Free ATI RN Nursing Care of Children practice for ATI RN Nursing Care of Children 2019 Proctored (ATI RN). Answer 49 nursing exam-style questions with rationale
Which factor is most likely to cause a "brittle" diabetic state in a child with type 1 diabetes?
Select the best answer.
Explanation:
Frequent infections can destabilize blood sugar levels, leading to a "brittle" diabetic state in children with type 1 diabetes. Infections increase metabolic demands and can result in significant blood glucose fluctuations, requiring careful monitoring and adjustment of insulin therapy. Noncompliance with diet may affect blood sugar control but is not the primary cause of a "brittle" state. Insulin resistance is more common in type 2 diabetes rather than type 1. Hypothyroidism can impact metabolism but is not directly linked to the development of a "brittle" diabetic state in type 1 diabetes.
What test is used to screen for carbohydrate malabsorption?
Select the best answer.
Explanation:
Stool pH testing is used to screen for carbohydrate malabsorption. A low pH indicates the presence of unabsorbed carbohydrates, which are fermented by bacteria, leading to acidic stool.
The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.)
Select the best answer.
Explanation:
In acute renal failure, laboratory findings typically include hyperkalemia, hyponatremia, and elevated blood urea nitrogen (BUN) levels due to the kidneys' inability to excrete waste and balance electrolytes. Metabolic alkalosis is less common, with metabolic acidosis being more typical.
A 14-month-old child is admitted to the hospital with laryngotracheobronchitis (LTB). Which assessment findings should the nurse expect?
Select the best answer.
Explanation:
The correct answer is C: 'Barking cough and inspiratory stridor.' Classic signs of laryngotracheobronchitis (LTB) include a barking cough, often described as a seal-like cough, and inspiratory stridor, which is a high-pitched sound heard during inspiration. These symptoms occur due to inflammation and narrowing of the upper airway. Choices A, B, and D are incorrect as they do not align with the typical assessment findings of LTB. Cyanosis and dyspnea (Choice A) may occur in severe cases but are not specific to LTB. Productive cough and high fever (Choice B) are more indicative of lower respiratory tract infections. Pale laryngeal and dyspnea (Choice D) are not characteristic findings of LTB.
A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after the administration of prednisone. The nurse realizes further teaching is required if the parents state what?
Select the best answer.
Explanation:
Children with MCNS who are in remission can usually attend school and participate in normal activities with precautions to avoid infections. Home schooling may not be necessary, and this indicates a misunderstanding of the condition's management.
The nurse is caring for a patient from a culture unfamiliar to the local area. The best way for a culturally competent nurse to interact with the family is to:
Select the best answer.
Explanation:
The best way for a culturally competent nurse to interact with a family from an unfamiliar culture is to be respectful and open-minded when discussing beliefs. This approach demonstrates cultural competence by honoring and valuing the family's beliefs and practices. Choice A is incorrect as it disregards the family's cultural practices without understanding them. Choice B is not the best approach as it focuses on language rather than respecting beliefs. Choice D is inappropriate as it goes against the principles of cultural competence by imposing beliefs on the family.
In pediatric patients, what is the primary concern with untreated vesicoureteral reflux (VUR)?
Select the best answer.
Explanation:
The primary concern with untreated vesicoureteral reflux (VUR) in pediatric patients is chronic renal failure. Untreated VUR can lead to this complication due to recurrent urinary tract infections and kidney damage. While recurrent UTIs (Choice A) are a common consequence of VUR, the ultimate worry is the development of chronic renal failure. Hypertension (Choice C) may occur as a result of renal damage but is not the primary concern. Bladder dysfunction (Choice D) is not the most significant consequence of untreated VUR in terms of long-term outcomes compared to chronic renal failure.
The nurse is administering activated charcoal to a preschool child with acetaminophen (Tylenol) poisoning. What potential complications from the use of activated charcoal should the nurse plan to assess for?
Select the best answer.
Explanation:
Common complications of activated charcoal administration include diarrhea and vomiting. Intestinal obstruction can occur if the charcoal forms a mass in the intestines. Fluid retention is less likely and not typically a complication associated with activated charcoal.
Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period?
Select the best answer.
Explanation:
Morphine is the drug of choice for PCA in children because of its efficacy, safety profile, and rapid onset of action for pain management.
When assessing a child with leukemia, which clinical manifestations should the nurse anticipate?
