RN ATI Nursing Care of Children Online Practice with NGN: 2024 Versions, Exams of Pediatrics

Download RN ATI Nursing Care of Children Online Practice with NGN: 2024 Versions and more Exams Pediatrics in PDF only on Docsity! RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN | 2 DIFFERENT VERSIONS | ALL 120 QUESTIONS AND CORRECT ANSWERS WITH EXPLANATIONS | ALREADY GRADED A+ | LATEST VERSIONS 2024 RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (FIRST VERSION) A nurse is planning care for a toddler who has a serum lead level of 4 mcg/dL. Which of the following actions should the nurse plan to take? a. instruct parents to decrease calcium in toddlers diet b. prepare the toddler for chelation tehrapy c. refer the family to Child Protective Services d. Schedule the toddler for a yearly rescreening ------CORRECT ANSWER- --------------d. schedule the toddler for a yearly rescreening & educate the family on how to prevent further exposure A nurse is assessing a toddler who has gastroenteritis and is exhibiting manifestations of dehydration. Which finding is the nurse's priority? a. skin breakdown b. hypotension c. hyperpyrexia d. tachypnea ------CORRECT ANSWER---------------d. tachypnea results when the kidneys are unable to excrete hydrogen ions & produce bicarbonate leading to metabolic acidosis A nurse is caring for a school-age child who has experienced a tonic-clonic seizure, Which of the following actions should the nurse take during the immediate postictal period? a. place the child in a side-lying position b. delay documentation until the child is fully alert c. give the child a high-carb snack d. administer an oral sedative to the child ------CORRECT ANSWER---------- -----a. place child in side-lying position A nurse is caring for a toddler who is experiencing acute diarrhea & has moderate dehydration. Which nutritional item should the nurse offer the toddler? a. apple juice b. peanut butter c. chicken broth d. oral rehydration solution ------CORRECT ANSWER---------------d. oral rehydration solution - a toddler who has acute diarrhea should consume an oral rehydration solution to replace electrolytes and water by promoting the reabsorption of water and sodium - this promotes recovery form dehydration A nurse is caring for an infant who has respiratory syncytial virus (RSV). Which actions should the nurse implement for infection control? a. have designated stethoscope in infants room b. place infant in a room equipped with negative airflow c. administer palivizumab as prescribed for the infant d. remove gloves after leaving ------CORRECT ANSWER---------------a. have a designated stethoscope in infants room - contact or droplet precautions are implemented for RSV??? - RSV is spread through direct contact with respiratory secretions is refusing solid foods. Guardians report that the child is voiding dark yellow urine. 0730:Child is alert and responsive to verbal stimuli. Mucous membranes are dry and sticky. Skin turgor without tenting. Tonsils enlarged and erythematous. Respirations are regular and non-labored. No accessory muscle use noted. Lungs clear anterior and posterior bilaterally. Point of maximum intensity (PMI) in the left mid-clavicular line 4th intercostal space. Heart rate is regular without murmurs, gallops, or rubs. Radial and pedal pulse 2+ bilaterally. Capillary refill greater than 2 seconds. A ------ CORRECT ANSWER---------------The nurse should identify that the child is at risk for developing splenomegaly as evidenced by positive mononucleosis rapid test. a nurse is teaching the parent of infant who has a Pavlik harness for the treatment of developmental dysplasia of the hip. the nurse should identify that which of the following statements by the parent indicates an understanding of the teaching? a. "I should remove the harness at night to allow my infant to stretch her legs." b. "I will need to adjust the straps on the harness once each week." c. "I should apply baby powder to my infant's skin twice daily." d. "I will place my infant's diapers under the harness straps." ------ CORRECT ANSWER---------------d. "I will place my infant's diapers under the harness straps" A nurse is caring for a toddler who has spastic (pyramidal) cerebral palsy. Which of the following do you expect to find? (all that apply) a. Negative Babinksi reflex b. Ankle clonus c. Exaggerated stretch reflexes d. Uncontrollable movements of the face e. Contractures ------CORRECT ANSWER---------------b, c, e - ankle clonus - exag stretch reflexes - contractures A nurse in the ED is performing a physical assessment on a 2 week old male newborn. Which findings is the priority for nurse to report to provider? a. excoriated scrotal area b. multiple capillary hemangiomas c. depressed posterior fontanel d. substernal retractions ------CORRECT ANSWER---------------d. Substernal retractions (*priority finding) - When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority finding to report to the provider is substernal retractions. This finding indicates the infant is experiencing acute respiratory distress and increased respiratory effort, which could quickly progress to respiratory failure. - The nurse should report a depressed posterior fontanel. However, this is not the priority finding. A nurse s preparing to collect a sample form a toddler for a sickle-turbidity test. Which actions should the nurse plan to take? a. obtain a sputum collection b. perform an Allen test c. Perform a finger stick d. Obtain a stool specimen ------CORRECT ANSWER---------------c. perform a finger stick - if the test is positive, hemoglobin electrophoresis is required to distinguish between children who has the genetic trait and children who have the disease A nurse is providing teaching to the parent of an infant who has diaper dermatitis. The nurse should instruct the parent to apply which of the following tp the effected area? a. zinc oxide b. antibiotic ointment c. talcum powder d. antiseptic solution ------CORRECT ANSWER---------------a. zinc oxide - diaper dermatitis is a common inflammatory skin disorder caused by contact with an irritant such as urine, feces, soap, or friction & takes the form of scaling, blisters, or papules with erythema. Providing a protective barrier, such as zinc oxide, against the irritants allows the skin to heal A nurse is caring for a preschooler who has been receiving IV fluids via a peripheral IV catheter. When preparing to discontinue the IV fluids and catheter, which of the following actions should the nurse plan to take? (move steps in correct order) - remove tape securing the catheter - turn off the IV pump - occlude the IV tubing - apply pressure over the catheter insertion site ------CORRECT ANSWER-- -------------1. turn off the IV pump 2. occlude the IV tubing 3. remove the tape securing the catheter 4. apply pressure over the catheter insertion site A nurse is interviewing the parent of an 18 month old toddler during a well- child visit. The nurse should identify that which of the following findings indicates a need to assess the toddler for hearing loss? a. The toddler has a vocabulary of 25 words. b. The toddler developed a mild rash following a recent varicella immunization. Nurses' Notes 0915: Guardians report that lately the child has had severe itching and is breaking out with sores on their eyebrows, wrists, and ankles. The "sores started to bleed." Guardians report no relief with application of the topical hydrocortisone cream. 