Critical Care Exam 3 ONLY PEDS

A child is sent to the school nurse for assessment because she comes to school every day disheveled, unbathed, and hungry. The assessment does not indicate any bruises or marks on the body. What do these finding indicate? a. Sexual abuse b. Physical abuse c. Physical neglect d. Emotional abuse

C. Physical neglect. Physical neglect is the failure to provide for the basic physical needs of the child, including food, clothing, shelter, and basic cleanliness.

A pediatric nurse is assisting with the care of a child diagnosed with a fractured femur. What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse? a. Stress fracture b. Compound fracture c. Spiral fracture d. Greenstick fracture

C. Spiral fracture. A spiral fracture of the femur is caused by a forceful twisting motion. When the history of an injury does not correlate with x-ray findings, child abuse should be suspected because spiral fractures can be the result of manual twisting of the extremity.

When developing the plan of care for a child with early Duchenne's muscular dystrophy, which of the following nursing goals is the priority? 1.Encouraging early wheelchair use. 2.Fostering social interactions. 3.Maintaining function of unaffected muscles. 4.Preventing circulatory impairment.

3.Maintaining function of unaffected muscles. The primary nursing goal is to maintain function in unaffected muscles for as long as possible. There is no effective treatment for childhood muscular dystrophy. Children who remain active are able to forestall being confined in wheelchair. Remaining active also minimizes the risk for social isolation. Preventing rather than encouraging wheelchair use by maintaining function for as long as possible is an appropriate nursing goal. Children with muscular dystrophy become socially isolated as their condition deteriorates and they can no longer keep up with friends. Maintaining function helps prevent social isolation. Circulatory impairment is not associated with muscular dystrophy

33. Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

ANS: A Bulging fontanel, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

A nurse is providing discharge teaching to parents whose infant had a ventriculoperitoneal shunt placement for the treatment of hydrocephalus. Which of the following statements by the parents indicates an understanding of the teaching? A. "We will chech his abdomen daily for signs of fluid accumulation." B. "We will notifiy the doctor right away if he has a fever." C. "We should keep a helmet on him when he's awake" D. "We can expect him to have occasional seizure episodes."

B. Rationale: Infection is a risk after ventriculoperitoneal shunt insertion, esp 1 to 2 months after placement. The parents should report fevers, vomiting, seizure activity, and decreased responsiveness, as these findings can indicate infections.

Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis? a. Wearing splints at night to prevent extension contractures b. Applying moist heat packs upon awakening c. Taking a warm tub bath the evening before d. Sleeping with two pillows under the head

B. Applying moist heat packs upon awakening. Application of moist heat, with a compress or by tub bath upon awakening, will help to lessen stiffness

Which will help a school-age child with muscular dystrophy stay active longer? Select all that apply. 1. Normal activities, such as swimming. 2. Using a treadmill every day. 3. Several periods of rest every day. 4. Using a wheelchair upon getting tired. 5. Sleeping as late as needed

1. Normal activities, such as swimming. 3. Several periods of rest every day. 4. Using a wheelchair upon getting tired. (1. Swimming is an excellent exercise that uses many muscles and helps build strength. Children who are active are usually able to postpone use of a wheelchair. It is important to keep using muscles for as long as possible, and aerobic activity is good for a child. 2. Use of a treadmill is not fun for children or adults, so keeping the child using the treadmill might be an issue. 3. Any child with a chronic disease should be kept as active as possible for as long as possible; short rest periods built into the day are helpful in maintaining stamina. 4. Children with neuromuscular diseases oftentimes will use a wheelchair to conserve energy and increase mobility. The wheelchair acts as the child's means of getting to where they want to go as independently as possible. 5. The child should be on a regular daily schedule including the same bedtime and getting up time. Rest times should be provided during the day.)

The nurse knows that teaching was successful when a parent states which of the following are early signs of muscular dystrophy? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity

2. Difficulty climbing stairs.

A nurse is making an initial visit to a family with a 3-year-old child with early Duchenne's muscular dystrophy. Which of the following findings is expected when assessing this child? 1.Contractures of the large joints. 2.Enlarged calf muscles. 3.Difficulty riding a tricycle. 4.Small, weak muscles.

