a 3 year old female has had severe diarrhea and vomiting for 4 days she is now unresponsive with rapid shallow respirations and thready radial pulses

ATI LPN

ATI Pediatrics Proctored Test

1. A 3-year-old female has had severe diarrhea and vomiting for 4 days. She is now unresponsive with rapid, shallow respirations and thready radial pulses. Her heart rate is 160 beats/min, and her oxygen saturation is 88%. You should:

A. Ventilate her with a bag-valve mask.
B. Start chest compressions.
C. Administer high-flow oxygen via a non-rebreathing mask.
D. Place her in the recovery position.

Correct answer: A

Rationale: In a pediatric patient presenting with unresponsiveness, rapid, shallow respirations, thready pulses, high heart rate, and low oxygen saturation, the priority is to ensure adequate oxygenation. Ventilating the child with a bag-valve mask is crucial in this scenario to support her breathing and improve oxygenation, as indicated by her low oxygen saturation and respiratory distress. Starting chest compressions is not indicated as the child has a pulse. Administering high-flow oxygen via a non-rebreathing mask may not be as effective as providing positive pressure ventilation with a bag-valve mask in this situation. Placing her in the recovery position is not appropriate when the child is unresponsive and in respiratory distress.

2. A breastfeeding mother reports breast engorgement. The nurse advises her to:

A. Increase the frequency of feedings
B. Apply ice packs to the breasts
C. Avoid breastfeeding until the pain subsides
D. Use a breast pump to empty the breasts completely

Correct answer: A

Rationale: Breast engorgement occurs when the breasts become overfilled with milk. By increasing the frequency of feedings, the mother can ensure that her breasts are emptied regularly, helping to relieve the discomfort associated with engorgement. This advice promotes effective milk removal and prevents further accumulation, which can worsen the condition. Applying ice packs may provide temporary relief, but it does not address the underlying issue of milk accumulation. Avoiding breastfeeding can lead to further engorgement and potential complications. Using a breast pump to empty the breasts completely may be necessary in some cases, but increasing the frequency of feedings is the initial and most appropriate intervention to manage breast engorgement.

3. Which of the following statements regarding pediatric anatomy is correct?

A. The child's trachea is more rigid and less prone to collapse.
B. The occiput is proportionately larger when compared to an adult.
C. Airway obstruction is common in children due to their large uvula.
D. Relative to the overall size of the airway, a child's epiglottis is smaller.

Correct answer: B

Rationale: The occiput, the back part of the head, is proportionately larger in children compared to adults, which can have implications for airway management techniques. This anatomical difference is important to consider when providing care to pediatric patients, especially during airway interventions.

4. A postpartum client is experiencing heavy lochia and a boggy uterus. What should be the nurse's initial action?

A. Administer a uterotonic medication
B. Encourage the client to void
C. Perform fundal massage
D. Increase the client's fluid intake

Correct answer: C

Rationale: The correct initial action for a postpartum client experiencing heavy lochia and a boggy uterus is to perform fundal massage. Fundal massage helps to firm the uterus and reduce bleeding by promoting uterine contractions, which can assist in preventing postpartum hemorrhage. Administering uterotonic medication may be necessary in some cases but should not be the initial action. Encouraging the client to void and increasing fluid intake can be important interventions but are not the priority in this situation where immediate uterine firmness is needed to control bleeding.

5. The parents of a child hospitalized with asthma who is recovering and is being prepared for discharge are receiving home care instructions from the nurse. Which statement by a parent indicates a need for further instruction?

A. Coughing spells may be triggered by dust or smoke
B. Vomiting may occur when our child has coughing episodes
C. We need to encourage our child to drink fluids
D. We need to maintain droplet precautions and a quiet environment for at least 2 weeks

Correct answer: D

Rationale: The statement 'We need to maintain droplet precautions and a quiet environment for at least 2 weeks' indicates a need for further instruction. Asthma management does not typically require maintaining droplet precautions. The focus should be on environmental control, medication adherence, and monitoring symptoms rather than droplet precautions, which are more relevant for contagious respiratory infections.