0930:Child is alert. Multiple small erythematous papules with some scaling noted on the child's eyebrows, forearms, and lower legs bilaterally. 1015:Provider in to evaluate the child. Discharge to home after medication administration of new prescriptions and discharge teaching for atopic dermatitis. Medical History: Family history of atopic dermatitis MAR: 1000: Loratadine (oral solution) 5 mg PO daily. Administer first dose now prior to discharge. Tacrolimus 0.03% ointment. Apply thin layer to affected areas twice daily; rub in gently and completely. Return to primary care provider in 1 to 2 week ------CORRECT ANSWER---------------a, b, e - apply skkin emollient immediately after bathing the child - keep child's fingernails short - use a mild detergent for laundry (because of the Tacrolimus ointment) - never choose answer that says "rub skin vigorously" - they SHOULD allow a bath prior to bedtime but should AVOID BUBBLE baths - Apply ointment as a "thin layer" - see pg 202-203 ATI book A nurse is creating a plan of care for a school-age child who has heart disease and has developed heart failure. Which of the following interventions should the nurse include in the plan? a. Provide small, frequent meals for the child. b. Schedule time in the play room for the child. c. Weigh the child weekly. d. Maintain the child in a supine position. ------CORRECT ANSWER---------- -----a. Provide small, frequent meals for the child. - The metabolic rate of a child who has heart failure is high because of poor cardiac function. - Therefore, the nurse should provide small, frequent meals for the child because it helps to conserve energy. School-age child who is experiencing fatigue. Which finding should nurse recognize as an indication of anemia? a. Hematocrit 28% b. Hemoglobin 13.5 g/dL c. WBC count 8,000/mm^3 d. Platelets 250,000/mm^3 ------CORRECT ANSWER---------------a. Hematocrit 28% - expected range: 32%-44% for a school aged child - the child can also exhibit fatigue, lightheadedness, tachycardia, dyspnea, & pallor due to the decreased oxygen carrying capacity A nurse is reviewing the lumbar puncture results of a school-age child who is suspected of having bacterial meningitis. Which of the following findings should the nurse identify as an indication of bacterial meningitis? a. decreased cerebrospinal fluid pressure b. decreased WBC count c. increased protein concentration d. increased glucose level ------CORRECT ANSWER---------------c. increased protein concentration A nurse is reviewing the laboratory report of a 7-year-old child who is receiving chemotherapy. which of the following laboratory values should the nurse report to the provider? a. Hgb 8.5 g/dL b. WBC count 9,500/mm^3 c. Prealbumin 18 mg/dL d. Platelets 300,000/mm^3 ------CORRECT ANSWER---------------a. Hgb 8.5 g/dL - a child receiving chemotherapy is at risk for anemia due to the chemotherapy effects on the blood-forming cells of the bone marrow - the development of anemia is diagnosed through lab testing of hgb & hematocrit levels - the nurse should recognize that a hemoglobin level of 8.5 g/dL is below the expected reference range of 10 to 15.5 g/dL for a 7 year old child and should be reported to the provider A nurse is caring for a preschooler whose father is going home for a few hours while another relative stays with the child. which of the following statements should the nurse make to explain to the child when their father will return? a. "Your daddy will be back at 7 pm" b. Your daddy will be back after he takes care of your brother" c. Your daddy will be back in the morning" d. "Your daddy will be back after you eat" ------CORRECT ANSWER--------- ------d. "Your daddy will be back after you eat" - preschoolers make sense of time best when they can associate it with an expected daily routine, such as meals and bedtime - therefore, the child comprehends time best when it is explained to them in relation to an event they are familiar with, such as eating A nurse if receiving change-of-shift report for four children. Which of the following children should the nurse see first? a. A school aged child who has sickle cell anemia & reports decreased vision in the left eye b. A school aged child who has cystic fibrosis & a frequent nonproductive cough c. A preschooler who has asthma & a peak flow meter reading in the green zone a. Identifies right from left hand b. Uses a utensil to spread butter c. Cuts an outlined shape using scissors d. Draws a stick figure with seven body parts ------CORRECT ANSWER----- ----------c. Cuts an outlined shape using scissors - The nurse should recognize that an expected develop- mental milestone of a 4-year-old child is using scissors to cut out a shape A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse? a. Elevate the head of the child's bed. b. Insert a large bore IV catheter for the child. c. Determine the allergen that caused the child's reaction. d. Administer epinephrine IM to the child. ------CORRECT ANSWER---------- -----d. Administer epinephrine IM to the child. - When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority action is ad- ministering epinephrine IM to the child - During an anaphylactic reaction, histamine release causes bronchoconstriction and vasodilation - This is an emergency because ultimately this causes decreased blood return to the heart A nurse is preparing to administer an immunization to a 4-year-old child. Which of the following actions should the nurse plan to take? a. Place the child in a prone position for the immunization. b. Request that the child's caregiver leave the room during the immunization. c. Administer the immunization using a 24-gauge needle. d. Inject the immunization slowly after aspirating for 3 seconds. ------ CORRECT ANSWER---------------c. Administer the immunization using a 24-gauge needle. - The nurse should administer an immunization for a 4-year-old child using a 24-gauge needle to minimize the amount of pain experienced by the toddler. Severe abdominal pain due to appendicitis. Locate McBurney's point ------ CORRECT ANSWER---------------RLQ A nurse in an emergency department is caring for a 4-year-old