Free ATI RN Nursing Care of Children practice for ATI Nursing Care of Children 2019 B (ATI RN). Answer 66 nursing exam-style questions with rationales, exam mod
What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-24 months)? (Select all that apply.)
Select the best answer.
Explanation:
In infants, urinary tract disorders may present with poor feeding, hypothermia, and frequent urination. Pallor can be associated with other conditions but is less specific to urinary tract disorders.
The nurse is aware that if patients from different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what?
Select the best answer.
Explanation:
Ethnocentrism is the belief that one's own culture is superior to others, which can lead to bias and a lack of cultural competence in healthcare.
What major complication is associated with a child with chronic renal failure?
Select the best answer.
Explanation:
Water and sodium retention is a major complication in chronic renal failure, leading to hypertension and edema. Hypokalemia and metabolic alkalosis are less common, and while BUN levels rise, retention rather than excretion is problematic in chronic renal failure.
An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which situation?
Select the best answer.
Explanation:
These symptoms are indicative of dehydration or water depletion, which is common in infants and can rapidly lead to severe consequences if not addressed promptly.
Where is the best place to observe for the presence of petechiae in dark-skinned individuals?
Select the best answer.
Explanation:
The oral mucosa and conjunctivae are the best places to observe petechiae in dark-skinned individuals because these areas have less pigmentation.
Which condition is characterized by a 'seal-like' barking cough in children?
Select the best answer.
Explanation:
Croup is the correct answer. Croup is characterized by a 'seal-like' barking cough due to inflammation and narrowing of the upper airways, particularly the larynx and trachea. It is most common in young children and can cause significant respiratory distress, especially at night. Treatment often includes humidified air and corticosteroids. Asthma (choice B) typically presents with wheezing and shortness of breath, not a barking cough. Bronchitis (choice C) is characterized by productive cough with mucus, not a barking cough. Pneumonia (choice D) often presents with fever, productive cough, and chest pain, not a barking cough.
The parents of an infant with a cleft palate ask the nurse, "What follow-up care will our infant need after the repair?" Which is an accurate response by the nurse?
Select the best answer.
Explanation:
After cleft palate repair, the child will need ongoing follow-up with audiologists, speech pathologists, and orthodontists to monitor hearing, speech development, and dental alignment.
What is the most common cause of acute kidney injury in children?
Select the best answer.
Explanation:
Hemolytic uremic syndrome is the most common cause of acute kidney injury in children. While dehydration can lead to prerenal acute kidney injury, it is not the most common cause in children. Glomerulonephritis is a common cause of chronic kidney disease but not typically the most common cause of acute kidney injury in children. Sepsis can lead to acute kidney injury, but in children, hemolytic uremic syndrome is more prevalent.
Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.)
Select the best answer.
Explanation:
Preschool children may exhibit regressive behavior, fear abandonment, and blame themselves for their parents' divorce due to their limited understanding of the situation.
A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and doses of immunizations. What is the most appropriate nursing intervention?
Select the best answer.
Explanation:
Children who began primary immunization at the recommended age but fail to receive all the doses do not need to begin the series again but should receive only the missed doses. The child may receive missed vaccinations on a catch-up schedule per CDC guidelines.
When should a child receive the first dose of the hepatitis B virus (HBV) vaccine if the mother is hepatitis B surface antigen (HBsAg) negative?
Select the best answer.
Explanation:
If the mother is HBsAg negative, it is recommended that the child receives the first dose of the hepatitis B vaccine at birth before discharge from the hospital. This is to provide early protection against the hepatitis B virus. The second dose of the vaccine is typically given at the first well-child visit, and the third dose is usually administered at a later date. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, including the hepatitis B virus vaccine. Choice A is incorrect as the first dose should ideally be given at birth. Choice C is incorrect as waiting until 6 months of age may leave the child vulnerable to infection during the early months of life. Choice D is incorrect as the hepatitis B vaccine is recommended for all newborns, especially if the mother is HBsAg negative, to prevent transmission of the virus.
