Unit 32: Pediatric Musculoskeletal, Neuromuscular, Neurocognitive Disorders/Cognitive Impairment

The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply? a. "It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." b. "The contents of the sac you see only has fluid in it and should cause the child no problem." c. "Your child's defect involves only the nerves to the bladder and bowel and can be easily repaired." d. "The sac is a very small cyst and should resolve within the first year of life."

a. "It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year.

The nurse is caring for a child who has just received a cast for a broken wrist. The parents ask, "Why do we need to keep the arm up on a pillow?" Which response by the nurse is appropriate? a. "Keeping the arm raised helps to lessen the swelling." b. "Using a pillow helps to promote healing." c. "There is less chance of infection when the arm is kept elevated." d. "Positioning the arm like upward helps to make sure the bones stay aligned."

a. "Keeping the arm raised helps to lessen the swelling." If an extremity has been casted, the client should keep it elevated with a pillow to prevent edema in the fractured area. Elevating a casted extremity does not promote healing or discourage infection. The cast will ensure proper bone alignment.

The nurse is administering nevirapine to an adolescent client diagnosed with HIV. The client asks the nurse how this medication helps fight HIV. How should the nurse respond? a. "The medication disrupts the virus life cycle of HIV. This prevents the disease from progressing." b. "This medication prevents infection from occurring in your body." c. "This medication boosts your immune system so you don't get infections." d. "This medication is an anti-inflammatory drug that will help you feel better."

a. "The medication disrupts the virus life cycle of HIV. This prevents the disease from progressing." Nevirapine is a nonnucleoside analog reverse transcriptase inhibitor (NNRTIs) that binds to HIV-1 reverse transcriptase, blocking DNA polymerase activity and disrupting the virus life cycle. It's used for treatment of HIV-1 infection as part of a three-drug regimen.

The parents of a child with physical and developmental special needs state, "We wish our child could get some kind of educational experience." How should the nurse respond? a. "This must be difficult for you. Let's talk with the social worker to see what programs are available for your child." b. "I am sure it must be difficult to know that your child will never be able to go to school like other children." c. "Since all children can attend school regardless of their special need, I suggest you talk with your local school about enrolling your child." d. "It would be very difficult for your child to attend school with all of his disabilities. It's unfortunate, but it is reality."

a. "This must be difficult for you. Let's talk with the social worker to see what programs are available for your child." Education is federally mandated. Contacting the social worker gives the parents the support they need to find and choose the appropriate school. Telling them to contact their local school is not supportive of the parent's needs.

The nurse is providing education to the parents of a child with spinal muscular atrophy (SMA) regarding the use of chest physiotherapy. Which statement by the parents indicates an understanding of the teaching? a. "This will help facilitate drainage and airway clearance." b. "This will allow our child to maintain an upright sitting position." c. "This will help strengthen the swallowing muscles." d. "This will slow the progression of the curvature of the spine."

a. "This will help facilitate drainage and airway clearance." The statement, "This will help facilitate drainage and airway clearance," indicates an understanding of the purpose of chest physiotherapy, which includes percussion, vibration, and positioning. The statement, "This will allow our child to maintain an upright sitting position," describes the purpose of rigid trunk braces that can be used to support a sitting position, but not chest physiotherapy. Although children with SMA often have difficulty swallowing, "This will help strengthen the swallowing muscles," is not a statement that indicates an understanding of chest physiotherapy, as the focus of the therapy is on respiratory function. Similarly, children with SMA frequently have scoliosis, which is fixed by surgical correction, and not with chest physiotherapy. Therefore, "This will slow the progression of the curvature of the spine," is not a statement that indicates understanding of the teaching.

A nurse is discussing genetic screening with a client who gave birth yesterday. Which statement by the nurse best explains the reason for genetic screening? a. "This will help to detect for possible inborn errors of metabolism such as phenylketonuria (PKU)." b. "Genetic screening helps identify diseases your newborn may contract during the first few days of life." c. "Screening provides us with information to select an immunization schedule that is best for your newborn." d. "Screening is a mandated procedure that is unable to be refused, but it will not harm you or your newborn."

a. "This will help to detect for possible inborn errors of metabolism such as phenylketonuria (PKU)." Newborn screening is required for all infants to help detect for PKU. Genetic screening does not relate to diseases the newborn may contract and it does not alter the immunization schedule. It is true that screening is mandated, but this does not answer the reason for genetic screening.

A nurse is teaching about autosomal dominant and recessive genetics. Which statement by the nurse is accurate? a. "Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." b. "An autosomal dominant disorder has a lower risk of phenotyping than an autosomal recessive disorder." c. "One abnormal autosomal recessive gene is needed for outward presentation of the disorder." d. "An autosomal dominant disorder is classified as X-linked."

a. "Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." An autosomal recessive disorder requires two abnormal genes to outwardly express the disorder. Recessive disorders have a lower risk of phenotyping than dominant disorders. X-linked and autosomal disorders are two different classifications.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which of the following instructions would be most important to emphasize to the boy and his parents? a. "You and your coaches need to understand that you cannot play soccer for at least 6 weeks." b. "Ice will help reduce the inflammation." c. "You will need to see a physical therapist for stretching and strengthening exercises." d. "NSAIDS can help with pain control and inflammation."

a. "You and your coaches need to understand that you cannot play soccer for at least 6 weeks." A child with an overuse injury needs to avoid the causative activity for six to eight weeks. Although ice, seeing a physical therapist, and NSAIDs are also important, the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or primary health care provider to help the parent avoid undue pressure from coaches. The child and family need a discussion of realistic expectations about the treatment plan.

Which client will the nurse assess first after receiving shift report? a. A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) b. A client with serum sickness stating, "I just feel bad all over." c. A client newly diagnosed with allergic rhinitis prescribed loratadine 10 mg d. A client with contact dermatitis who has blisters and mild edema on the lower extremities

a. A client with human immunodeficiency virus (HIV) whose temperature is 102.2°F (39°C) Of the immunologic disorders, HIV infection is the most serious. This client is also exhibiting an unexpected manifestation, which could indicate an infection. The clients with serum sickness and dermatitis are exhibiting expected findings and would be seen last. The client newly diagnosed needs to be seen second to have the medication started and receive education.

