ATI RN Nursing Care of Children Proctored Exam (7 Latest Versions, 2020) / ATI Nursing Care of Children Proctored Exam / Nursing Care of Children ATI Proctored Exam (Complete Guide for Exam Preparation, 100% Correct Answers)

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ATI RN Nursing Care of Children Proctored Exam (7 Latest Versions, 2020) / ATI Nursing Care of Children Proctored Exam / Nursing Care of Children ATI Proctored Exam (Complete Guide for Exam Prepara... tion, 100% Correct Answers) ATI RN Nursing Care of Children Proctored Exam (7 Latest Versions, 2020) / ATI Nursing Care of Children Proctored Exam / Nursing Care of Children ATI Proctored Exam (Complete Guide for Exam Preparation, 100% Correct Answers) written by WALDENQUIZEXPERT www.stuvia.com Downloaded by: candyck524 | [email protected] Distribution of this document is illegalATI NURSING CARE OF CHILDREN PROCTORED EXAM  Latest 7 Versions / 7 Sets Exam  Verified Questions and Answers  Complete and Best Document for Exam Preparation Stuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material ATI Nursing Care of Children Version-1 5) A nurse is receiving change-of-shift report for four children. Which of the following children should the nurse assess first? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material a. A toddler who has a concussion and an episode of forceful vomiting b. An adolescent who has infective endocarditis and reports having a headache c. An adolescent who was placed into halo traction 1 hr ago and reports pain as 6 on a scale of 0 to 10 d. A school-age child who has acute glomerulonephritis and brown-colored urine 6) A nurse is providing dietary teaching to the guardian of a school-age child who has cystic fibrosis. Which of the following statements should the nurse make? a. "You should offer your child high-protein meals and snacks throughout the day." b. "You should decrease your child's dietary fat intake to less than 10% of their caloric intake." c. "You should restrict your child's calorie intake to 1,200 per day." d. "You should give your child a multivitamin once weekly." 7) A nurse is providing discharge teaching to the guardians of a toddler who had lower leg cast applied 24 hr ago. The nurse should instruct the guardians to report which of the following finding to the provider? a. Capillary refill time less than 2 seconds b. Restricted ability to move the toes c. Swelling of the casted foot when the leg is dependent d. Pedal pulse +3 bilateral 8) A nurse in an emergency department is auscultating the lungs of an adolescent who is experiencing dyspnea. The nurse should identify the sound as which of the following? a. Wheezes b. Crackles c. Pleural friction rub Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d. Rhonchi 9) A nurse is caring for a preschooler who has congestive heart failure. The nurse observes wide QRS complexes and peaked T waves on the cardiac monitor. Which of the following prescriptions should the nurse clarify with the provider? a. Furosemide b. Captopril c. Regular insulin d. Potassium chloride 10) A nurse is planning an educational program for school-age children and their parents about bicycle safety. Which of the following information should the nurse plan to include? a. The child should be able to stand on the balls of their feet when sitting on the bike. b. The child should ride their bike 2 feet to the side of other bike riders. c. The child should wear dark-colored clothing with a fluorescent stripe when riding at night. d. The child should ride the bike facing traffic when it is necessary to ride in the street. 11) A nurse is an emergency department is caring for a school-age child who has epiglottitis. Which of the following actions should the nurse take? a. Obtain a throat culture from the child. b. Monitor the child's oxygen saturation. c. Put a warm mist humidifier in the child's room. d. Place the child in the supine position 12) A nurse in an emergency department is caring for a school-age child who has Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material sustained a minor superficial burn from fireworks on their forearm. Which of the following actions should the nurse take? a. Administer the tetanus toxoid vaccine if more than 1 year since the prior dose. b. Apply an antimicrobial ointment to the affected area. c. Leave the burn area open to air. d. Place an ice pack on the affected area. 13) A nurse in a providers office is caring for a school-age child who has varicella. The parents asks the nurse when their child will no longer be contagious. Which of the following responses should the nurse make? a. "When your child no longer has an increased temperature." b. "Three days after you first noticed the rash appear on your child." c. "When your child's lesions are crusted, usually 6 days after they appear." d. "Two to three weeks, when your child's lesions completely disappear." 14) A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistant asthma. Which of the following instructions should the nurse include? a. "You should give your child their salmeterol inhaler every 4 hours when they are having an acute episode of wheezing." b. "You should monitor your child's weight weekly while they are receiving inhaled corticosteroid therapy." c. "Pulmonary function tests will be performed every 12 to 24 months to evaluate how your child is responding to therapy." d. "When using the peak expiratory flow meter, record your child's average of three readings." 15) A nurse is admitting an infant who has intussusception. Which of the following findings should the nurse expect? (Select all that apply.) Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material a. Steatorrhea b. Vomiting c. Lethargy d. Constipation e. Weight gain 16) A nurse is reviewing the laboratory results of a school-age child who is 1 week postoperative following an open fracture repair. Which of the following findings should the nurse identify as an indication of a potential complication? a. Erythrocyte sedimentation rate 18 mm/hr b. WBC count 6,200/mm3 c. C-reactive protein 1.4 mg/L d. RBC count 4.7 million/mm3 17) A nurse is providing discharge teaching to the parents of a 3-month old infant following a cheiloplasty. Which of the following instructions should the nurse include? a. "Clean your baby's sutures daily with a mixture of chlorhexidine and water." b. "Expect your baby to swallow more than usual over the next few days." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c. "Inspect your baby's tongue for white patches using a tongue depressor every 8 hours." d. "Apply a thin layer of antibiotic ointment on your baby's suture line daily for the next 3 days." 18) A nurse is discussion organ donation with the parents of a school-age child who has sustained brain death due to a bicycle crash. Which of the following actions should the nurse take first? a. Inform the parents that written consent is required prior to organ donation. b. Provide written information to the parents about organ donation. c. Ask the provider to explain misconceptions of organ donation to the parents. d. Explore the parents' feelings and wishes regarding organ donation. 19) A nurse is caring for a 1-month-old infant who is breastfeeding and requires a heel stick. Which of the following actions should the nurse take to minimize the infants pain? a. Use a manual lancet to obtain the heel blood sample. b. Apply an ice pack to the infant's heel prior to obtaining the sample. c. Allow the mother to breastfeed while the sample is being obtained. d. Apply a topical lidocaine cream prior to obtaining the sample. 20) A nurse is assessing an adolescent who received a sodium polystyrene sulfonate enema. Which of the following findings indicates effectiveness of the medication? a. Reports an absence of nausea and vomiting b. Reports experiencing an onset of loose stools within 15 min of administration c. Serum potassium level 4.1 mEq/L d. Blood pressure 86/52 mm Hg 21) A charge nurse is preparing to make a room assignment for a newly admitted schoolage child. Which of the following considerations is the nurses priority? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material a. Length of stay b. Treatment schedule c. Disease process d. Self-care ability 22) A nurse is assessing the pain level of a 3-year-old toddler. Which of the following pain assessment scales should the nurse use? a. FACES b. Numeric c. CRIES d. Visual analog 23) A nurse is preparing to administer ibuprofen 5 mg/kg every 6 hr PRN for a temperatures above 38.0 C (100.5 F) to an infant who weighs 17.6 lb. Available is ibuprofen oral suspension 100mg/5mL. How many mL should the nurse administer to the infant per dose? i) 2 mL 24) A nurse is assessing a 6-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? a. Presence of a central incisor tooth b. Presence of strabismus c. Presence of an open anterior fontanel d. Presence of external cerumen 25) A school nurse is caring for a child following tonic-clonic seizure. Which of the following actions should the nurse take first? a. Check the child for a head injury. b. Observe for oral bleeding. c. Check the child's respiratory rate. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d. Observe for extremity weakness. 26) A nurse is planning developmental activities for a newly admitted 10-year-old child who has neutropenia. Which of the following actions should the nurse plan to take? a. Provide the child with a book about adventure. b. Arrange frequent visits from family members and peers. c. Give the child a large-piece puzzle. d. Use puppets to entertain the child. 27) A nurse in a health department is caring for an emancipated adolescent who has an STI and is unaccompanied by a guardian. Which of the following actions should the nurse take? a. Have the adolescent sign a consent form for treatment. b. Instruct the adolescent to return with a guardian. c. Obtain consent from the adolescent's guardian over the phone. d. Treat the adolescent without a consent form. 28) A nurse is assessing an 8-year-old child who has early indications of shock. After establishing an airway and stabilizing the childs respirations, which of the following actions should the nurse take next? a. Insert an indwelling urinary catheter. b. Measure weight and height. c. Initiate IV access. d. Maintain ECG monitoring. 29) A nurse is performing hearing screenings for children at a community health fair. Which of the following children should the nurse refer to a provider for a more extensive hearing evaluation? a. An 18-month-old toddler who has unintelligible speech b. A 3-month-old infant who has an exaggerated startle response Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c. A 4-year-old preschooler who prefers playing with others rather than alone Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d. An 8-month-old infant who is not yet making babbling sounds 30) A nurse is providing discharge teaching to the guardian of a school-age child who has undergone a tonsillectomy. Which of the following statements by the guardian indicates an understanding the teaching? a. "My child can resume usual activities since this was just an outpatient surgery." b. "My child will be able to drink the chocolate milkshake I promised to get for them tonight." c. "I will notify the doctor if I notice that my child is swallowing frequently." d. "I will have my child gargle with warm salt water to relieve their sore throat." 31) A community health nurse is assessing an 18-month-old toddler in a community day care. Which of the following findings should the nurse identify as a potential indication of physical neglect? a. Resists having an axillary temperature taken b. Exhibits withdrawal behaviors when their parent leaves c. Has multiple bruises on their knees d. Poor personal hygiene 32) A nurse assessing a school-age child who has an infratentorial brain tumor. Which of the following findings should the nurse identify as a manifestation of increased intracranial pressure? a. Hypotension b. Reports insomnia c. Difficulty concentrating d. Tachycardia 33) A nurse is providing teaching to an adolescent about how to manage tinea pedis. Which of the following statements by the adolescent indicates an understanding of the teaching? a. "I should buy plastic shoes to wear at the swimming pool." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material b. "I should wear sandals as much as possible." c. "I should place the permethrin cream between my toes twice daily." d. "I should seal my nonwashable shoes in plastic bags for a couple of weeks." 34) A nurse is caring for a school-age child who has diabetes mellitus and was admitted with a diagnosis of diabetic ketoacidosis. When performing the respiratory assessment, which of the following findings should the nurse expect? a. Deep respirations of 32/min b. Shallow respirations of 10/min c. Paradoxic respirations of 26/min d. Periods of apnea lasting for 20 seconds 35) A nurse is planning n educational program to teach parents about protecting their children from sunburns. Which of the following instructions should the nurse plan to include? a. "Allow your child to play outside during the hours between 10:00 a.m. and 2:00 p.m." b. "Choose a waterproof sunscreen with a minimum SPF of 15." c. "Dress your child in loose weave polyester fabric prior to sun exposure." d. "Reapply sunscreen every 4 hours." 36) A nurse is providing teaching to the parents of a preschooler who has heart failure and a new prescription for digoxin twice daily. Which of the following instructions should the nurse include in the teaching? a. "Use a kitchen teaspoon to measure the medication." b. "Brush the child's teeth after giving the medication." c. "Double the next dose if the child misses a dose." d. "Repeat the dose if the child vomits." 37) A nurse is providing teaching to the family of a school-age child who has juvenile idiopathic arthritis. Which if the following instructions should the nurse include in the Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material teaching? a. "Limit movement of the child's large joints." b. "Encourage the child to perform independent self-care." c. "Provide the child with a soft mattress for sleeping." d. "Schedule a 2-hour daily nap for the child in the afternoon." 38) A nurse is creating a plan of care for a child who has varicella. Which of the following interventions should the nurse include? a. Maintain the child's room temperature at 80° F. b. Prepare the child for a lumbar puncture. c. Administer aspirin to the child for a temperature greater than 38.3° C (101° F). d. Initiate airborne precautions for the child. 39) A nurse is assessing a school-age child who has an acute spinal cord injury following a sports injury 1 week ago. Identify the area the nurse should tap to elicit the bicep reflect. i) Correct answer is A 40) A school nurse is providing an in-service for faculty about improving education for students who have ADHD. Which of the following statements by a faculty member indicates an understanding of the teaching? a. "I will plan to increase the amount of homework I assign to students who have ADHD." b. "I will give students who have ADHD the same amount of time as other students to complete tests." c. "I will allow students who have ADHD one rest break throughout the day." d. "I will teach challenging academic subjects to students who have ADHD in the morning." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 41) A nurse is caring for a school-age child who has peripheral edema. The nurse should identify that which of the following assessments should be performed to confirm peripheral edema? a. Palpate the dorsum of the child's feet. b. Weigh the child daily using the same scale. c. Assess the child's skin turgor. d. Observe the child for periorbital swelling. 42) A nurse is caring for an infant who is receiving IV fluids for the treatment of Tetralogy of Fallot and begins to have hypercryanotic spell. Which of the following actions should the nurse take? a. Place the infant in a knee-chest position. b. Administer a dose of meperidine IV. c. Discontinue administration of IV fluids. d. Apply oxygen at 2 L/min via nasal cannula. 43) A nurse is reviewing the dietary choices of an adolescent who has iron deficiency anemia. The nurse should identify that which of the following menu items has the highest amount of nonheme iron? a. ½ cup whole milk b. 1 cup orange juice c. ½ cup raisins d. 1 cup raw carrots 44) A nurse in an emergency department is assessing a 3-month-old infant who has rotavirus and is experiencing acute vomiting and diarrhea. Which of the following manifestations should the nurse identify as an indication that the infant has moderate to severe dehydration? a. Heart rate 124/min b. Increased tear production Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c. Sunken anterior fontanel d. Capillary refill 2 seconds 45) A nurse is planning care for a school-age child who has tunneled central venous access device. Which of the following interventions should the nurse include in the plan? a. Use sterile scissors to remove the dressing from the site. b. Irrigate each lumen weekly with 10 mL of 0.9% sodium chloride solution when not in use. c. Access the site using a non-coring angled needle. d. Use a semipermeable transparent dressing to cover the site. 46) A nurse is teaching a group of parents about infectious mononucleosis. Which of the following statements by parent indicates an understanding the teaching? a. "Mononucleosis is caused by an infection with the Epstein-Barr virus." b. "Mononucleosis is a bacterial infection requiring 14 days of antibiotics." c. "A Monospot is a throat culture used to diagnosis mononucleosis." d. "Children who get mononucleosis will need to refrain from sports for 6 months." 