ATI RN
RN Nursing Care of Children Online Practice 2019 A
1. The LPN is caring for a 1-month-old patient post-surgery. Which pain scale is expected to be used to evaluate post-op pain?
- A. Oucher
- B. Wong-Baker FACES
- C. FLACC
- D. 0-10 pain scale
Correct answer: C
Rationale: The FLACC (Face, Legs, Activity, Cry, Consolability) scale is commonly used to assess pain in infants and young children who are unable to verbally communicate their pain. This scale is particularly useful in assessing post-operative pain in infants as it evaluates different behaviors and physiological responses to pain. The Oucher scale is more commonly used with children who are older and can provide self-report of pain intensity. Wong-Baker FACES scale is primarily used with children who are older and can indicate their pain level by pointing to facial expressions. The 0-10 pain scale is typically used with older children and adults who can rate their pain on a numerical scale.
2. Which parental statement indicates correct understanding of preventive techniques for heat-related illnesses when children exercise?
- A. Wearing dark clothing during exercise is not recommended.
- B. Water is the preferred fluid for fluid replenishment.
- C. During activity, stopping for fluids every 15 to 20 minutes is essential.
- D. Hydration should be maintained throughout the exercise session.
Correct answer: C
Rationale: The correct preventive technique for heat-related illnesses during exercise is to stop for fluids every 15 to 20 minutes to prevent dehydration and maintain hydration levels. This practice helps regulate body temperature and prevent heat-related complications. Choice A is incorrect as wearing light-colored, loose-fitting clothing is recommended to reflect sunlight and allow better air circulation. Choice B is incorrect as while water is important, a sports drink containing electrolytes may be more beneficial for longer exercise sessions. Choice D is incorrect as it does not emphasize the importance of regular fluid intake during exercise to prevent dehydration.
3. A patient who has immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the healthcare provider before obtaining and administering platelets?
- A. Platelet count is 42,000/µL
- B. Petechiae are present on the chest
- C. Blood pressure (BP) is 94/56 mm Hg
- D. Blood is oozing from the venipuncture site
Correct answer: A
Rationale: The correct answer is A. Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/µL unless the patient is actively bleeding. In this scenario, the platelet count of 42,000/µL is not significantly low to warrant a platelet transfusion without active bleeding. Consulting with the healthcare provider is essential before giving the transfusion to ensure the appropriateness of the treatment. Choices B, C, and D are not directly related to the need for consulting before a platelet transfusion. Petechiae, low blood pressure, and oozing from the venipuncture site are common findings in patients with ITP and may not necessarily contraindicate a platelet transfusion at this platelet count.
4. A common side effect of diuretic medications is _____.
- A. dry mouth
- B. urinary tract infection
- C. increased taste perception
- D. nausea
Correct answer: A
Rationale: Diuretic medications can lead to dry mouth due to increased fluid loss through urination, reducing saliva production.
5. Where are most body fluids located?
- A. Intravascular space.
- B. Intracellular space.
- C. Extracellular space.
- D. Transcellular space.
Correct answer: Intracellular space.
Rationale: Most body fluids are located within cells in the intracellular space. While the extracellular space also contains body fluids, the majority is found within the cells. Intravascular space refers to fluids within blood vessels, and transcellular space includes fluids in compartments like cerebrospinal, pleural, and peritoneal cavities.