the nurse in the pediatric clinic performs a physical assessment of a 13 year old boy which of the following findings by the nurse requires an immedi
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Nursing Elites

ATI RN

ATI RN Custom Exams Set 5

1. The nurse in the pediatric clinic performs a physical assessment of a 13-year-old boy. Which of the following findings by the nurse requires immediate intervention?

Correct answer: D

Rationale: Choice D is the correct answer because a swollen and thickened spermatic cord could indicate testicular torsion, which is a surgical emergency. Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testicle. This condition requires immediate intervention to prevent testicular damage. Choices A, B, and C do not present findings that suggest a surgical emergency requiring immediate intervention.

2. Which vitamin deficiency is commonly associated with prolonged antibiotic use?

Correct answer: D

Rationale: The correct answer is Vitamin K. Prolonged antibiotic use can disrupt the gut flora, leading to Vitamin K deficiency and an increased risk of bleeding. Vitamin A deficiency is not commonly associated with antibiotic use. Similarly, Vitamin B6 and Vitamin C deficiencies are not typically linked to prolonged antibiotic use.

3. A nurse administers albuterol to a child with asthma. For what common side effect should the nurse monitor the child?

Correct answer: C

Rationale: The correct answer is C, Tachycardia. Albuterol, a bronchodilator used to treat asthma, commonly causes tachycardia as a side effect. This occurs due to the medication's stimulatory effect on beta-2 adrenergic receptors. Flushing (Choice A) is not a common side effect of albuterol. Dyspnea (Choice B) refers to difficulty breathing, which is a symptom albuterol aims to alleviate. Hypotension (Choice D) is not typically associated with albuterol use; instead, albuterol can lead to an increase in blood pressure.

4. The nurse is teaching the client diagnosed with colon cancer who is scheduled for a colostomy the next day. Which behavior indicates the best method of applying adult teaching principles?

Correct answer: A

Rationale: Choice A is the best method of applying adult teaching principles because repeating information and addressing the client’s questions as they arise is effective for reinforcing learning in adults. This approach allows for clarification of doubts and ensures that the client understands the information provided. Choice B is incorrect as teaching all the information in one session may overwhelm the client and hinder retention. Choice C is incorrect as using medical terms without ensuring the client's understanding may lead to confusion. Choice D is incorrect because waiting for the client to ask questions may result in missed opportunities to address important information proactively.

5. For a patient on lithium therapy, which dietary recommendation is essential?

Correct answer: B

Rationale: The correct answer is to increase sodium intake. For patients on lithium therapy, maintaining consistent sodium intake is crucial to avoid fluctuations in drug levels. Increasing caffeine intake (choice A) is not recommended as it can interfere with lithium levels. While protein intake (choice C) is important for overall health, it is not specifically essential for patients on lithium therapy. Similarly, increasing fiber intake (choice D) is beneficial but not a primary concern for patients on lithium therapy.

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