ATI RN
Nursing Care of Children Final ATI
1. A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this?
- A. The parent is trying to feed the child only what the child likes most
- B. Hispanics believe the evil eye enters when a person gets cold
- C. The parent is trying to restore normal balance through appropriate hot remedies
- D. Hispanics believe an innate energy called chi is strengthened by eating soup
Correct answer: C
Rationale: In Hispanic culture, the balance between hot and cold is important, and the parent may be giving the child broth to restore this balance while avoiding "cold" foods.
2. A healthcare professional is preparing to administer Pamidronate to a client who has bone pain related to cancer. Which of the following precautions should the healthcare professional take when administering pamidronate?
- A. Inspect the IV site for redness and irritation when changing the intravenous patch.
- B. Assess the IV site for thrombophlebitis frequently during administration.
- C. Instruct the client to sit upright or stand for 30 min following intravenous administration.
- D. Watch for manifestations of anaphylaxis for 20 min after intramuscular administration.
Correct answer: B
Rationale: Pamidronate is administered through intravenous (IV) infusion. As this medication can be irritating to veins, the healthcare professional should carefully assess the IV site for thrombophlebitis during administration to prevent potential complications. Choice A is incorrect as Pamidronate is not administered via intradermal patch. Choice C is incorrect as it does not relate to the administration of Pamidronate. Choice D is incorrect as Pamidronate is not administered intramuscularly.
3. What is the most appropriate intervention for a client experiencing acute alcohol withdrawal?
- A. Encourage physical activity to reduce withdrawal symptoms
- B. Administer diazepam to prevent seizures
- C. Monitor for signs of dehydration
- D. Encourage the client to verbalize their feelings
Correct answer: B
Rationale: The most appropriate intervention for a client experiencing acute alcohol withdrawal is to administer diazepam. Diazepam is a benzodiazepine commonly used to prevent seizures and manage the symptoms of alcohol withdrawal. Encouraging physical activity may not be safe during acute withdrawal as the client may be at risk for seizures and other complications. Monitoring for signs of dehydration is important but not the most immediate intervention needed in acute alcohol withdrawal. While encouraging the client to verbalize their feelings is beneficial for therapeutic communication, it is not the priority intervention when managing acute alcohol withdrawal.
4. A client with a history of seizures is admitted for monitoring. What should the nurse prioritize?
- A. Ensure the client is on seizure precautions.
- B. Educate the client about seizure triggers.
- C. Monitor for signs of an impending seizure.
- D. Initiate IV access for anti-seizure medication.
Correct answer: A
Rationale: The correct answer is to ensure the client is on seizure precautions. This is crucial in preventing injury during a seizure episode. While educating the client about seizure triggers (choice B) is important for long-term management, it is not the priority when the client is admitted for monitoring. Monitoring for signs of an impending seizure (choice C) is essential but does not address immediate safety concerns. Initiating IV access for anti-seizure medication (choice D) is not the priority unless a seizure occurs and medical intervention is needed.
5. What is the most effective way to limit the number of microorganisms in the hospital?
- A. Using strict aseptic technique in all procedures
- B. Wearing a mask and gown when caring for all patients with communicable diseases
- C. Sterilizing all instruments
- D. Handwashing
Correct answer: A
Rationale: The most effective way to limit the number of microorganisms in the hospital is by using strict aseptic technique in all procedures. This approach ensures that the risk of introducing harmful microorganisms into the hospital environment or patients is minimized. Choice B, wearing a mask and gown when caring for patients with communicable diseases, is important but not as comprehensive as using aseptic technique in all procedures. Sterilizing all instruments (Choice C) is crucial for preventing infections but may not address all avenues of microorganism transmission. Handwashing (Choice D) is a fundamental practice in infection control but alone may not be as effective as utilizing aseptic techniques in all procedures to limit microorganisms in the hospital.
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