ATI Custom NUR 2730 Exam 4 version 1 Part1
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Free ATI Custom NUR 2730 Exam 4 version 1 Part1 Questions
The parents of a 6-month-old girl bring the infant to the emergency department because "she has not held anything down for 2 days." The nurse obtains a fingerstick blood glucose of 94. The infant's rectal temperature is 101°F, heart rate is 198 bpm, respiratory rate is 40, blood pressure is 60/38 in the left arm, and the infant's lips are dry. Which nursing action is the priority?
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Administer a bolus of normal saline.
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Administer an antipyretic rectally.
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Administer an antiemetic rectally.
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Administer a bolus of D10W.
Explanation
Correct Answer: (A) Administer a bolus of normal saline.
The infant is showing signs of hypovolemic shock: heart rate of 198 bpm, blood pressure of 60/38 mmHg, dry lips, and inability to tolerate oral intake for 2 days. The priority intervention is fluid resuscitation with a normal saline bolus to restore circulating volume and prevent cardiovascular collapse.
Why the other options are incorrect:
B. Administer an antipyretic rectally — While the infant has a fever, the priority is circulatory stabilization. Fever management is secondary to treating shock.
C. Administer an antiemetic rectally — Addressing vomiting is not the priority when the infant is in hemodynamic compromise.
D. Administer a bolus of D10W — The blood glucose is 94, which is within normal range. A dextrose bolus is not indicated and could cause hyperglycemia.
A nurse is planning care for a 5-month-old infant who is scheduled for a lumbar puncture to rule out meningitis. Which of the following actions should the nurse include in the plan of care?
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Hold the infant's chin to his chest and knees to his abdomen during the procedure.
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Apply a eutectic mixture of lidocaine and prilocaine cream topically 15 min prior to the procedure.
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Place the infant in an infant seat for 2 hr following the procedure.
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Keep the infant NPO for 6 hr prior the procedure.
Explanation
Proper positioning is essential for a successful lumbar puncture. Holding the infant in a side-lying position with the chin flexed to the chest and knees drawn to the abdomen maximally arches the back, which widens the spaces between the vertebrae and allows the provider optimal access to insert the needle into the subarachnoid space. The nurse's role in securely maintaining this position also prevents movement that could cause injury during the procedure.
Why the other options are incorrect:
B. Apply a eutectic mixture of lidocaine and prilocaine cream topically 15 min prior to the procedure. EMLA cream requires application at least 60 minutes before a procedure to achieve adequate topical anesthesia; 15 minutes is insufficient time for the cream to be effective. C. Place the infant in an infant seat for 2 hr following the procedure. Following a lumbar puncture, the infant should remain lying flat to reduce the risk of post-puncture headache and cerebrospinal fluid leakage; an upright position in an infant seat is contraindicated. D. Keep the infant NPO for 6 hr prior the procedure. A lumbar puncture does not routinely require prolonged NPO status, especially in an infant; if sedation were planned, specific NPO guidelines would apply, but 6 hours NPO is not a standard requirement for this procedure.
A nurse is admitting a 6-month-old infant who has dehydration. Which of the following amounts of urinary output should indicate to the nurse that the treatment has corrected the fluid imbalance?
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2 mL/kg/hr
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7.5 mL/kg/hr
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0.5 mL/kg/hr
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15 mL/kg/hr
Explanation
Correct Answer: (A) 2 mL/kg/hr
Normal urinary output for an infant is 1 to 2 mL/kg/hr. A urine output of 2 mL/kg/hr indicates adequate renal perfusion and confirms that fluid resuscitation has been effective in correcting the dehydration and restoring circulating volume.
Why the other options are incorrect:
B. 7.5 mL/kg/hr — This output is significantly above the normal range for infants and would suggest fluid overload rather than correction of dehydration.
C. 0.5 mL/kg/hr — This output is below the minimum acceptable range of 1 mL/kg/hr for infants and would indicate persistent dehydration and inadequate renal perfusion requiring further intervention.
D. 15 mL/kg/hr — This output is dangerously high and would indicate severe fluid overload, which could lead to electrolyte imbalances and cardiovascular compromise.
A nurse is instructing the parents of a client who has a new prescription for methylphenidate. Which of the following instructions should the nurse include?
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Take this medication before bedtime.
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Avoid activities that require alertness such as driving.
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Reduce calorie intake.
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Increase caffeine intake.
Explanation
While methylphenidate is a stimulant used to improve focus in clients with ADHD, it can cause adverse effects such as dizziness, and clients should be monitored for how the medication affects them before engaging in activities requiring full alertness. Until the client's individual response to the medication is established, caution with activities such as driving is appropriate safety teaching for a new prescription.
Why the other options are incorrect:
A. Take this medication before bedtime. Methylphenidate is a stimulant that causes insomnia if taken late in the day; it should be administered in the morning, with the last dose given before late afternoon to avoid sleep disturbance. C. Reduce calorie intake. Methylphenidate commonly suppresses appetite and can cause weight loss and growth suppression in children, so adequate caloric intake should be encouraged, not reduced. D. Increase caffeine intake. Caffeine is a stimulant that can compound the effects of methylphenidate, increasing the risk of nervousness, tachycardia, and insomnia; caffeine intake should be limited, not increased.
A child with Hirschsprung disease arrives on the pediatric unit from the operating room with a temporary colostomy. Which task should the nurse delegate to unlicensed assistive personnel?
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Assess the patient for pain.
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Assess the ostomy site for breakdown.
