Chapter 31: Health Supervision (Prep U)
The nurse is caring for a variety of pediatric clients in the community health clinic. Which client is the nurse most concerned with being at risk for iron-deficiency anemia? a 7-year-old active in competitive sports and activities a 2-month-old infant who breastfeeds a 7-month-old with supplemental breast feeding a 16-year-old, pregnant for the first time and lives with her parents
a 16-year-old, pregnant for the first time and lives with her parents. The adolescent is at risk for iron-deficiency anemia due to the growth spurt, and the pregnant adolescent is at higher risk due to the needs of the developing baby. The other choices indicate low-risk situations for iron-deficiency anemia.
The nurse is performing an Apgar test on a newborn. The newborn is at high risk for a hearing deficit because the infant's 1-minute Apgar score fell below what number? 7 6 5 4
4 The newborn with an Apgar score of 4 or less at 1 minute or of 6 or less at 5 minutes is at high risk for a hearing deficit. Careful, continuing follow-up is important.
Children in what age range are screened by nurses using the Denver II Screening Test? Birth to 12 months 6 to 10 years 0 to 6 years 10 to 12 years
0 to 6 years The Denver II Developmental Screening Test is the most widely used tool to assess childhood development during the years leading up to school. It is regularly administered by nurses, requires special training but is simple to learn to administer.
Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer? naturally acquired active immunity artificially acquired active immunity artificially acquired passive immunity naturally acquired passive immunity
artificially acquired active immunity Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child's body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child's body to produce them. This type of immunity has a short life.
The nurse is anticipating that health supervision for a 5-year-old child will be challenging. Which indicator supports this concern? The home is in a high-crime neighborhood. The child has a number of chores and responsibilities. The mother dotes on the child. Grandparents play a significant role in the family.
Neighborhoods with high crime, high poverty, and lack of resources may contribute to poor health care and illness. If the aged grandparents have healthy lifestyles, they would be positive partners. Developmentally appropriate chores and responsibilities could be positive signs of parental guidance. The doting mother could make a strong health supervision partner.
The student nurse asks the nursing instructor why nurses must be adept at understanding normal growth and development in children when providing care. How should the nursing instructor respond? "The nurse must understand normal development in order to measure the child's height and weight accurately." "Understanding normal growth and development is vital because it allows the nurse to administer the correct doses of medication to children." "By knowing normal growth and development, the nurse is able to identify problems in growth and development." "If a nurse understands normal growth and development, he or she will be able to identify normal milestones in children."
"By knowing normal growth and development, the nurse is able to identify problems in growth and development." The nurse must understand normal growth and development in order to identify children who are not meeting milestones. A child meeting milestones does not need further intervention. Understanding normal growth and development is important in applying the assessment findings when measuring height and weight of children, but will not assure the procedure is completed properly. Administering the correct dose of medication is vital and involves accurate knowledge of the medication and dosage.
The nurse manager is orienting a new nurse. Which statement by the new nurse would indicate that the nurse manager should intervene? "If a child receives a vaccine at another facility, we will need to document it in the child's permanent record." "I do not need to document the vaccine manufacturer's name in the child's permanent record." "I will document the date and time the vaccine was given in the child's permanent record." "If a child has a fever after a vaccine, I do not have to report it to the Vaccine Adverse Event Reporting System."
"I do not need to document the vaccine manufacturer's name in the child's permanent record." Documentation in the child's permanent record includes the following: date the vaccine was administered, name of vaccine (commonly used abbreviation is acceptable), lot number and expiration date of vaccine, manufacturer's name, site and route by which vaccine was administered (e.g., left deltoid, intramuscularly), edition date of VIS given to the parents, name and address of the facility administering the vaccine (where the permanent record will be kept), name of the person administering the immunization. Only significant adverse effects need to be reported to the Vaccine Adverse Event Reporting System.
The mother of a 1-month-old baby is scheduling the next well-child visit for her baby. Which statement by the mother indicates an understanding of the recommended appointment schedule? "My baby will need to again be seen when he is 2 months old." "My baby should be seen monthly for the first year of life." "I will need to schedule an appointment for my baby to be seen when he is 3 months old." "Unless there is a problem I do not need to bring my baby back to be seen until he is 6 months old."
