The nurse is reviewing the immunization schedule with the parent of a child who is positive for human immunodeficiency virus (HIV). What statement by the parents indicates that teaching has been effective?
"The varicella vaccine should be withheld if my child is symptomatic of their illness."
"The vaccination schedule does not apply to my child."
"The pneumococcal (PCV) vaccine should be delayed until my child's first birthday."
"The human papillomavirus (HPV) vaccine is contraindicated for my child."
The Correct Answer is A
Rationale:
A. The varicella vaccine, which is a live attenuated vaccine, may be withheld if the child is symptomatic of their illness or has a significantly compromised immune system. This is due to the increased risk of severe reactions or complications in immunocompromised individuals.
B. The vaccination schedule is still applicable to children with HIV, but there may be adjustments based on the child’s immunocompetence and specific health status.
C. The pneumococcal vaccine is recommended for children with HIV and is typically administered according to the standard schedule, not delayed until the first birthday.
D. The HPV vaccine is generally recommended for children with HIV, as they are at increased risk for HPV-related complications. It is not contraindicated.
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Correct Answer is D
Explanation
Rationale:
A. Monitoring for infection is important, but the white blood cell count is within normal limits, so it is not the immediate priority.
B. Although the hemoglobin is slightly low, it is not critically low, so transfusion of packed red blood cells is not immediately necessary.
C. Intravenous immunoglobulins are not indicated based on the current lab values.
D. The platelet count is critically low, placing the client at high risk for bleeding. Initiating bleeding precautions is the priority to prevent hemorrhage.
Correct Answer is B
Explanation
Rationale:
A. Intravenous fluids are generally not required if the child is alert and active with mild dehydration; oral rehydration is usually sufficient.
B. Oral rehydration solutions are appropriate for treating mild dehydration and should be given in small amounts frequently.
C. Chicken broth is not ideal for replacing electrolytes because it is low in electrolytes and high in sodium. Oral rehydration solutions are preferred.
D. A depressed soft spot (fontanel) is a sign of severe dehydration in infants. For a 4-year-old, signs of dehydration would include changes in urine output, thirst, or dry mucous membranes rather than a depressed fontanel.