RICCI Peds Review Exam 2 - Chapter 44

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

A - B - C - D

Corticosteroids

ANTI-INFLAMMATORY

Benzodiazepines

ANTICONVULSANT

Oxybutynin

ANTISPASMODIC

Baclofen

CENTRAL ACTING SKELETAL MUSCLE RELAXANT

Kyphosis refers to excessive ____ curvature of the spine resulting in a hump back appearance

CONVEX

Atrophy is a ____ or wasting in size of a muscle

DECREASE

The ____ is where the ossification of new bone occurs

EPIPHYSIS

Decreased muscle tone is called ____

HYPOTONIA

Spasticity is _____ muscle contractions that are not coordinated with other muscles

INVOLUNTARY

What factors increase the risk of a fetus developing a neural tube defect?

LACK OF PRENATAL CARE; INSUFFICIENT INTAKE OF FOLIC ACID PRECONCEPTION AND / OR PRENATALLY; PREVIOUS HISTORY OR FAMILY HISTORY OF CHILD BORN WITH NEURAL TUBE DEFECT; CERTAIN DRUGS THAT ANTAGONIZE FOLIC ACID ABSORPTION (ANTICONVULSANTS)

The structural disorders of spina bifida occulta, meningocele, and myelomeningocele are all considered ____

NEURAL TUBE DEFECTS

Botulin toxin

NEUROTOXIN

Discuss the commonalities of the various forms of muscular dystrophy. What is the most common childhood type of muscular dystrophy?

NINE TYPES OF MD, DUCHENNE IS THE MOST COMMON CHILDHOOD TYPE. ALL TYPES RESULT IN PROGRESSIVE SKELETAL MUSCLE (VOLUNTARY) WASTING AND WEAKNESS. THERE ARE VARIOUS PATTERNS OF INHERITANCE AMONG THE VARIOUS TYPES OF MD.

Transient ____ of the hip is the most common cause of pain in children

SYNOVITIS

A nurse is caring for an 11-year old with an Illizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction? a. "Cleansing by showering should be sufficient" b. "You must clean the pin sites with saline" c. "The pin sites should be cleaned with antibacterial solution" d. "Please make sure that the pin site is cleansed with betadine swabs after showering"

a. "Cleansing by showering should be sufficient"

A young girl has been prescribed corticosteroids for dermatomyositis. Which statements by her mother indicated the need for further education? SELECT ALL THAT APPLY a. "I give it to her first thing the morning before breakfast" b. "We are taking her to Disney in the summer" c. "The physician said when it is time for her to stop taking this medication; he will gradually start reducing her dose" d. "She's got to take this medication to help with the calcium deposits that can form" e. "She might recover completely from this condition"

a. "I give it to her first thing the morning before breakfast" b. "We are taking her to Disney in the summer"

A young child is experiencing muscle spasms and has been given lorazepam. Which statements by the child indicates that the child may be experiencing some common side effects? SELECT ALL THAT APPLY a. "I sort of feel dizzy" b. "I need to take a nap" c. "My muscle cramps are getting worse" d. "I think I am going to throw up" e. "My belly hurts"

a. "I sort of feel dizzy" b. "I need to take a nap"

List and explain the four types of fractures seen in children.

a. BUCKLE - COMPRESSION INJURY b. GREENSTICK - INCOMPLETE FRACTURE c. COMPLETE - BONE BREAKS INTO SEPARATE PIECES d. PLASTIC / BOWING - NOT ACTUALLY A FRACTURE... BONE BENDS WITHOUT BREAK

The nurse is caring for a 5-year old with Guillain-Barre syndrome. Which would be the best way to assess the level of paralysis? a. Gentle tickling b. Observe for symmetrical flaccid weakness c. Monitor for ataxia d. Inquire about sensory disturbances

a. Gentle tickling

The nurse is conducting a physical examination of a 10-year old with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? a. Gowers sign b. Appearance of smaller than normal calf muscles c. Indications of hydrocephalus d. Lordosis

a. Gowers sign

A child has a meningocele and a neurogenic bladder. Which topics should the nurse include in the teaching plan when educating the child and the child's caregivers? SELECT ALL THAT APPLY a. How and when to administer oxybutynin chloride b. The importance of antibiotic use to prevent UTIs from occurring c. How and when to perform clean intermittent urinary catheterization d. Signs and symptoms of a UTI e. Different types of surgeries used to treat this condition

a. How and when to administer oxybutynin chloride c. How and when to perform clean intermittent urinary catheterization d. Signs and symptoms of a UTI e. Different types of surgeries used to treat this condition