Select the best answer.
Explanation:
The correct answer is A: Petechiae, fever, fatigue. Children with leukemia commonly present with petechiae (due to low platelet count), fever (due to infection), and fatigue (due to anemia), which are classic manifestations of the disease. Option B is incorrect because headache, papilledema, and irritability are more indicative of increased intracranial pressure, not leukemia. Option C is incorrect as muscle wasting and weight loss are not typical initial manifestations of leukemia in children. Option D is incorrect as decreased intracranial pressure, psychosis, and confusion are not commonly associated with leukemia.
When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation?
Select the best answer.
Explanation:
When caring for a child with probable appendicitis, sudden relief from pain is a critical sign that could indicate perforation of the appendix. Perforation results in the release of pressure and inflammation, leading to a temporary relief of pain. Anorexia (loss of appetite) and decreased abdominal distention are symptoms commonly associated with appendicitis itself, not perforation. Bradycardia (slow heart rate) is not typically a direct manifestation of appendicitis or its complications.
What information should be given to the parents of a 12-month-old child regarding appropriate play activities for this age?
Select the best answer.
Explanation:
Large push-pull toys are suitable for a 12-month-old as they encourage gross motor skills and physical activity, which are crucial for their development at this age.
What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis?
Select the best answer.
Explanation:
Postinfectious glomerulonephritis is typically caused by immune complex deposition in the glomeruli following a streptococcal infection. This immune response leads to inflammation and impaired kidney function.
Which condition is characterized by a "barking" cough in children?
Select the best answer.
Explanation:
Croup is the correct answer. It is characterized by a distinctive "barking" cough, typically worse at night, caused by the inflammation of the upper airway, specifically the larynx and trachea. Asthma (Choice A) typically presents with wheezing and shortness of breath rather than a barking cough. Bronchiolitis (Choice B) commonly causes wheezing and respiratory distress in infants and young children. Pneumonia (Choice D) often presents with symptoms like fever, productive cough, and chest pain, but not typically a barking cough.
Which food should be introduced first to a 6-month-old infant?
Select the best answer.
Explanation:
Vegetables, particularly pureed ones, are often recommended as a first solid food for infants because they are easy to digest and less likely to cause allergies. Fruits can be introduced later due to their natural sweetness, while eggs and meat are typically introduced after fruits and vegetables as they may pose a higher risk of allergies.
What is the most effective way to prevent sudden infant death syndrome (SIDS)?
Select the best answer.
Explanation:
The correct answer is to place the baby on their back to sleep. This position is the most effective way to prevent sudden infant death syndrome (SIDS) according to research and recommendations from healthcare providers. Choice A, using a firm mattress, is important for infant safety but not as directly related to preventing SIDS. Keeping the room warm, as mentioned in choice C, is not recommended as it may increase the risk of SIDS. While breastfeeding has many benefits, choice D, breastfeeding exclusively is not the most effective method for preventing SIDS.
All of the following statements are true regarding the value of play except:
Select the best answer.
Explanation:
Play is an effective way to establish rapport with children as it helps build trust, communication, and a positive relationship. Choices A, B, and C are true statements about the value of play: A) Play helps preschoolers develop moral values by promoting social skills, cooperation, and empathy. B) Play aids in developing muscle coordination, utilizing energy, and fostering self-confidence through physical activities. C) 'Play is the work of children' emphasizes the importance of play in a child's development, learning, and creativity. Therefore, D is the correct answer as it incorrectly suggests that play is not an effective way for the nurse to establish rapport with the child.
A four-year-old boy is admitted to the hospital with leg pain and fever. He is pale-looking and has bruises over various areas of his body. The physician suspects acute lymphoblastic leukemia (ALL). Which test would be used to confirm the diagnosis?
Select the best answer.
Explanation:
A bone marrow aspirate is the definitive test to confirm acute lymphoblastic leukemia (ALL) in this case. It allows for the examination of leukemic cells in the bone marrow, providing a direct assessment of the disease. Red blood cell count (Choice B) is not specific for diagnosing leukemia but may show anemia commonly seen in leukemia patients. Lumbar puncture (Choice C) is used to assess central nervous system involvement, not primarily for confirming ALL. Bone scan (Choice D) is not a standard diagnostic test for ALL and is mainly used for evaluating bone metastases in other conditions.
What is a suitable nutritional goal for a preschool-aged child?
