ATI RN
RN Nursing Care of Children Online Practice 2019 A
1. The nurse is selecting a site to begin an intravenous infusion on a 2-year-old child. The superficial veins on his hand and arm are not readily visible. What intervention should increase the visibility of these veins?
- A. Gently tap over the site.
- B. Apply a cold compress to the site.
- C. Raise the extremity above the level of the body
- D. Use a rubber band as a tourniquet for 5 minutes.
Correct answer: A
Rationale: Gently tapping over the site helps dilate the veins and increase visibility. Applying a cold compress or raising the extremity above the body level constricts the veins, making them harder to access. Prolonged tourniquet use can cause discomfort and venous congestion.
2. In general, how much is a child that was 10 pounds at birth expected to weigh at 6 months old?
- A. Double = 20 lbs
- B.
- C.
- D.
Correct answer: A
Rationale: The correct answer is A. A child is expected to double their birth weight by 6 months. This is a common guideline used to monitor healthy growth and development in infants. Choices B, C, and D are incorrect as they do not provide the expected weight based on the given information.
3. What laboratory finding should the nurse expect in a child with an excess of water?
- A. Decreased hematocrit
- B. High serum osmolality
- C. High urine specific gravity
- D. Increased blood urea nitrogen (BUN)
Correct answer: A
Rationale: 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.
4. While making rounds, the nurse observes the following client behaviors. Which child should the nurse further evaluate for postoperative pain?
- A. The 6-month-old in deep sleep
- B. The 2-year-old who is cooperative when the nurse takes vital signs
- C. The 4-year-old who is actively watching cartoons
- D. The 14-month-old who is screaming and thrashing his arms and legs
Correct answer: D
Rationale: The correct answer is D because screaming and thrashing his arms and legs are indicative behaviors of discomfort or pain in young children. The child's actions suggest a higher likelihood of experiencing postoperative pain and necessitate further evaluation. Choices A, B, and C do not exhibit overt signs of distress or discomfort associated with pain, making them less likely candidates for postoperative pain assessment.
5. A 12-month-old infant has been diagnosed with failure to thrive (FTT). Which assessment findings does the nurse expect to be documented with this infant?
- A. Fear of strangers
- B. Minimal smiling
- C. Avoidance of eye contact
- D. All of the above
Correct answer: D
Rationale: These behaviors are consistent with FTT and indicate social withdrawal, which is often observed in infants who are not thriving. A wide-eyed gaze and avoidance of eye contact can also indicate developmental delays or emotional disturbances.
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