you are assessing a 5 year old boy with major trauma his blood pressure is 7040 mm hg and his pulse rate is 140 beatsmin and weak the childs blood pre
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ATI Pediatrics Proctored Test

1. When assessing a 5-year-old boy with major trauma, his blood pressure is 70/40 mm Hg, and his pulse rate is 140 beats/min and weak. The child's blood pressure:

Correct answer: A

Rationale: In a 5-year-old boy with major trauma, a blood pressure of 70/40 mm Hg and a pulse rate of 140 beats/min, and weak, indicate decompensated shock. This presentation signifies inadequate perfusion, leading to compensatory mechanisms being overwhelmed, resulting in decompensated shock. Choice B is incorrect as the vital signs suggest the body is unable to adequately compensate for the trauma. Choice C is incorrect as the vital signs are more indicative of shock rather than increased intracranial pressure. Choice D is incorrect as such low blood pressure is not appropriate for a child of this age and indicates a critical condition.

2. A 30-year-old woman is 22 weeks pregnant with her first child. She tells you that her rings are not fitting as loosely as they usually do and that her ankles are swollen. Her blood pressure is 150/86 mm Hg. She is MOST likely experiencing:

Correct answer: D

Rationale: The symptoms of swollen ankles, tight rings, and elevated blood pressure in a pregnant woman at 22 weeks gestation are concerning for preeclampsia. Preeclampsia is characterized by high blood pressure and signs of organ damage, commonly seen with symptoms such as swelling (edema) and protein in the urine. It is crucial to monitor and manage preeclampsia promptly as it can lead to severe complications for both the mother and the baby.

3. A postpartum client is being discharged. The nurse should include which information about postpartum depression?

Correct answer: C

Rationale: Postpartum depression is a serious condition that can impact a mother's ability to care for her newborn. It is crucial for healthcare providers to educate clients about the signs and symptoms of postpartum depression, as it may necessitate medical intervention to ensure the well-being of both the mother and the newborn.

4. Which of the following is NOT a function of hormones?

Correct answer: A

Rationale: Hormones play various roles in the body, such as promoting growth and beauty, maintaining body temperature, and fighting infections. However, producing new offspring is not a direct function of hormones. Reproduction is primarily regulated by other factors like the reproductive system. Choice B is incorrect because hormones can indeed influence growth but not specifically 'beauty.' Choice C is incorrect as hormones can help regulate body temperature indirectly. Choice D is incorrect as hormones like cytokines can be involved in the body's immune response to fight infections.

5. What is the purpose of the pediatric assessment triangle?

Correct answer: D

Rationale: The pediatric assessment triangle is used to form a rapid, hands-off general impression of the child's condition without directly touching them. This visual assessment helps in identifying children who require immediate attention and further evaluation.

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