ATI RN
Pediatric Nursing Practice Questions Questions
Question 1 of 5
A client who is receiving a blood transfusion begins to experience chills, shortness of breath, nausea, excessive perspiration, and a vague sense of uneasiness. What is the nurse's first best action?
Correct Answer: D
Rationale: The client is exhibiting signs of a transfusion reaction, most likely a hemolytic reaction. The first best action for the nurse to take in this situation is to immediately stop the blood transfusion to prevent further complications for the client. Once the infusion is stopped, the nurse can then proceed with assessing the client's vital signs, respiratory status, and other appropriate interventions. It is crucial to prioritize stopping the transfusion to ensure the client's safety and well-being.
Question 2 of 5
After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin'sdisease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. The nurse suspects that these finding result from:
Correct Answer: A
Rationale: The symptoms of fever, severe abdominal pain, and increasing confusion following a liver biopsy are indicative of a potential complication such as bleeding in the liver caused by the biopsy. Hepatic bleeding can lead to abdominal pain and can cause a change in the level of consciousness. These symptoms should prompt immediate medical attention to address the bleeding and prevent further complications. Perforation of the colon, an allergic reaction to contrast media, or normal post-procedural pain would not typically present with these specific symptoms in this context.
Question 3 of 5
A 35-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client?
Correct Answer: D
Rationale: According to the American Cancer Society guidelines, women with average risk for breast cancer should start getting mammograms every 2 years starting at age 40. Since the client is not considered at high risk for breast cancer, this recommendation applies to her. Regular mammograms are important for early detection of breast cancer, even in those at average risk. It is also important for the client to perform monthly breast self-exams and report any changes or concerns to her healthcare provider.
Question 4 of 5
A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which statement indicates an accurate understanding of appropriate ways to deal with this deficit?
Correct Answer: A
Rationale: Option A, "I'll play card games with my friends," indicates an accurate understanding of appropriate ways to deal with the deficit of deficient diversional activity related to decreased energy. Playing card games with friends can provide a social and mentally stimulating activity that can be easily modified based on the client's energy levels. It also promotes social interaction and emotional support, which are important aspects of diversional activities for individuals undergoing chemotherapy. This option aligns well with addressing the nursing diagnosis by engaging in a low-energy but potentially enjoyable activity that can help combat feelings of isolation and boredom.
Question 5 of 5
A client with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?
Correct Answer: A
Rationale: Tamoxifen (Nolvadex) is associated with the potential side effect of retinopathy, which can present as changes in vision. Retinopathy is a serious condition that can lead to vision loss. Therefore, it is crucial for the client to report any vision changes immediately to their healthcare provider for further evaluation and management. Reporting this adverse reaction promptly can help prevent serious complications and ensure the client's safety and well-being.