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 of the following statements does NOT apply to a nursing plan of care?

Correct answer: B

Rationale: The correct answer is B. A nursing plan of care is developed by the nursing staff, not the patient's physician. Choice A is correct as nursing plans of care typically include short-term goals to address immediate patient needs. Choice C is correct because nursing plans of care must be continually evaluated and adjusted based on the patient's progress. Choice D is incorrect as nursing plans of care can include both short-term and long-range goals to address the patient's overall health and well-being.

3. The two members of the health care team who work closely to monitor drug-nutrient interactions are:

Correct answer: D

Rationale: Clinical dietitians and pharmacists are the key members of the healthcare team responsible for monitoring drug-nutrient interactions. Clinical dietitians assess patients' nutritional needs and develop appropriate diets that consider medication effects, while pharmacists provide expertise on medications and their interactions with nutrients. Physicians and nurses are essential healthcare providers but typically do not have the specialized knowledge required to manage drug-nutrient interactions, making choices A, B, and C incorrect.

4. Which laboratory data indicate the client’s pancreatitis is improving?

Correct answer: A

Rationale: The correct answer is A. Amylase and lipase are enzymes specifically related to pancreatitis. A decrease in their serum levels indicates improvement in pancreatitis. White blood cell count (WBC), choices C and D, are not direct markers for pancreatitis improvement. Bilirubin levels, choice C, are more related to liver function rather than pancreatitis. Blood urea nitrogen (BUN) level, choice D, is a marker for kidney function, not pancreatitis.

5. During the admission interview, which question should the nurse ask the male client diagnosed with aorto-iliac disease?

Correct answer: D

Rationale: The correct answer is D: “Have you experienced any problems having sexual intercourse?” Aorto-iliac disease can lead to impaired blood flow to the pelvis and lower extremities, potentially causing sexual dysfunction. The other choices (A, B, and C) are less relevant to the specific effects of aorto-iliac disease on the client's health. While choice A may relate to discomfort, it does not directly address the impact of the disease on sexual function. Choices B and C are more general and do not specifically target the potential issues related to aorto-iliac disease.

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