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ATI Nursing Care of Children 2019 B
1. Which electrolyte imbalance is a common concern in children with severe diarrhea?
- A. Hypernatremia
- B. Hypokalemia
- C. Hypercalcemia
- D. Hypomagnesemia
Correct answer: B
Rationale: Hypokalemia is the correct answer because it is a common concern in children with severe diarrhea. Diarrhea can lead to significant potassium loss, resulting in hypokalemia. Hypernatremia (Choice A) is less common in diarrhea as sodium concentration is usually diluted by the fluid loss. Hypercalcemia (Choice C) is not typically associated with severe diarrhea. Hypomagnesemia (Choice D) can occur but is not as common as hypokalemia in this scenario.
2. The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which?
- A. 50th percentile
- B. 75th percentile
- C. 80th percentile
- D. 95th percentile
Correct answer: D
Rationale: A child with a BMI greater than the 95th percentile is classified as obese, according to standard growth charts used in pediatric practice.
3. An infant is suspected of having esophageal atresia/tracheoesophageal fistula. While waiting for the pediatrician to see the infant, which action should the nurse take?
- A. Position the infant with the head of the bed slightly elevated
- B. Allow the infant to bond with the mother in her room
- C. Offer the infant breastfeeding instead of formula feeding
- D. Wrap the infant in blankets and place in a crib by the viewing window
Correct answer: A
Rationale: Positioning the infant with the head of the bed elevated helps to prevent aspiration and manage secretions until further treatment can be provided. Choice B is incorrect as the priority is ensuring the infant's safety and health, not immediate bonding. Choice C is incorrect as breastfeeding may worsen the condition. Choice D is incorrect as it does not address the potential risk of aspiration associated with esophageal atresia/tracheoesophageal fistula.
4. The nurse is caring for a child with a urinary tract infection who is on intravenous gentamicin (Garamycin). What interventions should the nurse plan for this child with regard to this medication? (Select all that apply.)
- A. Encourage fluids.
- B. Monitor urinary output.
- C. Monitor sodium serum levels.
- D. All above
Correct answer: D
Rationale: Gentamicin is an aminoglycoside antibiotic that requires monitoring of serum peak and trough levels to avoid toxicity, particularly nephrotoxicity and ototoxicity. Encouraging fluids and monitoring urinary output are also crucial to minimize the risk of kidney damage.
5. The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe?
- A. Fever
- B. Vomiting
- C. Tachycardia
- D. All of the above
Correct answer: D
Rationale: Correct! Typical signs of appendicitis include fever, vomiting, and tachycardia due to infection and inflammation. These clinical manifestations are commonly observed in patients with appendicitis. Hyperactive bowel sounds are not typically associated with appendicitis, so they are not expected findings in this situation. Therefore, the correct answer is 'All of the above.'
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