Unit 1 Exam

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 pass on passive immunity." "Breastfeeding my baby will provide lifelong immunity against certain diseases."

"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? "You need to renew this immunization every 10 years." "Bring her back for the second dose when she is 4 months old." "The 'T' stands for tuberculosis." "There are no side effects from this vaccine."

"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.

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? "By knowing normal growth and development, the nurse is able to identify problems in growth and development." "Understanding normal growth and development is vital because it allows the nurse to administer the correct doses of medication to children." "If a nurse understands normal growth and development, he or she will be able to identify normal milestones in children." "The nurse must understand normal development in order to measure the child's height and weight accurately."

"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 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." "Varicella is a highly contagious herpes virus." "Mild reactions occur in 5% to 10% of children." "The rate of herpes zoster has been declining since the vaccination program began."

"Children not immunized are at risk if exposed to the disease." The most compelling argument for vaccinating for varicella is that children not immunized are at risk if exposed to the disease. The parent needs to know that the infant has a greater chance of contracting the illness if not immunized. The contagious nature of the disease, low risk of the vaccine, nor the declining rate of incidence are not appropriate explanations for why the infant should have the vaccine.

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 will document the date and time the vaccine was given in the child's permanent record." "I do not need to document the vaccine manufacturer's name 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 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 always drink a big glass of milk before school." "I love to eat dry cereal for breakfast." "My mom put's frozen grapes in my lunch box." "I always pick chocolate milk instead of juice boxes for lunch."

"I love to eat dry cereal for breakfast." Protein is important at breakfast, and a glass of milk or milk on your cereal is a good source of it. 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.

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." "Since our child does not like broccoli, we will not put it on our child's plate." "We will freeze fruits before putting them in our child's lunchbox." "We will limit our child's snacks to after school and bedtime."

"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 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." "Unless there is a problem I do not need to bring my baby back to be seen until he is 6 months old." "I will need to schedule an appointment for my baby to be seen when he is 3 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

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 clinic offered me a list of resources that I can access via the citywide transportation system." "When I arrived, I found an area in the waiting room playing my toddler's favorite movie." "I ride the bus from my apartment that drops us off at the corner where the clinic is located."

"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." To be effective, the child's medical home must be easy to access, focused on the family, be culturally congruent and be community focuses. The clinic not having interpreters and printed information in the parents' native language demonstrates a lack of cultural congruency. Additional barriers are encountered when a parent must take time off from work in order to be at the appointment. Easy access is demonstrated by a location near the bus stop and the waiting room is child friendly. Offering a list of resources within the community and via city transportation further enhances the effectiveness of the clinic.

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." "Unfortunately there are no reliable screening tools for autism spectrum disorder available." "Autism spectrum disorder is on the rise and I understand your concern but screening is only done for those children considered to be at an increased risk." "Your child is too young for screening at this time."

"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 spectrum disorder 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? "This allows us to assess for color blindness in infants younger than 6 months." "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." "Children respond emotionally better to black and white patterns and pictures."

"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? "It is one of the most commonly used childhood vaccines." "This vaccine is approved by the American Academy of Pediatrics." "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.

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 chicken pox can be avoided, why not do so?" "I realize that the vaccine is somewhat costly, but it is likely to be more economical than dealing with chicken pox." "Your toddler should not receive this live-virus immunization today. It may present a risk to your pregnancy." "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."

"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.

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? "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?" "It is important to be current with your baby's progress, so we will see her today." "Follow me into the private exam room so we can discuss any concerns you have about your baby."

"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? 1/2 to 7 years 6 to 10 years 6 months to one year 0 to 2 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 reviewing a group of medical records for compliance with recommended well-child care visits. Which finding would warrant further investigation? A child who is 5 months old who was seen at one, two, and three months of age. A child who is 26 months whose last 2 visits were at 18 and 24 months. The 5-year-old child who has been seen annually since age 3. A 13-year-old child who was last seen 2 years ago.

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.

When providing anticipatory guidance to parents about lying during the preschool period, which of the following would the nurse emphasize? A) "You need to determine the reason for lying before punishing the child." B) "Lying typically occurs because the child is afraid of being punished." C) "The misbehavior is usually more serious than the lying itself." D) "It is okay to become angry when dealing with the child's lying."

A) "You need to determine the reason for lying before punishing the child."

