ATI RN
ATI Nursing Care of Children
1. Baby M is 5 months old. You notice that she now has the ability to grasp objects between her fingers and opposing thumb. This is known as:
- A. Parachute reflex
- B. Grasp reflex
- C. Pincer grasp
- D. Prehension
Correct answer: C
Rationale: The correct answer is C: Pincer grasp. The pincer grasp is the ability to hold objects between the thumb and another finger, typically developed around 9-12 months. At 5 months, it is early for a pincer grasp to fully develop, but the beginning of this skill can be seen as early as 5 months. Choices A and B are incorrect as the parachute reflex is a protective response to falling and the grasp reflex is an automatic response to touch. Choice D, prehension, is a general term for the act of grasping or holding objects, but it does not specifically refer to holding objects between the thumb and fingers like the pincer grasp does.
2. The nurse is caring for a child who had a tonsillectomy. Which clinical manifestation should the nurse observe the child for in the postoperative period?
- A. Arrhythmias
- B. Increased swallowing
- C. Increased blood sugar
- D. Increased urinary output
Correct answer: B
Rationale: Correct Answer: B. Increased swallowing can indicate bleeding at the surgical site, which is a potential complication after tonsillectomy. Choice A, Arrhythmias, are not typically associated with tonsillectomy. Choice C, Increased blood sugar, is not a common clinical manifestation after a tonsillectomy. Choice D, Increased urinary output, is not a typical clinical manifestation to observe for in the postoperative period after a tonsillectomy.
3. The mother of a 6-month-old infant has returned to work and is expressing breast milk to be frozen. She asks for directions on how to safely thaw the breast milk in the microwave. What should the nurse recommend?
- A. Heat only 10 oz or more.
- B. Do not thaw or heat breast milk in a microwave oven.
- C. Always leave the bottle top uncovered to allow heat to escape.
- D. Shake the bottle vigorously for at least 30 seconds after heating.
Correct answer: B
Rationale: Thawing or heating breast milk in a microwave is not recommended because it can create hot spots that may burn the infant and destroy essential nutrients.
4. A new dad is concerned about his toddler's play patterns. The nurse informs him that ____________ play is normally exhibited by toddlers:
- A. Associative
- B. Team
- C. Solitary
- D. Parallel
Correct answer: D
Rationale: The correct answer is D, 'Parallel.' Parallel play is a common play pattern observed in toddlers where they play alongside each other without direct interaction. This type of play allows toddlers to observe and mimic each other's actions, aiding in their social development. Choices A, B, and C are incorrect. Associative play involves some interaction between children, team play involves organized group activities, and solitary play is when a child plays alone, all of which are not typically exhibited by toddlers during play.
5. A 3-year-old child, previously potty-trained, becomes a bed-wetter again during a hospital stay. Which explanation should the nurse provide to the parents?
- A. “Your child is no longer potty-trained and will need to be retrained when she goes home.”
- B. “The child may have developed a bladder infection in the hospital. I will notify the doctor.”
- C. “Preschool children may regress in their behaviors when they are ill in the hospital but should return to normal when they go back home.”
- D. “Don’t worry about it, she is fine.”
Correct answer: C
Rationale: During a hospital stay, preschool children may exhibit regression in behaviors such as bed-wetting due to stress. It is important for parents to understand that this behavior is a common response to the hospital environment and should resolve once the child is back home. Therefore, the correct explanation for the nurse to provide to the parents is choice C. Choice A is incorrect because it inaccurately states that the child is no longer potty-trained. Choice B is incorrect as it assumes a medical issue without evidence. Choice D is incorrect as it dismisses the parents' concerns without addressing the underlying cause of the behavior.
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