ATI RN
Burns Pediatric Primary Care 7th Edition Test Bank Questions
Question 1 of 5
What is an important consideration for the nurse who is communicating with a very young child?
Correct Answer: B
Rationale: When communicating with a very young child, using transition objects, such as a doll, can help create a sense of familiarity, comfort, and security. These objects can serve as a bridge for the child to express themselves and can also provide a point of reference for the nurse to better understand the child's perspective. Additionally, transition objects can help the child feel more at ease during interactions with healthcare providers, making the communication process smoother and more effective.
Question 2 of 5
A nurse is assessing a patient admitted for an asthma exacerbation. Which breath sounds does the nurse expect to assess?
Correct Answer: C
Rationale: Wheezes are high-pitched, musical sounds heard during inspiration or expiration due to the constriction or narrowing of the airways, commonly associated with asthma exacerbations. The presence of wheezes indicates airway obstruction, making it the expected breath sound in a patient admitted for an asthma exacerbation. Rubs, rattles, and crackles are associated with different conditions such as pleural friction rubs, respiratory secretions, and fluid in the alveoli, respectively.
Question 3 of 5
A 3-month-old infant, born at 38 weeks of gestation, will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. How should the nurse interpret this action?
Correct Answer: C
Rationale: At 3 months of age, most infants should be able to voluntarily grasp objects placed in their hands. This infant, who was born at 38 weeks of gestation, is showing signs of slight delay in development. Premature infants often have developmental delays, especially in motor skills, compared to full-term infants. The fact that the infant can hold a rattle if it is put in her hands is a positive sign, indicating that she is on the right track developmentally but might be a little behind schedule. Continuing to monitor the infant's progress and providing appropriate developmental stimulation can help promote further motor skill development. There is no indication at this point to suspect a significant developmental lag or a neurologic disorder like cerebral palsy without further assessment and observation.
Question 4 of 5
A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What should the nurse recommend the infant be given?
Correct Answer: C
Rationale: When a mother decides to discontinue breastfeeding, it is important for the infant to receive an appropriate alternative that provides essential nutrients, including iron. Commercial iron-fortified formula ensures that the infant is receiving adequate iron, which is crucial for healthy growth and development. Skim milk is not recommended for infants under age 1 due to its high protein and mineral content, which can strain the baby's immature kidneys. Whole cow's milk is also not suitable before age 1 because it lacks essential nutrients such as iron and vitamin E, and can lead to iron deficiency anemia. Commercial formula without iron would not provide enough iron for the infant's needs, making commercial iron-fortified formula the most appropriate choice for the 5-month-old infant.
Question 5 of 5
In terms of gross motor development, which should the nurse expect a 5-month-old infant to do? (Select all that apply.)
Correct Answer: A
Rationale: At 5 months old, an infant would typically be able to roll from abdomen to back (Choice A). This is an important gross motor skill that develops during this stage. Additionally, putting their feet in their mouth when lying on their back (Choice B) is also a common movement seen at this age. Both these actions demonstrate the increasing strength and coordination of the infant's muscles as they develop and explore their physical abilities. Rolling from back to abdomen (Choice C) and sitting erect without support (Choice D) typically develop later, around 6-7 months and 8-9 months, respectively. Moving from prone to sitting position (Choice E) and adjusting posture to reach an object (Choice F) are usually mastered around 8-9 months as well.