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? A) A less discriminating sense of taste B) A lack of fully developed hearing C) Visual acuity that has not fully developed D) A less discriminating sense of touch

A) A less discriminating sense of taste

The nurse is conducting a well-child assessment for a 5-year-old boy in preparation for kindergarten. The boy's grandmother is his primary caregiver because the boy's mother has suffered from depression and substance abuse issues. The nurse understands that the child is at increased risk for which developmental problem? A) Lack of social and emotional readiness for school B) Stuttering C) Speech and language delays D) Fine motor skills delay

A) Lack of social and emotional readiness for school

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. Discuss systemic corticosteroid therapy. Change the bandage on a cut on the child's hand. Assess the child's fluid volume.

Assess how the family is coping with the chronic illness. Maintaining proper therapy for eczema can be exhausting both physically and mentally. Therefore it is essential that the nurse assess the parents' ability to cope with this stress. Changing a bandage is not part of a health supervision visit. Skin hydration is important for a child with eczema; however, fluid volume is not a concern. Systemic corticosteroid therapy is very rarely used and the success of the current therapy needs to be assessed first.

The parents of a 5-year-old boy tell the nurse that their son is having frequent episodes of night terrors. Which of the following statements would indicate that the boy is having nightmares instead of night terrors? A) "It usually happens about an hour after he falls asleep." B) "He will tell us about what happened in his dream." C) "He is completely unaware that we are there." D) "When we try to comfort him, he screams even more."

B) "He will tell us about what happened in his dream."

The nurse is conducting a well-child examination of a 5-year-old girl, who was 40 inches tall at her last examination at age 4. Which of the following height measurements would be within the normal range of growth expected for a preschooler? A) 41 inches B) 43 inches C) 45 inches D) 47 inches

B) 43 inches

The parents of a preschooler ask the nurse to help them choose a preschool for their child. Which of the following are recommended guidelines and goals for choosing a preschool? Select all answers that apply. A) The main goal of preschool is to improve reading and writing skills and readiness for entering into grade school. B) When selecting a preschool the parent may want to consider the accreditation of the school and the teachers' qualifications. C) The teachers should decide how focused on curriculum the school should be for each individual student. D) The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices. E) The type of discipline used in the school is also an important factor. Parents should choose a preschool that uses corporal punishment. F) The parent should observe the classroom to determine how the children interact with each other and how the teachers interact with the children.

B) When selecting a preschool the parent may want to consider the accreditation of the school and the teachers' qualifications. D) The parent should observe the classroom, evaluating the environment, noise level, and sanitary practices. F) The parent should observe the classroom to determine how the children interact with each other and how the teachers interact with the children.

After teaching the mother about follow-up immunizations for her daughter, who received the varicella vaccine at age 14 months, the nurse determines that the teaching was successful when the mother states that a follow-up dose should be given at which time? A) When the child is 20 to 36 months of age B) When the child is 4 to 6 years of age C) When the child is 11 to 12 years of age D) When the child is 13 to 15 years of age

B) When the child is 4 to 6 years of age

The nurse is performing a vision screening for a 4-year-old child. Which of the following screening charts would be best for determining the child's visual acuity? A) Snellen B) Ishihara C) Allen figures D) Color Vision Testing Made Easy (CVTME)

C) Allen figures

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? Complete a comprehensive health screening within the next week. 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. Postpone vaccines if the child has a low-grade fever or respiratory illness.

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 examining a 2-year-old child who was adopted from Guatemala. Which of the following would be a priority screening for this child? A) Screening for congenital defects B) Screening for abuse C) Screening for childhood illnesses D) Screening for infectious diseases

D) Screening for infectious diseases

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 DPT DT TdaP

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 performs the Weber test on a pediatric client. When the nurse asks the child if sound is heard in one ear or both, the child states, "I hear sound in the right ear." Which nursing action is most important? Document the finding in the medical record. Repeat the test in 30 minutes to 1 hour. Notify the primary health care provider. Ensure the child receives a referral to a specialist.

Ensure the child receives a referral to a specialist. This procedure assesses hearing and evaluates bone conduction of sound. The sound should be heard in both ears. It is a priority for the nurse to ensure the client is referred for proper follow-up care since the client only heard the sound in one ear. The nurse would document the finding and notify the primary health care provider; however, ensuring the client receives proper care is the most important. There is no need to repeat the test.

The nurse is discussing healthy eating habits with a school-age child and her parents. Which recommendation would the nurse make for the family? When serving food the child doesn't like, insist he or she takes several bites. Light snacks should be offered so the child doesn't overeat at meals. 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.

