Chapter 31: Health Supervision

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.

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 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 student nurse asks the nursing instructor why nurses must be adept at understanding normal growth and development in children when providing care. What should the nursing instructor respond?

"By knowing normal growth and development, the nurse is able to identify problems in growth and development."

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

"Do you hear the sound in one or both ears?"

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 statements 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."

The nurse is caring for families at a health clinic. Which statement by a client would indicate to the nurse the health clinic could 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."

A pregnant woman reports she is interested in breastfeeding to promote improved health for her child. Which statement by the nurse is most appropriate?

"Passive immunity can be transmitted to your child providing him with some temporary immunity against illness."

The mother of a 6-month-old child reports she has been hearing so much about autism. 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."

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

"The testing may have been unreliable due to outdated testing supplies, poor storage of testing supplies and unreliable documentation."

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."

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?"

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 is caring for a variety of pediatric clients in the community health clinic. Which client is the nurse most concerned with being at risk for iron-deficiency anemia?

A 16-year-old, pregnant for the first time and lives with her parents

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

Artificially acquired active immunity

The nurse will expect that which hearing test will be performed before the newborn is discharged home?

Auditory brainstem response

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

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

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

Denver Articulation Screening

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

Parents report that their neonate received intravenous antibiotics while in the newborn nursery. The nurse recognizes this as a potential risk factor for which health problem?

Hearing impairment

The 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 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.

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

Sign a consent form

The nurse is anticipating that health supervision for a 5-year-old child will be challenging. Which indicator supports this concern?

The home is in a high-crime neighborhood.

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."

Which situation would indicate the nurse is facilitating trust in the family members decisions about their child's health?

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

The nurse has just taken the blood pressure of a 13-year-old, and the percentile rank is 88%. Why would the nurse categorize the child as prehypertensive?

The teenager's blood pressure was 122/83.

A family of five seeks care for their preschooler with an upper respiratory infection. The facility has no medical record for the family. Why does the nurse encourage this family to establish a medical home?

To establish a continuing relationship with a physician or nurse practitioner