ATI Peds Practice A
1. A nurse is assessing the vital signs of a 10-year-old child following a burninjury. The
nurse should identify that which of the following findings is an indication of early septic
shock?: Temperature 39.1° C (102.4° F)
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.
2. A nurse is caring for an infant who has respiratory syncytial virus (RSV).Which of the
following actions should the nurse implement for infection control?: Have a designated
stethoscope in the infant's room.
The nurse should initiate droplet precautions for an infant who has RSV because thevirus 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.
3. A nurse is caring for a 15-year-old client following a head injury. Which of the following
findings should the nurse identify as an indication that the
child is developing syndrome of inappropriate antidiuretic hormone secretion(SIADH)?:
Mental confusion
A child who has a head injury can develop SIADH as a result of altered pitu- itary function,
leading to an oversecretion of antidiuretic hormone. Oversecretionof antidiuretic hormone
leads to a decrease in urine output, hyponatremia, and
hypoosmolality due to overhydration. As the hyponatremia becomes more severe,mental
confusion and other neurologic manifestations such as seizures can occur.
4. A nurse in a provider's office is preparing to administer immunizations toa toddler during
a well-child visit. Which of the following actions should the nurse plan to take? (Click on the
"Exhibit" button for additional information about the client. There are three tabs that contain
separate categories of data.): Withhold the measles, mumps, and rubella (MMR) vaccine.
The nurse should recognize that an allergy to neomycin with an anaphylactic reaction is a
contraindication for receiving the MMR vaccine. Clients who have asevere allergy to eggs or
gelatin should not receive this vaccine.
5. A nurse is teaching the guardian of a 6-month-old infant about car seat use.Which of the
following statements by the guardian indicates an understanding
, of the teaching?: "I should secure the car seat using lower anchors and tethersinstead of the
seat belt."
Lower anchors and tethers, or the LATCH child safety seat system, should be used to secure an
infant's car seat in the vehicle. This system provides anchors between the front cushion and the
back rest for the car seat. Therefore, if this system is available, the seat belt does not have to be
used.
6. A nurse is providing teaching to the parent of an infant who has diaper dermatitis.The
nurse should instruct the parent to apply which of the followingto the affected area?: Zinc oxide
Diaper dermatitis is a common inflammatory skin disorder caused by contact with an irritant such
as urine, feces, soap, or friction, and takes the form of scaling, blisters, or papules with
erythema. Providing a protective barrier, such as zinc oxide, against the irritants allows the skin
to heal.
7. A nurse is reviewing the lumbar puncture results of a school-age child whois suspected of
having bacterial meningitis. Which of the following findings should the nurse identify as an
indication of bacterial meningitis?: Increasedprotein concentration
The nurse should identify that an increased protein concentration in the spinal fluidis a finding
that can indicate bacterial meningitis.
8. A nurse is interviewing the parent of an 18-month-old toddler during a well-child visit.
The nurse should identify that which of the following findingsindicates a need to assess the
toddler for hearing loss?: The toddler receivedtobramycin during a hospitalization 2 weeks
ago.
The nurse should identify tobramycin as an aminoglycoside, which is an ototoxic medication
that can cause mild to moderate hearing loss, and should assess the toddler for a hearing
impairment.
9. A nurse is caring for a school-age child who has experienced a tonic-clonicseizure. Which of
the following actions should the nurse take during the immediate postictal period?: Place the
child in a side-lying position.
The nurse should place the child in a side-lying position to prevent aspiration.
10. A nurse in an emergency department is caring for a toddler who has partial-thickness
burns on their right arm. Which of the following actionsshould the nurse take?: Cleanse the
affected area with mild soap and water.
1. A nurse is assessing the vital signs of a 10-year-old child following a burninjury. The
nurse should identify that which of the following findings is an indication of early septic
shock?: Temperature 39.1° C (102.4° F)
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.
2. A nurse is caring for an infant who has respiratory syncytial virus (RSV).Which of the
following actions should the nurse implement for infection control?: Have a designated
stethoscope in the infant's room.
The nurse should initiate droplet precautions for an infant who has RSV because thevirus 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.
3. A nurse is caring for a 15-year-old client following a head injury. Which of the following
findings should the nurse identify as an indication that the
child is developing syndrome of inappropriate antidiuretic hormone secretion(SIADH)?:
Mental confusion
A child who has a head injury can develop SIADH as a result of altered pitu- itary function,
leading to an oversecretion of antidiuretic hormone. Oversecretionof antidiuretic hormone
leads to a decrease in urine output, hyponatremia, and
hypoosmolality due to overhydration. As the hyponatremia becomes more severe,mental
confusion and other neurologic manifestations such as seizures can occur.
4. A nurse in a provider's office is preparing to administer immunizations toa toddler during
a well-child visit. Which of the following actions should the nurse plan to take? (Click on the
"Exhibit" button for additional information about the client. There are three tabs that contain
separate categories of data.): Withhold the measles, mumps, and rubella (MMR) vaccine.
The nurse should recognize that an allergy to neomycin with an anaphylactic reaction is a
contraindication for receiving the MMR vaccine. Clients who have asevere allergy to eggs or
gelatin should not receive this vaccine.
5. A nurse is teaching the guardian of a 6-month-old infant about car seat use.Which of the
following statements by the guardian indicates an understanding
, of the teaching?: "I should secure the car seat using lower anchors and tethersinstead of the
seat belt."
Lower anchors and tethers, or the LATCH child safety seat system, should be used to secure an
infant's car seat in the vehicle. This system provides anchors between the front cushion and the
back rest for the car seat. Therefore, if this system is available, the seat belt does not have to be
used.
6. A nurse is providing teaching to the parent of an infant who has diaper dermatitis.The
nurse should instruct the parent to apply which of the followingto the affected area?: Zinc oxide
Diaper dermatitis is a common inflammatory skin disorder caused by contact with an irritant such
as urine, feces, soap, or friction, and takes the form of scaling, blisters, or papules with
erythema. Providing a protective barrier, such as zinc oxide, against the irritants allows the skin
to heal.
7. A nurse is reviewing the lumbar puncture results of a school-age child whois suspected of
having bacterial meningitis. Which of the following findings should the nurse identify as an
indication of bacterial meningitis?: Increasedprotein concentration
The nurse should identify that an increased protein concentration in the spinal fluidis a finding
that can indicate bacterial meningitis.
8. A nurse is interviewing the parent of an 18-month-old toddler during a well-child visit.
The nurse should identify that which of the following findingsindicates a need to assess the
toddler for hearing loss?: The toddler receivedtobramycin during a hospitalization 2 weeks
ago.
The nurse should identify tobramycin as an aminoglycoside, which is an ototoxic medication
that can cause mild to moderate hearing loss, and should assess the toddler for a hearing
impairment.
9. A nurse is caring for a school-age child who has experienced a tonic-clonicseizure. Which of
the following actions should the nurse take during the immediate postictal period?: Place the
child in a side-lying position.
The nurse should place the child in a side-lying position to prevent aspiration.
10. A nurse in an emergency department is caring for a toddler who has partial-thickness
burns on their right arm. Which of the following actionsshould the nurse take?: Cleanse the
affected area with mild soap and water.
