Chapter 31: Health Supervision

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? A. "Screening is recommended between 18 and 24 months or when concerns are identified." B. "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." C. "Unfortunately there are no reliable screening tools for autism spectrum disorder available." D. "Your child is too young for screening at this time."

A. "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.

The nurse is assessing a 4-year-old child who the parents report as "hard to understand" when speaking. Which screening will the nurse prepare to implement? A. Denver Articulation Screening B. Denver II Developmental C. Screening Test (Denver II) C. Weber and Rinne assessments D. Bayley Scales

A. 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. The Weber and Rinne assessments are used to assess hearing, which would be a consideration only after the speech is evaluated. The Bayley Scales of Infant and Toddler Development is an assessment tool for determining developmental delays in children.

A dental home (like a medical home) establishes a continuing comprehensive relationship of care with the child and family. The American Academy of Pediatric Dentistry (AAPD) recommends this dental home be established by the time the child is age: A. 2 years. B. 1 year. C. 3 years. D. 1½ years. E. 2½ years.

B. 1 year. The recommendation is by the child's first birthday. This is the time the first dental exam should occur.

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? A. "My mom put's frozen grapes in my lunch box." B. "I always drink a big glass of milk before school." C. "I always pick chocolate milk instead of juice boxes for lunch." D. "I love to eat dry cereal for breakfast."

D. "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 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? A. Taking a child's vital signs. B. Providing vaccinations to the children in a community. C. Ordering the prescribed diet for a child who had surgery. D. Teaching handwashing at an elementary school.

D. 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.

Place in proper order the vision screening procedures used by the nurse to assess children from neonate to school age. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1. Respond to E chart 2. Fixate on an object at 10 to 12 inches 3. Follow object to midline 4. Use Snellen test for visual acuity 5. Follow object past midline

1. Fixate on an object at 10 to 12 inches 2. Follow object to midline 3. Follow object past midline 4. Respond to E chart 5. 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.

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? A. "I recommend you talk with your adolescent child and discuss their preference for which dentist to visit." B. "If your school-aged child isn't current on immunizations, we can work to get them caught up." C. "I suggest you offer your toddler healthy snacks after school and at bedtime rather than after dinner." D. "I am so glad you are reading to your baby, especially during feeding time."

A. "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 preparing to perform the Denver II screening test. Which items should the nurse prepare for use in the assessment? Select all that apply. A. ball B. crackers C. crayon D. doll E. four plastic rings

A. ball C. crayon D. doll The Denver II screening test employs props. These include dolls, crayons, and balls.

The nurse is reviewing the health history of an infant who is demonstrating developmental delays. Which finding would be considered a possible risk factor? A. being raised by a single adolescent mom B. paternal history of alcohol use disorder C. age 35 weeks D. birth weight of 1,950 grams

A. being raised by a single adolescent 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.

Nurses use standardized materials to administer the Denver II Developmental Screening Test. What are some of the materials included in the test kit? Select all that apply. A. raisins to place in a bottle B. shapes to fit into corresponding openings C. blocks to stack D. cards with letters of the alphabet E. a ball to throw and catch

A. raisins to place in a bottle C. blocks to stack E. a ball to throw and catch Contents of the Denver II Developmental Screening Test kit include a ball, blocks, and raisins. Items such as a rattle, a plastic doll, a toy baby feeding bottle, a bell, and others are included as well. No alphabet letters are part of the testing. Shape testing is accomplished by having the preschooler draw geometric forms as demonstrated by the tester.

The nursing instructor has just completed a discussion about immunization. Which statement by a student would indicate a need for further instruction? A. "Passive immunity only lasts a few weeks or months." B. "Immunologic memory develops after a person receives a vaccine." C. "Active immunity develops when a person receives a vaccine." D. "An example of active immunity would be when immunoglobulins are passed from a mother to her infant by colostrum."

D. "An example of active immunity would be when immunoglobulins are passed from a mother to her infant by colostrum." Passive, not active, immunity is produced when the immunoglobulins of one person are transferred to another. This can happen via colostrum or the placenta. Active immunity lasts only weeks or months. Active immunity is acquired when a person's own immune system generates the immune response from either a vaccine or the actual disease. This long-term protection is the result of immunologic memory.

