RN ATI MATERNAL NEWBORN PROCTORED EXAM (ATI CHILD CARE 2.0)

1 The parents of a 5-month-old infant state that their infant seems to eat very little. Most of the food comes out of the infant's mouth and onto his clothes. Which of the following explanations should the nurse give to the parents? Trying to introduce food after the intake of a bottle formula is usually not recommended because the infant is satiated and has no inclination to try something new. Solid foods should be offered at 4 to 6 months. The gastrointestinal tract has matured enough to handle more nutrients and is less sensitive to potentially allergenic foods. This deprives the infant of the pleasure of learning new tastes and developing a discriminating palate. It may cause problems with poor chewing because of lack of experience. Due to the extrusion (protrusion) reflex, the infant’s tongue pushes the food out of the mouth. It is most helpful to suggest using a longhandled spoon and placing the food in the back of the infant's mouth to avoid the reflex. "Give the baby a bottle of formula before solid food to assure adequate caloric intake." "Stop the solid foods and try again when the baby is 12 months old." "Put the cereal in a bottle and feed the baby through a nipple with a large hole." "Place the food in the back of the baby's mouth using a long-handled spoon." 2 A nurse smells an odor identified as marijuana coming from a room. Which of the following client findings would confirm inhalation of the substance? All are findings of a client who has smoked/inhaled cannabis/marijuana. These clients are typically euphoric or somewhat mildly intoxicated. They have poor coordination with bloodshot (red) eyes and may laugh inappropriately. These findings are more commonly due to of the effects of depressants. These findings are more commonly due to the effects of opiates. These findings are more commonly due to the effects of cocaine. Poor coordination, red eyes, and euphoria Slurred speech, confusion, and combativeness Loss of consciousness, respiratory depression, and coma Hypertension, tachycardia, and hyperflexia 3 A nurse is checking children at an orthopedic outpatient setting. Which of the following should the nurse expect to see as manifestations of scoliosis? Lumbar curvature is a manifestation of lordosis. These are manifestations of scoliosis. Often parents observe that a child's skirt doesn't hang straight or the pant legs are uneven. Tenderness is a general symptom that may indicate something is wrong in an underlying organ. A nurse could not see changes such as swelling of the spine. These symptoms could be associated with other orthopedic problems but are not characteristic of scoliosis. Pain and an exaggerated lumbar curvature Uneven shoulder heights and poorly fitting slacks Tenderness and swelling of the spine Limited range of motion of the back and a limp 4 A nurse is providing client/patient education to the mother of an 8-year-old child diagnosed with B-hemolytic streptococci infection (strep throat). The nurse emphasizes the importance of promptly starting and completing the entire course of antibiotics. The mother asks why this is important. The nurse states that the antibiotic will Pain may interfere with oral intake, but this is not the priority concern with prompt diagnosis and care of strep throat. Cool fluids or ice chips may be comforting. Relief to the neck may be provided by the application of cold or warm compresses to the area. Warm saline gargles may also relieve throat discomfort. Sinusitis and abscess formation on the pharyngeal and peri tonsillar areas are complications that can develop with a strep throat infection, but these complications are not of the greatest concern with this infection. Anterior cervical lymphadenopathy is a symptom of a streptococcal infection resulting in pharyngitis and tender lymph nodes. This usually subsides in 3 to 5 days if uncomplicated. Antibiotics should be initiated as soon as possible and taken as prescribed to quickly and completely eliminate the streptococcal organism, which can lead to acute rheumatic fever, glomerulonephritis, and acute renal failure. alleviate painful swallowing to avoid complications of dehydration and malnutrition. prevent sinusitis or abscess formation on the pharyngeal or peri tonsillar areas. reduce the risk of anterior cervical lymphadenopathy. eliminate organisms that might initiate acute renal failure or rheumatic fever. 