Peds ATI PROTOCO
A nurse is preparing to administer amoxicillin 80 mg/kg/day divided into two doses daily to a 2-year-old client who weighs 10kg (22lbs). available is amoxicillin suspension 400mg / 5 mL. How many mL of amoxicillin should the nurse administer per doses number?
- 5 mL
A nurse is assessing a child who has measles. Which of the following areas should the nurse inspect for Kolpik's spots?
- C
A nurse in an emergency department is assessing an adolescent who reports inhalation of gasoline. Which of the following findings should the nurse expect? A) Ataxia B) Pinpoint pupils C) Hypothermia D) Hyperactive reflexes
A) Ataxia
A nurse is caring for a child who has epiglottitis due to an infection with influenza B. Which of the following should the nurse take? SATA? A) Begin droplet precautions B) Monitor oxygen saturation C) Inspect the epiglottitis D) Obtain a throat culture E) Initiate IV access
A) Begin droplet precautions B) Monitor oxygen saturation E) Initiate IV access
A nurse is planning to complete dressing changes of an adolescent who has multiple burn injuries. Which of the following interventions addresses the greatest risk to the client? A) Check the wound sites for manifestations of infection B) Perform passive range of motion exercises during the dressing change C) Apply tepid water to the old dressing before removal D) Adjust the room temperature to 33 degree (91.4 F)
A) Check the wound sites for manifestations of infection.
A nurse is caring for a child during a tonic-clonic seizure. Which of he following actions should the nurse take? SATA A) Clear the area of hard objects B) Insert a tongue blade C) Firmly hold the child's arm to one side D) Loosen tight clothing around the child's neck E) Place a pillow under the child's head
A) Clear the area of hard objects. D) Loosen tight clothing around the child's neck. E) Place a pillow under the child's head.
A nurse is caring for a child who is 2 hours postoperative. Which of the following actions should the nurse take first? A) Determine the child's sedation level B) Recheck the child's temperature C) Compare the child's pedal pulses D) Assess the child's pain level
A) Determine the child's sedation level.
A nurse is admitting a child who has pertussis. Which of the following transmission-based precautions should the nurse initiate? A) Droplet B) Airborne C) Protective D) Contact
A) Droplet
A nurse is preparing a parents' education class about nutrition for toddlers. The nurse should identify which of the following findings as an indication of protein deficiency? A) Dry, thinning hair B) Muscle twitching C) Dental caries D) Poor skin turgor
A) Dry, thinning hair
A nurse is providing teaching to the parents of a school-age child newly diagnosed with a seizure disorder. Which of the following factors should the nurse include as a common trigger that increases the risk of seizures? A) Exposure to secondhand smoke B) Decreased temperature C) Prolonged headache D) Lack of sleep
A) Exposure to secondhand smoke
A nurse is providing teaching to the guardian of a school age child who has idiopathic arthritis. Which of the following instructions should the nurse provide? A) Give the child ibuprofen on a routine schedule B) Apply ice to the affected joints C) Encourage the child to take a nap D) Provide the child with a low purine diet
A) Give the child ibuprofen on a routine schedule.
A nurse is providing postoperative care for a child following an arterial cardiac catheterization. Which of the following actions should the nurse take? A) Keep the affected extremity straight for at least 6 hr. B) Remove the child's pressure dressing after the first 4 hr. C) Maintain the child's NPO status for 4 to 6 hr. D) Monitor output using an indwelling urinary catheter for the first 24 hr
A) Keep the affected extremity straight for at least 6 hr.
A nurse in the emergency department is caring for an adolescent who is requesting testing for STIS. Which of the following actions is appropriate for the nurse to take? A) Obtain written consent from the client B) Contact the client parent to obtain phone consent. C) Request verbal consent from the social worker D) Postpone the testing until the client parents are present
A) Obtain written consent from the client
A nurse is teaching the family of a child who has cystic fibrosis about preventing pulmonary complications. Which of the following instructions should the nurse include in the teaching? A) Perform chest physiotherapy at least twice per day B) Suction the child nose each morning C) Encourage the child to use incentive spirometer. D) Give recombinant deoxyribonuclease every 4 hr. as needed for wheezing
A) Perform chest physiotherapy at least twice per day
A nurse is assessing the cognitive development of a preschooler. The nurse should expect that the child to be in which of the following phases? A) Preoperational B) Sensorimotor C) Concrete operational D) Formal operational
A) Preoperational
A nurse is caring for adolescent who is experiencing acute sickle cell crisis. Which of the following actions should the nurse take? A) Request a prescription for meperidine B) Prepare to administer potassium IV Bolus C) Provide hydration orally and IV D) Administer multiple units of platelets.
