ATI Real Life 3.0- RN Nursing Care of Children: Well Child

ATI Real Life 3.0- RN Nursing Care of Children: Well Child Nurse Denise discusses Kellen's immunization status, and Ms. Ralston appears upset. Which of the following responses by Denise is appropriate? - CORRECT ANSWER- "You appear upset. Can we discuss your thoughts regarding immunizations?" Rationale This response acknowledges the client is upset and seeks clarification of her perceptions of immunizations. Scenario Nurse Denise is taking Kellen's vital signs. Question Nurse Denise auscultates Kellen's heart. Which of the following heart rates is within the expected range for Kellen? - CORRECT ANSWER-Selected Option 89/min Rationale A heart rate of 89/min is within the expected reference range for a 24-month-old child. Scenario Nurse Denise discusses Kellen's developmental milestones and gross motor skills. Question Nurse Denise is preparing to assess Kellen's gross motor development. Which of the following gross motor skills should Kellen accomplish? (Select all that apply.) - CORRECT ANSWER-Selected Option Use a wide stance when running Walk up and down stairs with two feet on each step Kick a ball forward Rationale At age 2, toddlers should kick a ball forward without overbalancing, go up and down stairs alone with two feet on each step, and run reasonably well with a wide stance. At age 2, toddlers are not coordinated enough to balance on one foot or jump off the bottom step. These gross motor skills occur between the ages of 3 and 4. Scenario Nurse Denise completes an assessment of Kellen's gross motor skills and is preparing to assess Kellen's fine motor skills. Question Nurse Denise is preparing to assess Kellen's fine motor development. Which of the following fine motor skills should Denise include in the assessment plan? (Select all that apply.) - CORRECT ANSWER-Selected Option Turn each page of a book Unscrew lids on a container Stack six or seven blocks Rationale At age 2, toddlers can stack six or seven blocks, unscrew lids on a container, and turn each page of a book. At age 2, toddlers are not coordinated enough to draw a circle with eyes and nose or to thread shoelaces through shoe eyelets. These fine motor skills occur in children who are preschool age, 3 or 4. Scenario The nurse assesses Kellen's language development. Question Nurse Denise assesses Kellen's language development. Which of the following audio clips represents typical language development for a 24-month-old child? (Click to play the audio file.) - CORRECT ANSWER-Selected option Audio file where the child says, "I love you" Rationale By 24 months of age, a child should be speaking two- to three-word phrases. Scenario Nurse Denise educates Ms. Ralston prior to administering the measles, mumps, rubella (MMR) and varicella vaccines. Question Nurse Denise is teaching Ms. Ralston about immunizations. Which of the following information should Denise include about measles, mumps, rubella (MMR) and varicella vaccines? (Select all that apply.) - CORRECT ANSWER-Selected Option The client who has an egg allergy can receive the MMR and varicella vaccines. MMR and varicella vaccines should be administered subcutaneously. Mild illness is not a reason to delay vaccination with the MMR and varicella vaccines. Rationale Vaccination should not be delayed because of the presence of mild respiratory tract illness or other acute illness with or without fever. The nurse should administer the MMR and varicella vaccines subcutaneously. An allergy to eggs is not a contraindication to administration of the MMR and varicella vaccines; however, a gelatin allergy is a contraindication to receiving the vaccines. There is no causal link between MMR and varicella vaccines and autism. Scenario Nurse Denise calculates the ibuprofen dosage for Kellen. Question Nurse Denise is calculating Kellen's dose of ibuprofen. Available is a liquid preparation that contains 100 mg/5 mL. The label indicates to administer 10 mg/kg/dose. Kellen weighs 27.5 lb. How many mL should Denise tell Ms. Ralston to administer? (Round the answer to the nearest tenth.) - CORRECT ANSWER-Selected Option 6.3 Scenario Nurse Denise is discussing immunizations with Chloe and her father. Question Nurse Denise is discussing immunizations with Chloe and her father. Which of the following vaccinations should Denise anticipate administering to Chloe today? (Select all that apply.) - CORRECT ANSWER-Selected Option Human Papilloma Virus (HPV) Tetanus, diphtheria, acellular pertussis (Tdap) Meningococcal Hepatitis A (Hep A) Rationale According to the Centers for Disease Control and Prevention guidelines, this client is missing the Tdap booster, HPV series, Hep A, series and meningococcal immunization. The DTaP series has been completed, and the rotavirus is not initiated 15 weeks or older. Scenario Nurse Denise calculates and plots Chloe's body mass index (BMI). Question Nurse Denise calculates Chloe's body mass index (BMI) using this formula: weight (kg) divided by stature (cm) divided by stature (cm) multiplied by 10,000 or weight (lb) divided by stature (in) divided by stature (in) multiplied by 703. Select the area of the chart where Denise should plot Chloe's BMI. (Selectable areas, or "Hot Spots," can be found by moving your cursor over the artwork until the cursor changes appearance, usually into a hand. Click only on the Hot Spot that corresponds to your answer.) - CORRECT ANSWER-Rationale The calculated BMI of 30 is correct. Weight in pounds (height in inches x height in inches) x 703 = BMI 200 / (68 x 68) x 703 = 30.4 = 30 Scenario Nurse Denise discusses weight loss ideas with Chloe. Question Nurse Denise prepares to discuss weight loss ideas with Chloe. Which of the following should Denise recommend Chloe integrate on a daily basis? - CORRECT ANSWERSelected Option Be physically active for at least 60 min. Rationale