Other ATI questions Flashcards
A nurse is providing dietary teaching to the parent of a child who has cystic fibrosis. Which of the following dietary recommendations should the nurse make? A. Increase the child's protein intake B. Decrease the child's calorie intake C. Increase the child's fiber intake D. Decrease the child's salt intake
A. increase the childs protein intake
The nurse should recommend an increased protein intake for the child who has cystic fibrosis. These children require up to 150% of the recommended daily allowance to meet their nutritional needs.
A nurse is assessing a 6-year-old client at a well-child visit. Which of the following findings requires further assessment by the nurse?
A. Presence of sparse, fine pubic hair
B. Decreased head circumference compared to full height
C. Increased leg length in relation to height
D. Presence of a loose central incisor
A. Presence of sparse, fine pubic hair.
A nurse is assessing a preschooler who has HIV. Which of the following manifestations should the nurse expect? A. Generalized petechiae B. Jaundice C. Obesity D. Chronic diarrhea
D. Chronic diarrhea
Chronic diarrhea is an expected finding for a preschooler who has HIV.
A nurse is providing postoperative teaching to the parent of a 3-month-old infant who is recovering from an umbilical hernia repair. Which of the following statements by the parent indicates an understanding of the teaching?
A. “I will expect the site to bulge when my baby cries.”
B. “I will place a belly band around my baby’s abdomen.”
C. “I will fold my baby’s diaper away from the incision.”
D. “I will bathe my child in the bathtub daily.”
C. I will fold by babys diaper away from the incision.
A nurse is providing teaching to the parent of a child who has cystic fibrosis and a prolapsed rectum. The nurse should identify that which of the following is a cause of this complication? A. Bulky stools B. Weakened rectal sphincter C. Elevated pancreatic enzymes D. Decreased intra-abdominal pressure
A. Bulky stools.
The nurse should identify that bulky stools can cause a child who has cystic fibrosis to develop a prolapsed rectum. The nurse should implement interventions to help decrease the bulk of the child’s stools.
A nurse in the emergency department is assessing an infant who recently started taking digoxin to treat a supraventricular arrhythmia. Which of the following findings should the nurse identify as an indication of digoxin toxicity? A. Irritability B. Diaphoresis C. Vomiting D. Tachycardia
C. Vomiting
A nurse in the emergency department is caring for an unaccompanied infant following a motor-vehicle crash. During the assessment, the nurse notes that the infant's anterior fontanel is almost closed. She has 6 teeth, is able to sit unsupported, and can drink from a cup. The child cries whenever anyone new to her enters the room, says a few words, and is asking for "mama" and "dada." The nurse should make which of the following age assessments for this child? A. 6 months old B. 12 months old C. 18 months old D. 24 months old
B
The nurse should know that this infant must be less than 18 months old because her anterior fontanel is still open. The infant is approximately 12 months old due to the presence of 6 teeth. Her skills—sitting unsupported (8 months), drinking well from a cup (9 months), stranger anxiety (8 months), and ability to say 2 words (12 months)—should also help the nurse estimate the infant’s age as 12 months.
A nurse is caring for a preschool-age child who is dying. Which of the following findings is an age-appropriate reaction to death by the child? (Select all that apply.)
A. The child views death as similar to sleep.
B. The child is interested in what happens to the body after death.
C. The child recognizes that death is permanent.
D. The child believes his thoughts can cause death.
E. The child thinks death is a punishment.
A. The child views death as similar to sleep.
D. The child believes his thoughts can cause death.
E. The child thinks death is a punishment.
Preschool-age children may think of death like sleep. Preschool-age children also believe that their thoughts and wishes can make things happen since they are egocentric. This is part of why the death of a family member can be difficult for a child at this age. Finally, preschool-age children sometimes believe that death is the result of guilt or a punishment for something they did, said, or thought.
A nurse is assessing a 6-month-old infant during a well-child visit. Which of the following motor activities should the nurse expect the infant to have achieved?
A. Sitting alone
B. Attempting to stack objects
C. Picking up small objects with a crude pincer grasp
D. Turning from back to stomach
D. Turning from back to stomach.
A nurse is providing teaching about immunization schedules to the parents of a newborn who is 1 week old. Which of the following pieces of information should the nurse include in the teaching?
