ATI PN NURSING CARE OF CHILDREN STUDY
SHEET 2026 QUESTIONS WITH ANSWERS FULL
SOLUTION GUIDE
▶ A client who has had a stroke with left-sided hemiparesis has been referred to a
rehabilitation center. The client asks, "Why do I need rehabilitation?" How does the
nurse respond?
A) "Rehabilitation will reverse any physical deficits caused by the stroke."
B) "Rehabilitation will help you function at the highest level possible."
C) "If you do not have rehabilitation, you may never walk again."
D) "Your doctor knows best and has ordered this treatment for you." Answer: B
The goal of rehabilitation is to maximize the client's abilities in all aspects of life. The
other responses do not answer the client's question appropriately.
▶ The nurse is monitoring a client with hypoglycemia. Glucagon provides which
function?
A) It enhances the activity of insulin, restoring blood glucose levels to normal more
quickly after a high-calorie meal.
B) It prevents hypoglycemia by promoting release of glucose from liver storage sites.
C) It is a storage form of glucose and can be broken down for energy when blood
glucose levels are low.
D) It converts excess glucose into glycogen, lowering blood glucose levels in times of
excess. Answer: B
Glycogen is a counterregulatory hormone secreted by the alpha cells of the pancreas
when blood glucose levels are low. The actions of glycogen that raise blood glucose
levels include stimulating the liver to break down glycogen (glycogenolysis) and forming
new glucose from protein breakdown (gluconeogenesis). The other statements are not
accurate descriptions of the actions of glucagon.
▶ A client has a deep wound covered with a wet-to-damp dressing. Which intervention
does the nurse include on this client's care plan?
A) Apply a new dressing when the seal breaks and the dressing leaks.
B) Change the dressing when the current dressing is saturated.
C) Leave the dressing intact until next week.
D) Change the dressing every 6 hours around the clock. Answer: D
Wet-to-damp dressings are changed every 4 to 6 hours to provide maximum
débridement. Synthetic dressings can be left in place for extended periods of time but
,need to be changed if the seal breaks and the exudate is leaking. Dry gauze dressings
should be changed when the outer layer becomes saturated.
▶ A client is hospitalized with a urinary tract infection (UTI). Which clinical manifestation
alerts the nurse to the possibility of a complication from the UTI?
A) Hematuria
B) Fever and chills
C) Cloudy, dark urine
D) Burning on urination Answer: B
Lower urinary tract infections are rarely associated with systemic symptoms of fever and
chills. A client with a UTI who develops fever and chills should be assessed for the
development of pyelonephritis. The other options can be seen with UTI.
▶ The nurse observes a small opening that is draining purulent material on the skin
over the trochanter area of a bedridden client. Which is the nurse's next best action?
A) Probe for a larger pocket of necrotic tissue.
B) Apply alginate dressing daily.
C) Apply a transparent film dressing.
D) Measure the reddened area on the skin surface. Answer: A
This "hidden" wound may first be observed as a small opening in the skin through which
purulent drainage exudes. Applying a transparent film dressing would not help this type
of wound to heal. Measuring the reddened area would not assist in determining the
actual size of the wound, because internal damage has occurred. Alginate dressings
could not be applied if the area were not opened.
▶ When reviewing an older client's medical record, which findings lead the nurse to
perform a nutrition assessment? (Select all that apply.)
A) Widow/widower status
B) Chronic constipation
C) Cholecystectomy 4 years ago
D) Random blood sugar level of 198 mg/dL
E) History of depression
F) Inability to afford a new pair of glasses Answer: A,B,E,F
Many factors contribute to malnutrition in older clients. Depression and loneliness from
the loss of a spouse; constipation; poor eyesight; chronic medical problems, including
depression; and taking prescription and/or over-the-counter medications can contribute
to malnutrition. Blood glucose levels and a previous cholecystectomy would not
necessarily contribute.
,▶ The nurse is caring for a female client who is 5 feet, 7 inches tall and weighs 115
pounds. The client asks the nurse if she needs to lose weight. Which response by the
nurse is best?
A) "No. In fact, your body mass index suggests that you are already underweight."
