ATI PED Unit 3 Assessment

The correct answer is C: Perform a thorough assessment noting acute conditions.

Explanation: C. Perform a thorough assessment noting acute conditions: The first priority in caring for a child with a suspected head injury is to perform a thorough assessment to determine the severity of the injury and identify any acute conditions, such as signs of intracranial hemorrhage, concussion, or neurological deficits. A comprehensive assessment should include checking the child's level of consciousness, vital signs, neurological status, and any signs of trauma or complications. This allows the nurse to promptly identify any life-threatening conditions and take appropriate actions, such as notifying the provider or initiating emergency interventions.

Why the other options are incorrect: 

A. Collect a detailed past medical history: While a past medical history is important, it is not the first priority when a child presents with a suspected head injury. Immediate assessment of the current condition takes precedence to ensure that no life-threatening conditions are overlooked. The past medical history can be obtained once the initial assessment is completed and the child is stable. 

B. Administer pain medication to the adolescent: While pain management is important for comfort, administering pain medication is not the priority in the case of a suspected head injury. Pain medications, such as those containing narcotics, could mask neurological symptoms, making it more difficult to accurately assess the child's condition. Pain relief should only be administered after a thorough assessment is completed and any acute conditions are ruled out. 

D. Notify the adolescent's primary care provider: Notifying the primary care provider is important, but it is not the first step in this scenario. The priority is to perform a thorough assessment to ensure that immediate intervention can be taken if necessary. The provider should be notified after the initial assessment if required, especially if the condition warrants further evaluation or treatment.

Summary: When caring for a child with a suspected head injury, the nurse’s first priority should be to perform a thorough assessment of the child’s condition to identify any acute issues such as neurological deficits or signs of a life-threatening injury. This allows the nurse to prioritize care and take appropriate action before addressing other concerns, such as notifying the provider or administering pain medication.

The correct answer is C: Speech and language acquisition

Explanation:

C. Speech and language acquisition:

This is correct. A cleft palate directly affects the structure of the oral cavity, which plays a vital role in the development of normal speech and language. Infants with cleft palate may experience difficulty forming certain sounds due to the gap in the palate, leading to delays or impairments in speech clarity, resonance, and articulation. Even before the child begins to talk, cooing and babbling (which begin around 4 to 6 months) may be affected. Therefore, speech and language acquisition is a key developmental area that must be addressed in planning care for an infant with cleft palate. Early referral to a speech-language pathologist is often necessary.

Why the other options are incorrect:

A. Fine motor skill development:

This is incorrect. Fine motor skills (such as grasping toys or transferring objects between hands) involve the coordination of small muscles in the hands and fingers. These skills are typically unaffected by a cleft palate unless other comorbidities exist. Cleft palate does not interfere with hand or finger movements, so this area is not a primary concern.

B. Gross motor skill development:

This is incorrect. Gross motor development (such as rolling over, sitting, or crawling) involves large muscle groups and is also not directly affected by cleft palate. Unless the infant has other conditions that impact mobility, gross motor skills should progress normally.

D. Cognitive development:

This is incorrect. Cognitive development, including the ability to recognize caregivers, explore the environment, and understand cause-effect relationships, is not directly impacted by cleft palate. While speech delays can influence learning later in life, the presence of cleft palate alone does not impair cognitive function in infancy.

Summary:

The area of greatest concern in the overall development of a 6-month-old infant with a cleft palate is speech and language acquisition, because the structural defect impairs normal sound formation and vocalization. Early speech therapy intervention can help minimize long-term speech difficulties and support communication development. Fine and gross motor skills, as well as cognitive development, are not typically affected by cleft palate alone.

The correct answer is B: Processed foods are acceptable, as long as they don't contain flour.

Explanation:

This statement indicates a misunderstanding about celiac disease and the risks associated with processed foods. Although flour is a major source of gluten, many processed foods may still contain hidden gluten from ingredients like malt, modified food starch, hydrolyzed vegetable protein, and soy sauce. Additionally, even products that do not list flour may be cross-contaminated if produced in facilities that also handle gluten-containing ingredients. For individuals with celiac disease, it is essential to choose certified gluten-free processed foods to prevent unintentional gluten exposure.