"My baby will need to again be seen when he is 2 months old." Health supervision visits for children without health problems and appropriate growth and development are recommended at birth, within the first week of life, by 1 month, then at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months, and then yearly until age 21.
During a physical assessment of a 6-year-old child, the nurse observes the child has lost a tooth. The nurse uses the opportunity to promote oral health care with the child and parents. Which comment should the nurse include in this discussion? "Limit the amount of soft drinks in the child's diet." "Fluoridated water has significantly reduced cavities." "Oral health can affect general health." "Try to keep the child's hands out of the mouth."
"Oral health can affect general health." The nurse will advise the parents that poor oral health can have significant negative effects on systemic health. Discussing fluoridation and community health may have little interest to the mother. Placing the hands in the mouth exposes the child to pathogens and is appropriate for personal hygiene promotion. Soft drink consumption is better covered during healthy diet promotion.
A pregnant woman reports she is interested in breastfeeding to promote improved health for her child. Which statement by the nurse is most appropriate? "Breastfeeding provides what is called active immunity." "Breastfeeding will improve your child's health." "Lifelong immunity is provided against some bacterial illnesses from breasting." "Passive immunity can be transmitted to your child providing him with some temporary immunity against illness."
"Passive immunity can be transmitted to your child providing him with some temporary immunity against illness." Children may obtain some temporary immunity from breastfeeding. This is referred to as passive immunity. Active immunity is achieved when the immune system is exposed to pathogens and antigens are developed.
The mother of a 6-month-old child reports she has been hearing so much about autism. She questions if this is something that can be tested for. What response by the nurse is appropriate? "Your child is too young for screening at this time." "Unfortunately there are no reliable screening tools for autism available." "Autism is on the rise and I understand your concern but screening is only done for those children considered to be at an increased risk." "Screening is recommended between 18 and 24 months or when concerns are identified."
"Screening is recommended between 18 and 24 months or when concerns are identified." The American Academy of Pediatrics recommends performing a screening test for autism with a standardized developmental tool at 18 and 24 months or at any point that concerns about autism spectrum disorder are raised. Although the child is younger than the normal period of screening it could be performed in the event there are identified concerns.
How would the nurse respond when the parent asks the nurse why she is using pictures with high-contrast patterns to assess a 4-month-old's vision? "Children respond emotionally better to black and white patterns and pictures." "A child's color vision isn't well developed until 12 to 18 months of age or later." "The child's eyes are more attune to high-contrast patterns than to specific colors." "This allows us to assess for color blindness in infants younger than 6 months."
"The child's eyes are more attune to high-contrast patterns than to specific colors." Infants younger than 6 months of age have more attuned vision to high-contrast items such as patterns using black and white. Children do not respond emotionally better to this pattern and their color vision is developing before the age of 12 to 18 months.
The nurse is discussing measles, mumps, and rubella vaccination with a mother who is concerned about using the combined vaccine for her 12-month-old. Which statement by the nurse will be most helpful to the mother in accepting the vaccine? "This vaccine is approved by the American Academy of Pediatrics." "It is one of the most commonly used childhood vaccines." "The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." "This vaccine is recommended by the Centers for Disease Control and Prevention."
"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." The mother may not understand that combining the vaccines creates no safety problems or effectiveness issues, and the one shot reduces the number of injections her child must endure. The other statements are true and offer some reassurance as to safety and efficacy but are not as helpful to the parent in understanding how she can protect her child from unnecessary discomfort.
The parents of a 12-month-old child tell the nurse the child has stopped walking and is now only crawling or sitting with support. How should the nurse respond? "This is a concern. Let's be sure the physician is aware of this change." "If you continue to notice these changes, we should follow up within the next 3 months." "Children often regress in their developmental stages...no need to worry." "Every child develops at different rates. Don't be alarmed. Just enjoy your child!"
"This is a concern. Let's be sure the physician is aware of this change." Children who have previously met a developmental milestone and then lose that milestone need an immediate and full evaluation due to the concern of significant neurologic problems. Children do often regress in behavior when under stress (hospitalization, new baby in the home, etc) but should not completely lose a milestone. Three months is too long to wait for additional evaluation. Children do develop at different rates, but this child had already met a milestone so this response is inappropriate.
