ATI RN
Nursing Care of Children ATI
1. The nurse is caring for a child with an order of Ampicillin 250 mg IV in 30 mL of Normal Saline to infuse over 30 minutes. How many mL/hour should the nurse set the pump?
- A. 60
- B. 30
- C. 120
- D. 15
Correct answer: A
Rationale: The correct setting for the infusion pump should be 60 mL/hour to deliver 30 mL in 30 minutes. To calculate the infusion rate in mL/hour, divide the total volume to be infused (30 mL) by the total time for infusion (30 minutes) and then multiply by 60 to convert minutes to hours. Therefore, 30 mL / 30 minutes * 60 minutes/hour = 60 mL/hour. Choices B, C, and D are incorrect because they do not match the calculation based on the given parameters.
2. Which of the following parameters should be checked when assessing respirations?
- A. Rate
- B. Rhythm
- C. Symmetry
- D. All of the above
Correct answer: D
Rationale: When assessing respirations, it is essential to evaluate the rate at which breaths are taken, the rhythm of breathing patterns, and the symmetry of chest expansion. Each of these parameters provides valuable information about a person's respiratory status. Therefore, it is important to assess all of the listed parameters to have a comprehensive understanding of the individual's respiratory function.
3. Which of the following statements is incorrect about a patient with dysphagia?
- A. The patient will find pureed or soft foods, such as custards, easier to swallow than water
- B. Fowler’s or semi Fowler’s position reduces the risk of aspiration during swallowing
- C. The patient should always feed himself
- D. The nurse should perform oral hygiene before assisting with feeding
Correct answer: C
Rationale: The incorrect statement is that 'The patient should always feed himself.' Patients with dysphagia may require assistance with feeding due to difficulty in swallowing safely. It is essential to provide appropriate support and supervision during meal times to prevent complications such as aspiration or inadequate nutrition intake.
4. A client has a new prescription for Filgrastim. Which of the following instructions should be included by the healthcare provider?
- A. Take this medication with food.
- B. Avoid taking this medication with orange juice.
- C. Report bone pain to your healthcare provider.
- D. Expect a persistent cough while taking this medication.
Correct answer: C
Rationale: The correct answer is C: 'Report bone pain to your healthcare provider.' Filgrastim is known to cause bone pain as a common side effect. Therefore, it is crucial for clients to report any bone pain to their healthcare provider to monitor for potential complications or the need for further management. Choices A, B, and D are incorrect because taking Filgrastim with food, avoiding it with orange juice, and expecting a persistent cough are not relevant instructions associated with this medication.
5. When administering Phenytoin, what should you monitor?
- A. Behavior
- B. Therapeutic blood levels
- C. For signs of Stevens-Johnson syndrome
- D. All of the above
Correct answer: D
Rationale: When administering Phenytoin, monitoring the patient's behavior is important to assess for any changes that may indicate adverse effects. Monitoring therapeutic blood levels helps ensure the medication is within the effective range and not causing toxicity. Additionally, being vigilant for signs of Stevens-Johnson syndrome, a severe skin reaction associated with Phenytoin use, is crucial for early detection and intervention. Therefore, monitoring behavior, therapeutic blood levels, and for signs of Stevens-Johnson syndrome are all essential when administering Phenytoin.