A nurse is performing a pre-college physical assessment on an adolescent. Which of the following immunizations should the nurse anticipate administering?

Choice A: This statement is correct, as a fracture of an epiphyseal plate, which is a cartilage layer at the end of a long bone where growth occurs, can impair the normal growth and development of the bone. Depending on the type and severity of the fracture, the epiphyseal plate may close prematurely, stop growing, or grow unevenly, resulting in deformity, shortening, or angular deviation of the affected limb.

Choice B: This statement is incorrect, as a fracture of an epiphyseal plate does not necessarily disrupt the blood supply to the bone unless there is also damage to the periosteum, which is a membrane that covers and nourishes

the bone. A disruption of the blood supply to the bone can cause avascular necrosis, which is a condition that causes bone death due to lack of oxygen and nutrients.

Choice C: This statement is incorrect, as a fracture of an epiphyseal plate does not cause bone marrow loss through the fracture unless there is damage to the medullary cavity, which is a hollow space within the bone that contains bone marrow. Bone marrow loss through the fracture can cause bleeding, infection, or anemia.

Choice D: This statement is incorrect, as a fracture of an epiphyseal plate does not take longer to heal in younger children than in older children. In fact, younger children tend to heal faster than older children due to their higher metabolic rate, greater blood supply, and more active growth factors. The healing time of a fracture depends on various factors, such as the type and location of the fracture, the treatment method, and the presence of complications.

Choice A reason: This choice is correct because providing a latex-free environment is an essential intervention for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac. Spina bifida is a congenital defect in which the spinal cord and its coverings do not close properly, resulting in a protrusion of the meninges (meningocele) or the meninges and spinal cord (myelomeningocele). Children who have spina bifida are at a high risk of developing a latex allergy, which can cause severe reactions such as anaphylaxis or death. Therefore, avoiding exposure to latex products such as gloves, catheters, balloons, or bandages is crucial to prevent complications.

Choice B reason: This choice is incorrect because initiating contact precautions is not necessary for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac. Contact precautions are infection control measures that prevent the transmission of microorganisms that can be spread by direct or indirect contact with the client or their environment. They may be indicated for clients who have multidrug-resistant organisms, clostridium difficile, or scabies, but they are not required for clients who have spina bifida unless they have a concurrent infection.

Choice C reason: This choice is incorrect because limiting visitors to immediate family members is not indicated for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac. Limiting visitors may be indicated for clients who have immunosuppression, isolation, or terminal illness, but it may not be beneficial for clients who have spina bifida. Allowing visitors may provide emotional and social support for the client and their family, as long as they follow standard precautions and do not pose any risk of infection or injury.

Choice D reason: This choice is incorrect because maintaining the infant in the supine position is not an appropriate intervention for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac.
Maintaining the infant in the supine position may cause pressure or trauma to the sac, which can lead to rupture, infection, or nerve damage. Therefore, positioning the infant in a prone or side-lying position with the hips flexed and knees abducted can help to protect the sac and prevent complications.