The nurse is providing education to a group of parents concerning safety and sun exposure. Which statement by a participant indicates the need for further instruction? A. "Sunscreen should be applied about 30 minutes prior to sun exposure." B. "I should apply sunscreen to my child even if we are outside for only 15 minutes." C. "Hourly application of sunscreen is needed if my child is perspiring." D. "It is important I use sunscreen on my 4-month-old child."

D. "It is important I use sunscreen on my 4-month-old child." Children under the age of 6 months should not use sunscreen. Efforts should be made to protect this population from sun exposure. The remaining statements are correct actions.

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

A. The mother rarely looks at her infant when the nurse is assessing the child. D. The mother becomes very frustrated and tells the nurse she can't handle her toddler's temper tantrum. 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 preparing to administer the hepatitis A vaccine to a child. Which statement by the child's parent would indicates correct understanding of the vaccination? A. "The first hepatitis A vaccine should be given at 6 months." B. "Hepatitis A vaccine is given by a nasal spray." C. "Two doses are required for the hepatitis A vaccine." D. "My child will need a booster dose in 1 to 2 months."

C. "Two doses are required for the hepatitis A vaccine." Hepatitis A vaccine is a two-dose series recommended to be given by intramuscular injection to all children at age 12 months, followed by a repeat dose in 6 to 12 months.

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? A. Encourage the children to play with the dressings, syringes, and medication before using them. B. Make a coloring page and allow the child to color it completely before beginning the screening. C. Purchase stickers or make coloring pages to be given to the children after the screening is completed. D. Allow the children to choose whether to get the screening completed that day or another day.

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

D. 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 conducting a community screening program for hyperlipidemia in children. Which child(ren) would the nurse identify as being a candidate for screening? Select all that apply. A. child with older siblings who are obese and lead sedentary lifestyles B. child who reports his uncle has type 1 diabetes diagnosed at age 19 C. child who reports grandfather had angioplasty at 72 years of age D. child with one sibling diagnosed with peripheral vascular disease E. child whose mother has a cholesterol level of 250 mg/dl (6.47 mmol/l)

D. child with one sibling diagnosed with peripheral vascular disease E. child whose mother has a cholesterol level of 250 mg/dl (6.47 mmol/l) The nurse would screen a child for hyperlipidemia if a parent, grandparent, aunt/uncle, or sibling, have/had documented coronary atherosclerosis, myocardial infarction, angina pectoris, peripheral vascular disease, cerebrovascular disease/stroke, coronary artery bypass graft/stent/angioplasty at younger than 55 years in males and younger than 65 years in females, or sudden cardiac death. They would also screen a child if a parent's blood cholesterol level is 240 mg/dl (6.22 mmol/l) or higher. Of the children presented, the child whose mother has a cholesterol level of 250 mg/dl (6.47 mmol/l) and the child with one sibling diagnosed with peripheral vascular disease should be screened for hyperlipidemia.

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? A. "My baby will need to again be seen when he is 2 months old." B. "My baby should be seen monthly for the first year of life." C. "Unless there is a problem I do not need to bring my baby back to be seen until he is 6 months old." D. "I will need to schedule an appointment for my baby to be seen when he is 3 months old."

A. "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 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? A. "The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." B. "It is one of the most commonly used childhood vaccines." C. "This vaccine is approved by the American Academy of Pediatrics." D. "This vaccine is recommended by the Centers for Disease Control and Prevention."

A. "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.

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? A. "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." B. "Hearing loss related to sensory concerns are often not noticeable by parental observations." C. "Hearing deficits related to neurological problems are often not noticeable by parental observations." D. "Since you do not see any issues we can wait to test at a later time."

A. "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.

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

A. "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 mother of a 2-year-old child questions when she will need to initially have her child's vision screened. The nurse should inform the mother that vision screening begins at which age? A. 3 years of age B. 4 years of age C. 1 year of age D. 2 years of age

A. 3 years of age In the absence of risk factors vision screening should begin in children once they reach the age of 3.

A nursing student is asked to provide reasons it is important for the physician or nurse practitioner to have knowledge of the community in which the families and children seen in the practice live. Select all that apply. A. Awareness of agencies serving children results from knowing the community. B. The community can be a contributor to child-family health or a cause of illness. C. Knowing the community is necessary in developing appropriate health surveillance programs. D. Understanding the community promotes improved working relationships between families and physicians or nurse practitioners.

