the nurse provides home care instructions to the parents of a child hospitalized with asthma who is recovering and is being prepared for discharge whi

ATI LPN

Pediatric ATI Proctored Test

1. 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.

2. When inserting an oropharyngeal airway in a small child, what is the preferred method?

A. Insert the airway with the curvature towards the roof of the mouth and then rotate it 180 degrees.
B. Insert the airway as you would in an adult, but use an airway that is one size smaller than usual.
C. Depress the tongue with a tongue blade and insert the airway with the downward curve facing the tongue.
D. Open the airway with the tongue-jaw lift maneuver and insert the airway until slight resistance is met.

Correct answer: C

Rationale: When inserting an oropharyngeal airway in a small child, it is crucial to depress the tongue with a tongue blade and insert the airway with the downward curve facing the tongue. This technique helps in maintaining an open airway and preventing obstruction by the tongue. Placing the airway with the curve facing the roof of the mouth or using a smaller size is not recommended for small children, as it may not effectively keep the airway patent. The tongue-jaw lift maneuver is not the preferred method for inserting an oropharyngeal airway in small children.

3. Which of the following findings is abnormal?

A. Rapid, irregular breathing in a newly born infant
B. Heart rate of 80 beats/min in a 3-month-old infant
C. Respiratory rate of 26 breaths/min in a 2-year-old child
D. Systolic BP of 100 mm Hg in a 10-year-old child

Correct answer: B

Rationale: A heart rate of 80 beats per minute in a 3-month-old infant is abnormally low for that age group and could indicate underlying health issues. The normal heart rate for a 3-month-old infant is typically higher, around 100-150 beats per minute. Therefore, this finding stands out as abnormal and warrants further evaluation. Choice A is not necessarily abnormal in a newly born infant as irregular breathing patterns can be common during the neonatal period. Choice C falls within the normal respiratory rate range for a 2-year-old child, which is around 20-30 breaths per minute. Choice D reflects a systolic blood pressure value within the normal range for a 10-year-old child, which is typically around 90-110 mm Hg.

4. How should you assist with the delivery of the baby's head?

A. Grasping each side of the baby's head and gently pulling to facilitate delivery.
B. Placing your fingers on the bony part of the skull and applying gentle pressure.
C. Carefully rotating the baby's head to face up during delivery.
D. Placing the palm of your hand firmly against the back of the baby's skull.

Correct answer: B

Rationale: To assist with the delivery of the baby's head, the correct technique involves placing your fingers on the bony part of the skull and applying gentle pressure. This method helps guide the baby's head through the birth canal safely and effectively. Choices A, C, and D are incorrect. Grasping and pulling the baby's head, rotating the head, or placing the palm of your hand against the back of the baby's skull can potentially cause harm or complications during delivery.

5. 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.