3.Difficulty riding a tricycle. Usually the first clinical manifestations of Duchenne's muscular dystrophy include difficulty with typical age-appropriate physical activities such as running, riding a bicycle, and climbing stairs. Contractures of the large joints typically occur much later in the disease process. Occasionally enlarged calves may be noted, but they are not typical findings in a child with Duchenne's muscular dystrophy. Muscular atrophy and development of small, weak muscles are later signs.

The nurse is caring for a school-age child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

4. Activity intolerance.

A nurse is caring for a school aged child who has juvenile idiopathic arthritis. Which of the following home care instructions should the nurse include in the teaching. (Select all that apply). A. Provide extra time for ADL's B. Use cold compress for joints C. Take ibuprofen on an empty stomach D. Remain home during periods of exacerbation E. Perform ROM exercises.

A & E A. Provide extra time for ADL's — Providing extra time for ADL's promotes independence in the child and provides a means to maintain mobility E. Perform ROM exercises — ROM will assist in maintaining function of the joints

A nurse is caring for an adolescent who has a closed head injury. Which of the following findings are indications of increased intracranial pressure (ICP)? (Select all that apply) A. Report of headache B. Alteration in pupillary response C. Increased motor response D. Increased sleeping E. Increased sensory response

A. Report of headache B. Alteration in pupillary response D. Increased sleeping

Which observation may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs? a. Red, green, and yellow bruises on his body b. Bruises are dispersed on his head, arms, and legs c. A broken arm last year, and the child being described as accident-prone d. The mother is very anxious for her son to get medical attention

A. Red, green, and yellow bruises on his body. As bruises heal, they change color in stages. Different colors of bruises indicate that injuries have not all occurred at the same time. The nurse must consider whether the bruises match the caretaker's explanation of what happened.

a nurse is caring for a school age child who has JIA. What are appropriate home care instructions? select all that apply A. sleep on firm mattress B. use cold compress for joint pain C. take ibuprofen on empty stomach D. take frequent rest periods throughout day E. perform ROM exercises

A. sleep on firm mattress D. take frequent rest periods throughout day E. perform ROM exercises

8. The priority nursing intervention when a child is unconscious after a fall is to: a. Establish an adequate airway. b. Perform neurologic assessment. c. Monitor intercranial pressure. d. Determine whether a neck injury is present.

ANS: A Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishing an adequate airway is always the first priority. A neurologic assessment and determination of neck injury are performed after breathing and circulation are stabilized. Intracranial, not intercranial, pressure is monitored if indicated after airway, breathing, and circulation are maintained.

45. An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care (Select all that apply)? a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

ANS: A, E, F Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping the shunt reservoir, administering sedation, and maintaining Trendelenburg position are not interventions associated with this condition.

48. The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased ICP in an infant (Select all that apply)? a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirations

ANS: B, D, E Late signs of ICP in an infant or child include bradycardia, alteration in pupil size and reactivity, decreased motor response, extension or flexion posturing, and Cheyne-Stokes respirations.

40. A 10-year-old boy has been hit by a car while riding his bicycle in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action should be to: a. Place on side. b. Take blood pressure. c. Stabilize neck and spine. d. Check scalp and back for bleeding.

ANS: C After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma. The child's position should not be changed until the neck and spine are stabilized. Blood pressure is a later assessment. Less urgent, but an important assessment, is inspection of the scalp for bleeding.

44. Clinical manifestations of increased intracranial pressure (ICP) in infants are (Select all that apply): a. Low-pitched cry. b. Sunken fontanel. c. Diplopia and blurred vision. d. Irritability. e. Distended scalp veins. f. Increased blood pressure.

ANS: C, D, E Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Low-pitched cry, sunken fontanel, and increased blood pressure are not clinical manifestations associated with ICP in infants.

386. The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing? 1. Flaccid paralysis of all extremities 2. Adduction of the arms at the shoulders 3. Rigid extension and pronation of the arms and legs 4. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities

Answer: 3 Rationale: Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs. Option 1 is incorrect. Options 2 and 4 describe decorticate (flexion) posturing.

A nurse is caring for a child who is taking mannitol for cerebral edema. Which of the following adverse effects should the nurse monitor the child for and report to the provider? A. Bradycardia B. Weight loss C. Confusion D. Constipation

C. Confusion

The parents of an infant with hydrocephalus ask about future activities in which their child can participate in school and as an adolescent. The nurse should tell the parents which of the following? a. A helmet should be worn during any activity that could lead to head injury. b. Only non-contact sports should be pursued, such as swimming or tennis. c. Because of the risk of shunt system infection, swimming is not a sports option. d. The child should wear a life alert bracelet; then there is no need to be aware of the shunt system.

a. A helmet should be worn during any activity that could lead to head injury.

