ATI RN
Nursing Care of Children Final ATI
1. At what stage can infants raise their heads and gain control of their trunks before walking due to which directional pattern of development?
- A. Cephalocaudal
- B. Anterior to posterior
- C. Proximodistal
- D. Normal growth curve charts
Correct answer: A
Rationale: The correct answer is A: Cephalocaudal. The cephalocaudal pattern of development means that growth and motor control proceed from the head downward through the body. This explains why infants can raise their heads before they can sit and gain control of their trunks before walking. Choices B, C, and D are incorrect. Anterior to posterior refers to development from the front to the back, while proximodistal refers to development from the center of the body outward. Normal growth curve charts are used to track physical growth over time and are not directly related to the directional pattern of development in infants.
2. An adolescent states, “I want to be a doctor or a lawyer when I grow up because I like taking care of people.” Which Eriksonian challenge is the adolescent attempting?
- A. Identity vs. role diffusion
- B. Trust vs. mistrust
- C. Industry vs. inferiority
- D. Autonomy vs. shame and doubt
Correct answer: A
Rationale: The correct answer is A: Identity vs. role diffusion. During adolescence, individuals face the challenge of forming a cohesive sense of self and identity. In this scenario, the adolescent's desire to become a doctor or lawyer reflects the exploration of potential roles and career paths, indicating an attempt to establish a clear identity. Choices B, C, and D are incorrect. Trust vs. mistrust is a challenge experienced in infancy, industry vs. inferiority is relevant to the school-age period, and autonomy vs. shame and doubt is associated with the toddler stage, not adolescence.
3. The charge nurse in the pediatric unit is teaching nursing students about pyloric stenosis. A student asks what causes pyloric stenosis. How should the nurse respond?
- A. One portion of the intestines invaginates or telescopes into another
- B. Hypertrophy of the circular pylorus muscle
- C. Relaxed cardiac sphincter
- D. Absent ganglion cells in the colon
Correct answer: B
Rationale: Pyloric stenosis is caused by the hypertrophy (thickening) of the circular muscle of the pylorus, leading to obstruction. Choice A is incorrect as it describes intussusception, not pyloric stenosis. Choice C is incorrect as a relaxed cardiac sphincter is related to gastroesophageal reflux. Choice D is incorrect as it describes Hirschsprung's disease, not pyloric stenosis.
4. An infant weighed 8 lb at birth and was 18 inches in length. What weight and length should the infant be at 5 months of age?
- A. 12 lb, 20 inches
- B. 14 lb, 21.5 inches
- C. 16 lb, 23 inches
- D. 18 lb, 24.5 inches
Correct answer: C
Rationale: By 5 months, an infant's weight should typically double from birth, and length should increase by approximately 50%.
5. In assessing sexual maturity levels, which tool would you expect to use?
- A. Denver II Developmental Screening
- B. Tanner staging
- C. Antibody testing
- D. Nursing process
Correct answer: B
Rationale: The correct answer is B: Tanner staging. Tanner staging is a tool specifically used to assess sexual maturity in adolescents based on the development of secondary sexual characteristics. The Tanner scale ranges from stage 1 (prepubertal) to stage 5 (adult maturity). This tool helps healthcare providers evaluate the physical development and sexual maturation of individuals. Choice A, the Denver II Developmental Screening, is used to assess developmental milestones in children. Choice C, antibody testing, is a diagnostic tool used to detect the presence of specific antibodies in the blood. Choice D, the nursing process, is a systematic method that nurses use to deliver patient-centered care, involving assessment, diagnosis, planning, implementation, and evaluation.
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