ATI RN
RN Nursing Care of Children 2019 With NGN
1. A 12-year-old child had an appendectomy 18 hours ago. The nurse is monitoring the child for pain control. Which of the following tools is most appropriate for assessing the child’s pain?
- A. FLACC scale
- B. Numeric scale
- C. NIPS scale
- D. FACES scale
Correct answer: B
Rationale: The Numeric scale is the most appropriate tool for assessing pain in older children, like a 12-year-old, as they can comprehend and use numbers to indicate their pain levels accurately. The FLACC scale is typically used for nonverbal or preverbal children. The NIPS scale is designed for neonates and infants. The FACES scale is more commonly used in younger children who may have difficulty expressing their pain in other ways.
2. What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)
- A. Fever
- B. Hypotension
- C. All are applicable
- D. Swelling and tenderness of graft area
Correct answer: B
Rationale: 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.
3. When the nurse interviews an adolescent, which is especially important?
- A. Focus the discussion on the peer group
- B. Allow an opportunity to express feelings
- C. Use the same type of language as the adolescent
- D. Emphasize that confidentiality will always be maintained
Correct answer: B
Rationale: Allowing adolescents to express their feelings helps them feel heard and supported, which is crucial for effective communication.
4. The nurse is providing education to the parent of a child with Beta-thalassemia. Which risk factors about the condition should the nurse include in the teaching?
- A. Hypertrophy of the thyroid
- B. Polycythemia vera
- C. Thrombocytopenia
- D. Chronic hypoxia and iron overload
Correct answer: D
Rationale: The correct answer is D: Chronic hypoxia and iron overload. Children with Beta-thalassemia often suffer from chronic hypoxia due to ineffective erythropoiesis and require frequent blood transfusions, leading to iron overload. These complications must be managed to prevent organ damage. Choices A, B, and C are incorrect. Hypertrophy of the thyroid, polycythemia vera, and thrombocytopenia are not direct risk factors associated with Beta-thalassemia. Therefore, they should not be included in the teaching regarding this condition.
5. At what stage can infants raise their heads and gain control of their trunks before walking due to which directional pattern of development?
- A. Cephalocaudal
- B. Anterior to posterior
- C. Proximodistal
- D. Normal growth curve charts
Correct answer: A
Rationale: The correct answer is A: Cephalocaudal. The cephalocaudal pattern of development means that growth and motor control proceed from the head downward through the body. This explains why infants can raise their heads before they can sit and gain control of their trunks before walking. Choices B, C, and D are incorrect. Anterior to posterior refers to development from the front to the back, while proximodistal refers to development from the center of the body outward. Normal growth curve charts are used to track physical growth over time and are not directly related to the directional pattern of development in infants.
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