ATI RN
RN Nursing Care of Children 2019 With NGN
1. What name is given to inflammation of the bladder?
- A. Cystitis
- B. Urethritis
- C. Urosepsis
- D. Bacteriuria
Correct answer: A
Rationale: Cystitis is the medical term for inflammation of the bladder. Urethritis refers to inflammation of the urethra, urosepsis to a systemic infection stemming from the urinary tract, and bacteriuria to the presence of bacteria in the urine.
2. The mother of a 6-year-old boy who has recently had surgery for the removal of his tonsils and adenoids complains that he has begun sucking his thumb again. Which defense mechanism should the nurse include when responding to the mother?
- A. Repression
- B. Regression
- C. Rationalization
- D. Fantasy
Correct answer: B
Rationale: The correct answer is B: Regression. Regression is a common defense mechanism where a child reverts to an earlier stage of development, such as thumb-sucking, to cope with stress. In this scenario, the 6-year-old boy is using thumb-sucking (a behavior typical of earlier developmental stages) as a way to deal with the stress of surgery. Repression (choice A) involves unconsciously blocking out thoughts or feelings, which is not applicable in this case. Rationalization (choice C) is a defense mechanism where illogical or unreasonable explanations are provided to justify behavior, which is not relevant here. Fantasy (choice D) refers to the use of imagination to escape from reality, which is also not the appropriate defense mechanism for the situation described.
3. Ongoing fluid losses can overwhelm the child’s ability to compensate, resulting in shock. What early clinical sign precedes shock?
- A. Tachycardia
- B. Slow respirations
- C. Warm, flushed skin
- D. Decreased blood pressure
Correct answer: A
Rationale: Tachycardia is an early sign of shock as the body tries to maintain cardiac output in the face of declining circulatory volume. Blood pressure often remains normal until late in the progression, at which point decompensated shock is occurring.
4. A child with acetylsalicylic acid (aspirin) poisoning is being admitted to the emergency department. What early clinical manifestation does the nurse expect to assess on this child?
- A. Hematemesis
- B. Hematochezia
- C. Hyperglycemia
- D. Hyperventilation
Correct answer: D
Rationale: Early signs of aspirin poisoning include hyperventilation due to the stimulation of the respiratory center and the resultant respiratory alkalosis. Hematemesis, hematochezia, and hyperglycemia can occur later in the poisoning process or may not be directly related to aspirin toxicity.
5. During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action?
- A. Recheck head control at the next visit
- B. Teach the parents appropriate exercises
- C. Schedule the child for further evaluation
- D. Refer the child for further evaluation if the anterior fontanel is still open
Correct answer: C
Rationale: Significant head lag at 8 months is concerning and warrants further evaluation, as it may indicate developmental delays or neurological issues.
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