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ATI Pediatric Practice B

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                                                           ATI PEDIATRIC PRACTICE B

1.     A nurse is collecting date from a school-age child. The nurse should identify that which of the following findings is a manifestation of physical abuse?

a)     Multiple dental caries

b)     Malnutrition

c)     Recurrent urinary tract infections

d)     Bruises at various stages of healing (The nurse should recognize that bruises at various stages of healing are a clinical manifestation of physical abuse.)

2.     A nurse is reinforcing teaching with an adolescent who has an inflamed nonperforated appendix and is scheduled for a laparoscopic assisted appendectomy. Which of the following instructions should the nurse include in the teaching?

a)     “You can begin drinking fluids again 2 days after your surgery.”

b)     “You will need to ask for pain medication for the first 24 hours after surgery.”

c)     “You will have your vital signs monitored every 8 hours after surgery.”

d)     “You will sit in your chair at least twice a day after surgery.” (The nurse should instruct the client that she will sit in a bedside chair at least twice a day and will be encouraged to ambulate as soon as possible following surgery. This activity will enhance lung function and help prevent postoperative complications.)

3.     A nurse is reinforcing teaching about sudden infant death syndrome (SIDS) with the parent of a 1-month-old infant. Which of the following statements by the parent indicates an understanding of the teaching?

a)     “I will let my baby sleep with me in bed at night.”

b)     “I will allow my baby to have a pacifier while sleeping.” (The nurse should reinforce with the parent that allowing the infant to fall asleep with a pacifier in his mouth decreases the risk for SIDS.)

c)     “I will place my baby on a soft mattress to sleep.”

d)      “I will cover my baby with a quilt while he sleeping.”

4.     A nurse is assisting with the care of a child who is postoperative and received a transfusion during a surgical procedure. Which of the following findings indicates the child is havig a hemolytic reaction?

a)     Chills and flank pain (Chills and flank pain are findings that indicate an incompatibility of the transfused blood product with the client's blood. The nurse should identify this finding as an indication that the child is having a hemolytic reaction.)

b)     Pruritus and flushing

c)     Rales and cyanosis

d)     Bradycardia and diarrhea 

5.     A guardian calls the clinic nurse after his child has developed symptoms of varicella and asks when his child will no longer be contagious. Which of the following responses should the nurse make?

a)     “When your child no longer has a fever.”

b)     “Three days after the rash started.”

c)     “Six days after lesions appear if they are crusted.” (The nurse should inform the guardian that a child will stop being contagious around 6 days after the lesions appeared, as long as they are crusted over.)

d)     “When your child’s lesions disappear.”

6.     A nurse is collecting date from a child during a well-child visit. The nurse should recognize that which of the following findings places the child at a higher risk for abuse?

a)     The child is 6 years old.

b)     The child is male.

c)     The child was born at 30 weeks of gestation. (The nurse should identify that children who are born prematurely are at greater risk for abuse because of the potential for impaired bonding during early infancy.)

d)     The child was born via cesarean birth.

7.     A nurse is reinforcing teaching with the guardian of a child who has a new diagnosis of rheumatic fever. Which of the following statements by the guardian indicates an understanding of the teaching?

a)     “I should not give my child aspirin for pain or fever.”

b)     “My child will take antibiotic for 6 months.”

c)     “My child might have a period of irregular movement of the extremities.” (The nurse should instruct the guardian that the child might experience chorea weeks or months after the initial diagnosis. Chorea is a temporary lack of coordination and the presence of sudden, irregular movements or periods of clumsiness.)

d)     “I should expect there to be blood in my child’s urine.”

8.     A nurse is collecting data from an infant during a well-child visit. Which of the following sites should the nurse use when obtaining the infant’s heart rate?

a)     Apical (The nurse should use the apical pulse to obtain the infant's heart rate and count it for a full minute, because it gives a reliable rate and rhythm and provides accurate baseline assessment data. In an infant, the apical heart rate is auscultated at the fourth intercostal space lateral to the midclavicular line.)

b)     Radial

c)     Carotid

d)     Femoral

9.     A nurse is preparing a toddler for suturing of a minor facial laceration. The nurse should place the toddler in which of the following restraints?

a)     Mummy restraint (The nurse should use a mummy wrap when a short-term restraint is needed for treatment of the toddler that involves the head and neck. The nurse should always use the least amount of restraint necessary.)

b)     Jacket restraint

c)     Elbow restraint

d)     Wrist restraint

10.  A nurse is reinforcing dietary teaching with the parent of a 2-year-old toddler. Which of the following should the nurse include in the teaching?

a)     "It is recommended that the toddler consumes no more than 12 ounces of fruit juice each day."

b)     "An appropriate serving size is 1 tablespoon of food per year of age." (The nurse should include that an appropriate serving size for a 2-year-old toddler is 1 tbsp of food per year of age.)

c)     "Introduce healthy finger foods like carrots and celery sticks."

d)     "Encourage 5 cups of low-fat milk each day."

