Peds Chapters 49 & 51

The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment?

"At least when I take a shower I have a few minutes out of this brace."

In discussing the treatment for children with scoliosis, a group of pediatric nurses makes the following statements. Which statement is most accurate related to the treatment of scoliosis?

"Children treated for scoliosis by using braces have to wear the brace almost all the time."

A nurse is caring for an 11-year-old with an Ilizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction?

"Cleansing by showering should be sufficient." Explanation: The Ilizarov fixator uses wires that are thinner than ordinary pins, so simply cleansing by showering is usually sufficient to keep the pin site clean.

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?

"Does she/he report pain in the groin that results in a limp?" Symptoms first noticed in Legg-Calvé-Perthes disease are pain in the hip or groin and a limp accompanied by muscle spasms and limitation of motion.

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

"Let's ask your mom to bring your friends for a visit." Explanation: After two weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the girl's mother or supervised by the child-life specialist would help her adapt to her immobilized state. Telling the girl she is too big to suck her thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as she has likely grown tired of books and coloring after two weeks.

The caregiver of a 2-year-old who has a polyurethane resin cast on her arm calls the clinic to report that her child is crying and says that the cast has sand in it. The caregiver states that she has had casts herself and knows how badly they can itch. She says she always used a hanger to scratch but is worried that it will be too sharp for the child. Which statement would be appropriate for the nurse to make to this caregiver?

"Nothing should be put into the cast. You can blow cool air into it with a hair dryer."

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected."

A mother is angry about her son's diagnosis of osteosarcoma. She is telling him that if he had not played football last year and broken his leg, this would not have happened. What is the nurse's best response to the mother's statement?

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."

The nurse is caring for a child who has a hip spica cast. The child's mother asks why is there a hole cut in it. What is the best response by the nurse?

"The window allows us to assess bowel sounds and helps to prevent abdominal distention."

The nurse is caring for a child who is using crutches due to a leg injury. The child's parents state that child reports pain in the axilla when using the crutches. What is the best response by the nurse?

"We need to make sure the crutches are not too tall; there should be about an inch of space between the crutch pad and the axilla."

Barlow test

"when you go to the bar you go OUT" push knees back and down to push hip out HIP OUT

At what age range do children with Duchenne muscular dystrophy lose ambulation?

- 7-12 years

children with Duchenne Muscular Dystrophy lose ambulation at _______ to ________ years

- 7-12 years

What is the most common movement disorder of childhood?

- cerebral palsy

What lab/diagnostic tests would be used to detect botulism infection?

- stool culture - serum culture

Myasthenia Gravis can be aggrivated by what kinds of things? (3)

- stress - temperature extremes - infections

list 4 causes of botulism. what organism causes it?

- toxin produced by Clostridium botulinum - Food-borne, - wound infections, -intestinal infections - aerosolized spores where endemic in soil

Children with Duchenne Muscular Dystrophy tend to be late _______________ with poor _______________

- walkers - balance

The nurse has reinforced teaching for a school-age child who was given a brace to wear for the treatment of scoliosis. The nurse determines that the child needs further teaching if the child makes which statement? 1. "This brace will correct my curve." 2. "I will wear my brace under my clothes." 3. "I may not need surgery if I wear my brace." 4. "I will do back exercises at least five times a week."

1 Bracing can halt the progression of most curvatures, but it is not curative for scoliosis. The statements in the remaining options represent correct understanding on the part of the child.

The nurse is reviewing a chart for a child with a head injury. The nurse notes that the level of consciousness has been documented as obtunded. Which finding should the nurse expect to note on assessment of the child? 1. Not easily arousable and limited interaction 2. Loss of the ability to think clearly and rapidly 3. Loss of the ability to recognize place or person 4. Awake, alert, interacting with the environment

1 Obtunded indicates that the child sleeps unless aroused and once aroused has limited interaction with the environment. Confusion indicates that the ability to think clearly and rapidly is lost. Disorientation indicates that the ability to recognize place or person is lost. Full consciousness indicates that the child is alert, awake, oriented, and interacts with the environment.

Treat soft tissue injury

1) RICE Rest: Slings, crutches, bedrest Prevent re-injury Ice: 3-5 times per day; 20 minutes/application Compression: Ace-bandage/splint Elevation Above the heart Reduce edema formation 2) Nsaids as ordered 3) Physical therapy

four common additional impairments of OI

1. Blue Sclera 2. Deafness 3. Easily brusing and excessive sweating 4. dentiongenesis imperfecta

A child with developmental dysplasia of the hip is placed in a Pavlik harness. The nurse should demonstrate to the parents how to place the child in this harness by placing the child's legs in which position? 1. Prone 2. Abduction 3. Adduction 4. Extension

2 The Pavlik harness consists of chest and shoulder straps and foot stirrups. The device, which is used to correct hip dislocations in infants with developmental dysplasia of the hip, consists of a set of straps that hold the hips in flexion and abduction. Therefore, the remaining options are incorrect positions.

Question: Put the following events of a generalized epileptic seizure in correct order: Postictal period Prodromal period Clonic stage Tonic stage

2 4 3 1 A tonic-clonic seizure is characterized by the following events: 1) prodromal period, 2) tonic stage, 3) clonic stage, and 4) postictal period.

The nurse is assessing a child with increased intracranial pressure. On assessment, the nurse notes that the child is now exhibiting decerebrate posturing. The nurse should modify the client's plan of care based on which interpretation of the client's change? 1. An insignificant finding 2. An improvement in condition 3. Decreasing intracranial pressure 4. Deteriorating neurological function

4 The progression from decorticate to decerebrate posturing usually indicates deteriorating neurological function and warrants health care provider notification. The remaining options are inaccurate interpretations.

A child and mother come into the orthopedic clinic. The mother is concerned about her child who has recently been diagnosed with scoliosis. The mother asks about surgical treatment and if it will be necessary. The nurse bases her response on knowledge that surgery is implicated for curvatures greater than:

40 degrees. Explanation: Nonsurgical treatment is attempted first for spinal curvatures less than 40 degrees.

A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother, based on the understanding that this disorder is most likely caused by which of the following? a) Enterovirus b) Escherichia coli c) Streptococcus group B d) Haemophilus influenza type B

A Aseptic meningitis is the most common type of meningitis, and if a causative organism can be identified, it is usually a virus such as enterovirus. E. coli is a cause of bacterial meningitis. H. influenza type B is a cause of bacterial meningitis. Streptococcus group B is a cause of bacterial meningitis.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. Which of the following would the nurse identify as a possible trigger? a) Drinking three cans of diet cola b) Swimming twice a week c) 11 p.m. bedtime; 6:30 a.m. wake-up d) Use of nonscented soap

A Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

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 genu varum?

A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray Explanation: Blount disease is retardation of growth of the epiphyseal line on the medial side of the proximal tibia (inside of the knee) that results in bowed legs. Unlike the normal developmental aspect of genu varum, Blount disease is usually unilateral and is a serious disturbance in bone growth that requires treatment. In those with Blount disease, the medial aspect of the proximal tibia will show a sharp, beaklike appearance. The other answers all describe genu varum, not Blount disease.

The nurse is caring for an 8-month-old in Bryant traction for developmental dysplasia of the hip and is monitoring for complications. Which assessment finding would alert the nurse to a possible complication?

A weak pedal pulse

When teaching a group of parents about the skeletal development in children, what information is most helpful?

A young child's bones commonly bend instead of break with an injury.

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which intervention would the nurse expect to perform?

Administering a sedative as ordered to keep the child still.

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age? -Adolescence -School age -Preschool age -Toddlerhood

Adolescence Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

What muscles are affected in Duchenne?

All muscles will be affected, including cardiac and respiratory

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy occurs because of too much oxygen to the brain." b) "Cerebral palsy is a condition that doesn't get worse." c) "Cerebral palsy means there will be many disabilities." d) "Cerebral palsy is a condition that runs in families."

B By definition, cerebral palsy is a nonprogressive neuromuscular disorder. It can be mild or quite severe and is believed to be the result of a hypoxic event during pregnancy or the birth process and doesn't run in families

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Decreased pressure b) Cloudy appearance c) Elevated sugar d) Decreased leukocytes

B In the CSF of clients diagnosed with bacterial meningitis, the pressure is elevated, the appearance is cloudy, and the leukocytes are elevated. A decreased sugar content is noted.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) The patient is bradycardiac. b) Convulsive activity occurs. c) Cyanosis occurs at the onset of the seizure. d) The EEG is normal.

B During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

The nurse is caring for an 8-year-old girl who was in a car accident. Which symptom suggests the child has a cerebral contusion? a) Bleeding from the ear b) Trouble focusing when reading c) Vomiting d) Difficulty concentrating

B Signs and symptoms for cerebral contusions include disturbances to vision, strength, and sensation. A child suffering a concussion will be distracted and unable to concentrate. Vomiting is a sign of a subdural hematoma. Bleeding from the ear is a sign of a basilar skull fracture.

A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A) "Would you like me to bring you a blanket and pillow?" B) "You are doing such a wonderful job with your son." C)"He's in good hands; consider going home to get some sleep." D)"Are you planning to spend the night or to go home?"

C)"He's in good hands; consider going home to get some sleep."

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage

The nurse is caring for a child with muscular dystrophy. Which prescription will the nurse question? -Calcium supplement -Vitamin D -Prednisone -Clozapine

Clozapine Duchenne muscular dystrophy is the most common neuromuscular disorder of childhood, mostly affecting males. There is no cure, but treatments are available to slow progression and provide symptom management. Corticosterioids, such as prednisone, may be prescribed to protect muscle fibers from damage to the sarcolemma. Studies have shown males treated with prednisone have increased strength and function. Calcium supplements and vitamin D are prescribed to prevent osteoporosis. Antidepressants, not antipsychotics (such as clozapine), may be helpful when depression occurs related tothe chronicity of the disease and/or as an effect of corticosteroid use.

When treating JIA we will want to use ____________ modalities rather then _____________ modalities.

Cold; heat

After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A) Limb-girdle B) Myotonic C) Distal D) Duchenne

D) Duchenne

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client? -Duchenne muscular dystrophy -Facioscapulohumeral muscular dystrophy -Congenital myotonic dystrophy -Juvenile arthritis

Duchenne muscular dystrophy By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy By age 3, children with: Duchenne muscular dystrophy = can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints

Soft Tissue Injury: Signs and Symptoms (4)

Edema Pain Ecchymosis Inflammation

Infants 10-12 months with only postural or muscle tightness of <15 degrees cervical rotation.

Grade V: Late Moderate CMT

Infants between 7-12 months with muscle tightness >15 degrees cervical rotation.

Grade VI: Late severe CMT

Examining a JIA pt in the chronic stage we will find.....

Loss of joint integrity Loss of cartilage

Club foot definition:

Mal-alignment of feet which resists being moved into proper alignment

interventions to correct head tilt of CMT patient

Manual stretching active cervical lateral flexion away from head tilt passive positioning to stretch tight tissues

A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply.

Oxygen gauge and tubing, suction at bedside, and padding for side rails

At birth an infant should be able to move all of his or her extremities but the movement is not __________________

Purposeful

steps that will be different when examining a JIA pt.

ROM: use a goni MMT: use dymometer

Two forms of polyarticular arthritis.

Rheumatoid factor positive and Rheumatoid factor negative

A group of nursing students are reviewing information about types of skin traction and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction?

Side arm 90-90 traction Explanation: Side arm 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin traction.

The nurse is caring for a child in the postanesthesia care unit following a surgical procedure to place pins in the child's fractured femur. This pin placement is an example of which type of traction?

Skeletal

A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis?

Staphylococcus aureus

A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client?

Teach the client not to rest with the crutch pad pressing on the axilla.

A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client? -Teach the client not to rest with the crutch pad pressing on the axilla. -Assess the tips of the crutches to be certain the rubber tip is intact. -Be certain the child is walking with the crutches about 6 inches to the side of the foot. -Caution parents to clear articles such as throw rugs out of paths at home.

Teach the client not to rest with the crutch pad pressing on the axilla. Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. Explanation: Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours.

The nurse is caring for a child in a type of traction in which weights are being used. What is true regarding the weights?

The weights must be hanging freely, not touching the bed or floor.

A neonatal nurse examines an infant and notes decreased hip motion that causes pain upon movement. This nurse suspects Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity.

True

Idiopathic scoliosis is the most common form that occurs.

True

The nurse working in orthopedics knows that a torsional deformity is a musculoskeletal condition in which the bone is "twisted."

True

The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?

Type II Explanation: According to the Salter-Harris classification........... a type II fracture= partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis.

Scoliosis: Signs and Symptoms

Uneven posture One scapula/clavicle higher than the other Hip/rib asymmetry Back pain

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair? -Antitip device -Extended breaks -Headrest support -Wheelchair belt

Wheelchair belt This client has poor trunk control; a belt will prevent him from falling out of the wheelchair. Antitip devices, head rest supports, and extended breaks are all important options but aren't the most important options in this situation.

Assessment of Fractures

X-ray Ultrasound 5 P's Pulses Pallor Pain Paralysis Parasthesia

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) "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." b) "It has little influence on the intellectual and perceptual abilities of the child." c) "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life." d) "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth."

a)"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." Explanation: When a spinal cord lesion exists at birth, it commonly leads to altered development or function of other areas of the CNS. Spina bifida is a complex neurologic defect that heavily impacts the physical, cognitive, and psychosocial development of the child and involves collaborative, lifelong management due to the chronicity and multiplicity of the problems involved.

A teenager has been admitted to the hospital with respiratory complications related to Duchenne muscular dystrophy. How can the nurse best provide support for the parents, who are the caretakers of this adolescent? a) Assume responsibility for the teen's daily care while accepting input from parents and the teen b) Encourage the parents to assist their child with his activities of daily living while hospitalized c) Teach the parents how to add chest physical therapy to the care they provide d) Provide accommodations for both parents to room-in with their teen

a)Assume responsibility for the teen's daily care while accepting input from parents and the teen Explanation: The parents have probably been caring daily for their son for longer than 10 years while his condition has deteriorated and his care has become more complex. They may use this hospitalization as an opportunity to be relieved briefly of some of this responsibility (respite). Chest PT and rooming-in are important but do not address the need for respite.

Muscular dystrophy is a result of which cause? a) Gene mutation b) Chromosomal aberration c) Genetic and environmental factors d) Unknown nongenetic origin

a)Gene mutation Explanation: Muscular dystrophy is a result of a gene mutation. It isn't from a chromosome aberration or environmental factors. It's genetic and there's a known origin of the disease.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? a) Muscle biopsy b) EEG c) Assessment of ambulation d) X-ray

a)Muscle biopsy Explanation: A muscle biopsy shows the degeneration of muscle fibers and infiltration of fatty tissue. It's used for diagnostic confirmation of muscular dystrophy. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

The nurse will prepare the 17-year-old with myasthenia gravis for which surgical procedure to treat the disorder? a) Thymectomy b) Thyroidectomy c) Splenectomy d) Cholecystectomy

a)Thymectomy Explanation: Myasthenia gravis is an autoimmune disease that can be treated in several ways. Thymectomy can be used for children who have reached puberty. Cholecystectomy is removal of the gallbladder. Thyroidectomy removes the thyroid gland, and splenectomy removes the spleen.

Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer? a) Vagal nerve stimulator b) Baclofen pump c) Botulinum toxin d) Central venous catheter

b)Baclofen pump Explanation: A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures.

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? a) Prevent cold stress using an Isolette and blankets b) Cover the sac with a saline-moistened dressing c) Change position from side to side hourly d) Keep the mass uncovered and dry

b)Cover the sac with a saline-moistened dressing Explanation: Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided.

The nurse is caring for an 8-month-old boy presenting with poor feeding, listlessness, and a weak cry. What assessment finding would lead the nurse to suspect a diagnosis of botulism? a) Floppy extremities b) Diminished gag reflex c) Drooping eyelids d) Inadequate sucking

b)Diminished gag reflex Explanation: A diminished gag reflex is indicative of botulism and not typically associated with other conditions. The other symptoms could be indicative of a number of neuromuscular diseases. Botulism is a rare disease and is difficult to diagnose since its symptoms are similar to those of other neuromuscular diseases.

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? a) Clavicle b) Head and neck c) Lower extremities d) Torso

b)Head and neck Explanation: The head and neck should remain immobilized until cervical spine injury is ruled out. Motion in this area could damage the spinal cord. The rest of the child's body should be examined carefully so as not to aggravate an unsuspected injury. The clavicle is the bone most frequently fractured during childhood.

Which characteristic is true of cerebral palsy? a) It's progressive. b) It appears at birth or during the first 2 years of life. c) It's reversible. d) It results in mental retardation.

b)It appears at birth or during the first 2 years of life. Explanation: Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are mentally retarded, many have normal intelligence.

The nurse is caring for a 7-year-old with Guillain-Barré syndrome (GBS). Which of the following would be the most effective intervention to monitor for respiratory deterioration? a) Pulse oximetry b) Serial measurement of tidal volume c) Ineffective cough d) Diminished breath sounds

b)Serial measurement of tidal volume Explanation: Serial measurement of tidal volumes may reveal respiratory deterioration in a child with GBS. Pulse oximetry gives no information regarding ventilation, only oxygen saturation. A decrease in oxygen saturation noted on pulse oximetry would be helpful for determining a change in respiratory function. However, it would not be the most effective method. Ineffective cough may indicate a change in respiratory function, but this change is nonspecific. Diminished breath sounds reveal a change in respiratory function; however, they are nonspecific.

The pediatric nurse practioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this? a) The head is held tilted with limited side-to-side motion. b) The boy rises from the floor by walking his hands up his legs. c) The boy has a large tan skin lesion on his torso. d) Severe lordosis is evident in the lumbar spine.

b)The boy rises from the floor by walking his hands up his legs. Explanation: Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand. The other options do not describe Gowers' sign, although lordosis is often a manifestation of Duchenne muscular dystrophy.

The parent of a child with osteomyelitis asks why his child is in so much pain. What will the nurse respond causes the pain experienced with osteomyelitis? a. "Pressure of inelastic bone" b. "Purulent drainage in the bone marrow" c. "The cast applied on the extremity" d. "Circulatory congestion of the skin"

b. "Purulent drainage in the bone marrow" Osteomyelitis is an infection of the bone. Inflammation produces an exudate that collects under the marrow and cortex of the bone. The vessels are compressed and thrombosis occurs, producing ischemia and pain.

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). Which of the following would the nurse emphasize in the discharge teaching? a) "It is very important to comply with the use of this brace." b) "If the brace is painful, feel free to take it off." c) "Check the skin that is covered by the braces for redness and breakdown." d) "Please try and follow the therapist's on and off schedule."

c)"Check the skin that is covered by the braces for redness and breakdown." Explanation: Assessing skin integrity should be the priority, as braces can lead to pressure ulcers and infection. Compliance is important, but attention to skin care is the priority teaching. Following the schedule is important for compliance, but skin integrity is the priority. Advising the parents to remove the brace if it is painful is inaccurate; the child may require pain management or further consultation with the physical therapist.

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? a) Pain will interfere with the feeding process. b) Nausea and vomiting often follow repair of the cystic mass. c) Assuming the usual feeding position will be difficult. d) The infant will have a poor sucking reflex.

c)Assuming the usual feeding position will be difficult. Explanation: Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic.

Other than providing direct care to children, what is the major role of nurses in the care of nearly all children with neuromuscular disorders? a) Consoling parents b) Helping with specialized equipment c) Coordinating care by specialists d) Teaching children self-care

c)Coordinating care by specialists Explanation: Being part of a multidisciplinary team and coordinating the care the child usually needs from a variety of specialists is an essential and major role. The other nursing activities are important as well, but many children/families require individual interventions.

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? a) Folic acid to 0.4 mg/day b) Ascorbic acid to 4 mg/day c) Folic acid above 0.4 mg/day d) Ascorbic acid to 0.4 mg/day

c)Folic acid above 0.4 mg/day Explanation: The American Academy of Pediatrics recommends that a woman who has had a child with a neural tube defect increase her intake of folic acid to above 0.4 mg per day 1 month before becoming pregnant and continue this regimen through the first trimester. A woman who has no family history of neural tube defects should take 0.4 mg/day. All women of childbearing age should be encouraged to take a folic acid supplement because the majority of pregnancies in the United States are unplanned. Ascorbic acid hasn't been shown to have any effect on preventing neural tube defects.

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. Which of the following would the nurse emphasize as most important in preventing neural tube defects? a) Maternal serum α-fetoprotein levels screening b) Ultrasound screening at 16 weeks' gestation c) Folic acid supplementation d) Genetic testing for gene identification

c)Folic acid supplementation Explanation: Strong evidence exists that folic acid supplementation by the mother before conception decreases the incidence of neural tube defects by 50%. Ultrasound screening at 16 to 18 weeks' gestation can help identify fetuses at risk, but this would not prevent neural tube defects. Screening of maternal serum α-fetoprotein levels can help identify fetuses at risk, but this would not prevent neural tube defects. Neural tube defects are not related to genetic dysfunction, so genetic testing would be of no value.

The nurse is taking a health history of a 6-year-old girl with suspected dermatomyositis. During the physical examination, which of the following would help confirm the nurse's suspicions? a) Delayed capillary refill b) Ptosis or altered eye movements c) Red-purple rash on upper eyelids, knuckles, elbows, and knees d) Tenting of skin

c)Red-purple rash on upper eyelids, knuckles, elbows, and knees Explanation: The nurse would expect to find a rash involving the upper eyelids and extensor surfaces of the knuckles, elbows, and knees. Tenting of the skin would suggest dehydration. Ptosis or altered eye movements are more commonly seen with other forms of paralysis, like myasthenia gravis. Delayed capillary refill is associated with dehydration or problems involving circulation.

What would the nurse include in planning teaching to parents of a child with Legg-Calvé-Perthes disease about the long-term effects of this disease? a. There are no long-term effects. b. The disease is self-limited and requires no long-term treatment. c. Degenerative arthritis may develop later in life. d. There is risk of osteogenic sarcoma in adulthood.

c. Degenerative arthritis may develop later in life.

A school nurse is conducting a staff in-service to other school nurses on idiopathic scoliosis. During which period of child development does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. Preadolescent growth spurt d. Adolescence

c. Preadolescent growth spurt

If scoliosis is severe?

cardiac and respiratory compromise

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? a) "He must have an adequate amount of fluid." b) "I need to figure out his usual pattern for passing stool." c) "I can palpate his abdomen to assess for constipation" d) "My son's activity is too limited to stimulate his bowels."

d)"My son's activity is too limited to stimulate his bowels." Explanation: The nurse needs to point out to the mother that even minimal activity increases peristalsis. Together they can come up with appropriate activities within the child's limits or restrictions to promote peristalsis. It is important to determine the usual pattern for passing stool so that the mother and nurse can determine the best program. Palpating the abdomen can reveal distention suggesting constipation. Adequate fluid is necessary to stimulate peristalsis.

