Level: Advanced
Difficulty: Hard
Subtopic: Newborn safety
NCLEX: A newborn is due for the first hepatitis B vaccine and vitamin K. The parent refuses both. What is the nurse’s be…
Maternal-newborn nursing Health Promotion and Maintenance Reduction of Risk Potential
Case Study
A newborn is due for the first hepatitis B vaccine and vitamin K. The parent refuses both. What is the nurse's best action?
Question
A. Explore the parent's concerns, provide education, and document informed refusal per policy.
B. Administer the injections while the parent is out of the room.
C. Tell the parent refusal is illegal and will be reported to police.
D. Ignore the refusal because vaccines are mandatory in all states.
B. Administer the injections while the parent is out of the room.
C. Tell the parent refusal is illegal and will be reported to police.
D. Ignore the refusal because vaccines are mandatory in all states.
Rationale
Correct answer: A. Explore the parent's concerns, provide education, and document informed refusal per policy.
Rationale: Parents may refuse after informed discussion; the nurse educates, respects informed refusal, and documents without administering without consent.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Parents may refuse after informed discussion; the nurse educates, respects informed refusal, and documents without administering without consent.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.