ATI_RN Pediatric Nursing 2023 at at Baton Rouge Community College
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Free ATI_RN Pediatric Nursing 2023 at at Baton Rouge Community College Questions
A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?
- A. Decreased bone density
- B. Decreased intraocular pressure
- C. Weight loss
- D. Hypoglycemia
Explanation
Prednisolone is a corticosteroid, and long-term or repeated use in children can interfere with bone growth and calcium metabolism. Corticosteroids decrease bone formation and increase bone resorption, placing pediatric clients at risk for decreased bone density and fractures. Because children are still growing, monitoring for bone-related adverse effects is especially important to prevent long-term skeletal complications.
Correct Answer Is:
A. Decreased bone densityA nurse is preparing to administer ampicillin 50 mg/kg/day divided equally every 6 hr to a child who weighs 30 kg (66 lb). Available is ampicillin oral suspension 125 mg/5 mL. How many mL should the nurse administer per dose? (Round to the nearest whole number.)
- A. 10 mL
- B. 12 mL
- C. 15 mL
- D. 18 mL
Explanation
Explanation
The total daily dose is 50 mg/kg/day × 30 kg = 1,500 mg/day. The medication is given every 6 hours, which equals 4 doses per day. Each dose is 1,500 mg ÷ 4 = 375 mg per dose. The concentration is 125 mg per 5 mL, which equals 25 mg/mL. Dividing 375 mg by 25 mg/mL results in 15 mL per dose.Correct Answer Is:
C. 15 mLA nurse is caring for an infant who has heart failure and is receiving digoxin. Which of the following findings indicates a positive response to the medication?
- A. Respiratory rate 32/min
- B. Urine output 2 mL/kg/hr
- C. Capillary refill 4 seconds
- D. Heart rate 187/min
Explanation
Explanation
Digoxin improves myocardial contractility and cardiac output in infants with heart failure. As cardiac output improves, renal perfusion increases, leading to improved urine output. A urine output of 2 mL/kg/hr indicates adequate kidney perfusion and effective circulation, which is a key indicator that the medication is successfully improving the infant’s cardiac function and reducing fluid overload associated with heart failure.Correct Answer Is:
B. Urine output 2 mL/kg/hrWhy the other options are incorrect:
A nurse is providing discharge teaching to the parent of a 5-year-old child who has sickle cell anemia and was admitted for a vaso-occlusive crisis. Which of the following instructions should the nurse include in the teaching?
- A. You should schedule a follow-up appointment with your provider in 1 month.
- B. Your child will need weekly blood transfusions.
- C. You should administer aspirin daily to your child.
- D. Your child will need to receive hydroxyurea.
Explanation
Explanation
Hydroxyurea is commonly prescribed for children with sickle cell anemia to reduce the frequency and severity of vaso-occlusive crises. The medication works by increasing fetal hemoglobin levels, which decreases red blood cell sickling and improves blood flow. This reduces pain episodes, acute chest syndrome, and hospitalizations, making it an important long-term management therapy included in discharge teaching.Correct Answer Is:
D. Your child will need to receive hydroxyurea.Why the other options are incorrect:
A nurse is caring for a 5-year-old child who has nephrotic syndrome. Which of the following findings should indicate to the nurse that treatment has been effective?
- A. No report of pain with voiding
- B. Urine output 256 mL over 8 hr
- C. Odorless urine
- D. Temperature 37.2° C (99° F)
Explanation
Nephrotic syndrome is characterized by fluid retention and edema due to protein loss in the urine. Effective treatment results in mobilization of excess fluid and improved renal perfusion, which is reflected by increased urine output. A urine output of 256 mL over 8 hours in a 5-year-old child represents adequate diuresis and indicates that edema is resolving and the treatment is improving kidney function and fluid balance.
Correct Answer Is:
B. Urine output 256 mL over 8 hrA nurse is caring for an adolescent who has acute glomerulonephritis. Which of the following actions should the nurse take?
- A. Increase the client’s dietary protein intake.
- B. Assess the client’s blood pressure every 8 hr.
- C. Weigh the client daily.
- D. Avoid palpating the client’s abdomen.
Explanation
Acute glomerulonephritis causes decreased kidney filtration, leading to fluid retention and edema. Daily weight measurement is the most sensitive and accurate method for evaluating fluid balance and detecting subtle changes in fluid status. Monitoring weight allows the nurse to assess the effectiveness of treatment, identify worsening fluid overload early, and guide interventions to prevent complications such as hypertension and pulmonary edema.