11.  During a well-child visit, the parent of a toddler expresses concern to the nurse that the toddler takes several hours to fall asleep at night. Which of the following recommendations should the nurse make?

a)     Vary the time the toddler goes to bed each night

b)     Allow the toddler to watch television before bedtime

c)     Provide the toddler with a favorite toy at bedtime. (The nurse should recommend to the parent that providing the toddler with a favorite toy at bedtime will help the toddler to feel more secure and facilitate sleep.)

d)     Increase the toddler's activity prior to bedtime

12.  A nurse is assisting with the care for a 7-month-old infant who has a cleft palate. Which of the following actions should the nurse take to decrease the infant’s risk for aspiration?

a)     Feed the infant in supine position.

b)     Encourage the mother to breastfeed the infant exclusively.

c)     Burp the infant frequently during feedings. (Infants with a cleft palate have difficulty creating a seal around a bottle. Burping the infant frequently, following every ounce of fluid consumed, dissipates swallowed air and helps to prevent aspiration.)

d)     Perform nasotracheal suctioning if coughing occurs

13.  A nurse is reviewing the laboratory values of a school-age child who has iron deficiency anemia. Which of the following findings should the nurse expect?

a)     Hgb 9.0 g/dL (The nurse should expect a child who has iron deficiency anemia to have an Hgb level below the expected reference range of 9.5 to 15.5 g/dL. An Hgb of 9.0 g/dL is below the expected reference range.)

b)     Hct 37%

c)     Iron 100 mcg/dL

d)     Total iron binding capacity 325 mcg/dL

14.  A nurse is reinforcing teaching about vital signs with the guardian of a 1-year-old toddler. Which of the following statements by the guardian indicates an understanding of the teaching?

a)     "My child's pulse could increase to 150 beats a minute with activity.” (A pulse rate of 150/min is within the expected reference range for a toddler during physical activity.)

b)     "My child's temperature should be 96.8 degrees Fahrenheit."

c)     "My child should take 40 breaths a minute."

d)     "My child's pulse could get as low as 60 beats a minute while asleep."

15.  A nurse is caring for an adolescent who has acne and anew prescription for isotretinoin. For which of the following adverse effects should the nurse monitor?

a)     Hypersalivation

b)     Depression (Clients taking isotretinoin can experience mental status changes, such as suicidal thoughts, aggression, emotional lability, and depression. The nurse should monitor the adolescent's mental status while taking isotretinoin.)

c)     Bradycardia

d)     Hyperreflexia

16.  A nurse is reinforcing teaching about interventions for mild hypoglycemia with the parent of a child who has diabetes mellitus. Which of the following statements by the parent indicates that the teaching has been effective?

a)     "I should administer a glucagon injection to my child."

b)     "I should give my child 5 grams of a simple carbohydrate."

c)     "I should give my child 4 ounces of orange juice followed by cheese and crackers." (The parent should treat mild hypoglycemia with 10 to 15 g of a simple carbohydrate, such as 4 oz. of orange juice, and follow it with a starch-protein snack.)

d)     "I should give my child a snack that is 10 percent of his daily caloric intake."

17.  A nurse is collecting data from a 10-month-old infant. Which of the following findings should the nurse report to the provider?

a)     Pulls self to standing position

b)     Moves by creeping on hands and knees

c)     Takes intentional steps when standing

d)     Sits with support by leaning on hands (The nurse should identify that sitting with support can indicate a developmental delay, because an infant should be able to sit unsupported by 8 months of age. Therefore, the nurse should report this finding to the provider.)

18.  A nurse is preparing to administer phenobarbital to a toddler who has a seizure disorder and weights 10 kg (22 lb). The prescription reads phenobarbital sodium 2.5 mg/kg PO BID. Available is phenobarbital 20 mg/5 mL. How many mL should the nurse administer with each dose? (Round to the nearest hundredth. Use a leading zero if it applies. Do not use a trailing zero

Ratio and Proportion

6.26 mL

Step 1: What is the unit of measurement the nurse should calculate? mL 

Step 2: What is the dose the nurse should administer? Dose to administer = Desired 2.5 mg/kg = 2.5 x 10 = 25 mg

Step 3: What is the dose available? Dose available = Have 20 mg 

Step 4: Should the nurse convert the units of measurement? No 

Step 5: What is the quantity of the dose available? 5 mL 

Step 6: Set up an equation and solve for X. 

