A nurse is caring for a 9-month-old infant in a pediatric clinic. The child's guardian tells the nurse that the child has missed the scheduled 6-month immunizations. Which of the following responses should the nurse make?
"We can give your child all of the missed immunizations in one injection."
"Your child will have to start their immunization series over from the beginning."
"We will administer the immunizations your child missed today."
"We will give your child all of the needed immunizations at 12 months."
The Correct Answer is C
Choice A rationale:
Administering all the missed immunizations in one injection is not recommended and can lead to increased discomfort and potential adverse reactions.
Choice B rationale:
Starting the immunization series over is unnecessary and can delay the child's protection against vaccine-preventable diseases.
Choice C rationale:
The most appropriate action is to administer the immunizations the child missed at the earliest opportunity to catch up on the schedule.
Choice D rationale:
Waiting until 12 months of age is not necessary if the child has already missed scheduled immunizations. The catch-up schedule should be followed based on the child's current age.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Replacing the ritual with a different ritualistic behavior is possible, but it does not necessarily predict the initial response when the restriction is first imposed.
Choice B rationale:
Reporting auditory hallucinations is not a typical response to restricting ritualistic behavior in someone with OCD.
Choice C rationale:
Expressing relief from not having to perform the ritual is unlikely, as ritualistic behaviors in OCD are often driven by distress and anxiety.
Choice D rationale:
If ritualistic behavior is restricted in an individual with obsessive- compulsive disorder (OCD), they may experience panic-level anxiety due to their inability to engage in their usual coping mechanism. OCD rituals are often performed to reduce anxiety, and restricting them can lead to increased distress.
Correct Answer is A
Explanation
Choice A rationale:
Assessing for the presence of command hallucinations is a priority, as they can pose a risk to the client's safety and the safety of others.
Choice B rationale:
Consistent staff assignments can be important for clients with schizophrenia, but immediate safety concerns should take precedence.
Choice C rationale:
Administering medication is not the priority action unless there is a specific reason to do so based on the assessment.
Choice D rationale:
Using the client's name is respectful and helpful, but it is not the priority action in this scenario.
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