ATI RN
Nursing Care of Children ATI
1. The nurse is caring for a 1-month-old infant diagnosed with Hirschsprung’s disease. Which treatment measure should be included in the plan of care?
- A. Barium Enema
- B. Surgical removal of the affected section of bowel
- C. High-fiber diet
- D. Permanent colostomy
Correct answer: B
Rationale: The correct answer is B: Surgical removal of the affected section of bowel. Hirschsprung's disease is a congenital condition where a portion of the large intestine lacks nerve cells, leading to difficulties in passing stool. The definitive treatment for this condition is the surgical removal of the affected section of the bowel. Barium enema (Choice A) may be used for diagnosis but is not a treatment. A high-fiber diet (Choice C) is not effective in managing Hirschsprung's disease. A permanent colostomy (Choice D) is not the initial treatment for this condition in infants.
2. The Denver II is a test used to assess children. What does it evaluate?
- A. Behavior problems
- B. Developmental status
- C. Body mass index
- D. Infection likelihood
Correct answer: B
Rationale: The Denver II Developmental Screening Test is used to assess a child's development in four areas: personal-social, fine motor-adaptive, language, and gross motor skills. It helps identify children who may need further evaluation. Choice A, behavior problems, is incorrect as the Denver II primarily focuses on developmental milestones rather than behavior. Choice C, body mass index, is unrelated to the assessment of child development. Choice D, infection likelihood, is also not evaluated by the Denver II test.
3. Where is the best place to observe for the presence of petechiae in dark-skinned individuals?
- A. Face
- B. Buttocks
- C. Oral mucosa
- D. Palms and soles
Correct answer: C
Rationale: The oral mucosa and conjunctivae are the best places to observe petechiae in dark-skinned individuals because these areas have less pigmentation.
4. 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.
5. The nurse is preparing to complete documentation on a patient's chart. Which should be included in documentation of nursing care? (Select all that apply.)
- A. Reassessments
- B. Nursing care provided
- C. Initial assessments
- D. All of the above
Correct answer: D
Rationale: Proper documentation includes reassessments, initial assessments, care provided, and the patient's response, but incident reports are typically documented separately.
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