ATI RN Pediatric Nursing 2023.
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Free ATI RN Pediatric Nursing 2023. Questions
Drag words from the choices below to fill in each blank in the following sentence.
The child is at greatest risk for developing __________ and __________.
Word Choices:
disseminated intravascular coagulation hydrocephalus seizures increased intracranial pressure hypothermia
- disseminated intravascular coagulation
- hydrocephalus
- seizures
- increased intracranial pressure
- hypothermia
Explanation
Correct Answers: disseminated intravascular coagulation and increased intracranial pressure
Disseminated intravascular coagulation (DIC) is a life-threatening complication of bacterial meningitis, particularly when caused by Neisseria meningitidis. The presence of petechia on the face and trunk in this child is a key clinical indicator of vascular involvement and coagulopathy. In bacterial meningitis, the overwhelming systemic inflammatory response triggers abnormal clotting cascade activation throughout the body, consuming clotting factors and platelets, leading to both clotting and bleeding simultaneously.
Increased intracranial pressure is the other greatest risk in this child with bacterial meningitis. The inflammatory response to the bacterial infection causes cerebral edema and impaired cerebrospinal fluid circulation, resulting in dangerously elevated pressure within the skull. Clinical signs already present in this child, including lethargy, nuchal rigidity, headache, irregular respirations, and capillary refill of 4 seconds, are all consistent with rising intracranial pressure that can rapidly progress to herniation if not treated urgently.
Why the other options are incorrect:
Hydrocephalus can be a long-term complication of bacterial meningitis due to scarring and obstruction of cerebrospinal fluid pathways, but it is not the greatest immediate risk in the acute phase of the illness compared to DIC and increased intracranial pressure.
Seizures can occur in bacterial meningitis as a result of cortical irritation and elevated intracranial pressure, but they are a secondary manifestation rather than the primary and greatest risk this child faces given the current clinical presentation.
Hypothermia is not a complication associated with bacterial meningitis. This child is presenting with fever of 38.7° C, which is the expected finding. Hypothermia would be more consistent with septic shock in its late stages or neonatal sepsis, not bacterial meningitis in a school-age child.
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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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An allergic reaction
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A negative result
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Active tuberculosis
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Disseminated disease
Explanation
Correct Answer: (B) A negative result
A tuberculin skin test (TST) is read 48 to 72 hours after placement by measuring the diameter of the induration, not redness. In a school-age child who is not considered high risk, an induration of less than 5 mm is interpreted as a negative result. A 3-mm induration falls below this threshold and therefore indicates that the child has not been infected with Mycobacterium tuberculosis.
Why the other options are incorrect:
A. An allergic reaction is not the correct interpretation of a 3-mm induration on a tuberculin skin test. Allergic reactions to the TST are rare and would present differently, such as with redness, swelling, or systemic symptoms, rather than a small induration at the site.
C. Active tuberculosis cannot be determined from a tuberculin skin test alone, and even a positive TST result would only indicate exposure or latent infection, not necessarily active disease. A 3-mm induration does not even meet the threshold for a positive result.
D. Disseminated disease refers to tuberculosis that has spread throughout the body beyond the lungs and is a severe complication of TB infection. A 3-mm induration on a TST does not suggest disseminated disease in any way
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Osteomyelitis
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Compartment syndrome
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Renal calculi
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Volkmann ischemic contracture
Explanation
Correct Answer: (B) Compartment syndrome.
Compartment syndrome is the most critical acute complication following closed fractures, occurring within the first 24–48 hours. Swelling within the closed fascial compartment increases pressure, compromising circulation and nerve function. Early signs include the 6 P's: pain, pressure, paralysis, paresthesia, pallor, and pulselessness. It requires immediate intervention to prevent permanent tissue damage.
Why other options are incorrect:
A. Osteomyelitis is a bone infection that develops over days to weeks, not within the first 24 hours of a closed fracture.
C. Renal calculi are associated with prolonged immobility and hypercalcemia, not an acute complication of fractures within the first 24 hours.
D. Volkmann ischemic contracture is a late complication of untreated compartment syndrome, not an immediate 24-hour concern.
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Whole grain spaghetti with tomato sauce and a banana
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Baked sweet potato with cinnamon and honey
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Graham crackers and strawberry-flavored gelatin
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Blueberry smoothie made with Greek yogurt and whole milk
Explanation
Correct Answer: (D) Blueberry smoothie made with Greek yogurt and whole milk
A blueberry smoothie made with Greek yogurt and whole milk is the highest protein option among the choices. Greek yogurt is an excellent source of high-quality complete protein, and whole milk adds additional protein and calories. Children recovering from full-thickness burns have dramatically increased protein and caloric requirements due to the hypermetabolic state caused by severe burns. Adequate protein intake is essential for wound healing, tissue repair, immune function, and prevention of muscle wasting.
Why the other options are incorrect:
A. Whole grain spaghetti with tomato sauce and a banana is primarily a carbohydrate-rich meal. While it provides some protein from the pasta, it is not a high-protein choice and would not adequately meet the increased protein demands of a child recovering from a full-thickness burn.
B. Baked sweet potato with cinnamon and honey is a carbohydrate-dense food with minimal protein content. Sweet potatoes provide vitamins and fiber but are not a significant source of protein needed for burn recovery.
