PEDS EXAM #3

The process of diagnosis in a child suspected of having epilepsy includes

(1) determining whether epilepsy or seizures exist and not an alternative diagnosis; and (2) defining the underlying cause, if possible.

Deep vein thrombosis (DVT)

) involves the formation of a thrombus in a deep vein such as the iliac and femoral veins and can cause significant morbidity if it remains undetected and untreated

• Which statement is most accurate in describing tetanus? A. Acute infectious disease caused by an exotoxin produced by an anaerobic, gram-positive bacillus B. Inflammatory disease that causes extreme, localized muscle spasm C. Acute infection that causes meningeal inflammation, resulting in symptoms of generalized muscle spasm D. Disease affecting the salivary gland with resultant stiffness of the jaw

A. Acute infectious disease caused by an exotoxin produced by an anaerobic, gram-positive bacillus Tetanus is an acute, preventable disease caused by an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus, Clostridium tetani. Tetanus is caused by the effect of the exotoxins becoming fixed on nerve cells and is not an inflammatory disorder that causes muscle spasms. Tetanus is not an acute infection that leads to generalized muscle spasms. Tetanus is not a disease that affects the salivary glands, with resultant stiffness of the jaw.

The nurse is caring for a child with a Wilms' tumor. What is the most important nursing intervention preoperatively? A. Avoid abdominal palpation. B. Closely monitor the arterial blood gases. C. Prepare the child and family for long-term dialysis. D. Prepare the child and family for renal transplantation.

A. Avoid abdominal palpation. Wilms' tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. A sign should be placed over the bed indicating that no abdominal palpation should be conducted. Monitoring of arterial blood gases is not indicated preoperatively for this abdominal surgery. Long-term dialysis is not indicated, unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative irradiation and/or chemotherapy is used to minimize the tumor size. Renal transplantation is a last resort if both kidneys need to be removed and a compatible living donor exists.

The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.) A. Do not reuse needles B. Inject insulin when it is cold C. Flex or tense the muscle during injection D. Remove all bubbles from the syringe prior to injection E. Do not move the direction of the needle-syringe during insertion or withdrawal

A. Do not reuse needles D. Remove all bubbles from the syringe prior to injection E. Do not move the direction of the needle-syringe during insertion or withdrawal

What is the most important nursing consideration related to congenital hypothyroidism? A. Early identification of the disorder B. Facilitation of parent-infant attachment C. Initiation of referrals for mental retardation D. Help for parents in dealing with the child's future prospects

A. Early identification of the disorder Early diagnosis of congenital hypothyroidism is imperative. Because brain growth is complete by 2 to 3 years of age, the thyroid hormone deficiency must be detected and replacement therapy begun as soon as possible to prevent long-term or life-threatening complications. The promotion of parent-infant attachment is important with all infants. With appropriate intervention, the child may not have any developmental deficit. With appropriate intervention, the child may not have any developmental deficit.

The nurse is planning care for a child recently diagnosed with diabetes insipidus. Which nursing intervention should be planned? A. Encourage the child to wear medical identification. B. Discuss with the child and family ways to limit fluid intake. C. Teach the child and family how to do required urine testing. D. Reassure the child and family that diabetes insipidus is usually not a chronic or life-threatening illness.

A. Encourage the child to wear medical identification. Because of the unstable nature of the child's fluid and electrolyte balance, wearing a medical alert bracelet or carrying a medical identification card is an extremely important intervention. With diabetes insipidus, the child should have unrestricted access to fluids because the child will characteristically have polyuria due to a hyposecretion of antidiuretic hormone. No urine testing is required with diabetes insipidus. This disorder should not be confused with diabetes mellitus. Diabetes insipidus is both lifelong and life-threatening. Medication must be taken and the effects monitored closely.

An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What should the nurse's explanation include? A. Explain the disorder so that the parents can explain it to others. B. Help the parents understand that no one knows how this occurs. C. Suggest that the parents avoid family and friends until the gender is assigned. D. Encourage the parents not to worry while the tests are being done.

A. Explain the disorder so that the parents can explain it to others. Explaining the disorder to the parents so that they can explain it to others is the most therapeutic approach while the parents await the gender assignment of their child. Ambiguous genitalia are caused by decreased enzyme activity required for adrenocortical production of cortisol. Avoidance of family and friends is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling the parents not to worry without giving them specific alternative actions will not be effective.

In addition to presenting symptoms, what laboratory finding indicates nephrosis? A. Hypoalbuminemia B. Low specific gravity C. Decreased hematocrit D. Decreased hemoglobin

A. Hypoalbuminemia Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine in a child with nephrosis. The specific gravity is increased due to the large amount of protein in a child with nephrosis. The hematocrit would be elevated secondary to nephrosis. The hemoglobin would be elevated secondary to the hypovolemia in a child with nephrosis.

During the summer, many children are more physically active. What changes in the management of the child with type 1 diabetes mellitus should be expected as a result of more exercise? A. Increased food intake B. Decreased food intake C. Increased risk of hyperglycemia D. Decreased risk of insulin shock

A. Increased food intake Food intake should be increased in the summer when the child is more active. During races and other competitions, more food may be required than at other practice times to maintain a balance between glucose and exogenously administered insulin. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid administering too much insulin during a time of reduced need.

Which statement best describes Cushing syndrome? A. It is caused by excessive production of cortisol. B. The major clinical features are exophthalmia and pigmentary changes. C. Treatment involves replacement of cortisol. D. Diagnosis is suspected with findings of hypotension, hyperkalemia, and polyuria.

A. It is caused by excessive production of cortisol. Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome. The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia—not hypotension, hyperkalemia, or polyuria—are expected findings with Cushing syndrome.

The nurse is planning care for a school-age child with bacterial meningitis. Which nursing intervention should be included? A. Keep environmental stimuli to a minimum. B. Avoid giving pain medications that could dull the sensorium. C. Measure the head circumference to assess developing complications. D. Have the child move the head side to side at least every 2 hours.

A. Keep environmental stimuli to a minimum Children with meningitis are sensitive to noise, bright lights, and other external stimuli because of the irritation on the meningeal nerves. The nurse should keep the room as quiet as possible with a minimum of external stimuli, including lighting. After consultation with the practitioner, pain medications can be used on an as-needed basis. A school-age child will have closed sutures; therefore, the head circumference cannot change. The head circumference is not relevant to a child of this age. The child is placed in a side-lying position, with the head of the bed slightly elevated. The nurse should avoid measures such as lifting the child's head that increase discomfort and put tension on the neck.

A 3-year-old child is status post shunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? (Select all that apply.) A. Personality change B. Bulging anterior fontanel C. Vomiting D. Dizziness E. Fever

A. Personality change, C. Vomiting, E. Fever <div>Personality change can be a sign of shunt malformation related to increased intracranial pressure.<br>Vomiting can be a sign of shunt malformation related to increased intracranial pressure.<br>Fever can be a sign of shunt malformation and is a very serious complication.<br>The anterior fontanel closes between 12-18 months of age.<br>Dizziness is difficult to assess in a 3-year-old and is not necessarily a sign of shunt malformation.</div>

The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. What is the priority assessment for this child? A. Reactivity of pupils B. Doll's head maneuver C. Oculovestibular response D. Funduscopic examination to identify papilledema

A. Reactivity of pupils Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. The doll's head maneuver should not be performed if there is a cervical spine injury. Assessing for an oculovestibular response is a painful test that should not be done for a child who is having variable levels of consciousness. Papilledema does not develop for 24 to 48 hours in the course of unconsciousness.

The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. What is the most appropriate nursing action? A. Reassure the family that this condition is temporary. B. Reassure the family that flaccid paralysis is not problematic. C. Prepare the family for impending death. D. Prepare the family for the long-term consequences of paralysis

A. Reassure the family that this condition is temporary. During the recovery phase, paralysis may develop. It is a temporary, quickly reversible clinical manifestation. Flaccid paralysis is problematic if not reversible. Flaccidity can indicate impending death in a child with neurologic deficits but is not associated with adrenocortical insufficiency. Ascending flaccid paralysis is a reversible condition when associated with adrenocortical insufficiency. Paralysis is a temporary, quickly reversible clinical manifestation.

What is a clinical manifestation of increased intracranial pressure (ICP) in infants? A. Shrill, high-pitched cry B. Photophobia C. Pulsating anterior fontanel D. Vomiting and diarrhea

A. Shrill, high-pitched cry A shrill, high-pitched cry is a common clinical manifestation of increased ICP in infants. The characteristic cry occurs secondary to the pressure being placed on the meningeal nerves, causing pain. Photophobia is not indicative of increased ICP in infants. A pulsating anterior fontanel is normal in infants. The infant with increased ICP would be seen with a bulging anterior fontanel. Vomiting is one of the signs of increased ICP in children, but when present with diarrhea, it is more indicative of a gastrointestinal disturbance.

• A 6-year-old child born with a myelomeningocele has a neurogenic bladder. The parents have been performing clean intermittent catheterization. What should the nurse recommend? A. Teach the child to do self-catheterization. B. Teach the child appropriate bladder control. C. Continue having the parents do the catheterization. D. Encourage the family to consider urinary diversion

A. Teach the child to do self-catheterization. At 6 years of age, this child should have the dexterity to perform the intermittent catheterization. This will give the child more control and mastery over the disability. Bladder control cannot be taught in a child with a neurogenic bladder. School-age children, even as young as 6 years, should be able to begin self-catheterization. A urinary diversion is not necessary for a neurogenic bladder.

Which statement is the most descriptive of rhabdomyosarcoma? A. The most common sites are the head and neck. B. It is a common hereditary neoplasm of childhood. C. It is the most common bone tumor of childhood. D. It is a benign tumor and unusual in children

A. The most common sites are the head and neck. Although striated muscle fibers from which this tumor arises can be found anywhere in the body, the most common sites are the head and neck. Rhabdomyosarcoma is not known to be hereditary. Rhabdomyosarcoma arises from skeletal muscle tissue, not bone. Rhabdomyosarcoma is highly malignant.

A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse's knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply) A. Vomiting B. Jaundice C. Swelling of the face D. Persistent diaper rash E. Failure to gain weight

A. Vomiting D. Persistent diaper rash E. Failure to gain weight

In a non-potty-trained child with nephrotic syndrome, what is the best way to detect fluid retention? A. Weigh the child daily. B. Test the urine for hematuria. C. Measure the abdominal girth weekly. D. Count the number of wet diapers.

A. Weigh the child daily. A daily weight taken at the same time every day, with the child wearing the same clothing, is the most accurate way to determine fluid gains and losses. The presence or absence of blood in the urine will not help with the determination of fluid retention. The abdominal girth will reflect edema, but weekly measurements are too infrequent. The number of wet diapers reflects how often the diapers have been changed. The diapers should be weighed to reflect the fluid balance.