During a well-check for a 2-year-old client, the nurse notes the client's vaccinations are not up to date. The caregiver states, "It is hard to make it to all the appointments, but my child will get caught up before going to school." Which response by the nurse is most appropriate? "As long as you keep your child away from crowded public areas, I think things will be okay." "I understand it is a lot of visits; however, your child's health is worth it." "Your child will need to get all the vaccines before starting school." "To prevent serious illnesses, it is vital your child receive all vaccines as scheduled."
"To prevent serious illnesses, it is vital your child receive all vaccines as scheduled." The most important tool to increase immunization awareness is education. The nurse would educate the caregiver on the importance of the child receiving vaccinations first. The nurse should not guilt the caregiver by stating the child is "worth it," nor can the nurse generalize a statement about the health of the child such as "I think things will be okay." Depending on the laws of the school district the child will attend, vaccines may be required before starting school; however, the caregiver has already stated this knowledge.
A mother tells the nurse that she is newly pregnant and asks about her 15-month-old's need for the chicken pox immunization because her two older children did "fine" when they had the disease. What is the nurse's best response? "When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions." "Your toddler should not receive this live-virus immunization today. It may present a risk to your pregnancy." "I realize that the vaccine is somewhat costly, but it is likely to be more economical than dealing with chicken pox." "When chicken pox can be avoided, why not do so?"
"When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions." The best response explains the impact that chicken pox can have on vulnerable individuals. High immunization levels mean low levels of disease. This reduces exposure for those who are unimmunized and susceptible. The live-virus vaccine given to the toddler does not present risk to the pregnant mother or fetus. Varicella vaccine is not inexpensive. Avenues for providing immunizations to families who cannot afford them are available. The "why not" response is somewhat dismissive and does not address the mother's question.
Infants born to mothers who are HbsAg (hepatitis B surface antigen)-positive need to receive the hepatitis B immunoglobulin (HBIg) within how many hours? HBIg needs to be given within 4 hours. HBIg needs to be given within 24 hours. HBIg needs to be given within 12 hours. HBIg needs to be given within 8 hours.
HBIg needs to be given within 12 hours. Hepatitis B is a serious disease that can affect the liver. It can be transmitted via blood and body fluids that manifest during birth. The infant needs to receive the vaccine within 12 hours of life. A hepatitis B series is three injections and children should complete all doses in the series for protection. Without a complete series, child remain at risk for contracting hepatitis B. If adolescents have not had the hepatitis B immunization series, it is important for them to receive them. Hepatitis B is also transmitted sexually. Having the protection of the vaccines can prevent the disease and future damage to the liver later in life.
The nurse has just taken the blood pressure of a 13-year-old, and the percentile rank is 88%. Why would the nurse categorize the child as prehypertensive? The teen gets no regular exercise. The teenager was born at 33 weeks' gestation. The teenager's blood pressure was 122/83. The teenager eats a high-fat diet.
The teenager's blood pressure was 122/83. A blood pressure greater than 120/80 is categorized as prehypertensive regardless of the percentile. Preterm birth is a risk factor for hypertension and does not indicate prehypertension itself. A high-fat diet and lack of exercise are risks for cardiovascular disease. Both require the nurse's attention to promote health but are not factors in categorizing the adolescent as prehypertensive.
The nurse is preparing to administer a diphtheria, tetanus and pertussis vaccine to a 3-year-old child. Which version of the formulation of the vaccine should be administered? DPT DTaP TdaP DT
DTaP The vaccine currently used for children younger than age 7 is diphtheria, tetanus, acellular pertussis (DTaP). The older version of this vaccine was DPT. Diphtheria and tetanus (DT) vaccine is used for children younger than age 7 who have contraindications to pertussis immunization. The TdaP is used clients over the age of 7.
The nurse is reviewing a group of medical records for compliance with recommended well-child care visits. Which finding would warrant further investigation? The 5-year-old child who has been seen annually since age 3. A child who is 26 months whose last 2 visits were at 18 and 24 months. A 13-year-old child who was last seen 2 years ago. A child who is 5 months old who was seen at one, two, and three months of age.
A 13-year-old child who was last seen 2 years ago. Health supervision visits for children without health problems and appropriate growth and development are recommended at birth, within the first week of life, by 1 month, then at 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months, and then yearly until age 21.
