FINAL 15
The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching?
"I will use an ice pack to relieve the itching."
What statement is most accurate in describing tetanus?
Acute infectious disease caused by an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus.
What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)?
Control pain and preserve joint function.
A recommendation to prevent neural tube defects (NTDs) is the supplementation of what?
Folic acid for all women of childbearing age
What is the primary method of treating osteomyelitis?
Intravenous antibiotic therapy
An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department. She has completed the tetanus immunization series, receiving the last tetanus toxoid booster 8 years ago. What care is necessary for therapeutic management of this adolescent to prevent tetanus?
Tetanus toxoid booster is needed because of the type of injury.
What is the rationale for orthopedic surgery for a child with cerebral palsy?
To improve function
An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device?
When the infant is developmentally ready to stand up
The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching?
"I should gently massage the skin under the straps once a day to stimulate circulation."
The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session?
"Lift the infant by the buttocks, not the ankles, when changing diapers."
The nurse should suspect a child has cerebral palsy (CP) if the parent says what?
"My 4-month-old doesn't lift his head when on his tummy."
The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment. The nurse's response should be based on which knowledge?
About 45% of affected children have normal intelligence.
What statement is correct regarding sports injuries during adolescence?
Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.
What functional ability should the nurse expect in a child with a spinal cord lesion at C7?
Almost complete independence within limitations of wheelchair
A young girl has just injured her ankle at school. In addition to notifying the child's parents, what is the most appropriate, immediate action by the school nurse?
Apply ice.
The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention?
Apply towels wet with cool water.
What is an appropriate nursing intervention when caring for a child in traction?
Assessing for tightness, weakness, or contractures in uninvolved joints and muscles
What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)?
Assist the child to dorsiflex the feet and rotate the ankles.
A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed?
Assistance is needed to use the bathroom.
When a child develops latex allergy, which food may also cause an allergic reaction?
Bananas
A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included?
Check for abdominal pain and bloody stools.
The nurse is preparing a staff education in-service session for a group of new graduate nurses who will be working in a long-term care facility for children; many of the children have cerebral palsy (CP). What statement should the nurse include in the training?
Children with spastic pyramidal CP have a positive Babinski sign and ankle clonus.
The nurse is caring for a child with tetanus during the acute phase. What should the nurse plan in the care for this child?
Clustering nursing care to limit distractions
What is the recommended drink for athletes during practice and competition?
Cold water for gastrointestinal tract rapid absorption
When does idiopathic scoliosis become most noticeable?
During the preadolescent growth spurt
The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved?
Education of adults to recognize signs that indicate a risk for injury
A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take?
Elevate the foot and leg on pillows.
An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident. The parents keep asking the nurse, "How bad is it?" The nurse's response should be based on which knowledge?
Extent and severity of damage cannot be determined for several weeks or even months.
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain?
Frequent, serial casting is tried first.
Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care?
Meticulous dental hygiene
A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. What nursing intervention is a priority for this child?
Monitoring and maintaining systemic blood pressure
What is the most common cause of cerebral palsy (CP)?
Neonatal encephalopathy
The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication?
Pulmonary embolism
The nurse is caring for a 4-year-old child with cerebral palsy (CP). The child, developmentally, is at an infant stage. Appropriate developmental stimulation for this child should be what?
Putting a colorful mobile with music on the bed
What is a major goal of therapy for children with cerebral palsy (CP)?
Recognize the disorder early and promote optimum development.
An 8-year-old girl with moderate cerebral palsy (CP) recently began joining a regular classroom for part of the day. Her mother asks the school nurse about joining the after-school Girl Scout troop. The nurse's response should be based on which knowledge?
Recreational activities often provide children with CP with opportunities for socialization and recreation.
A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material?
Soak in a bathtub.
What most accurately describes bowel function in children born with a myelomeningocele?
Some degree of fecal continence can usually be achieved.
What type of cerebral palsy (CP) is the most common type?
Spastic
What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)?
Teach the child and family correct administration of medications.
Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement?
"Surgical correction requires a 3- to 4-month recovery period."
A mother tells the clinic nurse that she often puts honey on her infant's pacifier to soothe the infant. What response should the nurse make to the mother?
