ATI RN
ATI RN Pediatric Nursing 2023 Exam 3 Questions
Extract:
Question 1 of 5
A nurse is assessing a 7-year-old child who has diabetes mellitus. Which of the following findings should the nurse identify as a manifestation of hypoglycemia?
Correct Answer: B
Rationale: The correct answer is B: Shakiness. Hypoglycemia in a child with diabetes mellitus can cause the body to release stress hormones like adrenaline, leading to symptoms such as shakiness, sweating, and palpitations. This is due to the low blood sugar levels affecting the brain's glucose supply, causing these physical manifestations. Increased capillary refill (choice
A) is more indicative of dehydration. Thirst (choice
C) is a symptom of hyperglycemia, not hypoglycemia. Decreased appetite (choice
D) can occur with both high and low blood sugar levels but is not a specific manifestation of hypoglycemia in this context.
Question 2 of 5
A nurse is planning care for a child who is in the acute stage of nephrotic syndrome. Which of the following interventions should the nurse include in the plan of care?
Correct Answer: A
Rationale: The correct answer is A: Weigh the child once per day. In nephrotic syndrome, monitoring weight daily is crucial to assess fluid status and response to treatment. Weight gain indicates fluid retention, a common complication. Positioning the child supine (
B) is not relevant. Calorie intake should be sufficient to meet increased metabolic demands, so limiting it to 45 cal/kg/day (
C) is incorrect. Increasing fluid intake to 2 L/day (
D) may worsen fluid overload.
Question 3 of 5
A nurse is caring for a group of toddlers receiving digoxin therapy. For which of the following toddlers should the nurse revise the plan of care?
Correct Answer: A
Rationale: The correct answer is A because vomiting can affect the absorption and effectiveness of digoxin. Vomiting can lead to decreased drug levels in the bloodstream, potentially causing subtherapeutic effects. This can result in inadequate control of the toddler's condition and may lead to worsening symptoms.
Choices B, C, and D are within acceptable ranges and do not necessarily warrant a revision of the plan of care.
Choice B indicates a digoxin level within the therapeutic range, choice C indicates a slightly elevated pulse rate which can be expected with digoxin therapy, and choice D indicates a potassium level within the normal range.
Therefore, the nurse should focus on the toddler who has vomited to ensure proper absorption of the medication and adjust the plan of care accordingly.
Question 4 of 5
A nurse is planning postoperative care for an adolescent following scoliosis repair with spinal instrumentation. Which of the following actions should the nurse include in the plan of care?
Correct Answer: D
Rationale: The correct answer is D: Ensure two nurses logroll the adolescent every 2 hr. This is essential postoperative care for a patient with spinal instrumentation to prevent injury to the surgical site and reduce the risk of complications such as pressure ulcers and venous thromboembolism. Logrolling helps maintain spinal alignment and stability.
A: Offering sips of water 4 hr following surgery is not recommended as the patient may still be recovering from anesthesia and at risk of aspiration.
B: Assisting the adolescent to ambulate 12 hr following surgery may be too soon, as the patient may still be weak and in pain.
C: Maintaining the head of the bed at a 30° angle is a general guideline for postoperative patients but is not specific to spinal surgery.
Therefore, the correct choice is D as it directly addresses the specific needs of a patient following scoliosis repair with spinal instrumentation.
Question 5 of 5
A nurse is preparing to assess a 4-year-old child's visual acuity. Which of the following actions should the nurse plan to take?
Correct Answer: D
Rationale: The correct answer is D, using a tumbling E chart for the assessment. This type of chart is commonly used for young children due to its simplicity - the child is asked to identify the direction the "E" is facing. This helps assess visual acuity accurately in children who may not yet know letters. Assessing both eyes together first (choice
A) may lead to inaccuracies. Positioning the child 4.6 meters away (choice
B) is too far for a child's assessment. Testing without glasses first (choice
C) may not provide an accurate baseline. Overall, using a tumbling E chart is the most appropriate method for assessing visual acuity in a 4-year-old child.