ATI RN
Nursing Care of Children ATI
1. In terms of gross motor development, what should the nurse expect an infant age 5 months to do?
- A. Sit erect without support
- B. Roll from the back to the abdomen
- C. Turn from the abdomen to the back
- D. Move from a prone to a sitting position
Correct answer: C
Rationale: At 5 months, infants typically can turn from their abdomen to their back. Rolling from back to abdomen and sitting erect without support occur later.
2. An infant has been diagnosed with bladder obstruction. What do symptoms of this disorder include?
- A. Renal colic
- B. Strong urinary stream
- C. Urinary tract infections
- D. Post urination dribbling
Correct answer: D
Rationale: Post-urination dribbling is a symptom of bladder obstruction due to the incomplete emptying of the bladder. A strong urinary stream is typically absent in such cases. UTIs are common, but dribbling is more directly related to the obstruction.
3. 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.
4. What amount of fluid loss occurs with moderate dehydration?
- A. <50 ml/kg
- B. 50 to 90 ml/kg
- C. <5% total body weight
- D. >15% total body weight
Correct answer: B
Rationale: Moderate dehydration is typically defined as a loss of 50 to 90 mL/kg of body weight. This amount reflects significant fluid loss that requires medical attention but is not yet severe.
5. After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time?
- A. Notify the healthcare provider.
- B. Insert a new NG tube for feedings.
- C. Replace the NG tube to maintain gastric decompression.
- D. Leave the NG tube out as it may have been in long enough.
Correct answer: A
Rationale: The most appropriate action for the nurse to take in this situation is to notify the healthcare provider immediately. This is important as the removal of the NG tube can disrupt postoperative care, especially in terms of maintaining gastric decompression. Inserting a new NG tube without practitioner direction can be unsafe and is not within the nurse's scope of practice. Similarly, replacing the NG tube or leaving it out should be decided by the healthcare provider to ensure the infant's safety and appropriate postoperative care.
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