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A parent asks why it is recommended that the second dose of the measles, mumps, and rubella (MMR) vaccine be given at 4 to 6 years of age? The nurse should explain to the parent that the second dose is given at this age for what reason?
- A. If the child has not developed immunity and becomes pregnant when receiving the vaccine, the risks to the fetus are high.
- B. The chance of contracting the disease is much lower at this age.
- C. The dangers associated with a strong reaction to the vaccine are increased at this age.
- D. A serious complication from the vaccine is swelling of the joints.
Correct Answer:
Rationale: The second MMR dose ensures long-term immunity, as some children may not respond fully to the first dose.
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Which of the following diet plans would be appropriate for the nurse to discuss with the family of a child with acute renal failure?
- A. High carbohydrate and protein.
- B. High fat and carbohydrate.
- C. Low fat and protein.
- D. Low in carbohydrate and fat.
Correct Answer: A
Rationale: High carb/protein supports nutritional needs.
A 2-year-old always puts his teddy bear at the head of his bed before he goes to sleep. The parents ask if this behavior is normal. The nurse should explain to the parents that toddlers use ritualistic patterns to:
- A. Establish a sense of identity.
- B. Establish control over adults in their environment.
- C. Establish sequenced patterns of learning behavior.
- D. Establish a sense of security.
Correct Answer: D
Rationale: Ritualistic behaviors in toddlers provide comfort and security.
The parents of a neonate with hypospadias and chordee wish to have him circumcised. Which of the following explanations should the nurse incorporate into the discussion with the parents concerning the recommendation to delay circumcision?
- A. The associated chordee is difficult to remove during circumcision.
- B. The foreskin is used to repair the deformity surgically.
- C. The meatus can become stenosed, leading to urinary obstruction.
- D. The infant is too small to have a circumcision.
Correct Answer: B
Rationale: The foreskin is needed for surgical repair.
A child is started on a soft diet after having been on clear liquids following an episode of severe gastroenteritis. When helping the mother choose foods for her child, which of the following foods would be most appropriate?
- A. Muffins and eggs.
- B. Bananas and rice.
- C. Bran cereal and a bagel.
- D. Pancakes and sausage.
Correct Answer: B
Rationale: Bananas and rice are gentle on the gut, suitable for a soft diet.
When performing cardiopulmonary resuscitation (CPR), which of the following indicates that external chest compressions are effective?
- A. Mottling of the skin.
- B. Pupillary dilation.
- C. Palpable pulse.
- D. Cool, dry skin.
Correct Answer: C
Rationale: A palpable pulse during CPR indicates effective chest compressions, as it confirms adequate circulation.