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. Allow the children to choose whether to get the screening completed that day or another day. Make a coloring page and allow the child to color it completely before beginning the screening. 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. 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 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? Taking a child's vital signs. Providing vaccinations to the children in a community. Teaching handwashing at an elementary school. Ordering the prescribed diet for a child who had surgery.

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. Many babies adopted from foreign countries have pediculosis. Testing by the child's home country is unreliable. The child may have come from rural China.

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.

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 infant should be seen by a dentist only if there is a concern of caries, decay, or infection. The infant should be seen by a dentist by 6 months of age if the infant has good oral health habits. The family should establish a regular dentist for the infant by his or her first birthday. The teeth should be brushed weekly with a washcloth or infant toothbrush and a small amount of toothpaste.

The family should establish a regular dentist for the infant by his or her first birthday. The infant should have an established regular dentist by the first birthday, regardless of oral health. The teeth should be brushed more often than weekly. If the parent notes caries or decay or has concerns about infection, the infant should be seen at that time and a dentist should be consulted for routine cleanings and care.

The nurse is anticipating that health supervision for a 5-year-old child will be challenging. Which indicator supports this concern? The mother dotes on the child. Grandparents play a significant role in the The child has a number of chores and responsibilities. The home is in a high-crime neighborhood. family.

The home is in a high-crime neighborhood. 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.

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 utilizes the correct size of infant car seat for her 3-month-old child. The mother becomes very frustrated and tells the nurse she can't handle her toddler's temper tantrum. The mother rarely looks at her infant when the nurse is assessing the child. The mother asks if the nurse has suggestions on ways to "potty train" her toddler. The mother voices pride in the academic accomplishments of her 7-year-old child.

The mother becomes very frustrated and tells the nurse she can't handle her toddler's temper tantrum. The mother rarely looks at her infant when the nurse is assessing the child. When the family is faced with excessive stressors, the nurse may be able to ascertain the stress by observing the parent-child interaction during the health supervision visit. The nurse can learn much about the family dynamic by observing the family for behavioral clues. Lack of eye contact and care of the infant is a clue to family stress, as well as ineffective parenting techniques for behaviors such as temper tantrums

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 father of the child states, "He didn't get first at the spelling bee, but he did well in his class." 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 says, "Wait until we are finished with this doctor's visit and then I will take you to the bathroom." The mother asks the father to hold the toddler when the nurse asks the mother to sign paperwork at the front desk.

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.

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 recommends the parents review the list of available specialists before they select one for referral. 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 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.

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 was born at 33 weeks' gestation. The teenager's blood pressure was 122/83. The teen gets no regular exercise. 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 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.

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 Rinne test tympanometry auditory brain stem response 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 will expect that which hearing test will be performed before the newborn is discharged home? pure-tone audiometry whisper test tympanometry auditory brainstem response

auditory brainstem response The auditory brainstem response (ABR) or the brainstem auditory-evoked response (BAER) is used for newborns. It measures the infant's electroencephalographic response to sound. All of the other hearing tests listed are used with older infants and children and are not appropriate for evaluating newborns.

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? hypertension eating disorder gross motor problems hearing deficit visual deficit

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.

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? difficulty with fine motor skills visual disorder articulation difficulties 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? diphtheria, tetanus, pertussis (DTap) rotavirus (RV) hepatitis A (HepA) H. influenzae type B (Hib)

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 will record what information about each vaccine after immunizing a child? Select all that apply. site and route of vaccine administration how vaccine was stored whether bacterial or viral lot number and expiration date of vaccine manufacturer of vaccine

site and route of vaccine administration manufacturer of vaccine lot number and expiration date 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.

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." "I suggest you offer your toddler healthy snacks after school and at bedtime rather than after dinner." "I am so glad you are reading to your baby, especially during feeding time." "If your school-aged child isn't current on immunizations, we can work to get them caught up."

"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 aware that the community affects the health of its members. Which of the following statements accurately reflect a community influence of health care? Select all answers that apply. A) A community can be a contributor to a child's health or be the cause of his or her illnesses. B) The child's health should be separated from the health of the surrounding community. C) Community support and resources are necessary for children with significant problems. D) Poverty has not been linked to an increase in health problems in communities. E) The breakdown of community and family support systems can lead to depression and violence. F) Ideally, the child's medical home is located outside the community.