child who was rescued from a home fire by emergency medical services (EMS). History and Physical 4-year-old child was in a house fire and rescued by EMS. Child has partial- thickness and full-thickness burns on their left arm, hand, anterior neck, and upper left side of the anterior chest. Total body surface area (TBSA) estimated to be 18%. Child is awake and crying. Lungs are clear bilaterally. Has a non-productive cough. Graphic Record Temperature 37.7° C (99.9° F)Heart rate 150/minRespiratory rate 32/minBlood pressure 100/52 mm HgSaO2 89% on room air The nurse should identify that which of the following findings require immediate follow-up? Select the 3 findings that require immediate follow-up. ------CORRECT ANSWER---------------- burns on chest and neck - SaO2 89% on room air - HR 150/min A nurse in an emergency department is caring for a 4-year-old child who was rescued from a home fire by emergency medical services (EMS). History and Physical 4-year-old child was in a house fire and rescued by EMS. Child has partial- thickness and full-thickness burns on their left arm, hand, anterior neck, and upper left side of the anterior chest. Total body surface area (TBSA) estimated to be 18%. Child is awake and crying. Lungs are clear bilaterally. Has a non-productive cough. Graphic Record Temperature 37.7° C (99.9° F)Heart rate 150/minRespiratory rate 32/minBlood pressure 100/52 mm HgSaO2 89% on room air Which of the following potential provider prescriptions should the nurse identify as anticipated or contraindicated? - Apply sterile gauze soaked with cool 0.9% sodium chloride to the burn areas. - Insert an indwelling urinary catheter. - Provide 100% oxygen via face mask. - Weigh the child. ------CORRECT ANSWER---------------???? anticipated: - provide 100% oxygen via face mask - weigh the child contraindicated: - apply sterile gauze soaked with cool 0.9% sodium chloride to the burn areas - insert an indwelling urinary catheter ATI pg 208-209 The nurse is caring for the child 4 days after admission. Graphic Record Temperature 35.8° C (96.4° F) Heart rate 68/min Respiratory rate 14/min Blood pressure 90/50 mm HgSaO2 88% on room air Nurses' Notes Pediatric Burn Unit 0800: Reinforced preoperative teaching with the child and parent. Child is awake and alert. Moving all extremities. Child limits their range-of- motion of the left arm. Anterior neck and upper chest dressings are dry and intact. Left arm and hand dressings are intact and slightly moist with serous drainage. Breath sounds are clear and equal bilaterally. Abdomen is soft and nondistended. Bowel sounds are active in all quadrants. Child remains NPO for surgery. Right antecubital peripherally inserted central catheter (PICC) line dressing is ------CORRECT ANSWER---------------- provide 100% oxygen via face mask - check anterior neck & chest dressing for bleeding - place a warm blanket on the child - keep the child's head in a neutral position?? The nurse is providing discharge teaching to the child and their parent 36 days after admission Nurses' Notes 0900: Home care consultation and supply delivery arrangements completed by the child's case manager. 1400: Provided discharge teaching to the parent and child regarding medications, skin and wound care, and psychosocial needs. Parent verbalized understanding of teaching. Select 6 statements by the parent that indicate an understanding of the discharge teaching. - I will give my child hydroxyzine to prevent bacterial infection - I should apply a moisturizer to the scar tissue - I will use a measured spoon or medicine cup to give my child hydroxyzine - I can give my child hydroxyzine every 6 hours as needed - puppet play can be helpful for my child - I should avoid giving hydroxyzine at bedtime - I will avoid massage the scar tissue - My child is too young to be concerned about their body image - I need t ------CORRECT ANSWER---------------- I should apply a moisturizer to the scar tissue - I will use a measured spoon or medicine to give my child hydroxyzine - I can give my child hydroxyzine every 6 hours as needed - puppet play can be helpful for my child - I need to assess for nay redness or open skin areas before paplying my childs left arm splint - my child will need to use a compression garment to decrease blood supply to the scarred tissue ???? A school nurse is planning to administer atomoxetine 1.2 mg/kg/day PO to a school age child who weighs 75 lb. Available is atomoxetine 40 mg/capsule. How many capsules should the nurse administer per day? ----- -CORRECT ANSWER---------------1 capsule - convert lb --> kg - 75 lb / 2.2 lb = 34.09 kg - multiply the child's weight in kg (34.09kg) by the amount of medicine ordered per kg (1.2mg/kg) = 40.9 mg/day - available is 40 mg/capsule - therefore, child needs 1 capsule per day A nurse is caring for a school aged child who is receiving cefazolin via intermittent IV bolus. The child suddenly develops diffuse flushing of the skin and angio-edema. After discontinuing the medication infusion, which of the following medications should the nurse administer first? - prednisone - epinephrine - diphenhydramine - albuterol ------CORRECT ANSWER---------------epinephrine A nurse on a pediatric unit is caring for a school-age child. Nurses' Notes 0830: Child is alert and responsive to stimuli. Skin is warm and dry. Capillary refill less than 3 seconds. Respirations regular and shallow. Mild intercostal retractions noted. Expiratory wheezes auscultated in the anterior and posterior lung bases. Abdomen is soft, flat, and non-distended. 1100: Child appears restless. Moderate intercostal retractions noted. Scattered rhonchi anterior bases with wheezing noted on inhalation and exhalation. Point of maximum intensity (PMI) in the left mid-clavicular line 4th intercostal space. Heart rate is regular without murmurs, gallops, or rubs. Radial and pedal pulse 2+ bilaterally. Vital Signs 0830: Temperature 37.1° C (98.8° F) Heart rate 100/min Respiratory rate 22/min Blood pressure 90/60 mm Hg Pulse oximetry 97% on 2 L of oxygen via nasal cannula 1100: Temperature 37.1° C (98.8° F) Heart ------CORRECT ANSWER---------------- ABGs b. Administer the measles, mumps, and rubella (MMR) vaccine to the child. c. Screen the child's visitors for indications of infection. d. Infuse packed RBCs. ------CORRECT ANSWER---------------c. Screen the child's visitors for indications of infection. A nurse is admitting a school age child who has pertussis. Which actions should the nurse take? a. Place the child in a room with positive-pressure airflow. b. Place the child in a room with negative-pressure airflow. c. Initiate contact precautions for the child. d. Initiate droplet precautions for the child. ------CORRECT ANSWER-------- -------d. Initiate droplet precautions for the child. - droplet precaution: