ATI RN
RN Nursing Care of Children Online Practice 2019 A
1. What organism is a parasite that causes acute diarrhea?
- A. Shigella organisms
- B. Salmonella organisms
- C. Giardia lamblia
- D. Escherichia coli
Correct answer: C
Rationale: Giardia lamblia is a protozoan parasite known to cause acute diarrhea, often through contaminated water or food. Shigella, Salmonella, and E. coli are bacterial pathogens that also cause diarrhea but are not parasites.
2. A client experiencing acute dyspnea and diaphoresis reports anxiety and difficulty breathing. Vital signs include HR 117/min, respirations 38/min, temperature 38.4 C (101.2 F), and blood pressure 100/54 mm Hg. What should the nurse prioritize?
- A. Notify the provider.
- B. Administer heparin via IV infusion.
- C. Administer oxygen therapy.
- D. Obtain a spiral CT scan.
Correct answer: C: Administer oxygen therapy.
Rationale: In a client with acute dyspnea, diaphoresis, tachycardia, tachypnea, fever, and hypotension, the priority is to ensure adequate oxygenation. Administering oxygen therapy helps improve oxygenation levels and stabilize the client's condition. This intervention takes precedence over notifying the provider, administering heparin, or obtaining a CT scan, as oxygen therapy addresses the client's immediate need for respiratory support.
3. A client experiencing dyspnea will receive continuous oxygen. Which oxygen device should be used to deliver a precise amount of oxygen?
- A. Non-rebreather mask
- B. Venturi mask
- C. Nasal cannula
- D. Simple face mask
Correct answer: B: Venturi mask
Rationale: A Venturi mask is the most appropriate choice for delivering a precise amount of oxygen to a client with dyspnea. Unlike other oxygen delivery devices, the Venturi mask allows for accurate oxygen concentration delivery by controlling the amount of air entrained. This feature is crucial in ensuring the client receives the prescribed oxygen concentration, especially in cases where precise oxygen delivery is required.
4. What is the appropriate nursing action for a patient experiencing an acute allergic reaction?
- A. Administer antihistamines
- B. Administer corticosteroids
- C. Administer oxygen
- D. Administer bronchodilators
Correct answer: A
Rationale: The appropriate nursing action for a patient experiencing an acute allergic reaction is to administer antihistamines. Antihistamines work by blocking the action of histamine, a chemical released during an allergic reaction, and can help relieve symptoms such as itching, swelling, and hives. Corticosteroids are used for severe allergic reactions not responding to antihistamines, as they have anti-inflammatory properties. Oxygen is administered in cases of respiratory distress, while bronchodilators are used for bronchospasms. However, the first-line intervention for an acute allergic reaction is antihistamines.
5. The nurse is caring for a client on amiodarone who complains of visual disturbances. What is the nurse’s best response?
- A. Notify the healthcare provider immediately.
- B. Reassure the client that this is a common side effect.
- C. Advise the client to monitor their symptoms at home.
- D. Suggest the client reduce physical activity.
Correct answer: A
Rationale: The correct answer is to notify the healthcare provider immediately. Visual disturbances in a client taking amiodarone can indicate amiodarone toxicity, a serious side effect. Notifying the healthcare provider promptly is essential for further assessment and management. Reassuring the client that this is a common side effect (choice B) is incorrect as visual disturbances should not be dismissed without evaluation. Advising the client to monitor their symptoms at home (choice C) may delay necessary intervention. Suggesting the client reduce physical activity (choice D) is unrelated to addressing visual disturbances caused by amiodarone.
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