A nurse is preparing to administer the measles, mumps, and rubella (MMR) vaccine to an adolescent. Which of the following should the nurse identify as a contraindication to administering this vaccine?

Choice A rationale:
Occupational therapy is the appropriate referral for an adolescent with rheumatoid arthritis who is having difficulty feeding themselves. Rheumatoid arthritis is a chronic autoimmune disorder that can lead to joint inflammation and deformities. Occupational therapy focuses on helping individuals improve their ability to perform daily activities, which includes activities like feeding, dressing, and grooming. Occupational therapists work with patients to develop strategies and use adaptive equipment to make these tasks more manageable. In the case of an adolescent with rheumatoid arthritis, occupational therapy can provide techniques and tools to facilitate feeding independently despite joint limitations.
Choice B rationale:
Physical therapy primarily focuses on improving mobility, strength, and function in individuals with musculoskeletal issues. While physical therapy could be beneficial for an adolescent with rheumatoid arthritis to address joint mobility and muscle strength, it might not directly address the difficulty in feeding. Therefore, although physical therapy can be a helpful component of care for patients with rheumatoid arthritis, it might not be the first choice for addressing feeding difficulties.
Choice C rationale:
Speech therapy is not the most appropriate referral for an adolescent with rheumatoid arthritis experiencing feeding difficulties. Speech therapy primarily addresses communication and swallowing disorders. While swallowing difficulties might be relevant in some cases of rheumatoid arthritis due to potential joint involvement in the jaw, the primary focus should be on addressing joint limitations and adaptive techniques for feeding, making occupational therapy a more suitable referral.
Choice D rationale:
A case manager is not the recommended referral for an adolescent with rheumatoid arthritis and feeding difficulties. Case managers typically coordinate and facilitate various aspects of a patient's care, such as arranging appointments and services. While case managers play a valuable role in healthcare, the immediate concern of feeding difficulties in an adolescent with rheumatoid arthritis is best addressed through specialized interventions like occupational therapy.

Choice A rationale:
A 2 cm scalp laceration, while a concern, is not the nurse's priority in this scenario. The child's head injury could potentially be serious, but priority should be given to neurological assessments and signs of increased intracranial pressure.
Choice B rationale:
Nasal discharge negative for glucose is not indicative of a major issue in this context. While cerebrospinal fluid (CSF) leaking from the nose after head trauma is a concern, it is not mentioned in this scenario, and this choice does not take precedence over other neurological signs.
Choice C rationale:
This is the correct answer. Asymmetric pupils can be a sign of a serious neurological issue, such as a brain injury or increased intracranial pressure. It requires immediate attention and further evaluation to assess the child's neurological status and determine the extent of the injury.
Choice D rationale:
A negative Babinski reflex is a normal finding in this context and does not require immediate priority attention. The Babinski reflex is typically present in infants and disappears as the child grows older. Its absence is expected in older children and adults.