Pediatrics Ch. 30
The nurse is caring for a patient who has sustained a spinal cord injury in an accident. What immediate step should the nurse take to prevent the complications of spinal cord injury?
Assess the patient's respiratory status and pattern.
What is associated with infant botulism?
Honey and corn syrup
What does the nurse understand about the neural tube defect anencephaly?
It is the most serious neural tube defect and is incompatible with life.
The parents of a child with cerebral palsy ask the nurse about the advantages of ankle-foot orthoses (AFOS). What is the most appropriate response by the nurse?
"AFOS are used to prevent deformity and increase energy efficiency of gait."
The nurse is teaching the parents of a child with cerebral palsy about the importance of baclofen therapy. Which statement made by the nurse is relevant to the medication regimen?
"Baclofen is administered into the intrathecal space."
The nurse is educating a group of pregnant women about the importance of folic acid supplementation in the diet. Which suggestion given by the nurse is appropriate?
"Foods rich in folic acid prevent the development of neural tube defects."
The parents find that their son has X-linked Duchenne muscular dystrophy (DMD). They also have a daughter and are concerned about their daughter's well-being. Neither parent has muscular dystrophy. Their daughter has not shown any symptoms. Which are. the most appropriate statements to address their concerns? Select all that apply.
"It can be a new mutation, and the mother need not be a carrier." "Your daughter may be a carrier and could develop cardiomyopathy." "It is a genetic disease caused by mutation of the gene that encodes dystrophin:"
A 4-month-old child shows signs of being infected with Clostridium botulinum, such as mild constipation, loss of neurologic function, and respiratory failure. The nurse asks the senior nurse about the child's care. What are the appropriate responses by the senior nurse? Select all that apply.
"Observe and report signs of poor feeding, constipation, and muscle impairment." Educate the parents about stool softeners, fatigue after recovery, and feeding."
The nurse identifies a child living in an unclean environment who has an outbreak of tetanus infection. The nurse observes that the child has trismus and a sardonic smile. Which immediate action by the nurse is helpful in managing muscle spasticity in the child?
Administering dantrolene
An 8-year-old has been found to have moderate cerebral palsy (CP). The child recently began participating in a regular classroom for part of the day. The child's mother asks the school nurse about joining the afterschool Scout troop. The nurse's response should be based on what knowledge?
After-school activities often provide children with CP with opportunities for socialization and recreation
What is the most serious neural tube defect, consisting of a congenital malformation in which both cerebral hemispheres are absent?
Anencephaly
Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy (DMD)?
DMD is characterized by muscle weakness, usually beginning around the age of 3 years.
The nurse is caring for a child who sustained a deep puncture wound 6 weeks earlier. What are the initial symptoms of tetanus?
Difficulty opening the mouth
A 10-year-old child falls down the stairs at school and shows symptoms of major spinal injury. The school nurse needs to take care of the child before emergency medical technicians arrive. What should be the initial nursing actions? Select all that apply.
Ensure that the child has adequate initial stabilization of the entire spinal column. Provide a cervical collar with supportive blocks on a rigid backboard to support the spine.
A patient with Guillain-Barré syndrome has chronic pain. Which drug should the nurse administer to relieve this symptom in the patient?
Gabapentin
What is an important aspect of the care of a child with newly diagnosed Duchenne (pseudohypertrophic) muscular dystrophy?
Genetic counseling
What acquired neuromuscular disorder is characterized by progressive, usually ascending flaccid paralysis?
Guillain-Barré syndrome
What is the priority intervention if a spinal cord injury is suspected in a child?
Perform the jaw-thrust technique.
What clinical manifestation is found in a child with spastic cerebral palsy?
Positive Babinski
The nurse is caring for a patient with muscular dystrophy. Which drug should the nurse administer for the effective management of the condition?
Prednisone
Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is what?
Prenatal brain abnormalities
What are the initial symptoms of tetanus? Select all that apply.