A) A community can be a contributor to a child's health or be the cause of his or her illnesses. C) Community support and resources are necessary for children with significant problems. E) The breakdown of community and family support systems can lead to depression and violence.

When assessing the vision of a 2-month-old, the nurse would use which of the following? A) Black-and-white checkerboard B) Red and blue circles C) Gray and blue animal drawings D) Green and yellow letters

A) Black-and-white checkerboard

During a physical assessment of a 5-month-old child, the nurse observes the first tooth has just erupted and uses the opportunity to advise the mother to schedule a dental examination for her baby. Which of the following is the correct time for the dentist visit? A) By the first birthday B) By the second birthday C) By entry into kindergarten D) By entry into first grade

A) By the first birthday

The parents of a 4-year-old who is a picky eater ask the nurse what foods to include in their child's diet to provide adequate iron consumption. Which of the following foods would the nurse recommend? A) Cooked lentils B) Whole milk C) Oranges D) Sweet potatoes

A) Cooked lentils

The nurse is caring for preschoolers in a day care center. Of which of the following developmental milestones of this age group should the nurse be aware? Select all answers that apply. A) Counting 10 or more objects B) Correctly naming at least four colors C) Understanding the concept of time D) Knowing everyday objects E) Understanding the differences of others F) Forming concepts as logical as an adult's

A) Counting 10 or more objects B) Correctly naming at least four colors C) Understanding the concept of time D) Knowing everyday objects

The nurse is conducting a psychosocial assessment of a child with asthma brought to the physician's office for a check-up. Which of the following are psychosocial issues that might be assessed? Select all answers that apply. A) Health insurance coverage B) Transportation to health care facilities C) School's response to the chronic illness D) Past medical history E) Future treatment plans F) Health maintenance needs

A) Health insurance coverage B) Transportation to health care facilities C) School's response to the chronic illness

The nurse is caring for a 5-year-old girl posttonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process? A) Magical thinking B) Centration C) Transduction D) Animism

A) Magical thinking

The nurse is teaching the parents of a 4-year-old boy about the normal maturations of the child's organs during the preschool years and their effect on body functions. Which of the following statements accurately describe these changes? Select all answers that apply. A) Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. B) The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. C) Heart rate increases and blood pressure decreases slightly during the preschool years; an innocent heart murmur may be heard upon auscultation. D) The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. E) The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler. F) The urethra remains long in both boys and girls, making them more susceptible to urinary tract infections than adults.

A) Myelination of the spinal cord allows for bowel and bladder control to be complete in most children by age 3 years. B) The respiratory structures are continuing to grow in size, and the number of alveoli continues to increase, reaching the adult number at about 7 years of age. D) The bones continue to increase in length and the muscles continue to strengthen and mature; however, the musculoskeletal system is still not fully mature. E) The small intestine is continuing to grow in length, and stool passage usually occurs once or twice per day in the average preschooler.

When observing a group of preschoolers at play in the clinic waiting room, which type of play would the nurse be least likely to note? A) Parallel play B) Cooperative play C) Dramatic play D) Fantasy play

A) Parallel play

The nurse working in a community clinic attempts to establish a free vaccination program to refer low-income families. What is the key strategy for success when implementing a health promotion activity? A) Partnership development B) Funding for projects C) Finding an audience D) Adequate staffing

A) Partnership development

The nurse is assessing the psychosocial development of a preschooler. Which of the following are normal activities characteristic of the preschooler? Select all answers that apply. A) Plans activities and makes up games B) Initiates activities with others C) Acts out roles of other people D) Engages in parallel play with peers E) Classifies or groups objects by their common elements F) Understands relationships among objects

A) Plans activities and makes up games B) Initiates activities with others D) Engages in parallel play with peers

The school nurse is helping parents choose books for their preschoolers. What literacy skills present in the preschooler would the nurse consider when making choices? Select all answers that apply. A) Preschoolers enjoy books with pictures that tell stories. B) Preschoolers like stories with repeated phrases as they help keep their attention. C) Preschoolers like stories that describe experiences different from their own. D) Preschoolers demonstrate early literacy skills by reciting stories or portions of books. E) Preschoolers may retell the story from the book, pretend to read books, and ask questions about the story. F) Preschoolers do not have enough focus and expanded attention to notice when a page is skipped during reading.

