ATI - Pediatrics

a c e f

A 10-year-old child is admitted to the hospital with a temperature of 104°F (40°C) and is difficult to arouse. The child has a history of varicella 2 weeks ago. Reye's syndrome is suspected. Which objective data are supportive of the diagnosis? Select all that apply. a) Coma b) Client states, "I have a headache" c) Disorientation d) Dysuria e) An abnormal liver biopsy f) Vomiting

a c e f

A 10-year-old child visits the health care provider's office for an annual sports examination. When a nurse asks how he is doing, he becomes quiet and states that his grandmother died last week. Which statements by the child show that he understands the concept of death? Select all that apply. a) "My grandmother is an angel watching over me." b) "My grandmother died because someone in the family did something bad." c) "I am mad that she is gone." d) "My grandmother is dead, but she'll come back." e) "My grandmother's death has been hard to understand." f) "My grandmother died because she was sick and nothing could make her better."

b d e

A 15-month-old has just received routine immunizations, including DTaP, IPV, and MMR. What information would the nurse give to the parents before they leave the office? Select all that apply. a) The parents would restrict toddler activity for the remainder of the day. b) Discomfort at the immunization site and mild fever are common. c) The immunizations prevent the toddler from contracting their associated diseases. d) Minor symptoms can be treated with acetaminophen. e) Call the office if the toddler develops a fever above 103°F (39.4°C), seizures, or difficulty breathing. f) Analgesics for discomfort are suggested following arrival home.

a b c e

A 17-year-old client confides in the school nurse that he/she is interested in understanding safe sex practices. In instructing the client on how to correctly use a condom, which information would be stressed? Select all that apply. a) Leave a ½ inch space at the end of the condom. b) The condom would be applied on an erect penis. c) Condoms should be stored in a cool, dry place to prevent damage. d) The condom only needs to be placed on the penis immediately before ejaculation. e) Never reuse a condom. f) A condom would be applied to the penis when sexual contact is anticipated.

b

A 2-year-old is being treated for pneumonia. After reviewing the respiratory section of the client care flow sheet (shown below), the nurse concludes that which position is most beneficial to maximize oxygenation? a) Semi-Fowler b) Right-side lying c) Supine with the head of the bed elevated 30° d) Left-side lying

b

A 3-year-old boy has arrived in the emergency department. The nurse documents the following assessment findings in the client's chart, knowing that they are consistent with which disease process? a) Bronchiolitis b) Pneumonia c) Asthma d) Cystic fibrosis

63

A 3-year-old is to receive 500 ml of dextrose 5% in normal saline solution (D5NSS) over 8 hours. At what rate (in milliliters per hour) would a nurse set the infusion pump? Round your answer to a whole number. _________ ml/hour

1 4 3 2 5

A 4-year-old postoperative child is found unresponsive. Place the following actions in the correct sequence to perform CPR after the child has been assessed for responsiveness and help has been called. All options must be used. 1. Feel for the carotid pulse. 2. Check for breathing. 3. Open the airway. 4. Perform 30 compressions. 5. Provide 2 rescue breaths.

25

A 4½-year-old is ordered to receive 25 ml/hour of intravenous solution. The nurse is using a pediatric microdrip chamber (60 gtts/min) to administer the medication. For how many drops per minute would the microdrip chamber be set? Record your answer using a whole number. ________drops/minute

b c d

A 5-year-old is admitted to the pediatric unit with diagnosis of possible intussusception. Which assessment data supports this diagnosis? Select all that apply. a) Diarrhea b) Abdominal pain c) Abdominal distention d) Currant jelly stools e) Tarry, black stools

1 5 2 3 4

A 6-year-old child who reports fever, malaise, and anorexia is diagnosed with varicella (chickenpox). The nurse explains to the parents how skin lesions will develop. Place the following descriptions in the order that they will occur as the disease progresses. All options must be used. 1. Itchy red macules on the face, scalp, and trunk progress to papules. 2. Vesicles become cloudy and break easily. 3. Scabs form. 4. As initial lesions progress through stages, new lesions form on the trunk and extremities. 5. Papules develop into clear vesicles on an erythematous base.

a d e

A 7-year-old child is admitted to the hospital for a course of intravenous antibiotics. What actions would the nurse take before inserting the peripheral intravenous catheter?Select all that apply. a) Apply a topical anesthetic to the I.V. site before the procedure. b) Do not let the child see the equipment to be used in the procedure. c) Explain the procedure to the child immediately before the procedure. d) Ask the child which hand he/she uses for drawing. e) Tell the child that they can cry but they must hold still during the procedure. f) Explain the procedure to the child using abstract terms.