• A 15 year-old is admitted to the intensive care unit (ICU) with a spinal cord injury. The most appropriate nursing interventions for this adolescent are (select all that apply) A. monitoring neurologic status. B. administering corticosteroids. C. monitoring for respiratory complications. D. discussing long-term care issues with the family. E. monitoring and maintaining hemodynamic status.

A. monitoring neurologic status. B. administering corticosteroids. C. monitoring for respiratory complications. E. monitoring and maintaining hemodynamic status. <div>Close monitoring of sensory and motor function is important to prevent further deterioration of neurologic status as a result of spinal cord edema.<br> Corticosteroids are administered to minimize the inflammation associated with the injury.<br> Close monitoring of respiratory status for possible need of ventilator support. Remember A-B-Cs, airway, breathing, circulation.<br> Monitoring and maintaining hemodynamic status may require immediate attention related to increased intracranial pressure resulting in hypotension and bradycardia.<br> The discussion of long-term care issues with the family is not appropriate in the acute phase of spinal cord injury.</div>

The nurse is performing a neurologic assessment of a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest A. neurologic health B. severe brain damage C. decorticate posturing D. decerebrate posturing

A. neurologic health The Moro, tonic neck, and withdrawal reflexes are usually present in infants under 3 to 4 months of age. Therefore, the presence of these reflexes indicates neurologic health. The presence of the Moro, tonic neck, and withdrawal reflexes does not indicate severe brain damage. Decorticate posturing is indicative of severe dysfunction of the cerebral cortex and is not related to the presence of the Moro, tonic neck, or withdrawal reflexes. Decerebrate posturing is indicative of dysfunction at the level of the midbrain and is not related to the presence of the Moro, tonic neck, or withdrawal reflexes.

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and the pupils are unequal and sluggish. The most appropriate nursing action is to A. notify the practitioner immediately. B. assess for level of consciousness (LOC). C. observe closely for signs of increased intracranial pressure (ICP). D. administer pain medication and assess for response.

A. notify the practitioner immediately. The worsening of symptoms may indicate that the ICP is increasing. The practitioner should be notified immediately because this is considered a medical emergency. Assessing for the LOC should be done as part of the assessment. The nurse is noting signs of potentially increased ICP as described; therefore, this has already been completed. Pain medication should not be given, because it can often mask the signs of increasing ICP. The priority nursing intervention is to consult with the practitioner immediately.

Which urine test would be considered abnormal? A. pH: 4 B. Specific gravity: 1.020 C. Protein level: absent D. Glucose level: absent

A. pH: 4 The expected pH of urine is 4.8 to 7.8. A specific gravity of 1.020 is within the normal specific gravity range of 1.015 to 1.030. Protein should not be present in the urine. It would indicate an abnormality in glomerular filtration. Glucose should not be present in the urine. If present, it could indicate diabetes mellitus, glomerulonephritis, or a response to infusion of fluids with high glucose concentrations.

A breastfed newborn has just been diagnosed with galactosemia. The therapeutic management for this newborn is to A. stop breastfeeding. B. add amino acids to the breast milk. C. substitute a lactose-containing formula for breast milk. D. give the appropriate enzyme along with breast milk.

A. stop breastfeeding. All milk- and lactose-containing formulas, including breast milk, must be stopped during infancy. Soy protein is the formula of choice for newborns and infants with galactosemia. Breast milk should not be used in newborns and infants with galactosemia. The formula used for a newborn and infant with galactosemia cannot contain lactose. Breast milk should not be used in newborns and infants with galactosemia.

the basic mechanism of a seizure

Abnormal electrical discharges (1) may arise from central areas in the brain that affect consciousness; (2) may be restricted to one area of the cerebral cortex, producing manifestations characteristic of that particular anatomic focus; or (3) may begin in a localized area of the cortex and spread to other portions of the brain; if sufficiently extensive, this produces generalized seizure activity.

Lordosis

Accentuation of the lumbar spine; Caused by contractures of the hip; Caused by obesity

What is the most common cause of secondary hyperparathyroidism? A. Diabetes mellitus B. Chronic renal disease C. Congenital heart disease D. Growth hormone deficiency

B. Chronic renal disease Chronic renal disease is the most common cause of secondary hyperparathyroidism. The parathyroid gland plays an integral role in the maintenance of calcium in the body, as do the kidneys. Diabetes mellitus does not contribute to secondary hypoparathyroidism. Congenital heart disease does not contribute to secondary hypoparathyroidism. Growth hormone deficiency does not contribute to secondary hypoparathyroidism.

The nurse should recognize that when a child develops diabetic ketoacidosis (DKA), treatment will be instituted as described in which of the following statements? A. No treatment is required, because DKA is an expected outcome of type 1 diabetes mellitus B. Immediate treatment is required because DKA is a life-threatening situation C. DKA is best treated at home D. DKA is best treated at a practitioner's office or clinic

B. Immediate treatment is required because DKA is a life-threatening situation DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an intensive care unit for assessment, intravenous insulin administration, and fluid and electrolyte replacement. DKA is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. It is not an expected outcome of type 1 diabetes mellitus. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit. DKA is a medical emergency that requires hospitalization, usually in an intensive care unit.

• An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome). When explaining this disease process to the parents, what should the nurse consider? A. Paralysis is progressive, with little hope for recovery. B. Muscle function will gradually return, and recovery is possible in most children. C. Guillain-Barré syndrome results from an apparently toxic reaction to certain medications. D. Guillain-Barré syndrome is inherited as an autosomal recessive, sex-linked gene.

B. Muscle function will gradually return, and recovery is possible in most children. Most patients regain full muscle strength following recovery from Guillain-Barré syndrome. The return of function is in reverse order of onset. Onset occurs as ascending paralysis; recovery occurs as descending return of function. The paralysis is progressive in Guillain-Barré syndrome, but most children have full recovery. Supportive nursing care is essential. Guillain-Barré syndrome is an immune-mediated disease most often associated with viral infections. During the history, the parents should be asked about the child's having a cold or viral infection within the past 2 weeks. Guillain-Barré syndrome is an immune-mediated disease most often associated with viral infections

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

B. OI is an inherited disorder. OI is an autosomal dominant inherited disorder. OI is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. OI has a predictable course that is determined by the pathophysiologic processes, not the time of onset. Lightweight braces and splints can help support limbs and fractures.

What is characteristic of fractures in children? A. Fractures rarely occur at the growth plate site because it absorbs shock well. B. Rapidity of healing is inversely related to the child's age. C. Pliable bones of growing children are less porous than those of adults. D. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared with that of the adult.

B. Rapidity of healing is inversely related to the child's age Fractures heal in less time in children than in adults. As the child ages, the healing time increases. The cartilage epiphyseal plate is the weakest point of the long bone. Therefore, it is a frequent site of damage and fractures. The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs. Bone healing in children is rapid due to the thickened periosteum and generous blood supply.

• A 3-year-old has cerebral palsy (CP) and is hospitalized for orthopedic surgery. The child's mother states the child has difficulty swallowing and cannot hold a utensil to self-feed. The child is slightly underweight for height. What is the most appropriate nursing action related to feeding? A. Bottle-feed or tube-feed the child with a specialized formula until sufficient weight is gained. B. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. C. Place the child in a well-supported, semireclining position to make use of gravity flow. D. Place the child in a sitting position with the neck hyperextended to make use of gravity flow.

B. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. Because the jaw is compromised, more normal control can be achieved if the feeder provides stability. Manual jaw controls assist with head control, correction of neck and trunk hyperextension, and jaw stabilization. The child is too old to be bottle-fed. The neuromuscular compromise of the jaw interferes with the child's ability to eat. The child should be sitting up for meals to prevent aspiration. For swallowing, the neck should not be hyperextended.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a prosthetic device? A. As soon as possible after birth B. When the infant is developmentally ready to stand up C. At about age 12 to 15 months, when most children are walking D. At about 4 years, when the healthy limb is not growing so rapidly

B. When the infant is developmentally ready to stand up The optimum time for the child to be fitted with a prosthetic device is when he or she is developmentally ready to stand up. The prosthetic device will be integrated into the child's capabilities. Fitting the infant for a prosthesis as soon as possible after birth will not be useful, because the child is not ready to use the leg. Waiting until age 12 to 15 months to fit the child for a prosthesis may be too late. The fitting should be provided when the child is showing readiness to stand. Waiting until age 4 years to fit the child for a prosthesis may be too late. The fitting should be provided when the child is showing readiness to stand.

The postoperative care of a preschool child who has had a brain tumor removed should include A. recording of colorless drainage as normal on the nurse's notes. B. close supervision of the child while he or she is regaining consciousness. C. positioning the child on the right side in the Trendelenburg position. D. no administration of analgesics.

B. close supervision of the child while he or she is regaining consciousness The child needs to be observed closely, with careful and frequent assessment of the vital signs and monitoring for signs of increasing intracranial pressure. Any changes should be reported immediately to the practitioner. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported to the practitioner immediately. The child should not be positioned in the Trendelenburg position postoperatively. Analgesics can be used for postoperative pain as needed.

• A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. A priority nursing intervention is to A. recommend allergy testing. B. provide a latex-free environment. C. use only powder-free latex gloves. D. limit the use of latex products as much as possible.

B. provide a latex-free environment. The most important nursing intervention is to provide a latex-free environment. From birth on, limitation of exposure to latex is essential in an attempt to minimize sensitization. Latex-free catheters for self-catheterization are available. Allergy testing may expose the child to the allergen and, therefore, is not recommended. The gloves contain latex and will contribute to sensitization. No latex products should be used with children who have latex allergies. Latex products should be avoided at all times.

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The most appropriate response by the nurse is A. "The pills work with an adult pancreas only." B. "The drugs affect fat and protein metabolism, not sugar." C. "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." D. "Perhaps when your child is older, the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

C. "Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." In type 1 diabetes, the beta cells have been destroyed. It is necessary to supply the insulin no longer produced by the beta cells. The oral medications have different modes of action that supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes and are primarily used in type 2 diabetes mellitus. Oral hypoglycemics can supplement insulin production by the pancreas, decrease insulin resistance, or affect the liver production of glucose. In type 1 diabetes, the beta cells have been destroyed. Without a pancreatic beta cell transplant, it is unlikely that insulin would be produced.

