ATI Custom NUR 2730 Exam 4 version 1 Part1
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Free ATI Custom NUR 2730 Exam 4 version 1 Part1 Questions
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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.
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Use the FACES scale
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Ask the child to describe the pain
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Use the FLACC scale
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Use the 0 to 10 numeric scale
Explanation
Correct Answer: (D) Use the 0 to 10 numeric scale.
A 12-year-old is developmentally capable of understanding and using an abstract numeric pain scale. The 0 to 10 numeric scale is the most appropriate and reliable tool for school-age children and adolescents who can self-report, as it provides a precise, quantifiable measure of pain intensity useful for tracking changes and evaluating treatment effectiveness.
Why the other options are incorrect:
A. Use the FACES scale. The FACES scale is designed for younger children, typically ages 3 to 7, who cannot yet conceptualize abstract numbers. It is not the best tool for a 12-year-old.
B. Ask the child to describe the pain. While qualitative description is a useful adjunct, it does not quantify pain intensity and cannot be used consistently to monitor changes over time.
C. Use the FLACC scale. The FLACC scale (Face, Legs, Activity, Cry, Consolability) is a behavioral observation tool used for infants, toddlers, and non-verbal or cognitively impaired patients who cannot self-report. It is not appropriate for a verbal 12-year-old.
- 75 mL/hr
Explanation
Correct Answer: 75 mL/hr
Step 1 — Convert pounds to kilograms: 33 lbs ÷ 2.2 = 15 kg
Step 2 — Calculate total daily fluid requirement: 15 kg × 120 mL/kg/day = 1800 mL/day
Step 3 — Convert to hourly rate: 1800 mL ÷ 24 hours = 75 mL/hr
The nurse should set the IV pump to 75 mL/hr.
Vital Signs:
2 years ago: Heart rate 75/min | Respiratory rate 18/min | Pulse oximetry 100% on room air | Blood pressure 106/72 mm Hg (left arm) | Height 144.78 cm (57 inches) | Weight 38.5 kg (85 lb)
1 year ago: Heart rate 80/min | Respiratory rate 18/min | Pulse oximetry 100% on room air | Blood pressure 108/68 mm Hg (left arm) | Height 149.86 cm (59 inches) | Weight 40.37 kg (89 lb)
1 month ago: Heart rate 78/min | Respiratory rate 20/min | Pulse oximetry 100% on room air
Assessment:
2 years ago: HEAD, EYES, EARS, NOSE, AND THROAT: moist mucous membranes, normocephalic, atraumatic. RESPIRATORY: breath sounds equal bilaterally. CARDIOVASCULAR: regular rate and rhythm. ABDOMEN: soft, nontender, nondistended, no mass, normoactive bowel sounds. SKIN: no rash. NEURO: awake, alert, cooperative. Pupils equal, round, and reactive to light. Client enjoys video games, tik-tok, and sometimes riding their bike in the summer.
1 one year ago: HEAD, EYES, EARS, NOSE, AND THROAT: moist mucous membranes, normocephalic, atraumatic. RESPIRATORY: breath sounds equal bilaterally. CARDIOVASCULAR: regular rate and rhythm. ABDOMEN: soft, nontender, nondistended, no mass, normoactive bowel sounds. SKIN: no rash. NEURO: awake, alert, cooperative. Pupils equal, round, and reactive to light.
1 month ago: HEAD, EYES, EARS, NOSE, AND THROAT: moist mucous membranes, normocephalic, atraumatic. RESPIRATORY: breath sounds equal bilaterally. CARDIOVASCULAR: regular rate and rhythm. ABDOMEN: soft, nontender, nondistended, no mass, normoactive bowel sounds. SKIN: no rash. NEURO: awake, alert, cooperative. Pupils equal, round, and reactive to light.
Today: HEAD, EYES, EARS, NOSE, AND THROAT: moist mucous membranes, normocephalic, atraumatic.
Click to highlight the findings that require immediate follow-up.
