Peds - Chapter 31: Health Supervision
The nurse will use the Denver Articulation Screening for children in what age range? a) 6 to 10 years b) 2 1/2 to 7 years c) 0 to 2 years d) 6 months to one year
2 1/2 to 7 years
The nurse is counseling a pregnant adolescent about the health benefits associated with breastfeeding. Which statements 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 passive immunity." c) "Breastfeeding my baby will provide lifelong immunity against certain diseases." d) "Breastfeeding my baby will pass on a type of active immunity."
"Breastfeeding my baby will pass on passive immunity."
The nurse has just finished administering the DTaP vaccine to a 2-month-old and is educating the parent about immunization. Which statement is accurate? a) "The 'T' stands for tuberculosis." b) "You need to renew this immunization every 10 years." c) "There are no side effects from this vaccine." d) "Bring her back for the second dose when she is 4 months old."
"Bring her back for the second dose when she is 4 months old."
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? a) "Varicella is a highly contagious herpes virus." b) "Mild reactions occur in 5% to 10% of children." c) "Children not immunized are at risk if exposed to the disease." d) "Risk of Varicella is greater than the risk of vaccine."
"Children not immunized are at risk if exposed to the disease."
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) "Oral health can affect general health." b) "Fluoridated water has significantly reduced cavities." c) "Try to keep the child's hands out of the mouth." d) "Limit the amount of soft drinks in the child's diet."
"Oral health can affect general health."
During the health interview, the mother of a 4-month-old says, "I'm not sure my baby is doing what he should be." What is the nurse's best response? 1. "I'll be able to tell you more after I do his physical." 2. "Fill out this developmental screening questionnaire and then I can let you know." 3. "Tell me more about your concerns." 4. "All mothers worry about their babies. I'm sure he's doing well."
"Tell me more about your concerns."
Which child poses the greatest risk for elevated lead levels? a) 10-year-old Caucasian child who lives with his grandparents b) 2-year-old Caucasian child who lives in a city apartment c) 2-year-old Asian child who lives with his adopted American parents d) 18-month-old African American child who lives in a suburban home
2-year-old Asian child who lives with his adopted American parents
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? a) "The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." b) "This vaccine is recommended by the Centers for Disease Control and Prevention." c) "This vaccine is approved by the American Academy of Pediatrics." d) "It is one of the most commonly used childhood vaccines."
"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need."
Which question by the nurse is the best one to elicit complete information about a young boy's immunization status? a) "Are your son's immunizations up-to-date?" b) "When and where did your child receive his last immunization?" c) "Do you have any questions about the immunizations children need at various ages?" d) "Tell me which immunizations your child needs today."
"When and where did your child receive his last immunization?"
A mother tells the nurse that she is newly pregnant and asks about her 15-month-old's need for the chicken pox immunization because her two older children did "fine" when they had the disease. What is the nurse's best response? a) "I realize that the vaccine is somewhat costly, but it is likely to be more economical than dealing with chicken pox." b) "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." c) "Your toddler should not receive this live-virus immunization today. It may present a risk to your pregnancy." d) "When chicken pox can be avoided, why not do so?"
"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."
Julie calls the doctor's office to let them know that her son Jacob has had a fever and a runny nose. Julie wants to know if she should still bring him for his 15-month immunizations. What is the appropriate response from the nurse? a) "No, do not bring him until his symptoms subside." b) "Yes, bring him in, but we will not do his shots today." c) "Yes, bring him in, he can still have his shots." d) "No, do not bring Jacob in today."
"Yes, bring him in, he can still have his shots."
Children in what age range are screened by nurses using the Denver II Screening Test? a) 6 to 10 years b) Birth to 12 months c) 10 to 12 years d) 0 to 6 years
0 to 6 years
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) 1 year. b) 3 years. c) 1½ years. d) 2 years. e) 2½ years.
1 year.
