ATI RN
ATI RN Pediatrics Nursing 2023 Questions
Extract:
Nurses' Notes (0800 hrs): The client's guardian reports that the child has been unable to sleep recently and has been very irritable. The guardian expresses concern about the child's skin condition worsening and the child scratching excessively, which results in the areas bleeding. The guardian states the child has a history of allergic rhinitis. The child appears alert and responsive but frequently scratches at the affected areas. The guardian mentions that the child has been using a new laundry detergent recently. The child has been given diphenhydramine 10 mg PO for itching. The guardian is worried about the potential for infection due to the open sores; Vital Signs (0800 hrs): Temperature: 37.2°C (99°F), Heart rate: 110/min, Respiratory rate: 22/min, Blood pressure: 100/60 mmHg; Physical Examination Results (0800 hrs): Generalized small clusters of reddish, scaly patches with lichenifications and depigmentation on the child's bilateral upper and lower extremities. The affected areas are dry and rough to the touch. Some areas show signs of excoriation and minor bleeding. No signs of systemic infection observed. The child appears to be in mild distress due to itching; Medication Administration Record: Diphenhydramine 10 mg PO, 4 times per day, Pimecrolimus 1% cream, apply to skin lesions daily; A nurse is caring for a 3-year-old male client in the emergency department. The client presents with a history of irritability, scratching, and bleeding from skin lesions. The nurse is preparing to discharge the client.
Question 1 of 5
Which of the following statements should the nurse plan to include in the discharge instructions for the child's guardian? (Select all that apply)
Correct Answer: A,B,C,E,G
Rationale:
Correct
Answer: A, B, C, E, G
Rationale:
A: "You should use a mild detergent for your child's laundry." This is important to prevent skin irritation in sensitive skin.
B: "You should apply emollients to your child's skin after bathing." Emollients help in moisturizing and soothing the skin.
C: "You can apply gloves to your child's hands." Gloves can protect the skin from further irritation and damage.
E: "You should cut and file your child's fingernails frequently." Short nails help prevent scratching and worsening of skin lesions.
G: "Your child will experience occasional flare-ups of this condition." Setting realistic expectations about the condition helps in long-term management.
Summary:
D: "You should apply a thick layer of pimecrolimus cream to your child's lesions." Pimecrolimus cream is not usually recommended for all types of skin conditions.
F: "Your child's condition is contagious when lesions
Extract:
Nurse's Notes (0700hrs): The adolescent is alert and oriented but appears distressed. Reports severe pain in the right side and lower back, rating it as 8/10. Hands and right knee are painful and swollen. The adolescent's parent reports a low-grade fever and vomiting for the past 3 days. The adolescent is lying in a fetal position, clutching their abdomen. Skin is warm and dry to touch. The adolescent is tearful and intermittently moaning in pain; Medical History: Diagnosed with sickle cell disease at age 2. History of multiple hospitalizations for vaso-occlusive crises. Last hospitalization was 6 months ago. No known drug allergies. Current medications include hydroxyurea and folic acid; Vital Signs (0700hrs): Temperature: 38.2°C (100.8°F), Heart rate: 110 beats per minute, Respiratory rate: 22 breaths per minute, Blood pressure: 130/80 mmHg, Oxygen saturation: 95% on room air; Physical Examination Results (0700hrs): Abdomen: Soft, non-distended, tender in the right lower quadrant. Musculoskeletal: Swelling and tenderness in the right knee and both hands. Neurological: Alert and oriented, no focal deficits. Skin: Warm, dry, no rashes or lesions; A nurse is caring for a 15-year-old adolescent who is admitted with a vaso-occlusive crisis in the emergency department.
Question 2 of 5
Select the 4 interventions the nurse should include.
Correct Answer: C,E,F,G
Rationale: The correct interventions are C, E, F, and G. C: Administering folic acid is essential for managing sickle cell anemia. E: Oral hydroxyurea helps reduce the frequency of pain crises. F: Continuous monitoring of oxygen saturation is crucial to detect hypoxia early. G: Bed rest helps reduce oxygen demand. A: Cold compresses may not directly address the underlying cause. B: Meperidine IV is not recommended due to potential complications. D: Restricting oral intake can worsen dehydration.
Extract:
Nurses' Notes: The child's guardian states the child has been unable to sleep recently and has been very irritable. Guardian expresses concern about the child's atopic dermatitis worsening and the child scratching excessively, which results in the areas bleeding. Guardian states the child has a history of allergic rhinitis. Medication Administration Record: Diphenhydramine 10 mg PO 4 times per day, Pimecrolimus 1% cream apply to skin lesions daily. Assessment: Child is alert and responsive. Respiratory rate even and nonlabored at rate of 24/min. No adventitious sounds auscultated. Heart rate 108/min. Generalized small clusters of reddish, scaly patches with lichenifications and depigmentation on the child's bilateral upper and lower extremities.
Question 3 of 5
Which of the following statements should the nurse plan to include in the discharge instructions for the child's guardian? Select all that apply.
Correct Answer: A,B,D,F,G
Rationale:
Correct
Answer: A, B, D, F, G
Rationale:
A: Cutting and filing the child's fingernails frequently can help prevent scratching and further irritation of the skin.
B: Using a mild detergent for the child's laundry can help reduce potential skin irritation from harsh chemicals.
D: Informing the guardian about occasional flare-ups prepares them for potential worsening of the condition.
F: Applying gloves to the child's hands can prevent scratching and help protect the lesions from further irritation.
G: Applying emollients to the child's skin after bathing helps moisturize and soothe the skin, reducing dryness and itching.
Incorrect
Choices:
C: Pimecrolimus cream is a prescription medication and should not be included in general discharge instructions.
E: Incorrect, the child's condition is not contagious unless specified by a healthcare provider.
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 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 expiratory 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 86/46 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. Biplane radiographic study identifies object in esophagus. No foreign objects visualized in the chest or abdomen.
Question 4 of 5
Complete the following sentence by using the list of options. The nurse should first __ followed by __.
Correct Answer: A,B
Rationale: The correct answer is A,B. Firstly, keeping the child NPO (nothing by mouth) is essential before a flexible endoscopy to prevent aspiration. Secondly, preparing the child for the procedure ensures readiness and cooperation.
Choice C and E focus on prevention of choking hazards, not directly related to the procedure.
Choice D is important but typically done after the initial preparations. Waiting for return of gag reflex (F) is not necessary before a flexible endoscopy.
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 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).
Question 5 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:
Correct
Answer: A,C,D,E,G
Rationale:
A: Monitoring oxygen saturation is crucial in assessing respiratory status, especially in adolescents with potential respiratory issues.
C: Oral hydroxyurea is commonly used in treating certain hematologic conditions in adolescents.
D: Administering meperidine IV for pain management is appropriate for adolescents experiencing severe pain.
E: Ensuring the pneumococcal vaccine is current helps prevent serious infections in adolescents.
G: Administering folic acid as prescribed is essential for adolescents with certain medical conditions.
Summary:
B: Restricting oral intake may not be appropriate unless specified by a healthcare provider.
F: Strict bed rest is not typically recommended for adolescents unless medically necessary.