47) A nurse is caring for a newly admitted school-age child who has hypopituitarism. Which of the following medications should the nurse expect the provider to prescribe? a. Desmopressin b. Luteinizing hormone-releasing hormone c. Recombinant growth hormone d. Levothyroxine 48) A nurse is creating a plan of care for a preschooler who has Wilms’ tumor and is scheduled for surgery. Which of the following interventions should the nurse include? a. Avoid palpating the abdomen when bathing the child before surgery. b. Refrain from auscultating the child's bowel sounds during the Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material postoperative assessment. c. Encourage the child to play with other children on the unit prior to surgery. d. Explain to the child that their pain will be managed after the surgery. 49) A nurse is providing discharge teaching to the parent of an 18-month-old toddler who has dehydration due to acute diarrhea. Which of the following statements by the parent indicates an understanding of the teaching? a. "I will offer my child small amounts of fruit juice frequently." b. "I will avoid giving my child solid foods until the diarrhea has stopped." c. "I will monitor my child's number of wet diapers." d. "I will give my child polyethylene glycol daily for 7 days." 50) A nurse is teaching the guardian of a 6-month-old infant about teething. Which of the following statements should the nurse make? a. "Your baby might pull at their ears when they are teething." b. "Rub your baby's gums with an aspirin to decrease discomfort." c. "Place a beaded teething necklace around your baby's neck." d. "Your baby's upper middle teeth will erupt first. 51) A nurse is creating a plan of care for a newly admitted adolescent who has bacterial meningitis. How long should the nurse plan to maintain the adolescent in droplet precautions? a. Until the adolescent is afebrile b. For 7 days following admission to the facility c. Until the adolescent has a negative blood culture d. For 24 hr following initiation of antimicrobial therapy 52) A nurse is providing anticipatory guidance to the parent of a toddler. Which of the following expected behavior characteristics of toddlers should the nurse include? a. Controls impulsive feelings Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material b. Understands right from wrong Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c. Easily separates from parents for long periods of time d. Expresses likes and dislikes 53) A nurse is admitting a 4-month-old infant who has heart failure. Which of the following findings is the nurses priority? a. Episodes of vomiting b. Formula consumption c. Weight d. Temperature 54) A nurse in an emergency department is assessing a toddler who has Kawasaki disease. Which of the following findings should the nurse expect? (Select all that apply.) i) Increased temperature ii) Gingival hyperplasia iii) Xerophthalmia iv) Bradycardia v) Cervical lymphadenopathy 55) A nurse is caring for a 10-year-old child following a head injury. Which of the following findings should the nurse identify as an indication that the child is developing diabetes insipidus? a. Urine specific gravity 1.045 b. Sodium 155 mEq/L c. Blood glucose 45 mg/dL d. Urine output 35 mL/hr 56) A nurse is planning care to address nutritional needs for a preschooler who has cystic fibrosis. Which of the following interventions should the nurse include in the plan? a. Administer pancreatic enzymes 2 hr after meals. b. Discontinue the use of pancreatic enzymes if steatorrhea develops. c. Limit fluid intake to 750 mL per day. d. Increase fat content in the child's diet to 40% of total calories. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 57) A nurse is caring for a toddler who has acute otitis media and a temperature of 40 C (104 F). After administering acetaminophen, which of the following actions should the nurse plan to take to reduce the toddler’s temperature? a. Apply a cooling blanket to the toddler. b. Dress the toddler in minimal clothing. c. Give the toddler a tepid bath. d. Administer diphenhydramine to the toddler. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material ATI Nursing Care of Children Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 6) A nurse is planning care for a newly admitted school-age child who has generalized seizure disorder. Which of the following interventions should the nurse plan to include? a) Ensure that a padded tongue blade is at the child's bedside. b) Allow the child to play video games on a tablet computer. c) Allow the child to take a tub bath independently. d) Ensure the oxygen source is functioning in the child's room. 7) A nurse is receiving change-of-shift report for four children. Which of the following children should the nurse assess first? a) A toddler who has a concussion and an episode of forceful vomiting b) An adolescent who has infective endocarditis and reports having a headache c) An adolescent who was placed into halo traction 1 hr ago and reports pain as 6 on a scale of 0 to 10 d) A school-age child who has acute glomerulonephritis and brown-colored urine 8) A nurse is providing dietary teaching to the guardian of a school-age child who has cystic fibrosis. Which of the following statements should the nurse make? a) "You should offer your child high-protein meals and snacks throughout the day." b) "You should decrease your child's dietary fat intake to less than 10% of their caloric intake." c) "You should restrict your child's calorie intake to 1,200 per day." d) "You should give your child a multivitamin once weekly." 9) A nurse is providing discharge teaching to the guardians of a toddler who had lower leg cast applied 24 hr ago. The nurse should instruct the guardians to report which of the following finding to the provider? a) Capillary refill time less than 2 seconds b) Restricted ability to move the toes c) Swelling of the casted foot when the leg is dependent d) Pedal pulse +3 bilateral Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 10) A nurse is caring for a preschooler who has congestive heart failure. The nurse observes wide QRS complexes and peaked T waves on the cardiac monitor. Which of the following prescriptions should the nurse clarify with the provider? a) Furosemide b) Captopril c) Regular insulin d) Potassium chloride 11) A nurse is planning an educational program for school-age children and their parents about bicycle safety. Which of the following information should the nurse plan to include? a) The child should be able to stand on the balls of their feet when sitting on the bike. b) The child should ride their bike 2 feet to the side of other bike riders. c) The child should wear dark-colored clothing with a fluorescent stripe when riding at night. d) The child should ride the bike facing traffic when it is necessary to ride in the street. 12) A nurse in an emergency department is caring for a school-age child who has sustained a minor superficial burn from fireworks on their forearm. Which of the following actions should the nurse take? a) Administer the tetanus toxoid vaccine if more than 1 year since the prior dose. b) Apply an antimicrobial ointment to the affected area. c) Leave the burn area open to air. d) Place an ice pack on the affected area. 13) A nurse in a providers office is caring for a school-age child who has varicella. The parents asks the nurse when their child will no longer be contagious. Which of the following responses should the nurse make? a) "When your child no longer has an increased temperature." b) "Three days after you first noticed the rash appear on your child." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c) "When your child's lesions are crusted, usually 6 days after they appear." d) "Two to three weeks, when your child's lesions completely disappear." 14) A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistant asthma. Which of the following instructions should the nurse include? a) "You should give your child their salmeterol inhaler every 4 hours when they are having an acute episode of wheezing." b) "You should monitor your child's weight weekly while they are receiving inhaled corticosteroid therapy." c) "Pulmonary function tests will be performed every 12 to 24 months to evaluate how your child is responding to therapy." d) "When using the peak expiratory flow meter, record your child's average of three readings." 15) A nurse is admitting an infant who has intussusception. Which of the following findings should the nurse expect? (Select all that apply.) a) Steatorrhea b) Vomiting c) Lethargy d) Constipation e) Weight gain 16) A nurse is reviewing the laboratory results of a school-age child who is 1 week postoperative following an open fracture repair. Which of the following findings should the nurse identify as an indication of a potential complication? a) Erythrocyte sedimentation rate 18 mm/hr b) WBC count 6,200/mm3 c) C-reactive protein 1.4 mg/L d) RBC count 4.7 million/mm3 17) A nurse is providing discharge teaching to the parents of a 3-month old Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material infant following a cheiloplasty. Which of the following instructions should the nurse include? a) "Clean your baby's sutures daily with a mixture of chlorhexidine and water." b) "Expect your baby to swallow more than usual over the next few days." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c) "Inspect your baby's tongue for white patches using a tongue depressor every 8 hours." d) "Apply a thin layer of antibiotic ointment on your baby's suture line daily for the next 3 days." 18) A nurse is discussion organ donation with the parents of a school-age child who has sustained brain death due to a bicycle crash. Which of the following actions should the nurse take first? a) Inform the parents that written consent is required prior to organ donation. b) Provide written information to the parents about organ donation. c) Ask the provider to explain misconceptions of organ donation to the parents. d) Explore the parents' feelings and wishes regarding organ donation. 19) A nurse is caring for a 1-month-old infant who is breastfeeding and requires a heel stick. Which of the following actions should the nurse take to minimize the infants pain? a) Use a manual lancet to obtain the heel blood sample. b) Apply an ice pack to the infant's heel prior to obtaining the sample. c) Allow the mother to breastfeed while the sample is being obtained. d) Apply a topical lidocaine cream prior to obtaining the sample. 20) A nurse is assessing an adolescent who received a sodium polystyrene sulfonate enema. Which of the following findings indicates effectiveness of the medication? a) Reports an absence of nausea and vomiting b) Reports experiencing an onset of loose stools within 15 min of administration c) Serum potassium level 4.1 mEq/L d) Blood pressure 86/52 mm Hg 21) A charge nurse is preparing to make a room assignment for a newly admitted school- age child. Which of the following considerations is the nurses priority? a) Length of stay Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material b) Treatment schedule c) Disease process d) Self-care ability 22) A nurse is assessing the pain level of a 3-year-old toddler. Which of the following pain assessment scales should the nurse use? a) FACES b) Numeric c) CRIES d) Visual analog 23) A nurse is preparing to administer ibuprofen 5 mg/kg every 6 hr PRN for a temperatures above 38.0 C (100.5 F) to an infant who weighs 17.6 lb. Available is ibuprofen oral suspension 100mg/5mL. How many mL should the nurse administer to the infant per dose? i) 2 mL 24) A nurse is assessing a 6-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? a) Presence of a central incisor tooth b) Presence of strabismus c) Presence of an open anterior fontanel d) Presence of external cerumen 25) A school nurse is caring for a child following tonic-clonic seizure. Which of the following actions should the nurse take first? a) Check the child for a head injury. b) Observe for oral bleeding. c) Check the child's respiratory rate. d) Observe for extremity weakness. 26) A nurse is planning developmental activities for a newly admitted 10-year-old Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material child who has neutropenia. Which of the following actions should the nurse plan to take? a) Provide the child with a book about adventure. b) Arrange frequent visits from family members and peers. c) Give the child a large-piece puzzle. d) Use puppets to entertain the child. 27) A nurse in a health department is caring for an emancipated adolescent who has an STI and is unaccompanied by a guardian. Which of the following actions should the nurse take? a) Have the adolescent sign a consent form for treatment. b) Instruct the adolescent to return with a guardian. c) Obtain consent from the adolescent's guardian over the phone. d) Treat the adolescent without a consent form. 28) A nurse is assessing an 8-year-old child who has early indications of shock. After establishing an airway and stabilizing the childs respirations, which of the following actions should the nurse take next? a) Insert an indwelling urinary catheter. b) Measure weight and height. c) Initiate IV access. d) Maintain ECG monitoring. 29) A nurse is performing hearing screenings for children at a community health fair. Which of the following children should the nurse refer to a provider for a more extensive hearing evaluation? a) An 18-month-old toddler who has unintelligible speech b) A 3-month-old infant who has an exaggerated startle response c) A 4-year-old preschooler who prefers playing with others rather than alone Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d) An 8-month-old infant who is not yet making babbling sounds 30) A nurse is providing discharge teaching to the guardian of a school-age child who has undergone a tonsillectomy. Which of the following statements by the guardian indicates an understanding the teaching? a) "My child can resume usual activities since this was just an outpatient surgery." b) "My child will be able to drink the chocolate milkshake I promised to get for them tonight." c) "I will notify the doctor if I notice that my child is swallowing frequently." d) "I will have my child gargle with warm salt water to relieve their sore throat." 31) A community health nurse is assessing an 18-month-old toddler in a community day care. Which of the following findings should the nurse identify as a potential indication of physical neglect? a) Resists having an axillary temperature taken b) Exhibits withdrawal behaviors when their parent leaves c) Has multiple bruises on their knees d) Poor personal hygiene 32) A nurse assessing a school-age child who has an infratentorial brain tumor. Which of the following findings should the nurse identify as a manifestation of increased intracranial pressure? a) Hypotension b) Reports insomnia c) Difficulty concentrating d) Tachycardia 33) A nurse is providing teaching to an adolescent about how to manage tinea pedis. Which of the following statements by the adolescent indicates an understanding of the teaching? a) "I should buy plastic shoes to wear at the swimming pool." b) "I should wear sandals as much as possible." c) "I should place the permethrin cream between my toes twice daily." d) "I should seal my nonwashable shoes in plastic bags for a couple of weeks." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 34) A nurse is caring for a school-age child who has diabetes mellitus and was admitted with a diagnosis of diabetic ketoacidosis. When performing the respiratory assessment, which of the following findings should the nurse expect? a) Deep respirations of 32/min b) Shallow respirations of 10/min c) Paradoxic respirations of 26/min d) Periods of apnea lasting for 20 seconds 35) A nurse is planning n educational program to teach parents about protecting their children from sunburns. Which of the following instructions should the nurse plan to include? a) "Allow your child to play outside during the hours between 10:00 a.m. and 2:00 p.m." b) "Choose a waterproof sunscreen with a minimum SPF of 15." c) "Dress your child in loose weave polyester fabric prior to sun exposure." d) "Reapply sunscreen every 4 hours." 36) A nurse is providing teaching to the parents of a preschooler who has heart failure and a new prescription for digoxin twice daily. Which of the following instructions should the nurse include in the teaching? a) "Use a kitchen teaspoon to measure the medication." b) "Brush the child's teeth after giving the medication." c) "Double the next dose if the child misses a dose." d) "Repeat the dose if the child vomits." 