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ATI PN PEDIATRICS PROCTORED EXAM 4
NEWEST VERSIONS| WITH ACTUAL
CORRECT QUESTIONS AND VERIFIED
DETAILED RATIONALES ANSWERS|
2024(NEWEST) ALREADY GRADED A+
PKU will causes _______ ______if left untreated
Mental Retardation
rationale: Phenylketonuria (PKU) is a recessive hereditary defect of metabolism that, if untreated,
causes severe mental retardation. It is not related to congenital heart defects, increased intracranial
pressure, or to a strangulated intestine.
In working with the child or family of a child with a congenital disorder, the most effective nursing
intervention for this child or family would be for the nurse to
Use reflective listening and offer nonjudgmental support
rationale: Families are naturally apprehensive and find it difficult not to overprotect a child who is ill.
They often increase the child's anxiety and cause fear in the child about participating in normal
activities. Children are rather sensible about finding their own limitations and usually limit their
activities to their capacity if they are not made unduly apprehensive. Some families can adjust well
and provide guidance and security for the sick child. Others may become confused and frightened and
show hostility, disinterest, or neglect; these families need guidance and counseling. The nurse has a
great responsibility to support the family. The nurse's primary goal is to reduce anxiety in the child
and family. This goal may be accomplished through open communication and ongoing contact.
Following birth the newborn's independent circulatory system is established. If there is an abnormal
opening between the chambers in the heart, which of the following cardiac defects may occur?
Ventricular septal defect
Explanation:
A ventricular septal defect is the most common intracardiac defect. It consists of an abnormal opening
in the septum between the two ventricles.
One of the clinical manifestations seen in the child with hydrocephalus is which of the following?
An extremely large and rapidly growing head
An excessively large head at birth is suggestive of hydrocephalus. Rapid head growth with widening
cranial sutures is also strongly suggestive and may be the first manifestation of this condition
,2|Page
The nurse is caring for a newborn of a substance abusing mother who is withdrawing from alcohol.
Which of the following would the nurse likely see in this newborn?
Newborn is hyperactive and irritable
The newborn that is withdrawing from alcohol typically is hyperactive, irritable, has trouble sleeping,
and may have tremors or seizures. Characteristics of FAS include low birth weight, and small height
and head circumference. This newborn is prone to respiratory difficulties, hypoglycemia,
hypocalcemia, and hyperbilirubinemia.
A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae
of the vertebrae have failed to close. The nurse knows that this infant is suffering from which of the
following disorders?
Spina bifida
rationale: Spina bifida is a failure of the posterior laminae of the vertebrae to close, leaving an
opening through which the spinal meninges and spinal cord may protrude. Hydrocephalus is a
condition characterized by excess cerebrospinal fluid (CSF) within the ventricular and subarachnoid
spaces of the cranial cavity. Cleft palate is a result of failure of the primary and secondary palates to
fuse. Esophageal atresia is the absence of a normal opening or abnormal closure of the esophagus.
You care for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have
caused you to suspect this might be present?
Hydramnios
Rationale: Because a fetus swallows amniotic fluid, when there is an obstruction of the esophagus,
amniotic fluid accumulates, leading to hydramnios.
Four weeks before the birth of her already large child, the physician has told the pregnant woman that if
the baby gets bigger and his lungs are ready, the physician would like to perform a cesarean to deliver
the baby. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal
delivery. What is an appropriate response by the nurse?
"As the baby passes through the birth canal some of the excess fluid is expelled from the lungs, if that
doesn't happen there's a higher risk of respiratory distress."
Rationale: Transient tachypnea of the newborn (TTN) involves the development of mild respiratory
distress in a newborn. TTN results from a delay in absorption of fetal lung fluid after birth. As the fetus
passes through the birth canal during delivery, some of the fluid is expelled as the thoracic area is
compressed. TTN is commonly seen in newborns born by cesarean delivery. It typically occurs after
birth with the greatest degree of distress occurring approximately 36 hours after birth. TTN commonly
disappears spontaneously around the third day
A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive
drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and
cyanosis. What disorder should the nurse suspect based on these findings?