58

A child is brought to the emergency department severely dehydrated after having gastroenteritis for 4 days. The health care provider orders an intravenous infusion to maintain fluid replacement for this child. If the child weighs 18 kg, what is the hourly flow rate in milliliters? Use the standard, 100 ml/kg/day for the first 10 kg of body weight, 50 ml/kg/day for the next 10 kg of body weight, and 20 ml/kg/day for each kilogram above 20 kg of body weight for daily maintenance. __________ ml

9

A child weighing 44 lb (20 kg) is to receive 45 mg/kg/day of penicillin V potassium oral suspension in four divided doses for every 6 hours. The suspension that is available is penicillin V potassium 125 mg/5 ml. How many milliliters would the nurse administer for each dose? Record your answer using a whole number. _________ ml

200

A nurse is caring for an infant who weighs 8 kg and is ordered to receive ampicillin 25 mg/kg intravenously every 6 hours. How many milligrams would a nurse administer per dose? Record the answer as a whole number. _________mg/dose

c e f

A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises would the nurse provide to the child and family? Select all that apply. a) Use cold packs to relieve joint pain. b) Avoid foods high in folic acid. c) Report a sore throat to an adult immediately. d) Restrict activity to quiet board games. e) Drink plenty of fluids. f) Wash hands before meals and after playing.

0.2

A child with sickle cell anemia is being treated for sickle cell crisis. The physician orders morphine sulfate 2 mg intravenously. The concentration of the vial is 10 mg/1 ml of solution. How many milliliters of solution would the nurse administer? Record your answer using one decimal place. __________ ml

c d e f

A healthy 2-month-old infant is being seen in the local clinic for a well-child checkup and initial immunizations. When analyzing the pediatric record, which immunizations would the nurse anticipate administering at this appointment? Select all that apply. a) MMR (measles, mumps, and rubella) b) Varicella (chickenpox) vaccine c) Hib (Haemophilus influenzae vaccine) d) DTaP (diphtheria, tetanus, and acellular pertussis) e) PCV (pneumococcal vaccine) f) IPV (inactivated polio vaccine)

a b e

A mother brings her child to the health care provider's office for evaluation of chronic stomach pain. The mother states that the pain seems to go away when she keeps the child home from school. The health care provider diagnoses school phobia. Which other behaviors or symptoms may the child exhibit? Select all that apply. a) Headaches b) Nausea c) Specific areas of pain d) Weight loss e) Dizziness

a b d

A nurse is assessing a 10-month-old infant during a checkup. Which developmental milestones would the nurse expect the infant to display? Select all that apply. a) Holding the head erect b) Sitting on a firm surface without support c) Demonstrating good bowel and bladder control d) Bearing the majority of weight on legs e) Self-feeding with a spoon f )Walking alone

c e f

A nurse is caring for a 17-year-old female client with cystic fibrosis who has been admitted to the hospital for administration of intravenous antibiotics and respiratory treatment for exacerbation of a lung infection. The client states, "I have a number of questions about my future and the consequences of this disease." Which statements about the course of cystic fibrosis are true? Select all that apply. a) Pregnancy and childbearing are not affected. b) By age 20, the client is able to decrease the frequency of respiratory treatments. c) The client is at risk for developing diabetes. d) Only males carry the gene for the disease. e) Breast development is commonly delayed. f) Normal sexual relationships can be expected.

a c d f

A nurse is caring for a 3-year-old diagnosed with viral meningitis. Which signs and symptoms would the nurse expect to find during the admission assessment? Select all that apply. a) Photophobia b) Petechiae c) Nuchal rigidity d) Irritability e) Bulging anterior fontanelle f) Fever

b c e

A nurse is caring for a 34-month-old who is hospitalized for a lengthy illness. Which behaviors would the nurse identify as examples of expected developmental regression for the child's age group? Select all that apply. a) Altered gait b) One- to two-word expressions c) Encopresis d) Loss of fine motor skills e) Enuresis

