ATI RN
Nursing Care of Children ATI
1. The clinic nurse is assessing a child with a heavy ascariasis lumbricoides (common roundworm) infection. Which assessment findings should the nurse expect?
- A. Anemia
- B. Anorexia
- C. All are applicable
- D. Intestinal colic
Correct answer: D
Rationale: A heavy roundworm infection can cause anemia, anorexia, irritability, and an enlarged abdomen due to the worms’ effects on nutrient absorption and intestinal function.
2. The parent of a 1-month-old infant voices concern about the infant’s respirations. The parent states the respirations are rapid and irregular. Which information should the nurse provide?
- A. The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute.
- B. The respirations of a 1-month-old infant are normally irregular and periodically pause.
- C. An infant at this age should have regular respirations.
- D. The irregularity of the infant's respirations is concerning; I will notify the health care provider.
Correct answer: B
Rationale: The correct answer is B. Irregular respirations with periodic pauses are normal in a 1-month-old infant. Choice A is incorrect because the normal respiratory rate for an infant at this age is higher than the range provided. Choice C is incorrect as irregular respirations are expected in infants. Choice D is not appropriate as irregular respirations with periodic pauses are a normal finding in young infants and do not necessarily indicate a concern that requires immediate notification of the healthcare provider.
3. The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy?
- A. Help the toddler complete tasks
- B. Encourage the toddler to do things for themselves when capable
- C. Provide opportunities for the toddler to play with other children
- D. Help the toddler learn the difference between right and wrong
Correct answer: B
Rationale: Encouraging the toddler to do things for themselves when capable is the correct intervention to foster autonomy. This approach helps the toddler develop independence, self-confidence, and a sense of achievement. Choice A is incorrect as it focuses on assisting rather than encouraging independence. Choice C is incorrect as playing with other children primarily fosters social skills, not necessarily autonomy. Choice D is incorrect as learning the difference between right and wrong is related to moral development, not autonomy.
4. The parents of a 2-year-old boy who had a repair of exstrophy of the bladder at birth ask when they can begin toilet training their son. The nurse replies based on what knowledge?
- A. Most boys in the United States can be toilet trained at age 3 years.
- B. Training can begin when he has sufficient bladder capacity.
- C. Additional surgery may be necessary to achieve continence.
- D. They should begin now because he will require additional time.
Correct answer: B
Rationale: Toilet training should begin when the child has sufficient bladder capacity and control, which may be delayed in children who have undergone surgical repairs for conditions like bladder exstrophy. Premature training can lead to frustration and setbacks.
5. Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.)
- A. Regressive behavior
- B. Fear of abandonment
- C. Blame themselves for the divorce
- D. All of the above
Correct answer: D
Rationale: Preschool children may exhibit regressive behavior, fear abandonment, and blame themselves for their parents' divorce due to their limited understanding of the situation.
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