After receiving an immunization for pediatric diphtheria, tetanus, and acellular pertussis (DTaP), a patient develops swelling and tenderness at the injection site, a low-grade fever, and malaise. The pediatric nurse informs the patient's parents that:

Correct Answer: B

Rationale: Mild reactions like swelling, tenderness, low-grade fever, and malaise are common after DTaP vaccination and can be managed with supportive care.

Correct Answer: D

Rationale: The screening test for PKU (Phenylketonuria) is most reliable when the blood sample is fresh and taken from the heel. This is because the test requires a small amount of blood, and obtaining a fresh sample from the heel minimizes the risk of contamination and ensures accurate results. Additionally, collecting the blood sample from the heel is less invasive for the newborn and is a common practice for newborn screening tests. Blood samples taken from cord blood, 14 days after birth, or before oral feedings are initiated may not provide accurate results for the PKU screening test.

Correct Answer: A

Rationale: The nurse should walk to the other side of the bed and approach the patient from the right side. Poststroke patients may have neglect syndrome, which can cause them to ignore stimuli on one side of their body. By approaching from the neglected side (the right side in this case), the nurse may be able to better capture the patient's attention and engage them in the assessment process. It is essential to adapt care to accommodate the patient's condition and ensure effective communication and interaction.

Correct Answer: B

Rationale: For a patient with a history of hemophilia A complaining of a "funny feeling" in the elbow, suspecting bleeding into the joint, the correct response by the nurse is to notify the physician immediately and expect an order for factor VIII. Hemophilia A is a genetic disorder characterized by a deficiency in clotting factor VIII, leading to prolonged bleeding. In this case, immediate medical intervention in the form of factor VIII replacement therapy is crucial to control and manage the bleeding episode. Urgent treatment aims to prevent complications such as joint damage and to promote hemostasis in patients with hemophilia. Palpating the elbow, preparing for an x-ray, or applying heat are not the appropriate initial actions when managing a suspected bleeding episode in a patient with hemophilia.

Correct Answer: D

Rationale: Congenital hypothyroidism is a condition where a newborn baby is born with an underactive thyroid gland. If left untreated within the first 3 months following birth, it can lead to serious consequences such as stunted growth, cognitive impairment, and mental retardation.