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Stock the room with ostomy supplies.
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Instruct the parents on skin care.
Explanation
Stocking the room with supplies is a task that does not require nursing assessment, judgment, or clinical decision-making, making it appropriate to delegate to unlicensed assistive personnel. This allows the nurse to focus on tasks that require professional nursing expertise.
Why the other options are incorrect:
A. Assess the patient for pain. Assessing pain requires nursing judgment and falls within the scope of licensed nursing practice, so this cannot be delegated to unlicensed assistive personnel. B. Assess the ostomy site for breakdown. Assessing the ostomy site for skin breakdown requires clinical assessment skills and nursing judgment, making it inappropriate to delegate. D. Instruct the parents on skin care. Patient and family teaching requires nursing knowledge and falls within the scope of licensed nursing practice, so it cannot be delegated to unlicensed assistive personnel.
A nurse is preparing to administer vaccines to a 4-year-old child. Which of the following vaccines should the nurse give? (Select All that Apply.)
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Varicella (VAR)
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Hepatitis A (Hep A)
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Human papillomavirus (HPV4)
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Measles, mumps rubella (MMR)
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Rotavirus (RV)
Explanation
The second dose of the varicella vaccine is routinely recommended at 4 to 6 years of age, making it appropriate for a 4-year-old child. Similarly, the second dose of the MMR vaccine is recommended at 4 to 6 years of age. Both of these vaccines are standard components of the pre-kindergarten immunization schedule.
Why the other options are incorrect:
B. Hepatitis A (Hep A) The hepatitis A vaccine series is routinely administered as two doses between 12 and 23 months of age, so a 4-year-old would typically have already completed this series unless catch-up dosing is needed. C. Human papillomavirus (HPV4) The HPV vaccine is recommended beginning at 9 to 12 years of age, not for a 4-year-old child. E. Rotavirus (RV) The rotavirus vaccine is an oral vaccine series completed in infancy, with the final dose given no later than 8 months of age; it cannot be administered to a 4-year-old.
A nurse is planning care for a 6-year-old child who has bacterial meningitis. Which of the following nursing interventions is unnecessary in the client's plan of care?
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Measure head circumference every shift.
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Place the client in a semi-Fowler's position.
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Implement seizure precautions.
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Admit the client to a private room.
Explanation
Measuring head circumference is only useful in infants whose cranial sutures and fontanels have not yet closed, allowing the skull to expand with increased intracranial pressure. In a 6-year-old child, the sutures are fused and the skull cannot expand, so head circumference measurement provides no useful clinical information, making this intervention unnecessary.
Why the other options are incorrect:
B. Place the client in a semi-Fowler's position. Elevating the head of the bed is a necessary intervention because it promotes venous drainage from the brain and helps reduce intracranial pressure, which is a major concern in bacterial meningitis.
C. Implement seizure precautions. Seizure precautions are necessary because meningeal irritation and increased intracranial pressure from bacterial meningitis place the child at significant risk for seizure activity.
D. Admit the client to a private room. A private room is necessary because bacterial meningitis requires droplet isolation precautions for at least the first 24 hours of effective antibiotic therapy to prevent transmission to others.
A nurse is caring for a 4-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following play activities should the nurse recognize is therapeutic in helping the child deal with the injection?
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A needleless syringe and a doll
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A story book about a child who has diabetes
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A period of play in the playroom
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A video game
Explanation
Therapeutic play, such as allowing a young child to give an injection to a doll using a needleless syringe, helps the child process and express feelings about a frightening or distressing procedure in a safe, developmentally appropriate way. This type of medical play allows the child to gain a sense of control over the situation, which is especially important for a preschool-age child dealing with painful procedures.
Why the other options are incorrect:
B. A story book about a child who has diabetes While reading about another child's experience can be educational, it does not offer the same hands-on, active processing that therapeutic medical play provides for a distressed 4-year-old. C. A period of play in the playroom General playroom time offers a distraction and normal developmental play, but it is not specifically therapeutic for processing the emotional impact of the injection itself. D. A video game A video game may serve as a distraction but does not allow the child to actively process or work through feelings about the medical procedure.
Enter text here. ____ mL
Explanation
Correct Answer: 0.5 mL
Step 1 — Identify the desired dose: 2 mg
Step 2 — Identify the available concentration: 20 mg/5 mL = 4 mg/mL
Step 3 — Calculate the volume to draw up: 2 mg ÷ 4 mg/mL = 0.5 mL
The nurse should draw up 0.5 mL of ondansetron.
A nurse is teaching a client who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following statements by the client indicates an understanding of the teaching?
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"My appetite will be decreased."
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"I will be more thirsty than usual."
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"I will feel shaky."
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"My skin will be warm and moist."
Explanation
Shakiness or tremors is a classic manifestation of hypoglycemia, resulting from the release of epinephrine as the body responds to low blood glucose levels. Other common signs include diaphoresis, palpitations, anxiety, hunger, and cool, clammy skin, so recognizing shakiness indicates the client correctly understands the warning signs of low blood sugar.
Why the other options are incorrect:
A. "My appetite will be decreased." Hypoglycemia typically causes increased hunger, not decreased appetite, as the body signals its need for glucose. B. "I will be more thirsty than usual." Increased thirst, or polydipsia, is a manifestation of hyperglycemia, not hypoglycemia. D. "My skin will be warm and moist." Hypoglycemia typically causes cool, clammy, diaphoretic skin due to the sympathetic nervous system response, while warm skin is more associated with hyperglycemia.
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