Answer to Question 1
Correct Answer: 2
Rationale 1: Cough and runny nose are not common adverse effects.
Rationale 2: Pain, swelling, and redness at the injection site are common side effects.
Rationale 3: A slight elevation of body temperature could occur, but not 101F or higher.
Rationale 4: Clients should not respond to a vaccine with a full-body rash.
Global Rationale: The most common adverse effects of vaccination are pain, swelling, and redness at the injection sites. Allergy or anaphylaxis following vaccination is extremely rare. Cough, runny nose, high fever, and rash are not expected reactions.
Answer to Question 2
Correct Answer: 1
Rationale 1: Multiple doses might be needed to establish immunity.
Rationale 2: The drug level is not what is essential; the level of immunity is.
Rationale 3: Immunizations are not considered prophylactic.
Rationale 4: This does not provide an appropriate answer to the mother.
Global Rationale: The total dose of a vaccine is important for the development of immunity. For some vaccinations, multiple doses are required to achieve immunity. Omitting subsequent doses could result in the lack of full disease protection. The nurse should provide correct information. Drug level is not associated with development of immunity and the dosing schedule is not prophylactic.