ATI RN NURSING CARE OF CHILDREN PROCTORED EXAM

VERSION 10

A nurse is assessing a 4-year-old child at a well-child visit. Which of the following developmental milestones should the nurse expect to

observe?

a. Identifies right from left hand

b. Uses a utensil to spread butter

c. Cuts a shape using scissors

d. Draws a stick figure with seven body parts

c. Cuts a shape using scissors

A- Identifying the right from left hand is an expected developmental milestone of a 6-year-old child.

B- Using a utensil to spread butter is an expected developmental milestone of a 6-year-old child.

D- Drawing a stick figure with seven body parts is an expected developmental milestone of a 5-year-old child.

A school nurse is preparing to administer atomoxetine 1.2 mg/kg/day PO to a school-age child who weighs 75lb. Available is atomexetine 40

mg/capsule. How many capsules should the nurse administer per day?

1

A nurse in the emergency department is assessing a toddler who has Kawasaki disease. Which of the following findings should the nurse

expect? (select all that apply.)

a. Increased temperature

b. Gingival hyperplasia

c. Xerophthalmia

d. Bradycardia

e. Cervical lymphadenopathy

Answer- a,c,e

Increased temperature is correct. Kawasaki disease is an acute illness associated with a fever lasting more than 4 days that is unresponsive to

antipyretics or antibiotics.

Gingival hyperplasia is incorrect. Children who have Kawasaki disease develop a strawberry tongue, cracked lips, and edema of the oral mucosa

and pharynx. A child who is receiving phenytoin therapy can develop gingival hyperplasia.

Xerophthalmia is correct. Ophthalmic manifestations of Kawasaki disease include reddening of the conjunctiva and dryness of the eyes, or

xerophthalmia.

Bradycardia is incorrect. Kawasaki disease is an infection that affects the vascular system, including the heart. The nurse should expect the child

to be tachycardic with a gallop rhythm. Long term effects of Kawasaki disease include the development of coronary artery aneurysms or

myocardial infarction.

Cervical lymphadenopathy is correct. The child who has Kawasaki disease may develop enlarged cervical nodes on one side of the neck that are

nontender and greater than 1.5 cm in size.

A nurse is teaching a school-age child who has a new diagnosis of type 1 diabetes MELITIS. The nurse should identify which of the following 

statements by the child as understanding the teaching?

a. I will puncture the pad of my finger when I am testing my blood glucose."

b. "I will give myself a shot of regular insulin 30 minutes before I eat breakfast."

c. "I will eat a snack of 5 grams of carbohydrates if my blood glucose is low."

d. "I will decrease the amount of fluids I drink when I am sick."

Answer- b. "I will give myself a shot of regular insulin 30 minutes before I eat breakfast." The child should administer regular insulin 30 min

before meals so that the onset coincides with food intake.

A- The child should avoid puncturing the pads of the fingers because they have fewer blood vessels and more nerve fibers. Instead, the child

should puncture the skin to either side of the finger pad to promote blood flow and decrease pain.

C- The child should eat a snack of 15 g of carbohydrates, such as 120 mL (4 oz) of fruit juice or 66 g (1/2 cup) of ice cream, to rapidly increase a

mild hypoglycemic reaction.

D- During acute illness the child is prone to hyperglycemia and ketonuria and is at risk for dehydration. Therefore, the child's fluid intake should

increase rather than decrease.

A school nurse is assessing an adolescent who has scoliosis. Which of the following findings should the nurse expect?

a. Increase in anterior convexity of the lumbar spine

b. Increased curvature of the thoracic spine

c. Lateral flexion of the neck

d. A unilateral rib hump

Answer- d. A unilateral rib hump

When assessing an adolescent for scoliosis, the school nurse should expect to see a unilateral rib hump with hip flexion. This results from a

lateral S- or C-shaped curvature to the thoracic spine resulting in asymmetry of the ribs, shoulders, hips, or pelvis. Scoliosis can be the result of a

neuromuscular or connective tissue disorder, or it can be congenital in nature.

A- An increased anterior convexity of the lumbar spine is a manifestation of lordosis. An expected finding in toddlers, lordosis can indicate a

complication of a disease process, such as flexion contractures, congenital dislocation of the hip, or obesity, when seen in older children.

B- An increased curvature of the thoracic spine is a manifestation of kyphosis. Kyphosis can be a manifestation of a congenital condition or

disease process such as rickets, or it can be posture-related. In posture-related kyphosis, the adolescent presents with rounded shoulders and a

slouching posture.

C- Lateral flexion of the neck is an indication of torticollis as a result of contracture of the sternocleidomastoid muscle. Torticollis can be

congenital, the result of intrauterine fetal posturing or abnormality of the cervical spine, or it can be acquired, due to such factors as a traumatic

lesion to the sternocleidomastoid muscle.

A nurse is reviewing the lumbar puncture results of a school-age child suspected of having bacterial meningitis. Which of the following results

should the nurse identify as a finding associated with bacterial meningitis?

a. Decreased cerebrospinal fluid pressure

b. Decreased WBC count

c. Increased protein concentration

d. Increased glucose level

Answer- c. Increased protein concentration. The nurse should recognize that an increased protein concentration in the spinal fluid is a finding

associated with bacterial meningitis.

A- Increased cerebrospinal fluid pressure is a finding associated with bacterial meningitis.

B- An increased WBC count in the spinal fluid is a finding associated with bacterial meningitis.

D- A decreased glucose level in the spinal fluid is a finding associated with bacterial meningitis.

A nurse is planning care for a preschooler who has cystic fibrosis. Which of the following interventions should the nurse include in the plan?

a. Administer pancreatic enzymes 2 hr after meals.

b. Decrease pancreatic enzymes if steatorrhea develops.