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) 2 years of age c) 1 year of age d) 4 years of age
3 years of age
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) 4 b) 6 c) 7 d) 5
4
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) Naturally acquired active immunity b) Artificially acquired active immunity c) Artificially acquired passive immunity d) Naturally acquired passive immunity
Artificially acquired active immunity
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? a) Show the family the appropriate weight for the child b) Ask what activities she enjoys such as dance or sports c) Suggest that the child join a little league softball team d) Point out fattening foods and excesses in their diet
Ask what activities she enjoys such as dance or sports
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) Assess how the family is coping with the chronic illness b) Change the bandage on a cut on the child's hand c) Discuss systemic corticosteroid therapy d) Assess the child's fluid volume
Assess how the family is coping with the chronic illness
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) Tympanometry b) Weber test c) Rinne test d) Auditory brain stem response test
Auditory brain stem response test
The nurse will expect that which hearing test will be performed before the newborn is discharged home? a) Auditory brainstem response b) Whisper test c) Pure-tone audiometry d) Tympanometry
Auditory brainstem response
When should the child's first examination by a dentist occur? 1. By the first birthday 2. By the second birthday 3. By entry into kindergarten 4. By entry into first grade
By the first birthday
A 15-month-old girl is having her first health supervision visit at your facility. Her mother has not brought a copy of the child's immunization record but believes she is fully immunized: "She had immunizations 3 months ago at the local health department." Which would be the best action by the nurse? 1. Ask the mother to bring the records to the 18-month health supervision visit. 2. Start the "catch-up" schedule because there are no immunization records. 3. Keep the child at the facility while the mother returns home for the records. 4. Call the local health department and verify the child's immunization status.
Call the local health department and verify the child's immunization status.
The nurse is collecting data from the mother of a 3-year-old child. Which report warrants further follow-up? a) Cannot throw a ball overhand b) Cannot grasp a crayon with the thumb and fingers c) Cannot stack five blocks d) Cannot copy a circle
Cannot copy a circle
Parents report that their 4-year-old is difficult to understand. Which screening tool will the nurse use? a) Denver II Developmental Screening Test (Denver II) b) Bayley Scale c) Goodenough-Harris Drawing Test d) Denver Articulation Screening
Denver Articulation Screening
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) Goodenough-Harris Drawing Test b) Denver Prescreening Developmental Questionnaire (R-PDQ) c) Denver Articulation Screening d) Bayley Scale
Denver Prescreening Developmental Questionnaire (R-PDQ)
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? a) Suggest fever and cough control for home care, do the well-child exam, and reschedule the immunizations. b) Provide the well-child exam and give all the immunizations except the MMR. c) Complete the well-child exam and reschedule the immunizations. d) Do the well-child exam and give the immunizations due. e) Reschedule the visit.
Do the well-child exam and give the immunizations due.
Infants born to mothers who are HbsAg-positive need to receive the hepatitis B immunoglobulin (HBIG) within how many hours? a) HBIG needs to be given in 8 hours. b) HBIG needs to be given in 24 hours. c) HBIG needs to be given in 4 hours. d) HBIG needs to be given in 12 hours.
HBIG needs to be given in 12 hours.
The nurse is doing a health history for a 14-year-old boy during a health supervision visit. The boy says he has outgrown his clothes recently. For which condition should the nurse check, based on this information? a) Developmental problems b) Hyperlipidemia c) Systemic hypertension d) Iron deficiency anemia
Iron deficiency anemia
During the health surveillance of a 13-year-old girl, the nurse recorded the following information: blood pressure 108/48, pulse 70, respirations 18; dieting, dislikes meat; eats yogurt, drinks two glasses low-fat milk daily; gymnastics team member; fairly regular, normal menstrual periods. What risk would the nurse identify? a) Inadequate calcium in the diet b) Iron-deficiency anemia c) Risk for injury d) Prehypertension
Iron-deficiency anemia
The nurse is doing a health history for a 14-year-old pregnant girl during a health supervision visit. For which condition should she be screened? a) Iron-deficiency anemia b) Congenital problems c) Hyperlipidemia d) Lead level
Iron-deficiency anemia
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) CVTME c) Ishihara d) Allen figures
Ishihara
The nurse is performing a vision screening for a 2-month-old. Which technique should the nurse use? a) Move a colorful toy through the field of vision. b) Move a card with a black-and-white checkerboard pattern in a 180-degree arc past the infant. c) Move a small stuffed panda to midline. d) Hold a photo of a clown 10 to 12 inches in front of the child.
