ATI RN
RN Nursing Care of Children Online Practice 2019 A
1. A 13-year-old boy comes to the school nurse complaining of sudden and severe scrotal pain. He denies any trauma to the scrotum. What is the most appropriate nursing action?
- A. Refer him for immediate medical evaluation
- B. Administer analgesics and recommend scrotal support.
- C. Apply an ice bag and observe for increasing pain.
- D. Reassure the adolescent that occasional pain is common with the changes of puberty.
Correct answer: A
Rationale: Sudden and severe scrotal pain in an adolescent male is a medical emergency and may indicate testicular torsion, which requires immediate evaluation and intervention to prevent testicular loss.
2. When examining heredity, mental disorders are almost always ________
- A. influenced by one particular gene.
- B. influenced by multiple genes.
- C. influenced by recessive genes.
- D. not influenced by genes.
Correct answer: B
Rationale: When examining heredity, mental disorders are influenced by multiple genes. Mental disorders are complex conditions that typically result from a combination of genetic, environmental, and other factors. While genetics play a significant role in predisposing individuals to mental disorders, it is rare for a single gene to be solely responsible for a mental disorder. Therefore, choice B is correct. Choices A, C, and D are incorrect because mental disorders are not usually influenced by one particular gene, recessive genes specifically, or not influenced by genes at all.
3. A client has a new prescription for Alendronate. Which of the following instructions should the nurse include?
- A. Take this medication at bedtime.
- B. Remain upright for 30 minutes after taking the medication.
- C. Take this medication with food.
- D. Increase your intake of calcium-rich foods.
Correct answer: B
Rationale: The correct answer is to instruct the client to remain upright for 30 minutes after taking Alendronate. Alendronate can cause esophageal irritation and even ulceration if it remains in contact with the esophagus. By staying upright, the medication is more likely to pass through the esophagus and into the stomach, reducing the risk of irritation and complications. Choice A is incorrect because Alendronate should be taken in the morning, not at bedtime, and the client should remain upright after taking it. Choice C is incorrect because Alendronate should be taken on an empty stomach, usually in the morning, to enhance absorption. Choice D is incorrect because while calcium intake is important, it is not directly related to the administration of Alendronate.
4. A nurse is teaching a patient with hypertension about the DASH diet. What is the most important instruction to include?
- A. Increase the patient's intake of fruits and vegetables.
- B. Limit the patient's intake of saturated fats.
- C. Encourage the patient to reduce sodium intake.
- D. Recommend the patient avoid caffeine.
Correct answer: C
Rationale: The correct answer is to encourage the patient to reduce sodium intake. The Dietary Approaches to Stop Hypertension (DASH) diet emphasizes reducing sodium intake to help manage hypertension. While increasing fruits and vegetables (Choice A) is important in the DASH diet, reducing sodium intake is considered more crucial. Limiting saturated fats (Choice B) is beneficial but not as critical as reducing sodium. Avoiding caffeine (Choice D) is not a specific recommendation of the DASH diet for managing hypertension.
5. The nurse aspirates 40 mL of undigested formula from the client’s nasogastric tube. Before administering an intermittent tube feeding, the nurse understands that the 40 mL of gastric aspirate should be
- A. Discarded properly and recorded as output on the client’s intake and output record.
- B. Poured into the nasogastric tube through a syringe with the plunger removed.
- C. Mixed with the formula and poured into the nasogastric tube through a syringe with the plunger removed.
- D. Diluted with water and injected into the nasogastric tube by putting pressure on the plunger.
Correct answer: B
Rationale: After checking the residual feeding contents, the gastric contents are reinstalled into the stomach by removing the syringe bulb or plunger and pouring the gastric contents into the syringe and through the nasogastric tube. Gastric contents should be reinstalled to maintain the client’s electrolyte balance. The gastric contents should be poured into the nasogastric tube through a syringe without a plunger and not injected by putting pressure on the plunger. Gastric contents do not need to be mixed with water or should the contents be discarded.
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