,3|Page
esophageal atresia
Rationale: Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn
suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling,
and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be
given until the newborn has been examined.
An infant with hydrocephalus is scheduled to have a ventriculoperitoneal shunt inserted. Immediately
following the procedure, which nursing action would best prevent decompression from excessive CSF
flow?
Keeping the head of the infant level with the body
Rationale: Keeping the infant's head fairly even with the rest of the body prevents gravity from
moving more fluid into the shunt than necessary
The nurse who is caring for newborn Andrew notices that although he has seemed healthy at 18 hours
of age, Andrew's abdomen is now distended. By 24 hours he has passed no stool. The nurse will
Inform the physician of the findings
In some newborns, a shallow opening may occur in the anus with the rectum ending in a blind pouch
some distance higher. Thus, being able to pass a thermometer into the rectum does not guarantee
that the rectoanal canal is normal. More reliable presumptive evidence is obtained by watching
carefully for the first meconium stool. Abdominal distention also occurs. If the newborn does not pass
a stool within the first 24 hours, the physician should be notified. Definitive diagnosis is made by
radiographic studies. In some newborns, a colostomy is performed and extensive abdominoperineal
resection is delayed until 3-5 months of age or later.
A pre-term newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and
increased head circumference. These signs indicate the newborn most likely has which of the following
complications?
intraventricular hemorrhage (IVH)
Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full (or bulging) fontanelle,
cyanosis, and increased head circumference.
A newborn is diagnosed with congenital hypothyroidism prior to discharge from the hospital. What
medication does the nurse anticipate administering to the newborn?
Levothyroxine
rationale: The thyroid hormone must be replaced as soon as the diagnosis is made. Levothyroxine
sodium, a synthetic thyroid hormone replacement, is the drug most commonly used.
Over the course of an eight hour shift of postoperative care for a child who has had ventriculoatrial
shunt placement, the nurse notes that the child's cry has become increasingly shrill and the child has
, 4|Page
projectile vomiting. The nurse would notify the physician immediately because of the possibility that the
child might be experiencing
increased intracranial pressure
Symptoms of increased intracranial pressure (IICP) may include irritability, restlessness, personality
change, high-pitched cry, ataxia, projectile vomiting, failure to thrive, seizures, severe headache,
changes in level of consciousness, and papilledema.
At least every 2-4 hours, the nurse should monitor the newborn's level of consciousness, check the
pupils for equality and reaction, monitor the neurologic status, and observe for a shrill cry, lethargy,
or irritability.
When examining a newborn for developmental hip dysplasia, which of the following motions would the
newborn's hip be unable to accomplish?
abduction
rationale:
Infants with shallow acetabulums are unable to abduct their hips.
It would be best to place an infant with a myelomeningocele in which position prior to surgery?
on the stomach (prone)
Placing the infant prone prevents direct trauma to the lesion and reduces the chance that feces will
contaminate the lesion.
The nurse is caring for a newborn with retinopathy of prematurity (ROP). Which of the following is the
best explanation of this disorder?
The infant has a degenerative disease of the retina
Retinopathy of prematurity (ROP) is a form of retinopathy (degenerative disease of the retina)
commonly associated with the preterm newborn. The immature liver in the preterm infant cannot
manage all the bilirubin produced by hemolysis (destruction of red blood cells with the release of
hemoglobin), making the infant prone to jaundice and high blood bilirubin levels. Intraventricular
hemorrhage (IVH) is a complication of preterm birth in which there is bleeding into the brain's
ventricles. In hyaline membrane disease, the premature infant's lungs are deficient in surfactant and
thus collapse after each breath, greatly increasing the work of breathing.
When planning preoperative care for a newborn with a cleft lip and palate, a major need for which you
would plan interventions is
Nutrition
An infant with a cleft lip is unable to suck effectively, so obtaining adequate nutrition is a major
concern.