37) A nurse is providing teaching to the family of a school-age child who has juvenile idiopathic arthritis. Which if the following instructions should the nurse include in the teaching? a) "Limit movement of the child's large joints." b) "Encourage the child to perform independent self-care." c) "Provide the child with a soft mattress for sleeping." d) "Schedule a 2-hour daily nap for the child in the afternoon." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 38) A nurse is creating a plan of care for a child who has varicella. Which of the following interventions should the nurse include? a) Maintain the child's room temperature at 80° F. b) Prepare the child for a lumbar puncture. c) Administer aspirin to the child for a temperature greater than 38.3° C (101° F). d) Initiate airborne precautions for the child. 39) A nurse is assessing a school-age child who has an acute spinal cord injury following a sports injury 1 week ago. Identify the area the nurse should tap to elicit the bicep reflect. i) Correct answer is A 40) A school nurse is providing an in-service for faculty about improving education for students who have ADHD. Which of the following statements by a faculty member indicates an understanding of the teaching? a) "I will plan to increase the amount of homework I assign to students who have ADHD." b) "I will give students who have ADHD the same amount of time as other students to complete tests." c) "I will allow students who have ADHD one rest break throughout the day." d) "I will teach challenging academic subjects to students who have ADHD in the morning." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 41) A nurse is caring for a school-age child who has peripheral edema. The nurse should identify that which of the following assessments should be performed to confirm peripheral edema? a) Palpate the dorsum of the child's feet. b) Weigh the child daily using the same scale. c) Assess the child's skin turgor. d) Observe the child for periorbital swelling. 42) A nurse is caring for an infant who is receiving IV fluids for the treatment of Tetralogy of Fallot and begins to have hypercryanotic spell. Which of the following actions should the nurse take? a) Place the infant in a knee-chest position. b) Administer a dose of meperidine IV. c) Discontinue administration of IV fluids. d) Apply oxygen at 2 L/min via nasal cannula. 43) A nurse is reviewing the dietary choices of an adolescent who has iron deficiency anemia. The nurse should identify that which of the following menu items has the highest amount of nonheme iron? a) ½ cup whole milk b) 1 cup orange juice c) ½ cup raisins d) 1 cup raw carrots 44) A nurse in an emergency department is assessing a 3-month-old infant who has rotavirus and is experiencing acute vomiting and diarrhea. Which of the following manifestations should the nurse identify as an indication that the infant has moderate to severe dehydration? a) Heart rate 124/min b) Increased tear production c) Sunken anterior fontanel d) Capillary refill 2 seconds Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 45) A nurse is planning care for a school-age child who has tunneled central venous access device. Which of the following interventions should the nurse include in the plan? a) Use sterile scissors to remove the dressing from the site. b) Irrigate each lumen weekly with 10 mL of 0.9% sodium chloride solution when not in use. c) Access the site using a non-coring angled needle. d) Use a semipermeable transparent dressing to cover the site. 46) A nurse is teaching a group of parents about infectious mononucleosis. Which of the following statements by parent indicates an understanding the teaching? a) "Mononucleosis is caused by an infection with the Epstein-Barr virus." b) "Mononucleosis is a bacterial infection requiring 14 days of antibiotics." c) "A Monospot is a throat culture used to diagnosis mononucleosis." d) "Children who get mononucleosis will need to refrain from sports for 6 months." 47) A nurse is caring for a newly admitted school-age child who has hypopituitarism. Which of the following medications should the nurse expect the provider to prescribe? a) Desmopressin b) Luteinizing hormone-releasing hormone c) Recombinant growth hormone d) Levothyroxine 48) A nurse is creating a plan of care for a preschooler who has Wilms’ tumor and is scheduled for surgery. Which of the following interventions should the nurse include? a) Avoid palpating the abdomen when bathing the child before surgery. b) Refrain from auscultating the child's bowel sounds during the postoperative assessment. c) Encourage the child to play with other children on the unit prior to surgery. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d) Explain to the child that their pain will be managed after the surgery. 49) A nurse is providing discharge teaching to the parent of an 18-month-old toddler who has dehydration due to acute diarrhea. Which of the following statements by the parent indicates an understanding of the teaching? a) "I will offer my child small amounts of fruit juice frequently." b) "I will avoid giving my child solid foods until the diarrhea has stopped." c) "I will monitor my child's number of wet diapers." d) "I will give my child polyethylene glycol daily for 7 days." 50) A nurse is teaching the guardian of a 6-month-old infant about teething. Which of the following statements should the nurse make? a) "Your baby might pull at their ears when they are teething." b) "Rub your baby's gums with an aspirin to decrease discomfort." c) "Place a beaded teething necklace around your baby's neck." d) "Your baby's upper middle teeth will erupt first. 51) A nurse is creating a plan of care for a newly admitted adolescent who has bacterial meningitis. How long should the nurse plan to maintain the adolescent in droplet precautions? a) Until the adolescent is afebrile b) For 7 days following admission to the facility c) Until the adolescent has a negative blood culture d) For 24 hr following initiation of antimicrobial therapy 52) A nurse is providing anticipatory guidance to the parent of a toddler. Which of the following expected behavior characteristics of toddlers should the nurse include? a) Controls impulsive feelings b) Understands right from wrong Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c) Easily separates from parents for long periods of time d) Expresses likes and dislikes 53) A nurse is admitting a 4-month-old infant who has heart failure. Which of the following findings is the nurses priority? a) Episodes of vomiting b) Formula consumption c) Weight d) Temperature 54) A nurse in an emergency department is assessing a toddler who has Kawasaki disease. Which of the following findings should the nurse expect? (Select all that apply.) vi) Increased temperature vii) Gingival hyperplasia viii) Xerophthalmia ix) Bradycardia x) Cervical lymphadenopathy 55) A nurse is caring for a 10-year-old child following a head injury. Which of the following findings should the nurse identify as an indication that the child is developing diabetes insipidus? a) Urine specific gravity 1.045 b) Sodium 155 mEq/L c) Blood glucose 45 mg/dL d) Urine output 35 mL/hr 56) A nurse is planning care to address nutritional needs for a preschooler who has cystic fibrosis. Which of the following interventions should the nurse include in the plan? a) Administer pancreatic enzymes 2 hr after meals. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material b) Discontinue the use of pancreatic enzymes if steatorrhea develops. c) Limit fluid intake to 750 mL per day. d) Increase fat content in the child's diet to 40% of total calories. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material ATI Nursing Care of Children Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d. "Your child should be able to scribble spontaneously using a crayon at the age of 15 months." Rationale: The nurse should teach the parent that at the age of 15 months, the toddler should be able to scribble spontaneously, and at the age of 18 months, the toddler should be able to make strokes imitatively. 3. A nurse is caring for a toddler and is preparing to administer 0.9% sodium chloride 100 mL IV to infuse over 4 hr. The drop factor of the manual IV tubing is 60 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 25 gtt Rationale: 100ml/4 hr x 60gtt/1mlx 1 hr/60min= 6000/240= 25 gtt Ratio and Proportion STEP 1: What is the unit of measurement to calculate? gtt/min STEP 2: What is the volume needed? 100 mL STEP 3: What is the total infusion time? 4 hr STEP 4: Should the nurse convert the units of measurement? Yes (min does not equal hr) 1 hr/60 min = 4 hr/X min X = 240 min STEP 5: Set up an equation and solve for X. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material Volume (mL)/Time (min) = drop factor (gtt/mL) = X 100 mL/240 min x 60 gtt/mL = X gtt/min X = 25 STEP 6: Round if necessary. STEP 7: Reassess to determine whether the amount to administer makes sense. If the prescription reads 100 ml of 0.9% sodium chloride IV to infuse over 4 hr, it makes sense to administer 25 gtt/min. The nurse should set the manual IV infusion to deliver0.9% sodium chloride IV at 25 gtt/min. Dimensional Analysis STEP 1: What is the unit of measurement to calculate? gtt/min STEP 2: What is the volume needed? 100 mL STEP 3: What is the total infusion time? 4 hr STEP 4: Should the nurse convert the units of measurement? Yes (min does not equal hr) STEP 5: Set up an equation and solve for X. X = Quantity / 1 mL x Conversion (hr) / Conversion (min) x Volume (mL) / Time (hr) X gtt/min = 60 gtt/1 mL x 1 hr/ 60 min x 100 mL/4 hr X = 25 Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material STEP 6: Round if necessary. STEP 7: Reassess to determine whether the amount to administer makes sense. If the prescription reads 100 ml of 0.9% sodium chloride IV to infuse over 4 hr, it makes sense to administer 25 gtt/min. The nurse should set the manual IV infusion to deliver 0.9% sodium chloride IV at 25 gtt/min. 4. A nurse in a pediatric clinic is assessing a toddler at a well-child visit. Which of the following actions should the nurse take? a. Perform the assessment in a head to toe sequence. b. Minimize physical contact with the child initially. c. Explain procedures using medical terminology. d. Stop the assessment if the child becomes uncooperative. Rationale: The nurse should initially minimize physical contact with the toddler, and then progress from the least traumatic to the most traumatic procedures. 5. A nurse is caring for an 18-year-old adolescent who is up-to-date on immunizations and is planning to attend college. The nurse should inform the client that he should receive which of the following immunizations prior to moving into a campus dormitory? a. Pneumococcal polysaccharide b. Meningococcal polysaccharide c. Rotavirus d. Herpes zoster Rationale: The meningococcal polysaccharide immunization is used to prevent infection by certain groups of meningococcal bacteria. Meningococcal infection can cause life-threatening illnesses, such as meningococcal meningitis, which affects the brain, and meningococcemia, which affects the blood. Both of these conditions can be fatal. College freshmen, particularly those who live in dormitories, are at an increased risk for meningococcal disease relative to other Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material persons their age. Therefore, the Centers for Disease Control and Prevention has issued a recommendation that all incoming college students receive the meningococcal immunization. 6. A nurse is teaching the parent of an infant about food allergens. Which of the following foods should the nurse include as being the most common food allergy in children? a. Cow's milk b. Wheat bread c. Corn syrup d. Eggs Rationale: According to evidence-based practice, the nurse should instruct the parent that cow’s milk is the most common food allergy in children. Some children are sensitive to the protein, called casein, found in cow’s milk. They have difficulty metabolizing the casein and are, therefore, allergic to cow’s milk. 7. A nurse is teaching the parent of a toddler about home safety. Which of the following statements by the parent indicates an understanding of the teaching? a. "I lock my medications in the medicine cabinet." b. "I keep my child's crib mattress at the highest level." c. "I turn pot handles to the side of my stove while cooking." d. "I will give my child syrup of ipecac if she swallows something poisonous." Rationale: Locking up medications and other potential poisons prevents access. Toddlers have improved gross and fine motor skills that allow for further exploration of the environment and possible access to hazardous substances. 8. A nurse is performing a physical assessment on a 6-month-old infant. Which of the following reflexes should the nurse expect to find? a. Stepping b. Babinski c. Extrusion Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d. Moro Rationale: The Babinski reflex, which is elicited by stroking the bottom of the foot and causing the toes to fan and the big toe to dorsiflex, should be present until the age of 1 year. Persistence of neonatal reflexes might indicate neurological deficits. 9. A nurse is preparing to administer recommended immunizations to a 2-month-old infant. Which of the following immunizations should the nurse plan to administer? a. Human papillomavirus (HPV) and hepatitis A b. Measles, mumps, rubella (MMR) and tetanus, diphtheria, and acellular pertussis (TDaP) c. Haemophilus influenzae type B (Hib) and inactivated polio virus (IPV) d. Varicella (VAR) and live attenuated influenza vaccine (LAIV) Rationale: The recommended immunizations for a 2-month-old infant include Hib and IPV. The Hib immunization series consists of 3 to 4 doses, depending on the immunization used, and at a minimum is administered at the ages of 2 months, 4 months, and 12 to 15 months. The IPV immunization series consists of 4 doses and is administered at the ages of 2 months, 4 months, 6 to 18 months, and 4 to 6 years. 10. A nurse is developing a plan of care for a school-age child who underwent a surgical procedure that resulted in temporary loss of vision. Which of the following interventions should the nurse include in the plan of care? a. Assign an assistive personnel to feed the child. b. Explain sounds the child is hearing. c. Have the child use a cane when ambulating. d. Rotate nurses caring for the child. Rationale: The noises in a facility can be frightening to a child who is experiencing a sensory loss. It is important to explain these noises to allay the child’s fears. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 11. A nurse is assessing a 3-year-old child who is 1 day postoperative following a tonsillectomy. Which of the following methods should the nurse use to determine if the child is experiencing pain? a. Ask the parents. b. Use the FACES scale. c. Use the numeric rating scale. d. Check the child's temperature. Rationale: Pain is a subjective experience even for a 3-year-old child. The FACES scale can be used to accurately determine the presence of pain in children as young as 3 years of age. 12. A nurse is assessing a 6-month-old infant at a well-child visit. Which of the following findings indicates the need for further assessment? a. Grabs feet and pulls them to her mouth b. Posterior fontanel is closed c. Legs remain crossed and extended when supine d. Birth weight has doubled Rationale: Legs crossed and extended when supine is an unexpected finding and requires further assessment. At 6 months of age, the legs flex at the knees when the infant is supine. Crossed and extended legs when supine is a finding associated with cerebral palsy. 13. A nurse is observing a mother who is playing peek-a-boo with her 8-month-old child. The mother asks if this game has any developmental significance. The nurse should inform the mother that peek-a-boo helps develop which of the following concepts in the child? a. Hand-eye coordination b. Sense of trust c. Object permanence d. Egocentrism Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material Rationale: Object permanence refers to the cognitive skill of knowing an object still exists even when it is out of sight. In discovering a hidden object while playing peek-a-boo, the infant experiences validation of this concept. 14. A nurse is caring for a 15-month-old toddler who requires droplet precautions. Which of the following actions should the nurse take? a. Have the toddler wear a disposable gown when in the unit's playroom. b. Wear sterile gloves when changing the toddler's diapers. c. Wear a mask when assisting the toddler with meals. d. Ask visitors to wear an N-95 mask when entering the room. Rationale: The nurse should wear a mask when within 3 to 6 feet of the toddler to prevent the transmission of infections that are spread via large droplet particles expelled in the air. 15. A nurse at a pediatric clinic is assessing a 5-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? a. Head lags when pulled from a lying to a sitting position b. Absence of startle and crawl reflexes c. Inability to pick up a rattle after dropping it d. Rolls from back to side Rationale: At the age of 5 months, the infant should have no head lag when pulled to a sitting position; therefore, the nurse should report this finding to the provider. 