A 6-year-old child with acute renal failure (ARF) is being transferred out of the intensive care unit. Which children, considering their diagnoses, would be the most appropriate roommate for this child? A. 6-year-old child with pneumonia B. 4-year-old child with gastroenteritis C. 5-year-old child who has a fractured femur D. 7-year-old child who had surgery for a ruptured appendix

C. 5-year-old child who has a fractured femur The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin. A child with pneumonia has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF. A child with gastroenteritis has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF. A child who has had surgery for a ruptured appendix may have an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. What is the major priority of nursing care? A. Initiate isolation precautions as soon as the diagnosis is confirmed. B. Initiate isolation precautions as soon as the causative agent is identified. C. Administer antibiotic therapy as soon as it is ordered. D. Administer sedatives and analgesics on a preventive schedule to manage pain

C. Administer antibiotic therapy as soon as it is ordered. Initiation of antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to prevent death and to avoid resultant disabilities. Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued. Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued. Initiation of antibiotics is the priority nursing intervention. Pain should be managed on an as-needed basis.

What is an advantage to teach to the family about continuous cycling peritoneal dialysis (CCPD) or continuous ambulatory peritoneal dialysis (CAPD) for adolescents who require dialysis? A. Hospitalization is only required several nights per week. B. Dietary restrictions are no longer necessary. C. Adolescents can carry out procedures themselves. D. Insertion of a catheter does not require surgical placement.

C. Adolescents can carry out procedures themselves. This type of dialysis provides the most independence for adolescents with end-stage renal disease and their families. Adolescents can carry out the procedure themselves, and the procedure is usually performed at night, enabling the adolescent to live life more normally during the day. CCPD and CAPD can be done at home. Dietary restrictions are still required but are less strict when an adolescent is on CCPD or CAPD. The catheter is surgically implanted in the abdominal cavity for both CCPD and CAPD.

A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? (Select all that apply.) A. Lordosis B. Negative Babinski sign C. Asymmetric thigh and gluteal folds D. Positive Ortolani and Barlow tests E. Shortening of limb on affected side

C. Asymmetric thigh and gluteal folds D. Positive Ortolani and Barlow tests E. Shortening of limb on affected side <div>Asymmetric thigh and gluteal folds are clinical manifestation of DDH and seen from birth to two months.<br>Positive Ortolani and Barlow tests are clinical manifestations of DDH. Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation. Barlow test is the adducting to feel if the femoral head slips out of the socket postolaterally.<br>Shortening of limb on affected side is another clinical manifestation of DDH.<br>Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH.<br>A negative Babinski sign is not a clinical manifestation of DDH. It is a neurological reflex

• Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy (DMD)? A. DMD is inherited as an autosomal dominant disorder. B. DMD is characterized by weakness of the proximal muscles of both the pelvic and shoulder girdles. C. DMD is characterized by muscle weakness, usually beginning at about age 3 years. D. The onset of DMD occurs in later childhood and adolescence.

C. DMD is characterized by muscle weakness, usually beginning at about age 3 years. Usually, children with DMD reach the early developmental milestones, but the muscular weakness is usually observed in the third year of life. DMD is inherited as an X-linked recessive disorder. Weakness in a child with DMD is usually first noted in walking. Progressive muscle weakness in other muscle groups then follows. DMD usually develops in the third year of life.

What statement should the nurse include when discussing a child's precocious puberty with the parents? A. The child is not yet fertile. B. Sexual interest is usually advanced. C. Dress and activities should be appropriate to the chronologic age. D. The appearance of secondary sex characteristics does not proceed in the usual order.

C. Dress and activities should be appropriate to the chronologic age. Development of the secondary sex characteristics proceeds in the usual order. Functioning sperm or ova may be produced, making the child fertile. Heterosexual interest is usually appropriate to the chronologic age. Because of the child's early sexual maturation, both the family and child require extensive teaching. Included in this teaching is the information that the child should be engaged in activities according to his or her chronologic age.

The nurse is caring for a 2-year-old child who is unconscious but stable after a car accident. The child's parents are staying at the bedside most of the time. What is an appropriate nursing intervention? A. Suggest that the parents go home until the child is alert enough to know they are present. B. Use ointment on the lips but do not attempt to cleanse the teeth until swallowing returns. C. Encourage the parents to hold, talk to, and sing to the child as they usually would. D. Position the child with proper body alignment and the head of the bed lowered 15 degrees.

C. Encourage the parents to hold, talk to, and sing to the child as they usually would. The parents should be encouraged to interact with the child. Senses of hearing and tactile perception may be intact, and stimulation is important in the child's recovery. Suggesting that the parents go home until the child is awake is not recommended. The child may be able to hear that they are present, and this stimulation may assist in recovery. Oral care is essential in the unconscious child. Mouth care should be done at least twice daily to prevent oral infections. The head of the bed should be elevated, not lowered, in a child with neurologic involvement.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if playing soccer, playing baseball, and swimming are still possible. The nurse's response should be based on knowledge that A. Exercise is contraindicated in the type 1 diabetic child B. Soccer and baseball are too strenuous, but swimming is acceptable C. Exercise is not restricted unless indicated by other health conditions D. The level of activity depends on the type of insulin required

C. Exercise is not restricted unless indicated by other health conditions Exercise is encouraged for children with type 1 diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged, with insulin and food adjusted for the exercise. The child needs to be cautioned to monitor responses to the exercise. The level of activity does not depend on the type of insulin used. Long-acting and short-acting insulin may both be used to provide coverage for the training and sporting events.

What are considered major goals of the therapeutic management of juvenile rheumatoid arthritis (JRA)? A. Prevent joint discomfort; regain proper alignment. B. Prevent loss of joint function; achieve cure. C. Prevent physical deformity; preserve joint function. D. Prevent skin breakdown; relieve symptoms.

C. Prevent physical deformity; preserve joint function The goals of treatment for JRA include the prevention of physical deformity, the preservation of joint function, and the control of pain. Once the joint is damaged from the physiologic processes of JRA, it may not be possible to regain proper alignment. Children with JRA may be cured of the disease. Skin breakdown is usually not an issue in JRA.

• What most accurately describes bowel function in children born with a myelomeningocele? A. Incontinence cannot be prevented. B. Enemas and laxatives are contraindicated. C. Some degree of fecal continence can usually be achieved. D. A colostomy is usually required by the time the child reaches adolescence.

C. Some degree of fecal continence can usually be achieved. With diet modification and regular toilet habits (bowel training) to prevent constipation and impaction, some degree of fecal continence can be achieved. Although a lengthy process, continence can be achieved with modification of diet, use of stool softeners, and/or enemas. Enemas and stool softeners are part of the strategy to achieve continence. Laxatives should be used only as a last resort, although they may be used in some instances. A colostomy is not indicated for the child with myelomeningocele.

The parent of a child hospitalized with acute glomerulonephritis (AGN) asks the nurse why blood pressure readings are being taken so often. Based on the nurse's knowledge of AGN, the most appropriate response by the nurse is A. blood pressure fluctuations are a common side effect of antibiotic therapy. B. blood pressure fluctuations are a sign that the condition has become chronic. C. acute hypertension must be anticipated and identified. D. hypotension leading to sudden shock can develop at any time.

C. acute hypertension must be anticipated and identified. Vital signs, in particular the blood pressure, provide information about the severity of AGN and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover. Hypertension, not hypotension, is more likely with AGN.

The temperature of an unconscious adolescent is 105º F (40.5º C). The priority nursing intervention is to A. continue to monitor temperature. B. initiate a pain assessment. C. apply a hypothermia blanket. D. administer aspirin stat.

C. apply a hypothermia blanket. Brain damage can occur at temperatures as high as 105º F (40.5º C). It is extremely important to institute temperature-lowering interventions such as hypothermia blankets and tepid water baths immediately. The temperature needs to be monitored, but lowering the temperature is the priority. Pain assessments should be ongoing, but this is not the priority at this time. Lowering the body temperature is the priority. Aspirin should never be administered to a child, because of the risk of Reye syndrome. Antipyretics, such as acetaminophen or ibuprofen, usually are not effective with temperatures as high as 105º F (40. 5ºC).

A 3-year-old has just returned from surgery in a hip spica cast. The priority nursing intervention is to A. elevate the head of the bed. B. offer sips of water. C. check circulation, sensation, and motion of toes. D. turn the child to the right side, then the left side every 4 hours.

C. check circulation, sensation, and motion of toes. The chief concern is that the extremity may continue to swell. The circulation, sensation, and motion of the toes must be assessed to ensure that the cast does not become a tourniquet and cause complications. Elevating the head of the bed might help with comfort, but it is not a priority. The nurse must be observant to the risk of increased swelling in the extremities. Offering sips of water is acceptable once assessment of the extremities has been completed. The child's position should be changed every 2 hours. Positioning a child with a spica cast is important to prevent injury.

A 3-year-old child is scheduled for surgery to remove a Wilms' tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on knowledge that A. no additional treatments are usually necessary. B. chemotherapy is usually not necessary. C. chemotherapy with or without radiotherapy is indicated. D. kidney transplant will be indicated within the year.

C. chemotherapy with or without radiotherapy is indicated. The determination of chemotherapy and/or radiotherapy as treatment modalities will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiotherapy is usually indicated. Additional therapy of some type is indicated after the tumor is removed. Chemotherapy or radiotherapy, or both, may be indicated as a postsurgical intervention. Most children with Wilms' tumor do not require renal transplants.

A neonate with a goiter has just been admitted to the newborn nursery. A priority nursing intervention is to A. position the neonate on the left side. B. explain to the parents how to place the dressing on the goiter. C. have a tracheostomy set at bedside. D. suction at least every 5 to 10 minutes.

C. have a tracheostomy set at bedside. The goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including having a tracheostomy set at the bedside. Placing the neonate in a side-lying position is not indicated. Hyperextension of the child's neck may facilitate breathing. No dressing is indicated in a neonate who has a goiter. There is no indication for suctioning in a neonate with goiter.

A 5-year-old child has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to the child's parent that the first action is to have the child evaluated for A. school phobia. B. emotional causes. C. possible urinary tract infection. D. possible structural defects of urinary tract.

C. possible urinary tract infection Incontinence in a previously toilet-trained child can be an indication of a urinary tract infection. A physical cause of the problem needs to be eliminated before a psychological cause is considered. Emotional causes should be investigated only once a physical cause has been ruled out. Possible structural defects would be explored as a cause after a urinary tract infection is confirmed.

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this is usually associated with A. incontinence. B. urinary obstruction. C. recurrent kidney infections. D. infarction of renal vessels.

C. recurrent kidney infections Reflux allows urine to flow back to the kidneys. When the urine is infected, this contributes to kidney infections. Incontinence may be associated with urinary tract infections but not directly with vesicoureteral reflux. Vesicoureteral reflux can cause renal scarring but not obstruction. Infarction of the renal vessels does not occur with vesicoureteral reflux.

