EXAM 3; ortho, neuro & preschoolers.

Which of the following would cause a nurse to suspect that an infection has developed under a cast? a. Cold toes b. Increased respirations c. Complaint of paresthesia d. "Hot spots" felt on the cast surface

d

A 5-year-old female has been diagnosed with a seizure disorder. Her teacher noticed that she has been having episodes where she drops her pencil and simply appears to be daydreaming. This is most likely called: . An absence seizure. 2. An akinetic seizure. 3. A non-epileptic seizure. 4. A simple spasm seizure

1

A preschooler thinks that he or she has done something wrong. What feeling can result? 1. Guilt 2. Mistrust 3. Isolation 4. Shame and doubt

1

The nurse is discussing a ketogenic diet with a family. The nurse knows that this diet is sometimes used with children who have had little success with anticonvulsant medication. The diet that produces anticonvulsant effects from ketosis consists of: 1. High fat and low carbohydrates. 2. High fat and high carbohydrates. 3. Low fat and low carbohydrates. 4. Low fat and high carbohydrates.

1

The nurse is preparing to give preoperative teaching to the parents of an infant with hydrocephalus. The nurse knows that the most common treatment for hydrocephalus includes the surgical placement of a shunt connecting which of the following? 1. The ventricle of the brain to the peritoneum. 2. The ventricle of the brain to the right atrium of the heart. 3. The ventricle of the brain to the lower esophagus. 4. The ventricle of the brain to the small intestine.

1

The parents of a 12-month-old with CP ask the nurse if they should teach their child sign language because he has not begun any vocalization yet. The nurse bases her response on which of the following? 1. Sign language may be a very beneficial way to help children with CP communicate. 2. Sign language may cause confusion and further delay verbalization. 3. Most children with CP will have great difficulty learning sign language. 4. Sign language may be beneficial, but it would be best to wait until the child is closer to the preschool age.

1

The school nurse is called to the preschool classroom to evaluate a child. He has been noted to have periods where he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse's best response. 1. "Have the parents follow up with his pediatrician as this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life, as it could be attention-seeking behavior." 3. "Have the parents follow up with his pediatrician as this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him, and see if it continues."

1

Which statement about language development in preschoolers is correct? 1. Preschoolers find words such as "die" and "dye" confusing. 2. Preschoolers realize that words have arbitrary rather than absolute meanings. 3. Preschoolers become aware of the rules for linking words into phrases and sentences. 4. Preschoolers accept language as a means of representing the world in a subjective manner.

1

Which statement is true regarding the development of body image in preschoolers? 1. They can become conscious of their size. 2. They have well-defined body boundaries. 3. They are not likely to learn prejudices and biases. 4. They do not reflect the opinions of others regarding their own appearance.

1

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

1, 3, 5.

The nurse is caring for a neonate who has just been diagnosed with a meningocele. The parents ask what to expect. Which of the following is the nurse's best response? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

1, Because it is a Meningocele not myelomeningocele

The nurse is caring for a 5-year-old female recently diagnosed with epilepsy. She is being evaluated for anticonvulsant medication therapy. The nurse knows that the child will likely be placed on which kind of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensure compliance.

2

The emergency room nurse is caring for an unconscious 6-year-old girl who has had a severe closed-head injury and notes the following changes in her vital signs. Her heart rate has dropped from 120 to 55, her blood pressure has increased from 110/44 to 195/62, and her respirations are becoming more irregular. After calling the physician, which of the following should the nurse expect to do? 1. Call for additional help, and prepare to administer mannitol. 2. Continue to monitor the patient's vital signs, and prepare to administer a bolus of isotonic fluids. 3. Call for additional help, and prepare to administer an antihypertensive. 4. Continue to monitor the patient, and administer supplemental oxygen.

1, Symptoms of cushings triad and increased ICP

A 2-month-old infant is brought to the emergency room after experiencing a seizure. The nurse notes that the infant appears lethargic with very irregular respirations and periods of apnea. The parents report that the child is no longer interested in feeding and that, prior to the seizure, the infant rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography scan of the head and dilation of the eyes. 2. Computed tomography scan of the head and EEG. 3. Close monitoring of vital signs. 4. X-rays of all long bones.

1, dilation of the eyes to view if there is retinal hemorrhage

According to Erikson's theory, what behavior would the nurse explain a preschooler exhibits? 1. The child develops the superego. 2. The child plays beside other children. 3. The child concentrates on work and play. 4. The child becomes casual about body appearance.