What reflex response will the nurse consider abnormal when assessing the 8-month-old infant? a) Plantar grasp b) Babinski c) Parachute d) Brisk deep tendon

d)Brisk deep tendon Explanation: By 8 months, the infant should have +2 or average deep tendon reflexes. The protective parachute reflex would have developed between 6 and 7 months. The plantar grasp will remain until about 9 months and the Babinski until 12 months.

A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests. Which test would the nurse identify as most important to be completed first? a) Electromyogram b) Nerve conduction velocity c) Muscle biopsy d) Creatine kinase

d)Creatine kinase Explanation: The sample for creatine kinase must be obtained before the electromyogram or muscle biopsy because those tests may lead to a release of creatine kinase and provide false results. Nerve conduction velocity tests could be done at anytime.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? a) Serum potassium b) Sodium c) Bilirubin d) Creatinine

d)Creatinine Explanation: Creatinine is a by-product of muscle metabolism as the muscle hypertrophies. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors? a) Duchenne muscular dystrophy is a progressive disease of muscles and nerves that affects males and females equally. b) Duchenne muscular dystrophy is diagnosed in boys who develop gait changes during the late school-age years. c) Duchenne muscular dystrophy is a nonprogressive disorder that severely affects muscle function through spinal cord atrophy. d) Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.

d)Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Explanation: Duchenne muscular dystrophy is the most common of several muscular dystrophies and is a progressive, fatal disorder. It involves mainly skeletal muscles, but other muscles are affected over time. Onset occurs in early childhood. The disorder is X-linked recessive. An enzyme is lacking that is necessary for the maintenance of muscle cells. No structural abnormalities of the spinal cord or peripheral nerves are noted.

Given knowledge of muscular dystrophy, the nurse would expect to see which form of this condition most commonly in children? a) Limb-girdle b) Becker's c) Myotonic d) Duchenne's

d)Duchenne's Explanation: Duchenne's accounts for 50% of all cases of muscular dystrophy.

Which condition would alert the nurse that a child may be suffering from muscular dystrophy? a) Upper extremity spasticity b) Hypertonia of extremities c) Hyperactive lower extremity reflexes d) Increased lumbar lordosis

d)Increased lumbar lordosis Explanation: An increased lumbar lordosis would be seen in a child suffering from muscular dystrophy secondary to paralysis of lower lumbar postural muscles. Increased lower extremity support may also be seen. Hypertonia isn't seen in this disease. Upper extremity spasticity isn't seen because this disease isn't caused by upper motor neuron lesions. Hyperactive reflexes aren't indications of muscular dystrophy.

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele? a) Impaired physical mobility b) Constipation c) Delayed growth and development d) Risk for infection

d)Risk for infection Explanation: All of these diagnoses are important for a child with a myelomeningocele. However, during the first 12 hours of life, the most life-threatening event would be an infection. The other diagnoses will be addressed as the child develops.

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 which of the following? a) Athetoid or dyskinetic b) Ataxic c) Spastic diplegia d) Spastic hemiplegia

d)Spastic hemiplegia Explanation: Spastic hemiplegia involves hypertonicity and permanent contractures on both extremities on one side. Athetoid (dyskinetic) involves abnormal involuntary movements affecting all four extremities and sometimes the face, neck, and tongue. Ataxic affects balance and depth perception. Spastic diplegia affects the lower extremities.

Type II OI

death at birth or still birth

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

epiphysiolysis of the proximal humerus.

Ortalani Test

put knees opposite AND pushing back IN

examining a JIA pt in the acute stage we will find....

significant joint inflammation ligament laxity joint instability

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction.

prevention of spina bifida

take folic acid at child bearing age

Physical Appearance of DDH (3 things)

uneven thigh folds uneven femur length/unequal knee height

Assessment of Soft tissue injury

x-ray to rule out fracture

How do you assess club foot?

x/ray ultrasound

A girl who is playing in the playroom experiences a tonic-clonic seizure. During the seizure, the nurse should take which actions? Select all that apply. 1. Remain calm. 2. Time the seizure. 3. Ease the child to the floor. 4. Loosen restrictive clothing. 5. Keep the child on her back.

1.2.3.4 When a child is having a seizure, the nurse should remain calm, time the seizure, ease the child to the floor if the child is standing or seated, keep the child on the side (to prevent aspiration), and loosen restrictive clothing.

A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.

13.3 Explanation: The nurse will divide the number of doses per day into the total amount prescribed for each day. 40 mg ÷ 3 doses = 13.3 mg/dose

A child has just returned from surgery and has a hip spica cast. What is the nurse's priority action for this client? 1. Elevate the head of the bed. 2. Assess the circulatory status. 3. Abduct the hips using pillows. 4. Turn the child onto the right side.

2 During the first few hours after a cast is applied, the chief concern is swelling, which may cause the cast to act as a tourniquet and obstruct circulation. Therefore, circulatory assessment is a high priority. Elevating the head of the bed of a child in a hip spica cast would cause discomfort. Using pillows to abduct the hips is not necessary because a hip spica cast immobilizes the hip and knee. Turning the child from one side to the other at least every 2 hours is important because it allows the body cast to dry evenly and prevents complications related to immobility; however, it is not a higher priority than checking circulation.

The nurse should plan to place a child who had a medulloblastoma brain tumor (infratentorial) removed in which position postoperatively? 1. Trendelenburg's 2. Flat, on either side 3. With the head of the bed elevated above heart level 4. With the head of the bed elevated in low Fowler's position

2 If an infratentorial tumor has been removed, the child is positioned flat on either side. The pillow is placed behind the child's back for comfort and for maintaining the position. The pillow is not placed behind the head because when the pillow is behind the head, proper alignment is not maintained, and this misalignment can impair circulation. The child should never be placed in a Trendelenburg's position (head down) because this position increases intracranial pressure. The head is elevated when the tumor is a supratentorial one. Remember though that the surgeon's prescription for positioning is always followed.

when will Oligoarthritis typically develop and is more likely to develop in _____________.

2-4 years old; girls (4:1)

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

3 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.

An alert child, who is crying loudly, is brought to the hospital emergency department for a simple fracture to the lower right arm that occurred after a fall off a bicycle. What is the nurse's priority assessment? 1. Mobility 2. Skin integrity 3. Neurovascular 4. Level of consciousness

3 A simple fracture is a fracture of the bone across its entire shaft with some possible displacement but without breaking the skin. The priority assessment is the neurovascular status in the affected arm. The affected arm should be immobilized. Skin integrity is a higher priority in a compound fracture since there is an open wound. The level of consciousness is already established, as the child is alert and crying.

The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. Which assessment finding should the nurse expect if this type of posturing is present? 1. Flexion of the upper extremities and extension of the lower extremities. 2. Unilateral or bilateral postural change in which the extremities are rigid. 3. Abnormal extension of the upper and lower extremities with some internal rotation. 4. Arms are adducted with fists clenched, and the legs are flaccid with external rotation.

3 Decerebrate (extension) posturing is an abnormal extension of the upper extremities, with internal rotation of the upper arm and wrist and extension of the lower extremities with some internal rotation. Decorticate posturing involves flexion of the upper extremities and extension of the lower extremities. The remaining two options are incorrect and not characteristics of decerebrate posturing.

The nurse is monitoring an infant for signs of increased intracranial pressure. On assessment of the fontanelles, the nurse notes that the anterior fontanelle bulges when the infant is sleeping. Based on this finding, which is the priority nursing action? 1. Increase oral fluids. 2. Document the finding. 3. Notify the health care provider. 4. Place the infant supine in a side-lying position.

3 The anterior fontanelle is diamond shaped and is located on the top of the head. It should be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age. A larger-than-normal fontanelle may be a sign of increased intracranial pressure (ICP) within the skull. Although the anterior fontanelle may bulge slightly when the infant cries, bulging at rest may indicate ICP. Increasing oral fluids and placing the infant in a side-lying position are inaccurate interventions and will not be helpful. Although the nurse would document the finding, the priority action would be to report the finding to the health care provider.

The nursing student is writing a plan of care for a child who presents with an acute head injury. The nursing instructor reviews the plan of care and praises the student for identifying which assessment as a priority? 1. Inspecting the scalp 2. Pupillary assessment 3. Airway and breathing 4. Palpating the child's head

3 The first step in the emergency treatment of child with head injury includes the ABCs-airway, breathing, and circulation-assessments. The other assessments are included when evaluating a head injury, but the priority is ABC.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?

"Blowing cool air with a fan or hair dryer may relieve the feeling." Explanation: Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image?

"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." Explanation: A positive self-image is very important for adolescents wearing a brace. They want to look like their peers and wear the same clothing, but often that is not possible when wearing a brace. Assisting the adolescent in selecting clothing that looks stylish but still hides the brace is one of the best ways to help this client. Telling her she looks fine, to be confident, or bringing up the times she has been embarrassed does not help the client.

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction?

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed."

What are the 4 classifications of Cerebral Palsy? Which is the most common? Which is rare?

- Spastic (most common) - Athetoid or dyskinetic - Ataxic (rare) - Mixed

Neurogenic Bladder is more common in which neurologic disorder?

- Spina Bifida

Name 3 Structural Congenital Neuromuscular Disorders

- Spina Bifida Occulta - Meningocele - Myelomeningocele

Name 2 interventions for Maintaining cardiopulmonary function in a child with Duchenne Muscular Dystrophy

- Teaching deep breathing exercises - Performing chest physical therapy

The nurse creates a plan of care for a child with Reye's syndrome. Which priority intervention should the nurse include in the plan of care? 1. Monitor for signs of increased intracranial pressure. 2. Immediately check the presence of protein in the urine. 3. Reassure the parents hyperglycemia is a common symptom. 4. Teach the parents signs and symptoms of a bacterial infection

1 Intracranial pressure and encephalopathy are major symptoms of Reye's syndrome. Protein is not present in the urine. Reye's syndrome is related to a history of viral infections, and hypoglycemia is a symptom of this disease.

The nurse notes that an infant with the diagnosis of hydrocephalus has a head that is heavier than that of the average infant. The nurse should determine that special safety precautions are needed when moving the infant with hydrocephalus. Which statement should the nurse plan to include in the discharge teaching with the parents to reflect this safety need? 1. "Feed your infant in a side-lying position." 2. "Place a helmet on your infant when in bed." 3. "Hyperextend your infant's head with a rolled blanket under the neck area." 4. "When picking up your infant, support the infant's neck and head with the open palm of your hand."

4 Hydrocephalus is a condition characterized by an enlargement of the cranium because of an abnormal accumulation of cerebrospinal fluid in the cerebral ventricular system. This characteristic causes the increase in the weight of the infant's head. The infant may experience significant head enlargement. Care must be exercised so that the head is well supported when the infant is fed or moved to prevent extra strain on the infant's neck, and measures must be taken to prevent the development of pressure areas. Supporting the infant's head and neck when picking up the infant will prevent the hyperextension of the neck area and prevent the infant from falling backward. The infant should be fed with the head elevated for proper motility of food processing. A helmet could suffocate an unattended infant during rest and sleep times, and hyperextension of the infant's head could put pressure on the neck vertebrae, causing injury.

The nurse is assisting a health care provider (HCP) during the examination of an infant with developmental hip dysplasia. The HCP performs the Ortolani maneuver. The nurse determines that the infant exhibits a positive response to this maneuver if which finding is noted? 1. A shrill cry from the infant 2. Asymmetry of the affected hip 3. Reduced range of motion in the right and left hip 4. A palpable click during abduction of the affected hip

4 In the Ortolani maneuver, the examiner abducts both hips. A positive finding is a palpable click on the affected side during abduction. Crying is expected. Asymmetry and reduced range of motion of the affected hip are not positive signs of this maneuver.

The community health nurse is providing information to parents of children in a local school regarding the signs of meningitis. The nurse informs the parents that the classic signs/symptoms of meningitis include which findings? 1. Nausea, delirium, and fever 2. Severe headache and back pain 3. Photophobia, fever, and confusion 4. Severe headache, fever, and a change in the level of consciousness

4 The classic signs/symptoms of meningitis include severe headache, fever, stiff neck, and a change in the level of consciousness. Photophobia also may be a prominent early manifestation and is thought to be related to meningeal irritation. Although nausea, confusion, delirium, and back pain may occur in meningitis, these are not the classic signs/symptoms.

A 9-year-old child fractures the left tibia along an epiphyseal line while using a skateboard. What is the nurse's priority concern during future growth? 1. Infection 2. Paralysis 3. Pressure ulcer 4. Uneven leg growth

4 The epiphyseal line is the area that is responsible for longitudinal bone growth. A fracture affecting this area places the child at risk for uneven future growth if proper healing does not occur. The epiphyses are located at the proximal and distal ends of a bone and are the insertion sites for muscles. The diaphysis is the shaft or main longitudinal portion of a long bone. The metaphysis is an area of flaring of bone, located between the epiphysis and the diaphysis. Paralysis, pressure ulcer, and infection are not priority concerns for future growth. Paralysis and neurovascular status are priority concerns during the immediate period postinjury, but not during future growth.

Fractures: Signs and Symptoms

5 PS Inflammation Bruising Pallor Limited ROM Non-weight bearing Displaced/non-displaced

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for? a) Irritability, fever, and vomiting b) Jaundice, drowsiness, and refusal to eat c) Negative Kernig's sign d) Flat fontanel

A Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels would be bulging as intracranial pressure rises, and Kernig's sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis

The nurse caring for a patient with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. a) False b) True

A Antibiotics or antivirals are used to treat infectious disease processes. Glucocorticoids and diuretics are used to reduce cerebral edema.

In caring for a child with a seizure disorder, the highest priority goal is which of the following? a) The child will be free from injury during a seizure. b) The family caregivers anxiety will be reduced. c) The family will understand seizure precautions. d) The child will have an understanding of the disorder.

A Keeping the child free from injury is the highest priority goal. The other choices are important, but keeping the child safe is higher than the anxiety or knowledge deficit concerns. The physical always is a priority over the psychological.

Which of the following age groups of children have the highest actual rate of death from drowning? a) Toddlers b) School-age children c) Preschool children d) Infants

A Toddlers and older adolescents have the highest actual rate of death from drowning.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Explanation: Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "You look funny. Well, both of you do. I see two of you." b) "I am glad that my headache is getting better." c) "It will be nice when you will let me take a long nap. I am sleepy." d) "My stomach is upset. I feel like I might throw up."

A The caregiver should notify the health-care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling naueauted is not a reason to notify the provider.

A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state:

A child's bones heal more quickly than those of an adult.

The nurse is caring for a child with a possible diagnosis of muscular dystrophy. The nurse explains to the parents that which of the following will likely be used to confirm this child's diagnosis?

A muscle biopsy

The nurse is caring for a child with a possible diagnosis of muscular dystrophy. The nurse explains to the parents that which of the following will likely be used to confirm this child's diagnosis?

A muscle biopsy Explanation: A decrease in muscle fibers, which is seen in a muscle biopsy, can confirm the diagnosis of muscular dystrophy.

13. A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion? A) Swelling and point tenderness B) Decreased erythrocyte sedimentation rate C) Coolness of the affected site D) Increased range of motion

A) Swelling and point tenderness

A ________________ is used to measure passive lateral flexion and rotation of a CMT infant.

Arthodial

__________________ is a nonprogressive neuromuscular disorder leading to severe joint contractures and muscle weakness with fibrosis.

Arthrogryposis Multiplex Congenita

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast?

Assess the fingers for warmth, pain, and function

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?

Assess the popliteal region carefully for skin breakdown.

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority?

Assessing the child's level of consciousness.

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?

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?

Auscultation Explanation: The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired.

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? -Auscultation -Palpation -Inspection -Observation

Auscultation The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired.

The nurse is collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "His arms had jerking movements in his legs and face." b) "He was just staring into space and was totally unaware." c) "He kept smacking his lips and rubbing his hands." d) "He usually is very coordinated, but he couldn't even walk without falling."

B Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

Which of the following is consistent with increased ICP in the child? a) Increased appetite b) Bulging fontanel c) Emotional lability d) Narcolepsy

B Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Lying prone, with the feet higher than the head b) Lying on one side, with the back curved c) Lying prone, with the neck flexed d) Sitting up, with the back straight

B Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

Any individual taking phenobarbital for a seizure disorder should be taught a) to brush his or her teeth four times a day. b) never to discontinue the drug abruptly. c) never to go swimming. d) to avoid foods containing caffeine.

B Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Elevated sugar b) Cloudy appearance c) Decreased leukocytes d) Decreased pressure

B In the CSF of clients diagnosed with bacterial meningitis, the pressure is elevated, the appearance is cloudy, and the leukocytes are elevated. A decreased sugar content is noted

A 1-year-old has just undergone surgery to correct craniosynostosis. Which of the following comments is the best psychosocial intervention for the parents? a) "I told you yesterday there would be facial swelling." b) "The surgery was successful. Do you have any questions?" c) "I'll be watching hemoglobin and hematocrit closely." d) "This only happens in 1 out of 2,000 births."

B Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.

When assisting a child while she is having a tonic-clonic seizure, it would be important to a) turn the child onto her back and observe her. b) protect the child from hitting her arms against furniture. c) place a tongue blade between the child's teeth. d) restrain the child from all movement.

B protect the child from hitting her arms against furniture.

The best way to evaluate a child's level of consciousness is through conversation. a) False b) True

B The best way to evaluate a child's level of consciousness is through conversation. Note any drowsiness or lethargy. Allow the child to answer questions without prompting, and listen carefully to be certain the answer is appropriate to the question.

cause of cerebral palsy

BIRTH HYPOXIA /HYPOXIA IN UTERO May occur later in life after hypoxic event

Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer? -Baclofen pump -Vagal nerve stimulator -Central venous catheter -Botulinum toxin

Baclofen pump A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures.

How does osteomyelitis happen

Bacteria from the blood invade growth plates Break in skin

_______________ is characterized by flattening across the back of the skull.

Brachycepthaly

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client?

Bracing

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which of the following interventions should the nurse take initially? a) Encourage the mother to hold and comfort the infant. b) Educate the family about preventing bacterial meningitis. c) Institute droplet precautions in addition to standard precautions. d) Palpate the child's fontanels.

C Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later on once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.

Signs of increased intracranial pressure for which you would assess are a) decreased level of consciousness, increased respiratory rate. b) numbness of fingers, decreased temperature. c) increased temperature, decreased respiratory rate. d) increased pulse rate, decreased blood pressure.

C Pressure on the vital-sign centers causes an elevated temperature and a decreased respiratory rate. Blood pressure increases; pulse decreases.

Which of the following is consistent with increased ICP in the child? a) Narcolepsy b) Emotional lability c) Bulging fontanel d) Increased appetite

C Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping

The nurse is developing a teaching plan for a child who is to have his cast removed. Which of the following would the nurse most likely include? A) Applying petroleum jelly to the dry skin B) Rubbing the skin vigorously to remove the dead skin C) Soaking the area in warm water every day D) Washing the skin with dilute peroxide and water

C) Soaking the area in warm water every day

A child is born with a talipes disorder. The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?

Check the infant's toes for coldness or blueness.

The mother of a child who has sustained a fractured leg is worried how long her child will be unable to walk without crutches. The nurse would explain to the mother that the child should be walking independently soon due to what reason?

Children's bones heal faster than adults.

Botulism toxin is produced by what organism?

Clostridium botulinum

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. -Color -Sensation -Pulse -Capillary refill -Vital signs

Color Sensation Pulse Capillary refill A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete

_______________ is caused by unilateral shortening of the SCOM shortly after birth.

Congenital Muscular Torticollis

Any individual taking phenobarbital for a seizure disorder should be taught a) never to go swimming. b) to avoid foods containing caffeine. c) to brush his or her teeth four times a day. d) never to discontinue the drug abruptly.

D Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which of the following would the nurse include when teaching the parents about caring for their child? A) Waiting 48 hours before allowing the child to take a tub bath B) Not allowing the child to sleep on his side for about 4 weeks C) Calling the physician if the child's temperature is over 100.5°F D) Discouraging the child from stretching or bending forward for 4 weeks

D) Discouraging the child from stretching or bending forward for 4 weeks

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: -Duchenne. -facioscapulohumeral. -limb-girdle. -myotonia.

Duchenne. Studies have shown that Duchenne is the most severe form of muscular dystrophy. Myotonia isn't a form of the disease; it's a symptom.

Osteomyelitis: Signs and Symptoms

Fever Crying a lot Redness Warmth Swelling Pain Limping

Infants 0-6 months oldwith muscle tightness >30 degrees rotation or a SCM nodule

Grade III: Early Severe CMT

Scoliosis

Lateral curvature and rotation of the spine >10 degrees

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse?

Notify the health care provider of the findings immediately.

Slipped Capital Femoral Epiphysis- what is the cause?

OVERWEIGHT TEENAGER (at growth spurt)

Three types of CMT.

Postural Muscular SCM Nodule

Three different periods of CMT development.

Prenatal Perinatal Postnatal

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

Presence of Moro reflex Explanation: The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflex are expected in a normally developing 9-month-old child.

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? -Presence of symmetrical spontaneous movement -Absence of Moro reflex -Absence of tonic neck reflex -Presence of Moro reflex

Presence of Moro reflex The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflex are expected in a normally developing 9-month-old child.

The nurse is caring for a number of children with bone fractures who are being treated with casts, traction, or external fixation. Which consideration is unique to external fixation?

Preventing further injury

Duchenne Muscular Dystrophy

Progressive loss of function due to muscular loss

Assessment of scoliosis

Screening Bend over at the hips and touch toes Monitor physical appearance during exam

Implementing a frequent _______________ is key for an infant with AMC as well as utilizing _____________.

Stretching; splinting and ADs

Developmental Dysplasia of the Hip (DDH)

Subluxation or complete dislocation of hip

A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion?

Swelling and point tenderness Explanation: Findings associated with osteomyelitis include swelling, point tenderness, warmth over the site, decreased range of motion, and an elevated sedimentation rate.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours. Explanation: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?

The parents report that their son is vomiting and not eating well.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.

The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

The nurse is caring for a child in a type of traction in which weights are being used. What is true regarding the weights?

The weights must be hanging freely, not touching the bed or floor. Explanation: When a child is in traction the weights must be hanging freely, not touching the bed or floor.

A 14-year-old male is brought to the ER by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. Which of the following best describes this type of fracture?

There are three or more fracture fragments.

Family and patient teaching for cerebral palsy

There is NO cure Encourage participation with classmates; adapt as necessary

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction?

When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily for all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort, a lightweight t-shirt may be worn under the brace.

Women attending a health and wellness event ask the presenting nurse what is meant by "neural tube defect." Which is the accurate response? a) "Neural tube defect refers to abnormal development of the brain and spinal cord in the embryo." b) "Neural tube defect refers to improper development of the digestive system in the fetus." c) "Neural tube defect refers to abnormal development of the genitourinary system in the embryo." d) "Neural tube defect refers to abnormal development of the brain and spinal cord in the fetus."

a)"Neural tube defect refers to abnormal development of the brain and spinal cord in the embryo." Explanation: The neural tube from which the brain and spinal cord develop closes between the third and fourth weeks of gestation in the embryonic period of development. Failure of the neural tube to close properly results in most congenital anomalies of the central nervous system.

