Exam 3 ATI Questions

A nurse is teaching the parent of an infant who has seborrheic dermatitis of the scalp. Which of the following instructions should the nurse include in the teaching? A. "You can use petrolatum to help soften and remove patches from your infant's scalp." B. "When patches are present, you should keep your infant away from others." C."You should avoid washing your infant's hair while patches are present on the scalp." D."When patches are present, it indicates that your infant has a systemic infection."

"You can use petrolatum to help soften and remove patches from your infant's scalp." The nurse should recommend that the parent use petrolatum, vegetable oil, or mineral oil to help soften and remove scales and crusted areas.

A nurse is teaching a school‐age child who has diabetes mellitus about insulin administration. Which of the following should the nurse include in the teaching? A. "You should inject the needle at a 30‐degree angle." B. "You should combine your glargine and regular insulin in the same syringe." C."You should aspirate for blood before injecting the insulin." D."You should give four or five injections in one area before switching sites."

"You should give four or five injections in one area before switching sites." The nurse should instruct the client to administer four or five injections about 2.5 cm (1 in) apart before switching to another site.

A nurse is completing preoperative teaching with an adolescent client who is schedules to receive spinal instrumentation for scoliosis. Which of the following information should the nurse include in the teaching? A. "You will go home the same day of surgery." B. "You will have minimal pain." C."You will need to receive blood." D."You will not be able to eat until the day after surgery."

"You will need to receive blood." Clients who have spinal instrumentation for scoliosis have a lengthy surgery with blood loss and require blood replacements.

A nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica cast. The child's mother asks the nurse why a Pavlik harness is not being used. Which of the following responses should the nurse make? A. "The Pavlik harness is used for children with scoliosis, not hip dysplasia." B. "The Pavlik harness is used for school‐age children." C."The Pavlik harness cannot be used for your child because her condition is too severe." D."The Pavlik harness is used for infants less than 6 months of age."

"The Pavlik harness is used for infants less than 6 months of age." The Pavlik harness is a soft brace designed for infants less than 6 months of age. A toddler is too large to fit into the brace.

A nurse is teaching a group of parent about fractures. Which of the following information should the nurse include in the teaching? A. "Children need a longer time to heal from a fracture than an adult." B. "Epiphyseal plate injuries can result in altered bone growth." C."A greenstick fracture is a complete break in the bone." D."Bones are unable to bend, so they break."

"Epiphyseal plate injuries can result in altered bone growth." Detection and early treatment is crucial for an epiphyseal plate injury to prevent altered bone growth.

A nurse is teaching a group of adolescents about HIV/AIDS. Which of the following statements should the nurse include in the teaching? A. "You can contract HIV through casual kissing." B. "HIV is transmitted through IV substance use." C."HIV is now curable if caught in the early stages." D."Medications inhibit transmission of the HIV virus."

"HIV is transmitted through IV substance use." HIV is transmitted via blood, semen, vaginal secretions, and breast milk. IV substance use is a potential mode of transmission.

A nurse is teaching a child who has type 1 diabetes mellitus about self‐care. Which of the following statements by the child indicates understanding of the teaching? A. "I should skip breakfast when I am not hungry." B. "I should increase my insulin with exercise." C."I should drink a glass of milk when I am feeling irritable." D."I should draw up the NPH insulin into the syringe before the regular insulin."

"I should drink a glass of milk when I am feeling irritable." An early manifestation of hypoglycemia is irritability. Drinking a glass of milk, which is approximately 15g of carbohydrates, indicates understanding of the teaching.

A nurse in a community center is providing an in‐service to a group of parents on management of airway obstructions in toddlers. Which of the following responses by the parents indicates understanding? (Select all that apply.) A. "I will push on my child's abdomen." B. "I will hyperextend my child's head to open his airway." C."I will listen over my child's mouth for sounds of breathing." D."I will use my finger to check my child's mouth for objects." E. "I will place my child in my car and take him to the closest emergency facility."

"I will push on my child's abdomen"... "I will listen over my child's mouth for sounds of breathing"... "I will use my finger to check my child's mouth for objects."

