A nurse is preparing to administer a vaccine to a 4-year-old child.
Which of the following vaccines should the nurse administer?
Hepatitis B (HepB).
Meningococcal (MenACWY).
Varicella (VAR).
Human papillomavirus (HPV).
The Correct Answer is C
Choice A rationale
Hepatitis B (HepB) is typically given at birth and in subsequent doses but isn't scheduled for 4-year-olds.
Choice B rationale
Meningococcal (MenACWY) vaccine is generally recommended for older children and adolescents.
Choice C rationale
Varicella (VAR) vaccine is recommended for children around 4 years old to protect against chickenpox.
Choice D rationale
Human papillomavirus (HPV) vaccine is recommended for preteens starting at age 11, not 4-year-olds.
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Correct Answer is B
Explanation
Choice A rationale
A pincer grasp, using the thumb and index finger to pick up small objects, typically develops around 9 to 12 months of age, not at 4 months.
Choice B rationale
The posterior fontanel typically closes by the age of 2 to 3 months, so a 4-month-old infant would be expected to have a closed posterior fontanel. This finding is consistent with normal development.
Choice C rationale
Lateral incisors, the teeth on either side of the front teeth, typically erupt around 9 to 13 months of age, not at 4 months.
Choice D rationale
Sitting steadily without support generally occurs closer to 6 to 8 months of age, so it would not be expected in a 4-month-old infant.
Correct Answer is A
Explanation
Choice A rationale
Monitoring for hypoglycemia is critical in newborns born to mothers with gestational diabetes, as they can experience significant drops in blood sugar levels post-birth due to the
sudden discontinuation of the high glucose supply from the mother.
Choice B rationale
Physiological jaundice is common in many newborns but does not represent the most immediate threat. It typically resolves within a few days with appropriate monitoring and care.
Choice C rationale
Hyperthermia can be a concern for newborns, but it is not the primary immediate complication in newborns born to gestational diabetic mothers. Hypoglycemia poses a greater
immediate risk.
Choice D rationale
Development of rash is generally a less critical concern and does not represent an immediate threat to the newborn’s well-being in comparison to hypoglycemia.