a nurse in an emergency department is caring for a school age child who is experiencing an anaphylactic reaction which of the following is the priorit
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Nursing Elites

ATI RN

RN Pediatric Nursing 2023 ATI

1. A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse?

Correct answer: D

Rationale: In the management of anaphylaxis, the priority action for the nurse is to administer IM epinephrine to the child. Epinephrine is the first-line treatment for anaphylaxis as it helps reverse the severe manifestations of the reaction by constricting blood vessels, relaxing airway muscles, and decreasing hives and swelling. Elevating the head of the child's bed may be beneficial for respiratory distress but is not the priority over administering epinephrine. Inserting a large-bore IV catheter may be necessary for fluid resuscitation but is not the initial priority. Identifying the allergen is important for prevention and future management but is not the immediate action needed in the acute phase of an anaphylactic reaction.

2. A patient taking sildenafil (Viagra) asks a nurse what action to take if priapism occurs. Which response should the nurse provide?

Correct answer: D

Rationale: Patients experiencing priapism from sildenafil should seek immediate medical attention. Priapism is a serious condition where an erection lasts longer than 4 hours, and if left untreated, it can lead to irreversible damage to the penile tissue, potentially causing permanent erectile dysfunction. Therefore, prompt intervention is crucial to prevent long-term complications.

3. A healthcare professional is preparing to collect a sample from a toddler for a sickle turbidity test. Which of the following actions should the healthcare professional plan to take?

Correct answer: C

Rationale: The healthcare professional should perform a finger stick on a toddler as a component of the sickle turbidity test. If the test is positive, hemoglobin electrophoresis is required to distinguish between children who have the genetic trait and children who have the disease. Finger stick is a common method used to collect blood samples, especially in pediatric patients, for various tests.

4. What is functional behavior analysis?

Correct answer: A

Rationale: Functional behavior analysis involves systematically observing behavior to understand its function and context. It focuses on identifying the antecedents and consequences that maintain or influence behavior. This systematic observation helps in determining patterns, triggers, and maintaining factors of behavior. Standardized assessments (choice B) involve using specific tools or tests to measure a person's performance or behavior but do not focus on observation. Multiple choice examinations (choice C) and parent-teacher questionnaires (choice D) are not synonymous with functional behavior analysis as they do not involve direct observation of behavior for analysis.

5. During an assessment, a healthcare professional is evaluating an infant with pneumonia. Which of the following findings should be the priority for the healthcare professional to report to the provider?

Correct answer: A

Rationale: When assessing an infant with pneumonia, the priority finding to report to the provider is nasal flaring. Nasal flaring indicates acute respiratory distress, which can be a life-threatening condition requiring immediate intervention. Monitoring and addressing respiratory distress take precedence over other symptoms or laboratory results in this situation.

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