🤓CHAPTER 22 PREP U

hypertonia in the upper extremities

A 3-month-old infant is seen in the pediatric clinic. The infant's parent expresses concern that the child has developed cerebral palsy. The nurse assesses the infant. Which assessment finding indicates to the nurse that the parent's concern is valid?

A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental bowlegs (genu varum)?

development of gross motor movement

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal?

syndactyly

A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as:

"It is important that the harness be worn continuously."

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point?

"Let's put you in touch with other families who have experienced this."

A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents?

halo traction.

A type of traction sometimes used in the treatment of the child with scoliosis is called:

"We'll apply a warm moist compress to the wrist for 20 minutes at a time."

After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching?

to continue with age-appropriate activities

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?

Petal the cast with strips of adhesive.

Clubfoot (congenital talipes equinovarus) is determined and serial casting has begun. When assisting with cast application, in which manner will the nurse protect the client's skin from the cast's sharp plastered edges?

coordinating care by specialists

Other than providing direct care to children, what is the major role of nurses in the care of nearly all children with neuromuscular disorders?

lordosis

The child diagnosed with muscular dystrophy often exhibits a forward curvature of the lumbar spine. What is this spinal condition called?

"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection."

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents?

Cover the sac with a saline-moistened dressing.

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way?

Application of a splint or cast

The nurse is answering questions from the parents of a newborn diagnosed with clubfoot (congenital talipes equinovarus). When asked by the parents which treatment will be used, what would the nurse predict?

spastic

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as:

Assess the popliteal region carefully for skin breakdown.

The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?

"Check the skin that is covered by the braces for redness and breakdown."

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching?

Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined.

The nurse is caring for a child who has had an open reduction with cast placement on the forearm. While assessing the cast, the nurse notes serosanguineous fluid on the cast. What action by the nurse is appropriate?

clozapine

The nurse is caring for a child with muscular dystrophy. Which prescription will the nurse question?

"Let's ask your parents to bring your friends for a visit."

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention?

Gowers sign

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?

Developmental dysplasia of the hip (DDH)

The parent has brought a 2-year-old to the public clinic for immunizations. The nurse documents the following characteristics: A duck waddle gait Shortened extremity Asymmetry of the gluteal folds Protruding abdomen The nurse then refers the toddler to the health care provider for potential diagnosis of which?

Impaired physical mobility related to a cast on the leg

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priorityfor this client?

Skin traction

The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction?

serial casting

What treatment can the nurse anticipate assisting with for a newborn with clubfoot (congenital talipes equinovarus)?

muscles of the hip

When a child is suspected of having muscular dystrophy, a nurse should expect which muscles to be affected first?

It appears at birth or during the first 2 years of life.

Which characteristic is true of cerebral palsy?

significant level of alpha-fetoprotein present in amniotic fluid

Which diagnostic measure is most accurate in detecting neural tube defects?

"When the strips start to dry, they can get warm, but they won't burn you."

A nurse is caring for an adolescent who is having a plaster cast applied. When the plaster strips are applied, the adolescent complains of it feeling hot. What is the best response by the nurse?

flexible passively past neutral, but only to midline actively.

A nurse is conducting a physical examination of an infant with suspected metatarsus adductus. Type II metatarsus adductus is indicated when the forefoot is:

Trendelenburg gait

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected?

spina bifida occulta

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?

Auscultation

A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?

"My mom is going to have to pick up all of her throw rugs so I don't slip on them."

A nurse is performing crutch training for an adolescent who has a fractured tibia. What statement by the adolescent indicates successful teaching?

Muscular wasting results in generalized immobility and difficulty feeding and breathing.

A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?

"Before the test, my child will drink a special liquid that will be absorbed into her bones."

A nurse is speaking with the parents of a child scheduled for a bone scan. Which statement by a parent indicates a need for further education?

"The very first step is to apply water-based lubricant to the catheter."

A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching?

"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida?

A 13-year-old boy who is on his school's cross-country team

A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the mostlikely to develop this condition?

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?

obesity

A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor?

suspected failure to thrive

A parent brings a 12-month-old child diagnosed with congenital cerebral palsy to the clinic. The nurse completes an assessment. Which assessment finding requires immediate intervention by the nurse?

back with hips up off the bed.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

The spinal meninges protrude through the bony defect and form a cystic sac.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele?

Advise the child that this is to be expected.

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?

creatine kinase

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

Head and neck

The nurse caring for a toddler immediately after a fall from a grocery cart will avoid moving which body area as the child is examined?

During adolescence, muscle growth is influenced by increased production of androgenic hormones.

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which statement regarding these variations is true?

Quietly observe the child at play while interviewing the parent.

A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment?

"You should apply pressure to the site and then bring your child in to be evaluated."

A pediatric client's parent calls the nurse and states, "My child fell off the bike. My child was wearing a helmet, but did scrape the knee and it is bleeding a lot. What should I do?" Which response by the nurse is best?

"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future."

The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education?

NSAIDs, ice, and limiting exercise

The nurse is assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client?

"Your baby's feet are normal. The longitudinal arch will develop after your baby walks for several months."

The nurse is assessing an infant at a well-check visit. The infant's parent expresses worry about the infant's feet because they are so flat and wide. What is the appropriate response by the nurse?

"You and your coaches need to understand that you cannot play soccer for at least six weeks."

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?

"It will be hard, but we know our child will be in this device for a long time."

The nurse is reinforcing teaching with the caregivers of a child who has been placed in an external fixation device for the treatment of an orthopedic condition. Which statement made by the caregivers indicates an understanding of the external fixation device?

"Would you please describe the weakness you are seeing in your son?"

The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information?

"My son's activity is too limited to stimulate his bowels."

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching?

"Does your child report pain in the groin that results in a limp?"

The nurse is caring for a child admitted with possible Legg-Calvé-Perthes disease. Which assessment question should the nurse ask the child's caregivers to help support this diagnosis?

Holding feet/ankles in position for casting

The nurse is caring for a neonate in the newborn nursery with clubfoot (congenital talipes equinovarus). If nonsurgical treatment is chosen, which nursing action is anticipated?

"I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain."

The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education?

"I will get the prescription for the antibiotics filled as soon as we leave the office today."

The nurse is caring for a school-age child diagnosed with transient synovitis. What statement by a parent indicates a need for further education regarding this diagnosis?

blue sclera

The nurse is conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common?

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond?

The child places the crutches on the lower step before placing the good foot down between the crutches.

The nurse is observing a child walk down stairs using a swing-through gait. What action by the child is correct?

"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state:

Obese adolescent boys

The nurse meets a child with a slipped capital femoral epiphysis. In what type of child does this usually occur?