ATI RN
Nursing Care of Children Final ATI
1. Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined?
- A. Ethnicity
- B. Racial variation
- C. Status
- D. Geographic boundaries
Correct answer: C
Rationale: Status, or the social standing within a culture, is often culturally determined and plays a significant role in shaping behaviors and expectations.
2. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." Which is the nurse's most appropriate answer?
- A. "I'm sure he'll be fine if you get a good babysitter."
- B. "You will need to stay home until Eric starts school."
- C. "Let's talk about the childcare options that will be best for Eric."
- D. "You should go back to work so Eric will get used to being with others."
Correct answer: C
Rationale: The best approach is to discuss childcare options that would suit Eric's needs, allowing the mother to make an informed decision without guilt or pressure.
3. Which of the following is a hallmark sign of intussusception in children?
- A. Bilious vomiting
- B. "Currant jelly" stools
- C. Abdominal distention
- D. Constipation
Correct answer: B
Rationale: "Currant jelly" stools, consisting of mucus and blood, are characteristic of intussusception in children. It occurs due to the telescoping of a segment of the intestine into an adjacent segment, leading to obstruction and subsequent mucosal ischemia, causing the passage of bloody mucus in the stool. Bilious vomiting can be seen in other conditions like bowel obstruction, abdominal distention can be present but is not as specific, and constipation is less likely in the presentation of intussusception.
4. What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock?
- A. Thirst
- B. Irritability
- C. Apprehension
- D. Confusion and somnolence
Correct answer: D
Rationale: As shock progresses and decompensation occurs, confusion and somnolence are indicative of reduced cerebral perfusion. Early signs include thirst and irritability, while confusion and altered consciousness appear as the condition worsens.
5. What interventions should be implemented to maintain the skin integrity of a preterm infant born at 30 weeks?
- A. Avoid cleaning the skin
- B. Bathe the infant with sterile water
- C. Cleanse the skin with a gentle alkaline-based soap and water
- D. Thoroughly rinse the skin with plain water after bathing
Correct answer: B
Rationale: The correct intervention to maintain the skin integrity of a preterm infant born at 30 weeks is to bathe the infant with sterile water. Bathing with sterile water or a neutral pH solution is recommended to protect the delicate skin of preterm infants, which is more permeable and prone to damage. Choices A, C, and D are incorrect as avoiding cleaning the skin may lead to hygiene issues, cleansing with alkaline-based soap can be harsh on the delicate skin, and thoroughly rinsing with plain water after bathing may not be as gentle and protective for preterm infants.
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