ATI RN
Nursing Care of Children ATI
1. By which age should the nurse expect that an infant will be able to pull to a standing position?
- A. 5 to 6 months
- B. 7 to 8 months
- C. 11 to 12 months
- D. 14 to 15 months
Correct answer: C
Rationale: Pulling to a standing position typically occurs between 11 to 12 months, marking the progression towards walking.
2. A child with nephrotic syndrome is severely edematous. The primary healthcare provider has placed the child on bed rest. Which nursing intervention should be included in the plan of care?
- A. Monitor blood pressure every 30 minutes.
- B. Reposition the child every two hours.
- C. Limit visitors.
- D. Encourage fluids.
Correct answer: B
Rationale: Repositioning the child every two hours is essential to prevent pressure ulcers and promote circulation, especially when the child is on bed rest and experiencing severe edema. Monitoring blood pressure is important but does not need to be done every 30 minutes unless indicated. Limiting visitors and encouraging fluids are not directly related to managing edema and preventing complications from immobility. Therefore, choice B is the most appropriate nursing intervention in this scenario.
3. What is the recommended method to assess hydration status in infants?
- A. Capillary refill time
- B. Skin turgor
- C. Urine output
- D. Mucous membranes
Correct answer: C
Rationale: The correct answer is C: Urine output. Assessing urine output is a recommended method to determine hydration status in infants. Adequate urine output indicates good hydration, while decreased urine output may suggest dehydration. Capillary refill time (Choice A) is more indicative of circulatory status rather than hydration. Skin turgor (Choice B) is a useful assessment in adults but can be less reliable in infants. Checking mucous membranes (Choice D) can provide some information on hydration, but it is not as reliable as assessing urine output in infants.
4. Which parameter correlates best with measurements of total muscle mass?
- A. Height
- B. Weight
- C. Skinfold thickness
- D. Upper arm circumference
Correct answer: D
Rationale: Upper arm circumference correlates best with total muscle mass because it includes both muscle and fat components, making it a reliable indicator of muscle mass.
5. What does the Hib conjugate vaccine protect against?
- A. Bacterial meningitis
- B. Epiglottitis
- C. Bacterial pneumonia
- D. All Correct
Correct answer: D
Rationale: The Hib conjugate vaccine is crucial for protecting children from several severe infections caused by Haemophilus influenzae type b, including bacterial meningitis, epiglottitis, bacterial pneumonia, septic arthritis, and sepsis. Therefore, all the provided options are correct. Bacterial meningitis, epiglottitis, and bacterial pneumonia are serious conditions that the Hib vaccine effectively prevents, making choice D the correct answer. Choices A, B, and C are incorrect when considered individually as the Hib vaccine does not protect against only one specific infection; rather, it provides immunity against multiple diseases caused by Haemophilus influenzae type b.
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