A nurse is caring for a 6-week-old infant who has pyloric stenosis. Which of the following clinical manifestations should the nurse expect?

Choice A: This information is incorrect, as the first dose of the diphtheria, tetanus, pertussis (DTaP) vaccine is usually given at 2 months of age, not 2 weeks. The DTaP vaccine protects against three serious bacterial diseases that can cause respiratory infections, nerve damage, or death. The DTaP vaccine is given in five doses at 2, 4, 6, 15 to 18 months, and 4 to 6 years of age.

Choice B: This information is correct, as the first dose of the hepatitis B vaccine is usually given within 24 hours of birth or prior to discharge from the hospital. The hepatitis B vaccine protects against a viral infection that can cause liver inflammation, cirrhosis, or cancer. The hepatitis B vaccine is given in three doses at birth, 1 to 2 months, and 6 to 18 months of age.

Choice C: This information is incorrect, as the first dose of the measles, mumps, rubella (MMR) vaccine is usually given at 12 to 15 months of age, not 6 months. The MMR vaccine protects against three viral diseases that can cause fever, rash, swelling of glands, or complications such as pneumonia, encephalitis, or deafness. The MMR vaccine is given in two doses at 12 to 15 months and 4 to 6 years of age.

Choice D: This information is incorrect, as the first dose of the pneumococcal conjugate (PCV13) vaccine is usually given at 2 months of age, not on the first birthday. The PCV13 vaccine protects against a bacterial infection that can cause pneumonia, meningitis, or sepsis. The PCV13 vaccine is given in four doses at 2, 4, 6, and 12 to 15 months of age.

Choice A: Using a pain-rating tool to determine the severity of the joint pain is not the priority assessment for an 8-year-old child who has acute rheumatic fever, which is an inflammatory condition that can affect various organs, especially the heart, joints, skin, and brain. Joint pain is one of the major criteria for diagnosing acute rheumatic fever and can affect one or more large joints, such as knees, ankles, elbows, or wrists. Joint pain can be managed with analgesics or anti-inflammatory drugs.

Choice B: Assessing the client's erythematous rash is not the priority assessment for an 8-year-old child who has acute rheumatic fever, which is an inflammatory condition that can affect various organs, especially the heart, joints, skin, and brain. The erythematous rash is one of the minor criteria for diagnosing acute rheumatic fever and can appear as pink or red patches on the trunk or limbs. The erythematous rash can fade or change location over time and does not require any specific treatment.

Choice C: Identifying the degree of parental anxiety related to the diagnosis is not the priority assessment for an 8-year-old child who has acute rheumatic fever, which is an inflammatory condition that can affect various organs, especially the heart, joints, skin, and brain. Parental anxiety related to the diagnosis can affect their coping skills and ability to care for their child. Parental anxiety can be addressed by providing education, support, and referral to appropriate resources.

Choice D: Auscultating the rate and regularity of the child's heart sounds and notifying the provider immediately of abnormalities is the priority assessment for an 8-year-old child who has acute rheumatic fever, as it can indicate cardiac involvement, which is the most serious complication of acute rheumatic fever. Cardiac involvement can cause damage to the heart valves, myocardium, or pericardium and lead to heart failure or death. Abnormalities in heart sounds may include murmurs, rubs, gallops, or arrhythmias.