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response? a) "The cause is unknown and there are many environmental factors that may contribute to it." b) "It's a common complication of amniocentesis." c) "It has been linked to maternal alcohol consumption during pregnancy." d) "Older age at conception is one of the major causes of the defect."

a)"The cause is unknown and there are many environmental factors that may contribute to it." Explanation: There is no one known cause of spina bifida, but scientists believe that it's linked to hereditary and environmental factors; neural tube defects, including spina bifida, have been strongly linked to low dietary intake of folic acid. Maternal age doesn't have an impact on spina bifida. An amniocentesis is performed to help diagnose spina bifida in utero but doesn't cause the disorder. Maternal alcohol intake during pregnancy has been linked to mental retardation, craniofacial defects, and cardiac abnormalities, but not spina bifida.

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize which of the following as the primary goal? a) Development of gross motor movement b) Enhance feeding capabilities c) Development of fine motor skills d) Promote optimal self-care ability

a)Development of gross motor movement Explanation: Physical therapy focuses on assisting in the development of gross motor movements such as walking and positioning and helps the child develop independent movement. Occupational therapy assists in the development of fine motor skills and fashioning orthotics and splints. Occupational therapy assists the child in performing optimal self-care ability by working on skills such as activities of daily living. Speech therapy assists with feeding techniques for the child who has swallowing problems.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? a) Record and refer the finding for follow-up to the pediatrician b) Move on to other assessments without calling attention to the difference c) Snip the tuft of hair off close to the skin for hygienic reasons d) Inspect for precocious hair growth in the genital and underarm areas

a)Record and refer the finding for follow-up to the pediatrician Explanation: Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. Magnetic resonance imaging (MRI) is often the diagnostic tool used. No hygienic concerns need prevail. These findings do not suggest development of precocious puberty or any other hormonal problem. The dimpling and hair tuft must be clearly explained to the parents.

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair? a) Wheelchair belt b) Antitip device c) Headrest support d) Extended breaks

a)Wheelchair belt Explanation: This client has poor trunk control; a belt will prevent him from falling out of the wheelchair. Antitip devices, head rest supports, and extended breaks are all important options but aren't the most important options in this situation.

What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis? a. Ask the child to bend forward at the waist and observe the child's back for asymmetry. b. Observe the gait while the child is walking forward heel to toe. c. Have the child flex the knees and look for uneven knee height. d. Look at the child's shoulders and hips while fully clothed.

a. Ask the child to bend forward at the waist and observe the child's back for asymmetry.

Fracture definition:

any break to the bone

When a child is suspected of having muscular dystrophy, a nurse should expect which muscles to be affected first? a) Muscles of the foot b) Muscles of the hip c) Muscles of respiration d) Muscles of the hand

b)Muscles of the hip Explanation: Positional muscles of the hip and shoulder are affected first. Progression later advances to muscles of the foot and hand. Involuntary muscles, such as the muscles of respiration, are affected last.

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? a) Disorganized infant behavior b) Risk for impaired skin integrity c) Peripheral neurovascular dysfunction d) Risk for activity intolerance

b)Risk for impaired skin integrity Correct Explanation: The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? a) Careful supine positioning b) Listening for a shrill cry c) Inspection of the cystic sac on the child's back for leakage d) Auscultation for bowel sounds

c)Inspection of the cystic sac on the child's back for leakage Explanation: Leakage from the cystic area indicates loss of cerebrospinal fluid (CSF) and risk of infection of the central nervous system. Prompt intervention is needed, probably surgical. Listening for bowel sounds confirms intestinal peristalsis but is not necessary with each infant contact. A shrill cry may indicate increased intracranial pressure (ICP). This is important to note yet is not as pressing as being aware of leakage. The baby would be positioned prone, not supine, to protect the sac.

Which of the following strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy? a) Motorized wheelchair b) Manual wheelchair c) Long leg braces d) Walker

c)Long leg braces Explanation: Long leg braces are functional assistive devices that provide increased independence and increased use of upper and lower body strength. Wheelchairs, both motorized and manual, provide less independence and less use of upper and lower body strength. Walkers are functional assistive devices that provide less independence than braces.

A nurse is conducting a physical examination of a 5-year-old boy with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find? a) Loss of strength in ankle dorsiflexion b) Pseudohypertrophy of the calves c) Pectus excavatum d) Loss of strength in hip extension

c)Pectus excavatum Explanation: Pectus excavatum develops in children with SMA type 1 and type 2 who exhibit paradoxical breathing. The chest becomes funnel shaped and the xiphoid process is retracted. Pseudohypertrophy of the calves is associated with Duchenne muscular dystrophy. Loss of strength in hip extension is associated with Duchenne muscular dystrophy. Loss of strength in ankle dorsiflexion is associated with Duchenne muscular dystrophy.

In caring for the child with Guillain-Barré syndrome, the nurse will provide much supportive care while watching carefully for signs of deterioration in which body system? a) Urinary b) Cardiovascular c) Respiratory d) Integumentary

c)Respiratory Explanation: Guillain-Barré is a life-threatening disease; the greatest risk occurs during the acute stage, when respiratory failure may occur. The child with this syndrome will be ill and will have limited mobility for an extended time. All body systems will be stressed, requiring supportive care.

Why does the nurse suspect cerebral palsy in the 8-month-old just assessed? a) The baby drools almost constantly. b) The child does not crawl. c) When startled, a strong Moro reflex is noted. d) The child sits independently with a straight back.

c)When startled, a strong Moro reflex is noted. Explanation: The Moro reflex is a primitive one that should have disappeared around 4 months of age. Persistence of this reflex may occur in children with cerebral palsy. Older children with cerebral palsy often drool owing to the inability to control oral muscles. Drooling in an 8-month-old is developmentally normal, as is sitting independently with the back straight. It fits developmentally that the 8-month-old does not yet crawl.

The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality? a. Encourage follow-through with physical therapy exercises. b. Restrict the child to a special needs classroom. c. Encourage after-school activities within the limits of the child's abilities. d. Ensure the school is aware of the child's capabilities.

c. Encourage after-school activities within the limits of the child's abilities.

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. Falls frequently and is clumsy

A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

c. Frequent, serial casting is tried first. Serial casting is begun shortly after birth before discharge from nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove harness several times a day to prevent contractures. c. Return to clinic every 1 to 2 weeks. d. Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

c. Return to clinic every 1 to 2 weeks.

How would the nurse best describe Gowers' sign to the parents of a child with muscular dystrophy? a) A waddling-type gait b) The pelvis position during gait c) Muscle twitching present during a quick stretch d) A transfer technique

d)A transfer technique Explanation: Gowers' sign is a description of a transfer technique present during some phases of muscular dystrophy. The child turns on the side or abdomen, extends the knees, and pushes on the torso to an upright position by walking his hands up the legs. The child's gait is unrelated to the presence of Gowers' sign. Muscle twitching present after a quick stretch is described as clonus.

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? a) Impaired physical mobility related to spinal cord defect b) Risk for injury related to lack of muscle control c) Ineffective coping related to diagnosis of chronic condition d) Deficient knowledge related to diagnosis and condition

d)Deficient knowledge related to diagnosis and condition Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for healthcare professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: a) facioscapulohumeral. b) myotonia. c) limb-girdle. d) Duchenne's.

d)Duchenne's. Explanation: Studies have shown that Duchenne's is the most severe form of muscular dystrophy. Myotonia isn't a form of the disease; it's a symptom.

Through which mechanism is Duchenne's muscular dystrophy acquired? a) Virus b) Environmental toxins c) Autoimmune factors d) Heredity

d)Heredity Explanation: Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which position postoperatively? Select all that apply. a) Left side lying b) Supine c) Semi-Fowler d) Prone e) Right side lying

d)Prone e)Right side lying a)Left side lying Explanation: Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

Which type of spinal neural tube defect does the nurse recognize as common and usually benign? a) Myelomeningocele b) Spina bifida c) Meningocele d) Spina bifida occulta

d)Spina bifida occulta Explanation: Spina bifida occulta usually is benign and is estimated to affect 20% of the population. It is a defect in the vertebral body without protrusion of the spinal cord or its coverings. Spina bifida is a general term that is often used to refer to all neural tube disorders of the spinal cord. Meningocele and myelomenigocele do involve protrusion of elements of the spinal portion of the central nervous system and require treatment.

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? a) Swallowing b) Breathing c) Sitting d) Standing

d)Standing Explanation: Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a client would have difficulty standing before having difficulty sitting.

The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel? a. Ambulate the children twice daily to promote mobility. b. Encourage commode use to promote bowel function. c. Provide diversionary activities, as the children must stay flat on their backs. d. Assist with log-rolling the children every 2 hours.

d. Assist with log-rolling the children every 2 hours.

The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

d. Elevate casted arm when resting and when sitting up.

A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention? a. Apply supplemental oxygen. b. Notify the respiratory therapist. c. Monitor pulse oximetry. d. Position for adequate airway clearance.

d. Position for adequate airway clearance. Positioning for airway clearance is the priority intervention, although suctioning may also be required. Interventions for airway maintenance take priority over other issues.

Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step.

false

Club foot cause: (3) more common in what gender

fetal positioning Intrauterine restriction Myelomeningocele more common in boys

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding? -kyphosis -lordosis -idiopathic scoliosis -sway back

idiopathic scoliosis Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.

2 things you want to prep for spina bifida

infection control surgical prep get everyone on board to advocate for pt: Neurology Neurosurgery Urology Orthopedics Therapy Rehab

How do you asses for Slipped Capital Femoral Epiphysis?

obese pre-teen X-ray

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking. Explanation: A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as: -significant bending without actual breaking. -bone buckling due to compression. -incomplete fracture. -bone that breaks into two pieces.

significant bending without actual breaking. A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

Spina bifida results in 3 things

spina bifida occulta meningocele meninomyelocele

An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse (child maltreatment). Which type of fracture would the radiograph most likely reveal?

spiral fracture

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

to continue with age-appropriate activities

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? -to continue with age-appropriate activities -to stand absolutely still when not wearing the brace -to wear the brace a maximum of 20 hours each day -that secondary sex changes will stop until the brace is removed

to continue with age-appropriate activities The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. Bracing is one way to do that. The brace should be worn for 23 hours per day. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. It is extremely important that the adolescent has compliance with the brace usage. The nurse can help by teaching the adolescent ways to help peers understand the need for the brace. Sex changes continue with or without bracing.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unhooking a weight while providing pin care

Spina bifida cause?

unknown cause LACK OF FOLIC ACID

Nursing interventions for cerebral palsy

we want to recognize this early!! Promote mobility Promote optimal development using multidisciplinary opportunities Physical therapy Occupational therapy Early intervention

Duchenne muscular dystrophy- by teenage years?

wheel chair bound

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?

when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?

when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand Explanation: A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?

when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? -"Itching is common. It's nothing to worry about." -"Blowing cool air with a fan or hair dryer may relieve the feeling." -"You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." -"A small amount of lotion or baby oil can be poured in the cast to moisturize the area."

"Blowing cool air with a fan or hair dryer may relieve the feeling." Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they make what statement?

"He will need more surgeries to replace the shunt as he grows."

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?

"I hate to think that I will need to be worried about my child having seizures for the rest of his life."

The nurse is talking with the caregiver of a 13-year-old diagnosed with scoliosis. The child has come to the clinic to be fitted with a brace to begin her treatment. The child appears upset and angry and states, "I hate this brace; I hate it already." In an effort to support this child, which statement would be the most appropriate for the nurse to make to this child's caregiver?

"If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good." Explanation: Help the child select clothing that blends with current styles but is loose enough to hide the brace. Self-image and the need to be like others are very important at this age. Wearing a brace creates a distinct change in body image, especially in the older child or adolescent, at a time when body consciousness is at an all-time high. The need to wear the brace and deal with the limitations it involves may cause anger; the change in body image can cause a grief reaction. Handling these feelings successfully requires understanding support from the nurse, family, and peers. It is important for the child to have an opportunity to talk about his or her feelings

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?

"In most cases treatment is not necessary, only observation." Explanation: The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate? -"In most cases treatment is not necessary, only observation." -"Have you seen any signs of improvement?" -"Was this from pressure resulting from forceps?" -"This is the most common facial nerve palsy."

"In most cases treatment is not necessary, only observation." The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? -"It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms." -"It is important to correct spinal curvature before it gets too bad, causing you problems." -"It is important to prevent herniation of a spinal disk, which is painful." -"It is important to prevent torticollis."

"It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms." It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

The nurse is caring for a child diagnosed 3 months ago with juvenile idieopathic arthritis (JIA). The caregiver states that the child has recently reported little pain and is not currently taking aspirin or NSAIDs. The caregiver also tells the nurse that just to be on the safe side, she is continuing to keep the child from doing physical exercise. The mother states, "I think we have beaten this disease." In working with this child and the caregiver, which statement would be best for the nurse to make?

"Let's review some of the instructions. She does need to take an anti-inflammatory every day." Explanation: Teach family caregivers the importance of regular administration of the medications, even when the child is not experiencing pain. The primary purpose of aspirin or NSAIDs is not to relieve pain but to decrease joint inflammation.

The caregiver of a 2-year-old who has a polyurethane resin cast on her arm calls the clinic to report that her child is crying and says that the cast has sand in it. The caregiver states that she has had casts herself and knows how badly they can itch. She says she always used a hanger to scratch but is worried that it will be too sharp for the child. Which statement would be appropriate for the nurse to make to this caregiver?

"Nothing should be put into the cast. You can blow cool air into it with a hair dryer." Explanation: Children and caregivers should be cautioned not to put anything inside the cast, no matter how much the casted area itches. Small toys and sticks or stick-like objects should be kept out of reach until the cast has been removed. Ice packs applied over the cast may help decrease the itching. Blowing cool air through a cast with a hair dryer set on a cool temperature or using a fan may help to relieve discomfort under a cast.

A mother is angry about her son's diagnosis of osteosarcoma. She is telling him that if he had not played football last year and broken his leg, this would not have happened. What is the nurse's best response to the mother's statement?

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Explanation: Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma.

A mother is angry about her son's diagnosis of osteosarcoma. She is telling him that if he had not played football last year and broken his leg, this would not have happened. What is the nurse's best response to the mother's statement? -"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." -"When he broke his leg last year, it may have weakened the bone, allowing cancer to start there." -"Does bone cancer run in your family? Maybe he inherited it through his genes." -"Cancer in the bone can result from old injuries so it probably was not caused from getting hurt last year, but an earlier injury."

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma.

The nurse is observing a child walk down stairs using a swing-through gait. What action by the child would indicate a need for intervention by the nurse?

"The child places the crutches on the lower step before placing the good foot down." Explanation: To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs.

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." Explanation: Bracing is the primary treatment for scoliosis. The braces used today are designed by computer-aided techniques and fit under the arms rather than extending to the neck. Braces must be worn 23 hours a day. Surgical intervention is only performed in severe cases.

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:

"These make a smooth edge on the cast so the skin is better protected."

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education?

"This medication will cure my child of this disorder."

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education?

"This medication will cure my child of this disorder." Explanation: Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening.

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? -"This medication will help to increase bone mineral density." -"My child's risk for fractures will hopefully be decreased as by taking this medication." -"This medication will cure my child of this disorder." -"This medication doesn't prevent fractures from happening."

"This medication will cure my child of this disorder." Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening.

The nurse is caring for a newborn client newly diagnosed with developmental dysplasia of the hip (DDH). Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis?

"Treatment will begin immediately."

The nurse is caring for a child who is using crutches due to a leg injury. The child's parents state that child reports pain in the axilla when using the crutches. What is the best response by the nurse?

"We need to make sure the crutches are not too tall; there should be about an inch of space between the crutch pad and the axilla." Explanation: Axilla pain is a common report and should not be ignored or just medicated. Proper fitting crutches should have 1 to 1.5 inches (2.5 to 3.8 cm) between the crutch pad and the axilla. This should help to prevent axilla pain. When crutches fit properly, padding should not be needed on the crutch pad.

The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? -"At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better." -"Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon." -"We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." -"Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own."

"We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." When a parent describes a child as always falling over the feet or awkward, the nurse needs to assess for toeing-in or metatarsus adductus. One way to assess for this is to have the child stand on a copier and make a print of the feet. It will show any inward turning of the feet. For most instances, it resolves without therapy. If it persists past 1 year, passive stretching exercises may be prescribed. It is not a severe bone disorder and typically does not need surgical intervention.

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction? -"I check my brace daily to make sure there is no damage or change to it." -"I leave my brace on for gym at school." -"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." -"I wear a t-shirt under my brace." -"I do exercises after school."

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily or all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort a lightweight t-shirt may be work under the brace.

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? -"When the strips start to dry, they can get warm, but they won't burn you." -"That is a normal feeling when casts are applied." -"Your temperature may be going up. I'll check it when they are done applying the cast." -"That is unusual. Most people complain of feeling cold."

"When the strips start to dry, they can get warm, but they won't burn you." As the plaster strips are applied, they initially feel cool but almost immediately they will begin to feel warm. This is due to evaporation. The statement that it is a "normal" feeling is not the best answer because it does not give enough information. The client having a temperature would not cause the cast to feel hot.

An infant was born with a severely deformed hand. He is now 6 months old. The nurse informs the parents that the orthopedic surgeon has recommended amputation of the hand and fitting of a prosthesis. The mother objects and tells the nurse that they would like to wait and see how the hand develops. Which of the following should the nurse say in response?

"With a deformity such as this, the hand is highly unlikely to improve."

An infant was born with a severely deformed hand. He is now 6 months old. The nurse informs the parents that the orthopedic surgeon has recommended amputation of the hand and fitting of a prosthesis. The mother objects and tells the nurse that they would like to wait and see how the hand develops. Which of the following should the nurse say in response?

"With a deformity such as this, the hand is highly unlikely to improve." Explanation: Depending on the condition, in many children, there is a potential for better function if the malformed portion of an extremity is amputated before a prosthesis is fitted. This creates a difficult decision for parents because it is one they cannot undo later. They need assurance hands with malformed fingers, for example, will not later grow to become normal and a well-fitted prosthesis will allow their child a more usual childhood and adult life than if the original disorder was left unchanged. It is not the nurse's place to insert her opinion about the matter.

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? -"You and your coaches need to understand that you cannot play soccer for at least six weeks." -"Ice will help reduce the inflammation." -"You will need to see a physical therapist for stretching and strengthening exercises." -"NSAIDs can help with pain control and inflammation."

"You and your coaches need to understand that you cannot play soccer for at least six weeks." A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

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?

"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate?

"You are doing a great job. Let's put our heads together on how to keep her busy." Explanation: The nurse should support the parents by encouraging and praising their compliance with bracing. It is also important to work with the parents to help develop age-appropriate diversions to promote normal growth and development. Telling the parents that they must be compliant or their daughter could develop severe bowing does not teach, does not offer solutions, and does not address the parents' concerns. Telling the parents that they must simply accept this and that the treatment could take years is likely to upset them and does not teach. It also does not address their concerns.

The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What the appropriate response by the nurse? -"You don't need to worry about your child's feet. They will change as your child grows." -"Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." -"Flat feet are normal in infants. Their longitudinal arch doesn't appear until they are 3 to 5 years old." -"When your child starts walking, encourage walking on the heels. This will help to develop the arch more so your child doesn't have a problem with flat feet as an adult."

"Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." A newborn's foot is flatter and proportionately wider than an adult's foot. Feet do change as a child grows, but this answer does not address the mother's concern. The longitudinal arch may not be present until the child has been walking for a few months, not at 3 to 5 years of age. Encouraging a child to walk on the heels does not help with arch development.

Describe the onset, symptoms (3), and Progression (2) of Type 2 Spinal Muscular Atrophy

- 6-18 months of age - Proximal muscles are more affected i.e. thighs are weaker than lower legs; legs tend to be weaker than arms - respiratory muscles may be involved - scoliosis may occur - Slower progression - survival into adulthood common if respiratory status maintained appropriately

Name 2 interventions for promoting mobility in a child with Duchenne Muscular Dystrophy

- Administering corticosteroids and calcium supplements - Perofrming passive stretching and strengthening exercises

List 3 management interventions for a child with Myasthenia gravis

- Anticholinesterase medications - Steroids, immunosuppresants - IVIG or plasmapheresis

What type of infection can lead to an acquired neuromuscular disorder?

- Botulism

Muscular Dystrophy has what type of inheritance?

- Can be X-linked, Autosomal Dominant, or Recessive

Name 2 interventions for preventing complications and maximizing quality of life in a child with Duchenne Muscular Dystrophy

- Developing a diversional schedule - Providing emotional support

Which type of muscular dystrophy is the most common and is universally fatal?

- Duchenne Muscular Dystrophy

Duchenne Muscular Dystrophy is characterized by what?

- Generalized weakness of voluntary muscles

What kinds of signs might a nurse find on assessment of a child with Duchenne Muscular Dystrophy?

- Gower's sign - Late Walker - Poor balance

Name 3 autoimmune acquired neuromuscular disorders. Briefly describe each

- Guillain-Barre syndrome: immune response attacks the peripheral nervous system but does not affect brain or spinal cord - Myasthenia gravis: genetic, inherited, or acquired disease with progressive weakness and fatigue brought on by inhibited neuromuscular transmission - Dermatomyositis: disease that results in inflammation of the muscles that occurs most often in girls

Which foods are associated with botulism infection in children under 1 year of age?

- Honey - Corn syrup

Name 3 Nursing diagnoses for a child with a neuromuscular disorder

- Impaired physical mobility related to muscle weakness, hypertonicity, impaired coordination, loss of muscle function, or control as evidenced by an inability to move extremities, to ambulate without assistance, to move without limitations etc. - nutrition, imbalanced, less than body requirements, related to difficulty feeding secondary to deficient sucking, swallowing, or chewing; difficulty assuming normal feeding position; inability to feed self as evidenced by decreased oral intake, impaired swallowing, weight loss, or plateau - Urinary retention related to sensory motor impairment as evidenced by dribbling, inadequate bladder emptying

Type 2 Spinal Muscular Atrophy is also known as_ __________________________

- Intermediate SMA

Type 3 Spinal Muscular Atrophy is also known as what 2 other names?

- Kugelberg-Welander Disease - Juvenile SMA

Name 2 Genetic neuromuscular disorders

- Muscular Dystrophy (various types) - Spinal Muscular Atrophy

Name 3 nursing management goals for a child with Duchenne Muscular Dystrophy

- Promoting mobility - maintaining cardiopulmonary function - preventing complications and maximizing quality of life

Type 1 Spinal Muscular Atrophy goes by which 2 other names?