Maria is a 9-month-old whose babysitter brings her to the emergency department. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. Which of the following would be most appropriate for the nurse to do? a. Arrange for the parents to come in for an evaluation for possible physical abuse. b. Evaluate the child for an underlying musculoskeletal disorder. c. Call social services to find the parents and evaluate them for child abuse. d. Ask the babysitter to advocate for the child and report the incident to the authorities.

a. Arrange for the parents to come in for an evaluation for possible physical abuse. A child younger than age 1 year who presents with a fracture should be evaluated for possible physical abuse. The parents should be contacted first, and the family should undergo an evaluation for possible physical abuse because femoral fractures in nonambulating infants, particularly spiral fractures, are believed to be highly specific for inflicted injury. If physical abuse is not found, the infant should be evaluated for an underlying musculoskeletal disorder.

The nurse is assisting with skin testing for allergies in a pediatric client. What will the nurse do to ensure the results are accurate? a. Be certain the child has not received an antihistamine in the past 8 hours b. Read the test results within 40 minutes of administration. c. Inject the allergens into the muscle of the child's forearm. d. Apply a topical diphenhydramine cream to the site following each injection.

a. Be certain the child has not received an antihistamine in the past 8 hours Skin testing is done to detect the presence of IgE in the skin, or to isolate an antigen (allergen) to which the IgE is responding or to which a child is sensitive. When an allergen is introduced into the child's skin and the child is sensitive to that allergen, a wheal or flare response will appear at the site of the test from the release of histamine, which leads to local vasodilation. Because this reaction appears quickly, the test should be read in 20 minutes, not 40 minutes. Systemic or aerosol administration of an antihistamine will inhibit the flare response, so the nurse must be certain the child has not received these drugs for 8 hours before skin testing. Applying a diphenhydramine cream would interfere with the results. Diphenhydramine is an antihistamine medication and should be avoided up to 10 days prior to the procedure.

The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply. a. Document any signs of pain. b. Check capillary refill time in the both arms. c. Monitor the color of the nail beds in the right hand. d. Wear a protective gown when moving the child's arm. e. Wear sterile gloves when removing or touching the cast.

a. Document any signs of pain. b. Check capillary refill time in the both arms. c. Monitor the color of the nail beds in the right hand. The most important function for the nurse in caring for a child in a cast is frequent neurovascular checks. The nurse should monitor for increased pain and edema, a pale or blue color to the extremities, skin coolness, numbness or tingling, poor capillary refill, and decreased pulse strength. Increased pain, especially unrelieved with pain medications, can indicate serious complications such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary as the cast is not sterile.

Which interventions will the nurse include when caring for a child with an infectious disorder? Select all that apply. a. Ensure immunization status is current. b. Administer antibiotics for all infections. c. Use appropriate personal protective equipment. d. Provide information about disease transmission. e. Educate the child and family about infection control.

a. Ensure immunization status is current. c. Use appropriate personal protective equipment. d. Provide information about disease transmission. e. Educate the child and family about infection control. Nursing interventions for care of children with infectious disorders center around preventing disease through immunization and preventing further spread by practicing good infection control measures. Educating parents about infection control measures and teaching them about how the particular infectious agent is spread remains critical to preventing the spread of disease once the child leaves the hospital. Although antibiotics are used for bacterial infections, antibiotics are not needed for other types of infections (viral, fungal, etc.).

The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? a. Ensure traction weights are hanging freely, not touching the bed or floor. b. Remove traction weights once per shift for 30 minutes and then replace them. c. Plan to add additional weights as the fracture heals, usually once per day. d. Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed.

a. Ensure traction weights are hanging freely, not touching the bed or floor. Traction is used as a pulling force on an extremity or body part. For it to be effective, the weights need to hang freely at all times and the ropes need to remain in the pulley grooves. The weights are not replaced or removed during traction. The child can move all extremities except the affected one(s). The child remains in traction until healing occurs, a cast is applied, or surgical repair is performed.

The nurse is assessing the moro reflex of a 3-month-old infant. What action will the nurse perform? a. Gently lift the infant off the bed by the arms, and let go when the shoulders are off the bed. b. With the infant supine and calm, turn the infant's head to one side. c. With the infant prone, stroke along the spine on one side. d. Place a finger in the palm of the infant's hand.

a. Gently lift the infant off the bed by the arms, and let go when the shoulders are off the bed. The nurse should start with the infant supine, then gently lift the infant off the bed by the arms. When the shoulders are off the bed but the majority of the head is still on the bed, the nurse should let go of the arms. The infant should "startle," with arms flaring outward and abducting. Turning the infant's head to one side with the infant supine and calm tests the infant's asymmetric tonic neck reflex. Stroking the spine along one side with the infant prone tests the trunk incurvation reflex. Placing a finger in the palm of the infant's hand tests the palmar grasp reflex.

A child has just been received into the clinic, and the nurse is assigned to her care. The physician determines that the child has a broken left radius, and the arm is placed in a short cast. The nurse should give the mother which of the following instructions to care for the child's cast properly? Select all that apply. a. Handle the cast only with the open palms as it dries. b. Check the child's hand function by moving the fingers and extending the thumb. c. Use a padded hanger to scratch inside the cast if itching. d. Check to see whether the fingers are warm to the touch. e. Report a foul odor around the cast.

a. Handle the cast only with the open palms as it dries. b. Check the child's hand function by moving the fingers and extending the thumb. d. Check to see whether the fingers are warm to the touch. e. Report a foul odor around the cast. Nothing should be placed inside the cast. The other selections are appropriate to teach the mother.

The nurse is educating parents of an toddler with Down syndrome. What would the nurse include in the teaching plan? a. Have the child's thyroid function tested regularly. b. Use a heating pad if the child reports neck pain. c. The child should be meeting milestones the same as typical peers. d. Plan to see a dentist when the child is in preschool to screen for extra teeth eruptions.

a. Have the child's thyroid function tested regularly. Children with Down syndrome are at risk for thyroid dysfunction (either high or low functioning) and should have routine thyroid screening completed. Neck pain in a child with Down syndrome may be a sign of atlantoaxial instability and the health care provider should be notified immediately. Milestones are met in the same order as typical children but may be delayed. Children with Down syndrome should be seen by a dentist due to the risk of delayed teeth eruption or hypodontia.