The nurse is conducting a routine physical examination of a newborn to screen for DDH (Developmental Dysplasia of the Hip). The nurse correctly assesses the infant by placing the infant: a. In a prone position, noting asymmetry of the thigh or gluteal folds b. With both legs extended and observes the hip and knee joint relationship c. With both legs extended and observes the feet d. In a supine position with both legs extended and observes the tibia / fibula

a. In a prone position, noting asymmetry of the thigh or gluteal folds

A 5-year old child is in traction and at risk for impaired skin integrity due to pressure. Which intervention is most effective? a. Inspect the child's skin for rashes, redness, irritation, or pressure sores b. Apply lotion to dry skin c. Gently massage the child's back to stimulate circulation d. Keep the child's skin clean and dry

a. Inspect the child's skin for rashes, redness, irritation, or pressure sores

What are the four classifications of cerebral palsy? Which is the most common form? Which is the rarest?

a. SPASTIC - MOST COMMON b. ATHETOID (DYSKINETIC) c. ATAXIC - RAREST d. MIXED

The nurse is assessing a young boy who has been brought to the physician for mobility and balance issues by his parents. Which findings are positively associated with the presence of Duchenne muscular dystrophy? SELECT ALL THAT APPLY a. Serum creatine kinase levels are elevated b. An electromyogram demonstrates the problem is within the nerves, not the muscles c. A muscle biopsy shows an absence of dystrophin d. The child is unable to rise easily into a standing position when placed on the floor e. Genetic testing indicates the presence of a gene associated with spinal muscular atrophy

a. Serum creatine kinase levels are elevated b. An electromyogram demonstrates the problem is within the nerves, not the muscles d. The child is unable to rise easily into a standing position when placed on the floor

The nurse learns that her patient has been admitted with clinical manifestations associated with cholinergic crisis. Which findings are associated with this condition? SELECT ALL THAT APPLY a. The child exhibits diaphoresis b. The child's apical heart rate is 52 beats per minute c. The child's blood pressure is 172/94 d. The child is complaining that his muscles are very weak e. The child is drooling excessively

a. The child exhibits diaphoresis b. The child's apical heart rate is 52 beats per minute d. The child is complaining that his muscles are very weak e. The child is drooling excessively

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point? a. "The baby needs the harness for only 2-3 weeks" b. "It is important that the harness be worn continuously" c. "The harness does not hurt the baby" d. "Let me teach you how to make appropriate adjustments to the harness"

b. "It is important that the harness be worn continuously"

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching? a. "We must avoid causing depressions in the cast" b. "Pale, cool, or blue skin coloration is to be expected" c. "The casted arm must be kept still" d. "We need to be aware of odor or drainage from the cast"

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

A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching? a. "We much be careful to use latex-free catheters" b. "The very first step is to apply water-based lubricant to the catheter" c. "My son may someday learn how to do this for himself" d. "We need to soak the catheter in a vinegar and water solution daily"

b. "The very first step is to apply water-based lubricant to the catheter"

The nurse is conducting a wellness examination of a 6-month old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond? a. "This could be an indicator of spina bifida" b. "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look" c. "Dimpling, skin discoloration, and abnormal patches of hair are often indicators of spina bifida occulta" d. "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica"

b. "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look"

The nurse is taking the history of a 4-year old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year old sister on the playground. Which question should the nurse ask to elicit the most helpful information? a. "Has he achieved his developmental milestones on time?" b. "Would you please describe the weakness you are seeing in your son?" c. "Do you think he is simply fatigued?" d. "Has his pace of achieving milestones diminished?"

b. "Would you please describe the weakness you are seeing in your son?"