A parent of a school‐age child who has GH deficiency asks the nurse how long the child will need to take injections for growth delay. Which of the following responses should the nurse make? A. "Injections are usually continued until age 10 for girls and age 12 for boys." B. "Injections continue until your child reaches the fifth percentile on the growth chart." C."Injections should be continued until there is evidence of epiphyseal closure." D."The injections will need to be administered throughout your child's entire life."

"Injections should be continued until there is evidence of epiphyseal closure." Injections are continued until there is evidence of epiphyseal closure on radiographic tests.

A nurse is providing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which of the following statements by the parent indicates an understanding of the teaching? A. "I should take my child to the emergency department if his stools become dark." B. "My child should avoid eating citrus fruits while taking the supplements." C."I should give the iron with milk to help prevent an upset stomach." D."My child should take the supplement through a straw."

"My child should take the supplement through a straw." The child should take the supplement through a straw to prevent or minimize staining of the teeth.

A nurse is caring for a toddler who has rhinitis, cough, and diarrhea for 2 days. Upon assessment, it is noted that the tympanic membrane has an orange discoloration and decreased movement. Which of the following statements should the nurse to make? A. "Your child has an ear infection that requires antibiotics." B. "Your child could experience transient hearing loss." C."Your child will need to be on a decongestant until this clears." D."Your child will need to have a myringotomy."

"Your child could experience transient hearing loss." Rhinitis, cough, diarrhea, and an orange discoloration of the tympanic membrane are findings of OME. Transient hearing loss is a complication of OME.

A nurse is caring for a toddler who has acute otitis media. Which of the following is the priority action for the nurse to take? A. Provide emotional support to the family. B. Educate the family on care of the child. C. Prevent clinical complications. D. Administer analgesics.

Administer analgesics. The priority action the nurse should take when using Maslow's hierarchy of needs is to meet the toddler's physiological need first. Administering analgesics to alleviate or decrease physical pain is the priority action for the nurse to take.

A nurse is caring for a client who has a major burn and is experiencing severe pain. Which of the following actions should the nurse implement to manage this client's pain? A. Administer morphine sulfate IV via continuous infusion. B. Administer meperidine IM as needed. C. Administer acetaminophen PO every 4 hr. D. Administer hydrocodone PO every 6 hr.

Administer morphine sulfate IV via continuous infusion Opioids administered IV via continuous infusion are recommended for clients who have major burns.

A nurse is caring for a child who has cellulitis on the hand. Which of the following actions should the nurse take? A. Administer oral antibiotics. B. Cleanse area using Burrow solution. C. Prepare for cryotherapy. D. Apply a topical antifungal medication.

Administer oral antibiotics Oral antibiotics are often prescribed for the treatment of cellulitis.

A nurse is assessing a child who has short stature. Which of the following findings would indicate a growth hormone deficiency? A. Proportional height to weight B. Height proportionally greater than weight C. Weight proportionally greater than height D. BMI greater than height/weight ratio

Proportional height to weight Children who have growth hormone deficiency present with short stature with proportional height and weight.

A nurse is planning care for an infant who has diaper dermatitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Apply talcum powder with every diaper change. B. Allow the buttocks to air dry. C. Use commercial baby wipes to cleanse the area. D. Use cloth diapers until the rash is gone. E. Apply zinc oxide ointment to the affected area.

Allow the buttocks to air dry, Apply zinc oxide ointment to the affected area

A nurse is caring for a child who has a fracture. Which of the following are manifestations of a fracture? (Select all that apply.) A. Crepitus B. Edema C. Pain D. Fever E. Ecchymosis

Crepitus, Edema, Pain, Ecchymosis

A nurse is caring for an infant who has a myelomenigocele. Which of the following actions should the nurse include in the preoperative plan of care? A. Assist the mother with cuddling the infant. B. Assess the infant's temperature rectally. C. Place the infant in a supine position. D. Apply a sterile, moist dressing on the sac.

Apply a sterile, moist dressing on the sac A sterile, moist, nonadhering dressing is placed on the sac to keep it moist until surgery. This should be in the preoperative plan of care.

A nurse is caring for a client who has a superficial partial-thickness burn. Which of the following actions should the nurse take? A. Administer IV infusion of 0.9% sodium chloride. B. Apply cool, wet compresses to the affected area. C. Clean the affected area using a soft-bristle brush. D. Administer morphine sulfate.