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective? a. Inspect the child's skin for rashes, redness, irritation, or pressure injuries. b. Assess neurovascular status on the affected extremity once every shift. c. Gently massage the child's back to stimulate circulation. d. Keep the child's skin distal to the traction clean and dry.

a. Inspect the child's skin for rashes, redness, irritation, or pressure injuries. It is important to be vigilant in inspecting the child's skin for rashes, redness, and irritation to uncover areas where pressure injuries are likely to develop. Applying lotion, gentle massage, and keeping the skin dry and clean are part of the routine skincare regimen. However, performing these interventions without first performing a skin assessment can cause the nurse to miss important signs that can potentially result in more injury to the child. Neurovascular assessment should be performed frequently as prescribed by the health care provider or at least every 4 hours to evaluate skin integrity and venous circulation.

The child is recovering from multiple leg fractures in Buck extension traction and reports pain out of proportion to the injury. The child's parent reports that the pain is unrelieved by the opioid treatment. Which action will the nurse perform first? a. Notify the health care provider. b. Increase the elevation of the affected limb. c. Administer an additional dose of opioids as prescribed. d. Remove the limb from the traction apparatus.

a. Notify the health care provider. The nurse will notify the health care provider first, because pain out of proportion to the injury which is unrelieved by opioids is often the first and cardinal sign of compartment syndrome, a medical emergency. Adjusting the position of the limb, additional opioid therapy, and removing the limb from the traction device may be performed later in the child's plan of care.

The nurse is assessing the vestibulocochlear nerve function of an infant. How will the nurse proceed with the assessment? a. Observe the infant's ability to startle to loud noises. b. Check hearing by rubbing fingers together near the infant's ears. c. Observe the strength and quality of the infant's cry. d. Evaluate for the presence of the gag reflex.

a. Observe the infant's ability to startle to loud noises. The nurse will observe the infant's ability to startle to loud noises as part of assessing the vestibulocochlear nerve function of an infant. Checking the hearing by rubbing the fingers together near the infant's ears is part of assessing the vestibulocochlear nerve function in an adult. Observing the strength and quality of the infant's cry, and evaluating for the presence of the gag reflex, are part of assessing the vagus nerve function.

The nurse is caring for a newborn with spina bifida and a myelomeningocele who was born approximately 1 hour ago. What action will the nurse anticipate in the plan of care for the child? a. Prepare the infant for spinal surgery. b. Assess the infant for Gower sign. c. Administer IV furosemide as prescribed. d. Monitor for signs of autonomic dysreflexia.

a. Prepare the infant for spinal surgery. The nurse will anticipate preparing the infant for spinal surgery, because this is typically done for newborns with spina bifida within 24 to 36 hours of birth. Gower sign is a finding associated with muscular dystrophy, and furosemide may be given to treat cardiac dysfunction in a child with muscular dystrophy. Autonomic dysreflexia is a complication of spinal cord injury.

The nurse is caring for a 3-year-old child with muscular dystrophy who has a respiratory infection and is on mechanical ventilation. What intervention(s) will the nurse take to maintain effective ventilation for the child? Select all that apply. a. Provide frequent suctioning as needed. b. Perform frequent mouth care. c. Secure tubing and airway devices. d. Keep the bed flat. e. Avoid repositioning.

a. Provide frequent suctioning as needed. b. Perform frequent mouth care. c. Secure tubing and airway devices. The nurse will provide frequent suctioning as needed to address excessive production of mucus and other secretions. Frequent mouth care will be performed to reduce the risk of ventilator-associated pneumonia and mucosal breakdown. The nurse will secure the tubing and airway devices to avoid accidental removal or disconnection by the child. Keeping the bed flat does not support ventilation for the child. The nurse should frequently reposition the child to avoid pressure injury.

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. Which of the following would the nurse do next? a. Reposition the child's foot on a pressure-reducing device. b. Apply lotion to his foot and avoid friction to the area. c. Make sure the skin and linens are clean and dry. d. Turn the child regularly.

a. Reposition the child's foot on a pressure-reducing device. The nurse's first action is to remove continuous pressure from this area. Applying lotion, avoiding friction, keeping the skin and linens clean and dry and turning the child regularly can help decrease potential for skin breakdown, but the pressure must be relieved first.

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention? a. Reposition the child's foot on a pressure-reducing device. b. Apply lotion to his foot and avoid friction to the area. c. Make sure the skin and linens are clean and dry. d. Gently massage his foot and heel each shift.

a. Reposition the child's foot on a pressure-reducing device. The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first.

The student nurse is studying the genetics of clients who are seeking assistance from a genetic counseling center. The student nurse notes monogenic disorders have which characteristic? a. The disorders are considered single-gene. b. The disorders are considered multifactorial inheritance. c. The disorders are considered nontraditional inheritance patterns. d. The disorders are considered mitochondrial inheritance patterns.

a. The disorders are considered single-gene. Principles of inheritance of single-gene disorders are the same that govern the inheritance of other traits, such as eye and hair color. These patterns occur because a single gene is defective and the disorders that result are referred to as monogenic disorders (sometimes referred to as Mendelian disorders).

While examining a 4-year-old child, the nurse notes a decrease in hip motion that causes pain upon movement. The nurse interprets this finding as indicating Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. a. True b. False

a. True Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 850 children in northern Europe and the United States, occurring four times more often in males.

