which is the priority nursing diagnosis when planning care for a newborn who is born with esophageal atresia and tracheoesophageal fistula
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Nursing Elites

ATI RN

ATI Pediatric Proctored Exam

1. When planning care for a newborn with esophageal atresia and tracheoesophageal fistula, which is the priority nursing diagnosis?

Correct answer: D

Rationale: The priority nursing diagnosis for a newborn with esophageal atresia and tracheoesophageal fistula is 'Risk for Aspiration' because of the potential respiratory complications associated with these conditions. The newborn is at a higher risk of aspirating oral or gastric contents due to the abnormal connections between the esophagus and trachea, posing a serious threat to the airway and lungs. Addressing this risk is crucial to prevent respiratory distress and maintain the airway's patency, making it the priority nursing diagnosis in this scenario. 'Ineffective Tissue Perfusion' is not the priority as respiratory compromise takes precedence over perfusion concerns. 'Ineffective Infant Feeding Pattern' may be relevant but addressing the risk of aspiration is more critical. 'Acute Pain' is not the priority compared to the life-threatening risk of aspiration.

2. Which strategy is most effective in preventing existing challenging behaviors?

Correct answer: B

Rationale: Individualized interventions are tailored to address the specific needs and triggers of the individual's challenging behaviors. By customizing the approach to each person, it increases the likelihood of effectively preventing and managing the existing challenging behaviors.

3. In which frame of reference do activities involve responses to movement, balance, weight bearing, and tactile activities?

Correct answer: B

Rationale: Ayres' sensory integration focuses on activities that target responses to movement, balance, weight bearing, and tactile stimuli to improve sensory processing and integration. This approach aims to address sensory challenges through structured activities to enhance overall function and participation. Motor control/motor learning (Choice A) deals with the control and coordination of voluntary movements. Neurodevelopmental treatment (Choice C) focuses on facilitating normal movement patterns and postural control. Developmental (Choice D) refers to the natural sequence of growth and development in children.

4. Which clinical manifestations should the nurse anticipate upon assessment for a preschool-age child with a urinary tract infection (UTI)?

Correct answer: C

Rationale: Preschool-age children with a urinary tract infection commonly present with urgency (feeling the need to urinate urgently), dysuria (painful urination), and fever. These symptoms are indicative of a UTI in this age group and should prompt further assessment and intervention by the nurse. Choice A is incorrect because headache and vertigo are not typical symptoms of UTI in preschool-age children. Choice B is incorrect because while foul-smelling urine and hematuria can be present in UTI, elevated blood pressure is not a common finding in this condition. Choice D is incorrect as severe flank pain and nausea are not typical manifestations of UTI in preschool-age children.

5. Which statement most reflects the observation that the infant sleeps soundly, awakens on his own, and maintains a quiet alert state?

Correct answer: C

Rationale: A quiet alert state in infants indicates positive neurological development. It showcases the infant's ability to regulate sleep-wake cycles and maintain an optimal state for learning and interaction. Therefore, observing an infant who sleeps soundly, awakens on his own, and stays in a quiet alert state is a reassuring sign of neurological gains and healthy development. Choice A is incorrect as it misinterprets normal behavior as atypical. Choice B is incorrect as it suggests the infant should be on high alert, which is not developmentally appropriate. Choice D is incorrect as it falsely blames the family for disrupting the child's sleep patterns, whereas the scenario described indicates positive neurological growth.

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