RN ATI MATERNAL NEWBORN PROCTORED EXAM ATI CHILD CARE 1.0

CHILD CARE 1.0 1 A child diagnosed with asthma begins corticosteroid treatments. The nurse explains to the parents that the purpose of corticosteroid treatment is to produce which therapeutic effect? Incorrect: Dilation of the bronchial airways is common in treating asthma. Albuterol is a common medication. Incorrect: Bronchospasms are usually reduced by B-2 agonists and bronchodilators. Incorrect: Infections are treated by antibiotics but not indicated in the treatment of asthma unless lung congestion is noted. Correct: Corticosteroid usage is common for decreasing inflammation of the bronchial airways. Dilation of bronchial airways Decrease bronchospasms Prevention of infection Anti-inflammatory effect 2 Which is the recommended treatment for moderate to severe lead poisoning? Incorrect: IV fluids are typically not used in the treatment of lead poisoning. IV fluids area conservative treatment regimen and are not indicated for treatment of lead poisoning; a more radical therapy is needed to remove the lead from the body. Incorrect: Treatment with antiemetic is not effective in the treatment of lead toxicity because the heavy metal is absorbed into the body. Lead ingestion usually occurs more than one time. Correct: The heavy metal antagonist, edetate calcium disodium, is frequently the drug of choice for the removal of the lead toxin from the body. Chelating agents inactivate the toxicity of the lead and cause excretion through the urine. Others drugs may treat the symptoms of toxicity rather than remove the lead from the body. Untreated lead toxicity can lead to a wide array of neurobehavioral problems include: attention deficit-hyperactivity disorder, reduced cognitive performance, irritability or lethargy, aggressiveness, and hearing impairment. The most serious and irreversible side effect of lead poisoning is encephalopathy, which is associated with lead levels > 100 mg/ dL. Incorrect: Antibiotics have no effect on the removal of the toxin. IV fluids Antiemetics Heavy metal antagonist Antibiotics 3 Which treatment is a nursing priority when providing care for an infant diagnosed with bacterial meningitis? Incorrect: Cardiorespiratory monitoring is standard for care of the child with bacterial meningitis as a means of establishing the baseline parameters for vital signs. The infant with meningitis may have a low baseline heart rate, tachypnea or fever. This however, is not the priority nursing intervention. Incorrect: The initiation of IV fluids for hydration and nutrition is a primary concern for the care of the infant with bacterial meningitis. However, the most important intervention is starting antibiotic therapy. Incorrect: Meningococcal meningitis is the only type of meningitis spread through air-born droplets and therefore, respiratory precautions need to be initiated as soon as possible. Respiratory isolation is important for the control of transmission of the disease after the child receives the first doses of antibiotics. Correct: The first nursing priority is the implementation of antibiotic therapy, which prohibits the microbial damage to the neurologic system through the cerebral spinal fluid. Bacterial meningitis has a high rate of infant morbidity (illness) or mortality (death). Immediate treatment with antibiotics can prevent: death, deafness, reduced cognitive ability, attention deficithyperactive disorder, seizures and various other complications. Initiate cardiorespiratory monitoring. Initiate intravenous fluids. Observe respiratory isolation. Administer antibiotic therapy. 4 The dosage of a pediatric medication is 120mg/kg/day to be give t.i.d. The patient weighs 12 pounds. What is the correct dose for the nurse to administer? Incorrect: The dose of 120 mg is half the indicated dose. The erred dosage represents a failure to divide the total daily dose by the number of individual dosages required per day. The failure to use the weight in the calculation is evident. Incorrect: The dosage of 480 mg is an excessive dose for the child. The calculation error is likely a failure to convert pounds to kilograms. Correct: The patient weighs twelve pounds. This weight converts to kilograms by dividing 12 by 2.2 (1 kg. = 2.2 lb.). In this example, the child's weight converts to 5.4 kg. The daily dose of 120 mg is given t.i.d: each individual dose is 40 mg/kg. Then multiply the weight in kilograms by the individual dose (40mg). The individual dose is 218 mg. Incorrect: The dose of 650 mg is too large of a dose. The weight of the child when converting from pounds to kilograms is 5.45 kg. The dose is ordered to be given t.i.d.. Therefore, the daily dose of 120 mg/kg/day is divided by 3 to yield an individual dose of 40 mg/kg/dose. The error is this dosage was likely a failure to divide the total daily dose by the number of doses required per day. 120 mg 480 mg 218 mg 651 mg 5 In a child diagnosed with Tetralogy of Fallot, which of the following is a compensatory mechanism to decrease venous return to the heart? Correct: Squatting is a compensatory mechanism that decreases venous return (deoxygenated blood) to the heart. The clinical sign is commonly seen in young children with Tetralogy of Fallot (a type of cyanotic heart disease). The signs associated with cyanotic heart disease include hypoxia, poor growth, low