Peds PrepU Quizzes Ch. 9

Children in what age range are screened by nurses using the Denver II Screening Test?

0 to 6 years Explanation: 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.

The parents of a toddler adopted from an area outside the United States ask the nurse why their child would need testing for infectious diseases since the child was tested as a newborn in the child's home country. Which response by the nurse would be appropriate?

"The testing may have been unreliable due to outdated testing supplies, poor storage of testing supplies and unreliable documentation." Explanation: Screening, testing and treatment for infectious diseases in the child's home country may be unreliable due to a lack of resources, sporadic screening, outdated supplies and improper storage of testing supplies. Newborns are not immunocompromised at birth. The child's health record will be updated as additional information is assessed and testing again is not indicated for this reason.

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:

1 year. Explanation: 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?

2 1/2 to 7 years Explanation: The Denver Articulation Screening is designed for children 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 two weeks and referred for complete language testing if the repeat exam is abnormal.

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?

4 Explanation: 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.

The nurse is conducting education with a group of community partners regarding mandatory metabolic screenings for newborns. The nurse would identify the recommended screening tests be conducted for specific diseases for what reason?

These screenings are for diseases that have treatments available for the child Explanation: Newborn screenings are conducted to alert the health care team and the parents to diseases that have treatments available. These disorders may go unnoticed without routine screenings. The screening alone does not explain or teach the parents and does not assure resources/assistance is available. This is the role of the health team. The diseases included in the screening have treatments avialable, but not all are curable and telling this to the parents would give them false hope.

The parents of a child, recently adopted internationally, asks the nurse why it is recommended that their child be screened for intestinal parasites. What would be the best response by the nurse?

"Children with intestinal parasites often exhibit no signs or symptoms, so a screening is recommended." Explanation: Children with intestinal parasites are often asymptomatic so screening is recommended. It is not true that all children from other countries have intestinal parasites. The public school system does not screen or treat for parasites. The screening is done for the health of the child and is not related to the cost of treatment. Treatment would not be completed unless the child had intestinal parasites.

What will the nurse ask the school-age client when a vibrating tuning fork is placed at the middle of the top of the child's head?

"Do you hear the sound in one or both ears?" Explanation: This procedure, known as the Weber test, assesses hearing and evaluates bone conduction of sound. The sound should be heard in both ears. Another hearing test using a tuning fork is the Rinne test, which compares bone conduction of sound versus air conduction. The other questions if asked by the nurse do nothing to evaluate the hearing of the school-age client.

The nurse is providing education to a group of parents concerning safety and sun exposure. Which statement by a participant indicates the need for further instruction?

"It is important I use sun screen on my 4-month-old child." Explanation: Children under the age of 6 months should not use sunscreen. Efforts should be made to protect this population from sun exposure. The remaining responses are correct.

The school nurse has just finished an educational program for the children at a local elementary school. Which statement by a student would indicate a need for further education?

"I love to eat dry cereal for breakfast." Explanation: Protein is important at breakfast, a glass of milk or milk on your cereal is a good source. Most dry cereals don't provide enough protein and may consist of high amounts of sugar that could make the child sleepy. Low-fat chocolate milk is more nutritious than prepackaged juice boxes, which have high sugar concentrations. Freeze fruits before putting them in the lunch box. This will keep the lunch items cool and the fruit fresh tasting.

Which nurse response to the parent indicates the nurse recognizes the importance of the child's increasing responsibility for their personal heath choice?

"I recommend you talk with your adolescent child and discuss their preference for which dentist to visit." Explanation: The child's participation in their 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 school nurse has completed an educational program about vaccines to a group of parents. Which statement by a parent would indicate the need for further education?

"My 7-year-old will need to get a Hib booster at his next checkup." Explanation: Hib vaccine is not routinely given to children 5 years of age or older. Haemophilus influenzae type B is a bacterium that causes several life-threatening illnesses in children younger than 5 years of age. These infections include meningitis, epiglottitis, and septic arthritis. A booster vaccine is needed at 12 to 15 months.

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." Explanation: 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?

"Oral health can affect general health." Explanation: 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.

The grandmother of a child born at 32 'gestation to a teen mother is tearful. She worries her grandchild will have developmental problems. What response by the nurse is most appropriate?

"The risks of developmental concerns are heightened for your grandchild." Explanation: Children born to teen mothers and those who are born at a gestation of 33 weeks or less have an increased risk for experiencing developmental delays. The child's grandmother is expressing concerns. It is most appropriate to explain to her that there are risks involved. The most appropriate response by the nurse is one that personalizes and responds to her question.

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?

"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." Explanation: 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?