ATI PN PEDIATRICS PROCTORED EXAM 4
NEWEST VERSIONS| WITH ACTUAL
CORRECT QUESTIONS AND VERIFIED
DETAILED RATIONALES ANSWERS|
2024(NEWEST) ALREADY GRADED A+
PKU will causes _______ ______if left untreated
Mental Retardation
rationale: Phenylketonuria (PKU) is a recessive hereditary defect of metabolism that, if untreated,
causes severe mental retardation. It is not related to congenital heart defects, increased intracranial
pressure, or to a strangulated intestine.
In working with the child or family of a child with a congenital disorder, the most effective nursing
intervention for this child or family would be for the nurse to
Use reflective listening and offer nonjudgmental support
rationale: Families are naturally apprehensive and find it difficult not to overprotect a child who is ill.
They often increase the child's anxiety and cause fear in the child about participating in normal
activities. Children are rather sensible about finding their own limitations and usually limit their
activities to their capacity if they are not made unduly apprehensive. Some families can adjust well
and provide guidance and security for the sick child. Others may become confused and frightened and
show hostility, disinterest, or neglect; these families need guidance and counseling. The nurse has a
great responsibility to support the family. The nurse's primary goal is to reduce anxiety in the child
and family. This goal may be accomplished through open communication and ongoing contact.
Following birth the newborn's independent circulatory system is established. If there is an abnormal
opening between the chambers in the heart, which of the following cardiac defects may occur?
Ventricular septal defect
Explanation:
A ventricular septal defect is the most common intracardiac defect. It consists of an abnormal opening
in the septum between the two ventricles.
One of the clinical manifestations seen in the child with hydrocephalus is which of the following?
An extremely large and rapidly growing head
An excessively large head at birth is suggestive of hydrocephalus. Rapid head growth with widening
cranial sutures is also strongly suggestive and may be the first manifestation of this condition
,2|Page
The nurse is caring for a newborn of a substance abusing mother who is withdrawing from alcohol.
Which of the following would the nurse likely see in this newborn?
Newborn is hyperactive and irritable
The newborn that is withdrawing from alcohol typically is hyperactive, irritable, has trouble sleeping,
and may have tremors or seizures. Characteristics of FAS include low birth weight, and small height
and head circumference. This newborn is prone to respiratory difficulties, hypoglycemia,
hypocalcemia, and hyperbilirubinemia.
A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae
of the vertebrae have failed to close. The nurse knows that this infant is suffering from which of the
following disorders?
Spina bifida
rationale: Spina bifida is a failure of the posterior laminae of the vertebrae to close, leaving an
opening through which the spinal meninges and spinal cord may protrude. Hydrocephalus is a
condition characterized by excess cerebrospinal fluid (CSF) within the ventricular and subarachnoid
spaces of the cranial cavity. Cleft palate is a result of failure of the primary and secondary palates to
fuse. Esophageal atresia is the absence of a normal opening or abnormal closure of the esophagus.
You care for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have
caused you to suspect this might be present?
Hydramnios
Rationale: Because a fetus swallows amniotic fluid, when there is an obstruction of the esophagus,
amniotic fluid accumulates, leading to hydramnios.
Four weeks before the birth of her already large child, the physician has told the pregnant woman that if
the baby gets bigger and his lungs are ready, the physician would like to perform a cesarean to deliver
the baby. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal
delivery. What is an appropriate response by the nurse?
"As the baby passes through the birth canal some of the excess fluid is expelled from the lungs, if that
doesn't happen there's a higher risk of respiratory distress."
Rationale: Transient tachypnea of the newborn (TTN) involves the development of mild respiratory
distress in a newborn. TTN results from a delay in absorption of fetal lung fluid after birth. As the fetus
passes through the birth canal during delivery, some of the fluid is expelled as the thoracic area is
compressed. TTN is commonly seen in newborns born by cesarean delivery. It typically occurs after
birth with the greatest degree of distress occurring approximately 36 hours after birth. TTN commonly
disappears spontaneously around the third day
A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive
drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and
cyanosis. What disorder should the nurse suspect based on these findings?
