ATI Nursing Care of Children Proctored Exam
A nurse is caring for a child who has a possible intussusception. The parents of the child ask the nurse how the diagnosis is determined. Which of the following responses should the nurse make? A. "An abdominal ultrasound will confirm the pocket in the intestine." B. "Genotyping will be done to identify this condition." C. "A biopsy will be done on a small amount of tissue from the colon." D. "An upper GI series should identify the area involved."
Correct Answer: A. "An abdominal ultrasound will confirm the pocket in the intestine." Intussusception is the invasion of a part of the intestine into another, creating a pocket. The presence of an intussusception is confirmed by an abdominal X-ray, ultrasound, or CT scan. Incorrect Answers:B. Genotyping is performed to determine a child's gene composition and is used for hereditary disease identification. C. A biopsy is done to identify a defect of nerve innervation in the colon and is used for the diagnosis of Hirschsprung's disease. D. An upper gastrointestinal series focuses on an area that is too high to allow visualization of an intussusception and is used for the diagnosis of pyloric stenosis.
A nurse is providing teaching to the parent of a 2-year-old toddler about nutrition. Which of the following statements by the parent indicates an understanding of the teaching? A. "My child should consume 1,000 calories per day." B. "My child should have 4 oz of protein per day." C. "I should give my child 32 oz (4 cups) of milk per day." D. "I should feed my child 4 oz (1/2 cup) of vegetables per day."
Correct Answer: A. "My child should consume 1,000 calories per day." Toddlers who are 2 years old should consume 1,000 calories daily. Incorrect Answers:B. Toddlers who are 2 years old should have 2 oz of protein daily. C. Toddlers who are 2 years old should have no more than 24 oz (3 cups) of milk per day. D. Toddlers who are 2 years old should consume 8 oz (1 cup) of vegetables per day.
A nurse is assessing a 6-month-old infant who had a cardiac catheterization with right femoral entry to diagnose a possible congenital heart defect. Which of the following findings should the nurse report to the provider? A. Cool toes on the right foot B. Weak pedal pulses on both feet C. Positive Babinski reflex on both feet D. Erythema on the right foot
Correct Answer: A. Cool toes on the right foot The nurse should monitor the temperature of the infant's right extremity and should report any indication of coolness distal to the entry site to the provider because this can indicate an obstruction of an artery. Incorrect Answers:B. The nurse should monitor the infant's pedal pulses for bilateral symmetry and equal strength. The nurse should expect the pedal pulse distal to the entry site to be weak after the procedure; however, it should gradually increase in strength. C. The nurse should expect infants to have a positive Babinski reflex until about 12 months of age. D. The nurse should monitor the color of the infant's right extremity and should report any indication of pallor or blanching to the provider because this can indicate an obstruction of an artery.
A nurse is caring for a child who has electrical burns on the lower arms and hands. Which of the following findings indicate the child is experiencing a complication of the injury? A. Dark urine B. 2+ radial pulses C. Respiratory rate of 20/min D. Minimal pain
Correct Answer: A. Dark urine Dark urine can be an indication of myoglobinuria. It results from the elimination of waste products from muscle damage and can cause renal failure. Incorrect Answers:B. Radial pulses of +2 are within the expected reference range. They are a reflection of circulatory status, not burn complications. C. A respiratory rate of 20/min is within the expected reference range. It reflects respiratory status, not burn complications. D. Electrical injuries can cause major, full-thickness burns that destroy the nerve endings in the skin, thus reducing the amount of pain the client feels.
A nurse is assessing a 4-year-old child. The nurse should expect the child to be able to perform which of the following activities? A. Fastening buttons on a shirt B. Tying shoelaces C. Parting and combing hair D. Cutting the meat at dinner
Correct Answer: A. Fastening buttons on a shirt The nurse should expect a 4-year-old child to have the fine motor ability to fasten buttons on a shirt; however, the child may have difficulty if the buttons are small. Incorrect Answers:B. The nurse should expect a 4-year-old child to have the fine motor ability to lace shoes; however, tying shoelaces is a fine motor skill expected of a 5-year-old child. C. The nurse should expect a 7-year-old child to have the fine motor ability to part and comb his/her hair without the need of assistance. D. The nurse should expect a 7-year-old child to have the fine motor ability to cut tender pieces of meat with a table knife.