"When and where did your child receive his last immunization?" Explanation: 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 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 16-year-old, pregnant for the first time and lives with her parents Explanation: 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.

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?

Auditory brain stem response test Explanation: 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 teenaged mom Explanation: 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.

The father of a 13-year-old boy reports his family has a strong history of depression. He questions screening for his son. What information should be provided by the nurse?

Children should be screened for depression every year beginning at age 11." Explanation: Academy of Pediatrics recommended screening tool [CRAFFT) and a depression screening is recommended annually beginning at age 11. It is clear that the parent is voicing concerns for his son's risk factors. The question asked does not provide the information being requested.

Parents report that their 4-year-old is difficult to understand. Which screening tool will the nurse use?

Denver Articulation Screening Explanation: The nurse would administer the Denver Articulation Screening. It is given to children 2½ to 7 years of age to detect differences in speech sounds beyond those considered normal. It is standardized, is easy to administer in a brief time, and is meant for English speakers only. Those who score below their age group norms should be retested within 2 weeks and referred for complete language testing if the repeat examination is abnormal. The Denver II includes a language category but is not an articulation screening test. Goodenough-Harris and Bayley are tests of intelligence that do not evaluate speech sounds.

The 4-year-old due for the DTaP, IVP, MMR, and varicella vaccines has a runny nose, slight cough, and temperature of 99° F (37.2° C). What should be the response of the nurse?

Do the well-child exam and give the immunizations due. Explanation: The well-child exam can proceed and all the immunizations can be given. The child is not at risk for adverse reactions because she has an upper respiratory infection and very slightly elevated temperature. The child is also not at risk for not developing the proper immune response. Slight fever and minor respiratory illness should not postpone immunizations. Those postponed are at risk for not being received. There is no reason to give some of the immunizations and not others (MMR).

Place in proper order the vision screening procedures used by the nurse to assess children from neonate to school age.

Fixate on an object at 10 to 12 inches Follow object to midline Follow object past midline Respond to E chart Use Snellen test for visual acuity Explanation: Neonates should be able to fixate on an object 10 to 12 inches from the face. After fixation, infants should follow to midline. By 2 months, infants follow to 180°. The preschool E chart, sometimes called the "tumbling E," works well for this age group. School-age children who know the alphabet should be given the Snellen test.

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?

Hearing deficit Explanation: 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.

During the health surveillance of a 13-year-old girl, the nurse recorded the following information: blood pressure 108/48, pulse 70, respirations 18; dieting, dislikes meat; eats yogurt, drinks two glasses low-fat milk daily; gymnastics team member; fairly regular, normal menstrual periods. What risk would the nurse identify?

Iron-deficiency anemia Explanation: Iron-deficiency anemia is the risk exacerbated by likely low iron intake with dieting and dislike of meat. Gymnastic training raises the need for iron. Menstrual periods (even though not completely regular and normal in length and flow) help to deplete iron. There is adequate calcium in her diet, which is a plus to enhance bone density, yet not an overabundance, which would block iron absorption. Injury may be a risk related to gymnastics, but there are no data to support an unusual risk. Her blood pressure is normal.

The nurse is performing a vision screening for 6-year-old child. Which screening chart is best for the nurse use to determine the child's ability to discriminate color?

Ishihara Explanation: The Ishihara chart is best for the 6-year-old because the child will know numbers. CVTME charts are designed to assess color vision discrimination for preschoolers. The Allen figures chart and the Snellen charts are for assessing visual acuity.

The nurse is working with an adolescent to promote a healthy weight. Which goal would be appropriate for the nurse and adolescent to work towards?

Limiting computer/TV time Explanation: Healthy weight promotion is geared towards 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 increased possibility of eating disorders, nutritional deficiencies and poor body image.

The nurse working with children and families knows there are certain universal screening tests all children should receive. Which tests are included in this group? Select all that apply.

Phenylketonuria Auditory brain stem response Explanation: Phenylketonuria (PKU) and auditory brain stem response (ABSR) tests are used universally (throughout the entire population regardless of individual risk). The Denver II is one of several developmental screening exams that can be used between birth and age 6 years. Screening for hyperlipidemia and lead occurs in those children with risk factors (selective screening).

Which children will the nurse avoid immunizing with a live-virus vaccine? Select all that apply.

Preschooler receiving radiation therapy Pregnant teen Explanation: The immune compromised child undergoing radiation therapy and the pregnant teen should not receive live-virus vaccines. The preschooler could contract the disease. In pregnancy, the virus could cross the placenta and infect the fetus. The other children can safely receive a live-virus vaccine.

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?

