a child receives a vaccine for mmr six hours after the injection the childs parent reports local soreness erythema lethargy and a fever of 101f to a n
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ATI RN

ATI Pediatric Proctored Exam

1. A child receives a vaccine for MMR. Six hours after the injection, the child�s parent reports local soreness, erythema, lethargy, and a fever of 101�F to a nurse. Which action should the nurse take?

Correct answer: A

Rationale: Low-grade fever, malaise, and muscle aches are common reactions. Acetaminophen usually alleviates these problems. MMR is a live vaccine but it is attenuated or completely avirulent and does not cause measles in healthy children, only immunocompromised children.

2. Which statement best describes the recommended approach to increase participation as the focus of intervention with children and youth?

Correct answer: D

Rationale: The recommended approach to intervention with children and youth focuses on evaluating the child's areas of competence and achievement, along with challenges. By understanding the child's strengths and competencies, interventions can be tailored to build upon these existing positive attributes. This approach fosters a positive self-image and encourages further development by capitalizing on the child's strengths.

3. A child with glomerulonephritis receiving corticosteroid treatment requires dietary teaching. What instruction should the nurse provide to the parent?

Correct answer: C

Rationale: The correct answer is to offer the child a variety of fresh fruits. Glomerulonephritis and corticosteroid use can lead to potassium depletion. Fresh fruits are a good source of potassium, which can help counteract the depletion caused by corticosteroids. Encouraging a variety of fresh fruits can provide necessary nutrients and help maintain a balanced diet for the child.

4. Which assessment finding for a 4-month-old infant would require further action by the nurse?

Correct answer: A

Rationale: The correct answer is A. The posterior fontanel should be closed by 4 months of age. An open posterior fontanel at this age may indicate a delay in normal closure, which could be a cause for concern and require further evaluation by the healthcare provider to ensure proper development and growth. Choices B, C, and D are typical developmental milestones for a 4-month-old infant and do not raise immediate concerns requiring further action by the nurse.

5. What is the recommended sleep duration for 14-17-year-olds?

Correct answer: B

Rationale: The recommended sleep duration for adolescents aged 14-17 is 8-10 hours to promote optimal health. Getting enough sleep is crucial for their physical and mental well-being, as it supports growth, development, learning, and overall health.

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