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. A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurse's best response?
- A. Blood pressure will stabilize.
- B. Your child will have more energy.
- C. Urine will be free of protein.
- D. Urine output will increase.
Correct answer: D
Rationale: Increased urine output is often the first sign that acute glomerulonephritis is improving, as it indicates a reduction in fluid retention and better kidney function. Stabilization of blood pressure and other symptoms typically follow.
3. What nursing consideration is most important when caring for a child with end-stage renal disease (ESRD)?
- A. Children with ESRD usually adapt well to minor inconveniences of treatment.
- B. Children with ESRD require extensive support until they outgrow the condition.
- C. Multiple stresses are placed on children with ESRD and their families until the illness is cured.
- D. Multiple stresses are placed on children with ESRD and their families because children's lives are maintained by drugs and artificial means.
Correct answer: D
Rationale: ESRD places significant stress on both the child and the family due to the ongoing need for dialysis, medications, and lifestyle restrictions, making it important for healthcare providers to offer extensive support and resources to manage these challenges.
4. Which clinical manifestations should the nurse anticipate when assessing a child for hypoglycemia?
- A. Lethargy
- B. Thirst
- C. Nausea and vomiting
- D. Shaky feeling and dizziness
Correct answer: D
Rationale: The correct answer is D: 'Shaky feeling and dizziness.' Hypoglycemia in children often presents with symptoms like shakiness, dizziness, sweating, hunger, and irritability. These symptoms occur because the brain and body are deprived of the glucose they need to function properly. Choices A, B, and C are incorrect because lethargy, thirst, nausea, and vomiting are not typically primary manifestations of hypoglycemia in children.
5. The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should the nurse do first?
- A. Introduce him- or herself
- B. Make the family comfortable
- C. Give assurance of privacy
- D. Explain the purpose of the interview
Correct answer: A
Rationale: Introducing oneself is the first step in establishing a rapport and setting a professional tone for the interaction.
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