Have/Quantity = Desired/X 

20 mg/5 mL = 25 mg/X mL 

X = 6.25 

19.  A nurse is caring for a child who has type 1 diabetes mellitus and has been receiving insulin via subcutaneous infusion pump. Which of the following laboratory tests would verify the average blood glucose level over the past 2 months?

a)     Postprandial blood glucose

b)     Fasting blood glucose

c)     Glycosylated hemoglobin (Glycosylated hemoglobin provides an accurate average of the client's blood glucose level over the past 120 days. This test can be used to determine the effectiveness of, or compliance with, a treatment plan. It can also be used to diagnose diabetes mellitus.)

d)     Mean corpuscular hemoglobin

20.  A nurse is reinforcing teaching with the guardian of a child who has a new prescription for levalbuterol solution for use in a nebulizer. Which of the following statements by the guardian indicates an understanding of the teaching?

a)     "I should store the unused medication in the freezer."

b)     "I should make sure I use the vial within 3 weeks of opening it from the foil package."

c)     "My child might be drowsy while taking this medication."

d)     "My child might experience palpitations after taking this medication." (Palpitations are an adverse effect of levalbuterol. If this occurs, the guardian should discontinue the medication and notify the provider.

21.  A nurse is collecting data from a 12-month-old infant during a well-child visit. At birth, the infant’s weight was 3.6 kg (8 lb.) and his length was 50.8 cm (20 in). Based on this data, which of the following findings should the nurse expect?

a)     The infant weighs 6.4 kg (14 lb)

b)     The infant is 101.6 cm (40 in) long

c)     The infant is 76.2 cm (30 in) long (The nurse should expect a length of 76.2 cm (30 in), because the infant's length should increase by about 50% by 12 months of age.)

d)     The infant weighs 14.5 kg (32 lb)

22.  A nurse is reinforcing teaching about home care with the guardian of a 14-month-old toddler who has spastic cerebral palsy. Which of the following statements by the guardian indicates an understanding of the teaching?

a)     "I will perform daily stretching exercises to my toddler's affected muscles." (The nurse should reinforce that performing stretching exercises of the toddler's affected muscles will prevent muscle contractures.)

b)     "I will ensure my toddler avoids activities that involve repetitive joint movements."

c)     "I will place my toddler on his stomach to nap after meals."

d)     "I will give my toddler pain medication just after he performs strenuous activities."

23.  A nurse is assisting with the development of a health promotion program for the guardians of adolescents. Which of the following information about adolescents should the nurse recommend to include in the program?

a)     The sleep patterns of adolescents are well established.

b)     The percentage of adolescents that consider suicide is higher for males than for females.

c)     The leading cause of death in adolescents is physical injury. (The nurse should recommend including this information, because injuries from motor-vehicle crashes are the leading cause of death in the adolescent population.)

d)     The caloric intake needs of adolescents are less than that of school-age children.

24.  A nurse in a pediatric clinic is caring for an infant who has heart failure and a prescription for digoxin. Which of the following statements by the parent indicates the desired therapeutic effect of the medication?

a)     "My baby is breathing easier than she used to." (The nurse should identify that the desired effect of digoxin is to increase cardiac output and decrease venous pressure and pulmonary edema, which will reduce respiratory demands.)

b)     "My baby is taking longer naps."

c)     "My baby is having fewer wet diapers."

d)     "My baby's heart rate is faster than it used to be."

25.  A nurse is contributing to the plan of care for a 10-month-old infant who is postoperative following cleft palate repair. Which of the following actions should the nurse include in the plan of care?

a)     Place the infant in side-lying position. (The nurse should place the infant in side-lying position to promote healing and prevent injury to the surgical site.)

b)     Offer the infant liquids with a straw.

c)     Prohibit the guardian from holding the infant for 8 hr.

d)     Cleanse the suture line with a lemon glycerin swab.

26.  A nurse is caring for a toddler following a tonsillectomy. Which of the following is the priority finding that the nurse should report to the provider?

a)     Drowsiness

b)     Throat pain

c)     Continuous swallowing (When using the urgent vs. nonurgent approach to client care, the nurse should identify that continuous swallowing is a manifestation of hemorrhage. Therefore, this is the priority finding for the nurse to report to the provider.)

d)     Dark brown emesis

27.  A nurse is reinforcing teaching with the guardian of a school age-age child who has acute bacterial conjunctivitis and a new prescription for sulfacetamide. Which of the following instructions should the nurse include?

a)     Remove dried drainage with a cold washcloth.

b)     Instill medication immediately after cleansing the eye. (The nurse should instruct the guardian to place the medication in the eye immediately after cleansing.)

c)     Apply an occlusive gauze over the child's eye.

d)     Cleanse the eye by gently wiping from the outer aspect of the eye inward toward the nose.

28.  A nurse is preparing to leave the room after performing nasal suctioning for an infant who has respiratory syncytial virus (RSV). Identify the sequence in which the nurse should remove the following personal protective equipment (PPE). (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

 

Mask

 

Gloves

Gloves

 

Goggle

Gown

 

Gown

Goggle

 

Mask

The infant is on droplet and contact precautions due to the RSV. First, the nurse should remove his gloves, because these are the most contaminated. Second, the nurse should remove goggles, so they do not interfere with removing the other PPE. The nurse should then remove the gown, and finally the mask, to decrease exposure to the disease.