- Werdnig-Hoffman Disease - Infantile SMA

Duchenne Muscular Dystrophy has what type of inheritance?

- X-linked recessive

Describe the onset, symptoms (3), and progression (2) of Type 3 Spinal Muscular Atrophy

- after 18 months of age; child has started walking or has taken at least 5 independent steps - weakness that is most severe in the shoulders, hips, thighs, and upper back - respiratory muscles may be involved - scoliosis may occur - slow progression - life span usually unaffected. - Walking ability maintained until at least adolescence; may need wheelchair later in life

Name 2 goals of treatment for Myasthenia Gravis

- alleviate respiratory distress - adequate nutrition & other supportive care

The majority of causes for Cerebral paulsy occur when?

- before birth (but can also ccur in the natal and postnatal periods)

Describe the onset, symptoms (3), and Progression (2) of Type 1 Spinal Muscular Atrophy

- before birth to 6 months of age - generalized weakness, cannot sit without support - weak cry - difficulty sucking, swallowing, and breathing - rapidly porgresses to early childhood death. - Use of ventilators and gastrostomy feeding tubes may prolong life

name 2 common types of birth trauma

- brachial plexus injuries - cranial nerve injuries

Cerebral Palsy is caused by nonprogressive abnormal _____________ function

- brain

Describe 4 interventions for neurogenic bladder

- clean intermittent catheterization to promote bladder emptying - medications such as oxybutynin chloride (ditropan) to improve bladder capacity - prompt recognition and treatment of infections - surgical interventions such as a continenet urinary reservoir or vesicostomy to facilitate urinary elimination

Describe the Gower's Sign

- compensatory method of standing up seen in children with neuromuscular weakness - First, child must roll on to hands on knees - then the child must bear weight by using hands to support some of his weight, while raising his posterior - The child then uses his hands to "walk" up his legs to assume an upright position

List 7 signs and symptoms of Botulism. Which one is usually the first sign?

- constipation (usually the first sign) - poor feeding - listlessness - generalized weakness - weak cry - drooping eyelids - diminished gag reflex

Duchenne Muscular Dystrophy is progressive, with a life expectancy in ______________

- early 30s

List 4 signs and symptoms of spinal cord injury

- inability to move or feel extremities - numbness - tingling - weakness

What is ataxia?

- lack of coordination of muscle movements during voluntary movements such as walking or picking up objects

List some complications associated with Cerebral palsy (6)

- mental impairments - seizures - growth problems - impaired vision or hearing - abnormal sensation or perception - hydrocephalus

What is the prognosis for a child with Cerebral Palsy?

- most children can survive into adulthood, but function and quality of life can vary from near normal to substantial impairments

Electromyography (EMG) shows that the problem in Duchenne Muscular Dystrophy is in the ____________ and not the ___________

- muscle - nerve

What does EMG stand for? EMG on children with Duchenne Muscular Dystrophy shows that the problem is in the _________________________

- muscle (not the nerve)

In Muscular Dystrophy, a genetic mutation results in decrease in specific _______________ ____________________ that prevents normal function of the muscle

- muscle protein

List some nursing care focus points for the child with Cerebral Palsy (6)

- promoting growth and development - promoting mobility - maintaining optimal nutritional intake - providing support and education to the child and family - pharmacologic management - surgical management

List 3 management interventions for Botulism

- respiratory support - nutrition support (past the pylorus) - Botulism immune globulin

What are the signs and symptoms of Cerebral Palsy? (4)

- spasticity, - muscle weakness - ataxia - other motor impairments

Name 2 types of trauma that may cause neuromuscular disorders

- spinal cord injury - birth trauma

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. -The boy experiences mild pain when wiggling his toes. -The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. -New drainage is seeping out from under the cast. -The outside of the boy's cast got wet and had to be dried using a hair dryer. -The boy's toes are light blue and very swollen.

-The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. -New drainage is seeping out from under the cast. -The boy's toes are light blue and very swollen. The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place.

1 The supplement has 5 mcg of vitamin D in each 0.5 mL. The child is supposed to receive 10 mcg each day of supplemental vitamin D. Desired/Have x Quantity = dose 10 mcg/5 mcg x 0.5 mL = 1.0 mL Ratio/proportion: 0.5 mL/5 micrograms = x/10 micrograms = 1.0 mL

The nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled for surgical closure of the sac. In the preoperative period, which is the priority problem? 1. Infection 2. Choking 3. Inability to tolerate stimulation 4. Delayed growth and development

1 A myelomeningocele is a type of spina bifida that results from failure of the neural tube to close during embryonic development. With a myelomeningocele, protrusion of the meninges, cerebrospinal fluid, nerve roots, and a portion of the spinal cord occurs. The newborn with spina bifida is at risk for infection before the closure of the sac, which is done soon after birth. Initial care of the newborn with myelomeningocele involves prevention of infection. A sterile normal saline dressing is placed over the sac to maintain moisture of the sac and its contents and to prevent tearing or breakdown of the skin integrity at the site. Any opening in the sac greatly increases the risk of infection of the central nervous system. Choking and inability to tolerate stimulation are not priority problems with this defect. Delayed growth and development is a problem for the infant with myelomeningocele, but preventing infection has priority in the preoperative period.

The nurse is caring for a child who sustained a head injury after falling from a tree. On assessment of the child, the nurse notes the presence of a watery discharge from the child's nose. The nurse should immediately test the discharge for the presence of which substance? 1. Protein 2. Glucose 3. Neutrophils 4. White blood cells

1 After a head injury, bleeding from the nose or ears necessitates further evaluation. A watery discharge from the nose (rhinorrhea) that tests positive for glucose is likely to be cerebrospinal fluid (CSF) leaking from a skull fracture. On noting watery discharge from the child's nose, the nurse should test the drainage for glucose using an agency approved reagent strip. If the results are positive, the nurse will contact the health care provider. The items in options 1, 3, and 4 are not normally found in mucus.

A school-age child with Down syndrome is brought to the ambulatory care center by the mother. The child has bruising all over the body. To work most effectively with this child, the nurse first addresses which complication associated with Down syndrome? 1. Children with Down syndrome are more likely to develop acute leukemia than the average child. 2. Children with Down syndrome fall down easily as a result of hyperflexibility and muscle weakness. 3. Children with Down syndrome are at risk for physical abuse because of their low intellectual functioning. 4. Children with Down syndrome scratch themselves a lot because of dry, cracked, and frequently fissuring skin.

1 Children with Down syndrome have an increased risk for developing leukemia compared with the average child. The other statements also could be true, but the nurse should first gather baseline data to determine the cause of the bruising before making other assumptions.

A child who sustained a fractured ankle has a short leg cast applied, and the nurse provides home care instructions to the mother. The mother returns to the emergency department 16 hours later because the child is complaining of severe pain. The nurse notes that the child's toes are cool, pale, and puffy and that the child is agitated and crying loudly. The mother states, "I gave her the pain medication you sent with us just like you told us, and I have kept her foot up on two pillows since we left, except when she gets up to go to the bathroom. I don't understand why she hurts so much. Do something!" What is the most likely clinical situation that occurred? 1. Compartment syndrome 2. Inadequate pain medication 3. Skin breakdown around the cast edges 4. Noncompliance with home care instructions

1 Compartment syndrome occurs as a result of pressure buildup within a tissue compartment bound by anatomical structures such as fascia. With a fracture, this pressure increase may occur as a result of the intense inflammatory response or severe bleeding caused by the bone injury, even when diligent nursing care has been provided. Pain disproportionate to the injury despite analgesic administration is the classic sign of compartment syndrome. The nurse should constantly assess for this complication and should instruct the caregiver about the manifestations associated with this complication.

The nurse is performing an assessment on a child with a head injury. The nurse notes an abnormal flexion of the upper extremities and an extension of the lower extremities. What should the nurse document that the child is experiencing? 1. Decorticate posturing 2. Decerebrate posturing 3. Flexion of the arms and legs 4. Normal expected positioning after head injury

1 Decorticate posturing is an abnormal flexion of the upper extremities and an extension of the lower extremities with possible plantar flexion of the feet. Decerebrate posturing is an abnormal extension of the upper extremities with internal rotation of the upper arms and wrists and an extension of the lower extremities with some internal rotation.

A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition? 1. Limited range of motion in the affected hip 2. An apparent lengthened femur on the affected side 3. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 4. Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table

1 In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical and restricted abduction of the affected hip, when the child is placed supine with the knees and hips flexed, would be an assessment finding in developmental dysplasia of the hip in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.

A child is admitted to the hospital with a diagnosis of acute bacterial meningitis. In reviewing the health care provider's prescriptions, which would the nurse question as appropriate for a child with this diagnosis? 1. Administer an oral antibiotic. 2. Maintain strict intake and output. 3. Draw blood for a culture and sensitivity. 4. Place the child on droplet precautions in a private room.

1 Medication to treat acute bacterial meningitis is administered intravenously, not orally. A culture and sensitivity is done to determine if the diagnosis is bacterial or viral. Until meningitis is ruled out, the child is placed in isolation on droplet precautions because the disease is spread by airborne means. Strict intake and output should be maintained.

The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? 1. Meningitis 2. Spinal cord injury 3. Intracranial bleeding 4. Decreased cerebral blood flow

1 Meningitis is an infectious process of the central nervous system caused by bacteria and viruses. The inability to extend the leg when the thigh is flexed anteriorly at the hip is a positive Kernig's sign, noted in meningitis. Kernig's sign is not seen specifically with spinal cord injury, intracranial bleeding, or decreased cerebral blood flow.

The nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle crash for signs of increased intracranial pressure (ICP). The nurse should assess the child frequently for which early sign of increased ICP? 1. Nausea 2. Papilledema 3. Decerebrate posturing 4. Alterations in pupil size

1 Nausea is an early sign of increased ICP. Late signs of increased ICP include a significant decrease in level of consciousness, Cushing's triad (increased systolic blood pressure and widened pulse pressure, bradycardia, and irregular respirations), and fixed and dilated pupils. Other late signs include decreased motor response to command, decreased sensory response to painful stimuli, posturing, Cheyne-Stokes respirations, and papilledema.

The nurse is performing an admission assessment on a child with a seizure disorder. The nurse is interviewing the child's parents to determine their adjustment to caring for their child, who has a chronic illness. Which statement, if made by the parents, would indicate a need for further teaching? 1. "Our child sleeps in our bedroom at night." 2. "We worry about injuries when our child has a seizure." 3. "Our child is involved in a swim program with neighbors and friends." 4. "Our babysitter just completed cardiopulmonary resuscitation training."

1 Parents are especially concerned about seizures that might go undetected during the night. The nurse needs to decrease parental overprotection and should suggest the use of a baby monitor at night. Involvement in a swim program and knowing CPR identify parental understanding of the disorder. Worrying about injuries when a child has a seizure is a common concern. The parents need to be reminded that as the child grows, they cannot always observe their child, but their knowledge of seizure activity and care is appropriate to minimize complications.

A nursing student is assisting a school nurse in performing scoliosis screening on the children in the school. The nurse assesses the student's preparation for conducting the screening. The nurse determines that the student demonstrates understanding of the disorder when the student states that scoliosis is characterized by which finding? 1. Abnormal lateral curvature of the spine 2. Abnormal anterior curvature of the lumbar spine 3. Excessive posterior curvature of the thoracic spine 4. Abnormal curvature of the spine caused by inflammation

1 Scoliosis is defined as an abnormal lateral curvature in any area of the spine. The region of the spine most commonly affected is the right thoracic area, where it results in rib prominence. Option 2 describes lordosis, which usually is exaggerated during pregnancy, in obesity, or in persons with large tumors. Option 3 describes kyphosis, which also is known as humpback. Scoliosis does not occur as a sequela of inflammation.

A child with cerebral palsy is in a management program to achieve maximum potential for locomotion, self-care, and socialization in school. The nurse works with the child to meet these goals by performing which action? 1. Placing the child on a wheeled scooter board 2. Removing ankle-foot orthoses and braces once the child arrives at school 3. Keeping the child in a special education classroom with other children with similar disabilities 4. Placing the child in the supine position with a 30-degree elevation of the head of the bed to facilitate feeding

1 The correct option provides the child with maximum potential in locomotion, self-care, and socialization. While lying on the abdomen, the child can move around independently anywhere the child wants to go and can interact with others as desired. Orthoses need to be used all the time to aid locomotion. Children with cerebral palsy (CP) need to be mainstreamed as much as cognitive ability permits to provide for maximum socialization and normalization. Not all children with CP are intellectually challenged. Just as children without CP sit up and use assistive devices when eating, so should children with CP.

The nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement by one of the parents indicates an understanding of the use of the harness? 1. "I can remove the harness to bathe my infant." 2. "I need to remove the harness to feed my infant." 3. "I need to remove the harness to change the diaper." 4. "My infant needs to remain in the harness at all times."

1 The harness should be worn 23 hours a day and can be removed only to check the skin and for bathing. The hips and buttocks should be supported carefully when the infant is out of the harness. The harness does not need to be removed for diaper changes or feedings.

The nurse is reinforcing instructions to the mother of a child who has a plaster cast applied to the left arm. Which statement by the mother indicates a need for further teaching? 1. "I will have to use a heat lamp to help the cast dry." 2. "I need to cover the cast with plastic during baths or showers." 3. "I should call the health care provider if the cast feels warm or hot or has an unusual smell or odor." 4. "I will keep small toys and sharp objects away from the cast and be sure that my child does not put anything inside the cast."

1 The mother needs to be instructed not to use a heat lamp to help the cast dry because of the risk associated with a burn injury from the heat lamp. The statements in the remaining options indicate understanding of instructions.

A neighborhood nurse is attending a soccer game at a local middle school. One of the students falls off the bleachers and sustains an injury to the left arm. The nurse quickly attends to the child and suspects that the child's arm may be broken. Which nursing action would be the priority before transferring the child to the hospital emergency department? 1. Immobilize the arm. 2. Ask for the name of the child's pediatrician or family health care provider so that he or she can be contacted. 3. Have someone call the radiology department of the local hospital to let staff know that the child will be arriving. 4. Tell the child that the arm probably is fractured but not to worry because permanent damage to the arm will not occur.

1 When a fracture is suspected, it is imperative that the area be splinted and immobilized before the injured person is transferred or moved. The nurse should remain with the child and provide realistic reassurance. Although it may be necessary to contact the child's pediatrician, this is not the priority. It is not necessary to notify the radiology department because this would be the responsibility of the emergency department staff when the child arrives if it is determined that the child needs a radiograph. The child should not be told that permanent damage will not occur.

6 discharge criteria for CMT

1. full PROM of neck, trunk and extremities within 5 degrees of unaffected side. 2. symmetrical movment throughotu PROM 3. age appropriate gross motor development; no assymetrical movement patterns 4. Improved skull symmetry 5. no visible head tilt 6. parents understand what to monitor for.

Cerebral palsy (CP) is suspected in a child and the parents ask the nurse about the potential warning signs of CP. The nurse should provide which information? Select all that apply. 1. The infant's arms or legs are stiff or rigid. 2. A high risk factor for CP is very low birth weight. 3. By 8 months of age, the infant can sit without support. 4. The infant has strong head control but a limp body posture. 5. The infant has feeding difficulties, such as poor sucking and swallowing. 6. If the infant is able to crawl, only one side is used to propel himself or herself.

1.2.5.6 Cerebral palsy (CP) is a term applied to a disorder that impairs movement and posture. The effects on perception, language, and intellect are determined by the type that is diagnosed. Stiff, rigid arms and legs, low birth weight, poor sucking and swallowing, and inability to crawl properly are potential warning signs of CP. By 8 months of age, if the infant cannot sit up without support, this would be considered a potential warning sign, because this developmental task should be completed by this time. The infant with a potential diagnosis of CP has poor head control by 3 months of age, when head control should be strong.

A child is brought to the emergency department, and diagnostic x-rays of the child reveal that a fracture is present. The mother states that the child was rollerblading and attempted to break a fall with an outstretched arm. A plaster of Paris cast is applied to the arm. Which instructions should the nurse provide the mother? Select all that apply. 1. The cast will mold to the body part. 2. The cast should be dry in about 6 hours. 3. Keep the cast elevated on pillows for the first day. 4. Make sure that the child can frequently wiggle the fingers. 5. The cast is water-resistant, so the child is able to take a bath or a shower. 6. The cast needs to be kept dry because it will begin to disintegrate when wet.

1.3.4.6 Plaster of Paris is a heavier material than that used in a synthetic cast. It molds easily to the extremity and is less expensive than a synthetic cast. It takes about 24 hours to dry, but drying time could be longer, depending on the size of the cast. Plaster of Paris is not water resistant and will begin to disintegrate when wet. The cast should be elevated on a pillow for the first day to decrease swelling as the cast begins to mold to the arm. As the cast molds, it is imperative that the child can wiggle the fingers because the extremity continues to swell. If the child can wiggle the fingers, adequate motion is present. Color and sensation of the fingers should also be assessed. All of these are important components of a teaching plan for a parent.

The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply. 1. Time the seizure. 2. Restrain the child. 3. Stay with the child. 4. Place the child in a prone position. 5. Move furniture away from the child. 6. Insert a padded tongue blade in the child's mouth.

1.3.5 A seizure is a disorder that occurs as a result of excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. During a seizure, the child is placed on his or her side in a lateral position. Positioning on the side prevents aspiration because saliva drains out the corner of the child's mouth. The child is not restrained because this could cause injury to the child. The nurse would loosen clothing around the child's neck and ensure a patent airway. Nothing is placed into the child's mouth during a seizure because this action may cause injury to the child's mouth, gums, or teeth. The nurse would stay with the child to reduce the risk of injury and allow for observation and timing of the seizure.

The nurse is assigned to care for a child with a brain injury who has a temporal lobe herniation and increasing intracranial pressure. Which signs should the nurse identify as indicative of this type of injury? Select all that apply. 1. Flaccid paralysis 2. Pupil response to light 3. Ipsilateral pupil dilation 4. Compression of the sixth cranial nerve 5. Shifting of the temporal lobe laterally across the tentorial notch

1.3.5 Temporal lobe herniation or uncal herniation refers to a shifting of the temporal lobe laterally across the tentorial notch. This produces compression of the third cranial nerve and ipsilateral pupil dilation. If pressure continues to rise, flaccid paralysis, pupil fixation, and death will result.

Which nursing actions apply to the care of a child who is having a seizure? Select all that apply. 1. Time the seizure. 2. Restrain the child. 3. Stay with the child. 4. Insert an oral airway. 5. Loosen clothing around the child's neck. 6. Place the child in a lateral side-lying position.

1.3.5.6 During a seizure, the nurse should stay with the child to reduce the risk of injury and allow for observation and timing of the seizure. The child is not restrained because this could cause injury to the child. The child is placed on his or her side in a lateral position. Nothing is placed in the child's mouth during a seizure because this could injure the child's mouth, gums, or teeth. Positioning on the side prevents aspiration because saliva drains out of the corner of the child's mouth. The nurse should loosen clothing around the child's neck and ensure a patent airway.

The nurse is caring for a child who fractured the ulna bone and had a cast applied 24 hours ago. The child tells the nurse that the arm feels like it is falling asleep. Which nursing action is appropriate? 1. Encourage the child to keep the arm elevated. 2. Report the findings to the health care provider. 3. Document the findings and reassess the arm in 4 hours. 4. Tell the child that this is normal while the cast is drying.

2 A child's complaint of pins and needles or of the extremity falling asleep needs to be reported to the health care provider. These complaints indicate the possibility of circulatory impairment and paresthesia. Paresthesia is a serious concern because paralysis can result if the problem is not corrected. The five Ps of vascular impairment are pain, pallor, pulselessness, paresthesia, and paralysis. Prompt intervention is critical if neurovascular impairment is to be prevented.

The nurse is providing home care instructions to the parents of a child with a seizure disorder. Which statement indicates to the nurse that the teaching regarding seizure disorders has been effective? 1. "We're glad we only have to give our child the medication for 30 days." 2. "We will make appointments for follow-up blood work and care as directed." 3. "We're glad there are no side effects from taking the antiseizure medications." 4. "After our child has been seizure free for 1 month, we can discontinue the medication."

2 Antiseizure medications are continued for a prolonged time even if seizures are controlled. Periodic reevaluation of the child is important to assess the continued effectiveness of the medication, to check serum medication levels, and to determine the need to alter the dosage if indicated. Antiseizure medications have potential side effects, and parents should be informed of such effects specific to the medication the child will be taking. Withdrawal of medication follows a predesigned protocol, usually begun when the child has been seizure free for at least 2 years. When a medication is discontinued, the dosage should be reduced gradually over 1 to 2 weeks.

A child must wear a brace for correction of scoliosis. The nurse creates a plan of care knowing the child is at risk for which problem? 1. Inability to ambulate 2. Breaks in skin integrity 3. Decreased oxygenation 4. Delayed growth and development

2 Braces for treatment of scoliosis usually are worn 16 to 23 hours a day. The skin should be kept clean and dry and inspected for signs of redness or breakdown. Therefore, breaks in skin integrity are the client problem that should be included in this child's plan of care. The brace assists with posture, so mobility is not an issue. The brace does not compromise the respiratory status, so oxygenation is not decreased. The child will not have a risk for delayed growth and development because normal developmental milestones can be met while wearing a brace.

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.

2 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 to 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.

Russell's traction is prescribed for a child with a lower leg fracture. The mother of the child asks the nurse about the purpose of the traction. The nurse explains to the mother that which is the primary action of this type of traction? 1. Relieves the child's pain 2. Reduces or realigns a fracture site 3. Provides a form of restraint for the child 4. Keeps the child from moving around in bed

2 Russell's traction uses skin traction to realign a fracture in the lower extremity and to immobilize the hip and knee in a flexed position. It is important to keep the hip flexion at the prescribed angle to prevent fracture malalignment. The traction may also relieve pain by reducing muscle spasms, but this is not the primary reason for this traction. The child can still move in bed with some restriction as a result of the traction. Traction is never used to restrain a child.

A 4-year-old child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further instruction? 1. "The cast may feel warm as the cast dries." 2. "I can use lotion or powder around the cast edges to relieve itching." 3. "A small amount of white shoe polish can touch up a soiled white cast." 4. "If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast."

2 Teaching about cast care is essential to prevent complications from the cast. The parents need to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast. Lotions or powders can become sticky or caked and cause skin irritation. Options 1, 3, and 4 are appropriate statements.

The nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse should monitor for which sign of a serious complication associated with this type of traction? 1. Lack of appetite 2. Elevated temperature 3. Decrease in the urinary output 4. Increase in the blood pressure

2 The most serious complication associated with skeletal traction is osteomyelitis, an infection involving the bone. Organisms gain access to the bone systemically or through the opening created by the metal pins or wires used with the traction. Osteomyelitis may occur with any open fracture. Clinical manifestations include complaints of localized pain, swelling, warmth, tenderness, an unusual odor from the fracture site, and an elevated temperature. The remaining options are not specifically associated with osteomyelitis.