A nurse is preparing to assess a 3-month-old infant during a well-child visit. Which of the following observations should the nurse expect? A. The infant looks at his hands B. The infant has a pincer grasp C. The infant has no head lag when pulled to a sitting position D. The infant can independently roll from his back to his abdomen
Correct Answer: A. The infant looks at his hands Infants usually start to look at their hands while lying down or sitting between 12 to 20 weeks of age. Convergence on near objects is usually well established by 3 months of age. Incorrect Answers:B. By 3 months of age, infants' hands should be mostly open, and they usually hold onto objects placed into their hands. Voluntary grasping of objects does not usually occur until 5 months of age. A crude pincer grasp usually develops by 8 to 9 months of age. C. Infants usually have a partial to slight head lag when pulled to a sitting position at 3 months. By 4 to 6 months, infants gain full head control. D. While some infants might independently roll from their back to their abdomen earlier than expected, a nurse would not expect an infant to be able to do this until 6 months of age.
A nurse is teaching the parents of a toddler who has enterobiasis about managing this parasitic disease. Which of the following pieces of information should the nurse include in the teaching? A. "You should encourage your child to take a tub bath daily." B. "You should keep your child's fingernails trimmed short." C. "You should dress your child in a 2-piece outfit at bedtime." D. "You should expect your child not to have a recurrence of the parasitic disease."
Correct Answer: B. "You should keep your child's fingernails trimmed short." The nurse should instruct the parents to keep their child's fingernails trimmed short to minimize the collection of ova under the nails. Incorrect Answers:A. The parents should encourage the toddler to take a shower instead of a tub bath. C. The parents should dress the child in a 1-piece sleeping outfit. D. Recurrence is common, and the disease should be managed and treated as it was previously.
A nurse is providing teaching about foods high in fiber to the guardian of a child who has chronic constipation. Which of the following foods should the nurse recommend? A. 1/2 cup whole milk B. 1/2 cup cooked pinto beans C. 1 cup green leaf lettuce D. 1 cup apple juice
Correct Answer: B. 1/2 cup cooked pinto beans The nurse should recommend foods high in fiber for a child who has chronic constipation. A half cup of cooked pinto beans contains approximately 5 g of fiber. Therefore, the nurse should instruct the guardian to include this food in the child's diet. Incorrect Answers: A. A half cup of whole milk contains no fiber. C. One cup of green leaf lettuce contains no fiber. D. One cup of apple juice contains no fiber.
A nurse is assessing the visual acuity of a group of school-aged children. Which of the following actions should the nurse take? A. Position each child with their heels at a line that is 6 m (20 ft) away from the Snellen chart B. Allow each child to wear his or her glasses during the exam C. Start the screening by covering each child's right eye D. Begin by having each child read the largest line of letters at the top of the Snellen chart
Correct Answer: B. Allow each child to wear his or her glasses during the exam The nurse should allow each child to wear his or her glasses during a screening for visual acuity. Incorrect Answers:A. The nurse should position each child so that the heels are at a line that is 3 m (10 ft) away from the Snellen chart. C. The nurse should start the screening by testing each child's right eye first. D. The nurse should start the screening by having each child read the 20/20 line of letters on the chart. If they are unable to do so, the nurse should move up to the next larger line of letters on the chart until the child can read at least 4 out of 6 letters correctly.
A nurse is assessing a 9-month-old infant. Which of the following findings should the nurse report to the provider as a possible developmental delay? A. Grasping a small object with just the thumb and index finger B. Dropping a cube when passing from 1 hand to the other C. Falling from a standing position to sitting D. Losing balance when leaning sideways while sitting
Correct Answer: B. Dropping a cube when passing from 1 hand to the other The ability to pass a cube from a hand to the other is a fine motor skill expected of a 7-month-old infant. Therefore, the nurse should identify the 9-month-old infant's inability to perform this task as a possible developmental delay and should report this finding to the provider. Incorrect Answers:A. The pincer grasp is an expected fine motor skill for a 9-month-old infant. C. Falling down to a sitting position from a standing position is an expected gross motor skill for a 9-month-old infant. D. A 9-month-old infant should have the gross motor ability to maintain balance while leaning forward in a sitting position; however, the infant does not yet have the ability to maintain balance while leaning sideways. A 9-month old infant should be able to bear weight on legs with support, sit with help, babble ("mama", "baba", "dada"), play games involving back-and-forth play, respond to own name, recognize familiar people, look where you point, and transfer toys from one hand to the other.
