ATI RN
ATI Nur 223a Sect 4 Pediatrics Final Exam Questions
Extract:
Nurses Notes: 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. Vital Signs 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. Physical Examination Results 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. Diagnostic Results 0900: Chest X-ray: Hyperinflation of lungs, no focal consolidation. Blood gas analysis: pH 7.35, PaCO2 45 mmHg, PaO2 60 mmHg, HCO3 24 mEq/L. 1200: Chest X-ray: No significant change from previous. Blood gas analysis: pH 7.38, PaCO2 42 mmHg, PaO2 75 mmHg, HCO3 24 mEq/L. Provider's Prescriptions 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.
Question 1 of 5
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)
Correct Answer: C,D,F
Rationale: The correct answer is C, D, and F. Oxygen saturation, respiratory rate, and breath sounds in bilateral bases are key indicators of effective treatment in pediatric patients. Oxygen saturation reflects adequate oxygenation, respiratory rate indicates proper breathing effort, and clear breath sounds suggest improved lung function. Nasal flaring and retractions signify respiratory distress, pulse and heart rate can be affected by various factors not directly related to treatment effectiveness.
Therefore, choices A, B, E, and G are not reliable indicators of treatment efficacy in this context.
Extract:
Nurses Notes (0700 hrs): 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. Vital Signs (0700 hrs): Temperature: 37.7°C (99.9°F), Pulse rate: 98/min, Respiratory rate: 22/min, Blood pressure: 124/64 mm Hg, Oxygen saturation: 99% on room air. Diagnostic Results (0700 hrs): CBC and C-Reactive Protein drawn and sent to lab. Nurses Notes (0800 hrs): 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. Vital Signs (0800 hrs): Temperature: 38.1°C (100.6°F), Pulse rate: 102/min, Respiratory rate: 24/min, Blood pressure: 126/68 mm Hg, Oxygen saturation: 98% on room air. Diagnostic Results (0800 hrs): WBC count: 22,000/mm³, RBC count: 4.5 million/mm³, Hgb: 14 g/dL, Hct: 44%, Platelets: 350,000/mm³, C-Reactive Protein: 11.8 mg/dL.
Question 2 of 5
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?
Correct Answer: B,D,E,F
Rationale: The correct answer is B, D, E, and F.
B: Obtaining informed consent for surgery is essential after notifying the provider of assessment data and lab results, as it indicates the provider may have ordered a surgical procedure based on the information provided.
D: Initiating IV antibiotics may be necessary based on the assessment data and lab results to treat a possible infection or prevent complications.
E: Maintaining NPO status may be required before surgery or certain procedures to prevent aspiration and ensure the client's safety.
F: Obtaining an abdominal ultrasound may be indicated based on the assessment data and lab results to further assess the client's condition.
Incorrect choices:
A: Giving promethazine is not indicated based solely on assessment data and lab results.
C: Administering acetaminophen is not a priority based on the information provided.
G: Administering enemas until clear is not indicated without further assessment or provider orders.
Extract:
Vital Signs (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%. Medication Administration Record (0700 hrs): Furosemide 40 mg IV every 6 hr. Administered at 0600. Digoxin 250 mcg IV now. Administered at 0600. Physical Examination Results (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. Diagnostic Results (0700 hrs): Chest X-ray: Cardiomegaly noted. Echocardiogram: Left ventricular hypertrophy, mitral valve stenosis. BNP: 1200 pg/mL.
Question 3 of 5
Based on the information provided, what is the most appropriate initial nursing action?
Correct Answer: D
Rationale: The most appropriate initial nursing action is to reposition the client to a high Fowler's position (choice
D). This position helps improve oxygenation by maximizing lung expansion. It facilitates better airflow and oxygen exchange in the lungs, making it crucial for clients experiencing respiratory distress. Increasing the oxygen flow rate (choice
A) can be done after repositioning the client. Administering an additional dose of furosemide (choice
B) is not appropriate without further assessment. Notifying the healthcare provider (choice
C) can be done after addressing the immediate need for improved oxygenation through repositioning.
Extract:
Medical History: Diagnosis: Bilateral pneumonia, Past medical history: Cystic fibrosis, Plan: Aggressive airway clearance therapy, intravenous antibiotic therapy. Nurses Notes: 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. Vital Signs: 0700 hrs: Oral temperature: 39.1°C (102.4°F), Heart rate: 116/min, Respiratory rate: 32/min, Blood pressure: 102/60 mm Hg, Oxygen saturation: 95% on room air. 0900 hrs: Oral temperature: 38.1°C (100.6°F), Heart rate: 128/min, Respiratory rate: 32/min, Blood pressure: 88/48 mm Hg, Oxygen saturation: 88% on room air. Diagnostic Results: 0900 hrs: Chest X-ray: Bilateral infiltrates consistent with pneumonia, CBC: WBC: 15,000/mm³, Hemoglobin: 11 g/dL, Platelets: 250,000/mm³.
Question 4 of 5
Which of the following assessment findings should the nurse report to the provider? (Select all that apply)
Correct Answer: A,B,E
Rationale: The correct answers are A, B, and E. A low oxygen saturation of 88% on room air indicates poor oxygenation, which is a critical finding that should be reported to the provider promptly. A heart rate of 128/min is elevated and may indicate distress or an underlying issue that requires attention. Passing three large, frothy, foul-smelling stools can be a sign of gastrointestinal distress or infection, which also requires further evaluation. These findings indicate potential respiratory, cardiovascular, and gastrointestinal issues that need immediate medical attention.
Choices C and D are not immediate concerns that require urgent reporting to the provider.
Extract:
Vital Signs (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. Nurse's Notes (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. Diagnostic Results (0700 hrs): Rapid RSV antibody test: Positive (per nasal swab), Blood culture: Pending, Hgb: 10 g/dL, Hct: 40%, WBC: 10,000/mm³, Platelets: 230,000/mm³, Glucose: 82 mg/dL, BUN: 18 mg/dL. Medication Administration Record (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.
Question 5 of 5
Which of the following findings should the nurse identify as an indication that the treatment plan is effective? (Select all that apply.)
Correct Answer: C,D,E
Rationale: The correct answers are C, D, and E.
C: Oxygen saturation indicates how well the patient is oxygenating. An increase in oxygen saturation signifies improved oxygen levels, indicating treatment effectiveness.
D: Clear breath sounds in bilateral bases suggest proper airflow in the lungs, indicating treatment success.
E: A decrease in respiratory rate indicates that the patient is breathing more comfortably due to treatment efficacy.
Incorrect choices:
A: Nasal flaring and B: Retractions are signs of respiratory distress and would suggest that the treatment plan is not effective.
F: Heart rate alone does not directly indicate respiratory treatment effectiveness.
In summary, the correct choices directly reflect improvements in oxygenation, lung function, and respiratory effort, while the incorrect choices signify respiratory distress or are not specific indicators of respiratory treatment effectiveness.