A nurse is preparing to administer a vaccine to a 4-year-old child. Which of the following vaccines should the nurse administer?
Haemophilus influenzae type b (Hib)
Varicella (VAR)
Hepatitis B (HepB)
Meningococcal (MCV4)
The Correct Answer is B
Choice A reason: Haemophilus influenzae type b (Hib) vaccine is not the correct choice, as it is usually given to children at 2, 4, 6, and 12 to 15 months of age. A 4-year-old child should have already completed the Hib vaccine series.
Choice B reason: Varicella (VAR) vaccine is the correct choice, as it is recommended for children at 12 to 15 months and 4 to 6 years of age. A 4-year-old child is due for the second dose of the VAR vaccine.
Choice C reason: Hepatitis B (HepB) vaccine is not the correct choice, as it is usually given to children at birth, 1 to 2 months, and 6 to 18 months of age. A 4-year-old child should have already completed the HepB vaccine series.
Choice D reason: Meningococcal (MCV4) vaccine is not the correct choice, as it is not routinely recommended for children younger than 11 years of age. MCV4 vaccine is given to children at 11 to 12 years and 16 years of age, or to children with certain high-risk conditions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Improved hydration is not a specific indicator of the effectiveness of the treatment for acute laryngotracheobronchitis. Hydration status should be monitored for any child with a respiratory infection, but it does not reflect the severity of the airway inflammation.
Choice B reason: Decreased temperature is not a specific indicator of the effectiveness of the treatment for acute laryngotracheobronchitis. Fever may or may not be present in this condition, and it does not correlate with the degree of airway obstruction.
Choice C reason: Decreased stridor is a specific indicator of the effectiveness of the treatment for acute laryngotracheobronchitis. Stridor is a high-pitched sound caused by turbulent airflow through a narrowed upper airway. It indicates a significant obstruction that can compromise breathing. A reduction in stridor means that the airway inflammation has subsided and the child can breathe more easily.
Choice D reason: Barking cough is not a specific indicator of the effectiveness of the treatment for acute laryngotracheobronchitis. Barking cough is a characteristic symptom of this condition, caused by the swelling of the vocal cords. It may persist for several days after the acute episode, even when the child is improving.
Correct Answer is D
Explanation
Choice A reason: The child has acute lymphoblastic leukemia (ALL) and is receiving chemotherapy and steroids, which can cause constipation. The nurse should monitor the child's bowel function and provide interventions such as fluids, fiber, and laxatives as prescribed, but this is not an urgent finding.
Choice B reason: The child is in the induction phase of treatment for ALL, which can be stressful and frightening for the child and the family. The child's crying and clinging behavior indicates anxiety and fear, which are normal reactions. The nurse should provide emotional support and education to the child and the guardian, but this is not an urgent finding.
Choice C reason: The child has a fever, which is a common side effect of chemotherapy and steroids. The nurse should assess the child for other signs of infection, administer antipyretics as prescribed, and monitor the child's vital signs, but this is not an urgent finding.
Choice D reason: The child has a double-lumen central line catheter in the left chest wall, which is a potential source of infection. The erythema and purulent drainage at the insertion site indicate that the child has a local infection, which can spread to the bloodstream and cause sepsis. This is a life-threatening complication that requires immediate attention and treatment. The nurse should report this finding to the provider, obtain blood cultures, and administer antibiotics as prescribed.
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