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
Correct Answer: B. Minimize physical contact with the child initially The nurse should initially minimize physical contact with the toddler and progress from the least traumatic to the most traumatic procedures. Incorrect Answers:A. The nurse should start with the least invasive interventions and proceed to the more invasive. The head-to-toe approach is recommended for preschool-age and older children. C. The nurse should describe procedures using age-appropriate language the child can understand. D. If the child becomes uncooperative, the nurse should perform the procedures more quickly.
A nurse is admitting a child who has acute lymphocytic leukemia. Which of the following laboratory values should the nurse expect? A. Platelets 500,000 mm^3 B. RBCs 2.5 million/uL C. WBCs 4,000/mm^3 D. Hct 60%
Correct Answer: B. RBCs 2.5 million/uL An RBC count of 2.5 million/uL is below the expected reference range. A child who has acute lymphocytic leukemia has a low RBC count. Incorrect Answers:A. A platelet count of 500,000 mm^3 is above the expected reference range. A child who has acute lymphocytic leukemia has a low platelet count. C. A WBC count of 4,000/mm^3 is below the expected reference range. A child who has acute lymphocytic leukemia has a very high WBC count. D. An Hct level of 60% is above the expected reference range. A child who has acute lymphocytic leukemia has a low Hct level.
A nurse in a provider's office is observing children playing in the waiting room. The nurse should expect to identify parallel behavior in which of the following age groups? A. Infants B. Toddlers C. Preschoolers D. School-age children
Correct Answer: B. Toddlers Toddlers demonstrate parallel play. Incorrect Answers:A. Infants demonstrate solitary play. C. Preschoolers demonstrate associative play. D. School-age children demonstrate cooperative play.
A nurse is teaching the guardian of a preschooler. The guardian states that the preschooler has had an imaginary playmate for about 3 months. Which of the following pieces of information should the nurse give the guardian? A. "Children commonly begin having imaginary friends when they reach school age." B. "Notify your provider if the imaginary friend persists longer than 6 months." C. "Have your child take responsibility for actions if he tries to blame the imaginary friend." D. "Set limits by not allowing your child to have the imaginary friend present during family meals."
Correct Answer: C. "Have your child take responsibility for actions if he tries to blame the imaginary friend." The nurse should inform the guardian that imaginary playmates are common during the preschool years due to the high level of imagination among this age group. Although having an imaginary friend is considered healthy, the preschooler might try to use this imaginary friend as a means of avoiding responsibility or punishment for unacceptable behavior. The nurse should inform the guardian of the need to have the preschooler take responsibility for his actions. Incorrect Answers:A. Imaginary playmates are common during the preschool years due to the high level of imagination among this age group. B. Imaginary playmates are common during the preschool years and are not a cause for concern as long as the preschooler also socializes with other children. D. The nurse should instruct the guardian that this behavior is expected and that pretending with the preschooler is okay.
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 indicates 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."
Correct Answer: C. "Injury by a corrosive liquid is more extensive than by a corrosive solid." The coating action of liquids permits larger areas of contact with tissues and results in more extensive injury. Incorrect Answers:A. The absence of oral or pharyngeal burns does not eliminate the possibility of esophageal burns. The existence and extent of burns depend on the substance and the length of time it has been in contact with tissues. A burn may be present in the esophagus but not in the mouth. B. Neutralization can result in heat injury to tissues due to an exothermic reaction. This might cause both chemical and thermal burns of tissues. D. Activated charcoal is not administered to an adolescent who has ingested a corrosive substance because it can infiltrate any tissue that is burned.