1. During the initiative versus guilt stage.

The nurse is caring for a child with meningitis. The parents call for the nurse as "something is wrong." When the nurse arrives, she notes that the child is having a generalized tonic-clonic seizure. Which of the following should the nurse do first? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child's temperature and blood pressure

1. The child experiencing a seizure usually requires more oxygen as the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help.

A 3-year-old male with CP has just been fitted for braces and is beginning physical therapy to assist with ambulation. His parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse's best response: 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child ages and grows, the CP can manifest in different ways, and different muscle groups can need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

2

A child is being evaluated in the emergency room for a possible diagnosis of meningitis. The nurse is assisting with the lumbar puncture and notes that the CSF is cloudy. The nurse is aware that cloudy CSF most likely means: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, as CSF is usually cloudy. 4. Sepsis.

2

A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influence on the child's response to hospitalization? 1. Fear of separation 2. Fear of bodily harm 3. Belief in death's finality 4. Belief in the supernatural

2

An infant is born with a sac protruding through the spine. The sac contains CSF, a portion of the meninges, and nerve roots. The nurse knows that this is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly

2

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preop period? 1. Test the urine for protein 2. Reposition the infant frequently 3. Provide a stimulating environment 4. Assess blood pressure every 15 minutes

2

The nurse is caring for a 3-year-old female with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: 1. Name the president of the United States. 2. Identify her parents and state her own name. 3. State her full name and phone number. 4. Identify the current month but not the date.

2

The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response: 1. "We measure all babies' heads to ensure that their growth is on track." 2. "Babies with myelomeningocele are at risk for hydrocephalus, which can show up with an increase in head circumference." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up with an increase in head circumference." 4. "Many infants with myelomeningocele have microcephaly, which can show up with a decrease in head circumference."

2

The nurse is providing discharge instructions to the parents of a 13-year-old girl who has been diagnosed with epilepsy. Her parents ask if there are any activities that she should avoid. Select the nurse's best response. 1. "She should avoid swimming, even with a friend." 2. "She should avoid being in a car at night." 3. "She should avoid any strenuous activities." 4. "She should not return to school right away as her peers will likely cause her to feel inadequate."

2

The nurse is working in the emergency room when an ambulance arrives with a 9-year-old male who has been having a generalized seizure for 35 minutes. The paramedics have provided blow-by oxygen and monitored vital signs. The patient does not have intravenous access yet. Which of the following medications should the nurse anticipate administering first? 1. Establish an intravenous line, and administer intravenous lorazepam. 2. Administer rectal diazepam. 3. Administer an oral glucose gel to the side of the child's mouth. 4. Place a nasogastric tube, and administer oral diazepam.

2

Which behavior noted by the nurse when observing a preschool-age client indicates the end of the Oedipus or Electra complex? 1. Identification with siblings 2. Identification with same-sex parent 3. Identification with opposite-sex peers 4. Identification with opposite-sex parent

2

Which areas are sources of stress in four-year-old children? Select all that apply. 1. School 2. Attention 3. Insecurity 4. Activity level 5. Separation anxiety

2, 3, 4

The nurse is caring for several children. She knows that which of the following children is at increased risk for CP? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with sepsis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike

2, any infection of the CNS increase the infant's risk of CP. apgar score 3 or less at five minutes

The nurse is working in the PICU caring for an infant who has just returned from having a ventriculoperitoneal shunt placed. Which position initially will be most beneficial for this child? 1. Semi-Fowler in an infant seat. 2. Flat in the crib. 3. Trendelenburg. 4. In the crib with the head elevated to 90 degrees.

2, gradually increasing as the child can tolerate.

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

2.

An 8-year-old child is attending a Cub Scout camp picnic. He has a history of epilepsy and has had generalized seizures since the age of 3. The child falls to the ground and has a generalized seizure. Which of the following is the best action for the nurse to take during the child's seizure? 1. Administer the child's rescue dose of oral valium. 2. Loosen the child's clothing, and call for help. 3. Place an oral tongue blade in the child's mouth to prevent aspiration. 4. Carry the child to the infirmary to call 911 and start an intravenous line

2.

Which type of language development is seen in 4-year-olds? 1. Names four or more colors 2. Knows simple songs 3. Has vocabulary of about 2100 words 4. Uses sentences of six to eight words, with all parts of speech

2. a 5 year old can name four or more colors, has a vocab of about 2100 words and uses sentences of 6-8 words with all parts of speech.