In the newborn nursery, the nurse assesses a newborn and sees the ears are low-set. What action will the nurse take first? a. assess for additional anomalies b. document the findings c. report the finding to the health care provider d. check the family history for genetic conditions

a. assess for additional anomalies Low-set ears are considered a minor anomaly, but if they are present, the nurse should further assess for additional anomalies. Low-set ears are associated with numerous genetic dysmorphisms. The nurse could assess for overlapping digits, syndactyly, a flat occiput, hemangioma, nevi, and ear lobe creases. The number of minor anomalies found increases the likelihood of a major anomaly. If three or more minor anomalies are found, the chances of a major anomaly or cognitive impairment increases 19% to 26%. The nurse should thoroughly assess the newborn first for all anomalies, then document the findings and report them to the health care provider. The family history could provide clues as to why the newborn has the assessment findings, but exploring this history is not as imperative as conducting a thorough assessment.

A nurse is talking to parents whose children have immune disorders. What does the nurse identify as causing dysfunction of the immune system? Select all that apply. a. congenital problems b. not eating a proper diet c. secondary complication from a viral invasion d. exposure to a toxic substance e. being underweight

a. congenital problems c. secondary complication from a viral invasion d. exposure to a toxic substance When any portion of the immune system is not functioning adequately, an immunodeficiency results. The immunodeficiency disorder may be primary (congenital) or acquired (secondary to viral invasion or exposure to a toxic substance).

The nurse is assessing a newborn following a cesarean birth necessitated by a breech presentation. The nurse knows that this presentation places the newborn at increased risk for: a. developmental dysplasia of the hip (DDH). b. clubfoot (congenital talipes equinovarus). c. genu valgum (knock-knees). d. osteogenesis imperfecta.

a. developmental dysplasia of the hip (DDH). Developmental dysplasia of the hip has a higher incidence with breech presentation. Breech presentation does not cause clubfoot, genu valgum, or osteogenesis imperfecta.

The nurse is caring for a 1-year-old child who was diagnosed with cerebral palsy during a well-child examination after a series of screening and diagnostic testing. What will the nurse plan to include in the child's care? a. facilitating referral to a developmental health care provider b. surgical correction of the spinal lesion c. serial head circumference measurements d. assessment for Gower sign

a. facilitating referral to a developmental health care provider The nurse will plan to facilitate a referral to a developmental health care provider. Surgical correction of a spinal lesion and serial head circumference measurements are both part of the care of children with spina bifida. Assessment for Gower sign is part of screening for muscular dystrophy.

The nurse is educating a female client about genetic disorders. Which statement by the client best describes the major risk factor for trisomy 21? a. increasing maternal age b. family history c. drug use during pregnancy d. nondisjunction during conception

a. increasing maternal age Increasing maternal age is the most significant risk factor for having a child with trisomy 21. In most cases trisomy 21 is not inherited. Drug use during pregnancy can increase the risk of disorders, but not a greater risk than advancing age. Nondisjunction is part of the pathophysiology that occurs with trisomy 21; it is not a risk factor for trisomy 21 but instead a pathophysiologic process.

A nurse has written the above discharge note. What other information should the nurse have included in the discharge instructions? a. information about early intervention programs b. an appointment to see a nutritionist c. information on community preschools d. an appointment with a cardiologist

a. information about early intervention programs The nurse should have include information about early intervention programs for the child. An early intervention program will provide resources and assistance for infants and younger children at risk for or who have cognitive, developmental, or behavioral impairment. This type of program would benefit children with fragile X who may have these types of impairments. This child has difficulty with verbal expression in new situations and would benefit from this type of program, especially because the parents want to send the child to preschool. Children with fragile X do not require a special diet, so an appointment with a nutritionist is not necessary. A referral to an early intervention program would provide the family with information about the most appropriate preschool for their child. An appointment with a cardiologist is recommended for a child with Down syndrome or Turner syndrome, not fragile X.

A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care? a. maintaining intravenous antibiotic therapy b. keeping the child quiet while in skeletal traction c. restricting fluid to encourage red cell production d. assisting the child with crutch walking

a. maintaining intravenous antibiotic therapy Osteomyelitis is a serious infection. It is treated vigorously with intravenous antibiotics. It would not require traction. The stem does not indicate the location of the infection, so the child may not need crutches. Fluid restriction does not help red blood cell production.

The nurse is preparing to perform a neurologic assessment on a 2-year-old child at a well-child visit. How will the nurse begin the assessment? a. while the child is in the caregiver's lap b. with the child seated at rest on the examination table c. by picking up the child from the caregiver's lap d. offering a variety of toys of the child to play with

a. while the child is in the caregiver's lap The nurse will perform the assessment while the child is in the caregiver's lap, because young children are often more comfortable in this setting. While some children may be eager to show off gross and fine motor skills during play, some may shy away from the nurse, especially if the child is separated from the caregiver.

The nurse is providing a class for a group of child care providers. When discussing allergic reactions, which statement by a participant indicates the need for further instruction? a. "Most allergic reactions will happen within a few minutes of eating a problematic food." b. "If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it. c. "Allergic reactions can happen hours after eating something." d. "In addition to hives some children may also have vomiting and diarrhea when having an allergic reaction to a food."

b. "If a child has previously eaten a food and not had a reaction they are not 'truly' allergic to it. Previous exposure with no incident does not mean an individual cannot develop a hypersensitivity to a food or other substance. An allergy may develop at any time. The remaining statements are correct.

The parents of a 15-month-old infant diagnosed with atopic dermatitis bring the child to the clinic for a follow up visit. When reviewing the care measurse the parents have been using, which statement by the parents would the nurse identify as a need for additional teaching? a. "We'be been applying cream to the skin while it's still moist. b. "The sore have been so wet lately that I'm using alcohol to dry them up." c. "We've been avoiding the use of soap when giving our child a bath." d. "After bathing, we try to pat the skin dry instead of rubbing it."

b. "The sore have been so wet lately that I'm using alcohol to dry them up." Skin hydration with liberal use of moisturizers is essential to prevent excessive skin dryness. Be certain that parents know that the infant should soak in the bath for approximately 15 to 30 minutes and then be patted dry, not rubbed, so lesions are not aggravated. The moisture must immediately be applied to seal in the moisture to help prevent dryness and avoid evaporation which contributes to pruritus. Caution them not to use soap for bathing because it can be drying.