2 3 1 4

A nurse is caring for a 4-year-old child who developed acute renal failure after a traumatic injury with hemorrhaging. Place the following events in the order in which they most likely occurred during progression of the severe renal deterioration. All options must be used. 1. Acidosis 2. Oliguria 3. Azotemia 4. Severe hypocalcemia

b c d f

A nurse is caring for a 5-year-old child who is in the terminal stages of cancer. Which statements about the child's impending death are most likely to be true? Select all that apply. a) Avoid the topic of death unless brought up by the child. b) The child does not fully understand the concept of death. c) The parents may be at different stages of grief in dealing with the child's impending death. d) The dying child may become clingy and act like a toddler. e) The child is thinking about the future and knows he/she may not be able to participate. f) The death of a child may have long-term disruptive effects on the family.

a c

A nurse is caring for a group of toddlers in a large urban hospital. When considering providing care, which clients require contact precautions? Select all that apply. a) A toddler with a multidrug-resistant organism b) A toddler with streptococcal pharyngitis c) A toddler with scabies d) A toddler with mumps e) A toddler with pulmonary tuberculosis

b e f

A nurse is caring for an 8-year-old postoperative tonsillectomy client. When performing a postoperative assessment, which signs and symptoms of bleeding would be monitored for by the nurse? Select all that apply. a) Pulse rate of 98 beats/minute b) Blood red vomitus c) Throat pain d) Breathing through the mouth e) Frequent swallowing f) Frequent clearing of the throat

a b c d e

A nurse is caring for an adolescent who was admitted to the hospital's medical unit after attempting suicide by ingesting acetaminophen. Which interventions would the nurse incorporate into the client's care plan? Select all that apply. a) Ask the client's parents if they keep firearms in their home. b) Inventory all personal items upon arrival to the unit. c) Inspect the client's mouth after giving oral medications. d) Ask the client if he/she is currently having suicidal thoughts. e) Assist the client with bathing and grooming as needed. f) Assure the client that anything said will be held in strict confidence.

a b c e

A nurse is completing a screening tool on a 4½-year-old child. To be consistent with others at this age, what behaviors would the nurse expect the child to demonstrate? Select all that apply. a) The child speaks clearly. b) The child copies a circle that is closed or very nearly closed. c) The child draws a person with at least three body parts. d) The child balances on each foot for at least 6 seconds. e) The child is able to follow one basic instruction through completion.

a b d

A nurse is conducting an infant nutrition class for parents. Which foods would the nurse tell parents that they may introduce during the first year of life? Select all that apply. a) Strained vegetables b) Oatmeal cereal c) Fruit drink d) Pureed fruits e) Bread with honey f) Whole grapes

5

A nurse is preparing a dose of amoxicillin for a 3-year-old with acute otitis media. The child weighs 33 lb (15 kg). The dosage prescribed is 50 mg/kg/day in divided doses for every 8 hours. The concentration of the drug is 250 mg/5 ml. How many milliliters would the nurse administer? Record your answer using a whole number. __________ ml

0.6

A nurse is preparing to administer intravenous methylprednisolone sodium succinate to a child who weighs 44 lb. The order is for 0.03 mg/kg intravenously daily. How many milligrams would the nurse prepare? Record your answer using one decimal place. __________ mg

b c d e f

A nurse is teaching a 16-year-old female client with inflammatory bowel disease about corticosteroid treatment. Which adverse effects are likely to be concerns for this client? Select all that apply. a) Growth spurts b) Mood swings c) Adrenal suppression d) Hirsutism e) Osteoporosis f) Acne

1 3 2 4 5

A nurse is teaching parents about the developmental milestones of an infant. Place the following developmental activities for an infant in order of occurrence by age from earliest to latest. All options must be used. 1. Turning self from prone to supine 2. Sitting alone 3. Turning self from supine to prone 4. Crawling on hands and knees 5. Effectively using pincer grasp

d e f

A nurse is teaching the parents of a 6-month-old infant about normal growth and development. Which statements regarding infant development are true? Select all that apply. a) A 6-month-old infant has difficulty holding objects. b) Stranger anxiety usually peaks at age 12 to 18 months. c) Head lag is commonly noted in infants at age 6 months. d) A 6-month-old infant can usually roll from prone to supine and supine to prone positions. e) A teething ring is appropriate for a 6-month-old infant. f) Lack of visual coordination usually resolves by age 6 months.