29.  A nurse in a provider’s office is caring for a preschooler who has findings of croup. Which of the following statements by the parent requires immediate intervention by the nurse?

a)     "My child has refused to drink any fluids for the past 8 hours." (An inadequate fluid intake indicates the child is at greatest risk for dehydration and electrolyte imbalance. Therefore, this statement by the parent requires immediate intervention by the nurse.)

b)     "My child has been coughing throughout the night."

c)     "My child is very hoarse and has a fever of 100.4 degrees Fahrenheit."

d)     "My child recently had the flu."

30.  A nurse is administering an injection of epinephrine to a child who is experiencing manifestations of anaphylaxis. The nurse should monitor for which of the following adverse effects?

a)     Pinpoint pupils

b)     Decreased heart rate

c)     Increased systolic blood pressure (Epinephrine is an adrenergic agonist used to treat anaphylaxis by activating the sympathetic nervous system. The nurse should expect the child to have an increased systolic blood pressure following administration of epinephrine.)

d)     Dry skin

31.  A nurse is reinforcing anticipatory guidance to the parents of an adolescent. Which of the following recommendations should the nurse include?

a)     Compare the adolescent's behavior to older siblings.

b)     Be open to the adolescent's point of view. (During this stage of development, adolescents are developing autonomy and self-identity. The nurse should recommend that the parents actively listen and be open to the adolescent's point of view, even if the parents disagree with his viewpoint.)

c)     Select school activities for the adolescent.

d)     Provide the adolescent with flexible rules.

32.  A nurse is preparing to administer furosemide to a toddler who has a heart defect. Which of the following should the nurse take to identify the toddler?

a)     Ask the child to state her name.

b)     Ask the pharmacy for the child's room number.

c)     Ask the child to state her birthday.

d)     Ask the guardian to verify the child's name. (Prior to administration of any medication, the nurse must correctly identify the toddler using two identifiers. The nurse should ask the guardian to verify the identity of the child and use the identification band as the second identifier.)

33.  A nurse is reinforcing teaching about liquid oral iron supplements with the guardian of a school-age child who has iron deficiency anemia. Which of the following statements by the guardian indicates an understanding of the teaching?

a)     "I will give my child a double dose of this medication if she misses a dose."

b)     "I will give this medication to my child with a cup of skim milk."

c)     "This medication will turn my child's stools white."

d)     "I will give this medication to my child with a straw." (The nurse should reinforce with the guardian to administer this medication with a straw to prevent staining the child's teeth.)

34.  A nurse is reinforcing teaching with the parent of a child who is being treated with diphenhydramine for allergic rhinitis. The nurse should tell the parent to monitor the child for which of the following?

a)     Polyuria

b)     Drowsiness (Diphenhydramine can cause drowsiness due to CNS depression. The nurse should reinforce with the parent to administer the medication at bedtime to avoid daytime sedation.)

c)     Drooling

d)     Hypogeusia

35.  A nurse is caring for a toddler who has terminal cancer and is receiving hospice care. The child’s parent tells the nurse. “I’m a bad parent, and I can’t deal with this.” Which of the following responses should the nurse make?

a)     "Tell me more about what you are feeling." (The nurse should use open-ended statements that will allow the parent to share his feelings and emotions. During times of grief, the parent needs to express his emotions. The use of an open-ended statement relays the message that it is safe to do so with the nurse.)

b)     "I understand how you are feeling."

c)     "Let's talk about home care for your child."

d)     "I'm sure you're just tired right now."

36.  A nurse is preparing to administer levalbuterol via nebulizer to a child with asthma. Which of the following data should the nurse collect prior to administering the medication?

a)     Peak flow reading

b)     Lung sounds (Levalbuterol is a bronchodilator used to increase air exchange. The nurse should evaluate lung sounds prior to and after the administration of the medication to determine changes in respiratory status.)

c)     ABGs

d)     Inspiratory reserve volume

37.  A nurse is preparing to obtain a peak expiration flow rate from an adolescent. Which of the following actions should the nurse take?

a)     Document the average of the client's three attempts.

b)     Instruct the client to exhale slowly over 5 seconds into the meter.

c)     Determine the zone according to the client's age.

d)     Have the client stand during the procedure. (To obtain the peak expiratory flow rate, the nurse should have the client stand during the procedure, which will allow the nurse to get an accurate reading.)

38.  A nurse is contributing to the pan of care for a child who is in Buck’s traction. Which of the following interventions should the nurse include in the plan?

a)     Remove the weights when changing the bed linens.

b)     Maintain the leg in an extended position. (The nurse should have the child maintain her affected leg in an extended position while in Buck's traction. This position decreases the risk for further injury to the extremity and minimizes the occurrence of muscle spasms.)

c)     Monitor the halo device every 4 hr.

d)     Provide pin care as prescribed.