A. Awareness of agencies serving children results from knowing the community. B. The community can be a contributor to child-family health or a cause of illness. C. Knowing the community is necessary in developing appropriate health surveillance programs. D. Understanding the community promotes improved working relationships between families and physicians or nurse practitioners. These are all good reasons for a physician or nurse practitioner to know the community. Awareness of the strengths and limits within the community helps the physician or nurse practitioner better manage the health of the families served.

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. A. Churches, synagogues, and mosques B. Day care centers C. Political organizations D. Environmental groups E. Schools (public and private)

A. Churches, synagogues, and mosques B. Day care centers E. Schools (public and private) 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 initiatives 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.

The nurse is caring for a family and their internationally adopted child. The parents indicate the child was adopted and brought to the United States 7 days ago. What recommendation would the nurse give the family? A. Complete a comprehensive health screening within the next week. B. Update the child's medical record within the next 8 weeks at their medical home. C. Assure the child has completed hepatitis B, C, and A screening in their home country. D. Postpone vaccines if the child has a low-grade fever or respiratory illness.

A. 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 practitioner inspects a toddler's teeth. The nurse practitioner encourages the family to establish a dental home in order to achieve optimal dental health for the various family members. Select all reasons for this action that apply. A. Comprehensive health care is possible only if oral health is part of the equation. B. Poor oral health care for children can result in systemic health problems. C. Dental care is the most unmet health need of children in the United States. D. Certain dental interventions including fluoride treatments could significantly reduce the cost of oral care for children.

A. Comprehensive health care is possible only if oral health is part of the equation. B. Poor oral health care for children can result in systemic health problems. C. Dental care is the most unmet health need of children in the United States. D. Certain dental interventions including fluoride treatments could significantly reduce the cost of oral care for children. All statements are true and underscore the importance of good oral health care best achieved through a dental home.

The student nurse is preparing for a class project about health supervision. The student plans to include which information? Select all that apply. A. Health supervision of the child is most effective when the child has multiple sources of health care. B. Health supervision promotes education about preventing injury and illness. C. Education regarding proper immunizations is included in health supervision. D. Health supervision involves providing services after the child has become ill. E. The goal of health supervision is to optimize the child's level of functioning.

A. Health supervision promotes education about preventing injury and illness. C. Education regarding proper immunizations is included in health supervision. E. The goal of health supervision is to optimize the child's level of functioning. The goal of health supervision is optimizing the child's level of functioning. Health supervision involves providing services proactively, not reactively after the child has become ill. It promotes the best possible health of the child by teaching parents and children about preventing injury and illness with topics like proper vaccinations. It is vital to every child and is most effective when the child has a centralized source of health care rather than multiple sources of health care.

The nurse is discussing healthy eating habits with a school-age child and her parents. Which recommendation would the nurse make for the family? A. Light snacks should be offered so the child doesn't overeat at meals. B. When serving food the child doesn't like, insist he or she takes several bites. C. A bedtime snack should be part of the child's bedtime ritual/pattern. D. Carbohydrates at breakfast will give a child energy to start the day.

A. 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 nurse interviews the parent of a toddler to identify factors that may place the child at risk for developmental problems. What information obtained from the parent would be of concern to the nurse? Select all that apply. A. Neither parent graduated high school. B. Father suffers from schizophrenia C. Recent lead level was 7 µg/dl (0.34 µmol/L) D. The child's birth weight was 1600 g E. The mother reports gestational age of 35 weeks.

A. Neither parent graduated high school. B. Father suffers from schizophrenia C. Recent lead level was 7 µg/dl (0.34 µmol/L) Factors placing the child at risk for developmental problems include a parent with less than a high school education, parent with mental illness and a lead level above 5 µg/dL (0.24 µmol/L). The gestational age of 35 weeks is above the 33-week criteria. Birth weights less than 1500 g are a concern.F

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? A. Providing combination vaccines to reduce the number of shots the child is to receive. B. Providing education that free vaccines are only given by the local public health agencies. C. Schedule separate appointments for families with multiple children so the focus will be on one child at a time during the visit. D. Providing a modified vaccine schedule to allow for more time between vaccines.

A. 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 nurse is preparing to administer an intramuscular immunization to a 1-month-old infant. What action will the nurse take? A. Request the parent to remove the infant's pants so the vastus lateralis muscle is accessible. B. Locate and clean the deltoid muscle with alcohol prior to administering the injection. C. Ask the parent to remove the infant's diaper to allow access to the dorsogluteal muscle. D. Swab the fatty tissue on the infant's upper leg with alcohol prior to administering the injection.

