ATI RN
RN Nursing Care of Children 2019 With NGN
1. A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor?
- A. Flank pain rarely occurs in children with renal injuries.
- B. Few nonpenetrating injuries cause renal trauma in children.
- C. Kidneys are immobile, well protected, and rarely injured in children.
- D. The amount of hematuria is not a reliable indicator of the seriousness of renal injury.
Correct answer: D
Rationale: The amount of hematuria is not a reliable indicator of the severity of renal trauma, as even minor injuries can cause significant bleeding, while severe injuries may result in little or no visible blood. Renal trauma should be evaluated through imaging and clinical assessment.
2. The nurse is caring for a 2-year-old child in the postoperative period. Which pain assessment tool is most appropriate for assessing pain intensity in a 2-year-old?
- A. Poker chip tool
- B. Oucher Scale
- C. Faces Pain Rating Scale
- D. FLACC Behavioral Pain Assessment Scale
Correct answer: D
Rationale: The FLACC Behavioral Pain Assessment Scale is the most suitable tool for assessing pain in 2-year-old children postoperatively. It assesses pain by evaluating facial expression, leg movement, activity, cry, and consolability, making it effective for non-verbal children. The Poker chip tool is not appropriate for this age group. The Oucher Scale and Faces Pain Rating Scale are more suitable for older children who can self-report pain levels.
3. The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe?
- A. Fever
- B. Vomiting
- C. Tachycardia
- D. All of the above
Correct answer: D
Rationale: Correct! Typical signs of appendicitis include fever, vomiting, and tachycardia due to infection and inflammation. These clinical manifestations are commonly observed in patients with appendicitis. Hyperactive bowel sounds are not typically associated with appendicitis, so they are not expected findings in this situation. Therefore, the correct answer is 'All of the above.'
4. Which family theory is described as a series of tasks for the family throughout its life span?
- A. Exchange theory
- B. Developmental theory
- C. Structural-functional theory
- D. Symbolic interactional theory
Correct answer: B
Rationale: Developmental theory outlines the series of tasks and stages that a family goes through over its life span, helping to understand the family's development and needs over time.
5. The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?
- A. Hypertension
- B. Pain at the entry site
- C. Fever and general malaise
- D. Redness and swelling at the entry site
Correct answer: C
Rationale: Fever and general malaise are systemic signs of bacteremia, indicating that the infection may have spread beyond the local entry site. Localized pain, redness, and swelling are signs of a localized infection but do not necessarily indicate bacteremia.
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