Chapter 9 Flashcards
The nurse is caring for children in a physician’s office where health supervision is practiced. Which are some points of focus of health supervision? Select all that apply.
A)
Making referrals for all health care needs
B)
Monitoring disease incidence
C)
Optimizing the child’s level of functioning
D)
Monitoring quality of care provided
E)
Teaching parents to prevent injury
F)
Providing care developed from national guidelines
Ans:
C, E, F
Feedback:
Health supervision involves providing services proactively, with the goal of optimizing the child’s level of functioning. It ensures the child is growing and developing appropriately and it promotes the best possible health of the child by teaching parents and children about preventing injury and illness (e.g., proper immunizations and anticipatory guidance). The framework for the health supervision visit is developed from national guidelines available through the U.S. Department of Health and Human Services (DHHS), the American Medical Association (AMA), and the American Academy of Pediatrics (AAP). Making referrals and monitoring disease incidence and quality of care provided may occur with this model, but they are not key focal points.
The nurse is providing care for children in a pediatric medical home. What is a characteristic of care in these types of facilities?
A)
All insurance except Medicaid is accepted.
B)
Ambulatory care is not provided
C)
A centralized database contains all child information.
D)
Continuity of care is provided from infancy through adulthood.
Ans:
C
Feedback:
In a medical home a centralized database contains all pertinent information. All insurance including Medicaid is accepted in the medical home and ambulatory care is provided. Continuity of care is also provided from infancy to adolescence.
The nurse is preparing a presentation to a local parent group about pediatric health supervision. Which would the nurse emphasize as the focus? A) Injury prevention B) Wellness C) Health maintenance D) Developmental surveillance
Ans:
B
Feedback:
The focus of pediatric health supervision is wellness. Injury and disease prevention, health maintenance and promotion, and developmental surveillance are all critical components of wellness.
A large portion of the nurse's efforts is dedicated to health supervision for children who use the facility as their primary medical contact. At which facility does the nurse work? A) An urgent care center B) A pediatric practice C) A mobile outreach immunization program D) A dermatology practice
Ans:
B
Feedback:
A pediatric practice is most likely to fulfill the characteristics for primary care, also known as a medical home. An urgent care center does not provide preventative care activities. Mobile outreach would not provide for any care requiring hospitalization. A dermatology practice is unlikely to provide service outside its area of specialization.
The nurse strives to provide culturally competent care for children in a health clinic that follows the principles of health supervision. Which nursing action reflects this type of care?
A)
The nurse treats all children the same regardless of their culture.
B)
The nurse negotiates a care plan with the child and family.
C)
The nurse researches the child’s culture and provides care based on the findings.
D)
The nurse provides future-based care for culturally diverse children.
Ans:
B
Feedback:
Optimal wellness for the child requires the nurse and the family to negotiate a mutually acceptable plan of care. The nurse must consider the culture of children because if the goals of the health care plan are not consistent with the health belief system of the family, the plan has little chance for success. Researching the culture is helpful, but the nurse should not assume all children follow cultural directives and base the care plan solely on the research. Most health promotion and disease prevention strategies in the United States have a future-based orientation; however, significant numbers of children belong to cultures with a present-based orientation. For these children, health promotion activities need shorter-term goals and outcomes to be useful.
The nurse is aware that the community affects the health of its members. Which statements accurately reflect a community influence of health care? Select all that apply.
A)
A community can be a contributor to a child’s health or be the cause of his or her illnesses.
B)
The child’s health should be separated from the health of the surrounding community.
C)
Community support and resources are necessary for children with significant problems.
D)
Poverty has not been linked to an increase in health problems in communities.
E)
The breakdown of community and family support systems can lead to depression and violence.
F)
Ideally, the child’s medical home is located outside the community.
Ans:
A, C, E
Feedback:
A community can be a contributor to a child’s health or be the cause of his or her illnesses. Community support and resources are necessary for children with significant problems since a close working relationship between the child’s physician and community agencies is an enormous benefit to the child. Children from communities suffering the large-scale breakdown of family relationships and loss of support systems will be at increased risk for depression, violence and abuse, substance abuse, and HIV infection. The child’s health cannot be totally separated from the health of the surrounding community. Poverty has been linked to low birthweight and premature birth, among other health problems. Ideally the child’s medical home is within the family’s community to reduce barriers such as lack of transportation, expense of travel, and time away from the parents’ workplace.
The nurse is conducting a psychosocial assessment of a child with asthma brought to the physician's office for a check-up. Which psychosocial issues may be assessed? Select all that apply. A) Health insurance coverage B) Transportation to health care facilities C) School's response to the chronic illness D) Past medical history E) Future treatment plans F) Health maintenance needs
Ans:
A, B, C
Feedback:
Comprehensive health supervision includes frequent psychosocial assessments. Issues to be covered include health insurance coverage, transportation to health care facilities, financial stressors, family coping, and the school’s response to the chronic illness. These are often stressful and emotionally charged issues. Past medical history, future treatment plans, and health maintenance needs would also be assessed; however, these are not psychosocial issues.
