Peds Exam Neuro/Musculoskeletal

The nurse teaches parents to alert their healthcare provider about which adverse effect when a child receives valproic acid (Depakene) to control generalized seizures? a. Weight loss b. Bruising c. Anorexia d. Drowsiness

b. Bruising

. A child with a head injury sleeps unless aroused, and when aroused responds briefly before falling back to sleep. Which term corresponds to this childs level of consciousness? a. Disoriented b. Obtunded c. Lethargic d. Stuporous

b. Obtunded

A 6-year-old patient in skeletal traction for a femur fracture has pain and edema of the thigh and is febrile. The nurse should suspect which condition? a. Meningitis b. Crepitus c. Osteomyelitis d. Osteochondrosis

c. Osteomyelitis

A nurse is performing a Glasgow Coma Scale assessment. Which assessment should the nurse not include? a. Eye opening b. Verbal response c. Sensory response d. Motor response

c. Sensory response

A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports he will not stop crying even after taking Tylenol with codeine. He also will not straighten the fingers on his right arm. The nurse tells the mother to do which? a. Take him to the emergency department. b. Put ice on the injury. c. Avoid letting him get so tired. d. Wait another hour. If he is still crying, call back.

a. Take him to the emergency department.

In caring for a child with a compound fracture, what should the nurse carefully assess for? a. Infection b. Osteoarthritis c. Epiphyseal disruption d. Periosteum thickening

A. Infection

A nurse is teaching parents the difference between pediatric fractures and adult fractures. Which observation is true about pediatric fractures? a. They seldom are complete breaks. b. They are often compound fractures. c. They are often at the epiphyseal plate. d. They are often the result of decreased mobility of the bones.

A. They seldom complete breaks.

What should the nurse teach parents when the child is taking phenytoin (Dilantin) to control seizures? a. The child should use a soft toothbrush and floss his teeth after every meal. b. The child will require monitoring of his liver function while taking this medication. c. Dilantin should be taken with food because it causes gastrointestinal distress. d. The medication can be stopped when the child has been seizure free for 1 month.

a. The child should use a soft toothbrush and floss his teeth after every meal.

When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from: a. automobile accidents. b. falls. c. physical abuse. d. sports injuries.

B. Falls

What is a realistic outcome for the child with osteogenesis imperfecta? a. The child will have a decreased number of fractures. b. The child will demonstrate normal growth patterns. c. The child will participate in contact sports. d. The child will have no fractures after infancy.

a. The child will have a decreased number of fractures.

Which is an accurate statement concerning a Childs musculoskeletal system and how it may be different from adults? a. Growth occurs in children as a result of an increase in the number of muscle fibers. b. Infants are at greater risk for fractures because their epiphyseal plates are not fused. c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. d. Their bones have less blood flow.

C -Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.

2. When infants are seen for fractures, which nursing intervention is a priority? a. No intervention is necessary. It is not uncommon for infants to fracture bones. b. Assess the family's safety practices. Fractures in infants usually result from falls. c. Assess for child abuse. Fractures in infants are often nonaccidental. d. Assess for genetic factors.d. Osgood-Schlatter disease.

C- Asses for child abuse. Fractures in infants are often nonaccidental.

Which nursing assessment is appropriate for determining neurovascular competency? a. Degree of motion and ability to position the extremity b. Length, diameter, and shape of the extremity c. Amount of swelling noted in the extremity and pain intensity d. Skin color, temperature, movement, sensation, and capillary refill of the extremity

D.Skin color, temperature, movement, sensation, and capillary refill of the extremity

A mother reports that her child has episodes in which he appears to be staring into space. This behavior is characteristic of which type of seizure? a. Absence b. Atonic c. Tonic-clonic d. Simple partial

a. Absence

Which finding in an analysis of cerebrospinal fluid (CSF) is consistent with a diagnosis of bacterial meningitis? a. CSF appears cloudy. b. CSF pressure is decreased. c. Few leukocytes are present. d. Glucose level is increased compared with blood.

a. CSF appears cloudy.