Select the best answer.
Explanation:
Introducing new foods gradually and offering a variety of options is a suitable nutritional goal for preschool-aged children as it helps in providing essential nutrients and expanding their palate. Choice A is incorrect as reducing messiness and spills is more related to behavior than nutrition. Choice C is incorrect as forcing a child to finish all the food on the plate may override their natural hunger and fullness cues. Choice D is incorrect as allowing a child to eat only preferred foods may lead to an imbalanced diet lacking in essential nutrients.
Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain?
Select the best answer.
Explanation:
Oral sucrose and nonnutritive sucking are effective nonpharmacologic interventions for reducing procedural pain in neonates.
Which physiological acid-base balance complication would be most important for the nurse to assess in a patient with diarrhea?
Select the best answer.
Explanation:
The correct answer is metabolic acidosis. Diarrhea can lead to the loss of bicarbonate, causing an imbalance in the acid-base status of the body, specifically resulting in metabolic acidosis. High serum pH (choice A) is incorrect as diarrhea-induced bicarbonate loss would lower pH, not increase it. Normal serum pH (choice B) is not the best answer as diarrhea can disrupt the acid-base balance. Metabolic alkalosis (choice C) is an alkaline state, which is less likely to be caused by diarrhea.
During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which?
Select the best answer.
Explanation:
A brilliant, uniform red reflex in both eyes is a normal finding, indicating that the retina is healthy and there are no significant obstructions in the visual pathway.
The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching?
Select the best answer.
Explanation:
At 2 months, infants are most stimulated by visual and auditory activities, such as a music box or soft mobiles. These activities help in sensory development and are appropriate for this age.
How is masturbation in the pre-school child viewed?
Select the best answer.
Explanation:
Masturbation in preschool children is a normal behavior as they explore their bodies. It is best viewed as a natural part of development. Parents are often advised to ignore it and provide distractions rather than making the child feel ashamed or embarrassed. Choice A is incorrect because it is a natural behavior and not considered abnormal in this context. Choice B is incorrect as it does not necessarily disrupt the family. Choice D is incorrect as the focus should be on the child's development and well-being, not on the parents' feelings of embarrassment.
Which is the most frequently used test for measuring visual acuity?
Select the best answer.
Explanation:
The Snellen letter chart is the most commonly used test for measuring visual acuity, particularly in school-age children and adults.
Which pediatric disorder is associated with a 'boot-shaped' heart on a chest x-ray?
Select the best answer.
Explanation:
The correct answer is A: Tetralogy of Fallot. Tetralogy of Fallot is often associated with a 'boot-shaped' heart appearance on a chest x-ray due to the characteristic heart anatomy in this condition. This appearance is caused by the combination of pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy. Choice B, Transposition of the great arteries, is incorrect because it presents with a 'egg-on-a-string' appearance on x-ray due to the abnormal position of the aorta and pulmonary artery. Choice C, Coarctation of the aorta, typically presents with rib notching on x-ray. Choice D, Ventricular septal defect, does not produce the 'boot-shaped' heart appearance seen in Tetralogy of Fallot.
The nurse is caring for an infant who had surgical repair of a tracheoesophageal fistula 24 hours ago. Gastrostomy feedings have not been started. What do nursing actions related to the gastrostomy tube include?
Select the best answer.
Explanation:
Leaving the gastrostomy tube open to gravity drainage prevents the accumulation of air and fluids, reducing the risk of complications such as vomiting or aspiration in the immediate postoperative period. Keeping the tube clamped or suctioning it can lead to pressure buildup, increasing the risk of complications. Securing the tube with tape is important but not the primary action related to the gastrostomy tube in this case.
The nurse is preparing to admit a 6-year-old child with celiac disease. What clinical manifestations should the nurse expect to observe?
Select the best answer.
Explanation:
Celiac disease often presents with steatorrhea, malnutrition, and foul-smelling stools due to the malabsorption of nutrients. Therefore, all the manifestations listed (steatorrhea, malnutrition, foul-smelling stools) are expected in a child with celiac disease. Polycythemia is not associated with celiac disease, making choice B the correct answer.
The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest?
Select the best answer.