A child sustains a fall at home and is brought to the hospital emergency department by the child's mother. After a radiographic examination, the child is determined to have a fractured arm, and a plaster cast is applied. The nurse provides instructions to the mother regarding neurocirculatory assessment and function. Which statement by the mother indicates a need for further instruction? 1. "I'll need to check her skin twice a day at the cast edges." 2. "If her hand gets real cool and pale, I can apply the heating pad to it." 3. "For the first couple of days, I should try to keep her hand higher than her heart most of the time using pillows." 4. "If she seems way too fussy and her arm is painful even after I've given her the pain medication, it might be a problem, and I should call you for help to decide on what is happening."

2 The mother needs to understand that compartment syndrome is a complication of fracture and casting and can result in permanent limb damage as a result of pressure-related tissue necrosis. The extremity is elevated to prevent swelling, and the health care provider is notified immediately if any signs of neurovascular impairment develop. Cold fingers could indicate neurovascular impairment and should be reported. A heating pad is not applied to the cast or fingers. Skin edges are checked to monitor for irritation and skin breakdown.

The nurse is caring for a child after surgical removal of a brain tumor. The nurse should assess the child for which sign that would indicate that brainstem involvement occurred during the surgical procedure? 1. Inability to swallow 2. Elevated temperature 3. Altered hearing ability 4. Orthostatic hypotension

2 Vital signs and neurological status are assessed frequently after surgical removal of a brain tumor. Special attention is given to the child's temperature, which may be elevated because of hypothalamic or brainstem involvement during surgery. A cooling blanket should be in place on the bed or readily available if the child becomes hyperthermic. Inability to swallow and altered hearing ability are related to functional deficits after surgery. Orthostatic hypotension is not a common clinical manifestation after brain surgery. An elevated blood pressure and widened pulse pressure may be associated with increased intracranial pressure, which is a complication after brain surgery, but they are not related to brainstem involvement.

The young child has been diagnosed with Guillain-Barré syndrome and it is progressing in a classic manner. Rank the following sequence of events in the order that they typically occur. 1 The child is having difficulty producing facial expressions. 2The child reports numbness and tingling in his toes. 3The child states that it is difficult to move his legs. 4The child states that it is difficult to move his arms.

2)The child reports numbness and tingling in his toes. 3)The child states that it is difficult to move his legs. 4)The child states that it is difficult to move his arms. 1)The child is having difficulty producing facial expressions. Explanation: Guillain-Barré syndrome paresthesias and muscle weakness. Classically it initially affects the lower extremities and progresses in an ascending manner to upper extremities and then the facial muscles. Progression is usually complete in 2 to 4 weeks, followed by a stable period leading to the recovery phase.

The nurse enters a child's room and discovers that the child is having a seizure. Which actions should the nurse take? Select all that apply. 1. Call a code. 2. Run to get the crash cart. 3. Turn the child on her side. 4. Loosen any restrictive clothing. 5. Check the child's respiratory status. 6. Place an airway into the child's mouth.

2.3.4 During a seizure the child is placed on his or her side in a lateral position. Positioning on the side will prevent aspiration because saliva will drain out the corner of the child's mouth. The child is not restrained because this could cause injury to the child. The nurse loosens clothing around the child's neck and ensures a patent airway by checking respiratory status. A code is called if the child is not breathing or the heart is not beating. There are no data in the question indicating that this is the case. The nurse stays with the child to reduce the risk of injury and to allow for observation and timing of the seizure. Nothing is placed into the child's mouth during a seizure because this could injure the child's mouth, gums, or teeth.

The clinic nurse is assessing a child suspected of having juvenile rheumatoid arthritis (JRA). Which assessment findings should the nurse expect to note in a child who has been diagnosed with JRA? Select all that apply. 1. Hematuria 2. Morning stiffness 3. Painful, stiff, and swollen joints 4. Limited range of motion of the joints 5. Stiffness that develops later in the day 6. History of late-afternoon temperature

2.3.4.6. Clinical manifestations associated with JRA include intermittent joint pain that lasts longer than 6 weeks and painful, stiff, and swollen joints that are warm to the touch, with limited range of motion. The child will complain of morning stiffness and may protect the affected joint or refuse to walk. Systemic symptoms include malaise, fatigue, lethargy, anorexia, weight loss, and growth problems. A history of a late-afternoon fever with temperature spiking up to 105°F (40.6°C) will also be part of the clinical manifestations. Hematuria is not specifically associated with JRA.

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? Select all that apply. 1. Use the fingertips to lift the cast while it is drying. 2. Keep small toys and sharp objects away from the cast. 3. Use a padded ruler or another padded object to scratch the skin under the cast if it itches. 4. Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold. 5. Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling. 6. Contact the health care provider (HCP) if the child complains of numbness or tingling in the extremity.

2.5.6 While the cast is drying, the palms of the hands are used to lift the cast. If the fingertips are used, indentations in the cast could occur and cause constant pressure on the underlying skin. Small toys and sharp objects are kept away from the cast, and no objects (including padded objects) are placed inside the cast because of the risk of altered skin integrity. The extremity is elevated to prevent swelling, and the HCP is notified immediately if any signs of neurovascular impairment develop. A heating pad is not applied to the cast or fingers. Cold fingers could indicate neurovascular impairment, and the HCP should be notified.

The neonatal nurse caring for infants with musculoskeletal alterations knows that the following structural abnormalities are common in newborns, Which resolve on their own as the infant grows? Select all answers that apply

20° to 30° hip and knee contractures Inward rotation of the lower leg Metatarsus adductus (in-toeing or pigeon-toedness) C-shaped appearance of the spine Explanation: Normal newborns have 20° to 30° hip and knee contractures, which usually resolve by age 4 to 6 months. The infant frequently has inward rotation of the lower leg, creating a bowed appearance in which the feet may be turned slightly inward. Metatarsus adductus (in-toeing or "pigeon-toedness") is a common finding in infants and toddlers. At birth, the child's spine has a C-shaped appearance that undergoes changes as the child grows. Developmental dysplasia of the hip and brachial plexus injury are not normal findings and must be treated to correct the malformation.

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 1. "I will encourage my child to perform prescribed exercises." 2. "I will have my child wear soft fabric clothing under the brace." 3. "I should apply lotion under the brace to prevent skin breakdown." 4. "I should avoid the use of powder because it will cake under the brace."

3 A brace may be prescribed to treat scoliosis. Braces are not curative, but may slow the progression of the curvature to allow skeletal growth and maturity. The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation. Options 1, 2, and 4 are appropriate interventions in the care of a child with a brace.

The nurse is creating a plan of care for a newborn infant with spina bifida (myelomeningocele type). The nurse includes assessment measures in the plan to monitor for increased intracranial pressure. Which assessment technique should be performed that will best detect the presence of an increase in intracranial pressure? 1. Check urine for specific gravity. 2. Monitor for signs of dehydration. 3. Assess anterior fontanel for bulging. 4. Assess blood pressure for signs of hypotension.

3 A bulging or taut anterior fontanel would indicate the presence of increased intracranial pressure. Urine concentrating ability is not well developed at the newborn stage of development. Monitoring for signs of dehydration will not provide data related to increased intracranial pressure. Blood pressure is difficult to assess during the newborn period and is not the best indicator of intracranial pressure.

The nurse assists a health care provider in performing a lumbar puncture on a 3-year-old child with leukemia in whom central nervous system disease is suspected. In which position will the nurse place the child during this procedure? 1. Lithotomy position 2. Modified Sims' position 3. Lateral recumbent position with the knees flexed and chin resting on the chest 4. Prone with knees flexed to the abdomen and head bent with chin resting on the chest

3 A lateral recumbent position with the knees flexed to the abdomen and the head bent with the chin resting on the chest is assumed for a lumbar puncture. This position separates the spinal processes and facilitates needle insertion into the subarachnoid space. The positions in the remaining options are incorrect.

The nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit. The nurse prepares for the child's arrival and plans to implement which type of precautions? 1. Enteric 2. Contact 3. Droplet 4. Neutropenic

3 A major priority in nursing care for a child with suspected meningitis is to administer the appropriate antibiotic as soon as it is prescribed. The child will be placed in a private room, with droplet transmission precautions, for at least 24 hours after antibiotics are given. Enteric, contact, and neutropenic precautions are not associated with the mode of transmission of meningitis. Enteric precautions are instituted when the mode of transmission is through the gastrointestinal tract. Contact precautions are instituted when contact with infectious items or materials is likely. Neutropenic precautions are instituted when the client has a low neutrophil count.

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

3 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 syndrome is an example of a congenital condition that results in moderate to severe intellectual disabilities.

Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? 1. "Treatment needs to be started as soon as possible." 2. "I realize my infant will require follow-up care until fully grown." 3. "I need to bring my infant back to the clinic in 1 month for a new cast." 4. "I need to come to the clinic every week with my infant for the casting."

3 Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; the defect may be unilateral or bilateral. Treatment for clubfoot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved in 3 to 6 months, surgery usually is indicated. Because clubfoot can recur, all children with clubfoot require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome.

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

3 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.

The nurse is caring for a child with a head injury. The nurse observes decerebrate posturing. What is the nurse's best action? 1. Document the finding. 2. Complete a head-to-toe examination. 3. Notify the health care provider. 4. Inform the family of the improved status.

3 Decorticate posturing indicates a lesion in the cerebral hemisphere or disruption of the corticospinal tracts. Decerebrate posturing indicates damage in the diencephalon, midbrain, or pons. The progression from flexion to extension posturing usually indicates deteriorating neurological function, not improvement, and warrants physician notification. A focused neurological examination is priority at this time, not a complete head to toe.

The nurse is monitoring a child with a brain tumor for complications associated with increased intracranial pressure. Which finding, if noted by the nurse, would indicate the presence of diabetes insipidus? 1. Weight gain 2. Hypertension 3. High urine output 4. Urine specific gravity greater than 1.030

3 Diabetes insipidus (DI) can occur in a child with increased intracranial pressure. Weight gain, hypertension, and a urine specific gravity greater than 1.030 are indications of the syndrome of inappropriate antidiuretic hormone secretion, not DI. A high urine output would be indicative of DI.

The nurse is assessing a client with fragile X syndrome. The nurse anticipates noting which physical assessment finding? 1. Low, straight palate 2. Short, narrow protruding ears 3. Long, narrow face with a prominent jaw 4. Short, rounded face with an indiscernible jaw

3 Fragile X syndrome is a genetic condition that causes developmental problems including learning disabilities and cognitive impairment. Physical assessment findings of fragile X syndrome include long, wide, and/or protruding ears; a long, narrow face with a prominent jaw; and large testes. Therefore, the descriptions in the remaining options are incorrect.

The nurse is providing instructions to the parents of an infant with a ventriculoperitoneal shunt. The nurse should include which instruction? 1. Expect an increased urine output from the shunt. 2. Notify the health care provider if the infant is fussy. 3. Call the health care provider if the infant has a high-pitched cry. 4. Position the infant on the side of the shunt when the infant is put to bed.

3 If the shunt is malfunctioning, the fluid from the ventricle part of the brain will not be diverted to the peritoneal cavity. The cerebrospinal fluid will build up in the cranial area. The result is increased intracranial pressure, which then causes a high-pitched cry in the infant. The infant should not be positioned on the side of the shunt because this will cause pressure on the shunt and skin breakdown. This type of shunt affects the gastrointestinal system, not the genitourinary system, and an increased urinary output is not expected. Being fussy is a concern only if other signs indicative of a complication are occurring.

The nurse is assisting a health care provider (HCP) examining a 3-week-old infant with developmental dysplasia of the hip. What test or sign should the nurse expect the HCP to assess? 1. Babinski's sign 2. The Moro reflex 3. Ortolani's maneuver 4. The palmar-plantar grasp

3 In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Ortolani's maneuver is a test to assess for hip instability and can be done only before 4 weeks of age. The examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A "clicking" sensation indicates a dislocated femoral head moving into the acetabulum. Babinski's sign is abnormal in anyone older than 2 years of age and indicates central nervous system abnormality. The Moro reflex is normally present at birth but is absent by 6 months; if still present at 6 months, there is an indication of neurological abnormality. The palmar-plantar grasp is present at birth and lessens within 8 months.

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse should make which response? 1. "Avoid all exercise during painful periods." 2. "Range-of-motion exercises must be performed every day." 3. "Have the child perform simple isometric exercises during this time." 4. "Administer additional pain medication before performing range-of-motion exercises."

3 Juvenile idiopathic arthritis is an autoimmune inflammatory disease affecting the joints and other tissues, such as articular cartilage. During painful episodes of juvenile idiopathic arthritis, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Although resting the extremity is appropriate, beginning simple isometric or tensing exercises as soon as the child is able is important. These exercises do not involve joint movement.

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis? 1. Clear CSF, decreased pressure, and elevated protein level 2. Clear CSF, elevated protein, and decreased glucose levels 3. Cloudy CSF, elevated protein, and decreased glucose levels 4. Cloudy CSF, decreased protein, and decreased glucose levels

3 Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. Meningitis is diagnosed by testing CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure; turbid or cloudy CSF; and elevated leukocyte, elevated protein, and decreased glucose levels.

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates a need for further teaching? 1. "I cannot place powder under the brace." 2. "I need to place a soft shirt on my child under the brace." 3. "I need to be sure to apply lotion on the skin under the brace." 4. "I need to encourage my child to perform prescribed exercises."

3 The use of lotions or powders should be avoided with a brace because they can become sticky or cake under the brace, causing irritation. The actions in the remaining options are appropriate interventions for the use of a brace on a child.

An infant is brought to the child care clinic for a follow-up visit. The nurse notes that the infant is wearing this apparatus. The nurse documents that the infant is wearing which device? Refer to Figure. (Figure shows harness that is secured on chest with straps going to lower legs and feet, baby is shown with hips and knees bent) 1. A back brace for the treatment of scoliosis 2. Bilateral foot braces for the treatment of clubfoot 3. A shoulder brace for the treatment of shoulder dystocia 4. A Pavlik harness for the treatment of congenital hip dislocation

4 A Pavlik harness is a device that is used to treat congenital hip dislocation. It keeps the hips and knees flexed, the hips abducted, and the femoral head in the acetabulum. The Pavlik harness is worn continuously for 3 to 6 months. It promotes the development of muscle and cartilage, resulting in a stable hip.

The nurse develops a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? 1. Emergency cart 2. Tracheotomy set 3. Padded tongue blade 4. Suctioning equipment and oxygen

4 A seizure results from the excessive and unorganized neuronal discharges in the brain that activate associated motor and sensory organs. A type of generalized seizure is a tonic-clonic seizure. This type of seizure causes rigidity of all body muscles, followed by intense jerking movements. Because increased oral secretions and apnea can occur during and after the seizure, oxygen and suctioning equipment are placed at the bedside. A tracheotomy is not performed during a seizure. No object, including a padded tongue blade, is placed into the child's mouth during a seizure. An emergency cart would not be left at the bedside, but would be available in the treatment room or nearby on the nursing unit.

The nurse is performing an assessment of a 7-year-old child who is suspected of having episodes of absence seizures. Which assessment question to the mother will assist in providing information that will identify the symptoms associated with this type of seizure? 1. "Does twitching occur in the face and neck?" 2. "Does the muscle twitching occur on one side of the body?" 3. "Does the muscle twitching occur on both sides of the body?" 4. "Does the child have a blank expression during these episodes?"

4 Absence seizures are brief episodes of altered awareness or momentary loss of consciousness. No muscle activity occurs except eyelid fluttering or twitching. The child has a blank facial expression. These seizures last only 5 to 10 seconds, but they may occur one after another several times a day. Simple partial seizures consist of twitching of an extremity, face, or neck, or the sensation of twitching or numbness in an extremity or the face or neck. Myoclonic seizures are brief, random contractions of a muscle group that can occur on one or both sides of the body.

The nurse caring for a child with suspected absence seizures is collecting data from the parents on how to manage the disorder. Which statement, if made by the parents, indicates the presence of signs congruent with this disorder? 1. "My child does well with group activities." 2. "My child leads the other children during group play." 3. "My child is doing really well in school and has high grades." 4. "My child's teacher mentioned that he seems to daydream a lot."

4 Absence seizures are very brief episodes of altered awareness. There is no muscle activity except eyelid fluttering or twitching. The child has a blank facial expression. These seizures last only 5 to 10 seconds but may occur one after another several times a day. The child experiencing absence seizures may appear to be daydreaming. If the child is participating in group activities, they sometimes need help catching up with the group, especially if a seizure occurs. Decreasing grades is a sign of absence seizures, as well as lowered intellectual processes.

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic. 2. Release the skin traction. 3. Apply ice to the extremity. 4. Notify the health care provider (HCP).

4 An absent pulse to an extremity of the affected limb after a bone fracture could mean that the child is developing or experiencing compartment syndrome. This is an emergency situation, and the HCP should be notified immediately. Administering analgesics would not improve circulation. The skin traction should not be released without an HCP's prescription. Applying ice to an extremity with absent perfusion is incorrect. Ice may be prescribed when perfusion is adequate to decrease swelling.

The nurse caring for a child who has sustained a head injury in an automobile crash is monitoring the child for signs of increased intracranial pressure (ICP). For which early sign of increased ICP should the nurse monitor? 1. Increased systolic blood pressure 2. Abnormal posturing of extremities 3. Significant widening pulse pressure 4. Changes in level of consciousness

4 An altered level of consciousness is an early sign of increased intracranial pressure (ICP). Late signs of increased ICP include tachycardia leading to bradycardia, apnea, systolic hypertension, widening pulse pressure, and posturing.

The nurse caring for an infant with a diagnosis of hydrocephalus should monitor the infant for which sign of increased intracranial pressure? 1. Proteinuria 2. Bradycardia 3. A drop in blood pressure 4. A bulging anterior fontanel

4 An elevated or bulging anterior fontanel indicates an increase in cerebrospinal fluid collection in the cerebral ventricle. Proteinuria, bradycardia, and a drop in blood pressure are not specific signs of increased intracranial pressure (ICP). Changes in the level of consciousness and a widened pulse pressure are additional signs of increased ICP.

The nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which assessment finding should the nurse expect to note documented in the infant's record regarding this condition? 1. Full range of motion in the affected hip 2. An apparent short femur on the unaffected side 3. Asymmetrical adduction of the affected hip when placed supine, with the knees and hips flexed 4. Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

4 Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table is noted in hip dysplasia. Asymmetrical abduction of the affected hip when an infant is placed supine with the knees and hips flexed would also be an assessment finding in hip dysplasia in infants beyond the newborn period. An apparent short femur on the affected side is noted, as well as limited range of motion.

The nurse is providing home care instructions to the mother of a child who is recovering from Reye's syndrome. Which instruction should the nurse provide to the mother? 1. Increase stimuli in the home environment. 2. Avoid daytime naps so that the child will sleep at night. 3. Give the child frequent small meals, if vomiting occurs. 4. Check the skin and eyes every day for a yellow discoloration.

4 Checking for jaundice will assist in identifying the presence of liver complications, which are characteristic of Reye's syndrome. Decreasing stimuli and providing rest decrease stress on the brain tissue. If vomiting occurs in Reye's syndrome, it is caused by cerebral edema and is a sign of intracranial pressure.

The nurse is caring for a child diagnosed with Down syndrome. Which explanation of this syndrome should the nurse provide the parents? 1. Subaverage intellectual functioning with a congenial nature 2. Above-average intellectual functioning with deficits in adaptive behavior 3. Average intellectual functioning and the absence of deficits in adaptive behavior 4. Moderate to severe intellectual disability and linkage to an extra chromosome 21, group G

4 Down syndrome is a form of mental retardation and is a congenital condition that results in moderate to severe intellectual disability. Most cases are attributable to an extra chromosome (group G)—hence the name trisomy 21. The characteristics in the remaining options are incorrect characteristics of this syndrome.

The nurse is caring for an infant with spina bifida (myelomeningocele type) who had the sac on the back containing cerebrospinal fluid, the meninges, and the nerves (gibbus) surgically removed. The nursing plan of care for the postoperative period should include which action to maintain the infant's safety? 1. Covering the back dressing with a binder 2. Placing the infant in a head-down position 3. Strapping the infant in a baby seat sitting up 4. Elevating the head with the infant in the prone position

4 Elevating the head will decrease the chance that cerebrospinal fluid will accumulate in the cranial cavity. The infant needs to be prone or side-lying to decrease the pressure on the surgical site on the back. Binders and a baby seat should not be used because of the pressure they would exert on the surgical site.

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

4 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.

The nurse is implementing a teaching plan for a 4-month-old child who has been diagnosed with developmental dysplasia of the hip. The child will be placed in the Pavlik harness. Which statement by the family indicates that they understand the care of their child while placed in the Pavlik harness? 1. "I know that the harness must be worn continuously." 2. "I will bring my child back to the orthopedic office in a month or two so the straps can be checked." 3. "I realize that I will also need to put two diapers on my child so that the harness will stay dry and does not get soiled." 4. "I will watch for any redness or skin irritation where the straps are applied and call the health care provider for red areas."

4 If stabilization of the hip is required, a cast is initially applied. This is kept in place for 3 to 6 months until the hip is stabilized. After this is completed, and if further treatment is required, a Pavlik harness is the treatment of choice next. A Pavlik harness is a removable abduction brace. The brace must be checked every 1 to 2 weeks for adjustment of the straps. The use of double diapering is not recommended for developmental dysplasia of the hip (DDH) because of the possibility of hip extension. Because there are straps applied to the child's skin, it is important to check the skin of the child frequently.

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care? 1. Maintain enteric precautions. 2. Maintain neutropenic precautions. 3. No precautions are required as long as antibiotics have been started. 4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.

4 Meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. A major priority of nursing care for a child suspected to have meningitis is to administer the antibiotic as soon as it is prescribed. The child also is placed on respiratory isolation precautions for at least 24 hours while culture results are obtained and the antibiotic is having an effect. Enteric precautions and neutropenic precautions are not associated with the mode of transmission of meningitis. Enteric precautions are instituted when the mode of transmission is through the gastrointestinal tract. Neutropenic precautions are instituted when a child has a low neutrophil count.

A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and should include which intervention in the plan? 1. Assessing hearing loss 2. Monitoring urine output 3. Changing body position every 2 hours 4. Providing a quiet atmosphere with dimmed lighting

4 Reye's syndrome is an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver. In Reye's syndrome, supportive care is directed toward monitoring and managing cerebral edema. Decreasing stimuli in the environment by providing a quiet environment with dimmed lighting would decrease the stress on the cerebral tissue and neuron responses. Hearing loss and urine output are not affected. Changing the body position every 2 hours would not affect the cerebral edema directly. The child should be positioned with the head elevated to decrease the progression of the cerebral edema and promote drainage of cerebrospinal fluid.

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Place the child in a Sims' position. 4. Notify the health care provider (HCP).