Apply cool, wet compresses to the affected area Applying cool, wet compresses stops the burn process.

A nurse is caring for a child who is in a plaster spica cast. Which of the following actions should the nurse take? A. Use a heat lamp to facilitate drying. B. Avoid turning the child until the cast is dry. C. Assist the client with crutch walking after the cast is dry. D. Apply moleskin to the edges of the cast.

Apply moleskin to the edges of the cast The nurse should apply moleskin to the edges of the cast to prevent the cast from rubbing on the client's skin.

A nurse is caring for a child who is in skeletal traction. Which of the following actions should the nurse take? (Select all that apply.) A. Remove the weights to reposition the client. B. Assess the child's position frequently. C. Assess pin sites every 4 hr. D. Ensure the weights are hanging freely. E. Ensure the rope's knot is in contact with the pulley.

Assess the child's position frequently, Assess pin sites every 4 hr, Ensure the weights are hanging freely

A nurse in an outpatient facility is caring for an infant who has manifestations of acute otitis media (AOM). Which of the following factors places the infant at risk for otitis media? (Select all that apply.) A. Breastfeeding without formula supplementation. B. Attends day care 4 days per week. C. Immunizations are up to date. D. History of a cleft palate repair. E. Parents smoke cigarettes outside.

Attends day care 4 days per week, History of a cleft palate repair, Parents smoke cigarettes outside

A nurse is teaching a group of parents about preventing insect bites. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Wear perfumes when outside. B. Avoid areas of tall grass. C. Wear bright‐colored clothing. D. Wear insect repellent. E. Check house pets frequently.

Avoid areas of tall grass, Wear insect repellent, Check house pets frequently

A nurse is caring for a child who has cerebral palsy. Which of the following medications should the nurse expect to administer to treat painful muscle spasms? (Select all that apply.) A. Baclofen B. Diazepam C. Oxybutynin D. Methotrexate E. Prednisone

Baclofen, Diazepam

A nurse is caring for a child who has short stature. Which of the following diagnostic tests should be completed to confirm growth hormone (GH) deficiency? (Select all that apply.) A. CT scan of the head B. Bone age scan C. GH stimulation test D. Serum IGF‐1 E. DNA testing

CT scan of the head, Bone age scan, GH stimulation test, Serum IGF‐1

A nurse is caring for an adolescent who has acne and a prescription for isotretinoin from the dermatologist. Which of the following laboratory findings should the nurse plan to monitor? A. Cholesterol and triglycerides B. BUN and creatinine C. Serum potassium D. Serum sodium

Cholesterol and triglycerides Adverse effects of isotretinoin include elevated cholesterol and triglycerides. The nurse should plan to monitor these laboratory values during treatment.

A nurse is caring for a child who has type 1 diabetes mellitus. Which of the following are manifestations of diabetic ketoacidosis? (Select all that apply.) A. Blood glucose 58 mg/dL B. Weight gain C. Dehydration D. Mental confusion E. Fruity breath

Dehydration, Mental confusion, Fruity breath

A nurse is teaching the parent of a child who has a growth hormone deficiency. Which of the following are complications of untreated growth hormone deficiency? (Select all that apply.) A. Delayed sexual development B. Premature aging C. Advanced bone age D. Short stature E. Increased epiphyseal closure

Delayed sexual development, Premature aging, Short stature

A nurse is admitting a child who has HIV. The nurse should identify which of the following findings as an indication that the child is in the mildly symptomatic category of HIV? (Select all that apply.) A. Herpes zoster B. Anemia C. Dermatitis D. Hepatomegaly E. Lymphadenopathy

Dermatitis, Hepatomegaly, Lymphadenopathy

A nurse is providing teaching for an adolescent client who has mononucleosis. The client has a fever, fatigue, swollen lymph nodes, sore throat, and a sore upper abdomen. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Take antibiotics until symptoms subside. B. Drink plenty of liquids. C. Avoid participating in strenuous activities. D. Allow for periods of rest. E. Take aspirin as needed for fever and discomfort. F. Gargle with saltwater every 2 to 3 hr.

