ATI LPN
ATI LPN Pediatrics Exam Questions
Extract:
Question 1 of 5
Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?
Correct Answer: A
Rationale: Weighing the infant every day on the same scale at the same time is crucial in monitoring excess fluid volume in congestive heart failure. Sudden weight gain can indicate fluid retention, a common sign of worsening heart failure. Daily weight monitoring helps in early detection and timely intervention. Notifying the physician when weight gain exceeds more than 20 g/day might be too late for intervention. Daily weight monitoring is essential to detect trends and intervene promptly to manage excess fluid volume. Placing the infant in a car seat to minimize movement is not directly related to managing excess fluid volume in congestive heart failure. It is essential for safety during transportation but does not address the nursing diagnosis. Administering digoxin as ordered by the physician is a medical intervention for congestive heart failure. While important, the nursing diagnosis is related to excess fluid volume, and the focus should be on nursing interventions such as monitoring daily weights.
Question 2 of 5
A nurse is caring for a 2-year-old child who has been diagnosed with nephrotic syndrome. The nurse collects data knowing that a common characteristic associated with nephrotic syndrome is:
Correct Answer: B
Rationale: Hypotension, or low blood pressure, is not typically associated with nephrotic syndrome. In fact, some patients with nephrotic syndrome may experience high blood pressure. Generalized edema, or swelling, is a common characteristic of nephrotic syndrome. It occurs due to the loss of proteins in the urine, which leads to a decrease in the amount of protein in the blood. This decrease in blood protein levels causes fluid to move from the blood vessels into the tissues, leading to swelling. Increased urinary output is not typically associated with nephrotic syndrome. In fact, some patients may experience decreased urine output. Bright red blood in the urine is not a typical symptom of nephrotic syndrome. Hematuria, or blood in the urine, when present in nephrotic syndrome, is usually microscopic and not visible to the naked eye.
Question 3 of 5
A nurse is providing care to a group of children at a pediatric clinic. Which of the following children meets the criteria to receive a varicella vaccine?
Correct Answer: D
Rationale: A child who received a blood transfusion 1 month ago is not recommended to receive the varicella vaccine. This is because blood transfusions can introduce new antibodies into the body that may interfere with the immune response to the vaccine. A child currently receiving immunoglobulins should not receive the varicella vaccine. Immunoglobulins are proteins in the blood that function as antibodies. They can interfere with the body's immune response to the vaccine. A child currently receiving chemotherapy should not receive the varicella vaccine. Chemotherapy can weaken the immune system, making it less effective at responding to vaccines. A child who has a cold and nasal discharge can receive the varicella vaccine. Mild illnesses, such as a cold, do not interfere with the immune response to the vaccine.
Question 4 of 5
Upon finding a school-age child having a seizure, what should be the nurse's first action after lowering the client to the floor?
Correct Answer: A
Rationale: The first action a nurse should take upon finding a school-age child having a seizure is to ease the person to the floor and turn the person gently onto one side. This will help the person breathe and can prevent injury. Administering an anticonvulsant medication is not the immediate first action a nurse should take upon finding a child having a seizure. The first priority is to ensure the child's safety by easing them to the floor and turning them onto their side. Applying oxygen by nasal cannula is not the immediate first action a nurse should take upon finding a child having a seizure. The first priority is to ensure the child's safety by easing them to the floor and turning them onto their side. Checking the client's oxygen saturation is not the immediate first action a nurse should take upon finding a child having a seizure. The first priority is to ensure the child's safety by easing them to the floor and turning them onto their side.
Question 5 of 5
A nurse is contributing to the plan of care for a 5-week-old infant in the pediatric unit. The infant has been vomiting since week 2 of life and it has been progressively worse over the past 2 weeks. Parents report the vomiting is now forceful and projectile ('like a volcano erupting') immediately after every feeding, but the infant is eager to eat and seems to be constantly hungry. The infant has been receiving a cow's milk-based, iron-fortified formula since birth. The pediatrician reports the infant has not gained weight in the past 2 weeks. The last weight in the pediatrician's office is 3.54kg (8 lb). No other significant medical or surgical history. What condition is the client most likely experiencing and what actions should the nurse take to address that condition? What parameters should the nurse monitor to assess the client's progress?
Correct Answer: B
Rationale: Gastroesophageal Reflux Disease (GER
D) in infants is a condition where the stomach contents flow back into the esophagus causing discomfort. However, the symptoms described, such as projectile vomiting and constant hunger, are more consistent with Pyloric Stenosis. Pyloric Stenosis is a condition in infants where the opening from the stomach to the small intestine narrows, preventing food from entering the small intestine. The symptoms described by the parents, such as projectile vomiting after every feeding and constant hunger, align with this condition. The infant's lack of weight gain could be due to the fact that food is not being properly digested and absorbed. The nurse should refer the infant for a surgical consultation as the treatment for Pyloric Stenosis is usually surgical. The nurse should monitor the infant's weight and frequency of vomiting to assess the infant's progress. Lactose Intolerance in infants is a condition where the infant has difficulty digesting lactose, a sugar found in milk and dairy products. Symptoms can include gas, bloating, and diarrhea. However, the symptoms described by the parents do not align with this condition. Milk Protein Allergy in infants is a condition where the infant's immune system reacts negatively to the proteins in cow's milk. Symptoms can include hives, itching, wheezing, difficulty breathing, constipation, and bloody diarrhea. However, the symptoms described by the parents do not align with this condition.