ATI RN Pediatric Nursing 2023.

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Ace Your Test with ATI RN Pediatric Nursing 2023. Actual Questions and Solutions - Full Set

Free ATI RN Pediatric Nursing 2023. Questions

1.

A 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?

  • Weight loss

  • Bradycardia

  • Exercise intolerance

  • Decreased respirations

Explanation

Explanation
Exercise intolerance is a classic sign of heart failure in a postoperative child following tetralogy of Fallot repair. When the heart is failing, it cannot generate sufficient cardiac output to meet the body's metabolic demands during activity. As a result, the child becomes easily fatigued, short of breath, and unable to tolerate physical exertion that would normally be appropriate for their age. This finding indicates that the heart is not functioning effectively following surgical correction.
Why the other options are incorrect:
A. Weight loss is not a typical sign of heart failure. Heart failure in children more commonly causes weight gain due to fluid retention and edema. Unexplained weight gain rather than weight loss would be a concerning finding in a postoperative cardiac patient.
B. Bradycardia is not a characteristic sign of heart failure. Heart failure typically causes compensatory tachycardia as the body attempts to maintain adequate cardiac output by increasing heart rate. Bradycardia would be more concerning for a conduction abnormality or medication side effect rather than heart failure.
D. Decreased respirations are not associated with heart failure. Heart failure causes increased respiratory rate and respiratory distress due to pulmonary congestion and fluid accumulation in the lungs. Tachypnea and increased work of breathing, not decreased respirations, are the expected respiratory findings in heart failure.
2.

A nurse is caring for an adolescent who has a new diagnosis of type 1 diabetes mellitus. Which of the following recommendations should the nurse make?

  • Store opened vials of insulin for up to 60 days.

  • Consult with a nutritionist.

  • Follow up with physical therapy.

  • Monitor capillary blood glucose daily.

Explanation

Explanation
Correct Answer: (B) Consult with a nutritionist.
A newly diagnosed adolescent with type 1 diabetes requires comprehensive dietary education to understand carbohydrate counting, meal timing, and how food affects blood glucose levels. A nutritionist consultation is essential for developing an individualized meal plan that supports glycemic control and normal adolescent growth and development.
Why other options are incorrect:
A. Opened vials of insulin should be stored for no more than 28–30 days, not 60 days, as potency diminishes after this period.
C. Physical therapy is not a standard referral for a new diagnosis of type 1 diabetes mellitus unless there is a specific musculoskeletal concern.
D. Monitoring capillary blood glucose daily is insufficient; adolescents with type 1 diabetes typically need to monitor blood glucose multiple times per day, including before meals and at bedtime.
3.

A nurse is assessing a school-age child who was admitted 2 days ago for treatment of fluid volume excess. Which of the following findings should the nurse recognize as an indication the therapy is effective?

  • Decreased urine specific gravity

  • Weight loss of 1 kg (2.2 lb) in the past 48 hr

  • Increase in pitting edema to +4

  • Decreased hematocrit

Explanation

Explanation
Correct Answer: (B) Weight loss of 1 kg (2.2 lb) in the past 48 hr
Weight loss is the most reliable and direct indicator that treatment for fluid volume excess is effective. In fluid volume excess, the body retains excess fluid that manifests as weight gain, edema, and fluid overload. As treatment progresses with diuretics and fluid restriction, the excess fluid is eliminated through urination, resulting in measurable weight loss. A loss of 1 kg over 48 hours reflects successful removal of excess fluid from the body.

Why the other options are incorrect:
A. Decreased urine specific gravity would indicate dilute urine, which is not a specific indicator of effective treatment for fluid volume excess. While increased urine output is expected with diuretic therapy, specific gravity alone does not confirm effective fluid removal.

C. An increase in pitting edema to +4 indicates worsening fluid retention and would be a sign that therapy is not effective. Effective treatment would result in a decrease in pitting edema, not an increase.

D. Decreased hematocrit is associated with fluid volume excess itself, where hemodilution causes a falsely low hematocrit. A decreasing hematocrit would suggest worsening fluid overload rather than effective treatment.
4. A nurse in a provider's office is caring for a 1-year-old toddler.

Nurses' Notes: 0930: Parent presents child to provider's office. Parent reports the child has had a fever for 2 days and that the child has cried more than usual. Parent also reports the child has had a decreased appetite for the last 24 hr. Child febrile and lethargic. 0945: Notified provider of parent reports and child's fever. New prescriptions received. 1000: Urine sample obtained via sterile straight catheter.

Medical History: 0930: Three urinary tract infections over the past year treated with antibiotics. Diagnosed at 6 months old with vesicoureteral reflux.

Provider Prescriptions: 0945: Obtain urine sample for urinalysis and culture and sensitivity via sterile straight catheter.