Drink plenty of liquids, Avoid participating in strenuous activities, Allow for periods of rest, Take aspirin as needed for fever and discomfort, Gargle with saltwater every 2 to 3 hr

A nurse in the emergency department is admitting an infant who experienced a life‐threatening event. Which of the following prescriptions by the provider should the nurse anticipate? (Select all that apply.) A. Electroencephalogram B. Electrocardiogram C. Urine culture D. Arterial blood gases E. Blood culture

Electroencephalogram, Electrocardiogram, Blood culture

A nurse is caring for a child who sustained a fracture. Which of the following actions should the nurse take? (Select all that apply.) A. Place a heat pack on the site of injury. B. Elevate the affected limb. C. Assess neurovascular status frequently. D. Encourage ROM of the affected limb. E. Stabilize the injury.

Elevate the affected limb, Assess neurovascular status frequently, Stabilize the injury

A nurse is developing a plan of care for a toddler who has cerebral palsy. Which of the following actions should the nurse include? A. Structure interventions according to the toddler's chronological age. B. Evaluate the toddler's need for an evaluation of hearing ability. C. Monitor the toddler's pain level routinely using a numeric rating scale. D. Provide total care for daily hygiene activities.

Evaluate the toddler's need for an evaluation of hearing ability. The nurse should recognize that the toddler who has CP has an increased risk for hearing impairment; therefore, the nurse should evaluate the toddler's need for an evaluation of hearing ability.

A nurse is assessing an infant who has eczema. Which of the following findings should the nurse expect? (Select all that apply.) A. Generalized distribution of lesions B. Papules C. Ecchymosis in flexural areas D. Crusting lesions E. Keratosis pilaris

Generalized distribution of lesions, Papules, Crusting lesions

A nurse is caring for an infant whose screening test reveals that he might have sickle cell disease. Which of the following tests should be performed to distinguish if the infant has the trait or the disease? A. Sickle solubility test B. Hemoglobin electrophoresis C. Complete blood count D. Transcranial Doppler

Hemoglobin electrophoresis The hemoglobin electrophoresis test should be performed to distinguish if the infant has the trait or the disease.

A nurse is assessing a child who has Legg-Calve-Perthes disease. Which of the following findings should the nurse expect? (Select all that apply.) A. Longer affected leg B. Hip stiffness C. Intense pain D. Limited ROM E. Limp with walking

Hip stiffness, Limited ROM, Limp with walking

A nurse is teaching an adolescent who has diabetes mellitus about manifestations of hypoglycemia. Which of the following findings should the nurse include in the teaching? (Select all that apply.) A. Increased urination B. Hunger C. Signs of dehydration D. Irritability E. Sweating and pallor F. Kussmaul respirations

Hunger, Irritability, Sweating and pallor

A nurse is caring for a client who has a moderate burn. Which of the following actions should the nurse take? A. Maintain immobilization of the affected area. B. Expose affected area to the air. C. Initiate a high-protein, high-calorie diet. D. Implement contact isolation.

Implement contact isolation A high-protein, high-calorie diet is initiated to meet increased metabolic demands and promote healing.

A nurse is caring for a client who has major burns and suspected septic shock. Which of the following findings are consistent with septic shock? (Select all that apply.) A. Increased body temperature B. Altered sensorium C. Decreased capillary refill D. Decreased urine output E. Increased bowel sounds

Increased body temperature, Altered sensorium, Decreased urine output

A nurse is admitting a child who has severely symptomatic HIV. Which of the following findings should the nurse expect? (Select all that apply.) A. Kaposi's sarcoma B. Hepatitis C. Wasting syndrome D. Pulmonary candidiasis E. Cardiomyopathy

Kaposi's sarcoma, Wasting syndrome, Pulmonary candidiasis

A nurse is reviewing sick‐day management with a parent of a child who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Monitor blood glucose levels every 3 hr. B. Discontinue taking insulin until feeling better. C. Drink 8 oz of fruit juice every hour. D. Test urine for ketones. E. Call the provider if blood glucose is greater than 240 mg/dL.

