ATI PEDIATRICS CMS 2023 AND 2019 TEST BANK/PEDS CMS
CONTAINS 450 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|ALREADY
GRADED A+||COMPREHENSIVE DOCUMENT FOR PEDS
CMS||BRAND NEW!!!
A nurse is providing teaching to the guardian of a school-age child who has sickle
cell disease about management of the illness. Which of the following instructions
should the nurse include?
a. Apply cold compress to painful areas
b. but I shall wear a surgical mask to school
c. encourage physical activity as tolerated
d. offer fluids of bedtime – ANSWER- c. encourage physical activity as tolerated
A nurse is assessing a 5-month-old infant. Which of the following findings should
the nurse report to the provider?
a. Unable to hold a bottle
b. exhibits head lag when pulled a sitting position
c. absent grasp reflex
d. unable to roll from back to abdomen – ANSWER- b. exhibits head lag when
pulled a sitting position
A nurse is caring for a five-year-old child following a tonsillectomy and
adenoidectomy. Which of the following findings should the nurse identify as an
indication of hemorrhage?
a. Flushing of the face
b. continuous swallowing
c. blood pressure 99/ 56 mmhg
d. heart rate 54/ minutes – ANSWER- b. continuous swallowing
A nurse is discussing coping mechanisms with a parent of a three-month- old
infant which of the following therapeutic questions should the nurse ask the
parent?
a. What do you do when your infant is fussy?
b. Are you willing to take new parenting classes?
c. Does parenting cause you stress?
d. Is it overwhelming when your infant is having a bad day? – ANSWER- a. What
do you do when your infant is fussy?
A nurse is providing teaching about the effects of sun exposure to a parent of a
toddler. which of the following responses by the parent indicates an understanding
of the teaching?
a. my child should wear a wide-brimmed hat
b. my child should remain under a beach umbrella during morning hours
c. I should apply 10 SPF sunscreen to my child’s entire body
d. I should dress my child in loose active clothing – ANSWER- d. I should dress
my child in loose weave clothing
or
a. my child should wear a wide-brimmed hat
A nurse is evaluating a 6 year old child who has cystic fibrosis and has been
receiving chest physiotherapy treatment. The nurse should identify which of the
following findings as an indication of the therapy has been effective?
a. Increased urine output
b. increase expectoration
c. reduced pain
d. increased heart rate – ANSWER- b. increase expectoration
A nurse is planning care for a six-month-old infant who has bacterial meningitis.
Which of the following interventions should the nurse include in the plan of care?
a. Place the infant in a semi-private room
b. keep the television on in the room to provide background noise
c. Pad the side rails of the crib
d. provide for you can range of motion to the neck and shoulders – ANSWER- c.
Pad the side rails of the crib
A nurse is reviewing the medical record of a child with cystic fibrosis which of the
following should the nurse report to the provider? Click on the exhibit button for
additional information about the client.
a. heart rate
b. HbA1c
c. oxygen saturation
d. WBC48. – ANSWER- b. HbA1c
A nurse is assessing an infant who has severe dehydration due to gastroenteritis
which of the following findings should the nurse expect?
a. Increased respiratory rate
b. capillary refill of 2 seconds
c. Hypertension
d. increased urine output – ANSWER- a. Increased respiratory rate
A nurse is assessing an infant who has intussusception. Which of the following
findings should the nurse expect?
a. sausage-shaped abdominal Mass
b. board like abdomen
c. Constipation
d. increased urinary output – ANSWER- a. sausage-shaped abdominal Mass
A nurse is caring for a 14 year old adolescent who has a cast on the right arm and
swelling of their right hand. The nurse elevates The Adolescents affected
extremity. The nurse should identify that which of the following findings is an
indication that the intervention has been effective?
a. The Adolescent reports of the cast feels tight
b. The Adolescents hands feel cool to touch
c. the Adolescent is able to move their fingers freely
d. the Adolescent reports feeling tingling in their arms – ANSWER- c. the
Adolescent is able to move their fingers freely
A nurse in a provider’s office is assessing the vital signs of a two-year-old child at
a well-child visit. Which of the following findings should the nurse report to the
provider?
a. Respiratory rate 26 / min
b. pulse rate 98 / minutes
c. temperature 37.2 Celsius (99 Fahrenheit)
d. blood pressure 118 / 74 mmhg – ANSWER- d. blood pressure 118 / 74 mmhg
A nurse is preparing to administer a prescribed medication to a toddler whose
parent is nearby. Which of the following actions should the nurse take to identify
the toddler?
Assisting with administration of nasogastric enteral feeding for an infant (x2)
Position the head of crib at 30 degree angle between feedings
Planning to administer a nasogastric enteral feeding
Always confirm placement first (with pH- you cannot just auscultate to confirm placement) then aspirate contents
Best food options for a child who has phenylketonuria
Child with PKU cannot digest phenylalanine, which is present in most animal products
Caring for a child in buck’s traction
This is a skin traction of the lower extremity; make sure that knots are away from pulleys, that the leg remains extended, that weights are free-hanging at all times, that blankets do not cover ropes and that the child cannot reach or interfere with the mechanism
Converting ounces to mL
1 oz = 30 mL
Dietary recommendations for a child who has celiac disease (x2)
Child with celiac disease cannot process plant protein gluten (present in wheat, barley, rye). Avoid oats b/c usually contaminated with gluten. Rice is okay!
