ATI RN
ATI Nursing Care of Children
1. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is which?
- A. Ask her why she wants to know.
- B. Determine why she is so anxious.
- C. Explain in simple terms how it works.
- D. Tell her she will see how it works as it is used.
Correct answer: C
Rationale: Providing a simple explanation satisfies the child's curiosity and helps reduce any anxiety about the procedure.
2. A nurse is assessing a client who is in active labor. Which of the following findings should the nurse report to the provider?
- A. Contractions lasting 80 seconds.
- B. FHR baseline 170/min.
- C. Early decelerations in the FHR.
- D. Temperature 37.4°C (99.3°F).
Correct answer: B
Rationale: The correct answer is B. An FHR baseline of 170/min is considered tachycardia, which is above the normal range during labor and requires immediate attention. High FHR can indicate fetal distress or maternal fever. Choice A, contractions lasting 80 seconds, are within normal range for active labor. Choice C, early decelerations in the FHR, are usually benign and do not typically require immediate intervention. Choice D, a temperature of 37.4°C (99.3°F), is within normal limits.
3. Which of the following categories identifies the focus of community/public health nursing practice?
- A. Promoting and maintaining the health of populations and preventing and minimizing the progress of disease
- B. Rehabilitation and restorative services
- C. Adaptation of hospital care to the home environment
- D. Hospice care delivery
Correct answer: C
Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.
4. Which of the following describes the pathophysiology of exercise-induced asthma?
- A. Bronchospasm after exercise
- B. IgE-mediated inflammatory response to antigen
- C. Bronchoconstriction after ingesting high-allergen foods
- D. Increased mucus production due to a genetic mutation
Correct answer: A
Rationale: The correct answer is A: 'Bronchospasm after exercise.' Exercise-induced asthma involves the narrowing of the airways (bronchospasm) triggered by physical activity. This bronchospasm leads to symptoms such as coughing, wheezing, and shortness of breath. Choices B, C, and D are incorrect because exercise-induced asthma is not primarily caused by an IgE-mediated inflammatory response to an antigen, bronchoconstriction after ingesting high-allergen foods, or increased mucus production due to a genetic mutation.
5. The patient taking spironolactone (Aldactone) makes a statement indicating effective teaching. Which statement shows understanding of the teaching?
- A. I will use salt substitutes to lower my sodium intake
- B. I will increase my intake of foods that are high in potassium
- C. I will call my doctor if I begin having menstrual irregularities
- D. I will take this medication at bedtime each evening
Correct answer: C
Rationale: The correct answer is C because spironolactone is a potassium-sparing diuretic that can cause endocrine effects like menstrual irregularities. Therefore, the patient recognizing the need to report such changes indicates effective teaching. Choices A and B are incorrect as salt substitutes and high-potassium foods should be avoided with spironolactone. Choice D is also incorrect because diuretics, including spironolactone, are ideally taken in the morning to prevent disturbances in sleep due to nocturia.
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