A nurse on a pediatric oncology unit is helping the parents of a child who is terminally ill to prepare for the impending loss of their child. Which of the following statements should the nurse make? A. "The nursing staff will bathe your child and take care of his daily needs." B. "Your child will be most comfortable in a low-stimulation environment." C. "Would you like assistance in planning where your child will die?" D. "Would you like hospice to continue providing curative care in your home?"
Correct Answer: C. "Would you like assistance in planning where your child will die?" The nurse should inform the parents that they can choose to keep the child in a hospital setting or take the child home to die. The nurse should be aware that active participation in planning for the location of the child's death promotes positive bereavement outcomes. The nurse should provide assistance to the parents in making and implementing this plan. Incorrect Answers:A. The nurse should ask the parents if they would like to participate in providing care for their child. Active participation in the child's care promotes positive bereavement outcomes. B. The nurse should support the parents' and child's decisions and should allow the parents to participate in activities of their choosing (e.g. having multiple visitors, playing games, and going on family outings). If the child and parents choose a low-stimulation environment, then the nurse should ensure it is provided. D. The nurse should discuss the option of hospice care with the parents; however, the nurse should inform the parents that hospice care will provide palliative rather than curative care.
A nurse is caring for a 4-month-old child who is hospitalized. Which of the following toys should the nurse provide for the child? A. A board book with large pictures B. A toy with movable parts C. A plastic mirror D. Push-pull toy
Correct Answer: C. A plastic mirror A 4-month-old infant can recognize herself and will also attempt to play with "the baby in the mirror." A mirror is a bright object that provides appropriate visual stimulation for this age group. For the infant's safety, however, the mirror must be unbreakable. Incorrect Answers:A. This would be an appropriate choice for a 6- to 12-month-old infant. A 4-month-old infant cannot understand the pictures on a board book or hold the book by herself. B. This would be an appropriate choice for a 6- to 12-month-old infant. A 4-month-old infant would not be able to manipulate the toy's movable parts. D. This is an appropriate toy for a 9- to 12-month-old infant. A 4-month-old infant would not be able to perform the actions of pushing and pulling the toy.
A nurse is assessing the pain level of a 3-year-old child who is postoperative following abdominal surgery. Which of the following pain scales should the nurse use? A. Word graphic rating scale B. Color tool C. FACES pain rating scale D. Numeric scale
Correct Answer: C. FACES pain rating scale The FACES scale includes various faces, which represent various levels of pain. A 3-year-old child is able to identify faces that represent different pain levels. Incorrect Answers:A. A word graphic rating scale uses a line with words identifying a scale of no pain to the worst possible pain. Children ages 4 to 17 place a line on the scale that describes their pain. Children who are 3 years old will have difficulty understanding this scale. B. The color tool uses 4 markers for the child to represent pain at various levels. Children ages 4 and older can use this tool. Children who are 3 years old might have difficulty remembering what each marker represents. D. Using a numeric scale from 0 to 10 to rate pain requires the child to understand numbers. This tool is helpful for children ages 5 and older.
A nurse is teaching to a group of parents of adolescents about developmental needs. Which of the following statements by a parent should the nurse investigate further? A. "My child has frequent mood swings." B. "My child has a very messy bedroom." C. "My child takes 1 to 2 showers per day." D. "My child spends 4 hours per day using online chat rooms."
Correct Answer: D. "My child spends 4 hours per day using online chat rooms." Adolescents may spend time using a computer, but parents should know what they are doing and who they are communicating with and limit the time. The American Academy of Pediatrics guidelines recommends 2 hours of screen time daily. Incorrect Answers:A. Adolescents strive for independence and have frequent mood changes. B. Many adolescents assert their independence by controlling what they can. Their environment is an area where they feel they can assert control. C. Adolescents are very preoccupied with body image and how they appear to others. Therefore, they may shower more than once daily to maintain their self-appearance.
A nurse is preparing to obtain an antistreptolysin O (ASO) titer from a child who has acute glomerulonephritis. The child's parent asks the nurse to explain the purpose of the test. Which of the following responses should the nurse provide? A. "The test determines the level of antibiotics in your child's blood." B. "The test tells us if your child ever had measles." C. "The test verifies the amount of albumin in your child's blood." D. "The test shows us if your child had a recent strep infection."
