ATI RN
RN Nursing Care of Children 2019 With NGN
1. A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube?
- A. Prevent the spread of infection.
- B. Monitor electrolyte balance.
- C. Prevent abdominal distention.
- D. Maintain accurate records of output.
Correct answer: C
Rationale: The primary purpose of an NG tube post-surgery for Hirschsprung disease is to prevent abdominal distention by decompressing the stomach and intestines. This helps prevent complications and promotes healing.
2. A 10-year-old male is stung by a bee while playing in the yard. He begins itching and develops pain, swelling, redness, and respiratory difficulties. He is suffering from:
- A. Immunodeficiency
- B. Autoimmunity
- C. Anaphylaxis
- D. Tissue-specific hypersensitivity
Correct answer: C
Rationale: The correct answer is C: Anaphylaxis. Anaphylaxis is a severe, immediate allergic reaction mediated by IgE. In this scenario, the symptoms of itching, pain, swelling, redness, and respiratory difficulties following a bee sting are indicative of anaphylaxis. Choice A, Immunodeficiency, refers to a weakened immune system's inability to protect the body from infections and diseases, which is not the case here. Choice B, Autoimmunity, involves the immune system attacking healthy cells and tissues by mistake, which is not the mechanism at play in anaphylaxis. Choice D, Tissue-specific hypersensitivity, does not accurately describe the immediate, systemic reaction seen in anaphylaxis.
3. The nurse is assessing a client who had a cast placed 4 hours ago. What assessment finding is cause for concern?
- A. The nurse assesses capillary refill of 2 seconds
- B. The nurse cannot insert one finger between the cast and the skin
- C. The nurse finds 2+ pulses distal from the cast
- D. The nurse does not observe any drainage
Correct answer: B
Rationale: Inability to insert a finger between the cast and skin indicates the cast is too tight, risking circulation problems.
4. A client with a history of preterm labor is reviewing a new prescription for Terbutaline. Which of the following client statements indicates understanding of the teaching?
- A. I will increase my daily fluid intake to 3 quarts.
- B. I can increase my activity now that I've started on this medication.
- C. I will report increasing intensity of contractions to my doctor.
- D. I am glad this will prevent preterm labor.
Correct answer: C
Rationale: The correct answer is C. The client should report increasing intensity, frequency, or duration of contractions to the provider because these are manifestations of preterm labor. This response demonstrates the client's understanding of the importance of monitoring contractions and seeking appropriate medical attention. Choices A, B, and D are incorrect because increasing fluid intake, increasing activity, or assuming the medication will prevent preterm labor are not relevant actions in managing preterm labor or taking Terbutaline.
5. Listed below are five categories that identify the responsibilities of the practical nurse manager in personnel management. Which of these categories is most appropriate for the task 'Know what your soldiers are doing during duty hours'?
- A. Accountability
- B. Personal/professional development
- C. Individual training
- D. Military appearance/physical condition
Correct answer: A
Rationale: The correct answer is A: Accountability. Accountability involves knowing what individuals are doing during duty hours, ensuring they are responsible and answerable for their actions. Personal/professional development (choice B) refers to enhancing one's skills and knowledge, individual training (choice C) focuses on specific training needs, and military appearance/physical condition (choice D) pertains to the physical presentation and fitness of individuals, not directly related to knowing what they are doing during duty hours.
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