ATI RN
ATI Pediatrics Test Bank Questions
Question 1 of 5
A few minutes after beginning a blood transfusion, the nurse notes that the client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem?
Correct Answer: A
Rationale: The client is likely experiencing a hemolytic reaction to mismatched blood due to the symptoms of chills, dyspnea, and urticaria occurring shortly after beginning the blood transfusion. These symptoms are classic signs of a transfusion reaction, especially a hemolytic reaction where the recipient's immune system attacks the transfused red blood cells. This can happen if the donor blood is not compatible with the recipient's blood type, leading to a severe reaction. It is crucial to report this immediately to the physician to halt the transfusion and provide appropriate treatment to the client.
Question 2 of 5
A client requires minor surgery for removal of a basal cell tumor. The anesthesiologist administers the anesthetic ketamine hydrochloride (Ketalar), 60g IV. After Ketamine administration, the nurse should monitor the client for:
Correct Answer: A
Rationale: Ketamine hydrochloride (Ketalar) is a dissociative anesthetic that can cause muscle rigidity and spasms as a side effect. This is known as a dose-dependent reaction to ketamine administration. Monitoring for muscle rigidity and spasms is important to ensure the client's safety and to provide appropriate management if this adverse effect occurs. It is essential for the nurse to closely observe the client for any signs of muscle rigidity and spasms after the administration of ketamine.
Question 3 of 5
A nurse is working with a dying client and his family. Which communication technique is most important to use?
Correct Answer: D
Rationale: Active listening is the most important communication technique to use when working with a dying client and their family. This technique involves the nurse fully concentrating, understanding, responding, and remembering what is being said. By actively listening, the nurse can provide empathy, support, and validation to the client and their family members during this emotionally challenging time. This technique helps in creating a safe and supportive environment for honest and open communication, allowing the nurse to assess and address the needs and concerns of both the client and their family effectively.
Question 4 of 5
While receiving radiation therapy for the treatment of breast cancer, a client complains of dysphagia and skin texture changes, at the radiation site. Which of the following instructions would be most appropriate to suggest to minimize the risk of complications, and promote healing?
Correct Answer: B
Rationale: Eating a diet high in protein and calories to optimize tissue repair would be the most appropriate instruction to suggest in this scenario. Dysphagia (difficulty swallowing) and skin texture changes can occur as side effects of radiation therapy for breast cancer. Protein is essential for tissue repair, while calories provide the necessary energy for the body to heal. By consuming a diet high in protein and calories, the client can support their body's healing process, minimize the risk of complications, and promote healing at the radiation site. It is important to note that maintaining proper nutrition is crucial during cancer treatment to support overall health and well-being.
Question 5 of 5
Which of the ff nursing interventions would a nurse perform to avoid maceration from irritating drainage or the wound compresses in a client with breast abscess?
Correct Answer: A
Rationale: Applying zinc oxide to the surrounding skin can help protect it from becoming macerated due to irritating drainage or wound compresses. Zinc oxide acts as a barrier that helps prevent moisture from affecting the skin, thus reducing the risk of maceration. It provides a protective layer and promotes healing by keeping the affected area dry and free from further irritation. It is an effective intervention to maintain skin integrity and promote optimal wound healing in clients with a breast abscess.