ATI RN Pediatric Nursing 2023.
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Free ATI RN Pediatric Nursing 2023. Questions
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Allow the toddler to visit the playroom 30 min prior to bedtime.
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Establish a daily schedule with the toddler and their family.
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Administer diuretics with the toddler's lunch.
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Keep the television on in the toddler's room.
Explanation
Correct Answer: (B) Establish a daily schedule with the toddler and their family.
Establishing a daily schedule with the toddler and their family promotes rest by providing a consistent, predictable routine that minimizes unnecessary stimulation and activity. Toddlers thrive on routine and predictability, and a structured daily schedule allows for planned rest periods, organized care activities, and reduced environmental stress. In heart failure, conserving energy and minimizing cardiac workload are essential, and a consistent daily routine supports both adequate rest and the family's ability to participate in the child's care.
Why the other options are incorrect:
A. Allowing the toddler to visit the playroom 30 minutes prior to bedtime is incorrect because physical activity and stimulation immediately before bedtime will increase cardiac workload, elevate heart rate, and make it more difficult for the toddler to settle and fall asleep. This would be counterproductive to promoting rest in a child with heart failure.
C. Administering diuretics with the toddler's lunch is incorrect for promoting rest. Diuretics cause increased urination, and administering them at lunchtime would result in frequent urination during the afternoon and evening hours, disrupting sleep and rest periods. Diuretics are typically administered in the morning to prevent nighttime sleep disruption from frequent voiding.
D. Keeping the television on in the toddler's room is incorrect because continuous television creates an overstimulating environment with constant noise and light that interferes with rest and sleep quality. A quiet, calm, low-stimulation environment is essential for promoting adequate rest in a toddler with heart failure.
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Irritability
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Constipation
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Increased abdominal girth
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Increased urinary output
Explanation
Correct Answer: (C) Increased abdominal girth.
Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and generalized edema. In toddlers, fluid accumulation in the peritoneal cavity (ascites) causes increased abdominal girth, which is a hallmark sign of the condition alongside periorbital and dependent edema.
Why other options are incorrect:
A. Irritability is a nonspecific finding not specific to nephrotic syndrome.
B. Constipation is not a characteristic feature of nephrotic syndrome and may occur for many unrelated reasons in toddlers.
D. Nephrotic syndrome causes decreased, not increased, urinary output due to sodium and water retention, along with foamy urine from proteinuria.
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Antibiotics initiated 24 hr ago
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Absent nuchal rigidity
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Temperature below 37.4° C (99.3° F)
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Negative cerebrospinal fluid culture
Explanation
Correct Answer: (A) Antibiotics initiated 24 hr ago
For bacterial meningitis, droplet precautions can be discontinued after the child has received appropriate antibiotic therapy for at least 24 hours. At this point, the organism is considered no longer transmissible via droplets. This is the standard evidence-based guideline for infection control in bacterial meningitis.
Why the other options are incorrect:
B. Absent nuchal rigidity indicates clinical improvement but does not determine when droplet precautions can be safely lifted, as transmission risk is based on antibiotic exposure, not symptom resolution.
C. A temperature below 37.4° C indicates the fever has resolved, but fever reduction alone does not determine when droplet precautions can be removed.
D. A negative cerebrospinal fluid culture would take days to result and is not used as the criterion for discontinuing droplet precautions. The 24-hour antibiotic rule is the standard guideline.
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Assess the child every 4 hr while in restraints.
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Request that the provider renew the prescription for restraints every 48 hr.
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Tie the restraints to the side rails of the child's bed.
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Secure the restraints with a quick-release knot.
Explanation
Correct Answer: (D) Secure the restraints with a quick-release knot.
Restraints must always be secured with a quick-release knot to allow immediate removal in case of emergency such as a fire, cardiac arrest, or sudden deterioration. This ensures client safety while maintaining the restraint's purpose.
Why other options are incorrect:
A. Clients in restraints must be assessed every 15 minutes, not every 4 hours, to monitor circulation, skin integrity, and psychological status.
B. Restraint prescriptions must be renewed every 24 hours for children, not every 48 hours, per Joint Commission and facility safety standards.
C. Restraints must never be tied to side rails, as lowering or raising the rails can injure the child. They should be secured to the bed frame instead.
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A child who has viral pneumonia
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A child who has cellulitis of the right radius
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A child who has impetigo
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A child who has a fractured left femur
Explanation
A child with a fractured left femur is the most appropriate roommate for the preschooler recovering from Wilms' tumor removal because a fracture is a non-infectious orthopedic condition that poses no risk of transmitting infection to the immunocompromised postoperative child. Following surgery and potential chemotherapy for Wilms' tumor, the child's immune system is compromised, making infection prevention the highest priority when selecting a roommate.