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Heart rate 75/min
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Pulse oximetry 98% on room air
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Blood Pressure 148/88 mm Hg
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Height 154.9 cm (61 inches)
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Weight 44.5 kg (98 lb)
Explanation
Correct Answer: (C) Blood Pressure 148/88 mm Hg
A blood pressure of 148/88 mm Hg in a school-aged child is significantly elevated and meets the criteria for hypertension in the pediatric population. This represents a marked increase from prior visits where blood pressure readings were within acceptable ranges (106/72 and 108/68 mm Hg). A single elevated reading combined with a clear upward trend over multiple visits requires immediate follow-up to evaluate for secondary causes of hypertension such as renal disease, endocrine disorders, or coarctation of the aorta. Untreated hypertension in children can lead to end-organ damage including cardiac and renal complications.
Why the other options are incorrect:
A. Heart rate 75/min — This is a completely normal heart rate for a school-aged child. The normal range is 60 to 100 beats per minute and requires no follow-up.
B. Pulse oximetry 98% on room air — An oxygen saturation of 98% is within the normal range of 95% to 100% and does not indicate any respiratory compromise requiring follow-up.
D. Height 154.9 cm (61 inches) — This height represents normal growth progression consistent with prior measurements showing steady increase over the years. No follow-up is required.
E. Weight 44.5 kg (98 lb) — While weight has increased over the visits, this follows a gradual pattern consistent with normal childhood growth and development. The sedentary lifestyle noted in the assessment may warrant a wellness conversation but does not require immediate follow-up in the same urgent manner as the blood pressure finding.
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Constipation
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Pain
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Bradycardia
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High fever
Explanation
Correct Answer: (B) Pain
Severe pain is the hallmark manifestation of a sickle cell vaso-occlusive crisis. When sickled red blood cells obstruct small blood vessels, they cause ischemia and infarction of surrounding tissues, resulting in intense pain most commonly in the extremities, chest, abdomen, and back. Pain management is the primary focus of nursing care during a sickle cell crisis.
Why Other Options are Incorrect:
A. Constipation — Constipation is not a characteristic finding of sickle cell crisis. It may occur as a side effect of opioid pain management but is not an expected assessment finding of the crisis itself.
C. Bradycardia — Sickle cell crisis typically causes tachycardia due to pain, fever, dehydration, and anemia-induced compensatory mechanisms. Bradycardia is not an expected finding.
D. High fever — While low-grade fever may occur during a crisis due to tissue infarction, high fever is more indicative of an infectious process, which can trigger a crisis but is not the defining finding of the crisis itself.
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Murmur, excessive weight gain, and tachypnea
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Murmur, tachypnea, and fatigue with feeds
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Bradypnea, excessive weight gain, and fatigue with feeds
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Bradypnea, murmur, and fatigue with feeds
Explanation
Correct Answer: (B) Murmur, tachypnea, and fatigue with feeds. A ventricular septal defect (VSD) allows oxygenated blood to shunt from the left ventricle back to the right ventricle and into the pulmonary circulation, causing volume overload of the lungs and heart. This produces a characteristic loud holosystolic murmur at the left lower sternal border, tachypnea from increased pulmonary blood flow, and fatigue with feeds because the infant must work harder to breathe while simultaneously trying to feed, leading to poor feeding endurance and failure to thrive.
Why Other Options are Incorrect:
A. Murmur, excessive weight gain, and tachypnea. VSD causes poor weight gain and failure to thrive from the increased metabolic demand, not excessive weight gain.
C. Bradypnea, excessive weight gain, and fatigue with feeds. Bradypnea is not a feature of VSD. The increased pulmonary blood flow causes tachypnea, not slowed breathing.
D. Bradypnea, murmur, and fatigue with feeds. Again, bradypnea is inconsistent with VSD physiology. The respiratory pattern in VSD is rapid, not slow, due to pulmonary congestion from the left-to-right shunt.
Signs/Symptoms to classify: Extreme Proteinuria, Hyperlipidemia, Hypertension, Mild Proteinuria, Past Strep Infection, Hypoalbuminemia
- Nephrotic Syndrome — Extreme Proteinuria, Hyperlipidemia, Hypoalbuminemia
- Acute Post Infection Glomerulonephritis (APIGN) — Hypertension, Mild Proteinuria, Past Strep Infection
Explanation
Correct Answer: Nephrotic Syndrome — Extreme Proteinuria, Hyperlipidemia, Hypoalbuminemia. Acute Post Infection Glomerulonephritis (APIGN) — Hypertension, Mild Proteinuria, Past Strep Infection
Nephrotic syndrome is characterized by massive protein loss through the glomeruli leading to extreme proteinuria, subsequent hypoalbuminemia, and compensatory hyperlipidemia as the liver attempts to compensate for low oncotic pressure by producing more lipoproteins. APIGN follows a streptococcal infection and presents with mild proteinuria, hematuria, and hypertension due to immune complex deposition in the glomeruli causing inflammation and fluid retention.
