ATI Pediatrics Practice Exam A

A nurse is a providers office is preparing to administer vaccinations to a toddler during a well-child visit. Which of the actions should the nurse plan to take? (kid has increased RR & HR; allergy to Neomycin) A. Withhold the measles, mumps, and rubella (MMR) vaccine. B. Withhold the diphtheria, tetanus, and pertussis (DTaP) vaccine. C. Withhold the influenza vaccine. D. Withhold the tuberculin skin test (TST). - A. Withhold the measles, mumps, and rubella (MMR) vaccine. Rationale: The nurse should recognize that an allergy to neomycin with an anaphylactic reaction is a contraindication for receiving the MMR vaccine. Clients who have a severe allergy to eggs or gelatin should not receive this vaccine. A nurse is providing teaching to the parent of a school-aged child who has a new prescription for oral nystatin for the treatment of oral candidacies. Which of the following instructions should the nurse include? A. "Shake the medication prior to administration." B. "Provide the medication through a straw." C. "Rinse the child's mouth with water immediately after giving the medication." D. "Mix the medication with applesauce if the child dislikes the taste." - A. "Shake the medication prior to administration." Rationale: The nurse should instruct the parent to shake the medication prior to administration to disperse the medication evenly within the suspension. A nurse is reviewing the lumbar puncture results of a school-aged child who has suspected bacterial meningitis. Which of the following findings should the nurse identify as an indication of bacterial meningitis? A. Decreased cerebrospinal fluid pressure B. Decreased WBC count C. Increased protein concentration D. Increased glucose level - C. Increased protein concentration Rationale: The nurse should identify that an increased protein concentration in the spinal fluid is a finding that can indicate bacterial meningitis. A nurse is caring for a preschooler whose father is going home home for a few hours while another relative stays with the child. Which of the following statements should the nurse make to explain to the child when their father will return? A. "Your daddy will be back at 7 p.m." B. "Your daddy will be back after you eat." C. "Your daddy will be back in the morning." D."Your daddy will be back after he takes care of your brother." - B. "Your daddy will be back after you eat." Rationale: Preschoolers make sense of time best when they can associate it with an expected daily routine, such as meals and bedtime. Therefore, the child comprehends time best when it is explained to them in relation to an event they are familiar with, such as eating. A nurse is reviewing the laboratory report of a school-aged child who is experiencing fatigue. Which of the following findings should the nurse recognize as an indication of anemia? A. Hematocrit 28% B. Hemoglobin 13.5 g/dL C. WBC count 8,000/mm3 D. Platelets 250,000/mm3 - A. Hematocrit 28% Rationale: The nurse should recognize that this hematocrit level is below the expected reference range of 32% to 44% for a school-age child. The child can exhibit fatigue, lightheadedness, tachycardia, dyspnea, and pallor due to the decreased oxygen-carrying capacity. A nurse is reviewing the laboratory results of an infant who is receiving treatment for severe dehydration. The nurse should identify which of the following lab values indicates that the treatment is working? A. Potassium 2.9 mEq/L B. Sodium 140 mEq/L C. Urine specific gravity 1.035 D. BUN 25 mg/dL - B. Sodium 140 mEq/L Rationale: The nurse should identify that a sodium level of 140 mEq/L is within the expected reference range of 134 to 150 mEq/L and indicates the current treatment regimen the infant is receiving for dehydration is effective. A nurse is reviewing the laboratory report of a 7-year-old child who is going through chemotherapy. which of the following lab values should the nurse report to the provider? A. Hgb 8.5 g/dL B. WBC count 9,500/mm3 C. Prealbumin 18 mg/dL D. Platelets 300,000/mm3 - A. Hgb 8.5 g/dL Rationale: A child receiving chemotherapy is at risk for anemia due to the chemotherapy effects on the blood-forming cells of the bone marrow. The development of anemia is diagnosed through laboratory testing of hemoglobin and hematocrit levels. The nurse should recognize that a hemoglobin level of 8.5 g/dL is below the expected reference range of 10 to 15.5 g/dL for a 7-year-old child and should be reported to the provider. A nurse is teaching the parents of an infant ways to prevent sudden infant death syndrome (SIDS). Which of the following instructions should the nurse include? A. "Place the infant in a prone position to sleep." B. "Allow the infant to sleep on a large pillow." C. "Use a soft mattress in the infant's crib." D. "Give the infant a pacifier at bedtime." - D. "Give the infant a pacifier at bedtime." Rationale: The nurse should inform the parent that protective factors against SIDS include breastfeeding and the use of a pacifier when the infant is sleeping. A nurse is caring for a preschooler who has been receiving IV fluids via a peripheral IV catheter. When preparing to discontinue the IV fluids and catheter, which of the following actions should the nurse plan to take? (place in order) Remove the tape securing the catheter Turn off the IV pump Occlude the IV tubing Apply pressure over the catheter insertion site - First, the nurse should turn off the IV pump. Next, the nurse