5 A nurse is reinforcing teaching about accidental poisoning to a parent during a routine well-child visit. The nurse asks the parent, "What would be your first response if your child accidentally took an overdose of acetaminophen (Tylenol)?" Which of the following statements by the parent would indicate a correct understanding? Syrup of ipecac is no longer recommended as a routine home treatment of poisoning. Giving syrup of ipecac might possibly be appropriate, but certain substances that are corrosive would make using this measure contraindicated because it would increase the damage to the mucosa lining. Placing the child into a side-lying position is an appropriate measure to prevent aspiration. Calling the Poison Control Center is the best initial response to an accidental poisoning because each case needs to be dealt with by getting prompt medical attention to initiate the appropriate emergency treatment actions. Giving the child one sip of water, not a full glass, is appropriate to dilute the ingested poison. However, this is not the first action that should be taken. "I will give my child a dose of ipecac." "I will place my child on her back." "I will call the Poison Control Center." "I will get my child to drink a full glass of water." 6 A nurse is caring for a 23-month-old child with iron-deficiency anemia. The parents indicate they have been taught about the diagnosis, but are concerned that they are not doing all that they need to do. Which of the following should the nurse include when reinforcing teaching? Cow's milk contains substances that bind with iron and interfere with its absorption. Iron should not be given with milk or milk products. There are no food limitations or suggestions when children are taking oral iron preparations. Foods with vitamin C, such as citrus fruits, enhance the absorption of iron. Oral iron supplements do not cause GI bleeding or ulcers. Liquid iron may stain the teeth, so the nurse should instruct the parents to give it through a straw placed in the back of the child's mouth to avoid staining the teeth. Give the oral iron supplementation with a glass of cow's milk to prevent stomach problems. Provide diet instructions including limiting citrus fruits in favor of more vegetables. Provide information about complications of iron including gastrointestinal bleeding and ulcers. Give liquid iron through a straw placed in the back of the mouth. 7 A nurse is reviewing discharge teaching with the parents of a child who has pediculosis. Which of the following should the nurse include in the teaching? Children should not share combs, hair ornaments, hats, caps, scarves, coats, and other items used on or near the hair. Pets are not carriers of lice. Clothes should be dried in a hot dryer for at least 20 min to kill the lice. Lice need a blood source to survive. Placing the nonwashable items in a sealed plastic bag for 14 days will kill the lice. "Children can share scarves and coats, but not hats or combs." "Household pets can carry and transmit lice to people." "After washing clothing, hang clothes outside to dry." "Seal nonwashable items in plastic bags for 14 days." 8 A nurse is caring for a toddler who is in an oxygen tent. Which of the following actions should the nurse take in order to promote comfort while maintaining the child's safety? Not all toys are safe to put inside an oxygen tent. Vinyl or plastic toys that do not absorb moisture are suitable to put inside the tent. Stuffed animals absorb moisture and are difficult to dry. High levels of oxygen are a source of sparks, so mechanical or electrical toys are a potential fire hazard. The moisture inside an oxygen tent will make the child cold and the child’s clothes moist. Therefore, the nurse should try to keep the child warm and dry by changing bedding and clothes, which will enhance the child's comfort without compromising safety. Oxygen is heavier than air; therefore, oxygen loss will be greater at the bottom of the tent. The tent should be tucked snugly without open edges to prevent oxygen loss. Some tents are opened at the top. Oxygen is a heavy gas and most of it will stay at the bottom of the tent. This measure does not promote the child's comfort while in the oxygen tent. Give the child a stuffed animal and car with rubber wheels to play with. Change the bedding and the child's clothing frequently or as often as needed. Tuck the bottom of the tent under the mattress on three sides, leaving one side open so the child can look out. Cover the opening on the roof of the tent with a blanket to prevent the child from becoming chilled. 9 A nurse is reinforcing teaching with the parent of a child with a urinary tract infection. Which of the following statements made by the parent indicates understanding of how to prevent future infections? Children should be encouraged to void frequently, especially before long trips or other circumstances in which toilet facilities may not be available for an extended period of time. Urine that is held can harbor bacteria that can result in a urinary tract infection. Cotton underwear allows for more air flow to the perineal area and reduces the risk of urinary tract infections. Wiping from back to front increases the risk of feces entering the urethra and causing a urinary tract infection. Bubble baths and perfumed perineal products can irritate the urethra and lead to a urinary tract infection. These should be avoided, especially for girls. "I will bring my child to the bathroom before we leave for extended trips." "I need to switch my child from cotton underwear to nylon underwear." "I