pertussis is whooping cough - transmitted through contact with infected large-droplet nuclei that are suspended in the air when the child coughs, sneezes, or talks A charge nurse is the ED is preparing an in-service for a group of newly licensed nurses about manifestations of child maltreatment. Which of the following manifestations should the charge nurse include as a potential indication of physical abuse? a. Recurrent urinary tract infections b. Symmetric burns of the lower extremities c. Failure to thrive d. Lack of subcutaneous fat ------CORRECT ANSWER---------------b. Symmetric burns of the lower extremities - the patterns are usually characteristic of the method or object used, such as cigar, cigarrette burns, or burns in the shape of an iron A nurse is caring for a 15 year old client who is married and is scheduled for a surgical procedure. The client asks, "who should sign my surgical consent?" Which of the following responses should the nurse make? a. "You can sign the consent form because you are married." b. "Your spouse should sign the consent form for you." c. "Your parent should sign the consent form for you." d. "You can appoint a legal guardian to sign the consent form." ------ CORRECT ANSWER---------------a. "You can sign the consent form because you are married." - the nurse should inform the adolescent that marriage gives adolescents the legal right to consent to surgical procedures and sign other legal documents that they would not otherwise be able to sign due to their age A nurse is providing teaching about play activities for social development to the parents of a preschooler. Which of the following play activities should the nurse recommend for the child? a. Playing pat-a-cake b. Using a push-pull toy c. Creating a scrapbook d. Playing dress-up ------CORRECT ANSWER---------------d. Playing dress- up - the nurse should instruct the parents that at the preschool age, play should focus on social, mental & physical development - preschool = magical thinking years! encourage it (even imaginary friend) do not discourage it A nurse in the ED is caring for a toddler who has partial-thickness burns on their right arm. Which of the following actions should the nurse take? a. Insert a nasogastric tube b. Initiate prophylactic antibiotic therapy. c. Cleanse the affected area with mild soap and water. d. Apply a topical corticosteroid to the affected area. ------CORRECT ANSWER---------------c. Cleanse the affected area with mild soap and water. - nurse should wash the affected area with mild soap and water to remove any loose tissue that could cause infection A nurse is teaching the guardian of a 6 month old infant about car seat use. Which of the following statements by the guardian indicates an understanding of the teaching? a. "I should secure the car seat using lower anchors and tethers instead of the seat belt." b. "I should position the car seat harness 1 inch above my baby's shoulders." c. "I will make sure that the car seat is placed at a 90-degree angle." d. "I will pad my baby's car seat with a blanket for traveling long distances." ------CORRECT ANSWER---------------a. "I should secure the car seat using lower anchors and tethers instead of the seat belt." - lower anchors and tethers, or the LATCH child safety seat system, should be used to secure an infants car5 seat in the vehicle - this system provides anchors between the front cushion & the back rest for the car seat - therefore, if this system is available, the seat belt does not have to be used A nurse is reviewing the lab report of an infant who is receiving treatment for severe dehydration. The nurse should identify that which of the following lab values indicates effectiveness of the current treatment? a. Potassium 2.9 mEq/L b. Sodium 140 mEq/L c. Urine specific gravity 1.035 d. BUN 25 mg/dL ------CORRECT ANSWER---------------b. Sodium 140 mEq/L RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 2 / 33 brother." "Your daddy will be back in the morning." "Your daddy will be back after you eat." 4. A nurse is reviewing the laboratory report of an infant who is receiving treatment for severe de- hydration. The nurse should identify that which of the following laboratory values indicates effective- ness of the current treatment? Potassium 2.9 mEq/L Sodium 140 mEq/L Urine specific gravity 1.035 BUN 25 mg/dL 5. A nurse is creating a plan of care for a school-age child who has heart disease and has developed heart failure. Which of the following interventions should the nurse include in the plan? Provide small, frequent meals for the child. Schedule time in the play room for the child. Weigh the child weekly. Maintain the child in a supine position. 6. A nurse is admitting a school-age child who has pertussis. Which of the following actions should the nurse take? expected daily rou- tine, such as meals and bedtime. There- fore, the child compre- hends time best when it is explained to them in relation to an event they are familiar with, such as eating.. Sodium 140 mEq/L The nurse should identify that a sodi- um level of 140 mEq/L is within the expected reference range of 134 to 150 mEq/L and indi- cates the current treat- ment regimen the in- fant is receiving for de- hydration is effective. Provide small, fre- quent meals for the child. The metabolic rate of a child who has heart failure is high because of poor cardiac func- tion. Therefore, the nurse should provide small, frequent meals for the child because it helps to conserve en- ergy. Initiate droplet precau- tions for the child. RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 3 / 33 Place the child in a room with positive-pressure airflow. Place the child in a room with negative-pressure airflow. Initiate contact precautions for the child. Initiate droplet precautions for the child. 7. A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should the nurse expect? Increase in anterior convexity of the lumbar spine Increased curvature of the thoracic spine Lateral flexion of the neck A unilateral rib hump 8. A nurse is providing teaching to the parent of a school-age child who has a new prescription for oral nystatin for the treatment of oral candidiasis. Which of the following instructions should the nurse include? The nurse should ini- tiate droplet precau- tions for a child who has pertussis, also known as whoop- ing cough. Pertussis is transmitted through contact with infect- ed large-droplet nuclei that are suspended in the air when the child coughs, sneezes, or talks. A unilateral rib hump When assessing an adolescent for scolio- sis, the school nurse should expect to see a unilateral rib hump with hip flexion. This results from a later- al S- or C-shaped curvature to the tho- racic spine resulting in asymmetry of the ribs, shoulders, hips, or pelvis. Scoliosis can be the result of a neu- romuscular or connec- tive tissue disorder, or it can be congenital in nature. "Shake the medica- tion prior to adminis- tration." The nurse should in- struct the parent to RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 4 / 33 "Shake the medication prior to administration." "Provide the medication through a straw." "Rinse the child's mouth with water immediately after giving the medication." "Mix the medication with applesauce if the child dislikes the taste." 