ATI RN
Nursing Care of Children ATI
1. In the newborn, into what muscle is intramuscular vitamin K administered?
- A. Deltoid
- B. Dorsogluteal
- C. Rectus femoris
- D. Vastus lateralis
Correct answer: D
Rationale: In newborns, intramuscular vitamin K is traditionally administered into the vastus lateralis muscle. This site is preferred due to its large muscle mass and accessibility. The dorsogluteal site is not recommended for newborns due to the risk of injury to the sciatic nerve. The deltoid site is also not recommended for newborns. The rectus femoris muscle is not commonly used for intramuscular injections in newborns.
2. What self-report pain rating scales can be used in children as young as 3 years of age?
- A. Poker Chip Tool
- B. Visual Analog Scale
- C. FACES Pain Rating Scale
- D. Word-Graphic Rating Scale
Correct answer: C
Rationale: The FACES Pain Rating Scale is suitable for children as young as 3 years of age. It uses facial expressions to depict different levels of pain, making it easy for young children to understand and use. The Poker Chip Tool is validated for children aged 4 and older who have a certain level of cognitive ability. The Visual Analog Scale is more appropriate for children aged 7 and above. The Word-Graphic Rating Scale, which uses descriptive words, is recommended for children in the age range of 4 to 17 years.
3. Which intervention is the most appropriate recommendation for relief of teething pain?
- A. Rub gums with aspirin to relieve inflammation
- B. Apply hydrogen peroxide to gums to relieve irritation
- C. Give the infant a frozen teething ring to relieve inflammation
- D. Have the infant chew on a warm teething ring to encourage tooth eruption
Correct answer: C
Rationale: A frozen teething ring is effective for relieving teething pain as the cold helps numb the gums and reduce inflammation, making it a safe and effective method for managing discomfort
4. A 5-year-old is hospitalized with a fractured femur. Which pain assessment tool is appropriate for this child?
- A. CRIES Scale
- B. Faces Pain Rating Scale
- C. SUN Scale
- D. NIPS Scale
Correct answer: B
Rationale: The Faces Pain Rating Scale is appropriate for assessing pain in children who can express their feelings visually. For a 5-year-old child who can communicate effectively, using a tool like the Faces Pain Rating Scale, which uses facial expressions to indicate pain levels, is more suitable than the CRIES Scale (used for neonates), the SUN Scale (used for infants), or the NIPS Scale (used for preterm and term newborns).
5. Which type of family should the nurse recognize when a mother, her children, and a stepfather live together?
- A. Traditional nuclear
- B. Blended
- C. Extended
- D. Binuclear
Correct answer: B
Rationale: A blended family consists of a couple and their children from this and all previous relationships, including stepfamilies.
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