Vital Signs: 0930: Temperature 38.4°C (101.1°F) | Heart rate 128/min | Respiratory rate 28/min

Diagnostic Results: 1030: Urinalysis: Appearance: cloudy and dark amber (clear) Specific gravity 1.035 (1.005 to 1.030) Leukocyte esterase: positive (negative) Nitrites: present (none) WBCs: 10 (0 to 4)

The child is at risk for developing _____ and _____.

  • Polycystic kidney

  • Acute glomerulonephritis

  • Nephrotic syndrome

  • Renal scarring

  • Pyelonephritis

Explanation

Explanation
Correct Answer: D. Renal scarring and E. Pyelonephritis.
E. Pyelonephritis — The child presents with fever, lethargy, decreased appetite, and abnormal urinalysis findings including cloudy urine, elevated specific gravity, positive leukocyte esterase, presence of nitrites, and elevated WBCs. Combined with a history of vesicoureteral reflux and three prior UTIs, these findings are classic indicators of an ascending urinary tract infection progressing to pyelonephritis.
D. Renal scarring — Children with vesicoureteral reflux are at significant risk for renal scarring due to repeated episodes of pyelonephritis. Backflow of infected urine into the renal parenchyma causes inflammation and permanent scarring that can lead to chronic kidney disease over time.
Why other options are incorrect:
A. Polycystic kidney is a genetic structural disorder not associated with UTIs or vesicoureteral reflux.
B. Acute glomerulonephritis typically follows streptococcal infection and presents with hematuria, proteinuria, edema, and hypertension, not with the UTI findings seen here.
C. Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema, none of which are present in this clinical picture.
5.

A nurse is caring for an 8-year-old child who has a new onset of generalized seizures. Which of the following interventions should the nurse include in the plan of care?

  • Restrain the child's arms during a seizure.

  • Loosen restrictive clothing during a seizure.

  • Elevate the head of the bed to 30° during a seizure.

  • Administer oral valproic acid during a seizure.

Explanation

Explanation
Correct Answer: (B) Loosen restrictive clothing during a seizure.
Loosening restrictive clothing such as tight collars or belts during a seizure helps maintain adequate breathing and prevents injury. It is a safe, appropriate seizure precaution that supports airway management without restraining the child.
Why other options are incorrect:
A. Restraining a child's arms during a seizure can cause injury such as fractures or dislocations and is contraindicated. The nurse should protect the child from the environment, not restrain their movements.
C. Elevating the head of the bed to 30° is not a standard seizure intervention. The child should be positioned on their side in a lateral position to prevent aspiration and maintain airway patency.
D. Oral medications should never be administered during an active seizure due to the risk of aspiration. Emergency seizure medications are given IV or rectally, not orally.
6.

A nurse is planning to complete dressing changes for an adolescent who has multiple burn injuries. Which of the following interventions addresses the greatest risk to the client?

  • Check the wound sites for manifestations of infection.

  • Adjust the room temperature to 33°C (91.4°F).

  • Apply tepid water to the old dressings before removal.

  • Perform passive range-of-motion exercises during the dressing change.

Explanation

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.
7. A nurse is caring for the client in the emergency department (ED).

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

Complete the following sentence by using the lists of options.

The nurse should __________ in order to __________.

First Blank Options: administer humidified oxygen place the client in a supine position request a stat ABG

Second Blank Options: determine PaO₂ and PCO₂ levels reduce airway resistance maintain an oxygen saturation greater than 92%

  • administer humidified oxygen

  • place the client in a supine position

  • request a stat ABG

  • determine PaO₂ and PCO₂ levels

  • reduce airway resistance

  • maintain an oxygen saturation greater than 92%

Explanation

Explanation
Correct Answer: The nurse should administer humidified oxygen in order to maintain an oxygen saturation greater than 92%.

Administer humidified oxygen is the correct first blank because the child is now presenting in the emergency department with an acute asthma exacerbation evidenced by diaphoresis, agitation, coarse wheezing throughout all lung fields, intercostal retractions, prolonged expiration, and tachycardia. These are signs of significant respiratory distress and hypoxia. Administering humidified oxygen is the immediate priority nursing intervention to correct hypoxemia, reduce the work of breathing, and prevent respiratory failure. Humidified oxygen is preferred over dry oxygen in children to prevent drying of the airways and mucous membranes.

Maintain an oxygen saturation greater than 92% is the correct second blank because the goal of oxygen therapy in an acute asthma exacerbation is to maintain oxygen saturation at or above 92% to ensure adequate tissue oxygenation. An SpO₂ below 92% indicates significant hypoxemia requiring urgent intervention, and maintaining saturation above this threshold is the standard clinical target in pediatric asthma management.