Dietary recommendations for child with lactose intolerance
Child needs supplementary calcium and vitamin D intake, as the dairy products that they cannot consume are high in calcium. Also, take lactase when consuming a dairy product.
Findings associated with poststreptococcal glomerulonephritis
Oliguria
Nutritional needs of the child who has acute postreptococcal glomerulonephritis
Sodium restrictions (they are puffy and edematous and sodium follows water; limit it)
Reinforcing Dietary Teaching for a Child who is recovering from Glomerulnephritis
Pick lowest sodium option: apples
Identifying nutritional risks in an adolescent
Adolescents tend to eat a lot of junk foods high in calories but low in other nutritional content. At risk for inadequate micronutrient nutrition.
Priority findings to report with skeletal traction
Skeletal traction consists of force applied directly to bones through pins. Increased crusting or purulent drainage, along with other signs of infection, should be reported to provider.
Priority intervention during a lumbar puncture
Immediately after the procedure, maintain the child in their side lying position to prevent injury to the spinal nerves.
Responding to a patient’s refusal of medication
“Provide the parent with vaccine information sheet.” (Don’t ask why, don’t question them, don’t tell them they HAVE to get vaccine)
Identifying risk factors for Urinary Tract Infection
Constipation (bowel movements every 4-5 days), urinary stasis, episode/hypospadias
Assisting with scoliosis screenings for school age children
Stand with feet together and then bend down as if touching toes, back parallel to floor
Checking skin turgor in a child
Best on abdomen
Deviation from expected growth and development for a 12 month old infant
Birth weight should be tripled
Expected behavior for a 7 year old female child
Spends a lot of time by herself
Facilitating communication for a child who has hearing loss
Speak slowly, facing the patient, avoid exaggerated movements, use facial expressions and hand gestures
Interventions to promote sleep for a toddler
Provide a consistent bedtime routine, “favorite stuffed animal”
Reportable vital signs for a 12 month old infant
Blood pressure in young children is usually low. Report 120/80 because outside of range
Obtaining an infant’s heart rate
Apical pulse 60s
Recommended immunizations for an adolescent
Usually HPV, Tdap, or meningococcal vaccine
Risk factors for primary amenorrhea
Hypothyroidism, cannabis use, emotional stress, oral contraceptive use
Administering ophthalmic drops to a child
Apply pressure to tear duct for 1 min after, wipe from inner canthus to outer canthus, instill eye drops immediately after cleaning the eye
Evaluating compliance to ferrous sulfate therapy, reinforcing teaching about liquid iron supplements
Iron supplements are given with citrus fruit, between meals when the stomach is most acidic for better absorption, taken with a straw to avoid teeth discoloration, administered IM using z-track technique to prevent tissue staining. Iron supplements turn stool to a tarry green.
Evaluating therapeutic effect of pancrelipase
Pancrelipase is effective if steatorrhea resolves
Identifying therapeutic effect of digoxin, findings to report for a child who is receiving digoxin, identifying digoxin toxicity
Therapeutic effect: increased cardiac output, “my baby is breathing easier than she used to.” Findings to report: anorexia, n/v, infant HR < 90, child HR < 70, vision changes, hypokalemia potentiates digoxin toxicity
Medications to administer for acute exacerbations of asthma
albuterol/levabuterol = the only rescue/quick acting bronchodilators
Monitoring for allergic reactions to contrast dye
Urticaria (itching)
Caring for a toddler who has stomatitis
Provide oral care (since the mouth with chlorhexidine mouthwash)
Evaluating treatment of infant who has dehydration
“sodium level of 145” is within expected range of 134-150
Expected findings of gastroesophageal reflux disease
chronic cough
Expected findings of severe dehydration
Body weight loss > 10%, extreme thirst, no tears when crying, sunken fontanelles
Home care of conjunctivitis
Conjunctivitis is considered non-communicable after 24 hrs of antibiotic treatment. Do not share towels with the infected child, as this promotes spread of highly contagious injection
Identifying a hemolytic reaction during a transfusion, monitoring a child who is receiving a blood transfusion
Signs and symptoms of hemolytic reaction include chills and flank pain
Interventions for mild hypoglycemia
Administer 15 grams of carbohydrates (usually 4 oz of juice or soda) then recheck the blood glucose after 15 mins. Follow up with a more complex carbohydrate, such as toast or crackers
Manifestations of pertussis
dry cough
Observing for an anaphylactic reaction
Hives is the earliest manifestation (then wheezing, angioedema – hypotension is a late sign)
Period of communicability for varicella
Contagious until 6 days after the lesions appear, if they have crusted
Priority finding for a toddler following a tonsillectomy
Frequent swallowing or clearing of the throat = bleeding
Expected lab values for a child who has iron deficiency anemia
Lowered Hgb/Hct, NOT high WBCs
Identifying splenic sequestration in a child who has sickle cell anemia
Spleen (and liver) will be enlarged during this phase, the child must avoid activities that have a risk of abdominal trau,a
Priority interventions during a vaso-occlusive crisis
Oxygen first (ABCs) then encourage fluid intake
Lab findings to report for an adolescent experiencing sickle cell crisis
A very low Hgb (6 for example)
Recognizing clinical manifestations of Hemophilia A
Disabling joint pain -> hemarthrosis
Recognizing manifestations of hypocalcemia
Hypotension
Reinforcing teaching about HIV, contributing to plan of care for adolescent who has HIV
“I should bring my child in for immunizations on schedule”
Reinforcing teaching about neutropenic precautions
“Inform the adolescent regarding routes of transmission” (need mask, not gowns and gloves)
Reinforcing teaching about poison control
Determine if the child is breathing, then empty the child’s mouth of remaining residue, identify the medication dosage, call the poison control center. (I’ve seen induce vomiting as correct answer)
Reinforcing teaching about rheumatic fever
Chorea/St. Vitus’s dance: uncontrolled muscle movements + a sign of rheumatic fever
Reinforcing teaching about exposure to poison ivy
“Flush the child’s skin within 15 minutes with cold, running water.”
