ATI RN
ATI Pediatrics Exam 1 Questions
Extract:
A client with partial paralysis repositioned to a side-lying position.
Question 1 of 5
A client who suffered partial paralysis is repositioned by the nurse every 2 hours. After placing the client in a side-lying position, what action will nurse take to prevent complications?
Correct Answer: C
Rationale: The correct answer is C: Place a pillow between the knees and ankles. Placing a pillow between the knees and ankles helps to maintain proper alignment of the lower extremities, reducing pressure on bony prominences and preventing skin breakdown and contractures. This position also promotes comfort and circulation.
A: Measuring the calves for symmetry is not directly related to preventing complications from immobility.
B: Palpating the bladder is important for assessing urinary retention but not specifically related to preventing complications from immobility.
D: Checking the gag reflex is unrelated to repositioning a partially paralyzed client.
Therefore, choice C is the most appropriate action to prevent complications in this scenario.
Extract:
A client with deficits from a spinal cord injury with an O2 saturation of 92%.
Question 2 of 5
After assessing a client with deficits from a spinal cord injury, the nurse identifies the client's O2 saturation is 92%. Which of the following is the best first action by the nurse?
Correct Answer: B
Rationale: The correct answer is B: Ask client to cough, then inhale and exhale deeply. This is the best first action as it helps to increase ventilation and oxygen exchange in the lungs, potentially improving oxygen saturation. Anticipating intubation (choice
A) is premature and invasive without further assessment. Inserting an IV catheter (choice
C) is not directly related to addressing the oxygen saturation concern. Administering antihypertensives (choice
D) is not indicated for low O2 saturation. Asking the client to cough and breathe deeply is a non-invasive, immediate intervention that can improve oxygenation levels.
Extract:
A client with a spinal cord injury reporting hot, burning, tingling pain shooting down extremities.
Question 3 of 5
A client with a spinal cord injury reports hot, burning, tingling, pain that shoots down his extremities. When the client asks why this occurs, what is the nurse's best response?
Correct Answer: C
Rationale: The correct answer is C because hot, burning, tingling pain shooting down the extremities is a common symptom of nerve damage in the spinal cord, known as neuropathic pain. This type of pain is often experienced by individuals with spinal cord injuries due to disrupted nerve signals. Repositioning (choice
A) would not address the underlying cause of the pain.
Choice B is incorrect as it suggests an ongoing inflammatory process, which is not typically associated with this type of pain.
Choice D is incorrect as neuropathic pain is chronic and may not resolve quickly.
Extract:
A client diagnosed with trigeminal neuralgia.
Question 4 of 5
The nurse is caring for a client diagnosed with trigeminal neuralgia. The client asks the nurse, 'Why do I have so much pain?' Which of the following responses by the nurse is most appropriate?
Correct Answer: D
Rationale: The correct answer is D because trigeminal neuralgia is characterized by episodes of severe facial pain due to stimulation of the trigeminal nerve by pressure or temperature. This explanation directly addresses the client's question about the source of their pain.
Choice A is incorrect as nasal stuffiness is not directly related to trigeminal neuralgia pain.
Choice B is incorrect as hypoglycemia does not affect the cranial nerve in this manner.
Choice C is incorrect as catecholamines do not play a direct role in trigeminal neuralgia pain. A logical and precise response is crucial in providing the client with an accurate understanding of their condition.
Extract:
A client with a spinal cord injury.
Question 5 of 5
After performing an assessment on a client with a spinal cord injury, which intervention will the nurse employ to prevent cardiovascular complications?
Correct Answer: A
Rationale: The correct answer is A: Sit the client at a 90-degree angle. This intervention helps prevent orthostatic hypotension in clients with spinal cord injuries by improving venous return and maintaining blood pressure. Sitting at a 90-degree angle promotes proper circulation and reduces the risk of cardiovascular complications. Administering 2000 liters of fluid (
B) is excessive and not indicated. Applying compression socks (
C) may help with venous return but is not specific to preventing cardiovascular complications in spinal cord injury clients. Maintaining blood pressure exactly at 110/80 (
D) is not feasible or necessary for all clients with spinal cord injuries.