ATI RN
ATI RN Pediatric Nursing 2023 II Questions
Extract:
Question 1 of 5
A nurse is assessing a preschool-age child who is in the immediate postoperative period following a tonsillectomy. Which of the following assessment findings is the priority?
Correct Answer: D
Rationale: The correct answer is D: The child swallows frequently. This is the priority assessment finding because it could indicate bleeding post-tonsillectomy, which is a potential complication requiring immediate intervention to prevent further complications. The other options are not as urgent: A is expected after surgery, B can be managed by offering alternatives, and C is common postoperatively due to discomfort.
Question 2 of 5
A nurse is planning care for a preschooler who has neutropenia. Which of the following interventions should the nurse include in the plan?
Correct Answer: B
Rationale: The correct answer is B. Neutropenia is a condition characterized by low levels of neutrophils, which are important in fighting infection. Raw fruits and vegetables can harbor bacteria that may lead to infections in individuals with neutropenia.
Therefore, it is crucial to avoid them to prevent potential infections. Administering vaccines (choice
A) may further compromise the child's immune system, bathing the child every other day (choice
C) may not directly impact infection risk, and obtaining rectal temperature daily (choice
D) may not prevent infections.
Question 3 of 5
A nurse is caring for a 1-week-old newborn who has hyperbilirubinemia and is being treated with phototherapy. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Monitor the newborn's temperature every 2 hr. This is important because phototherapy can lead to heat loss in newborns, making them prone to hypothermia. By monitoring the temperature every 2 hours, the nurse can promptly detect any changes and take appropriate measures to maintain the newborn's body temperature within a safe range. Checking the newborn's eyes every 8 hours (
A) is not directly related to the management of hyperbilirubinemia or phototherapy. Placing mittens on the newborn's hands (
B) is not necessary for this situation. Applying lotion to the newborn's skin (
D) is also not relevant to managing hyperbilirubinemia.
Question 4 of 5
A nurse is evaluating the pain level of a toddler who is cognitively impaired to a nonpharmacologic intervention. Which of the following pain scales should the nurse use to evaluate the toddler's pain level?
Correct Answer: C
Rationale: The correct answer is C: FLACC. The FLACC scale is specifically designed for assessing pain in nonverbal individuals such as toddlers or cognitively impaired patients. It evaluates Facial expression, Leg movement, Activity, Cry, and Consolability. This scale is suitable for assessing pain in this population as it focuses on observable behaviors that may indicate pain. The Visual Analog scale (
A) requires the ability to comprehend and communicate pain levels, which may be challenging for a cognitively impaired toddler. The FACES scale (
B) relies on the individual's ability to understand and point to facial expressions representing pain, which may not be possible for the toddler in this scenario. The CRIES scale (
D) is typically used for neonates and may not be appropriate for a toddler.
Question 5 of 5
A nurse is caring for an infant who has heart failure and vomited following administration of digoxin. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Administer the next dose as prescribed. Vomiting after digoxin administration does not necessarily indicate toxicity. It is crucial to adhere to the prescribed dosing schedule to maintain therapeutic levels. Skipping a dose can lead to suboptimal treatment. Mixing with formula (
A) can affect absorption, giving an antiemetic (
B) is unnecessary if vomiting is a one-time occurrence, and increasing fluids (
C) may worsen heart failure.