The student nurse is working on a program to address barriers to immunizations. Which would be an example of an intervention that the student nurse should include? Providing combination vaccines to reduce the number of shots the child is to receive. Schedule separate appointments for families with multiple children so the focus will be on one child at a time during the visit. Providing education that free vaccines are only given by the local public health agencies. Providing a modified vaccine schedule to allow for more time between vaccines.
Providing combination vaccines to reduce the number of shots the child is to receive. One of the top parental concerns regarding vaccine safety is that too many vaccines are given during a single office visit. Manufacturer-produced combination vaccines address this issue. Scheduling separate appointments for each child in a family actually increases the barriers to proper immunization. Modified vaccine schedules can put the child at risk for contracting a disease. Free immunizations can be administered at a variety of agencies, not just public health agencies.
The nursing staff at the clinic are discussing the best way to encourage cooperation from young pediatric clients during screenings. Which suggestion would be appropriate? Make a coloring page and allow the child to color it completely before beginning the screening. Allow the children to choose whether to get the screening completed that day or another day. Encourage the children to play with the dressings, syringes, and medication before using them. Purchase stickers or make coloring pages to be given to the children after the screening is completed.
Purchase stickers or make coloring pages to be given to the children after the screening is completed. Young children respond well to a reward system. Allowing them to have a sticker or a coloring page after the screening is finished will encourage cooperation. They should not be permitted to play with equipment that is dangerous (syringes/medication) or should be sterile when used on them. Playing with medication is contraindicated also because it gives the illusion that medication is a toy. Allowing a child the choice of completing the reward before the screening will hinder cooperation; the child should only complete the reward after screening.
The nursing instructor has just completed a discussion about immunization. Which statement by a student would indicate a need for further instruction? "Immunologic memory develops after a person receives a vaccine." "Passive immunity only lasts a few weeks or months." "An example of active immunity would be when immunoglobulins are passed from a mother to her infant by colostrum." "Active immunity develops when a person receives a vaccine."
"An example of active immunity would be when immunoglobulins are passed from a mother to her infant by colostrum." Passive, not active, immunity is produced when the immunoglobulins of one person are transferred to another. This can happen via colostrum or the placenta. Active immunity lasts only weeks or months. Active immunity is acquired when a person's own immune system generates the immune response from either a vaccine or the actual disease. This long-term protection is the result of immunologic memory.
A dental home (like a medical home) establishes a continuing comprehensive relationship of care with the child and family. The American Academy of Pediatric Dentistry (AAPD) recommends this dental home be established by the time the child is age: 2 years. 2½ years. 3 years. 1½ years. 1 year.
1 year. The recommendation is by the child's first birthday. This is the time the first dental exam should occur.
The nurse will use the Denver Articulation Screening for children in what age range? 6 months to one year 6 to 10 years 0 to 2 years 2 1/2 to 7 years
2 1/2 to 7 years The Denver Articulation Screening is designed for children ages 2 ½ to 7 years to identify difficulty in producing word sounds (articulation). It is standardized, easy to administer in a brief time, and meant only for English-speakers. Those who score below their age group norms should be retested within 2 weeks and referred for complete language testing if the repeat exam is abnormal.
The nurse is counseling a pregnant adolescent about the health benefits associated with breastfeeding. Which statement by the client indicates understanding? "Breastfeeding my baby will pass on a type of active immunity." "Breastfeeding my baby will help to stimulate my baby's immune system to activate." "Breastfeeding my baby will provide lifelong immunity against certain diseases." "Breastfeeding my baby will pass on passive immunity."
"Breastfeeding my baby will pass on passive immunity." Passive immunity results when immunoglobulins are passed from one person to another. This immunity is temporary. This is the type of immunity that takes place when a mother breastfeeds her child. Active immunity results when an individual's own immunity generates an immune response.
The nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. Which statement is accurate? "The 'T' stands for tuberculosis." "There are no side effects from this vaccine." "You need to renew this immunization every 10 years." "Bring her back for the second dose when she is 4 months old."
"Bring her back for the second dose when she is 4 months old." DTaP is given as a series of five injections—at 2, 4, and 6 months; between 15 and 18 months; and between 4 and 6 years. A TdaP booster is needed by 11 to 12 years. There are common side effects such as fever and redness and swelling at the injection site as well as other less common reactions such as seizures. The "T" in the vaccine stands for tetanus.
