ATI RN
ATI Pediatric Proctored Exam 2023
1. A pediatric client is admitted to the emergency department with a traumatic brain injury (TBI) that caused a loss of consciousness. The last set of vital signs showed heart rate 48, blood pressure (BP) 148/74 mmHg, respiratory rate 28 and irregular. What does the nurse suspect based on these data?
- A. Spinal cord injury
- B. Increased intracranial pressure
- C. Typical for sleep
- D. Improvement
Correct answer: B
Rationale: The vital signs of bradycardia, hypertension, and irregular respirations indicate increased intracranial pressure. Bradycardia (heart rate of 48), hypertension (blood pressure of 148/74 mmHg), and irregular respirations are typical signs of increased intracranial pressure in a pediatric client with a traumatic brain injury and loss of consciousness.
2. A healthcare professional in a provider's office is monitoring serum electrolytes for four older adult clients who take digoxin. Which of the following electrolyte values increases a client's risk for Digoxin toxicity?
- A. Calcium 9.2 mg/dL
- B. Calcium 10.3 mg/dL
- C. Potassium 3.4 mEq/L
- D. Potassium 4.8 mEq/L
Correct answer: C
Rationale: The correct answer is C: Potassium 3.4 mEq/L. Potassium 3.4 mEq/L is below the expected reference range and puts a client at risk for digoxin toxicity. Low potassium levels can lead to fatal dysrhythmias, especially in older clients taking Digoxin, as potassium plays a crucial role in the heart's electrical activity. Choices A and B are related to calcium levels, which do not directly increase the risk of Digoxin toxicity. Choice D, Potassium 4.8 mEq/L, is within the expected reference range and would not increase the risk of Digoxin toxicity.
3. When caring for a client with COPD, which intervention should the nurse include in the care plan?
- A. Restrict the client's fluid intake to less than 2 L/day.
- B. Encourage the client to use the upper chest for respiration.
- C. Have the client use the early-morning hours for exercise and activity.
- D. Instruct the client to use pursed-lip breathing.
Correct answer: Instruct the client to use pursed-lip breathing.
Rationale: The correct answer is to instruct the client to use pursed-lip breathing. This technique helps improve breathing efficiency by keeping the airways open during exhalation and reducing air trapping. Restricting fluid intake to less than 2 L/day is not appropriate for a client with COPD, as they need adequate hydration. Using the upper chest for respiration is incorrect as it promotes shallow breathing, which is not ideal for COPD patients. While exercise is beneficial, early-morning hours may not be the best time for clients with COPD due to increased respiratory distress in the morning.
4. You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results?
- A. Respiratory acidosis with no compensation
- B. Metabolic alkalosis with a compensatory alkalosis
- C. Metabolic acidosis with no compensation
- D. Metabolic acidosis with a compensatory respiratory alkalosis
Correct answer: D
Rationale: A low pH indicates acidosis (normal pH is 7.35 to 7.45). The PaCO2 is also low, which causes alkalosis. The bicarbonate is low, which causes acidosis. The pH bicarbonate more closely corresponds with a decrease in pH, making the metabolic component the primary problem. Therefore, the correct interpretation of the arterial blood gas results is metabolic acidosis with a compensatory respiratory alkalosis. Choices A, B, and C are incorrect because they do not accurately reflect the primary acid-base disturbance and the compensatory response seen in the given results.
5. What is the expected pharmacological action of propranolol?
- A. Block stimulation of beta1 receptors
- B. Alter water and electrolyte transport in the large intestine
- C. Block stimulation of beta2 receptors
- D. Both A and C are correct
Correct answer: D
Rationale: Propranolol exerts its pharmacological action by blocking stimulation of both beta1 and beta2 receptors. By doing so, it leads to decreased heart rate and blood pressure. Therefore, both options A and C are correct as propranolol affects both types of beta receptors. Choice B is incorrect as propranolol does not alter water and electrolyte transport in the large intestine.
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