NURS431 Ch31 Health Supervision

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 passive immunity."

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?

"Bring her back for the second dose when she is 4 months old."

The nurse is discussing varicella immunization with a parent of a 13-month-old infant. The parent is reluctant to vaccinate because "it is not necessary." Which comment by the nurse will be most persuasive for immunization?

"Children not immunized are at risk if exposed to the disease."

The nurse manager is orienting a new nurse. Which statement by the new nurse would indicate that the nurse manager should intervene?

"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.

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."

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 sunscreen on my 4-month-old child." Children under the age of 6 months should not use sunscreen. Efforts should be made to protect this population from sun exposure. The remaining statements are correct actions.

The nurse prepares to administer the measles, mumps and rubella (MMR) vaccine to a child. What statement by the child's parent would alert the nurse to avoid giving the vaccine?

"My child had gelatin at day care and broke out in hives afterwards."

The nurse is caring for families at a health clinic. Which statement by a client would indicate to the nurse that the health clinic should take steps to be more effective at providing health supervision to this community?

"My husband takes off work to go to the clinic with our child so he can relay the visit details to me in our language."

The mother of a 6-month-old child reports she has been hearing so much about autism spectrum disorder. She questions if this is something that can be tested for. What response by the nurse is appropriate?

"Screening is recommended between 18 and 24 months or when concerns are identified."

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."

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."

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?

"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need."

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?

"To prevent serious illnesses, it is vital your child receive all vaccines as scheduled."

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."

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?

"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 will use the Denver Articulation Screening for children in what age range?

2 1/2 to 7 years

The nurse is promoting the benefits of achieving a healthy weight to an overweight 12-year-old child and her parents. Which approach is best?

Ask what activities she enjoys such as dance or sports.

The nurse is assessing a 4-year-old child who the parents report as "hard to understand" when speaking. Which screening will the nurse prepare to implement?

Denver Articulation Screening

During a developmental screening, the nurse notes the toddler is not meeting expected developmental milestones. What is the best action by the nurse?

Discuss the delay in milestones with the primary care provider and family.

Before administering an immunization to their child, the nurse asks parents to take which priority action?

Sign a consent form.

The nurse is providing discharge teaching to parents preparing to take their 1-day-old newborn home from the hospital. The parents question the nurse about the timing of metabolic screening for their infant. What information can be provided by the nurse?

Newborn metabolic screening needs to be performed at or after 48 hours of age.

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.

The nurse is preparing to administer an intramuscular immunization to a 1-month-old infant. What action will the nurse take?

Request the parent to remove the infant's pants so the vastus lateralis muscle is accessible.

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?

Teaching handwashing at an elementary school.

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?

Testing by the child's home country is unreliable.

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. 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 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.

A mother of three brings her children in for their vaccinations, and tells the nurse that her mom recently died and her husband just lost his job due to his company downsizing. Which parenting behaviors is the nurse likely to observe? Select all that apply.

The mother rarely looks at her infant when the nurse is assessing the child. The mother becomes very frustrated and tells the nurse she can't handle her toddler's temper tantrum.

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 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.

The student nurse is preparing to administer an immunization to an 18-month-old child under the direction of a registered nurse. Which actions by the student nurse indicate the need for the registered nurse to intervene? Select all that apply.

The student nurse prepares the triceps muscle for the IM injection. The student nurse reports that IM injections are to be avoided for children under the age of 2 years. The student nurse reports plans to use a 20G needle for an IM deltoid injection. When administering an injection in a child who is 18 months of age the nurse may utilize both intramuscular (IM) or subcutaneous sites. Intramuscular sites include the deltoid muscle and anterior thigh. The triceps is used for subcutaneous injections. The appropriate needle length for an IM injection into the deltoid muscle is 5/8 inches.

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 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 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

Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?

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.

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

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

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?

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.

A pediatric nurse will state that the priority reason to have a thorough grasp of the growth and development of children is to:

identify developmental risks or delays promptly.

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)

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?

setting up screenings in a public library downtown