A. “Initial vaccines should be administered between birth and 2 weeks of age.”
B. “Your child will need to begin the vaccination series over again if subsequent doses in the series are missed.”
C. “An allergic reaction to a vaccine is due to the active ingredient in the vaccine.”
D. “A vaccination should be postponed if your child has a rectal temperature of 99.5°F and head congestion.”
A.
The first dose of the hepatitis B vaccine should be administered within the first 2 weeks after birth. The dose should be given before discharge from the hospital if the mother is hepatitis B surface antigen (HBsAg) negative.
A nurse is teaching a group of parents of toddlers about measures to reduce the risk of choking. Which of the following foods increase the risk of choking in toddlers? (Select all that apply.) A. Hot dogs B. Grapes C. Bagels D. Marshmallows E. Graham crackers
A. Hot dogs
B. Grapes
C. Bagels
D. Marshmallows
A nurse is teaching the parent of a child who has ADHD and a new prescription for methylphenidate sustained-release tablets. Which of the following pieces of information should the nurse include in the teaching?
A. “Crush the medication and mix it in your child’s food.”
B. “Administer the medication 1 hour before bedtime.”
C. “Expect your child to have cloudy urine while he is taking this medication.”
D. “Weigh your child twice per week while he is taking this medication.”
D
The nurse should instruct the parent to weigh the child 2 to 3 times per week to monitor for weight loss, which is an adverse effect of methylphenidate. The parent should report weight loss to the provider.
A nurse is creating a plan of care for a preschooler who was admitted for the treatment of measles. Which of the following activities should the nurse include in the client’s care plan?
A. Constructing a model airplane
B. Playing a video game in the playroom
C. Pulling a wagon with toys in the hallway
D. Putting together a puzzle with large pieces
Check Answer
D. Putting together a puzzle with large pieces.
A nurse is providing discharge teaching for the parent of a newborn who is prescribed a Pavlik harness for developmental dysplasia of the hip. Which of the following responses indicates an understanding of the teaching?
A. “I should apply powder to the folds of skin on my baby’s knees and thighs.”
B. “I should adjust the straps on the harness once a week as my baby grows.”
C. “I should lightly massage my baby underneath the straps once a day.”
D. “I should place my baby’s diaper over the straps of the harness.”
C. “I should lightly massage my baby underneath the straps once a day.”
The nurse is preparing to administer an oral medication to an 8-month-old infant. Which of the following actions should the nurse take?
A. Mix the medication with 1 tsp of honey to sweeten the taste for the infant
B. Use an oral syringe to place the medication alongside the infant’s tongue
C. Add the medication to the infant’s bottle of formula
D. Place the infant in a supine position to administer the medication
B.
Use an oral syringe to place the medication alongside the infant’s tongue The nurse should use an oral syringe to administer the medication slowly alongside the infant’s tongue or at the side of the mouth. The nurse should give the child time to swallow between deposits.
A nurse is assessing a 6-month-old infant who had a cardiac catheterization with right femoral entry to diagnose a possible congenital heart defect. Which of the following findings should the nurse report to the provider? A. Cool toes on the right foot B. Weak pedal pulses on both feet C. Positive Babinski reflex on both feet D. Erythema on the right foot
A. Cool toes on the right foot The nurse should monitor the temperature of the infant’s right extremity and should report any indication of coolness distal to the entry site to the provider because this can indicate an obstruction of an artery.
A nurse is providing teaching to the guardians of an infant who has failure to thrive (FTT). Which of the following pieces of information should the nurse include in the teaching?
A. Add fortified rice cereal to the infant’s formula
B. Alternate feedings between several family members
C. Offer the infant juice between feedings
D. Provide feedings on demand rather than on a schedule
A. Add fortified rice cereal to the infants formula
The nurse should inform the guardians that adding fortified rice cereal or vegetable oil to the infant’s formula helps promote weight gain.
A nurse is teaching the parent of an infant about home safety. Which of the following pieces of information should the nurse include? (Select all that apply.)
A. Use a wheeled infant walker.
B. Place soft pillows around the edge of the infant’s crib.
C. Position the car seat so it is rear-facing.
D. Secure a safety gate at the top and bottom of the stairs.
E. Maintain the water heater temperature at 49°C (120°F).
C, D, E
C. Position the car seat so it is rear-facing. D. Secure a safety gate at the top and bottom of the stairs. E. Maintain the water heater temperature at 49°C (120°F).
