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. A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child?
- A. It is unnecessary because of child’s age.
- B. It is essential because it will be an adjustment.
- C. Preparation is not needed because the colostomy is temporary.
- D. Preparation is important because the child needs to deal with negative body image.
Correct answer: B
Rationale: Preparation is essential even for a young child, as they need to adjust to the temporary colostomy and understand the changes to their body, which can be confusing and distressing without proper explanation.
3. Which action should the nurse implement when taking an axillary temperature?
- A. Take the temperature through one layer of clothing
- B. Add a degree to the result when recording
- C. Place the tip of the thermometer under the arm in the center of the axilla
- D. Hold the child's arm away from the body while taking the temperature
Correct answer: C
Rationale: The correct technique involves placing the thermometer tip in the center of the axilla to ensure an accurate reading, with the arm held close to the body.
4. Which factor is most likely to cause a "brittle" diabetic state in a child with type 1 diabetes?
- A. Noncompliance with diet
- B. Insulin resistance
- C. Frequent infections
- D. Hypothyroidism
Correct answer: C
Rationale: Frequent infections can destabilize blood sugar levels, leading to a "brittle" diabetic state in children with type 1 diabetes. Infections increase metabolic demands and can result in significant blood glucose fluctuations, requiring careful monitoring and adjustment of insulin therapy. Noncompliance with diet may affect blood sugar control but is not the primary cause of a "brittle" state. Insulin resistance is more common in type 2 diabetes rather than type 1. Hypothyroidism can impact metabolism but is not directly linked to the development of a "brittle" diabetic state in type 1 diabetes.
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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