A) Preschoolers enjoy books with pictures that tell stories. B) Preschoolers like stories with repeated phrases as they help keep their attention. D) Preschoolers demonstrate early literacy skills by reciting stories or portions of books. F) Preschoolers do not have enough focus and expanded attention to notice when a page is skipped during reading

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. Which of the following is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? A) Reward the child for initiative in order to build self-esteem. B) Change the routine of the preschooler often to stimulate initiative. C) Do not set limits on the preschooler's behavior as this results in low self-esteem. D) As a parent, decide how and with whom the child will play.

A) Reward the child for initiative in order to build self-esteem.

The nurse is examining a 15-month-old child who was able to walk at the last visit and now can no longer walk. What would be the nurse's best intervention in this case? A) Schedule a full evaluation since this may indicate a neurologic disorder. B) Note the regression in the child's chart and recheck in another month. C) Document the findings as a developmental delay since this is a normal occurrence. D) Ask the parents if they have changed the child's schedule to a less active one

A) Schedule a full evaluation since this may indicate a neurologic disorder.

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn. The nurse understands that due to her developmental stage, the girl is at risk of which of the following? A) Viewing her baby sister's illness as her fault B) Harming the baby C) Experiencing clinical depression D) Creating an imaginary friend to cope with the situation

A) Viewing her baby sister's illness as her fault

The parents of a 4-year-old ask the nurse when their child will be able to differentiate right from wrong and develop morals. What would be the best response of the nurse? A) "The preschooler has no sense of right and wrong." B) "The preschooler is developing a conscience." C) "The preschooler sees morality as internal to self." D) "The preschooler's morals are their own, right or wrong."

B) "The preschooler is developing a conscience."

The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond? A) "It is best to just ignore this and to not respond to his questions." B) "This is normal; children his age do not understand the permanence of death." C) "You have to keep repeating that his grandfather is never coming back." D) "He will eventually figure this out on his own."

B) "This is normal; children his age do not understand the permanence of death."

The nurse is discussing vaccination for Haemophilus influenzae type B (Hib) with the mother of a 6-month-old child. Which of the following comments provides the most compelling reason to get the vaccination? A) "These bacteria live in every human." B) "Young children are especially susceptible to these bacteria." C) "You have a choice of two excellent vaccines." D) "Your child needs this final dose for protection."

B) "Young children are especially susceptible to these bacteria."

The nurse is performing developmental surveillance for children at a medical home. Which of the following infants are most at risk for developmental delays? Select all answers that apply. A) A child whose birthweight was 1,600 g B) A child whose parent has a mental illness C) A child raised by a single parent D) A child with a lead level above 10 mg/dL E) A child with hypertonia or hypotonia F) A child with gestational age more than 33 weeks

B) A child whose parent has a mental illness C) A child raised by a single parent E) A child with hypertonia or hypotonia

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 of the following facilities does the nurse work? A) An urgent care center B) A pediatric practice C) A mobile outreach immunization program D) A dermatology practice

B) A pediatric practice

The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. Which of the following will the nurse do during the visit? A) Change the bandage on a cut on the child's hand B) Assess the compliance with treatment regimens C) Discuss systemic corticosteroid therapy D) Assess the child's fluid volume

B) Assess the compliance with treatment regimens

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. Which of the following is a recommended guideline when dealing with this issue? A) Be prepared to thoroughly cover a topic before the child asks about it. B) Before answering questions, find out what the child thinks about the subject. C) Expand upon the topic when answering questions to prevent further confusion. D) Provide a less than honest response to shelter the child from knowledge that is too advanced.

B) Before answering questions, find out what the child thinks about the subject.

The nurse is caring for an infant who had hyperbilirubinemia requiring exchange transfusion. Based on this information, this infant is at risk for what type of disorder? A) Vision loss B) Hearing loss C) Hypertension D) Hyperlipidemia

B) Hearing loss

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 of the following is the best action for the nurse to take? A) Do nothing because responding to the bell proves he does not have a hearing deficit. B) Immediately schedule the infant for a newborn hearing screening. C) Ask the mother to observe for signs that the infant is not hearing well. D) Screen again with the bell at the 2-month-old health supervision visit.

B) Immediately schedule the infant for a newborn hearing screening.

The nurse is explaining the difference between active and passive immunity to the student nurse. Which of the following statements accurately describes a characteristic of the process of immunity? A) Active immunity is produced when the immunoglobulins of one person are transferred to another. B) Passive immunity can be obtained by injection of exogenous immunoglobulins. C) Active immunity can be transferred from mothers to infants via colostrum or the placenta. D) Passive immunity is acquired when a person's own immune system generates the immune response.

