ATI RN
Nursing Care of Children Final ATI
1. A child is admitted to the hospital with acute renal failure. The parents ask about the prognosis for acute renal failure. The nurse’s response should be based on which statement about acute renal failure?
- A. Children with acute renal failure will have to take prophylactic antibiotics for life.
- B. Acute renal failure always leads to chronic renal failure.
- C. Acute renal failure may be reversible.
- D. All children with acute renal failure will eventually need a kidney transplant.
Correct answer: C
Rationale: The correct answer is C: Acute renal failure in children is often reversible, especially when the underlying cause is identified and treated promptly. It does not always lead to chronic renal failure or the need for a kidney transplant. Choice A is incorrect as prophylactic antibiotics for life are not a standard treatment for acute renal failure. Choice B is incorrect as acute renal failure does not always progress to chronic renal failure. Choice D is incorrect as not all children with acute renal failure will eventually require a kidney transplant.
2. In what condition should the nurse be alert for altered fluid requirements in children? (Select all that apply.)
- A. Oliguric renal failure
- B. Increased intracranial pressure
- C. Mechanical ventilation
- D. All above
Correct answer: D
Rationale: Conditions like oliguric renal failure, increased intracranial pressure, and mechanical ventilation significantly alter fluid requirements in children. These conditions either restrict fluid output or require careful fluid management to avoid worsening the condition.
3. Which reflex is expected to disappear by 4 months of age?
- A. Rooting reflex
- B. Moro reflex
- C. Babinski reflex
- D. Palmar grasp
Correct answer: B
Rationale: The Moro reflex, also known as the startle reflex, typically disappears by 4 months as the infant's nervous system matures. This reflex is important for assessing the development of the nervous system in newborns. The Rooting reflex (Choice A) is related to turning the head in response to cheek stimulation; the Babinski reflex (Choice C) involves the fanning of toes in response to foot stimulation; and the Palmar grasp (Choice D) is the curling of the fingers around an object placed in the infant's hand. These reflexes have different timelines for disappearance and are not typically expected to be gone by 4 months of age.
4. What is an essential nursing care intervention for a neonate with a suspected tracheoesophageal fistula?
- A. Feed glucose water only.
- B. Elevate the patient's head for feedings.
- C. Raise the patient's head and give nothing by mouth.
- D. Avoid suctioning unless the infant is cyanotic.
Correct answer: C
Rationale: Raising the patient’s head and giving nothing by mouth is crucial in managing tracheoesophageal fistula. This intervention helps prevent aspiration and further complications until surgical correction can be performed. Feeding the neonate or suctioning could exacerbate the condition by risking aspiration. Elevating the head for feedings does not address the primary concern of preventing oral intake, making it less appropriate than the correct answer.
5. One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation?
- A. Pain
- B. Rectal bleeding
- C. Perianal lesions
- D. Growth retardation
Correct answer: B
Rationale: Rectal bleeding is more commonly associated with ulcerative colitis (UC) than with Crohn disease (CD). While both conditions can cause abdominal pain and growth issues, bleeding is a hallmark of UC due to its superficial mucosal inflammation. Perianal lesions are more characteristic of CD, and growth retardation is typically not a direct clinical manifestation of either CD or UC.