Correct Answer: D

Rationale: The correct answer is 'D. Low-grade fever.' A low-grade fever is a common and mild side effect of the Hib vaccine, indicating that the immune system is responding to the immunization. Lethargy (choice
A) can be a sign of more serious adverse effects and should be monitored closely but is not typically associated with the Hib vaccine. Urticaria (choice
B) and generalized rash (choice
C) are less common side effects of the Hib vaccine compared to low-grade fever.

Correct Answer: B

Rationale: Establishing a bedtime routine is the most appropriate suggestion for a parent seeking help with a child experiencing night terrors. Bedtime routines can create a sense of security and predictability for the child, potentially reducing the frequency of night terrors. Encouraging the child to talk about the night terrors (
Choice
A) may not be effective during the episode as the child is usually not fully awake. Allowing the child to sleep with the parents (
Choice
C) may inadvertently reinforce the behavior and hinder the child's ability to learn to self-soothe. Waking the child during the night (
Choice
D) may disrupt the sleep cycle and exacerbate the night terrors.

Correct Answer: A

Rationale: The correct answer is monitoring fluid and electrolyte balance. Gastroenteritis is characterized by inflammation of the gastrointestinal tract leading to diarrhea and vomiting, which can result in dehydration and electrolyte imbalances.
Therefore, the priority nursing intervention is to monitor and maintain the child's fluid and electrolyte balance to prevent complications. Encouraging regular exercise (
Choice
B) may not be appropriate initially for a child with gastroenteritis who needs rest and fluid replacement. Administering antipyretics (
Choice
C) is not the priority unless the child has a fever. Administering antibiotics (
Choice
D) is not indicated for viral gastroenteritis, which is the most common cause of the condition.

Correct Answer: C

Rationale: The most appropriate nursing diagnosis for a child with acute glomerulonephritis is fluid volume excess related to decreased plasma filtration. Acute glomerulonephritis is characterized by inflammation of the glomeruli in the kidneys, leading to decreased plasma filtration and retention of fluid. This results in fluid volume excess rather than fluid deficit (choice
B) or fluid accumulation in tissues and third spaces (choice
D). The diagnosis of 'risk for injury related to malignant process and treatment' (choice
A) is not directly related to the pathophysiology of acute glomerulonephritis.

Correct Answer: C

Rationale: Infants receive passive immunity through antibodies from the mother during pregnancy and breastfeeding, which protect them initially.