ATI Custom NUR 2730 Exam 4 version 1 Part1
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Free ATI Custom NUR 2730 Exam 4 version 1 Part1 Questions
1. A nurse is discharging a child who has sickle cell anemia after an acute crisis episode. Which of the following instructions should the nurse include in the teaching?
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"Offer fluids to your child multiple times every day."
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"Apply cold compresses when your child expresses pain."
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"Monitor your child's temperature daily."
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"Restrict outdoor play activity to 1 hour per day."
Explanation
Explanation
Adequate hydration is one of the most important measures in preventing sickle cell crises, because dehydration increases blood viscosity and promotes the sickling of red blood cells, which leads to vaso-occlusion and pain. Encouraging frequent fluid intake throughout the day helps maintain hydration and reduce the risk of another crisis episode.
Why the other options are incorrect:
B. "Apply cold compresses when your child expresses pain." Cold causes vasoconstriction, which worsens sickling and vaso-occlusion; warm compresses should be used for pain relief instead. C. "Monitor your child's temperature daily." While parents should be alert for fever, which requires prompt medical attention in sickle cell disease, routine daily temperature monitoring in a well-appearing child is not the key discharge instruction compared to maintaining hydration. D. "Restrict outdoor play activity to 1 hour per day." Children with sickle cell anemia can participate in normal activities with rest periods as needed; arbitrary activity restriction is unnecessary, though extremes of temperature and overexertion should be avoided.
Adequate hydration is one of the most important measures in preventing sickle cell crises, because dehydration increases blood viscosity and promotes the sickling of red blood cells, which leads to vaso-occlusion and pain. Encouraging frequent fluid intake throughout the day helps maintain hydration and reduce the risk of another crisis episode.
Why the other options are incorrect:
B. "Apply cold compresses when your child expresses pain." Cold causes vasoconstriction, which worsens sickling and vaso-occlusion; warm compresses should be used for pain relief instead. C. "Monitor your child's temperature daily." While parents should be alert for fever, which requires prompt medical attention in sickle cell disease, routine daily temperature monitoring in a well-appearing child is not the key discharge instruction compared to maintaining hydration. D. "Restrict outdoor play activity to 1 hour per day." Children with sickle cell anemia can participate in normal activities with rest periods as needed; arbitrary activity restriction is unnecessary, though extremes of temperature and overexertion should be avoided.
2. The provider orders diphenhydramine for a child that weighs 38 lbs. The safe dose range for diphenhydramine is 2 to 5 mg/kg/dose. What is the minimum safe dose for this child? (round answer to the nearest whole number)
Answer: 35 mg
- 35 mg
Explanation
Explanation
First, convert the child's weight from pounds to kilograms: 38 lb ÷ 2.2 = 17.27 kg. Then, calculate the minimum safe dose using the lower end of the dosage range: 2 mg/kg × 17.27 kg = 34.5 mg. Rounded to the nearest whole number, the minimum safe dose is 35 mg.
First, convert the child's weight from pounds to kilograms: 38 lb ÷ 2.2 = 17.27 kg. Then, calculate the minimum safe dose using the lower end of the dosage range: 2 mg/kg × 17.27 kg = 34.5 mg. Rounded to the nearest whole number, the minimum safe dose is 35 mg.
3. A nurse is teaching a parent of an infant who has heart failure about meeting the infant's nutritional needs. Which of the following statements by the parent indicates an understanding of the teaching?
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"I will allow my baby to take as much time as they need to finish the bottle."
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"My baby will need extra calories added to his feedings."
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"I will limit my baby's crying to 15 minutes prior to each feeding."
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"I will feed my baby on a schedule every 8 hours."
Explanation
Explanation
Infants with heart failure often have increased caloric needs due to the extra energy expended from increased cardiac and respiratory workload, while also frequently having difficulty feeding effectively and tiring easily during feeds. Concentrating formula or adding calorie supplements helps ensure adequate growth and weight gain despite these challenges, making this statement correct.
Why the other options are incorrect:
A. "I will allow my baby to take as much time as they need to finish the bottle." Infants with heart failure tire easily and can expend too much energy with prolonged feeding times; feedings are generally kept shorter, around 30 minutes or less, to conserve the infant's energy. C. "I will limit my baby's crying to 15 minutes prior to each feeding." Crying and excessive exertion should be minimized as much as possible in infants with heart failure to reduce cardiac workload, not limited to a specific time frame before feeding. D. "I will feed my baby on a schedule every 8 hours." Infants with heart failure typically require smaller, more frequent feedings, often every 3 hours, rather than infrequent feedings every 8 hours, to meet caloric needs without overtiring the infant.