A toddler is being evaluated for SIADH. The nurse should observe the child for which symptoms? Select all that apply. 1. Dehydration. 2. Fluid retention. 3. Hyponatremia. 4. Hypoglycemia. 5. Myxedema

2. ADH assists the body in retaining fluids and subsequently decreases serum osmolarity while the urine osmolarity rises. When serum sodium levels are decreased below 120 mEq/L, the child becomes symptomatic. 3. ADH assists the body in retaining fluids and subsequently decreases serum osmolarity while the urine osmolarity rises. When serum sodium levels are decreased below 120 mEq/L, the child becomes symptomatic.

The nurse is working in the pediatric developmental clinic. Which of the children requires continued follow-up because of behaviors suspicious of CP? 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

2. Early preference of one hand can be an early sign. startle reflex is expected in 1 month old. many 2 year olds have not achieved bladder control.

The nurse is working on the pediatric floor, caring for an infant who is very fussy and has a diagnosis of DI. Which parameter should the nurse monitor while the infant is on fluid restrictions? 1. Oral intake. 2. Urine output. 3. Appearance of the mucous membranes. 4. Pulse and temperature.

2. It is crucial to monitor and record urine output. The infant with DI has hyposecretion of ADH, and fluid restriction has little effect on urine formation. This infant is at risk for dehydration and for fluid and electrolyte imbalances.

The nurse is providing discharge teaching to the parents of a toddler who has experienced a febrile seizure. The nurse knows that clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2. Most children over the age of 5 do not have febrile seizures.

A 5-year-old female has been diagnosed with a midline brain tumor. In addition to showing signs of increased ICP, she has been voiding large amounts of very dilute urine. Which of the following medications does the nurse expect to administer? 1. Mannitol. 2. Vasopressin. 3. Lasix. 4. Dopamine.

2. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Vasopressin is a hormone that is used to help the body retain water.

The most common complication associated with myelomeningocele is: 1. Learning disability. 2. Urinary tract infection. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown.

2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection

The nurse is caring for a child who has just been admitted to the pediatric floor with a diagnosis of bacterial meningitis. When reviewing the child's plan of care, which of the following orders would the nurse question? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fluids at 1&1/2 times regular maintenance. 3. Neurological checks every 4 hours. 4. Administer acetaminophen for temperatures higher than 38°C (100.4°F)

2. can lead to fluid overload and increased ICP

A toddler is being admitted to the hospital with a diagnosis of bacterial meningitis. Select the best room assignment for the patient. 1. A semiprivate room with a roommate who also has bacterial meningitis. 2. A semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. A private room that is dark and quiet with minimal stimulation. 4. A private room that is bright and colorful and has developmentally appropriate activities available.

3

The emergency room nurse is caring for a 5-year-old child who fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which of the following statements is a priority for the nurse at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"

3

The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. Which of the following signs best indicates increased ICP in this child? 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite

3

The nurse is giving morning medications to a 4-year-old female who has just had a surgical procedure to release her hamstrings. The child has a history of CP. When the nurse prepares to administer baclofen, the child's parents ask what the medication is for. Select the nurse's best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

3

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

3

Which characteristics observed in a five-year-old child are appropriate? Select all that apply. 1. Involvement in parallel play 2. Finicky eating habits 3. Ability to swim and skate 4. Interest in trying new foods 5. Ability to draw triangles and diamonds

3, 4, 5. Toddlers usually partake in parallel play 4 year olds tend to have finicky eating habits

The family of a young child has been told the child has DI. What information should the nurse emphasize to the family? 1. One caregiver needs to learn to give the injections of vasopressin (Pitressin). 2. Children should wear MedicAlert tags if they are over 5 years old. 3. DI is different from DM. 4. Over time, the child may grow out of the need for medication.

3.

The nurse caring for a 14-year-old girl with DI understands which of the following about this disorder? 1. DI is treated on a short-term basis with hormone replacement therapy. 2. DI may cause anorexia if proper meal planning is not addressed. 3. DI is treated with vasopressin on a lifelong basis. 4. DI requires strict fluid limitation until it resolves

3. Vasopressin is the treatment of choice. It is important for patients and parents to understand that DI is a lifelong disease. fluid restriction is only part of the diagnostic phase.