Why the other options are incorrect:
Place the client in a supine position is incorrect because placing a child in respiratory distress in a supine position worsens breathing by increasing the work of breathing and reducing lung expansion. The child is already naturally sitting upright, which is the correct therapeutic position as it maximizes diaphragmatic excursion and lung expansion during an acute asthma exacerbation.

Request a stat ABG is not the immediate priority intervention in this situation. While an arterial blood gas may be obtained to assess the severity of respiratory compromise, it is a diagnostic measure rather than a direct therapeutic intervention. The priority is to first treat the hypoxemia with oxygen before pursuing diagnostic testing.

Determine PaO₂ and PCO₂ levels is the purpose of requesting a stat ABG rather than the goal of oxygen administration. While knowing blood gas values is important for assessing severity, the immediate therapeutic goal of oxygen administration in this acute setting is to maintain adequate oxygen saturation above 92% rather than simply to obtain diagnostic values.

Reduce airway resistance is the goal of bronchodilator therapy such as albuterol, not oxygen administration. While reducing airway resistance is an important treatment goal in asthma, it is achieved through bronchodilators and corticosteroids rather than through oxygen supplementation.
8.

A nurse is caring for a preschooler who has a gastrostomy tube. Which of the following actions should the nurse take?

  • Use barrier ointments around the site.

  • Maintain tension between the tubing and the site.

  • Cleanse the tube site with hydrogen peroxide.

  • Place a transparent occlusive dressing over the site.

Explanation

Explanation
Barrier ointments are used around the gastrostomy tube site to protect the surrounding skin from irritation caused by gastric secretions and moisture. The peristomal skin is vulnerable to breakdown from leakage of stomach contents, and barrier ointments create a protective layer that maintains skin integrity and prevents excoriation around the tube site.
Why the other options are incorrect:
B. Maintaining tension between the tubing and the site is incorrect and harmful. Tension on the gastrostomy tube can cause pressure injury, tissue necrosis, and enlargement of the stoma site. The tube should be secured without tension to prevent trauma to the surrounding tissue.
C. Cleansing the tube site with hydrogen peroxide is incorrect because hydrogen peroxide is cytotoxic and damages healthy granulation tissue. The gastrostomy site should be cleansed with mild soap and water or sterile saline per facility protocol.
D. Placing a transparent occlusive dressing over the site is incorrect because an occlusive dressing traps moisture around the tube site, creating a warm, moist environment that promotes bacterial growth and skin breakdown rather than protecting the site.
9.

A nurse is preparing to administer an enteral feeding to an adolescent who has an NG tube. Which of the following actions should the nurse take first?

  • Flush the tube with water.

  • Set the administration rate on the feeding pump.

  • Check the pH of the gastric secretions.

  • Attach the feeding bag tubing to the end of the NG tube.

Explanation

Explanation
Correct Answer: (C) Check the pH of the gastric secretions.
Before initiating any enteral feeding, the nurse must first verify correct NG tube placement by checking the pH of gastric aspirate. A pH of 1–5 confirms gastric placement. Administering feeding without confirming placement risks aspiration pneumonia if the tube has migrated into the lungs.
Why other options are incorrect:
A. Flushing the tube with water occurs after placement is confirmed, not before.
B. Setting the pump rate is done after placement confirmation and after the feeding bag is connected.
D. Attaching the feeding bag tubing occurs after confirming correct tube placement, not before.
10.

A nurse is assessing a toddler during a well-child visit. Which of the following parent statements indicates the correct use of time-out as a method of discipline?

  • "I give my child one warning before she has to go in time-out."

  • "I send my child to her room and shut the door during time-out."

  • "I explain to my child why her actions are wrong after I put her in time-out."

  • "I typically leave my child in time-out for 10 minutes."

Explanation

Explanation
Giving one warning before placing a toddler in time-out is the correct and recommended approach to using time-out as a discipline method. One clear warning allows the child an opportunity to correct the behavior before the consequence is applied, which helps the child learn cause and effect and understand behavioral expectations. This approach is consistent with evidence-based guidance on positive discipline for toddlers.
Why the other options are incorrect:
B. Sending the child to her room and shutting the door is not the correct method for time-out. Time-out should take place in a safe, boring, and non-stimulating location such as a chair or corner, not in the child's room, which may contain toys and entertainment that defeat the purpose of the consequence. Shutting the door can also cause fear and anxiety in a toddler.
C. Explaining why the child's actions were wrong after placing her in time-out is incorrect timing. Any explanation of the behavior should be given briefly before the time-out begins, not after, as toddlers have limited attention spans and the connection between the behavior and the consequence is lost if the discussion happens after the time-out period.
D. Leaving a toddler in time-out for 10 minutes is too long. The recommended guideline for time-out duration is approximately 1 minute per year of the child's age. For a toddler, this means 1 to 3 minutes is appropriate. A 10-minute time-out exceeds the toddler's developmental capacity for understanding and is not effective as a learning tool.

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