RN ATI PEDIATRIC NURSING EXAM

(70 NGN Questions with Answers)

1.Vaso-occlusive crisis plan of care interventions 5/year old child (flower)/ Possibly mistyped the
Question?? 15 year old adolescent

A. Monitor Oxygen, Bed Rest, Oral Hydroxyurea,

A nurse is caring for an adolescent who is admitted with a vaso-occlusive crisis.

Exhibit 1

History and Physical

A 15-year-old adolescent is admitted for a vaso-occlusive crisis. The parent reports that the
adolescent has a low-grade fever and has vomited for 3 days. The adolescent reports having
right- sided and low back pain. They also report hands and right knee are painful and swollen.
The client reports pain as 8 on a scale of 0 to 10.

Exhibit 2

Vital Signs

Temperature 37.8° C (100° F) Heart rate 100/min

Blood pressure 110/72 mm Hg Respiratory rate 20/min Oxygen saturation 95% on room air

Exhibit 3

Assessment

Awake, alert, and oriented x 3

Yellow sclera of eyes noted bilaterally

Right upper quadrant tender to palpation Hands painful to touch and swollen bilaterally

Right knee is swollen, warm to palpation, and the client reports pain as 8 on a scale of 0 to 10.

Exhibit 4

Client is tearful and grimacing during the examination.

The nurse is planning care for the adolescent. Select the 5 interventions the nurse should
include.
A. Instruct the parent to ensure the pneumococcal vaccine is current.

B. Administer folic acid as prescribed.

C. Monitor oxygen saturation continuously.

D. Place the client on strict bed rest.

E. Apply cold compresses to the affected joints.

F. Administer meperidine IV for pain.

G. Restrict oral intake.

H. Give oral hydroxyurea.

ANS: B C E F H

2. Atopic dermatitis discharge teaching SATA

A. Occasional flare ups, mild detergent laundry, apply gloves, cut nails frequency, apply
emollients after bathing Question

A nurse in the emergency department is preparing to discharge a 3-year- old child

Nurses' Notes
The child's guardian states the child has been unable to sleep recently and has been very irritable.
Guardian expresses concern about the child's atopic dermatitis worsening and the child
scratching excessively, which results in the areas bleeding. Guardian states the child has a history
of allergic rhinitis.

Assessment

Child is alert and responsive.

Respiratory rate even and nonlabored at rate of 24/min. No adventitious sounds auscultated.

Heart rate 108/min

Generalized small clusters of reddish, scaly patches with lichenifications and depigmentation on
the child's bilateral upper and lower extremities.
Which of the following statements should the nurse plan to include in the discharge instructions
for the child's guardian?

Select all that apply.

A. "You should cut and file your child's fingernails frequently."**

B. "You should use a mild detergent for your child's laundry."**

C. "You should apply a thick layer of pimecrolimus cream to your child's lesions."

D. "Your child will experience occasional flare-ups of this condition."**

E. "Your child's condition is contagious when lesions are present."

F. "You can apply gloves to your child's hands."**

G. "You should apply emollients to your child's skin after bathing**

ANS: A B D F G

3. 6-week infant failure to thrive, tachypnea & tachycardia nursing actions

A. Admin digoxin, elevate HOB, CHF, Monitor respiratory & I/O

A nurse is caring for a 6-week-old infant.

History and Physical

Infant was full-term at birth. Birth weight was 3.5 kg (7.7 lb). Infant is not gaining weight as
expected. One week ago at outpatient visit, weight was 3.6 kg (7.9 lb).
Parent reports for past 2 days infant is breathing faster during feedings and does not finish
feedings. Parent also reports decreased appetite and puffiness around the infant's eyes. Parent
states that the last wet diaper was about 10 hr ago. Infant admitted for diagnostic evaluation,
failure to thrive, and nutritional/fluid support.

Vital Signs

Admission:

Temperature 37.7° C (99.9° F) Heart rate 174/min while sleeping

Respiratory rate 72/min while sleeping Assessment:

Admission:
Respirations: Tachypneic with moderate retractions and nasal flaring. Upon auscultation,
crackles heard in all lung fields. No nasal drainage noted. Dry cough noted periodically. Skin:
Pallor, scalp is diaphoretic, lower extremities are cool to touch.