Infants with heart failure often have increased caloric needs due to the extra energy expended from increased cardiac and respiratory workload, while also frequently having difficulty feeding effectively and tiring easily during feeds. Concentrating formula or adding calorie supplements helps ensure adequate growth and weight gain despite these challenges, making this statement correct.
Why the other options are incorrect:
A. "I will allow my baby to take as much time as they need to finish the bottle." Infants with heart failure tire easily and can expend too much energy with prolonged feeding times; feedings are generally kept shorter, around 30 minutes or less, to conserve the infant's energy. C. "I will limit my baby's crying to 15 minutes prior to each feeding." Crying and excessive exertion should be minimized as much as possible in infants with heart failure to reduce cardiac workload, not limited to a specific time frame before feeding. D. "I will feed my baby on a schedule every 8 hours." Infants with heart failure typically require smaller, more frequent feedings, often every 3 hours, rather than infrequent feedings every 8 hours, to meet caloric needs without overtiring the infant.
4. A nurse is preparing to instill eardrops to a 5-year-old child. Which of the following techniques should the nurse use?
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Pull the auricle up and back.
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Pull the auricle up and out.
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Pull the auricle down and back.
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Pull the auricle down and out.
Explanation
Explanation
For children 3 years of age and older, the auricle should be pulled up and back to straighten the ear canal and allow the medication to reach the tympanic membrane effectively. Since this child is 5 years old, the adult technique of pulling the pinna up and back is appropriate.
Why the other options are incorrect:
B. Pull the auricle up and out. Pulling the auricle up and out is not a recognized technique for straightening the ear canal and would not facilitate proper medication instillation.
C. Pull the auricle down and back. Pulling the auricle down and back is the correct technique for children younger than 3 years of age, whose ear canals curve upward; it is not appropriate for a 5-year-old.
D. Pull the auricle down and out. Pulling the auricle down and out is not a recognized technique for administering eardrops at any age.
For children 3 years of age and older, the auricle should be pulled up and back to straighten the ear canal and allow the medication to reach the tympanic membrane effectively. Since this child is 5 years old, the adult technique of pulling the pinna up and back is appropriate.
Why the other options are incorrect:
B. Pull the auricle up and out. Pulling the auricle up and out is not a recognized technique for straightening the ear canal and would not facilitate proper medication instillation.
C. Pull the auricle down and back. Pulling the auricle down and back is the correct technique for children younger than 3 years of age, whose ear canals curve upward; it is not appropriate for a 5-year-old.
D. Pull the auricle down and out. Pulling the auricle down and out is not a recognized technique for administering eardrops at any age.
5. A child arrives to the emergency department with potential internal bleeding after a car accident. The RN should delegate which of the below activities to the unlicensed assistive personnel (UAP)?
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Questioning the parents and child about the accident and injuries
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Obtaining vital signs
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Inserting an NG for decompression
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Completing a physical assessment
Explanation
Explanation
Obtaining vital signs is a task within the scope of unlicensed assistive personnel, as it involves measurement and data collection rather than clinical interpretation or judgment. The UAP can obtain and report the vital signs to the RN, who then interprets the values and makes clinical decisions based on the findings, allowing the nurse to focus on assessment and interventions requiring nursing judgment.
Why the other options are incorrect:
A. Questioning the parents and child about the accident and injuries Obtaining a health history requires interviewing skills and clinical judgment to gather and interpret relevant information, which falls within the RN's scope of practice and cannot be delegated to UAP.
C. Inserting an NG for decompression Inserting a nasogastric tube is an invasive procedure requiring specialized training and clinical skill, which is outside the scope of UAP practice.
D. Completing a physical assessment Physical assessment requires nursing knowledge, skill, and clinical judgment, making it a responsibility that must remain with the RN and cannot be delegated to UAP.
Obtaining vital signs is a task within the scope of unlicensed assistive personnel, as it involves measurement and data collection rather than clinical interpretation or judgment. The UAP can obtain and report the vital signs to the RN, who then interprets the values and makes clinical decisions based on the findings, allowing the nurse to focus on assessment and interventions requiring nursing judgment.
Why the other options are incorrect:
A. Questioning the parents and child about the accident and injuries Obtaining a health history requires interviewing skills and clinical judgment to gather and interpret relevant information, which falls within the RN's scope of practice and cannot be delegated to UAP.
C. Inserting an NG for decompression Inserting a nasogastric tube is an invasive procedure requiring specialized training and clinical skill, which is outside the scope of UAP practice.
D. Completing a physical assessment Physical assessment requires nursing knowledge, skill, and clinical judgment, making it a responsibility that must remain with the RN and cannot be delegated to UAP.