During a developmental screening, the nurse notes the toddler is not meeting expected developmental milestones. What is the best action by the nurse? Tell the parents they should monitor the child closely for changes over the next year. Encourage the family to provide specific developmental tasks to correct the delay. Ask the family if they have a preference of hospitals for an overnight stay for further evaluation. Discuss the delay in milestones with the primary care provider and family.
Discuss the delay in milestones with the primary care provider and family. Children who are not meeting developmental milestones should be referred to the primary care provider for more intensive assessment and testing. The family of the toddler would be the best resource in determining more detail. The parents may be given specific exercises or tasks to enhance the milestone after an evaluation and diagnosis are made. There would be no need for hospitalization at this time in the supervision visit. The family should be referred to the PCP at the time of the concern, so waiting a year would further delay treatment if it were needed.
The nurse is discussing healthy eating habits with a school-age child and her parents. Which recommendation would the nurse make for the family? Light snacks should be offered so the child doesn't overeat at meals. When serving food the child doesn't like, insist he or she takes several bites. A bedtime snack should be part of the child's bedtime ritual/pattern. Carbohydrates at breakfast will give a child energy to start the day.
Light snacks should be offered so the child doesn't overeat at meals. Children who do not manage their hunger with snacks will likely overeat at a meal. Protein is a better choice at breakfast for energy and to avoid being sleepy during the day. Bedtime snacks are recommended if the child is hungry, but should not be routine. Avoid battles over food during a meal. Offer the child healthy foods he or she likes and the child will eventually explore new or previously disliked foods.
Before administering an immunization to their child, the nurse asks parents to take which priority action? Assist in restraining the child. Sign a consent form. Reassure the child. Provide the child's immunization record.
Sign a consent form. Parents must sign a consent form before immunization of the child after receiving full information about the vaccines, their importance, and their administration. Reassuring the child and assisting in restraining are both important but are not the priority. Having the child's immunization record with them allows this record to be updated; otherwise, a full record should be given to the parent.
Which situation would indicate the nurse is facilitating trust in the family members' decisions about their child's health? The nurse asks the mother why she used a home remedy cream on the child's rash before being seen at the clinic. The nurse teaches the family about side effects of a prescribed medication without first assessing their knowledge about the medication. The nurse discourages the parents from following the advice of a grandparent regarding parenting approaches. The nurse recommends the parents review the list of available specialists before they select one for referral.
The nurse recommends the parents review the list of available specialists before they select one for referral. The nurse is validating and involving the family in the child's health decisions by asking them to review the list of specialists available rather than suggesting a specific specialist. The other options question the parents' decisions about their child's health by undermining the home remedy and the grandparent and failing to assess their knowledge level before teaching.
Parents report that their neonate received intravenous antibiotics while in the newborn nursery. The nurse recognizes this as a potential risk factor for which health problem? visual disorder articulation difficulties difficulty with fine motor skills hearing impairment
hearing impairment The child's hearing is at risk. Determining which antibiotics were administered will be helpful in evaluating the risk. Certain antibiotics are ototoxic. These require regular follow-up to check the child's hearing ability. Having received antibiotics should not increase the risk for the other health problems.
While enrolled in a geography course, a student nurse learns that diarrheal illness is deadly for large numbers of infants in Third World countries. What vaccine will this nursing student identify as part of the solution to this problem? hepatitis A (HepA) H. influenzae type B (Hib) rotavirus (RV) diphtheria, tetanus, pertussis (DTap)
rotavirus (RV) Rotavirus is a very common cause of gastroenteritis among young children that spreads readily via the fecal-oral route. The disease is most severe in children between 4 and 23 months, causing severe, watery diarrhea that results in dehydration. The other vaccines do not prevent diarrheal illness.
The nurse works at a health clinic located in a suburb of a large city. Which action by the health clinic will further enhance the bond between child, family, and community? discontinuing the practice of two evenings a week being set aside for walk-in visits setting up screenings in a public library downtown scheduling the last appointment each weekday at 3:30pm telling a family to take a taxi to the clinic if transportation is a concern
setting up screenings in a public library downtown By bringing services into the city to a community resource already established (library), the clinical nurse will be increasing access via public transportation and location. The other choices inhibit community access by closing at a time when most parents are still at work, by assuming parents can afford taxi fares, and by limiting evening hours and walk-ins for those parents who may be unable to schedule transportation but instead rely on neighbors or family for rides.
