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ATI RN Pediatric Nursing Proctored Exam New Bundle Update

1. A nurse in a pediatric unit is preparing to insert an IV catheter for a 7-year-old child. Which of the following actions should the nurse take? A. Tell the child they will not feel any discomfo... rt B. Tell the child they will feel discomfort during the catheter insertion C. Use a mummy restraint to hold the child during the catheter insertion D. Require the parents to leave the room during the procedure Correct Answer: B. Tell the child they will feel discomfort during the catheter insertion.  Rationale: Honest preparation helps build trust with the school-age child. The nurse should use age-appropriate language to explain that they will feel a brief stick or discomfort. False reassurance ("will not feel anything") damages trust. Mummy restraints are for infants, not 7-year-olds, and parents should be allowed to stay unless the child prefers otherwise . 2. A nurse is assessing a client who is receiving morphine IV for pain. Which of the following findings is the priority? A. Constipation B. Urinary retention C. Respiratory rate of 8/min D. Nausea Correct Answer: C. *Respiratory rate of 8/min.*  Rationale: A respiratory rate below 10/min indicates opioid-induced respiratory depression, which is life-threatening. This is the priority finding using the ABC approach. Constipation, urinary retention, and nausea are adverse effects but not immediately life threatening . 3. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following is the priority assessment? A. Monitor serum electrolytes B. Check the infusion pump settings C. Measure daily weight D. Check capillary blood glucose Correct Answer: D. Check capillary blood glucose.  Rationale: Hyperglycemia is a common and potentially dangerous complication of TPN due to its high glucose content. Blood glucose should be monitored every 4–6 hours. While electrolytes, pump settings, and daily weights are important, glucose monitoring addresses the most immediate metabolic risk . 4. A nurse is reviewing the laboratory findings of a client who has diabetes mellitus and reports that she has been following her care plan. The nurse should identify which of the following findings indicates a need to revise the client's plan of care? A. HbA1c 6.5% B. HbA1c 9.2% C. Fasting blood glucose 110 mg/dL D. Postprandial blood glucose 140 mg/dL Correct Answer: B. HbA1c 9.2%.  Rationale: An HbA1c of 9.2% indicates poor glycemic control over the previous 3 months. The target for most adults with diabetes is <7%. This finding indicates the current plan of care is ineffective and requires revision. The other values are within acceptable ranges . 5. A nurse is providing discharge teaching for a client who has an implantable cardioverter defibrillator (ICD). Which of the following statements demonstrates understanding of the teaching? [Show More]

Last updated: 4 months ago

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