A) Request a prescription for meperidine
A nurse is providing teachings about home care to the parent of a child who has scabies. Which of the following instructions should the nurse include in the teaching? A) Treat everyone who came into contact with the child B) Soak combs and brushes in boiling water C) Apply petroleum jelly to affected areas D) Wash the child's hair with shampoo containing ketoconazole
A) Treat everyone who came into contact with the child.
A nurse is caring for an infant who has heart failure and is receiving digoxin. Which of the following findings indicate a positive response to the medication? A) Urine output 2 mL/kg/hr. B) Heart rate 187/min C) Respiratory rate 32/min D) Capillary refill 4 seconds
A) Urine output 2 mL/kg/hr.
A nurse is planning care for an 8-month -old infant who has bronchiolitis. Which of the following actions should the nurse include in the plan of care? A) Use a bulb syringe to suction the nares. B) Place the infant in a room with negative-pressure airflow. C) Initiate IV antibiotic therapy. D) Administer a meningococcal vaccine upon admission
A) Use a bulb syringe to suction the nares.
A nurse is preparing a 4-year-old child for a tonsillectomy. Which of the following statements should the nurse make? A) "You will have a special sleep, so you won't feel anything." B) "Your throat will feel better when you wake up." C) "You will be put to sleep for your surgery." D) " Your mom will be there throughout the procedure."
B) "Your throat will feel better when you wake up."
A nurse in the emergency department is caring for a school-age child who has developed respiratory stridor, wheezing, and urticaria after receiving an IV medication. Which of the following actions should the nurse take first? A) Administer methylprednisolone. B) Administer epinephrine. C) Administer a nebulized bronchodilator. D) Administer oxygen.
B) Administer epinephrine.
A nurse is planning to administer immunizations to a 2-month -old infant. Which of the following actions should the nurse take to decrease the infant's pain? A) Ask the parent to leave the room during the injections B) Administer the injections while the infant is breastfeeding C) Administer the injections in the deltoid muscle. D) Apply a warm pack to the injection site prior to administration.
B) Administer the injections while the infant is breastfeeding.
A nurse is providing discharge teaching to the guardians of an infant who had a large myelomeningocele repair in the lumbar area. Which of the following instructions should the nurse include? A) Check toys and pacifiers for the presence of latex B) Anticipate gradual loss of function in the lower extremities C) Use rectal thermometer to stimulate the passage of stool twice per day D) Clean intermittent catheterization every 8 hr.
B) Anticipate gradual loss of function in the lower extremities
A nurse is preparing to apply lidocaine and prilocaine cream to a child prior to the Insertion of a catheter. Which of the follow should the nurse plan to take? A) Avoid removing the cream prior to the procedure. B) Apply the cream 1 hour before the procedure C) Gently rub the cream into the skin D) Wash the site with alcohol prior to applying the cream
B) Apply the cream 1 hour before the procedure.
A nurse is planning care for a 4-year-old child who has leukemia and receiving chemotherapy. The child has an absolute neutrophil count 140 / mm 3. Which of the following interventions should the nurse include in the plan? A) Restrict bathing to every other day. B) Avoid taking the child's temperature rectally. C) Administer the varicella vaccine to the child. D) Increase the child's intake of fresh fruit
B) Avoid taking the child's temperature rectally.
A nurse is providing teaching to the parents of a school-age child newly diagnosed with a seizure disorder. The nurse should teach the parents to take which of the following actions during a seizure? A) Place the child in a prone position. B) Clear the area of hard objects. C) Insert a tongue blade between the teeth. D) Minimize movement of the limbs.
B) Clear the area of hard objects.
A nurse is caring for a 4year old who has meningitis and is receiving gentamicin. Which of the following labs values should the nurse report to the provider? A) Creatinine 1.4 mg/dL B) Creatinine 0.3mg / dL C) BUN 12mg / dL D) BUN 6 mg /dL
B) Creatinine 0.3mg / dL
A nurse is reviewing the laboratory report of a toddler who has hemolytic uremic syndrome. Which of the following findings should the nurse expect? A) Hgb 18g / dL B) Creatinine 3mg / dL C) Urine casts absent D) BUN 28mg / dL
B) Creatinine 3mg / dL
A nurse is caring for a child who has cystic fibrosis. The nurse should identify that this client is at an increased risk for developing which of the following conditions? A) Obesity B) Diabetes C) Precocious puberty D) Heart failure
B) Diabetes
A nurse is caring for a school -age child following the application of a cast to a fractured right tibia. Which of the following actions should the nurse take first? A) Administer pain medication. B) Elevate the child's leg. C) Teach the child about cast care. D) Petal the edges of the cast.