tolerance for physical exertion, cardiomegaly, murmur and acute, intermittent blue spells that occur after crying or feeding (tet spells). Incorrect: Clubbing is found in children with chronic respiratory disease and cyanotic heart disease. However, this finding is rare in young children. Incorrect: Shortness of breath, retractions and increased respiratory effort occur with lung dysfunction. Generally, the child with impaired oxygenation due to a cardiac lesion does not exhibit signs of respiratory distress. Incorrect: Polycythemia is common in children with hypoxia due to respiratory or cardiac dysfunction. This compensatory mechanism increases the oxygen-. carrying capacity in the body. The effect is not related to the venous return of unoxygenated blood to the heart. Squatting Clubbing Shortness of breath Polycythemia 6 A 1-year-old receives routine health maintenance care at the pediatric clinic. The child receives an MMR immunization. The mother asks the nurse, "When will my child get the next dose of MMR vaccine?" Which is the correct response by the nurse? Incorrect: The DPT vaccine is routinely given in six months. Incorrect: An additional dose of MMR vaccine is needed in the middle school years to maintain full immunity from the diseases. Incorrect: The first dose of Hepatitis B vaccine (HBV) is given in the hospital prior to discharge home. A follow-up HBV is given in 1-2 months and followed up in 6-12 months following the second does. The schedule does not coordinate with the routine immunization schedule for MMR. Correct: A second MMR, often called a booster, will be needed when the child enters middle school at age eleven or twelve years of age. In six months with the next DPT No further vaccination needed With the Hepatitis B series After the child is 10 years of age 7 Which is a major difference in the clinical manifestation of adolescents with anorexia nervosa compared to bulimia? Incorrect: Binge eating is a common manifestation of both disorders. Incorrect: Purging can be associated with both disorders. Correct: The major difference between adolescents with anorexia nervosa and adolescents with bulimia is body image distortion. Clients with anorexia see themselves as being overweight no matter how underweight they become. Clients with bulimia see their weight realistically but have psychological problems that manifest in an eating disorder. Incorrect: Decreased self-esteem is often a catalyst of both disorders. Binge eating Purging Body image distortion Decreased self esteem 8 Which is the most common factor associated with non-organic failure to thrive? Incorrect: A cool, drafty sleeping area is not a comfortable environment for sleep, but is unrelated as a cause of failure to thrive. Correct: The most significant factor associated with non-organic failure to thrive is typically a disturbance in the mother/child relationship. A situation involving dysfunctional family relationships is often complex; characterized by marital discord, economic pressures, and parental immaturity with a low stress tolerance. Incorrect: Lack of interest in the surroundings is a symptom of failure to thrive but not an etiologic factor. Incorrect: The financial hardship related to the expense of infant formula is not usually a primary cause of non-organic failure to thrive. The Women's Infant and Children program (WIC) provides infant formula at a low or no cost with eligibility. Therefore, the disorder is not likely to be related to obtaining adequate nutrition but instead related to the ability of the infant to consume, digest, and utilize the nutritive source. A cool, drafty area for sleeping Disturbance of mother/child relationship Lack of interest in the surroundings Financial hardship causing poor nutritional care 9 An adolescent recovering from substance abuse is diagnosed with hepatitis B. Which nursing instruction should be included when planning the client's care? Incorrect: During periods of acute hepatitis, the client needs plenty of rest. Correct: The mode of the transmission in hepatitis B is via the parenteral route through blood products, intravenous injection and maternal-fetal trans placental transmission. It is extremely important for the nurse to educate the family about the relationship between intravenous exposure and the transmission of the disease. Incorrect: Fluid intake is not limited in the treatment of hepatitis B. Incorrect: Eating a diet high in fat is contraindicated because of the liver involvement. Increase exercise. Avoid sharing needles. Limit fluid intake. Eat a diet high in fat. 10 Changes in the growth and development of the preschooler are characterized by: Incorrect: Continued rapid physical growth is not common for this developmental level. Incorrect: Major changes in weight, height and head circumference have usually already taken place prior to this developmental level. Correct: Physical growth slows in the preschool years. Preschoolers enjoy social contacts. Preschoolers are gaining control of their muscles and participate in vigorous activities with other children. Incorrect: Improvement in motor ability is rapid at this developmental level as the children are gaining control of their muscles. Preschoolers' gait resembles that of an adult. Rapid physical growth and a persistent curiosity. Major changes in weight, height and head circumference. A slowing of physical growth and expansion of social contacts. A slow improvement in motor ability. 