ATI RN
Essential of Pediatric Nursing Test Bank Questions
Question 1 of 5
Which of the ff. statements, if made by a patient with hypertension, indicates to a nurse a need for more teaching?
Correct Answer: C
Rationale: Option C, "Medication will no longer be needed when I feel better," indicates a need for more teaching by the nurse. This statement shows a misunderstanding regarding hypertension management. Hypertension is a chronic condition that often requires long-term treatment with medications even if the patient feels better. The patient should be educated on the importance of continued medication adherence to effectively manage their hypertension and prevent complications. Options A, B, and D demonstrate understanding of hypertension and its management, indicating that more teaching is not necessary in those areas.
Question 2 of 5
Correct method of mouth to mouth respiration is that the victim's chin is held:
Correct Answer: D
Rationale: When performing the correct method of mouth-to-mouth respiration, it is essential to ensure that the victim's chin is held downward. This helps to properly open the airway, allowing for effective ventilation. By tilting the head back and holding the chin downward, you are able to align the victim's airway to allow the entry of air into the lungs during rescue breathing. Holding the chin in a downward position also helps prevent any obstruction that may hinder the flow of air. Remember to also pinch the victim's nose closed while giving breaths to ensure that the air goes into their lungs.
Question 3 of 5
A woman sees her primary care provider because of extreme fatigue for the past 2 months; she difficulty lifting even light objects. Her physician suspects myasthenia gravis. Which of the ff. tests should the nurse anticipate to confirm this diagnosis?
Correct Answer: D
Rationale: The Tensilon test is used to confirm the diagnosis of myasthenia gravis, a condition characterized by muscle weakness and fatigue. In this test, the medication Tensilon (also known as edrophonium) is administered intravenously. If the patient has myasthenia gravis, there will be a rapid but temporary improvement in muscle strength after the Tensilon injection. This response helps to differentiate myasthenia gravis from other causes of muscle weakness. The other options mentioned (Mestinon test, pulmonary function studies, and quinine tolerance test) do not specifically confirm the diagnosis of myasthenia gravis.
Question 4 of 5
Which of the ff actions should the nurse perform before a client with impaired physical mobility gets up?
Correct Answer: A
Rationale: Before a client with impaired physical mobility gets up, the nurse should ensure that the appropriate assistive device is available and properly set up for the client to use. Using parallel bars or a walker provides support and stability, helping the client maintain balance and prevent falls while standing and walking. This would be the most suitable action to take before assisting the client in getting up to ensure their safety and mobility. Applying incontinence pads, an abdominal binder, or using a footboard are not directly related to the immediate need of assisting the client with impaired physical mobility in getting up.
Question 5 of 5
The client with epilepsy is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/ml. Which of the following symptoms would be expected as a result of this laboratory result?
Correct Answer: A
Rationale: A phenytoin blood level of 35 mcg/ml is considered to be above the therapeutic range (usually 10-20 mcg/ml for phenytoin). At this elevated level, the client is at risk for phenytoin toxicity. Symptoms of phenytoin toxicity include nystagmus (rapid, involuntary eye movements), as well as other symptoms such as confusion, slurred speech, ataxia, and tremors. Tachycardia is not typically associated with phenytoin toxicity. Therefore, the expected symptom in this case would be nystagmus.