C, D, E
C. Position the car seat so it is rear-facing.
D. Secure a safety gate at the top and bottom of the stairs.
E. Maintain the water heater temperature at 49°C (120°F).
A nurse is assessing a toddler who has gastroenteritis. Which of the following findings indicates the toddler is experiencing severe dehydration? A. Slight thirst B. Capillary refill of 3 seconds C. Deep, rapid respirations D. Decreased tear production
C. Deep rapid respirations
Correct Answer: C. Deep, rapid respirations This finding is a manifestation of severe dehydration. Other manifestations include weight loss of 10% or more, parched mucus membranes, and tachycardia. Incorrect Answers: A. This finding indicates mild dehydration. A toddler experiencing severe dehydration would exhibit intense thirst. B. This finding indicates mild to moderate dehydration. A toddler experiencing severe dehydration would exhibit a capillary refill of 4 seconds or greater and skin tenting. D. This finding indicates moderate dehydration. A toddler experiencing severe dehydration would exhibit an absence of tears and sunken eyeballs.
A nurse is caring for a 16-year-old client who reports dysmenorrhea and asks about alternative therapies for treatment. Which of the following statements should the nurse make?
A. “Herbal medication can be effective but should be monitored by your provider.”
B. “You should place a cold compress on your lower abdomen to decrease inflammation.”
C. “You should limit exercise, which can increase the pain.”
D. “Avoid touching the painful areas because this can increase your discomfort.”
A “Herbal medication can be effective but should be monitored by your provider.” Herbal medicine may be helpful in relieving menstrual pain. However, there is a risk of toxicity and drug interactions if herbal medicine is taken in the wrong doses or with other medications. The nurse should ask the client if she is using herbal medication and document the dose and effects. Incorrect Answers: B. Dysmenorrhea can result from uterine ischemia and lower abdominal cramping. A cold compress causes vasoconstriction and can increase uterine ischemia. A heating pad or hot bath might provide relief of cramping through muscle relaxation and vasodilation, which can help minimize uterine cramping. C. Exercise helps relieve pain by increasing vasodilation, thereby reducing uterine ischemia, which is a cause of dysmenorrhea. Pelvic rocking is a helpful exercise that the nurse can recommend. D. Therapeutic touch can provide pain relief. Massaging the lower back can help relax the muscles and increase pelvic blood flow. Also, effleurage (gentle and rhythmic touching) can help distract the client from the pain and provide an alternative focal point.
A nurse is caring for a child who received penicillin IM 15 minutes ago. The child is now irritable and restless. Which of the following actions should the nurse take first?
A. Administer diphenhydramine
B. Assess for laryngeal edema
C. Initiate hourly urine output monitoring
D. Give epinephrine IV push
B. Assess for laryngeal edema
The greatest risk to this child is bronchoconstriction due to an anaphylactic reaction to penicillin. Therefore, the first action the nurse should take is to assess the child for laryngeal edema and implement interventions to maintain a patent airway.
A nurse is caring for a female adolescent who is being treated for frequent urinary tract infections (UTIs). Which of the following statements by the adolescent indicates a possible cause of the UTIs?
A. “I have bowel movements every 4 to 5 days.”
B. “My mom taught me to wipe from front to back after going to the bathroom.”
C. “I urinate every 2 to 3 hr during the day.”
D. “I don’t wear nylon underwear.”
A. “I have bowel movements every 4 to 5 days.” The nurse should identify that this frequency of UTIs indicates the adolescent is constipated. Therefore, large stool masses might prevent complete emptying of the bladder and lead to urinary stasis and infection. Incorrect Answers: B. The adolescent will improve perineal hygiene by wiping from front to back, which decreases the likelihood of a UTI. C. Emptying the bladder every 2 to 3 hours prevents urinary stasis and infection. D. The adolescent should wear cotton underwear to help prevent UTIs, as nylon underwear is more likely to trap bacteria in the genital area of a female client.
A nurse is providing teaching to the parents of a school-aged child who has type 1 diabetes mellitus about managing hypoglycemia. Which of the following responses by a parent indicates an understanding of the teaching?