Move a card with a black-and-white checkerboard pattern in a 180-degree arc past the infant.
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) Hyperlipidemia c) Phenylketonuria d) Lead levels e) Auditory brain stem response
Phenylketonuria Auditory brain stem response
During the health history, the parent of a 10-year-old child mentions the child seems to have trouble hearing. Which test is the nurse most likely to use? a) Rinne test b) Whisper test c) Evoked otoacoustic emissions test d) Auditory brain stem response test
Rinne test The Rinne test compares air conduction of sound with bone conduction of sound and can be performed in the office. The Whisper test requires a quiet room with no distractions. Auditory Brainstem Response (ABR) and the E voked Otoacoustic Emissions (EOAE) are indicated for newborns and are usually done by an audiologist.
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) Rotavirus b) Haemophilus influenzae c) Polio d) Hepatitis A
Rotavirus
Before administering an immunization to their child, the nurse asks parents to take which priority action? a) Reassure the child b) Sign a consent form c) Assist in restraining the child d) Provide the child's immunization record
Sign a consent form
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) Many babies adopted from foreign countries have pediculosis. b) The child may have come from rural China. c) Testing by the child's home country is unreliable. d) Infants tend to have insidious symptoms.
Testing by the child's home country is unreliable.
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? a) The child had neonatal conjunctivitis. b) The child has small eyes and chin. c) The child was born at 36 weeks. d) The parents are both in college.
The child has small eyes and chin. Congenital facial malformations are developmental warning signs
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's blood pressure was 122/83. b) The teenager eats a high-fat diet. c) The teen gets no regular exercise. d) The teenager was born at 33 weeks' gestation.
The teenager's blood pressure was 122/83.
Which nursing intervention is likely to be most effective in keeping the immunization status of children of all ages at its highest possible level? a) Promote immunization through mass media campaigns b) Make immunizations as pain-free as possible c) Organize community-wide immunization events d) Use every contact to potentially immunize
Use every contact to potentially immunize
A mother and her 2-week-old infant have arrived for a health supervision visit. Which of the following activities will the nurse perform? a) Take a health history for a minor injury b) Assess the child for an upper respiratory infection c) Warn against putting the baby to bed with a bottle d) Administer a Varicella injection
Warn against putting the baby to bed with a bottle
What developmental categories will the nurse assess when screening with the Denver II Developmental Screening Test? Select all that apply. a) Personal-social b) Gross motor skills c) Fine motor--adaptive d) Language e) Intelligence
• Personal-social • Gross motor skills • Fine motor--adaptive • Language
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) A ball to throw and catch b) Shapes to fit into corresponding openings c) Blocks to stack d) Raisins to place in a bottle e) Cards with letters of the alphabet
• A ball to throw and catch • Blocks to stack • Raisins to place in a bottle
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) Crackers b) Four plastic rings c) Crayon d) Doll e) Ball
• Ball • Doll • Crayon
Which facility fulfills the characteristics of a medical home? 1. An urgent care center 2. A primary care pediatric practice 3. A mobile outreach immunization program 4. A dermatology practice
A primary care pediatric practice
A 4-year-old child is having a vision screening performed. Which screening chart would be best for determining the child's visual acuity? 1. Snellen 2. Ishihara 3. Allen figures 4. CVTME
Allen figures
Question: Place in proper order the vision screening procedures used by the nurse to assess children from neonate to school age. 1 Fixate on an object at 10 to 12 inches 2 Use Snellen test for visual acuity 3 Follow object to midline 4 Respond to E chart 5 Follow object past midline
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
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) Visual deficit c) Gross motor problems d) Eating disorder e) Hypertension
Hearing deficit
Parents report that their neonate received intravenous antibiotics while in the newborn nursery. The nurse recognizes this as a potential risk factor for which health problem? a) Articulation difficulties b) Visual disorder c) Difficulty with fine motor skills d) Hearing impairment
Hearing impairment
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) Hepatitis A (HepA) b) H. influenzae type B (Hib) c) Diphtheria, tetanus, pertussis (DTap) d) Rotavirus (RV)
Rotavirus (RV)
An infant boy is at your facility for his initial health supervision visit. He is 2 weeks old and responds to a bell during his examination. You review all his birth records and find no documentation that a newborn hearing screening was performed. What is the best action by the nurse? 1. Do nothing; responding to the bell proves the infant does not have a hearing deficit. 2. Schedule the infant immediately for newborn hearing screening. 3. Ask the mother to observe for signs that the infant is not hearing well. 4. Screen again with the bell at the infant's 2-month health supervision visit.
