ATI RN
RN Pediatric Nursing 2023 ATI
1. A healthcare professional is planning care for an infant who has a colostomy. Which of the following actions should the healthcare professional take?
- A. Change the ostomy pouch every day.
- B. Use baby wipes to clean the stoma.
- C. Avoid using soap to clean the stoma.
- D. Apply barrier ointment to the skin around the stoma.
Correct answer: D
Rationale: When caring for an infant with a colostomy, it is essential to apply barrier ointment to the skin around the stoma. This helps in preventing skin breakdown and irritation caused by exposure to stool or urine. Changing the ostomy pouch as needed, using appropriate cleaning supplies such as warm water and mild soap (avoiding harsh chemicals like alcohol), and ensuring gentle cleaning of the stoma with a soft cloth or gauze are also important steps in colostomy care. Using baby wipes may not be recommended as they can contain chemicals that may irritate the sensitive skin around the stoma.
2. A client with generalized anxiety disorder (GAD) is being discharged. Which of the following instructions should the nurse include in the discharge teaching? Select one that does not apply.
- A. Practice relaxation techniques daily
- B. Avoid caffeine and alcohol
- C. Engage in regular physical activity
- D. Use benzodiazepines as the first line of treatment
Correct answer: D
Rationale: When discharging a client with GAD, it is important to provide instructions that promote holistic well-being and support without exacerbating the condition. Practicing relaxation techniques daily, avoiding caffeine and alcohol, and engaging in regular physical activity can help manage anxiety symptoms effectively. These strategies focus on self-care and healthy lifestyle choices. Seeking support from friends and family also plays a crucial role in maintaining mental health. However, using benzodiazepines as the first line of treatment is not recommended due to their potential for dependence and other associated risks. Non-pharmacological interventions and therapy are usually preferred as initial approaches in managing GAD. Therefore, the option 'D: Use benzodiazepines as the first line of treatment' is incorrect and should not be included in the discharge teaching for a client with GAD.
3. A nurse is assessing a client who is receiving digoxin for heart failure. Which of the following findings should the nurse report to the provider?
- A. Heart rate 68/min.
- B. Blood pressure 110/70 mm Hg.
- C. Vision changes.
- D. Respiratory rate 18/min.
Correct answer: C
Rationale: Corrected Rationale: Vision changes are a common sign of digoxin toxicity, which can be serious and should be reported to the provider immediately. Changes in heart rate, blood pressure, or respiratory rate are not typically associated with digoxin toxicity. Therefore, the nurse should prioritize reporting vision changes to ensure prompt assessment and intervention.
4. A nurse is discussing sources of vitamin K with a client. Which food should the nurse recommend?
- A. Fish
- B. Leafy greens
- C. Citrus fruits
- D. Nuts
Correct answer: B
Rationale: Leafy greens are rich in vitamin K, which is important for blood clotting.
5. The nurse is preparing a discharge teaching plan for the client who had an umbilical hernia repair. Which of the following would the nurse include in the plan?
- A. Restricting pain medication
- B. Maintaining bedrest
- C. Avoiding coughing
- D. Irrigating the drain
Correct answer: C
Rationale: Bedrest is not required following this surgical procedure. The client should take analgesics as needed and as prescribed to control pain. A drain is not used in this surgical procedure, although the client may be instructed in simple dressing changes. Coughing is avoided to prevent disruption of the tissue integrity, which can occur because of the location of this surgical procedure.
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