ATI RN
RN Nursing Care of Children Online Practice 2019 A Questions
Question 1 of 5
What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease?
Correct Answer: B
Rationale: In caring for an infant with a temporary colostomy for Hirschsprung disease, the priority intervention is option B) Protecting the skin around the colostomy. This is crucial because infants have delicate skin that is prone to breakdown and irritation from stool output. By protecting the skin around the colostomy, we can prevent skin breakdown, infection, and discomfort for the infant. Option A) Teaching how to irrigate the colostomy is not a priority for an infant with a temporary colostomy. This intervention is more relevant for older children or adults with a permanent colostomy. Option C) Discussing the implications of a colostomy during puberty is not a priority for an infant. This is a consideration for later stages of development and can be addressed at an appropriate time. Option D) Using simple, straightforward language to prepare the child is also not a priority for an infant who is not yet at an age where they can comprehend such information. In an educational context, understanding the priority interventions in caring for infants with colostomies is essential for nurses working in pediatric settings. By prioritizing skin protection, nurses can ensure the infant's comfort, prevent complications, and promote optimal healing.
Question 2 of 5
The nurse is preparing to give acetaminophen (Tylenol) to a child who has a fever. What nursing action is appropriate?
Correct Answer: C
Rationale: In this scenario, option C is the correct answer because it demonstrates safe medication administration practices. When giving acetaminophen (Tylenol) to a child with a fever, it is crucial to calculate the correct dosage based on the child's weight to prevent medication errors and potential harm. The recommended dose of acetaminophen should not exceed 15 mg/kg to avoid overdosing. Option A is incorrect because retaking the temperature in 15 minutes is not the most appropriate nursing action after administering acetaminophen. The priority should be to ensure the correct dosage is given. Option B is incorrect as placing a warm blanket on the child is not directly related to administering acetaminophen and managing fever. Option D is incorrect because using cold compresses instead of Tylenol may not effectively reduce the child's fever and does not address the need for appropriate medication administration. Educationally, this question highlights the importance of accurate medication dosing in pediatric patients and the necessity of calculating medication doses based on weight. It also emphasizes the nurse's role in ensuring safe and effective care for children.
Question 3 of 5
The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, okay?" What action should the nurse take?
Correct Answer: B
Rationale: In this scenario, the correct action for the nurse to take is option B: Start the IV line and then allow for expression of feelings. This response is appropriate because it balances the immediate need to administer antibiotics with the child's emotional needs and autonomy. Starting the IV line promptly is important to initiate the necessary treatment. However, it is equally vital to acknowledge and address the child's fear and discomfort. Allowing the child to express their feelings validates their emotions and fosters trust in the nurse-child relationship. This approach promotes a sense of control and empowerment for the child, which is crucial in pediatric care. Option A is incorrect because postponing the IV until the next shift may delay necessary treatment, which can compromise the child's health. Option C, changing the route to oral antibiotics, may not be feasible if IV administration is indicated for more rapid or effective treatment. Option D, postponing until the child is ready, does not address the immediate medical need and may not be in the best interest of the child's health. In an educational context, this question highlights the importance of holistic care in pediatric nursing. It underscores the significance of therapeutic communication, patient-centered care, and balancing clinical needs with emotional support when caring for pediatric patients. This rationale reinforces the principles of child-centered care and the significance of empathy and communication in nursing practice.
Question 4 of 5
When checking the intravenous (IV) site on a child, the nurse should take which action?
Correct Answer: C
Rationale: In the context of nursing care for children with intravenous (IV) sites, the correct action for a nurse to take when checking the site is to look at the site while palpating the area (Option C). This approach allows the nurse to visually inspect the site for signs of redness, swelling, or infiltration while also assessing for tenderness or warmth through palpation. Palpation can help identify any potential issues like phlebitis or infiltration that may not be immediately visible. Option A, simply looking at the site, is not comprehensive enough as it does not involve a tactile assessment that palpation provides. Option B, asking the child if the site hurts, relies on subjective information from a child who may not always accurately express discomfort. Option D, taking all the tape off, assessing the site, and redressing, is excessive and can increase the risk of dislodging the IV or introducing infection. In an educational context, it is crucial for nurses caring for children with IV sites to develop skills in thorough assessment techniques that involve both visual and tactile components. Teaching proper assessment methods helps ensure early detection of complications, promotes patient safety, and optimizes the delivery of care to pediatric patients.
Question 5 of 5
The clinic nurse is teaching parents about when to call the office immediately for a child with a fever. What should the nurse include in the teaching session? (Select all that apply.)
Correct Answer: D
Rationale: In this scenario, understanding when to seek immediate medical attention for a child with a fever is crucial for parents. The correct answer is D, which includes all of the options provided. Option A, "The child has a stiff neck," is important to include because it can be a sign of meningitis, a serious condition requiring urgent medical evaluation. Option B, "The fever is over 40.6 C (105 F)," is essential to emphasize as high fevers can indicate a severe infection or other underlying health issue. Option C, "The child is younger than 2 months," is also critical because infants in this age group have immature immune systems and are at higher risk for serious infections if they develop a fever. Educationally, this question highlights the significance of recognizing specific signs and symptoms that warrant immediate medical attention in children with fevers. It reinforces the importance of parental awareness and prompt action in seeking medical help to prevent potential complications or deterioration of the child's health. By understanding these key indicators, parents can better advocate for their child's well-being and collaborate effectively with healthcare providers in managing febrile illnesses.