ATI RN
ATI Nursing Care of Children 2019 B
1. What is a common sign of moderate dehydration in children?
- A. Dry mucous membranes
- B. Normal capillary refill
- C. Hyperactive bowel sounds
- D. Edema
Correct answer: A
Rationale: Dry mucous membranes are a common sign of moderate dehydration in children, indicating a loss of bodily fluids. When a child is moderately dehydrated, the mucous membranes in the mouth and nose may appear dry. This condition can occur due to various factors such as vomiting, diarrhea, or inadequate fluid intake. Normal capillary refill (choice B) is not typically associated with dehydration; it is a measure of circulatory status. Hyperactive bowel sounds (choice C) can be present in conditions like gastroenteritis but are not specific to dehydration. Edema (choice D) is the retention of fluid in the body and is not a typical sign of dehydration.
2. The nurse is aware that skin turgor best estimates what?
- A. Perfusion
- B. Adequate hydration
- C. Amount of body fat
- D. Amount of anemia
Correct answer: B
Rationale: Skin turgor is a quick and simple way to assess hydration status. Poor skin turgor can indicate dehydration.
3. 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.
4. A preschool-age child is admitted to the pediatric unit for surgery. The parents request to stay with their child. How should the nurse respond?
- A. Tell the parents they can stay in the hospital but not on the unit
- B. Read the rules and regulations of rooming in with the child
- C. Let the parents know they are allowed to stay with the child
- D. Explain to the parents why they cannot stay with the child
Correct answer: C
Rationale: The correct response is to let the parents know they are allowed to stay with the child. Allowing parents to stay with the child can help reduce the child's anxiety and provide comfort. Choice A is incorrect as the parents should be encouraged to stay with their child. Choice B is not the immediate response the nurse should provide. Choice D is inappropriate as it does not address the benefits and importance of parental presence for the child's well-being during hospitalization.
5. What type of dehydration occurs when the electrolyte deficit exceeds the water deficit?
- A. Isotonic dehydration
- B. Hypotonic dehydration
- C. Hypertonic dehydration
- D. Hyperosmotic dehydration
Correct answer: B
Rationale: Hypotonic dehydration occurs when the loss of electrolytes exceeds the loss of water, leading to a decrease in plasma osmolarity. This often occurs when sodium loss is greater than water loss, as in diarrhea or vomiting.
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