The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain A. cannot occur if the child is comatose. B. may occur if the child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with the child.

C. requires astute nursing assessment and management. Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. Pain can occur in the comatose child. The child can be in pain while comatose. The family can provide insight into the child's different responses, but the nurse should be monitoring physiologic and behavioral manifestations.

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. An important part of the discussion with the parents is that A. parental protection is essential until the child reaches adulthood. B. mental retardation is to be expected with hydrocephalus. C. shunt malfunction or infection requires immediate treatment. D. most usual childhood activities must be restricted.

C. shunt malfunction or infection requires immediate treatment. Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions. The development of mental retardation depends on the extent of damage before the shunt was placed. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions.

A 17-year-old with type 1 diabetes mellitus tells the school nurse about recently starting to drink alcohol with friends on weekends. The most appropriate intervention by the nurse is to A. tell the adolescent not to drink alcohol. B. ask the adolescent about the reasons for drinking alcohol. C. teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake. D. recommend counseling so that the adolescent understands the serious consequences of alcohol consumption.

C. teach the adolescent about the effects of alcohol on type 1 diabetes mellitus and how to prevent problems associated with alcohol intake. The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of the illness. Telling someone not to drink will not help should the person choose to continue drinking. Asking the adolescent why the drinking is occurring will provide information to the nurse but will not address the information that the adolescent needs to have about managing the disease. Counseling can be included in the teaching plan.

What clinical manifestations would alert you to the possibility of compartment syndrome?

Correct Answer: Deficit of neuromuscular status or weakness and pain; tenseness Rationale: Compartment syndrome occurs when pressure within a closed space (such as the muscles and nerves of the upper and lower extremities) rises and compromises circulation to the muscles and nerves within this space. The symptoms reflect a deficit or deterioration of neuromuscular status in the anatomic area surrounding the involved structures.

What is the pathogen most frequently associated with infection of the bone (osteomyelitis)?

Correct Answer: Staphylococcus aureus Rationale: Osteomyelitis is often secondary to a bloodstream infection and can be caused by any bacterial organism; however, S. aureus is the most common pathogen.

Kyphosis

Curvature of the thoracic spine; Caused by chronic arthritis

A child is admitted to the pediatric intensive care unit for a submersion injury. The child's parents express guilt over the submersion injury to the nurse. The most appropriate response by the nurse is A. "You will need to watch your child more closely in the future." B. "Why did you let your child almost drown?" C. "Your child will be fine, so don't worry." D. "Tell me more about your feelings."

D. "Tell me more about your feelings." The nurse needs to be nonjudgmental and provide the parents an opportunity to express their feelings. You will need to watch your child more closely in the future is a judgmental statement. Why did you let your child almost drown? is a judgmental question. Saying the child will be fine may not be true.

What is an appropriate nursing intervention while the child with nephrotic syndrome is confined to bed? A. Restrain the child as necessary. B. Discourage the parents from holding the child. C. Do passive range-of-motion exercises once a day. D. Adjust activities to the child's tolerance level.

D. Adjust activities to the child's tolerance level. The child will have a variable level of tolerance for activity. The activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child that are age appropriate. Restraints should not be used to confine children to bed, unless they are a potential threat to themselves or others. Parents should be encouraged to hold the child. The child should be encouraged to move all extremities while in bed to prevent the potential complications of immobility.

A child in renal failure has hyperkalemia. Which foods should be avoided? A. Cold cuts, chips, and canned foods B. Hamburger on a bun and lime Jell-O C. Spaghetti with meat sauce and breadsticks D. Bananas, carrots, and green leafy vegetables

D. Bananas, carrots, and green leafy vegetables Bananas, carrots, and green leafy vegetables are high in potassium. Cold cuts, chips, and canned foods are high in sodium but not necessarily in potassium. A hamburger on a bun and lime Jell-O is an acceptable choice for a low-potassium diet. Spaghetti with meat sauce and breadsticks is an acceptable choice for a low-potassium diet.

What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle? A. Elevation increases the pain threshold. B. Elevation increases metabolism in the tissues. C. Elevation produces deep tissue vasodilation. D. Elevation reduces edema formation

D. Elevation reduces edema formation Elevating the extremity uses gravity to facilitate venous return to reduce edema. Elevation should have no significant effect on the pain threshold. Elevation should not affect metabolism. Venous return to the heart, not vasodilation, is facilitated by elevation.

• What is important when caring for a child with myelomeningocele in the preoperative stage? A. Place the child on one side to decrease pressure on the spinal cord. B. Apply a heat lamp to facilitate drying and toughening of the sac. C. Keep the skin clean and dry to prevent irritation from diarrheal stools. D. Measure the head circumference and examine the fontanels for signs that might indicate developing hydrocephalus.

D. Measure the head circumference and examine the fontanels for signs that might indicate developing hydrocephalus Obstructive hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of the head circumference will aid in early detection of associated increased intracranial pressure. Preoperatively, the child is kept in a prone position to decrease tension on the sac and reduce the risk of trauma or sac tearing. The sac must be kept moist. Sterile, moist, nonadherent dressings are placed over the sac as prescribed by the physician. Most infants do not have diarrheal stools. The sac area, though, should be kept clean and dry and out of contact with urine and stools.

What is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)? A. Children with ESRD usually adapt well to the minor inconveniences of treatment. B. Children with ESRD require extensive support until they outgrow the condition. C. Multiple stresses are placed on children with ESRD and their families until the illness is cured. D. Multiple stresses are placed on children with ESRD and their families because their lives are maintained by drugs and artificial means.

D. Multiple stresses are placed on children with ESRD and their families because their lives are maintained by drugs and artificial means. ESRD is a chronic, progressive illness with dependence on technology. Families need to arrange for continuing examinations and procedures that are often painful and may require hospitalization. ESRD is a complex disease process that requires substantial medical intervention and is not minor in its treatment modalities. ESRD cannot be outgrown. Dialysis is necessary until renal transplantation is performed. ESRD cannot be cured. Dialysis is necessary until renal transplantation is performed.

Which of the following phrases describes a characteristic of most neonatal seizures? A. Generalized seizure B. Tonic-clonic seizure C. Well-organized seizure D. Subtle and barely discernible seizure

D. Subtle and barely discernible seizure Signs of seizures in newborns are subtle. They include symptoms such as lip smacking, tongue thrusting, eye rolling, and arching of the back. The newborn's central nervous system is not sufficiently developed to maintain a generalized seizure. The newborn's central nervous system is not sufficiently developed to maintain a tonic-clonic (generalized) seizure. The newborn's central nervous system is not sufficiently developed to maintain a well-organized seizure.

The nurse is caring for an immobilized preschool child. What is helpful during this period of immobilization? A. Encourage the child to wear pajamas. B. Let the child have few behavioral limitations. C. Keep the child away from other immobilized children if possible. D. Take the child for a "walk" by wagon outside the room.

D. Take the child for a "walk" by wagon outside the room. It is important for children to have activities outside of the room if possible. This can give them opportunities to meet their normal growth and developmental needs. The child should be encouraged to wear street clothes during the day. Limit setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.

• A woman who is 6 weeks pregnant tells the nurse that she is worried her baby might have spina bifida because of a family history. What should the nurse's response be based on? A. There is no genetic basis for the defect. B. Prenatal detection is not possible yet. C. Chromosomal studies done on amniotic fluid can diagnose the defect prenatally. D. The concentration of α-fetoprotein in amniotic fluid can potentially indicate the presence of the defect prenatally.

D. The concentration of α-fetoprotein in amniotic fluid can potentially indicate the presence of the defect prenatally. Fetal ultrasound and elevated concentrations of α-fetoprotein in amniotic fluid many indicate the presence of anencephaly, myelomeningocele, or other neural tube defects. The origin of neural tube defects is unknown but appears to have a multifactorial inheritance pattern. Prenatal detection is possible through amniotic fluid or chorionic villi sampling. There are no chromosomal studies currently that can diagnose spina bifida prenatally.

A toddler is hospitalized with acute renal failure (ARF) secondary to severe dehydration. The nurse should assess the child for what possible complications? A. Hypotension B. Hypokalemia C. Hypernatremia D. Water intoxication

D. Water intoxication The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes. The child needs to be monitored for hypertension, not hypotension, when hospitalized with acute renal failure. Hyperkalemia, not hypokalemia, is a concern in acute renal failure. Hyponatremia, not hypernatremia, may develop in acute renal failure as the sodium is diluted in large amounts of water.

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes A. application of cold salts to suppress the inflammatory process. B. a high-protein, low-salt diet. C. a rigorous exercise regimen to build up muscle strength and endurance. D. administration of corticosteroids to control inflammation.

D. administration of corticosteroids to control inflammation. Corticosteroid administration is the primary mode of therapy currently for SLE. The application of cold salts will not affect the inflammatory process associated with SLE. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation.

• An 8-year-old has been diagnosed with moderate cerebral palsy (CP). The child recently began participation in a regular classroom for part of the day. The child's mother asks the school nurse about joining the after-school Scout troop. The nurse's response should be based on knowledge that A. most activities such as Scouts cannot be adapted for children with CP. B. after-school activities usually result in extreme fatigue for children with CP. C. trying to participate in activities such as Scouts leads to lowered self-esteem in children with CP. D. after-school activities often provide children with CP with opportunities for socialization and recreation.

D. after-school activities often provide children with CP with opportunities for socialization and recreation. Recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs in order to promote socialization opportunities. Most activities can be adapted for children with CP. The child, family, and activity director should assess the degree of activity to ensure it matches the child's capabilities. A supportive environment associated with after-school activities will add to the child's self-esteem.

The most appropriate nursing intervention when caring for a child experiencing a seizure is to A. restrain the child when a seizure occurs to prevent bodily harm. B. place a padded tongue between the teeth if they become clenched. C. suction the child during the seizure to prevent aspiration. D. described and document the seizure activity observed.

D. described and document the seizure activity observed. The priority nursing intervention is to observe the child and seizure and document the activity observed. The child should not be restrained, because this may cause an injury. Nothing should be placed in the child's mouth, because this may cause an injury not only to the child but to the nurse. To prevent aspiration, the child should be placed on the side if possible to facilitate drainage.

The callus that develops at a fracture site is important because it provides A. use of the injured part. B. sufficient support for weight bearing. C. means for adequate blood supply. D. means for holding bone fragments together.

D. means for holding bone fragments together. New bone cells are formed in large numbers and stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus. Functional use cannot occur until the fracture site is stable. Sufficient support for weight bearing cannot occur until the fracture site is stable. The callus does not provide an adequate blood supply.

