ATI RN
ATI Nursing Care of Children
1. The mother of an infant diagnosed with bronchiolitis asks the nurse what causes the disease. How should the nurse respond?
- A. Respiratory syncytial virus (RSV)
- B. Haemophilus influenzae
- C. Parainfluenza
- D. Rotavirus
Correct answer: A
Rationale: The correct answer is A: Respiratory syncytial virus (RSV). RSV is the most common cause of bronchiolitis, especially in infants. Bronchiolitis is characterized by inflammation of the small airways in the lungs. Choice B, Haemophilus influenzae, is a bacterium that can cause respiratory infections but is not the primary cause of bronchiolitis. Choice C, Parainfluenza, is a common viral infection that can cause croup and other respiratory illnesses but is not the main cause of bronchiolitis. Choice D, Rotavirus, is a virus that primarily affects the gastrointestinal system, causing diarrhea and vomiting, and is not associated with bronchiolitis.
2. A nurse is caring for a client who has depression and reports taking St. John's wort along with citalopram. The nurse should monitor the client for which of the following conditions as a result of an interaction between these substances?
- A. Serotonin syndrome
- B. Tardive dyskinesia
- C. Pseudo-parkinsonism
- D. Acute dystonia
Correct answer: A
Rationale: The correct answer is A: Serotonin syndrome. When a client takes St. John's wort, a herbal supplement, along with citalopram, a selective serotonin reuptake inhibitor (SSRI), there is a risk of developing serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition characterized by symptoms such as confusion, agitation, fever, sweating, shivering, tremors, muscle rigidity, and in severe cases, seizures and coma. It is crucial for the nurse to monitor the client for these symptoms. Choices B, C, and D are incorrect because tardive dyskinesia is associated with long-term use of antipsychotic medications, pseudo-parkinsonism is a side effect of antipsychotic medications like haloperidol, and acute dystonia is a side effect of antipsychotic medications characterized by sustained muscle contractions.
3. The physician has ordered a peripheral IV to be inserted before the patient goes for computed tomography. What should the nurse do when selecting a site on the hand or arm for insertion of an IV catheter?
- A. Choose a site with minimal hair if available.
- B. Consider potential effects on the patient's mobility when selecting a site.
- C. Instruct the patient to hold his arm in a dependent position before insertion.
- D. Remove the tourniquet after 2 minutes.
Correct answer: B
Rationale: When selecting a site for IV insertion on the hand or arm, it is important to consider the potential effects on the patient's mobility. The chosen site should not interfere with the patient's movement. Instructing the patient to hold his arm in a dependent position helps increase blood flow, aiding in vein visualization and insertion. It is advisable to choose a site with minimal hair if possible for better adhesion of the dressing. Removing the tourniquet after 2 minutes is recommended to prevent complications like hemoconcentration and potential vein damage. Therefore, option B is the correct choice as it aligns with best practices for IV insertion.
4. Intrinsic factor from the stomach is needed for the absorption of which vitamin?
- A. vitamin B12
- B. folate
- C. niacin
- D. vitamin B6
Correct answer: A
Rationale: The correct answer is A: vitamin B12. Intrinsic factor is a glycoprotein produced by the stomach that is necessary for the absorption of vitamin B12 in the small intestine. Vitamin B12 binds to intrinsic factor in the stomach, forming a complex that is then absorbed in the ileum. This absorption process is crucial for preventing vitamin B12 deficiency. Choices B, C, and D are incorrect because they do not require intrinsic factor for absorption. Folate is absorbed in the small intestine through a different mechanism, niacin can be absorbed in the small intestine without the need for intrinsic factor, and vitamin B6 does not rely on intrinsic factor for absorption.
5. How can a colony-stimulating factor affect the patient's erythrocyte count?
- A. It stimulates the growth of red blood cells.
- B. It suppresses T-cell production.
- C. It inhibits protein synthesis.
- D. It stimulates antibody production.
Correct answer: A
Rationale: Colony-stimulating factors are substances that stimulate the production of blood cells in the bone marrow. Erythrocytes are red blood cells, so a colony-stimulating factor would specifically stimulate the growth of red blood cells, leading to an increase in the patient's erythrocyte count. Choice B is incorrect because colony-stimulating factors do not suppress T-cell production. Choice C is incorrect because colony-stimulating factors do not inhibit protein synthesis. Choice D is incorrect because colony-stimulating factors do not stimulate antibody production; they primarily affect the production of blood cells.