A nurse is caring for a child who was admitted with suspected rheumatic fever. The provider prescribes an antistreptolysin O (ASO) titer. The parent asks the nurse about the purpose of the test. Which of the following responses should the nurse make?

The correct answer is a. Measles, mumps, rubella (MMR) and d. Varicella (VAR).

Choice A reason:

Measles, mumps, rubella (MMR): The MMR vaccine is recommended for children at 12-15 months of age. It protects against three serious diseases: measles, mumps, and rubella. The first dose is typically given at 12-15 months, with a second dose at 4-6 years. Measles can cause severe complications such as pneumonia and encephalitis. Mumps can lead to meningitis and hearing loss, while rubella can cause congenital rubella syndrome in pregnant women. Administering the MMR vaccine at the recommended age ensures that the child is protected from these potentially severe diseases.

Choice B reason:

Rotavirus (RV): This vaccine is given to infants at 2, 4, and possibly 6 months of age. It is not typically administered to a 1-year-old child as the series should be completed by 8 months. Rotavirus is a leading cause of severe diarrhea and dehydration in infants and young children. The vaccine is given orally and is highly effective in preventing rotavirus gastroenteritis. However, since the vaccine series is completed by 8 months, it is not appropriate for a 1-year-old child.

Choice C reason:

Human papillomavirus (HPV4): The HPV vaccine is recommended starting at 11-12 years of age. It is not suitable for a 1-year-old child. HPV is a common virus that can lead to certain types of cancers, including cervical cancer. The vaccine is most effective when given before exposure to HPV, which is why it is recommended for preteens. Administering the HPV vaccine to a 1-year-old would not be appropriate as it is not within the recommended age range.

Choice D reason:

Varicella (VAR): The VAR vaccine is recommended for children at 12-15 months of age to protect against chickenpox. A second dose is given at 4-6 years. Chickenpox can cause an itchy rash, fever, and tiredness. In some cases, it can lead to severe skin infections, pneumonia, and encephalitis. Vaccinating at the recommended age ensures that the child is protected from these complications. The first dose at 12-15 months is crucial for building immunity against the varicella virus.

Choice E reason:

Diphtheria, tetanus and acellular pertussis (DTaP): The DTaP vaccine is given in a series of five doses at 2, 4, 6, 15-18 months, and 4-6 years. The 4th dose is given at 15-18 months, not at 1 year. DTaP protects against three serious diseases: diphtheria, which can cause breathing problems and heart failure; tetanus, which causes painful muscle stiffness; and pertussis (whooping cough), which can lead to severe coughing spells and pneumonia. The timing of the doses is crucial for ensuring effective immunity, and the 1-year mark is not one of the recommended times for the DTaP vaccine.

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.