When assessing the child with osteogenesis imperfecta, the nurse should expect to make which observation? a. Discolored teeth b. Below-normal intelligence c. Increased muscle tone d. Above-average stature

a. Discolored teeth

A nurse should expect which cerebral spinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis? Select all that apply. a. Elevated white blood count (WBC). b. Decreased protein c. Decreased glucose d. Cloudy in color e. Increase in red blood cells (RBC).

a. Elevated white blood count (WBC). c. Decreased glucose d. Cloudy in color

A nurse is assessing a 1-year-old child for increased intracranial pressure (ICP). Which sign should the nurse assess for with this age of child? a. Headache b. Bulging fontanel c. Tachypnea d. Increase in head circumference

a. Headache

When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with an observable distended scalp vein, the nurse recognizes these signs as indicative of which condition? a. Hydrocephalus b. SIADH (syndrome of inappropriate antidiuretic hormone) c. Cerebral palsy d. Reyes syndrome

a. Hydrocephalus

Which statement made by the mother of an adolescent being discharged after spinal fusion for severe scoliosis indicates the need for further teaching? a. I am glad we chose surgery. Now it is all over and done. b. Ill see you in a month; well be back fairly regularly. c. I have to pick up some more T-shirts on the way home. d. Those exercises the physical therapist showed us were not too hard.

a. I am glad we chose surgery. Now it is all over and done.

A child with osteomyelitis asks the nurse, What is a sed rate? What is the best response for the nurse? a. It tells us how you are responding to the treatment. b. It tells us what type of antibiotic you need. c. It tells us whether we need to immobilize your extremity. d. It tells us how your nerves and muscles are doing.

a. It tells us how you are responding to treatment.

A child with spina bifida is being admitted to the hospital for a shunt revision? The nurse admitting the child anticipates which type of precautions to be ordered for the child? a. Latex b. Bleeding c. Seizure d. Isolation

a. Latex

The nurse knows that treatment of Osgood-Schlatter disease includes which intervention? a. Limitation of knee bending or kneeling b. Increasing range of motion (ROM) of the knee c. Encouraging flexion of the hip d. Limitation of adduction of the hip

a. Limitation of knee bending or kneeling

What is the most appropriate intervention for an adolescent with a mild scoliosis? a. Long-term monitoring b. Surgical intervention c. Bracing d. No follow-up

a. Long-term monitoring

Which nursing intervention is a priority when caring for a child in a Pavlik harness? a. Skin care b. Bowel function c. Feeding patterns d. Respiratory function

a. Skin care

The nurse should expect a child who has frequent tension-type headaches to describe his headache pain with which statement? a. There is a rubber band squeezing my head. b. Its a throbbing pain over my left eye. c. My headaches are worse in the morning and get better later in the day. d. I have a stomachache and a headache at the same time.

a. There is a rubber band squeezing my head

The nurse should give a child who is to have magnetic resonance imaging (MRI) of the brain which information? a. Your head will be restrained. b. You will have to drink a special fluid before the test. c. You will have to lie flat after the test is finished. d. You will have electrodes placed on your head with glue.

a. Your head will be restrained.

The major concern guiding treatment for the child with Legg-Calv-Perthes disease is to: a. avoid permanent deformity. b. minimize pain. c. maintain normal activities. d. encourage new hobbies.

a. avoid permanent deformity.

The nurse caring for a child with Osgood-Schlatter disease should evaluate the childs: a. knowledge of activity restrictions. b. understanding of traction. c. acceptance of life-long limitations. d. knowledge of skin care.

a. knowledge of activity restrictions.

Discharge planning for the child with juvenile arthritis includes the need for: a. routine ophthalmological examinations to assess for visual problems. b. a low-calorie diet to decrease or control weight in the less mobile child. c. avoiding the use of aspirin to decrease gastric irritation. d. immobilizing the painful joints, which is the result of the inflammatory process.

a. routine ophthalmological examinations to assess for visual problems.

Which intervention is part of the discharge plan for a child with osteomyelitis? a. Instructions for a low-calorie diet b. A referral to a home healthcare agency c. Instructions for a high-fat, low-protein diet d. Instructions for the parent to return the child to team sports immediately

b. A referral to a home healthcare agency

Which statement made by the parent of a 6-month-old infant undergoing serial casting for treatment of clubfoot indicates the parent is correctly following the treatment plan? a. I am careful to leave him in his bed with his leg elevated as much as possible. b. I monitor the temperature of his foot often to make sure that the cast still fits. c. Its okay that hes not trying to roll over; hell catch up later. d. Its okay if the cast gets wet during baths because it will be changed often.

b. I monitor the temperature of his foot often to make sure that the cast still fits.

Juvenile arthritis should be suspected in a child who exhibits which symptom? a. Frequent fractures b. Joint swelling and pain lasting longer than 6 weeks c. Increased joint mobility d. Lurching and abnormal gait, limited abduction

b. Joint swelling and pain lasting longer than 6 weeks

After a tonic-clonic seizure, it would not be unusual for a child to display which symptom? a. Irritability and hunger b. Lethargy and confusion c. Nausea and vomiting d. Nervousness and excitability

b. Lethargy and confusion

During painful episodes of juvenile arthritis, a plan of care should include which nursing intervention? a. A weight-control diet to decrease stress on the joints b. Proper positioning of the affected joints to prevent musculoskeletal complications c. Complete bed rest to decrease stress to joints d. High-resistance exercises to maintain muscular tone in the affected joints

b. Proper positioning of the affected joints to prevent musculoskeletal complications

hat should be the nurses first action when a child with a head injury complains of double vision and a headache and then vomits? a. Immobilize the childs neck. b. Report this information to the physician. c. Darken the room and put a cool cloth on the childs forehead. d. Restrict the childs oral fluid intake.

b. Report this information to the physician.