The nurse is assessing the leg strength of a 2-year-old child by asking the child to extend the legs while resisting the movement. Instead of extending the legs, the child produces a small flicker of movement. How will the nurse grade the strength on the 5-point scale? a. 0 b. 1 c. 2 d. 3 e. 4 f. 5

b. 1 A grade of 0 would be documented for no muscle movement. A small flicker of movement should be graded as 1 out of 5. A grade of 2 would be documented for movement with gravity eliminated. Movement against gravity would be documented as grade 3. Movement against gravity and with some external force applied would be documented as grade 4. A grade of 5 would be documented for movement against gravity and with good external force applied.

The nurse in the emergency department is examining an 18-month-old child who recently received a first dose of penicillin. The nurse notes lip edema, urticaria, stridor, and tachycardia. Which action will the nurse take next? a. Begin cardiopulmonary resuscitation (CPR). b. Administer epinephrine. c. Obtain intravenous (IV) access. d. Gather tracheal intubation equipment.

b. Administer epinephrine. The nurse would suspect the child is experiencing anaphylaxis and administer epinephrine. Lip edema, urticaria, stridor, and tachycardia are common clinical manifestations of anaphylaxis. CPR is not indicated; the child is still breathing and has a heart rate at this time. The nurse would want to ensure IV access is obtained and have intubation equipment at hand; however, these are not priority.

The school nurse is teaching a child with stinging-insect allergies how to avoid insects while on the class trip. Which instruction will the nurse provide? a. Wear perfume but not cologne. b. Do not sit by the garbage can. c. Wear a hair net to contain hair. d. Limit your time outside in the heat of the day.

b. Do not sit by the garbage can. Because garbage attracts insects, being aware of where garbage cans are placed can decrease exposure and limit contact. Any time outside throughout the day can place someone at risk, not just during the heat of the day. Perfume and cologne both have a scent that can attract insects. Wearing a hair net that contains the hair still allows scents of shampoo or hairspray to be circulated and is not the most helpful advice.

When providing discharge instructions to a child who was admitted to the hospital following stridor, wheezing, and urticaria after taking penicillin, which nursing action is priority? a. Question the child about the amount of penicillin that was taken. b. Encourage the child to wear a medical alert bracelet for penicillin. c. Advise the parents to have their child evaluated for atopic diseases. d. Educate the parents about possible side effects of penicillin in children.

b. Encourage the child to wear a medical alert bracelet for penicillin. Oral medications most likely to cause an allergic reaction include antibiotics, acetylsalicylic acid (aspirin), and NSAIDs. Children experiencing stridor, wheezing, and urticaria after taking a medication most likely have an allergy to that medication. The priority nursing action for discharge education is to prevent the child from being exposed to penicillin again, which could be accomplished by encouraging the child to wear a medical alert bracelet. Although children with atopic diseases are more likely to have medication allergies, requesting parents have the child evaluated is not a priority. Questioning the child about the amount of penicillin taken and educating parents about the side effects of penicillin is not a priority.

The nurse is preparing educational materials for a group of new parents about allergic reactions. Which specific immunoglobulin should the nurse emphasize as being responsible for these types of reactions? a. IgA b. IgE c. IgG d. IgM

b. IgE IgE is involved in immediate hypersensitivity reactions and is associated with allergy and parasitic infections. IgA is found in saliva, sweat, and tears and provides defense against pathogens on exposed surfaces. IgG is the most frequently occurring antibody in plasma and neutralizes bacterial toxins. IgM lyses cell walls and is early to arrive in the presence of an infection in the bloodstream.

The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority? a. Advise parents the child may benefit from skin testing. b. Include the child when discussing foods that contain peanuts. c. Offer the parents information about a community support group. d. Remind parents to report the allergy to the child's school teacher.

b. Include the child when discussing foods that contain peanuts. Involving school-age children in education related to their allergy helps them play an active role in their own care. Involving the child in teaching also helps to plan nursing care that meets QSEN competencies and also best meets the family's needs. Although advising parents the child may benefit from skin testing of other allergies, informing the child's school of the peanut allergy, and offering information about community support groups are important, involving the child in education is the best method to prevent exposure to the allergen.

A nurse is evaluating the plan of care for a 30-month-old child with Down syndrome. Which outcome requires follow up by the nurse? a. The child requires assistance dressing and undressing. b. The parent has rescheduled three clinic visits. c. The parent has joined a support group. d. The child is starting an early intervention program.

b. The parent has rescheduled three clinic visits. The nurse will follow up with the parent about the rescheduled clinic visits to determine if there is a problem and to see if there is anything the nurse can do to help. A 30-month-old child with Down syndrome is not yet able to dress or undress without assistance. A typical child is able to undress around 32 months. The fact that the child's parent has joined a support group is a positive outcome that does not require follow up by the nurse. The nurse does not need to follow up on the child's start at an early intervention program.

A toddler is diagnosed with osteomyelitis. What should the nurse anticipate as a priority intervention when planning this child's care? a. assisting the child with crutch walking b. maintaining intravenous antibiotic therapy c. keeping the child quiet while in skeletal traction d. restricting fluid to encourage red cell production

b. maintaining intravenous antibiotic therapy For osteomyelitis, medical therapy includes administration of intravenous antibiotics, which is usually initiated in the hospital and then continued at home for as long as 2 weeks; an intermittent infusion device or peripherally inserted central catheter may be used. After this, the child will be prescribed an oral antibiotic for 3 to 4 more weeks. There is not enough information to determine the location of the infection so crutch walking may not be applicable. Skeletal traction is not needed to treat osteomyelitis. Fluid restriction does not encourage red blood cell production and may be harmful to the care of this child.

A nurse is reviewing the medical record of an infant whose mother is HIV positive. Which factor in the maternal history would the nurse interpret as helping to decrease the infant's risk for HIV transmission? a. low maternal CD4+ lymphocyte count b. use of zidovudine therapy during pregnancy c. coexistence of another sexually transmitted infection d. high maternal viral load

b. use of zidovudine therapy during pregnancy The use of zidovudine during pregnancy reduces the risk of transmission of HIV to the infant by 67%. A low maternal CD4+ lymphocyte, which indicates advanced HIV disease, a high maternal viral load, and the presence of other sexually transmitted infections would increase the infant's risk for transmission.