Correct Answer Is:
C. Weigh the client daily.A nurse is performing an assessment for a 5-year-old child who has celiac disease. Which of the following findings should the nurse expect?
- A. Hematemesis
- B. Sausage-shaped mass in the upper right abdomen
- C. Malnutrition
- D. Red currant jelly-like stools
Explanation
Celiac disease is an autoimmune disorder in which ingestion of gluten damages the intestinal villi, leading to impaired absorption of nutrients. Over time, this malabsorption results in poor weight gain, growth delays, vitamin and mineral deficiencies, and overall malnutrition. In children, this often presents as failure to thrive, fatigue, abdominal distension, and delayed development, making malnutrition a hallmark finding.
Correct Answer Is:
C. MalnutritionA nurse is caring for a child who is postoperative following surgical correction of tetralogy of Fallot. Which of the following findings should the nurse identify as an indication of heart failure?
- A. Decreased respirations
- B. Exercise intolerance
- C. Bradycardia
- D. Weight loss
Explanation
Exercise intolerance is a common indicator of heart failure in children because decreased cardiac output limits the heart’s ability to meet the body’s increased oxygen and energy demands during activity. Following cardiac surgery, a child with heart failure may fatigue easily, become short of breath with minimal exertion, or be unable to tolerate normal play activities. This finding reflects impaired circulation and inadequate tissue perfusion, making it a key sign of ongoing or developing heart failure.
Correct Answer Is:
B. Exercise intoleranceA nurse is admitting an 8-year-old child to the pediatric unit.
Nurses' Notes
Day 1, 1020:
Child is a direct admit from a pediatric clinic and is accompanied by their guardian. Guardian reports that child has been sick for about 2 days with fever and chills and appears to be more irritable. Approximately 2 weeks ago, guardian reports that their child had an upper respiratory infection that was managed with over-the-counter medications. Guardian also reports that child has no prior medical conditions and has received all recommended scheduled immunizations.
1030:
Child reports nausea and headache and rates the pain as 7 on a scale of 0 to 10. Lethargic and responsive to verbal stimuli. Agitation and irritability noted. Nuchal rigidity noted. Pupils equal, round, and reactive to light. Mucous membranes pink dry, and sticky. Cervical lymph slightly enlarged. Respirations irregular. No accessory muscle use noted. Breath sounds clear anterior posterior bilaterally. Heart rhythm regular without murmurs. Radial and pedal pulses 1+ bilateral. Capillary refill seconds. Abdomen flat and non-distended. Bowel sounds ac in all 4 quadrants. Extremities are warm and dry to touch
Flow Sheet
Day 1, 1030:
Temperature 38.7° C (101.7° F)
Heart rate 114/min
Respiratory rate 26/min
Blood pressure 114/80 mm Hg
SpO2 97% on room air
Height 122 cm (48 in)
Weight 29 kg (64 lb)
Diagnostic Results
Day 1, 1040:
Potassium 3.8 mEq/L (3.4 to 4.7 mEq/L)
Hemoglobin 9.5 g/dL (10 to 15.5 g/dL)
Hematocrit 30% (32% to 44%)
RBC count 4.2 x 106/pL (4.0 to 5.5 x 106/pL)
WBC count 14,000 mm3 (5,000 to 10,000 mm3)
Platelets 350,000/mm3 (150,000 to 400,000/mm3)
Glucose 90 mg/dL (< 200 mg/dL)
Blood cultures pending
Provider Prescriptions
Day 1, 1020:
Admit directly to pediatric unit.
Keep child NPO.
Obtain comprehensive metabolic panel and blood cultures
STAT.
Vital signs every 30 min, then every hr x 4, then every 4 hr.
Exhibit 1
Nurses' Notes
Day 1, 1020:
Child is a direct admit from a pediatric clinic and is accompanied by their guardian. Guardian reports that child has been sick for about 2 days with fever and chills and appears to be more irritable. Approximately 2 weeks ago, guardian reports that their child had an upper respiratory infection that was managed with over-the-counter medications. Guardian also reports that child has no prior medical conditions and has received all recommended scheduled immunizations.
