ATI RN
Nursing Care of Children Final ATI
1. When assessing an infant with intussusception, what type of stool would the nurse expect to find?
- A. Soft, seedy stool
- B. Currant-jelly stool
- C. Ribbon-like stool
- D. Soft and pasty stool
Correct answer: B
Rationale: The correct answer is B: Currant-jelly stool. This type of stool, which is red and mucous-like, is a classic sign of intussusception in infants. Choice A (Soft, seedy stool) is incorrect as it does not specifically describe the characteristic stool associated with intussusception. Choice C (Ribbon-like stool) is incorrect; ribbon-like stool may be seen in conditions like colon cancer, not intussusception. Choice D (Soft and pasty stool) is also incorrect as it does not match the typical stool finding in intussusception.
2. A healthcare provider is reviewing the laboratory report of a client who has been taking lithium carbonate for the past 12 months. The provider notes a lithium level of 0.8 mEq/L. Which of the following orders from the provider should the healthcare provider expect?
- A. Withhold the next dose
- B. Increase the dosage
- C. Discontinue the medication
- D. Administer the medication
Correct answer: Administer the medication
Rationale: A lithium level of 0.8 mEq/L falls within the therapeutic range for maintaining the drug's effectiveness while minimizing toxicity. Therefore, the appropriate action would be to continue administering the medication as prescribed by the healthcare provider to maintain the therapeutic effect for the client.
3. A nurse is providing discharge teaching to a client who is postoperative following a hip arthroplasty. Which of the following statements indicates a need for further teaching?
- A. I will avoid sitting in a recliner while recovering.
- B. I will bend at the waist to pick up items from the floor.
- C. I will use a pillow between my legs when lying on my side.
- D. I will avoid crossing my legs when sitting.
Correct answer: B
Rationale: The correct answer is B. Bending at the waist can increase the risk of dislocation following hip arthroplasty. This movement can put strain on the hip joint and potentially lead to complications. Choices A, C, and D are all correct statements that promote proper postoperative care and help prevent complications. Sitting in a recliner, using a pillow between the legs when lying on the side, and avoiding crossing legs when sitting are all appropriate instructions for a client recovering from hip arthroplasty.
4. The nurse is caring for a patient who is susceptible to infection. Which instruction will the nurse include in an educational session to decrease the risk of infection?
- A. Teaching the patient to take a temperature
- B. Teaching the patient to select nutritious foods
- C. Teaching the patient about the effects of alcohol
- D. Teaching the patient about fall prevention
Correct answer: B
Rationale: The correct answer is B: Teaching the patient to select nutritious foods. A nutritious diet plays a crucial role in strengthening the body's immune system, making it more capable of fighting off infections. Vitamins, minerals, and other nutrients found in healthy foods support immune function and overall health. Teaching the patient about taking a temperature (choice A) may be important for monitoring for signs of infection but does not directly decrease the risk of infection. Teaching about the effects of alcohol (choice C) and fall prevention (choice D) are important aspects of patient education but are not directly related to decreasing the risk of infection in a susceptible patient.
5. A client receiving radiation therapy for breast cancer may experience which of the following side effects that the nurse should monitor for?
- A. Fatigue
- B. Nausea
- C. Skin irritation
- D. Weight gain
Correct answer: C
Rationale: During radiation therapy for breast cancer, one common side effect is skin irritation due to the impact of radiation on the skin cells. This side effect should be closely monitored by the nurse. Fatigue may also occur as a side effect of radiation therapy, but skin irritation is more specific to the treatment area and is a priority in this case. Nausea and weight gain are not typically associated with radiation therapy for breast cancer, making them incorrect choices.