ATI RN
Wongs Essentials of Pediatric Nursing 11th Edition Test Bank Questions
Question 1 of 5
Decreasing level of consciousness is a symptom of which of the following physiological phenomena?
Correct Answer: A
Rationale: A decreasing level of consciousness is a symptom often associated with increased intracranial pressure (ICP). When the pressure inside the skull rises, it can compress and damage the brain, leading to a deterioration in consciousness. Common causes of increased ICP include traumatic brain injury, brain tumors, and infections. As ICP continues to rise, it can result in serious consequences such as brain herniation, which can be life-threatening if not promptly managed. Therefore, a decreasing level of consciousness should raise concerns about increased ICP and warrant immediate medical evaluation and intervention.
Question 2 of 5
A nurse has been examining the vital signs of the client for the past 2 days. On a particular day, she observe a sudden change in the vital signs of the client. Which of the ff steps should the nurse take immediately?
Correct Answer: A
Rationale: The nurse should immediately inform the physician about the sudden change in the client's vital signs. Sudden changes in vital signs can be indicative of a serious health issue or medical emergency that would require the expertise and intervention of a physician. Prompt communication with the physician is essential to ensure timely assessment, diagnosis, and appropriate treatment for the client. It is crucial to prioritize the client's well-being and safety in such situations, which is why informing the physician is the most appropriate and urgent step to take.
Question 3 of 5
Why does emotional counselling or helping the client perform common daily activities become important nursing care interventions in clients with Parkinson's or Huntington's diseases, or even epilepsy?
Correct Answer: A
Rationale: Emotional counseling and helping with common daily activities are important nursing care interventions for clients with neurologic diseases such as Parkinson's, Huntington's, and epilepsy because these clients often experience depression, anxiety, and difficulty performing basic self-care tasks. These diseases can have a significant impact on the client's mental health, leading to feelings of helplessness and loss of independence. Providing emotional support and assistance with daily activities can help improve the client's overall well-being and quality of life. Additionally, these interventions can also help prevent complications such as complications such as pressure sores, infections, and malnutrition that may arise from the inability to perform self-care tasks independently.
Question 4 of 5
The client is taking phenyton (Dilantin) for seizure control. A sample is drawn to determine the serum drug level, and the nurse reviews the results. Which of the following would indicate a therapeutic serum drug range?
Correct Answer: A
Rationale: The therapeutic serum drug range for phenytoin (Dilantin) is typically considered to be 10 to 20 mcg/ml. However, some sources may cite a broader range of 5 to 20 mcg/ml. Therefore, a serum drug level range of 5 to 10 mcg/ml would fall within the acceptable therapeutic range for phenytoin. Serum levels outside of this range may indicate potential toxicity (above range) or subtherapeutic levels (below range) which could result in inadequate seizure control.
Question 5 of 5
Which of the following would the nurse use to document a finding that the patient's ear is draining?
Correct Answer: A
Rationale: Otorrhea is the medical term used to describe drainage from the ear. It is a finding that indicates the ear is draining fluid, which can be a sign of infection or other underlying issues. Otalgia refers to ear pain, ototoxic refers to substances that can damage the ear, and tinnitus refers to ringing in the ears. Therefore, otorrhea is the most appropriate term to document the finding of a draining ear.