ATI RN
RN Nursing Care of Children 2019 With NGN
1. The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?
- A. Poor hygiene
- B. Constipation
- C. Urinary stasis
- D. Congenital anomalies
Correct answer: C
Rationale: Urinary stasis is the most important factor in the development of UTIs because it provides an environment for bacterial growth. While poor hygiene and congenital anomalies are contributing factors, preventing urinary stasis is key in UTI prevention.
2. During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which?
- A. A normal finding
- B. A sign of a possible visual defect and a need for vision screening
- C. An abnormal finding requiring referral to an ophthalmologist
- D. A sign of small hemorrhages, which usually resolve spontaneously
Correct answer: A
Rationale: A brilliant, uniform red reflex in both eyes is a normal finding, indicating that the retina is healthy and there are no significant obstructions in the visual pathway.
3. What intervention is crucial during a sickle cell crisis in a child?
- A. Administer oxygen
- B. Apply cold compresses
- C. Restrict fluids
- D. Encourage bed rest
Correct answer: A
Rationale: Administering oxygen is crucial during a sickle cell crisis in a child as it helps to prevent further sickling of cells. Oxygen therapy can improve oxygen saturation levels, reducing the risk of tissue damage and complications. Applying cold compresses (choice B) is not recommended as it can potentially worsen vaso-occlusive crisis by causing vasoconstriction. Restricting fluids (choice C) is not appropriate as hydration is essential to prevent dehydration and maintain adequate blood flow. Encouraging bed rest (choice D) may be necessary but administering oxygen takes precedence in managing a sickle cell crisis.
4. What pathologic process is believed to be responsible for the development of postinfectious glomerulonephritis?
- A. Infarction of renal vessels
- B. Immune complex formation and glomerular deposition
- C. Bacterial endotoxin deposition on and destruction of glomeruli
- D. Embolization of glomeruli by bacteria and fibrin from endocardial vegetation
Correct answer: B
Rationale: Postinfectious glomerulonephritis is typically caused by immune complex deposition in the glomeruli following a streptococcal infection. This immune response leads to inflammation and impaired kidney function.
5. What is the most appropriate action for a child with epistaxis?
- A. Have the child lie flat
- B. Pinch the nose and lean forward
- C. Apply a warm compress to the nose
- D. Encourage deep breathing
Correct answer: B
Rationale: The most appropriate action for a child with epistaxis is to pinch the nose and lean forward. This technique helps stop the bleeding and prevent aspiration of blood. By applying pressure to the bleeding vessels and allowing the blood to drain out of the nostrils instead of being swallowed, the risk of nausea and airway obstruction is reduced. Having the child lie flat (Choice A) may lead to blood flowing down the throat, causing potential choking. Applying a warm compress (Choice C) is not typically recommended for epistaxis as cold compresses are more effective. Encouraging deep breathing (Choice D) is not directly related to managing epistaxis.
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