the nurse is assessing a 3 year old child which assessment finding would the nurse identify as abnormal
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Nursing Elites

ATI RN

ATI Nursing Care of Children

1. The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal?

Correct answer: C

Rationale: The correct answer is C. Falling when bending over to touch toes could indicate a developmental delay or a balance issue that may need further assessment. Choices A, B, and D are typical developmental milestones for a 3-year-old child. Pedaling a tricycle without assistance, unscrewing a bolt on a toy, and building a tower of 10 cubes are all age-appropriate activities for a child of this age.

2. 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?

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.

3. Which is considered a block to effective communication?

Correct answer: B

Rationale: Using clichés is a communication block because it can come across as dismissive or insincere, hindering meaningful dialogue.

4. What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)?

Correct answer: D

Rationale: ESRD places significant stress on both the child and the family due to the ongoing need for dialysis, medications, and lifestyle restrictions, making it important for healthcare providers to offer extensive support and resources to manage these challenges.

5. The nurse is taking a sexual history on an adolescent girl. Which is the best way to determine whether she is sexually active?

Correct answer: A

Rationale: Directly asking the adolescent if she is sexually active is the most straightforward and respectful approach, ensuring privacy and fostering trust.

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