A. “I will make sure my child drinks 240 mL (8 oz) of milk as soon as possible.”
B. “I will give my child 2 units of regular insulin.”
C. “I will insist that my child lie down to rest for 30 min.”
D. “I will check my child’s urine for glucose twice daily.”
A. “I will make sure my child drinks 240 mL (8 oz) of milk as soon as possible.” Giving the child 10 to 15 g of simple carbohydrates such as 240 mL (8 oz) of milk will elevate the blood glucose level and alleviate hypoglycemia. Incorrect Answers: B. Administering additional insulin could worsen the child’s hypoglycemia and lead to neurological effects such as seizures, shock, and coma. C. Rest is important for overall health; however, rest will not alleviate the child’s symptoms. D. Checking the child’s urine for glucose will not manage a hypoglycemic episode. Children who are hyperglycemic have glucose in their urine.
A nurse is teaching an adolescent about managing asthma and using a peak expiratory flow meter. Which of the following statements by the client demonstrates an understanding of the teaching?
A. “I will use my peak flow meter whenever I feel short of breath.”
B. “I will continue to take my medication when my peak flow rate is in the green zone.”
C. “I need to use the average of 3 readings when I measure my flow rate.”
D. “My asthma is being controlled if my flow rate is in the yellow zone.”
Answer: B. “I will continue to take my medication when my peak flow rate is in the green zone.” This statement by the adolescent indicates an understanding of the teaching. A peak flow rate in the green zone indicates the current treatment has been effective; therefore, the adolescent should continue with their current medication regimen. Incorrect Answers: A. The nurse should instruct the adolescent to use a quick-relief (i.e. rescue) medication when they feel short of breath because this is a manifestation of an acute attack. C. The nurse should instruct the adolescent to obtain 3 readings and to write down the highest of the 3 readings rather than the average. D. The nurse should inform the adolescent that a flow rate in the yellow zone indicates inadequate control of asthma.
A nurse is teaching the parents of a 3-year-old child who has persistent otitis media about prevention. Which of the following statements by the parents indicates an understanding of the teaching?
A. “My child should not play around others who have ear infections.”
B. “We should not smoke around our child.”
C. “My child should not swim this summer.”
D. “I will encourage my child to blow his nose forcefully when he has a cold.”
“We should not smoke around our child.” Preventing exposure to tobacco smoke at home can prevent further episodes of ear infections because tobacco smoke can cause inflammation of the respiratory tract. Incorrect Answers: A. A child who has an ear infection is not contagious; therefore, the child may play with other children who have ear infections. C. A child who has recurrent ear infections is able to swim; however, wearing earplugs may decrease the risk of infection. D. A child who has recurrent ear infections should not forcefully blow the nose during a cold, as this causes organisms to ascend through the eustachian tubes.
A nurse is caring for a 12-month-old infant following the surgical repair of a cleft palate. The nurse should plan to feed the infant using which of the following instruments? A. Spoon B. Straw C. Firm nipple D. Cup
D. CUp
The infant should be fed clear liquids using a cup for 7 to 10 days following a cleft palate repair to prevent trauma and injury to the suture line. Incorrect Answers: A. Feeding the infant using a spoon is contraindicated following a cleft palate repair because placing objects in the mouth could rub or disturb the suture line. B. Feeding the infant using a straw is contraindicated following a cleft palate repair because placing objects in the mouth could rub or disturb the suture line. C. Feeding the infant using a firm nipple is contraindicated following a cleft palate repair because placing objects in the mouth could rub or disturb the suture line.
The nurse is providing teaching to the parent of a 4-year-old child who stutters. Which of the following statements by the parent indicates an understanding of the teaching?
A. “I should ignore the stuttering and not interrupt her.”
B. “I should finish my child’s sentence if she is stuck on a word.”
C. “I should reward my child when she doesn’t stutter.”
D. “I should tell my child to slow down when she starts stuttering.”
A. I should ignore the stuttering and not interupt her
Stuttering is an expected part of speech development in the preschool years. As language skills improve, stuttering typically ceases by 5 years of age. Parents should be instructed not to focus on the stuttering so the behavior is not reinforced and does not become prolonged.
A nurse is creating a plan of care for a child who has leukopenia secondary to chemotherapy. Which of the following interventions should the nurse include in the plan?
