A nurse in a well-child clinic is collecting data from four clients. Which of the following findings should the nurse report to the provider as a potential indication of child maltreatment?

Choice A rationale:
The Rotavirus vaccine is typically administered to infants, usually starting at 2 months of age, to protect against severe diarrhea and vomiting caused by rotavirus infection. However, the child in question is 11 years old, and the rotavirus vaccine is not recommended for administration at this age. The vaccine's protection window is within the infant and early childhood period, and the child would likely have received this vaccine earlier.
Choice B rationale:
Haemophilus influenzae type b (Hib) Hib vaccine is recommended as a series of doses to protect against Haemophilus influenzae type B infection, which can lead to severe illnesses like meningitis and pneumonia. While the child may have received this vaccine in infancy, a booster dose is often recommended around age 11 to ensure ongoing protection. This choice is correct for the given age group.
Choice C rationale:
Hepatitis A Hepatitis A vaccine is typically administered in two doses, with the first dose given at age 1 and the second dose administered at least 6 months later. The child in question is 11 years old, and assuming the child received the vaccine as per the standard schedule, there would be no need to administer this vaccine again.
Choice D rationale:
Human papillomavirus (HPV) HPV vaccine is recommended for adolescents to protect against several strains of the human papillomavirus that can lead to various cancers later in life. It's usually administered in a series of doses starting around age 11 or 12. However, the prompt states that the child is already up-to-date with current immunizations, and if the child received the HPV vaccine at the appropriate age, there would be no need for another dose at this time.

Choice A rationale:
Extremities warm to the touch. This manifestation is not indicative of decreased cardiac output. Warm extremities suggest adequate peripheral perfusion and circulation. In a child with decreased cardiac output, the body might attempt to shunt blood away from the extremities to prioritize vital organs, leading to cooler extremities.
Choice B rationale:
Capillary refill 2 seconds. A capillary refill time of 2 seconds is within the normal range for a preschool-aged child. This quick capillary refill suggests adequate circulation and is not a sign of decreased cardiac output. Prolonged capillary refill time might be indicative of poor peripheral perfusion.
Choice C rationale:
Blood pressure 112/66 mm Hg. While a blood pressure of 112/66 mm Hg might be within the normal range for a preschooler, it is not the most reliable indicator of decreased cardiac output. Blood pressure can be influenced by various factors, and a seemingly normal blood pressure does not rule out decreased cardiac output if other manifestations are present.
Choice D rationale:
Diminished pulses. This is the correct choice. Diminished or weak pulses are indicative of decreased cardiac output. Inadequate blood volume being pumped by the heart can lead to reduced peripheral perfusion, resulting in diminished pulses. This sign is important in assessing the child's cardiovascular status postoperatively, especially after a corrective procedure for tetralogy of Fallot.