Cardiac: Tachycardic, regular rhythm, no murmur is heard. Peripheral pulses are full and
bounding in the upper extremities and weak bilateral pedal pulses are noted.

Fluids: Mucous membranes are slightly dry and pink. Skin turgor is slightly decreased. Capillary
refill is 3 seconds. Noted periorbital edema and nonpitting edema of feet.

Anterior fontanel is soft and slightly depressed. Diaper remains dry. Abdomen: Soft, full, round,
bowel sounds are present and active.

Blood pressure in right upper extremity 60/39 mm Hg Oxygen saturation 90%

Laboratory Results Admission:

Chest x-ray: mild left ventricular hypertrophy is noted. Increased pulmonary vascular markings
are noted in all lobes.

Specify what condition the client is most likely experiencing, 2 actions the nurse should take to
address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Condition Most Likely Experiencing (Middle Box)

 • Pyloric stenosis

• Cystic fibrosis

• Congestive heart failure** - ANSWER

• Respiratory syncytial virus bronchiolitis

Actions to Take

• Anticipate a prescription for digoxin.** ANSWER

• Elevate the head of the bed to a 45° angle** ANSWER

• Implement contact precautions

• Provide chest physiotherapy and postural drainage

Parameters to Monitor

• Number of steatorrhea stools

• Intake and output** ANSWER
• Respiratory Status (Monitor respiratory) **ANSWER
• Presence of periorbital edema

4. Toddler in ED swallowed battery (drag and drop)

a. NPO b. Endoscopy

Exhibit 1 Nurses'

Notes 0915:

Received the child awake, alert, and crying. Parent states that child was playing with remote
control toy and when the parent heard the child crying. they noticed that a battery was missing
from the toy. The parent states that the child was drooling more than usual and witnessed them
gagging periodically.

0930:

Child is lying on parent's chest with eyes open and requesting sippy cup. Continues to have
expiratory wheezing in bilateral upper lobes. Preparing child for diagnostic testing. Exhibit 4

Laboratory Results 0930:

X-ray of the neck, chest, and abdomen completed. Biplane radiographic study identifies objects
in esophagus. No foreign objects visualized in the chest or abdomen.

Complete the following sentence by using the list of options.

The nurse should first ** keep the child NPO ** followed by

**prepare the child for flexible endoscopy**

Other Choices 1

• Teach the child’s parents the importance of inspecting the child’s play area.
• Obtain informed consent Other Choices 2

• Monitor the child closely for return of gag reflex

• Encourage the parents to inspect toys for easily removable parts
5. What is a 1-year-old with history of UTIs and diagnosed with vesicoureteral reflux &
tachycardia at risk for? a. pyelonephritis b. Renal scarring (kidney damage)

A nurse in a provider's office is caring for a 1-year-old toddler.

Exhibit 1

0930

Nurse Notes
Parent presents child to provider's office. Parent reports the child has had a fever for 2 days and
that the child has cried more than usual. Parent also reports the child has had a decreased
appetite for the last 24 hr. Child febrile and lethargic.

0945:

Notified provider of parent reports and child's fever. New prescriptions received.

1000:
Urine sample obtained via sterile straight catheter.

Exhibit 2 Vital

Signs 0930:

Temperature 38.4° C (101.1° F) Heart rate 128/min

Respiratory rate 28/min

Exhibit 3

Diagnostic Results

1030:

Urinalysis:

Appearance: cloudy and dark amber (clear) Specific gravity 1.035 (1.005 to 1.030)

Leukocyte esterase: positive (negative)

Nitrites: present (none)

WBCS: 10 (0 to 4)

The child is at risk for developing ___Renal Scarring__ and ___Pyelonephritis_______.

Drag words from the choices below to fill in each blank in the following sentence.

Word Choices

A. Nephrotic syndrome
B. Renal Scarring**

C. Polycystic kidney

D. Acute glomerulonephritis

E. Pyelonephritis**

ANS: A E

6. 7 year old with UTI intervention?

a. Monitor salicylic acid? I think that you are supposed to admin acetaminophen b.

Monitor Pain & fever

7. Acute laryngotracheobronchitis & pneumonia expected findings?

a. Temp?

b. Irritability?

c. Stridor? rhonchi, fine crackle

d. Cough?
8. Cystic fibrosis meds?

a. Acetaminophen?

A nurse is caring for a school-age child who has cystic fibrosis.

