ATI RN
Nursing Care of Children ATI
1. The nurse is preparing to administer a measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a contraindication associated with administering this vaccine?
- A. The child has recently been exposed to an infectious disease
- B. The child has symptoms of a cold but no fever
- C. The child is having intermittent episodes of diarrhea
- D. The child has a disorder that causes a deficient immune system
Correct answer: D
Rationale: A compromised immune system is a contraindication for the MMRV vaccine because it is a live attenuated vaccine and could potentially cause an infection in an immunocompromised child.
2. Examination of the abdomen is performed correctly by the nurse in which order?
- A. Inspection, palpation, percussion, and auscultation
- B. Inspection, percussion, auscultation, and palpation
- C. Palpation, percussion, auscultation, and inspection
- D. Inspection, auscultation, percussion, and palpation
Correct answer: D
Rationale: The correct order for abdominal examination is inspection, auscult
3. After 8 weeks in the neonatal intensive care unit, Chris will soon be discharged. His parents seem apprehensive and worry that he may still be in danger. What is this considered by the nurse?
- A. A common parental reaction
- B. Suggestive of maladaptation
- C. A reason to postpone discharge
- D. Suggestive of inadequate bonding
Correct answer: A
Rationale: Parents become apprehensive and worried as the time for discharge approaches, which is a common parental reaction. They often have concerns and insecurities about caring for their infant. The worry about potential dangers is a normal adaptive response reflecting the parents' concern for their child's well-being. It is essential for healthcare providers to acknowledge these feelings and support parents in gaining confidence in caring for their infant. Choices B, C, and D are incorrect because the parents' apprehension in this context is a typical emotional response and not indicative of maladaptation, a reason to postpone discharge, or inadequate bonding.
4. By which age should the nurse expect that an infant will be able to pull to a standing position?
- A. 5 to 6 months
- B. 7 to 8 months
- C. 11 to 12 months
- D. 14 to 15 months
Correct answer: C
Rationale: Pulling to a standing position typically occurs between 11 to 12 months, marking the progression towards walking.
5. Which immunization should the nurse include in a teaching session for parents of toddler-age clients to decrease the risk for epiglottitis?
- A. Hepatitis B
- B. Polio
- C. Measles, mumps, and rubella (MMR)
- D. Hemophilus influenzae type B (Hib)
Correct answer: D
Rationale: The correct answer is D, Hemophilus influenzae type B (Hib) vaccine. Hib vaccine is crucial in preventing epiglottitis, a serious respiratory condition caused by Haemophilus influenzae type b bacteria. This vaccine is recommended for toddlers to protect them from developing epiglottitis. Choices A, B, and C are incorrect because while they are important vaccines for children, they do not specifically target the prevention of epiglottitis, unlike the Hib vaccine.
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