Schedule the infant immediately for newborn hearing screening.
The nurse is anticipating that health supervision for a 5-year-old child will be challenging. Which indicator supports this concern? a) The child has a number of chores and responsibilities. b) Grandparents play a significant role in the family. c) The mother dotes on the child. d) The home is in a high-crime neighborhood.
The home is in a high-crime neighborhood.
The nurse will administer which recommended immunizations to an 11- or 12-year-old patient during a wellness visit? Select all that apply. a) Hepatitis A (HepA) b) Human papillomavirus (HPV) c) Tetanus, diphtheria, pertussis (Tdap) d) Meningococcal vaccine (MCV) e) Varicella
• Human papillomavirus (HPV) • Tetanus, diphtheria, pertussis (Tdap) • Meningococcal vaccine (MCV)
The nurse will record what information about each vaccine after immunizing a child? Select all that apply. a) How vaccine was stored b) Lot number and expiration date of vaccine c) Manufacturer of vaccine d) Whether bacterial or viral e) Site and route of vaccine administration
• Lot number and expiration date of vaccine • Manufacturer of vaccine • Site and route of vaccine administration
Which children will the nurse avoid immunizing with a live-virus vaccine? Select all that apply. a) Pregnant teen b) School-age patient with fractured arm c) Preschooler receiving radiation therapy d) Toddler with constipation e) Two-month-old infant
• Preschooler receiving radiation therapy • Pregnant teen
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) Environmental groups b) Schools (public and private) c) Political organizations d) Day care centers e) Churches, synagogues, and mosques
• Schools (public and private) • Day care centers • Churches, synagogues, and mosques
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) Knowing the community is necessary in developing appropriate health surveillance programs. b) Understanding the community promotes improved working relationships between families and physicians or nurse practitioners. c) Awareness of agencies serving children results from knowing the community. d) The community can be a contributor to child-family health or a cause of illness.
• The community can be a contributor to child-family health or a cause of illness. • Knowing the community is necessary in developing appropriate health surveillance programs. • Awareness of agencies serving children results from knowing the community. • Understanding the community promotes improved working relationships between families and physicians or nurse practitioners.
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. a) The mother did not complete high school. b) The infant was delivered via a scheduled cesarean section. c) The infant's mother is a single parent. d) A sibling was born prematurely.
• The infant's mother is a single parent. • The mother did not complete high school.
Choose the options that will assist nurses in overcoming some of the barriers to having children fully immunized. Select all that apply. a) Using separate vaccines (except the well-known DTaP) so parents can more readily track/understand immunizations received b) Using combination vaccines to reduce the number of injections children receive c) Checking the immunization status of siblings who accompany the child who has the healthcare appointment d) Having parents postpone all immunizations when they are concerned about certain vaccines e) 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 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