Chapter 31 Peds PrepU
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?"
The mother of a 4-month-old refuses for her baby to be "stuck" when immunized. What immunization will the nurse administer under these restrictions?
rotavirus
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 nursing instructor has just completed a discussion about immunization. Which statement by a student would indicate a need for further instruction?
"An example of active immunity would be when immunoglobulins are passed from a mother to her infant by colostrum."
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 employed at a clinic that provides services to a large population of clients from a culture with a present-based orientation. When providing education about proper nutrition to a family from this culture, which would be the best response by the nurse?
"Eating a healthy breakfast will give your child the energy to stay awake and focused during school each day."
The nurse is completing an admission assessment on a 6-month-old infant. Which statement by the infant's mother would indicate a risk for the child to develop iron-deficiency anemia?
"I love breastfeeding my daughter but I guess I will need to start feeding her baby food soon."
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."
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."
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."
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."
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 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."
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?
"The child's eyes are more attune to high-contrast patterns than to specific colors."
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 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."
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."
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
Which statements by a parent would indicate to the nurse that the family has a future-based orientation? Select all that apply.
"We will fill our son's prescription for asthma prevention medication today in case he has another asthma attack." "We will get our son vaccinated for varicella. We don't want him to get chickenpox." "We limit the amount of TV our children watch and are sure they get enough physical activity."
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."
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?"
A mother calls the doctor's office to let them know that her son has had a fever and a runny nose. The mother wants to know if she should still bring him for his 15-month immunizations. What is the appropriate response from the nurse?
"Yes, bring him in, he can still have his shots."
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
The nurse will use the Denver Articulation Screening for children in what age range?
2 1/2 to 7 years
The nurse is reviewing a group of medical records for compliance with recommended well-child care visits. Which finding would warrant further investigation?
A 13-year-old child who was last seen 2 years ago.
The mother of a 5-year-old with eczema is getting a check-up for her child before school starts. Which action should the nurse take during the visit?
Assess how the family is coping with the chronic illness.
A nurse is working to provide health promotion services throughout the community. What institutions or organizations best serve as important avenues for disseminating health promotion information? Select all that apply.
Churches, synagogues, and mosques Schools (public and private) Day care centers
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?
DTaP
When working in a very busy pediatric office or clinic, nurses could substitute which screening test for the Denver II Developmental Screening Test to detect delays that otherwise could be missed?
Denver Prescreening Developmental Questionnaire (R-PDQ)
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.
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.
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.
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 nurse is assisting the health care provider in evaluating a 4-year-old child with suspected hearing impairment. What would the nurse do to prepare for the evaluation? Select all that apply.
Obtain the equipment needed to perform the pure tone test. Position the child so the provider has room to stand 1 to 2 ft (0.3 to 0.6 m) behind the child.
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.
Before administering an immunization to their child, the nurse asks parents to take which priority action?
Sign a consent form.
A nurse is conducting visual acuity screening for a 6-year-old child. Assessment reveals that the child knows the alphabet. Which tool would be most appropriate for the nurse to use to screen this child's vision?
Snellen eye chart
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 nursing student is asked to provide reasons it is important for the physician or nurse practitioner to have knowledge of the community in which the families and children seen in the practice live. Select all that apply.
The community can be a contributor to child-family health or a cause of illness. Knowing the community is necessary in developing appropriate health surveillance programs. Awareness of agencies serving children results from knowing the community. Understanding the community promotes improved working relationships between families and physicians or nurse practitioners.
The nurse is educating the parent of a 6-month-old infant during a well-baby clinic visit. What does the nurse recommend regarding dental health?
The family should establish a regular dentist for the infant by his or her first birthday.
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.
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.
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
Nurses use standardized materials to administer the Denver II Developmental Screening Test. What are some of the materials included in the test kit? Select all that apply.
a ball to throw and catch blocks to stack raisins to place in a bottle
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
The nurse is collecting data from the mother of a 3-year-old child. Which report warrants further follow-up?
cannot copy a circle
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
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
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
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
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
The nurse prepares to administer a vaccine to a 12-month-old child using a 5/8-inch needle. The nurse cleans the fatty tissue over the anterolateral thigh before administering the vaccine. Which vaccine is the nurse preparing to administer?
varicella
The parents of a child ask the nurse why it is recommended that their child be screened for intestinal parasites. What would be the response by the nurse?
"Children with intestinal parasites often exhibit no signs or symptoms, so a screening is recommended."
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?
Purchase stickers or make coloring pages to be given to the children after the screening is completed.
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 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.
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 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 parent of a 13-year-old child asks about screening for depression because there is a strong family history. What information should the nurse provide to the parent?
"Children should be screened for depression every year beginning at age 11."
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."
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."