Why the Other Options Are Incorrect:

A. I need to check food labels for hidden sources of gluten, like barley and rye.

This is a correct statement. People with celiac disease must be diligent about reading labels because gluten can be present in unexpected ingredients, including barley, rye, malt, and triticale. Regularly checking food labels helps avoid accidental gluten ingestion.

C. My family should use separate serving utensils for gluten-free foods.

This is a correct statement. Cross-contamination is a significant concern for individuals with celiac disease. Sharing utensils, cooking surfaces, or food preparation tools between gluten and gluten-free foods can lead to gluten exposure, causing symptoms and intestinal damage.

D. I need to avoid foods like bread, pasta, and cereal.

This is a correct statement. Traditional bread, pasta, and cereal typically contain wheat or other gluten-containing grains. People with celiac disease must eliminate these items from their diet and seek gluten-free alternatives made from rice, corn, quinoa, or certified gluten-free oats.

Summary:

The statement that requires further teaching is "Processed foods are acceptable, as long as they don't contain flour." Many processed foods contain hidden gluten or are cross-contaminated. Patients with celiac disease must be careful to read food labels thoroughly and select certified gluten-free products to maintain a safe and gluten-free diet.

The correct answer is C: Regular exercise

Explanation:

Regular exercise is not a recognized risk factor for iron deficiency anemia in adolescents. While intense physical activity can slightly increase iron demands, routine exercise does not typically lead to anemia in healthy individuals. In fact, regular physical activity can improve overall health, including cardiovascular and circulatory function, without directly causing significant iron depletion.

Why the Other Options Are Correct Risk Factors:

A. Rapid growth:

Adolescents experience periods of rapid growth, which increases their need for iron to support expanding blood volume and muscle mass. If dietary intake does not meet this increased demand, it can lead to iron deficiency anemia. This is especially true during puberty when growth spurts are most pronounced.

B. Poor diet:

A poor diet lacking iron-rich foods (such as red meat, poultry, leafy green vegetables, and fortified cereals) is a leading cause of iron deficiency anemia. Adolescents who consume processed foods, skip meals, or follow restrictive diets are at increased risk due to insufficient iron intake.

D. Obesity:

Obesity is an unexpected but established risk factor for iron deficiency anemia. Inflammation associated with obesity can impair iron absorption and utilization. Additionally, obese adolescents may consume energy-dense but nutrient-poor diets, contributing to inadequate iron intake.

Summary:

The correct answer is regular exercise, as it is not a primary risk factor for iron deficiency anemia in adolescents. However, rapid growth, poor diet, and obesity all increase the likelihood of developing this condition by either raising iron demands or impairing iron intake and absorption.

The correct answer is B: Absolute neutrophil count (ANC)

Explanation:

The absolute neutrophil count (ANC) is the most accurate measure of a child’s infection-fighting capability, especially during chemotherapy. Neutrophils are a type of white blood cell (WBC) that play a critical role in the immune response, helping to fight infections by attacking bacteria, viruses, and other pathogens. Chemotherapy often causes bone marrow suppression, reducing the production of neutrophils, which increases the risk of infections.

An ANC below 1,500 cells/mm³ is called neutropenia, and a count below 500 cells/mm³ significantly increases the risk of serious infection. Monitoring ANC helps the healthcare team assess whether it is safe to administer chemotherapy or if treatment should be delayed to prevent life-threatening infections.

Why the Other Options Are Incorrect:

A. Red blood cell count (RBC)

This is incorrect because while chemotherapy can also suppress red blood cell production, which may lead to anemia, the RBC count does not directly measure the child’s ability to fight infections. RBCs are responsible for oxygen transport, but their levels do not indicate immune function.

C. Hemoglobin (Hgb)

This is incorrect because hemoglobin reflects the oxygen-carrying capacity of the blood. Although low hemoglobin may cause fatigue and pallor, it does not provide information about immune competence or infection risk.

