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: A

Rationale: Right-sided heart failure is characterized by the inability of the right side of the heart to pump blood effectively, leading to fluid accumulation in the systemic venous system. This fluid overload typically manifests as signs of congestion in the peripheral tissues. Dependent pitting edema is a classic symptom of right-sided heart failure, where swelling is noted in the lower extremities and sacral area, worsening later in the day due to the effects of gravity. Orthopnea (B) and exertional dyspnea (C) are more indicative of left-sided heart failure, where congestion occurs in the pulmonary system. Hemoptysis (D) refers to coughing up blood and is not a classic symptom of heart failure but may be seen in conditions such as pulmonary embolism or infection.

Correct Answer: B

Rationale: When assessing a female client who has experienced trauma to her urinary tract, it is essential for the nurse to focus on assessment and recognition of abnormal findings. This includes assessing for signs and symptoms such as pain, blood in the urine, difficulty urinating, frequent urination, or any other unusual changes in urinary habits. These abnormal findings can help the nurse identify the extent of the trauma and provide appropriate intervention or treatment. It is crucial to prioritize the client's physical health and well-being in this situation. Factors such as sexual habits, allergies to seafood, and insurance coverage may be important in other contexts but are not directly relevant to assessing trauma to the urinary tract.

Correct Answer: A

Rationale: Pursed lip breathing is a breathing technique commonly used to help improve breathing efficiency in individuals with respiratory conditions such as chronic obstructive pulmonary disease (COPD). By pursing the lips during exhalation, it creates back pressure that helps to keep the airways open longer. This results in slower and more controlled expiration, allowing the individual to exhale a smaller volume of air while maintaining adequate oxygen exchange. This can reduce the feeling of dyspnea (difficulty breathing) and help improve oxygen saturation levels in the blood.

Correct Answer: D

Rationale: Oxybutynin helps control bladder spasms and improves comfort after urinary reconstructive surgery.