ATI RN
Nursing Care of Children ATI
1. In the newborn, into what muscle is intramuscular vitamin K administered?
- A. Deltoid
- B. Dorsogluteal
- C. Rectus femoris
- D. Vastus lateralis
Correct answer: D
Rationale: In newborns, intramuscular vitamin K is traditionally administered into the vastus lateralis muscle. This site is preferred due to its large muscle mass and accessibility. The dorsogluteal site is not recommended for newborns due to the risk of injury to the sciatic nerve. The deltoid site is also not recommended for newborns. The rectus femoris muscle is not commonly used for intramuscular injections in newborns.
2. What findings would the nurse consider normal in assessing the anterior fontanel of a neonate?
- A. Closed anterior fontanel
- B. Sunken anterior fontanel
- C. Bulging anterior fontanel
- D. Pulsating anterior fontanel
Correct answer: D
Rationale: The correct answer is D: Pulsating anterior fontanel. The fontanel should feel flat, firm, and well demarcated. Pulsations are frequently visible at the anterior fontanel, which is a normal finding in a neonate. A closed anterior fontanel, as mentioned, is a potential sign of a major abnormality. A sunken or bulging fontanel (when the infant is quiet) may be indicative of distress or a major abnormality. Therefore, options A, B, and C are considered abnormal findings when assessing the anterior fontanel of a neonate.
3. What is the most important intervention in the management of a child with sickle cell crisis?
- A. Administration of iron supplements
- B. Initiation of high-calorie diet
- C. Administration of pain relief
- D. Limiting fluid intake
Correct answer: C
Rationale: The most important intervention in managing a child with sickle cell crisis is the administration of pain relief. During a sickle cell crisis, severe pain is a prominent symptom due to vaso-occlusive episodes. Effective pain management, along with adequate hydration and oxygen therapy, is crucial in treating a sickle cell crisis and preventing further complications. Choice A, the administration of iron supplements, is not the priority during a sickle cell crisis. Iron supplements are typically used to manage anemia in individuals with sickle cell disease but are not the primary intervention during a crisis. Choice B, the initiation of a high-calorie diet, is not the most critical intervention during a sickle cell crisis. While proper nutrition is important in managing sickle cell disease, it is not the immediate priority during a crisis. Choice D, limiting fluid intake, is not recommended during a sickle cell crisis. Hydration is essential in managing sickle cell crisis to prevent complications like dehydration and further vaso-occlusive episodes.
4. The school nurse is assessing children for risk factors related to childhood injuries. Which child has the most risk factors related to childhood injury?
- A. Female, multiple siblings, stable home life
- B. Male, high activity level, stressful home life
- C. Male, even-tempered, history of previous injuries
- D. Female, reacts negatively to new situations, no serious previous injuries
Correct answer: B
Rationale: A male child with a high activity level and a stressful home life has multiple risk factors for childhood injuries, requiring closer supervision and preventive measures.
5. Which is an accurate description of homosexual (or gay-lesbian) families?
- A. A nurturing environment is lacking.
- B. The children become homosexual like their parents.
- C. The stability needed to raise healthy children is lacking.
- D. The quality of parenting is equivalent to that of nongay parents.
Correct answer: D
Rationale: Research shows that the quality of parenting in homosexual families is equivalent to that in heterosexual families, and children thrive in nurturing environments provided by same-sex parents.
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