"There is still a risk for infant botulism from honey."
A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse?
"Until your vertebral column has reached skeletal maturity."
The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what?
"We're happy this is the only cast our baby will need."
The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal?
"You will feel a tickly sensation as the cast is removed."
A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long?
4 weeks
A toddler with spastic cerebral palsy needs to be transported to the radiology department. What transportation method should the nurse use to take the toddler to the radiology department?
A wagon with pillows
The nurse is caring for a child with myasthenia gravis (MG). What health care prescription should the nurse verify before administering?
Garamycin (gentamicin)
The nurse is caring for a family whose infant was just born with anencephaly. What is the most important nursing intervention?
Help the family cope with the birth of an infant with a fatal defect.
Spastic cerebral palsy (CP) is characterized by which clinical manifestations?
Hypertonicity; poor control of posture, balance, and coordinated motion
An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer?
Ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain.
After spinal fusion surgery the nurse should check for signs of what?
Impaired color, sensitivity, and movement to the lower extremities
During a well-child visit, the mother tells the nurse that her 4-month-old infant is constipated, is less active than usual, and has a weak-sounding cry. The nurse suspects botulism and questions the mother about the child's diet. What factor should support this diagnosis?
Infant cereal with honey
A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child?
Infant stimulation program
What statement is true concerning osteogenesis imperfecta (OI)?
It is an inherited disorder.
What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)?
It is characterized by presence of Gower sign, a waddling gait, and lordosis.
What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?
Kyphosis
What nursing intervention is most appropriate when caring for the child with osteomyelitis?
Move and turn the child carefully and gently to minimize pain.
An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome [GBS]). When explaining this disease process to the parents, what should the nurse consider?
Muscle strength slowly returns, and most children recover.
Neuropathic bladder disorders are common among children with which disorder?
Myelomeningocele
What refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column?
Myelomeningocele
An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents describe her as being angry, hostile, and uncooperative. The nurse should recognize that this is suggestive of which psychosocial state?
Normal response to her situation that can be redirected in a healthy way
A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first?
Notify the practitioner of the changes noted.
A woman who is 6 weeks pregnant tells the nurse that she is worried that, even though she is taking folic acid supplements, the baby might have spina bifida because of a family history. The nurse's response should be based on what?
Open neural tube defects (NTDs) result in elevated concentrations of -fetoprotein in amniotic fluid.
The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which?
Place the infant on the side to decrease pressure on the spinal sac.
A feeding technique the nurse can teach to parents of a child with cerebral palsy to improve use of the lips and the tongue to facilitate speech is which?
Placing food at the side of the tongue
The parents of a child with spastic cerebral palsy (CP) state that their child seems to have significant pain. In addition to systemic pharmacologic management, the nurse includes which teaching?
Positions to reduce spasticity
The nurse is teaching the girls' varsity sports teams about the "female athlete triad." What is essential information to include?
Pregnancy can occur in the absence of menstruation.
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?
Prone with the head turned to the side
What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)?
Protection from sun and fluorescent lights to minimize rash
A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention?
Provide a latex-free environment.
A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents' discharge teaching?
Specially designed car restraints are necessary.
A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he "heard a pop," that the pain is "pretty bad," and that the ankle feels "as if it is coming apart." Based on this description, the nurse suspects what injury?
Sprain
A child, age 3 years, has cerebral palsy (CP) and is hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. What is the most appropriate nursing action related to feeding this child?
Stabilize his jaw with caregiver's hand (either from a front or side position) to facilitate swallowing.
A 12-year-old child with Guillain-Barré syndrome (GBS) is admitted to the pediatric intensive care unit. She tells you that yesterday her legs were weak and that this morning she was unable to walk. After the nurse determines the current level of paralysis, which should the next priority assessment be?
Swallowing ability
The nurse is teaching the family of an infant with cerebral palsy how to administer a diazepam (Valium) pill by gastrostomy tube. What should the nurse include in the teaching session?
The pill should be crushed and mixed with a small amount of water.
The clinic nurse is assessing infant reflexes. What assessment indicates a persistence of primitive reflexes?
Tonic neck reflex at 8 months of age