should teach my child to wipe from back to front after urinating." "I will have my child soak in a bubble bath once or twice a week." 10 A nurse is reviewing discharge instructions with the parent of an infant who has acute laryngotracheobronchitis (croup). Which of the following statements made by the parent indicates a need for further teaching? This is a correct intervention. Corticosteroids have an anti-inflammatory effect that decreases subglottic edema. This will make breathing easier. This is a correct intervention. Clearing the nasal passages decreases the amount of secretions in the upper and lower airways. Dry air will exacerbate the child's croup. Cool temperature therapies are advocated for this condition. Cool mist constricts edematous blood vessels. A cool air vaporizer can be used at home to maintain high humidity and provide relief. Warm mist from warm running water such as a hot shower in a closed bathroom may be beneficial. It is essential that children with laryngotracheobronchitis (croup) be allowed and encouraged to drink any fluids they like to increase fluid intake. "I will give my child the corticosteroids prescribed by the doctor." "I will clear the child's nasal passages with a bulb syringe to aid in breathing." "I will place a dehumidifier in my child's room." "I will encourage my child to take plenty of fluids over the next several days." 11 A 15-year-old client visits the clinic to get medical clearance to play a sport. The nurse reviews measures to prevent athlete's foot with the client. Which of the following statements by the client indicates that the instructions were understood? Many people believe tinea pedis is transmitted via showering in the same location as someone who is infected. However, transmission of tinea pedis to other individuals is rare. Ointments have not proven to be successful in treating tinea pedis. Application of antifungal powder containing tolnaftate or tolnaftate liquid is a treatment measure. Medication is not usually recommended as a preventative measure. The client should avoid heat and perspiration by wearing light socks. Wearing well-ventilated shoes and clean, lightweight socks is encouraged in order to prevent heat and perspiration conditions. Occlusive shoes should be avoided. "I will avoid showering at the gym." "I can apply an antifungal cream daily." "I should wear dark-colored socks." "I should wear well-ventilated shoes." 12 A nurse is collecting data on a 3-year-old child with eczema in an outpatient center. The parent asks whether any changes can be made at home to prevent the recurrence of eczema. Which of the following is an appropriate response by the nurse? Clients with eczema should avoid any material that produces heat, as this can cause perspiration and itching. Bubble baths and harsh soaps cause drying of the skin and can further irritate the eczema. A room humidifier or vaporizer may be helpful for keeping moisture in the air and keeping the skin from drying. Woolen clothing or blankets cause itching and should not be used. "Cover the crib mattress with a plastic cover." "Give the child a bubble bath for 20 min each day." "Place a humidifier in the child's room." "Dress the child in warm wool clothing in cold weather." 13 A nurse is caring for a 7-year-old child who is admitted with an asthma exacerbation. This is the third admission since diagnosis 6 months ago. Which of the following topics should be reinforced with the parents and child in order to prevent future readmissions? Monitoring the child's oxygen saturation and respiratory rate provides information about how well the child is oxygenating, but does not prevent future attacks. Allergen control is aimed at the prevention of exposure to airborne allergens and irritants that can trigger an asthma attack. Preventing exposure to allergens does reduce the risk for future attacks. Peak flow readings allow parents to make educated decisions regarding asthma management. However, these measurements will not prevent future asthma attacks or hospitalization. Upright positioning is important to help with lung expansion during an asthma attack, but it is not a preventative measure. Monitoring oxygen saturation and respiratory rate daily Identification and avoidance of factors that trigger symptoms Monitoring peak flow measurements regularly Positioning the client upright in a position of comfort 14 Which of the following physical manifestations of a client with anorexia nervosa best indicates compliance with the treatment plan of care? Effectiveness of nursing interventions includes weight gain or no further weight loss. Measuring weight is routinely completed to determine the effectiveness of the plan of care. This is the best indicator of compliance with the treatment plan. Return of soft bowel movements indicates that the client is not using laxatives or enemas to speed up the intestinal passage of food. This is a good indication but is not the best indicator of compliance. This is a good indication of weight gain