4 Scoliosis is a three-dimensional spinal deformity that usually involves lateral curvature, spinal rotation resulting in rib asymmetry, and hypokyphosis of the thorax. A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome. This disorder is caused by mechanical changes in the position of the child's abdominal contents, resulting from lengthening of the child's body. The disorder results in a syndrome of emesis and abdominal distention similar to that which occurs with intestinal obstruction or paralytic ileus. Postoperative vomiting in children with body casts or children who have undergone spinal fusion warrants attention because of the possibility of superior mesenteric artery syndrome. Options 1, 2, and 3 are incorrect.

An adolescent is seen in the emergency department for a suspected sprain of the ankle. X-rays have been obtained, and a fracture has been ruled out. Which instruction should the nurse provide to the adolescent regarding home care for treatment of the sprain? 1. Elevate the extremity, and maintain strict bed rest for a period of 7 days. 2. Immobilize the extremity, and maintain the extremity in a dependent position. 3. Apply heat to the injured area every 4 hours for the first 48 hours, and then begin to apply ice. 4. Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 to 48 hours.

4 The injured area should be wrapped immediately to support the joint and control the swelling. Ice is applied to reduce the swelling and should be applied for not longer than 30 minutes every 4 to 6 hours for the first 24 to 48 hours. The joint should be immobilized and elevated, but strict bed rest for a period of 7 days is not required. A dependent position will cause swelling in the affected area.

The pediatric nurse educator provides a teaching session to the nursing staff regarding juvenile idiopathic arthritis (JIA). Which action by a nursing staff member in the care of a child with JIA indicates a need for further education? 1. Assesses for joint stiffness in the child 2. Encourages performance of isometric exercises 3. Administers nonsteroidal antiinflammatory medication 4. Emphasizes the importance of rising quickly in the mornings

4 The nursing plan of care for juvenile idiopathic arthritis (JIA) focuses on the status of affected joints. Isometric exercises and passive range of motion exercises will prevent contractures and deformities. Nonsteroidal antiinflammatory medications are used to treat joint stiffness and pain. The child may need more time than average to begin morning activities.

The nurse is assessing for Kernig's sign in a child with a suspected diagnosis of meningitis. Which action should the nurse perform for this test? 1. Tap the child's facial nerve and assess for spasm. 2. Compress the child's upper arm and assess for tetany. 3. Bend the child's head toward the knees and hips and assess for pain. 4. Raise the child's leg with the knee flexed and then extend the leg at the knee and assess for pain.

4 To test for Kernig's sign, the client's leg is raised with the knee flexed and then extended at the knee. If any resistance is noted or pain is felt, the result is a positive Kernig's sign. This is a common finding in meningitis. Chvostek's sign, seen in tetany, is a spasm of the facial muscles elicited by tapping the facial nerve in the region of the parotid gland. Trousseau's sign is a sign for tetany in which carpal spasm can be elicited by compressing the upper arm and causing ischemia to the nerves distally. Brudzinski's sign occurs when flexion of the head causes flexion of the hips and knees.

A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? 1. Ensure that all ropes are outside the pulleys. 2. Ensure that the weights are resting lightly on the floor. 3. Restrict diversional and play activities until the child is out of traction. 4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied.

4 When a child is in traction, the nurse would check the HCP's prescription to verify the prescribed amount of traction weight. The nurse would maintain the correct amount of weight as prescribed, ensure that the weights hang freely, check the ropes for fraying and ensure that they are on the pulleys appropriately, monitor the neurovascular status of the involved extremity, and monitor for signs and symptoms of immobilization. The nurse would provide therapeutic and diversional play activities for the child.

A pregnant client asks if there is any danger to the development of her fetus in the first few weeks of her pregnancy. How should the nurse respond? a) "During the first 3 to 4 weeks of pregnancy brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma." b) "As long as you were taking good care of your health before becoming pregnant, your fetus should be fine during the first few weeks of pregnancy." c) "The respiratory system matures during this time so good prenatal care during the first weeks of pregnancy is very important." d) "Bones begin to harden in the first 5 to 6 weeks of pregnancy so vitamin D consumption is particularly important."

A Brain and spinal cord development occur during the first 3 to 4 weeks of gestation. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal central nervous system (CNS) development. Good health before becoming pregnant is important but must continue into the pregnancy. Hardening of bones occurs during 13 to 16 weeks gestation, and the respiratory system begins maturing around 23 weeks' gestation.

In caring for a child with a seizure disorder, the highest priority goal is which of the following? a) The child will be free from injury during a seizure. b) The child will have an understanding of the disorder. c) The family will understand seizure precautions. d) The family caregivers anxiety will be reduced.

A Keeping the child free from injury is the highest priority goal. The other choices are important, but keeping the child safe is higher than the anxiety or knowledge deficit concerns. The physical always is a priority over the psychological.

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which of the following symptoms indicate that the shunt is infected? a) The child is not responding or eating well. b) The fontanels are bulging or tense. c) The child's pupil reaction time is rapid and uneven. d) The child has a high-pitched cry.

A Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract. Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure. A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction. Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure.

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? a) A private room near the nurses' station b) A two-bed room in the middle of the hall c) A room with a 12-month-old infant with a urinary tract infection d) A room with an 8-month-old infant with failure to thrive

A A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until that child has received I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for which of the following? a) Head trauma b) Positional plagiocephaly c) Congenital hydrocephalus d) Intracranial hemorrhaging

A A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the wellchild clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a) "I always keep phenobarbital with me in case of a fever." b) "The most likely time for a seizure is when the fever is rising." c) "I have ibuprofen available in case it's needed." d) "My child will likely outgrow these seizures by age 5."

A Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.

Which of the following is most correct regarding the nervous system of the child? a) As the child grows, the gross and fine motor skills increase. b) The child has underdeveloped gross motor skills and well-developed fine motor skills. c) The child's nervous system is fully developed at birth. d) The child has underdeveloped fine motor skills and well-developed gross motor skills.

A As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills.

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which of the following interventions would be most important for the nurse to perform? a) Assess the child's level of consciousness. b) Help the child cope with an altered appearance. c) Monitor core body temperature. d) Pull up the side rails on the bed

A Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure patient. The child's eyes will correct themselves when ICP is reduced.

Any individual taking phenobarbital for a seizure disorder should be taught a) never to discontinue the drug abruptly. b) never to go swimming. c) to avoid foods containing caffeine. d) to brush his or her teeth four times a day.

A Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "You look funny. Well, both of you do. I see two of you." b) "It will be nice when you will let me take a long nap. I am sleepy." c) "My stomach is upset. I feel like I might throw up." d) "I am glad that my headache is getting better."

A The caregiver should notify the health-care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling naueauted is not a reason to notify the provider.

In understanding the nervous system, the nurse recognizes that the central nervous system is made up of which of the following? a) The brain and spinal cord b) Fluid that flows through the brain c) Nerves throughout the upper body d) A protective cushion for nerve cells

A The central nervous system is made up of the brain and spinal cord. The peripheral nervous system is made up of the nerves throughout the body. A fluid known as cerebrospinal fluid (CSF) flows through the chambers of the brain and through the spinal cord, serving as a cushion and protective mechanism for nerve cells.

To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Cerebral edema b) Cardiogenic shock c) Renal failure d) Left-sided heart failure

A The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of I.V. therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.

The nurse is reinforcing teaching with the caregivers of a child who has had a head injury and is being discharged. Which of the following statements made by the caregiver indicate an accurate understanding of the follow-up care for their child? a) "Even if the flashlight bothers him, we will check his eyes." b) "If he vomits again, we will bring him back immediately." c) "We can give him Tylenol for a headache, but no aspirin." d) "If he falls asleep, we will wake him up every 15 minutes."A

A The child's pupils are checked for reaction to light every four hours for 48 hours. If the child falls asleep, he or she should be awakened every one to two hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The caregiver should observe the child for at least six hours for vomiting or a change in the child's level of consciousness. The caregiver should notify the health-care provider immediately if the child vomits more than three times, but if the child vomits once, returning to the care provider immediately is not needed.

A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention? -A 2-month-old infant who reaches for a rattle several times before connecting with it -A 10-month-old infant who is able to ambulate with assistance -A 2-year-old toddler who can walk up the steps one at a time -A 4-year-old preschool-age child who consistently walks on tip toes

A 4-year-old preschool-age child who consistently walks on tip toes At 4 years of age, a child should not consistently walk on tip toes. This is common manifestation of muscular dystrophy and requires intervention. At 2 months of age, an infant's movements are uncoordinated and may take several attempts to touch objects the infant reaches for. Infants begin to walk between 9 and 18 months of age, and may begin by walking while holding a caregiver's hands. At 2 years of age, a toddler is able to walk up the steps one step at a time.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation? -A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. -A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. -A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. -A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating.

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

When caring for a child who has a history of seizures, which of the following nursing interventions would be appropriate? (Select all that apply) a) The nurse has oxygen available to use during a seizure. b) The nurse positions the child on the side during a seizure. c) The nurse places a washcloth in the mouth to prevent injury during seizure. d) The nurse goes for help as soon as a seizure begins. e) The nurse pads the crib or side rails before a seizure. f) The nurse teaches the caregivers regarding seizure precautions.

A B E F Pad the crib sides and keep sharp or hard items out of the crib. Position the child to one side to prevent aspiration of saliva or vomitus. Have oxygen and suction equipment readily available for emergency use. Teach family caregivers seizure precautions so they can handle a seizure that occurs at home. Do not put anything in the child's mouth; doing so could cause injury to the child or to you. Stay with the patient

Choice Multiple question - Select all answer choices that apply. A nurse is providing information to the parents of a child diagnosed with absence seizures. Which of the following would the nurse expect to include when describing this type of seizure? Select all that apply. a) This type of seizure is usually short, lasting usually for no more than 30 seconds. b) The child will commonly report a strange odor or sensation before the seizure. c) You might see a blank facial expression after a sudden stoppage of speech. d) Your child will probably sleep deeply for ½ to 2 hours after the seizure. e) You might have mistaken this type of seizure for lack of attention. f) This type of seizure is more common in girls than it is in boys.

A C E F Absence seizures are more common in girls than boys and are characterized by a sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. This type of seizure lasts less than 30 seconds and may have been mistaken for inattentiveness because of the subtle changes. Absence seizures are not associated with a postictal state.

Choice Multiple question - Select all answer choices that apply. The nurse determines that a child is experiencing late signs of increased intracranial pressure based on assessment of which of the following? Select all that apply. a) Fixed dilated pupils b) Increased blood pressure c) Irregular respirations d) Sunset eyes e) Bradycardia

A E C Late signs of increased intracranial pressure include bradycardia, fixed and dilated pupils, and irregular respirations. Increased blood pressure and sunset eyes are early signs of increased intracranial pressure.

A 9-year-old girl who is suspected of having an infection of the central nervous system is undergoing a lumbar puncture to withdraw cerebrospinal fluid for analysis. The nurse knows that the needle will be introduced into the subarachnoid space at the level of which of the following vertebrae? a) L4 or L5 b) L1 or L2 c) T3 or T4 d) C1 or C2

A Lumbar puncture, the introduction of a needle into the subarachnoid space (under the arachnoid membrane) at the level of L4 or L5 to withdraw CSF for analysis, is used most frequently with children to diagnose hemorrhage or infection in the CNS or to diagnose an obstruction of CSF flow.

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the patient's ear. This would be documented as which of the following? a) Battle sign b) Rhinorrhea c) Otorrhea d) Raccoon eyes

A Two signs of basilar skull fracture include Battle sign (bruising or ecchymosis behind the ear) and "raccoon eyes" (blood leaking into the frontal sinuses causing an edematous and bruised periorbital area). Rhinorrhea is CSF leakage from the nose. Otorrhea is CSF leaking from the ear.

When teaching a group of parents about the skeletal development in children, what information is most helpful?

A young child's bones commonly bend instead of break with an injury. Explanation: A young child's bones are more flexible and more porous with a lower mineral count than adults. Thus, bones will often bend rather than break when an injury occurs. The growth plate is composed of the epiphysis and physis. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply.

The nurse is providing care to a child with a long-leg hip spica cast. Which of the following would be a priority nursing diagnosis? A) Risk for impaired skin integrity due to cast and location B) Deficient knowledge related to cast care C) Risk for delayed development related to immobility D) Self-care deficit related to immobility

A) Risk for impaired skin integrity due to cast and location

A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching? A) "We should give this drug before he eats anything." B) "We need to keep a close eye for possible infection." C) "The drug should not be stopped suddenly." D) "He might gain some weight with this drug."

A) "We should give this drug before he eats anything."

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A) Notifying the doctor immediately B) Applying ice C) Elevating the arm D) Giving additional pain medication as ordered

A) Notifying the doctor immediately

When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A) Skeletal traction B) Physical therapy C) Orthotics D) Occupational therapy

A) Skeletal traction

The nurse is caring for a child with a spinal cord injury and providing instruction to the parents on promoting skin integrity. Which response from the mother indicates a need for further teaching? A)"I need to monitor his skin at least twice a week." B)"I must monitor skin affected by his adaptive equipment." C)"He must change positions frequently." D)"We must avoid harsh cleaning products."

A)"I need to monitor his skin at least twice a week."

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A)"I will help you become comfortable in caring for your daughter." B)"You must learn how to care for your daughter at home." C)"You will need to learn to collaborate with all the caregivers." D)"There is a lot to learn, and you need a positive attitude."

A)"I will help you become comfortable in caring for your daughter."

For patients with JIA we should do ______________ ROM and use ______________ to increase end ROM.

Active; Splinting

A 6-year-old child with hydrocephalus had a ventriculoperitoneal (VP) shunt placed 6 weeks ago and now has experienced a seizure, vomiting, and loss of appetite. Which intervention will target the child's priority need?

Administer intravenous antibiotics as prescribed.

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?

Advise the child that this is to be expected. Explanation: Plaster becomes hot as it sets. Even with fiberglass casts, there will be a warm feeling inside the cast when it is drying. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, the nurse should notify the health care provider. Infection would not present in this way with a cast application. A cast should not be moistened. If it does become wet, the cast should be dried with a hair dryer. There are some newer types of casts which can get wet but the nurse should know this before applying any moisture.

When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all that apply.

African American ethnicity Obesity

Muscle weakness and soft tissue fibrosis in patients with AMC is likely due to_________________

Anterior horn cell degeneration

Maria is a 9-month-old whose babysitter brings her to the ER. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. How should the nurse respond to this situation?

Arrange for the parents to come in for an evaluation for possible physical abuse. Explanation: Any type of fracture can be the result of child abuse, but spiral femur fractures, rib fractures, and humerus fractures, particularly in the child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of abuse. The parents should be contacted first, and the family should undergo an evaluation for possible physical abuse since femoral fractures in nonambulating infants, particularly spiral fractures, are believed to be highly specific for inflicted injury. If physical abuse is not found, the infant should be evaluated for an underlying musculoskeletal disorder and not a seizure disorder.

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?

Assess the popliteal region carefully for skin breakdown. Explanation: The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care.

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?

Assuming the usual feeding position will be difficult. Explanation: Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2° F(39° C). The highest priority nursing intervention for this child would be which of the following? a) The nurse will encourage the child to do his or her own self-care. b) The nurse will institute safety precautions. c) The nurse will offer age appropriate activities. d) The nurse will provide family teaching related to the child's history.

B A child with an elevated temperature is at high risk for having seizures and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

Absence seizures are marked by which of the following clinical manifestations? a) Sudden, brief jerks of a muscle group b) Loss of motor activity accompanied by a blank stare c) Loss of muscle tone and loss of consciousness d) Brief, sudden onset of increased tone of the extensor muscle

B An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

The treatment for children with seizures disorders is most often which of the following? a) Restricted fat diet b) Use of anticonvulsant medications c) Strict exercise regimen d) Surgical intervention

B Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. A few children may be candidates for surgical intervention but, in most cases, surgery is not the treatment. Ketogenic diets (high in fat and low in carbohydrates and protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Exercise is not a treatment for seizure disorders.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Rock the child frequently b) Avoid making noise when in the child's room c) Have the child's 2-year-old brother stay in the room d) Keep the lights on brightly so that he can see his mother

B Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" What could the nurse say to begin educating the woman? a) "Don't worry; you're in good hands. We have it under control now." b) "Sometimes it's hard to tell what products may contain aspirin." c) "Do you think that maybe your child took aspirin on his own?" d) "Aspirin in combination with the virus will make the brain swell and the liver fail."

B Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. Don't state the obvious, but also don't minimize the situation. Encouraging the mother to ask for information and offering explanations in terms she will understand are important, but this response does not address the mother's assertion.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. Which of the following would the nurse identify as a possible trigger? a) Use of nonscented soap b) Drinking three cans of diet cola c) Swimming twice a week d) 11 p.m. bedtime; 6:30 a.m. wake-up

B Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2° F(39° C). The highest priority nursing intervention for this child would be which of the following? a) The nurse will encourage the child to do his or her own self-care. b) The nurse will institute safety precautions. c) The nurse will offer age appropriate activities. d) The nurse will provide family teaching related to the child's history

B A child with an elevated temperature is at high risk for having seizures and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction you would want to give her parents regarding this is a) watching television while taking the drug may cause seizures. b) their child will have to practice good tooth brushing. c) even small doses may cause noticeable dizziness. d) numbness of the fingers is common while taking this drug.

B A side effect of phenytoin sodium is hypertrophy of the gumline. Good tooth brushing helps prevent inflammation under the hypertrophied tissue.

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n) a) antihistamine. b) steroid. c) anticonvulsant. d) diuretic.

B A steroid may be prescribed to reduce inflammation and pressure on vital centers.

Absence seizures are marked by which of the following clinical manifestations? a) Brief, sudden onset of increased tone of the extensor muscle b) Loss of motor activity accompanied by a blank stare c) Sudden, brief jerks of a muscle group d) Loss of muscle tone and loss of consciousness

B An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which of the following interventions would be most important for the nurse to perform? a) Help the child cope with an altered appearance. b) Assess the child's level of consciousness. c) Monitor core body temperature. d) Pull up the side rails on the bed.

B Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure patient. The child's eyes will correct themselves when ICP is reduced.

The nurse is educating the family of a 7-year-old epilepsy patient about care and safety for this child. Which of the following comments will be most valuable in helping the parent and the child cope? a) "If he is out of bed, the helmet's on the head." b) "Use this information to teach family and friends." c) "You'll always need a monitor in his room." d) "Bike riding and swimming are just too dangerous."

B Families need and want information they can share with relatives, childcare providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The boy may be able to bike ride and swim with proper precautions.

The nurse is educating parents of a male infant with Chiari type II malformation. Which of the following statements about their child's condition is most accurate? a) "Lay him down after feeding." b) "Take your time feeding your baby." c) "You won't need to change diapers often." d) "You'll see a big difference after the surgery."

B One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms, rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be which of the following? a) The child's history indicates she has infantile seizures. b) The child is in status epilepticus. c) The child is having generalized seizures. d) The child may begin to have absence seizures every day.

B Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? a) Negative Kernig's sign b) Positive Kernig's sign c) Positive Homans' sign d) Negative Brudzinski's sign

B A positive Kernig's sign can indicate irritation of the meninges. A positive Brudzinski's sign also is indicative of the condition. A positive Homans' sign may indicate venous inflammation of the lower leg.

When assessing a neonate for seizures, which of the following would the nurse expect to find? Select all that apply. a) Tonic-clonic contractions b) Elevated blood pressure c) Ocular deviation d) Jitteriness e) Tachycardia

B C D E Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic-clonic contractions typically are more common in older children.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" What could the nurse say to begin educating the woman? a) "Aspirin in combination with the virus will make the brain swell and the liver fail." b) "Sometimes it's hard to tell what products may contain aspirin." c) "Do you think that maybe your child took aspirin on his own?" d) "Don't worry; you're in good hands. We have it under control now."

B Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. Don't state the obvious, but also don't minimize the situation. Encouraging the mother to ask for information and offering explanations in terms she will understand are important, but this response does not address the mother's assertion.

A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statement by the parents demonstrates understanding of the instructions? Select all answers that apply. A) "We need to adjust the straps so that they are snug but not too tight." B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." D) "We need to send the harness to the dry cleaners to have it cleaned." E) "We need to call the doctor if she is not able to actively kick her legs."

B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." E) "We need to call the doctor if she is not able to actively kick her legs."

The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which of the following findings would help confirm this diagnosis? A) Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C) A high-pitched "click" is heard with hip flexion or extension. D) The thigh and gluteal folds are symmetric.

B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers.

24. When assessing a child for slipped capital femoral epiphysis, which of the following would the nurse identify as a possible risk factor? Select all answers that apply. A) Age younger than 8 years B) African American ethnicity C) History of cystic fibrosis D) Excessive activity E) Obesity

B) African American ethnicity E) Obesity

The nurse is assessing an 11-year-old girl with scoliosis. Which of the following would the nurse expect to find? Select all answers that apply. A) Complaints of severe back pain B) Asymmetric shoulder elevation C) Even curve at the waistline D) Pronounced one-sided hump on bending over E) Diminished motor function F) Hyperactive reflexes

B) Asymmetric shoulder elevation D) Pronounced one-sided hump on bending over

14. Which of the following would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A) Positioning supine with a pillow under the buttocks B) Covering the sac with saline-soaked nonadhesive gauze C) Wrapping the infant snugly in a blanket D) Applying a diaper to prevent fecal soiling of the sac

B) Covering the sac with saline-soaked nonadhesive gauze

A 10-year-old girl is brought to the emergency department by her father after tripping over a rock while running in the yard. She tells the nurse, "I think I twisted my ankle." When assessing the child, which of the following would the nurse most likely assess? A) Bruising B) Edema C) Limited range of motion D) Absent pulse

B) Edema

15. The nurse is assessing a child with a possible fracture. Which of the following would the nurse identify as the most reliable indicator? A) Lack of spontaneous movement B) Point tenderness C) Bruising D) Inability to bear weight

B) Point tenderness

The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. Which of the following would the nurse use when documenting these observations? A) Spastic B) Athetoid C) Ataxic D) Mixed

B) Athetoid

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A) Myelinization is completed by 4 years of age. B) The process occurs in a head-to-toe fashion. C) The speed of nerve impulses slows as myelinization occurs. D) Nerve impulses become less specific in focus with myelinization.

B) The process occurs in a head-to-toe fashion.

The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A)Deep-breathing exercises B)Upright positioning C)Coughing D)Chest percussion

B)Upright positioning

The nurse is caring for a child with myotonic muscular dystrophy. The nurse accurately states that this form of muscular dystrophy is the most common neuromuscular disorder of childhood, and is universally fatal (usually by the teens or 20s) A. True B. False

B. False Duchenne Muscular Dystrophy is the most common neuromuscular disorder of childhood, and is universally fatal (usually by the teens or 20s). The incidence of Duchenne muscular dystrophy is about 1 in 3,600 live male births. The hips, thighs, pelvis, and shoulders are affected initially; as the disease progresses, all voluntary muscles as well as cardiac and respiratory muscles are affected

Osteomyelitis

Bacterial infection in the bone and tissue around the bone

Treatment for scoliosis

Based on age and curvature Bracing: NOT curative, help prevent worsening

Two most common medical management tools for OI

Biphosphonates surgery to correct bone bowing and scoliosis

What can cause Perinatal CMT development?