What is the priority nursing intervention for the child with ascending paralysis as a result of Guillain-Barr syndrome (GBS)? a. Immunosuppressive medications b. Respiratory assessment c. Passive range-of-motion exercises d. Anticoagulant therapy

b. Respiratory assessment

A child is admitted to the hospital with spastic cerebral palsy. The nurse will assess for which manifestations associated with this disorder? a. Tremulous movements at rest and with activity b. Sudden jerking movement caused by stimuli c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements

b. Sudden jerking movement caused by stimuli

. Which factor should the nurse include when teaching a parent about the care of a child in a Pavlik harness for hip dysplasia? a. The harness may be removed with every diaper change. b. The harness is used to maintain the infants hips in flexion and abduction and external rotation. c. The harness is only the first step of treatment. d. The harness is worn for only 2 weeks.

b. The harness is used to maintain the infants hips in flexion and abduction and external rotation.

What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure? a. Guide the child to the floor if he is standing and go for help. b. Turn the Childs body on his side. c. Place a padded tongue blade between the teeth. d. Quickly slip soft restraints on the Childs wrists.

b. Turn the Childs body on his side.

During a well-child visit, the nurse identifies that an 18-month-old infant is bow legged. The nurse is aware that this assessment is: a. common in children between the ages of 2 and 7 years. b. a common variation until 1 year after walking begins. c. a serious condition needing further evaluation. d. an indication of neurological impairment.

b. a common variation until 1 year after walking begins.

A child who has fractured his forearm is unable to extend his fingers. The nurse knows that this: a. is normal following this type of injury. b. may indicate compartmental syndrome. c. may indicate fat embolism. d. may indicate damage to the epiphyseal plate.

b. may indicate compartmental syndrome.

Which would be an appropriate nursing intervention for the child with a tension headache? a. Assess for an aura. b. Maintain complete bed rest. c. Administer pharmacological headache relief measures. d. Assess for nausea and vomiting.

c. Administer pharmacological headache relief measures

When teaching care for a child immobilized in a spica cast, which is the most appropriate intervention? a. Application of talcum powder to the skin twice daily b. Fluid restriction to prevent loose stools or diarrhea c. Assessment for a sluggish capillary refill d. Instructing that insertion of small objects into the cast for itching or discomfort is helpful

c. Assessment for a sluggish capillary refill

The teaching plan for the child with structural disorders of the bones and joints, such as developmental dysphasia of the hip, should include which instruction? a. Importance of limiting physical activity to decrease the chance of injury b. Need for long-term hospitalization to ensure adequate treatment c. Importance of follow-up until the child reaches skeletal maturity d. Importance of avoiding child-resistant devices, as these can exacerbate the condition

c. Importance of follow-up until the child reaches skeletal maturity

Which assessment noted in an infant 1 day after placement of a ventriculoperitoneal shunt is indicative of surgical complications? a. Hypoactive bowel sounds b. Congestion in upper airways c. Increasing lethargy d. Mild incisional pain

c. Increasing lethargy

Nursing care of the infant who has had a myelomeningocele repair should include which intervention? a. Securely fastening the diaper b. Measurement of pupil size c. Measurement of head circumference d. Administration of seizure medications

c. Measurement of head circumference

What is the best response to a father who tells the nurse that his son daydreams at home and his teacher has observed this behavior at school? a. Your son must have an active imagination. b. Can you tell me exactly how many times this occurs in one day? c. Tell me about your sons activity when you notice the daydreams. d. He is probably getting tired and needs a rest.

c. Tell me about your sons activity when you notice the daydreams.

Which factor is important to include in the teaching plan for parents of a child with Legg-Calv-Perthes disease? a. It is a chronic disease with long-term sequelae. b. It affects children in the toddler stage. c. There is a disturbance in the blood supply to the femoral epiphysis. d. It is caused by a virus.

c. There is a disturbance in the blood supply to the femoral epiphysis.

Which interventions should the nurse perform if a child is having a tonic-clonic seizure? Select all that apply. a. Place a padded tongue blade in the childs mouth. b. Place the child in a supine position. c. Time the seizure. d. Restrain the child. e. Stay with the child. f. Loosen the childs clothing.

c. Time the seizure. e. Stay with the child. f. Loosen the childs clothing.