A. Request the parent to remove the infant's pants so the vastus lateralis muscle is accessible. The vastus lateralis muscle is used for intramuscular injections in infants. The deltoid would be appropriate for an older child and adult. The dorsogluteal muscle is not used for injections in an infant, if at all. The injection would be given into fatty tissue if it were a subcutaneous injection rather than an intramuscular injection.

Before administering an immunization to their child, the nurse asks parents to take which priority action? A. Sign a consent form. B. Assist in restraining the child. C. Provide the child's immunization record. D. Reassure the child.

A. 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.

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

A. 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.

Which nursing intervention is likely to be most effective in keeping the childhood immunization status for all ages at its highest possible level? A. Use every contact to potentially immunize. B. Make immunizations as pain-free as possible. C. Promote immunization through mass media campaigns. D. community-wide immunization events.

A. 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, children seen for injuries, children scheduled for surgery, children hospitalized, and all other children should have their immunization records reviewed and immunizations 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.

A nurse is working at a busy pediatric clinic and is scheduled to see several children this morning to conduct health supervision. Which child would the nurse expect to screen for hypertension? A. a 3-year-old child in for a well-child visit B. a 1-year-old child who was born at term C. an 18-month-old with a history of ear infections D. a 2-year-old child with a fever

A. a 3-year-old child in for a well-child visit Universal hypertension screening for children beginning at 3 years of age is recommended. If the child has risk factors for systemic hypertension, such as preterm birth, very low birthweight, renal disease, organ transplant, congenital heart disease, or other illnesses associated with hypertension, then screening begins when the risk factor becomes apparent.

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? A. auditory brain stem response test B. Rinne test C. Weber test D. tympanometry

A. 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.

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? A. hearing deficit B. eating disorder C. visual deficit D. gross motor problems E. hypertension

A. 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.

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

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

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? A. rotavirus (RV) B. diphtheria, tetanus, pertussis (DTap) C. hepatitis A (HepA) D. H. influenzae type B (Hib)

A. 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 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? A, "Every child develops at different rates. Don't be alarmed. Just enjoy your child!" B. "This is a concern. Let's be sure the physician is aware of this change." C, "Children often regress in their developmental stages...no need to worry." D. "If you continue to notice these changes, we should follow up within the next 3 months."

B. "This is a concern. Let's be sure the physician is aware of this change." Children who have previously met a developmental milestone and then lose that milestone need an immediate and full evaluation due to the concern of significant neurologic problems. Children do often regress in behavior when under stress (hospitalization, new baby in the home, etc) but should not completely lose a milestone. Three months is too long to wait for additional evaluation. Children do develop at different rates, but this child had already met a milestone so this response is inappropriate.

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? A. "Eating a diet low in fat will help to reduce the risk of colon cancer in your child when they get older." B. "Eating a healthy breakfast will give your child the energy to stay awake and focused during school each day." C. Eating a diet that is healthy will greatly reduce risk factors for several chronic diseases that occur later in life. D. "Eating a well-balanced diet that includes fresh fruits and vegetables, your child will not be at risk for becoming obese in the future."

B. "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.

The nurse is discussing healthy eating with the parents of a school-age client. Which statement by the parents indicates additional teaching is needed? A. "We will freeze fruits before putting them in our child's lunchbox." B. "It is more important for our child to get sleep than eat breakfast." C. "Since our child does not like broccoli, we will not put it on our child's plate." D. "We will limit our child's snacks to after school and bedtime."

B. "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.

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? A. "Fluoridated water has significantly reduced cavities." B. "Oral health can affect general health." C. "Try to keep the child's hands out of the mouth." D. "Limit the amount of soft drinks in the child's diet."

B. "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.

During a well-check for a 2-year-old client, the nurse notes the client's vaccinations are not up to date. The caregiver states, "It is hard to make it to all the appointments, but my child will get caught up before going to school." Which response by the nurse is most appropriate? A. "As long as you keep your child away from crowded public areas, I think things will be okay." B. "To prevent serious illnesses, it is vital your child receive all vaccines as scheduled." C. "Your child will need to get all the vaccines before starting school." D. "I understand it is a lot of visits; however, your child's health is worth it."

