Chapter 9 PREP U
a centralized database contains all child information
The nurse is providing care for children in a pediatric medical home. What is a characteristic of care in these types of facilities?
Newborn metabolic screening needs to be performed at or after 48 hours of age.
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?
2 1/2 to 7 years
The nurse will use the Denver Articulation Screening for children in what age range?
"tell me what concerns you."
During the health history, the mother of a 4-month-old child tells the nurse she is concerned that her baby is not doing what he should be at this age. What is the nurse's best response?
Rinne test
During the health history, the parent of a 10-year-old child mentions the child seems to have trouble hearing. Which test is the nurse likely to use?
Immediately schedule the infant for a newborn hearing screening.
A 2-week-old child responds to a bell during an initial health supervision examination. The child's records do not show that a newborn hearing screening was done. Which is the best action for the nurse to take?
conditioned play audiometry
A 3-year-old child is scheduled for a hearing screening. The nurse would prepare the child for screening by which method?
1 year.
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:
a pediatric practice
A large portion of the nurse's efforts is dedicated to health supervision for children who use the facility as their primary medical contact. At which facility does the nurse work?
Plot the child's head circumference on a growth chart
A mother and her 4-week-old infant have arrived for a health maintenance visit. Which activity will the nurse perform?
"Yes, bring him in, he can still have his shots."
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?
"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."
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?
hearing deficit
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?
Snellen eye chart
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?
Churches, synagogues, and mosques Schools (public and private) Day care centers
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.
identify developmental risks or delays promptly.
A pediatric nurse will state that the priority reason to have a thorough grasp of the growth and development of children is to:
Testing by the child's home country is unreliable.
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?
Sign a consent form.
Before administering an immunization to their child, the nurse asks parents to take which priority action?
artificially acquired active immunity
Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?
The infant's mother is a single parent. The mother did not complete high school.
During the health history of a 3-month-old, the nurse identified risk factors for developmental delay and is preparing to assess the child's development. Which risk factors did the nurse find? Select all that apply.
Discuss the delay in milestones with the primary care provider and family.
During a developmental screening, the nurse notes the toddler is not meeting expected developmental milestones. What is the best action by the nurse?
"Oral health can affect general health."
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?
"To prevent serious illnesses, it is vital your child receive all vaccines as scheduled."
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?
"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."
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?
The child has small eyes and chin.
During the health history of a 2-month-old infant, the nurse identified a risk factor for developmental delay and is preparing to screen the child's development. Which risk might the nurse have found?
auditory brain stem response test
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?
The infant's mother is a single parent. The mother did not complete high school.
During the health history of a 3-month-old, the nurse identified risk factors for developmental delay and is preparing to assess the child's development. Which risk factors did the nurse find? Select all that apply.
"The child's eyes are more attune to high-contrast patterns than to specific colors."
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?
HBIg needs to be given within 12 hours.
Infants born to mothers who are HbsAg (hepatitis B surface antigen)-positive need to receive the hepatitis B immunoglobulin (HBIg) within how many hours?
hearing impairment
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?
The family should establish a regular dentist for the infant by his or her first birthday.
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?
"By knowing normal growth and development, the nurse is able to identify problems in growth and development."
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?
Do the well-child exam and give the immunizations that are due.
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?
Teaching handwashing at an elementary school.
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?
3 years of age
The mother of a 2-year-old child questions when she will need to initially have her child's vision screened. The nurse should inform the mother that vision screening begins at which age?
rotavirus
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?
assess for compliance with treatment regimens
The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. What will the nurse do during the visit?
Assess how the family is coping with the chronic illness.
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?
"Screening is recommended between 18 and 24 months or when concerns are identified,"
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?
"Bring her back for the second dose when she is 4 months old."
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 teenager's blood pressure was 122/83.
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 home is in a high-crime neighborhood.
The nurse is anticipating that health supervision for a 5-year-old child will be challenging. Which indicator supports this concern?
Denver Articulation Screening
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?
A community can be a contributor to a child's health or be the cause of his or her illnesses. Community support and resources are necessary for children with significant problems. The breakdown of community and family support systems can lead to depression and violence.
The nurse is aware that the community affects the health of its members. Which statements accurately reflect a community influence of health care? Select all that apply.
Complete a comprehensive health screening within the next week.
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?
a 16-year-old, pregnant for the first time and lives with her parents
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?
optimizing the child's level of functioning teaching parents to prevent injury providing care developed from national guidelines
The nurse is caring for children in a physician's office where health supervision is practiced. Which are some points of focus of health supervision? Select all that apply.
"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 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?
health insurance coverage transportation to health care facilities schools response to the chronic illness
The nurse is conducting a psychosocial assessment of a child with asthma brought to the physician's office for a check-up. Which psychosocial issues may be assessed? Select all that apply.
"Breastfeeding my baby will pass on passive immunity."
The nurse is counseling a pregnant adolescent about the health benefits associated with breastfeeding. Which statement by the client indicates understanding?
Light snacks should be offered so the child doesn't overeat at meals,
The nurse is discussing healthy eating habits with a school-age child and her parents. Which recommendation would the nurse make for the family?
"It is more important for our child to get sleep than eat breakfast."
The nurse is discussing healthy eating with the parents of a school-age client. Which statement by the parents indicates additional teaching is needed?
"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need."
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?
"Children not immunized are at risk if exposed to the disease."
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?
"Eating a healthy breakfast will give your child the energy to stay awake and focused during school each day."
