the nurse is preparing to perform a physical assessment on a 10 year old girl the nurse gives her the option of her mother staying in the room or leav
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Nursing Elites

ATI RN

ATI Nursing Care of Children

1. The nurse is preparing to perform a physical assessment on a 10-year-old girl. The nurse gives her the option of her mother staying in the room or leaving. This action should be considered which?

Correct answer: A

Rationale: It is appropriate to give a 10-year-old the choice of having a parent present or not during an exam, respecting the child's growing need for privacy.

2. The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss?

Correct answer: B

Rationale: The weight loss is most likely due to the reduction of edema, as glomerulonephritis often causes fluid retention that resolves with treatment, leading to significant weight loss.

3. What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome?

Correct answer: D

Rationale: Reduced serum albumin is a hallmark of minimal change nephrotic syndrome (MCNS) due to massive proteinuria. This results in hypoalbuminemia, which contributes to the edema characteristic of this condition.

4. Evidence-based practice (EBP), a decision-making model, is best described as which?

Correct answer: D

Rationale: Evidence-based practice involves gathering and integrating all relevant evidence to guide clinical decision-making, ensuring that care is based on the best available research.

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.)

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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