the nurse is working in an immunization clinic which patient will the nurse identify as not eligible to receive routine immunizations the nurse is working in an immunization clinic which patient will the nurse identify as not eligible to receive routine immunizations
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Nursing Elites

ATI RN

RN Pediatric Nursing 2023 ATI

1. In an immunization clinic, which patient will the nurse identify as not eligible to receive routine immunizations?

Correct answer: C

Rationale: The nurse should identify the 4-year-old with a fever and upper respiratory tract infection as not eligible to receive routine immunizations. It is contraindicated to administer vaccines in the presence of moderate to severe illness, whether with or without fever, to prevent potential complications or reduced vaccine efficacy.

2. Which country does not rank well on any key measure of children's health and well-being?

Correct answer: D

Rationale: The United States is the correct answer as it ranks poorly in measures of children's health and well-being compared to other developed nations. According to the extract provided, the United States does not perform well in this aspect. Choices A, B, and C are incorrect as there is no information provided suggesting that Sweden, Spain, or Australia do not rank well on key measures of children's health and well-being.

3. A client is 4 hours postpartum. Which of the following interventions should be implemented to prevent postpartum hemorrhage?

Correct answer: D

Rationale: Administering methylergonovine intramuscularly helps contract the uterus, reducing the risk of postpartum hemorrhage. Monitoring for signs of infection (Choice A) is important but not directly related to preventing postpartum hemorrhage. Uterine massage (Choice B) is beneficial to prevent uterine atony, but methylergonovine is a more specific intervention to prevent hemorrhage. Applying ice packs to the perineum (Choice C) is helpful for perineal pain and swelling, not for preventing postpartum hemorrhage.

4. A toddler is displaying signs/symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The client's family asks how he got this. The nurse will respond:

Correct answer: C

Rationale: The correct answer is C. Spinal muscular atrophy (SMA) is an inherited disorder, often autosomal recessive, that affects lower motor neurons. Choice A is incorrect because SMA is not caused by ingesting bacteria from playing in soil. Choice B is incorrect as SMA is not something that a person grows out of. Choice D is incorrect because SMA is not a demyelination disorder that affects nerve roots and muscle groups.

5. A nurse is caring for a client in labor who is receiving electronic fetal monitoring. The nurse notes early decelerations. Which of the following should the nurse expect?

Correct answer: D

Rationale: When a nurse notes early decelerations in electronic fetal monitoring, it indicates head compression, which is generally considered benign and not associated with fetal hypoxia, abruptio placentae, or post maturity. Early decelerations mirror the uterine contractions and are a normal response to fetal head compression during labor.

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