and normalizing of body function, but it is not the best indication of treatment plan success. Improvement of the oral mucosa indicates that nutritional deficiencies are improving. This is a positive sign, but not the best indicator of compliance with the treatment plan of care. A weekly weight gain of 1 kg (2.2 lb) Daily bowel movements that are soft Return of regular menstrual periods Improvement of the oral mucosa 15 An assistive personnel (AP) is caring for a child diagnosed with leukemia and undergoing chemotherapy. In which of the following clinical situations should a nurse intervene? Chemotherapy can damage gastrointestinal mucosal cells. Using a soft toothbrush will provide mouth care and will be gentle on the mucous membranes in order to prevent ulceration. Hair loss is a common side effect of chemotherapy. Children often feel better if their heads are covered so no one can see that they have lost their hair. A soft cap is most comfortable and won't increase perspiration or cause itching as do other materials. Chemotherapy will put children at risk for infection secondary to immunosuppression, so all visitors with infections are restricted. The rectal area is prone to ulceration from various drugs, feces, and urine. Urine and feces must be removed immediately and the perianal area washed. Using rectal temperatures is avoided to prevent trauma. The AP offers a soft toothbrush for oral care. The AP applies a soft cotton cap to the child's head. The AP maintains a restriction of all visitors and health personnel with infections. The AP prepares to take a rectal temperature. ???16 A nurse is preparing to administer an intramuscular (IM) injection to a 2month-old infant. Which of the following is the preferred injection site? (PICTURE HERE) The vastus lateralis is the preferred site for IM injections in infants. The deltoid muscle is not the preferred site for IM injections in infants. It is recommended that the ventrogluteal site not be used until infants begin walking. 17 A nurse is reinforcing teaching with the parent of an infant who has club feet with bilateral casts. Which of the following statements should be included in the teaching? If a cast is too tight, circulation will be impaired and the toes will swell. Serial manipulation and casting allows for the gradual stretching of skin and accommodates the rapid growth in early infancy, and is performed every week for 8 to 12 weeks. If normal alignment is not achieved by 3 months, surgical intervention is indicated and will take place at about 6 to 12months of age. It can take 24 to 48 hr for the cast to dry completely. A regular fan or cool-air hair dryer to circulate air may facilitate drying when humidity is high. Heated fans and dryers should not be used because they can cause the cast to dry on the outside but remain wet on the inside. They may also cause burns from the conduction of heat from the cast to the underlying tissue. Pain is not a problem associated with casting for club feet. "Check the toes for any swelling or discoloration." "Monthly recasting should be scheduled with the orthopedist." "Use a heated fan or dryer to facilitate the drying of the cast." "Give the baby Tylenol every 4 hr to help with pain." 18 A nurse is caring for a child with measles. Which of the following actions is appropriate supportive care? Photophobia accompanies rubeola; therefore, diversional activities with bright lights are contraindicated. Dimming the room lights is soothing for the child. Isolation should be until day 5of the rash. The period of communicability is from 4 days before the appearance of the rash until5 days following the appearance of the rash. An elevated temperature is common. Overheating, which increases itching, should be avoided. The child should wear lightweight, loose, and nonirritating clothing, and keep out of the sun. Antipyretics should also be administered. Vitamin A supplementation reduces the morbidity and mortality in children with the measles. Children with measles should be given vitamin A supplements. Nurses need to instruct parents on safe storage and administration of vitamin A to prevent excessive administration and possible toxicity. Provide diversional activities such as video games. Maintain isolation for 48 hr after the rash resolves. Keep the child warm with adequate undergarments and bedding. Administer vitamin A supplements as prescribed. 