B) Passive immunity can be obtained by injection of exogenous immunoglobulins.

The nurse is counseling parents of a picky eater on how to promote healthy eating habits in their child. Which of the following interventions would be appropriate advice? A) Allow the child to pick out his or her own foods for meals. B) Present the food matter-of-factly and allow the child to choose what to eat. C) Offer high-fat snacks if the child does not eat to get him or her to eat something. D) Offer the child a special treat if he or she eats all the food on the plate.

B) Present the food matter-of-factly and allow the child to choose what to eat.

The nurse is performing a risk assessment of a 5-year-old and determines the child has a risk factor for cystic fibrosis. What type of screening would the nurse perform to confirm or rule out this disease? A) Universal screening B) Selective screening C) Hyperlipidemia screening D) Developmental screening

B) Selective screening

When preparing to administer the polio vaccine to an infant, the nurse would expect to administer the vaccine by which route? A) Intramuscular B) Subcutaneous C) Oral D) Intradermal

B) Subcutaneous

The nurse strives to provide culturally competent care for children in a health clinic that follows the principles of health supervision. Which of the following nursing actions reflects this type of care? A) The nurse treats all children the same regardless of their culture. B) The nurse negotiates a care plan with the child and family. C) The nurse researches the child's culture and provides care based on the findings. D) The nurse provides future-based care for culturally diverse children.

B) The nurse negotiates a care plan with the child and family.

The nurse is preparing a presentation to a local parent group about pediatric health supervision. Which of the following would the nurse emphasize as the focus? A) Injury prevention B) Wellness C) Health maintenance D) Developmental surveillance

B) Wellness

Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium? A) Spinach B) White beans C) Enriched bread D) Fortified cereal

B) White beans

A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother? A) "It is best to avoid the playground until she outgrows the fear." B) "She needs to face her fears head-on; take her to the park as much as possible." C) "Acknowledge her fear and help her develop a strategy for dealing with it." D) "Try to minimize her fears and insist that she go to the park."

C) "Acknowledge her fear and help her develop a strategy for dealing with it."

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? A) "I'll be able to tell you more after I do his physical." B) "Fill out the questionnaire and then I can let you know." C) "Tell me what concerns you." D) "All mothers worry about their babies. I'm sure he's doing well."

C) "Tell me what concerns you."

The nurse is providing care for children in a pediatric medical home. Which of the following is a characteristic of care in these types of facilities? A) All insurance except Medicaid is accepted. B) Ambulatory care is not provided C) A centralized database contains all child information. D) Continuity of care is provided from infancy through adulthood.

C) A centralized database contains all child information

The nurse is assessing the motor skills of a 5-year-old girl. Which finding would cause the nurse to be concerned? A) Can copy a square on another piece of paper B) Can dress and undress herself without help C) Draws a person with three body parts D) Is beginning to tie her own shoelaces

C) Draws a person with three body parts

The nurse is screening a 6-year-old child for mental ability. Which of the following tests would the nurse use to assess intelligence? A) Denver Articulation Screening B) Denver PRQ C) Goodenough-Harris Drawing Test D) Parents' Evaluation of Developmental Status (PEDS

C) Goodenough-Harris Drawing Test

The nurse is caring for children in a physician's office where health supervision is practiced. Which of the following is a key focus of health supervision? Select all answers that apply. A) Making referrals for all health care needs B) Monitoring disease incidence C) Optimizing level of functioning D) Monitoring quality of care provided E) Teaching parents to prevent injury F) Providing care developed from national guidelines

C) Optimizing level of functioning E) Teaching parents to prevent injury F) Providing care developed from national guidelines

The nurse is supervising lunch time for children on a pediatric ward. Which of the following observations is considered abnormal for this age group? A) The child has a full set of primary teeth. B) The child has no difficulty chewing and swallowing meat. C) The child uses his fingers and refuses to use a fork. D) The child is a picky eater.

C) The child uses his fingers and refuses to use a fork.

A 3-year-old child is scheduled for a hearing screening. The nurse would prepare the child for screening by which method? A) Auditory brain stem response B) Evoked otoacoustic emissions C) Visual reinforcement audiometry D) Conditioned play audiometry

D) Conditioned play audiometry

The nurse is providing teaching about car safety to the parents of a 5-year-old girl who weighs 45 pounds. What should the nurse instruct the parents to do? A) "Place her in a booster seat with lap and shoulder belts in the front seat." B) "Place her in the back seat with the lap and shoulder belts in place." C) "Place her in a forward-facing car seat with a harness and top tether." D) "Place her in a booster seat with lap and shoulder belts in the back seat."