1030:
Child reports nausea and headache and rates the pain as 7 on a scale of 0 to 10. Lethargic and responsive to verbal stimuli. Agitation and irritability noted. Nuchal rigidity noted. Pupils equal, round, and reactive to light. Mucous membranes pink dry, and sticky. Cervical lymph slightly enlarged. Respirations irregular. No accessory muscle use noted. Breath sounds clear anterior posterior bilaterally. Heart rhythm regular without murmurs. Radial and pedal pulses 1+ bilateral. Capillary refill seconds. Abdomen flat and non-distended. Bowel sounds ac in all 4 quadrants. Extremities are warm and dry to touch
Exhibit 2
Flow Sheet
Day 1, 1030:
Temperature 38.7° C (101.7° F)
Heart rate 114/min
Respiratory rate 26/min
Blood pressure 114/80 mm Hg
SpO2 97% on room air
Height 122 cm (48 in)
Weight 29 kg (64 lb)
Exhibit 3
Diagnostic Results
Day 1, 1040:
Potassium 3.8 mEq/L (3.4 to 4.7 mEq/L)
Hemoglobin 9.5 g/dL (10 to 15.5 g/dL)
Hematocrit 30% (32% to 44%)
RBC count 4.2 x 106/pL (4.0 to 5.5 x 106/pL)
WBC count 14,000 mm3 (5,000 to 10,000 mm3)
Platelets 350,000/mm3 (150,000 to 400,000/mm3)
Glucose 90 mg/dL (< 200 mg/dL)
Blood cultures pending
Exhibit 4
Provider Prescriptions
Day 1, 1020:
Admit directly to pediatric unit.
Keep child NPO.
Obtain comprehensive metabolic panel and blood cultures
STAT.
Vital signs every 30 min, then every hr x 4, then every 4 hr.
A nurse is reviewing the child's electronic medical record (EMR). Which of the following findings should the nurse identify as requiring immediate follow-up?
Select the 5 findings that require immediate follow-up.
- A. Hemoglobin
- B. Glucose
- C. Pain assessment
- D. Peripheral pulses
- E. Temperature
- F. Abdominal assessment
- G. Neurologic assessment
- H. WBC
Explanation
Explanation
C. Pain assessmentThe child reports a headache rated 7/10 accompanied by nausea, lethargy, and irritability. Severe headache in combination with nuchal rigidity and altered responsiveness is concerning for meningeal irritation or increased intracranial pressure. This finding requires immediate follow-up to guide urgent neurologic evaluation and intervention.
D. Peripheral pulses
Radial and pedal pulses documented as 1+ bilaterally indicate decreased peripheral perfusion. In the setting of fever, lethargy, and suspected infection, weak pulses may signal early circulatory compromise or sepsis. This finding requires prompt reassessment and close monitoring.
E. Temperature
A temperature of 38.7° C (101.7° F) with chills and irritability suggests an acute infectious process. Fever combined with neurologic signs raises concern for meningitis or systemic infection, requiring immediate follow-up for rapid evaluation and treatment.
G. Neurologic assessment
Lethargy, agitation, irritability, nuchal rigidity, and irregular respirations are significant neurologic red flags. These findings strongly suggest central nervous system involvement, such as meningitis or rising intracranial pressure, and require immediate provider notification and intervention.
H. WBC
An elevated WBC count of 14,000/mm³ indicates an active inflammatory or infectious process. When paired with fever and neurologic symptoms, this finding supports possible serious bacterial infection and requires urgent follow-up to prevent rapid deterioration.
Correct Answer Is:
C. Pain assessmentD. Peripheral pulses
E. Temperature
G. Neurologic assessment
H. WBC
A nurse is caring for a 6-week-old infant.
History and Physical
Infant was full-term at birth. Birth weight was 3.5 kg (7.7 lb). Infant is not gaining weight as expected. One week ago at outpatient visit, weight was 3.6 kg (7.9 lb). Parent reports for past 2 days infant is breathing faster during feedings and does not finish feedings. Parent also reports
decreased appetite and puffiness around the infant's eyes. Parent states that the last wet diaper was about 10 hr ago. Infant admitted for diagnostic evaluation, failure to thrive, and
nutritional/fluid support.
