2023 ATI Nursing Care of Children Proctored Exam 2023 ,
Nursing Care of Children ATI Proctored Exam 2023
A nurse in the emergency department is caring for a 2-year-old child who
was found by his parents crying and holding a container of toilet bowl
cleaner. The child's lips are edematous and in...
2023 ATI Nursing Care of Children Proctored Exam 2023 ,
Nursing Care of Children ATI Proctored Exam 2023
A nurse in the emergency department is caring for a 2-year-old child who
was found by his parents crying and holding a container of toilet bowl
cleaner. The child's lips are edematous and inflamed, and he is drooling.
Which of the following is the priority action by the nurse?
a. Remove the child's contaminated clothing.
b. Check the child's respiratory status.
c. Administer an antidote to the child.
d. Establish IV access for the child.
Rationale: The nurse should apply the ABC priority-setting framework when
answering this item. This framework emphasizes the basic core of human
functioning: having an open airway, being able to breathe in adequate
amounts of oxygen, and circulating oxygen to the body's organs via the
blood. An alteration in any of these can indicate a threat to life, and is
therefore the nurse’s priority concern. When applying the ABC priority setting
framework, airway is always the highest priority because the airway must be
clear and open for oxygen exchange to occur. Breathing is the second
highest priority in the ABC priority setting framework because adequate
ventilatory effort is essential in order for oxygen exchange to occur.
Circulation is the third highest priority in the ABC priority setting framework
because delivery of oxygen to critical organs only occurs if the heart and
blood vessels are capable of efficiently carrying oxygen to them. The nurse
observes that the child’s lips are edematous and inflamed and that he is
drooling. These findings indicate that the child might have swelling of the
oral cavity and pharynx, which can result in a compromised airway.
2. A nurse is teaching a parent of a 12-month old child about development
during the toddleryears. Which of the following statements should the nurse
include?
a. "Your child should be referring to himself using the appropriate
pronoun by 18 months of age."
b. "A toddler's interest in looking at pictures occurs at 20 months of
age."
c. "A toddler should have daytime control of his bowel and bladder by
24 months of age."
, d. "Your child should be able to scribble spontaneously using a
crayon at the age of 15
months."
Rationale: The nurse should teach the parent that at the age of 15 months,
the toddler should be able to scribble spontaneously, and at the age of 18
months, the toddler should be able to make strokes imitatively.
3. A nurse is caring for a toddler and is preparing to administer 0.9% sodium
chloride 100 mL IV to infuse over 4 hr. The drop factor of the manual IV
tubing is 60 gtt/mL. The nurse should set the manual IV infusion to deliver
how many gtt/min? (Round the answer to the nearest whole number. Use a
leading zero if it applies. Do not use a trailing zero.)
25 gtt
Rationale: 100ml/4 hr x 60gtt/1mlx 1 hr/60min= 6000/240= 25 gtt
Ratio and Proportion
STEP 1: What is the unit of measurement to calculate? gtt/min
STEP 2: What is the volume needed? 100 mL
STEP 3: What is the total infusion time? 4 hr
STEP 4: Should the nurse convert the units of measurement? Yes (min
does not equal hr)
1 hr/60 min = 4 hr/X min
X = 240 min
STEP 5: Set up an equation and solve for X.
Volume (mL)/Time (min) = drop factor (gtt/mL) = X
100 mL/240 min x 60 gtt/mL = X gtt/min
X = 25
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