B. "To prevent serious illnesses, it is vital your child receive all vaccines as scheduled." The most important tool to increase immunization awareness is education. The nurse would educate the caregiver on the importance of the child receiving vaccinations first. The nurse should not guilt the caregiver by stating the child is "worth it," nor can the nurse generalize a statement about the health of the child such as "I think things will be okay." Depending on the laws of the school district the child will attend, vaccines may be required before starting school; however, the caregiver has already stated this knowledge.

Which statements by a parent would indicate to the nurse that the family has a future-based orientation? Select all that apply. A. "Heart problems run in our family, I don't think it matters how healthy our son eats." B. "We limit the amount of TV our children watch and are sure they get enough physical activity." C. "We will get our son vaccinated for varicella. We don't want him to get chickenpox." D. "We will fill our son's prescription for asthma prevention medication today in case he has another asthma attack." E. "We will wait until our daughter's high glucose level causes her problems before we treat it."

B. "We limit the amount of TV our children watch and are sure they get enough physical activity." C. "We will get our son vaccinated for varicella. We don't want him to get chickenpox." D. "We will fill our son's prescription for asthma prevention medication today in case he has another asthma attack." 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.

Which question by the nurse is the best one to elicit complete information about a young boy's immunization status? A. "Do you have any questions about the immunizations children need at various ages?" B. "When and where did your child receive his last immunization?" C. "Are your son's immunizations up-to-date?" D. "Tell me which immunizations your child needs today."

B. "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.

The nurse is speaking to a parent of a 5-year-old child. Which statement by the parent would indicate a potential hearing impairment in the child? A. "My son is always listening to music with headphones on." B. "When my son is watching TV, I can't stand to be in the room. The sound is always turned up so loud." C. "My daughter loves to talk on the phone to her grandparents." D. "My daughter is learning sign language in school."

B. "When my son is watching TV, I can't stand to be in the room. The sound is always turned up so loud." One sign of potential hearing impairment is turning the television up too loudly. Listening to music with headphones, talking on the telephone, and learning sign language are not signs of potential hearing impairment.

The nurse will use the Denver Articulation Screening for children in what age range? A. 0 to 2 years B. 2 1/2 to 7 years C. 6 months to one year D. 6 to 10 years

B. 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 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? A. DT B. DTaP C. TdaP D. DPT

B. 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 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? A. Snellen B. Ishihara C. Allen figures D. CVTME

B. 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 chart are for assessing visual acuity.

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? A. Infants tend to have insidious symptoms. B. Testing by the child's home country is unreliable. C. Many babies adopted from foreign countries have pediculosis. D. The child may have come from rural China.

B. 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 observing the parents and child during a health supervision visit. Which observation would alert the nurse to inquire and observe further? A. The father of the child states, "He didn't get first at the spelling bee, but he did well in his class." B. The mother says, "Wait until we are finished with this doctor's visit and then I will take you to the bathroom." C. The mother asks the father to hold the toddler when the nurse asks the mother to sign paperwork at the front desk. D. 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

B. 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? A. The nurse teaches the family about side effects of a prescribed medication without first assessing their knowledge about the medication. B. The nurse recommends the parents review the list of available specialists before they select one for referral. C. The nurse asks the mother why she used a home remedy cream on the child's rash before being seen at the clinic. D. The nurse discourages the parents from following the advice of a grandparent regarding parenting approaches.

B. 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? A. The teenager eats a high-fat diet. B. The teenager's blood pressure was 122/83. C. The teenager was born at 33 weeks' gestation. D. The teen gets no regular exercise.

B. 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. a 2-month-old infant who breastfeeds B. a 16-year-old, pregnant for the first time and lives with her parents C. a 7-month-old with supplemental breast feeding D. a 7-year-old active in competitive sports and activities

B. 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.

The nurse working with children and families knows there are certain universal screening tests all children should receive. Which tests are included in this group? Select all that apply. A. Denver II B. auditory brain stem response C. phenylketonuria D. hyperlipidemia E. lead levels

B. auditory brain stem response C. phenylketonuria Phenylketonuria (PKU) and auditory brain stem response (ABSR) tests are used universally (throughout the entire population regardless of individual risk). The Denver II is one of several developmental screening exams that can be used between birth and age 6 years. Screening for hyperlipidemia and lead occurs in those children with risk factors (selective screening).

