ATI RN
RN Nursing Care of Children 2019 With NGN
1. The nurse is caring for an adolescent who has just started dialysis. The child always seems angry, hostile, or depressed. The nurse should recognize that this is most likely related to what underlying cause?
- A. Physiologic manifestations of renal disease
- B. The fact that adolescents have few coping mechanisms
- C. Neurologic manifestations that occur with dialysis
- D. Resentment of the control and enforced dependence imposed by dialysis
Correct answer: D
Rationale: Adolescents may feel anger and depression due to the loss of independence and control over their lives, which is imposed by the need for regular dialysis treatments. This reaction is common as they struggle with the restrictions placed on their social and personal lives.
2. In terms of gross motor development, what should the nurse expect an infant age 5 months to do?
- A. Sit erect without support
- B. Roll from the back to the abdomen
- C. Turn from the abdomen to the back
- D. Move from a prone to a sitting position
Correct answer: C
Rationale: At 5 months, infants typically can turn from their abdomen to their back. Rolling from back to abdomen and sitting erect without support occur later.
3. Which is usually the only symptom of pediculosis capitis (head lice)?
- A. Itching
- B. Vesicles
- C. Scalp rash
- D. Localized inflammatory response
Correct answer: A
Rationale: Itching is typically the primary and most common symptom of pediculosis capitis due to the lice bites on the scalp.
4. An infant is diagnosed with a tracheoesophageal fistula. Which assessment finding should the nurse expect?
- A. Jaundice
- B. Hyperactive bowel sounds
- C. Absence of sucking, vomiting
- D. Coughing, with excessive secretion
Correct answer: D
Rationale: Coughing with excessive secretion is a common sign of tracheoesophageal fistula. In this condition, the connection between the trachea and esophagus allows saliva and food to enter the airways, leading to coughing and excessive secretions. Choice A, jaundice, is not typically associated with tracheoesophageal fistula. Hyperactive bowel sounds (Choice B) are more likely seen in conditions like gastroenteritis. Absence of sucking and vomiting (Choice C) is not a typical finding related to tracheoesophageal fistula.
5. Which are included in the evaluation step of the nursing process? (Select all that apply.)
- A. All below
- B. Ascertaining if the plan requires modification
- C. Determination if the outcome has been met
- D. Selecting alternative interventions if the outcome has not been met
Correct answer: A
Rationale: The evaluation step involves determining if outcomes are met, modifying the plan if needed, and selecting alternative interventions if goals are not achieved.
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