B) "Yes. Your body mass index suggests you are slightly overweight."
C) "Your weight is just fine. Don't worry about it."
D) "Maybe. Let's look at your risks for cardiovascular disease." Answer: A
The client's body mass index (BMI) is 18.0, so she is already underweight. It is
inaccurate to tell the client she is overweight, and it is unnecessary to consider her
weight in light of any cardiovascular risk factors. The nurse should not reassure the
client that her weight is just fine because she is underweight.
▶ A client who has type 2 diabetes is prescribed glipizide (Glucotrol). Which
precautions does the nurse include in the teaching plan related to this medication?
A) "Avoid taking nonsteroidal anti-inflammatory drugs."
B) "Change positions slowly when you get up."
C) "If you miss a dose of this drug, you can double the next dose."
D) "Discontinue the medication if you develop an infection." Answer: A
Nonsteroidal anti-inflammatory drugs potentiate the hypoglycemic effects of
sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable
to glipizide.
▶ The nurse is caring for a client who had a stroke. Which nursing intervention does the
nurse implement during the first 72 hours to prevent complications?
A) Position with the head of the bed flat to enhance cerebral perfusion.
B) Monitor neurologic and vital signs closely to identify early changes in status.
C) Administer prescribed analgesics to promote pain relief.
D) Cluster nursing procedures together to avoid fatiguing the client. Answer: B
Early detection of neurologic, blood pressure, and heart rhythm changes offers an
opportunity to intervene in a timely fashion. Evidence is not yet sufficient to recommend
a specific back rest elevation after stroke. Analgesics are often held during the first 72
hours to ensure that the client's neurologic status is not altered by pain medications.
Preventing fatigue is not a priority in the first 72 hours.
▶ A client with diabetes is prescribed insulin glargine once daily and regular insulin four
times daily. One dose of regular insulin is scheduled at the same time as the glargine.
How does the nurse instruct the client to administer the two doses of insulin?
A) "Draw up and inject the insulin glargine first, then draw up and inject the regular
insulin."
, B) "First draw up the dose of regular insulin, then draw up the dose of insulin glargine in
the same syringe, mix, and inject the two insulins together."
C) "First draw up the dose of insulin glargine, then draw up the dose of regular insulin in
the same syringe, mix, and inject the two insulins together."
D) "Draw up and inject the insulin glargine first, wait 20 minutes, then draw up and inject
the regular insulin." Answer: A
Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing
results in an unpredictable alteration in the onset of action and time to peak action. The
correct instruction is to draw up and inject first the glargine, then the regular insulin right
afterward.
▶ The nurse would identify which body systems as directly involved in the process of
normal gas exchange? (Select all that apply.)
A) Endocrine system
B) Neurologic system
C) Hepatic system
D) Immune system
E) Cardiovascular system
F) Pulmonary system Answer: B, E, F
The neurologic system controls respiratory drive; the respiratory system controls
delivery of oxygen to the lung capillaries; and the cardiac system is responsible for the
perfusion of vital organs. These systems are primarily responsible for the adequacy of
gas exchange in the body. The endocrine and hepatic systems are not directly involved
with gas exchange. The immune system primarily protects the body against infection.
▶ The nurse is discharging home a client at risk for venous thromboembolism (VTE) on
low-molecular-weight heparin. What instruction does the nurse provide to this client?
A) "You must have your aPTT checked every 2 weeks."
B) "Notify your health care provider if your stools appear tarry."
C) "An IV catheter will be placed to administer your heparin."
D) "Massage the injection site after the heparin is injected." Answer: B
As with any anticoagulation, low-molecular-weight heparin incurs risk of bleeding.
Clients should be taught to report to their health care provider the presence of tarry
stools, bleeding gums, hematuria, ecchymosis, or petechiae. Low-molecular-weight
heparin does not affect activated partial thromboplastin time (aPTT), as does
intravenous heparin. This type of heparin is administered subcutaneously to deliver a
slow sustained response. Massaging the site would hasten absorption and decrease
effects.
▶ Which is the highest priority goal to set for a client with pneumonia?