39.  A nurse is assisting with the care of plan of a 4-year-old child who is prescribed an IV medication preoperatively. Which of the following techniques should the nurse use to assist the child to cope with this procedure? (Select all that apply)

a)     Discuss benefits of the procedure.( The nurse should discuss the benefits of the procedure with the child, because this action is an age-appropriate activity that will decrease the child's anxiety about the procedure. It will also provide an opportunity for the nurse to clarify any misconceptions the child might have about the procedure.)

b)     Provide the child with a detailed explanation of the procedure.

c)     Implement interactive sessions of 30 min.

d)     Give the child needleless IV supplies to play with. (The nurse should allow the child to see, hold, and collect the supplies to familiarize the child with the potentially frightening aspects of the procedure, which will decrease the child's anxiety.)

e)     Allow the child to perform the procedure with a doll. (The nurse should allow the child to mimic the procedure with a doll to alleviate anxiety. It will also provide an opportunity for the nurse to clarify any misconceptions the child might have about the procedure.)

40.  A nurse is reviewing the plan of care for a child who has cystic fibrosis. Which of the following is the priority goal for this child?

a)     The child will participate in age-appropriate recreational activities.

b)     The child will maintain an effective breathing pattern. (Manifestations of cystic fibrosis, such as chronic cough, pulmonary infection, and bronchiolar obstruction lead to severely impaired ventilation and gas exchange, which causes long-term pulmonary complications. Therefore, when utilizing the airway, breathing, circulation approach to client care, maintaining an effective breathing pattern is the priority goal for the child who has cystic fibrosis.)

c)     The child will maintain an adequate bowel elimination pattern.

d)     The child will receive immunizations as recommended

41.  A nurse is collecting physical data from a 4-year-old child who has diarrhea and has been vomiting for 24 hr. which of the following sites should the nurse grasp to determine the child’s skin turgor?

a)     The child's sacral area.

b)     The top of the child's hand.

c)     The child's sternal area.

d)     The child's abdomen. (The nurse should expect the child who has diarrhea and has been vomiting to exhibit manifestations of dehydration, such as a decrease in skin turgor. To check skin turgor, the nurse should grasp the skin on the child's abdomen, pull it taut, and release it quickly. The child who is dehydrated will have a prolonged period of tenting.)

42.  A nurse is caring for a 1-month-old infant who has a nasogastric tube in place for intermittent feedings. Which of the following actions should the nurse take?

a)     Position the head of the crib at a 30° angle between feedings. (The nurse should place the infant with the head of the crib elevated 30° to 45° to prevent aspiration.)

b)     Place the infant on her left side after a feeding.

c)     Administer feedings over 5 min.

d)    Flush the tube with 30 mL of tap water.

43.  A nurse is reinforcing teaching with the family of an adolescent client who was recently diagnosed with celiac disease. Which of the following foods should the nurse recommend?

a)     Graham crackers

b)     Rye bread

c)     Whole wheat spaghetti

d)     Yellow corn (A client who has celiac disease is unable to process gluten, a protein found in wheat, barley, rye, and oats. The nurse should instruct the family that the client's diet is restricted to foods that are free of gluten, such as corn, rice, and millet.)

44.  A nurse is reinforcing teaching with the parents of a 2-year-old toddler at a well-child visit. Which of the following should the nurse recommend as an age-appropriate activity for the toddler?

a)     Creating a rock collection

b)     Learning the alphabet with flash cards

c)     Putting together a large-piece puzzle (The nurse should recommend putting together a large-piece puzzle as an age-appropriate activity for a 2-year-old toddler. Puzzles provide the child an opportunity to develop fine motor skills. Other fine motor skill activities include finger painting and coloring with thick crayons.)

d)     Riding a tricycle

45.  A nurse is reinforcing with the parent of a school-age child who has lactose intolerance. Which of the following supplements should the nurse instruct the parent to include in the child’s diet?

a)     Zinc

b)     Vitamin D (Lactose intolerance is managed by eliminating dairy products from the diet. However, this can result in a decrease in bone density because of the lack of calcium and vitamin D in the diet. The nurse should instruct the parent to administer a vitamin D supplement to the child to enhance the absorption of calcium from foods other than those containing lactose.)

c)     Thiamine

d)     Folic acid

46.  A nurse is caring for a toddler who has otitis media and a temperature of 39.1° C (102.4° F). Which of the following actions should the nurse take first?

a)     Administer an antipyretic. (When using the urgent vs. nonurgent approach to client care, the nurse should first administer an antipyretic to decrease the toddler's body temperature.)

b)     Reduce the room temperature.

c)     Dress the child in minimal clothing.

d)     Apply cool compresses to the child's forehead.