Progressive stiffness Difficulty opening mouth Progressive tenderness of muscles in neck and jaw
What most accurately describes bowel function in children born with a myelomeningocele?
Some degree of fecal continence can usually be achieved.
What is a neural tube defect that is not visible externally in the lumbosacral area called?
Spina bifida occulta
A 6-year-old child born with a myelomeningocele has a neurogenic bladder. The parents have been performing clean intermittent catheterization. What should the nurse recommend?
Teaching the child to perform self-catheterization
A woman who is 6 weeks pregnant tells the nurse that she is worried that her baby might have spina bifida because of family history. On what knowledge should the nurse's response be based?
The concentration of a-fetoprotein may indicate the presence of the defect.
A nurse is caring for an infant born with a myelomeningocele. What is the priority nursing goal in the management of genitourinary function for this infant?
To preserve renal function
What factors help determine the degree of neurologic dysfunction that occurs with spina bifida occulta?
Where the sac protrudes through the vertebrae, the anatomic level of the defect, and the amount of neurologic tissue involved
The nurse is caring for a child with cerebral palsy. On electroencephalogram analysis, the nurse identifies that the child has epilepsy. Which drug should the nurse administer to manage the condition?
Carbamazepine
The nurse is teaching a patient with spina bifida about latex allergies. Which suggestion given by the nurse is helpful in preventing the occurrence of allergic reactions to latex?
"Reduce the intake of avocado."
The nurse is teaching a group of nursing students about the precautions to be taken while caring for latex-hypersensitized patients. Which statement made by the nurse is appropriate?
"Use disposable plastic gloves while caring for patients who have a latex allergy."
What care should a nurse caring for an infant with a myelomeningocele provide?
Application of a sterile, moist, nonadherent dressing over the defect
Which treatments does the nurse understand can help ease spasticity in a child with cerebral palsy?
Implanted medication pump
What is the nursing role in supporting the parents of an infant born with physical defects? Select all that apply.
Instruction on modifying their home for the care of their child Providing information about the diagnosis on an ongoing basis Clarification on what they can expect in the hospital and home Supporting the family in coping with the emotional aspects of the disorder
The primary health care provider asks the nurse to watch for signs of developing hydrocephalus in a toddler with spina bifida. For what signs should the nurse look?
Temperature instability, irritability, and lethargy, and elevated intracranial pressure
After assessing a patient who has had a spinal cord injury, the nurse finds that the patient has loss of neural function below the acute spinal cord lesion and flaccid paralysis. What should the nurse deduce from this finding?
The patient has spinal cord concussion.
The nurse is reviewing the computed tomography scan results of a newborn and finds that the newborn has a hernial protrusion of a saclike cyst filled with spinal fluid. What condition does the nurse suspect in the infant from this finding?
Meningocele
An inadequately immunized 4-year-old child with tetanus is admitted to the pediatric intensive care unit. How should the nurse care for the child? Select all that apply.
Monitor fluid balance, pain, and keep appropriate emergency equipment handy. Evaluate muscle spasms and keep prescribed relaxants, opioids, and sedatives ready. Monitor intravenous infusions and suction oropharyngeal secretions. Carry out surgical debridement and cleansing of the wound immediately.
A 15 year-old is admitted to the intensive care unit (ICU) with a spinal cord injury. What are the most appropriate nursing interventions for this adolescent? Select all that apply.
Monitoring neurologic status Administering corticosteroids Monitoring for respiratory complications Monitoring and maintaining hemodynamic status.
An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome). When explaining this disease process to the parents, what should the nurse consider?
Muscle function will gradually return, and recovery is possible in most children.
A nurse is caring for an adolescent who has sustained a spinal cord injury. What complication may occur as a result of a disruption in the descending sympathetic pathways with loss of vasomotor tone and sympathetic innervation of the cardiovascular system?
