ATI RN
Nursing Care of Children ATI
1. A mother has just given birth to a newborn with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" What is the most appropriate nursing action?
- A. Encourage the mother to express her feelings
- B. Explain in simple language that the baby has a cleft lip
- C. Provide emotional support until the practitioner can talk to the mother
- D. Tell the mother a pediatrician will talk to her as soon as the baby is examined
Correct answer: A
Rationale: Encouraging the mother to express her feelings allows her to process the situation and prepares her for receiving further information in a supportive environment.
2. The nurse determines that a child's intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?
- A. Stop the infusion and apply ice.
- B. End the infusion and notify the practitioner.
- C. Slow the infusion rate and notify the practitioner.
- D. Discontinue the infusion and apply warm compresses.
Correct answer: B
Rationale: If a vesicant solution infiltrates, stopping the infusion immediately and notifying the practitioner is critical to prevent tissue damage. Cold or warm compresses should only be applied following specific medical advice based on the vesicant involved.
3. Which is usually the only symptom of pediculosis capitis (head lice)?
- A. Itching
- B. Vesicles
- C. Scalp rash
- D. Localized inflammatory response
Correct answer: A
Rationale: Itching is typically the primary and most common symptom of pediculosis capitis due to the lice bites on the scalp.
4. The nurse is evaluating research studies according to the GRADE criteria and has determined the quality of evidence on the subject is moderate. Which type of evidence does this determination indicate?
- A. Strong evidence from unbiased observational studies
- B. Evidence from randomized clinical trials showed inconsistent results
- C. Consistent evidence from well-performed randomized clinical trials
- D. Evidence for at least one critical outcome from randomized clinical trials had serious flaws
Correct answer: B
Rationale: Moderate evidence typically indicates that results from randomized clinical trials were inconsistent, highlighting the need for further research to confirm findings.
5. When assessing a child with chronic renal failure, which clinical manifestations would the nurse expect to find?
- A. Uremic frost
- B. Hypotension
- C. Massive hematuria
- D. Severe metabolic acidosis
Correct answer: A
Rationale: When assessing a child with chronic renal failure, the nurse would expect to find uremic frost as a clinical manifestation. Uremic frost, a white powdery deposit of urea on the skin, occurs in severe cases of chronic renal failure due to the accumulation of urea and other waste products in the blood. Hypotension and massive hematuria are less common in chronic renal failure, while severe metabolic acidosis is typically mild to moderate and not a prominent clinical manifestation.
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