Question 1

A community health nurse is making a family home visit. The family consists of the mother, father, 1-year-old child, and 4-year-old child. The mother states that the 4-year-old child who is in preschool had a cold last week and now the 1-year-old child has it. She asks the nurse if she can use the over-the-counter cold medication that she gave to the 4-year-old child for the 1-year-old child. Which response would be most appropriate?

Accepted Answer

Community health nurses should emphasize that over-the-counter cough and cold medications should not be used for children under age 2. The U.S. Food and Drug Administration (FDA) questioned their safety and effectiveness at a hearing in October 2007, and manufacturers removed medication targeted to infants and toddlers; they also changed labels on all cold and cough medications to read that they should not be used in children under age 4. This was in response to emergency room visits and deaths linked to their toxic effects. In 2011, the U.S. Food and Drug Administration formally recommended that the drugs not be used in children under age 2 as they had "serious and potentially life-threatening side effects."

Question 2

A community health nurse is working with a group of parents who have infants and toddlers. Which instruction would the nurse include in a teaching plan for this group about measures to reduce dental caries?

Accepted Answer

It is recommended that sugary foods be eaten at mealtimes and not as snacks and that regular snack times be established. Between-meal drinks should consist of water or milk. Juice should be given only with meals. Allowing infants to fall asleep with a bottle can lead to baby bottle tooth decay or nursing caries.

Question 3

A community health nurse is involved in secondary prevention level activities focusing on child abuse and neglect. Which activity would the nurse most likely implement?

Accepted Answer

Providing respite care for families with special needs children is an example of a secondary prevention action. Prenatal parent preparation classes, public service announcements, and education to improve family functioning skills are examples of primary prevention level activities.

Question 4

A community health nurse is conducting an educational program for a group of parents at a local community health center about promoting adequate brain development in children during the first 2 years of life. The nurse determines that the teaching was effective when the group identifies which nutrient as most important?

Accepted Answer

During the first 2 years, when rapid myelination is taking place, 50% of total calories should come from fat, but after age 2, the choice of 1% or 2% milk-should be the norm. A well-balanced diet including an adequate intake of vitamins, protein, and carbohydrates is needed for overall growth and development.

Question 5

A community health nurse is working to develop a program to address the problem of HIV/AIDS in maternal and child health populations and mother-to-child transmission. Which area would be most important for the nurse to focus on?

Accepted Answer

Most children with acquired immunodeficiency syndrome (AIDS) are children of HIV-positive mothers (WHO, 2015a). Thus, mother-to-child transmission (MTCT) of HIV is a key focus area. It can be almost fully prevented with antiretroviral treatment for mother and infant (WHO, 2015a). To reduce MTCT, women must seek prenatal care early enough in their pregnancies for the antiretroviral drug to be effective. Safer sex practices would be important in reducing the risk of HIV transmission, not MTCT. Handwashing practices and nutritional supplements would not be effective in addressing the problem of MTCT.

Question 6

A community health nurse is providing care to a group of pregnant women at risk for hypertensive disease of pregnancy. When teaching this group about preventive measures, which suggestions would the nurse most likely include? Select all that apply.

Accepted Answer

Various methods are employed to attempt to prevent and control hypertension during pregnancy, namely, careful and constant monitoring of blood pressure, use of blood pressure medications if needed, frequent prenatal visits with monitoring of laboratory tests, a diet rich in fresh fruits and vegetables, lower sodium food choices, adequate fluid intake, weight gain limitations, rest, and regular exercise. Intermittent fetal monitoring may be required. These remain the most common preventive suggestions that PHNs, in collaboration with the clients' primary health care providers, can give to their pregnant clients. A calm environment, periods of rest, and the pregnant woman either elevating her feet or reclining in a left side-lying position are also recommended.

Question 7

A community health nurse is reviewing a program at a local women's community health center for pregnant women. The nurse is conducting an evaluation of the effectiveness of the center's screening for gestational diabetes. The nurse determines that the program is effective as evidenced by documentation of this screening occurring at which time?

Accepted Answer

The average onset for GDM is around the 24th week of pregnancy (American Diabetes Association, 2016). Therefore, screening for gestational diabetes should occur around 24 weeks' gestation.

Question 8

A community health nurse is conducting a teaching session with a group of pregnant women who have gestational diabetes. The nurse determines that the teaching was successful when the women state that which problem could occur in the infant?

Accepted Answer

The infant is at increased risk for fetal death because gestational diabetes has been associated with macrosomia, or large-for-gestational-age (LGA) babies, birth injuries such as broken shoulders, breathing problems, and abnormally high blood sugars at birth. Heart conditions are not commonly associated with infants born to mothers with gestational diabetes.

Question 9

A community health nurse is preparing a program for a local parent group about measures to prevent drowning in children. Which measures would the nurse most likely include in the discussion? Select all that apply.

Accepted Answer

Measures to reduce the risk of drowning in children include having children learn how to swim, keeping bathwater shallow, keeping children within an arm length, eliminating water collection devices around the home, and keeping toilet lids down and bathroom doors closed and preferably secured with a childproof safety handle.

Question 10

A nurse is caring for a pregnant woman who had high blood glucose levels during her 25th week of pregnancy. Which statement is included in teaching the client about gestational diabetes?

Accepted Answer

Gestational diabetes mellitus (GDM) occurs in pregnant women around the 24th week of pregnancy. The client should be counseled about treatment that includes early prenatal care, adequate nutrition, rest and exercise, and adherence to the particular dietary, activity, and blood glucose monitoring and prevention of complications such as hypertension, preeclampsia, urinary tract infections, cesarean section, and future risk of type 2 diabetes. Once diagnosed during pregnancy, GDM can be controlled but not reversed. If measures of treatment discussed earlier are not helpful, oral hypoglycemics are usually prescribed. A diet with low carbohydrates is not indicated by the American Diabetes Association for the treatment of GDM, but rather a diet rich in fruits and vegetables.

Question 11

A nurse is preparing to develop a screening program for school-aged children to assess for adverse childhood events. Which question should be included in the screening?

Accepted Answer

Adverse childhood events (ACEs) are potentially traumatic events that occur in children from 0 to 17 years such as experiencing violence or abuse, witnessing violence in the home or community, and having a family member attempt or die by suicide. Asking about seeing abuse in the question "Have you witnessed anyone hurting you or one of your siblings" is the best question for the screening tool. The question asking "Do you feel like you want to hurt yourself" assesses the risk for suicide in the client and not the community. The question asking "Do you like the neighborhood you live in" is a closed question requiring a yes or no response but does not address witnessing violence in the home or community. The question "How many times have you seen the police driving around the neighborhood" does not address witnessing violence but a measure to reduce violence.

Question 12

A nurse is caring for a 1-year-old child who was diagnosed with an acute respiratory illness. The nurse is teaching the caregiver about how to manage the illness. Which statements are included in the instruction? Select all that apply.

Accepted Answer

Acute respiratory illnesses are common in children under the age of 5 years. C/PHNs need to emphasize that over-the-counter cough and cold medications should not be used for children under age 2. Parents and caregivers need to be informed of the dangers of these products and suggest a safer alternative such as alternating ibuprofen and acetaminophen, the use of a humidifier, offering cold liquids, and avoiding large crowds during illness.

Quiz 19: Maternal-Child Health