The nurse will administer which recommended immunizations to an 11- or 12-year-old client during a wellness visit? Select all that apply. A. hepatitis A (HepA) B. human papillomavirus (HPV) C. varicella D. meningococcal vaccine (MCV) E. tetanus, diphtheria, pertussis (Tdap)

B. human papillomavirus (HPV) D. meningococcal vaccine (MCV) E. tetanus, diphtheria, pertussis (Tdap) Tdap, HPV, and MCV are the vaccines that would be administered to a school-age client. Other vaccines may be given as catch-up, and some are administered to children considered at high risk. It is important that the nurse check immunization records at each contact while taking into account changing immunization recommendations to keep children up-to-date.

A pediatric nurse will state that the priority reason to have a thorough grasp of the growth and development of children is to: A. thoroughly enjoy working with the different age groups. B. identify developmental risks or delays promptly. C. interact with children in age-appropriate, nonthreatening ways. D. give parents anticipatory guidance as their children grow and change.

B. 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 is counseling a pregnant adolescent about the health benefits associated with breastfeeding. Which statement by the client indicates understanding? A. "Breastfeeding my baby will help to stimulate my baby's immune system to activate." B. "Breastfeeding my baby will pass on a type of active immunity." C. "Breastfeeding my baby will pass on passive immunity." D. "Breastfeeding my baby will provide lifelong immunity against certain diseases."

C. "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 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? A. "The rate of herpes zoster has been declining since the vaccination program began." B. "Mild reactions occur in 5% to 10% of children." C. "Children not immunized are at risk if exposed to the disease." D. "Varicella is a highly contagious herpes virus."

C. "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? A. "If a child has a fever after a vaccine, I do not have to report it to the Vaccine Adverse Event Reporting System." B. "If a child receives a vaccine at another facility, we will need to document it in the child's permanent record." C. "I do not need to document the vaccine manufacturer's name in the child's permanent record." D. "I will document the date and time the vaccine was given in the child's permanent record."

C. "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 completed an educational program about vaccines to a group of parents. Which statement by a parent would indicate the need for further education? A. "I only need to worry about the Hib vaccine if my kids are under 5 years old." B. "My 14-month-old will need a Hib vaccine booster." C. "My 7-year-old will need to get a Hib booster at his next checkup." D. "The Hib vaccine helps to prevent infections such as meningitis, epiglottitis and septic arthritis."

C. "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.

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? A. "A child's color vision isn't well developed until 12 to 18 months of age or later." B. "Children respond emotionally better to black and white patterns and pictures." C. "The child's eyes are more attune to high-contrast patterns than to specific colors." D. "This allows us to assess for color blindness in infants younger than 6 months."

C. "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.

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? A. "Yes, bring him in, but we will not do his shots today." B. "No, do not bring him until his symptoms subside." C. "Yes, bring him in, he can still have his shots." D. "No, do not bring Jacob in today."

C. "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 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? A. 7 B. 5 C. 4 D. 6

C. 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.

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? A. Discuss systemic corticosteroid therapy. B. Assess the child's fluid volume. C. Assess how the family is coping with the chronic illness. D. Change the bandage on a cut on the child's hand.

C. 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.

Infants born to mothers who are HbsAg (hepatitis B surface antigen)-positive need to receive the hepatitis B immunoglobulin (HBIg) within how many hours? A. HBIg needs to be given within 4 hours. B. HBIg needs to be given within 24 hours. C. HBIg needs to be given within 12 hours. D. HBIg needs to be given within 8 hours.

C. HBIg needs to be given within 12 hours. Hepatitis B is a serious disease that can affect the liver. It can be transmitted via blood and body fluids that manifest during birth. The infant needs to receive the vaccine within 12 hours of life. A hepatitis B series is three injections and children should complete all doses in the series for protection. Without a complete series, child remain at risk for contracting hepatitis B. If adolescents have not had the hepatitis B immunization series, it is important for them to receive them. Hepatitis B is also transmitted sexually. Having the protection of the vaccines can prevent the disease and future damage to the liver later in life.

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

C. 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.

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? A. The screening was completed at the clinic when the newborn was 4 days old. B. The screening was completed and the results noted in the infant's permanent record. C. The screening was completed when the newborn was 24 hours old. D. The screening was completed prior to discharge from the birthing unit.

C. The screening was completed when the newborn was 24 hours old. Newborn metabolic screenings should occur when the child is older than 48 hours. The other options indicate the screening was completed appropriately and should not be repeated.