Why the other options are incorrect:
A. A child who has viral pneumonia is inappropriate because viral pneumonia is a contagious respiratory infection that could be transmitted to the postoperative child through respiratory droplets. An immunocompromised child recovering from tumor surgery is highly susceptible to respiratory infections that could become life-threatening.
B. A child who has cellulitis of the right radius is inappropriate because cellulitis is a bacterial skin infection that, while typically not highly contagious through casual contact, still represents an active infectious process. Placing an immunocompromised postoperative child in a room with any active infection increases the risk of cross-contamination and secondary infection.
C. A child who has impetigo is inappropriate because impetigo is a highly contagious bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes that spreads easily through direct contact and contaminated surfaces. This poses an unacceptable infection risk to a child who is immunocompromised following Wilms' tumor surgery.
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Hypokalemia
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Metabolic alkalosis
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Oliguria
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Hypercalcemia
Explanation
Oliguria, defined as urine output less than 1 mL/kg/hr in children, is a hallmark finding of acute renal failure. When the kidneys fail, they lose their ability to filter blood and produce adequate urine, resulting in significantly decreased urine output. This is one of the earliest and most reliable indicators of acute renal failure and reflects the severity of renal impairment.
Why the other options are incorrect:
A. Hypokalemia is not expected in acute renal failure. The kidneys normally excrete potassium, so when renal function fails, potassium accumulates in the blood, leading to hyperkalemia rather than hypokalemia. Hyperkalemia is one of the most dangerous complications of acute renal failure due to its effects on cardiac conduction.
B. Metabolic alkalosis is not the expected acid-base disturbance in acute renal failure. The kidneys normally excrete hydrogen ions and reabsorb bicarbonate to maintain acid-base balance. When renal function fails, hydrogen ions accumulate and bicarbonate is lost, leading to metabolic acidosis, not metabolic alkalosis.
D. Hypercalcemia is not expected in acute renal failure. The kidneys play a role in activating vitamin D and regulating calcium and phosphorus balance. In acute renal failure, phosphorus retention occurs and calcium levels typically decrease, leading to hypocalcemia rather than hypercalcemia.
Exhibit 1 — Nurses' Notes
3 months ago:
Past medical history: Eczema, recurrent otitis media, born small for gestational age at 40 weeks of gestation, weighing 2,580 g (5 lb 11 oz)
Surgical history: Status-post tympanostomy tube placement at 14 months of age
Family history: Client's sister has asthma, mother has hypertension
Social history: Lives at home with parents and siblings, father smokes cigarettes
Physical examination: General: No acute distress Respiratory: Faint expiratory wheezing, prolonged expiration Cardiovascular: S1, S2, no murmur or rub Skin: Warm, dry
Height: 114.3 cm (45 in) Weight: 18.2 kg (40 lb) BMI: 13.9 kg/m²
Today, 1300:
The client presents to the ED with their parents. The parents state, "Something isn't right. My child is short of breath and anxious."
Physical examination: General: Diaphoretic, sitting upright, agitated Respiratory: Coarse wheezing throughout, intercostal retractions, prolonged expiration Cardiovascular: Tachycardia, regular rhythm
Today, 1330:
Physical examination: General: Drowsy, quiet Respiratory: Tachypnea, no wheezing auscultated, paradoxic thoracoabdominal movement Cardiovascular: Bradycardia, regular rhythm
Select all that apply.
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A 5-year-old male child presents to the office with their parents. The parents state the child has a chronic cough that just won't go away. The parents state the child often coughs at night when they are sleeping, and the parents are worried this is making the child tired and contributing to poor school performance.
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The parents advise the child to place their lips around the mouthpiece tightly.
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The parents advise the child to lean their head forward and breathe out quickly.
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The parents do not shake the cannister.
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The parents remove the cap and hold the inhaler upright.
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At the beginning of expiration, the parents push the top of the cannister and ask the child to breathe in rapidly.
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The parents tell the child to hold their breath for 5 to 10 seconds to allow the aerosol medication to reach deeply into the lungs.
Explanation
Correct Answers: (A) The parents advise the child to place their lips around the mouthpiece tightly, (D) The parents remove the cap and hold the inhaler upright, (F) The parents tell the child to hold their breath for 5 to 10 seconds to allow the aerosol medication to reach deeply into the lungs.
Placing the lips around the mouthpiece tightly is correct inhaler technique because creating a tight seal around the mouthpiece ensures that all of the aerosolized medication is directed into the airways and none escapes around the sides of the mouth. This maximizes the dose of medication delivered to the lungs with each actuation.
Removing the cap and holding the inhaler upright is correct because the cap must be removed before use to allow medication to be dispensed, and holding the inhaler upright ensures that the medication canister is properly positioned to deliver a full and accurate dose. An improperly positioned inhaler will not deliver the correct amount of medication.
