PEDS Practice: Chapter 9 Health Supervision
During a physical assessment of a 6-year-old child, the nurse observes the child has lost a tooth. The nurse uses the opportunity to promote oral health care with the child and parents. Which comment should the nurse include in this discussion?
"Oral health can affect general health." The nurse will advise the parents that poor oral health can have significant negative effects on systemic health. Discussing fluoridation and community health may have little interest to the mother. Placing the hands in the mouth exposes the child to pathogens and is appropriate for personal hygiene promotion. Soft drink consumption is better covered during healthy diet promotion. pg 263
The nurse 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 to provide additional teaching to the newly licensed nurse?
"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.
A dental home (like a medical home) establishes a continuing comprehensive relationship of care with the child and family. The American Academy of Pediatric Dentistry (AAPD) recommends this dental home be established by the time the child is age:
1 year The recommendation is by the child's first birthday. This is the time the first dental exam should occur. pg 263
The nurse is observing the parents and child during a health supervision visit. Which observation would alert the nurse to inquire and observe further?
The mother says, "Wait until we are finished with this doctor's visit and then I will take you to the bathroom." The parent is not responding the child's need to go to the bathroom, which would alert the nurse to inquire and observe further. The other choices are ideal responses from the parent, indicating they have a healthy parent-child interaction and dynamic. pg 237
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." 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. page 249
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." 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.
By which route is the diphtheria, tetanus, and pertussis (TDaP) vaccine administered to infants?
Intramuscularly All diphtheria, tetanus, and pertussis vaccines (TDaP, TD, Tdap) are administered intramuscularly to children of all ages. A needle of appropriate length must be used to reach the muscle and avoid depositing the vaccine in subcutaneous tissue. pg 250
Which question by the nurse is the best one to elicit complete information about a young boy's immunization status?
"When and where did your child receive his last immunization?" The when/where questions gather relevant information and are good starting points for further investigation of the immunization status as well as an opening for discussion of any concerns. The parent is likely to be able to answer these questions. Asking which immunization the child needs and questions regarding immunizations at various ages may cause the parent to be unable to answer and create discomfort. The up-to-date question will likely result in a "yes-no" response and yield little information and not further discussion. pg 250
The nurse will use the Denver Articulation Screening for children in what age range?
2 1/2 to 7 years The Denver Articulation Screening is designed for children 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 two weeks and referred for complete language testing if the repeat exam is abnormal. pg 242
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?
4 The newborn with an Apgar score of 4 or less at 1 minute or of 6 or less at 5 minutes is at high risk for a hearing deficit. Careful, continuing follow-up is important. pg 245
Which nurse response to the parent indicates the nurse recognizes the importance of the child's increasing responsibility for their personal heath choice?
"I recommend you talk with your adolescent child and discuss their preference for which dentist to visit." The child's participation in their 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. pg 237
The nurse is performing a vision screening for a 2-month-old. Which technique should the nurse use?
Move a card with a black-and-white checkerboard pattern in a 180-degree arc past the infant. By 2 months of age, the infant should be able to fixate and follow objects 180 degrees. The black-and-white checkerboard pattern has distinct contrasts for which the young infant's vision is attuned. A colorful toy is less visually appealing. The clown photo held at 10 to 12 inches from the infant will invite fixation but not check the visual range. The black-and-white panda has good contrast, but the 2-month-old should follow to 180 degrees, not to just midline. pg 243
What developmental categories will the nurse assess when screening with the Denver II Developmental Screening Test? Select all that apply.
Personal-social Fine motor--adaptive Language Gross motor skills The Denver II is not a test of intelligence; it is used to assess the child's level of development. This differentiation should be made clear to parents. A task not passed on the Denver II indicates a delay in that area. Further evaluation is needed to determine the reason for this delay. pg 239
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. 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. pg 262
A single mother has brought her 9-month-old, recently adopted Chinese daughter for a health supervision visit. Although there are screening documents from China and the child seems healthy, the nurse plans to screen for infectious diseases. What explains the nurse's caution?
Testing by the child's home country is unreliable. 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. p 238
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." 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. pg 239
Which information obtained by the nurse from the parents at the initial health supervision visit would alert the nurse to conduct the newborn metabolic screening during this visit?