6. Liam is a 10-year-old male with a negative history and an up-to-date immunization record. Liam's mother reports that over the past month, he has been drinking large amounts of water and waking up several times during the night to urinate. He has been feeling unusually tired, struggling to concentrate in school, and has lost 3 kg (6.6 lbs) without any changes in diet or activity level. His appetite has been normal, but he continues to lose weight. His mother also noticed that his breath has a fruity smell, especially in the last few days. Concerned, they brought him to the clinic for evaluation. Vital Signs: Weight: 28 kg (61.7 lbs), Height: 140 cm (55 inches), Temperature: 37.0°C (98.6°F), Pulse: 110 bpm, Blood Pressure: 100/65 mmHg, Respiratory Rate: 24 breaths/min, Oxygen Saturation: 99% on room air. Physical Assessment: General: Appears tired but alert, Skin: Dry, no signs of rashes or lesions, Mucous Membranes: Dry, Cardiovascular: Tachycardia, normal heart sounds, Respiratory: Clear breath sounds, no wheezing, Abdomen: Soft, non-tender, no organomegaly, Neurological: Alert, oriented, normal reflexes, mild fatigue noted.
Select the 5 data points that the nurse should be concerned about:
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Mucous membranes
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Weight changes
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Temperature
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Nocturia
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Energy level
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Lung sounds
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Abdominal assessment
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Heart rate
Explanation
Explanation
Correct Answer: (A, B, D, E, H) Mucous membranes, Weight changes, Nocturia, Energy level, Heart rate
Liam's clinical picture is consistent with new-onset Type 1 Diabetes Mellitus. These five data points are priority concerns because they reflect the classic triad of hyperglycemia, dehydration, and cellular energy deprivation. Dry mucous membranes signal dehydration from osmotic diuresis, unexplained weight loss indicates the body is catabolizing fat and muscle due to insulin deficiency, nocturia reflects glucose spillage into urine, low energy and poor concentration demonstrate cells are starved of glucose, and tachycardia (110 bpm) is a compensatory response to volume depletion and possible early DKA.
Why the other options are incorrect:
C. Temperature — 37.0°C is completely within normal range, presenting no concern for infection or thermoregulation issues.
F. Lung sounds — Described as clear with no wheezing, indicating no respiratory compromise at this time.
G. Abdominal assessment — Abdomen is soft, non-tender with no organomegaly, presenting no immediate concern.
Correct Answer: (A, B, D, E, H) Mucous membranes, Weight changes, Nocturia, Energy level, Heart rate
Liam's clinical picture is consistent with new-onset Type 1 Diabetes Mellitus. These five data points are priority concerns because they reflect the classic triad of hyperglycemia, dehydration, and cellular energy deprivation. Dry mucous membranes signal dehydration from osmotic diuresis, unexplained weight loss indicates the body is catabolizing fat and muscle due to insulin deficiency, nocturia reflects glucose spillage into urine, low energy and poor concentration demonstrate cells are starved of glucose, and tachycardia (110 bpm) is a compensatory response to volume depletion and possible early DKA.
Why the other options are incorrect:
C. Temperature — 37.0°C is completely within normal range, presenting no concern for infection or thermoregulation issues.
F. Lung sounds — Described as clear with no wheezing, indicating no respiratory compromise at this time.
G. Abdominal assessment — Abdomen is soft, non-tender with no organomegaly, presenting no immediate concern.
7. What is a key dietary recommendation for a pediatric patient diagnosed with acute post-infection glomerulonephritis?
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Increase protein intake to promote kidney healing
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Limit sodium intake to reduce fluid retention and blood pressure
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Encourage high potassium foods to support overall health
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Increase fluid intake to flush out toxins from the kidneys
Explanation
Explanation
Correct Answer: (B) Limit sodium intake to reduce fluid retention and blood pressure.
Acute post-infectious glomerulonephritis causes sodium and water retention, leading to hypertension and edema. Restricting sodium intake is the primary dietary intervention to reduce fluid overload, control blood pressure, and decrease the workload on the kidneys during the acute phase.
Why Other Options are Incorrect:
A. Increase protein intake to promote kidney healing. Protein restriction is actually recommended during acute glomerulonephritis because the damaged kidneys cannot adequately excrete nitrogen waste products from protein metabolism, which would worsen azotemia.
C. Encourage high potassium foods to support overall health. With impaired renal function, the kidneys cannot adequately excrete potassium, putting the child at risk for hyperkalemia. High-potassium foods should be avoided, not encouraged.
D. Increase fluid intake to flush out toxins from the kidneys. Fluid intake is typically restricted in acute glomerulonephritis because the kidneys are already retaining sodium and water, and increased intake would worsen hypertension and edema.
Correct Answer: (B) Limit sodium intake to reduce fluid retention and blood pressure.