The newborn diagnosed with phenylketonuria (PKU) will require long-term follow-up to assess for the development of A. obesity. B. diabetes insipidus. C. respiratory distress. D. mental retardation.

D. mental retardation. PKU, an inborn error of metabolism, may lead to mental retardation if early intervention is not performed. Obesity is not associated with PKU. Diabetes insipidus is not associated with PKU. Respiratory distress is not associated with PKU.

The nurse is instructing a group of parents about head injuries in children. The nurse should explain that infants are particularly vulnerable to acceleration-deceleration head injuries because the A. anterior fontanel is not yet closed. B. nervous tissue is not well developed. C. scalp of head has extensive vascularity. D. musculoskeletal support of head is insufficient.

D. musculoskeletal support of head is insufficient. The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants of acceleration-deceleration head injuries. The lack of closure of the anterior fontanel is not relevant to the development of acceleration-deceleration head injuries in infants. The lack of well-developed nervous tissue is not relevant to the development of acceleration-deceleration head injuries in infants. The vascularity of the scalp is not relevant to the development of acceleration-deceleration injuries in infants.

An adolescent has had a lower leg amputation secondary to a motorcycle accident and is complaining of pain in the missing extremity. The nurse should recognize that this is A. indicative of narcotic addiction B. indicative of the need for psychological counseling C. abnormal and suggests nerve damage D. normal and called phantom limb sensation

D. normal and called phantom limb sensation Phantom limb sensation is an expected experience because the nerve-brain connections are still present. They gradually fade. This should be discussed preoperatively with the child. There is no indication of narcotic addiction by the adolescent complaining of pain in the amputated extremity. Phantom limb pain is expected after an amputation; psychological counseling is not required for the adolescent experiencing it. Phantom limb pain is expected after an amputation and is not suggestive of nerve damage.

Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is A. birth asphyxia B. neonatal diseases C. cerebral trauma D. prenatal brain abnormalities

D. prenatal brain abnormalities The most common currently identifiable cause of CP is existing brain abnormalities during the prenatal period. Birth asphyxia had previously been thought of as a factor in the development of CP. Neonatal diseases have previously been thought of as factors in the development of CP. Cerebral trauma has previously been thought of as a factor in the development of CP.

• The major goal of therapy for children with cerebral palsy (CP) is A. reversing degenerative processes that have occurred. B. curing the underlying defect causing the disorder. C. preventing spread to individuals in close contact with the children. D. recognizing the disorder early and promoting optimal development.

D. recognizing the disorder early and promoting optimal development. Because CP is currently a permanent disorder, the goal of therapy is to promote optimal development. This is done through early recognition and beginning of therapy. It is difficult to reverse the degenerative processes associated with CP. The underlying defect(s) associated with the development of CP cannot be cured. CP is not contagious.

• A neural tube defect that is not visible externally in the lumbosacral area would be called A. meningocele. B. myelomeningocele. C. spina bifida cystica. D. spina bifida occulta.

D. spina bifida occulta. Spina bifida occulta is completely enclosed. Often, this disorder will not be noticed. A clue to the presence of this internal disorder will be a dimple or tuft of hair on the lumbosacral area. A meningocele contains meninges and spinal fluid but no neural tissue and is evident at birth as a sac in the lumbosacral area. Transillumination of light will be present. A myelomeningocele is a neural tube defect that contains meninges, spinal fluid, and nerves and is evident at birth as a sac in the lumbosacral area. Transillumination of light will not be present. Spina bifida cystica is a cystic formation with an external saclike protrusion

What is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? A. Increased metabolism B. Increased venous return C. Increased cardiac output D. Decreased exercise tolerance

Decreased exercise tolerance Muscle disuse leads to tissue breakdown and loss of muscle mass or muscle atrophy. It may take weeks or months to recover. Metabolism decreases during periods of immobility. There is decreased venous return due to decreased muscle activity secondary to immobility. There is decreased cardiac output secondary to immobility.

symptoms that are associated with DI

Excessive urination Compensatory insatiable thirst Dehydration Electrolyte imbalance Circulatory collapse

Describe the two sources for acquiring osteomyelitis.

Exogenous acquired by invasion of bone by direct extension from outside as a result of penetrating wound, open fracture, contamination during surgery Hematogenous spread of organisms from preexisting focus, such as furuncles, skin abrasions, impetigo, otitis media, tonsillitis, infected burns, poor injection technique Rationale: Osteomyelitis can be acquired from exogenous or hematogenous sources. These terms are defined in the text.

Discuss ketoacidosis

Fats used for energy; glycerol from fat cells converted by the liver to ketone bodies; limited rate; excess eliminated in the urine (ketonuria) or the lungs (acetone breath); ketone bodies are strong acids; lower serum pH. The definition of ketoacidosis is provided in the text.

idiopathic scoliosis

Idiopathic scoliosis is a complex spinal deformity in three planes, usually involving lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. In most cases of adolescent scoliosis, there is no apparent cause.

Identify five clinical signs or symptoms that are seen in children with spastic CP

Increased muscle tone Increased deep tendon reflexes and clonus (sudden dorsiflexion of the ankle or rapid distal movement of the patella resulting in alternating spasm and relaxation of the muscles being stretched) Flexor, adductor, and internal rotator muscles more involved than extensor, abductor, and external rotator muscles Difficulty with fine and gross motor skills Most common contracture is that of the heel cord. Hip adductor contractures leading to progressive subluxation and dislocation Knee contractures Scoliosis common Typical gait is crouched, in-toeing, and scissoring. Elbow, wrist, and fingers in flexed position with thumb adducted Motor weakness of antagonist muscle groups

What signs and symptoms might be seen in a child with acute osteomyelitis?

Irritability, restlessness Elevated temperature Rapid pulse Dehydration Localized tenderness Increased warmth and diffuse swelling over affected bone Pain Rationale: The signs and symptoms of acute osteomyelitis begin abruptly and commonly accompany a history of trauma to the affected bone.

Identify five important postoperative nursing interventions for the care of the child undergoing spinal fusion due to severe scoliosis.

Log roll the patient to prevent damage to the fusion. Closely observe skin for redness or breakdown. Use pressure-relieving mattress or bed. Assess for neurologic impairment. Ensure adequate pain relief. Perform routine postoperative assessments of the wound, circulation, and vital signs. Ensure adequate urinary output and fluid and electrolyte balance. Prevent constipation (pain medications may contribute to this).

What diagnostic test is used to definitively diagnose Legg-Calvé-Perthes disease? Needle biopsy of the affected area X-ray examination of the leg Magnetic resonance imaging (MRI) Spinal tap

Magnetic resonance imaging (MRI) Rationale: The definitive diagnosis is confirmed by MRI, which demonstrates osteonecrosis

Which bones are most affected by osteomylitis in children?

Most cases involve the femur or tibia. To a lesser extent, the humerus and hip are affected. Rationale: Infections in older children can be confined to the affected bones, which are most commonly the femur or tibia and to a lesser extent the humerus and hip.

Describe how to do a physical assessment for scoliosis

Observe the position of the spine by having the child stand in front of you while undressed. First note asymmetry of the shoulder height, scapula and hip height, and alignment. Next have the child bend forward at the waist (Adams test) while hanging the arms down. Observe for asymmetry of the ribs and flanks. Remember, a curve of less than 10 degrees is considered a postural variation.

List the "five Ps" of ischemia from a vascular injury.

Pain and point of tenderness, pulse distal to fracture, pallor, paresthesia distal, and paralysis

Identify at least six warning signs associated with CP

Physical Signs Poor head control after 3 months of age Stiff or rigid arms or legs Pushing away or arching back Floppy or limp body posture Inability to sit up without support by 8 months Use of only one side of the body, or only the arms to crawl Behavioral Signs Extreme irritability or crying Failure to smile by 3 months Feeding difficulties Persistent gagging or choking when fed After 6 months of age, tongue pushing soft food out of the mouth

What are the chief signs of diabetes type 1?

Polyuria, polydipsia, polyphagia The increased concentration of glucose produces an osmotic gradient that causes the movement of body fluid from the intracellular space to the interstitial space, then to the extracellular space and into the glomerular filtrate in order to dilute the hyperosmolar filtrate. The resulting spilling of glucose into the urine with an osmotic diversion of water causes the classic signs of diabetes mellitus: polyuria, an excessive urinary output; polydipsia, the bodys attempt to replenish intravascular fluid volume; and polyphagia, the bodys attempts to meet its energy needs.

Which diagnostic studies are most useful for assessing skeletal trauma?

Radiography The calcium deposits in bone make the entire structure radiopaque, making visualization and diagnosis of injury possible. Blood studies Severe soft tissue, muscle, and bone injury often results in the destruction of red blood cells with a rise in bilirubin and a fall in the hemoglobin or hematocrit reading.

What are the goals of fracture management?

Reduction to regain alignment and length of the bony fragments Immobilizationto retain alignment and length Restorationto restore function to the injured parts

RICES:

Rest, Ice, Compression, Elevation, and Support Basic principles for managing sprains and other soft tissue injuries

vaccines that reduce the incidence of bacterial meningitis

Routine immunization of infants with Haemophilus influenzae type b and pneumococcal conjugate

Legg-Calvé-Perthes Disease; There are four stages of this disease. Describe each stage

Stage I: Aseptic necrosis or infarction of the femoral capital epiphysis with degenerative changes producing flattening of the upper surface of the femoral headthe avascular stage Stage II: Capital bone absorption and revascularization with fragmentation (vascular resorption of the epiphysis) that gives a mottled appearance on radiographsthe fragmentation, or revascularization, stage Stage III: New bone formation, which is represented on radiographs as calcification and ossification or increased density in the areas of radiolucency; this filling-in process appears to take place from the periphery of the head centrallythe reparative stage Stage IV: Gradual reformation of the head of the femur without radiolucency and, it is hoped, to a spherical formthe regenerative stage

common treatment for a complex fractures.

Surgical pinning and either open or closed reduction may be used

Legg-Calvé-Perthes Disease; What is this disorder, and what causes it?

The cause of this disease is unknown. There is a disruption in blood flow to the femoral capital epiphysis that results in ischemic aseptic necrosis of the head of the femur. Circulation to this area is more susceptible during middle childhood.

How long is typical antibiotic therapy for osteomyelitis? By which route should the antibiotics be administered?

Three to four weeks. Often the medication is given intravenously, and a venous access device or a peripheral intravenous central catheter is placed. Rationale: The length of antibiotic therapy is determined by the duration of symptoms, the initial response to treatment, and the sensitivity of the organism in the specific case. Intravenous antibiotic therapy is indicated because of the seriousness of the infection causing potential destruction to the childs bone. The intravenous mode of administration ensures high blood and tissue levels of the antibiotic.

