ATI RN
Pediatric Respiratory Assessment Nursing Questions
Question 1 of 5
As you receive a report, which assessment finding should you recognize as an indication of a vaginal laceration?
Correct Answer: C
Rationale: Lacerations of the birth canal should always be suspected if excessive bleeding continues when the fundus is firm. Bleeding from the genital tract often is bright red, in contrast to the darker red color of lochia. A firm fundus, pulse of 90 bpm, blood pressure of 110/78 mm Hg, and being medicated twice in one shift are common findings in the postpartum patient.
Question 2 of 5
An infant at 39 weeks' gestation was just delivered; included in the protocol for a term infant is an initial blood glucose assessment. The nurse obtains the blood sample and the reading is 58 mg/dL. What is the priority nursing action based upon this reading?
Correct Answer: A
Rationale: A blood glucose reading of 58 mg/dL in a term infant is within the normal range (50 to 90 mg/dL). Therefore, the priority nursing action would be to document the finding in the newborn's chart. No further interventions or notifications are necessary as the glucose level is appropriate for a term infant.
Question 3 of 5
The nurse is assessing a newborn delivered 24 hours ago for jaundice. What is the best way to evaluate for this finding?
Correct Answer: A
Rationale: The best way to evaluate for jaundice in a newborn is by pressing the infant's skin over a firm surface, such as the end of the nose or the sternum. Jaundice is identified by the yellow color that remains when the skin is pressed and blanches. This method is effective in detecting jaundice, which becomes visible when the bilirubin level is greater than 5 mg/dL. The other choices are not appropriate methods for evaluating jaundice.
Question 4 of 5
The parents require further teaching if they suggest that congenital hypothyroidism is not screened. The newborn screening tests are performed at 24 to 48 hours after birth. Newborn screening requires a blood sample taken from the infant's heel, and only one blood sample is needed for all tests. Tests performed within the first 24 hours of life are less sensitive than those performed after 24 hours. Infants tested before 12 to 24 hours of age should have repeat tests at 1 to 2 weeks of age so that disorders are not missed because of early testing.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 5 of 5
Which intervention will be most helpful to parents in identifying problems with an infant car seat?
Correct Answer: C
Rationale: The correct answer is C because observing the parents demonstrate the use of the car seat is the best way to identify any problems or misunderstandings. This allows for a hands-on assessment of their understanding. Questioning the parents may not reveal actual issues, providing laws does not ensure understanding, and allowing questions without a demonstration may not address potential errors. A return demonstration ensures comprehension and application of car seat safety.