9. A school nurse is preparing to administer atomox- etine 1.2 mg/kg/day PO to a school-age child who weighs 75 lb. Available is atomoxetine 40 mg/cap- sule. How many capsules should the nurse admin- ister per day? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 10. A nurse is reviewing the laboratory report of a school-age child who is experiencing fatigue. Which of the following findings should the nurse recognize as an indication of anemia? Hematocrit 28% Hemoglobin 13.5 g/dL WBC count 8,000/mm3 Platelets 250,000/mm3 11. A nurse is interviewing the parent of an 18-month-old toddler during a well-child visit. The nurse should identify that which of the following findings indicates a need to assess the toddler for hearing loss? The toddler has a vocabulary of 25 words. The toddler developed a mild rash following a re- cent varicella immunization. The toddler's Moro reflex is absent. shake the medication prior to administration to disperse the med- ication evenly within the suspension. The nurse should ad- minister atomoxetine 1 capsule PO each day. Hematocrit 28% The nurse should rec- ognize that this hema- tocrit level is below the expected refer- ence range of 32% to 44% for a school-age child. The child can ex- hibit fatigue, lighthead- edness, tachycardia, dyspnea, and pal- lor due to the de- creased oxygen-carry- ing capacity. The toddler re- ceived tobramycin dur- ing a hospitalization 2 weeks ago. The nurse should identify tobramycin as an aminoglycoside, which is an ototox- RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 7 / 33 15. A nurse is reviewing the lumbar puncture results of a school-age child who is suspected of having bacterial meningitis. Which of the following find- ings should the nurse identify as an indication of bacterial meningitis? Decreased cerebrospinal fluid pressure Decreased WBC count Increased protein concentration Increased glucose level 16. A nurse is preparing to collect a sample from a toddler for a sickle-turbidity test. Which of the fol- lowing actions should the nurse plan to take? Obtain a sputum specimen. Perform an Allen test. Perform a finger stick. Obtain a stool specimen. 17. A nurse is providing dietary teaching to the par- ent of a school-age child who has celiac disease. The nurse should recommend that the parent offer which of the following foods to the child? Wheat crackers Rye bread Barley soup White rice Increased protein con- centration The nurse should identify that an in- creased protein con- centration in the spinal fluid is a finding that can indicate bacterial meningitis. Perform a finger stick. The nurse should per- form a finger stick on a toddler as a compo- nent of the sickle-tur- bidity test. If the test is positive, hemoglo- bin electrophoresis is required to distinguish between children who have the genetic trait and children who have the disease. White rice The nurse should rec- ommend that the par- ent offer white rice to the child because it is a gluten-free food. The nurse should in- struct the parent that the child will remain on a lifelong gluten-free diet and the child should not consume oats, rye, barley, or wheat, and sometimes lactose deficiency can RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 8 / 33 18. A nurse in an emergency department is perform- ing a physical assessment on a 2-week-old male newborn. Which of the following findings is the priority for the nurse to report to the provider? Excoriated scrotal area Multiple capillary hemangiomas Depressed posterior fontanel Substernal retractions 19. A nurse is caring for an adolescent who received a kidney transplant. Which of the following findings should the nurse identify as an indication the ado- lescent is rejecting the kidney? Negative leukocyte esterase Serum creatinine 3.0 mg/dL Negative urine protein Urine output 40 mL/hr be secondary to this disease. Substernal retractions When using the air- way, breathing, and circulation approach to client care, the nurse should determine that the priority finding to report to the provider is substernal retrac- tions. This finding in- dicates the newborn is experiencing in- creased respiratory ef- fort, which could quick- ly progress to respira- tory failure. Serum creatinine 3.0 mg/dL Creatinine is a byprod- uct of protein metab- olism and is excreted from the body through the kidneys. An el- evated serum creati- nine level, therefore, can be an indication that the kidneys are not functioning. The nurse should identi- fy that the adoles- cent's serum creati- nine level is higher than the expected ref- erence range of 0.4 to RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 9 / 33 20. A nurse is reviewing the laboratory report of a 7-year-old child who is receiving chemotherapy. Which of the following laboratory values should the nurse report to the provider? Hgb 8.5 g/dL WBC count 9,500/mm3 Prealbumin 18 mg/dL Platelets 300,000/mm3 21. A nurse in an emergency department is caring for a 4-year-old child who was rescued from a home fire by emergency medical services (EMS History and Physical 4-year-old child was in a house fire and rescued by EMS. Child has partial-thickness and full-thick- ness burns on their left arm, hand, anterior neck, and upper left side of the anterior chest. Total body surface area (TBSA) estimated to be 18%. Child is awake and crying. Lungs are clear bilater- 1.0 mg/dL for an ado- lescent and can indi- cate rejection of the kidney. Hgb 8.5 g/dL A child receiving chemotherapy is at risk for anemia due to the chemothera- py effects on the blood-forming cells of the bone mar- row. The development of anemia is diag- nosed through labo- ratory testing of he- moglobin and hemat- ocrit levels. The nurse should recognize that a hemoglobin level of 8.5 g/dL is be- low the expected ref- erence range of 10 to 15.5 g/dL for a 7-year-old child and should be reported to the provider. . Partial- and full-thick- ness burns to the left upper anterior chest and anterior neck is correct. Airway, breathing, and circu- lation are the imme- diate concerns. Burns to the chest and neck RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 12 / 33 23. The nurse is caring for the child 4 days after ad- mission. Graphic Record 0800: Temperature 38.8° C (101.8° F)Heart rate 124/min- accurate hourly I&O to