Correct Answer: D. "The test shows us if your child had a recent strep infection." An ASO titer indicates the child had a recent strep infection. When determining a definitive diagnosis for acute glomerulonephritis, this must be documented because the condition is usually the result of this type of infection. Incorrect Answers:A. A therapeutic blood level indicates a medication (e.g. an antibiotic) is effective. B. A rubella titer indicates the presence of measles. C. A serum albumin level is monitored in a child who has nephrotic syndrome.
A nurse is providing teaching to a 12-year-old client who is recovering from an acute episode of hemophilia A. Which of the following statements should the nurse include in the teaching? A. "Have your parent stretch and move your legs for you." B. "Apply heat to joints that become painful, stiff, and swollen." C. "Take aspirin at the first sign of a headache." D. "You will be able to participate in physical exercises."
Correct Answer: D. "You will be able to participate in physical exercises." Physical exercise is important for the maintenance of joint mobility and muscle strengthening. Participation in non-contact sports and the use of protective equipment such as knee pads are encouraged, although high-impact athletic activities such as karate should be avoided. Incorrect Answers:A. Passive range-of-motion exercises are not done after a bleeding episode because rebleeding can occur. Active motion is best to allow activity to be tailored to the child's pain level. B. A manifestation of hemophilia A is hemarthrosis (bleeding into a joint capsule). This can result in numbness, tingling, or pain, along with discoloration, warmth, and swelling of the affected joint. The nurse should instruct the child to rest the joint, elevate it above the level of the heart, and apply ice to decrease the rate of bleeding into the joint capsule. C. Intracranial hemorrhage is a leading cause of death in clients who have hemophilia A. The nurse should instruct the child to avoid the use of aspirin because it has antiplatelet properties that can increase bleeding.
A nurse is creating a plan of care for a 6-month-old infant who requires continuous pulse oximetry monitoring. Which of the following interventions should the nurse include? A. Reposition the sensor to a new site once every 24 hr B. Secure the oximetry sensor to the infant's wrist C. Apply conduction gel to the skin before attaching the sensor D. Cover the oximetry sensor with clothing
Correct Answer: D. Cover the oximetry sensor with clothing The nurse should cover the sensor with clothing to prevent outside light from causing an altered or false reading. Incorrect Answers:A. The nurse should move the sensor to a new site every 4 to 8 hours. The pulse oximetry sensor should not remain in a single location for an extended period of time because of the risk of tissue necrosis. B. The pulse oximetry sensor should be placed around the infant's hand or foot to obtain an accurate reading. C. The pulse oximeter uses a sensor to measure oxygen in the infant's hemoglobin. Conduction gel would interfere with the reading because it would not allow the sensor to attach to the skin.
A nurse is caring for an infant who has a cleft palate. The parents ask the nurse how long they should wait before the child can have corrective surgery. The nurse should explain that the parents should wait no longer than 6 to 12 months for surgery to prevent which of the following outcomes? A. Repeated ear infections B. Nutritional deficits C. Immune system deficits D. Difficulty with language acquisition
Correct Answer: D. Difficulty with language acquisition Clients who have a cleft palate can have difficulty acquiring language because they need to use the palate for vocalizing sounds. Because of the cleft in the palate, these infants could develop poor speech habits. Incorrect Answers: A. Infants who have a cleft palate are at increased risk of ear infections; however, this can persist even after the repair of the palate. B. Infants who have a cleft palate are at increased risk for poor nutrition due to feeding difficulties. However, there are multiple strategies to teach the parents to promote nutrition and to help the infant create a seal and generate suction to feed. C. Repair of a cleft palate does not affect the child's immune system. However, repairing the palate too soon can affect the skeletal growth of the mid portion of the child's face.