The LPN is caring for a 1-month-old patient post-surgery. Which pain scale is expected to be used to evaluate post-op pain?
Select the best answer.
Explanation:
The FLACC (Face, Legs, Activity, Cry, Consolability) scale is commonly used to assess pain in infants and young children who are unable to verbally communicate their pain. This scale is particularly useful in assessing post-operative pain in infants as it evaluates different behaviors and physiological responses to pain. The Oucher scale is more commonly used with children who are older and can provide self-report of pain intensity. Wong-Baker FACES scale is primarily used with children who are older and can indicate their pain level by pointing to facial expressions. The 0-10 pain scale is typically used with older children and adults who can rate their pain on a numerical scale.
The nurse is teaching parents about expected language development for their 6-month-old infant. The nurse recognizes the parents understand the teaching if they make which statement?
Select the best answer.
Explanation:
At 6 months, infants typically begin to combine syllables like "dada" or "mama," but they do not yet understand the meaning of these words.
The parents of a newborn with an umbilical hernia ask about treatment options. The nurse's response should be based on which knowledge?
Select the best answer.
Explanation:
The correct answer is B. Most umbilical hernias in newborns resolve on their own by 3 to 5 years of age without the need for surgical intervention, unless complications arise. Surgery is not typically recommended for umbilical hernias in newborns due to the high rate of spontaneous resolution. Aggressive treatment is not necessary as umbilical hernias are typically benign and not associated with high mortality. Taping the abdomen is not recommended as it can cause skin irritation and does not speed up the resolution of the hernia.
A school-age client is in the playroom when the respiratory therapist arrives to give a scheduled breathing treatment. What is the most appropriate nursing action?
Select the best answer.
Explanation:
The most appropriate action is to assist the child back to their room for the treatment but reassure them that they may return when the procedure is completed. This approach ensures that the child receives the necessary treatment while also acknowledging their desire to continue playing in the playroom. Choice A is incorrect because it suggests moving the child to the room and asking the child-life specialist to bring toys, which may not be necessary. Choice B is incorrect as rescheduling the treatment may not be in the best interest of the child's health. Choice D is incorrect as the nurse should guide the child back to their room for the treatment.
Because children younger than 5 years are egocentric, the nurse should do which when communicating with them?
Select the best answer.
Explanation:
Focusing communication directly on the child aligns with their egocentric nature and helps engage them in the conversation.
Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?
Select the best answer.
Explanation:
The correct answer is A: Sitting independently. By 11 months, most infants can sit independently. This milestone usually precedes walking, which typically occurs closer to 12 months. Turning a doorknob and building a tower of four cubes involve more complex motor skills that are typically achieved later in development. Therefore, at 11 months, sitting independently is the milestone that the nurse would expect an infant to have achieved.
At a well-child check-up, the nurse notes that an infant with a previous diagnosis of failure to thrive (FTT) is now steadily gaining weight. The nurse should recommend that fruit juice intake be limited to no more than how much?
Select the best answer.
Explanation:
The American Academy of Pediatrics recommends limiting fruit juice intake to no more than 4 oz per day for infants, as excessive juice can contribute to poor nutrition and dental issues.
Which disease would require strict isolation of the patient?
Select the best answer.
Explanation:
The correct answer is B: Chickenpox. Chickenpox is highly infectious and is transmitted through direct contact, droplet spread, and contaminated objects. Due to its high communicability, strict isolation of the patient is necessary to prevent the spread of the disease. Mumps is primarily transmitted through direct contact with the infected person's saliva, with peak contagiousness before the onset of swelling. Exanthema subitum (roseola) has an unknown transmission source. Erythema infectiosum (fifth disease) is contagious before the appearance of symptoms. Therefore, these diseases do not require the same level of strict isolation as chickenpox.
Which information about hemophilia will the nurse include in the teaching plan for the parents of a child diagnosed with hemophilia?
Select the best answer.