manage fluid replace- ment. Provide 100% oxy- gen via face mask is anticipated. Upon ad- mission to the emer- gency department, the nurse should recog- nize the need to pro- vide 100% oxygen via face mask as an essential prescription. The child's SaO2 is below the expected reference range and their respiratory rate is increased. Weigh the child is an- ticipated. The nurse should recognize the need to weigh the child as essential. Children of the same age weigh different amounts. The amount of fluid resus- citation and medica- tion a pediatric patient receives is based on their weight. Dropdown 1: Temperature is cor- rect. When using the urgent vs. nonurgent approach to client Respiratory rate 22/minBlood pressure 100/56 mm care, the nurse should HgSaO2 97% on room airWeight 17.1 kg (37.7 lb)Urine output 15 mL in past hour determine that an in- creased temperature RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 13 / 33 Nurses' Notes 0800: Child is awake, watching cartoons on television, and parent is at bedside. IV site in right antecubital is without redness or edema and dressing is dry and intact. Dressings to left arm and hand, anterior is a priority finding, because it can indi- cate an infection and sepsis. Wound sepsis is most likely to oc- cur between the third neck, and anterior chest are moderately saturated and fifth day after a with serous drainage and several small spots of serosanguineous drainage. Dressings remain in- tact and smell malodorous. Breath sounds are equal and clear bilaterally. Respirations are unlabored. Abdomen is soft burn. Therefore, the nurse should first ad- dress the child's tem- perature. and nondistended. Mucous membranes are moist. Dropdown 2: Skin turgor is slightly brisk. Pupils are equal, round, and reactive to light and accommodation. Child is oriented to place, time, and name. Wh 24. The nurse is continuing to care for the child. Nurses' Notes 0800: Child is awake, watching cartoons on TV, and par- ent is at bedside. IV site in right antecubital is without redness or edema and dressing is dry and intact. Dressings to left arm and hand, anterior Pain is correct. When using the urgent vs. nonurgent approach to client care, the nurse should determine that an 8 out of 10 pain rating on the FACES scale is a priority finding and should be addressed next. Severe pain impacts the stress response, which can lead to complications and ad- versely affect healing. Change the morphine route to family-con- trolled analgesia via a PCA pump is an- ticipated. A pain rat- ing of 8 indicates se- vere pain. The use of neck, and anterior chest are moderately saturated a PCA pump should with serous drainage and several small spots of serosanguineous drainage. Dressings remain in- increase the effective- ness of pain man- RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 14 / 33 tact and smell malodorous. Breath sounds are equal and clear bilaterally. Respirations are unlabored. Abdomen is soft agement during move- ment and procedures. The nurse should and nondistended. Mucous membranes are moist. teach the child's pri- Skin turgor is slightly brisk. Pupils are equal, round, and reactive to light and accommodation. Child is oriented to place, time, and name. When child attempts to move, they begin to cry. Child reports pain as 8 on the FACES scale. Noted a 1 cm x 2 cm stage 1 pressure injury on the right side of the occiput. Prepared child and parent for transport to hydro mary caregiver about the use of the PCA pump. Obtain a wound cul- ture is anticipated. The child has an elevated temperature and mal- odorous green wound drainage. The nurse should obtain a wound culture to determine the causative organ- ism and an antibiot- ic should be adminis- tered. Place the child on a pressure-reduction mattress is anticipat- ed. The child has developed a stage 1 pressure injury on their occiput. A pres- sure-reduction mat- tress can help prevent further tissue injury. Limit daily protein in- take is contraindi- cated. Children who have major burns re- quire a high-protein, high-calorie diet to help with wound heal- ing. The nurse should provide high-protein RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 17 / 33 Hydroxyzine is admin- istered every 6 to 8 hr each day as needed. "Puppet play can be helpful for my child" is correct. Preschoolers engage in imaginative play. The use of pup- pets will encourage the child to express their feelings through imaginary play. "I need to assess for any redness or open skin areas before applying my child's left arm splint" is correct. It is impor- tant that the child's skin be assessed for redness, open areas, or blisters prior to putting on a splint. The splint is used to prevent contrac- tures of the extremities and promote normal alignment during the healing process. Be- cause the splint might be worn for a long period of time, the child's growth might cause the splint to not fit properly and can cause a pressure in- RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 18 / 33 27. A nurse is caring for a toddler who has spastic (pyramidal) cerebral palsy. Which of the following findings should the nurse expect? (Select all that apply.) Negative Babinski reflex Ankle clonus Exaggerated stretch reflexes Uncontrollable movements of the face Contractures jury. "My child will need to use a compression garment to decrease blood supply to the scarred tissue" is cor- rect. Using a compression garment on the scar tissue decreases the blood supply to avoid nourishing the hyper- trophic tissue. It also forces the collagen into a more nor- mal alignment. Com- pression garments are worn during the heal- ing of the burned tis- sue and should be worn as much as pos- sible. Ankle clonus is cor- rect. The nurse should expect a child who has spastic cerebral palsy to exhibit ankle clonus, which is a rhythmic re- flex tremor when the foot is dorsiflexed Exaggerated stretch reflexes is correct. The nurse should expect a child who has spastic cerebral palsy to ex- hibit spasticity or exag- gerated stretch reflex- es. RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 19 / 33 28. A hospice nurse is caring for a preschooler who has a terminal illness. One of the preschooler's parents tells the nurse that they cannot cope any- more and are thinking about moving out of the house. Which of the following statements should the nurse make? "It is important that you provide emotional support for your family at this time." "You have to do what you feel is best. Everything will turn out fine." "I know how you feel. This is an extremely stressful time for your family." "Let's talk about some of the ways you have han- dled previous stressors in your life." 29. A nurse in an emergency department is caring for a toddler who has partial-thickness burns on their right