Which nurse response to the parent indicates that the nurse recognizes the importance of the child's increasing responsibility for his or her personal heath choices? "I recommend you talk with your adolescent child and discuss their preference for which dentist to visit." "If your school-aged child isn't current on immunizations, we can work to get them caught up." "I am so glad you are reading to your baby, especially during feeding time." "I suggest you offer your toddler healthy snacks after school and at bedtime rather than after dinner."
"I recommend you talk with your adolescent child and discuss their preference for which dentist to visit." The child's participation in his or her health choices increases as the child grows and develops. By asking the adolescent for input, the nurse is encouraging the parent to include the child in responsible decision making. The other choices are ideal suggestions for younger children, but these children are dependent on their parents providing supervision of their health choices.
The nurse is discussing healthy eating with the parents of a school-age client. Which statement by the parents indicates additional teaching is needed? "It is more important for our child to get sleep than eat breakfast." "We will freeze fruits before putting them in our child's lunchbox." "We will limit our child's snacks to after school and bedtime." "Since our child does not like broccoli, we will not put it on our child's plate."
"It is more important for our child to get sleep than eat breakfast." Healthy eating habits are important and should be taught at an early age. Children should not skip breakfast because this will limit their energy and can lead to poor performance in school. Freezing fruits helps keep them cool and fresh for lunch. Snack time should be limited to after school and bedtime. Light snacks such as yogurt or fruit provide good hunger management. A very hungry child will tend to overeat at meals. Forcing children to eat foods they do not like will only deepen their dislike of them. Parents should give children the healthy foods they enjoy and eventually they will explore more options. Parents should lead by example and eat the foods they want their children to eat.
The nurse manager is mentoring a newly licensed nurse in the health clinic, talking with the single mother of an infant. The mother was 10 minutes late to the appointment and is concerned the clinic will not allow the health visit to be conducted today. Which statement by the newly licensed nurse would alert the nurse manager to provide additional teaching? "It is important to be current with your baby's progress, so we will see her today." "Why don't you plan to have your retired neighbor bring the baby next time since having the parent with the baby isn't necessary?" "Follow me into the private exam room so we can discuss any concerns you have about your baby." "I know work schedules can make getting to appointment on time difficult; I am glad you are here now."
"Why don't you plan to have your retired neighbor bring the baby next time since having the parent with the baby isn't necessary?" The nurse should not indicate to the mother that she is not necessary at the child's health promotion visits. The nurse would instead validate the role of the mother and her influence on the child's concept of wellness. The other choices support the mother in taking an active role in her child's health and decrease the barriers to clinic access.
The nurse is caring for a family and their internationally adopted child. The parents indicate the child was adopted and brought to the United States 7 days ago. What recommendation would the nurse give the family? Postpone vaccines if the child has a low-grade fever or respiratory illness. Update the child's medical record within the next 8 weeks at their medical home. Assure the child has completed hepatitis B, C, and A screening in their home country. Complete a comprehensive health screening within the next week.
Complete a comprehensive health screening within the next week. When a child is adopted internationally, it is recommended the child have a health screening within the first few weeks of coming to the United States. The child should be screened for hepatitis after arrival to the US due to unreliable testing methods in their home country. The child's medical record should be updated with each visit. Vaccines are not postponed for mild respiratory illnesses or low-grade fevers.
The nurse is preparing to administer a routine vaccine to a pediatric client. When obtaining the vaccine, the nurse discovers the refrigerator containing the facility's vaccines has been unplugged for an unknown amount of time and is warmer than the proper storage temperature. Which action by the nurse is appropriate? Discard all of the vaccines and reschedule the child for another appointment Contact another local facility to borrow a vaccine to administer to the child Use only the vaccines that feel cold to the touch and discard all others Plug the refrigerator back in but wait to use the vaccines until it is cool
Discard all of the vaccines and reschedule the child for another appointment Proper storage of vaccines is essential for preserving their efficacy. Temperatures that are too cold or too warm are detrimental. Improperly stored vaccines should not be used. They are ineffective in preventing disease and should not be administered. It is not appropriate for the nurse to contact another facility to borrow routine vaccines. The client should be rescheduled to receive the vaccine.
