ATI RN
RN Nursing Care of Children 2019 With NGN
1. A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.)
- A. Dialysis
- B. All below
- C. Sodium bicarbonate
- D. Glucose 50% and insulin
Correct answer: A
Rationale: Calcium gluconate, sodium bicarbonate, and glucose with insulin are used as temporary measures to rapidly reduce serum potassium levels. They help shift potassium into cells and stabilize the heart but do not remove potassium from the body like dialysis does.
2. What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)?
- A. Nausea, vomiting
- B. Weakness, fatigue
- C. Muscle hypotonicity
- D. Neuromuscular irritability
Correct answer: D
Rationale: Hypocalcemia can lead to neuromuscular irritability, causing symptoms such as muscle cramps, tetany, or seizures. Other symptoms like nausea, vomiting, and weakness are less specific and can be related to various conditions.
3. What statement best describes Hirschsprung disease?
- A. The colon has an aganglionic segment.
- B. It results in frequent evacuation of solids, liquid, and gas.
- C. The neonate passes excessive amounts of meconium.
- D. It results in excessive peristaltic movements within the gastrointestinal tract.
Correct answer: A
Rationale: Hirschsprung disease is characterized by the absence of ganglion cells in a segment of the colon, leading to a lack of peristalsis and obstruction. The other options do not accurately describe this condition.
4. The nurse is providing anticipatory guidance to the parent of a 9-month-old infant during a well-baby visit. Which topic would be most appropriate?
- A. Cautioning about putting the infant in a walker
- B. Advising how to create a toddler-safe home
- C. Instructing on safety procedures during baths
- D. Warning about leaving small objects on the floor
Correct answer: D
Rationale: The correct answer is D because at 9 months, infants become more mobile, increasing the risk of choking hazards from small objects left on the floor. Cautioning about putting the infant in a walker (Choice A) is not as crucial at this age as warning about choking hazards. While advising how to create a toddler-safe home (Choice B) is essential, the most critical concern at 9 months is small objects. Instructing on safety procedures during baths (Choice C) is important but does not address the immediate risk of choking hazards associated with small objects.
5. Which disease requires strict isolation due to its mode of transmission?
- A. Mumps
- B. Chickenpox
- C. Exanthema subitum (roseola)
- D. Erythema infectiosum (fifth disease)
Correct answer: B
Rationale: The correct answer is Chickenpox (choice B). Chickenpox is highly communicable and requires strict isolation to prevent the spread of the virus through direct contact, droplet transmission, and contaminated objects. Mumps (choice A) is also contagious but does not typically require strict isolation. Exanthema subitum (roseola) (choice C) and Erythema infectiosum (fifth disease) (choice D) are not as highly contagious as chickenpox and do not necessitate strict isolation.
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