4 3 2 5 1

A nurse, on the pediatric unit, received shift handoff on a 15-month-old with the following needs. Using Maslow's hierarchy framework, prioritize the following nursing care activities for the toddler. All options must be used. 1. Progressing the diet after surgery 2. Changing a soiled diaper 3. Notifying the health care provider about suspected compartment syndrome 4. Clearing the airway of thick secretions 5. Administering antipyretics for an axillary temperature of 103°F (39.4°C)

a b f

A parent is planning to enroll a 9-month-old infant in a day care facility. The parent asks a nurse what to look for as indicators that the facility is adhering to good infection control measures. The nurse identifies which as an indication of meeting proper infection control standards? Select all that apply. a) Soiled diapers are discarded in covered receptacles. b) Facilities for hand hygiene are located in every classroom. c) Soiled clothing and cloth diapers are sent home in labeled paper bags. d) Toys are kept on the floor for the children to share. e) The facility keeps boxes of gloves in the director's office. f) Disposable papers are used on the diaper-changing surfaces.

c e

A parent phones the health care provider's office stating that his 13-month-old has had diarrhea for 3 days and he is unsure what fluids to offer. Which suggestions would the nurse provide? Select all that apply. a) Apple juice b) Ginger ale c) Water d) Cola e) Pedialyte f) Whole milk

70

A physician orders an intravenous infusion of dextrose 5% in quarter-normal saline solution (D5 0.25 NSS) to be infused at 7 ml/kg/hour for a 10-month-old infant. The infant weighs 22 lb (10 kg). How many milliliters of the ordered solution would the nurse infuse each hour? Record your answer using a whole number. _________ ml/hour

a b d

A school nurse is gathering registration data for a child entering first grade. Which immunizations would the school nurse verify that the child has had? Select all that apply. a) Varicella vaccine b) H. influenzae type b series c) Influenza vaccine d) Diphtheria-tetanus-pertussis series e) Pneumonia vaccine f) Oral polio series

d

An 11-year-old girl comes into the health care provider's office stating dysuria. The nurse suspects a urinary tract infection. Which finding on the laboratory report is consistent with a urinary tract infection? a) pH 7.8 b) Ketones: positive c) Glucose: positive d) WBCs: 20 per high-power field

a b d e

An adolescent scored a 20 on the Depression Scale for Children indicating moderate depression. Citalopram 20 mg daily is prescribed. Which nursing instructions are essential? Select all that apply. a) Improvement in mood may take up to one month b) Discard any MAO inhibitor medications in home c) Stop medication immediately if side effects of nausea develop d) Have the parent be involved in medication management e) Monitor the adolescent for signs of self-harm f) Eliminate aged cheese, yogurt and chocolate from the diet

a c e

The emergency room nurse documents the following in the note. When completing the documentation, which information would be included? Select all that apply. a) Objective findings from a thorough head to toe assessment b) Quotes from the toddler of what happened c) Diagram of site of injuries d) Documentation of notifying Children and Youth Services e) Description, including color and measurement, of injuries f) Information about the parent's mental health

a

The nurse is assessing the primitive reflexes of a 1-month-old infant. Of the reflexes shown in the photos, which one would the nurse expect to remain the longest? a) 2 b) 4 c) 1 d) 3

a c

The nurse is caring for a 15-year-old client with myelogenous leukemia whose platelet count is 26,000/mcl. Which nursing interventions would be included in the plan of care? Select all that apply. a) Instruct the client not to use a razor for shaving. b) Encourage jogging to increase endurance. c) Assess the client for pain in the joints. d) Encourage the client to eat foods high in iron. e) Plan to infuse packed red blood cells

a b e

The nurse is caring for a 17-year-old male client with Duchenne muscular dystrophy. When assisting the client during a hospitalization for pneumonia, which anticipated nursing interventions would reflect client-specific care? Select all that apply. a) Providing directions to the client's educational level b) Clearing a path to the bathroom for safe and easy access c) Feeding the client a high-calorie breakfast d) Completing a bed bath to conserve energy e) Assisting the client to a Fowler position for a breathing treatment f) Crushing pills for morning medication administration

b

The nurse is caring for a 3-year-old client being treated for severe status asthmaticus. After comparing clinical manifestations with laboratory results (reported below), a nurse determines evidence that this client has progressed to which condition? a) Metabolic acidosis b) Respiratory acidosis c) Respiratory alkalosis d) Metabolic alkalosis

b c f

The nurse is caring for a 4-year-old recently diagnosed with acute lymphocytic leukemia (ALL). Which statement, made by the parents, indicates the effectiveness of teaching? Select all that apply. a) "Because of the increased risk of bleeding, I will eliminate evening teeth brushing." b) "I am glad that there's a 95% chance of obtaining a first remission with treatment." c) "I understand that ALL affects all blood-forming organs and systems throughout the body." d) "I will not discipline my child during this difficult time." e) "I read that ALL is a rare form of childhood leukemia." f) "I realize that the adverse effects of chemotherapy include sleepiness, loss of hair, and sores in the mouth."