A mother arrives at an ED with her 5yo child and state that the child fell off a bunk bed, A head injury is suspected, and the nurse checks the child's airway status and assesses the child for early and late signs of increased ICP. Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

4

The nurse is caring for a child who has sustained a closed-head injury. The nurse knows that brain damage can be caused by which of the following factors? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain

4

The nurse is caring for a child who is being admitted with a diagnosis of meningitis. The child's plan of care includes the following: administration of intravenous antibiotics, administration of maintenance intravenous fluids, placement of a Foley catheter, and obtaining cultures of spinal fluid and blood. Select the procedure the nurse should do first. 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fluids. 3. Placement of a Foley catheter. 4. Send the spinal fluid and blood cultures to the laboratory.

4

The nurse is caring for a newborn infant who has just been diagnosed with a myelomeningocele. Which of the following is included in the child's plan of care? 1. Place the child in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the child in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the child in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

4

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

4

The nurse receives a phone call from the parents of a 9-year-old female who is complaining of a headache and blurry vision. The child has been healthy but has a history of hydrocephalus and received a ventriculoperitoneal shunt at the age of 1 month. The parents also state that she is not acting like herself, is irritable, and sleeps more than she used to. They ask the nurse what they should do. Select the nurse's best response. 1. "Give her some acetaminophen, and see if her symptoms improve. If they do not improve, bring her to the pediatrician's office." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely as it has been working well for 9 years." 4. "You should immediately bring her to the emergency room as these may be symptoms of a shunt malfunction."

4

The parents of a child recently diagnosed with cerebral palsy ask the nurse about this disorder. The nurse bases the response on the understanding that cerebral palsy is which type of condition? 1. An infectious disease of the CNS 2. An inflammation of the brain as a result of a viral illness 3. A congenital condition that results in moderate to severe retardation 4. A chronic disability characterized by impaired muscle movement and posture

4

The pediatric nurse compares the sources of stress in preschoolers of different ages. Which source creates stress in both 3-year-olds and 4-year-olds? 1. Nap or bedtime 2. Insecurity 3. Questions 4. Fears

4

What is the required average daily intake of calories in preschoolers? 1. 400 2. 700 3. 1000 4. 1800

4

Which gross motor skill is exhibited by 3-year-olds? 1. Walking backward with heel to toe 2. Repeatedly catching a ball 3. Skipping and hopping on one foot 4. Riding a tricycle

4

In terms of fine motor development, what could a 3-year-old child be expected to do? 1. Tie shoelaces. 2. Use scissors or a pencil very well. 3. Draw a person with seven to nine parts. 4. Draw single-line shapes such as circles.

4 a 5 year old can perform the other skills

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

4.

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

4.

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

4.

A 7-year-old is tested for DI. Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. The most likely reason for this is which of the following? 1. Twenty-four hours is too early to evaluate effects of fluid restriction. 2. The urine should be concentrated, and it is unlikely the child has DI. 3. The child may have been sneaking fluids and needs closer observation. 4. In DI, fluid restriction does not cause urine concentration.

4. Children with DI cannot concentrate urine

The nurse has completed discharge teaching of the family of a 10-year-old diagnosed with DI. Which of the following statements best demonstrates the family's correct understanding of DI? 1. "My child's disease was probably brought on by a bad diet and little exercise." 2. "My father is a diabetic, and that may be why my child has it." 3. "My child will need to check blood sugar several times a day." 4. "My child will have to use the bathroom more often than other children."

4. Despite the use of vasopressin to to treat the symptoms of DI, breakthrough urination is likely/

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

4. for after the seizure

The nurse is teaching the family with a child with cerebral palsy (CP) strategies to prevent constipation. What should the nurse include in the teaching session? (Select all that apply.) a. Increase fluid intake. b. Increase fiber in the diet. c. Administer stool softeners daily as prescribed. d. Increase the amount of dairy products in the diet. e. Allow the child to decide when to try to have a bowel movement.

A, B, C

The nurse is preparing to admit a 5-year-old with spina bifida cystica that was below the second lumbar vertebra. What clinical manifestations of spina bifida cystica below the second lumbar vertebra should the nurse expect to observe? (Select all that apply.) a. No motor impairment b. Lack of bowel control c. Soft, subcutaneous lipomas d. Flaccid, partial paralysis of lower extremities e. Overflow incontinence with constant dribbling of urine

B, D, E

In terms of cognitive development, a 5-year-old child should be expected to do which? a. Think abstractly. b. Use magical thinking. c. Understand conservation of matter. d. Understand another persons perspective.

