ATI RN
RN Nursing Care of Children Online Practice 2019 A
1. A four-year-old boy is admitted to the hospital with leg pain and fever. He is pale-looking and has bruises over various areas of his body. The physician suspects acute lymphoblastic leukemia (ALL). Which test would be used to confirm the diagnosis?
- A. Bone marrow aspirate
- B. Red blood cell count
- C. Lumbar puncture
- D. Bone scan
Correct answer: A
Rationale: A bone marrow aspirate is the definitive test to confirm acute lymphoblastic leukemia (ALL) in this case. It allows for the examination of leukemic cells in the bone marrow, providing a direct assessment of the disease. Red blood cell count (Choice B) is not specific for diagnosing leukemia but may show anemia commonly seen in leukemia patients. Lumbar puncture (Choice C) is used to assess central nervous system involvement, not primarily for confirming ALL. Bone scan (Choice D) is not a standard diagnostic test for ALL and is mainly used for evaluating bone metastases in other conditions.
2. The nurse in the intensive care unit receives arterial blood gases (ABG) with a patient who is complaining of being 'short of breath.' The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mmol/L. The labs reflect:
- A. Respiratory acidosis
- B. Metabolic alkalosis
- C. Respiratory alkalosis
- D. Metabolic acidosis
Correct answer: A
Rationale: The ABG values indicate respiratory acidosis. A pH below 7.40, a PaCO2 above 40 mm Hg, and a normal HCO3 level (24 mmol/L) suggest respiratory acidosis. In this case, the patient has an acidic pH (7.21) and an elevated PaCO2 (64 mm Hg), indicating inadequate ventilation. The normal HCO3 level suggests that compensation by the kidneys has not occurred, implying an acute event. Choices B, C, and D can be ruled out based on the given ABG values and the criteria for acid-base disorders.
3. Which question should the healthcare provider ask when assessing the client for an endocrine dysfunction?
- A. “Have you noticed any pain in your legs when walking?”
- B. “Have you had any unexplained weight loss?”
- C. “Have you noticed any change in your bowel movements?”
- D. “Have you experienced any joint pain or discomfort?”
Correct answer: B
Rationale: The correct answer is B: “Have you had any unexplained weight loss?” Unexplained weight loss can be a significant symptom of various endocrine disorders, such as hyperthyroidism and diabetes. Weight changes are often closely linked to endocrine dysfunction due to the hormonal imbalances affecting metabolism. Choices A, C, and D are less specific to endocrine dysfunction. Pain in the legs, changes in bowel movements, and joint pain or discomfort are symptoms that can be related to various health conditions but are not as indicative of endocrine disorders as unexplained weight loss.
4. A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a client having problems in her hand/wrist. In order to test Tinel sign, the nurse should give the client which direction?
- A. Stand tall, arms at your side, shut your eyes; place the tip of your index finger to your nose.
- B. Hold your wrist in complete flexion, keep it in this position for 60 seconds. How does your hand feel after placing it in a neutral position?
- C. I'm going to tap (percuss) over the median nerve in your wrist; tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else?
- D. I'm going to tap this tuning fork; place it on the side of your thumb, then tell me what you are feeling in your hand and wrist.
Correct answer: C
Rationale: The correct answer is C. The Tinel sign involves percussing over the median nerve in the wrist to test for carpal tunnel syndrome. Choice A is incorrect as it describes a different action unrelated to the Tinel sign. Choice B is also incorrect as it involves holding the wrist in flexion, which is not part of the Tinel sign assessment. Choice D is incorrect as it mentions using a tuning fork on the thumb, which is not the correct technique for assessing the Tinel sign.
5. Which food should the nurse recommend for a client deficient in vitamin A?
- A. Orange slices
- B. Steamed carrots
- C. Apple sauce
- D. Baked potato
Correct answer: B
Rationale: The correct answer is B, steamed carrots, as they are high in vitamin A. Carrots are rich in beta-carotene, a precursor to vitamin A, which is essential for good vision, a healthy immune system, and cell growth. Oranges (choice A) are a good source of vitamin C but not vitamin A. Apple sauce (choice C) and baked potato (choice D) do not provide significant amounts of vitamin A compared to steamed carrots, making them less suitable recommendations for a client deficient in this specific nutrient.