ATI RN
Nursing Care of Children Final ATI
1. As the primary caregiver for a 5-month-old baby, according to Maslow’s hierarchy of basic needs, which intervention takes the highest priority?
- A. Feeding every four hours
- B. Protection from harm
- C. Providing stimulation
- D. Providing love
Correct answer: A
Rationale: The correct answer is A: Feeding every four hours. According to Maslow’s hierarchy of needs, physiological needs, such as food, water, and warmth, take the highest priority. Ensuring that the baby is fed regularly is crucial for survival and overall health. Choice B, protection from harm, relates more to safety needs which come after physiological needs. Choice C, providing stimulation, is associated with higher-level needs like belongingness and esteem. Choice D, providing love, corresponds to esteem and self-actualization needs, which are higher in the hierarchy than physiological needs.
2. Which laboratory test would be most important for the nurse to assess when caring for a toddler suspected of having cystic fibrosis?
- A. Liver enzymes
- B. Serum calcium
- C. Sweat chloride test
- D. Urine creatinine
Correct answer: C
Rationale: The sweat chloride test is the primary diagnostic test for cystic fibrosis. Cystic fibrosis is characterized by abnormal transport of chloride and sodium across epithelial cell membranes, leading to increased chloride in sweat. This test is crucial for diagnosing cystic fibrosis in suspected cases. Liver enzymes (Choice A), serum calcium (Choice B), and urine creatinine (Choice D) are not specific tests for cystic fibrosis and would not provide the necessary information for diagnosis in this case.
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 teaching parents about diarrhea in young children. A parent asks the nurse what causes most cases of diarrhea in young children. How should the nurse respond?
- A. Rotavirus
- B. Giardia
- C. Shigella
- D. Salmonella
Correct answer: A
Rationale: Rotavirus is the most common cause of diarrhea in young children, particularly those under the age of 2. Giardia, Shigella, and Salmonella can also cause diarrhea, but in the context of young children, Rotavirus is the primary pathogen responsible for diarrheal illnesses.
5. A child who has just had definitive repair of a high rectal malformation is to be discharged. What should the nurse address in the discharge preparation of this family?
- A. Safe administration of daily enemas
- B. Necessity of firm stools to keep suture line clean
- C. Bowel training beginning as soon as the child returns home
- D. Changes in stooling patterns to report to the practitioner
Correct answer: D
Rationale: Postoperative care should focus on monitoring changes in stooling patterns, which could indicate complications such as stenosis or obstruction. It is crucial to educate the family on the importance of promptly reporting any changes in stooling patterns to the healthcare provider. Options A and B are not recommended unless specifically ordered by the physician as they can potentially cause harm or discomfort postoperatively. Option C may not be appropriate immediately after surgery and should be guided by the healthcare provider's recommendations.
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