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? A. visual disorder B. articulation difficulties C. hearing impairment D. difficulty with fine motor skills

C. 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.

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? A. scheduling the last appointment each weekday at 3:30pm B. discontinuing the practice of two evenings a week being set aside for walk-in visits C. setting up screenings in a public library downtown D. telling a family to take a taxi to the clinic if transportation is a concern

C. 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.

The nurse is interacting with several families with children during their health visits. Which child would the nurse prioritize to receive a hearing screening? A. the 3-month-old whose mother reports the child turns his head to noises B. the 8-week-old who had an initial hearing screening reported as negative C. the 3-week-old infant who was discharged without a hearing screening D. the 6-month-old who attempts to mimic sounds the parents make

C. the 3-week-old infant who was discharged without a hearing screening Healthy People 2030 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 because it was already completed and there are no indications of hearing loss.

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

D. "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 nurse is talking with the grandparent of an infant born at 32 weeks' gestation to an adolescent mother who states, "I am concerned my grandbaby will have developmental problems." Which response by the nurse is most appropriate? A. "Premature children often have problems." B. "Children born to adolescent mothers will likely have developmental delays." C. "We cannot know the outcomes for your grandchild at this point in time." D. "The risks of developmental concerns are heightened for your grandchild."

D. "The risks of developmental concerns are heightened for your grandchild." Children born to adolescent mothers and those who are born at a gestation of 33 weeks or less have an increased risk for experiencing developmental delays. The child's grandparent is expressing concerns. It is most appropriate to explain to the grandparent that there are risks involved. The most appropriate response by the nurse is one that personalizes and responds to the client's question.

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? A. "Your child needs to be tested again because most newborns are immunocompromised and test negative at birth." B. "Your child is likely to have received excellent treatment for infectious diseases as a newborn in their home country, but we need to repeat the testing again." C. "The testing needs to be repeated so your child can have an up-to-date record at our primary physician's office." D. "The testing may have been unreliable due to outdated testing supplies, poor storage of testing supplies, and unreliable documentation."

D. "The testing may have been unreliable due to outdated testing supplies, poor storage of testing supplies, and unreliable documentation." Screening, testing, and treatment for infectious diseases in the child's home country may be unreliable due to a lack of resources, sporadic screening, outdated supplies, and improper storage of testing supplies. Newborns are not immunocompromised at birth. The child's health record will be updated as additional information is assessed and testing again is not indicated for this reason.

The nurse is assessing a 4-year-old child who the parents report as "hard to understand" when speaking. Which screening will the nurse prepare to implement? A. Denver II Developmental Screening Test (Denver II) B. Weber and Rinne assessments C. Bayley Scales D. Denver Articulation Screening

D. 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. The Weber and Rinne assessments are used to assess hearing, which would be a consideration only after the speech is evaluated. The Bayley Scales of Infant and Toddler Development is an assessment tool for determining developmental delays in children.

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? A. Bayley Scale B. Denver Articulation Screening D. Denver Prescreening Developmental Questionnaire (R-PDQ) E. Goodenough-Harris Drawing Test

D. 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.

The nurse is performing a vision screening for a 2-month-old. Which technique should the nurse use? A. Move a small stuffed panda to midline. B. Hold a photo of a clown 10 to 12 inches in front of the child. C. Move a colorful toy through the field of vision. D. Move a card with a black-and-white checkerboard pattern in a 180-degree arc past the infant.

D. 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.

Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer? A. artificially acquired passive immunity B. naturally acquired passive immunity C. naturally acquired active immunity D. artificially acquired active immunity

D. 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.

The nurse will expect that which hearing test will be performed before the newborn is discharged home? A. tympanometry B. pure-tone audiometry C. whisper test D. auditory brainstem response

D. 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.

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? A. hepatitis A B. Haemophilus influenzae C. polio D. rotavirus

D. 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.

The nurse prepares to administer a vaccine to a 12-month-old child using a 5/8-inch needle. The nurse cleans the fatty tissue over the anterolateral thigh before administering the vaccine. Which vaccine is the nurse preparing to administer? A. hepatitis A B. DTaP C. influenza D. varicella

D. varicella The nurse is preparing to give a subcutaneous injection, which would be varicella. The other choices are IM and the site and needle size are not appropriate for an IM injection.