The nurse is educating a parent of a toddler with Down syndrome. Which statement by the parent indicates teaching was effective? a. "I will continue to offer my child low fiber foods for meal and snacks." b. "I am aware my child needs to be immunized on a delayed schedule." c. "I hope my child does well with the various therapies we have arranged." d. "I know my child will meet developmental milestones earlier than my other children."

c. "I hope my child does well with the various therapies we have arranged." The child with Down syndrome will likely require individualized physical, occupational and speech therapy. The nurse would encourage high fiber meals/snacks due to gastrointestinal concerns such as constipation. The child with Down syndrome should be immunized on the same schedule as a child without Down syndrome. Typically, children with Down syndrome meet the same developmental milestones as children without Down syndrome but on a delay.

A pediatric client is newly diagnosed with a stinging-insect allergy. Which advice is most appropriate for the nurse to provide this client's parent? a. "Your child should join a peer support group to help relieve anxiety about this problem." b. "I recommend you consult a genetic counselor to reveal other susceptible family members." c. "Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily." d. "Arrange for your child to receive allergy testing for foods with ingredients similar to those in insect venom."

c. "Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily." Stinging-insect allergy can lead to anaphylactic shock. Alerting others to the possibility of an insect sting and allergy is important. To alert others of the allergy, the client should wear a medical alert ID bracelet at all times. A support group may be joined if needed, but is not priority over the client's safety. Genetic testing is not appropriate for allergies. These are tested through allergy testing. It is also not appropriate to recommend testing for foods similar to insect venom.

A nurse has assessed a newborn diagnosed with trisomy 13. The parents are at the bedside and have just been informed of the diagnosis. Which is the nurse's most appropriate action? a. Prepare the parents for the newborn's imminent death. b. Provide the parents with information on early intervention programs. c. Allow time for the parents to ask questions and express their concerns. d. Explain that the child will need to follow a special diet for life.

c. Allow time for the parents to ask questions and express their concerns. The nurse's most appropriate action should be to allow the parents to ask questions and express their feelings and concerns about the diagnosis. There is no indication that the newborn's death is imminent. Although many infants with trisomy 13 do not survive the first month of life, some do survive past the first year of life. An early intervention program may provide some resources for parental support, but this would not be the nurse's most appropriate action. Whether or not the child would need to follow a special diet would depend on the type of complications the child has and/or how long the child survives. This would be a more appropriate action for a child diagnosed with phenylketonuria (PKU) disease.

The nurse is caring for several pregnant women. Which woman would the nurse identify as being at highest risk for having a child born with Down syndrome? a. a woman at 24 weeks' gestation having an amniocentesis b. a women whose husband's family has a history of genetic disorders c. a women at 28 weeks' gestation who will be 37 years old at the time of delivery d. a woman with a 2-year-old child diagnosed with Turner syndrome at birth

c. a women at 28 weeks' gestation who will be 37 years old at the time of delivery The chances of having a child born with Down syndrome are higher with a maternal age older than 35 years. The other situations do not indicate a higher risk for a child born with Down syndrome.

A client presents to the clinic for allergy testing. The nurse is reviewing current medications taken within the past 5 to 7 days. Which classification of medication, if taken by the client, will cause the nurse to reschedule the allergy testing appointment? a. antipyretic b. antibiotic c. antihistamine d. corticosteroid

c. antihistamine If the client has taken an antihistamine within the past 5 to 7 days, the skin testing appointment will need to be rescheduled because antihistamines will provide false results to the testing. When an allergen is introduced into the client's skin, the client, sensitive to the allergen, will respond with redness and a wheal at the site, due to the release of histamine by local mast cells. Inhibiting this histamine release will result in a false negative. If the client has taken a drug from the other classifications listed, the skin testing may proceed. These medications are able to be taken concurrently with allergy testing.

The most important assessment of neurovascular status to make after spinal surgical instrumentation is: a. check the nailbeds of the fingers for capillary refill. b. determine the presence of brachial pulses. c. assess the legs for warmth. d. ask if the child has pain.

c. assess the legs for warmth. The edema that accompanies spinal instrumentation surgery can impair circulation to lower extremities. The lower extremities are affected and need to be assessed over the nail beds of the fingers. The brachial pulse is in the arm. Most children will have pain after surgery.

The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food? a. blueberries b. pumpkins c. bananas d. pomegranates

c. bananas The nurse should instruct children and their families to avoid foods with a known cross-reactivity to latex, such as bananas.

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 Symptoms of constipation and bladder dysfunction may result due to an increasing size of the lesion. Increasing ICP and head circumference would point to hydrocephalus. Leaking cerebrospinal fluid would indicate the sac is leaking.

The nurse is monitoring the labs of a child admitted for an exacerbation of juvenile pauciarticular arthritis. Which lab result does the nurse expect to be elevated? a. immunoglobulin electrophoresis b. lymphocyte immunophenotyping T-cell quantification c. erythrocyte sedimentation rate (ESR) d. radioallergosorbent test

c. erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) is an indicator of inflammation; it would likely be elevated during an exacerbation of arthritis. Immunoglobulin electrophoresis determines the level of individual immunoglobulins; it would not be elevated in an autoimmune disease. Lymphocyte immunophenotyping T-cell quantification measures T-cells; this would be used to monitor immunosuppressive disorders. The radioallergosorbent test measures minute quantities of IgE in the blood; it is used for asthma and food allergy testing.

A 7-year-old child with cerebral palsy comes to the clinic for an evaluation. The child is prescribed medications to address muscle spasticity and seizures. When assessing the child's mouth, which condition would the nurse associate with the child's medication regimen? a. malocclusion b. enamel erosion c. gingival hyperplasia d. multiple dental caries

c. gingival hyperplasia Although enamel defects and malocclusion are common dental problems in children with cerebral palsy, the child is receiving anticonvulsant therapy, which can lead to gingival hyperplasia. Dental caries are unrelated to the child's diagnosis or medication therapy.