47.  A nurse is collecting data from an 18-month-old toddler who has just presented to the urgent care clinic. Which of the following data should the nurse investigate further?

a)     Respiratory rate 25/min

b)     Blood pressure 120/80 mm Hg (A blood pressure of 120/80 mm Hg is outside the expected reference range for an 18-month-old toddler and requires further investigation by the nurse.)

c)     Heart rate 110/min

d)     Rectal temperature 37.4° C (99.3° F)

48.  A nurse in a pediatric clinic is talking on the telephone with the parent of a 6-month-old infant who has a urinary tract infection and started taking an oral antibiotic the day before. Listen to the audio clip and determine which of the following responses the nurse should make. (Audio says. “every time I try to give a dose of this medicine to my baby, she either refuses it or takes it and then spits it out. Is there anything I can try that might get her to take it?”

a)     "Mix the medicine with ¼ cup of juice before giving it to your baby."

b)     "Mix the medicine with 1 teaspoon of honey before giving it to your baby."

c)     "Mix the medicine with ¼ cup of formula before giving it to your baby."

d)     "Mix the medicine with 1 teaspoon of applesauce before giving it to your baby." (To enhance acceptance of an oral medication, the parent can mix the medication with a small amount of a sweet, nonessential food item.)

49.  A nurse is collecting data from an 18-month-old toddler. Which of the following is a deviation from expected growth and development that the nurse should report to the provider?

a)     The toddler is unable to recognize familiar objects by name. (The nurse should report that the toddler is unable to recognize familiar objects by name, because this is a deviation from expected growth and development. The toddler should be able to accomplish this task by 12 months of age.)

b)     The toddler is unable to dress himself in simple clothing.

c)     The toddler is unable to talk in complete sentences.

d)     The toddler is unable to draw a circle

50.  A nurse is reinforcing teaching with the parents of preschoolers regarding the use of booster seats in a motor vehicle. Which of the following instructions should the nurse include in the teaching?

a)     Ensure the shoulder-lap portion of the seat belt fits across the child's abdomen when sitting in the booster seat.

b)     Use a no-back, belt-positioning booster seat if the motor vehicle does not have head rests.

c)     Discontinue using a booster seat when the child is 135 cm (4 feet 5 in) in height.

d)     Secure the child in the booster seat using the motor vehicle's shoulder-lap seat belt. (The nurse should instruct the parents to secure both the child and the booster seat with the shoulder-lap seat belt inside the motor vehicle, because booster seats do not have built-in straps.)

51.  A nurse is assisting with the admission of a toddler who has bacterial meningitis caused by Haemophilus influenza type B. which of the following isolation guidelines should the nurse plan to initiate?

a)     Protective environment

b)     Contact precautions

c)     Airborne precautions

d)     Droplet precautions (The nurse should plan to initiate droplet precautions for this child, because bacterial meningitis caused by Haemophilus influenzae type B is transmitted through the air via large-particle droplets)

52.  A nurse is reinforcing teaching with the parent of a 4-month-old infant who has a new prescription for nystatin to treat oral candidiasis and is breastfeeding. Which of the following instructions should the nurse include in the teaching?

a)     Continue nystatin for 2 weeks after the symptoms disappear. (To prevent relapse, nystatin therapy should continue for at least 2 weeks after the lesions disappear.)

b)     Clean the infant's pacifier every 2 days.

c)     Discontinue breastfeeding until the infant is symptom-free.

d)     Wipe the white patches from the infant's tongue using a gauze pad.

 

53.  A nurse is preparing to administer an intramuscular injection to an 11-month-old infant. In which of the following areas should the nurse administer the injection?

B is correct. The nurse should administer an IM injection in the vastus lateralis muscle of an 11-month-old infant. The vastus lateralis is a well-developed muscle that is safe to use for infants and small children.

54.  A nurse is reinforcing dietary teaching with an adolescent who is a lacto-vegetarian and had iron deficiency anemia. The nurse should recommend which of the following as the best source of iron?

a)     1 cup (8 oz) shredded wheat cereal (The nurse should determine that shredded wheat cereal is an iron-fortified food. Therefore, it is the best option to recommend because it contains 1 g of iron per serving.)

b)     1 cup (8 oz) apple juice

c)     ½ cup (4 oz) sweet green peppers

d)     ⅛ cup (1 oz) low-fat cheese

55.  A nurse is reinforcing teaching with the parent of an infant who has a new diagnosis of human immunodeficiency virus (HIV). Which of the following statements made by the parent indicates an understanding of the teaching?

a)     "The antiretroviral medication will stop the progression of the disease."

b)     "It won't be possible for my child to attend daycare."

c)     "I should bring my child in for immunizations on schedule." (Immunizations provide protection from communicable diseases and should be administered on schedule.)

d)     "My child's nutritional needs will not change."