The screening was completed when the newborn was 24 hours old Newborn metabolic screenings should when the child is older than 48 hours. The other options indicate the screening was completed appropriately and should not be repeated.
The nurse has just taken the blood pressure of a 13-year-old, and the percentile rank is 88%. Why would the nurse categorize the child as prehypertensive?
The teenager's blood pressure was 122/83. A blood pressure greater than 120/80 is categorized as prehypertensive regardless of the percentile. Preterm birth is a risk factor for hypertension and does not indicate prehypertension itself. A high-fat diet and lack of exercise are risks for cardiovascular disease. Both require the nurse's attention to promote health but are not factors in categorizing the adolescent as prehypertensive. pg 248
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." Children may obtain some temporary immunity from breastfeeding. This is referred to as passive immunity. Active immunity is achieved when the immune system is exposed to pathogens and antigens are developed. pg 249
The father of a 13-year-old boy reports his family has a strong history of depression. He questions screening for his son. What information should be provided by the nurse?
"Children should be screened for depression every year beginning at age 11." Academy of Pediatrics recommended screening tool [CRAFFT) and a depression screening is recommended annually beginning at age 11. It is clear that the parent is voicing concerns for his son's risk factors. The question asked does not provide the information being requested. pg 241
The parents of a child, recently adopted internationally, asks the nurse why it is recommended that their child be screened for intestinal parasites. What would be the best response by the nurse?
"Children with intestinal parasites often exhibit no signs or symptoms, so a screening is recommended." Children with intestinal parasites are often asymptomatic so screening is recommended. It is not true that all children from other countries have intestinal parasites. The public school system does not screen or treat for parasites. The screening is done for the health of the child and is not related to the cost of treatment. Treatment would not be completed unless the child had intestinal parasites.
The school nurse has completed an educational program about vaccines to a group of parents. Which statement by a parent would indicate the need for further education?
"My 7-year-old will need to get a Hib booster at his next checkup." Hib vaccine is not routinely given to children 5 years of age or older. Haemophilus influenzae type B is a bacterium that causes several life-threatening illnesses in children younger than 5 years of age. These infections include meningitis, epiglottitis, and septic arthritis. A booster vaccine is needed at 12 to 15 months. pg 260
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." 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. pg 239
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 communiuty?
"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. 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 American Academy of Pediatrics recommends performing a screening test for autism 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. pg 239
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 mother may not understand that combining the vaccines creates no safety or effectiveness problems and 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. pg 262
During a well-child visit for a 2-month-old infant, the nurse explains the need to perform a hearing screening on the child within the next few months. The child's mother reports she has not noticed any deficits and does not see the need for this being done. Which response by the nurse is indicated?
"Unfortunately hearing losses in infants are common and it is best to check hearing before your child is 6 months old to rule out problems." Hearing screening should be performed by the age of 6 months. This will help to ensure early intervention if needed. pg 243
Which statements by a parent would indicate to the nurse that the family has a future-based orientation?
"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." Obtaining prescriptions to have on hand for an asthma attack demonstrates planning ahead for an event. Having the child vaccinated now in order to avoid the disease in the future demonstrates a future-based orientation in which the child/family believe they have control in their own health. Ensuring physical activity helps in preventing obesity in children. The other choices indicate a present-based orientation in which there is little control over health concerns and the family/child feel their own input or prevention strategies are not going to make a difference. pg 237
Children in what age range are screened by nurses using the Denver II Screening Test?
0 to 6 years The Denver II Developmental Screening Test is the most widely used tool to assess childhood development during the years leading up to school. It is regularly administered by nurses, requires special training but is simple to learn to administer. pg 242
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. 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 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 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 undated with each visit. Vaccines are not postponed for mild respiratory illnesses or low grade fevers
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?
Do the well-child exam and give the immunizations due. The well-child exam can proceed and all the immunizations can be given. The child is not at risk for adverse reactions because she has an upper respiratory infection and very slightly elevated temperature. The child is also not at risk for not developing the proper immune response. Slight fever and minor respiratory illness should not postpone immunizations. Those postponed are at risk for not being received. There is no reason to give some of the immunizations and not others (MMR). pg 251
The nurse is performing a vision screening for 6-year-old child. Which screening chart is best for the nurse use to determine the child's ability to discriminate color?