The nurse is assessing a 2-week-old boy who was born at home and has not had metabolic screening. Which sign or symptom indicates phenylketonuria? a. increased reflex action on palpation b. signs of jaundice c. musty or mousy odor to the urine d. report of seizures

c. musty or mousy odor to the urine Children with phenylketonuria will have a musty or mousy odor to their urine, as well as an eczema-like rash, irritability, and vomiting. Increased reflex action and seizures are typical of maple sugar urine disease. Signs of jaundice, diarrhea, and vomiting are typical of galactosemia. Seizures are a sign of biotinidase deficiency or maple sugar urine disease.

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? a. breathing b. sitting c. standing d. swallowing

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

An adolescent girl has spinal instrumentation surgery at 16 years of age. Immediately after this procedure, the nurse would teach her to: a. sit up, although this may hurt. b. always sleep prone. c. wait to be log-rolled before turning from one side to the other. d. plan on 6 months of hospitalization.

c. wait to be log-rolled before turning from one side to the other. Spinal instrumentation means rods are placed beside the spine, and the vertebrae are fused. Log-rolling is necessary to prevent injury until the fusion is complete. She will be flat for a specific period of time depending on the amount of fusion in the surgery; she will be allowed to sleep in different positions, and the hospital stay is not 6 months.

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse? a. "Unfortunately, bracing is the only option for treating this disorder. I'm sure your child will get used to it after a few weeks." b. "The newer braces only have to be worn while the child is asleep and don't have to be worn at school." c. "Braces have been replaced with surgical intervention. Your child will only wear a brace for a few weeks after the surgery." d. "The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

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

The nurse is working with a family as they make decisions regarding their newborn's care following the diagnosis of a serious genetic disorder. What response by the nurse would be appropriate? a. "My niece has the same disorder so I can tell you what I think you should do about it." b. "Are you sure your doctor has enough experience to help you care for your child?" c. "Requesting input from your extended family will likely complicate your ability to make decisions." d. "What are some advantages and disadvantages of the decisions you are making for the baby?"

d. "What are some advantages and disadvantages of the decisions you are making for the baby?" The nurse should encourage the family to list advantages and disadvantages of each alternative, which aids in problem solving. The nurse should not take an obtrusive role by telling the family what to do or indicating their choice of health care provider is inadequate. The nurse should encourage the parents to express their feelings, and not to avoid discussion.

A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? a. 9-month-old infant who can pull self up to a standing position b. 14-month-old toddler who walks with a parent's assistance c. 24-month-old toddler who engages in parallel play d. 3-year-old preschool-aged child who goes up stairs on hands and knees

d. 3-year-old preschool-aged child who goes up stairs on hands and knees At 3 years of age, a child should be able to climb the stairs one step up at a time or using alternating feet. If the child can only go up on hands and knees, further evaluation is needed. At 9 months of age, an infant can pull oneself up to a standing position and sometimes is able to cruise around furniture or even walk. Toddlers begin to walk between 9 and 18 months of age. Toddler at 24 months of age engage in parallel play rather than cooperative play.

The nurse is teaching a group of peers regarding different types of fractures seen in children. Which statement best describes a complete fracture? a. A fracture in which the bone bends without breaking b. A fracture in which the bone buckles rather than breaks c. An incomplete fracture of the bone d. A fracture in which the bone breaks into two pieces

d. A fracture in which the bone breaks into two pieces A fracture in which the bone breaks into two pieces is called a complete fracture. A fracture in which the bone bends without breaking is called a plastic or bowing deformity. A fracture in which the bone buckles rather than breaks is called a buckle fracture. An incomplete fracture of the bone is called a greenstick fracture.

A child is admitted to the emergency room with dyspnea and hypoxia immediately following a bee sting. What is the first action made by the nurse? a. Administer IM diphenhydramine b. Administer oral prednisolone c. Administer oral cetirizine d. Administer IM epinephrine

d. Administer IM epinephrine Dyspnea and hypoxia are signs of anaphylactic shock. Anaphylaxis is treated with IM epinephrine. IM diphenhydramine, oral prednisolone, and oral cetirizine may all be useful for the treatment of hypersensitivity reactions; however, they do not act as fast as epinephrine. Therefore, IM epinephrine is the first intervention a nurse would choose.

A 14-year-old male is brought to the emergency department by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. When describing this fracture to the child and his parents, the nurse would integrate knowledge of which of the following? a. The break occurs in a line that crosses the shaft at a 90-degree angle. b. There is a diagonal line across the bone. c. The bone is bent but not broken. d. There are three or more fracture fragments.

d. There are three or more fracture fragments. In a comminuted fracture, there are three or more fracture fragments. With a transverse fracture, a line crosses the shaft at a 90-degree angle. In an oblique fracture, there is a diagonal line across the bone. With a greenstick fracture, the bone is bent, but not broken.

The nurse is planning care for a 14-year-old client whose x-ray shows a comminuted fracture with the need for external appliance stabilization. Which nursing action is most important? a. assisting the child to the bathroom to void b. using the 0-10 pain scale for pain level in the arm c. placing the child in the bed and arm on a pillow d. assessing the color and movement of the hand and fingers

d. assessing the color and movement of the hand and fingers All of the options are correct nursing actions when the client returns from surgery following comminuted fracture; however, one is most important. Following surgery and external appliance stabilization, it is most important to complete a neurologic assessment checking for circulation sensation and motion. This is a priority as disruption in circulation can cause permanent tissue damage. After the check for sensation and motion, the nurse would assist the child to the bathroom, place the arm on a pillow to decrease edema, and assess for pain.

Fractures in children are always potentially serious injuries. Which child with a fracture would you observe most closely for complication? a. one who has a greenstick radial injury b. one who has an ulnar fracture c. one who has a fractured patella d. one who has an elbow fracture

d. one who has an elbow fracture Elbow injuries are particularly dangerous because edema can interfere with blood vessels and nerves that pass beside the joint. The radius and ulna are long bones and would not be at increased risk for complications. The patella is the knee and can be maintained in a straight position for casting.

