What is the most appropriate action for the nurse to take, given that a 4-month-old infant, brought in for a routine checkup and vaccinations, was exposed to a sibling with the flu?

Measure the child's temperature and postpone the immunizations if the fever is over 100°F.

Administer the vaccinations as scheduled.

Give the infant the flu vaccination but withhold the others.

Postpone all vaccinations.

Answer and Explanation

The Correct Answer is A

Choice A reason: It is crucial to assess for fever, as a fever over 100°F after exposure to the flu may indicate an active infection, necessitating the postponement of immunizations.

Choice B reason: Administering vaccinations without assessing the child's health status, especially after known exposure to the flu, could be risky.

Choice C reason: Giving only the flu vaccination ignores the potential risk of the infant currently incubating the flu virus, which could be exacerbated by vaccination.

Choice D reason: While withholding all vaccinations is a cautious approach, it is not necessary unless the infant shows signs of illness, such as a fever over 100°F.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A reason: This is the correct choice. An 8-year-old is typically capable of understanding and using PCA effectively, especially after a major surgery like spinal fusion.
Choice B reason: A 6-year-old may not fully understand how to use PCA and could be at risk for under or overdosing.
Choice C reason: While a 10-year-old could use PCA, the presence of a concussion may impair their ability to use it properly.
Choice D reason: A 16-year-old with Down Syndrome may have cognitive impairments that could hinder the safe use of PCA.

A. The patient can only receive blood that has been donated by family members. B. Under no circumstances will the patient receive blood products. C. In an emergency, a court order can be obtained for the patient to receive blood transfusions. D. The patient can receive volume expanders.

Correct Answer is C

Explanation

The correct answer is: c. In an emergency, a court order can be obtained for the patient to receive blood transfusions.

Choice A: The patient can only receive blood that has been donated by family members.

Jehovah’s Witnesses refuse blood transfusions, including those from family members, due to their religious beliefs. They believe that both the Old and New Testaments command them to abstain from blood (Genesis 9:4; Leviticus 17:10; Deuteronomy 12:23; Acts 15:28, 29). Therefore, this option is incorrect.

Choice B: Under no circumstances will the patient receive blood products.

While Jehovah’s Witnesses generally refuse blood transfusions, there are exceptional circumstances where medical professionals can seek a court order to administer blood transfusions, especially in life-threatening situations involving minors. Thus, this statement is not entirely accurate.

Choice C: In an emergency, a court order can be obtained for the patient to receive blood transfusions.

In life-threatening emergencies, especially involving minors, courts can intervene and issue orders to administer necessary medical treatments, including blood transfusions, despite parental objections based on religious beliefs. This ensures the child’s right to life and health is protected. Therefore, this is the correct answer.

Choice D: The patient can receive volume expanders.

Volume expanders can be used to increase blood volume and maintain circulation, but they do not carry oxygen or replace lost blood cells. While they are an option for managing blood loss, they are not a substitute for blood transfusions in severe cases of anemia or blood loss, which are common in leukemia patients. Thus, this option is not entirely correct.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

What is the most appropriate action for the nurse to take, given that a 4-month-old infant, brought in for a routine checkup and vaccinations, was exposed to a sibling with the flu?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

In a pediatric surgical unit, when discussing patient-controlled analgesia (PCA) in a preoperative parental meeting, which client would be the most appropriate candidate for PCA?

Correct Answer is A

Explanation

A four-year-old patient has been diagnosed with leukemia. The patient's parents, who follow the Jehovah's Witness faith, inform the physician that they will not approve any type of blood transfusions. The pediatric nurse is aware that:

Correct Answer is C

Explanation

A nurse is conducting developmental assessments on several children in the day-care setting. Which two children does the nurse identify as having developmental delays?

Which intervention should be implemented for a school-age client admitted to the pediatric intensive care unit (PICU) in critical condition after a motor vehicle accident?

Which of the following is NOT a risk factor for pediatric mental health disorders such as Attention Deficit Disorder (ADD)/ADHD?

A newborn is diagnosed with Hirschsprung disease. Which clinical manifestations found on assessment support this newborn’s diagnosis?

Which nursing intervention is most developmentally appropriate for a toddler with a birth injury of a torn brachial plexus that resulted in muscle atrophy and weakness of the right arm?

In the pediatric emergency department, the nurse must prioritize patient care. Which patient should the nurse assess first?

A group of children on one hospital unit are all suffering from separation anxiety. Which child is experiencing the "despair" stage of separation anxiety?

Which statement is accurate concerning a child's musculoskeletal system and how it differs from that of an adult?