ATI RN
ATI Nur 223a Sect 4 Pediatrics Final Exam Questions
Extract:
Nurses Notes (0700hrs): Guardian reports infant has been forcefully vomiting after feedings. Guardian states the emesis is so forceful that it often lands 3 to 4 feet away. Infant is very fussy and rooting and sucks vigorously on a pacifier. Guardian mentions the vomiting started about a week ago and has progressively worsened. Infant has had fewer wet diapers over the past two days. Guardian reports the infant has been crying more than usual and seems uncomfortable. Infant's weight has decreased slightly since the last visit. Vital Signs (0700hrs): Temperature: 37.8°C (100°F), Heart Rate: 160 bpm, Respiratory Rate: 40 breaths per minute, Blood Pressure: 80/50 mmHg, Oxygen Saturation: 98% on room air. Medical History (0700hrs): Full-term infant, born via vaginal delivery. No known allergies. Up-to-date on vaccinations. No previous hospitalizations or surgeries. Family history of gastrointestinal issues. Diagnostic Results (0700hrs): Complete Blood Count (CBC): WBC: 10,000/mm³, Hemoglobin: 12 g/dL, Platelets: 300,000/mm³. Electrolytes: Sodium: 138 mEq/L, Potassium: 4.0 mEq/L, Chloride: 102 mEq/L, Bicarbonate: 22 mEq/L. Physical Examination Results (0700hrs): Abdomen is distended and firm to touch. Visible peristaltic waves observed. No signs of dehydration such as dry mucous membranes or sunken fontanelle. Infant appears irritable and cries during the examination. Bowel sounds are hyperactive. No palpable masses detected. Provider's Prescriptions (0700hrs): NPO (nothing by mouth) status. IV fluids: D5 0.45% NS at 20 mL/hr. Monitor intake and output. Abdominal ultrasound to be performed. Administer ondansetron 0.15 mg/kg IV every 8 hours as needed for vomiting.
Question 1 of 5
Which of the following actions should the nurse take? (Select all that apply)
Correct Answer: C,E
Rationale:
Choice A: FACES Scale is for older children.
Choice B: NPO status prohibits feedings.
Choice C: Head circumference monitors for intracranial issues.
Choice D: No infectious cause for precautions.
Choice E: Weighing monitors dehydration.
Choice F: Enema is inappropriate for vomiting.
Extract:
Nurses Notes: Emergency Department - 0900: Two-year-old toddler brought in by parents due to concerns about child's breathing. Parents report child has a history of asthma and woke up today with a bad asthma attack. Parents state child has had a runny nose and occasional cough for 2 days and has not been eating or drinking well. Child is restless and crying intermittently while clinging to parent. Appears ill with flushed face. Large amount of clear thick nasal drainage from bilateral nares and marked nasal flaring noted. Oral mucosa pink and slightly dry. Moderate to severe suprasternal and substernal retractions. Bilateral wheezes in upper lobes throughout inspiration and expiration. Diminished breath sounds in bilateral bases. Frequent dry hacking cough when crying. Pediatric Unit - 1200: Two-year-old toddler admitted from the emergency department due to exacerbation of asthma. Child currently asleep in parent's arms but rouses easily when touched. Oral mucosa pink and moist. No nasal flaring noted. Mid substernal retractions noted. Mild bilateral expiratory wheezes auscultated in upper lobes with breath sounds diminished in bilateral bases. No cough noted. O2 at 2 L/min via nasal cannula. Vital Signs 0900: Temperature: 38.3°C (100.9°F), Heart rate: 130 bpm, Respiratory rate: 40 breaths/min, Oxygen saturation: 88% on room air. 1200: Temperature: 37.8°C (100.0°F), Heart rate: 120 bpm, Respiratory rate: 32 breaths/min, Oxygen saturation: 94% on 2 L/min O2 via nasal cannula. Physical Examination Results 0900: Child appears ill with flushed face. Large amount of clear thick nasal drainage from bilateral nares. Marked nasal flaring noted. Oral mucosa pink and slightly dry. Moderate to severe suprasternal and substernal retractions. Bilateral wheezes in upper lobes throughout inspiration and expiration. Diminished breath sounds in bilateral bases. Frequent dry hacking cough when crying. 1200: Child currently asleep in parent's arms but rouses easily when touched. Oral mucosa pink and moist. No nasal flaring noted. Mid substernal retractions noted. Mild bilateral expiratory wheezes auscultated in upper lobes with breath sounds diminished in bilateral bases. No cough noted. Diagnostic Results 0900: Chest X-ray: Hyperinflation of lungs, no focal consolidation. Blood gas analysis: pH 7.35, PaCO2 45 mmHg, PaO2 60 mmHg, HCO3 24 mEq/L. 1200: Chest X-ray: No significant change from previous. Blood gas analysis: pH 7.38, PaCO2 42 mmHg, PaO2 75 mmHg, HCO3 24 mEq/L. Provider's Prescriptions 0900: Albuterol nebulizer treatment every 4 hours. Prednisolone 2 mg/kg/day PO divided into two doses. Oxygen therapy at 2 L/min via nasal cannula. IV fluids at maintenance rate. 1200: Continue Albuterol nebulizer treatment every 4 hours. Continue Prednisolone 2 mg/kg/day PO divided into two doses. Continue oxygen therapy at 2 L/min via nasal cannula. Continue IV fluids at maintenance rate.
Question 2 of 5
Which of the following findings should the nurse on the pediatric unit identify as an indication that the treatment plan is effective? (Select all that apply)
Correct Answer: C,D,F
Rationale:
Choice A: Nasal flaring is a sign of respiratory distress. The absence of nasal flaring indicates improvement.
Choice B: Retractions are a sign of respiratory distress. Their presence indicates ongoing distress.
Choice C: Oxygen saturation improvement (88% to 94%) indicates effective treatment.
Choice D: Decreased respiratory rate (40 to 32 breaths/min) shows reduced distress.
Choice E: Pulse rate is not a specific indicator of respiratory function.
Choice F: Improved breath sounds indicate better lung function.
Choice G: Heart rate is not a specific indicator of respiratory function.
Extract:
Child who has cystic fibrosis and has a prescription for pancreatic enzymes three times per day.
Question 3 of 5
A nurse is teaching the mother of a child who has cystic fibrosis and has a prescription for pancreatic enzymes three times per day. Which of the following statements indicates that the mother understands the teaching?
Correct Answer: D
Rationale: Pancreatic enzymes aid fat digestion in cystic fibrosis.
Extract:
9-month-old infant.
Question 4 of 5
A nurse in a clinic is assessing a 9-month-old infant. Which of the following findings requires further intervention?
Correct Answer: D
Rationale: A positive Moro reflex at 9 months is abnormal, indicating potential neurological issues.
Extract:
12-year-old child who is newly diagnosed with asthma.
Question 5 of 5
A nurse is teaching a 12-year-old child who is newly diagnosed with asthma about managing the condition to prevent asthma attacks. Which of the following statements by the child should indicate to the nurse that the teaching has been effective?
Correct Answer: C
Rationale: Eliminating allergens prevents asthma attacks, indicating effective teaching.