ATI RN
RN ATI Pediatric Nursing 2023 with NGN Questions
Extract:
A nurse in the emergency department is caring for a toddler. Nurse's Notes: 0915: Received the child awake, alert, and crying. Parent states that child was playing with remote control toy and when the parent heard the child crying, they noticed that a battery was missing from the toy. The parent states that the child was drooling more than usual and witnessed them gagging periodically. 0930: Child is lying on parent's chest with eyes open and requesting €˜sippy cup.' Continues to have wheezing in bilateral upper lobes. Preparing child for diagnostic testing. Vital Signs: 0915: Blood Pressure: 88/45 mm Hg. Heart Rate: 90/min. Respiratory Rate: 30/min. Axillary Temperature: 36.9°C (98.4°F). Oxygen Saturation: 96%. 0930: Blood Pressure: 85/46 mm Hg. Heart Rate: 88/min. Respiratory Rate: 28/min. Axillary Temperature: 36.9°C (98.4°F). Oxygen Saturation: 95%. Assessment: 0915: Child awake and sobbing, asking parent for €˜sippy cup' with excessive drooling and occasionally gagging. Breath sounds with small expiratory wheezing noted in bilateral upper lobes. Respirations slightly elevated as child continues to cry and sob. Oxygen saturation 96% on room air. Penlight used to inspect throat with no visual signs of foreign object. No visual objects in child's nose or ears upon inspection. Pupils equal, round, and reactive to light and accommodation. Abdomen soft and nontender with active bowel sounds in all four quadrants. Skin warm, pink, and smooth. Yellow urine noted in child's diaper. Provider notified of assessment findings. Laboratory Results: 0930: X-ray of the neck, chest, and abdomen completed. Barium radiography study identifies object in the esophagus. No foreign objects visualized in the chest or abdomen.
Question 1 of 5
Complete the following sentence using the list of options: 'The nurse should first select _____, followed by _____.'
Correct Answer: C,E
Rationale: The correct answer is C and E. First, keeping the child NPO is important to prevent complications during the flexible endoscopy procedure (E). This ensures the child's stomach is empty and reduces the risk of aspiration. Second, preparing the child for the procedure (E) is essential for their comfort and cooperation. Obtaining informed consent (
A) may be necessary but is not the first step in this scenario. Teaching parents about inspecting play areas (
B) and toys for safety, and monitoring the child's gag reflex (F) are important, but not the immediate priorities before a flexible endoscopy.
Extract:
A nurse is caring for an adolescent who is admitted with a vaso-occlusive crisis. History and Physical: 15-year-old adolescent admitted for a vaso-occlusive crisis. The parent reports low-grade fever and has vomited for 3 days. The adolescent reports having right-sided and lower back pain. They also report hands and right knee are painful and swollen. The client reports pain as 8 on a scale of 0 to 10. Vital Signs: Temperature: 37.8°C (100°F). Heart rate: 100/min. Blood pressure: 110/72 mmHg. Respiratory rate: 20/min. Oxygen saturation: 95% on room air. Assessment: Awake, alert, and oriented ×3. Yellow sclera of eyes noted bilaterally. Right upper quadrant tender to palpation. Hands painful to touch and swollen bilaterally. Right knee is swollen, warm to palpation, and the client reports pain as 8 on a scale of 0 to 10. Client is tearful and grimacing during the examination. Laboratory Results: Hct: 28% (32% to 44%). Hgb: 6 g/dL (10 to 15.5 g/dL). WBC count: 20,000/mm³ (6,200 to 17,000/mm³). ALT: 50 units/L (4 to 36 units/L). AST: 62 units/L (10 to 40 units/L). Total bilirubin: 3.0 mg/dL (0.3 to 1.0 mg/dL). Chest radiographic examination indicates cardiomegaly and left flow murmur.
Question 2 of 5
The nurse is planning care for the adolescent. Select the 5 interventions the nurse should include:
Correct Answer: A,B,C,G
Rationale:
Correct Answer: A, B, C, G
Rationale:
A: Instruct the parent to ensure the pneumococcal vaccine is current to prevent pneumococcal infections in the adolescent.