arm. Which of the following actions should the nurse take? Insert a nasogastric tube. Initiate prophylactic antibiotic therapy. Cleanse the affected area with mild soap and wa- ter. Apply a topical corticosteroid to the affected area. 30. A nurse is assessing a 3-year-old toddler at a well-child visit. Which of the following manifesta- tions should the nurse report to the provider? . Contractures is cor- rect. The nurse should expect a child who has spastic cerebral palsy to exhibit contractures due to the tightening of the muscles. "Let's talk about some of the ways you have handled previous stressors in your life." This statement offers a general lead to allow the parent to express their feelings and pre- vious actions when faced with stressful sit- uations. It also helps the parent to focus on ways that they can cope with the current situation. Cleanse the affected area with mild soap and water. The nurse should wash the affected area with mild soap and water to remove any loose tissue that could cause infection. Respiratory rate 45/min The nurse should RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 22 / 33 35. Provider Prescriptions Tuberculin skin test (TST)Measles, mumps, and rubella (MMR) vaccineInactivated influenza vaccineDiphtheria, tetanus, and pertussis (DTaP) vaccine Graphic RecordRespiratory rate 24/minHeart rate 115/minTemperature 36.9° C (98.4° F) History and Physical Age 15 monthsHeight 71.1 cm (28 in)Allergies Neomycin (anaphylactic re- action)Caregiver reports rhinitis with clear nasal drainage for 2 daysOccasional nonproductive cough for 2 daysHistory of asthma A nurse in a provider's office is preparing to administer immunizations to a toddler during a well-child visit. Which of the following actions should the nurse plan to take? (Click on the "Ex- hibit" button for additional information about the client. There are three tabs that contain separate categories of data.) Withhold the measles, mumps, and rubella (MMR) vaccine. Withhold the diphtheria, tetanus, and pertussis (DTaP) vaccine. Withhold the 36. A nurse is teaching the parent of an infant who has a Pavlik harness for the treatment of developmen- tal dysplasia of the hip. The nurse should identify that which of the following statements by the par- ent indicates an understanding of the teaching? "I should remove the harness at night to allow my infant to stretch her legs." nurse should complete a neurologic assess- ment and implement seizure precautions to maintain the child's safety. Withhold the measles, mumps, and rubella (MMR) vaccine. The nurse should rec- ognize that an aller- gy to neomycin with an anaphylactic reac- tion is a contraindica- tion for receiving the MMR vaccine. Clients who have a severe al- lergy to eggs or gelatin should not receive this vaccine. "I will place my infant's diapers under the har- ness straps." To prevent soiling of the harness, the par- ent should apply the RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 23 / 33 "I will need to adjust the straps on the harness once each week." "I should apply baby powder to my infant's skin twice daily." "I will place my infant's diapers under the harness straps." 37. A nurse is planning care for a toddler who has a serum lead level of 4 mcg/dL. Which of the follow- ing actions should the nurse plan to take? Instruct the parents to decrease the calcium in their toddler's diet. Prepare the toddler for chelation therapy. Refer the family to Child Protective Services. Schedule the toddler for a yearly rescreening. 38. A nurse on a pediatric unit is caring for a school-age child. Nurses' Notes 0830:Child is alert and responsive to stimuli. Skin is warm and dry. Capillary refill less than 3 sec- onds. Respirations regular and shallow. Mild in- tercostal retractions noted. Expiratory wheezes auscultated in the anterior and posterior lung bases. Abdomen is soft, flat, and non-distend- ed.1100:Child appears restless. Moderate inter- costal retractions noted. Scattered rhonchi ante- rior bases with wheezing noted on inhalation and exhalation. Point of maximum intensity (PMI) in the left mid-clavicular line 4th intercostal space. Heart rate is regular without murmurs, gallops, or rubs. Radial and pedal pulse 2+ bilaterally. Vital Signs 0830: Temperature 37.1° C (98.8° F)Heart rate 100/min- Respiratory rate 22/minBlood pressure 90/60 mm infant's diaper under the straps. Schedule the toddler for a yearly rescreen- ing. The nurse should schedule the toddler for a lead level re- screening in 1 year and educate the family on ways to prevent ex- posure. Arterial blood gas- es is correct. The child's arterial blood gases (ABGs) indicate respiratory alkalosis, which is associated with complications of asthma, such as hy- perventilation and hy- poxia. Therefore, the nurse should report these findings to the provider. WBC count is correct. The child's WBC count is above the expect- ed reference range, which could be an indication of infec- RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 24 / 33 HgPulse oximetry 97% on 2 L of oxygen via nasal cannula1100: Temperature 37.1° C (98.8° F)Heart rate 110/min- Res 39. A nurse is caring for a 15-year-old client who is married and is scheduled for a surgical proce- dure. The client asks, "Who should sign my sur- gical consent?" Which of the following responses should the nurse make? "You can sign the consent form because you are married." "Your spouse should sign the consent form for tion or inflammation. Therefore, the nurse should report this find- ing to the provider. Oxygen saturation lev- el is correct. The child's oxygen satu- ration level has de- creased below the expected reference range despite the use of supplemental oxy- gen. Therefore, the nurse should report this finding to the provider. Respiratory assess- ment is correct. The child's respiratory as- sessment indicates in- creased respiratory distress, as evidenced by the presence of tachypnea, retrac- tions, and increased wheezing. Therefore, the nurse should re- port these findings to the provider. "You can sign the con- sent form because you are married." The nurse should in- form the adolescent that marriage gives adolescents the legal right to consent to sur- RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 27 / 33 45. A nurse is assessing a 4-year-old child at a well-child visit. Which of the following develop- mental milestones should the nurse expect to ob- serve? Identifies right from left hand Uses a utensil to spread butter Cuts an outlined shape using scissors Draws a stick figure with seven body parts 46. A nurse is caring for a school-age child who is re- ceiving a blood transfusion. Which of the following manifestations should alert the nurse to a possible hemolytic transfusion reaction? Laryngeal edema Flank pain Distended neck veins