16. A nurse is planning to collect a specimen from a male infant using a urine collection bag. Which of the following actions should the nurse take? a. Wash and dry the infant's genitalia and perineum thoroughly. b. Apply a small coating of water-soluble lubricant to the skin of the infant's perineal area. c. Avoid placing the scrotum inside the collection bag. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d. Wait several hours after positioning the device before checking it. Rationale: This is the method used to obtain a routine urine specimen of any sort in a child who is not toilet trained. The skin should be washed and dried to promote application of the adhesive of the collection device. 17. A nurse in a pediatric clinic is caring for a 3-year-old child who has a blood lead level of 3 mcg/dL. When teaching the toddler's parents about the correlation of nutrition with lead poisoning, which of the following information is appropriate for the nurse to include in the teaching? a. Decrease the child's vitamin C intake until the blood lead level decreases to zero. b. Administer a folic acid supplement to the child each day. c. Give pancreatic enzymes to the child with meals and snacks. d. Ensure the child's dietary intake of calcium and iron is adequate. Rationale: A child who has an elevated blood lead level should have an adequate intake of calcium and iron to reduce the absorption and effects of the lead. Dietary recommendations should include milk as a good source of calcium. 18. A nurse is planning care for a 10-month-old infant who has suspected failure to thrive (FTT). Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) a. Observe the parents' actions when feeding the child. b. Maintain a detailed record of food and fluid intake. c. Follow the child's cues as to when food and fluids are provided. d. Sit beside the child's high chair when feeding the child. e. Play music videos during scheduled meal times. Rationale: Observing the parents’ actions when feeding the child is correct. Inappropriate feeding techniques and meal patterns provided by parents can contribute to a child’s growth failure. Maintaining a detailed record of food and fluid intake is correct. A nutritional goal for Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material the child who has suspected FTT is to correct nutritional deficiencies, which can be identified by recording all food and fluid intake. Following the child’s cues as to when food and fluids are provided is not correct. A consistent structured routine of feeding the child at the same time and place is used to promote weight gain. A child who has failure to thrive might not offer feeding cues. Sitting beside the child’s high chair when feeding the child is not correct. Caregivers should sit directly in front of the child to maintain a face-to-face position during feeding and promote eye contact. The emphasis is on encouraging feeding. Playing music videos during scheduled meal times is not correct. A quiet, stimulation-free environment should be provided at meal times to avoid distractions and focus attention on food intake. 19. A nurse is assessing a 7-year-old child's psychosocial development. Which of the following findings should the nurse recognize as requiring further evaluation? a. The child prefers playmates of the same sex. b. The child is competitive when playing board games. c. The child complains daily about going to school. d. The child enjoys spending time alone. Rationale: Complaining every day about going to school is an unexpected finding for a 7-yearold child. The child is in Erikson’s psychosocial development stage of industry vs. inferiority. Children in this stage want to learn and master new concepts. If the child complains daily about going to school, it warrants further evaluation. 20. A nurse is providing education to the parent of a toddler who is about to receive her first dose of the MMR (measles, mumps and rubella) immunization. Which of the following statements by the parent indicates an understanding of the teaching? a. "I am not going to let my child play with other children for 2 days." b. "I will need to return in 2 weeks for my child to receive the varicella immunization." c. "I can give my child acetaminophen for discomfort associated with the immunization." d. "My child might have some discharge from the injection site." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material Rationale: Parents can give acetaminophen for minor discomforts such as low-grade fever and local tenderness resulting from the administration of the immunization. 21. A nurse is providing teaching to the parents of a 4-year-old child about fine motor development. Which of the following tasks should the nurse include in the teaching as an expected finding for this age group? a. Copies a circle b. Cuts foods using a table knife c. Begins writing in cursive d. Prints first and last name clearly Rationale: The nurse should explain that copying a circle is a skill achieved by the age of 4 years. 22. A nurse is providing teaching to the parents of a 4-year-old child about fine motor development. Which of the following tasks should the nurse include in the teaching as an expected finding for this age group? a. Brightly colored mobile b. Plastic stethoscope c. Small piece jigsaw puzzle d. A book of short stories Rationale: Preschool play centers on imitative activities. Providing a stethoscope allows the child an opportunity for therapeutic play. Imitating health care personnel helps to ease the fear of unfamiliar equipment. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 23. A nurse in an emergency department is caring for an 8-year old who is up-to-date with current immunization recommendations and has a deep puncture injury. Which of the following should the nurse anticipate administering? a. Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine b. A single injection of tetanus immune globulin (TIG) mixed with the pediatric tetanus booster (DT) c. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine d. Adult tetanus booster (Td) Rationale: Td is recommended for wound prophylaxis in children ages 7 years and older. Td is also recommended every 10 years after 18 years of age. 24. A nurse is providing teaching about promoting sleep with the parent of a 3-year-old toddler. Which of the following information should the nurse include? a. Follow a nightly routine and established bedtime. b. Encourage active play prior to bedtime. c. Let the child remain awake until tired enough to go to sleep. d. Reward the child with a food treat just prior to sleep if the child goes to bed on time. Rationale: Preschool-age children test limits. Consistency in approach to bedtime is very important. Bedtime is more likely to be pleasant for everyone if a routine is established and followed every night. 25. A nurse is planning to implement relaxation strategies with a young child prior to a painful procedure. Which of the following actions should the nurse take? a. Ask the child to hold his breath and then blow it out slowly. b. Ask the child to describe a pleasurable event. c. Bounce the child gently while holding him upright. d. Rock the child in long rhythmic movements. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material Rationale: The nurse can implement relaxation strategies by sitting with the child in a wellsupported position such as against the chest, and then rocking or swaying back and forth in long, wide movements. 26. A nurse is assessing a 6-year-old child at a well-child visit. Which of the following findings requires further assessment by the nurse? a. Presence of sparse, fine pubic hair b. Decreased head circumference compared to full height c. Increased leg length related to height d. Presence of a loose, central incisor Rationale: The development of sexual characteristics prior to the age of 9 years in boys, and 8 years in girls, is an indication of precocious puberty and requires further evaluation. 27. A nurse is caring for a preschool-age child who is dying. Which of the following findings is an age-appropriate reaction to death by the child? (Select all that apply.) a. The child views death as similar to sleep. b. The child is interested in what happens to his body after death. c. The child recognizes that death is permanent. d. The child believes his thoughts can cause death. e. The child thinks death is a punishment. Rationale: The child views death as similar to sleep is correct. Preschool-age children might make this comparison. The child is interested in what happens to his body after death is not correct. A school-age child is interested in post-death services and what happens to the body after death due to an improved ability to comprehend what is happening. The child recognizes that death is permanent is not correct. Preschool-age children have difficulty understanding the concept of time and are therefore not likely to believe that death is permanent. They perceive death as reversible. The child believes his thoughts can cause death is correct. Preschool-age children believe that their thoughts and wishes can make things happen since they are egocentric. This is one reason why the death of a family member can be very difficult for a child at this age. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material The child thinks death is a punishment is correct. Preschool-age children sometimes believe that death is the result of guilt or punishment due to something they have done, said, or thought. 28. A nurse is teaching the parent of an infant about home safety. Which of the following information should the nurse include? a. Use a wheeled infant walker. b. Place soft pillows around the edge of the infant's crib. c. Position the car seat so it is rear-facing. d. Secure a safety gate at the top and bottom of the stairs. e. Maintain the water heater temperature at 49° C (120° F). Rationale: Using a wheeled infant walker is incorrect. A stationary infant walker is recommended. Wheeled infant walkers can quickly move across uneven surfaces and result in injury. Placing soft pillows and cushions around the edge of the infant’s crib is incorrect. Soft pillows and cushions should not be used in cribs due to the increased risk of suffocation. Positioning the car seat so it is rear-facing is correct. Infants and children should remain in the rear-facing position when in a car seat until the age of 2 years or until they reach the recommended height and weight per the manufacturer’s guidelines. Securing a safety gate at the top and bottom of the stairs is correct. As the infant begins to crawl and becomes more mobile, the risk of falls increases. Maintaining the water heater temperature at 49° C (120° F) is correct. To prevent a burn injury, the temperature of the water heater should not exceed 49° C (120° F). 29. A nurse is caring for an adolescent who is receiving pain medication via a PCA pump. When the nurse assess the client's pain at 0800, the client describes the pain as a 3 on a scale of 1 to 10. At 100, the client describes the pain as a 5. The nurse discovers the client has not pushed the button to deliver medication in the past 2 hr. Which of the following actions should the nurse take? a. Ask the provider to discontinue the PCA so the nurse can administer PRN pain medication. b. Suggest the client's parent push the button for the client if the parent thinks the adolescent is having pain. c. Reevaluate the client in 1 hr since a pain level of 5 is acceptable on a scale of 1 to 10. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d. Reinforce teaching with the client about how to push the button to deliver the med. Rationale: The appropriate action at this time is to reinforce client teaching about the PCA. The nurse should remind the client about the availability of the medication, verify that the client knows how to use the equipment, and emphasize the importance of using it regularly to manage pain effectively. 30. A nurse is assessing a 12-month-old male infant's vital signs during a well-child visit. The infant is in the 90th percentile of height. Which of the following findings should the nurse report to the provider? a. Heart rate 175/min b. Respiratory rate 26/min c. Blood pressure 88/40 mm Hg) d. Temperature 37.6° C (99.7° F Rationale: A heart rate of 175/min is above the expected reference range for a 12-month-old infant; therefore, the nurse should report this finding to the provider. 31. A nurse is teaching the parent of a 12-month-old infant about nutrition. Which of the following statements by the parent indicates a need for further teaching? a. "I can give my baby 4 ounces of juice to drink each day." b. "I will offer my baby dry cereal and chilled banana slices as snacks." c. "I am introducing my baby to the same foods the family eats." d. "My infant drinks at least 2 quarts of skim milk each day." Rationale: As the infant transitions into toddlerhood, whole milk intake should average 24 to 30 oz per day. Too much milk can affect intake of solid foods and result in iron deficiency anemia. Skim milk is not recommended until after age 2 since it lacks essential fatty acids which are needed for growth and development. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 32. A nurse is assisting a provider during a femoral venipuncture on a toddler. The nurse should place the child in which of the following positions? a. Side-lying b. Semi-recumbent c. Flexed sitting d. Supine Rationale: The client is placed in the supine position, with the client's legs in a frog position. 33. A nurse is assessing a 9-month-old infant during a well-child visit. Which of the following findings indicates that the infant has a developmental delay? a. Creeps on hands and knees b. Inability to vocalize vowel sounds c. Uses crude pincer grasp d. Stands by holding onto support Rationale: The infant should begin vocalizing vowel sounds at the age of 7 months, and by the age of 10 months, be able to say at least one word. 34. A nurse is preparing to administer a liquid medication to an infant. Which of the following actions should the nurse take? a. Administer the medication while the infant is supine. b. Give the medication at the side of the infant's mouth. c. Add the medication to a full bottle of the infant's formula. d. Administer the medication slowly while holding the nares closed. Rationale: When administering medications to an infant, a needleless oral syringe or medicine dropper is placed in the side of the mouth (buccal cavity alongside the tongue) to prevent gagging and aspiration. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 35. A nurse on a pediatric unit is reviewing the health record of a client who is demonstrating increasing levels of stress after admission. The nurse should identify which of the following findings as a risk factor for a stress-related reaction to hospitalization? a. Age 10 b. First hospitalization c. Male gender d. Calm, quiet demeanor Rationale: Male clients are at increased risk for hospitalization-related stress compared to female clients. 36. A nurse in the emergency department is caring for a 12-year-old child who has ingested bleach. Which of the following statements by the nurse indicated an understanding of this ingestion? a. "The absence of oral burns excludes the possibility of esophageal burns." b. "Treatment focuses on neutralization of the chemical." c. "Injury by a corrosive liquid is more extensive than by a corrosive solid." d. "Immediate administration of activated charcoal is warranted." Rationale: The coating action of liquids permits larger areas of contact with tissues and results in more extensive injury. 37. A nurse is caring for a child who has a bacterial endocarditis. The child is scheduled to receive moderate term antibiotic therapy and requires a peripherally inserted central catheter (PICC). Which of the following statements should the nurse include when teaching the child's parent? a. "The PICC line will last several weeks with proper care." b. "The public health nurse will rotate the insertion site every 3 days." c. "You will need to make certain the arm board is in place at all times." d. "Your child will go to the operating room to have the line placed." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 40. A nurse is assessing a 30-month-old toddler during a well-child visit. Which of the following findings requires further assessment by the nurse? a. Primary dentition is complete b. Unable to hop on one foot c. Birth weight is tripled d. Able to state first and last name Rationale: The birth weight should triple by 12 months of age. By 30 months of age, the birth weight should be quadrupled. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material ATI Nursing Care of Children 4. A nurse is assisting with the care of a child who is postoperative and received a transfusion during a surgical procedure. Which of the following findings indicates the child is havig a hemolytic reaction? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material a) Chills and flank pain (Chills and flank pain are findings that indicate an incompatibility of the transfused blood product with the client's blood. The nurse should identify this finding as an indication that the child is having a hemolytic reaction.) b) Pruritus and flushing c) Rales and cyanosis d) Bradycardia and diarrhea 5. A guardian calls the clinic nurse after his child has developed symptoms of varicella and asks when his child will no longer be contagious. Which of the following responses should the nurse make? a) “When your child no longer has a fever.” b) “Three days after the rash started.” c) “Six days after lesions appear if they are crusted.” (The nurse should inform the guardian that a child will stop being contagious around 6 days after the lesions appeared, as long as they are crusted over.) d) “When your child’s lesions disappear.” 6. A nurse is collecting date from a child during a well-child visit. The nurse should recognize that which of the following findings places the child at a higher risk for abuse? a) The child is 6 years old. b) The child is male. c) The child was born at 30 weeks of gestation. (The nurse should identify that children who are born prematurely are at greater risk for abuse because of the potential for impaired bonding during early infancy.) d) The child was born via cesarean birth. 7. A nurse is reinforcing teaching with the guardian of a child who has a new diagnosis of rheumatic fever. Which of the following statements by the guardian indicates an understanding of the teaching? a) “I should not give my child aspirin for pain or fever.” b) “My child will take antibiotic for 6 months.” c) “My child might have a period of irregular movement of the extremities.” (The nurse should instruct the guardian that the child might experience chorea weeks or months after the initial diagnosis. Chorea is a temporary lack of coordination and the presence of sudden, irregular movements or periods of clumsiness.) d) “I should expect there to be blood in my child’s urine.” Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 8. A nurse is collecting data from an infant during a well-child visit. Which of the following sites should the nurse use when obtaining the infant’s heart rate? a) Apical (The nurse should use the apical pulse to obtain the infant's heart rate and count it for a full minute, because it gives a reliable rate and rhythm and provides accurate baseline assessment data. In an infant, the apical heart rate is auscultated at the fourth intercostal space lateral to the midclavicular line.) b) Radial c) Carotid d) Femoral 9. A nurse is preparing a toddler for suturing of a minor facial laceration. The nurse should place the toddler in which of the following restraints? a) Mummy restraint (The nurse should use a mummy wrap when a short-term restraint is needed for treatment of the toddler that involves the head and neck. The nurse should always use the least amount of restraint necessary.) b) Jacket restraint c) Elbow restraint d) Wrist restraint 10. A nurse is reinforcing dietary teaching with the parent of a 2-year-old toddler. Which of the following should the nurse include in the teaching? a) "It is recommended that the toddler consumes no more than 12 ounces of fruit juice each day." b) "An appropriate serving size is 1 tablespoon of food per year of age." (The nurse should include that an appropriate serving size for a 2-year-old toddler is 1 tbsp of food per year of age.) c) "Introduce healthy finger foods like carrots and celery sticks." d) "Encourage 5 cups of low-fat milk each day." 11. During a well-child visit, the parent of a toddler expresses concern to the nurse that the toddler takes several hours to fall asleep at night. Which of the following recommendations should the nurse make? a) Vary the time the toddler goes to bed each night b) Allow the toddler to watch television before bedtime c) Provide the toddler with a favorite toy at bedtime. (The nurse should recommend to the parent that providing the toddler with a favorite toy at bedtime will help the toddler to feel more secure and facilitate sleep.) Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d) Increase the toddler's activity prior to bedtime 12. A nurse is assisting with the care for a 7-month-old infant who has a cleft palate. Which of the following actions should the nurse take to decrease the infant’s risk for aspiration? a) Feed the infant in supine position. b) Encourage the mother to breastfeed the infant exclusively. c) Burp the infant frequently during feedings. (Infants with a cleft palate have difficulty creating a seal around a bottle. Burping the infant frequently, following every ounce of fluid consumed, dissipates swallowed air and helps to prevent aspiration.) d) Perform nasotracheal suctioning if coughing occurs 13. A nurse is reviewing the laboratory values of a school-age child who has iron deficiency anemia. Which of the following findings should the nurse expect? a) Hgb 9.0 g/dL (The nurse should expect a child who has iron deficiency anemia to have an Hgb level below the expected reference range of 9.5 to 15.5 g/dL. An Hgb of 9.0 g/dL is below the expected reference range.) b) Hct 37% c) Iron 100 mcg/dL d) Total iron binding capacity 325 mcg/dL 14. A nurse is reinforcing teaching about vital signs with the guardian of a 1-year-old toddler. Which of the following statements by the guardian indicates an understanding of the teaching? a) "My child's pulse could increase to 150 beats a minute with activity.” (A pulse rate of 150/min is within the expected reference range for a toddler during physical activity.) b) "My child's temperature should be 96.8 degrees Fahrenheit." c) "My child should take 40 breaths a minute." d) "My child's pulse could get as low as 60 beats a minute while asleep." 15. A nurse is caring for an adolescent who has acne and anew prescription for isotretinoin. For which of the following adverse effects should the nurse monitor? a) Hypersalivation b) Depression (Clients taking isotretinoin can experience mental status changes, such as suicidal thoughts, aggression, emotional lability, and depression. The nurse should monitor the adolescent's mental status while taking isotretinoin.) c) Bradycardia d) Hyperreflexia Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 16. A nurse is reinforcing teaching about interventions for mild hypoglycemia with the parent of a child who has diabetes mellitus. Which of the following statements by the parent indicates that the teaching has been effective? a) "I should administer a glucagon injection to my child." b) "I should give my child 5 grams of a simple carbohydrate." c) "I should give my child 4 ounces of orange juice followed by cheese and crackers." (The parent should treat mild hypoglycemia with 10 to 15 g of a simple carbohydrate, such as 4 oz. of orange juice, and follow it with a starch-protein snack.) d) "I should give my child a snack that is 10 percent of his daily caloric intake." 17. A nurse is collecting data from a 10-month-old infant. Which of the following findings should the nurse report to the provider? a) Pulls self to standing position b) Moves by creeping on hands and knees c) Takes intentional steps when standing d) Sits with support by leaning on hands (The nurse should identify that sitting with support can indicate a developmental delay, because an infant should be able to sit unsupported by 8 months of age. Therefore, the nurse should report this finding to the provider.) 18. A nurse is preparing to administer phenobarbital to a toddler who has a seizure disorder and weights 10 kg (22 lb). The prescription reads phenobarbital sodium 2.5 mg/kg PO BID. Available is phenobarbital 20 mg/5 mL. How many mL should the nurse administer with each dose? (Round to the nearest hundredth. Use a leading zero if it applies. Do not use a trailing zero Ratio and Proportion 6.26 mL Step 1: What is the unit of measurement the nurse should calculate? mL Step 2: What is the dose the nurse should administer? Dose to administer = Desired 2.5 mg/kg = 2.5 x 10 = 25 mg Step 3: What is the dose available? Dose available = Have 20 mg Step 4: Should the nurse convert the units of measurement? No Step 5: What is the quantity of the dose available? 5 mL Step 6: Set up an equation and solve for X. Have/Quantity = Desired/X 20 mg/5 mL = 25 mg/X mL X = 6.25 Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 19. A nurse is caring for a child who has type 1 diabetes mellitus and has been receiving insulin via subcutaneous infusion pump. Which of the following laboratory tests would verify the average blood glucose level over the past 2 months? a) Postprandial blood glucose b) Fasting blood glucose c) Glycosylated hemoglobin (Glycosylated hemoglobin provides an accurate average of the client's blood glucose level over the past 120 days. This test can be used to determine the effectiveness of, or compliance with, a treatment plan. It can also be used to diagnose diabetes mellitus.) d) Mean corpuscular hemoglobin 20. A nurse is reinforcing teaching with the guardian of a child who has a new prescription for levalbuterol solution for use in a nebulizer. Which of the following statements by the guardian indicates an understanding of the teaching? a) "I should store the unused medication in the freezer." b) "I should make sure I use the vial within 3 weeks of opening it from the foil package." c) "My child might be drowsy while taking this medication." d) "My child might experience palpitations after taking this medication." (Palpitations are an adverse effect of levalbuterol. If this occurs, the guardian should discontinue the medication and notify the provider. 21. A nurse is collecting data from a 12-month-old infant during a well-child visit. At birth, the infant’s weight was 3.6 kg (8 lb.) and his length was 50.8 cm (20 in). Based on this data, whichof the following findings should the nurse expect? a) The infant weighs 6.4 kg (14 lb) b) The infant is 101.6 cm (40 in) long c) The infant is 76.2 cm (30 in) long (The nurse should expect a length of 76.2 cm (30 in), because the infant's length should increase by about 50% by 12 months of age.) d) The infant weighs 14.5 kg (32 lb) 22. A nurse is reinforcing teaching about home care with the guardian of a 14-month-old toddler who has spastic cerebral palsy. Which of the following statements by the guardian indicates an understanding of the teaching? a) "I will perform daily stretching exercises to my toddler's affected muscles." (The nurse should reinforce that performing stretching exercises of the toddler's affected muscles will prevent muscle contractures.) b) "I will ensure my toddler avoids activities that involve repetitive joint movements." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c) "I will place my toddler on his stomach to nap after meals." d) "I will give my toddler pain medication just after he performs strenuous activities." 23. A nurse is assisting with the development of a health promotion program for the guardians of adolescents. Which of the following information about adolescents should the nurse recommend to include in the program? a) The sleep patterns of adolescents are well established. b) The percentage of adolescents that consider suicide is higher for males than for females. c) The leading cause of death in adolescents is physical injury. (The nurse should recommend including this information, because injuries from motor-vehicle crashes are the leading cause of death in the adolescent population.) d) The caloric intake needs of adolescents are less than that of school-age children. 24. A nurse in a pediatric clinic is caring for an infant who has heart failure and a prescription for digoxin. Which of the following statements by the parent indicates the desired therapeutic effect of the medication? a) "My baby is breathing easier than she used to." (The nurse should identify that the desired effect of digoxin is to increase cardiac output and decrease venous pressure and pulmonary edema, which will reduce respiratory demands.) b) "My baby is taking longer naps." c) "My baby is having fewer wet diapers." d) "My baby's heart rate is faster than it used to be." 25. A nurse is contributing to the plan of care for a 10-month-old infant who is postoperative following cleft palate repair. Which of the following actions should the nurse include in the plan of care? a) Place the infant in side-lying position. (The nurse should place the infant in side-lying position to promote healing and prevent injury to the surgical site.) b) Offer the infant liquids with a straw. c) Prohibit the guardian from holding the infant for 8 hr. d) Cleanse the suture line with a lemon glycerin swab. 26. A nurse is caring for a toddler following a tonsillectomy. Which of the following is the priority finding that the nurse should report to the provider? a) Drowsiness b) Throat pain Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c) Continuous swallowing (When using the urgent vs. nonurgent approach to client care, the nurse should identify that continuous swallowing is a manifestation of hemorrhage. Therefore, this is the priority finding for the nurse to report to the provider.) d) Dark brown emesis 27. A nurse is reinforcing teaching with the guardian of a school age-age child who has acute bacterial conjunctivitis and a new prescription for sulfacetamide. Which of the following instructions should the nurse include? a) Remove dried drainage with a cold washcloth. b) Instill medication immediately after cleansing the eye. (The nurse should instruct the guardian to place the medication in the eye immediately after cleansing.) c) Apply an occlusive gauze over the child's eye. d) Cleanse the eye by gently wiping from the outer aspect of the eye inward toward the nose. 28. A nurse is preparing to leave the room after performing nasal suctioning for an infant who has respiratory syncytial virus (RSV). Identify the sequence in which the nurse should remove the following personal protective equipment (PPE). (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.) Mask Gloves Gloves Goggle Gown Gown Goggle Mask The infant is on droplet and contact precautions due to the RSV. First, the nurse should remove his gloves, because these are the most contaminated. Second, the nurse should remove goggles, so they do not interfere with removing the other PPE. The nurse should then remove the gown, and finally the mask, to decrease exposure to the disease. 29. A nurse in a provider’s office is caring for a preschooler who has findings of croup. Which of the following statements by the parent requires immediate intervention by the nurse? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material a) "My child has refused to drink any fluids for the past 8 hours." (An inadequate fluid intake indicates the child is at greatest risk for dehydration and electrolyte imbalance. Therefore, this statement by the parent requires immediate intervention by the nurse.) b) "My child has been coughing throughout the night." c) "My child is very hoarse and has a fever of 100.4 degrees Fahrenheit." d) "My child recently had the flu." 30. A nurse is administering an injection of epinephrine to a child who is experiencing manifestations of anaphylaxis. The nurse should monitor for which of the following adverse effects? a) Pinpoint pupils b) Decreased heart rate c) Increased systolic blood pressure (Epinephrine is an adrenergic agonist used to treat anaphylaxis by activating the sympathetic nervous system. The nurse should expect the child to have an increased systolic blood pressure following administration of epinephrine.) d) Dry skin 31. A nurse is reinforcing anticipatory guidance to the parents of an adolescent. Which of the following recommendations should the nurse include? a) Compare the adolescent's behavior to older siblings. b) Be open to the adolescent's point of view. (During this stage of development, adolescents are developing autonomy and self-identity. The nurse should recommend that the parents actively listen and be open to the adolescent's point of view, even if the parents disagree with his viewpoint.) c) Select school activities for the adolescent. d) Provide the adolescent with flexible rules. 32. A nurse is preparing to administer furosemide to a toddler who has a heart defect. Which of the following should the nurse take to identify the toddler? a) Ask the child to state her name. b) Ask the pharmacy for the child's room number. c) Ask the child to state her birthday. d) Ask the guardian to verify the child's name. (Prior to administration of any medication, the nurse must correctly identify the toddler using two identifiers. The nurse should ask the guardian to verify the identity of the child and use the identification band as the second identifier.) Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 33. A nurse is reinforcing teaching about liquid oral iron supplements with the guardian of a school-age child who has iron deficiency anemia. Which of the following statements by the guardian indicates an understanding of the teaching? a) "I will give my child a double dose of this medication if she misses a dose." b) "I will give this medication to my child with a cup of skim milk." c) "This medication will turn my child's stools white." d) "I will give this medication to my child with a straw." (The nurse should reinforce with the guardian to administer this medication with a straw to prevent staining the child's teeth.) 34. A nurse is reinforcing teaching with the parent of a child who is being treated with diphenhydramine for allergic rhinitis. The nurse should tell the parent to monitor the child for which of the following? a) Polyuria b) Drowsiness (Diphenhydramine can cause drowsiness due to CNS depression. The nurse should reinforce with the parent to administer the medication at bedtime to avoid daytime sedation.) c) Drooling d) Hypogeusia 35. A nurse is caring for a toddler who has terminal cancer and is receiving hospice care. The child’s parent tells the nurse. “I’m a bad parent, and I can’t deal with this.” Which of the following responses should the nurse make? a) "Tell me more about what you are feeling." (The nurse should use open-ended statements that will allow the parent to share his feelings and emotions. During times of grief, the parent needs to express his emotions. The use of an open-ended statement relays the message that it is safe to do so with the nurse.) b) "I understand how you are feeling." c) "Let's talk about home care for your child." d) "I'm sure you're just tired right now." 36. A nurse is preparing to administer levalbuterol via nebulizer to a child with asthma. Which of the following data should the nurse collect prior to administering the medication? a) Peak flow reading b) Lung sounds (Levalbuterol is a bronchodilator used to increase air exchange. The nurse should evaluate lung sounds prior to and after the administration of the medication to determine changes in respiratory status.) Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c) ABGs d) Inspiratory reserve volume 37. A nurse is preparing to obtain a peak expiration flow rate from an adolescent. Which of the following actions should the nurse take? a) Document the average of the client's three attempts. b) Instruct the client to exhale slowly over 5 seconds into the meter. c) Determine the zone according to the client's age. d) Have the client stand during the procedure. (To obtain the peak expiratory flow rate, the nurse should have the client stand during the procedure, which will allow the nurse to get an accurate reading.) 38. A nurse is contributing to the pan of care for a child who is in Buck’s traction. Which of the following interventions should the nurse include in the plan? a) Remove the weights when changing the bed linens. b) Maintain the leg in an extended position. (The nurse should have the child maintain her affected leg in an extended position while in Buck's traction. This position decreases the risk for further injury to the extremity and minimizes the occurrence of muscle spasms.) c) Monitor the halo device every 4 hr. d) Provide pin care as prescribed. 39. A nurse is assisting with the care of plan of a 4-year-old child who is prescribed an IV medication preoperatively. Which of the following techniques should the nurse use to assist the child to cope with this procedure? (Select all that apply) a) Discuss benefits of the procedure.(The nurse should discuss the benefits of the procedure with the child, because this action is an age-appropriate activity that will decrease the child's anxiety about the procedure. It will also provide an opportunity for the nurse to clarify any misconceptions the child might have about the procedure.) b) Provide the child with a detailed explanation of the procedure. c) Implement interactive sessions of 30 min. d) Give the child needleless IV supplies to play with. (The nurse should allow the child to see, hold, and collect the supplies to familiarize the child with the potentially frightening aspects of the procedure, which will decrease the child's anxiety.) e) Allow the child to perform the procedure with a doll. (The nurse should allow the child to mimic the procedure with a doll to alleviate anxiety. It will also provide an opportunity for the nurse to clarify any misconceptions the child might have about the procedure.) Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 40. A nurse is reviewing the plan of care for a child who has cystic fibrosis. Which of the following is the priority goal for this child? a) The child will participate in age-appropriate recreational activities. b) The child will maintain an effective breathing pattern. (Manifestations of cystic fibrosis, such as chronic cough, pulmonary infection, and bronchiolar obstruction lead to severely impaired ventilation and gas exchange, which causes long-term pulmonary complications. Therefore, when utilizing the airway, breathing, circulation approach to client care, maintaining an effective breathing pattern is the priority goal for the child who has cystic fibrosis.) c) The child will maintain an adequate bowel elimination pattern. d) The child will receive immunizations as recommended 41. A nurse is collecting physical data from a 4-year-old child who has diarrhea and has been vomiting for 24 hr. which of the following sites should the nurse grasp to determine the child’s skin turgor? a) The child's sacral area. b) The top of the child's hand. c) The child's sternal area. d) The child's abdomen. (The nurse should expect the child who has diarrhea and has been vomiting to exhibit manifestations of dehydration, such as a decrease in skin turgor. To check skin turgor, the nurse should grasp the skin on the child's abdomen, pull it taut, and release it quickly. The child who is dehydrated will have a prolonged period of tenting.) 42. A nurse is caring for a 1-month-old infant who has a nasogastric tube in place for intermittent feedings. Which of the following actions should the nurse take? a) Position the head of the crib at a 30° angle between feedings. (The nurse should place the infant with the head of the crib elevated 30° to 45° to prevent aspiration.) b) Place the infant on her left side after a feeding. c) Administer feedings over 5 min. d) Flush the tube with 30 mL of tap water. 43. A nurse is reinforcing teaching with the family of an adolescent client who was recently diagnosed with celiac disease. Which of the following foods should the nurse recommend? a) Graham crackers b) Rye bread c) Whole wheat spaghetti Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material d) Yellow corn (A client who has celiac disease is unable to process gluten, a protein found in wheat, barley, rye, and oats. The nurse should instruct the family that the client's diet is restricted to foods that are free of gluten, such as corn, rice, and millet.) 44. A nurse is reinforcing teaching with the parents of a 2-year-old toddler at a well-child visit. Which of the following should the nurse recommend as an age-appropriate activity for the toddler? a) Creating a rock collection b) Learning the alphabet with flash cards c) Putting together a large-piece puzzle (The nurse should recommend putting together a large-piece puzzle as an age-appropriate activity for a 2-year-old toddler. Puzzles provide the child an opportunity to develop fine motor skills. Other fine motor skill activities include finger painting and coloring with thick crayons.) d) Riding a tricycle 45. A nurse is reinforcing with the parent of a school-age child who has lactose intolerance. Which of the following supplements should the nurse instruct the parent to include in the child’s diet? a) Zinc b) Vitamin D (Lactose intolerance is managed by eliminating dairy products from the diet. However, this can result in a decrease in bone density because of the lack of calcium and vitamin D in the diet. The nurse should instruct the parent to administer a vitamin D supplement to the child to enhance the absorption of calcium from foods other than those containing lactose.) c) Thiamine d) Folic acid 46. A nurse is caring for a toddler who has otitis media and a temperature of 39.1° C (102.4° F). Which of the following actions should the nurse take first? a) Administer an antipyretic. (When using the urgent vs. nonurgent approach to client care, the nurse should first administer an antipyretic to decrease the toddler's body temperature.) b) Reduce the room temperature. c) Dress the child in minimal clothing. d) Apply cool compresses to the child's forehead. 47. A nurse is collecting data from an 18-month-old toddler who has just presented to the urgent care clinic. Which of the following data should the nurse investigate further? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material a) Respiratory rate 25/min b) Blood pressure 120/80 mm Hg (A blood pressure of 120/80 mm Hg is outside the expected reference range for an 18-month-old toddler and requires further investigation by the nurse.) c) Heart rate 110/min d) Rectal temperature 37.4° C (99.3° F) 48. A nurse in a pediatric clinic is talking on the telephone with the parent of a 6-month-old infant who has a urinary tract infection and started taking an oral antibiotic the day before. Listen to the audio clip and determine which of the following responses the nurse should make. (Audio says. “every time I try to give a dose of this medicine to my baby, she either refuses it or takes it and then spits it out. Is there anything I can try that might get her to take it?” a) "Mix the medicine with ¼ cup of juice before giving it to your baby." b) "Mix the medicine with 1 teaspoon of honey before giving it to your baby." c) "Mix the medicine with ¼ cup of formula before giving it to your baby." d) "Mix the medicine with 1 teaspoon of applesauce before giving it to your baby." (To enhance acceptance of an oral medication, the parent can mix the medication with a small amount of a sweet, nonessential food item.) 49. A nurse is collecting data from an 18-month-old toddler. Which of the following is a deviation from expected growth and development that the nurse should report to the provider? a) The toddler is unable to recognize familiar objects by name. (The nurse should report that the toddler is unable to recognize familiar objects by name, because this is a deviation from expected growth and development. The toddler should be able to accomplish this task by 12 months of age.) b) The toddler is unable to dress himself in simple clothing. c) The toddler is unable to talk in complete sentences. d) The toddler is unable to draw a circle 50. A nurse is reinforcing teaching with the parents of preschoolers regarding the use of booster seats in a motor vehicle. Which of the following instructions should the nurse include in the teaching? a) Ensure the shoulder-lap portion of the seat belt fits across the child's abdomen when sitting in the booster seat. b) Use a no-back, belt-positioning booster seat if the motor vehicle does not have head rests. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material c) Discontinue using a booster seat when the child is 135 cm (4 feet 5 in) in height. d) Secure the child in the booster seat using the motor vehicle's shoulder-lap seat belt. (The nurse should instruct the parents to secure both the child and the booster seat with the shoulder-lap seat belt inside the motor vehicle, because booster seats do not have built-in straps.) 51. A nurse is assisting with the admission of a toddler who has bacterial meningitis caused by Haemophilus influenza type B. which of the following isolation guidelines should the nurse plan to initiate? a) Protective environment b) Contact precautions c) Airborne precautions d) Droplet precautions (The nurse should plan to initiate droplet precautions for this child, because bacterial meningitis caused by Haemophilusinfluenzae type B is transmitted through the air via large-particle droplets) 52. A nurse is reinforcing teaching with the parent of a 4-month-old infant who has a new prescription for nystatin to treat oral candidiasis and is breastfeeding. Which of the following instructions should the nurse include in the teaching? a) Continue nystatin for 2 weeks after the symptoms disappear. (To prevent relapse, nystatin therapy should continue for at least 2 weeks after the lesions disappear.) b) Clean the infant's pacifier every 2 days. c) Discontinue breastfeeding until the infant is symptom-free. d) Wipe the white patches from the infant's tongue using a gauze pad. 53. A nurse is preparing to administer an intramuscular injection to an 11-month-old infant. In which of the following areas should the nurse administer the injection? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material B is correct. The nurse should administer an IM injection in the vastuslateralis muscle of an 11-month-old infant. The vastuslateralis is a well-developed muscle that is safe to use for infants and small children. 54. A nurse is reinforcing dietary teaching with an adolescent who is a lacto-vegetarian and had iron deficiency anemia. The nurse should recommend which of the following as the best source of iron? a) 1 cup (8 oz) shredded wheat cereal (The nurse should determine that shredded wheat cereal is an iron-fortified food. Therefore, it is the best option to recommend because it contains 1 g of iron per serving.) b) 1 cup (8 oz) apple juice c) ½ cup (4 oz) sweet green peppers d) ⅛ cup (1 oz) low-fat cheese 55. A nurse is reinforcing teaching with the parent of an infant who has a new diagnosis of human immunodeficiency virus (HIV). Which of the following statements made by the parent indicates an understanding of the teaching? a) "The antiretroviral medication will stop the progression of the disease." b) "It won't be possible for my child to attend daycare." c) "I should bring my child in for immunizations on schedule." (Immunizations provide protection from communicable diseases and should be administered on schedule.) d) "My child's nutritional needs will not change." 56. A nurse is preparing to assist a provider with a lumbar puncture for a school-age child. Which of the following actions is the nurse’s priority? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material a) Labeling collected specimens b) Providing reassurance to the child c) Maintaining the child's position (The greatest risk to the child is injury to the spinal nerves or the major vessels. Therefore, the priority action is for the nurse to maintain the child's position to prevent trauma.) d) Monitoring the child's vital signs 57. A nurse is reinforcing discharge teaching with the guardians of a 6-month-old infant following a surgical procedure to repair a hypospadias. Which of the following instructions should the nurse include? a) Wait 1 week before giving the infant a tub bath.(The nurse should instruct the guardians to keep the infant's penis as dry as possible until the stent or catheter is removed. The parent should provide sponge-baths to the child until the stent or catheter is removed.) b) Apply antifungal ointment to the infant's penis. c) Avoid giving the infant fruit juice. d) Apply dry gauze dressing to the infant's penis twice daily. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material ATI Nursing Care of Children A nurse is teaching a school-age child and his parent about postoperative care following cardiac catheterization. Which of the following instructions should the nurse include? - "Wait 3 days before taking a tub bath." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse in an emergency department is caring for a school-age child who has sustained a superficial minor burn from fireworks on his forearm. Which or the following actions should the nurse take? - Use an antimicrobial ointment on the affected area. A nurse is preparing to suction an infant who has a tracheostomy. Which of the following actions should the nurse take? - Suction for 5 seconds of less A nurse is teaching a group of parents about infectious mononucleosis. which of the following statements by a parent should the nurse identify as understanding the teaching? - "Mononucleosis is caused by an infection with the Epstein-Barr virus." A hospice nurse is caring for a preschooler who has a terminal illness. The father tells the nurse that he cannot cope anymore and has decided to move out of the house. Which of the following statements should the nurse make? - "Let's talk about some of the ways you have handled previous stressors in your life." A nurse is admitting an infant who has intussusception. Which of the following findings should the nurse expect? - Vomiting - Lethargy Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse is assessing an infant who has a ventricular septal defect. Which of the following findings should nurse expect? - Loud, harsh murmur A nurse is reviewing laboratory results of a school-age child who is 1 week postoperative following an open fracture repair. Which of the following values should the nurse identify as an indication of a potential complication? - Erythrocyte sedimentation rate 18 mm/hr A nurse is caring for an infant who is receiving IV fluids for the treatment of Tetralogy of Fallot and begins to have a hyper cyanotic spell. Which of the following actions should the nurse take? - Place the infant in a knee-chest position. A nurse is admitting a school-age child who has pertussis. Which of the following actions should the nurse take? - Initiate droplet precautions for the child. A nurse is teaching mother of a 6-month-old infant about teething. Which of the following statements should nurse make? - "Your baby may pull at her ears when she is teething." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse is reviewing the laboratory report of a 6-year-old child who is receiving chemotherapy. Which of the following laboratory values should the nurse report to the provider? - Hgb 8.5 g/dL A nurse is assessing a 4-year-old child at a well-child visit. Which of the following developmental milestones should the nurse expect to observe? - Cuts a shape using scissors A nurse is teaching a school-age child who has a new diagnosis of type 1 diabetes millets. The nurse should identify which of the following statements by the child as understanding the teaching? - "I will give myself a shot of regular insulin 30 minutes before I eat breakfast." A nurse is caring for a newly-admitted school-age child who has hypopituitarism. Which of the following medications should the nurse expect the provider to recommend to the parents for treating the child's condition? - Recombinant growth hormone A nurse is assessing a 6-month-old infant as a well-infant visit. Which of the following should the nurse report to the provider? - Presence of strabismus Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse is admitting a 4-month-old infant who has heart failure. Which fo the following findings is the nurse's priority? (look at exhibit) - Episodes of vomiting A charge nurse is preparing to make a room assignment for a newly admitted school-age child. Which of the following considerations is the nurse's priority when making a room assignment? - Disease process A nurse is planning care for a school-age child who has a tunneled central venous access device. Which of the following interventions should the nurse include in the plan? - Use a semipermeable transparent dressing to cover the site. A nurse is providing anticipatory guidance to the parents of a 2-week-old infant about risk factors for sudden infant death syndrome (SIDS). Which of the following risk factors should the nurse include in the teaching? - Covering the sleeping infant with a blanket A nurse is planning an educational program for school-age children and their parents about bicycle safety. Which of the following information should the nurse plan to include? - The child should be able to stand on the balls of her feet when sitting on the bike. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A community health nurse is assessing an 18-month-old toddler in a community day care. Which of the following findings should the nurse identify as a potential indication of physical neglect? - Poor personal hygiene A nurse is planning care for a preschooler who has cystic fibrosis. Which of the following interventions should the nurse include in the plan? - Increase fat content in the child's diet to 40% of total calories. A nurse is an emergency department suspects that a toddler has epiglottis. Which of the following actions should the nurse take? - Prepare the toddler for nasotracheal intubation. A nurse in the emergency department is assessing a toddler who has Kawasaki disease. Which of the following findings should the nurse expect? (select all that apply.) - Increased temperature - Xerophthalmia - Cervical lymphadenopathy A school nurse is assessing a school-age child who has erythema infectious (fifth disease). Which of the following findings should the nurse expect? - Facial rash Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should the nurse expect? - A unilateral rib hump A nurse is providing teaching to the parent of an infant who has diaper dermatitis. The nurse should teach the parent to apply which of the following to the affected area? - Zinc oxide A nurse is teaching the parent of an infant who has a Pack harness to treat developmental dysplasia of the hip. The nurse should identify that which of the following statements by the parents indicates an understandings of the teaching? - "I will place my infant's diapers under the harness straps." A nurse is caring for a school-age child who has diabetes mellitus and was admitted with a diagnosis of diabetic ketoacidosis. When performing the respiratory assessment, which of the following findings should the nurse expect? - Deep respirations of 32/min A nurse is providing discharge teaching to the parents of a 6-month-old infant who is postoperative following hypospadias repair with a stent placement. Which of the following instructions should the nurse include in the teaching? - "Allow the stent to drain directly into your infant's diaper." Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse is assessing an 8-year-old child who has early indications of shock. After establishing an airway and stabilizing the child's respirations, which of the following actions should the nurse take next? - Initiate IV access. A nurse is planning care for a school-age-child who is in the oliguric phase of acute kidney injury (AKI) and has a sodium level of 129 mEq/L. Which of the following interventions should the nurse include in the plan? - Initiate seizure precautions for the child. A nurse is caring for a toddler who has acute otitis media and a temperature of 40 C (104 F). After administering acetaminophen, which of the following actions should the nurse plan to take to reduce the toddler's temperature? - Dress the toddler in minimal clothing. A nurse is assessing a school-age child who has an infratentorial brain tumor. Which of the following findings should the nurse identify as a manifestation of increased intracranial pressure? - Decreased attention span A nurse is assessing a school-age child who has appendicitis with possible perforation. The nurse should identify which of the following as a manifestation of peritonitis? - Abdominal distention Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse is caring for a 2-week-old infant who is breastfeeding and requires a heel stick. Which of the following actions should the nurse take to minimize the infant's pain? - Administer sucrose to the infant prior to the procedure. A nurse is caring for a school-age child who is receiving a cefazolin via intermittent IV bolus. The child suddenly develops diffuse flushing of the skin and angioedema. After discontinuing the medication infusion, which of the following medications should the nurse administer first? - Epinephrine A nurse is assessing a toddler who has leukemia and is receiving his first round of chemotherapy. Which of the following findings is the priority for the nurse to report to the provider? - Urticaria A nurse is caring for a school-age child who has experienced a tonic-clonic seizure. Which of the following actions should the nurse take during the immediate postictal period? - Place the child in a lateral position. A school nurse is preparing to administer atomoxetine 1.2 mg/kg/day PO to a school-age child who weighs 75lb. Available is atomexetine 40 mg/capsule. How many capsules should the nurse administer per day? 1 Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse in an emergency department is caring for a school-age child who has appendicitis and rates his abdominal pain t 7 on a 0 to 10 scale. Which of the following actions should the nurse take? - Give morphine 0.05mg/kg IV. A nurse is providing teaching to the parent of a preschooler about ways to prevent acute asthma attacks. Which fo the following statements by the parent should the nurse identify as understanding the teaching? - "I should keep my child indoors when I mow the yard." A nurse is reviewing the lumbar puncture results of a school-age child suspected of having bacterial meningitis. Which of the following results should the nurse identify as a finding associated with bacterial meningitis? - Increased protein concentration A nurse is preparing to administer a hepatitis B vaccine to a 1-month-old infant. The nurse should plan to inject the medication at which of the following locations? - Vastus lateralis A nurse is monitoring the oxygen saturation level of an infant using pulse oximetry. The nurse should secure the sensor to which of the following areas on the infant? - Great toe Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse is caring for an adolescent who received a kidney transplant. Which of the following findings should the nurse identify as an indication the adolescent is rejecting the kidney? - Serum creatinine 3.0 mg/dl A nurse is discussing organ donation with the parents of a school-age child who has sustained brain death due to a bicycling accident. Which of the following actions should the nurse take first? - Explore the parents' feelings and wishes regarding organ donation. A nurse is caring for a school-age who has acute rheumatic fever. Which of the following actions should the nurse take? - Maintain the child on bed rest. A nurse is assessing a toddler who has gastroenteritis and is exhibiting manifestations of dehydration. Which of the following findings should the nurse address first? - Tachypnea Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material A nurse is caring for a school-age child who is receiving a blood transfusion. Which of the following manifestations should alert the nurse to a possible hemolytic transfusion reaction? - Flank pain Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material ATI Nursing Care of Children Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 7. A nurse is planning care for a school age child who has a tunneled central venous access device. Which of the following intervention should the nurse include in the plan? a. A semi permeable transparent dressing to cover the site. 8. The nurse is providing anticipatory guidance to the parent of a toddler. Which of the following expected behavior characteristics of toddlers should the nurse include? a. Expresses likes and dislikes 9. A nurse is providing discharge teaching to the parent of a school age child who has moderate persistent asthma. Which of the following instruction should the nurse include? a. "Pulmonary function tests will be performed every 12 to 24 months to evaluate how your child is responding to therapy." 10. A nurse is assessing an adolescent who received a sodium polystyrene sulfonate enema. Which of the following findings indicate effectiveness of this medication? a. Serum potassium level 4.1 11. A nurse is assessing an infant who has pneumonia. Which of the following findings is the priority for the nurse to report to the provider? a. Nasal flaring 12. A nurse is providing discharge teaching to the Guardian of a school age child who has undergone a tonsillectomy. Which of the following statements by the guardian indicates an understanding that of the teaching? a. I will notify the doctor if I notice that my child is swallowing frequently 13. A nurse is discussing organ donation with the parents of a school age child who has sustained brain death due to a bicycle crash. Which of the following actions should the nurse take first? a. Explore the parents’ feelings and wishes regarding organ donation Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 14. A nurse is caring for a newly admitted school age child who has hypopituitarism. Which of the following medication should the nurse expect a provider to prescribe? a. Recombinant growth hormone 15. A nurse is providing discharge teaching to the parents of a 3-month-old infant following a cheiloplasty. Which of the following instructions should the nurse include? a. Apply a thin layer of antibiotic ointment on your baby's suture line daily for the next 3 days. 16. Just caring for a school age child who has peripheral edema. The nurse should identify that which of the following assessment should be performed to confirm peripheral edema? a. Palpate the dorsum of the child’s feet. 17. A nurse is caring for a 10-year-old child following a head injury. Which of the following findings should he nurse identify as an indication that they child is developing diabetes insipidus? a. Sodium 155 18. A school nurse is providing an in-service for faculty about improving education for students who have ADD. Which of the following statements by a faculty member indicates an understanding of the teaching? a. I will teach challenging academic subjects to students who have ADHD in the morning. 19. A nurse is providing discharge teaching to a parent of an 18-month-old toddler who has dehydration due to acute diarrhea. Which of the following statements by the parent indicates an understanding of the teaching? a. I will monitor my child’s number of wet diapers. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 20. A nurse is teaching a school-age child and their parent about postoperative care following cardiac catheterization. Which of the following instructions should the nurse include? a. Wait 3 days before taking a tub bath 21. A nurse is planning care to address nutritional needs for a preschooler who has cystic fibrosis. Which of the following interventions should the nurse include in the plan? a. Increase fat content in the child’s diet to 40% of total calories. 22. A nurse is admitting an infant who has intussusception. Which of the following findings should the nurse expect? a. 1. Vomiting 2. Lethargy 23. A nurse is assessing an 8-year-old child who has early indications of shock. After establishing an airway and stabilizing the child’s respirations, which of the following actions should the nurse take next? a. Initiate IV access 24. A nurse is providing teaching to an adolescent about how to manage tinea pedis. Which of the following statements by the adolescent indicates an understanding of the teaching? a. I should wear sandals as much as possible. 25. A nurse is caring for a school-age child who has DM and was admitted with a diagnosis of DKA. When performing the respiratory assessment, which of the following findings should the nurse expect? a. Deep respirations of 32/min 26. A nurse is assessing a 6-month old infant during a well-child visit. Which of the following finding should the nurse report to the provider? a. Presence of strabismus. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 27. A charge nurse is preparing to make a room assignment for a newly admitted school-age child. Which of the following considerations is the nurse’s priority? a. Disease process 28. A nurse is caring for a child following a tonic-clonic seizure. Which of the following actions should the nurse take first? a. Check the child’s respiratory rate 29. A nurse is caring for a toddler who has acute otitis media and a temperature of 104*F. After administering acetaminophen, which of the following actions should the nurse plan to take to reduce the toddler’s temperature? a. Dress the toddler in minimal clothing 30. A nurse is creating a plan of care for a newly admitted adolescent who has bacterial meningitis. How long should the nurse plan to maintain the adolescent in droplet precautions? a. For 24 hr following initiation of antimicrobial therapy 31. A nurse in a health department is caring for an emancipated adolescent who has an STI and is unaccompanied by a guardian. Which of the following actions should the nurse take? a. Have the adolescent sign a consent form for treatment 32. A nurse is caring for 1-month-old infant who is breast feeding and requires a heel stick period which of the following action should the nurse take to minimize the infant’s pain? a. Allow the mother to breastfeed while the same is being obtained. 33. A nurse is receiving change-of-shift report for four children. Which of the following children should the nurse assess first? a. A toddler who has a concussion and an episode of forceful vomiting Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 34. A community health nurse is assessing an 18-month-old toddler in a community daycare. Which of the following findings should the nurse identify as a potential indication of physical neglect? a. Poor personal hygiene 35. A nurse is creating a plan of care for a preschooler who has Wilms’ tumor and is scheduled for surgery. Which of the following interventions should the nurse include? a. Avoid palpating the abdomen when bathing the child before surgery 36. A nurse in a provider’s office is caring for a school-age child who has varicella. The parent asks the nurse when their child will no longer be contagious. Which of e following responses should the nurse make? a. When your child's lesions are crusted, usually 6 days after they appear. 