Explanation:
The correct answer is B: Hemophilia is an X-linked recessive disorder, primarily affecting males and passed from mothers to sons. It involves a deficiency in clotting factors, leading to prolonged bleeding. Choice A is incorrect as hemophilia is not autosomal dominant. Choice C is incorrect as hemophilia does not involve platelets. Choice D is incorrect as hemophilia is not autosomal recessive.
What intervention is crucial during a sickle cell crisis in a child?
Select the best answer.
Explanation:
Administering oxygen is crucial during a sickle cell crisis in a child as it helps to prevent further sickling of cells. Oxygen therapy can improve oxygen saturation levels, reducing the risk of tissue damage and complications. Applying cold compresses (choice B) is not recommended as it can potentially worsen vaso-occlusive crisis by causing vasoconstriction. Restricting fluids (choice C) is not appropriate as hydration is essential to prevent dehydration and maintain adequate blood flow. Encouraging bed rest (choice D) may be necessary but administering oxygen takes precedence in managing a sickle cell crisis.
Which should the nurse teach to parents regarding oral health of children? (Select all that apply.)
Select the best answer.
Explanation:
Fluoridated water helps prevent caries, early childhood caries is preventable, and dental hygiene should start with the first tooth eruption.
A child is admitted in acute renal failure (ARF). Therapeutic management to rapidly provoke a flow of urine includes the administration of what medication?
Select the best answer.
Explanation:
Mannitol and furosemide are diuretics commonly used to induce diuresis in acute renal failure, helping to provoke urine flow and manage fluid overload. Calcium gluconate and electrolyte supplementation are used for other specific conditions and not primarily for diuresis.
An appropriate method for administering oral medications that are bitter to an infant or small child should be to mix them with which?
Select the best answer.
Explanation:
Mixing bitter medication with a small amount of something sweet, like jam, can mask the taste effectively without diluting the medication too much. Mixing with milk or formula is not recommended as the child may refuse future feedings, and carbonated beverages are not suitable for infants.
What is the primary concern in a child with nephrotic syndrome?
Select the best answer.
Explanation:
The correct answer is C: Hyperlipidemia. Children with nephrotic syndrome often present with hyperlipidemia due to altered lipid metabolism, making it a primary concern in these patients. Hypotension (choice A) is not a primary concern in nephrotic syndrome. Hyperkalemia (choice B) and hypocalcemia (choice D) are not typically associated with nephrotic syndrome and are less likely to be primary concerns in these patients.
A 12-year-old girl has recently begun menstruating and is well into puberty. The child is visiting the health care provider today for a routine physical examination. Which finding should cause concern in the nurse?
Select the best answer.
Explanation:
Vulvar irritation may indicate an infection or other issues and should be further evaluated. In a pubescent girl, breasts of slightly different sizes and irregular periods are common variations of normal development. Supernumerary nipple, an extra nipple, is a benign condition that is not typically concerning during puberty.
In what condition should the nurse be alert for altered fluid requirements in children? (Select all that apply.)
Select the best answer.
Explanation:
Conditions like oliguric renal failure, increased intracranial pressure, and mechanical ventilation significantly alter fluid requirements in children. These conditions either restrict fluid output or require careful fluid management to avoid worsening the condition.
The nurse is caring for a child who had a tonsillectomy. Which clinical manifestation should the nurse observe the child for in the postoperative period?
Select the best answer.
Explanation:
Correct Answer: B. Increased swallowing can indicate bleeding at the surgical site, which is a potential complication after tonsillectomy. Choice A, Arrhythmias, are not typically associated with tonsillectomy. Choice C, Increased blood sugar, is not a common clinical manifestation after a tonsillectomy. Choice D, Increased urinary output, is not a typical clinical manifestation to observe for in the postoperative period after a tonsillectomy.
Which teaching point should the nurse include when providing education to an adolescent client who participates in soccer regarding the plan of care for diabetes mellitus?
Select the best answer.