B. Magical thinking is believing that thoughts can cause events. An example is thinking of the death of a parent might cause it to happen. Abstract thought does not develop until the school-age years. The concept of conservation is the cognitive task of school-age children, ages 5 to 7 years. A 5-year-old child cannot understand another persons perspective

A child age 4 1/2 years sometimes wakes her parents up at night screaming, thrashing, sweating, and apparently frightened, yet she is not aware of her parents presence when they check on her. She lies down and sleeps without any parental intervention. This is most likely what? a. Nightmare b. Sleep terror c. Sleep apnea d. Seizure activity

b

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. What is the most appropriate initial action by the school nurse? a. Stay with child and have someone else call emergency medical services (EMS). b. Notify the parent and regular practitioner. c. Notify the parent that the child should go home. d. Stay with the child, offering calm reassurance.

a

A common characteristic of those who sexually abuse children is which of the following? a. Pressure victim into secrecy b. Are usually unemployed and unmarried c. Are unknown to victims and victims' families d. Have many victims that are each abused only once

a

A mother calls the school nurse saying that her daughter has developed school phobia. She has been out of school for 3 days. The nurse's recommendations should include which of the following? a. Immediately return the child to school. b. Determine the cause of the phobia before returning the child to school. c. Explain to the child that this is the last day she can stay home. d. Seek professional counseling before forcing the child to return to school.

a

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate? a. Prone with the head turned to the side b. On the side c. Supine in an infant carrier d. Supine, with defect supported with rolled blankets

a

The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse should consider which of the following in caring for this child who has experienced severe trauma? a. Rapid assessment should begin with ABC status: airway, breathing, and circulation. b. Assessment should begin with the area injured; assessment of other areas can wait. c. The possibility of spinal cord injury should be ruled out before transporting the child to the hospital. d. Temperature maintenance is more difficult than in adults because young children have a larger surface area related to body mass.

a

What is important to incorporate in the plan of care for a child who is experiencing a seizure? a. Describe and record the seizure activity observed. b. Suction the child during a seizure to prevent aspiration. c. Place a tongue blade between the teeth if they become clenched. d. Restrain the child when seizures occur to prevent bodily harm

a

Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? a. Irritability b. Photophobia c. Vomiting and diarrhea d. Pulsating anterior fontanel

a

What type of seizure may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

a.

Which assessment data should a school nurse recognize as signs of physical abuse? a. The child is often absent from school and seems apathetic and tired b. The child is very insecure and has poor self-esteem c. The child has multiple bruises on various body parts d. The child has sophisticated knowledge of sexual behaviors

a.

The clinic nurse is assessing infant reflexes. What assessment indicates a persistence of primitive reflexes? a. Tonic neck reflex at 8 months of age b. Palmar grasp at 4 months of age c. Plantar grasp at 9 months of age d. Rooting reflex at 3 months of age

a. Persistence of primitive reflexes is one of the earliest clues to CP (e.g., obligatory tonic neck reflex at any age or nonobligatory persistence beyond 6 months of age and the persistence or even hyperactivity of the Moro, plantar, and palmar grasp reflexes). The palmar grasp disappears by 6 months, the plantar grasp disappears by 12 months, and the rooting reflex disappears at 4 months, so these are normal findings.

According to Piaget, magical thinking is the belief of which? a. Thoughts are all powerful. b. God is an imaginary friend. c. Events have cause and effect. d. If the skin is broken, the insides will come out.

a. p.526

A 6-month-old infant does not smile, has poor head control, has a persistent Moro reflex, and often gags and chokes while eating. These findings are most suggestive of a. hypotonia. b. cerebral palsy. c. spinal cord injury. d. neonatal myasthenia gravis.

b

A child, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following? a. This type of fracture is inconsistent with a fall. b. Bone growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. Healing is usually delayed in this type of fracture

b

A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention? a. Recommend allergy testing. b. Provide a latex-free environment. c. Use only powder-free latex gloves. d. Limit use of latex products as much as possible.

b

A young child has recently been fitted with a knee, ankle, and foot orthosis (brace). Care of the skin should include which of the following? a. Apply lotion or cream to soften the skin. b. Contact a practitioner or orthotist if skin redness does not disappear. c. Place padding between the skin and brace if the child experiences a burning sensation under the brace. d. If a small blister develops, apply rubbing alcohol and place padding between the skin and the brace.

