Pediatric ATI Practice Exam

Which child should the nurse assess first based on clinical priority?

1. A toddler who has a concussion and an episode of forceful vomiting

2. An adolescent who has infective endocarditis and reports having a headache

3. An adolescent who was placed into Halo traction 1 hour ago and rates his pain at a 6 on a 0-10 scale

4. A school-age child who has acute glomerulonephritis and brown colored urine

The correct answer is: A toddler who has a concussion and an episode of forceful vomiting

The child with a concussion and an episode of forceful vomiting should be assessed first because these symptoms indicate a potential worsening condition that requires urgent attention. In pediatric patients, a concussion can lead to complications such as increased intracranial pressure or possible brain injury. Forceful vomiting may suggest raised intracranial pressure or irritation of the brain, which can be life-threatening if not addressed promptly. In situations involving head injuries, especially in young children like toddlers, the clinical priority is to determine the stability of the airway, breathing, and circulation, as well as to assess for any signs of neurological deterioration. Therefore, the combination of a concussion and vomiting necessitates immediate evaluation and intervention. In contrast, although the other cases involve significant medical conditions, they may not present the same immediate risk of rapid deterioration as in the case of the toddler. For example, while an adolescent with infective endocarditis and a headache requires attention, headaches can be managed with careful monitoring. The adolescent who has recently been placed in Halo traction is experiencing pain that needs to be addressed, but this can typically be handled within a stable assessment timeframe. The school-age child with acute glomerulonephritis and brown urine may also require evaluation, but this condition is often manageable