Explanation:
The correct teaching point the nurse should include is to advise the adolescent client who participates in soccer to increase food intake. Physical activity increases glucose utilization, so adolescents with diabetes need to consume additional carbohydrates to prevent hypoglycemia during and after exercise. Choice A (Decreased food intake) is incorrect because the adolescent needs extra carbohydrates to support the increased physical activity. Choice B (Increased doses of insulin) is incorrect as the focus should be on adjusting food intake rather than insulin doses. Choice D (Decreased doses of insulin) is also incorrect as the insulin doses should be adjusted based on the increased food intake and physical activity level.
The nurse is talking to a group of parents of school-age children at an after-school program about childhood health problems. Which statement should the nurse include in the teaching?
Select the best answer.
Explanation:
Childhood obesity is the most common nutritional problem in children, with significant implications for long-term health, including the risk of developing chronic diseases.
Which sign is indicative of developmental dysplasia of the hip in infants?
Select the best answer.
Explanation:
The Ortolani sign is a specific maneuver used during physical examination to detect hip instability or dislocation in infants. A positive Ortolani sign, where the hip is felt to slip back into the socket, is indicative of developmental dysplasia of the hip, a condition that can lead to long-term disability if not treated early. Romberg sign is used to assess sensory ataxia, Trendelenburg sign indicates weakness of the hip abductor muscles, and Gower's sign is seen in children with proximal muscle weakness climbing up their own body from a supine position due to conditions like muscular dystrophy.
A parent and 4-year-old child are waiting in an exam room when the nurse enters and greets them. Which activity that the nurse observes the child doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson?
Select the best answer.
Explanation:
The correct answer is C. According to Erikson, the primary task of a preschool-aged child is to explore and assert control over their environment. This behavior is demonstrated by the child opening drawers, pulling out supplies, and examining them, showcasing curiosity and exploration. Choices A, B, and D do not align with the primary developmental task of a preschool-age child according to Erikson. Reading a book and singing a song are more passive activities, while roughhousing with the parent does not directly relate to exploration and asserting control over the environment.
What is the most common symptom of gastroesophageal reflux in infants?
Select the best answer.
Explanation:
Frequent spitting up is indeed a common symptom of gastroesophageal reflux in infants. It is caused by the backward flow of stomach contents into the esophagus, leading to infants regurgitating milk or formula shortly after feeding. Projectile vomiting (choice A) is more commonly associated with conditions like pyloric stenosis rather than gastroesophageal reflux. Bilious vomiting (choice B) often indicates an obstruction in the gastrointestinal tract. Diarrhea (choice D) is not typically a primary symptom of gastroesophageal reflux in infants.
The parents of a child born with ambiguous genitalia tell the nurse that family and friends are asking what caused the baby to be this way. Tests are being done to assist in gender assignment. What should the nurse's intervention include?
Select the best answer.
Explanation:
It is important for the nurse to provide the parents with accurate information so they can confidently explain the situation to others, helping to reduce stress and misinformation. Avoiding family and friends or minimizing the problem is not helpful.
An infant requires surgery for repair of a cleft lip. An important priority of the preoperative nursing care is which?
Select the best answer.
Explanation:
Performing a baseline physical and behavioral assessment is crucial to determine the infant's current health status and to identify any potential risks before surgery.
Identification and treatment of cryptorchid testes should be done by age 2 years. What is an important consideration?
Select the best answer.
Explanation:
Early treatment of cryptorchidism is essential to preserve fertility and prevent complications such as testicular cancer. Surgery is usually well-tolerated, and sexual reassignment is not typically related to this condition.
The nurse determines that a child's intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?
Select the best answer.
Explanation:
If a vesicant solution infiltrates, stopping the infusion immediately and notifying the practitioner is critical to prevent tissue damage. Cold or warm compresses should only be applied following specific medical advice based on the vesicant involved.
During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is which?
Select the best answer.
Explanation:
Bowleggedness is normal in toddlers due to the development of lower back and leg muscles. It usually resolves as the child grows.
What is a primary consideration for complications when planning nursing care for an infant with Meconium aspiration syndrome?
Select the best answer.