Monitor blood glucose levels every 3 hr, Test urine for ketones, Call the provider if blood glucose is greater than 240 mg/dL

A nurse is caring for a child who has muscular dystrophy. For which of the following findings should the nurse assess? (Select all that apply.) A. Purposeless, involuntary, abnormal movements B. Spinal defect and saclike protrusion C. Muscular weakness in lower extremities D. Unsteady, wide‐based or waddling gait E. Upward slant to the eyes

Muscular weakness in lower extremities, Unsteady, wide-based or waddling gait

A nurse is teaching a parent of a child who has HIV. Which of the following information should the nurse include? (Select all that apply.) A. Obtain yearly influenza vaccination. B. Monitor a fever for 24 hr before seeking medical care. C. Avoid individuals who have colds. D. Provide nutritional supplements. E. Administer aspirin for pain.

Obtain yearly influenza vaccination, Avoid individuals who have colds, Provide nutritional supplements

A nurse is teaching a group of parents about communicable diseases. The nurse should include that which of the following is the best method to prevent a communicable disease? A. Hand washing B. Avoiding persons who have active disease C. Covering your cough D. Obtaining immunizations

Obtaining immunizations Obtaining immunizations has decreased the rate of communicable diseases and is the best method to prevent further spread of illness.

A nurse is providing teaching to a parent about acetaminophen poisoning. Which of the following information should the nurse include in the teaching? A. Nausea begins 24 hr after ingestion. B. Pallor can appear as early as 2 hr after ingestion. C. Jaundice will appear in 12 hr if the child is toxic. D. Children can have 4 g/day of acetaminophen.

Pallor can appear as early as 2 hr after ingestion Sweating is a manifestation that starts 2 to 4 hr after ingestion.

A nurse is assessing an infant who has scabies. Which of the following findings should the nurse expect? (Select all that apply.) A. Presence of nits on the hair shaft B. Pencil‐like marks on hands C. Blisters on the soles of the feet D. Small, red bumps on the scalp E. Pimples on the trunk

Pencil‐like marks on hands, Blisters on the soles of the feet, Pimples on the trunk

A nurse in the emergency department is caring for a child whose parent reports that the child has swallowed paint thinner. The child is lethargic, gagging, and cyanotic. Which of the following actions should the nurse take? A. Induce vomiting with syrup of ipecac. B. Insert a nasogastric tube, and administer activated charcoal. C. Prepare for intubation with a cuffed endotracheal tube. D. Administer chelation therapy using deferoxamine mesylate.

Prepare for intubation with a cuffed endotracheal tube. Treatment for poisoning with hydrocarbons includes intubation to protect the airway before proceeding with gastric decontamination.

A nurse is providing teaching about epistaxis to the parent of a school-age child. Which of the following should the nurse include as an appropriate action to take when managing an episode of epistaxis? (Select all that apply.) A. Press the nares together for at least 10 min. B. Breathe through the nose until bleeding stops. C. Pack cotton or tissue into the naris that is bleeding. D. Apply a warm cloth across the bridge of the nose. E. Insert petroleum into the naris after the bleeding stops.

Press the nares together for at least 10 min, Pack cotton or tissue into the naris that is bleeding

A nurse is caring for a school age child who has juvenile idiopathic arthritis. Which of the following home care instructions should the nurse include in the teaching? (Select all that apply.) A. Provide extra time for completion of ADLs. B. Use cold compresses for joint pain. C. Take ibuprofen on an empty stomach. D. Remain home during periods of exacerbation E. Perform range‐of‐motion exercises.

Provide extra time for completion of ADLs, Perform range‐of‐motion exercises

A nurse is caring for a child who is suspected of having Legg-Calve-Perthes disease. The nurse should prepare the child for which of the following diagnostic procedures? A. Bone biopsy B. Genetic testing C. MRI D. Radiographs

Radiographs A child who has Legg‐Calve‐Perthes exhibits necrosis of the femoral head and can be diagnosed by radiographs of the hip and pelvis.

A nurse is caring for a child who has contact dermatitis due to poison ivy. Which of the following actions should the nurse take? (Select all that apply.) A. Remove the clothing over the rash. B. Initiate contact isolation precautions while the rash is present. C. Expose the rash to a heat lamp for 15 min. D. Cleanse the affected skin with hydrogen peroxide solution. E. Apply calamine lotion to the skin.