Ishihara The Ishihara chart is best for the 6-year-old because the child will know numbers. CVTME charts are designed to assess color vision discrimination for preschoolers. The Allen figures chart and the Snellen charts are for assessing visual acuity. pg 246
The nurse is discussing healthy eating habits with a school-age child and her parents. Which recommendation would the nurse make for the family?
Light snacks should be offered so the child doesn't overeat at meals 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 they do like and they will eventually explore new or previous disliked foods. pg 264-265
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 3-week-old infant who was discharged without a hearing screening Healthy People 2020 details the objective to increase the proportion of newborns who are screened for hearing loss by the age of 1 month. The 3-week-old infant would need to be screened since a screening was not done previously. The other choices indicate the screening is not recommended due to it previously being completed and there are not indications of hearing loss. page 243
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. 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. pg 238
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 infant's mother is a single parent. The mother did not complete high school. Being a single parent and not having a high school education are risk factors that could result in developmental problems for the child. Often poverty is the underlying associated difficulty. The other findings should not intrude negatively on the infant's development. pg 239
Due to a certain warning sign, the nurse is anticipating that health supervision for a 7-year-old child will be challenging. Which indicator supports this concern?
The parents made several negative remarks about the child. Disparaging remarks about the child is a warning sign. Lack of respect for the child can undermine the nurse-parent-child partnership needed for successful health supervision. Older grandparents who follow a healthy lifestyle are a plus for the child. Developmentally appropriate home responsibilities suggest positive parenting practices. A garden providing fresh produce can support good eating habits. page 236
A pediatric nurse will state that the priority reason to have a thorough grasp of the growth and development of children is to:
identify developmental risks or delays promptly. Finding risks for developmental delays early allows for prompt intervention likely to result in a more positive outcome. Having thorough knowledge of growth and development does enhance the joy of working with children, does assist with providing anticipatory guidance for parents, and does promote effective communication with the various ages. These are all important, but not the priority.
The nurse will record what information about each vaccine after immunizing a child? Select all that apply.
Lot number and expiration date of vaccine Site and route of vaccine administration Manufacturer of vaccine 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 presently is not recorded at the time of administration. The viral or bacterial nature of the vaccine is already known. pg 251
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. 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 nurse is employed at a clinic that provides services to a large population of clients from a culture with a present-based orientation. When providing education about proper nutrition to a family from this culture, which would be the best response by the nurse?
"Eating a healthy breakfast will give your child the energy to stay awake and focused during school each day." Significant numbers of children belong to cultures with a present-based orientation. These cultures are more concerned about what is going on now. For these children, health promotion activities need shorter-term goals and outcomes to be useful. pg 237
The nurse manager is orienting a new nurse. Which statement by the new nurse would indicate that the nurse manager should intervene?
"I do not need to document the vaccine manufacturer's name in the child's permanent record." pg 251 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.
A mother calls the doctor's office to let them know that her son has had a fever and a runny nose. The mother wants to know if she should still bring him for his 15-month immunizations. What is the appropriate response from the nurse?
"Yes, bring him in, he can still have his shots." Low-grade fevers and minor respiratory infections are not contraindications for vaccinations. The only true contraindications are a history of reactions to vaccines or encephalopathy within 7 days after the DTaP vaccine. If the mother does not bring her son in, or if he is seen in the office but no immunizations are given, he will be behind on his vaccination schedule.
The mother of a 5 month-old tells the nurse that she thinks her baby has difficulty hearing. The nurse anticipates assisting with which hearing tests to assess this 5 month-old child's hearing? Select all that apply.
Auditory brain stem response Otoacoustic emissions (EOAE) Auditory brain stem response and otoacoustic emissions (EOAE) testing are the methods used for infants 6 months of age and younger. Tympanometry is used for children 7 months and older. Conditioned play audiometry (CPA) is for children 2 to 4 years of age, and pure-tone audiometry is for children 4 years and older. pg 243
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 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. pg 244
The nurse will expect that which hearing test will be performed before the newborn is discharged home?
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. p 245
The nurse is reviewing the health history of an infant who is demonstrating developmental delays. Which finding would be considered a possible risk factor?
