ATI RN
Nursing Care of Children Final ATI
1. The parent asks when the soft area in the infant's head will go away. What is the best response by the nurse?
- A. The area is called the anterior fontanel (fontanelle) and typically closes anytime up to 18 months of age.
- B. The area is called a fontanel (fontanelle). They remain open to allow for rapid brain growth in the first months of life.
- C. The soft spots may stay open until your infant is 2 or 3 years old.
- D. Soft spots on the infant's head should have closed by now.
Correct answer: A
Rationale: The best response by the nurse is A, as the anterior fontanel typically closes between 12-18 months of age, allowing for brain growth during infancy. Choice B is incorrect because it does not provide a specific timeframe for the closure of the fontanel. Choice C is incorrect as it suggests a later closure timeframe than usual. Choice D is incorrect as it states that the soft spots should have closed already, which is inaccurate for a 6-month-old infant.
2. The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include?
- A. Advise bed rest until 1 week after the icteric phase.
- B. Teach infection control measures to family members.
- C. Inform the mother that the child cannot return to school until 3 weeks after onset of jaundice.
- D. Reassure the mother that hepatitis A cannot be transmitted to other family members.
Correct answer: B
Rationale: Teaching infection control measures is crucial as Hepatitis A is highly contagious, especially in household settings. Proper hand hygiene and avoiding sharing personal items can prevent the spread of the virus within the family. Option A is incorrect because bed rest is not typically required for hepatitis A. Option C is incorrect as the child can return to school once feeling well and no longer contagious, not necessarily after a specific duration. Option D is incorrect because hepatitis A can be transmitted through contaminated food, water, or close personal contact.
3. An infant, age 5 months, is brought to the clinic by his parents for a well-baby checkup. What is the best advice that the nurse should include at this time about injury prevention?
- A. Keep buttons, beads, and other small objects out of his reach.
- B. Do not permit him to chew paint from window ledges because he might absorb too much lead.
- C. When he learns to roll over, you must supervise him whenever he is on a surface from which he might fall.
- D. Lock the crib sides securely because he may stand and lean against them and fall out of bed.
Correct answer: A
Rationale: Small objects are a choking hazard for infants, so it is crucial to keep them out of reach to prevent injury.
4. When assessing an infant with intussusception, what type of stool would the nurse expect to find?
- A. Soft, seedy stool
- B. Currant-jelly stool
- C. Ribbon-like stool
- D. Soft and pasty stool
Correct answer: B
Rationale: The correct answer is B: Currant-jelly stool. This type of stool, which is red and mucous-like, is a classic sign of intussusception in infants. Choice A (Soft, seedy stool) is incorrect as it does not specifically describe the characteristic stool associated with intussusception. Choice C (Ribbon-like stool) is incorrect; ribbon-like stool may be seen in conditions like colon cancer, not intussusception. Choice D (Soft and pasty stool) is also incorrect as it does not match the typical stool finding in intussusception.
5. According to Maslow’s hierarchy, what is the most advanced need provided by the home environment?
- A. Love
- B. Self-actualization
- C. Esteem
- D. Physiological
Correct answer: B
Rationale: The correct answer is B, self-actualization. Self-actualization is the highest level in Maslow's hierarchy of needs, representing the realization of one's full potential. While love is an essential need, self-actualization builds upon the fulfillment of basic needs like safety and love. Esteem needs relate to feelings of accomplishment and recognition, which come before self-actualization. Physiological needs such as food, water, and shelter are the most basic needs at the bottom of the hierarchy.
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