ATI RN
Nursing Care of Children ATI
1. What is the first sign of puberty in boys?
- A. Enlargement of testes
- B. Decreased levels of testosterone
- C. Voice deepening
- D. Pubic hair
Correct answer: A
Rationale: The first sign of puberty in boys is typically the enlargement of the testes. This is due to the increase in production of testosterone, which leads to physical changes such as growth of the testes. Choice B, decreased levels of testosterone, is incorrect as puberty is marked by an increase in testosterone levels. Choice C, voice deepening, and choice D, pubic hair growth, usually occur later in the puberty process compared to testicular enlargement, making them incorrect answers.
2. Which laboratory test would be most important for the nurse to assess when caring for a toddler suspected of having cystic fibrosis?
- A. Liver enzymes
- B. Serum calcium
- C. Sweat chloride test
- D. Urine creatinine
Correct answer: C
Rationale: The sweat chloride test is the primary diagnostic test for cystic fibrosis. Cystic fibrosis is characterized by abnormal transport of chloride and sodium across epithelial cell membranes, leading to increased chloride in sweat. This test is crucial for diagnosing cystic fibrosis in suspected cases. Liver enzymes (Choice A), serum calcium (Choice B), and urine creatinine (Choice D) are not specific tests for cystic fibrosis and would not provide the necessary information for diagnosis in this case.
3. What is one focus of current health care?
- A. Increased provision of nursing services
- B. Disease prevention
- C. Symptom management
- D. Identification of disease processes
Correct answer: B
Rationale: The correct answer is 'Disease prevention.' Modern healthcare places emphasis on preventing diseases to enhance overall health and well-being. While nursing services, symptom management, and disease identification are crucial components of healthcare, disease prevention plays a key role in reducing the burden of illness on individuals and communities.
4. The nurse determines that a child's intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?
- A. Stop the infusion and apply ice.
- B. End the infusion and notify the practitioner.
- C. Slow the infusion rate and notify the practitioner.
- D. Discontinue the infusion and apply warm compresses.
Correct answer: B
Rationale: If a vesicant solution infiltrates, stopping the infusion immediately and notifying the practitioner is critical to prevent tissue damage. Cold or warm compresses should only be applied following specific medical advice based on the vesicant involved.
5. When checking the intravenous (IV) site on a child, the nurse should take which action?
- A. Look at the site.
- B. Ask the child if the site hurts.
- C. Look at the site while palpating the area.
- D. Take all the tape off, assess the site, and redress.
Correct answer: C
Rationale: Looking at and palpating the IV site helps assess for signs of infiltration or infection, such as swelling, redness, or pain. Simply looking or asking the child may miss subtle signs, and removing all the tape unnecessarily disrupts the site.
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