Explanation:
The correct answer is C: Airway obstruction. When planning nursing care for an infant with Meconium aspiration syndrome, a primary consideration for complications is the potential of airway obstruction. After the passage of meconium into the amniotic fluid, the infant may inhale or swallow the fluid, leading to meconium aspiration into the lower airways and causing a partial airway obstruction. This can result in respiratory distress and hypoxemia. Hypoglycemia (choice A) is a metabolic condition unrelated to meconium aspiration. Bowel obstruction (choice B) with meconium may indicate other conditions like cystic fibrosis or Hirschsprung disease, not directly related to meconium aspiration syndrome. Carbon dioxide retention (choice D) is not a primary consideration in meconium aspiration syndrome; instead, the focus is on addressing the airway obstruction and potential respiratory compromise.
The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching?
Select the best answer.
Explanation:
The correct answer is B: All are applicable. Ice, raw vegetables, and unpeeled fruits can be sources of contamination in areas where water purity is questionable. It's safer to avoid these during a mission trip to prevent waterborne illnesses. Choice A (Ice), C (Raw vegetables), and D (Unpeeled fruits) are all potential sources of contamination in areas with questionable water quality. Including all these items in the teaching will help adolescents make informed decisions to stay healthy during their mission trip.
Which of the following is a characteristic finding in Kawasaki disease?
Select the best answer.
Explanation:
A 'strawberry tongue' is a characteristic finding in Kawasaki disease. The presence of a 'strawberry tongue' is a classic sign of Kawasaki disease, along with other features such as conjunctivitis and rash. Choice B, polyarthritis, is not typically seen in Kawasaki disease. Choice C, hematuria, is not a common finding in Kawasaki disease but may be seen in other conditions. Choice D, rashes, are present in Kawasaki disease but are not as specific or characteristic as the 'strawberry tongue'. Therefore, the correct answer is A.
How is family systems theory best described?
Select the best answer.
Explanation:
Family systems theory views the family as a whole, where changes in one member affect the entire system, and changes can occur at any point within the system.
Which action should the nurse implement when taking an axillary temperature?
Select the best answer.
Explanation:
The correct technique involves placing the thermometer tip in the center of the axilla to ensure an accurate reading, with the arm held close to the body.
What is the recommended position for a child after a tonsillectomy?
Select the best answer.
Explanation:
The correct answer is C: Side-lying. The side-lying position is recommended after a tonsillectomy to facilitate drainage of secretions and reduce the risk of aspiration. This position helps prevent blood from pooling in the back of the throat, decreasing the chance of bleeding postoperatively. Supine (lying face up), while commonly used in other situations, may not be ideal immediately after a tonsillectomy due to the risk of airway obstruction from blood clots. Prone (lying face down) is not recommended as it can hinder breathing and increase the risk of complications. Fowler's position (semi-sitting) is also not typically used after a tonsillectomy because it may cause discomfort and hinder proper drainage.
The clinic nurse is assessing a child with a heavy ascariasis lumbricoides (common roundworm) infection. Which assessment findings should the nurse expect?
Select the best answer.
Explanation:
A heavy roundworm infection can cause anemia, anorexia, irritability, and an enlarged abdomen due to the worms' effects on nutrient absorption and intestinal function.
At an 8-month-old well-baby visit, the parent tells the nurse that her infant falls asleep at night during the last bottle feeding but wakes up when moved to the infant's crib. What is the most appropriate response for the nurse to make?
Select the best answer.
Explanation:
Encouraging the baby to fall asleep in the crib while still awake can help establish healthy sleep habits and reduce night waking.
Following treatment for iron deficiency anemia, the physician orders lab tests. Which lab value would indicate an improvement in the child's condition?
Select the best answer.
Explanation:
A high reticulocyte count indicates that the bone marrow is producing more red blood cells, which is a sign of recovery from anemia as the body replenishes its iron stores and increases hemoglobin levels. Low hemoglobin (Choice A) would indicate ongoing anemia rather than improvement. A normal platelet count (Choice B) and low hematocrit (Choice D) are not specific indicators of improvement in iron deficiency anemia.
A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child?
Select the best answer.