• Septic arthritis

a bacterial infection in the joint that usually results from hematogenous spread or from direct extension of an adjacent cellulitis or osteomyelitis

Cushing syndrome

a characteristic group of manifestations caused by excessive circulating free cortisol; physiologic disturbances: hyperglycemia, susceptibility to infection, hypertension, and hypokalemia, may have life-threatening consequences unless recognized early and treated successfully

• Systemic lupus erythematosus (SLE)

a chronic autoimmune disorder that affects the collagen tissues of the body. The cause of SLE is not known but it appears to result from a complex interaction of genetics with an unidentified trigger that activates the disease. Suspected triggers include exposure to ultraviolet light, estrogen, pregnancy, infections, and drugs.

Epilepsy

a condition characterized by two or more unprovoked seizures and can be caused by a variety of pathologic processes in the brain. Seizures are a symptom of an underlying disease process. A single seizure event should not be classified as epilepsy and is generally not treated with long-term antiepileptic drugs

Status epilepticus

a continuous seizure that lasts more than 30 minutes or a series of seizures from which the child does not regain a premorbid level of consciousness.

Reye syndrome (RS)

a disorder defined as a metabolic encephalopathy associated with other characteristic organ involvement. It is characterized by fever, profoundly impaired consciousness, and disordered hepatic function

Juvenile idiopathic arthritis

a group of idiopathic chronic inflammatory diseases affecting the joints and other tissues The disease pro¬cess is characterized by a chronic inflammation of the synovium with joint effusion and eventual erosion, destruction, and fibrosis of the articular cartilage

Cerebral palsy (CP)

a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. One of the major risk factors for development of CP is preterm birth.

Epidural (extradural) hematoma

a hemorrhage into the space between the dura and the skull. As the hematoma enlarges, the dura is stripped from the skull; this accumulation of blood results in a mass effect on the brain, forcing the underlying brain contents downward and inward as it expands.

diagnosis of UTI depends on

a high degree of suspicion, evaluation of the history and physical examination, and urinalysis and culture; Detection of bacteria in a urine culture confirms the diagnosis of UTI

Submersion injury

a major cause of unintentional injury-related death in children ages 1 to 14 years. The term near-drowning is no longer used; instead, the term submersion injury should be used up until the time of drowning-related death• All children who have a submersion injury should be admitted to the hospital for observation. Although many patients do not appear to have suffered adverse effects from the event, complications (e.g., respiratory compromise, cerebral edema) may occur 24 hours after the incident.

Acute bacterial meningitis

a medical emergency that requires early recognition and immediate therapy to prevent death and avoid residual disabilities. The child is isolated from other children, usually in an intensive care unit for close observation. An IV infusion is started to facilitate administration of antimicrobial agents, fluids, antiepileptic drugs, and blood, if needed. The child is placed on a cardiac monitor and in respiratory isolation.

• Disorders of adrenal function

acute adrenocortical insufficiency, chronic adrenocortical insufficiency, Cushing syndrome, congenital adrenal hyperplasia, and hyperaldosteronism.

Nursing care of the child with meningitis includes

administering antibiotics, taking isolation precautions, removing environmental stimuli, ensuring correct positioning, monitoring vital signs, administering intravenous (IV) therapy, promoting adequate fluid and nutritional status, and providing supportive care to the family.

. Management of hemolytic-uremic syndrome

aimed at control of complications and hematologic manifestations of renal failure.

• Management of nephrotic syndrome

aimed at reducing excretion of protein, reducing or preventing fluid retention by tissues, and preventing infection and other complications

Bacterial meningitis

an acute inflammation of the meninges and cerebrospinal fluid

Guillain-Barré syndrome

an ascending paralysis often first manifesting as falling down or clumsiness in walking

Encephalitis

an inflammatory process of the CNS that is caused by a variety of organisms, including bacteria, spirochetes, fungi, protozoa, helminths, and viruses. Encephalitis may result from direct invasion of the CNS by a virus or from involvement of the CNS after viral disease.

Hemolytic uremic syndrome

an uncommon, acute renal disease that occurs primarily in infants and small children between the ages of 6 months and 5 years. The disease occurs after a prodromal period during which there is an episode of diarrhea and vomiting. Less often, the preceding illness is an upper respiratory tract infection or, occasionally, varicella, measles, or a UTI.

• Developmental dysplasia of the hip

appears to be related to intrauterine, genetic, and postnatal factors. The primary treatment of congenital hip dysplasia in infancy is the use of a Pavlik harness. Older children may require a hip spica cast, traction, or a surgical hip reduction.

Headaches

are a common complaint of children and are associated with different pathologic conditions, including extracranial disease, intracranial disease, vascular abnormalities, psychogenic disorders, or a combination of the above.

Diagnosis/Treatment of a brain tumor

based on presenting clinical signs and diagnostic imaging. Treatment may involve the use of surgery, radiotherapy, and chemotherapy. All three may or may not be used, depending on the type of tumor

subdural hemorrhage

bleeding between the dura and the arachnoid membrane, which overlies the brain and the subarachnoid space. The hemorrhage may be from two sources: (1) tearing of the veins that bridge the subdural space and (2) hemorrhage from the cortex of the brain caused by direct brain trauma. Subdural hematomas are much more common than epidural hematomas and occur most often in infancy, with a peak incidence at 6 months.

Type 1 diabetes

characterized by destruction of the pancreatic beta cells, which produce insulin

Diabetes mellitus

chronic disorder of metabolism characterized by a partial or complete deficiency of the hormone insulin

Urine with a possible infection appears

cloudy, hazy, or thick with noticeable strands of mucus and pus; it also smells fishy and unpleasant, even when fresh.

Acute glomerulonephritis Management

consists of general supportive measures and early recognition and treatment of complications. Therapeutic management of acute glomerulonephritis entails maintenance of fluid balance, treatment of hypertension, and antibiotic therapy

Nursing care of the child with Guillain-Barré syndrome

consists of maintaining a patent airway; monitoring vital signs and neurologic signs; ensuring proper body alignment and positioning; and providing physical therapy, reassurance, and support to the child and family.

Treatment of clubfoot

consists of manipulation and serial casting to correct the deformity, maintenance of the correction, surgical heel cord release, and prevention of possible recurrence of the deformity. Clubfoot may occur with other congenital conditions such as myelomeningocele. The condition may be unilateral or bilateral.

Clinical manifestations of infant botulism

constipation, decreased activity, poor feeding, and lethargy. Treatment consists of immediate administration of botulism immune globulin intravenously (BIG-IV) without delaying for laboratory diagnosis. Early administration of BIG-IV neutralizes the toxin and stops the progression of the disease.

neural tube defects

constitute the largest group of congenital anomalies with multifactorial inheritance. The most common are spina bifida and myelomeningocele.

consequences of Hypopituitarism

depending on the degree of dysfunction, it often leads to: o Gonadotropin deficiency with absence or regression of secondary sexual characteristics o Growth hormone (GH) deficiency, in which children display retarded somatic growth o Thyroid-stimulating hormone deficiency, which produces hypothyroidism o Corticotropin deficiency, which results in manifestations of adrenal hypofunction

ARF, management

directed at determining treatment of the underlying cause, management of complications of renal failure, and supportive therapy

Therapy for hyperthyroidism

directed at retarding the rate of hormone secretion and may include drug therapy, thyroidectomy, or radioiodine therapy

Therapeutic management of spinal cord

directed toward immobilizing the entire spinal column at the scene of the traumatic event, transporting safely by health care personnel trained to transport possible spinal trauma victims, evaluating neurologic damage, preventing further neurologic damage, and implementing an aggressive rehabilitation program designed to help achieve independence and movement.

most important aspect of successful management of the child with RS

early diagnosis and aggressive therapy. Cerebral edema with increased ICP represents the most immediate threat to life. Recovery from RS is rapid and usually without sequelae if the diagnosis was made and therapy implemented early

goals of therapy for children with CP

early recognition and promotion of an optimum developmental course to enable affected children to attain their potential within the limits of their dysfunction

cerebral edema

expected after craniocerebral trauma ; Cerebral edema peaks at 24 to 72 hours after injury and may account for changes in a child's neurologic status. Cerebral edema associated with traumatic brain injury may be a result of two different mechanisms: cytotoxic edema or vasogenic edema.

• Leading causes of injury to children

falls, being struck by or against an object, motor vehicle accidents, fires, drowning, pedestrian-vehicle accidents, and firearms. Falls were the leading cause of nonfatal injury among children aged 0 to 15 years. Trauma from motor vehicle crashes was the leading cause of nonfatal injury in adolescents aged 15 to 19 years of age.

Congenital adrenal hyperplasia

family of disorders caused by decreased enzyme activity required for cortisol production in the adrenal cortex. Management includes assignment of a sex according to genotype, administration of cortisone, and, possibly, reconstructive surgery.

• Management of type 1 diabetes

focuses on insulin replacement, diet, and exercise. Management requires a multidisciplinary approach involving the family; the child (when appropriate); and professionals, including a pediatric endocrinologist, diabetes nurse educator, nutritionist, and exercise physiologist.

Absence seizures

formerly called petit mal or lapses, are generalized seizures. They have a sudden onset and are characterized by a brief loss of consciousness, a blank stare, and automatisms.

management of Migraine headaches

general measures (education, a headache diary to identify and eliminate precipitating factors, and documented response to treatment), abortive treatment, and prophylactic treatment. At the onset of the headache, the child should rest or sleep in a quiet, dark room when feasible. Migraine therapy, if administered early in the course of the headache, may provide rapid relief. Acetaminophen or ibuprofen is often effective if given early

Immobility

has a profound effect on all aspects of a child's growth and development. Because of the recognized problems with immobility, efforts are directed toward early ambulation.

Disorders of thyroid function

hypothyroidism, autoimmune thyroiditis, goiter, and hyperthyroidism.

• Pain management

ibuprofen has been shown to reduce fracture pain in children

Classic forms of hypoparathyroidism in childhood

idiopathic (involving a deficient production of parathyroid hormone) and pseudohypoparathyroidism (involving increased parathyroid hormone production with end-organ unresponsiveness to the hormone).

Potential complications of traction and casts

include circulatory impairment, nerve compression, nonunion of bones, and skin breakdown

Factors that contribute to bone infections such as osteomyelitis

include inoculation with a large number of organisms, presence of a foreign body, bone injury, high virulence of an organism, immunosuppression, and malnutrition. Certain types and locations of bone are also more vulnerable to infection. Osteomyelitis is managed with vigorous antibiotic therapy, immobilization of the affected part, and (sometimes) surgical drainage

Major complications of Duchenne muscular dystrophy

include joint contractures, disuse atrophy, obesity, cardiomyopathy, sleep disordered breathing, and respiratory failure as the condition progresses

• Features of children's fractures not observed in the adult

include presence of growth plate, thicker and stronger periosteum, bone porosity, more rapid healing, and less joint stiffness.