Holding the breath for 5 to 10 seconds after inhalation is correct because breath-holding after inhaling the medication allows the aerosolized particles to settle and deposit deep into the smaller airways and alveoli. Without breath-holding, the medication is exhaled before it can be fully absorbed into the lung tissue, significantly reducing its therapeutic effectiveness.
Why the other options are incorrect:
B. Advising the child to lean their head forward and breathe out quickly is incorrect. The correct technique is to tilt the head slightly back, not forward, to open the airway and optimize medication delivery. The child should exhale slowly and gently before actuation, not quickly, to avoid turbulence that can disrupt proper medication inhalation.
C. Not shaking the canister is incorrect technique. The inhaler canister must be shaken well before each use, typically for 5 to 10 seconds, to ensure the medication is properly mixed and that an accurate and consistent dose is dispensed with each actuation. Failure to shake the canister results in an uneven and potentially subtherapeutic dose.
E. Pushing the top of the canister at the beginning of expiration and asking the child to breathe in rapidly is entirely incorrect technique. The canister should be actuated at the beginning of a slow, deep inhalation, not expiration. Actuating during expiration means the medication is released as air is being pushed out of the lungs and cannot enter the airways. Breathing in rapidly also reduces medication deposition in the lower airways as fast airflow causes medication to impact in the upper airway rather than reaching the smaller bronchioles.
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Keep the affected extremity straight for at least 6 hr.
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Monitor output using an indwelling urinary catheter for the first 24 hr.
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Maintain the child's NPO status for 4 to 6 hr.
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Remove the child's pressure dressing after the first 4 hr.
Explanation
Following arterial cardiac catheterization, the affected extremity must be kept straight for at least 6 hours to prevent bleeding and hematoma formation at the arterial puncture site. Bending the extremity can disrupt clot formation at the insertion site and cause significant hemorrhage, given the arterial nature of the access. Maintaining the extremity straight ensures adequate hemostasis and reduces the risk of vascular complications.
Why the other options are incorrect:
B. Monitoring output using an indwelling urinary catheter for the first 24 hours is not a standard postoperative requirement following cardiac catheterization. Urine output can be monitored through regular voiding, and an indwelling catheter is not routinely indicated unless there is a specific clinical concern.
C. Maintaining NPO status for 4 to 6 hours postoperatively is incorrect. Following cardiac catheterization, oral intake is typically resumed as soon as the child is awake, alert, and tolerating fluids without nausea or vomiting, which is usually within 1 to 2 hours, not 4 to 6 hours.
D. Removing the pressure dressing after the first 4 hours is incorrect. The pressure dressing should remain in place and intact for a longer period as determined by facility protocol and provider orders. Premature removal of the pressure dressing increases the risk of bleeding and hematoma at the arterial access site.
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Check the wound sites for manifestations of infection.
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Adjust the room temperature to 33°C (91.4°F).
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Apply tepid water to the old dressings before removal.
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Perform passive range-of-motion exercises during the dressing change.
Explanation
Correct Answer: (B) Adjust the room temperature to 33°C (91.4°F).
Burn clients lose the ability to regulate body temperature due to destruction of the skin barrier. They are at extreme risk for hypothermia, as the damaged skin cannot retain heat. Raising the room temperature to 33°C (91.4°F) addresses the greatest risk — hypothermia — by minimizing heat loss during the dressing change when wounds are exposed.
Why other options are incorrect:
A. Checking for infection is important but is an assessment action, not an intervention addressing the greatest immediate risk during a dressing change.
C. Applying tepid water to old dressings eases removal and reduces pain but does not address the greatest risk.
D. Passive range-of-motion exercises support mobility and prevent contractures but are not the priority intervention during dressing changes.
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Increased respiratory rate
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Decreased heart rate
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Increased temperature
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Decreased systolic blood pressure
Explanation
In patent ductus arteriosus (PDA), the ductus arteriosus fails to close after birth, creating an abnormal connection between the aorta and the pulmonary artery. This causes increased blood flow to the lungs, leading to pulmonary congestion and fluid accumulation. As a result, the infant develops an increased respiratory rate as the body attempts to compensate for the impaired gas exchange caused by excess pulmonary blood flow.
Why the other options are incorrect:
B. Decreased heart rate is not expected in patent ductus arteriosus. The increased volume of blood returning from the pulmonary circulation causes the heart to work harder, typically resulting in tachycardia rather than bradycardia as a compensatory mechanism.
C. Increased temperature is not a characteristic finding of patent ductus arteriosus. Temperature elevation is more associated with infection or inflammation rather than a structural cardiac defect such as PDA.
D. Decreased systolic blood pressure is not the expected finding in patent ductus arteriosus. PDA is classically associated with a wide pulse pressure, where the systolic blood pressure may be normal or elevated while the diastolic blood pressure is low, resulting in a bounding pulse rather than decreased systolic pressure.
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