,3|Page
esophageal atresia
Rationale: Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn
suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling,
and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be
given until the newborn has been examined.
An infant with hydrocephalus is scheduled to have a ventriculoperitoneal shunt inserted. Immediately
following the procedure, which nursing action would best prevent decompression from excessive CSF
flow?
Keeping the head of the infant level with the body
Rationale: Keeping the infant's head fairly even with the rest of the body prevents gravity from
moving more fluid into the shunt than necessary
The nurse who is caring for newborn Andrew notices that although he has seemed healthy at 18 hours
of age, Andrew's abdomen is now distended. By 24 hours he has passed no stool. The nurse will
Inform the physician of the findings
In some newborns, a shallow opening may occur in the anus with the rectum ending in a blind pouch
some distance higher. Thus, being able to pass a thermometer into the rectum does not guarantee
that the rectoanal canal is normal. More reliable presumptive evidence is obtained by watching
carefully for the first meconium stool. Abdominal distention also occurs. If the newborn does not pass
a stool within the first 24 hours, the physician should be notified. Definitive diagnosis is made by
radiographic studies. In some newborns, a colostomy is performed and extensive abdominoperineal
resection is delayed until 3-5 months of age or later.
A pre-term newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and
increased head circumference. These signs indicate the newborn most likely has which of the following
complications?
intraventricular hemorrhage (IVH)
Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full (or bulging) fontanelle,
cyanosis, and increased head circumference.
A newborn is diagnosed with congenital hypothyroidism prior to discharge from the hospital. What
medication does the nurse anticipate administering to the newborn?
Levothyroxine
rationale: The thyroid hormone must be replaced as soon as the diagnosis is made. Levothyroxine
sodium, a synthetic thyroid hormone replacement, is the drug most commonly used.
Over the course of an eight hour shift of postoperative care for a child who has had ventriculoatrial
shunt placement, the nurse notes that the child's cry has become increasingly shrill and the child has
, 4|Page
projectile vomiting. The nurse would notify the physician immediately because of the possibility that the
child might be experiencing
increased intracranial pressure
Symptoms of increased intracranial pressure (IICP) may include irritability, restlessness, personality
change, high-pitched cry, ataxia, projectile vomiting, failure to thrive, seizures, severe headache,
changes in level of consciousness, and papilledema.
At least every 2-4 hours, the nurse should monitor the newborn's level of consciousness, check the
pupils for equality and reaction, monitor the neurologic status, and observe for a shrill cry, lethargy,
or irritability.
When examining a newborn for developmental hip dysplasia, which of the following motions would the
newborn's hip be unable to accomplish?
abduction
rationale:
Infants with shallow acetabulums are unable to abduct their hips.
It would be best to place an infant with a myelomeningocele in which position prior to surgery?
on the stomach (prone)
Placing the infant prone prevents direct trauma to the lesion and reduces the chance that feces will
contaminate the lesion.
The nurse is caring for a newborn with retinopathy of prematurity (ROP). Which of the following is the
best explanation of this disorder?
The infant has a degenerative disease of the retina
Retinopathy of prematurity (ROP) is a form of retinopathy (degenerative disease of the retina)
commonly associated with the preterm newborn. The immature liver in the preterm infant cannot
manage all the bilirubin produced by hemolysis (destruction of red blood cells with the release of
hemoglobin), making the infant prone to jaundice and high blood bilirubin levels. Intraventricular
hemorrhage (IVH) is a complication of preterm birth in which there is bleeding into the brain's
ventricles. In hyaline membrane disease, the premature infant's lungs are deficient in surfactant and
thus collapse after each breath, greatly increasing the work of breathing.
When planning preoperative care for a newborn with a cleft lip and palate, a major need for which you
would plan interventions is
Nutrition
An infant with a cleft lip is unable to suck effectively, so obtaining adequate nutrition is a major
concern.