SHEET 2026 QUESTIONS WITH ANSWERS FULL
SOLUTION GUIDE
▶ A client who has had a stroke with left-sided hemiparesis has been referred to a
rehabilitation center. The client asks, "Why do I need rehabilitation?" How does the
nurse respond?
A) "Rehabilitation will reverse any physical deficits caused by the stroke."
B) "Rehabilitation will help you function at the highest level possible."
C) "If you do not have rehabilitation, you may never walk again."
D) "Your doctor knows best and has ordered this treatment for you." Answer: B
The goal of rehabilitation is to maximize the client's abilities in all aspects of life. The
other responses do not answer the client's question appropriately.
▶ The nurse is monitoring a client with hypoglycemia. Glucagon provides which
function?
A) It enhances the activity of insulin, restoring blood glucose levels to normal more
quickly after a high-calorie meal.
B) It prevents hypoglycemia by promoting release of glucose from liver storage sites.
C) It is a storage form of glucose and can be broken down for energy when blood
glucose levels are low.
D) It converts excess glucose into glycogen, lowering blood glucose levels in times of
excess. Answer: B
Glycogen is a counterregulatory hormone secreted by the alpha cells of the pancreas
when blood glucose levels are low. The actions of glycogen that raise blood glucose
levels include stimulating the liver to break down glycogen (glycogenolysis) and forming
new glucose from protein breakdown (gluconeogenesis). The other statements are not
accurate descriptions of the actions of glucagon.
▶ A client has a deep wound covered with a wet-to-damp dressing. Which intervention
does the nurse include on this client's care plan?
A) Apply a new dressing when the seal breaks and the dressing leaks.
B) Change the dressing when the current dressing is saturated.
C) Leave the dressing intact until next week.
D) Change the dressing every 6 hours around the clock. Answer: D
Wet-to-damp dressings are changed every 4 to 6 hours to provide maximum
débridement. Synthetic dressings can be left in place for extended periods of time but
,need to be changed if the seal breaks and the exudate is leaking. Dry gauze dressings
should be changed when the outer layer becomes saturated.
▶ A client is hospitalized with a urinary tract infection (UTI). Which clinical manifestation
alerts the nurse to the possibility of a complication from the UTI?
A) Hematuria
B) Fever and chills
C) Cloudy, dark urine
D) Burning on urination Answer: B
Lower urinary tract infections are rarely associated with systemic symptoms of fever and
chills. A client with a UTI who develops fever and chills should be assessed for the
development of pyelonephritis. The other options can be seen with UTI.
▶ The nurse observes a small opening that is draining purulent material on the skin
over the trochanter area of a bedridden client. Which is the nurse's next best action?
A) Probe for a larger pocket of necrotic tissue.
B) Apply alginate dressing daily.
C) Apply a transparent film dressing.
D) Measure the reddened area on the skin surface. Answer: A
This "hidden" wound may first be observed as a small opening in the skin through which
purulent drainage exudes. Applying a transparent film dressing would not help this type
of wound to heal. Measuring the reddened area would not assist in determining the
actual size of the wound, because internal damage has occurred. Alginate dressings
could not be applied if the area were not opened.
▶ When reviewing an older client's medical record, which findings lead the nurse to
perform a nutrition assessment? (Select all that apply.)
A) Widow/widower status
B) Chronic constipation
C) Cholecystectomy 4 years ago
D) Random blood sugar level of 198 mg/dL
E) History of depression
F) Inability to afford a new pair of glasses Answer: A,B,E,F
Many factors contribute to malnutrition in older clients. Depression and loneliness from
the loss of a spouse; constipation; poor eyesight; chronic medical problems, including
depression; and taking prescription and/or over-the-counter medications can contribute
to malnutrition. Blood glucose levels and a previous cholecystectomy would not
necessarily contribute.
,▶ The nurse is caring for a female client who is 5 feet, 7 inches tall and weighs 115
pounds. The client asks the nurse if she needs to lose weight. Which response by the
nurse is best?
A) "No. In fact, your body mass index suggests that you are already underweight."
B) "Yes. Your body mass index suggests you are slightly overweight."
C) "Your weight is just fine. Don't worry about it."