56.  A nurse is preparing to assist a provider with a lumbar puncture for a school-age child. Which of the following actions is the nurse’s priority?

a)     Labeling collected specimens

b)     Providing reassurance to the child

c)     Maintaining the child's position (The greatest risk to the child is injury to the spinal nerves or the major vessels. Therefore, the priority action is for the nurse to maintain the child's position to prevent trauma.)

d)     Monitoring the child's vital signs

57.  A nurse is reinforcing discharge teaching with the guardians of a 6-month-old infant following a surgical procedure to repair a hypospadias. Which of the following instructions should the nurse include?

a)     Wait 1 week before giving the infant a tub bath. (The nurse should instruct the guardians to keep the infant's penis as dry as possible until the stent or catheter is removed. The parent should provide sponge-baths to the child until the stent or catheter is removed.)

b)     Apply antifungal ointment to the infant's penis.

c)     Avoid giving the infant fruit juice.

d)     Apply dry gauze dressing to the infant's penis twice daily.

58.  A nurse is reinforcing teaching with the guardians of a school-age child who has frequent nosebleeds. Which of the following instructions should the nurse include?

a)     Place ice on the child's forehead.

b)     Apply pressure to the child's nose. (The nurse should instruct the guardians to apply pressure to the child's nose for at least 10 min to decrease bleeding. The nurse should also instruct the guardians to tilt the child's head forward, because this position prevents aspiration of the blood.)

c)     Have the child lie down to rest until the bleeding stops.

d)     Tape cotton gauze on the child's nose.

59.  A nurse is caring for a 3 year-old female child who is prescribed an indwelling urinary catheter. Which of the following actions should the nurse take when performing this procedure?

a)     Place a nonsterile drape under the buttocks.

b)     Use a catheter that is 12 French in size.

c)     Insert the catheter another 10 cm (3.9 in) after urine returns.

d)     Apply 2% lidocaine lubricant into the urethral meatus. (The nurse should apply 2% lidocaine lubricant into the urethral meatus to assist in decreasing the discomfort the child might experience during catheterization.

60.  A nurse is reinforcing teaching regarding the immunization schedule with the parent of a 6-month-old infant during a well-baby visit.  Which of the following statements by the parent indicates an understanding of the teaching?

a)     "My baby will receive his third DTaP vaccine today." (The nurse should reinforce with the parent that the infant should receive his third diphtheria, tetanus, and pertussis (DTaP) immunization at 6 months of age.)

b)     "My baby is old enough to receive the varicella vaccine today."

c)     "My baby will receive his final polio vaccine today."

d)     "My baby will receive his first hepatitis B vaccine today."

 

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[Solved] ATI Pediatric Practice B