Primary head injury

involves features that occur at the time of trauma, including fractured skull, contusions, intracranial hematoma, and diffuse injury. Secondary complications include hypoxic brain damage, increased ICP, infection, cerebral edema, and posttraumatic syndromes.

• Myelomeningocele

involves the protrusion of a sac in the lumbar or lumbosacral area that contains meninges, spinal fluid, and nerves. Associated problems include infection, neurologic damage, impaired renal function, musculoskeletal impairment, and latex allergy.

major physical consequences of prolonged immobilization

loss of muscle strength, endurance, and muscle mass; bone demineralization; loss of joint mobility; and contractures. Secondary effects include alterations in the skin, cardiovascular, respiratory, metabolic, and renal systems. The three major cardiovascular consequences of immobility are orthostatic intolerance, increased workload of the heart, and thrombus formation. Prolonged immobility, friction, moisture, and impaired circulation also place the child at greater risk for tissue ischemia and pressure ulcer development.

Acute glomerulonephritis

may be a primary event or a manifestation of a systemic disorder that can range from minimal to severe. Common features of acute glomerulonephritis are oliguria, edema, hypertension, circulatory congestion, hematuria, and proteinuria. It is now generally accepted that acute poststreptococcal glomerulonephritis is an immune-complex disease (i.e., a reaction that occurs as a by-product of an antecedent streptococcal infection with certain strains of the group A hemolytic streptococci).

Deficiencies of the anterior pituitary hormones

may be due to organic defects or have an idiopathic etiology and may occur as a single hormonal problem or in combination with other hormonal deficiencies. Pituitary dysfunction is manifested primarily by growth disturbance

Migraine headaches

occur in children as well as in adults. Typical symptoms include nausea, vomiting, and abdominal pain, which are relieved by sleep. Toddlers may be seen with episodic pallor, decreased activity, and vomiting. The onset of a migraine headache in a young child is typically in the afternoon and may be bifrontal, temporal, and bilateral or unilateral. Children may vomit repetitively during a migraine headache.

Tetanus

occurs when tetanus spores or vegetative bacilli enter a wound and multiply in a susceptible host Primary prevention is key and occurs through immunization and boosters. Specific treatment to prevent tetanus after trauma includes administration of tetanus immunoglobulin and tetanus toxoid intramuscularly at a separate site.

• Infection of the genitourinary tract

one of the most common conditions of childhood. Up to 10% of children have a febrile UTI during the first 2 years of life. The structure of the lower urinary tract is believed to account for the increased incidence of bacteriuria in females

The five Ps of ischemia from a vascular injury that should be included in the assessment

pain, pallor, pulselessness, paresthesia, and paralysis

Hemolytic uremic syndrome: hemolytic process

persists for several days to 2 weeks. During this time, the child is anorexic, irritable, and lethargic. There is marked and rapid onset of pallor accompanied by hemorrhagic manifestations such as bruising, purpura, or rectal bleeding. Severely affected patients are anuric and often hypertensive. Seizures and stupor suggest central nervous system involvement, and there may be signs of acute heart failure

more common defects of the genitourinary tract

phimosis, cryptorchidism, inguinal hernia, hydrocele, and hypospadias

five categories of Cushing syndrome

pituitary, adrenal, ectopic, iatrogenic, and food-dependent

three "polys" of diabetes

polyphagia, polydipsia, and polyuria—the cardinal symptoms of the disease.

malignant bone tumors

produce localized pain in the affected site, which may be severe or dull and may be attributed to trauma or the vague complaint of "growing pains." The pain is often relieved by a flexed position, which relaxes the muscles overlying the stretched periosteum. Frequently it draws attention when the child limps, curtails physical activity, or is unable to hold heavy objects.

Slipped capital femoral epiphysis

refers to the spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction

Vesicoureteral reflux (VUR)

retrograde flow of bladder urine into the ureters. During voiding, urine is swept up the ureters and then flows back into the empty bladder, where it acts as a reservoir for bacterial growth until the next void. In most cases of VUR, conservative, nonoperative therapy is effective in controlling infection.

two main types of traction

skin traction and skeletal traction

three components: endocrine system

the cell, which sends a chemical message via a hormone; target cells, which receive the message; and the environment through which the chemical is transported from the site of synthesis to the sites of cellular action.

method of fracture reduction is determined by

the child's age, degree of displacement, amount of overriding, amount of edema, condition of the skin and soft tissues, sensation, and circulation distal to the fracture. Simple nondisplaced fractures in children may be managed with immobilization in a cast or splint for 4 to 6 weeks. Open, displaced, and compound fractures require surgical intervention.

Muscular dystrophies

the greatest and most important cause of neuromuscular dysfunction of childhood.

Renal failure

the inability of the kidneys to excrete waste material, concentrate urine, and conserve electrolytes. It can occur suddenly in response to inadequate perfusion, kidney disease, or urinary tract obstruction (acute renal failure [ARF]), or it can develop slowly as a result of long-standing kidney disease or an anomaly (chronic renal failure).

Neuroblastoma

the most common extracranial solid tumor of childhood and the most common cancer diagnosed in infancy. The signs and symptoms of neuroblastoma depend on the location and stage of the disease; a "silent" tumor. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site, usually the lymph nodes, bone marrow, skeletal system, skin, or liver

• Osteogenesis imperfecta

the most common osteoporosis syndrome in children, characterized by excessive fractures and bone deformity. OI has an autosomal dominant inheritance pattern in the majority of cases, although the most severe form demonstrates autosomal recessive inheritance. Clinical features may include varying degrees of bone fragility, deformity, and fracture; blue sclerae; hearing loss; and dentinogenesis imperfecta (hypoplastic discolored teeth). Medical management is primarily supportive. Children with OI may be erroneously identified as victims of child abuse as a result of numerous fractures

Rhabdomyosarcoma

the most common soft tissue sarcoma in children. The initial signs and symptoms are related to the site of the tumor and compression of adjacent organs. All rhabdomyosarcomas are high-grade tumors with the potential for metastases. Therefore multimodal therapy is recommended for all patients

• Diabetic ketoacidosis

the most complete state of insulin deficiency, is a life-threatening situation. Management consists of rapid assessment, adequate insulin to reduce the elevated blood glucose level, fluids to overcome dehydration, and electrolyte replacement (especially potassium).

Level of consciousness

the most important indicator of neurologic health. Various levels include full consciousness, confusion, disorientation, lethargy, obtundation, stupor, coma, and persistent vegetative state.

Duchenne muscular dystrophy

the most severe and the most common muscular dystrophy of childhood. It is inherited as an X-linked recessive trait, and the single-gene defect is located on the short arm of the X chromosome

postictal state

the period after a seizure

Dialysis

the process of separating colloids and crystalline substances in solution by the difference in their rate of diffusion through a semipermeable membrane. The types of dialysis used in end-stage renal disease are peritoneal dialysis and hemodialysis

• Ewing sarcomas, or the Ewing sarcoma family of tumors (which includes primitive neuroectodermal tumor of the bone),

the second most common malignant bone tumor (after osteosarcoma) in childhood.

goal of treatment of seizure disorders

to control the seizures or to reduce their frequency and severity, discover and correct the cause when possible, and help the child live as normal a life as possible. Long-term care of the child with recurrent seizure disorders includes physical care and education on the importance of drug therapy and problems related to emotional aspects of the disorder.

The purpose of the neurologic examination

to establish an accurate, objective baseline of neurologic information. Complete neurologic examination includes level of consciousness; posture; motor, sensory, cranial nerve, and reflex testing; and vital signs.

primary purposes of traction

to fatigue involved muscles and reduce muscle spasm, position bone ends in desired realignment, and immobilize the fracture site until realignment has been achieved to permit casting or splinting

goals of fracture management

to regain alignment and length of bony fragments, retain alignment and length, and restore function to injured parts

Type 2 diabetes

usually arises because of insulin resistance, in which the body fails to use insulin properly, combined with relative (rather than absolute) insulin deficiency. People with type 2 diabetes can range from predominantly insulin resistant with relative insulin deficiency to predominantly deficient in insulin secretion with some insulin resistance

Abnormalities in chronic renal failure

waste product retention, water and sodium retention, hyperkalemia, acidosis, calcium and phosphorus disturbance, anemia, and growth disturbances.

particularly intense in children with defects in the genital area

• Body-image concerns and castration

s/s of kidney rejection

• Fever • Swelling and tenderness over graft area • Diminished urinary output • Elevated blood pressure • Elevated serum creatinine

aseptic meningitis

• Many different viruses cause aseptic meningitis. The onset may be abrupt or gradual. The initial manifestations are headache, fever, malaise, and gastrointestinal symptoms. Signs of meningeal irritation develop 1 or 2 days after the onset of illness. Onset is more insidious in infants and toddlers. Signs and symptoms are vague and are often thought to be associated with a minor illness

treatment of Encephalitis

• Patients suspected of having encephalitis are hospitalized promptly for observation. Treatment is primarily supportive and includes conscientious nursing care, control of cerebral manifestations, and adequate nutrition and hydration, with observations and management as for other cerebral disorders.

Which measure is important in managing hypercalcemia in a child who is immobilized? A. Promote adequate hydration B. Change position frequently C. Encourage a diet high in calcium D. Provide a diet high in protein and calories

A. Promote adequate hydration Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia. Changing the child's position frequently will help with managing skin integrity but will not affect calcium levels. The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia. The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.

Which physiologic alteration is characterized by destruction of pancreatic beta cells that produce insulin? A. Type 1 diabetes B. Type 2 diabetes C. Impaired glucose tolerance D. Gestational diabetes

A. Type 1 diabetes Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic beta cells are destroyed in type 1 diabetes and are not associated with impaired glucose tolerance. Gestational diabetes occurs during pregnancy and is not associated with the destruction of pancreatic beta cells that produce insulin.

What nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? A. Suction the child frequently. B. Provide environmental stimulation. C. Turn the head side to side every hour. D. Avoid activities that cause pain or crying.

Avoid activities that cause pain or crying. Nursing interventions should focus on assessment and interventions to minimize pain. These activities can cause the ICP to increase. Suctioning is a distressing procedure. In addition, the resultant decrease in carbon dioxide can increase ICP. Environmental stimulation should be minimized because it can increase ICP. The child's head should not be turned side to side. If the jugular vein is compressed, the ICP can rise.

