ATI RN
ATI Pediatric Proctored Exam
1. A toddler is admitted to the surgical unit for a planned closure of a temporary colostomy. Which medical prescription should the nurse question?
- A. Clear liquids today, NPO tomorrow
- B. Type and cross-match for 1 unit of packed red blood cells
- C. Rectal temperatures every 4 hours
- D. Start an intravenous line with D5NS at 20 mL per hour
Correct answer: C
Rationale: The correct answer is C. Rectal temperatures should be avoided in a toddler with a colostomy due to the risk of injury. Choices A, B, and D are appropriate medical prescriptions for a toddler undergoing colostomy closure. Choice A ensures the toddler's intake of clear liquids before being made NPO, choice B prepares for possible blood transfusion needs, and choice D initiates intravenous hydration with D5NS at an appropriate rate.
2. Which question does not provide information regarding the family's cultural values?
- A. Who makes the decisions?
- B. What is the child's date of birth?
- C. What are the daily routines and rules of mealtime?
- D. What do the parents believe about disability?
Correct answer: B
Rationale: The correct answer is B. Asking for the child's date of birth is a factual question that does not directly relate to the family's cultural values. Choices A, C, and D delve into aspects that could offer insights into the family's cultural values and beliefs. Question A explores decision-making dynamics within the family, which can be influenced by cultural norms. Question C inquires about daily routines and mealtime rules, which often reflect cultural practices and values. Question D relates to the parents' beliefs about disability, which can be shaped by cultural, religious, or societal perspectives. Therefore, these questions are more likely to provide information about the family's cultural values compared to the child's date of birth.
3. Following a child's return from exploratory surgery due to a gunshot wound to the abdomen, which nursing intervention should be excluded from the plan of care?
- A. Immediate initiation of oral feedings
- B. Assessment of the surgical site
- C. Administration of opioid narcotics for pain management
- D. Visitation at the bedside
Correct answer: A
Rationale: Immediate initiation of oral feedings should be excluded from the plan of care post-abdominal surgery due to the risk of bowel complications like paralytic ileus or anastomotic leak. Starting oral feedings immediately can increase these risks and hinder healing. It is crucial to wait until bowel function returns and the patient shows signs of tolerance before introducing oral feedings. Assessment of the surgical site is necessary to monitor for any signs of infection or complications. Administration of opioid narcotics for pain management is essential for ensuring the patient's comfort post-surgery. Visitation at the bedside provides emotional support and can aid in the patient's recovery. Therefore, the correct answer is to exclude immediate initiation of oral feedings.
4. When a patient is taking glucocorticoids and digoxin, which electrolyte should the nurse prioritize monitoring?
- A. Calcium
- B. Magnesium
- C. Sodium
- D. Potassium
Correct answer: D
Rationale: The nurse should primarily monitor potassium levels in a patient taking glucocorticoids and digoxin. Glucocorticoids can lead to potassium loss, potentially increasing the risk of digoxin toxicity. Additionally, glucocorticoids may worsen hypokalemia induced by diuretics like thiazides and loops. While calcium, magnesium, and sodium are important electrolytes to monitor in various clinical situations, they are not the priority in this specific scenario of a patient on glucocorticoids and digoxin.
5. The patient taking warfarin for prevention of deep vein thrombosis has an INR of 1.2. Which action by the nurse is most appropriate?
- A. Administer IV push protamine sulfate
- B. Continue with the current prescription.
- C. Prepare to administer Vitamin K
- D. Call healthcare provider to increase the dose
Correct answer: D
Rationale: An INR level of 1.2 is below the therapeutic range (2-3) for warfarin therapy. Therefore, the nurse should contact the healthcare provider to discuss the need for an increased dose to achieve the desired therapeutic range and prevent deep vein thrombosis effectively. Administering IV push protamine sulfate is used to reverse the effects of heparin, not warfarin. Continuing with the current prescription without addressing the subtherapeutic INR level may not effectively prevent deep vein thrombosis. Administering Vitamin K is indicated for warfarin overdose leading to excessive anticoagulation, not for a subtherapeutic INR level that is below the target range.
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