ATI RN
ATI RN Pediatric Nursing 2023 Exam 3 Questions
Extract:
History and Physical: A 15-year-old adolescent is admitted for a vaso-occlusive crisis. The parent reports that the adolescent has a low-grade fever and has vomited for 3 days. The adolescent reports having right-sided and low 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 mm Hg, Respiratory rate 20/min, Oxygen saturation 95% on room air. Assessment: Awake, alert, and oriented X 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 client reports pain as 8 on a scale of 0-10, Client is tearful and grimacing during the examination. Laboratory Results: Hct 28% (32% to 44%), Hgb 6g/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 systolic murmur
Question 1 of 5
The nurse is planning care for the adolescent. Select the 5 interventions the nurse should include.
Correct Answer: A,C,D,E,G
Rationale: A. Continuous monitoring of oxygen saturation is crucial in a vaso-occlusive crisis to detect any signs of hypoxia early, which could exacerbate the crisis and lead to more severe complications. This is important for assessing respiratory status, especially in patients with sickle cell disease who may be at risk for acute chest syndrome. B. Oral intake should not be restricted during a vaso-occlusive crisis as hydration is important for maintaining adequate blood flow and preventing dehydration. C. Hydroxyurea is used to reduce the frequency of painful crises in patients with sickle cell disease. It works by increasing the production of fetal hemoglobin, which can help prevent sickle cell crises. D. Meperidine (Demerol) is an opioid analgesic commonly used to manage severe pain associated with sickle cell crises. E. Vaccination is important in preventing infections, which can trigger or worsen a vaso-occlusive crisis in individuals with sickle cell disease. Ensuring the pneumococcal vaccine is current helps protect the adolescent from potential infections. F. Placing the client on strict bed rest can increase the risk of thrombosis and impair circulation. G. Folic acid supplementation is often recommended for patients with sickle cell disease to support red blood cell production and prevent folate deficiency, which can worsen anemia.
Extract:
Nurses Notes: 0915: Received the child awake, alert, and crying. Parent states that child was playing with remote control toy and when the parent the child crying, they noticed that a battery was missing from the toy. The parent states that the child was drooling more and witnessed them gagging periodically. 0930: Child is lying on parent's chest with eyes open and requesting ‘sippy cup.' Continues to have expiratory wheezing in bilateral upper lobes. Preparing child for diagnostic testing. Vital Signs: 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 86/46 mmHg, 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 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 the throat with no visual signs of foreign object in child's nose or ears upon inspection. Pupils equal, round, and reactive to light and accommodation. Abdomen soft and non-tender 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 plane radiographic study identifies object in esophagus, No foreign objects visualized in the chest or abdomen
Question 2 of 5
Complete the following sentence by using the list of options. The nurse should first ___ followed by ___.
Correct Answer: A, E
Rationale: A. Keeping the child NPO is crucial to prevent further ingestion or aspiration of the battery, which could lead to serious complications. This is the first priority to ensure safety. B. Teaching the child's parents the importance of inspecting the child's play area is important for future prevention but is not the immediate priority in this acute situation. C. Obtaining an informed consent is not the priority in this scenario. It should be done after keeping the child NPO. D. Encouraging parents to inspect toys for easily removable parts is important for prevention but is not the immediate priority when dealing with a child who has already ingested a foreign object. E. Preparing the child for flexible endoscopy is the second action to visualize and safely remove the battery from the esophagus, following the initial step of keeping the child NPO.
Extract:
Question 3 of 5
A nurse is teaching the guardian of a newborn about how to prepare their 3-year-old child to meet their new sibling. Which of the following statements should the nurse make?
Correct Answer: B
Rationale: A. While preparing the 3-year-old child for changes in routines is important, it is too general. Providing specific strategies like role-playing with a doll would be more helpful. B. Providing a doll for the 3-year-old child to imitate parental behaviors is an effective way to help them understand and adjust to the new sibling's arrival. This encourages a sense of involvement and can help alleviate feelings of jealousy or displacement. C. While telling the 3-year-old child about having a new playmate is positive, it does not offer concrete strategies for preparing the child for the new sibling's arrival. D. Waiting for the newborn to come home before moving the 3-year-old child from the crib to a bed may not be necessary. The transition from crib to bed can be independent of the newborn's arrival and should be based on the child's readiness.
Question 4 of 5
A nurse is providing discharge teaching to a parent of a child who has juvenile idiopathic arthritis and a new prescription for prednisone. Which of the following statements should the nurse include in the teaching?
Correct Answer: D
Rationale: A. Instructing the parent to discontinue prednisone if gastrointestinal upset occurs is not appropriate, as abrupt discontinuation of corticosteroids can lead to adrenal insufficiency. Monitoring for and managing gastrointestinal upset while continuing the medication as prescribed is more appropriate. B. Limiting intake of potassium-rich foods is not specifically indicated with prednisone therapy. Prednisone may increase the risk of potassium loss, but dietary adjustments should be made under medical guidance. C. Prednisone can affect growth in children, but it is more commonly associated with slowing growth rather than stimulating a growth spurt. This statement is misleading and not accurate. D. Monitoring the child for indications of infection is crucial when taking prednisone, as corticosteroids can suppress the immune system and increase susceptibility to infections. This statement addresses an important aspect of medication safety and is the priority in discharge teaching.
Question 5 of 5
A nurse is planning care for a child who has varicella. Which of the following interventions should the nurse plan to include?
Correct Answer: D
Rationale: A. Providing a warm blanket can help alleviate discomfort associated with fever and chills, which are common symptoms of varicella, but it is not the priority intervention. B. Koplik spots are seen in measles, not varicella. C. Aspirin administration is contraindicated in varicella due to the risk of Reye's syndrome. Acetaminophen or ibuprofen may be used for fever. D. Varicella is spread through respiratory droplets and direct contact, so airborne precautions are necessary to prevent transmission.