what is the earliest age at which a satisfactory radial pulse can be taken in children
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Nursing Elites

ATI RN

ATI Nursing Care of Children

1. What is the earliest age at which a satisfactory radial pulse can be taken in children?

Correct answer: C

Rationale: A satisfactory radial pulse can typically be taken starting at around 3 years of age, as younger children often have pulses that are too fast and irregular for accurate measurement.

2. The nurse is taking a health history of an adolescent. Which best describes how the chief complaint should be determined?

Correct answer: B

Rationale: Asking the adolescent directly about the reason for their visit encourages open communication and helps the nurse understand the primary concern from the patient's perspective.

3. At what age is binocularity, the ability to fixate on one visual field with both eyes simultaneously, typically achieved?

Correct answer: B

Rationale: Binocularity, the ability to fixate on one visual field with both eyes simultaneously, is typically achieved by the age of 3 to 4 months. Achieving binocularity at 1 month is too early for most infants as their visual system is still developing. Similarly, 6 to 8 months and 12 months are beyond the normal age range for achieving binocularity, and delayed achievement could indicate potential issues like strabismus, which may lead to visual impairment if not addressed.

4. The parent of a 1-month-old infant voices concern about the infant’s respirations. The parent states the respirations are rapid and irregular. Which information should the nurse provide?

Correct answer: B

Rationale: The correct answer is B. Irregular respirations with periodic pauses are normal in a 1-month-old infant. Choice A is incorrect because the normal respiratory rate for an infant at this age is higher than the range provided. Choice C is incorrect as irregular respirations are expected in infants. Choice D is not appropriate as irregular respirations with periodic pauses are a normal finding in young infants and do not necessarily indicate a concern that requires immediate notification of the healthcare provider.

5. What are signs and symptoms of a possible kidney transplant rejection in a child? (Select all that apply.)

Correct answer: B

Rationale: Signs of kidney transplant rejection include fever, diminished urinary output, and swelling/tenderness in the graft area. These symptoms indicate that the body may be rejecting the transplanted organ, requiring immediate medical attention.

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