• What is associated with infant botulism? A. Contaminated soil B. Honey and corn syrup C. Commercial infant cereals D. Improperly sterilized bottles

B. Honey and corn syrup Unlike adult botulism, infant botulism is caused by ingesting spores of Clostridium botulinum, with the subsequent release of the toxin. The bacterium has been found in honey and corn syrup that were fed to affected infants. Contaminated soil is not associated with infants who develop infant botulism. Commercial infant cereals are not associated with the development of infant botulism. Improperly sterilized bottles are not associated with the development of infant botulism.

A child is receiving cyclosporine following a kidney transplant. The child's parents ask the nurse the reason for the cyclosporine. The nurse's response is based on the knowledge that the medication's purpose is to A. Decrease pain B. Boost immunity C. Suppress rejection D. Improve circulation to the kidney

C. Suppress rejection Cyclosporine is given to suppress rejection. Cyclosporine does not decrease pain, boost immunity, or improve circulation.

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. Based on the nurse's knowledge of seizures, the nurse recognizes this as A. absence seizure. B. generalized seizure. C. status epilepticus. D. simple partial seizure.

C. status epilepticus. Status epilepticus is a generalized seizure that lasts more than 30 minutes. This is considered a medical emergency and requires immediate treatment. Absence seizures are generalized seizures that are characterized by brief losses of consciousness, blank staring, and fluttering of the eyelids. Generalized seizures are the most common form of seizures. They include tonic-clonic (grand mal) seizures and absence (petit mal) seizures. Tonic-clonic seizures have tonic-clonic activity and loss of consciousness and involve both hemispheres of the brain. Simple partial seizures are characterized by varying sensations and motor behaviors.

What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis? A. Provide active range-of-motion exercises of the affected extremity. B. Administer pain medication with meals. C. Encourage frequent ambulation. D. Move and turn the child carefully and gently to minimize pain

D. Move and turn the child carefully and gently to minimize pain Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently. Active range-of-motion exercises are contraindicated until pain has subsided. Pain medication should be administered as needed. Ambulation is contraindicated until pain has subsided

External defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to ensure A. prevention of urinary tract complications. B. prevention of separation anxiety. C. acceptance of hospitalization. D. development of normal body image.

D. development of normal body image. Promotion of a normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Surgical intervention for external defects of the genitourinary system should be done as soon as possible. Prevention of urinary tract complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible. Proper preprocedure preparation can help prevent or at least reduce separation anxiety. Acceptance of hospitalization is important but not the reason for early surgical intervention of external defects of the genitourinary system.

Idiopathic scoliosis

No known cause

Compare type 1 and type 2 diabetes mellitus on the following characteristics: Age of onset Percentage of population Nutritional status Islet cell antibodies Insulin therapy

Type 1 Type 2 A. Age of onset <20 yr >40 yr B. Percentage of population 5%-8% 85%-90% C. Nutritional status Underweight Overweight D. Islet cell antibodies 80%-85% <5% E. Insulin therapy Always 20%-30%

Head injury

a pathologic process involving the scalp, skull, meninges, or brain as a result of mechanical force. Fractures resulting from head injuries may be classified as depressed, compound, basilar, and diastatic

Obstructive uropathy

a result of structural or functional abnormalities of the urinary system that obstruct the normal flow of urine. Obstruction may be congenital or acquired, unilateral or bilateral, complete or incomplete, with acute or chronic manifestations

Legg-Calvé-Perthes disease

a self-limiting disorder in which there is aseptic necrosis of the femoral head. The aims of treatment are to eliminate hip irritability; restore and maintain adequate range of hip motion; prevent capital femoral epiphyseal collapse, extrusion, or subluxation; and ensure a well-rounded femoral head at the time of healing.

seizure

a symptom of an underlying pathologic condition and may be manifested by sensory-hallucinatory phenomena, motor effects, sensorimotor effects, or loss of consciousness. The manifestation of seizures depends on the region of the brain in which they originate and may include unconsciousness or altered consciousness; involuntary movements; and changes in perception, behaviors, sensations, and posture.

major concerns of • Kidney transplantation

are tissue matching and prevention of rejection

management of scoliosis

bracing or surgical correction. Bracing is not curative, and surgical intervention may be required for correction of severe curves (usually 40 degrees or more).

Partial seizures

categorized as simple (meaning without associated impairment of consciousness) or complex (with impaired consciousness); both types may become generalized. Partial seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most often affected and are characterized by localized motor symptoms; somatosensory, psychic, or autonomic symptoms; or a combination of these.

Generalized seizures

categorized as tonic-clonic, absence, atonic and akinetic, myoclonic, and infantile spasms. The generalized tonic-clonic seizure, formerly known as grand mal, is the most dramatic of all seizure manifestations of childhood

Nephrotic syndrome

characterized by increased glomerular permeability to protein, with massive urinary loss of protein resulting in hypoproteinemia and edema. A previously well child begins to gain weight, which progresses insidiously over a period of days or weeks. Puffiness of the face, especially around the eyes, is apparent on arising in the morning but subsides during the day, when swelling of the abdomen and lower extremities is more prominent. The generalized edema may develop so slowly that parents consider it a sign of healthy growth. The disorder can occur as a primary disease, known as idiopathic nephrosis, childhood nephrosis, or minimal-change nephrotic syndrome

Spinal muscular atrophy type 1 (Werdnig-Hoffmann disease)

characterized by progressive weakness and wasting of skeletal muscles caused by degeneration of anterior horn cells of the spinal cord. In early infancy, spinal muscular atrophy may initially appear similar to infant botulism. Most affected children do not live past 3 to 4 years of age, and respiratory failure is the eventual outcome of this disorder.

female athlete triad

consists of amenorrhea, osteoporosis, and disordered eating. The phenomenon has been attributed to a complex interplay of physical, genetic, hormonal, nutritional, psychological, and environmental factors that include the stress of competition, decreased protein consumption, and altered lean-to-fat body ratio

Nursing care of the child with arthritis

consists of promoting general health, relieving pain and discomfort, preventing deformity, and preserving function

Clinical manifestations of CP

delayed gross motor development, altered motor performance, alterations of muscle tone and subsequent muscle contractures, abnormal posture, and associated disabilities such as seizures and sensory impairment

Hypopituitarism

diminished or deficient secretion of pituitary hormones

Care of the infant and child with myelomeningocele

directed toward protecting the meningeal sac, preventing infection and skin breakdown, observing for signs of urologic and bowel complications, promoting early parent-infant interaction, and planning appropriate interventions to optimize the child's development

signs and symptoms of brain tumors

directly related to their anatomic location and size and to some extent the child's age. For instance, in infants whose sutures are still open, a bulging fontanel indicates hydrocephalus. Head circumference measurements allow for detection of increased head size. Even in older children, clinical manifestations may be nonspecific. However, the most common symptoms of infratentorial brain tumors are headache, especially on awakening, and vomiting that is not related to feeding

Nursing care of the unconscious child focuses on :

ensuring respiratory management; performing neurologic assessment; monitoring ICP; supplying adequate nutrition and hydration; providing drug therapy; promoting elimination, hygienic care, proper positioning, exercise, and stimulation; and providing family support.

prime manifestation of ARF

oliguria, generally a urinary output of less than 1 ml/kg/hr.

adrenal cortex

secretes three important groups of hormones: glucocorticoids, mineralocorticoids, and sex steroids

• Nephrogenic diabetes insipidus (NDI)

the major disorder associated with a defect in the ability to concentrate urine. In this disorder, the distal tubules and collecting ducts are insensitive to the action of antidiuretic hormone or its exogenous counterpart, vasopressin. Although several inheritance patterns have been identified, more than 90% of patients have an X-linked defect of the vasopressin receptor. Therapy involves provision of adequate volumes of water to compensate for urinary losses and minimize urinary output through diet and medication.

Osteosarcoma (osteogenic sarcoma)

the most common bone cancer in children and most commonly affects patients in the second decade of life during their growth spurt. Optimum treatment of osteosarcoma includes surgery and chemotherapy.

• Lymphocytic thyroiditis (also known as Hashimoto disease or juvenile autoimmune thyroiditis)

the most common cause of thyroid disease in children. The enlarged thyroid gland is usually detected by the practitioner during a routine examination, although it may be noted by parents when the youngster swallows. In most children, the entire gland is enlarged symmetrically (though it may be asymmetric) and is firm, freely movable, and nontender

Febrile seizures

the most common type of childhood seizure. Long-term antiepileptic therapy is usually not required for children with simple febrile seizures

objectives in management of UTIs

to (1) eliminate the current infection, (2) identify contributing factors to reduce the risk of recurrence, (3) prevent urosepsis, and (4) preserve renal function.

Common inflammatory disorders of the genitourinary track

urinary tract infection (UTI), nephrotic syndrome, and acute glomerulonephritis.

renal replacement therapy, continuous venovenous hemofiltration

used primarily in acute care settings; This type of therapy uses specialized equipment (hemofilter, blood pump, tubing connected to a vascular access) to ultrafiltrate blood continuously at a very slow rate. With this procedure, fluid balance may be achieved within 24 to 48 hours after initiation. Continuous venovenous hemodialysis is used to remove excess fluid from patients with severe oliguric fluid overload.

• Chronic renal insufficiency or failure

when the diseased kidneys can no longer maintain the normal chemical structure of body fluids under normal conditions

common treatment for a simple, nondisplaced fracture

• Immobilization of the affected extremity with a synthetic cast

Meningitis can be caused by a variety of organisms, but the three main types are

(1) bacterial, or pyogenic, caused by pus-forming bacteria, especially meningococci, pneumococci, and group B streptococci; (2) viral, or aseptic, caused by a wide variety of viral agents; and (3) tuberculous, caused by the tuberculin bacillus. The majority of children with acute febrile encephalopathy have either bacterial meningitis or viral meningitis as the underlying cause

Three groups of children who should be evaluated for diabetes

(1) children who have glycosuria, polyuria, and a history of weight loss or failure to gain despite a voracious appetite; (2) those with transient or persistent glycosuria; and (3) those who display manifestations of metabolic acidosis, with or without stupor or coma

The broad aims of therapy for children with CP

(1) establish locomotion, communication, and self-help; (2) gain optimum appearance and integration of motor functions; (3) correct associated defects as early and effectively as possible; (4) provide educational opportunities adapted to the individual child's needs and capabilities; and (5) promote socialization experiences with other affected and unaffected children

The young child's response to head injury is different from older children and adults because:

: larger head size; expandable skull; larger blood volume to the brain; small subdural spaces; and thinner, softer brain tissue.