ATI RN
ATI Nursing Care of Children 2019 B
1. What is the most appropriate action for a child with epistaxis?
- A. Have the child lie flat
- B. Pinch the nose and lean forward
- C. Apply a warm compress to the nose
- D. Encourage deep breathing
Correct answer: B
Rationale: The most appropriate action for a child with epistaxis is to pinch the nose and lean forward. This technique helps stop the bleeding and prevent aspiration of blood. By applying pressure to the bleeding vessels and allowing the blood to drain out of the nostrils instead of being swallowed, the risk of nausea and airway obstruction is reduced. Having the child lie flat (Choice A) may lead to blood flowing down the throat, causing potential choking. Applying a warm compress (Choice C) is not typically recommended for epistaxis as cold compresses are more effective. Encouraging deep breathing (Choice D) is not directly related to managing epistaxis.
2. The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe?
- A. Spitting up
- B. Bilious vomiting
- C. Failure to thrive
- D. All of the above
Correct answer: D
Rationale: The correct answer is D, as gastroesophageal reflux disease (GERD) in infants typically presents with symptoms such as spitting up, failure to thrive, excessive crying, and respiratory problems due to aspiration. Bilious vomiting is not a common symptom of GERD in infants and may indicate a different or more severe condition, such as intestinal obstruction or other gastrointestinal issues. Therefore, choices A, B, and C are all expected clinical manifestations of GERD in a 6-month-old child, making option D the correct answer.
3. The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include?
- A. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping.
- B. Hold the infant in the prone position after a feeding.
- C. Discontinue breastfeeding so that a formula and rice cereal mixture can be used.
- D. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.
Correct answer: D
Rationale: Cimetidine is an H2 blocker that reduces stomach acid, helping manage GER. Holding the infant in the prone position is not recommended due to the risk of SIDS. Breastfeeding should not be discontinued unless advised by a physician. Elevating the head to 90 degrees is excessive.
4. Which of the following is a hallmark sign of intussusception in children?
- A. Bilious vomiting
- B. "Currant jelly" stools
- C. Abdominal distention
- D. Constipation
Correct answer: B
Rationale: "Currant jelly" stools, consisting of mucus and blood, are characteristic of intussusception in children. It occurs due to the telescoping of a segment of the intestine into an adjacent segment, leading to obstruction and subsequent mucosal ischemia, causing the passage of bloody mucus in the stool. Bilious vomiting can be seen in other conditions like bowel obstruction, abdominal distention can be present but is not as specific, and constipation is less likely in the presentation of intussusception.
5. Which pediatric disorder is associated with a 'boot-shaped' heart on a chest x-ray?
- A. Tetralogy of Fallot
- B. Transposition of the great arteries
- C. Coarctation of the aorta
- D. Ventricular septal defect
Correct answer: A
Rationale: The correct answer is A: Tetralogy of Fallot. Tetralogy of Fallot is often associated with a 'boot-shaped' heart appearance on a chest x-ray due to the characteristic heart anatomy in this condition. This appearance is caused by the combination of pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy. Choice B, Transposition of the great arteries, is incorrect because it presents with a 'egg-on-a-string' appearance on x-ray due to the abnormal position of the aorta and pulmonary artery. Choice C, Coarctation of the aorta, typically presents with rib notching on x-ray. Choice D, Ventricular septal defect, does not produce the 'boot-shaped' heart appearance seen in Tetralogy of Fallot.
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