ATI RN
ATI Pediatrics Proctored Exam 2023
1. The nurse is teaching a patient with cancer about a new prescription for a fentanyl patch, 25mcg/hr. for chronic back pain. Which statement is the most appropriate to include in the teaching plan.
- A. You will need to change this patch every day, regardless of your pain level.
- B. This type of pain medication is not as likely to cause breathing problems.
- C. With the first patch, it will take about 24hrs before you feel the full effects.
- D. Use your heating pad for the back pain. It will also improve the patch�s effectiveness.
Correct answer: C
Rationale: Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Has the same adverse effects as other opioids, including respiratory depression. Should avoid exposing the patch to external heat sources, because this may increase toxicity.
2. When receiving change-of-shift report for children, which child should the nurse assess first?
- A. A toddler who has a concussion and an episode of forceful vomiting
- B. An adolescent with infective endocarditis who reports having a headache
- C. An adolescent who was placed into Halo traction 1 hour ago and rates his pain at a 6 on a 0-10 scale
- D. A school-age child with acute glomerulonephritis and brown-colored urine
Correct answer: A
Rationale: The nurse should assess the toddler with a concussion and an episode of forceful vomiting first when receiving change-of-shift report for children. Forceful vomiting in a toddler with a concussion indicates increased intracranial pressure, requiring immediate assessment and intervention to prevent further complications.
3. When teaching a parent of a toddler with congenital heart disease, which of the following instructions should the nurse include?
- A. Offer small, frequent meals.
- B. Limit the toddler's physical activity.
- C. Provide a low-sodium diet.
- D. Monitor the toddler's intake and output.
Correct answer: A
Rationale: The correct instruction for a parent of a toddler with congenital heart disease is to offer small, frequent meals. This recommendation helps reduce the cardiac workload on the child's heart and supports easier digestion and nutrient absorption, promoting the child's overall health. Limiting physical activity (choice B) may be necessary but is not the priority in this case. While offering a low-sodium diet (choice C) can be beneficial, it is not the most critical instruction. Monitoring the toddler's intake and output (choice D) is important but not as essential as providing small, frequent meals to support the child's heart health.
4. A child is being cared for following a head injury. Which of the following findings should indicate to the healthcare provider that the child is developing diabetes insipidus?
- A. Urine specific gravity of 1.045
- B. Sodium level of 155
- C. Blood glucose level of 45
- D. Urine output of 35 ml per hour
Correct answer: B
Rationale: In a child with a head injury, the development of diabetes insipidus can occur due to pituitary hypofunction, leading to a deficiency of antidiuretic hormone. An elevated sodium level (hypernatremia) is a key finding in diabetes insipidus due to the excessive loss of free water in the urine, resulting in increased sodium concentration in the blood.
5. A patient in the emergency department reports taking sildenafil (Viagra) and nitroglycerin 1 hr before sexual activity. Which finding should the nurse immediately report to the physician?
- A. WBC of 3200 cells/mm³
- B. RR of 26 breaths/min
- C. Temp of 38°C
- D. BP of 70/50
Correct answer: D
Rationale: The correct answer is D: BP of 70/50. When sildenafil (Viagra) is taken with nitroglycerin, it can cause severe hypotension that is unresponsive to treatment. The combination of these medications can lead to a dangerous drop in blood pressure. It is crucial to immediately report hypotension in this scenario as it poses a significant risk to the patient's life. It is recommended to allow at least 24 hours to elapse between the last dose of sildenafil and nitroglycerin to prevent such adverse effects. The other vital signs and lab values may be abnormal but do not have the immediate life-threatening implications that severe hypotension does in this context.
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