A nurse is caring for an adolescent who has hemophilia A and is scheduled for wisdom teeth extractions. Prior to the procedure, the nurse should anticipate that the client will receive which of the following products?

Rationale:

A. Rotavirus (RV) vaccine is an oral live attenuated preparation designated strictly for young infants to prevent severe gastroenteritis. The standard administration window closes completely at 8 months and 0 days of age. Administering this vaccine to a 1-year-old child is clinically inappropriate and contraindicated due to insufficient safety data.

B. Human papillomavirus (HPV) vaccine is a recombinant preparation formulated to protect against oncogenic viral strains linked to cervical and anogenital carcinomas. Routine administration is universally deferred until late childhood or early adolescence, beginning between ages 9 and 12. It is not indicated or immunologically useful for a 1-year-old patient.

C. Measles, mumps, rubella (MMR) vaccine is a live attenuated viral immunization routinely scheduled between 12 and 15 months of age. Administering this vaccine at 1 year of age is clinically correct because the infant is biologically capable of mounting an adequate antibody response. This timing prevents outbreaks of these highly contagious diseases.

D. Varicella (VAR) vaccine contains live attenuated varicella-zoster virus designed to stimulate adaptive immunity against chickenpox and its neurological or systemic sequelae. The initial dose is officially scheduled for pediatric patients between 12 and 15 months of age. A 1-year-old child must receive this vaccine to optimize primary infectious defense.

E. Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine represents a combined toxoid and inactivated subunit series protecting against severe bacterial pathogens. The fourth dose is normally scheduled between 15 and 18 months of age. However, clinical guidelines permit early administration at 12 months provided at least 6 months have elapsed since dose 3.

Answer: D

Rationale:

A. "Drink 400 ml every hour until bowel movements are clear": The standard recommendation for PEG is to drink a specific volume, usually 240 ml every 10 to 15 minutes, rather than 400 ml every hour. The goal is to ensure the bowel is adequately cleansed, and this rate is typically more effective in achieving that.

B. "Expect bowel movements to begin 3 hr following completion of solution": Bowel movements often start within an hour or two after starting the PEG solution rather than waiting for 3 hours after finishing it. The timing can vary, but the onset is generally sooner.

C. "To prevent dehydration, drink an additional liter of fluid during preparation time": While it is important to stay hydrated, the specific recommendation for additional fluid intake beyond the PEG solution can vary. Typically, the instructions focus on the volume of PEG solution to drink rather than specifying a set amount of additional fluid.

D. "Abdominal bloating might occur": Abdominal bloating is a common side effect of bowel cleansing preparations like PEG. It can occur due to the large volume of fluid ingested and the rapid movement of the bowel contents, making it a relevant point to include in the instructions.