A nurse is teaching a group of parents about childhood immunizations.
The nurse should identify that infants should receive the first dose of which of the following immunizations at 12 months of age?

Choice A rationale:

A hoarse voice is consistent with the child’s condition. The child has a frequent cough and stridor, which can cause irritation and inflammation of the vocal cords, leading to a hoarse voice.

Choice B rationale:

Nasal flaring is a sign of respiratory distress. It indicates that the child is working harder to breathe, which is consistent with the observed symptoms of stridor, cough, and mild intercostal retractions.

Choice C rationale:

Increased appetite is not consistent with the child’s condition. The child is refusing to eat or drink and appears fatigued, which is typical in cases of respiratory distress and illness.

Choice D rationale:

Sitting upright and leaning forward is a common position adopted by children in respiratory distress. This position helps to open the airway and makes breathing easier.

Choice E rationale:

Decreased respiratory rate is not consistent with the child’s condition. The child’s respiratory rate has increased from 20/min to 24/min, indicating increased effort to breathe due to respiratory distress.

The correct answer is Choice C.

Choice A rationale

Offering a prize for not crying can create undue pressure and anxiety for the child.

Choice B rationale

Telling the child the medicine will fix them can be misleading and does not provide accurate information about the procedure.

Choice C rationale

Allowing the child to choose which leg to receive the injection in gives them a sense of control and can reduce anxiety.

Choice D rationale

Telling the child they will only feel a little stick can be misleading and may not adequately prepare them for the discomfort.