Explanation:
Preparation is essential even for a young child, as they need to adjust to the temporary colostomy and understand the changes to their body, which can be confusing and distressing without proper explanation.
According to Freud's developmental theory, infancy is a stage of:
Select the best answer.
Explanation:
In Freud's psychosexual development theory, the oral stage is the first stage and occurs during infancy. It focuses on activities involving the mouth, such as sucking and feeding. This stage is crucial for the child's development as it forms the basis for trust and attachment. Choices B, C, and D are incorrect as latency refers to the stage during middle childhood where sexual impulses are suppressed, genitality refers to the final stage focusing on mature sexual relationships, and anality refers to the stage occurring during the toddler years where toilet training plays a significant role.
The nurse is preparing to assess a 10-month-old infant. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which initial actions by the nurse should be most appropriate?
Select the best answer.
Explanation:
Engaging the infant in a familiar game like peek-a-boo can help reduce fear and build rapport before starting the assessment.
The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed?
Select the best answer.
Explanation:
The statement about making sure others realize the child is part of the family may indicate a focus on external validation rather than on the child's needs and identity, suggesting a need for further teaching.
By what age does birth weight usually triple?
Select the best answer.
Explanation:
The correct answer is A: 1 year. By the age of 1 year, a baby's birth weight typically triples. This period allows for significant growth and development in infants. Choices B, C, and D are incorrect because birth weight does not usually triple by 1 month, 2 years, or 6 months of age, respectively.
Prior to giving a hospitalized pre-schooler an injection, the nurse gives the child's teddy bear a "shot" first. This method is known as:
Select the best answer.
Explanation:
The correct answer is D: Dramatic play. Dramatic play involves children acting out experiences to better understand them and reduce fear. In this scenario, by giving the teddy bear a 'shot' first, the nurse is engaging in dramatic play to help the child comprehend and feel more comfortable with the upcoming injection.\n A: Critical play involves critical thinking and problem-solving, not acting out scenarios.\n B: Role play typically involves pretending to be someone else, not necessarily acting out a specific experience.\n C: Diversionary activity aims to distract or redirect attention, which is different from the purpose of dramatic play in this context.
A 14-year-old with chronic renal failure suddenly becomes non-compliant with the medication regimen. Which nursing intervention would most likely improve compliance?
Select the best answer.
Explanation:
Adolescents often seek guidance and support from their peers. Setting up a meeting with older teens who are effectively managing chronic renal failure can provide the 14-year-old with motivation, encouragement, and practical advice on how to handle their treatment regimen. This peer support can positively influence the non-compliant adolescent, making choice B the most likely intervention to improve compliance. Choices A and C may not address the peer influence aspect of adolescent behavior, while choice D focuses on punitive measures rather than addressing the underlying reasons for non-compliance.
The nurse is caring for a 1-month-old infant diagnosed with Hirschsprung's disease. Which treatment measure should be included in the plan of care?
Select the best answer.
Explanation:
The correct answer is B: Surgical removal of the affected section of bowel. Hirschsprung's disease is a congenital condition where a portion of the large intestine lacks nerve cells, leading to difficulties in passing stool. The definitive treatment for this condition is the surgical removal of the affected section of the bowel. Barium enema (Choice A) may be used for diagnosis but is not a treatment. A high-fiber diet (Choice C) is not effective in managing Hirschsprung's disease. A permanent colostomy (Choice D) is not the initial treatment for this condition in infants.
The clinic nurse is assessing a child with a heavy ascariasis lumbricoides (common roundworm) infection. Which assessment findings should the nurse expect?
Select the best answer.
Explanation:
A heavy roundworm infection can cause anemia, anorexia, irritability, and an enlarged abdomen due to the worms' effects on nutrient absorption and intestinal function.
At an 8-month-old well-baby visit, the parent tells the nurse that her infant falls asleep at night during the last bottle feeding but wakes up when moved to the infant's crib. What is the most appropriate response for the nurse to make?
Select the best answer.
Explanation:
Encouraging the baby to fall asleep in the crib while still awake can help establish healthy sleep habits and reduce night waking.