A. Maintain the child on bed rest
B. Monitor the child for increased temperature
C. Administer oxygen to the child
D. Monitor the child for bleeding
B
Leukopenia places the child at risk of infection; therefore, the nurse should monitor the child for a fever.
A nurse is caring for a 3-year-old child on a pediatric unit. The nurse should identify which of the following as an appropriate toy for the child? A. Jump rope B. Coloring book and crayons C. Checkers game D. Jack-in-the-box
B. Coloring book and crayons
Preschoolers have increasing fine motor control and imagination. They enjoy toys that allow creativity and self-expression.
Incorrect Answers:
A. A 3-year-old child does not have the physical coordination to use a jump rope. This choice is appropriate for a 5-year-old child.
C. A 3-year-old child might be able to play a game with simple rules. However, a game of checkers would not be appropriate due to the complex nature of the game. This choice would be appropriate for a child who is 6 years or older.
D. This toy would be an appropriate choice for an infant. A preschooler would quickly become bored with this toy.
A nurse is caring for an 8-year-old child who has acute glomerulonephritis. Which of the following findings should the nurse expect? A. Hypotension B. Stomatitis C. Bloody diarrhea D. Periorbital edema
D. Periorbital edema
Periorbital edema is an expected finding in a child who has glomerulonephritis. Incorrect Answers: A. Elevated blood pressure is an expected finding in a child who has acute glomerulonephritis. B. Stomatitis is an expected finding in a child who has chronic renal failure. C. Bloody diarrhea is an expected finding in a child who has hemolytic uremic syndrome.
A nurse is facilitating a group discussion with preschool teachers about child abuse. Which of the following examples should the nurse use to illustrate a suggestive finding?
A. Bruising of both knees with sutures on 1
B. Arm cast for a spiral fracture of the forearm
C. Consistent bedwetting at nap time
D. Frequent, vague reports of a stomachache or a headache
B. Arm cast for a spiral fracture of the forearm
A nurse is conducting a health assessment for a 24-month-old toddler at the local health department. The nurse should expect which of the following findings? (Select all that apply.)
A. 8 deciduous teeth
B. Ability to build a tower of 6 blocks
C. Vocabulary of 10-20 words
D. Slightly bowed or curved leg appearance
E. Head circumference greater than chest circumference
B. Ability to build a tower of 6 blocks
D. Slightly bowed or curved leg appearance
The nurse should expect a 24-month-old toddler to be able to stack a short tower of 6 or 7 blocks. Additionally, a 24-month-old toddler will have a “pot-bellied” appearance; the legs should be slightly bowed to support the weight of the comparatively large trunk. Incorrect Answers:
A. The nurse should expect a 24-month-old toddler to have 16 teeth.
C. The nurse should expect a 24-month-old toddler to have a vocabulary of about 300 words and to be able to speak in 2- to 3-word phrases.
E. The nurse should expect a 24-month-old toddler to have a head circumference that is equal to or less than the chest circumference.
A nurse is reviewing recommended immunizations with the guardian of a 2-month-old infant. Which of the following statements should the nurse make?
A. “Your baby can receive the varicella vaccine at 6 months of age.”
B. “Your baby can start the pneumococcal vaccine now.”
C. “Your baby should receive the flu vaccine before 6 months of age.” D. “You baby can start the measles, mumps, and rubella vaccine now.”
B. Your baby can start the pneumococcal vaccine now.
A nurse is preparing to obtain an antistreptolysin O (ASO) titer from a child who has acute glomerulonephritis. The child’s parent asks the nurse to explain the purpose of the test. Which of the following responses should the nurse provide?
A. “The test determines the level of antibiotics in your child’s blood.” B. “The test tells us if your child ever had measles.”
C. “The test verifies the amount of albumin in your child’s blood.”
D. “The test shows us if your child had a recent strep infection.”
D. The test shows us if your child has had a recent strep infection.
A nurse is assessing a 24-month-old toddler who has a new diagnosis of autism spectrum disorder (ASD). Which of the following findings should the nurse expect? A. Wanting to be held frequently B. Ability to build a tower of 10 cubes C. Impaired language skills D. Ability to stand on 1 foot
C. Impaired language skills