B) Elevate the child's leg.
A nurse in an emergency department is caring for a preschool-age child who has acute acetylsalicylic acid poisoning. Which of the following should the nurse expect? A) Jaundice B) Hyperpyrexia C) Neck vein distention D) Polyuria- oliguria it is cause
B) Hyperpyrexia
A nurse is providing discharge teaching to the parents of a school -age child following placement of a ventriculoperitoneal shunt. Which of the following statements by the parents indicate an understanding of the teaching? A) I should check my child's heart rate before administering medications B) I should call my doctor if my child begins vomiting C) I should pump the shunt at the same time each day D) My child will need to take prophylactic antibiotics until the shunt is removed
B) I should call my doctor if my child begins vomiting
A nurse is planning care of an infant following a cardiac catheterization. Which of the following interventions should the nurse include in the plan? A) Maintain the child's NPO status for 8 hours B) Monitor the color of the affected extremity C) Assess vital signs every 4 hours D) Keep the affected extremity elevated
B) Monitor the color of the affected extremity.
A nurse is teaching about growth and development to a parent of a 12-year-old child. The nurse should Instruct the parent to expect the child to exhibit which of the following characteristics during early adolescence? A) Decelerating growth rate B) Mood swings C) Increased self-esteem D) Emotional separation from parents
B) Mood swings
The nurse is teaching the parents of a child who has a terminal illness about the physical manifestations of impending death. Which of the following statements by the parents indicates an understanding of the teaching? A) My child will become increasingly more alert B) My child will have increased chest congestion C) My child will have increased sense of touch D) My child will have increased thirst
B) My child will have increased chest congestion
A nurse in a community center is providing an in-service for parents about nutritional guidelines. Which of the following should nurse include in the teaching? A) Offer 8 to 10 oz of juice per day to a preschooler. B) Provide 36 oz of milk per day to a toddler C) Introduce popcorn as a healthy snack at 12 months of age D) Encourage a 15 - year - old to increase calcium intake.
B) Provide 36 oz of milk per day to a toddler..
A nurse is caring for a 6-month-old who has gastroenteritis. Which of the following findings should the nurse identify as a manifestation of severe dehydration? A) Capillary refill time 3 seconds B) Sunken anterior fontanel C) Produces tears when crying D) Weight loss of 5%
B) Sunken anterior fontanel
A nurse is assessing a 6-month-old infant who has respiratory syncytial virus. The nurse should immediately report which of the following findings to the provider? A) Pharyngitis B) Tachypnea C) Rhinorrhea D) Coughing
B) Tachypnea
A nurse is conducting a class about parenting styles for a group of parents of school -age children. Which of the following parent statements Indicates the permissive style of parenting? A) I expect my children to follow my rules without question. " B) " I consider myself to be a role model for my child." C) " I allow my children to determine their own bedtime routines." D) " I set consistent expectations for my child's behavior."
C) " I allow my children to determine their own bedtime routines."
A nurse in the emergency department is caring for a school-age child. Which of the following actions should the nurse take? A) Provide sensory stimulation B) Measure the child's head circumference C) Administer antiviral medication to the child D) Place the child's head midline with the head of the bed at 30 angle
C) Administer antiviral medication to the child.
