ATI RN
RN Nursing Care of Children 2019 With NGN
1. In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information?
- A. Limit fluids to reduce reflux.
- B. Give cranberry juice twice a day.
- C. Have siblings examined for VUR.
- D. Surgery is indicated to reverse scarring.
Correct answer: C
Rationale: Siblings should be examined for VUR as it can run in families, and early detection can prevent complications. Limiting fluids is not advisable, and cranberry juice is not effective in preventing VUR. Surgery is usually not indicated for scarring reversal.
2. Picking up a pencil demonstrates the ability to use which of the following?
- A. Pincer grasp
- B. Prehension
- C. Parachute reflex
- D. Grasp reflex
Correct answer: A
Rationale: Picking up a pencil requires the use of the pincer grasp, which involves the coordination of the thumb and forefinger to hold small objects. The pincer grasp is a fine motor skill essential for tasks that necessitate precision and dexterity. Choices B, C, and D are incorrect. Prehension refers to the act of grasping or holding an object, parachute reflex is a protective response to sudden movement or loss of support, and grasp reflex is an automatic closing of the hand when an object is placed in the palm, none of which specifically relate to the action of picking up a pencil.
3. 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?
- A. Reassess the child in 15 minutes to see if the pain rating has changed
- B. Administer the prescribed analgesic
- C. Do nothing since the child appears to be resting
- D. Ask the child’s parents if they think the child is hurting
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.
4. At which age do most infants begin to fear strangers?
- A. 2 months
- B. 4 months
- C. 6 months
- D. 12 months
Correct answer: C
Rationale: Fear of strangers typically begins around 6 months as infants start recognizing familiar and unfamiliar faces, which is part of their social development.
5. The nurse is planning care for a hospitalized preschool-aged child. Which should the nurse plan to ensure atraumatic care?
- A. Limit explanation of procedures because the child is preschool-aged
- B. Ask that all family members leave the room when performing procedures
- C. Allow the child to choose the type of juice to drink with the administration of oral medications
- D. Explain that EMLA cream cannot be used for the morning lab draw because there is not time for it to be effective
Correct answer: C
Rationale: Allowing the child to make choices, such as selecting the type of juice, helps to maintain a sense of control and reduce anxiety, ensuring atraumatic care.
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