddler who is scheduled for an electrocardiogram. Which of the following statements should the nurse make?

A. "Your child can rest on your lap during the procedure." B. "An alarm will sound if your child has an abnormal heart rhythm." C. "Leads will be placed on your child's back prior to the procedure." D. "This procedure will take at least 30 minutes to complete."

Answer and Explanation

Choice A:

Allowing the child to sit on the parent's lap can provide comfort and support during the procedure.

Choice B:

While the electrocardiogram (ECG) machine may have alarms, they are not typically related to abnormal heart rhythms during the procedure.

Choice C:

ECG leads are typically placed on the chest, not the back.

Choice D:

The duration of an ECG is relatively short, usually only a few minutes, so stating that it will take at least 30 minutes may cause unnecessary concern for the parent.

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Question 8:

A nurse is preparing to administer an enteral feeding to an adolescent who has an NG tube. Which of the following actions should the nurse take first?

A. Check the pH of the gastric secretions. B. Set the administration rate on the feeding pump. C. Flush the tube with water. D. Attach the feeding bag tubing to the end of the NG tube.

Answer and Explanation

Choice A:

This is the priority action to confirm the correct placement of the NG tube in the stomach before administering the enteral feeding.

Choice B:

This should only be done after confirming proper tube placement.

Choice C:

Flushing the tube is necessary, but it should occur after confirming placement.

Choice D:

This should occur after confirming proper tube placement.

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Question 9:

A nurse is teaching a newly licensed nurse about infant safety. Which of the following information should the nurse include in the teaching?

A. Place an infant who is 5 months old in a high chair to feed. B. Position a 1-month-old infant supine on a soft mattress. C. Provide an infant with a one-piece pacifier for non-nutritive sucking. D. Secure the infant's car seat behind an airbag

Answer and Explanation

Choice A:

Placing an infant who is 5 months old in a high chair to feed is unsafe because the infant might fall or choke.

Choice B:

Positioning a 1-month-old infant supine on a soft mattress increases the risk of sudden infant death syndrome (SIDS).

Choice C:

Providing a one-piece pacifier is a safe practice since it prevents the pacifier from breaking apart and causing a choking hazard.

Choice D:

Infants should be secured in car seats that are away from airbags. Securing the infant's car seat behind an airbag is dangerous because the airbag could injure or kill the infant in a crash.

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Question 10:

A nurse in an emergency department is caring for a toddler who has manifestations of epiglottitis. Which of the following actions should the nurse take first?

A. Obtain an x-ray of the child's neck B. Administer intravenous antibiotics C. Initiate droplet precautions D. Place intubation equipment at the bedside.

Answer and Explanation

Choice A:

Obtaining an x-ray of the child's neck may be necessary for diagnosis, but ensuring immediate safety and infection control measures take precedence.

Choice B:

Administering intravenous antibiotics is important in the treatment of epiglottitis but is not the immediate priority.

Choice C:

Initiating droplet precautions is crucial in this case to prevent the spread of infection to others but is not as important as securing the airway.

Choice D:

Placing intubation equipment at the bedside is the first priority because epiglottitis can cause airway obstruction and respiratory distress.

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ATI RN Paediatric nursing 2023

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