Remove the clothing over the rash, Apply calamine lotion to the skin

A nurse is assessing an infant. Which of the following findings are clinical manifestations of acute otitis media? (Select all that apply.) A. Decreased pain in the supine position B. Rolling head side to side C. Loss of appetite D. Increased sensitivity to sound E. Crying

Rolling head side to side, Loss of appetite, Crying

A nurse is teaching a group of parents about complications of communicable diseases. Which of the following communicable diseases can lead to pneumonia? (Select all that apply.) A. Rubella (German measles) B. Rubeola (measles) C. Pertussis (whooping cough) D. Varicella (chickenpox) E. Mumps

Rubeola (measles), Pertussis (whooping cough), Varicella (chickenpox)

A nurse is assessing a client who has pertussis. Which of the following findings should the nurse expect? (Select all that apply.) A. Runny nose B. Mild fever C. Cough with whooping sound D. Swollen salivary glands E. Red rash

Runny nose, Mild fever, Cough with whooping sound

A nurse is providing teaching about the management of epistaxis to a child and his family. Which of the following positions should the nurse instruct the child to take when experiencing a nosebleed? A. Sit up and lean forward. B. Sit up and tilt the head up. C. Lie in a supine position. D. Lie in a prone position.

Sit up and lean forward The nurse should instruct the child to sit up and lean to prevent aspiration when experiencing a nosebleed.

A nurse is caring for a 2-year-old child who has had three ear infections in the past 5 months. Which of the following long-term complications is the child at risk for developing? A. Balance difficulties B. Prolonged hearing loss C. Speech delays D. Mastoiditis

Speech delays Speech delay is a common complication of otitis media.

A nurse is caring for a child who has AIDS. Which of the following isolation precautions should the nurse implement? A. Contact B. Airborne C. Droplet D. Standard

Standard Standard isolation precautions are used to protect transmission of disease that is bloodborne or present in a body fluid.

A nurse is caring for a child who is experiencing respiratory distress. Which of the following findings are early manifestations of respiratory distress? (Select all that apply.) A. Bradypnea B. Peripheral cyanosis C. Tachycardia D. Diaphoresis E. Restlessness

Tachycardia, Diaphoresis, Restlessness

A nurse is planning care for a child who has tinea capitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Treat infected house pets. B. Use selenium sulfide shampoo. C. Cleanse area with Burrow solution. D. Administer antiviral medication. E. Use moist, warm compresses.

Treat infected house pets, Use selenium sulfide shampoo

A nurse is assessing a preschool-age child for developmental dysplasia of the hip. Which of the following assessments should the nurse include? A. Barlow test B. Trendelenburg sign C. Manipulation of foot and ankle D. Ortolani test

Trendelenburg sign The Trendelenburg sign assesses for developmental dysplasia of the hip. The preschooler bears weight on the affected leg while holding on to something for balance. The examiner observes from behind for abnormal downward tilting of the pelvis on the unaffected side.

A nurse is caring for a client who has a skin graft. Which of the following manifestations indicate infection? (Select all that apply.) A. Pink color to subcutaneous fat B. Unstable body temperature C. Generation of granulation tissue D. Subeschar hemorrhage E. Change in skin color around the affected area

Unstable body temperature, Subeschar hemorrhage, Change in skin color around the affected area

A nurse is teaching a parent of a child who has pediculosis capitis. Which of the following instructions should the nurse include in the teaching? A. Apply mayonnaise to the affected area at night. B. Treat all household pets. C. Use an over‐the‐counter medication containing 1% permethrin. D. Discard the child's stuffed animals.

Use an over‐the‐counter medication containing 1% permethrin Pediculosis capitis is treated with 1% permethrin, which can be purchased over the counter.

A nurse is preparing to administer iron dextran IM to a school-age child who has iron deficiency anemia. Which of the following actions by the nurse is appropriate? A. Administer the dose in the deltoid muscle. B. Use the Z‐track method when administering the dose. C. Avoid injecting more than 2 mL with each dose. D. Massage the injection site for 1 min after administering the dose.

Use the Z‐track method when administering the dose. The nurse should use the Z‐track method when administering the dose.