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

In caring for the child with Guillain-Barré syndrome, the nurse will provide much supportive care while watching carefully for signs of deterioration in which body system? a. integumentary b. urinary c. cardiovascular d. respiratory

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

Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing? a. Head lag when pulled from supine to sitting b. Bilaterally open rather than closed hands c. Supporting own weight when placed in standing position d. Equal withdrawal of lower extremities from pain

a. Head lag when pulled from supine to sitting Head lag in the child requires referral. By 4 to 5 months, the infant should be able to maintain the head in a neutral position. The other assessment findings are normal for age, indicating no need for referral.

The nurse is performing a neurovascular assessment on a child in 90-90 skeletal traction. What will the nurse include in the assessment? Select all that apply. a. tactile sensation b. ability to wiggle fingers and toes c. capillary refill d. skin color e. ability to sit up in bed

a. tactile sensation b. ability to wiggle fingers and toes c. capillary refill d. skin color The nurse should assess the child's tactile sensation, the ability to wiggle fingers and toes, capillary refill, and the child's skin color. The nurse should not assess the child's ability to sit up in bed; the child should remain flat in the supine position while undergoing 90-90 traction.

The nurse is caring for a newborn whose mother is HIV positive. The nurse would expect to administer a 6-week course of which medication? a. Lopinavir b. Ritonavir c. Nevirapine d. Zidovudine

d. Zidovudine Children born to HIV-positive mothers should receive a 6-week course of zidovudine therapy. Lopinavir, ritonavir, and nevirapine are medications used for treatment of HIV-1 infections as part of a three-drug regimen.

The nurse is educating the parent of a male child born with trisomy 21. Which statement by the parent indicates teaching has been effective? a. "I plan to make time for my child's multiple therapy appointments." b. "I will research testosterone replacements in case the doctor recommends it." c. "I am concerned my child will be socially isolated and be very shy." d. "I am sad my child will likely not be able to have children someday."

a. "I plan to make time for my child's multiple therapy appointments." The parent of a child with trisomy 21 (Down syndrome) will be referred for needed therapy consults, including speech, physical and occupational therapy. Social isolation and shyness is a concern for a child diagnosed with Fragile X syndrome. Children with Down syndrome often have a warm, cheery personality. Testosterone replacement and inability to reproduce are noted in children with Klinefelter syndrome.

A child is diagnosed with a food allergy to milk. When teaching the parents about this allergy, what would the nurse suggest as a possible substitution(s) for milk? Select all that apply. a. fruit juice b. rice milk c. yogurt d. ice cream e. soy milk

a. fruit juice b. rice milk e. soy milk Milk can be replaced with water, fruit juice, rice milk, or soy milk. Yogurt and ice cream are made with milk.

Through which mechanism is Duchenne muscular dystrophy acquired? a. virus b. heredity c. autoimmune factors d. environmental toxins

b. heredity Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

Which condition is a part of normal newborn screening? a. Down syndrome b. phenylketonuria c. sickle cell anemia d. cystic fibrosis

b. phenylketonuria Phenylketonuria is part of normal newborn screening. Prenatal screening includes Down syndrome. Preconception screening includes sickle cell anemia and cystic fibrosis.

The nurse is assessing an infant with spina bifida for hydrocephalus. Which finding(s) requires further follow up by the nurse? Select all that apply. a. widening sutures on the head b. sunset eyes c. vomiting d. awake and alert e. flat fontanels

a. widening sutures on the head b. sunset eyes c. vomiting The findings of widening sutures on the head, the border of the pupil covered by the lower eyelid (sunset eyes), and vomiting are all signs of hydrocephalus and require further follow up by the nurse. Being awake and alert and having flat fontanels are expected findings that do not require further follow up by the nurse.

The nurse is educating a child with a peanut allergy about the signs and symptoms of an anaphylactic reaction. The nurse realizes additional teaching is needed when the child identifies which sign/symptom? a. nausea b. anxiety c. itchy mouth d. constipation

d. constipation Signs and symptoms of an anaphylactic allergic reaction include nausea, anxiety, and itchy mouth. Diarrhea, rather than constipation, is a sign of an allergic reaction.

A female child with Down syndrome is preadolescent. The parent is asking the nurse how to best explain the bodily changes to the child. How will the nurse reply? a. "Discuss the changes honestly and on her cognitive level." b. "Obtain some videos or pamphlets to use in teaching." c. "Have her go to a group sex education class." d. "Talk with other parents of children with Down syndrome for suggestions."

a. "Discuss the changes honestly and on her cognitive level." The female child with Down syndrome will go through bodily changes just like any other female child. To help the child through these changes, the parent should discuss these changes on the child's cognitive level. The parent should answer any questions and be honest in the responses. It may be helpful to the parents to seek advice from other parents of children with Down syndrome, to use additional teaching aids, or to go with the child to a class, but the best option is to talk to the child honestly and openly. This needs to be on the child's cognitive level.

A child's mother asks the nurse how likely it is the child will develop asthma because the child's father has asthma. Which response by the nurse is most appropriate? a. "Immune responses can be genetic and run in the family." b. "We don't know why children develop immune disorders." c. "Asthma can be prevented by avoiding any family allergens." d. "Your child will develop asthma since the father has asthma."

a. "Immune responses can be genetic and run in the family." The nurse's most appropriate response is to explain that there are familial tendencies with allergic responses but not all family members manifest the symptoms in the same way. For example, if the father has asthma, the child may have allergic rhinitis. Asthma cannot be prevented by avoiding allergens; however, asthma symptoms can be managed by avoiding allergens.

Which of the following is inconsistent with the mode of transmission of HIV? a. sexual contact b. skin contact c. mother-to-infant transmission d. blood

b. skin contact Modes of transmission for HIV include sexual contact, mother-to-infant transmission before or around the time of birth, and contamination by blood or body fluids.

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition? a. a demyelinating disease b. lesions of the brain cortex c. upper motor neuron lesions d. degeneration of muscle fibers

d. degeneration of muscle fibers Degeneration of muscle fibers with progressive weakness and wasting best describes muscular dystrophy. Demyelination of myelin sheaths is a description of multiple sclerosis. Lesions within the brain cortex and the upper motor neurons suggest a neurologic, not a muscular, disease.

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

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

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

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