C. Graham crackers and strawberry-flavored gelatin are predominantly carbohydrate foods with very little protein. Regular gelatin contains minimal protein and is not a therapeutic source of the complete amino acids needed for wound healing and tissue repair in burn patients.
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"I will throw out my first urine sample when I start the urine collection."
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"I will include toilet paper that falls into the urine as part of the collected sample."
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"I can discard urine while I am at school if I keep track of the number of times I void."
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"I can stop the urine test earlier than 24 hours if I fill up the collection container."
Explanation
Correct Answer: (A) "I will throw out my first urine sample when I start the urine collection."
The correct procedure for a 24-hour urine collection requires discarding the first void to establish a clean baseline, then collecting all urine for the next 24 hours. This statement accurately reflects understanding of the collection procedure.
Why the other options are incorrect:
B. Any contamination including toilet paper invalidates the sample. The collection must be free of foreign material for accurate results.
C. All urine must be collected without exception during the 24-hour period. Discarding any void, regardless of tracking, renders the test inaccurate.
D. The collection must continue for the full 24-hour period regardless of container volume. If the container fills, a second container should be used; the test cannot be stopped early.
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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.
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 are 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 4 seconds. Abdomen flat and non-distended. Bowel sounds active in all 4 quadrants. Extremities are warm and dry to touch. Petechia noted on face and trunk. Skin turgor with tenting.
Which of the following actions should the nurse take?
Select all that apply.
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Apply pressure to the puncture site following the procedure.
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Position the child in a prone position during the procedure.
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Ensure the child voids prior to the procedure.
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Monitor for paresthesia and tingling in extremities following the procedure.
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Insert an indwelling urinary catheter during the procedure.
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Ensure the guardian has signed the consent form prior to the procedure.
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Limit the child's fluid intake following the procedure.
Explanation
Correct Answers: (A) Apply pressure to the puncture site following the procedure, (D) Monitor for paresthesia and tingling in extremities following the procedure, (F) Ensure the guardian has signed the consent form prior to the procedure
Applying pressure to the puncture site following the procedure is correct because after the needle is withdrawn, applying pressure helps minimize bleeding and prevents cerebrospinal fluid leakage at the puncture site, reducing the risk of post-procedural complications such as headache and infection. This is particularly important in this child given the clinical severity of the presentation.
Monitoring for paresthesia and tingling in extremities following the procedure is correct because these symptoms can indicate nerve irritation or damage at the puncture site. The nurse must assess for any neurological changes following the lumbar puncture to identify and report complications promptly, especially in a child who already presents with abnormal neurological findings including lethargy, nuchal rigidity, and irregular respirations.
Ensuring the guardian has signed the consent form prior to the procedure is correct because a lumbar puncture is an invasive procedure that requires informed consent. Since this child is a minor accompanied by their guardian, the legal guardian must provide written consent before the procedure can be performed, as documented in the nurses' notes.
Why the other options are incorrect:
B. Positioning the child in a prone position is incorrect. The correct position for a lumbar puncture is either the lateral recumbent position with the knees drawn up to the chest and chin tucked, or the sitting position leaning forward, both of which widen the spaces between the vertebrae to allow needle insertion. A prone position would not allow adequate access to the lumbar spine.
C. Ensuring the child voids prior to the procedure is not a standard requirement for a lumbar puncture. Voiding beforehand is required for procedures involving the abdominal or pelvic region, not spinal procedures such as this one.
E. Inserting an indwelling urinary catheter is not indicated for a lumbar puncture. There is no clinical reason to catheterize this child for this procedure, and doing so would cause unnecessary discomfort and increase infection risk.
G. Limiting the child's fluid intake following the procedure is incorrect. The child should actually be encouraged to increase fluid intake after a lumbar puncture to help replace cerebrospinal fluid and reduce the risk of post-lumbar puncture headache, which is a common complication following the procedure.
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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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Retinal hemorrhages
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Fever
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Fixed and dilated pupils
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Vomiting
Explanation
Vomiting is a common and expected finding following a minor head injury in an adolescent. Trauma to the head stimulates the vomiting center in the brain and increases intracranial pressure transiently, leading to nausea and vomiting. This is a well-recognized symptom of concussion and minor traumatic brain injury and is considered a typical clinical manifestation in the immediate period following head trauma.
Why the other options are incorrect:
A. Retinal hemorrhages are not expected with a minor head injury. Retinal hemorrhages are classically associated with abusive head trauma, also known as shaken baby syndrome, in infants and young children. In an adolescent with a minor head injury from a typical mechanism, retinal hemorrhages would not be an expected finding.
B. Fever is not a typical finding associated with a minor head injury. Fever following head trauma would suggest infection such as meningitis or encephalitis, or it could indicate a more severe injury affecting the hypothalamic temperature regulation center. It is not an expected finding in a minor head injury.
C. Fixed and dilated pupils are a serious and ominous neurological sign indicating severe brain injury, herniation, or significant increased intracranial pressure. This finding is associated with severe traumatic brain injury or brain death, not a minor head injury. The presence of fixed and dilated pupils would immediately escalate the clinical response far beyond the management of a minor head injury.
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