A nurse is in the emergency department assessing a child following a motor-vehicle crash. The child is unresponsive, has spontaneous respirations of 22/min, and has a laceration on the forehead that is bleeding. Which of the following actions should the nurse take first? A. Stabilize the child's neck B. Clean the child's laceration with soap and water C. Implement seizure precautions for the child D. Initiate IV access for the child

a. Stabilize the child's neck

A newborn with suspected hydrocephalus is transferred to the intensive care unit for further evaluation and treatment. The baby's nurse knows which of the following? a. To use sedation as needed to keep the baby from crying or being fussy. b. To keep the crib in a flat and neutral position. c. To expect the infant to sleep more than a baby without hydrocephalus. d. To not use any scalp veins for intravenous infusions.

d. To not use any scalp veins for intravenous infusions.

Early signs and symptoms of hydrocephalus in an infant include which of the following? a. confusion, headache, diplopia b. rapid head growth, poor feeding, confusion c. papilledema, irritability, headache d. full fontanels, poor feeding, rapid head growth

d. full fontanels, poor feeding, rapid head growth

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. Which should the nurse tell them? Select all that apply. 1. "Muscular dystrophies usually result in progressive weakness." 2. "The weakness that your child is having will probably not increase." 3. "Your child will be able to function normally and not need any special accommodations." 4. "The extent of weakness depends on doing daily physical therapy." 5. "Your child may have pain in his legs with muscle weakness."

1 & 5 1. "Muscular dystrophies usually result in progressive weakness." (Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder.) 5. "Your child may have pain in his legs with muscle weakness." (The child may have pain due to loss of strength and muscle wasting.)

A 5-year-old has been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. Which nursing intervention(s) would be appropriate? Select all that apply. 1. Discuss with the parents the potential need for respiratory support. 2. Explain that this disease is easily treated with medication. 3. Suggest exercises that will limit the use of muscles and prevent fatigue. 4. Assist the parents in finding a nursing facility for future care. 5. Encourage the parents to contact the school to develop an IEP.

1, 3, & 5 1. Muscles become weaker, including those needed for respiration, and a decision will need to be made about whether respiratory support will be provided. 4. The parents need to decide eventually if they will keep the child home or cared for in a nursing facility, but that is not an immediate concern. 5. Parents should be encouraged to allow the child to go to school and participate in activities as tolerated.

The nurse should tell the parents of a child with Duchenne muscular dystrophy that some of the progressive complications include: Select all that apply. 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech. 5. Increasing difficulty swallowing and shallow breathing.

3. Contractures, obesity, and pulmonary infections. 5. Increasing difficulty swallowing and shallow breathing.

A nurse in the emergency department is caring for a client who fell through the ice on a pond and is unresponsive and breathing slowly. Which of the following are appropriate actions by the nurse? (Select all that apply.) A. Remove wet clothing. B. Maintain normal room temperature. C. Apply warm blankets. D. Apply a heat lamp. E. Infuse warmed IV fluids.

A, C, D, & E A.CORRECT: This is an appropriate action by the nurse because the body temperature can rise more quickly when heat is applied to dry skin. B.INCORRECT: The nurse should increase the temperature of the room to help return the client to a normal body temperature. C.CORRECT: This is an appropriate action by the nurse because the client's body temperature can rise more quickly when warm blankets are applied. D.CORRECT: This is an appropriate action by the nurse because the client's body temperature can rise more quickly when a heat lamp is safely applied. E.CORRECT: This is an appropriate action by the nurse because the client's body temperature can rise more quickly when warmed IV fluids are infused.

What factor(s) may trigger abuse in a parent? (Select all that apply.) a. Being abused as a child b. High self-esteem c. Substance abuse d. Overwhelming responsibility e. Knowledge deficit relative to child care

A, C, D, E. Correct. All options except high self-esteem are possible triggers for a parent to become abusive.

