A nurse is caring for a 2-month-old child. The child’s provider has ordered a diphtheria, tetanus, and pertussis (DTaP) vaccine to be administered. Which of the following should cause the nurse to question the administration of this vaccine?

Choice A reason: Pinworms (Enterobius vermicularis) cause perianal itching due to nocturnal egg-laying, not diarrhea or fever. Diarrhea and fever suggest other infections like bacterial gastroenteritis. Itching is the primary symptom, with irritability from sleep disruption, making this combination less accurate for pinworm infection in children.

Choice B reason: Pinworms cause intense perianal itching from egg deposition, leading to irritability and restlessness, especially at night, due to disrupted sleep. These symptoms reflect the parasite’s life cycle, where females lay eggs on the perianal skin, causing discomfort and behavioral changes, making this the most accurate symptom combination.

Choice C reason: Nausea and vomiting are not typical of pinworms, which primarily cause perianal irritation. Itching is a hallmark, but nausea and vomiting suggest gastrointestinal infections like rotavirus. This combination is less specific, as pinworms rarely affect the upper digestive tract, making it incorrect for diagnosis.

Choice D reason: Nausea, vomiting, and weight loss suggest systemic or gastrointestinal pathology, like inflammatory bowel disease, not pinworms. Pinworms cause localized perianal itching, not malabsorption or systemic symptoms. Itching with irritability is more characteristic, making this combination incorrect for the typical presentation of pinworm infection.

Choice A reason: Discontinuing corticosteroids after one week in nephrotic syndrome is inappropriate, as treatment requires a prolonged course (weeks to months) to reduce proteinuria and edema. Abrupt cessation risks adrenal insufficiency and disease relapse due to persistent glomerular inflammation, making this an incorrect approach for managing the immune-mediated pathology effectively.

Choice B reason: Corticosteroids in nephrotic syndrome suppress the immune system, increasing infection risk due to reduced immunoglobulin production and impaired immune response. Children are particularly vulnerable to bacterial infections like peritonitis. Close monitoring for fever, leukocytosis, or other infection signs is critical to detect and treat complications early, ensuring safe management.

Choice C reason: Administering corticosteroids with milk may reduce gastrointestinal irritation but is not the priority in nephrotic syndrome. The primary concern is immunosuppression, increasing infection risk. While milk may aid tolerability, it does not address the significant risk of sepsis or other infections, making monitoring for infection the more critical nursing action.

Choice D reason: Giving corticosteroids at bedtime may align with diurnal cortisol rhythms but is not the priority in nephrotic syndrome. Timing does not mitigate the immunosuppression that increases infection risk. Monitoring for infection signs like fever or malaise is essential, as corticosteroids heighten susceptibility, making bedtime administration a less critical consideration.