ATI RN
ATI Nursing Care of Children
1. What is the priority assessment for a nurse when caring for an infant suspected of having necrotizing enterocolitis (NEC)?
- A. Hold feedings.
- B. Check gastric residuals before feedings.
- C. Take rectal temperature.
- D. Closely monitor abdominal distention.
Correct answer: D
Rationale: The correct answer is D: Closely monitor abdominal distention. Monitoring the abdomen for signs of distention is crucial in the early detection of necrotizing enterocolitis (NEC). In NEC, the bowel wall is edematous and breaking down, leading to abdominal distention. Holding feedings is important in the management of NEC, as feedings may need to be stopped temporarily. Checking gastric residuals before feedings helps in assessing the infant's tolerance to feedings. Taking rectal temperatures is contraindicated in NEC as it can lead to the perforation of the bowel.
2. The school nurse is explaining to older school children that obesity increases the risk for which disorders? (Select all that apply.)
- A. Asthma
- B. Hypertension
- C. Dyslipidemia
- D. All of the above
Correct answer: D
Rationale: Obesity increases the risk for conditions like asthma, hypertension, dyslipidemia, and altered glucose metabolism, but not typically irritable bowel disease.
3. The nurse is providing education to the parent of a child with Beta-thalassemia. Which risk factors about the condition should the nurse include in the teaching?
- A. Hypertrophy of the thyroid
- B. Polycythemia vera
- C. Thrombocytopenia
- D. Chronic hypoxia and iron overload
Correct answer: D
Rationale: The correct answer is D: Chronic hypoxia and iron overload. Children with Beta-thalassemia often suffer from chronic hypoxia due to ineffective erythropoiesis and require frequent blood transfusions, leading to iron overload. These complications must be managed to prevent organ damage. Choices A, B, and C are incorrect. Hypertrophy of the thyroid, polycythemia vera, and thrombocytopenia are not direct risk factors associated with Beta-thalassemia. Therefore, they should not be included in the teaching regarding this condition.
4. The nurse is assessing a child's capillary refill time. This can be accomplished by doing what?
- A. Inspect the chest
- B. Auscultate the heart
- C. Palpate the apical pulse
- D. Palpate the nail bed with pressure to produce a slight blanching
Correct answer: D
Rationale: Capillary refill time is assessed by applying pressure to the nail bed and observing how quickly the color returns, indicating peripheral circulation status.
5. As the primary caregiver for a 5-month-old baby, according to Maslow’s hierarchy of basic needs, which intervention takes the highest priority?
- A. Feeding every four hours
- B. Protection from harm
- C. Providing stimulation
- D. Providing love
Correct answer: A
Rationale: The correct answer is A: Feeding every four hours. According to Maslow’s hierarchy of needs, physiological needs, such as food, water, and warmth, take the highest priority. Ensuring that the baby is fed regularly is crucial for survival and overall health. Choice B, protection from harm, relates more to safety needs which come after physiological needs. Choice C, providing stimulation, is associated with higher-level needs like belongingness and esteem. Choice D, providing love, corresponds to esteem and self-actualization needs, which are higher in the hierarchy than physiological needs.