ATI RN
Nursing Care of Children ATI
1. The nurse is preparing an airborne infection isolation room for a patient. Which communicable disease does the patient likely have?
- A. Varicella
- B. Pertussis
- C. Influenza
- D. Scarlet fever
Correct answer: A
Rationale: Varicella (chickenpox) is an airborne infectious disease, requiring isolation to prevent the spread of the virus.
2. A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?
- A. Surgical therapy is indicated.
- B. Place the infant in a prone position for sleep after feeding.
- C. Thicken feedings and enlarge the nipple hole.
- D. Reduce the frequency of feeding by encouraging larger volumes of formula.
Correct answer: C
Rationale: The correct recommendation for decreasing the number and total volume of emesis in an infant with gastroesophageal reflux is to thicken feedings and enlarge the nipple hole. Thicker feedings can reduce the frequency and volume of emesis by making the food less likely to be regurgitated. Enlarging the nipple hole helps ensure the thickened feedings can pass through. Surgical therapy (Choice A) is not the initial recommendation for managing gastroesophageal reflux in infants. Placing the infant in a prone position for sleep after feeding (Choice B) is not recommended due to the increased risk of sudden infant death syndrome (SIDS). Reducing the frequency of feeding by encouraging larger volumes of formula (Choice D) can exacerbate the reflux symptoms.
3. The nurse is interviewing the mother of an infant. The mother reports, "I had a difficult delivery, and my baby was born prematurely." This information should be recorded under which heading?
- A. History
- B. Present illness
- C. Chief complaint
- D. Review of systems
Correct answer: A
Rationale: The history section of the health record includes details about pregnancy, labor, and delivery, as these factors can have significant implications for the child's health.
4. A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock?
- A. Restlessness
- B. Rapid capillary refill
- C. Increased temperature
- D. Increased blood pressure
Correct answer: A
Rationale: Restlessness is an early sign of shock due to decreased perfusion and oxygenation to the brain. This symptom requires immediate attention to prevent the progression to more severe stages of shock. Rapid capillary refill (Choice B) is not typically an early sign of shock but rather a sign of adequate perfusion. Increased temperature (Choice C) may occur in later stages of shock due to the body's response to stress. Increased blood pressure (Choice D) is not an early sign of shock; in fact, blood pressure tends to decrease in shock as a compensatory mechanism.
5. A 14-year-old with chronic renal failure suddenly becomes non-compliant with the medication regimen. Which nursing intervention would most likely improve compliance?
- A. Give the child a computer-animated game that presents information on the management of chronic renal failure.
- B. Set up a meeting with some older teens who have chronic renal failure and have been managing their disease effectively.
- C. Arrange for a physician to sit down and talk to the child about the risks related to noncompliance with medications.
- D. Discuss with the child’s parents that privileges, such as a cell phone, can be taken away if compliance fails to improve.
Correct answer: B
Rationale: Adolescents often seek guidance and support from their peers. Setting up a meeting with older teens who are effectively managing chronic renal failure can provide the 14-year-old with motivation, encouragement, and practical advice on how to handle their treatment regimen. This peer support can positively influence the non-compliant adolescent, making choice B the most likely intervention to improve compliance. Choices A and C may not address the peer influence aspect of adolescent behavior, while choice D focuses on punitive measures rather than addressing the underlying reasons for non-compliance.
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