should occlude the IV tubing, and then remove the tape securing the catheter. Last, the nurse should apply pressure over the catheter insertion site. A school nurse is assessing an adolescent who has multiple burns in various stages of healing. Which of the following behaviors should the nurse identify as possible indication of physical abuse? A. Expresses a reluctance to leave home B. Provides a detailed description of how the burns occurred C. Denies discomfort during assessment of injuries D. Describes strong relationships with peers - C. Denies discomfort during assessment of injuries Rationale: The nurse should suspect child maltreatment in the form of physical abuse if the adolescent has a blunted response to painful stimuli or injury. A nurse is teaching the parent of an infant who has the Palvik Harness for the treatment of developmental dysplasia of the hip. The nurse should identify that which of the following statements made by the parents indicates an understanding of the teaching? A. "I should remove the harness at night to allow my infant to stretch her legs." B. "I will need to adjust the straps on the harness once each week." C. "I should apply baby powder to my infant's skin twice daily." D. "I will place my infant' - D. "I will place my infant's diapers under the harness straps." Rationale: To prevent soiling of the harness, the parent should apply the infant's diaper under the straps. A nurse is assessing a school-aged child who has peritonitis. Which of the following findings should the nurse expect? A. Hyperactive bowel sounds B. Abdominal distention C. Bradycardia D.Bloody stool - B. Abdominal distention Rationale: The nurse should identify that abdominal distention is an expected finding of peritonitis. Peritonitis is an inflammation of the lining of the abdominal wall. This inflammation in the abdomen, along with the ileus that develops, causes abdominal distention. Other manifestations include chills, irritability, and restlessness. A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should the nurse expect? A. Increase in anterior convexity of the lumbar spine B. Increased curvature of the thoracic spine C. Lateral flexion of the neck D. A unilateral rib hump - D. A unilateral rib hump Rationale: When assessing an adolescent for scoliosis, the school nurse should expect to see a unilateral rib hump with hip flexion. This results from a lateral S- or C-shaped curvature to the thoracic spine resulting in asymmetry of the ribs, shoulders, hips, or pelvis. Scoliosis can be the result of a neuromuscular or connective tissue disorder, or it can be congenital in nature. A nurse is assessing a school-aged child immediately following an appendix rupture repair. Which of the following findings should the nurse expect? A. Purulent nasogastric drainage B. Absence of peristalsis C. Passage of dark red stool with mucus D. WBC count 6,000/mm3 - B. Absence of peristalsis Rationale: The nurse should expect absence of peristalsis immediately following a perforated appendix repair, until the bowel resumes functioning. A nurse is providing discharge teaching to the parent of a child who is 1 week postoperative following a cleft palate repair. For which of the following members of the interprofessional team should the nurse initiate a referral? A. Occupational therapist B. Speech therapist C. Respiratory therapist D. Physical therapist - B. Speech therapist Rationale: The nurse should initiate a referral for a speech therapist for a child who is postoperative following a cleft palate repair. A child who has a cleft palate will require speech therapy immediately following the repair to support speech development and future articulation. A hospice nurse is caring for a preschooler who has a terminal illness. One of the preschooler's parents tells the nurse that they cannot cope anymore and are thinking about moving out of the house. Which of the following statements should the nurse make? A. "It is important that you provide emotional support for your family at this time." B. "You have to do what you feel is best. Everything will turn out fine." C. "I know how you feel. This is an extremely stressful time for your family." D. "L - D. "Let's talk about some of the ways you have handled previous stressors in your life." Rationale: This statement offers a general lead to allow the parent to express their feelings and previous actions when faced with stressful situations. It also helps the parent to focus on ways that they can cope with the current situation. A nurse is preparing an adolescent for a lumbar puncture. Which of the following actions should the nurse take? A. Place a cardiac monitor on the adolescent prior to the procedure B. Apply topical analgesic cream to the site 1 hr prior to the procedure. C. Keep the adolescent in a semi-Fowler's position for 4 hr following the procedure. D. Restrict fluids for 2 hr following the procedure. - B. Apply topical analgesic cream to the site 1 hr prior to the procedure. Rationale: The nurse should apply a topical analgesic to the lumbar site 1 hr prior to the procedure to decrease the adolescent's pain while the lumbar needle is inserted. A nurse in an emergency department is performing a physical assessment on a 2- week-old male newborn. Which of the following findings is the priority for the nurse to report to the provider? A.Excoriated scrotal area B. Multiple capillary hemangiomas C. Depressed posterior fontanel D. Substernal retractions - D. Substernal retractions Rationale: When using the airway, breathing, and circulation approach to client care, the nurse should determine that the priority finding to report to the provider is substernal retractions. This finding indicates the newborn is experiencing increased respiratory effort, which could quickly progress to respiratory failure. A nurse is providing teaching about play activities for social development to the parents of a preschooler. Which of the following play activities should the nurse recommend for the child? A. Playing pat-a-cake B. Using a push-pull toy C. Creating a scrapbook D. Playing dress-up - D. Playing dress-up Rationale: The nurse should instruct the parents that at the preschool age, play should focus on social, mental, and physical development. Therefore, playing dress-up is a recommended play activity for this child. A nurse is creating a plan of care for an infant who has an epidural hematoma from a head injury. Which of the following interventions should the nurse include in the plan of care? A. Position the infant side-lying with their head at a 0° to 5° angle. B. Perform a neurological assessment every 4 hr. C. Suction the infant's nares to remove secretions. D. Implement seizure precautions for the infant. - D. Implement seizure precautions for the infant. Rationale: An infant who has an epidural hematoma is at great risk for seizure activity. Therefore, the nurse should implement seizure precautions for the child. A nurse is admitting a school-aged child who has pertussis. Which of the following actions should the nurse take? A. Place the child in a room with positive-pressure airflow. B. Place the child in a room with negative-pressure airflow. C. Initiate contact precautions for the child. D.Initiate droplet precautions for the child. - D.Initiate droplet precautions for the child. Rationale: The nurse should initiate droplet precautions for a child who has pertussis, also known as whooping cough. Pertussis is transmitted through contact with infected large-droplet nuclei that are suspended in the air when the child coughs, sneezes, or talks. A nurse is caring for a preschooler who is scheduled for hydrotherapy treatment for wound debridement following a burn injury. Which of the following actions should the nurse take prior to the procedure? A. Apply topical antimicrobial ointment to the child's wound. B. Place a mesh gauze dressing over the child's wound. C. Administer an analgesic to the child. D. Initiate prophylactic antibiotic therapy for the child. - C. Administer an analgesic to the child. Rationale: Hydrotherapy for debridement of a wound is an extremely painful procedure which requires analgesia and/or sedation. When pain is controlled, it leads to reduced physiological demands on the body caused by stress and decreases the likelihood of children developing depression and post-traumatic stress disorder. A nurse is caring for a 15-year-old client who is married and is scheduled for a surgical procedure. The client asks, "who should sign my surgical consent?" which of the following responses' should the nurse make? A. "You can sign the consent form because you are married." B. "Your spouse should sign the consent form for you." C. "Your parent should sign the consent form for you." D. "You can appoint a legal guardian to sign the consent form." - A. "You can sign the consent form because you are married." Rationale: The nurse should inform the adolescent that marriage gives adolescents the legal right to consent to surgical procedures and sign other legal documents that they would not otherwise be able to sign due to their age. A nurse is teaching the parent of a preschooler about ways to prevent acute asthma attacks. Which of the following statements by the parents indicates an understanding of the teaching? A. "I will use a humidifier in my child's room at night." B. "I will give my child a cough suppressant every 6 hours if he has a cough." C. "I should avoid using a wet mop on my floors when I am cleaning." D. "I should keep my child indoors when I mow the yard." - D. "I should keep my child indoors when I mow the yard." Rationale: The nurse should instruct the parent to keep the preschooler indoors during lawn maintenance or when the pollen count is increased. Guarding against exposure to known allergens found outdoors, such as grass, tree, and weed pollen, will decrease the frequency of the preschooler's asthma attacks. A nurse is caring for a toddler who is experiencing acute diarrhea and has moderate dehydration. Which of the following nutritional items should the nurse offer the child? A. Apple juice B. Peanut butter C. Chicken broth D.Oral rehydration solution - D.Oral rehydration solution Rationale: A toddler who has acute diarrhea should consume an oral rehydration solution to replace electrolytes and water by promoting the reabsorption of water and sodium. This promotes recovery from dehydration. a nurse is caring for a school-aged child who has experienced a tonic-clonic seizure. Which of the following actions should the nurse take during the immediate postictal period? A. Place the child in a side-lying position. B. Give the child a high-carbohydrate snack C. Administer an oral sedative to the child. D.Delay documentation until the child is fully alert. - A. Place the child in a sidelying position. Rationale: The nurse should place the child in a side-lying position to prevent aspiration. A nurse is planning care for