Being raised by a single teenaged mom Parental factors can be associated with developmental delays in the child. Being raised by a single parent or a parent having less than a high school education are associated with delays in the child. Birth weight less than 1500 grams is associated with delays. Children born at 33 weeks' gestation or less are at an increased risk for developmental delays. pg 239
A nurse is working to provide health promotion services throughout the community. What institutions or organizations best serve as important avenues for disseminating health promotion information? Select all that apply.
Churches, synagogues, and mosques Schools (public and private) Day care centers Religious groups value health and often have a health committee or parish nurse who can participate in a community-wide health promotion effort. Schools teach health in their classrooms and have health promotion activities for students and employees through things such as nutrition and exercise programs. Day care centers work to promote health through the programs developed for their enrollees and parents. Many families can be reached through these venues. Political organizations and environmental groups may well have health-promoting functions, but these are likely to be narrower in focus and directed toward a particular constituent base. pg 263
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 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. pg 251
Parents report that their 4-year-old is difficult to understand. Which screening tool will the nurse use?
Denver Articulation Screening The nurse would administer the Denver Articulation Screening. It is given to children 2½ to 7 years of age to detect differences in speech sounds beyond those considered normal. It is standardized, is easy to administer in a brief time, and is meant for English speakers only. Those who score below their age group norms should be retested within 2 weeks and referred for complete language testing if the repeat examination is abnormal. The Denver II includes a language category but is not an articulation screening test. Goodenough-Harris and Bayley are tests of intelligence that do not evaluate speech sounds. page 242
When working in a very busy pediatric office or clinic, nurses could substitute which screening test for the Denver II Developmental Screening Test to detect delays that otherwise could be missed?
Denver Prescreening Developmental Questionnaire (R-PDQ) The Denver Prescreening Developmental Questionnaire serves as a parental report of items on the Denver II. It is designed to identify children for whom follow-up with a complete Denver II Developmental Screening Test is needed. It is useful for practices with little time to conduct the full Denver II for all infants and young children. The Bayley Scale and the Goodenough-Harris Test focus mainly on intelligence testing and require special training to administer and score. The Denver Articulation Screening is designed to assess early speech development. pg 242
Place in proper order the vision screening procedures used by the nurse to assess children from neonate to school age.
Fixate on an object at 10 to 12 inches Follow object to midline Follow object past midline Respond to E chart Use Snellen test for visual acuity Neonates should be able to fixate on an object 10 to 12 inches from the face. After fixation, infants should follow to midline. By 2 months, infants follow to 180°. The preschool E chart, sometimes called the "tumbling E," works well for this age group. School-age children who know the alphabet should be given the Snellen test. p 243
Infants born to mothers who are HbsAg-positive need to receive the hepatitis B immunoglobulin (HBIG) within how many hours?
HBIG needs to be given in 12 hours. The infant needs to receive the vaccine within 12 hours and complete all doses. Otherwise, the infant is at 90% risk of contracting hepatitis B or liver cancer in his or her 30s and 40s.
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 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. pg 245
The mother of a 4-month-old refuses for her baby to be "stuck" when immunized. What immunization will the nurse administer under these restrictions?
Rotavirus Rotavirus is the only vaccine given orally. All the others are injected. Because of the ease of administration, oral polio vaccine containing a live virus continues to be used in underdeveloped countries. Vulnerable individuals are at risk for infection from live viruses excreted in the stool. This is the reason why only injected polio vaccine is used in the United States.
While enrolled in a geography course, a student nurse learns that diarrheal illness is deadly for large numbers of infants in Third World countries. What vaccine will this nursing student identify as part of the solution to this problem?
Rotavirus (RV) 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. pg 261
The nurse works at a health clinic located in a suburb of a large city. Which action by the health clinic will further enhance the bond between child, family and community?
Setting up screenings in a public library downtown By bringing services into the city to a community resource already established (library) the clinical nurse will be increasing access via public transportation and location. The other choices inhibit community access by closing at a time when most parents are still at work, by assuming parents can afford taxi fares, and by limiting evening hours and walk-ins for those parents who may be unable to schedule transportation but instead rely on neighbors or family for rides. pg 238
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 A medical home is a physician or nurse practitioner with a long-term, comprehensive relationship with the family. This results in better health supervision and overall improved care. Having a medical home does not give special treatment to its constituents in the way of priority or services, insurance coverage, or cost reduction, although, because of the high level of health supervision, some of these benefits could result due to illnesses being prevented or discovered and treated early. p 236
The nurse is discussing Varicella immunization with a mother of a 13-month-old. The mother is reluctant to vaccinate because she feels it is "not necessary." Which comment by the nurse will be most persuasive for immunization?