Acute post-infectious glomerulonephritis causes sodium and water retention, leading to hypertension and edema. Restricting sodium intake is the primary dietary intervention to reduce fluid overload, control blood pressure, and decrease the workload on the kidneys during the acute phase.
Why Other Options are Incorrect:
A. Increase protein intake to promote kidney healing. Protein restriction is actually recommended during acute glomerulonephritis because the damaged kidneys cannot adequately excrete nitrogen waste products from protein metabolism, which would worsen azotemia.
C. Encourage high potassium foods to support overall health. With impaired renal function, the kidneys cannot adequately excrete potassium, putting the child at risk for hyperkalemia. High-potassium foods should be avoided, not encouraged.
D. Increase fluid intake to flush out toxins from the kidneys. Fluid intake is typically restricted in acute glomerulonephritis because the kidneys are already retaining sodium and water, and increased intake would worsen hypertension and edema.
8. 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
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.
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.
9. A nurse is educating a parent about the contagious period of chickenpox in their child. Which statement by the nurse accurately describes when the child is no longer contagious?
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The child is no longer contagious when the rash first appears.
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The child is no longer contagious once all the blisters have crusted over.
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The child is no longer contagious once the fever subsides.
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The child is no longer contagious after five days from the onset of the rash.
Explanation
Explanation
Chickenpox (varicella) remains contagious from about 1 to 2 days before the rash appears until all of the lesions have crusted over, which typically takes about 5 to 7 days after the rash onset. The crusting of all blisters is the definitive marker that the child can no longer transmit the virus, making this the accurate teaching point for when the child may safely return to school or be around others.
Why the other options are incorrect:
A. The child is no longer contagious when the rash first appears. The rash's first appearance actually marks a highly contagious period, and the child remains contagious as long as fluid-filled vesicles are present. C. The child is no longer contagious once the fever subsides. Fever resolution does not indicate the end of the contagious period, as active, uncrusted lesions can still transmit the virus. D. The child is no longer contagious after five days from the onset of the rash. The contagious period is determined by the condition of the lesions, not a fixed number of days; if any blisters have not yet crusted over after five days, the child remains contagious.
Chickenpox (varicella) remains contagious from about 1 to 2 days before the rash appears until all of the lesions have crusted over, which typically takes about 5 to 7 days after the rash onset. The crusting of all blisters is the definitive marker that the child can no longer transmit the virus, making this the accurate teaching point for when the child may safely return to school or be around others.
Why the other options are incorrect:
A. The child is no longer contagious when the rash first appears. The rash's first appearance actually marks a highly contagious period, and the child remains contagious as long as fluid-filled vesicles are present. C. The child is no longer contagious once the fever subsides. Fever resolution does not indicate the end of the contagious period, as active, uncrusted lesions can still transmit the virus. D. The child is no longer contagious after five days from the onset of the rash. The contagious period is determined by the condition of the lesions, not a fixed number of days; if any blisters have not yet crusted over after five days, the child remains contagious.
10. A nurse is assessing a child who has failure to thrive. Which of the following findings should the nurse expect?
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Low body weight
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Repetitive movements
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Slow heart rate
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Hyperactive behavior
Explanation
Explanation
Correct Answer: (A) Low body weight
Failure to thrive is characterized by inadequate physical growth, most notably weight that falls below expected standards for age, often below the 5th percentile or showing a significant downward trend across growth percentiles. Low body weight is the hallmark finding, resulting from insufficient caloric intake, inadequate absorption, or increased metabolic demands.
Why the other options are incorrect:
B. Repetitive movements Repetitive movements are more commonly associated with developmental or neurological conditions such as autism spectrum disorder, not failure to thrive. C. Slow heart rate Bradycardia is not a characteristic finding of failure to thrive; severe malnutrition may affect vital signs, but slow heart rate is not an expected hallmark of this condition. D. Hyperactive behavior Children with failure to thrive typically display lethargy, irritability, or decreased activity levels due to inadequate nutrition, not hyperactivity.
Correct Answer: (A) Low body weight
Failure to thrive is characterized by inadequate physical growth, most notably weight that falls below expected standards for age, often below the 5th percentile or showing a significant downward trend across growth percentiles. Low body weight is the hallmark finding, resulting from insufficient caloric intake, inadequate absorption, or increased metabolic demands.
Why the other options are incorrect:
B. Repetitive movements Repetitive movements are more commonly associated with developmental or neurological conditions such as autism spectrum disorder, not failure to thrive. C. Slow heart rate Bradycardia is not a characteristic finding of failure to thrive; severe malnutrition may affect vital signs, but slow heart rate is not an expected hallmark of this condition. D. Hyperactive behavior Children with failure to thrive typically display lethargy, irritability, or decreased activity levels due to inadequate nutrition, not hyperactivity.
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