ATI RN
ATI Nursing Care of Children 2019 B
1. The nurse is caring for a child with Meckel diverticulum. What type of stool does the nurse expect to observe?
- A. Steatorrhea
- B. Clay-colored
- C. Currant jelly-like
- D. Loose stools with undigested food
Correct answer: C
Rationale: Corrected Rationale: Currant jelly-like stools, which contain blood and mucus, are characteristic of Meckel diverticulum. This symptom occurs due to the bleeding from the ectopic gastric mucosa present in the diverticulum. Steatorrhea (choice A) is not typically associated with Meckel diverticulum. Clay-colored stools (choice B) are seen in conditions affecting the biliary system. Loose stools with undigested food (choice D) may indicate malabsorption issues, but it is not specifically linked to Meckel diverticulum.
2. The nurse is performing an oral examination on a preschool child. Which strategies should the nurse use to encourage the child to open the mouth for the examination? (Select all that apply.)
- A. Lightly brush the palate with a cotton swab
- B. Perform the examination in front of a mirror
- C. Let the child examine someone else's mouth first
- D. All of the above
Correct answer: D
Rationale: Using a cotton swab, allowing the child to observe, and demonstrating on someone else are effective ways to encourage a preschooler to open their mouth for examination.
3. What should the nurse explain about ringworm?
- A. It is not contagious
- B. It is a sign of uncleanliness
- C. It is expected to resolve spontaneously
- D. It is spread by both direct and indirect contact
Correct answer: D
Rationale: Ringworm is a fungal infection that spreads through direct and indirect contact. Good hygiene practices can help prevent its spread.
4. A mother tells the nurse that she does not want her infant immunized because of the discomfort associated with injections. What should the nurse explain?
- A. This cannot be prevented
- B. Infants do not feel pain as adults do
- C. This is not a good reason for refusing
- D. A topical anesthetic can be applied
Correct answer: D
Rationale: The nurse should explain that a topical anesthetic can be applied to the injection site before the immunization to reduce discomfort.
5. While making rounds, the nurse observes the following client behaviors. Which child should the nurse further evaluate for postoperative pain?
- A. The 6-month-old in deep sleep
- B. The 2-year-old who is cooperative when the nurse takes vital signs
- C. The 4-year-old who is actively watching cartoons
- D. The 14-month-old who is screaming and thrashing his arms and legs
Correct answer: D
Rationale: The correct answer is D because screaming and thrashing his arms and legs are indicative behaviors of discomfort or pain in young children. The child's actions suggest a higher likelihood of experiencing postoperative pain and necessitate further evaluation. Choices A, B, and C do not exhibit overt signs of distress or discomfort associated with pain, making them less likely candidates for postoperative pain assessment.
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