The nurse is caring for an infant who has heart failure and vomited following administration of digoxin. Which of the following actions should the nurse take? A) Mix the medication with 8 oz of formula B) Give an antiemetic C) Administer the next does as prescribed D) Increase fluid intake
C) Administer the next does as prescribed
A nurse is reviewing the medical records have a 15-month-old child who is scheduled to receive the measles mumps and rubella (MMR) vaccine. Which of the following findings should the nurse identify as a contra indication for receiving this vaccine? A) Upper respiratory infection 2 days ago. B) Family history of seizure. C) Allergy to neomycin D) Temperature of 37.2 degree (99 F)
C) Allergy to neomycin
A nurse is caring for a 7 - year - old child who has acute glomerulonephritis. Which of the following findings is the priority for the nurse to report to the provider? A) BUN 20mg / dL B) Urine protein 12mg / dL C) BP 150/90 mm Hg D) 2+ pedal edema
C) BP 150/90 mm Hg
A nurse is caring for a child who is postoperative following surgical correction up tetralogy of Fallot. Which of the following findings should the nurse identify as an indication of heart failure? A) Weight loss B) Bradycardia C) Decrease respirations D) Exercise intolerance
C) Decrease respirations
A nurse is caring for a child who has disseminated intravascular coagulation. Which of the following laboratory findings should the nurse expect? A) Increased RBC B) Decreased prothrombin time C) Decreased platelet count D) Increased Hgb level
C) Decreased platelet count
A nurse is assessing toddler during a well -child visit. Which of the following findings should the nurse identify as an indication nephrotic syndrome? A) Irritability B) Increased urinary output C) Increased abdominal girth D) Constipation
C) Increased abdominal girth
A nurse is reviewing safety measures with a group of parents to prevent burn injuries for toddlers. Which of the following safety measures should the nurse include in the teaching? A) Set the water heater to 60 degrees (140 F). B) Turn pot handles toward the front of the stove. C) Keep electrical wires hidden from view D) Encourage outdoor activities between the hours of 1100 and 1300.
C) Keep electrical wires hidden from view.
A nurse is planning care for a six-month-old infant who has bacterial meningitis. Which of the following interventions should the nurse include in the plan of care? A) Place the infant in a semiprivate room B) Provide frequent range of motion to the neck and shoulder C) Pad the side rails of the crib D) Keep the television on in the room to provide background noise.
C) Pad the side rails of the crib
A nurse is caring for an infant who has severe dehydration which of the following severe clinical findings should the nurse expect? A) Warm extremities B) Capillary refill 3 secs C) Rapid respirations D) Bradycardia
C) Rapid respirations
A nurse is providing discharge teaching to the parents of a toddler that has iron deficient anemia and a new prescription for ferrous sulfate elixir. Which of the following instructions should the nurse include? A) "Stop this medication if your child's stools are a tarry green color." ( B) "Give your child this medication with a glass of milk." C) "Don't allow your child to have orange juice while taking this medication. D) "Administer this medication to your child with a dropper."
D) "Administer this medication to your child with a dropper."
A nurse is teaching the parent of an infant who has a Pavlik harness to treat developmental dysplasia of the hip. The nurse should identify that which of the following statements by the parents indicates an understanding of the teaching? A) "I should remove the harness at night to allow my infant to stretch her legs." B) "I will need to adjust the straps on the harness once each week." C) "I should apply baby powder to my infant's skin twice daily." D) "I will place my infant's diapers under the harness straps."
D) "I will place my infant's diapers under the harness straps."
The nurse is planning to teach an adolescent who is lactose intolerant about dietary guidelines. Which of the following instruction should the nurse include in the teaching? A) "You should consume flavored yogurt instead of plain yogurt" B) "You can drink milk on an empty stomach" C) "You may tolerate plain milk better than chocolate milk" D) "You can replace milk with non-dairy sources of calcium"
D) "You can replace milk with non-dairy sources of calcium"
A nurse is providing teaching to the parents of a preschool-age child who has celiac disease. Which of the following Instructions should the nurse include? A) " You should replace white flour with wheat flour when preparing meals for your child. B) " Your child will need to follow a low- protein diet temporarily. C) " You should place your child on a high - fiber diet when she has an exacerbation. " D) "Your child will be on a gluten -free diet for the rest of her life."
D) "Your child will be on a gluten -free diet for the rest of her life."
A nurse is prioritizing care for four clients. Which of the following client should the nurse assess first? A) A toddler who has a partial thickness burn on his right hand and requires a dressing change B) A toddler who has a new diagnosis of osteomyelitis and is to receive an IV bolus of nafcillin C) An adolescent who is in skin traction and reports a pain level of seven on a scale from 0 to 10. D) An adolescent who has sickle cell anemia and slurred speech
D) An adolescent who has sickle cell anemia and slurred speech
A nurse is providing teaching to the parents of a child who has impetigo. Which of the following Instructions should the nurse Includes in teaching? A) Soak hairbrushes in boiling water for 10 min B) Administer acyclovir PO two times per day C) Seal soft toys in a plastic bag for 14 days D) Apply bactericidal ointment to lesions
D) Apply bactericidal ointment to lesions
A nurse is caring for a school age child who is experiencing pain. Which of the following assessment techniques will provide the nurse with the most accurate information regarding the child's pain? A) Assess the child's pulse and respirations. B) Monitor the child's involuntary movements. C) Observe the child's facial expressions D) Ask the child to use a FACES rating scale.
D) Ask the child to use a FACES rating scale.