37. A nurse is providing dietary teaching to the guardian of a school-age child who has cystic fibrosis. Which of the following statements should the nurse make? a. You should offer your child high protein means and snacks throughout the day. 38. A nurse is reviewing the dietary choices of an adolescent who has iron deficiency anemia. The nurse should identify that which of the following menu items has the highest amount of nonheme iron? a. ½ cup of raisins 39. A nurse is caring for a school-age child who has primary nephrotic syndrome and is taking prednisone. Following 1 week of treatment, which of the following manifestations indicates to the nurse that the medication is effective? a. Decreased edema Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 40. A nurse is providing teaching to the parents of a preschooler who has heart failure and a new prescription for digoxin twice daily. Which of the following instructions should the nurse include in the teaching? a. Brush the child’s teeth after giving the medication 41. A nurse is providing discharge teaching to the guardians of a toddler who had a lower leg cast applied 24 hr ago. The nurse should instruct the guardians to report which of the following findings to the provider? a. Restricted ability to move the toes 42. A nurse in an emergency department is caring for a school-age child who has epiglottitis. Which of the following actions should the nurse take? a. Monitor the child’s oxygen saturation 43. A nurse is providing discharge teaching to the parents of a 6-month-old infant who is postoperative following hypospadias repair with a stent placement. Which of the following instructions should the nurse include in the teaching? a. Allow the stent to drain directly into your infant’s diaper 44. A nurse is monitoring the oxygen saturation level of an infant using pulse oximetry. The nurse should secure the sensor to which of the following areas on the infant? a. Great toe 45. A nurse is reviewing the laboratory results of a school-age child who is 1 week postoperative following an open fracture repair. Which of the following findings should the nurse identify as an indication of a potential complication? a. Erythrocyte sedimentation rate 18 mm/hr Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 46. A nurse in an emergency department is caring for a school-age child who has sustained a minor superficial burn from fireworks on their forearm. Which of the following actions should the nurse take? a. Apply an antimicrobial ointment to the affected area. 47. A nurse is preparing to administer ibuprofen 5 mg/kg every 6 hr. PRN for a temperature above 100.5*F to an infant who weighs 17.6lb. Available is ibuprofen oral suspension 100 mg/5mL. How many mL should the nurse administer to the infant per dose? a. 2 mL 48. A nurse in an emergency department is assessing a toddler who has Kawasaki disease. Which of the following findings should the nurse expect? a. 1. Increased temperature 2.Xerophthalmia3.Cervical lymphadenopathy 49. A nurse in an emergency department is auscultating the lungs of an adolescent who is experiencing dyspnea. The nurse should identify the sound as which of the following? a. Wheezes 50. A nurse is planning developmental activities for a newly admitted 10-year-old child who has neutropenia. Which of the following actions should the nurse plan to take? a. Provide the child with a book about adventure. 51. A nurse is planning an educational program for school-age children and their parents about bicycle safety. Which of the following information should the nurse plan to include? a. The child should be able to stand on the balls of their feet when sitting on the bike. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 52. A nurse is assessing a school-age child who has an infratentorial brain tumor. Which of the following findings should the nurse identify as a manifestation of increased intracranial pressure? a. Difficulty concentrating 53. A nurse is teaching a group of parents about infectious mononucleosis. Which of the following statements by a parent indicates an understanding the teaching? a. Mononucleosis is caused by an infection with the Epstein-Barr virus. 54. A nurse is planning care for a newly admitted school-age child who has generalized seizure disorder. Which of the following interventions should the nurse plan to include? a. Ensure the oxygen source is functioning in the child's room. 55. A nurse is caring for an infant who is receiving IV fluids for the treatment of Tetralogy of Fallot and begins to have hyper cyanotic spell. Which of the following actions should the nurse take? a. Place the infant in a knee-chest position. 56. A nurse is creating a plan for a child who has varicella. Which of the following interventions should the nurse include? a. Initiate airborne precautions for the child 57. A nurse is teaching the parents of a toddler who has a cognitive impairment about toilet training. Which of the following instructions should the nurse include in the teaching? a. Award your child with a sticker when they sit on the potty chair 58. A nurse is assessing a school-age child who has an acute spinal cord injury following a sports injury 1 week ago. Identify the area the nurse should tap to elicit the bicep reflex. a. A Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material ATI Nursing Care of Children Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 6. A nurse is providing discharge teaching to the guardians of a toddler who had lower leg cast applied 24 hr ago. The nurse should instruct the guardians to report which of the following finding to the provider? Restricted ability to move the toes. 7. A nurse in an emergency department is auscultating the lungs of an adolescent who is experiencing dyspnea. The nurse should identify the sound as which of the following? Wheezes 8. A nurse is caring for a preschooler who has congestive heart failure. The nurse observes wide QRS complexes and peaked T waves on the cardiac monitor. Which of the following prescriptions should the nurse clarify with the provider? Potassium Chloride 9. A nurse is planning an educational program for school-age children and their parents about bicycle safety. Which of the following information should the nurse plan to include? The child should be able to stand on the balls of their feet when sitting on the bike. 10. A nurse is monitoring the oxygen saturation level of an infant using pulse oximetry. The nurse should secure the sensor to which of the following areas on the infant? Great Toe 11. A nurse is an emergency department is caring for a school-age child who has epiglottitis. Which of the following actions should the nurse take? Monitor the childs oxygen saturation Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 12. A nurse in an emergency department is caring for a school-age child who has sustained a minor superficial burn from fireworks on their forearm. Which of the following actions should the nurse take? Apply an antimicrobial ointment to the affected area. 13. A nurse in a providers office is caring for a school-age child who has varicella. The parents asks the nurse when their child will no longer be contagious. Which of the following responses should the nurse make? “When your childs lesions are crusted, usually 6 days after they appear.” 14. A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistant asthma. Which of the following instructions should the nurse include? “Pulmonary function tests will be performed every 12 to 24 months to evaluate how your child is responding to therapy.” 15. A nurse is admitting an infant who has intussusception. Which of the following findings should the nurse expect? (Select all that apply.) -Vomiting -Lethargy 16. A nurse is reviewing the laboratory results of a school-age child who is 1 week postoperative following an open fracture repair. Which of the following findings should the nurse identify as an indication of a potential complication? Erythrocyte sedimentation rate 18 mm/hr 17. A nurse is providing discharge teaching to the parents of a 3-month old infant following a cheiloplasty. Which of the following instructions should the nurse include? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material “Apply a thin layer of antibiotic ointment on the your babys suture line daily for the next 3 days.” 18. A nurse is discussion organ donation with the parents of a school-age child who has sustained brain death due to a bicycle crash. Which of the following actions should the nurse take first? Explore the parents feelings and wishes regarding organ donation. 19. A nurse is caring for a 1-month-old infant who is breastfeeding and requires a heel stick. Which of the following actions should the nurse take to minimize the infants pain? Allow the mother to breastfeed while the sample is being obtained. 20. A nurse is assessing an adolescent who received a sodium polystyrene sulfonate enema. Which of the following findings indicates effectiveness of the medication? Serum potassium level 4.1 mEq/L 21. A charge nurse is preparing to make a room assignment for a newly admitted school-age child. Which of the following considerations is the nurses priority? Disease process 22. A nurse is assessing the pain level of a 3-year-old toddler. Which of the following pain assessment scales should the nurse use? FACES 23. A nurse is preparing to administer ibuprofen 5 mg/kg every 6 hr PRN for a temperatures above 38.0 C (100.5 F) to an infant who weighs 17.6 lb. Available is ibuprofen oral suspension 100mg/5mL. How many mL should the nurse administer to the infant per dose? Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 2 mL 24. A nurse is assessing a 6-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? Presence of strabismus 25. A school nurse is caring for a child following tonic-clonic seizure. Which of the following actions should the nurse take first? Check the childs respiratory rate. 26. A nurse is planning developmental activities for a newly admitted 10-year-old child who has neutropenia. Which of the following actions should the nurse plan to take? Provide the child with a book about adventure. 27. A nurse in a health department is caring for an emancipated adolescent who has an STI and is unaccompanied by a guardian. Which of the following actions should the nurse take? Have the adolescent sign a consent form for treatment. 28. A nurse is assessing an 8-year-old child who has early indications of shock. After establishing an airway and stabilizing the childs respirations, which of the following actions should the nurse take next? Initiate IV access. 29. A nurse is performing hearing screenings for children at a community health fair. Which of the following children should the nurse refer to a provider for a more extensive hearing evaluation? An 8-month-old who is not yet making babbling sounds. Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 30. A nurse is providing discharge teaching to the guardian of a school-age child who has undergone a tonsillectomy. Which of the following statements by the guardian indicates an understanding the teaching? “I will notify the doctor if I notice that my child is swallowing frequently.” 31. A community health nurse is assessing an 18-month-old toddler in a community day care. Which of the following findings should the nurse identify as a potential indication of physical neglect? Poor personal hygiene 32. A nurse assessing a school-age child who has an infratentorial brain tumor. Which of the following findings should the nurse identify as a manifestation of increased intracranial pressure? Difficulty concentrating 33. A nurse is providing teaching to an adolescent about how to manage tineapedis. Which of the following statements by the adolescent indicates an understanding of the teaching? “I should wear sandals as much as possible.” 34. A nurse is caring for a school-age child who has diabetes mellitus and was admitted with a diagnosis of diabetic ketoacidosis. When performing the respiratory assessment, which of the following findings should the nurse expect? Deep respirations of 32/min 35. A nurse is planning n educational program to teach parents about protecting their children from sunburns. Which of the following instructions should the nurse plan to include? “Choose a waterproof sunscreen with a minimum SPF of 15.” Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 36. A nurse is providing teaching to the parents of a preschooler who has heart failure and a new prescription for digoxin twice daily. Which of the following instructions should the nurse include in the teaching? “Brush the childs teeth after giving the medication.” 37. A nurse is providing teaching to the family of a school-age child who has juvenile idiopathic arthritis. Which if the following instructions should the nurse include in the teaching? “Encourage the child to perform independent self-care.” 38. A nurse is creating a plan of care for a child who has varicella. Which of the following interventions should the nurse include? Initiate airborne precautions for the child. 39. A nurse is assessing a school-age child who has an acute spinal cord injury following a sports injury 1 week ago. Identify the area the nurse should tap to elicit the bicep reflect. Correct answer is A 40. A school nurse is providing an in-service for faculty about improving education for students who have ADHD. Which of the following statements by a faculty member indicates an understanding of the teaching? “I will teach challenging academic subjects to students who have ADHD in the morning.” 41. A nurse is caring for a school-age child who has peripheral edema. The nurse should identify that which of the following assessments should be performed to confirm peripheral edema? Palpate the dorsum of the childs feet Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 42. A nurse is caring for an infant who is receiving IV fluids for the treatment of Tetralogy of Fallot and begins to have hypercryanotic spell. Which of the following actions should the nurse take? Place the infant in a knee-chest position 43. A nurse is reviewing the dietary choices of an adolescent who has iron deficiency anemia. The nurse should identify that which of the following menu items has the highest amount of nonheme iron? ½ cup raisins 44. A nurse in an emergency department is assessing a 3-month-old infant who has rotavirus and is experiencing acute vomiting and diarrhea. Which of the following manifestations should the nurse identify as an indication that the infant has moderate to severe dehydration? Sunken anterior fontanel 45. A nurse is planning care for a school-age child who has tunneled central venous access device. Which of the following interventions should the nurse include in the plan? Use a semipermeable transparent dressing to cover the site. 46. A nurse is teaching a group of parents about infectious mononucleosis. Which of the following statements by parent indicates an understanding the teaching? “Mononucleosis is caused by an infection with the Epstein-Barr virus.” 47. A nurse is caring for a newly admitted school-age child who has hypopituitarism. Which of the following medications should the nurse expect the provider to prescribe? Recombinant growth hormone Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 48. A nurse is creating a plan of care for a preschooler who has Wilms’ tumor and is scheduled for surgery. Which of the following interventions should the nurse include? Avoid palpating the abdomen when bathing the child before surgery. 49. A nurse is providing discharge teaching to the parent of an 18-month-old toddler who has dehydration due to acute diarrhea. Which of the following statements by the parent indicates an understanding of the teaching? “I will monitor my childs number of wet diapers.” 50. A nurse is teaching the guardian of a 6-month-old infant about teething. Which of the following statements should the nurse make? “Your baby might pull at their ears when they are teething.” 51.A nurse is creating a plan of care for a newly admitted adolescent who has bacterial meningitis. How long should the nurse plan to maintain the adolescent in droplet precautions? For 24 hr following initiation of antimicrobial therapy 52. A nurse is providing anticipatory guidance to the parent of a toddler. Which of the following expected behavior characteristics of toddlers should the nurse include? Expressed likes and dislikes 53. A nurse is admitting a 4-month-old infant who has heart failure. Which of the following findings is the nurses priority? Episodes of vomiting Downloaded by: candyck524 | [email protected] Distribution of this document is illegalStuvia.com - The Marketplace to Buy and Sell your Study Material 54. A nurse in an emergency department is assessing a toddler who has Kawasaki disease. Which of the following findings should the nurse expect? (Select all that apply.) -Increased temperature -Xerophthalmia -Cervical lymphadenopathy 55. A nurse is caring for a 10-year-old child following a head injury. Which of the following findings should the nurse identify as an indication that the child is developing diabetes insipidus? Sodium 155 mEq/L 56. A nurse is planning care to address nutritional needs for a preschooler who has cystic fibrosis. Which of the following interventions should the nurse include in the plan? Increase fat content in the childs diet to 40% of total calories. 57. A nurse is caring for a toddler who has acute otitis media and a temperature of 40 C (104 F). After administering acetaminophen, which of the following actions should the nurse plan to take to reduce the toddler’s temperature? [Show More]

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