D) "Maybe. Let's look at your risks for cardiovascular disease." Answer: A
The client's body mass index (BMI) is 18.0, so she is already underweight. It is
inaccurate to tell the client she is overweight, and it is unnecessary to consider her
weight in light of any cardiovascular risk factors. The nurse should not reassure the
client that her weight is just fine because she is underweight.
▶ A client who has type 2 diabetes is prescribed glipizide (Glucotrol). Which
precautions does the nurse include in the teaching plan related to this medication?
A) "Avoid taking nonsteroidal anti-inflammatory drugs."
B) "Change positions slowly when you get up."
C) "If you miss a dose of this drug, you can double the next dose."
D) "Discontinue the medication if you develop an infection." Answer: A
Nonsteroidal anti-inflammatory drugs potentiate the hypoglycemic effects of
sulfonylurea agents. Glipizide is a sulfonylurea. The other statements are not applicable
to glipizide.
▶ The nurse is caring for a client who had a stroke. Which nursing intervention does the
nurse implement during the first 72 hours to prevent complications?
A) Position with the head of the bed flat to enhance cerebral perfusion.
B) Monitor neurologic and vital signs closely to identify early changes in status.
C) Administer prescribed analgesics to promote pain relief.
D) Cluster nursing procedures together to avoid fatiguing the client. Answer: B
Early detection of neurologic, blood pressure, and heart rhythm changes offers an
opportunity to intervene in a timely fashion. Evidence is not yet sufficient to recommend
a specific back rest elevation after stroke. Analgesics are often held during the first 72
hours to ensure that the client's neurologic status is not altered by pain medications.
Preventing fatigue is not a priority in the first 72 hours.
▶ A client with diabetes is prescribed insulin glargine once daily and regular insulin four
times daily. One dose of regular insulin is scheduled at the same time as the glargine.
How does the nurse instruct the client to administer the two doses of insulin?
A) "Draw up and inject the insulin glargine first, then draw up and inject the regular
insulin."
, B) "First draw up the dose of regular insulin, then draw up the dose of insulin glargine in
the same syringe, mix, and inject the two insulins together."
C) "First draw up the dose of insulin glargine, then draw up the dose of regular insulin in
the same syringe, mix, and inject the two insulins together."
D) "Draw up and inject the insulin glargine first, wait 20 minutes, then draw up and inject
the regular insulin." Answer: A
Insulin glargine must not be diluted or mixed with any other insulin or solution. Mixing
results in an unpredictable alteration in the onset of action and time to peak action. The
correct instruction is to draw up and inject first the glargine, then the regular insulin right
afterward.
▶ The nurse would identify which body systems as directly involved in the process of
normal gas exchange? (Select all that apply.)
A) Endocrine system
B) Neurologic system
C) Hepatic system
D) Immune system
E) Cardiovascular system
F) Pulmonary system Answer: B, E, F
The neurologic system controls respiratory drive; the respiratory system controls
delivery of oxygen to the lung capillaries; and the cardiac system is responsible for the
perfusion of vital organs. These systems are primarily responsible for the adequacy of
gas exchange in the body. The endocrine and hepatic systems are not directly involved
with gas exchange. The immune system primarily protects the body against infection.
▶ The nurse is discharging home a client at risk for venous thromboembolism (VTE) on
low-molecular-weight heparin. What instruction does the nurse provide to this client?
A) "You must have your aPTT checked every 2 weeks."
B) "Notify your health care provider if your stools appear tarry."
C) "An IV catheter will be placed to administer your heparin."
D) "Massage the injection site after the heparin is injected." Answer: B
As with any anticoagulation, low-molecular-weight heparin incurs risk of bleeding.
Clients should be taught to report to their health care provider the presence of tarry
stools, bleeding gums, hematuria, ecchymosis, or petechiae. Low-molecular-weight
heparin does not affect activated partial thromboplastin time (aPTT), as does
intravenous heparin. This type of heparin is administered subcutaneously to deliver a
slow sustained response. Massaging the site would hasten absorption and decrease
effects.
▶ Which is the highest priority goal to set for a client with pneumonia?
