during the nurses initial assessment of a school age child the child reports a pain level of 6 out of 10 the child is lying quietly in bed watching te
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Nursing Elites

ATI RN

RN Nursing Care of Children Online Practice 2019 A

1. During the nurse’s initial assessment of a school-age child, the child reports a pain level of 6 out of 10. The child is lying quietly in bed watching television. What action should the nurse take?

Correct answer: B

Rationale: Pain management should be based on the child’s report of pain, regardless of their activity level. Administering the prescribed analgesic is the appropriate action. Reassessing the child in 15 minutes without providing immediate pain relief may not be in the child's best interest. Doing nothing since the child appears to be resting may lead to inadequate pain management. Asking the child’s parents if they think the child is hurting does not replace the need for direct assessment and intervention by the nurse.

2. The nurse is administering activated charcoal to a preschool child with acetaminophen (Tylenol) poisoning. What potential complications from the use of activated charcoal should the nurse plan to assess for?

Correct answer: C

Rationale: Common complications of activated charcoal administration include diarrhea and vomiting. Intestinal obstruction can occur if the charcoal forms a mass in the intestines. Fluid retention is less likely and not typically a complication associated with activated charcoal.

3. The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which?

Correct answer: D

Rationale: A child with a BMI greater than the 95th percentile is classified as obese, according to standard growth charts used in pediatric practice.

4. Which laboratory test would be most important for the nurse to assess when caring for a toddler suspected of having cystic fibrosis?

Correct answer: C

Rationale: The sweat chloride test is the primary diagnostic test for cystic fibrosis. Cystic fibrosis is characterized by abnormal transport of chloride and sodium across epithelial cell membranes, leading to increased chloride in sweat. This test is crucial for diagnosing cystic fibrosis in suspected cases. Liver enzymes (Choice A), serum calcium (Choice B), and urine creatinine (Choice D) are not specific tests for cystic fibrosis and would not provide the necessary information for diagnosis in this case.

5. The school nurse is explaining to older school children that obesity increases the risk for which disorders? (Select all that apply.)

Correct answer: D

Rationale: Obesity increases the risk for conditions like asthma, hypertension, dyslipidemia, and altered glucose metabolism, but not typically irritable bowel disease.

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