ATI RN
RN Nursing Care of Children 2019 With NGN
1. A 14-month-old child is admitted to the hospital with laryngotracheobronchitis (LTB). Which assessment findings should the nurse expect?
- A. Cyanosis and dyspnea
- B. Productive cough and high fever
- C. Barking cough and inspiratory stridor
- D. Pale laryngeal and dyspnea
Correct answer: C
Rationale: The correct answer is C: 'Barking cough and inspiratory stridor.' Classic signs of laryngotracheobronchitis (LTB) include a barking cough, often described as a seal-like cough, and inspiratory stridor, which is a high-pitched sound heard during inspiration. These symptoms occur due to inflammation and narrowing of the upper airway. Choices A, B, and D are incorrect as they do not align with the typical assessment findings of LTB. Cyanosis and dyspnea (Choice A) may occur in severe cases but are not specific to LTB. Productive cough and high fever (Choice B) are more indicative of lower respiratory tract infections. Pale laryngeal and dyspnea (Choice D) are not characteristic findings of LTB.
2. The nurse is teaching parents about potential causes of colic in infancy. Which should the nurse include in the teaching session?
- A. Overeating
- B. All are applicable
- C. Frequent burping
- D. Parental smoking
Correct answer: B
Rationale: Overeating, swallowing excessive air (leading to frequent burping), and parental smoking are known to contribute to colic in infants. Understimulation is not typically associated with colic.
3. When planning care for a child with a urinary tract infection, the nurse should give priority to which treatment measure?
- A. Provide adequate nutrition to prevent dehydration.
- B. Administer ordered antibiotics on schedule.
- C. Prevent enuresis.
- D. Restrict fluid.
Correct answer: B
Rationale: Administering antibiotics on schedule is crucial in treating a UTI effectively and preventing complications. Antibiotics help to eliminate the infection-causing bacteria from the urinary tract. While maintaining adequate nutrition and hydration are important aspects of care, the priority in a UTI is to target the infection with antibiotics. Preventing enuresis (bedwetting) is not directly related to the treatment of the infection. Fluid restriction is not recommended in the management of a UTI; in fact, encouraging adequate fluid intake helps flush out bacteria from the urinary tract.
4. The nurse is performing an assessment on a 12-month-old infant. Which fine or gross motor developmental skill demonstrates the proximodistal acquisition of skills?
- A. Standing
- B. Sitting without assistance
- C. Fully developed pincer grasp
- D. Taking a few steps holding onto something
Correct answer: C
Rationale: The development of a pincer grasp reflects fine motor skills, which develop in a proximodistal pattern (from the center of the body outward).
5. A child diagnosed with aplastic anemia is admitted to the hospital. The parents ask the nurse what aplastic anemia is. Which response by the nurse is accurate?
- A. Aplastic anemia causes a proliferation of white blood cells.
- B. Aplastic anemia is characterized by abnormally shaped red blood cells.
- C. Aplastic anemia is caused by the bone marrow producing inadequate cells.
- D. Aplastic anemia is a disorder that occurs after a viral illness.
Correct answer: C
Rationale: Aplastic anemia is a condition where the bone marrow fails to produce sufficient red blood cells, white blood cells, and platelets, leading to pancytopenia. This can result in fatigue, infections, and bleeding tendencies. It is not characterized by abnormal red blood cell shapes, but rather by a reduction in the production of blood cells. Therefore, the accurate response is that aplastic anemia is caused by the bone marrow producing inadequate cells. Choices A and B are incorrect as aplastic anemia does not cause a proliferation of white blood cells or involve abnormally shaped red blood cells. Choice D is incorrect as aplastic anemia is not typically a disorder that occurs after a viral illness.
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