Birth trauma from breech birth or assisted delivery.

Pathophysiology of Legg- Calve- Perthes

Blood does not go to the head of the femur and sometimes the acetabulum 4-8 years is most common Unknown why

External fixation devices for fractures- what is it? what is a complication?

Bone screwed into external Osteomyelitis is a complication

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client?

Bracing Explanation: For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which of the following signs or symptoms was observed? a) Pupil of one eye dilated and reactive b) Vertical nystagmus c) Dramatic increase in head circumference d) Posterior fontanel is closed

C A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age.

The nurse is caring for a child who had a seizure, fell to the ground, and hit and injured his face, head, and shoulders. This information indicates the child likely had which of the following types of seizures? a) Absence b) Myoclonic c) Atonic d) Infantile

C Atonic or akinetic seizures cause a sudden momentary loss of consciousness, muscle tone, and postural control and can cause the child to fall. They can result in serious facial, head, or shoulder injuries. In absence seizures the child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes.

In caring for the child with meningitis, the nurse recognizes that which of the following nursing diagnoses would be the most important to include in this child's plan of care? a) Delayed growth and development related to physical restrictions b) Risk for acute pain related to surgical procedure c) Risk for injury related to seizure activity d) Ineffective airway clearance related to history of seizures

C Keeping the child free of injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and the history of seizures does not impact the airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

A 1-year-old has just undergone surgery to correct craniosynostosis. Which of the following comments is the best psychosocial intervention for the parents? a) "This only happens in 1 out of 2,000 births." b) "I'll be watching hemoglobin and hematocrit closely." c) "The surgery was successful. Do you have any questions?" d) "I told you yesterday there would be facial swelling."

C Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? a) "A drop in the plasma drug level will lead to a toxic state." b) "The capacity to metabolize the drug becomes overwhelmed over time." c) "Small increments in dosage lead to sharp increases in plasma drug levels." d) "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."

C Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which of the following signs or symptoms was observed? a) Posterior fontanel is closed b) Vertical nystagmus c) Dramatic increase in head circumference d) Pupil of one eye dilated and reactive

C A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a) Occurrence of urine and fecal contamination b) Degree and extent of nuchal rigidity c) Signs of increased intracranial pressure (ICP) d) Onset and character of fever

C Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which of the following interventions should the nurse take initially? a) Educate the family about preventing bacterial meningitis. b) Encourage the mother to hold and comfort the infant. c) Institute droplet precautions in addition to standard precautions. d) Palpate the child's fontanels.

C Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later on once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.

The nurse is caring for a child admitted with complex partial seizures. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child was dizzy and had decreased coordination. b) The child had jerking movements and then the extremities stiffened. c) The child was rubbing the hands and smacking the lips. d) The child had shaking movements on one side of the body.

C Complex partial seizures, also called psychomotor seizures, change or alter consciousness. They cause memory loss and staring and nonpurposeful movements, such as hand rubbing, lip smacking, arm dropping, and swallowing. In the tonic phase of tonic-clonic seizures, the child's muscles contract, the child may fall, and the child's extremities may stiffen. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination. Simple partial motor seizures cause a localized motor activity such as shaking of an arm, leg, or other part of the body

The nurse is caring for a near-term pregnant woman who has not taken prenatal vitamins or folic acid supplements. Which congenital defect is most likely to occur based on the mother's prenatal history? a) Neonatal conjunctivitis b) Incomplete myelinization c) A neural tube defect d) Facial deformities

C Folic acid supplementation has been found to reduce the incidence of neural tube defects by 50%. The fact that the mother has not used folic acid supplements puts her baby at risk for spina bifida occulta, one type of neural tube defect. Neonatal conjunctivitis can occur in any newborn during birth and is caused by virus, bacteria, or chemicals. Facial deformities are typical of babies of alcoholic mothers. Incomplete myelinization is present in all newborns.

An 8-year-old girl is diagnosed as having tonic-clonic seizures. You would want to teach her parents that a) their daughter should be kept quiet late in the day when she is most likely to have a seizure. b) if their daughter shows symptoms of beginning a seizure, immediately give her medication. c) their daughter should maintain an active lifestyle. d) their daughter should carry a padded tongue blade with her at all times.

C It is important for children with seizures to maintain as near normal a lifestyle as possible to maintain self-esteem and achievement. Most seizure medications must create a therapeutic level before they are effective.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Sitting up, with the back straight b) Lying prone, with the feet higher than the head c) Lying on one side, with the back curved d) Lying prone, with the neck flexed

C Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Have the child's 2-year-old brother stay in the room b) Keep the lights on brightly so that he can see his mother c) Avoid making noise when in the child's room d) Rock the child frequently

C Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) The patient is bradycardiac. b) Cyanosis occurs at the onset of the seizure. c) Convulsive activity occurs. d) The EEG is normal.

C During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A) "I know it is boring, but you must remain immobile for 2 more weeks." B) "If there are no complications, you only have 2 more weeks here." C) "Let's come up with things to do like books, movies, games, and friends to visit." D) "If you resist your treatment, your condition will only get worse."

C) "Let's come up with things to do like books, movies, games, and friends to visit."

A nurse is preparing a program for a group of parents about injury prevention. Which of the following would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization

C) Increased mobility of the spine

An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. Which of the following would the nurse include when teaching the child about the cast? A) The cast will take a day or two to dry completely. B) The edges will be covered with a soft material to prevent irritation. C) The child initially may experience a very warm feeling inside the cast. D) The child will need to keep his arm down at his side for 48 hours.

C) The child initially may experience a very warm feeling inside the cast.

The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which of the following responses from his mother indicates a need for further teaching? A) "He needs to get a medical alert identification." B) "I will need to discuss this with his caregivers." C) "A product's label indicates whether it is latex-free." D) "He must avoid all contact with latex."

C) "A product's label indicates whether it is latex-free."

The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A) "If you wear your brace properly, you may not need surgery." B) "The good news is that you have very minimal curvature of your spine." C) "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." D) "Let's talk to the doctor about your treatment options."

C) "Let's talk to another boy with scoliosis, who is winning trophies for his swim team."

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?

CORRECT: "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." INCORRECT: "It is important to correct spinal curvature before it gets too bad, causing you problems." It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply.

Calcium and vitamin D play important roles in bone growth and bone breakdown. Calcitonin plays a role in remodeling of bone. Periosteum is the outer covering of the bone.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? -Tendons -Ligaments -Joints -Cartilage

Cartilage During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

Color Sensation Pulse Capillary refill Explanation: Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Assisting With Cast Application, p. 755.

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

Color Sensation Pulse Capillary refill Explanation: A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

Color Sensation Pulse Capillary refill

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

Color, sensation, pulse, and capillary refill

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete Explanation: If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete Explanation: If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

Complications associated with bleeding most often involve joints and muscles. Adjunct measures to control bleeding include:

Compression

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

Cover the sac with a saline-moistened dressing Explanation: Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided.

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

Creatine kinase Explanation: Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? -Bilirubin -Creatine kinase -Serum potassium -Sodium

Creatine kinase Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

The nurse is collecting data from a child who may have a seizure disorder. Which of the following is a description of an absence seizure? a) Sudden, momentary loss of muscle tone, with a brief loss of consciousness b) Brief, sudden contracture of a muscle or muscle group c) Muscle tone maintained and child frozen in position d) Minimal or no alteration in muscle tone, with a brief loss of consciousness

D A child with an elevated temperature is at high risk for having seizures and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

Which of the following is most correct regarding the nervous system of the child? a) The child has underdeveloped fine motor skills and well-developed gross motor skills. b) The child's nervous system is fully developed at birth. c) The child has underdeveloped gross motor skills and well-developed fine motor skills. d) As the child grows, the gross and fine motor skills increase.

D As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills

The treatment for children with seizures disorders is most often which of the following? a) Strict exercise regimen b) Restricted fat diet c) Surgical intervention d) Use of anticonvulsant medications

D Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. A few children may be candidates for surgical intervention but, in most cases, surgery is not the treatment. Ketogenic diets (high in fat and low in carbohydrates and protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Exercise is not a treatment for seizure disorders.

The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is: a) maintaining effective cerebral perfusion. b) encouraging development of motor skills. c) establishing seizure precautions for the child. d) ensuring the parents know how to properly give antibiotics.

D ensuring the parents know how to properly give antibiotics. Explanation: Educating parents how to properly give the antibiotics would be the priority intervention because the child's shunt has become infected. Maintaining cerebral perfusion is important for a child with hydrocephalus, but the priority intervention for the parents at this time is in regards to the infection. Establishing seizure precautions is an intervention for a child with a seizure disorder. Encouraging development of motor skills would be appropriate for a microcephalic child.

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? a) Take vital signs every 4 hours b) Monitor temperature every 4 hours c) Encourage the parents to hold the child d) Decrease environmental stimulation

D A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.

The nurse is collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "He kept smacking his lips and rubbing his hands." b) "He usually is very coordinated, but he couldn't even walk without falling." c) "His arms had jerking movements in his legs and face." d) "He was just staring into space and was totally unaware."

D Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? A) Recommend the bed's side rails be raised throughout the day and night. B) Suggest a caregiver be present continuously to prevent falls from bed. C) Encourage a loose restraint to be used when he is in bed. D) Recommend raising the bed's side rails when a caregiver is not present.

D) Recommend raising the bed's side rails when a caregiver is not present.

DO NOT DO with Slipped Capital Femoral Epiphysis?

DO NOT ASSESS ROM

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?

Deficient knowledge related to diagnosis and condition Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for health care professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.

Three major impairments of OI

Diffuse osteoperosis with recurring fx Lax joints Weak Muscles

The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.

Document any signs of pain, Check radial pulse in the both arms, and Monitor the color of the nail beds in the right hand.

The nurse is caring for a child who fractured his arm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.

Document any signs of pain. Check radial pulse in the both arms. Monitor the color of the nail beds in the right hand.

The nurse is caring for a child who fractured his arm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.

Document any signs of pain. Check radial pulse in the both arms. Monitor the color of the nail beds in the right hand. Explanation: Monitoring for signs of pain, decreased circulation, or change or variation in pulses in the extremity is important for the child in a cast. Pain can indicate serious complications, such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary. Checking posterior pulses would be appropriate when a lower extremity is casted.

Osteomyelitis: Nursing Interventions

Draw labs Hang antibiotics as ordered STAT Prep for surgery PRN Prep for x-rays/MRI/CT scans/bone scans

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy Explanation: By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions? -Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns. -Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. -Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. -Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C.

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area?

Epiphysis Explanation: Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis.

Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step.

False Explanation: If a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step, the head of the radius may escape the ligament surrounding it and become dislocated (nursemaid's elbow). Fracture of the femur is rare and is typically caused by an automobile accident, a fall from a considerable height, or child maltreatment.

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion?

Febrile seizures are benign in nature.

The caregivers of an 8-year-old child diagnosed with muscular dystrophy are discussing appropriate activities for their child. The nurse might suggest to these caregivers that they take which action in regard to their child's activities?

Find a Little League team that encourages participation of kids at all disability levels. Explanation: The child must be encouraged to be as active as possible to delay muscle atrophy and contractures. To help keep the child active, physiotherapy, diet to avoid obesity, and parental encouragement are important. The nurse should advise the family to keep the child's life as normal as possible.

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? -Folic acid to 0.4 mg/day -Folic acid above 0.4 mg/day -Ascorbic acid to 0.4 mg/day -Ascorbic acid to 4 mg/day

Folic acid above 0.4 mg/day The American Academy of Pediatrics recommends that a woman who has had a child with a neural tube defect increase her intake of folic acid to above 0.4 mg per day 1 month before becoming pregnant and continue this regimen through the first trimester. A woman who has no family history of neural tube defects should take 0.4 mg/day. All women of childbearing age should be encouraged to take a folic acid supplement because the majority of pregnancies in the United States are unplanned. Ascorbic acid hasn't been shown to have any effect on preventing neural tube defects.

Pavlik harness- how many times do you go for checkups?

Frequent clinic visits for adjustments (1-2 weeks)

Which of the following would the nurse be least likely to assess in a 6-year-old with septic arthritis of the hip?

Full range of motion of the hip Explanation: The child with septic arthritis of the hip typically has limited range of motion, maintains the joint in flexion, and does not allow the leg to be straightened. Moderate to severe pain is usually noted and there is a history of a previous infection, such as a respiratory infection or otitis media.

during the acute stage strengthening we will use ______________. In the chronic stage we will strengthen using _______________.

Gentle isometrics; Concentric and eccentric.

Gower's sign

Get themselves in a crawling position to stand up Cant just pop up!

The nurse is caring for a 4-year-old boy following surgical removal of a stage I neuroblastoma. Which intervention is most appropriate for this child?

Giving medications as ordered via the least invasive route.

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

The child diagnosed with muscular dystrophy uses a method of rising from the floor which is referred to as which of the following?

Gowers sign

The child diagnosed with muscular dystrophy uses a method of rising from the floor which is referred to as which of the following?

Gowers sign Explanation: The child cannot rise easily to an upright position from a sitting or squatting position on the floor; instead, he or she develops Gowers sign, a method where the child rises from the floor by "walking up" the lower extremities with the hands.

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? -Gowers sign -Appearance of smaller than normal calf muscles -Indications of hydrocephalus -Lordosis

Gowers sign A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakeness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

Infants 0-6 months old with only postural preference or muscle tightness less then 15 degrees cervical rotation.

Grade I: Early Mild CMT

Infants 0-6 months old with muscle tightness of 15-30 degrees cervical rotation.

Grade II: Early Moderate CMT

Infants 7-9 months with ponly postural preference or muscle tightness <15 degrees cervical rotation.

Grade IV: Late Mild CMT

Infants >7 months with an SCM nodule or after 12 months with muscle tightness >30 degrees of cervical rotation.

Grade VII: Late Extreme CMT.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick Explanation: Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this? -Greenstick -Spiral -Complete -Epiphyseal

Greenstick Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through, i.e. looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse. A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child?

Handling the cast with open palms when moving the arm.

Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing? -Head lag when pulled from supine to sitting -Bilaterally open rather than closed hands -Supporting own weight when placed in standing position -Equal withdrawal of lower extremities from pain

Head lag when pulled from supine to sitting Head lag in the child requires referral. By 4 to 5 months, the infant should be able to maintain the head in a neutral position. The other assessment findings are normal for age, indicating no need for referral.

Slipped Capital Femoral Epiphysis

Head of the femur separated from the rest of the femur at the growth plate

Through which mechanism is Duchenne muscular dystrophy acquired?

Heredity Explanation: Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

Through which mechanism is Duchenne muscular dystrophy acquired? -Virus -Heredity -Autoimmune factors -Environmental toxins

Heredity Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

Slipped Capital Femoral Epiphysis: Signs and Symptoms

Hip tenderness Painful ROM Limp Decreased hip flexion Pain increases with toes turned inward Position of comfort with external rotation of the affected leg Inability to bear weight Trendelenburg gait

an infant with AMC in froglike position will present with....

Hips: abducted and ER Knees: flexed clubfeet Shoulders: IR Elbows: extended Wrists: flexed and ulnar deviation

An infant with AMC in Jackknifed positon will present with.....

Hips: flexed Knees: extended clubfeet Shoulders: IR Elbows: flexed Wrist: flexed and ulnar deviation

The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high risk for having a child with a myelomeningocele? -History of asthma taking montelukast -History of a seizure disorder and taking phenobarbital -History of a previous abdominal surgery -History of scoliosis

History of a seizure disorder and taking phenobarbital Maternal consumption of certain drugs that antagonize folic acid, such as anticonvulsants (carbamazepine and phenobarbital), places her at high risk for having a child with neural tube defect such as a myelomeningocele. A history of taking montelukast, previous abdominal surgery, or a history of scoliosis does not pose a risk for having a child with a myelomeningocele.

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?

Holding feet/ankles in position for casting

Cerebral Palsy: Signs and Symptoms how do they walk?? (2 things)

Hyperreflexia Hypertonia Muscle spasticity Toe walking! Scissoring- legs going over one another when walking Neonatal reflexes Writhing movement Trouble speaking Uncoordinated movements

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? -Hypertonia in the upper extremities -Exhibits Gower sign -Unable to sit without support -Turns head toward sounds

Hypertonia in the upper extremities Cerebral palsy manifests as hyper- or hypotonia, and cognitive and developmental delays. Gower sign is a manifestation of muscular dystrophy not cerebral palsy. A 3-month-old infant should be developmentally able to turn toward a voice or sound but is too young to sit without support.

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 priority for this client?

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 priority for this client?

Impaired physical mobility related to a cast on the leg Explanation: Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

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? -Impaired physical mobility related to a cast on the leg -Deficient diversional activities related to a need for imposed activity restriction for 6 weeks -Situational low self-esteem related to the use of a walker -Pain related to chronic inflammation of the lower leg

Impaired physical mobility related to a cast on the leg Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

The nurse is caring for a child admitted with juvenile idiopathic arthritis (JIA). Which of the clinical manifestation would likely have been noted in the child with this diagnosis?

Inflammation of the joints

The nurse is caring for a child admitted with juvenile idiopathic arthritis (JIA). Which of the clinical manifestation would likely have been noted in the child with this diagnosis?

Inflammation of the joints Explanation: In the child with juvenile idiopathic arthritis, joint inflammation occurs first; if untreated, inflammation leads to irreversible changes in joint cartilage, ligaments, and menisci (the crescent-shaped fibrocartilage in the knee joints), eventually causing complete immobility.

Osteogenesis Imperfecta is an ____________ disorder and is caused by a _____________ defect.

Inherited; Collagen

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? -Inspection of the cystic sac on the child's back for leakage -Auscultation for bowel sounds -Listening for a shrill cry -Careful supine positioning

Inspection of the cystic sac on the child's back for leakage Leakage from the cystic area indicates loss of cerebrospinal fluid (CSF) and risk of infection of the central nervous system. Prompt intervention is needed, probably surgical. Listening for bowel sounds confirms intestinal peristalsis but is not necessary with each infant contact. A shrill cry may indicate increased intracranial pressure (ICP). This is important to note yet is not as pressing as being aware of leakage. The baby would be positioned prone, not supine, to protect the sac.

What can cause Prenatal CMT development?

Ischnic injury leading to unilateral weakness Malpositioning in utero Muscle Rupture

Which characteristic is true of cerebral palsy?

It appears at birth or during the first 2 years of life. Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are intellectually disabled, many have normal intelligence.

Teaching for cast?

Itching weeks later Do not stick anything in the cast Callus formation to hold bone together Check for cap refill Younger the kid, the quicker the healing

In understanding the function of the musculoskeletal system, the nurse recognizes that which of the following allows for movement of the body parts?

Joints

_____________ is an autoimmune, chronic inflammatory disease in children and adolescents effecting joints or connective tissue through the body.

Juvenile Idiopathic Arthritis

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?

Latex Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record? -Low serum calcium levels -Low alkaline phosphate levels -High serum phosphate levels -X-ray confirmation of adequate bone shape

Low serum calcium levels With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

Type IV OI

Mild to moderate deformity POst natal short stature Dentinogenesis imperfector can ambulate

In understanding the physiology of the musculoskeletal system, the nurse recognizes that which of the following are stored in the bones?

Minerals

In understanding the physiology of the musculoskeletal system, the nurse recognizes that which of the following are stored in the bones?

Minerals Explanation: Minerals such as calcium, phosphorus, magnesium, and fluoride are stored in the bones.

Life long issues of spina bifida (4) what allergy?

Mobility GU function Hydrocephalus Latex allergy

The nurse is caring for a 1-year-old hospitalized child who is in Bryant traction. Which nursing intervention would be the highest priority for this child?

Monitor for excessive crying and irritability.

Type I OI

Most common weight and length are normal at birth short stature Conductive hearing loss Bone fragility Joint hyperelacticity

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? -X-ray -Muscle biopsy -EEG -Assessment of ambulation

Muscle biopsy Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

If a baby is >2 months you measure lateral flexion using _________________

Muscle function scale

What medications may our JIA patients be taking?

NSAIDS disease modifying antirheumatic drugs (methotexate) Corticosteroids TNF inhibitor

Treatment for Legg- Calve- Perthes (3)

NSAIDS & rest Non-weight bearing Brace

Legg-Calve-Perthes

Necrosis of femur head Blood supply returns, but damage to bone is done

Signs and symptoms of spina bifida? (4)

Neural tube abnormalities DIMPLING NEAR BUTTOCKS ABNORMAL PATCHES OF HAIR HYDROCEPHALUS

Infants and children should have ___________________ muscle tone

Nomal

Casting for fractures how does it feel when forming? may take time to?

Non-displaced=non-painful Help keep calm/distracting Explain that it gets warm when forming May take time to dry Stabilizes so extremity cannot move Comfort measures Sedation Traction Pulling

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority?

Notifying the doctor immediately Explanation: The nurse should notify the doctor immediately because the girl's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation.

Which nursing intervention is the priority for the immobilized child in an acute care setting?

Offer age-appropriate toys and diversional activities. Explanation: The immobilized child should be offered age-appropriate toys and diversional activities to stimulate the mind. An immobilized child is not able to walk or be taken to the playroom; they are bedfast. Passive and active range of motion exercises should be performed at least 3 to 4 times a day, not just once daily

Signs and Symptoms Legg- Calve- Perthes

Often painless Limp- worsens with activity

Subtype of JIA that is the most common and will affect 4 or less joints asymmetrically.

Oliogarthritis

2 tests we use for DDH:

Ortlani & Barlow +x-ray and ultrasound

The school nurse is presenting a class to a group of students about common overuse disorders. Which disorder would the school nurse include?

Osgood-Schlatter disease Explanation: Overuse syndromes refer to a group of disorders that result from repeated force applied to normal tissue. An example is Osgood-Schlatter disease. Dislocated radial head, transient synovitis of the hip, and scoliosis are not considered overuse syndromes.

A nurse assesses a client who is complaining of calf pain, has a temperature of 101°F (38.3°C) and reports that his leg is very sore. X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and his erythrocyte sedimentation rate is elevated. What problem do these symptoms suggest?

Osteomyelitis Explanation: Osteomyelitis is a bone infection usually caused by Staphylococcus aureus, which causes leg pain and fever. Labwork reflects an elevated leukocyte count and an increased erythrocyte sedimentation rate. X-rays look normal until 5 to 10 days after onset of symptoms.

a baby that is >3 months will need AROM cervical rotation in _____________

PT lap

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom?

Paresthesia

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom?

Paresthesia Explanation: Paresthesia is diminished or absent sensation or numbness or tingling. Pallor is paleness of color and paralysis is the loss of function.

when treating OI patients we should avoid.....

