ATI RN MATERNITY PROCTORED EXAM EXAM

ATI RN MATERNITY PROCTORED EXAM EXAM

VERSION 7

• A child diagnosed with asthma begins corticosteroid treatments. The nurse explains to the

parents that the purpose of corticosteroid treatment is to produce which therapeutic effect?

Incorrect: Dilation of the bronchial airways is common in treating asthma.Albuterol is a common medication.

Incorrect: Bronchospasms are usually reduced by B-2 agonists and bronchodilators.

Incorrect: Infections are treated byantibiotics but not indicated in the treatment of asthma unless lung congestion is noted.

Correct: Corticosteroid usage is common fordecreasing inflammation of the bronchial airways.

Dilationofbronchialairways

Decrease bronchospasms

Prevention of infection

Anti-inflammatory effect

• Which is the recommended treatment for moderate to severe lead poisoning?

Incorrect: IV fluids are typically not used in the treatment of lead poisoning. IV fluids area conservative treatment regimen and are not indicated for treatment of lead poisoning; a more radical therapy is needed to remove the lead from the body.

Incorrect: Treatment with antiemetic is not effective in the treatment of lead toxicitybecause the heavy metal is absorbed into the body. Lead ingestion usually occurs more than one time.

Correct:The heavy metal antagonist, edetate calcium disodium, is frequently the drug of choice for the removal of the lead toxin from the body. Chelating agents inactivate the toxicity of the lead and cause excretion through the urine. Others drugs may treat the symptoms of toxicity rather than remove the lead from the body. Untreated lead toxicity can lead to a wide array of neurobehavioral problems include: attention deficit- hyperactivity disorder, reduced cognitive performance, irritability or lethargy, aggressiveness, and hearing impairment. The most serious and irreversible side effect of lead poisoning is encephalopathy, which is associated with lead levels > 100 mg/ dL.

Incorrect:Antibiotics have no effect on the removal of the toxin.

IV fluids

Antiemetics

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Heavymetalantagonist

Antibiotics

• Which treatment is a nursing priority when providing care for an infant diagnosed with

bacterial meningitis?

Incorrect: Cardiorespiratory monitoring is standard for care of the child with bacterial meningitis as a means of establishing the baseline parameters for vital signs. The infant with meningitis may have a low baseline heart rate, tachypnea or fever. This however, is not the priority nursing intervention.

Incorrect: The initiation of IV fluids for hydration and nutrition is a primary concern for the care of the infant with bacterial meningitis. However, the most important intervention is starting antibiotic therapy.

Incorrect: Meningococcal meningitis is the only type of meningitis spread through air-born droplets and therefore, respiratory precautions need to be initiated as soon as possible.Respiratory isolation is important for the control of transmission of the disease after the child receives the first doses of antibiotics.Correct: The first nursing priority is the implementation of antibiotic therapy, which prohibits the microbial damage to the neurologic system through the cerebral spinal fluid.Bacterial meningitis has a high rate of infant morbidity (illness) or mortality (death).Immediate treatment with antibiotics can prevent: death, deafness, reduced cognitive ability,attentiondeficit-hyperactivedisorder,seizures andvariousothercomplications.

Initiatecardiorespiratorymonitoring.

Initiate intravenous fluids.

Observe respiratoryisolation.

Administer antibiotic therapy.

• The dosage of a pediatric medication is 120mg/kg/day to be give t.i.d. The patient weighs 12

pounds. What is the correct dose for the nurse to administer?

Incorrect: The dose of 120 mg is half the indicated dose. The erred dosage represents a failure to divide the total daily dose by the number of individual dosages required per day. The failure to use the weight in the calculation is evident.

Incorrect: The dosage of 480 mg is an excessive dose for the child. The calculation error is likely a failure to convert pounds to kilograms.

Correct: The patient weighs twelve pounds. This weight converts to kilograms by dividing 12 by 2.2 (1 kg. = 2.2 lb.). In this example, the child's weight converts to 5.4 kg. The daily dose of 120 mg is given t.i.d: each individual dose is 40 mg/kg. Then multiply the weight in kilograms by the individual dose (40mg). The individual dose is 218 mg.

Incorrect: The dose of 650 mg is too large of a dose. The weight of the child when converting 2 / 4

from pounds to kilograms is 5.45 kg. The dose is ordered to be given t.i.d.. Therefore, the daily dose of 120 mg/kg/day is divided by 3 to yield an individual dose of 40 mg/kg/dose. The error is this dosage was likely a failure to divide the total daily dose by the number of doses required per day.

120 mg

480 mg

218 mg

651 mg

• In a child diagnosed with Tetralogyof Fallot, which of the following is a compensatory

mechanism to decrease venous return to the heart?

Correct: Squatting is a compensatory mechanism that decreases venous return

(deoxygenated blood) to the heart. The clinical sign is commonly seen in young children with Tetralogy of Fallot (a type of cyanotic heart disease). The signs associated with cyanotic heart disease include hypoxia, poor growth, low tolerance for physical exertion, cardiomegaly, murmur and acute, intermittent blue spells that occur after crying or feeding (tet spells).

Incorrect: Clubbing is found in children with chronic respiratory disease and cyanotic heart disease. However, this finding is rare in young children.

Incorrect: Shortness of breath, retractions and increased respiratory effort occur with lung dysfunction. Generally, the child with impaired oxygenation due to a cardiac lesion does not exhibit signs of respiratory distress.

Incorrect: Polycythemia is common in children with hypoxia due to respiratory or cardiac dysfunction. This compensatorymechanism increases the oxygen-. carrying capacityin the body.The effect is not related to the venous return of unoxygenated blood to the heart.

Squatting

Clubbing

Shortnessofbreath

Polycythemia

• A 1-year-old receives routine health maintenance care at the pediatric clinic. The child receives

an MMR immunization. The mother asks the nurse, "When will my child get the next dose of MMR vaccine?" Which is the correct response by the nurse?

Incorrect: The DPT vaccine is routinely given in six months.

Incorrect:An additional dose of MMR vaccine is needed in the middle school years to maintain full immunity from the diseases.

Incorrect: The first dose of Hepatitis B vaccine (HBV) is given in the hospital prior to discharge 3 / 4

home. A follow-up HBV is given in 1-2 months and followed up in 6-12 months following the second does. The schedule does not coordinate with the routine immunization schedule for MMR.Correct: A second MMR, often called a booster, will be needed when the child enters middle school at age eleven or twelve years of age.

In six months with the next DPT

No further vaccination needed

With the Hepatitis B series

After the child is 10 years of age

• Which is a major difference in the clinical manifestation of adolescents with anorexia nervosa

compared to bulimia?

Incorrect: Binge eating is a common manifestation of both disorders.

Incorrect: Purging can be associated with both disorders.

Correct:The majordifference between adolescents with anorexia nervosa and adolescents with bulimia is body image distortion. Clients with anorexia see themselves as being overweight no matter how underweight they become. Clients with bulimia see their weight realistically but have psychological problems that manifest in an eating disorder.

Incorrect: Decreased self-esteem is often a catalyst of both disorders.

Binge eating

Purging

Bodyimagedistortion

Decreased self esteem

• Which is the most common factor associated with non-organic failure to thrive?

Incorrect:Acool, drafty sleeping area is not a comfortable environment for sleep, but is unrelated as a cause of failure to thrive.

Correct: The most significant factor associated with non-organic failure to thrive is typicallya disturbance in the mother/child relationship. Asituation involving dysfunctional family relationships is often complex; characterized by marital discord, economic pressures, and parental immaturity with a low stress tolerance.

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