b

In terms of fine motor development, what should the 3-year-old child be expected to do? a. Tie shoelaces. b. Copy (draw) a circle. c. Use scissors or a pencil very well. d. Draw a person with seven to nine parts.

b

The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which? a. Take vital signs every hour. b. Place the infant on the side to decrease pressure on the spinal sac. c. Watch for signs that might indicate developing hydrocephalus. d. Apply a heat lamp to facilitate drying and toughening of the sac.

b

What developmental achievements are demonstrated by a 4-year-old child? (Select all that apply.) a. Cares for self totally b. Throws a ball overhead c. Has a vocabulary of 1500 words d. Can skip and hop on alternate feet e. Tends to be selfish and impatient f. Commonly has an imaginary playmate

b, c, e, f

The nurse is caring for a hospitalized 4-year-old boy. His parents tell the nurse they will be back to visit at 6 PM. When he asks the nurse when his parents are coming, what would the nurses best response be? a. They will be here soon. b. They will come after dinner. c. Let me show you on the clock when 6 PM is. d. I will tell you every time I see you how much longer it will be.

b.

Which of the following is descriptive of a preschooler's concept of time? a. Has no understanding of time b. Associates time with events c. Can tell time on a clock d. Uses terms such as "yesterday" appropriately

b. 7 year olds can tell time on a clock by 6 children can use time oriented words

Imaginary playmates are beneficial to the preschool child because they do which of the following? a. Take the place of social interactions. b. Take the place of pets and other toys. c. Become friends in times of loneliness. d. Accomplish what the child has already successfully accomplished.

c

Preschoolers' fears can best be dealt with by which of the following interventions? a. Actively involving them in finding practical methods to deal with the frightening experience b. Forcing them to confront the frightening object or experience in the presence of their parents c. Using logical persuasion to explain away their fears and help them recognize how unrealistic the fears are d. Ridiculing their fears so that they understand that there is no need to be afraid

c

The Glasgow Coma Scale consists of an assessment of a. pupil reactivity and motor response. b. level of consciousness and verbal response. c. eye opening and verbal and motor response. d. intracranial pressure and level of consciousness

c

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. Which of the following is a priority of nursing care? a. Initiate isolation precautions as soon as diagnosis is confirmed. b. Provide environmental stimulation to keep the child awake. c. Administer antibiotic therapy as soon as it is available. d. Administer sedatives and analgesics on a preventive schedule to manage pain.

c

What term refers to seizures that involve both hemispheres of the brain? a. Absence b. Acquired c. Generalized d. Complex partial

c

Which of the following is descriptive of a parent who is an abuser? a. Usually has a good support system b. Is usually well educated c. Is likely a single parent or from a young parent family d. Often has good knowledge of parenting skills

c

The nurse is teaching parents of a 4-year-old child about fine motor developmental milestones. What milestones should the nurse include in the teaching session? (Select all that apply.) a. Can lace shoes b. Uses scissors successfully c. Builds a tower of nine or 10 cubes d. Builds a bridge with three cubes e. Adeptly places small pellets in a narrow-necked bottle

c, d, e

Which assessment of an 18mo with burns on his feet would cause suspicion of child abuse? a. Splash marks on his right lower leg b. Burns noted on right arm c. Symmetrical burns on both feet d. Burns mainly noted on right foot

c.

Which statement would be most therapeutic to a child the nurse suspects has been abused? a. Who did this to you? This is not right. b. This is wrong that your mother did not protect you. c. This is not your fault; you are not to blame for this. d. I will not tell anyone

c.

Parents of a preschool child tell the nurse, Our child seems to have many imaginary fears. What suggestion should the nurse give to the parents to help their child resolve the fears? a. Ignore the fears; they will go away. b. Explain to your child the fears are not real. c. Give your child some new toys to allay the fears. d. Help your child to resolve the fears through play activities.

d

The nurse should recommend medical attention if a child with a slight head injury experiences which of the following? a. Vomiting b. Sleepiness c. Headache, even if slight d. Confusion or abnormal behavior

d

Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child? a. Enuresis is more common in girls than boys. b. Enuresis is neither inherited nor has a familial tendency. c. Psychogenic factors that cause enuresis persist into adulthood. d. The child should be encouraged to take charge of treatment interventions

d