Muscular weakness 47. A nurse is providing discharge teaching to the parent of a child who is 1 week postoperative following a cleft palate repair. For which of the following members of the interprofessional team should the nurse initiate a referral? Occupational therapist Speech therapist Respiratory therapist Physical therapist 48. A nurse on a pediatric unit is admitting a preschooler. Vital Signs 0715: Temperature 38.3° C (100.9° F)Heart rate 126/min- Cuts an outlined shape using scissors The nurse should rec- ognize that an ex- pected developmen- tal milestone of a 4-year-old child is us- ing scissors to cut out a shape. Flank pain The nurse should rec- ognize that flank pain is caused by the breakdown of RBCs and is an indication of a hemolytic reaction to the blood transfusion. Speech therapist The nurse should ini- tiate a referral for a speech therapist for a child who is postoperative follow- ing a cleft palate re- pair. A child who has a cleft palate will require speech therapy imme- diately following the re- pair to support speech development and fu- ture articulation. Dropdown 1: Splenomegaly is cor- rect. The child's pos- itive mononucleosis rapid test result in- RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 28 / 33 Respiratory rate 26/minPulse oximeter 97% Physical Examination 0715:Guardians report that the child has been tired lately and has been experiencing a sore dicates the pres- ence of infectious mononucleosis, a con- dition caused by throat and fever. Child is tolerating sips of liquids, the Epstein-Barr virus. but is refusing solid foods. Guardians report that the child is voiding dark yellow urine.0730:Child is alert and responsive to verbal stimuli. Mucous membranes are dry and sticky. Skin turgor without tenting. Tonsils enlarged and erythematous. Res- pirations are regular and non-labored. No acces- sory muscle use noted. Lungs clear anterior and posterior bilaterally. Point of maximum intensity (PMI) in the left mid-clavicular line 4th intercostal space. Heart rate is regular without murmurs, gal- Therefore, the nurse should identify that the child is at risk for devel- oping splenomegaly, a common complication of infectious mononu- cleosis. Dropdown 2: Positive mononucleo- lops, or rubs. Radial and pedal pulse 2+ bilaterally. sis rapid test is correct. Capillary refill greater than 2 seconds. Abdom 49. A nurse in an emergency department is caring for a school-age child who has appendicitis and rates their abdominal pain as 7 on a scale of 0 to 10. Which of the following actions should the nurse take? Instill a 500 mL tap water enema. Give morphine 0.05 mg/kg IV. The child's positive mononucleosis rapid test result indicates the presence of infec- tious mononucleosis, a condition caused by the Epstein-Barr virus. Therefore, the nurse should identify that the child is at risk for devel- oping splenomegaly, a common complication of infectious mononu- cleosis. Give morphine 0.05 mg/kg IV. A pain level of 7 on a scale of 0 to 10 is considered severe. The nurse should ad- minister an analgesic RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 29 / 33 Administer polyethylene glycol 1g/kg PO. Apply a heating pad to the child's abdomen. 50. A nurse is caring for a school-age child who is in Buck's traction following a leg fracture 24 hr ago. Which of the following actions should the nurse take? Change the child's position every 2 hr. Clean the peripheral pin sites with chlorhexidine solution every 4 days. Assess peripheral pulses once every 4 hr. Ensure that the head of the bed is elevated to a 90° angle. 51. A nurse is caring for a school-age child who has experienced a tonic-clonic seizure. Which of the following actions should the nurse take during the immediate postictal period? Place the child in a side-lying position. Delay documentation until the child is fully alert. Give the child a high-carbohydrate snack. Administer an oral sedative to the child. 52. A nurse is auscultating the lungs of an adolescent who has asthma. The nurse should identify the sound as which of the following? (Click on the audio button to listen to the clip.) Biot respiration Cheyne-Stokes respiration medication for pain re- lief. Assess peripheral pulses once every 4 hr. Buck's traction is a type of skin traction that can be used to immobilize extremities prior to surgery. The nurse should provide frequent neurovascu- lar checks at least every 4 hr after the first 24 hr of placement in Buck's traction. The nurse should monitor and report signs of neurovascular impair- ment in the extremities such as cyanosis, ede- ma, pain, absent puls- es, and tingling. Place the child in a side-lying position. The nurse should place the child in a side-lying position to prevent aspiration. Tachypnea The nurse should identify the sound heard during auscul- tation as tachypnea, which is a rapid, reg- RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 32 / 33 Nuchal rigidity Positive Kernig's sign 58. A school nurse is assessing an adolescent who has multiple burns in various stages of heal- ing. Which of the following behaviors should the nurse identify as a possible indication of physical abuse? Expresses a reluctance to leave home Provides a detailed description of how the burns occurred Denies discomfort during assessment of injuries Describes strong relationships with peers 59. A nurse is caring for a toddler who is experienc- presence of meningo- coccemia. This type of rash indicates the greatest risk of se- rious rapid compli- cations from sepsis and should be report- ed immediately to the provider. Denies discomfort dur- ing assessment of in- juries The nurse should sus- pect child maltreat- ment in the form of physical abuse if the adolescent has a blunted response to painful stimuli or injury. Oral rehydration solu- ing acute diarrhea and has moderate dehydration. tion Which of the following nutritional items should the nurse offer to the toddler? Apple juice Peanut butter Chicken broth Oral rehydration solution 60. A nurse is providing teaching about play activ- ities for social development to the parents of a preschooler. Which of the following play activities should the nurse recommend for the child? A toddler who has acute diarrhea should consume an oral rehy- dration solution to re- place electrolytes and water by promoting the reabsorption of water and sodium. This pro- motes recovery from dehydration. Playing dress-up The nurse should in- struct the parents RN ATI NURSING CARE OF CHILDREN ONLINE PRACTICE WITH NGN (SECOND VERSION) 33 / 33 Playing pat-a-cake Using a push-pull toy Creating a scrapbook Playing dress-up that at the preschool age, play should fo- cus on social, mental, and physical develop- ment. Therefore, play- ing dress-up is a rec- ommended play activ- ity for this chil