ATI RN
Nursing Care of Children Final ATI
1. The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal?
- A. Adapt, as necessary, ethnic practices to health needs
- B. Attempt, in a nonjudgmental way, to change ethnic beliefs
- C. Encourage continuation of ethnic practices in the hospital setting
- D. Strive to keep ethnic background from influencing health needs
Correct answer: A
Rationale: Adapting ethnic practices to health needs respects the patient's cultural background while ensuring that care is effective and culturally sensitive.
2. A client has a new prescription for Warfarin. Which of the following statements should the nurse include in the teaching?
- A. You will need to have your blood tested regularly while taking this medication.
- B. It is safe to take over-the-counter NSAIDs with this medication.
- C. You will need to avoid foods high in vitamin K while taking this medication.
- D. You will need to take this medication with food.
Correct answer: C
Rationale: Warfarin interacts with vitamin K, so clients should be instructed to avoid foods high in vitamin K. This is because vitamin K can interfere with the anticoagulant effects of Warfarin. It is important to maintain a consistent intake of vitamin K-containing foods to keep the medication working effectively. Therefore, the correct statement for the nurse to include in the teaching is to advise the client to avoid foods high in vitamin K while taking Warfarin. Choices A, B, and D are incorrect. Regular blood testing is necessary with Warfarin to monitor its effects and adjust the dosage if needed (Choice A). Taking over-the-counter NSAIDs with Warfarin is not safe due to an increased risk of bleeding (Choice B). Warfarin can be taken with or without food, so there is no specific requirement to take it with food (Choice D).
3. A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following client statements indicates an understanding of the teaching?
- A. I will need to have my INR checked regularly while taking this medication.
- B. I should avoid eating leafy green vegetables while taking this medication.
- C. I will stop taking this medication if I experience nausea.
- D. I will avoid taking aspirin while taking this medication.
Correct answer: A
Rationale: The correct answer is A because clients taking warfarin should have their INR (International Normalized Ratio) checked regularly to monitor the medication's effectiveness and adjust the dose if needed. This monitoring helps to ensure the medication is working correctly and the client is within the therapeutic range. Choice B is incorrect because clients on warfarin should not avoid leafy green vegetables but should maintain a consistent intake. Leafy green vegetables contain vitamin K, which can affect warfarin, so it's important to maintain a consistent intake to keep INR stable. Choice C is incorrect as clients should not stop taking warfarin abruptly without consulting their healthcare provider as it can lead to serious health risks like blood clots. Choice D is incorrect because while taking warfarin, it is important to avoid unnecessary aspirin use due to an increased risk of bleeding. However, this statement does not indicate an understanding of the teaching about the need for regular INR monitoring.
4. What is the best initial action when a patient presents with confusion?
- A. Administer IV fluids
- B. Perform a neurological assessment
- C. Administer electrolytes
- D. Prepare for a CT scan
Correct answer: B
Rationale: When a patient presents with confusion, the best initial action is to perform a neurological assessment. This assessment helps in identifying potential causes of confusion such as neurological issues, infections, metabolic abnormalities, or medication side effects. Administering IV fluids (Choice A) may be necessary based on assessment findings, but it is not the first step. Administering electrolytes (Choice C) would also depend on the assessment results. Preparing for a CT scan (Choice D) may be indicated later in the diagnostic process but is not the initial action when a patient presents with confusion.
5. A healthcare professional is assessing a child who has nephrotic syndrome. Which of the following findings should the healthcare professional expect?
- A. Hypotension
- B. Hyperglycemia
- C. Facial edema
- D. Weight gain
Correct answer: D
Rationale: In nephrotic syndrome, there is increased permeability of the glomerular filtration barrier, leading to protein loss in the urine. This results in hypoalbuminemia, causing fluid retention and edema. Therefore, weight gain due to fluid retention is a common finding in children with nephrotic syndrome.
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