Explanation:
The correct answer is C: Corn on the cob with butter. Corn is a gluten-free option suitable for children with celiac disease. Choice A is incorrect because the bun contains gluten, so suggesting a hamburger patty without the bun is a better option. Choice B is not ideal as spaghetti often contains gluten, but spaghetti with marinara sauce could be a safer choice if the spaghetti is gluten-free. Choice D, rice cakes with hummus, is a gluten-free alternative, but corn on the cob is a more straightforward and common choice for children.
A thorough systemic physical assessment is necessary in the extremely low-birth-weight (ELBW) infant to detect what?
Select the best answer.
Explanation:
In extremely low-birth-weight (ELBW) infants, a thorough systemic physical assessment is crucial to detect subtle changes that may indicate an underlying problem. These infants are highly vulnerable and may show signs of stress through changes in feeding behavior, activity, color, oxygen saturation, or vital signs. Monitoring weight in ELBW infants primarily reflects genitourinary function rather than fluid retention. Difficulties in maternal-child attachment are important but are usually assessed during parental visits and are not the primary focus of a systemic physical assessment. Changes in the Apgar score are used immediately after birth to assess the transition to extrauterine life and are not as relevant in the following 24 hours to detect ongoing subtle issues.
A parent calls the hospital nursing hotline and asks, 'My 8-week-old infant cries 8 hours a day, and is hard to console. Is that normal?' What should the nurse's response be to this parent?
Select the best answer.
Explanation:
The correct response for the nurse to provide in this situation is to ask more questions to determine if the infant is displaying symptoms of colic. Colic is a common condition in infants that can lead to prolonged crying and fussiness. It is essential to assess for other symptoms before giving advice to the parent. Choices A, C, and D are incorrect because they do not address the possibility of colic or the need for further assessment of the infant's condition.
Which of the following is a key feature of autism spectrum disorder?
Select the best answer.
Explanation:
Delayed speech development is a significant feature of autism spectrum disorder. Many children with autism exhibit delays in speech and language development, which can be one of the early signs of the condition. Hyperactivity, lack of interest in toys, and aggressive behavior are not key defining features of autism spectrum disorder. While some individuals with autism may exhibit these behaviors, they are not universally characteristic of the disorder.
The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal?
Select the best answer.
Explanation:
The correct answer is C. Falling when bending over to touch toes could indicate a developmental delay or a balance issue that may need further assessment. Choices A, B, and D are typical developmental milestones for a 3-year-old child. Pedaling a tricycle without assistance, unscrewing a bolt on a toy, and building a tower of 10 cubes are all age-appropriate activities for a child of this age.
The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula?
Select the best answer.
Explanation:
Excessive frothy saliva is a hallmark sign of tracheoesophageal fistula. The abnormal connection between the esophagus and trachea causes difficulty in swallowing, leading to an accumulation of saliva in the mouth. This symptom is crucial for early identification and management of tracheoesophageal fistula. Choices A, B, and D are incorrect as they are not specific indicators of tracheoesophageal fistula.
The nurse is teaching parents about diarrhea in young children. A parent asks the nurse what causes most cases of diarrhea in young children. How should the nurse respond?
Select the best answer.
Explanation:
Rotavirus is the most common cause of diarrhea in young children, particularly those under the age of 2. Giardia, Shigella, and Salmonella can also cause diarrhea, but in the context of young children, Rotavirus is the primary pathogen responsible for diarrheal illnesses.
Which pediatric condition is most likely to present with a "whooping" sound during coughing?
Select the best answer.
Explanation:
The correct answer is C: Pertussis. Pertussis, also known as whooping cough, is characterized by a "whooping" sound during coughing episodes. This distinctive sound is due to the rapid intake of air after a series of coughs. Choice A, Croup, typically presents with a barking cough and stridor. Choice B, Bronchitis, is characterized by a productive cough with mucus. Choice D, Asthma, usually presents with wheezing and shortness of breath.
An infant has been diagnosed with bladder obstruction. What do symptoms of this disorder include?
Select the best answer.
Explanation:
Post-urination dribbling is a symptom of bladder obstruction due to the incomplete emptying of the bladder. A strong urinary stream is typically absent in such cases. UTIs are common, but dribbling is more directly related to the obstruction.
What is the most common piece of medical equipment that can transmit harmful microorganisms among patients?
Select the best answer.
Explanation:
The correct answer is B: Stethoscope. A stethoscope is commonly used between patients, and if not correctly disinfected, it can be a dangerous source of spreading microorganisms. Thermometers typically have barriers to prevent this type of transmission. Injection needles are discarded immediately after use and not reused, making them an unlikely source of transmission. Similarly, disposable gloves are not reused, so they are also not a common source of harmful microorganism transmission.