Exhibit 1
History and Physical

School-age child admitted, diagnosed with cystic fibrosis at 3 months of age, has experienced
failure to thrive, and has chronic obstructive pulmonary disease. The child presents with
wheezing, rhonchi, paroxysmal cough, and dyspnea. The parent reports large, frothy,
foulsmelling stools. The child has deficient levels of vitamin A, D, E, and K. Barrel-shaped
chest

Clubbing of the fingers bilaterally

Respiratory rate 40/min with wheezing and rhonchi noted bilaterally, dyspnea, and paroxysmal
cough

Exhibit 2
Vital Signs

Temperature 38.4° C (101.1° F) Heart rate 100/min Respiratory rate 40/min

Blood pressure 100/57 mm Hg

Exhibit 3
Laboratory Results
Sputum culture positive for Pseudomonas aeruginosa Stool analysis positive for presence of fat
and enzymes Chest x-ray indicates obstructive emphysema WBC count 20,000/mm3 (5,000 to
10,000/mm3)
A nurse is reviewing the child's medical record. Which of the following medications should the
nurse expect the provider to prescribe or reconcile from the child's home medication list? Select
all that apply.
A. Water-soluble vitamins**
B. Acetaminophen
C. Dornase alfa**
D. Meperidine
E. Pancreatic lipase**
ANS: A C E

9. Toddler injury prevention a. Loose buttons

A nurse is providing teaching about injury prevention to the parents of a toddler. Which of the
following safety measures should the nurse include in the teaching?

A. Check clothing for loose buttons.**

B. Adjust the water heater temperature to 54° C (129.2° F).

C. Place screens on all windows.

D. Provide balloons for play.

ANS: A

10. 20-year-old with syphilis

a. Contact health dept.

A nurse is providing teaching for a 20-year-old adolescent who has syphilis. Which of the
following statements should the nurse make?

A. "You need to come back in a week for retesting."

B. “I have to notify the public health department."**

C. “I have to contact your parents."

D. “Let’s review the side effects of metronidazole."

ANS: B

11. 15-year-old with STI medication teaching

a. Ask how they learn.

A nurse is providing teaching to a 15-year-old adolescent about a medication used to treat a

sexually transmitted infection. Which of the following actions should the nurse take?

A. Inform the client to contact the pharmacy regarding any questions related to the medication.

B. Provide instructions to the client's parent with the client present.

C. Instruct the client's parents to write down the information that is being provided. D. Ask how

the client prefers to learn new information.**

ANS: D

12. Cast finding to report a. Pallor extremity

13. 6-month-old with gastroenteritis, severe dehydration finding a. Sunken anterior fontanel
19
A nurse is caring for a 6-month-old infant who has gastroenteritis. Which of the following
findings should the nurse identify as a manifestation of severe dehydration? A. Capillary
refill time 3 seconds.

B. Sunken anterior fontanel.

C. Weight loss of 5%.

D. Produces tears when crying.

Answer: Sunken anterior fontanel.

14. Juvenile idiopathic arthritis teaching

a. Physical activity

15. Report priority patient

a. 18 month HR @ 68 or 3 month RR @ 30??

A nurse is caring for a group of clients. Which of the following findings should the nurse report
to the provider?

A. An 18-month-old toddler who has a heart rate of 68/min.

B. A school-age child who has a rectal body temperature of 37.3° Celcius.

C. An adolescent who has a BP of 132/82 mm Hg.

D. A 3-month-old infant who has a respiratory rate of 30/min.

ANS: A
*16. Prednisone teaching?*

a. Drink plenty fluids to promote hydration, take with food, rinse mouth after,

watch of redness, sores, or white patches in mouth and report them to provider,

taper off meds, weight gain in the face is an adverse effect, monitor height and

weight, growth alterations are possible with long-term. use, avoid exposure to

infectious agents

A nurse is providing teaching to the parent of a school-age child who has a maintenance
prescription for prednisone following an acute asthma attack. Which of the following statements
by the parent indicates an understanding of the teaching?

A. "My child might experience mood swings."

B. “I should take my child to the clinic for a weekly blood test."

C. “I should withhold my child's medication before physical activity."

D. "My child might have a decreased appetite."

ANS: A

17. 3 month with diarrhea priority lab a. Increased Hematocrit

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