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ATI PEDIATRIC PRACTICE B 1. A nurse is collecting date from a school-age child. The nurse should identify that which of the following findings is a manifestation of physical abuse? a) Multiple dental caries b) Malnutrition c) Recurrent urinary tract infections d) Bruises at various stages of healing (The nurse should recognize that bruises at various stages of healing are a clinical manifestation of physical abuse.) 2. A nurse is reinforcing teaching with an adolescent who has an inflamed nonperforated appendix and is scheduled for a laparoscopic assisted appendectomy. Which of the following instructions should the nurse include in the teaching? a) “You can begin drinking fluids again 2 days after your surgery.” b) “You will need to ask for pain medication for the first 24 hours after surgery.” c) “You will have your vital signs monitored every 8 hours after surgery.” d) “You will sit in your chair at least twice a day after surgery.” (The nurse should instruct the client that she will sit in a bedside chair at least twice a day and will be encouraged to ambulate as soon as possible following surgery. This activity will enhance lung function and help prevent postoperative complications.) 3. A nurse is reinforcing teaching about sudden infant death syndrome (SIDS) with the parent of a 1-month-old infant. Which of the following statements by the parent indicates an understanding of the teaching? a) “I will let my baby sleep with me in bed at night.” b) “I will allow my baby to have a pacifier while sleeping.” (The nurse should reinforce with the parent that allowing the infant to fall asleep with a pacifier in his mouth decreases the risk for SIDS.) c) “I will place my baby on a soft mattress to sleep.” d) “I will cover my baby with a quilt while he sleeping.” 4. A nurse is assisting with the care of a child who is postoperative and received a transfusion during a surgical procedure. Which of the following findings indicates the child is havig a hemolytic reaction? a) Chills and flank pain (Chills and flank pain are findings that indicate an incompatibility of the transfused blood product with the client's blood. The nurse should identify this finding as an indication that the child is having a hemolytic reaction.) b) Pruritus and flushing c) Rales and cyanosis d) Bradycardia and diarrhea 5. A guardian calls the clinic nurse after his child has developed symptoms of varicella and asks when his child will no longer be contagious. Which of the following responses should the nurse make? a) “When your child no longer has a fever.” b) “Three days after the rash started.” c) “Six days after lesions appear if they are crusted.” (The nurse should inform the guardian that a child will stop being contagious around 6 days after the lesions appeared, as long as they are crusted over.) d) “When your child’s lesions disappear.” 6. A nurse is collecting date from a child during a well-child visit. The nurse should recognize that which of the following findings places the child at a higher risk for abuse? a) The child is 6 years old. b) The child is male. c) The child was born at 30 weeks of gestation. (The nurse should identify that children who are born prematurely are at greater risk for abuse because of the potential for impaired bonding during early infancy.) d) The child was born via cesarean birth. 7. A nurse is reinforcing teaching with the guardian of a child who has a new diagnosis of rheumatic fever. Which of the following statements by the guardian indicates an understanding of the teaching? a) “I should not give my child aspirin for pain or fever.” b) “My child will take antibiotic for 6 months.” c) “My child might have a period of irregular movement of the extremities.” (The nurse should instruct the guardian that the child might experience chorea weeks or months after the initial diagnosis. Chorea is a temporary lack of coordination and the presence of sudden, irregular movements or periods of clumsiness.) d) “I should expect there to be blood in my child’s urine.” 8. A nurse is collecting data from an infant during a well-child visit. Which of the following sites should the nurse use when obtaining the infant’s heart rate? a) Apical (The nurse should use the apical pulse to obtain the infant's heart rate and count it for a full minute, because it gives a reliable rate and rhythm and provides accurate baseline assessment data. In an infant, the apical heart rate is auscultated at the fourth intercostal space lateral to the midclavicular line.) b) Radial c) Carotid d) Femoral 9. A nurse is preparing a toddler for suturing of a minor facial laceration. The nurse should place the toddler in which of the following restraints? a) Mummy restraint (The nurse should use a mummy wrap when a short-term restraint is needed for treatment of the toddler that involves the head and neck. The nurse should always use the least amount of restraint necessary.) b) Jacket restraint c) Elbow restraint d) Wrist restraint 10. A nurse is reinforcing dietary teaching with the parent of a 2-year-old toddler. Which of the following should the nurse include in the teaching? a) "It is recommended that the toddler consumes no more than 12 ounces of fruit juice each day." b) "An appropriate serving size is 1 tablespoon of food per year of age." (The nurse should include that an appropriate serving size for a 2-year-old toddler is 1 tbsp of food per year of age.) c) "Introduce healthy finger foods like carrots and celery sticks." d) "Encourage 5 cups of low-fat milk each day." 11. During a well-child visit, the parent of a toddler expresses concern to the nurse that the toddler takes several hours to fall asleep at night. Which of the following recommendations should the nurse make? a) Vary the time the toddler goes to bed each night b) Allow the toddler to watch television before bedtime c) Provide the toddler with a favorite toy at bedtime. (The nurse should recommend to the parent that providing the toddler with a favorite toy at bedtime will help the toddler to feel more secure and facilitate sleep.) d) Increase the toddler's activity prior to bedtime 12. A nurse is assisting with the care for a 7-month-old infant who has a cleft palate. Which of the following actions should the nurse take to decrease the infant’s risk for aspiration? a) Feed the infant in supine position. b) Encourage the mother to breastfeed the infant exclusively. c) Burp the infant frequently during feedings. (Infants with a cleft palate have difficulty creating a seal around a bottle. Burping the infant frequently, following every ounce of fluid consumed, dissipates swallowed air and helps to prevent aspiration.) d) Perform nasotracheal suctioning if coughing occurs 13. A nurse is reviewing the laboratory values of a school-age child who has iron deficiency anemia. Which of the following findings should the nurse expect? a) Hgb 9.0 g/dL (The nurse should expect a child who has iron deficiency anemia to have an Hgb level below the expected reference range of 9.5 to 15.5 g/dL. An Hgb of 9.0 g/dL is below the expected reference range.) b) Hct 37% c) Iron 100 mcg/dL d) Total iron binding capacity 325 mcg/dL 14. A nurse is reinforcing teaching about vital signs with the guardian of a 1-year-old toddler. Which of the following statements by the guardian indicates an understanding of the teaching? a) "My child's pulse could increase to 150 beats a minute with activity.” (A pulse rate of 150/min is within the expected reference range for a toddler during physical activity.) b) "My child's temperature should be 96.8 degrees Fahrenheit." c) "My child should take 40 breaths a minute." d) "My child's pulse could get as low as 60 beats a minute while asleep." 15. A nurse is caring for an adolescent who has acne and anew prescription for isotretinoin. For which of the following adverse effects should the nurse monitor? a) Hypersalivation b) Depression (Clients taking isotretinoin can experience mental status changes, such as suicidal thoughts, aggression, emotional lability, and depression. The nurse should monitor the adolescent's mental status while taking isotretinoin.) c) Bradycardia d) Hyperreflexia 16. A nurse is reinforcing teaching about interventions for mild hypoglycemia with the parent of a child who has diabetes mellitus. Which of the following statements by the parent indicates that the teaching has been effective? a) "I should administer a glucagon injection to my child." b) "I should give my child 5 grams of a simple carbohydrate." c) "I should give my child 4 ounces of orange juice followed by cheese and crackers." (The parent should treat mild hypoglycemia with 10 to 15 g of a simple carbohydrate, such as 4 oz. of orange juice, and follow it with a starch-protein snack.) ...
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