ATI RN
Nursing Care of Children Final ATI
1. Parents of a hospitalized toddler ask the nurse, "What is meant by family-centered care?" The nurse should respond with which statement?
- A. Family-centered care reduces the effect of cultural diversity on the family
- B. Family-centered care encourages family dependence on the health care system
- C. Family-centered care recognizes that the family is the constant in a child’s life
- D. Family-centered care avoids expecting families to be part of the decision-making process
Correct answer: C
Rationale: Family-centered care emphasizes the importance of the family as the constant in a child's life, involving them in all aspects of care and decision-making.
2. A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?
- A. Check the urine to see if hematuria has increased.
- B. Obtain the child's blood pressure and notify the healthcare provider.
- C. Obtain serum electrolytes and send urinalysis to the laboratory.
- D. Reassure the child and encourage bed rest until the headache improves.
Correct answer: B
Rationale: Blurred vision and headache in a child with acute glomerulonephritis may indicate severe hypertension, which requires immediate assessment and intervention. Blood pressure should be checked, and the healthcare provider notified.
3. The educator is teaching about the process of physical growth and development. Which of these describes the directional pattern from head to tail?
- A. Cephalodistal
- B. Cephalocaudal
- C. Proximodistal
- D. Proximocaudal
Correct answer: B
Rationale: Cephalocaudal development is the correct term that describes the directional pattern of growth from head to tail. This means that the head and upper body parts develop before the lower parts. Choice A, 'Cephalodistal,' refers to growth from the center of the body outward, not head to tail. Choice C, 'Proximodistal,' describes growth from the center of the body towards the extremities, not specifically from head to tail. Choice D, 'Proximocaudal,' is not a recognized term in the context of physical growth and development.
4. What intervention is contraindicated in a suspected case of appendicitis?
- A. Enemas
- B. Palpating the abdomen
- C. Administration of antibiotics
- D. Administration of antipyretics for fever
Correct answer: A
Rationale: Enemas are contraindicated in cases of suspected appendicitis because they can increase the risk of perforation. The pressure from the enema can exacerbate inflammation and potentially lead to the rupture of the appendix. Palpating the abdomen gently is essential for diagnosing appendicitis, as it helps identify the characteristic signs like rebound tenderness. Antibiotics are commonly used to treat the infection associated with appendicitis, and antipyretics are administered to manage fever, which is a common symptom of the condition. Therefore, enemas are the intervention to avoid in suspected appendicitis cases.
5. The nurse suspects fluid overload in an infant receiving intravenous fluids. What clinical manifestation is suggestive of water intoxication?
- A. Oliguria
- B. Weight loss
- C. Irritability and seizures
- D. Muscle weakness and cardiac dysrhythmias
Correct answer: C
Rationale: Water intoxication can lead to cerebral edema, causing neurological symptoms such as irritability and seizures. Oliguria, weight loss, and muscle weakness are not typical signs of water intoxication.
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