ATI RN
RN Nursing Care of Children 2019 With NGN
1. What is the primary consideration of susceptibility to infections in neonates?
- A. Increased humoral immunity
- B. Overwhelming anti-inflammatory response
- C. Diminished nonspecific and specific immunity
- D. Excessive levels of immunoglobulin A and immunoglobulin M
Correct answer: C
Rationale: The primary consideration of susceptibility to infections in neonates is their diminished nonspecific and specific immunity. Neonates lack the ability to mount a robust immune response, making them vulnerable to infections. Choice A is incorrect because neonates do not have increased humoral immunity; rather, their humoral immunity is diminished. Choice B is incorrect as neonates do not have an overwhelming anti-inflammatory response; instead, their immune responses are generally weakened. Choice D is incorrect because neonates have diminished or absent levels of immunoglobulin A and immunoglobulin M, contributing to their susceptibility to infections.
2. What interventions should be implemented to maintain the skin integrity of a preterm infant born at 30 weeks?
- A. Avoid cleaning the skin
- B. Bathe the infant with sterile water
- C. Cleanse the skin with a gentle alkaline-based soap and water
- D. Thoroughly rinse the skin with plain water after bathing
Correct answer: B
Rationale: The correct intervention to maintain the skin integrity of a preterm infant born at 30 weeks is to bathe the infant with sterile water. Bathing with sterile water or a neutral pH solution is recommended to protect the delicate skin of preterm infants, which is more permeable and prone to damage. Choices A, C, and D are incorrect as avoiding cleaning the skin may lead to hygiene issues, cleansing with alkaline-based soap can be harsh on the delicate skin, and thoroughly rinsing with plain water after bathing may not be as gentle and protective for preterm infants.
3. The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease about foods that can exacerbate acid reflux. What foods should be included in the teaching session?
- A. Citrus
- B. All of the above
- C. Spicy foods
- D. Peppermint
Correct answer: B
Rationale: The correct answer is B: All of the above. Citrus, spicy foods, and peppermint are known to exacerbate GER symptoms by increasing acid production or relaxing the lower esophageal sphincter. Therefore, these foods should be avoided by a child with GER disease. Bananas, on the other hand, are generally safe and do not contribute to acid reflux. Choice B is correct because all the mentioned foods can worsen GER symptoms, while bananas are considered safe.
4. The nurse is caring for an infant after a cleft lip repair. Which of these measures should be included in the plan of care?
- A. Position prone
- B. Provide fluids from a cup
- C. Position supine
- D. Avoid elbow restraints
Correct answer: C
Rationale: The correct measure that should be included in the plan of care for an infant after a cleft lip repair is to position the infant supine. Placing the infant in a supine position helps protect the surgical site from injury and promotes proper healing. Choice A, 'Position prone,' is incorrect as placing the infant prone can put pressure on the surgical site and hinder healing. Choice B, 'Provide fluids from a cup,' is not directly related to the surgical care of a cleft lip repair. Choice D, 'Avoid elbow restraints,' is not specific to the postoperative care of a cleft lip repair.
5. Which situation denotes a nontherapeutic nurse-patient-family relationship?
- A. The nurse is planning to read a favorite fairy tale to a patient
- B. During shift report, the nurse is criticizing parents for not visiting their child
- C. The nurse is discussing with a fellow nurse the emotional draw to a certain patient
- D. The nurse is working with a family to find ways to decrease the family’s dependence on health care providers
Correct answer: B
Rationale: Criticizing parents or making negative comments about their involvement is nontherapeutic and can damage the nurse-patient-family relationship.
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