When providing education for the parents of a child with Duchenne muscular dystrophy, the nurse plans to include: a. testing all female children for the disease. b. testing the father for the presence of the trait on the Y chromosome. c. genetic counseling for all female relatives. d. testing the parents to determine the carrier.

c. genetic counseling for all female relatives.

A 4-year-old child with a long leg cast complains of fire in his cast. The nurse should: a. notify the physician on his next rounds. b. chart the complaint in the nurses notes. c. notify the physician immediately. d. report the complaint to the next nurse on duty.

c. notify the physician immediately.

Which change in vital signs should alert the nurse to increased intracranial pressure (ICP) in a child with a head injury? a. Rapid, shallow breathing b. Irregular, rapid heart rate c. Increased diastolic pressure with narrowing pulse pressure d. Confusion and altered mental status

d. Confusion and altered mental status

A nurse is explaining to parents how the central nervous system of a child differs from that of an adult. Which statement accurately describes these differences? a. The infant has 150 milliliters of cerebrospinal fluid compared with 50 milliliters in the adult. b. Papilledema is a common manifestation of increased intracranial pressure in the very young child. c. The brain of a term infant weighs less than half of the weight of the adult brain. d. Coordination and fine motor skills develop as myelinization of peripheral nerves progresses.

d. Coordination and fine motor skills develop as myelinization of peripheral nerves progresses.

Patient and parent education for the child who has a synthetic cast should include which information? a. Apply a heating pad to the cast if the child has swelling in the affected extremity. b. Wrap the outer surface of the cast with an Ace bandage. c. Split the cast if the child complains of numbness or pain. d. Cover the cast with plastic and waterproof tape to keep it dry while bathing or showering.

d. Cover the cast with plastic and waterproof tape to keep it dry while bathing or showering.

Which statement made by an adolescent indicates an understanding about factors that can trigger migraine headaches? a. I should avoid loud noises because this is a common migraine trigger. b. Exercise can cause a migraine. I guess I wont have to take gym anymore. c. I think Ill get a migraine if I go to bed at 9 PM on week nights. d. I am learning to relax because I get headaches when I am worried about stuff.

d. I am learning to relax because I get headaches when I am worried about stuff.

A child is brought to the emergency department in generalized tonic-clonic status epilepticus. Which medication should the nurse expect to be given initially in this situation? a. Clorazepate dipotassium (Tranxene) b. Fosphenytoin (Cerebyx) c. Phenobarbital d. Lorazepam (Ativan)

d. Lorazepam (Ativan)

During a 14-year-old adolescents physical examination, the nurse identifies that he plays soccer and football and is complaining of knee pain when he rises from a squatting position. The nurse should suspect: a. Legg-Calv-Perthes disease. b. osteomyelitis. c. Duchenne muscular dystrophy. d. Osgood-Schlatter disease.

d. Osgood-Schlatter disease.

A nurse understands that which type of exercise would be best for a child with juvenile arthritis? a. Jogging b. Tennis c. Gymnastics d. Swimming in a heated pool

d. Swimming in a heated pool

Which statement is most correct with regard to childhood musculoskeletal injuries? a. After the injury is iced, the swelling decreases, indicating the injury is not severe. b. The presence of localized tenderness indicates a more serious injury. c. The more swelling there is, the less severe the injury is. d. The less willing the child is to bear weight, the more serious the injury is

d. The less willing the child is to bear weight, the more serious the injury is.

What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? a. One of the parents carries a defective gene that causes myelomeningocele. b. A deficiency in folic acid in the father is the most likely cause. c. Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele. d. There may be no definitive cause identified.

d. There may be no definitive cause identified.

How should the nurse explain positioning for a lumbar puncture to a 5-year-old child? a. You will be on your knees with your head down on the table. b. You will be able to sit up with your chin against your chest. c. You will be on your side with the head of your bed slightly raised. d. You will lie on your side and bend your knees so that they touch your chin.

d. You will lie on your side and bend your knees so that they touch your chin.

When teaching the parents of a child with osteogenesis imperfecta about nutrition, the nurse should emphasize a diet that is: a. high in protein. b. high in calories. c. low in fiber. d. high in calcium.

d. high in calcium

When instructing parents about the care of an infant in a cast for a clubfoot, the nurse should include: a. reassurance that clubfoot usually resolves spontaneously. b. instructions on washing the cast daily to keep it clean. c. the importance of analogous blood donations for impending surgery. d. notifying the physician of any vascular problems, such as toe swelling.

d. notifying the physician of any vascular problems, such as toe swelling