ATI RN
Pediatric Nursing Practice Questions Questions
Question 1 of 5
A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?
Correct Answer: A
Rationale: Chronic hyperparathyroidism can lead to excessive bone demineralization due to increased levels of parathyroid hormone. This can weaken the bones and increase the risk for pathologic fractures. Therefore, the most appropriate "related-to" phrase to add to the nursing diagnosis of Risk for injury for a client with chronic hyperparathyroidism would be bone demineralization resulting in pathologic fractures. This accurately reflects the potential risk for injury associated with the client's condition.
Question 2 of 5
Clients who will go through operations and who have undergone surgery need the proper observation, treatment and care. Implementing the nursing process to these patients will help reduce complications. Nurse Maria checks on Mr. Alberto who had abdominal surgery, and finds that the edges of the incision have separated. Also, a small portion of the bowel is sticking out through the incision. Nurse Maria would:
Correct Answer: A
Rationale: Nurse Maria should immediately cover the wound with a moist sterile dressing to protect the exposed tissue and prevent infection. This action will help maintain the moisture needed for wound healing and reduce the risk of further complications. It is important to cover the exposed area to prevent any external contaminants from entering the wound, while also keeping the area moist to promote healing. It is crucial to seek medical attention promptly to address the situation and ensure proper care for the patient.
Question 3 of 5
Mrs. Tan was prescribed with nitroglycerin. Nurse Amalia teaches her about the common side effect of the drug which includes:
Correct Answer: D
Rationale: Nitroglycerin is commonly known to cause a side effect of throbbing headache. Nitroglycerin works by dilating blood vessels to improve blood flow to the heart, which can sometimes lead to headaches due to the sudden increase in blood flow. This headache is often described as throbbing and can be quite bothersome. It is important for patients taking nitroglycerin to be aware of this common side effect and to consult their healthcare provider if the headaches become severe or persistent.
Question 4 of 5
In giving health instructions, the nurse should infrom the client about the risk fsctors associated with coronary artery disease. Which of the following controllable risk factors is closely linked to the development of MI?
Correct Answer: B
Rationale: High cholesterol levels are closely linked to the development of myocardial infarction (MI), also known as a heart attack. Elevated levels of cholesterol in the blood can lead to the buildup of plaque in the coronary arteries, causing atherosclerosis. This buildup can restrict blood flow to the heart muscle, potentially resulting in a heart attack. Managing and controlling cholesterol levels through lifestyle changes and medications can help reduce the risk of MI.
Question 5 of 5
Emil, just had a thyroidectomy this morning. Upon awakening, he complains of circumoral tingling, has a positive Chvostek's sign and positive Trousseau's sign. Nurse Ofel assesses this to be an indication of:
Correct Answer: A
Rationale: The symptoms Emil is experiencing, such as circumoral tingling, positive Chvostek's sign (facial muscle spasm when the facial nerve is tapped), and positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated), are characteristic signs of hypocalcemia. Hypocalcemia commonly occurs after thyroidectomy due to inadvertent damage or removal of the parathyroid glands. These glands regulate calcium levels in the body by secreting parathyroid hormone (PTH). Therefore, the symptoms Emil is exhibiting are likely due to the overstimulation of the parathyroid hormone in response to decreased calcium levels after the thyroidectomy. Insufficient iodine intake or overuse of radioactive iodine gland would not be the most likely explanations for his symptoms.