Rotavirus (RV) Explanation: 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 will administer which recommended immunizations to an 11- or 12-year-old patient during a wellness visit? Select all that apply.

Tetanus, diphtheria, pertussis (Tdap) Human papillomavirus (HPV) Meningococcal vaccine (MCV) Explanation: Tdap, HPV, and MCV are the vaccines that would be administered to a school-age patient. Other vaccines may be given as catch-up, and some are administered to children considered at high risk. It is important that the nurse check immunization records at each contact while taking into account changing immunization recommendations to keep children up-to-date.

The nurse is preparing an educational program for her peers regarding vaccinations. What information should the nurse include? Select all that apply.

The CDC provides the recommended schedule for vaccines. Parents must be given the proper Vaccine Information Statements prior to administration of the vaccine. Explanation: The Advisory Committee on Immunization Practices (ACIP), a branch of the CDC, reviews the recommended immunization schedules at least yearly and updates the schedule to ensure that it reflects current best practices. Vaccine storage and administration affect the efficacy of a vaccine. Not all vaccines are stored in the refrigerator. The National Childhood Vaccine Injury Act (NCVIA) requires that Vaccine Information Statements be provided to parents before an immunization is given. These provide the benefits, risks and discusses specific side effects that may be seen for each immunization. The manufacture's package insert may not be given in place of the Vaccine Information Statement.

During a health visit, the parents of a 6-month-old ask the nurse when to take the infant for the first dental visit. What would the nurse recommend?

The dental home should be established by the time the child has their first birthday. Explanation: The child should have a dental home established by their first birthday, regardless of oral health. The first tooth erupting is not a basis for a dental visit. If the parent notes caries, decay or has concerns about infection, the child should be seen at that time.

1. The student nurse is preparing for a class project about health supervision. The student plans to include which information? Select all that apply.

The goal of health supervision is to optimize the child's level of functioning. Health supervision promotes education about preventing injury and illness. Education regarding proper immunizations is included in health supervision. Explanation: The goal of health supervision is optimizing the child's level of functioning. Health supervision involves providing services proactively, not reactively after the child has become ill. It promotes the best possible health of the child by teaching parents and children about preventing injury and illness with topics like proper vaccinations. It is vital to every child and is most effective when "he child has a centralized source of health care rather than multiple sources of health care.

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 when the newborn was 24 hours old Explanation: Newborn metabolic screenings should when the child is older than 48 hours. The other options indicate the screening was completed appropriately and should not be repeated.

The nurse is reviewing the health history of a 3-year-old child who was recently adopted from outside of the United States. When considering lead testing, what actions are indicated? Select all that apply.

Complete lead level screenings at initial visit after coming to the United States. Complete lead level screening within 6 months of home placement. Explanation: Many cases of elevated blood lead levels have been reported in children who are recent immigrants, refugees, or international adoptees. The CDC recommends blood lead testing for these children upon entering the United States and a repeat test 3 to 6 months after placement in a permanent residence.

The nurse will record what information about each vaccine after immunizing a child? Select all that apply.

Lot number and expiration date of vaccine Site and route of vaccine administration Manufacturer of vaccine Explanation: 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 presently is not recorded at the time of administration. The viral or bacterial nature of the vaccine is already known.

The nurse is preparing to perform the Denver II screening test. Which items should the nurse prepare for use in the assessment? Select all that apply.

Ball Doll Crayon Explanation: The Denver II screening test employs props. These include dolls, crayons, and balls.

The nurse practitioner inspects a toddler's teeth. The nurse practitioner encourages the family to establish a dental home in order to achieve optimal dental health for the various family members. Select all reasons for this action that apply.

Comprehensive health care is possible only if oral health is part of the equation. Dental care is the most unmet health need of children in the United States. Certain dental interventions including fluoride treatments could significantly reduce the cost of oral care for children. Poor oral health care for children can result in systemic health problems. Explanation: All statements are true and underscore the importance of good oral health care best achieved through a dental home.

The nurse interviews the parent of a toddler to identify factors that may place the child at risk for developmental problems. What information obtained from the parent would be of concern to the nurse? Select all that apply.

Neither parent graduated high school Father suffers from schizophrenia Recent lead level was 7 mg/dL Explanation: Factors placing the child at risk for developmental problems include a parent with less than a high school education, parent with mental illness and a lead level above 5 mg/dL. The gestational age of 35 weeks is above the 33-week criteria. Birth weights less than 1500 g are a concern.

Which action should the nurse take when it is discovered that the refrigerator containing vaccines has been unplugged and is warmer than the proper storage temperature?

Not use any of the vaccines and alert others to do likewise. Explanation: 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.