Nursing care during the first 24 hours for an infant who has just had a VP shunt placed would involve: A. Sedating the patient frequently for pain B. Placing the infant in high-fowlers position C. Positioning the baby on the side that has the shunt D. Monitoring the infant for increasing ICP

D. Monitoring the infant for increasing ICP

The child with Duchenne's muscular dystrophy must push on his legs and "walk up the leg" in order to rise to a standing position. The nurse recognizes this characteristic behavior as _______________ maneuver.

Gower's. Gowers' maneuver is a unique way of rising from the floor by walking up the leg in order to get the upper body erect.

The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. Mother. 2. Sister. 3. Brother. 4. Aunts and all female cousins. 5. Uncles and all male cousins.

1. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. 2. The X chromosome carries the disease, and males are affected. The sister should have genetic testing to determine whether she carries the gene and identify her risks for having male offspring with the disease. 3. Because the disease is carried on the X chromosome, only females need to be genetically tested. Women carry the disease, and males are affected. All female relatives should be tested unless they are symptomatic. 4. The X chromosome carries the disease and males are affected. All female relatives should be tested. 5. The X chromosome carries the disease and males are affected. All female relatives should be tested.

The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and its management. Which of the following statements by the mother indicates successful teaching? 1."My son will probably be unable to walk independently by the time he is 9 to 11 years old." 2."Muscle relaxants are effective for some children; I hope they can help my son." 3."When my son is a little older, he can have surgery to improve his ability to walk." 4."I need to help my son be as active as possible to prevent progression of the disease.

1."My son will probably be unable to walk independently by the time he is 9 to 11 years old." Muscular dystrophy is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9 to 11 years. There is no effective treatment for childhood muscular dystrophy. Although children who remain active are able to avoid wheelchair confinement for a longer period, activity does not prevent disease progression.

The mother of a child with Duchenne's muscular dystrophy asks about the chance that her next child will have the disease. The nurse responds based on the understanding of which of the following? 1.Sons have a 50% chance of being affected. 2.Daughters have a 1 in 4 chance of being carriers. 3.Each child has a 1 in 4 chance of developing the disease. 4.Each child has a 50% chance of being a carrier.

1.Sons have a 50% chance of being affected. Duchenne's muscular dystrophy is an X-linked recessive disorder. The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50% chance of being carriers.

Which foods would be best for a child with Duchenne muscular dystrophy? Select all that apply. 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain. 5. Thickened liquids and smaller portions that are cut up.

4 & 5 4. Low-calorie foods to prevent weight gain. 5. Thickened liquids and smaller portions that are cut up. (1. As the child with muscular dystrophy becomes less active, diet becomes more important. Attention should be paid to quality and quantity of food, so the child does not gain too much weight. 2. Good-quality foods are important as the child continues to grow. 3. Extra protein will not help the child recover from this disease. 4. As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation. 5. As the child loses muscle control, the need for thickened liquids and small, well-cut-up solids becomes essential. TEST-TAKING HINT: Nutrition is important for every child; as the child becomes less ambulatory, weight concerns arise.)

19. A 3-year-old child is hospitalized after a near-drowning accident. The child's mother complains to the nurse, "This seems unnecessary when he is perfectly fine." The nurse's best reply is: a. "He still needs a little extra oxygen." b. "I'm sure he is fine, but the doctor wants to make sure." c. "The reason for this is that complications could still occur." d. "It is important to observe for possible central nervous system problems."

ANS: C All children who have a near-drowning experience should be admitted to the hospital for observation. Although many children do not appear to have suffered adverse effects from the event, complications such as respiratory compromise and cerebral edema may occur up to 24 hours after the incident. Stating that, "He still needs a little extra oxygen" does not respond directly to the mother's concern. Why is her child still receiving oxygen? The nurse should clarify that different complications can occur up to 24 hours later and that observations are necessary.

38. The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death? a. Papilledema c. Doll's head maneuver b. Delirium d. Periodic and irregular breathing

ANS: D Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Papilledema is edema and inflammation of the optic nerve. It is commonly a sign of increased intracranial pressure. Delirium is a state of mental confusion and excitement marked by disorientation to time and place. The doll's head maneuver is a test for brainstem or oculomotor nerve dysfunction.

