ATI Nursing Proctored Pediatric Test Banks

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A client is admitted to an acute care facility with a myocardial infarction. During the admission history, the nurse learns that the client also has hypertension and progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?

  • A. Risk for impaired skin integrity
  • B. Imbalanced nutrition: Risk for more than
  • C. Constipation body requirements
  • D. Ineffective thermoregulation
Correct Answer: A

Rationale: For a client with progressive systemic sclerosis, also known as Scleroderma, the nurse is most likely to formulate a nursing diagnosis related to the risk for impaired skin integrity. Scleroderma is a chronic connective tissue disease that can lead to changes in skin texture and thickness, making the skin more prone to breakdown, ulcers, and impaired wound healing. Therefore, assessing and addressing the risk for impaired skin integrity is essential to prevent complications in clients with Scleroderma. While the other options may also be relevant considerations for this client, the priority nursing diagnosis in this case would be related to maintaining skin integrity.

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A client has a serum calcium level of 7.2mg/dl. During the physical examination, the nurse expects to assess:

  • A. Trousseau's sign
  • B. Hegar's sign
  • C. Homan's sign
  • D. Goodell's sign
Correct Answer: A

Rationale: A client with a low serum calcium level (hypocalcemia) is at risk for exhibiting Trousseau's sign. Trousseau's sign is a clinical manifestation of hypocalcemia characterized by carpal spasm induced by inflating a blood pressure cuff on the arm above the systolic pressure for a few minutes. This spasm occurs due to the increased neuromuscular irritability caused by low calcium levels. Therefore, a nurse assessing a client with a serum calcium level of 7.2mg/dl should expect to assess Trousseau's sign.

The following. items are transported in blood plasma, EXCEPT:

  • A. Oxygen
  • B. Carbon dioxide
  • C. Nutrients
  • D. Hormones
Correct Answer: A

Rationale: Oxygen is not transported in blood plasma. Instead, it is transported bound to hemoglobin within red blood cells. Carbon dioxide, nutrients, and hormones are examples of substances that are transported in blood plasma. Oxygen binds to hemoglobin in the red blood cells as they pass through the lungs, while carbon dioxide is carried back to the lungs and expelled from the body through the respiratory system. Nutrients like glucose and amino acids are carried in the blood plasma to be delivered to various tissues for energy production and cellular processes. Hormones are chemical messengers that are released into the bloodstream by endocrine glands to regulate numerous physiological functions throughout the body.

A 15-month-old toddler was able to do all the following EXCEPT

  • A. walks alone
  • B. makes tower of 3 cubes
  • C. inserts raisin in a bottle
  • D. responds to his/her name
Correct Answer: D

Rationale: Responding to name usually occurs earlier, around 6-9 months.

The nurse is caring for a 5-year-old child with impetigo contagiosa. The parents ask the nurse what will happen to their child's skin after the infection has subsided and healed. Which answer should the nurse give?

  • A. There will be no scarring.
  • B. There may be some pigmented spots.
  • C. It is likely there will be some slightly depressed scars.
  • D. There will be some atrophic white scars.
Correct Answer: A

Rationale: Impetigo contagiosa typically does not leave scarring once it has subsided and healed. This skin infection primarily affects the superficial layers of the skin and does not cause damage deep enough to result in scarring. While there may be some temporary pigmented spots or mild changes in skin color after the infection resolves, scarring is not a common outcome of impetigo contagiosa in most cases. Thus, the nurse should reassure the parents that their child's skin is not likely to have any scarring after the infection has healed.

At the present time, the best treatment for cancer is complete __________ before metastasis occurs:

  • A. Chemotherapy
  • B. Radiation
  • C. Surgical removal
  • D. All of the above
Correct Answer: C

Rationale: The best treatment for cancer at the present time is complete surgical removal before metastasis occurs. Surgery is often the most effective method to remove the primary tumor and eliminate cancer cells in the affected area. While chemotherapy and radiation therapy are important in treating cancer, surgical removal of the tumor provides the best chance for complete eradication of cancer cells, especially if it is done before the cancer has spread to other parts of the body.

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