ATI RN
Nursing Care of Children ATI
1. The apnea monitor alarm sounds on a neonate for the third time during this shift. What is the priority action by the nurse?
- A. Provide tactile stimulation.
- B. Administer 100% oxygen.
- C. Investigate possible causes of a false alarm.
- D. Assess infant for color and presence of respirations.
Correct answer: D
Rationale: The priority action for the nurse when the apnea monitor alarm sounds on a neonate is to assess the infant for color and the presence of respirations. This initial assessment helps determine the infant's respiratory status and the need for immediate intervention. Providing tactile stimulation or administering oxygen should only be done after assessing the infant's respiratory status. Investigating possible causes of a false alarm comes after ensuring the infant's well-being through the initial assessment.
2. What is the most appropriate intervention for a child with suspected acute appendicitis?
- A. Administer antibiotics
- B. Apply heat to the abdomen
- C. Encourage oral fluids
- D. Prepare for surgery
Correct answer: D
Rationale: The correct answer is D: Prepare for surgery. Acute appendicitis is a surgical emergency that requires prompt removal of the appendix to prevent complications like rupture and peritonitis. Administering antibiotics (choice A) may be part of the treatment plan but should not delay surgical intervention. Applying heat to the abdomen (choice B) is not recommended as it can worsen the inflammation of the appendix. Encouraging oral fluids (choice C) is generally beneficial, but the priority in acute appendicitis is surgical intervention.
3. The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss?
- A. Poor appetite
- B. Reduction of edema
- C. Restriction to bed rest
- D. Increased potassium intake
Correct answer: B
Rationale: The weight loss is most likely due to the reduction of edema, as glomerulonephritis often causes fluid retention that resolves with treatment, leading to significant weight loss.
4. Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.)
- A. Regressive behavior
- B. Fear of abandonment
- C. Blame themselves for the divorce
- D. All of the above
Correct answer: D
Rationale: Preschool children may exhibit regressive behavior, fear abandonment, and blame themselves for their parents' divorce due to their limited understanding of the situation.
5. What is the therapeutic intervention that provides the best chance of survival for a child with cirrhosis?
- A. Nutritional support
- B. Liver transplantation
- C. Blood component therapy
- D. Treatment with corticosteroids
Correct answer: B
Rationale: Liver transplantation offers the best chance of survival for children with cirrhosis, especially in advanced stages where the liver can no longer function effectively. Cirrhosis is a late stage of scarring of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. While nutritional support, blood component therapy, and corticosteroids may be part of the treatment plan to manage symptoms and complications, they do not address the underlying cause of cirrhosis or provide a cure like liver transplantation does.
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