11 A teacher asks the school nurse to assess the behavior of a child with attention deficit-hyperactivity disorder (ADHD). Which situation best facilitates an effective nurse/child interaction? Incorrect: Playground time for the discussion is desirable because the child would not miss classroom instruction. However, recess is an appropriate time for the child to expel energy.The playground offers many opportunities for distraction and the child may have difficulty concentrating on the discussion in this environment. Incorrect: A discussion between the nurse and student in the classroom would be brief and impersonal due to the presence of other students. At the end of the day, this environment is noisy, chaotic and rushed and may be one of the least desirable locations for a meaningful dialogue between the nurse and student. The child will most likely be distracted. Correct: A characteristic of attention deficit-hyperactivity disorder is distractibility and impulsivity. A quiet and calm environment is necessary to engage the child in focused discussion. Incorrect: Although a physical education class provides the structured environment for the release of energy in an appropriate manner, this is not a place for the nurse to provide education to the child with ADHD. This setting also lacks the privacy necessary for a confidential exchange of information. Playground during recess In the classroom at the end of the day Nurse's office before school Physical education class 12 The health care provider orders 60% oxygen to be administered with a partial rebreather mask and bag reservoir. Which error regarding the oxygen delivery system requires correction? Incorrect: Moisture collecting in the mask is the result of humidification of the air. Oxygen can be very drying to the tissue and alveoli; damage can result to the airways without humidification. Incorrect: To optimize the delivery of oxygen via mask, a snug head strap is necessary. Incorrect: The mask covering the nose and mouth is a correct application of the mask. Correct: The reservoir bag on the non-rebreather mask should remain partially filled during inspiration to provide positive end expiratory pressure (PEEP). If the bag collapses the equipment may be faulty. Moisture collects inside the mask The strap around the head is snug The mask covers the nose and mouth The reservoir bag collapses during inspiration 13 A toddler is admitted to the hospital for treatment of acute gastroenteritis and dehydration. The mother states that she must go home to make arrangements for the care of her other children. To reduce the child's separation anxiety, which nursing intervention is most appropriate? Incorrect: Placing the child in the crib may make the child feel more alone and afraid. At this developmental stage, the child is not likely to be comfortable enough with the surroundings to adjust and begin to play. Correct: Anxiety is the child's predominant emotion with the separation from a parent. Activities that calm and comfort the child are appropriate. Often a toddler will fall asleep in the nurse's arms due to the stress of a parent's leaving the child alone in the hospital. Incorrect: The video may serve as a distraction, but does not provide the security of human contact. Incorrect: The nurse's station may allow an opportunity for social contact. Many toddlers may be overwhelmed or frightened by the activity at this central location. Place the child in the crib with toys. Rock the child in a rocking chair. Turn on an age-appropriate video. Take the child to the nurse's station. 14 Which technique is most appropriate when assessing the circulation of a child's leg in traction? Incorrect: The movement of the toes is a neurological assessment and does not relate to circulation. Correct: The best way to assess circulation is to palpate the dorsalis pedal pulse located on the top of the foot. If a peripheral pulse is not palpable, a Doppler may be necessary to ascertain loss of circulation and pulse. Incorrect: Assessing pain sensation in the lower extremities is a neurological assessment and does not relate to circulation. Incorrect: Range of motion to the affected area is usually contraindicated while in traction. Determine if the child can wiggle the toes. Palpate the dorsalis pedis artery. Assess for pain sensation in the lower extremity. Perform range of motion in the lower extremity. 15 Initially, which solid food is generally recommended for an infant's diet? Correct: Rice cereal is bland, easily digested and fortified with iron. Rice cereal is the first food introduced into the diet at approximately six months. Incorrect: Strained vegetables are introduced after the infant tolerates rice cereal. The order that various foods are initiated is controversial and dependent on regional, generational, cultural and personal factors. Incorrect: Strained fruits are introduced generally after the infant tolerates strained vegetables. Incorrect: Meats are introduced between 8-10 months of age. Infant meats are generally denser in texture and less preferred by many infants. The coordination of the muscles of the tongue and pharynx must be more developed for the introduction of solid meat. Infant rice cereal Strained vegetables Strained fruits Infant meats