ATI RN
ATI Pediatrics Exam 1 Questions
Extract:
A client with a newly diagnosed spinal cord injury.
Question 1 of 5
When addressing the needs of a client with a newly diagnosed spinal cord injury, the nurse understands that which of the following are true about nutritional needs?
Correct Answer: B
Rationale:
Correct
Answer: B
Rationale:
1. High calorie, high protein diet supports tissue repair post-injury.
2. Protein aids in wound healing and muscle strength recovery.
3. Early initiation within 3 days prevents muscle wasting and malnutrition.
Choice Analysis:
A: Incorrect. NPO unnecessary unless surgery required.
C: Incorrect. High fiber may cause bowel issues; protein crucial for healing.
D: Incorrect. Low fiber and no protein hinder recovery and wound healing.
Extract:
A 67-year-old male patient with early stage Alzheimer's disease whose spouse reports exhaustion and worry.
Question 2 of 5
The spouse of a 67-yr-old male patient with early stage Alzheimer's disease (AD) tells the nurse, 'I am exhausted from worrying all the time. I don't know what to do.' Which actions are best for the nurse to take at this time? Select All that Apply
Correct Answer: A,C
Rationale:
Correct
Answer: A, C
Rationale:
A: Asking the spouse about dementia care options shows empathy and provides valuable information tailored to their needs.
C: Teaching about adult day care offers respite care options, alleviating caregiver burden.
B: Suggesting placement may not be appropriate at this stage and can be distressing.
D: Antianxiety drugs should be a last resort and require medical evaluation, not a nurse's suggestion.
E: Offering distraction techniques is helpful but may not address the spouse's need for respite care.
Extract:
A client with partial paralysis repositioned to a side-lying position.
Question 3 of 5
A client who suffered partial paralysis is repositioned by the nurse every 2 hours. After placing the client in a side-lying position, what action will nurse take to prevent complications?
Correct Answer: C
Rationale: The correct answer is C: Place a pillow between the knees and ankles. Placing a pillow between the knees and ankles helps to maintain proper alignment of the lower extremities, reducing pressure on bony prominences and preventing skin breakdown and contractures. This position also promotes comfort and circulation.
A: Measuring the calves for symmetry is not directly related to preventing complications from immobility.
B: Palpating the bladder is important for assessing urinary retention but not specifically related to preventing complications from immobility.
D: Checking the gag reflex is unrelated to repositioning a partially paralyzed client.
Therefore, choice C is the most appropriate action to prevent complications in this scenario.
Extract:
A client with a new spinal cord injury and an indwelling urinary catheter that has stopped flowing.
Question 4 of 5
A nurse caring for a client with a new spinal cord injury notices that the indwelling urinary catheter has stopped flowing. What is the nurses best first action?
Correct Answer: B
Rationale: The correct answer is B: Check the tubing. This is the best first action because it allows the nurse to assess for any kinks, obstructions, or blockages in the tubing that may be causing the urine flow to stop. By checking the tubing first, the nurse can troubleshoot and potentially resolve the issue without needing to escalate to notifying the physician or performing more invasive procedures like removing or replacing the catheter. Removing or replacing the catheter should only be considered if checking the tubing does not resolve the issue. Notifying the physician would be premature without first assessing the tubing.
Extract:
A client hospitalized with Guillain-Barre Syndrome.
Question 5 of 5
When planning care for a client hospitalized with Guillain-Barre Syndrome, which of the following will the nurse report to the physician?
Correct Answer: C
Rationale: The correct answer is C: Hypoactive bowel sounds. In Guillain-Barre Syndrome, autonomic dysfunction can lead to ileus, causing hypoactive bowel sounds. This can indicate a potential complication like paralytic ileus, which requires immediate medical attention. Reporting this to the physician allows for prompt assessment and intervention to prevent further complications.
Choices A, B, and D are incorrect as they are not directly related to Guillain-Barre Syndrome or immediate concerns requiring physician notification.