The nurse is providing presurgical care for a newborn with myelomeningocele. Which action is the central nursing PRIORITY? a. Maintain infants' body temperature b. Prevent rupture or leaking of cerebrospinal fluid c. Maintain infant in prone position d. Keep lesion free from fecal matter or urine

b. Prevent rupture or leaking of cerebrospinal fluid

A young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? SELECT ALL THAT APPLY a. The boy experiences mild pain when wiggling his toes b. The boy has a fever greater than 102F (38.9C) for the last 36 hours c. New drainage or seeping out from under the cast d. The outside of the cast got wet and had to be dried using a hair dryer e. The boys' toes are light blue and very swollen

b. The boy has a fever greater than 102F (38.9C) for the last 36 hours c. New drainage or seeping out from under the cast e. The boys' toes are light blue and very swollen

A child has been diagnosed with slipped capital femoral epiphysis. Which characteristics about the client are risk factors associated with the development of this condition? SELECT ALL THAT APPLY a. The child is notes to be underweight by the nurse b. The child is 13-years old c. The child is African American d. The child's parent states that the child has recently experienced a "growth spurt" e. The child is male

b. The child is 13-years old c. The child is African American d. The child's parent states that the child has recently experienced a "growth spurt" e. The child is male

The nurse is providing post-operative care for a boy who has undergone surgical correction for pectus excavatum. The nurse should emphasize which instruction to the child's parents? a. "Please watch for signs of infection" b. "Be sure to monitor his vital capacity" c. "Do not allow him to lie on either side" d. "Do not allow him to lie on his stomach"

c. "Do not allow him to lie on either side"

Anurse is caring for a 6-year-old boy with a fractured ulna. He is fearful about the casting process and is resisting treatment. How should the nurse respond? a. "The application of the cast will not hurt" b. "Would you like to pick out your favorite color?" c. "Look over there at the neon fish in the aquarium" d. "Will you please take this medication for pain?"

c. "Look over there at the neon fish in the aquarium"

A nurse is caring for a 13-year old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond? a. "You need to remain as active as possible and have a positive attitude" b. "There are many things you can do like crafts, computers of art" c. "There are a lot of kids with the same type of MD you have at the MDA support group" d. "You have to go to a support group; it will be very helpful"

c. "There are a lot of kids with the same type of MD you have at the MDA support group"

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? a. Leaking cerebrospinal fluid b. Increasing ICP c. Constipation and bladder dysfunction d. Increasing head circumference

c. Constipation and bladder dysfunction

A nurse is conducting a physical examination of an infant with suspected metatarsus adductus. Type 2 metatarsus adductus is indicated when the forefoot is: a. Inverted and turned slightly upward b. Flexible past neutral actively and passively c. Flexible passively past neutral but only to midline actively d. Rigid, does not correct to midline even with passive stretching

c. Flexible passively past neutral but only to midline actively

A nurse is caring for a 2-year old girl with cerebral palsy. The child is having difficulty with proper nutrition and is not gaining adequate weight. How can the nurse elicit additional information to establish a diagnosis? a. "Let's see if she is dehydrated and we'll assess her respiratory system" b. "Does she have difficulty swallowing or chewing?" c. "Does she like to feed herself or do you feed her?" d. "Let's offer her a snack now and you can tell me about her diet on a typical day"

d. "Let's offer her a snack now and you can tell me about her diet on a typical day"

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns? a. "There are simple noninvasive treatment options" b. "Your daughter will likely wear a Pavlik harness" c. "Don't worry; this is a relatively common diagnosis" d. "This is not your fault and we will help you with her care and treatment"

d. "This is not your fault and we will help you with her care and treatment"

The nurse is conducting a physical examination of a newborn with suspected Osteogenesis Imperfecta (OI). Which finding is common? a. Foot is drawn up and inward b. Sole of foot face backward c. Dimpled skin, hair in lumbar area d. Blue sclera

d. Blue sclera

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

d. Presence of Moro reflex

Labeling spinal inborn deformities

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