The community nurse is preparing an educational session on how to provide anticipatory guidance to clients for other nurses. Which example will the nurse include in the teaching? Ordering the prescribed diet for a child who had surgery. Providing vaccinations to the children in a community. Teaching handwashing at an elementary school. Taking a child's vital signs.
Teaching handwashing at an elementary school. The nurse should take a proactive role in discussing anticipatory guidance issues with children and families. The nurse should be an educator to promote a healthy lifestyle, and any encounters with children and families should be an opportunity to educate. Taking vital signs, providing vaccinations, and ordering the prescribed diet are basic nursing care tasks.
A single mother has brought her 9-month-old, recently adopted Chinese daughter for a health supervision visit. Although there are screening documents from China and the child seems healthy, the nurse plans to screen for infectious diseases. What explains the nurse's caution? Infants tend to have insidious symptoms. Testing by the child's home country is unreliable. The child may have come from rural China. Many babies adopted from foreign countries have pediculosis.
Testing by the child's home country is unreliable. Documents from many foreign countries have proven unreliable. Universal screening is recommended for internationally adopted children. Insidious symptoms are common to infants overall. Pediculosis is not an infectious disease (lice do not carry disease). Internationally adopted children generally come from areas with prevalence of infectious disease, so having come from a rural area is not a particular risk indicator.
Which information obtained by the nurse from the parents at the initial health supervision visit would alert the nurse to conduct the newborn metabolic screening during this visit? The screening was completed and the results noted in the infant's permanent record. The screening was completed when the newborn was 24 hours old. The screening was completed at the clinic when the newborn was 4 days old. The screening was completed prior to discharge from the birthing unit.
The screening was completed when the newborn was 24 hours old. Newborn metabolic screenings should occur when the child is older than 48 hours. The other options indicate the screening was completed appropriately and should not be repeated.
During the health history of a 2-week-old neonate, the nurse discovers the child has not yet had a hearing screening. What test should the nurse schedule? Weber test tympanometry auditory brain stem response test Rinne test
auditory brain stem response test Auditory brain stem response (ABR) test and the evoked otoacoustic emissions (EOAE) test are indicated for newborns. A child not screened for hearing at birth should be screened before 1 month of age. The Rinne and Weber tests are used with children 6 years and older. Tympanometry is appropriate for children beyond 7 months of age.
The nurse is reviewing the health history of an infant who is demonstrating developmental delays. Which finding would be considered a possible risk factor? being raised by a single adolescent mom birth weight of 1,950 grams gestational age 35 weeks paternal history of alcohol use disorder
being raised by a single adolescent mom Parental factors can be associated with developmental delays in the child. Being raised by a single parent or a parent having less than a high school education are associated with delays in the child. Birth weight less than 1500 grams is associated with delays. Children born at 33 weeks' gestation or less are at an increased risk for developmental delays.
Using the recommended immunization schedule for infants, the nurse administers vaccines in what order from first to last? Measles, mumps, rubella (MMR) Influenza Hepatitis B (HepB) Rotavirus (RV)
hepatitis B (HepB) rotavirus (RV) influenza measles, mumps, rubella (MMR) Hepatitis B is administered IM at birth. Rotavirus is an oral vaccine that is given at 2 months along with several other immunizations. The influenza vaccine can be administered first at 6 months and then is needed yearly. The measles, mumps, rubella immunization (SC) is not administered until the child reaches 12 months.
A nurse asking questions during an infant's health surveillance visit has the mother tell her: "My baby was premature and weighed 3 pounds at birth." The medical record provides an Apgar score of 5 at 5 minutes and indicates the child received gentamicin in the neonatal intensive care unit (NICU). What should the nurse consider as the greatest risk for this child? visual deficit hearing deficit gross motor problems eating disorder hypertension
hearing deficit The greatest risk is for a hearing deficit. All factors point in that direction: low birth weight, Apgar less than 6 at 5 minutes, and having received an ototoxic medication. This child should have had a hearing evaluation prior to discharge from the NICU and now should be screened periodically at well-child visits. This premature infant is also at risk for anemia, hypertension, feeding problems, visual defects, and gross motor problems that would not be of the same concern in the full-term child.
