ATI RN
Burns Pediatric Primary Care Test Bank Questions
Question 1 of 5
Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?
Correct Answer:
Rationale: Acute glomerulonephritis is characterized by inflammation of the glomeruli in the kidneys, leading to decreased plasma filtration. As a result, fluid volume excess occurs due to impaired kidney function in regulating the fluid balance. Symptoms may include hypertension, edema, weight gain, and oliguria. Therefore, the most appropriate nursing diagnosis for a child with acute glomerulonephritis would be "Fluid Volume Excess related to decreased plasma filtration". This diagnosis focuses on the pathophysiological process of the condition and helps guide nursing interventions aimed at managing fluid volume overload.
Question 2 of 5
As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in which nutrient?
Correct Answer: B
Rationale: The diuretic furosemide (Lasix) can cause the loss of potassium in the body through increased urination. Potassium is an important mineral that helps maintain normal heart function. Therefore, it is essential to consume foods rich in potassium, such as bananas, oranges, and leafy vegetables, to prevent potassium deficiency (hypokalemia) and support heart health, especially in individuals taking diuretics for conditions like heart failure.
Question 3 of 5
Which type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?
Correct Answer: D
Rationale: Anaphylactic shock is characterized by a severe, systemic hypersensitivity reaction that can occur in response to allergens such as certain drugs or latex. During anaphylactic shock, the body releases large amounts of histamine and other inflammatory substances, leading to widespread vasodilation (dilation of blood vessels) and increased capillary permeability. This results in a rapid drop in blood pressure, decreased perfusion to vital organs, and potential life-threatening symptoms such as difficulty breathing and cardiovascular collapse. Immediate treatment with epinephrine and supportive measures such as intravenous fluids is crucial in managing anaphylactic shock.
Question 4 of 5
A client has been diagnosed with renal failure and is admitted for dialysis. Which of the ff is the nurse's responsibility as the client undergone dialysis?
Correct Answer: C
Rationale: The nurse's responsibility during dialysis includes weighing the client before and after the procedure. This is important to monitor the amount of fluid removed during dialysis and to ensure that the client's fluid balance is managed properly. It helps in determining the effectiveness of dialysis treatment in removing excess fluid from the body. Keeping the client's fluid balance in check is crucial in managing renal failure and preventing complications such as fluid overload. Therefore, monitoring the client's weight before and after dialysis is a key responsibility of the nurse in this situation.
Question 5 of 5
A college student goes to the college clinic and asks the best way to avoid contracting an STD. The nurse provides the clinic's standard STD teaching. Which statement by the student indicates the need for additional instruction?
Correct Answer: D
Rationale: The statement "If I question my partner about past sexual encounters, I can avoid STDs" indicates a need for additional instruction. While communication with a partner about sexual history is important, relying solely on questioning a partner is not a foolproof method of avoiding STDs. Some individuals may not disclose their complete sexual history or may be unaware that they have an STD. It is crucial to emphasize the importance of using protection such as condoms consistently and correctly, getting tested regularly, and practicing safe sex in general.