b d f

The nurse is caring for an 11-year-old client experiencing status epilepticus. When providing and delegating immediate nursing care, which nursing actions would be completed? Select all that apply. a) Instruct the licensed practical/vocational nurse (LPN/VN) to obtain vital signs. b) Pad side rails with cushions/pillows. c) Open clenched mouth to place an oral airway. d) Administer oxygen via nasal cannula. e) Place the bed in the lowest position and restrain all extremities. f) Instruct the nursing assistant to obtain the crash cart.

d

The nurse is caring for an adolescent with the following skin disorder. Which client statement indicates a need for further teaching? a) "I wash my face with soap and water every morning and night." b) "I use topical retinoids as prescribed at night on my skin." c) "Stress and hormones worsen my breakouts." d) "My breakouts are exacerbated by eating fatty foods."

c

The nurse is caring for an infant who exhibits the following characteristics. When planning care, which would be the best long-term client goal? a) The client will feed himself/herself independently. b) The client will express his/her thoughts and feelings. c) The client will reach his/her optimal level of functioning. d) The client will care for himself/herself without supervision.

b c d e f

The nurse is caring for an infant with the following congenital anomaly at birth. Which nursing interventions are helpful in feeding the 3 month old prior to surgical repair (usually 3-6 months of age)? Select all that apply. a) Use a sippy cup when drinking formula b) Record daily intake on a chart c) When feeding, give water last d) Feed in small amounts assessing for tolerance e) Dilute solids making them in a softer consistency f) Instruct on the normal feeding patterns

a

The nurse is caring for the following infant after surgery. Which short-term goal is the priority? a) The infant will remain infection-free in the postoperative period. b) The infant will continue breast-feeding 3 to 5 times daily. c) The infant will maintain 5 to 7 moderately wet diapers daily. d) The infant will bond with parents by holding and cuddling during each visit.

b

The nurse is examining an adolescent boy. The nurse classifies his sexual maturity as Tanner stage 3. Which graphic depicts this stage? a) 1 b) 2 c) 3 d) 4

c e f

The nurse is instructing a parent of a school age client on nutrition. The client is currently receiving vincristine for treatment of acute lymphocytic leukemia. Which instruction is included in the plan of care? Select all that apply. a) Encourage raw organic vegetables with a complementary dip b) Encourage farm fresh unpasteurized milk with meals c) Suggest nutrient dense supplements if appetite is poor d) Provide a diet high in protein and saturated fats to maintain weight e) Have the client select between three acceptable food options f) Offer nutrient dense snacks between meals and at bedtime

5 3 1 6 4 2

The nurse is preparing to insert an intravenous catheter into an acutely ill toddler. Place the following steps in the order the nurse would follow. All options must be used. 1. Prepare the equipment. 2. Insert the intravenous catheter and secure it appropriately. 3. Wash hands and gather supplies. 4. Select and prep the appropriate site. 5. Inform the parents of the procedure. 6. Inform the toddler of the procedure.

b

The pediatric cardiac nurse is assessing the heart sounds of a 3-year-old child with a mitral valve regurgitation. Which graphic shows the area where the nurse would assess the site of the insufficiency? a) 2 b) 1 c) 3 d) 4

a

The school nurse is assessing the chest of a first-grade child and notes a pectus excavatum. Which graphic depicts this abnormality? a) 1 b) 2 c) 3 d) 4

a b d e

Which nursing interventions are important when caring for a hospitalized toddler? Select all that apply. a) Encourage use of a security object from home. b) Maintain the toddler's routine when able. c) Discourage parents' participation in client care. d) Allow client autonomy by offering select choices. e) Instruct parent that regression commonly occurs. f) Provide thorough explanation to the toddler prior to a procedure.

d

While assessing a child experiencing respiratory distress, the nurse notes subcostal retractions. Which graphic highlights (in blue) the area where subcostal retractions are seen? a) 1 b) 4 c) 3 d) 2