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

This is incorrect because the child’s feet should be able to touch the ground comfortably when seated on the bicycle, but not necessarily 3 to 6 inches off the ground. Proper seat height is crucial for balance and control.

Choice B rationale

Riding against the flow of traffic is dangerous and increases the risk of accidents. Bicyclists should always ride with the flow of traffic to be more predictable to drivers.

Choice C rationale

Walking the bicycle through intersections is a key safety measure to prevent accidents. It ensures that the child is more visible to drivers and reduces the risk of collisions.

Choice D rationale

Keeping the bicycle at least 3 feet from the curb is not a standard safety recommendation. Instead, children should ride as close to the curb as safely possible, following the flow of traffic.