What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)
Select the best answer.
Explanation:
Signs of kidney transplant rejection include fever, diminished urinary output, and swelling/tenderness in the graft area. These symptoms indicate that the body may be rejecting the transplanted organ, requiring immediate medical attention.
The nurse is preparing to give acetaminophen (Tylenol) to a child who has a fever. What nursing action is appropriate?
Select the best answer.
Explanation:
Ensuring the dose does not exceed 15 mg/kg is critical to avoid overdose and potential liver damage. Retaking the temperature immediately or using cold compresses is not necessary, and placing a warm blanket could exacerbate the fever.
The nurse is taking a health history of an adolescent. Which best describes how the chief complaint should be determined?
Select the best answer.
Explanation:
Asking the adolescent directly about the reason for their visit encourages open communication and helps the nurse understand the primary concern from the patient's perspective.
A 7-year-old has been diagnosed with cystic fibrosis. Chest physiotherapy has been ordered. What information should the nurse give to the parents regarding when chest physiotherapy is done?
Select the best answer.
Explanation:
The correct answer is D: 'Before meals'. Chest physiotherapy should be performed before meals to reduce the risk of vomiting and to ensure that the airways are clear for effective nutrition. Choices A, B, and C are incorrect because chest physiotherapy is ideally done before meals to optimize its benefits and avoid complications associated with timing.
What laboratory finding should the nurse expect in a child with an excess of water?
Select the best answer.
Explanation:
Water excess typically leads to hemodilution, resulting in a decreased hematocrit. High serum osmolality and specific gravity would indicate dehydration, while elevated BUN could suggest renal impairment or dehydration, not fluid overload.
During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner?
Select the best answer.
Explanation:
At 2 months, infants typically react to loud noises with the Moro reflex, a startle response that is normal at this stage of development.
The nurse is administering the first hepatitis A vaccine to an 18-month-old child. When should the child return to the clinic for the second dose of hepatitis A vaccination?
Select the best answer.
Explanation:
The second dose of the hepatitis A vaccine is recommended 6 months after the first dose to ensure full immunity.
At what point in the hospitalization of the pediatric patient should discharge planning and teaching begin?
Select the best answer.
Explanation:
Discharge planning should begin on admission to ensure that all necessary teaching and preparations are completed in a timely manner. Starting discharge planning early allows for a comprehensive assessment of the patient's needs, coordination with the healthcare team, and adequate time for patient and family education. Choice A, post-operatively, is too late in the process and may lead to rushed planning. Choice B, right at discharge, may not allow enough time for thorough preparation. Choice C, on the morning of discharge, also does not provide sufficient time for effective planning and education.
Which pediatric condition is characterized by a "string sign" on an upper GI series?
Select the best answer.
Explanation:
The correct answer is B: Hypertrophic pyloric stenosis. The "string sign" is associated with hypertrophic pyloric stenosis, a condition where the pyloric canal is narrowed, leading to gastric outlet obstruction. Intussusception (choice A) typically presents with colicky abdominal pain and currant jelly stools. Hirschsprung disease (choice C) is characterized by the absence of ganglion cells in the distal colon. Meckel diverticulum (choice D) is a congenital outpouching of the small intestine that can present with painless rectal bleeding.
The nurse on a pediatric unit is writing guidelines for age-specific preparation of children for procedures based on developmental characteristics. What guideline is accurate?
Select the best answer.
Explanation:
Using simple diagrams helps school-age children understand what to expect in a procedure, catering to their developmental level and reducing anxiety. Informing toddlers too early can increase anxiety, and parents' presence is generally comforting, not discouraging.
What intervention is contraindicated in a suspected case of appendicitis?
Select the best answer.
Explanation:
Enemas are contraindicated in cases of suspected appendicitis because they can increase the risk of perforation. The pressure from the enema can exacerbate inflammation and potentially lead to the rupture of the appendix. Palpating the abdomen gently is essential for diagnosing appendicitis, as it helps identify the characteristic signs like rebound tenderness. Antibiotics are commonly used to treat the infection associated with appendicitis, and antipyretics are administered to manage fever, which is a common symptom of the condition. Therefore, enemas are the intervention to avoid in suspected appendicitis cases.
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