The nurse is working with an adolescent to promote a healthy weight. Which goal would be appropriate for the nurse and adolescent to work toward? limiting computer/TV time weighing on the scales weekly and recording weight loss of 1 to 2 pounds per week on average weekly physical activity of 60 minutes
limiting computer/TV time Healthy weight promotion is geared toward healthy habits and active lifestyles. Daily activity is recommended, not weekly. The focus should not be on specific weight-based goals. Linking the goals to weight-specific numbers leads to an increased possibility of eating disorders, nutritional deficiencies, and poor body image.
The nurse will record what information about each vaccine after immunizing a child? Select all that apply. site and route of vaccine administration manufacturer of vaccine how vaccine was stored whether bacterial or viral lot number and expiration date of vaccine
lot number and expiration date of vaccine site and route of vaccine administration manufacturer of vaccine Lot number, expiration date, site and route of administration, and the name of the vaccine manufacturer should be recorded. The name and address of the facility and the person administering the vaccine are also documented. In this way, details that can be used to track any untoward events related to the vaccine are available. Proper vaccine storage is important for the efficacy of the vaccine but currently is not recorded at the time of administration. The viral or bacterial nature of the vaccine is already known.
During a well-child visit for a 2-month-old infant, the nurse explains the need to perform a hearing screening on the child within the next few months. The child's mother reports she has not noticed any deficits and does not see the need for this being done. Which response by the nurse is indicated? "Hearing deficits related to neurological problems are often not noticeable by parental observations." "Unfortunately hearing losses in infants are common and it is best to check hearing before your child is 6 months old to rule out problems." "Since you do not see any issues we can wait to test at a later time." "Hearing loss related to sensory concerns are often not noticeable by parental observations."
"Unfortunately hearing losses in infants are common and it is best to check hearing before your child is 6 months old to rule out problems." Hearing screening should be performed by the age of 6 months. This will help to ensure early intervention if needed.
Which question by the nurse is the best one to elicit complete information about a young boy's immunization status? "Are your son's immunizations up-to-date?" "When and where did your child receive his last immunization?" "Do you have any questions about the immunizations children need at various ages?" "Tell me which immunizations your child needs today."
"When and where did your child receive his last immunization?" The when/where questions gather relevant information and are good starting points for further investigation of the immunization status as well as an opening for discussion of any concerns. The parent is likely to be able to answer these questions. Asking which immunization the child needs and questions regarding immunizations at various ages may cause the parent to be unable to answer and create discomfort. The up-to-date question will likely result in a "yes-no" response and yield little information and not further discussion.
The nurse is preparing to administer the measles, mumps and rubella (MMR) vaccine to a child. Which would be a contraindication to administering the vaccine at that time? The child received the intranasal flu vaccine 2 weeks ago. The child is to receive the varicella vaccine on the same day. The child is allergic to eggs. The child's mother is currently pregnant.
The child received the intranasal flu vaccine 2 weeks ago. Measles, mumps, and rubella (MMR) is a live attenuated virus combination vaccine. MMR can be given the same day as other live attenuated virus vaccines such as varicella vaccine. However, if not given on the same day, the immunizations should be spaced at least 28 days apart. The intranasal flu vaccine is a live attenuated virus vaccine. The vaccine is not prepared from the allergenic albumen portion of the egg, so egg allergy is no longer a contraindication for measles vaccine. Pregnancy in a child's mother is not a contraindication to the vaccination of the child.
The nurse is observing the parents and child during a health supervision visit. Which observation would alert the nurse to inquire and observe further? The mother says, "Wait until we are finished with this doctor's visit and then I will take you to the bathroom." The infant, in a car seat, is placed on the exam table so the baby is facing the parents as they talk with the nurse The mother asks the father to hold the toddler when the nurse asks the mother to sign paperwork at the front desk. The father of the child states, "He didn't get first at the spelling bee, but he did well in his class."
The mother says, "Wait until we are finished with this doctor's visit and then I will take you to the bathroom." The parent is not responding the child's need to go to the bathroom, which would alert the nurse to inquire and observe further. The other choices are ideal responses from the parent, indicating they have a healthy parent-child interaction and dynamic.