D) "Place her in a booster seat with lap and shoulder belts in the back seat."

The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond? A) "Is there a family history of diabetes?" B) "Suddenly having accidents can be a sign of diabetes." C) "That's normal; don't worry about it." D) "Tell me about the circumstances when this occurs."

D) "Tell me about the circumstances when this occurs."

The mother of a 15-month-old child is questioning the nurse about the need for the hepatitis B vaccination. Which of the following comments provides the most compelling reason for the vaccine? A) "The most common side effect is injection site soreness." B) "This is a recombinant or genetically engineered vaccine." C) "Immunizations are needed to protect the general population." D) "This protects your child from infection that can cause liver disease."

D) "This protects your child from infection that can cause liver disease."

Which activity would the nurse least likely include as exemplifying the preconceptual phase of Piaget's preoperational stage? A) Displays of animism B) Use of active imaginations C) Understanding of opposites D) Beginning questioning of parents' values

D) Beginning questioning of parents' values

A 15-month-old girl is having her first health visit at a clinic. The mother has no immunization record but says the child was immunized 3 months ago at the local health department. Which of the following is the best action for the nurse to take? A) Ask the mother to bring the records to the next health maintenance visit. B) Start the catch-up schedule since there are no immunization records. C) Keep the child at the facility while the mother returns home for the records. D) Call the local health department and verify the child's immunization status.

D) Call the local health department and verify the child's immunization status

The nurse is providing anticipatory guidance to an obese teenager. Which of the following interventions would be most likely to promote healthy weight in teenagers? A) Make the focus of the program weight centered. B) Begin directly advising children about their weight at age 6. C) Focus physical activity on competitive sports and activities. D) Obtain nutritional histories directly from the school-age child and adolescent

D) Obtain nutritional histories directly from the school-age child and adolescent.

A mother and her 4-week-old infant have arrived for a health maintenance visit. Which of the following activities will the nurse perform? A) Assess the child for an upper respiratory infection B) Take a health history for a minor injury C) Administer a varicella injection D) Plot the child's head circumference on a growth chart

D) Plot the child's head circumference on a growth chart

The nurse is administering a hepatitis B vaccine to a child. What is the classification of this type of vaccine? A) Killed vaccines B) Toxoid vaccines C) Conjugate vaccines D) Recombinant vaccines

D) Recombinant vaccines

The nurse is developing a nursing care plan for a hospitalized 6-year-old. Which of the following behaviors would warrant nursing intervention? A) The child pretends he is talking to an imaginary friend when the nurse addresses the child. B) The child states that her fairy godmother is going to come and take her home. C) The child starts talking about his grandmother and then quickly changes the subject to a new toy he received. D) The child does not want to play games with other children on the hospital ward.

D) The child does not want to play games with other children on the hospital ward.

The nurse of a preschool child is helping parents develop a healthy meal plan for their child. Which of the following nutritional requirements for this age group should the nurse consider? A) The 3- to 5-year-old requires 300 to 500 mg calcium and 10 mg iron daily. B) The 3-year-old should consume 10 mg dietary fiber daily. C) The 4- to 8-year-old requires 15 mg dietary fiber per day. D) The typical preschooler requires about 85 kcal/kg of body weight.

D) The typical preschooler requires about 85 kcal/kg of body weight.

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. Newborn screening needs to be repeated at 1 week of age. The newborn metabolic screen can be done anytime after the first formula or breastmilk feeding. These tests will need to be completed between 24 and 48 hours of age.

Newborn metabolic screening needs to be performed at or after 48 hours of age. Newborn metabolic screening is used to assess for the presence of health conditions and metabolic disorders. These tests are mandated by state law. If the tests were not performed or were performed at younger than 48 hours of age, the screening should be performed during the initial health supervision visit. The metabolic screening results need to be noted in the child's permanent record, as these tests are legally mandated.

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. 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. Schedule separate appointments for families with multiple children so the focus will be on one child at a time during the visit.

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 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? Schedule separate appointments for families with multiple children so the focus will be on one child at a time during the visit. 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. Providing education that free vaccines are only given by the local public health agencies.

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.