A nurse is creating a plan of care for a preschooler who was admitted for the treatment of measles. Which of the following activities should the nurse include in the client's care plan? A. Constructing a model airplane B. Playing a video game in the playroom C. Pulling a wagon with toys in the hallway D. Putting together a puzzle with large pieces
Correct Answer: D. Putting together a puzzle with large pieces The nurse should recommend putting together a puzzle with large pieces for a hospitalized preschooler. Other recommended activities for preschoolers on airborne precautions include playing pretend and dress up, painting, and looking at illustrated books. Incorrect Answers:A. Constructing a model airplane is advanced for a preschooler's fine motor skills. However, preschoolers do not have the skills or the attention span to build models. This activity is appropriate for a school-age child. B. A preschooler who has the measles is on airborne precautions and should not be in the playroom, as this would expose other children to the disease. The particles can be dispersed widely throughout the air and could be inhaled by another child in the playroom. C. A preschooler who has the measles is on airborne precautions and should not be outside of the hospital room. Pulling a wagon in the hallway would likely spread this disease by dispersing particles containing infectious agents to other children who are either in the hallway or have their room doors open.
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 a breath and 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 using long, rhythmic movements
Correct Answer: D. Rock the child using long, rhythmic movements The nurse can implement relaxation strategies by sitting with the child in a well-supported position such as against the chest and rocking or swaying back and forth in long, wide movements. Incorrect Answers:A. This is an example of a distraction strategy. B. This is an example of guided imagery. C. Evidence-based practice indicates that bouncing is not an appropriate action.
A nurse is providing teaching to the guardian of a child who has Kawasaki disease. Which of the following statements by the guardian indicates an understanding of the teaching? (Select all that apply.) A. "My child will likely be irritable for the next few weeks." B. "I will notify my child's doctor if the skin on her hands or feet begins to peel." C. "I will ensure my child does not receive any live vaccines for at least 18 months." D. "I will keep a record of my child's temperature until she has no fever for several days." E. "My child will have joint stiffness primarily at the end of the day."
Correct Answers: A. "My child will likely be irritable for the next few weeks." C. "I will ensure my child does not receive any live vaccines for at least 18 months." D. "I will keep a record of my child's temperature until she has no fever for several days." A child who is diagnosed with Kawasaki disease will likely be irritable for up to 2 months. A child who has Kawasaki disease receives high doses of gamma globulin during the initial phase, which might result in the inability to produce adequate antibodies in response to a live vaccine; therefore, these vaccines should be delayed for 11 months. Also, the temperature of this child who has Kawasaki disease should be recorded until she has been afebrile for several days. Incorrect Answers:B. Peeling of the skin of the hands and feet is expected for a child who has Kawasaki disease. The peeling does not cause any pain and usually occurs between the second and third week. There is no need to report this manifestation to the child's provider. E. A child who has Kawasaki disease will likely have joint stiffness and arthritis-related symptoms for several weeks. The joint stiffness is typically worse during cold weather and in the morning.
A nurse in an emergency department is assisting with the care of a 4-year-old child who ingested toilet bowl cleaner. The child has hemoptysis, is crying, and states, "It burns." Which of the following actions should the nurse perform? (Select all that apply.) A. Identify how much cleaner was in the bottle B. Administer activated charcoal C. Perform immediate gastric lavage D. Insert an IV for morphine administration E. Apply a pulse oximeter
Correct Answers: A. Identify how much cleaner was in the bottle D. Insert an IV for morphine administration E. Apply a pulse oximeter The nurse should ask the parent or guardian about the size of the container, its contents prior to ingestion, and its contents remaining following ingestion. This information provides an estimate of the amount of cleaner the child ingested and can assist the provider in directing treatment. A child who ingests a corrosive agent is likely to have intense pain due to burns in the gastrointestinal system. The nurse should administer morphine as prescribed via IV to provide pain relief. The child is also at risk for airway occlusion due to edema following ingestion of a corrosive agent. Monitoring the child's oxygen saturation level will help the nurse recognize if the child's airway is becoming obscured. Incorrect Answers: B. Activated charcoal is contraindicated for the treatment of poisoning with a corrosive agent because these substances can burn tissue, which the charcoal could then infiltrate. C. Gastric lavage is contraindicated for the treatment of poisoning with a corrosive agent because this could re-expose the upper gastrointestinal system to the corrosive substance, which can result in further injury.