Neurogenic shock
A newly hired nurse caring for an infant who has myelomeningocele asks the senior nurse for assistance. On what areas should the senior nurse tell the new nurse to focus? Select all that apply.
Neurologic and behavioral development and measurement of the head circumference and fontanels Meningeal sac protection and intervention plans to optimize the child's development Infection and skin breakdown occurrence and signs of urologic and bowel complications
A child with cerebral palsy needs multidisciplinary care and coordination. The child's parents ask the nurse for help. What areas should the nurse include in the teaching? Select all that apply.
Proper handling and adapting to the home environment Medication administration and the changing role of parents and siblings Devising and modifying equipment and activities as per child's ability
A child with spina bifida has developed a latex allergy as a result of numerous bladder catheterizations and surgeries. What is the priority nursing intervention?
Provide a latex-free environment
The nurse is caring for a preterm infant who has cerebral palsy. What intervention should the nurse take to ensure adequate nutrition of the infant?
Provide gastrostomy feedings.
What is the major goal of therapy for children with cerebral palsy (CP)?
Recognizing the disorder early and promoting optimal development
The nurse is caring for a child with impaired motor activity. On further examination, the nurse finds that the child has a reduced range of abduction movement in the upper limb. The lower limb muscle strength is normal. What illness is the nurse likely to recognize based on this observation?
The child is having symptoms of Landouzy-Dejerine muscular dystrophy.
The nurse is caring for an infant who has recently undergone surgery to correct myelomeningocele. What should be the nurse's basic focus during postoperative care? Select all that apply.
To monitor vital signs, nourishment, signs of infection, and. manage pain To care for the operative site and monitor signs of cerebrospinal fluid leakage To educate parents on positioning, feeding, skin care, and exercise
What clinical manifestation in a child is suggestive of Kugelberg-Welander disease?
Waddling gait
The nurse is caring for an infant in the pediatric unit. The nurse observes that the infant has a weak and a reduced reflex. cry gag On obtaining the history from the mother, the nurse finds that the mother gives honey to the child on a regular basis. Which condition is likely responsible for the symptoms observed in the infant?
Botulism
A child with cerebral palsy is admitted to the hospital for corrective surgery. How should the nurse approach the subject of family participation in the child's care during hospitalization?
By discussing the parents' desire to participate in the care of the child during hospitalization
An inadequately immunized child sustains a wound contaminated with dirt, feces, soil, and saliva. Primary symptoms of tetanus are noticed in the child. The child's mother asks the nurse for assistance. What is the most appropriate response by the nurse?
"TIG and tetanus toxoid at separate sites will treat and provide future protection."
A 2-month-year-old infant is showing slow, twisting movements of the trunk and abnormal posture. The health care provider detects the condition as dystonic cerebral palsy (CP) and asks the nurse to inform the parent. Which is the most appropriate immediate response by the nurse to the child's parent?
"The child has CP, in which upper motor neuron muscular weakness . occurs."
The nurse is caring for a child with some motor impairment. On examination, the nurse finds that the child has difficulty in swallowing and impaired vision. What should the nurse report to the primary health care provider based on the observations?
"The infant is demonstrating symptoms of cerebral palsy."
A mother of a newborn child has been diagnosed with asthma. The laboratory reports of the mother show elevated levels of serum creatine kinase. Which suggestion given by the nurse is appropriate?
"You should immunize your child for influenza to prevent pseudohypertrophy."
The nurse is teaching parents about the supportive mechanisms used in cerebral palsy. Which suggestion given by the nurse is appropriate for promoting mobilization in the infant?
"You should make use of strollers with custom seats to promote mobilization in your child."
Which nursing action is most important in the care of a child with a myelomeningocele in the preoperative stage?
Measuring the head circumference and examining the fontanels for signs of developing hydrocephalus
What should the nurse infer from the findings of no facial mobility, difficulty raising the arms, and a forward slope of the shoulders in a patient?
Landouzy-Dejerine muscular dystrophy