Passive stretching force across the long bones positioning out of neutral

Treatment of DDH- what kind of harness? how long is it worn? what is not allowed?

Pavlik harness Continuously warn!!! Less than 6 months Keeps legs abducted to keep trochanter in the acetabulum No lotions/powder; monitor skin

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important?

Placing a "no abdominal palpation" sign above the child's bed

________________ is characterized by ipsilateral temporal and contralateral occipital bulging.

Plagiocephaly

Subtype of JIA the affects 5+ joints symmetrically and presents with rheumatoid nodules.

Polyarticular

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. -Prone -Right side lying -Left side lying -Semi-Fowler -Supine

Prone Right side lying Left side lying Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination?

Record and refer the finding for follow-up to the pediatrician Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. Magnetic resonance imaging (MRI) is often the diagnostic tool used. No hygienic concerns need prevail. These findings do not suggest development of precocious puberty or any other hormonal problem. The dimpling and hair tuft must be clearly explained to the parents.

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention?

Reposition the child's foot on a pressure-reducing device.

The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first?

Reposition the child's foot on a pressure-reducing device.

The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first?

Reposition the child's foot on a pressure-reducing device. Explanation: The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first.

The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority?

Risk for Injury

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

Risk for impaired skin integrity Explanation: The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? -Peripheral neurovascular dysfunction -Disorganized infant behavior -Risk for activity intolerance -Risk for impaired skin integrity

Risk for impaired skin integrity The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis?

Risk for impaired skin integrity due to cast and location

The school nurse is doing a presentation to a group of caregivers of children diagnosed with scoliosis. One of the caregivers asks the nurse about structural scoliosis. Which condition is involved with the diagnosis of structural scoliosis?

Rotated and malformed vertebrae

The school nurse is doing a presentation to a group of caregivers of children diagnosed with scoliosis. One of the caregivers asks the nurse about structural scoliosis. Which condition is involved with the diagnosis of structural scoliosis?

Rotated and malformed vertebrae Explanation: Structural scoliosis involves rotated and malformed vertebrae. Functional scoliosis can have several causes: poor posture, muscle spasm caused by trauma, or unequal length of legs.

Treatment of club foot? what kind of casting how many applications

Serial casting Constant reapplication due to rapid growth Every 2 weeks Surgery Physical Therapy

Type III OI

Severe, progressive deformity of long bones and spine very short stature excessive kyphoscoliosis bowing of long bones

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?

Spica cast

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?

Spica cast Explanation: The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? -Internal fixation device -External fixation device -Spica cast -Stockinette

Spica cast The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? -Breathing -Sitting -Standing -Swallowing

Standing Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a client would have difficulty standing before having difficulty sitting.

A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis?

Staphylococcus aureus Explanation: Staphylococcus aureus is the most common cause of osteomyelitis; therefore, the nurse would expect the antibiotics to cover that bacteria.

Treatment for Slipped Capital Femoral Epiphysis?

Surgery immediatley Immobilization of the joint

If Pavlik harness fails or >6 month?

Surgery+Spica casting

A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion?

Swelling and point tenderness

The nurse is working with an 6-year-old boy who recently was diagnosed with Legg-Calvé-Perthes disease. The mother of the boy tells the nurse that she understands that exercise is important to help preserve muscle and joint function and asks the nurse for recommendations on types of exercise that would be appropriate. What exercise should the nurse recommend?

Swimming

The nurse is working with an 6-year-old boy who recently was diagnosed with Legg-Calvé-Perthes disease. The mother of the boy tells the nurse that she understands that exercise is important to help preserve muscle and joint function and asks the nurse for recommendations on types of exercise that would be appropriate. What exercise should the nurse recommend?

Swimming Explanation: Swimming and tricycle or bicycle riding are excellent exercises because they provide smooth joint action. In contrast, to reduce joint destruction, activities that place excessive strain on joints, such as running, jumping, prolonged walking, and kicking, should be avoided.

Subtype of JIA that is the most painful, has symmetric joint involvment, and typically has a fever and rash >2 weeks prior to onet.

Systemic Arthritis

Three subtypes of JIA

Systemic arthritis Oligoarthritis Polyarticular

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.

The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours, New drainage is seeping out from under the cast, The boy's toes are light blue and very swollen.

An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast?

The child initially may experience a very warm feeling inside the cast. Explanation: A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge so they usually do not cause skin rubbing at the edges and don't require petaling. The child should be instructed to elevate his arm above the level of the heart for the first 48 hours.

The nurse is caring for a child with an external fixator in the right humerus. When evaluating the effectiveness of the fixator, which is an appropriate outcome? Select all answers that apply

The fixator lengthen bones. The fixator corrects angular or rotational defects, The fixator treats complex, unstable fractures. Explanation: An external fixator is used to treat complex, unstable fractures of both upper and lower extremities since it can hold the bone fragments much more rigidly than a cast. An external fixator may also be used to lengthen bones or correct angular or rotational defects. The purpose of serial manipulation is to restore joint alignment or to maintain functional mobility of a joint. The purpose of a splint or brace is to immobilize a body part or to provide support for weak limbs. Heat is generally used to cause vasodilation and relieve inflammation from muscle stiffness or spasm.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. Explanation: Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. What is the mostimportant nursing intervention for the nurse to include in working with this child and his caregivers? -The nurse should provide information when the child or caregiver requests it. -The nurse should be a contact person when the child is hospitalized. -The nurse should support the caregivers in restricting activity during the treatment. -The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

A 14-year-old male is brought to the ER by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. Which of the following best describes this type of fracture?

There are three or more fracture fragments. Explanation: In a comminuted fracture there are three or more fracture fragments. With a transverse fracture, a line crosses the shaft at a 90º angle. In an oblique fracture, there is a diagonal line across the bone. With a greenstick fracture, the bone is bent, but not broken.

When will Systemic Arthritis typically develop?

Throughout childhood

The nurse is caring for a child who has had a cast applied to treat a fracture of the fibula. To monitor the pulse of the child's involved extremity the nurse will monitor which of the following?

Tibial pulse

If kid with DDH does not get treated, what gait will they have?

Trendelenburg gait:Unequal hip height

Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment?

a young adolescent female Explanation: Mild scoliosis occurs between the genders equally, but idiopathic scoliosis requiring treatment occurs 10 times more often in females than males. Usually, treatment is initiated during early adolescence, around age 11 to 14 years.

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy is a condition that doesn't get worse." b) "Cerebral palsy means there will be many disabilities." c) "Cerebral palsy is a condition that runs in families." d) "Cerebral palsy occurs because of too much oxygen to the brain."

a)"Cerebral palsy is a condition that doesn't get worse." Explanation: By definition, cerebral palsy is a nonprogressive neuromuscular disorder. It can be mild or quite severe and is believed to be the result of a hypoxic event during pregnancy or the birth process and doesn't run in families.

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents? a) "Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection." b) "Your child dribbles urine because the bladder either is overactive, pushing urine out, or is not active enough, becoming overfilled and causing urine to leak." c) "While your child is young, urine leaking from the bladder will not be a problem because diapering is expected." d) "Your child cannot properly control holding urine or emptying the bladder. "

a)"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection." Explanation: Parents need to understand that lack of urinary control is not the greatest problem. The larger threat is of urinary tract infection, which can result in kidney damage. Only one of the responses by the nurse carries the infection message. Continence is important. This along with the infection risk can be managed by clean intermittent catheterization (CIC) or other procedures.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? a) Baclofen b) Botulin toxin c) Lorazepam d) Prednisone

a)Baclofen Explanation: Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy.

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should she use to best describe this condition? a) Degeneration of muscle fibers b) A demyelinating disease c) Lesions of the brain cortex d) Upper motor neuron lesions

a)Degeneration of muscle fibers Explanation: Degeneration of muscle fibers with progressive weakness and wasting best describes muscular dystrophy. Demyelination of myelin sheaths is a description of multiple sclerosis. Lesions within the brain cortex and the upper motor neurons suggest a neurologic, not a muscular, disease.

A multidisciplinary team meeting is being called by the nurse to identify methods to reduce spasticity in a school-age child with cerebral palsy. Input from which discipline will not be needed at this gathering? a) Dietary b) Surgery c) Pharmacy d) Orthotics

a)Dietary Explanation: No dietary interventions are known to reduce spasticity in the child with cerebral palsy. However, dietitians are essential in helping to meet the nutritional needs of children with cerebral palsy, who may have chewing and swallowing disorders. All the other disciplines have interventions that may be helpful to the child in reducing spasticity, thereby increasing function and/or mobility.

Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing? a) Head lag when pulled from supine to sitting b) Bilaterally open rather than closed hands c) Supporting own weight when placed in standing position d) Equal withdrawal of lower extremities from pain

a)Head lag when pulled from supine to sitting Explanation: Head lag in the child requires referral. By 4 to 5 months, the infant should be able to maintain the head in a neutral position. The other assessment findings are normal for age, indicating no need for referral.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? a) Latex b) Cat dander c) Peanuts d) Alcohol ge

a)Latex Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

The nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which action would be most appropriate to help reduce friction resulting from this paralysis? a) Place a folded diaper in between the legs. b) Place synthetic sheepskin under the infant's chest. c) Place a pad beneath the diaper area and change frequently. d) Place the child on a special care mattress.

a)Place a folded diaper in between the legs. Explanation: To protect the myelomeningocele, the child must always be placed in the prone position. Special attention to the infant's legs needs to occur when positioning them. Using a folded diaper in between the legs can help reduce pressure and friction from the legs rubbing together. Placing a pad beneath the diaper area helps to keep the child clean. Using a special care mattress helps to reduce pressure. Using sheepskin under the infant's chest reduces friction on the chest area but not the legs.

The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching? a. "Apply warm compresses to the ankle for the first 24 hours." b. "Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off." c. "Wrap the ankle in an Ace bandage for support." d. "Keep the leg elevated when sitting."

a. "Apply warm compresses to the ankle for the first 24 hours." Heat is not a treatment for soft tissue injuries. The principles of managing soft tissue injuries are rest, ice, compression, and elevation.

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb f. Lordosis

a. Positive Ortolani click b. Unequal gluteal folds A positive Ortolani test and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Unequal gluteal folds, negative Babinski sign, and Trendelenburg sign are signs that appear in older infants and children. Telescoping of the affected limb and lordosis are not clinical manifestations of developmental dysplasia of the hip.

Which nursing diagnosis would be a priority when preparing a plan of care for a child in a leg cast? a. Risk for altered peripheral tissue perfusion b. Risk for altered urine elimination c. Knowledge deficit d. Risk for infection

a. Risk for altered peripheral tissue perfusion

A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate, immediate action by the school nurse is to: a. apply ice. b. observe for edema and discoloration. c. encourage child to assume a position of comfort. d. obtain parental permission for administration of acetaminophen or aspirin.

a. apply ice. Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a position of comfort, and obtaining parental permission for administration of acetaminophen or aspirin are not immediate priorities. The application of ice can reduce the severity of the injury.

interventions to correct positional preference in patient with CMT

active movemtn and streanghtening opposite of preferred side

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?

adolescence

when examining posture of a CMT patient what would we find?

asymmetry of head position and lack of tolerance of opposite head position.

A young child with Duchenne muscular dystrophy is placed on both prednisone and calcium. Parents view these two medications as rather "common" and question their importance for the child. What explanation by the nurse will be most helpful to the parents? a) "Prednisone will stimulate weight gain and appetite. Calcium is needed to ensure adequate supplies for the development of permanent teeth." b) "Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing." c) "Prednisone will help protect his vulnerable respiratory tract from developing reactive airway disease. Calcium is needed to guard against muscle cramping." d) "Prednisone will protect against nerve inflammation in his hips and legs. Calcium is necessary should dietary intake be insufficient to meet growth needs."

b)"Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing." Explanation: Studies have shown that boys treated with prednisone have improved muscle strength and function. This is thought to be due to the protection that prednisone provides to muscle fibers. Calcium is needed to prevent osteoporosis, which is a side effect of prednisone that also occurs when weight bearing is limited. Respiratory infection is a risk in that those muscles weaken with progression of the disease, but reactive airway disease is not a particular risk. No peripheral nerve involvement is observed in Duchenne muscular dystrophy. Side effects of prednisone include weight gain and appetite stimulation, but these are not the reasons for the prednisone therapy. Calcium does augment dietary intake of the mineral and is important for tooth development, and it may play a role in prevention of muscle cramps, but these are not the main reasons for taking the calcium supplement.

A nurse is developing a teaching plan for the parents of a child with myasthenia gravis. Which of the following would the nurse include? a) Establishment of plans for rest periods b) How to administer anticholinergic drugs c) Signs and symptoms of infection d) Ways to increase the temperature of the child's environment e) Stress management techniques

b)How to administer anticholinergic drugs a)Establishment of plans for rest periods c)Signs and symptoms of infection e)Stress management techniques Explanation: The teaching plan for a child with myasthenia gravis should include instructions about administering anticholinergic agents, usually 30 to 45 minutes before meals, on time and exactly as ordered; measures to allow for rest periods for energy conservation; signs and symptoms of infection and the need to notify the physician because infection can precipitate a myasthenic crisis; stress management techniques because stress can precipitate a myasthenic crisis; and ways to maintain the child's environmental temperature because exposure to extreme temperatures can precipitate a myasthenic crisis.

A nurse is caring for an infant with spinal muscle atrophy (SMA) type 1. What will the nurse note when assessing the child? a) Enlarged head with low-set ears b) Narrow chest and protuberant abdomen c) Spastic upper and lower extremities d) Lusty cry with voracious appetite

b)Narrow chest and protuberant abdomen Explanation: SMA type 1 is also known as Werdnig-Hoffman disease and infantile SMA. It is the most severe of the three types. This disease is autosomal recessive and affects the ability of spinal nerves to communicate with muscle, eventually leading to atrophy. The infantile form progresses rapidly to early childhood death, usually from respiratory complications. The narrow chest and large abdomen are characteristic. Over time, the chest develops pectus excavatum, which restricts respiration further when combined with muscle weakness. Extremities would not be spastic but hypotonic. Head size and ear placement are normal in the infant with SMA type 1. Difficulties in sucking and swallowing are common, and a lusty cry is not found.

Which diagnostic measure is most accurate in detecting neural tube defects? a) Presence of high maternal levels of albumin after 12th week of gestation b) Significant level of alpha-fetoprotein present in amniotic fluid c) Amniocentesis for lecithin-sphingomyelin (L/S) ratio d) Flat plate of the lower abdomen after the 23rd week of gestation

b)Significant level of alpha-fetoprotein present in amniotic fluid Explanation: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

The nurse is caring for a 10-year-old girl with myasthenia gravis. The nurse suspects myasthenic crisis based on which of the following? a) Bradycardia b) Tachycardia c) Increased salivation d) Sweating

b)Tachycardia Explanation: Tachycardia is a sign of myasthenic crisis. Bradycardia is a sign of cholinergic crisis. Sweating is a sign of cholinergic crisis. Increased salivation is a sign of cholinergic crisis.

The nurse is caring for a 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? a. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." b. "I know it will be important for me to catheterize my child for the rest of her life." c. "I will make sure that I always use latex-free catheters." d. "I will wash the catheter with warm soapy water after each use."

b. "I know it will be important for me to catheterize my child for the rest of her life." Children with adequate upper extremity function and normal intelligence usually learn to catheterize themselves around age 6.

A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. How long will the nurse indicate that antibiotic therapy will probably last? a. 2 weeks b. 6 weeks c. 2 months d. 3 months

b. 6 weeks

The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

b. Decreased metabolic rate Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

A 13-year-old girl is diagnosed with functional scoliosis. What does the nurse explain as the cause of this spinal curvature defect? a. Juvenile rheumatoid arthritis b. Poor posture c. Heredity d. Myelomeningocele

b. Poor posture

What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4-year-old child? a. Has inward-turned knees while standing b. Walks on the toes c. Appears to have flat feet d. Swings his arms when walking

b. Walks on the toes

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate? a) "Have you seen any signs of improvement?" b) "This is the most common facial nerve palsy." c) "In most cases treatment is not necessary, only observation." d) "Was this from pressure resulting from forceps?"

c)"In most cases treatment is not necessary, only observation." Explanation: The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

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 which of the following? a) "Before inserting the catheter, we need to wipe her labia with normal saline from back to front." b) "We need to apply some petroleum jelly to her labia and the catheter before we attempt to insert it." c) "When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty." d) "We need to insert the catheter about 6 inches so that we make sure the catheter is in the bladder."

c)+"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty." Explanation: When the urine stops flowing, the parents should press on the lower abdomen or have the child lean forward to tense the abdominals to ensure that no more urine is in the bladder. For a female, the catheter is inserted about 2 to 3 inches. For a male, the catheter is inserted about 4 to 6 inches. Before the catheter is inserted, the labia is cleaned with a washcloth or disposable wipe from front to back. A generous amount of water-soluble lubricant, not petroleum jelly, is applied to the catheter. There is no need to apply the lubricant to the labia.

A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history? a. Age that the child learned to walk b. Parents' expectations of the child's development c. Functional status related to eating and mobility d. Birth history to identify cause of cerebral palsy

c. Functional status related to eating and mobility Each child with cerebral palsy has individual strengths. The nurse must know this child's functional status, as mobility and feeding may both be affected in the child with cerebral palsy.

The nurse is taking care of a 10-year-old child who has osteomyelitis. Which treatment plan is considered the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

c. Intravenous antibiotic therapy Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

What is the Gower's sign?

child with muscular disorder such as Duchenne Muscular Dystrophy uses hands to walk up their legs in order to stand

When working with an infant with AMC we are looking for ______________ rather then _______________-

compensation;recovery

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

d. Teaching the family the care and management of the corrective appliance The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight bearing, which helps reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset.

The nurse is assessing a child with spastic cerebral palsy. Which of the following would the nurse expect to assess? Select all that apply. a) Poor control of balance b) Hemiplegia c) Drooling d) Hypertonicity e) Exaggerated deep tendon reflexes f) Dysarthria

e)Exaggerated deep tendon reflexes b)Hemiplegia a)Poor control of balance d)Hypertonicity Explanation: Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement; hypertonicity of the affected extremities; and hemiplegia, quadriplegia, or diplegia, based on the limbs affected. Drooling and dysarthria are associated with athetoid cerebral palsy.

What methods can a nurse use to evaluate extremity function in an 18-month-old? Select all that apply. a) Elicit from the parent a description of fine and gross motor activities. b) Ask the child to squeeze the nurse's fingers simultaneously. c) Have the child push against resistance with both feet. d) Look for symmetric motion in the arms and legs. e) Observe the child in developmentally appropriate play.

e)Observe the child in developmentally appropriate play. d)Look for symmetric motion in the arms and legs. a)Elicit from the parent a description of fine and gross motor activities. Explanation: Observing play, eliciting parental descriptions, and looking for symmetry in motion are all developmentally appropriate and effective methods of assessing extremity function in this toddler. Expecting the child to cooperate in squeezing fingers or pushing feet against resistance is not realistic and is likely to cause reluctance to participate in later assessments.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be: -epiphysiolysis of the proximal humerus. -Osgood-Schlatter disease. -Sever disease. -epiphysiolysis of the distal radius.

epiphysiolysis of the proximal humerus. Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child:

feels increasing severe pain.

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child: -cannot plantarflex his foot. -feels increasing severe pain. -has a weak femoral pulse. -has blue-looking nail beds on the toes.

feels increasing severe pain. Any reports of pain in a child with a new cast or immobilized extremity need to be explored and monitored closely for the possibility of compartment syndrome.

cause of DDH? more common in

fetal positioning more common in girls

The nurse is caring for a child with osteomyelitis who has a leg wound. The highest priority nursing intervention for this child would be for the nurse to:

follow transmission-based precautions. Explanation: All of these interventions are done for the child with osteomyelitis who has a wound, but the highest priority would be to follow transmission-based precautions to prevent the spread of infection, especially if the wound is open and draining.

With AMC what joints are most affected in order from most to least?

foot Hip Wrist Knee Elbow Shoulder

Polyarticular arthritis typically affects _____________.

girls

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

halo traction.

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

halo traction. Explanation: When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction.

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor?

headache, vision changes, and vomiting

How do you get Duchenne? WHO GETS IT?

hereditary ONLY BOYS GET IT

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?

idiopathic scoliosis

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?

idiopathic scoliosis Explanation: Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.

Duchenne Muscular Dystrophy: When do signs and Symptoms and symptoms start to show?

initially growth/development are NORMAL signs and symptoms start to show around 3 years old!

common primary symptoms of JIA

joint swelling and pain morning stiffness muscle atrophy and weakness poor muscle endurance

common secondary symptoms of JIA

limited joint motion soft tissue contracture Fatigue reduced exercise tolerance growth abnormalities

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record?

low serum calcium levels

Interventions to assist in decreased cervical rotation of CMT patient.

manual stretching active cervical rotation to nonpreferred side passive positioning to stretch tight tissue.

When does scoliosis occur? in boys or girls?

more common in girls in pre-adolescent growth spurt

Spina bifida is a developmental birth defect in which the

neural tube fails to close as a fetus

Around 3-years-old, what is seen in Duchenne muscular dystrophy? what sign develops?

not walking as well, taking the easy way out of things Initially small functions, then becomes gross motor Gowers sign develops

when is cerebral palsy diagnosed?

often diagnosed in first year of life

name 4 common oral medications used to treat spasticity. Name 2 parenteral medications used.

oral - baclofen - dantrolene - sodium - diazepam parenteral - botulin toxins - baclofen

Cerebral Palsy

paralysis caused by damage to the area of the brain responsible for movement Non-progressive, permanent disability Affects movement and speech Affects voluntary and involuntary muscles

Botulism is a rare but serious ________________ illness

paralytic

4 main red flags when assessing potential CMT patient.

poor visual tracking abnormal muscle tone Extramuscular mass other abnormal findings inconsistent with CMT

Diagnosis of spina bifida (2)

prenatal MRI

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to: -promote healing. -prevent edema. -discourage infection. -ensure proper bone alignment.

prevent edema. Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.

when assessing a AMC pateints nervous system we will find normal _________ and altered _____________

sensation; DTR's (decreased)

Soft Tissue Injury

strains and sprains Sprains Twisting of a joint Damage to the tendons and ligaments Overuse ("Strain") Tearing or breakdown of tissue

a baby that is < 3 months will need AROM cervical rotation measured in ____________

supine

Treatment for Duchenne muscular dystrophy (3)

there is NO CURE Deep breathing exercises/chest PT Preserve ambulation, vital organ function, and independence for as long as possible Monitoring/treatment for depression

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unhooking a weight while providing pin care Explanation: Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse? -using latex free sterile gloves -mixing hydrogen peroxide with sterile water to make half-strength hydrogen peroxide -placing sterile cotton gauze squares around the ends of the pins -unhooking a weight while providing pin care

unhooking a weight while providing pin care Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.