which is the priority nursing diagnosis when planning care for a newborn who is born with esophageal atresia and tracheoesophageal fistula
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Nursing Elites

ATI RN

ATI Pediatric Proctored Exam

1. When planning care for a newborn with esophageal atresia and tracheoesophageal fistula, which is the priority nursing diagnosis?

Correct answer: D

Rationale: The priority nursing diagnosis for a newborn with esophageal atresia and tracheoesophageal fistula is 'Risk for Aspiration' because of the potential respiratory complications associated with these conditions. The newborn is at a higher risk of aspirating oral or gastric contents due to the abnormal connections between the esophagus and trachea, posing a serious threat to the airway and lungs. Addressing this risk is crucial to prevent respiratory distress and maintain the airway's patency, making it the priority nursing diagnosis in this scenario. 'Ineffective Tissue Perfusion' is not the priority as respiratory compromise takes precedence over perfusion concerns. 'Ineffective Infant Feeding Pattern' may be relevant but addressing the risk of aspiration is more critical. 'Acute Pain' is not the priority compared to the life-threatening risk of aspiration.

2. A patient is prescribed Lisinopril as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug?

Correct answer: C

Rationale: The correct answer is C. Lisinopril, an ACE inhibitor, promotes venous dilation, which helps reduce pulmonary congestion and peripheral edema. The absence of previously heard crackles in the lungs indicates effectiveness in reducing pulmonary congestion. Edema and jugular vein distention are signs of heart failure and would not indicate the therapeutic effect of Lisinopril. A potassium level of 3.5mEq/L is within the normal range and not directly related to the therapeutic effect of Lisinopril.

3. What is the priority nursing action when preparing a neonate born with a gastroschisis defect for transport to a pediatric hospital for corrective surgery?

Correct answer: A

Rationale: The priority nursing action when preparing a neonate born with a gastroschisis defect for transport is to cover the exposed intestines with sterile moist gauze. This action helps prevent infection and keeps the tissue viable during transportation to the pediatric hospital for corrective surgery.

4. The healthcare provider is caring for a child on bed rest who has severe edema in the left lower extremity due to blocked lymphatic drainage. Which nursing diagnosis would take priority?

Correct answer: A

Rationale: The priority nursing diagnosis in this scenario is 'Risk for Impaired Skin Integrity' because severe edema in the left lower extremity can lead to compromised circulation and pressure ulcers, increasing the risk of skin breakdown and infection. Addressing and preventing impaired skin integrity is crucial for the child's overall health and well-being.

5. A nurse is caring for a child who has a new diagnosis of osteomyelitis. Which of the following actions should the nurse take?

Correct answer: C

Rationale: The nurse should monitor the child�s weight daily to assess the effectiveness of treatment for osteomyelitis and detect potential complications.

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