D. Eosinophils

This is incorrect because eosinophils are a type of white blood cell primarily involved in allergic reactions and parasitic infections. They are not a significant indicator of overall immune function or infection risk in patients receiving chemotherapy. Monitoring neutrophils, not eosinophils, is the priority for assessing infection risk.

Summary:

The correct answer is "Absolute neutrophil count (ANC)." Monitoring ANC is essential when caring for children receiving chemotherapy because it directly reflects their infection-fighting capacity. A low ANC increases the risk of infections, which can be life-threatening in immunocompromised patients.

The correct answer is D: Projectile vomiting after feedings.

Explanation:

D. Projectile vomiting after feedings: Pyloric stenosis is characterized by the narrowing of the pyloric sphincter, which obstructs the passage of food from the stomach to the small intestine. As a result, infants with pyloric stenosis often experience projectile vomiting shortly after feeding. This vomiting is forceful and can occur several hours after the baby eats.

Why the Other Choices Are Incorrect: 

A. Absent bowel sounds: Absent bowel sounds typically indicate a blockage or obstruction in the intestines, but this is not characteristic of pyloric stenosis. In pyloric stenosis, bowel sounds may be normal, but the infant is unable to pass food properly due to the obstruction at the pylorus.

B. Increased sodium levels: Pyloric stenosis can lead to dehydration and electrolyte imbalances, particularly hypochloremic, hypokalemic metabolic alkalosis, not increased sodium levels. The loss of chloride from the vomiting can cause this condition, rather than an increase in sodium.

C. Golf ball-sized mass over the left quadrant: The palpable mass in pyloric stenosis is typically located in the right upper quadrant of the abdomen, not the left quadrant. It is often described as a firm, movable "olive-shaped" mass, which is a key finding in diagnosing this condition.

Summary: Projectile vomiting after feedings is a hallmark clinical manifestation of pyloric stenosis. The other options, including absent bowel sounds, increased sodium levels, and a golf ball-sized mass in the left quadrant, are not consistent with this condition. Prompt recognition of projectile vomiting and other symptoms can help with early diagnosis and treatment of pyloric stenosis.

The correct answer is D: Treatment usually consists of surgery and chemotherapy

Explanation:

D. Treatment usually consists of surgery and chemotherapy:

The primary treatment for osteosarcoma, a type of bone cancer, typically involves a combination of surgery and chemotherapy. Surgery is performed to remove the tumor, which may involve limb-sparing procedures or, in some cases, amputation of the affected limb. Chemotherapy is used both before (neoadjuvant) and after (adjuvant) surgery to shrink the tumor, kill remaining cancer cells, and prevent metastasis. This combination has been shown to significantly improve survival rates for patients with osteosarcoma.

Why the Other Options Are Incorrect

A. Intensive irradiation is the primary treatment:

Radiation therapy is generally not the primary treatment for osteosarcoma because this type of cancer tends to be resistant to radiation. While radiation may be used in specific cases where surgery is not possible, it is not the primary treatment modality. Surgery and chemotherapy are the mainstays of treatment for osteosarcoma.

B. Amputation of the affected extremity is rarely necessary:

While limb-sparing surgery is often possible with osteosarcoma, amputation may still be required in some cases, particularly if the tumor is located in a critical area where it cannot be easily removed or if the tumor has metastasized. Therefore, it is incorrect to state that amputation is "rarely necessary." Advances in surgical techniques have increased the likelihood of preserving the limb, but amputation is still an option in certain situations.

C. Bone marrow transplantation offers the best chance of long-term survival:

Bone marrow transplantation is not the primary treatment for osteosarcoma. While bone marrow transplantation may be considered for some cancers (such as leukemia), it is not commonly used for osteosarcoma. The best chance of long-term survival for osteosarcoma patients comes from the combination of surgery and chemotherapy.

