ATI RN
ATI Nursing Care of Children 2019 B
1. A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include?
- A. Careful bathing and handling
- B. Monitoring of behavioral status
- C. Maintenance of strict isolation
- D. Administration of packed red blood cells
Correct answer: A
Rationale: The correct answer is A: Careful bathing and handling. Preoperative care for a child with a Wilms tumor should focus on preventing any trauma to the abdomen, which could lead to tumor rupture. Monitoring behavioral status and maintaining strict isolation are not as critical in this situation. Behavioral status is important but not a priority in preoperative care for a Wilms tumor. Strict isolation is not necessary unless there are specific infectious concerns, which is not typically the case for a Wilms tumor. Administration of packed red blood cells is not a standard preoperative intervention for Wilms tumor.
2. The nurse is educating a new nurse on the identification of pain in children. What does the nurse teach about physiologic measurements in children’s pain assessment?
- A. Not useful as the only indicator for pain
- B. Best indicator of pain in children of all ages
- C. Most valuable when children also report having pain
- D. Essential to determine whether a child is telling the truth about pain
Correct answer: A
Rationale: Physiologic manifestations of pain may vary considerably, so they do not provide a consistent measure of pain. Heart rate may increase or decrease. The same signs that may suggest fear, anxiety, or anger also indicate pain. In chronic pain, the body adapts, and these signs decrease or stabilize. Physiologic measurements are of limited value and must be viewed in the context of a pain rating scale, behavioral assessment, and parental report. When the child reports pain on an appropriate pain scale, the appropriate interventions should be used. Therefore, physiologic measurements are not considered a reliable standalone indicator for pain in children, making choice A the correct answer. Choice B is incorrect because physiologic measurements alone do not serve as the best indicator of pain. Choice C is incorrect as physiologic measurements are still limited even when children report pain. Choice D is incorrect as physiologic measurements are not primarily used to determine the truthfulness of a child's pain report.
3. The school nurse is teaching a group of adolescents about avoiding contaminated water during a mission trip. What should the nurse include in the teaching?
- A. Ice
- B. All are applicable
- C. Raw vegetables
- D. Unpeeled fruits
Correct answer: B
Rationale: The correct answer is B: All are applicable. Ice, raw vegetables, and unpeeled fruits can be sources of contamination in areas where water purity is questionable. It's safer to avoid these during a mission trip to prevent waterborne illnesses. Choice A (Ice), C (Raw vegetables), and D (Unpeeled fruits) are all potential sources of contamination in areas with questionable water quality. Including all these items in the teaching will help adolescents make informed decisions to stay healthy during their mission trip.
4. Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what?
- A. Minimize separation anxiety
- B. Prevent urinary complications.
- C. Increase acceptance of hospitalization.
- D. Promote development of normal body image.
Correct answer: D
Rationale: Early repair of congenital genitourinary defects like hypospadias is important to promote a normal body image and avoid psychological issues as the child grows. It also helps prevent urinary complications and allows for normal development.
5. What term describes the invagination of one segment of bowel within another?
- A. Atresia
- B. Stenosis
- C. Herniation
- D. Intussusception
Correct answer: D
Rationale: Intussusception is the correct answer. It refers to the condition where one segment of the bowel folds into another, leading to an obstruction. Atresia (Choice A) is the absence or abnormal closure of a normal opening or tubular structure. Stenosis (Choice B) is the narrowing of a passage in the body. Herniation (Choice C) is the abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Intussusception is a medical emergency commonly observed in infants and young children and necessitates prompt intervention to prevent severe complications.
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