A nurse is developing a plan of care for a toddler who has cerebral palsy. Which of the following actions should the nurse include? A. Structure interventions according to the toddler's chronological age B. Evaluate the toddler's need for an evaluation of hearing ability C. Monitor the toddler's pain level routinely using a numeric rating scale D. Provide total care for daily hygiene activities

B. Correct. Recognize that the toddler who has CP has an increased risk for hearing impairment. Therefore, evaluate the toddlers need for an evaluation of hearing ability

16. The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of the nursing assessment to detect early signs of a worsening condition is: a. Posturing. c. Focal neurologic signs. b. Vital signs. d. Level of consciousness.

ANS: D The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing indicates neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

391. An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1. Test the urine for protein. 2. Reposition the infant frequently. 3. Provide a stimulating environment. 4. Assess blood pressure every 15 minutes.

Answer: 2 Rationale: Hydrocephalus occurs as a result of an imbalance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracranial pressure (ICP). In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not repositioned frequently, pressure ulcers can occur on the back and side of the head. An egg crate mattress under the head is also a nursing intervention that can help prevent skin breakdown. Proteinuria is not specific to hydrocephalus. Stimulus should be kept at a minimum because of the increase in ICP. It is not necessary to check the blood pressure every 15 minutes.

385. The nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the pediatrician's prescriptions and should contact the pediatrician to question which prescription? 1. Obtain daily weight. 2. Provide clear liquid intake. 3. Nasotracheal suction as needed. 4. Maintain a patent intravenous line.

Answer: 3 Rationale: A basilar skull fracture is a type of head injury. Nasotracheal suctioning is contraindicated in a child with a basilar skull fracture. Because of the nature of the injury, there is a possibility that the catheter will enter the brain through the fracture, creating a high risk of secondary infection. Fluid balance is monitored closely by daily weight determination, intake and output measurement, and serum osmolality determination to detect early signs of water retention, excessive dehydration, and states of hypertonicity or hypotonicity. The child is maintained on NPO (nothing by mouth) status or restricted to clear liquids until it is determined that vomiting will not occur. An intravenous line is maintained to administer fluids or medications, if necessary.

382. The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysiological process? 1. An infectious disease of the central nervous system 2. An inflammation of the brain as a result of a viral illness 3. A chronic disability characterized by impaired muscle movement and posture 4. A congenital condition that results in moderate to severe intellectual disabilities

Answer: 3 Rationale: Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system. Meningitis is an infectious process of the central nervous system. Encephalitis is an inflammation of the brain that occurs as a result of viral illness or central nervous system infection. Down's syndrome is an example of a congenital condition that results in moderate to severe intellectual disabilities.

384. A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

Answer: 4 Rationale: Head injury is the pathological result of any mechanical force to the skull, scalp, meninges, or brain. A head injury can cause bleeding in the brain and result in increased ICP. In a child, early signs include a slight change in level of consciousness, headache, nausea, vomiting, visual disturbances (diplopia), and seizures. Late signs of increased ICP include a significant decrease in level of consciousness, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity, posturing, Cheyne-Stokes respirations, and coma.

Which statement is true concerning osteogenesis imperfecta (OI)? A. OI is easily treated. B. OI is an inherited disorder. C. With a later onset, the disease usually runs a more difficult course. D. Braces and exercises are of no therapeutic value.

B. OI is an inherited disorder

Parents of a child who has just had a VP shunt inserted for hydrocephalus are concerned about the prognosis. The nurse should explain that: A. The prognosis is excellent and the valve is permanent B. The shunt may need to be revised as the child grows older C. If any brain damage has occurred it is reversible during the first year of life D. Hydrocephalus is usually self-limited by 2 years of age and the shunt may be removed

B. The shunt may need to be revised as the child grows older

A nurse is caring for a child who has muscular dystrophy. For which of the following findings should the nurse assess? (Select all that apply) A. Purposeless, involuntary, abnormal movements B. Spinal defect and saclike protrusions C. Musculair weakness in lower extremities D. Unsteady, wide- based or waddling gait E. Upward slant to the eyes

C. Correct. A child who has MD will exhibit muscular weakness in the lower extremities as one of the first manifestations D. Correct. A child who has MD will exhibit an unsteady gait, wide-based, or waddling gait due to the progressive muscle weakness.

What characteristic manifestation does the nurse caring for a child with Duchenne's muscular dystrophy document? a. Ambulates by holding onto furniture b. Exhibits atrophy of the calf muscles c. Falls frequently and is clumsy d. Has delayed fine-motor development

C. Correct. Frequent falling and clumsiness are clinical manifestations of Duchenne's muscular dystrophy.