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?
screening for infectious diseases
The nurse is examining a 2-year-old child who was adopted from Guatemala. What would be a priority screening for this child?
the 3-week-old infant who was discharged without a hearing screening
The nurse is interacting with several families with children during their health visits. Which child would the nurse prioritize to receive a hearing screening?
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 observing the parents and child during a health supervision visit. Which observation would alert the nurse to inquire and observe further?
Move a card with a black-and-white checkerboard pattern in a 180-degree arc past the infant.
The nurse is performing a vision screening for a 2-month-old. Which technique should the nurse use?
4
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?
6
The nurse is performing an Apgar test on a newborn. The newborn is at high risk for a hearing deficit because the infant's 5-minute Apgar score fell below what number?
A child whose parent has a mental illness A child raised by a single parent A child with a lead level above 10 mg/dL A child with hypertonia or hypotonia
The nurse is performing developmental surveillance for children at a medical home. Which infants are most at risk for developmental delays? Select all that apply.
wellness
The nurse is preparing a presentation to a local parent group about pediatric health supervision. Which would the nurse emphasize as the focus?
DTAP
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?
Discard all of the vaccines and reschedule the child for another appointment.
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?
Request the parent to remove the infant's pants so the vastus lateralis muscle is accessible.
The nurse is preparing to administer an intramuscular immunization to a 1-month-old infant. What action will the nurse take?
The child received the intranasal flu vaccine 2 weeks ago.
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?
Ask what activities she enjoys such as dance or sports.
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?
"It is important I use sunscreen on my 4-month-old child,"
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?
A 13-year-old child who was last seen 2 years ago.
The nurse is reviewing a group of medical records for compliance with recommended well-child care visits. Which finding would warrant further investigation?
Complete lead level screenings at initial visit after coming to the United States. Complete lead level screening within 6 months of home placement.
The nurse is reviewing the health history of a 3-year-old child who was recentiy adopted from outside of the United States. When considering lead testing, what actions are indicated? Select all that apply.
Goodenough-Harris drawing test
The nurse is screening a 6-year-old child for mental ability. Which test would the nurse use to assess intelligence?
"When my son is watching TV, I can't stand to be in the room. The sound is always turned up so loud."
The nurse is speaking to a parent of a 5-year-old child. Which statement by the parent would indicate a potential hearing impairment in the child?
"The risks of developmental concerns are heightened for your grandchild."
The nurse is talking with the grandparent of an infant born at 32 weeks' gestation to an adolescent mother who states, "I am concerned my grandbaby will have developmental problems." Which response by the nurse is most appropriate?
limiting computer/TV time
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?
"I do not need to document the vaccine manufacturer's name in the child's permanent record."
The nurse manager is orienting a new nurse. Which statement by the new nurse would indicate that the nurse manager should intervene?
"My child had gelatin at day care and broke out in hives afterwards."
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?
Providing combination vaccines to reduce the number of shots the child is to receive.
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?
the nurse negotiates a care plan with the child and family
The nurse strives to provide culturally competent care for children in a health clinic that follows the principles of health supervision. Which nursing action reflects this type of care?
tetanus, diphtheria, pertussis (Tdap) human papillomavirus (HPV) meningococcal vaccine (MCV)
The nurse will administer which recommended immunizations to an 11- or 12-year-old client during a wellness visit? Select all that apply.
lot number and expiration date of vaccine site and route of vaccine administration Manufacturer of vaccine
The nurse will record what information about each vaccine after immunizing a child? Select all that apply.
phenylketonuria auditory brain stem response
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.
setting up screenings in a public library downtown
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?
"An example of active immunity would be when immunoglobulins are passed from a mother to her infant by colostrum."
The nursing instructor has just completed a discussion about immunization. Which statement by a student would indicate a need for further instruction?
Purchase stickers or make coloring pages to be given to the children after the screening is completed.
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?
"The testing may have been unreliable due to outdated testing supplies, poor storage of testing supplies, and unreliable documentation."
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?
"I love to eat dry cereal for breakfast."
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?
Denver Prescreening Developmental Questionnaire (R-PDQ)
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?
The screening was completed when the newborn was 24 hours old.
Which by the nurse from the parents at the initial health supervision would alert the nurse to conduct the newborn metabolic screening during this visit?
"When and where did your child receive his last immunization?"
Which question by the nurse is the best one to elicit complete information about a young boy's immunization status?
"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."
Which statements by a parent would indicate to the nurse that the family has a future-based orientation? Select all that apply.
rotavirus (RV)
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?
hives and petechiae appear
a child receives a vaccination. when should you educate the parents to call 911?
he can receive the vaccine because it is not contagious to the immunocompromised patient
patient going in for the IVP vaccine but there is an immunocompromised son in the household, and she's worried about giving it
schedule a full evaluation since this may indicate a neurological disorder
the nurse is examining a 15 month old who was able to walk and now isn't. what's the best nursing intervention?
passive immunity can be obtained by injection of exogenous immunoglobulins
the nurse is explaining the difference between active and passive immunity. which statement accurately describes a characteristic of the process of immunity?
Allen figures
the nurse is preforming a vision screening for a 4 year old child. which screening chart would be best for determining child's visual acuity?
consent form provide with an updated shot form and info sheet about the vaccine a booklet and allow time to answer questions document that you gave it in the medical record
what should you provide a patient before they receive a vaccine?
received another live vaccine 2 weeks ago
when would you postpone giving a vaccination and give it to the next appointment instead?
Tdap
which vaccine can be given at 11-12 years?