B: Monitor oxygen saturation continuously to assess respiratory status and detect any potential respiratory issues.
C: Administer folic acid as prescribed to support the adolescent's growth and development.
G: Give Oral Hydroxyurea to manage conditions like sickle cell anemia in adolescents.
Incorrect
Choices:
D: Applying cold compresses to the affected joints is not relevant to the care of an adolescent unless specifically indicated for a certain condition.
E: Placing the client on strict bed rest is not typically recommended for adolescents as it can lead to deconditioning and other complications.
F: Administering meperidine (Demerol) for pain is not a standard intervention for adolescents and may have adverse effects.
Extract:
Question 3 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: A
Rationale: The correct answer is A: FLACC. This scale is suitable for evaluating pain in toddlers and individuals with cognitive impairments as it assesses Facial expression, Leg movement, Activity level, Cry, and Consolability. It is effective in capturing pain cues in nonverbal or limited verbal individuals. The other options, B: Visual Analog Scale, C: CRIES, and D: FACES, are not as appropriate for toddlers with cognitive impairments due to their reliance on self-reporting or limited applicability in this population. The FLACC scale is specifically designed to assess pain in nonverbal or cognitively impaired individuals, making it the most suitable choice in this scenario.
Extract:
A nurse is caring for a client who is postoperative following placement of a halo vest to manage a cervical vertebral fracture. Which of the following actions should the nurse take?
Question 4 of 5
A nurse is caring for a client who is postoperative following placement of a halo vest to manage a cervical vertebral fracture. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Reposition the client using a turning sheet. Repositioning the client using a turning sheet helps prevent skin breakdown and pressure ulcers, which are common risks associated with prolonged immobilization in a halo vest. Turning the client also promotes circulation and respiratory function.
Choice A is incorrect because tightening the screws on the halo device should be done by a healthcare provider as per specific instructions, not by the nurse.
Choice C is incorrect as encouraging flexion and extension of the neck can destabilize the cervical spine and interfere with the healing process.
Choice D is incorrect because assessing the pin sites for infection should be done daily, not every other day, to promptly detect and treat any signs of infection.
Extract:
A nurse is caring for a school-age child who has cystic fibrosis. History and Physical: School-age child admitted, diagnosed with cystic fibrosis at 3 months of age, has experienced failure to thrive, and has chronic obstructive pulmonary disease. The child presents with wheezing, rhonchi, paroxysmal cough, and dyspnea. The parent reports large, frothy, foul-smelling stools. The child has deficient levels of vitamin A, D, E, and K. Barrel-shaped chest. Clubbing of the fingers bilaterally. Respiratory rate 40/min with wheezing and rhonchi noted bilaterally, dyspnea, and paroxysmal cough. Vital Signs: Temperature: 38.4°C (101.1°F). Heart rate: 100/min. Respiratory rate: 40/min. Blood pressure: 100/57 mm Hg. Laboratory Results: Sputum culture positive for Pseudomonas aeruginosa. Stool analysis positive for presence of fat and enzymes. Chest X-ray indicates obstructive emphysema. WBC count: 20,000/mm³ (normal range: 5,000 to 10,000/mm³).
Question 5 of 5
A nurse is reviewing the child's medical record. Which of the following medications should the nurse expect the provider to prescribe or reconcile from the child's home medication list?
Correct Answer: B,D,E
Rationale: The correct answer is B, D, and E. Dornase alfa is a medication used for cystic fibrosis, often prescribed for children with this condition. Water-soluble vitamins are commonly given to children to meet their nutritional needs. Pancreatic lipase is used to aid digestion in children with pancreatic insufficiency. Meperidine is not typically prescribed for children due to its potential for toxicity and adverse effects. Acetaminophen is a common over-the-counter medication but may not necessarily be part of the child's prescription regimen.
Therefore, A and C are less likely to be prescribed or reconciled from the child's medication list compared to B, D, and E.