ATI RN
RN Nursing Care of Children Online Practice 2019 A
1. Frequent urine tests for specific gravity are required on a 6-month-old infant. What method is the most appropriate way to collect small amounts of urine for these tests?
- A. Apply a urine collection bag to the perineal area.
- B. Tape a small medicine cup inside of the diaper.
- C. Aspirate urine from cotton balls inside the diaper with a syringe without a needle.
- D. Use a syringe without a needle to aspirate urine from a superabsorbent disposable diaper.
Correct answer: C
Rationale: Aspirating urine from cotton balls inside the diaper is a minimally invasive method and effective for collecting small amounts of urine. Using a collection bag can be more cumbersome, and other methods are not as effective for this age.
2. Which disease would require strict isolation of the patient?
- A. Mumps
- B. Chickenpox
- C. Exanthema subitum (roseola)
- D. Erythema infectiosum (fifth disease)
Correct answer: B
Rationale: The correct answer is B: Chickenpox. Chickenpox is highly infectious and is transmitted through direct contact, droplet spread, and contaminated objects. Due to its high communicability, strict isolation of the patient is necessary to prevent the spread of the disease. Mumps is primarily transmitted through direct contact with the infected person's saliva, with peak contagiousness before the onset of swelling. Exanthema subitum (roseola) has an unknown transmission source. Erythema infectiosum (fifth disease) is contagious before the appearance of symptoms. Therefore, these diseases do not require the same level of strict isolation as chickenpox.
3. The nurse is preparing a presentation on compensated, decompensated, and irreversible shock in children. What clinical manifestations related to decompensated shock should the nurse include? (Select all that apply.)
- A. All below
- B. Oliguria
- C. Confusion
- D. Pale extremities
Correct answer: A
Rationale: Decompensated shock is characterized by signs such as oliguria, confusion, pale extremities, hypotension, and a thready pulse. These indicate that the body is no longer able to maintain adequate circulation to vital organs.
4. What is the most appropriate action for a child with epistaxis?
- A. Have the child lie flat
- B. Pinch the nose and lean forward
- C. Apply a warm compress to the nose
- D. Encourage deep breathing
Correct answer: B
Rationale: The most appropriate action for a child with epistaxis is to pinch the nose and lean forward. This technique helps stop the bleeding and prevent aspiration of blood. By applying pressure to the bleeding vessels and allowing the blood to drain out of the nostrils instead of being swallowed, the risk of nausea and airway obstruction is reduced. Having the child lie flat (Choice A) may lead to blood flowing down the throat, causing potential choking. Applying a warm compress (Choice C) is not typically recommended for epistaxis as cold compresses are more effective. Encouraging deep breathing (Choice D) is not directly related to managing epistaxis.
5. Which immunization should the nurse include in a teaching session for parents of toddler-age clients to decrease the risk for epiglottitis?
- A. Hepatitis B
- B. Polio
- C. Measles, mumps, and rubella (MMR)
- D. Hemophilus influenzae type B (Hib)
Correct answer: D
Rationale: The correct answer is D, Hemophilus influenzae type B (Hib) vaccine. Hib vaccine is crucial in preventing epiglottitis, a serious respiratory condition caused by Haemophilus influenzae type b bacteria. This vaccine is recommended for toddlers to protect them from developing epiglottitis. Choices A, B, and C are incorrect because while they are important vaccines for children, they do not specifically target the prevention of epiglottitis, unlike the Hib vaccine.
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