a school-aged child who is in the oliguric phase of acute kidney injury and has a sodium level of 129 mEq/L. Which of the following interventions should the nurse include in the plan? A. Administer ibuprofen to the child for a temperature greater than 38º C (100.4º F). B. Assess the child's blood pressure every 8 hr. C. Weigh the child weekly at various times of the day. D. Initiate seizure precautions for the child. - D. Initiate seizure precautions for the child. Rationale: A sodium level of 129 mEq/L indicates hyponatremia and places the child at increased risk for neurological deficits and seizure activity. The nurse should complete a neurologic assessment and implement seizure precautions to maintain the child's safety. A nurse is caring for a school-aged child who is receiving cefazolin via intermittent IV bolus. The child suddenly develops diffuse flushing of the skin and angioedema. After discontinuing the medication infusion, which of the following medications should the nurse administer first? A. Epinephrine B. Diphenhydramine C. Albuterol D. Prednisone - A. Epinephrine Rationale: This child is most likely experiencing an anaphylactic reaction to the cefazolin. According to evidence-based practice, the nurse should first administer epinephrine to treat the anaphylaxis. Epinephrine is a beta adrenergic agonist that stimulates the heart, causes vasoconstriction of blood vessels in the skin and mucous membranes, and triggers bronchodilation in the lungs. A nurse is assessing an infant who has a ventricular septal defect. Which of the following findings should the nurse expect? A. Loud, harsh murmur B. Dysrhythmias C. Weak femoral pulses D. High blood pressure - A. Loud, harsh murmur Rationale: The nurse should expect to hear a loud, harsh murmur with a ventricular septal defect due to the left-to-right shunting of blood, which contributes to hypertrophy of the infant's heart muscle. A nurse is assessing the vital signs of a 10-year-old child following a burn injury. The nurse should identify that which of the following findings is an indication of early septic shock? A. Blood pressure 130/90 mm Hg B. Heart rate 60/min C. Temperature 39.1° C (102.4° F) D. Urinary output 100 mL/hr - C. Temperature 39.1° C (102.4° F) Rationale: The nurse should identify that a temperature of 39.1° C (102.4° F) is above the expected reference range of 37° to 37.5° C (98.6° to 99.5° F) for a 10- year-old child. The nurse should expect a child who has early septic shock to have a fever and chills. A nurse is preparing to collect a sample from a toddler for a sickle-turbidity test. Which of the following actions should the nurse plan to take? A. Obtain a sputum specimen. B. Perform an Allen test. C. Perform a finger stick. D. Obtain a stool specimen. - C. Perform a finger stick. Rationale: The nurse 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. A nurse in an emergency department is caring for an adolescent who has severe abdominal pain due to appendicitis. Which of the following locations should the nurse identify as McBurneys Point? - A - The nurse should identify this area of the client's abdomen as McBurney's point. This area of the right lower quadrant located about two-thirds of the way between the umbilicus and the client's anterosuperior iliac spine is the area where a client who has appendicitis is most likely to report pain and tenderness. A nurse is caring for an adolescent who received a kidney transplant. Which of the following finding should the nurse identify as an indication the adolescent is rejecting the kidney? A. Negative leukocyte esterase B. Serum creatinine 3.0 mg/dL C. Negative urine protein D. Urine output 40 mL/hr - B. Serum creatinine 3.0 mg/dL Rationale: Creatinine is a byproduct of protein metabolism and is excreted from the body through the kidneys. An elevated serum creatinine level, therefore, can be an indication that the kidneys are not functioning. The nurse should identify that the adolescent's serum creatinine level is higher than the expected reference range of 0.4 to 1.0 mg/dL for an adolescent and can indicate rejection of the kidney A nurse is caring for an infant who has RSV. Which of the following actions should the nurse implement for infection control? A. Have a designated stethoscope in the infant's room. B. Place the infant in a room equipped with negative airflow. C. Administer palivizumab as prescribed for the infant. D. Remove gloves after leaving the infant's room. - A. Have a designated stethoscope in the infant's room. Rationale: The nurse should initiate droplet precautions for an infant who has RSV because the virus is spread by direct contact with respiratory secretions. Therefore, designated equipment, such as a blood pressure cuff and a stethoscope, should be placed in the infant's room. A nurse is teaching the parents of a school-aged child who has osteomyelitis of the tibia. Which of the following statements by the parents indicated an understanding of the teaching? A. "My child will have a cast until healing is complete." B. "My child will receive antibiotics for several weeks." C. "My child can return to playing sports once they have been discharged." D. "My child needs to be in contact isolation." - B. "My child will receive antibiotics for several weeks." Rationale: The nurse should instruct the parent that the child will receive antibiotic therapy for at least 4 weeks. Surgery might be indicated if the antibiotics are not successful.