ATI RN
ATI Nur 223a Sect 4 Pediatrics Final Exam Questions
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 1 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:
Client for hypoxemia during an asthma attack.
Question 2 of 5
A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?
Correct Answer: D
Rationale: Agitation is a common sign of hypoxemia due to oxygen deficiency.
Extract:
Infant who has inadequate motility of part of the intestine resulting in a mechanical obstruction.
Question 3 of 5
A nurse is caring for an infant who has inadequate motility of part of the intestine resulting in a mechanical obstruction. The nurse should identify this finding as a manifestation of which of the following disorders?
Correct Answer: A
Rationale: Hirschsprung's disease causes mechanical obstruction due to absent ganglion cells.
Extract:
Medical History: Diagnosis: Bilateral pneumonia, Past medical history: Cystic fibrosis, Plan: Aggressive airway clearance therapy, intravenous antibiotic therapy. Nurses Notes: 0700 hrs: Caregiver reports child has had increased coughing, fatigue, and a poor appetite for the past several days. Wheezing and rhonchi auscultated bilaterally. Respirations labored with accessory muscle use. Frequent cough productive with thick, yellow blood-streaked sputum. Dyspnea noted with activity. Child reports “a bit of a stomachache†and rates the discomfort as 3 on a scale of 0 to 10. Abdomen soft and non-tender to palpation. Active bowel sounds auscultated. 0900 hrs: Respirations rapid with accessory muscle use. Dyspnea noted while at rest. Frequent cough. Thick yellow sputum expectorated following airway clearance therapy. Child reports chest discomfort as 4 on a scale of 0 to 10. Child consumes approximately 50% of meals. Denies abdominal pain. Passed three large, frothy, foul-smelling stools. Vital Signs: 0700 hrs: Oral temperature: 39.1°C (102.4°F), Heart rate: 116/min, Respiratory rate: 32/min, Blood pressure: 102/60 mm Hg, Oxygen saturation: 95% on room air. 0900 hrs: Oral temperature: 38.1°C (100.6°F), Heart rate: 128/min, Respiratory rate: 32/min, Blood pressure: 88/48 mm Hg, Oxygen saturation: 88% on room air. Diagnostic Results: 0900 hrs: Chest X-ray: Bilateral infiltrates consistent with pneumonia, CBC: WBC: 15,000/mm³, Hemoglobin: 11 g/dL, Platelets: 250,000/mm³.
Question 4 of 5
Which of the following assessment findings should the nurse report to the provider? (Select all that apply)
Correct Answer: A,B,E
Rationale:
Choice A: 88% oxygen saturation indicates hypoxemia, requiring intervention.
Choice B: Heart rate of 128/min suggests increased work of breathing or distress.
Choice C: Chest discomfort is less critical than other findings.
Choice D: Elevated WBC is expected with pneumonia.
Choice E: Frothy stools indicate malabsorption, significant in cystic fibrosis.
Extract:
Adolescent who has type 1 diabetes mellitus.
Question 5 of 5
A nurse is providing teaching to an adolescent who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching?
Correct Answer: A
Rationale: Annual influenza vaccine reduces infection risks in diabetes.