The nurse is examining a 2-year-old child who was adopted from Guatemala. What would be a priority screening for this child? A) Screening for congenital defects B) Screening for abuse C) Screening for childhood illnesses D) Screening for infectious diseases
Ans:
D
Feedback:
Although all the screenings are important, health supervision of the internationally adopted child must include comprehensive screening for infectious disease. In 2008, approximately 19,600 children were adopted from countries outside the United States, many from areas with a high prevalence of infectious diseases (Intercountry Adoption, Office of Children’s Issues, U.S. Department of State, 2010a, 2010b). Guatemala, China, and Russia supplied about half of all international adoptees in 2008, followed by Ethiopia, South Korea, and Vietnam. Proper screening is important not only to the child’s health but also to the adopting family and the larger community.
The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. What will the nurse do during the visit?
A)
Change the bandage on a cut on the child’s hand
B)
Assess the compliance with treatment regimens
C)
Discuss systemic corticosteroid therapy
D)
Assess the child’s fluid volume
Ans:
B
Feedback:
Maintaining proper therapy for eczema can be exhausting both physically and mentally. Therefore, it is essential that the nurse assess compliance and support the parents’ ability to cope if necessary. Changing a bandage is not part of a health maintenance visit. Hydration is important for a child with eczema; however, fluid volume is not the focus at this visit. Systemic corticosteroid therapy is very rarely used and the success of the current therapy needs to be assessed first.
During the health history, the mother of a 4-month-old child tells the nurse she is concerned that her baby is not doing what he should be at this age. What is the nurse’s best response?
A)
“I’ll be able to tell you more after I do his physical.”
B)
“Fill out the questionnaire and then I can let you know.”
C)
“Tell me what concerns you.”
D)
“All mothers worry about their babies. I’m sure he’s doing well.”
Ans:
C
Feedback:
Asking about the mother’s concerns is assessment and is the first thing the nurse should do. The mother has intimate knowledge of the infant and can provide invaluable information that can help structure the nurse’s assessment. Relying on the physical assessment ignores the value of the mother’s input. A screening questionnaire is no substitute for a developmental assessment. Minimizing the mother’s concerns reduces communication between the mother and the nurse.
A 3-year-old child is scheduled for a hearing screening. The nurse would prepare the child for screening by which method? A) Auditory brain stem response B) Evoked otoacoustic emissions C) Visual reinforcement audiometry D) Conditioned play audiometry
Ans:
D
Feedback:
For children between the ages of 2 and 4 years, conditioned play audiometry would be an appropriate method for hearing screening. Auditory brain stem response and evoked otoacoustic emissions are appropriate hearing screening methods for newborns through age 6 months. Visual reinforcement audiometry is appropriate for children ages 6 months to 2 years.
A 2-week-old child responds to a bell during an initial health supervision examination. The child’s records do not show that a newborn hearing screening was done. Which is the best action for the nurse to take?
A)
Do nothing because responding to the bell proves he does not have a hearing deficit.
B)
Immediately schedule the infant for a newborn hearing screening.
C)
Ask the mother to observe for signs that the infant is not hearing well.
D)
Screen again with the bell at the 2-month-old health supervision visit.
Ans:
B
Feedback:
Guidelines for infant hearing screening recommend universal screening with an auditory brain stem response (ABR) or evoked otoacoustic emissions (EOAE) test by 1 month of age. All the other answers rely on behavioral observation. Studies have shown that behavioral observations are not a reliable method of screening for hearing loss.
The nurse is performing developmental surveillance for children at a medical home. Which infants are most at risk for developmental delays? Select all that apply. A) A child whose birthweight was 1,600 g B) A child whose parent has a mental illness C) A child raised by a single parent D) A child with a lead level above 10 mg/dL E) A child with hypertonia or hypotonia F) A child with gestational age more than 33 weeks
Ans:
B, C, D, E
Feedback:
Risk factors for developmental delays include having a single parent, a parent with developmental disability or mental illness, hypertonia or hypotonia, birthweight less than 1,500 g, lead level above 5 mg/dL, and gestational age less than 33 weeks.
The nurse is examining a 15-month-old child who was able to walk at the last visit and now can no longer walk. What would be the nurse’s best intervention in this case?
A)
Schedule a full evaluation since this may indicate a neurologic disorder.
B)
Note the regression in the child’s chart and recheck in another month.
C)
Document the findings as a developmental delay since this is a normal occurrence.
D)
Ask the parents if they have changed the child’s schedule to a less active one.
Ans:
A
Feedback:
Any child who “loses” a developmental milestone—for example, the child able to sit without support who now cannot—needs an immediate full evaluation, since this indicates a significant neurologic problem.
During a physical assessment of a 5-month-old child, the nurse observes the first tooth has just erupted and uses the opportunity to advise the mother to schedule a dental examination for her baby. When is the correct time for the dentist visit? A) By the first birthday B) By the second birthday C) By entry into kindergarten D) By entry into first grade
Ans:
A
Feedback:
The American Academy of Pediatric Dentistry recommends that a dentist examine the infant by his or her first birthday. Besides assessing routine oral health care, establishing a dental contact by the first birthday provides a resource for emergency dental care if it is needed.
