During which phase of the nursing process does the nurse use essential information about the child's physical, social, and emotional health to decide which interventions to use?

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Nursing Care of Children Final ATI Questions

Question 1 of 5

During which phase of the nursing process does the nurse use essential information about the child's physical, social, and emotional health to decide which interventions to use?

Correct Answer: B

Rationale: The correct answer is B: Planning. During the planning phase of the nursing process, the nurse utilizes essential information gathered during the assessment about the child's physical, social, and emotional health to determine the most appropriate interventions to address the identified needs. This phase focuses on developing a comprehensive care plan tailored to the individual child. A) Implementation is incorrect because this phase involves carrying out the interventions outlined in the care plan. C) Diagnosis is incorrect as it refers to identifying health issues based on the assessment data. D) Assessment is incorrect as it involves collecting and analyzing data about the child's health status, rather than deciding on interventions.

Question 2 of 5

Which reflex, present at birth, is elicited by stroking the sole of the infant's foot, resulting in the fanning of the toes?

Correct Answer: A

Rationale: The Babinski reflex is the correct answer. This reflex is characterized by the fanning out of the toes when the sole of the foot is stroked. It is a normal reflex in infants and is typically present at birth, disappearing by around 12 months of age. The Moro reflex, which involves the infant's response to a sudden loss of support or a loud noise, is not related to the fanning of toes. Sucking and rooting reflexes are related to feeding behaviors and are not elicited by stroking the sole of the foot.

Question 3 of 5

As the primary caregiver for a 5-month-old baby, according to Maslow's hierarchy of basic needs, which intervention takes the highest priority?

Correct Answer: A

Rationale: The correct answer is A: Feeding every four hours. According to Maslow's hierarchy of needs, physiological needs, such as food, water, and warmth, take the highest priority. Ensuring that the baby is fed regularly is crucial for survival and overall health. Choice B, protection from harm, relates more to safety needs which come after physiological needs. Choice C, providing stimulation, is associated with higher-level needs like belongingness and esteem. Choice D, providing love, corresponds to esteem and self-actualization needs, which are higher in the hierarchy than physiological needs.

Question 4 of 5

The nurse is assessing a child with type 2 diabetes. The child is awake and alert with a serum glucose of 60 mg/dL. What action should the nurse take?

Correct Answer: C

Rationale: For a conscious child with mild hypoglycemia, giving 15 grams of fast-acting carbohydrates is the appropriate intervention. This can quickly raise blood glucose levels to prevent further complications. Administering insulin (Choice A) would further lower the glucose level, which is not suitable in this scenario. Administering epinephrine (Choice B) is not indicated for hypoglycemia. Glucagon (Choice D) is used for severe hypoglycemia with altered consciousness, not for mild cases where the child is awake and alert.

Question 5 of 5

A child is admitted to the hospital with acute renal failure. The parents ask about the prognosis for acute renal failure. The nurse's response should be based on which statement about acute renal failure?

Correct Answer: C

Rationale: The correct answer is C: Acute renal failure in children is often reversible, especially when the underlying cause is identified and treated promptly. It does not always lead to chronic renal failure or the need for a kidney transplant. Choice A is incorrect as prophylactic antibiotics for life are not a standard treatment for acute renal failure. Choice B is incorrect as acute renal failure does not always progress to chronic renal failure. Choice D is incorrect as not all children with acute renal failure will eventually require a kidney transplant.

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