ATI RN
Nursing Care of Children ATI
1. Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the “finger-to-nose test.†What is the purpose of this test?
- A. Deep tendon reflexes
- B. Cerebellar function
- C. Sensory discrimination
- D. Ability to follow directions
Correct answer: B
Rationale: The finger-to-nose test assesses cerebellar function, which is responsible for balance and coordination. The test evaluates how well the cerebellum controls motor functions and coordination. Choice A, deep tendon reflexes, is incorrect because this test does not assess reflexes but rather cerebellar function. Choice C, sensory discrimination, is incorrect as this test focuses on motor function rather than sensory abilities. Choice D, ability to follow directions, is incorrect since the test primarily assesses motor coordination and not cognitive skills related to following instructions.
2. The nurse is preparing to admit a 7-year-old child with Crohn disease. What clinical manifestations should the nurse expect to observe?
- A. Pain is common.
- B. Weight loss is severe.
- C. All are correct.
- D. Diarrhea is moderate to severe.
Correct answer: C
Rationale: The correct answer is C because Crohn's disease commonly presents with pain, severe weight loss, and moderate to severe diarrhea in affected individuals. Therefore, all the manifestations listed are typically observed in patients with Crohn's disease. Choice A alone is not sufficient as weight loss and diarrhea are also prominent symptoms. Choice B is incorrect as it only mentions weight loss, omitting other common manifestations. Choice D is also incorrect as it does not cover the full range of expected clinical signs in Crohn's disease.
3. The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?
- A. Hypertension
- B. Pain at the entry site
- C. Fever and general malaise
- D. Redness and swelling at the entry site
Correct answer: C
Rationale: Fever and general malaise are systemic signs of bacteremia, indicating that the infection may have spread beyond the local entry site. Localized pain, redness, and swelling are signs of a localized infection but do not necessarily indicate bacteremia.
4. The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching?
- A. Ice
- B. All are applicable
- C. Raw vegetables
- D. Unpeeled fruits
Correct answer: B
Rationale: The correct answer is B: All are applicable. Ice, raw vegetables, and unpeeled fruits can be sources of contamination in areas where water purity is questionable. It's safer to avoid these during a mission trip to prevent waterborne illnesses. Choice A (Ice), C (Raw vegetables), and D (Unpeeled fruits) are all potential sources of contamination in areas with questionable water quality. Including all these items in the teaching will help adolescents make informed decisions to stay healthy during their mission trip.
5. What is the best initial intervention for a child experiencing moderate dehydration?
- A. Administer IV fluids
- B. Encourage oral rehydration
- C. Monitor vital signs
- D. Provide clear fluids
Correct answer: B
Rationale: The correct answer is B: Encourage oral rehydration. Oral rehydration is the first-line treatment for moderate dehydration in children. It helps restore fluid balance and electrolyte levels. Administering IV fluids (Choice A) is usually reserved for severe cases of dehydration where oral rehydration is not feasible or ineffective. Monitoring vital signs (Choice C) is important but should not replace the immediate need for rehydration. Providing clear fluids (Choice D) may not contain the necessary electrolytes required for effective rehydration.
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