Vital Signs
Admission:
Temperature 37.7° C (99.9° F)
Heart rate 174/min while sleeping
Respiratory rate 72/min while sleeping
Blood pressure in right upper extremity 60/39 mm Hg
Oxygen saturation 90%
Assessment
Admission:
Respirations: Tachypneic with moderate retractions and nasal flaring. Upon auscultation, crackles heard in all lung fields. No nasal drainage noted. Dry cough noted periodically.
Skin: Pallor, scalp is diaphoretic, lower extremities are cool to touch.
Cardiac: Tachycardic, regular rhythm, no murmur is heard. Peripheral pulses are full and bounding in the upper extremities and weak bilateral pedal pulses are noted.
Fluids: Mucous membranes are slightly dry and pink. Skin turgor is slightly decreased. Capillary refill is 3 seconds. Noted periorbital edema and nonpitting edema of feet. Anterior fontanel is soft and slightly depressed. Diaper remains dry.
Abdomen: Soft, full, round, bowel sounds are present and active.
Laboratory Results
Admission:
[ Chest x-ray: mild left ventricular hypertrophy is noted. Increased pulmonary vascular markings are noted in all lobes.
Exhibit 1
A nurse is caring for a 6-week-old infant.
History and Physical
Infant was full-term at birth. Birth weight was 3.5 kg (7.7 lb). Infant is not gaining weight as expected. One week ago at outpatient visit, weight was 3.6 kg (7.9 lb). Parent reports for past 2 days infant is breathing faster during feedings and does not finish feedings. Parent also reports
decreased appetite and puffiness around the infant's eyes. Parent states that the last wet diaper was about 10 hr ago. Infant admitted for diagnostic evaluation, failure to thrive, and
nutritional/fluid support.
Exhibit 2
Vital Signs
Admission:
Temperature 37.7° C (99.9° F)
Heart rate 174/min while sleeping
Respiratory rate 72/min while sleeping
Blood pressure in right upper extremity 60/39 mm Hg
Oxygen saturation 90%
Exhibit 3
Assessment
Admission:
Respirations: Tachypneic with moderate retractions and nasal flaring. Upon auscultation, crackles heard in all lung fields. No nasal drainage noted. Dry cough noted periodically.
Skin: Pallor, scalp is diaphoretic, lower extremities are cool to touch.
Cardiac: Tachycardic, regular rhythm, no murmur is heard. Peripheral pulses are full and bounding in the upper extremities and weak bilateral pedal pulses are noted.
Fluids: Mucous membranes are slightly dry and pink. Skin turgor is slightly decreased. Capillary refill is 3 seconds. Noted periorbital edema and nonpitting edema of feet. Anterior fontanel is soft and slightly depressed. Diaper remains dry.
Abdomen: Soft, full, round, bowel sounds are present and active.
Exhibit 4
Laboratory Results
Admission:
[ Chest x-ray: mild left ventricular hypertrophy is noted. Increased pulmonary vascular markings are noted in all lobes.
What condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
-
A. Congestive heart failure
Actions to take:
• Anticipate a prescription for digoxin
• Elevate the head of the bed to a 45° angle
Parameters to monitor:
• Respiratory status
• Intake and output -
B. Cystic fibrosis
Actions to take:
• Implement contact precautions
• Provide chest physiotherapy and postural drainage
Parameters to monitor:
• Number of steatorrhea stools
• Respiratory status -
C. Pyloric stenosis
Actions to take:
• Place nasogastric tube for gastric decompression
• Keep the infant NPO
Parameters to monitor:
• Abdominal peristaltic waves
• Intake and output -
D. Respiratory syncytial virus (RSV) bronchiolitis
Actions to take:
• Implement contact precautions
• Provide supportive oxygen therapy
Parameters to monitor:
• Respiratory status
• Blood glucose
Explanation
Explanation
The infant exhibits classic signs of congestive heart failure, including poor weight gain, tachypnea with feeds, diaphoresis, crackles, edema, decreased urine output, bounding upper extremity pulses, weak pedal pulses, and chest x-ray findings of ventricular hypertrophy and pulmonary congestion. Digoxin improves cardiac contractility, and elevating the head of the bed reduces pulmonary congestion. Monitoring respiratory status and intake/output evaluates treatment effectiveness.Correct Answer Is:
A. Congestive heart failureActions to take:
• Anticipate a prescription for digoxin
• Elevate the head of the bed to a 45° angle
Parameters to monitor:
• Respiratory status
• Intake and output
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