ATI RN
Pediatrics Baby Fell off Bed Questions Questions
Question 1 of 5
Which of the ff must the nurse consider when administering IV fluids to clients with hypertension?
Correct Answer: B
Rationale: When administering IV fluids to clients with hypertension, the nurse must closely monitor the site and progress of the infusion every hour to ensure proper hydration and detect any signs of complications such as infiltration or infection. Checking the blood pressure every hour, as in choice A, may not be necessary unless specifically indicated by the healthcare provider. Checking the progress of the infusion once a day, as in choice C, does not provide adequate monitoring for a client with hypertension who may be at higher risk for fluid volume overload. Checking the client's pulse rate every hour, as in choice D, is important but does not directly address the immediate monitoring needs related to the administration of IV fluids.
Question 2 of 5
A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because of which reason?
Correct Answer: A
Rationale: Regression in toilet training is a common behavior seen in young children, especially during times of stress or change, such as hospitalization. The child may revert to familiar behaviors, such as wearing diapers, as a way of seeking comfort and security during a stressful experience like being in the hospital. It is important for the nurse to reassure the parents that this regression is temporary and normal under the circumstances. By providing support and understanding, the child will likely return to their previous toilet training habits once they are back in their usual environment.
Question 3 of 5
The nurse is aware that a healthy newborn's respirations are:
Correct Answer: B
Rationale: A healthy newborn's respirations are typically irregular, abdominal, with a rate of 30-60 per minute, and tend to be shallow. Newborns have immature respiratory centers in their brain, leading to irregular breathing patterns compared to adults. Their breathing is usually abdominal due to their diaphragmatic breathing pattern. The normal respiratory rate for a newborn can fluctuate between 30-60 breaths per minute, with shallow breathing being characteristic of their physiology. Regular shallow breathing with occasional periods of apnea is considered normal in newborns and should not be a cause for concern.
Question 4 of 5
A client who has been taking prednisone to treat lupus erythematosus has discontinued the medication because of lack of funds to buy the drug. When the nurse becomes aware of the situation, which assessment is most important for the nurse to make first?
Correct Answer: B
Rationale: The most important assessment for the nurse to make first in this situation is the client's blood pressure. Abrupt discontinuation of prednisone, especially in a client with lupus erythematosus, can lead to adrenal insufficiency or an Addisonian crisis. Addisonian crisis can present with symptoms such as severe hypotension, fatigue, weakness, and even shock. Therefore, monitoring the client's blood pressure is crucial to assess for signs of adrenal insufficiency and to intervene promptly if needed. Once blood pressure is assessed, the nurse can then proceed to assess other parameters such as breath sounds, capillary refill, and the presence of a butterfly rash.
Question 5 of 5
A parent of an infant with colic tells the nurse, "All this baby does is scream at me; it is a constant worry." What is the nurse's best action?
Correct Answer: A
Rationale: The nurse's best action is to encourage the parent to verbalize their feelings. This allows the parent to express their emotions and concerns, which can be therapeutic and provide an opportunity for support and understanding. By acknowledging the parent's feelings and providing a listening ear, the nurse can help validate the parent's experiences and build a trusting relationship. Additionally, encouraging the parent to express their emotions can help them cope with the challenges of caring for a colicky infant and seek appropriate resources for support. It is important for the nurse to be empathetic and supportive towards the parent's feelings during this difficult time.