A nurse is preparing to administer vaccines to a 1-year-old child. Which of the following vaccines should the nurse give? (Select two)

Choice A: Allowing for imaginative play with peers without supervision is not an appropriate intervention for a child who has autism spectrum disorder, as it can cause frustration, anxiety, or isolation for the child. A child who has autism spectrum disorder may have difficulty with social skills, communication, and imagination, which can affect their ability to interact and play with others. The nurse should provide structured and supervised play activities that promote socialization and cooperation.

Choice B: Providing a completely unpredictable schedule that adjusts to the child's interests is not an appropriate intervention for a child who has autism spectrum disorder, as it can cause confusion, stress, or tantrums for the child. A child who has autism spectrum disorder may have difficulty with transitions, changes, and flexibility, which can affect their ability to cope and adapt to different situations. The nurse should provide a consistent and predictable schedule that follows a routine and gives clear expectations.

Choice C: Allowing for adjustment of rules to correlate with the child's behavior is not an appropriate intervention for a child who has autism spectrum disorder, as it can cause inconsistency, insecurity, or manipulation for the child. A child who has autism spectrum disorder may have difficulty understanding and following rules, which can affect their ability to behave and function appropriately. The nurse should provide firm and fair rules that are enforced consistently and respectfully.

Choice D: Establishing a reward system for positive behavior with prizes is an appropriate intervention for a child who has autism spectrum disorder, as it can provide motivation, reinforcement, and feedback for the child. A child who has autism spectrum disorder may have difficulty with learning and performing new skills, which can affect their ability to achieve and succeed. The nurse should provide a reward system that recognizes and rewards positive behavior with tangible or intangible prizes.

Choice A: This action is not appropriate, as it may cause more harm than good to separate the child from the parents without sufficient evidence or reason. Separating the child from the parents can cause fear, anxiety, or resentment in both parties and may interfere with establishing rapport and trust. The nurse should only separate the child from the parents if there is an immediate threat or danger to the child's safety.

Choice B: This action is premature, as it may violate confidentiality and ethical principles to report suspected abuse to the authorities without sufficient evidence or reason. Reporting suspected abuse to the authorities can have serious legal and social consequences for both parties and may escalate or worsen the situation. The nurse should only report suspected abuse to the authorities if there is clear evidence or indication of abuse or if mandated by law.

Choice C: This action is irrelevant, as it may not address the issue or help resolve it to ask a psychiatrist to talk with the parents without sufficient evidence or reason. Asking a psychiatrist to talk with the parents can imply that they have mental health problems or that they are guilty of abuse, which can cause stigma, anger, or denial. The nurse should only ask a psychiatrist to talk with the parents if there is evidence or indication of mental health problems or if requested by them.

Choice D: This action is appropriate, as it can help determine whether there is any evidence or reason to suspect abuse or not. Obtaining a detailed history can provide information about how, when, where, and why the bruises occurred and whether they are consistent with accidental or intentional injury. The nurse should obtain a detailed history from both parties separately and in a nonjudgmental and supportive manner.