Why the other options are incorrect:
Hypertension assigned to Nephrotic Syndrome is incorrect because hypertension is not a hallmark of nephrotic syndrome. It is characteristic of APIGN due to fluid overload and sodium retention from glomerular inflammation.
Past Strep Infection assigned to Nephrotic Syndrome is incorrect because nephrotic syndrome is not triggered by streptococcal infection. APIGN is directly and specifically preceded by group A streptococcal infection of the throat or skin.
Extreme Proteinuria assigned to APIGN is incorrect because APIGN causes only mild to moderate proteinuria. Nephrotic-range proteinuria exceeding 3.5 g/day is the defining feature of nephrotic syndrome, not APIGN.
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Urine specific gravity 1.015
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Capillary refill greater than 3 seconds
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Respiratory rate 24/min
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Heart rate 130/min
Explanation
Correct Answer: (A) Urine specific gravity 1.015
A urine specific gravity of 1.015 falls within the normal range of 1.010 to 1.025, indicating adequate hydration. As rehydration therapy becomes effective, the kidneys resume normal concentrating ability and urine specific gravity normalizes, making this the most direct indicator of successful rehydration.
Why Other Options are Incorrect:
B. Capillary refill greater than 3 seconds. Prolonged capillary refill indicates ongoing poor perfusion and continued dehydration, not effective rehydration.
C. Respiratory rate 24/min. While within normal range for a toddler, respiratory rate is not a specific indicator of rehydration effectiveness and does not directly reflect fluid status.
D. Heart rate 130/min. Tachycardia is a compensatory sign of dehydration. A heart rate of 130/min in a 3-year-old suggests the dehydration has not yet been fully corrected, indicating rehydration therapy is still needed.
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Determine the social skills of the AP.
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Evaluate the ability of the AP to work with peers.
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Provide a clear description of the task to the AP.
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Assess the AP's ability to follow the client's teaching plan.
Explanation
Correct Answer: (C) Provide a clear description of the task to the AP.
When delegating a task, the nurse must provide clear, specific instructions about what the task involves, how it should be performed, and what findings should be reported back. Clear communication is a fundamental component of safe and effective delegation and is one of the Five Rights of Delegation.
Why the other options are incorrect:
A. Determine the social skills of the AP — Social skills are not a relevant criterion for task delegation. The nurse should assess the AP's competency and scope of practice for the specific task being delegated.
B. Evaluate the ability of the AP to work with peers — Interpersonal dynamics with peers are not part of the delegation process. The nurse evaluates the AP's ability to safely perform the specific delegated task.
D. Assess the AP's ability to follow the client's teaching plan — Client teaching is outside the scope of practice for assistive personnel and should never be delegated. Teaching remains the responsibility of the licensed nurse.
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Give with orange juice.
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Give with a 240 mL (8 oz) glass of milk.
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Administer at mealtimes.
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Administer at bedtime.
Explanation
Correct Answer: (A) Give with orange juice.
Vitamin C found in orange juice significantly enhances the absorption of iron by converting ferric iron to ferrous iron, which is more readily absorbed in the gastrointestinal tract. Parents should be instructed to administer ferrous sulfate with orange juice or another vitamin C-rich beverage to maximize the therapeutic effect of the medication.
Why Other Options are Incorrect:
B. Give with a 240 mL (8 oz) glass of milk — Milk and dairy products contain calcium, which inhibits iron absorption. Ferrous sulfate should never be administered with milk as it significantly reduces the amount of iron absorbed by the body.
C. Administer at mealtimes — Iron is best absorbed on an empty stomach. Administering it with food, especially foods containing calcium, phytates, or tannins, reduces absorption. It should be given between meals whenever possible.
D. Administer at bedtime — Ferrous sulfate can cause gastrointestinal side effects such as nausea and stomach upset. Administering it at bedtime is not recommended as it does not optimize absorption and may cause overnight discomfort.
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