19 A nurse is caring for a 14-year-old client diagnosed with diabetes mellitus. The nurse is discussing the ongoing monitoring needed with this diagnosis. Which of the following should be included in the discussion? When children are ill their fluid intake should be monitored. They often drink less, leading to dehydration. When children are hyperglycemic, dehydration from illness leads to increased hyperglycemia and requires extra fluid intake. Exercise results in increased movement of glucose into the cells and decreased blood glucose levels. The client should have a snack, not additional insulin. There is poor correlation between glycosuria and blood glucose. Blood glucose monitoring is much more accurate than urine glucose monitoring. Children with diabetes should increase the amount of whole grains, fruits, and vegetables, which contain complex carbohydrates, in their diets. Concentrated sweets are avoided to prevent hyperglycemia. The illness requires careful attention to fluid balance since hyperglycemia contributes to dehydration. Exercise requires additional insulin since glucose will be released from the cells during activity. Urine glucose must be monitored because there is a correlation between simultaneous glycosuria and blood glucose concentrations. The diet needs to include fewer complex carbohydrates because they quickly raise blood glucose. 20 A nurse is reinforcing teaching with the parent of a 4-year-old child with influenza. Which of the following should the nurse include in the teaching? Influenza is spread by direct contact. This means it can be spread from one person to another or by touching an object that has been contaminated by nasopharyngeal secretions. The most infectious period for influenza is 24 hr before and after the onset of symptoms. There is a possible link between aspirin and Reye syndrome, so children with influenza or other viral illnesses should not be given aspirin. Most cases of Reye syndrome follow a common viral illness such as chickenpox or influenza. The immunization vaccine can be given at the same time as other vaccines, but must be given in a separate syringe and at a different injection site. Influenza is transmitted by airborne means, so handwashing will not prevent transmission. Children are not infectious after 12 hr from the onset of influenza symptoms. Aspirin should not be given to children with influenza for relief of discomfort. The influenza vaccine may not be given at the same time as other immunizations. 21 A nurse is discussing nutrition with an adolescent who is pregnant. The adolescent's parent is in the room. Which of the following statements made by the parent indicates a need for further dietary instruction? This statement needs clarification. Snacks containing sugar are often eaten by the adolescent who is pregnant, but are not a good source of calories for energy and nutrition for the developing fetus. Whether pregnant or not, an adolescent's nutritional needs include an increase in calcium, protein, and iron. Nutritious between-meal snacks are a good source of energy. Complex carbohydrates of wheat and whole grains and fruits are appropriate snacks. This is a good suggestion because the adolescent does need additional calories in the second and third trimester. "I told my daughter that any calories ingested are a source of energy and nutrition." "I try to provide foods with an increased amount of calcium, protein, and iron." "I encourage between-meal snacks that are complex carbohydrates and fruits." "I have planned meals and snacks for additional calories in the second and third trimester." 22 A nurse is caring for a 14-year-old child with appendicitis who has a pain rating of 8 on a scale of 1 to 10. The child has just returned to the unit after a computed tomography (CT) scan of the abdomen and tells the nurse the pain just stopped. Which of the following should the nurse do first? Even though continued pain assessment is important, this is not the first priority with the sudden relief of pain. The child's vital signs will need to be taken before surgery, but this is not the priority at this time. The sudden cessation of pain in a child with appendicitis should cause the nurse to suspect a ruptured appendix. The primary care provider should be notified immediately since the client is at increased risk for developing peritonitis, which can cause death if appropriate interventions are not immediately taken. The nurse would assess bowel sounds as the child is prepared for surgery, but this is not the priority at this time. Continue with the pain assessment. Take the child's vital signs. Notify the primary care provider. Auscultate the child's bowel sounds. 23 A nurse is monitoring a 9-year-old child on the first postoperative day following abdominal surgery. The nurse notes the child grimacing and guarding her abdomen. Which of the following pain assessment tools should the nurse use based on its acceptance by children? The poker chip scale is used by children, but is not rated as the most preferred by that age group. The FACES pain rating scale is the best choice for a 9-year-old child because it includes visual face, numerical correspondence, and text stating feelings. This is the most preferred scale for children. The visual analog scale allows a child to mark a line stating the length of pain; however, this scale is difficult to determine and clarification is needed. The numerical 1 to 10 rating scale is used for adults. It has too many options and often requires clarification when used with children. Poker chip tool FACES rating scale Visual analog scale Numerical 1 to 10 rating scale