A nurse is planning care for a preschooler who has neutropenia. Which of the following interventions should the nurse include in the plan? A) Obtain the child's temperature rectally B) Bathe the child every other day C) Administer vaccines prior to discharge D) Avoid raw fruits and vegetables in the diet
D) Avoid raw fruits and vegetables in the diet
A school nurse is assessing a 7-year-old student. The nurse should Identify which of the following findings as a potential indicator abuse? A) Weight in 45th percentile B) Front deciduous teeth missing C) Abrasions on the knees D) Bruising around the wrists
D) Bruising around the wrists
A nurse is creating a plan of care for an adolescent who has muscular dystrophy. Which of the following interventions should the nurse include in the plan? A) Initiate a referral for chest physiotherapy every 4 hours B) Recommend the adolescent use a wheelchair to prevent stress on the lower extremities C) Avoid influenza and pneumococcal vaccines for 24 months D) Encourage the adolescent to perform incentive spirometry to maintain lung capacity
D) Encourage the adolescent to perform incentive spirometry to maintain lung capacity
A nurse in a community clinic is reviewing the laboratory results of four clients. The nurse should identify that which of the following sexually transmitted infections is nationally notifiable? A) Human papilloma virus B) Genital herpes simplex virus C) Bacterial vaginosis trichomoniasis D) Gonorrhea
D) Gonorrhea
A nurse is providing discharge teaching to the parents of a school -age child following placement of a ventriculoperitoneal shunt. The nurse should determine that the teaching was effective when the parents identify which of the following as an indicator the shunt has been displaced? A) Decreased urine output B) Elevated temperature C) Hyperactive bowel sounds D) Increased sleeping
D) Increased sleeping
A nurse is planning care for a school -age child who has autism spectrum disorder. Which of the following actions should the nurse include in the plan? A) Stay with the child for long periods of time. B) Explain procedures in detail to the child. C) Give the child three options when making choices. D) Introduce the child to new situations slowly
D) Introduce the child to new situations slowly
A nurse is assessing a 2-week-old newborn. Which of the following manifestations should the nurse report to the provider? A) Anterior fontanel 3 cm B) Enlarged breasts C) Slow, rhythmic movements of the lower extremities D) Irregular bluish pigmentation on the sacral area
D) Irregular bluish pigmentation on the sacral area
A nurse is preparing to perform peritoneal dialysis for a child who has an elevated serum creatinine level. After explaining the procedure, which of the following actions should the nurse plan to take? A) Keep the dialysate refrigerated until time of infusion B) Initiate IV access C) Check the fistula site for a bruit D) Obtain the child's weight
D) Obtain the child's weight
A nurse is caring for a school aged child who has acute renal failure. Which of the following manifestations should the nurse expect? A) Hypercalcemia B) Metabolic acidosis C) Hypokalemia D) Oliguria
D) Oliguria
A nurse is preparing to administer immunizations to a 3- month- old Infant. Which of the following is an appropriate action for the nurse to take to deliver atraumatic care? A) Inject the immunizations into the deltoid muscle B) Use a 20- gauge needle for the injections C) Apply eutectic mixture of local anesthetics (EMLA) cream immediately before the injections D) Provide a pacifier coated with an oral sucrose solution prior to the injections
D) Provide a pacifier coated with an oral sucrose solution prior to the injections
A nurse in a community health clinic is assessing the needs of a single parent who has three young children and works full time. Which of the following resources should the nurse recommend? A) Counseling for depression B) 12 step support group C) Child home health care D) Respite childcare
D) Respite childcare
A nurse is reviewing the laboratory values of a school age child who has nephrotic syndrome. Which of the following laboratory values should the nurse expect? A) Hemoglobin 12 B) BUN 15 C) Serum sodium 144 D) Serum protein 4.2g/dL
D) Serum protein 4.2g/dL
A nurse is caring for a toddler who is in the terminal stage of neuroblastoma. The parents ask how we can help our child. Which of the following responses by the nurse is appropriate? A) Stay close to your child B) Encourage your child's friends to visit C) Change your child's schedule everyday D) Talk to your child about the meaning of death
D) Talk to your child about the meaning of death
A nurse is preparing to initiate IV antibiotic therapy for a newly admitted 12-month -old Infant Which of the following actions should the nurse plan to take? A) Cover the insertion site with an opaque dressing B) Change the IV site every 3 days C) Start the IV in the infant's foot D) Use a 24 - gauge catheter to start the IV
D) Use a 24 - gauge catheter to start the IV
