ATI RN
Pediatric NCLEX Questions Questions
Question 1 of 5
Which discharge instruction for a child with encopresis should the nurse question?
Correct Answer: D
Rationale: A high-protein diet can worsen constipation; a high-fiber, balanced diet is preferable.
Question 2 of 5
A 4-year-old weighing 15 kg produces 150 mL of urine in 10 hours. What should the nurse do?
Correct Answer: C
Rationale: Expected urine output is 0.5-1 mL/kg/hr. For a 15-kg child over 10 hours, 75-150 mL is within normal limits.
Question 3 of 5
Biopsy is not usually performed for a child with suspicion of Wilms tumor EXCEPT
Correct Answer: E
Rationale: Presence of intratumoral calcifications may warrant biopsy to rule out other diagnoses.
Question 4 of 5
While examining a 2-year-old child, the nurse in charge sees that the anterior fontanel is open. The nurse should:
Correct Answer: C
Rationale: In infants and young children, it is normal for the anterior fontanel to remain open up to about 18-24 months of age. The fontanel serves an important function in allowing the skull to grow and expand as the brain grows rapidly during infancy. Therefore, the presence of an open fontanel in a 2-year-old child is a normal finding and does not warrant any immediate concern or action. It does not indicate abuse, the need to notify the doctor, or inquire about a family history of Tay-Sachs disease.
Question 5 of 5
Several hours after returning from surgery, the nurse tells the patient that she is ordered to be ambulated. The patient asks, "Why?" Which of the following complications would the nurse correctly explain can be prevented by early postoperative ambulation?
Correct Answer: C
Rationale: Early postoperative ambulation is important for preventing complications such as pneumonia. When a patient remains immobile for an extended period after surgery, they are at an increased risk of developing pneumonia due to decreased lung expansion and secretions pooling in the lungs. Ambulation helps improve lung function, promote better oxygenation, and prevent respiratory complications like pneumonia. In contrast, increased peristalsis helps prevent constipation, coughing helps prevent respiratory complications as well, and wound healing is not directly related to the need for early postoperative ambulation.