"Children not immunized are at risk if exposed to the disease." The most compelling argument for vaccinating for Varicella is that children not immunized are at risk if exposed to the disease. The mother needs to know about the chance of her child contracting the illness if not immunized. The contagious nature of the disease, low risk of the vaccine, or the low incidence of reactions is not appropriate explanations for why the child should have the vaccine.
The nurse is preparing to administer the hepatitis A vaccine to a child. Which statement by the child's parent would indicate a need for further education?
"Hepatitis A can result in a serious infection that affects the liver." Hepatitis B virus can result in a serious infection that affects the liver. Hepatitis A vaccine is recommended to be given to all children at age 12 months, followed by a repeat dose in 6 to 12 months. Hepatitis A is spread through close physical contact and by eating or drinking contaminated food or water. pg 260
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 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. pg 247
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 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. pg 260
Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?
Artificially acquired active immunity Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child's body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child's body to produce them. This type of immunity has a short life. pg 249
The nurse is promoting the benefits of achieving a healthy weight to an overweight 12-year-old child and her parents. Which approach is best?
Ask what activities she enjoys such as dance or sports Asking what activities the child enjoys in order to promote exercise is best for several reasons. It provides assessment of the child's activity preferences and whether the child is health-centered (positive) or weight-centered (negative). It also offers variety. If one sport doesn't work, others might. Emphasizing appropriate weight or dietary shortcomings can lead to eating disorders or body hatred. Suggesting only softball limits the success of the healthy weight promotion. pg 264
Choose the options that will assist nurses in overcoming some of the barriers to having children fully immunized. Select all that apply.
Checking the immunization status of siblings who accompany the child who has the healthcare appointment Using every health contact with the child (hospital, urgent care, emergency, and well-child visits) to check status/administer vaccines Using combination vaccines to reduce the number of injections children receive Checking the status of siblings and using all contacts to immunize children plus employing combination vaccines all assist in improving the immunization status of children. Using separate vaccines to improve understanding and parental record keeping is not substantiated. Postponing immunizations may result in immunizations not given or being improperly spaced. Some experts say, however, that a partially immunized child is safer than one unimmunized, so getting some vaccines and not others may be a realistic compromise with certain parents. pg 262
Parents report that their neonate received intravenous antibiotics while in the newborn nursery. The nurse recognizes this as a potential risk factor for which health problem?
Hearing impairment The child's hearing is at risk. Determining which antibiotics were administered will be helpful in evaluating the risk. Certain antibiotics are ototoxic. These require regular follow-up to check the child's hearing ability. Having received antibiotics should not increase the risk for the other health problems. pg 243
Before administering an immunization to their child, the nurse asks parents to take which priority action?
Sign a consent form Parents must sign a consent form before immunization of the child after receiving full information about the vaccines, their importance, and their administration. Reassuring the child and assisting in restraining are both important but are not the priority. Having the child's immunization record with them allows this record to be updated; otherwise, a full record should be given to the parent. pg 251
Which nursing intervention is likely to be most effective in keeping the immunization status of children of all ages at its highest possible level?
Use every contact to potentially immunize Each health care contact with children should be seen as an occasion to give needed immunizations. Children cared for in outpatient departments for minor problems, those seen for injuries, children scheduled for surgery, those hospitalized, and all others should have their immunization records reviewed and immunizations due should be administered unless contraindicated. Assisting with media campaigns, providing a community-wide immunization event, and using measures to reduce pain all encourage immunization but will not have the impact that immunizing at each contact provides. page 262
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?
The child has small eyes and chin. Congenital facial malformations are developmental warning signs. Neonatal conjunctivitis, when properly treated, has no long-term effects on development. Parents who are college students are not risk factors as would be high school dropouts. A 36-week birth is not a warning sign, but 33 weeks or less is.