Caring for family following unexpected death of a child
Allow the family to be in close proximity with the child’s body, to care for/dress/bathe it; do not instruct them to leave room
Appropriate response to death
Preschoolers: magical thinking = thinking their thoughts caused death, thinks that death is reversible and temporary
Findings indicating physical abuse, manifestations of physical abuse
Laceration on side of torso (any injuries that are not typical toddler clumsiness), symmetrical burns on lower extremities, spiral fractures
Identifying risk factors for physical abuse
A child with ADHD, a child who was born prematurely
Nursing actions for physical abuse
Report it to authorities
Therapeutic communication regarding a child’s religious beliefs
“Let’s discuss this with your parents.” Apparently they’re to young to have autonomy
Caring for an infant following repair of a hypospadias
Avoid giving the child a tub bath until stent has been removed, don’t toilet train the child during this process, encourage fluids to maintain hydration (DON’T limit fluids) leaving the child diaper less is uneccesary
Inserting an indwelling urinary catheter
“Apply 2% lidocaine lubricant to the urethral meatus.” (make sure of the sizing of the equipment used, it should be smaller in use with a child. Also, this procedure must be sterile to prevent UTIs)
Lab values requiring additional evaluation
Low platelet count (<150,000), low HCT/HGB (<12, <31%)
Lab values to report for Wilm’s Tumor
Antineoplastic medication regimen – report low CBC
Lab value to report for a child who is taking Prednisone
Hypernatremia (also hyperglycemia, hypokalemia, neutropenia)
Monitoring an adolescent who has asthma for improvement in condition
Looking for the respiratory rate to return to normal (no tachypnea). Also no wheezing
Monitoring urine protein for a child who has nephrotic syndrome
“A decrease in urine protein indicates that the treatment has been effective.”
Obtaining a peak expiratory flow rate
Patient takes 3 tries and BEST attempt is recorded (not the average). Have the patient stand during the procedure
Planning care following cleft palate repair
Place the child side-lying
Recognizing early manifestations of increased inter cranial pressure
Early sign: increased irritability, infant: irritability, high pitched cry, bulging fontanelles; late signs: CS respirations, abnormal posturing, fixed and dilated pupils are emergency (but not the earliest sign)
Reinforcing teaching about juvenile idiopathic arthritis
The child will sleep in splints to decrease pain
Reinforcing teaching about strabismus
Most common treatmentL patching the good eye; signs and symptoms: squinting, covering one eye/tilting head to see, missing objects reached for
Reinforcing teaching for an infant who has Down’s syndrome
“I will use a cool mist humidifier.” This question had less to do with Down’s it was about respiratory things
Evaluating understanding of home oxygen use
Make sure electrical equipment is grounded (tubes can be long! Also no smoking!)
Identifying a toddler prior to medication administration
Ask the guardian to confirm name/DOB
Isolation precautions for bacterial meningitis
Droplet precautions
Precautions for Tonic-Clonic Seizures
Do not restrain child, move furniture away from the child, pad the side rails of the bed to minimize injury, keep a suction set at the bedside, do not insert anything into the child’s mouth, loosen clothing around the child’s neck
Proper removal of PPE
Gloves, goggles, gown, and mask
Reinforcing home safety instructions with the parents of a toddler
“I will place a screen in front of the fireplace.” Medications go in LOCKED cabinets, toy box with lightweight lid
Reinforcing teaching about booster seats
Use until child is 4’9, use the car’s shoulder/lap belt
Reinforcing teaching about enterobiasis
Keep the child’s nails short
Reinforcing teaching about Sudden Infant Death Syndrome
“I will allow my child to have a pacifier while sleeping.” <- best answer, no pillows, blankets, or stuffed toys in the crib
Restraining a toddler for a procedure
Mummy restraints