ATI RN
Nursing Care of Children ATI
1. An infant, age 5 months, is brought to the clinic by his parents for a well-baby checkup. What is the best advice that the nurse should include at this time about injury prevention?
- A. Keep buttons, beads, and other small objects out of his reach.
- B. Do not permit him to chew paint from window ledges because he might absorb too much lead.
- C. When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall.
- D. Lock the crib sides securely because he may stand and lean against them and fall out of bed.
Correct answer: A
Rationale: Small objects are a choking hazard for infants, so it is crucial to keep them out of reach to prevent injury.
2. What is a primary consideration for complications when planning nursing care for an infant with Meconium aspiration syndrome?
- A. Hypoglycemia
- B. Bowel obstruction
- C. Airway obstruction
- D. Carbon dioxide retention
Correct answer: C
Rationale: The correct answer is C: Airway obstruction. When planning nursing care for an infant with Meconium aspiration syndrome, a primary consideration for complications is the potential of airway obstruction. After the passage of meconium into the amniotic fluid, the infant may inhale or swallow the fluid, leading to meconium aspiration into the lower airways and causing a partial airway obstruction. This can result in respiratory distress and hypoxemia. Hypoglycemia (choice A) is a metabolic condition unrelated to meconium aspiration. Bowel obstruction (choice B) with meconium may indicate other conditions like cystic fibrosis or Hirschsprung disease, not directly related to meconium aspiration syndrome. Carbon dioxide retention (choice D) is not a primary consideration in meconium aspiration syndrome; instead, the focus is on addressing the airway obstruction and potential respiratory compromise.
3. The mother of a 6-year-old boy who has recently had surgery for the removal of his tonsils and adenoids complains that he has begun sucking his thumb again. Which defense mechanism should the nurse include when responding to the mother?
- A. Repression
- B. Regression
- C. Rationalization
- D. Fantasy
Correct answer: B
Rationale: The correct answer is B: Regression. Regression is a common defense mechanism where a child reverts to an earlier stage of development, such as thumb-sucking, to cope with stress. In this scenario, the 6-year-old boy is using thumb-sucking (a behavior typical of earlier developmental stages) as a way to deal with the stress of surgery. Repression (choice A) involves unconsciously blocking out thoughts or feelings, which is not applicable in this case. Rationalization (choice C) is a defense mechanism where illogical or unreasonable explanations are provided to justify behavior, which is not relevant here. Fantasy (choice D) refers to the use of imagination to escape from reality, which is also not the appropriate defense mechanism for the situation described.
4. What are classified as hydrocarbon poisons?
- A. All below
- B. Gasoline
- C. Turpentine
- D. Lighter fluid
Correct answer: A
Rationale: Hydrocarbon poisons include substances like gasoline, turpentine, and lighter fluid, which are typically liquids derived from petroleum. Bleach is a corrosive substance, not a hydrocarbon.
5. The nurse is discussing development and play activities with the parent of a 2-month-old boy. Which statement by the parent would indicate a correct understanding of the teaching?
- A. I can give my baby a ball of yarn to pull apart or different textured fabrics to feel
- B. I can use a music box and soft mobiles as appropriate play activities for my baby
- C. I should introduce a cup and spoon or push-pull toys for my baby at this age
- D. I do not have to worry about appropriate play activities at this age
Correct answer: B
Rationale: At 2 months, infants are most stimulated by visual and auditory activities, such as a music box or soft mobiles. These activities help in sensory development and are appropriate for this age.
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