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ATI Pediatrics Proctored Test
1. A 30-year-old woman has severe lower abdominal pain and light vaginal bleeding. She tells you that her last menstrual period was 2 months ago. On the basis of these findings, you should suspect:
- A. a normal pregnancy.
- B. a ruptured ovarian cyst.
- C. an ectopic pregnancy.
- D. a spontaneous abortion.
Correct answer: C
Rationale: Severe lower abdominal pain, light vaginal bleeding, and a history of missed periods are concerning for an ectopic pregnancy. The absence of a normal menstrual period along with these symptoms raises suspicion for an ectopic pregnancy, which requires immediate medical attention due to the risk of rupture and life-threatening complications. A normal pregnancy would typically present with different symptoms such as a positive pregnancy test and typical signs of early pregnancy. A ruptured ovarian cyst may present with similar symptoms but typically lacks the history of missed periods. A spontaneous abortion usually involves heavier bleeding and tissue passage, which is not described in this scenario.
2. Upon delivery of a baby's head, you see that the umbilical cord is wrapped around its neck. Initial treatment for this condition should include:
- A. Clamping and cutting the umbilical cord.
- B. Gently pulling on the cord to facilitate removal.
- C. Trying to remove the cord from around the neck.
- D. Keeping the cord moist and providing rapid transport.
Correct answer: C
Rationale: When encountering a situation where the umbilical cord is wrapped around a baby's neck upon delivery, the initial treatment should involve trying to remove the cord from around the neck gently. It is crucial to handle this situation delicately to avoid causing harm to the baby. Attempting to ease the cord over the baby's head without pulling or tightening can help prevent potential complications associated with cord compression. Choice A, clamping and cutting the umbilical cord, is not recommended as it can lead to abrupt deprivation of oxygen to the baby. Choice B, gently pulling on the cord, can worsen the situation by tightening the cord around the baby's neck. Choice D, keeping the cord moist and providing rapid transport, is not the immediate concern and does not address the potential risks of cord compression during delivery. Therefore, the priority is to carefully attempt to remove the cord from around the baby's neck to ensure a safe delivery.
3. Which of the following statements regarding SIDS is correct?
- A. SIDS can occur in premature infants.
- B. It is most commonly a result of child abuse.
- C. Death usually occurs during sleep.
- D. SIDS can be prevented by placing the baby on its back to sleep.
Correct answer: C
Rationale: The correct statement regarding SIDS is that death usually occurs during sleep. Sudden Infant Death Syndrome (SIDS) is the unexpected death of a seemingly healthy infant, typically occurring during sleep. The exact cause of SIDS is not fully understood. While placing the baby on its back to sleep is a recommended preventive measure to reduce the risk of SIDS, it cannot guarantee prevention. Choice A is incorrect as SIDS is not limited to premature infants. Choice B is incorrect as SIDS is not primarily caused by child abuse.
4. Following delivery of a newborn and placenta, you note that the mother has moderate vaginal bleeding. The mother is conscious and alert, and her vital signs are stable. Treatment for her should include:
- A. carefully packing the vagina with sterile dressings.
- B. massaging the uterus if signs of shock develop.
- C. treating her for shock and providing rapid transport.
- D. administering oxygen and massaging the uterus.
Correct answer: D
Rationale: Administering oxygen and massaging the uterus are appropriate interventions to manage postpartum bleeding. Oxygen helps support tissue perfusion, and uterine massage can aid in uterine contraction, controlling bleeding. These actions are indicated when the mother experiences moderate vaginal bleeding post-delivery, as described in the scenario. Careful monitoring for signs of shock should continue while these interventions are implemented to ensure the mother's condition remains stable. Choices A and B are incorrect because packing the vagina with sterile dressings is not recommended for postpartum bleeding unless it is severe and immediate action is needed, while massaging the uterus is a proactive approach and should not be delayed until signs of shock develop. Choice C is also incorrect as rapid transport is not the primary intervention in this scenario where the mother is conscious, alert, and stable, and the focus should be on immediate management of the bleeding.
5. What is the MOST appropriate method for assessing a small child's level of responsiveness?
- A. Palpate for a radial pulse.
- B. Shout at the child to see if they respond.
- C. Ask the parent about the child's level of responsiveness.
- D. Tap the child and shout, 'Are you okay?'
Correct answer: D
Rationale: When assessing a small child's level of responsiveness, the most appropriate method is to tap the child and shout, 'Are you okay?' This approach is more likely to elicit a response from the child, providing a direct assessment of their level of consciousness and responsiveness. Palpating for a radial pulse (Choice A) is not the most direct method for assessing responsiveness in a child. Shouting at the child (Choice B) may startle them and not provide an accurate assessment. Asking the parent (Choice C) does not directly evaluate the child's responsiveness.
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