ATI RN
RN Nursing Care of Children Online Practice 2019 A
1. The nurse is admitting a child with severe isotonic dehydration. Which intravenous fluid should the nurse anticipate the doctor to order initially to replace fluids?
- A. 0.9% normal saline
- B. D5 0.2% (1/4) normal saline
- C. D5W
- D. Albumin
Correct answer: A
Rationale: In the case of severe isotonic dehydration, the initial fluid of choice is 0.9% normal saline. This solution is preferred because it helps to restore both fluids and electrolytes effectively. Options B, C, and D are not suitable for the initial management of severe isotonic dehydration. D5 0.2% (1/4) normal saline (Choice B) is a hypotonic solution and might worsen the imbalance. D5W (Choice C) is a hypotonic solution that does not contain electrolytes essential for rehydration. Albumin (Choice D) is a colloid solution used for specific indications like hypoproteinemia or hypoalbuminemia, not for initial rehydration in severe dehydration.
2. What intervention is crucial during a sickle cell crisis in a child?
- A. Administer oxygen
- B. Apply cold compresses
- C. Restrict fluids
- D. Encourage bed rest
Correct answer: A
Rationale: Administering oxygen is crucial during a sickle cell crisis in a child as it helps to prevent further sickling of cells. Oxygen therapy can improve oxygen saturation levels, reducing the risk of tissue damage and complications. Applying cold compresses (choice B) is not recommended as it can potentially worsen vaso-occlusive crisis by causing vasoconstriction. Restricting fluids (choice C) is not appropriate as hydration is essential to prevent dehydration and maintain adequate blood flow. Encouraging bed rest (choice D) may be necessary but administering oxygen takes precedence in managing a sickle cell crisis.
3. The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need?
- A. Consuming a regular diet
- B. Increasing protein
- C. Restricting fluids
- D. Decreasing calories
Correct answer: C
Rationale: Fluid restriction is often necessary to manage severe edema associated with MCNS. Increasing protein is not typically recommended due to the risk of exacerbating proteinuria, and calorie reduction is not generally needed.
4. A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family?
- A. Safe administration of daily enemas
- B. Necessity of firm stools to keep suture line clean
- C. Bowel training beginning as soon as the child returns home
- D. Changes in stooling patterns to report to the practitioner
Correct answer: D
Rationale: Postoperative care should focus on monitoring changes in stooling patterns, which could indicate complications such as stenosis or obstruction. It is crucial to educate the family on the importance of promptly reporting any changes in stooling patterns to the healthcare provider. Options A and B are not recommended unless specifically ordered by the physician as they can potentially cause harm or discomfort postoperatively. Option C may not be appropriate immediately after surgery and should be guided by the healthcare provider's recommendations.
5. Parents of a newborn with ambiguous genitalia want to know how long they will have to wait to know whether they have a boy or a girl. The nurse answers the parents based on what knowledge?
- A. Chromosome analysis will be complete in 7 days.
- B. A physical examination will be able to provide a definitive answer.
- C. Additional laboratory testing is necessary to assign the correct gender.
- D. Gender assignment involves collaboration between the parents and a multidisciplinary team.
Correct answer: D
Rationale: Gender assignment in cases of ambiguous genitalia is a complex process that requires a multidisciplinary approach, including genetic, endocrinological, and psychological evaluations. The decision should be made collaboratively with the parents.