ATI RN
RN Nursing Care of Children 2019 With NGN
1. Which food should be introduced first to a 6-month-old infant?
- A. Fruits
- B. Eggs
- C. Vegetables
- D. Meat
Correct answer: C
Rationale: Vegetables, particularly pureed ones, are often recommended as a first solid food for infants because they are easy to digest and less likely to cause allergies. Fruits can be introduced later due to their natural sweetness, while eggs and meat are typically introduced after fruits and vegetables as they may pose a higher risk of allergies.
2. What is a common sign of moderate dehydration in children?
- A. Dry mucous membranes
- B. Normal capillary refill
- C. Hyperactive bowel sounds
- D. Edema
Correct answer: A
Rationale: Dry mucous membranes are a common sign of moderate dehydration in children, indicating a loss of bodily fluids. When a child is moderately dehydrated, the mucous membranes in the mouth and nose may appear dry. This condition can occur due to various factors such as vomiting, diarrhea, or inadequate fluid intake. Normal capillary refill (choice B) is not typically associated with dehydration; it is a measure of circulatory status. Hyperactive bowel sounds (choice C) can be present in conditions like gastroenteritis but are not specific to dehydration. Edema (choice D) is the retention of fluid in the body and is not a typical sign of dehydration.
3. The parents of a 2-month-old boy are concerned about spoiling their son by picking him up when he cries. What is the nurse's best response?
- A. Allow him to cry for no longer than 15 minutes and then pick him up
- B. Babies need comforting and cuddling. Meeting these needs will not spoil him
- C. Babies this young cry when they are hungry. Try feeding him when he cries
- D. If he isn’t soiled or wet, leave him, and he'll cry himself to sleep
Correct answer: B
Rationale: Comforting and cuddling a 2-month-old baby when they cry helps build trust and security. At this age, responding to cries does not lead to spoiling, but rather supports healthy emotional development.
4. In the newborn, into what muscle is intramuscular vitamin K administered?
- A. Deltoid
- B. Dorsogluteal
- C. Rectus femoris
- D. Vastus lateralis
Correct answer: D
Rationale: In newborns, intramuscular vitamin K is traditionally administered into the vastus lateralis muscle. This site is preferred due to its large muscle mass and accessibility. The dorsogluteal site is not recommended for newborns due to the risk of injury to the sciatic nerve. The deltoid site is also not recommended for newborns. The rectus femoris muscle is not commonly used for intramuscular injections in newborns.
5. A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?
- A. Surgical therapy is indicated.
- B. Place the infant in a prone position for sleep after feeding.
- C. Thicken feedings and enlarge the nipple hole.
- D. Reduce the frequency of feeding by encouraging larger volumes of formula.
Correct answer: C
Rationale: The correct recommendation for decreasing the number and total volume of emesis in an infant with gastroesophageal reflux is to thicken feedings and enlarge the nipple hole. Thicker feedings can reduce the frequency and volume of emesis by making the food less likely to be regurgitated. Enlarging the nipple hole helps ensure the thickened feedings can pass through. Surgical therapy (Choice A) is not the initial recommendation for managing gastroesophageal reflux in infants. Placing the infant in a prone position for sleep after feeding (Choice B) is not recommended due to the increased risk of sudden infant death syndrome (SIDS). Reducing the frequency of feeding by encouraging larger volumes of formula (Choice D) can exacerbate the reflux symptoms.
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