Following treatment for iron deficiency anemia, the physician orders lab tests. Which lab value would indicate an improvement in the child's condition?
Select the best answer.
Explanation:
A high reticulocyte count indicates that the bone marrow is producing more red blood cells, which is a sign of recovery from anemia as the body replenishes its iron stores and increases hemoglobin levels. Low hemoglobin (Choice A) would indicate ongoing anemia rather than improvement. A normal platelet count (Choice B) and low hematocrit (Choice D) are not specific indicators of improvement in iron deficiency anemia.
A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child?
Select the best answer.
Explanation:
Preparation is essential even for a young child, as they need to adjust to the temporary colostomy and understand the changes to their body, which can be confusing and distressing without proper explanation.
According to Freud's developmental theory, infancy is a stage of:
Select the best answer.
Explanation:
In Freud's psychosexual development theory, the oral stage is the first stage and occurs during infancy. It focuses on activities involving the mouth, such as sucking and feeding. This stage is crucial for the child's development as it forms the basis for trust and attachment. Choices B, C, and D are incorrect as latency refers to the stage during middle childhood where sexual impulses are suppressed, genitality refers to the final stage focusing on mature sexual relationships, and anality refers to the stage occurring during the toddler years where toilet training plays a significant role.
The nurse is preparing to assess a 10-month-old infant. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which initial actions by the nurse should be most appropriate?
Select the best answer.
Explanation:
Engaging the infant in a familiar game like peek-a-boo can help reduce fear and build rapport before starting the assessment.
The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed?
Select the best answer.
Explanation:
The statement about making sure others realize the child is part of the family may indicate a focus on external validation rather than on the child's needs and identity, suggesting a need for further teaching.
By what age does birth weight usually triple?
Select the best answer.
Explanation:
The correct answer is A: 1 year. By the age of 1 year, a baby's birth weight typically triples. This period allows for significant growth and development in infants. Choices B, C, and D are incorrect because birth weight does not usually triple by 1 month, 2 years, or 6 months of age, respectively.
Prior to giving a hospitalized pre-schooler an injection, the nurse gives the child's teddy bear a 'shot" first. This method is known as:
Select the best answer.
Explanation:
The correct answer is D: Dramatic play. Dramatic play involves children acting out experiences to better understand them and reduce fear. In this scenario, by giving the teddy bear a 'shot' first, the nurse is engaging in dramatic play to help the child comprehend and feel more comfortable with the upcoming injection.\n A: Critical play involves critical thinking and problem-solving, not acting out scenarios.\n B: Role play typically involves pretending to be someone else, not necessarily acting out a specific experience.\n C: Diversionary activity aims to distract or redirect attention, which is different from the purpose of dramatic play in this context.
A 14-year-old with chronic renal failure suddenly becomes non-compliant with the medication regimen. Which nursing intervention would most likely improve compliance?
Select the best answer.
Explanation:
Adolescents often seek guidance and support from their peers. Setting up a meeting with older teens who are effectively managing chronic renal failure can provide the 14-year-old with motivation, encouragement, and practical advice on how to handle their treatment regimen. This peer support can positively influence the non-compliant adolescent, making choice B the most likely intervention to improve compliance. Choices A and C may not address the peer influence aspect of adolescent behavior, while choice D focuses on punitive measures rather than addressing the underlying reasons for non-compliance.
The nurse is caring for a 1-month-old infant diagnosed with Hirschsprung's disease. Which treatment measure should be included in the plan of care?
Select the best answer.
Explanation:
The correct answer is B: Surgical removal of the affected section of bowel. Hirschsprung's disease is a congenital condition where a portion of the large intestine lacks nerve cells, leading to difficulties in passing stool. The definitive treatment for this condition is the surgical removal of the affected section of the bowel. Barium enema (Choice A) may be used for diagnosis but is not a treatment. A high-fiber diet (Choice C) is not effective in managing Hirschsprung's disease. A permanent colostomy (Choice D) is not the initial treatment for this condition in infants.
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