Summary:

The treatment for osteosarcoma typically involves surgery and chemotherapy, not intensive irradiation, bone marrow transplantation, or amputation in all cases. Surgery aims to remove the tumor, and chemotherapy is used to shrink the tumor and prevent metastasis, significantly improving survival rates. While amputation may be necessary in some cases, it is not the first-line approach due to advances in limb-sparing surgery.

The correct answers are:

B. I will give my child acetaminophen when she has a fever to prevent her temperature from rising rapidly

C. Most children with febrile seizures do not require seizure medicine

D. My child could have another febrile seizure

Explanation:

B. I will give my child acetaminophen when she has a fever to prevent her temperature from rising rapidly:

Why it is correct: Acetaminophen (Tylenol) can be used to help reduce fever in children. Reducing the fever may help to prevent febrile seizures, though it is not a guaranteed way to prevent them. It's also important to monitor the child and seek medical advice if the fever becomes very high or lasts for an extended period.

C. Most children with febrile seizures do not require seizure medicine:

Why it is correct: Febrile seizures are typically self-limiting and do not require anticonvulsant medication. Most children who have febrile seizures outgrow them by the time they are 5 years old. The seizures usually do not lead to long-term health issues, and medication is generally not needed unless the seizures become recurrent or are prolonged.

D. My child could have another febrile seizure:

Why it is correct: Children who experience one febrile seizure are at risk for having another one, especially if they are between 6 months and 5 years old. The likelihood of recurrence can be higher if the child has a family history of febrile seizures or if the first seizure occurred before the child turned 1 year old.

Why the other options are incorrect:

A. My child's 4-year-old sibling is also at high risk for febrile seizures:

Why it is incorrect: Febrile seizures are typically more common in children aged 6 months to 5 years. A 4-year-old may still be at risk, but it depends on individual circumstances, such as the child’s health and history of febrile seizures. However, the sibling is not necessarily at "high risk" just because the other child experienced one. Risk can increase if there is a family history of febrile seizures, but it is not guaranteed.

E. My child will now take anticonvulsants every day to prevent seizures:

Why it is incorrect: Most children who experience febrile seizures do not need anticonvulsants unless they have a very specific medical condition or their seizures are frequent and prolonged. Anticonvulsant medications are generally not recommended for routine prevention of febrile seizures.

Summary: The parents demonstrated understanding when they acknowledged that febrile seizures are not typically treated with daily anticonvulsant medications, acetaminophen can help manage fever, and there is a possibility of future febrile seizures. Additionally, while siblings may share some risk, the sibling's risk is not automatically high, and medication is usually not required for febrile seizure prevention.

The correct answer is A: Myoclonic seizure

Explanation: Myoclonic seizures involve brief, rapid muscle contractions or jerks, typically affecting a group of muscles. These seizures are often brief, do not lead to a post-ictal state (the period of confusion or fatigue that follows some other types of seizures), and can occur more frequently during certain times, such as in the mornings, as described in Emily’s case.

Why the Other Answers Are Incorrect:

B. Absence seizure

Absence seizures (also known as petit mal seizures) involve a brief loss of consciousness, typically lasting only a few seconds. There is no motor activity like muscle contractions; instead, the person might appear to be staring blankly or have subtle movements like lip-smacking or eye blinking. This doesn't match Emily's symptoms of muscle contractions.

C. Atonic seizure

Atonic seizures (also called "drop attacks") involve a sudden loss of muscle tone, leading to a collapse or fall. These seizures typically cause the individual to lose control over their muscles temporarily, which doesn’t match the description of brief muscle contractions that Emily is experiencing.

D. Tonic-clonic seizure

Tonic-clonic seizures (formerly known as grand mal seizures) are characterized by two phases: the tonic phase (stiffening of muscles) and the clonic phase (jerking of muscles). These seizures typically involve a post-ictal state, which Emily does not experience. Therefore, this is not consistent with her symptoms.

Summary:

Emily is most likely experiencing myoclonic seizures, which involve brief muscle jerks or contractions, and they do not include a post-ictal state. These seizures can be frequent, particularly during certain times, like in the mornings, as described in the case. The other types of seizures listed are not consistent with Emily’s symptoms.