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.
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
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: While apple or orange juice contains vitamin C, which can aid iron absorption, it is not sufficient on its own to address anemia.
Choice B reason: Excessive cow's milk can interfere with iron absorption and is not recommended for a child with anemia.
Choice C reason: This is the correct choice. Meats, eggs, and green vegetables are rich in iron, which is essential for treating anemia.
Choice D reason: Fruits, whole grains, and rice are healthy but are not the best sources of iron for addressing anemia in a child.
Correct Answer is B
Explanation
Choice A reason: Clubbed fingers are a sign of chronic hypoxia and may be seen in older children with cystic fibrosis, but they are not typically present at birth.
Choice B reason: This is the correct choice. Meconium ileus is a blockage of the intestines that occurs shortly after birth and is often the first sign of cystic fibrosis.
Choice C reason: A barrel chest is associated with chronic respiratory conditions and would not be present in a newborn.
Choice D reason: Steatorrheic stools, or fatty stools, may occur in cystic fibrosis but are not a primary indicator in a newborn.
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