A school nurse is examining a child who has a toothache and bruises on both knees.
Which of the following observations should the nurse report as a potential sign of maltreatment at home?

Choice A rationale

Down syndrome does not typically require a modification in the standard immunization schedule. Children with Down syndrome should receive all recommended vaccinations according to the standard schedule.

Choice B rationale

Failure to thrive does not typically require a modification in the standard immunization schedule. Children with failure to thrive should receive all recommended vaccinations according to the standard schedule.

Choice C rationale

This is the correct answer. Children with leukemia or other cancers that weaken the immune system may require modifications to the standard immunization schedule. These children may need to avoid certain vaccines or delay vaccination until their immune system is stronger.

Choice D rationale

Sickle cell disease does not typically require a modification in the standard immunization schedule. Children with sickle cell disease should receive all recommended vaccinations according to the standard schedule.

Choice A rationale

Identifying alternative solutions to address concerns is an important step in any project. However, it is not the first step in developing a mobile meal program for older adults who no longer drive. The first step should be to understand the needs of the target population, which can be achieved through a needs assessment.

Choice B rationale

Determining potential funding sources for the program is indeed a crucial aspect of planning. However, before seeking funding, it is essential to understand what needs to be funded, which comes from performing a needs assessment.

Choice C rationale

Inquiring about the availability of volunteers is a significant part of implementing the program. Volunteers could be responsible for meal preparation, delivery, or other tasks. However, the availability of volunteers does not determine the necessity or structure of the program.

Choice D rationale

Performing a needs assessment is the first step in developing a program. A needs assessment involves determining the extent of the need for a service in a particular population. In this case, it would involve determining how many older adults in the community no longer drive and would benefit from a mobile meal program.