ATI - Comprehensive Assessment of Child Questions with Answers Correct!!

A nurse is preparing to perform a physical exam on a 10 yo child. Which of the following interventions should the nurse plan to implement A) Allow the child to touch and play with the equipment. B) Play games while performing the physical examination. C) Explain how the equipment works using correct medical terminology. D) Discuss the benefits of performing the examination with the child. - ANSWERSCorrect answer: C) Explain how the equipment works using correct medical terminology. Rationale: School-age children are interested in learning and building language skills. Therefore, the nurse should explain the function of the equipment using correct medical terminology. A nurse is obtaining the bp of a school-age child. Which of the following actions should the nurse take? A) Position the arm at the level of the umbilicus while the child is sitting in a chair. B) Select a cuff width that covers 40% of the upper arm. C) Ensure the cuff bladder encircles 50% of the extremity. D) Release the cuff pressure at a rate of 4 to 5 mm Hg per second. - ANSWERSCorrect answer: B) Select a cuff width that covers 40% of the upper arm. Rationale: Using a blood pressure cuff that is too large or too small will lead to an inaccurate blood pressure measurement. Therefore, the nurse should inspect the limb size of the child and choose a cuff which covers 40% of the upper arm circumference. A nurse is performing an annual physical exam on an adolescent. Which of the following should the nurse include in the general survey? A) The adolescent makes good eye contact. B) The adolescent is able to read small print at a distance of 14 inches. C) The adolescent demonstrates fine motor coordination D) The adolescent's deep tendon reflexes are 2+ bilaterally. - ANSWERSCorrect answer: A) The adolescent makes good eye contact. Rationale: The nurse should include this information in the general survey. The general survey includes identifying the clients demeanor, mood and interactions with others A nurse is inspecting the skin of a toddler. Which of the following findings should the nurse report to the provider? A) Presence of find hair on the lower arms and legs B) Ecchymotic area on the abdomen C) Mongolian spot across the buttocks D) Telangiectatic nevi on the back of the neck - ANSWERSCorrect answer: B) Ecchymotic area on the abdomen Rationale: Although bruising on the extremities is a common finding in children, bruising in other areas, such as the abdomen, should be investigated to determine the cause. Therefore, the nurse should report this finding to the provider. A nurse is preparing to obtain a temp on a 18-month old toddler during a well child exam. Which of the following actions should the nurse take? A) Pull the pinna up and back before placing the tympanic thermometer in the ear canal. B) Insert the lubricated tip of a rectal electronic thermometer 2.5 cm (1 inch) into the toddler's rectum. C) Place the tip of the oral electronic thermometer under the toddler's tongue in a posterior sublingual pocket. D) Place the thermometer tip in the center of the toddler's axilla against their skin. - ANSWERSCorrect answer: D) Place the thermometer tip in the center of the toddler's axilla against their skin. Rationale: The nurse should use the a collar y method to obtain a young child's temperature during a screening assessment. A nurse is assessing the reflexes of a 6-month-old infant. Which of the following reflex findings should the nurse expect? A) Positive Babinski reflex B) Negative plantar grasp reflex C) Positive extrusion reflex D) Negative sucking reflex - ANSWERSCorrect answer: A) Positive Babinski reflex Rationale: The Babinski reflex is elicited by stroking up the side of the foot and across the ball of the foot. A positive Babinski reflex is present when this action causes the toes to fan outwards. This is an expected finding through the first year of life, after which it begins to fade