ATI RN
Wongs Essentials of Pediatric Nursing 11th Edition Test Bank Questions
Question 1 of 5
When performing nursing care for a neonate after a birth, which intervention has the highest nursing priority?
Correct Answer: C
Rationale: The highest nursing priority when performing nursing care for a neonate after birth is giving the vitamin K injection. Vitamin K is essential for blood clotting, and neonates are born with low levels of this vitamin, putting them at risk for bleeding disorders. Administering the vitamin K injection helps prevent serious bleeding complications such as Vitamin K Deficiency Bleeding (VKDB). It is crucial to give this injection as soon as possible after birth to ensure the neonate receives adequate protection. Covering the neonate's head with a cap may help maintain body temperature but is not as critical as administering the vitamin K injection. Obtaining a dextrostix or giving the initial bath are important aspects of newborn care but do not take precedence over the administration of vitamin K.
Question 2 of 5
The pediatric nurse prepares a patient, who is newly paralyzed, for discharge. The patient will require home care, ancillary therapies, complex medication regimens, and would benefit from a peer support group. To ensure adequate preparation for discharge and transition to home life, the nurse will:
Correct Answer: A
Rationale: Organizing a care conference ensures all aspects of the patient's care are addressed and coordinated effectively.
Question 3 of 5
Which of the ff symptoms should a nurse assess in a client when implementing interventions for trauma to the upper airway?
Correct Answer: D
Rationale: When implementing interventions for trauma to the upper airway, it is crucial for the nurse to assess for the presence of laryngospasm. Laryngospasm is a sudden spasm of the vocal cords that may cause difficulty breathing and in severe cases, complete airway obstruction. It is a serious and potentially life-threatening complication that can occur following upper airway trauma. Therefore, prompt recognition and treatment of laryngospasm are essential to ensure adequate oxygenation and ventilation for the client. Pain when talking, increased nasal swelling, and burning in the throat may also be symptoms encountered in upper airway trauma, but the presence of laryngospasm signifies a more critical condition requiring immediate intervention.
Question 4 of 5
The nurse is caring for a patient, age 68, who is receiving digoxin (Lanoxin) 0.125 mg qd for cardiac myopathy. Which of the following assessments of the patient would indicate that he is experiencing a side effect of digoxin that requires follow-up?
Correct Answer: B
Rationale: Anorexia, or loss of appetite, is a common side effect of digoxin. It can lead to weight loss, weakness, and fatigue. Monitoring for anorexia is important because it may indicate digoxin toxicity, which can be serious and require intervention. Skin flushing is not a common side effect of digoxin. Hypertension is also not associated with digoxin use. Constipation is generally not a common side effect of digoxin. Therefore, anorexia is the assessment that indicates a potential side effect of digoxin that requires follow-up.
Question 5 of 5
A nurse has completed an assessment on a newborn. Which finding is considered abnormal?
Correct Answer: A
Rationale: Nystagmus refers to involuntary and repetitive eye movements. It is considered abnormal in a newborn as it may be a sign of a neurological or visual problem. Therefore, if a nurse observes nystagmus during a newborn assessment, it should be further investigated and discussed with a healthcare provider to determine the underlying cause and appropriate management. Profuse drooling, dark green or black stools, and slight vaginal reddish discharge are common findings in newborns and do not typically indicate a serious health issue.