MC Unit 4 Musculoskeletal

Which interventions does the nurse implement to prevent the elevation of intracranial pressure (ICP) in an unconscious child?

-monitor childs temperature frequently -provide dim lights in the room -administer prescribed pain medications -prevents sudden movements in the child

Which assessment findings should the nurse note in a school-age child with Duchennes muscular dystrophy(DMD)

-lordosis -gowers sign -waddling gait

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which instructions should be included in the teaching?

Elevate casted arm when resting and when sitting up

The priority nursing intervention when a child is unconscious after a fall is to:

Establish an adequate airway.

The nurse is assessing a child with juvenile idiopathic arthritis who is receiving methotrexate (MXT). The nurse finds that the child has persistent inflammation. Which drug does the nurse expect to be prescribed for the child?

Etanercept (Enbrel)

The Glasgow Coma Scale consists of an assessment of:

Eye opening and verbal and motor responses.

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)?

Nonsteroidal anti inflammatory drugs (NSAIDs)

Four-year-old David is placed in Bucks extension traction for Legg-Calv-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first?

Notify the practitioner of the changes noted

. Which term is used to describe a childs level of consciousness when the child can be aroused with stimulation?

Obtundation

Which test is never performed on a child who is awake?

Oculovestibular response

Which condition can result from the bone demineralization associated with immobility?

Osteoporosis

The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death?

Periodic and irregular breathing

Which conditions can occur from infection in the nervous system?

-meningitis -hydrocephalus -rabies

Which statement best describes a subdural hematoma?

Bleeding occurs between the dura and the cerebrum.

A clinic nurse is conducting a staff in-service for other clinic staff regarding the signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session

-abdominal mass -sore throat and ear pain -Ecchymosis of conjunctiva

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased ICP in an infant

-alteration in pupil size and reactivity -extension or flexion posturing -cheyne stokes respirations

A nurse should expect which cerebrospinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis

-elevated WBC -decreased glucose -cloudy in color

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that

Frequent, serial casting is tried first

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. The nurses approach should include:

Answering questions with straightforward honesty

Which is a priority nursing intervention for a child who is asking to discontinue the anticonvulsant drugs?

ensure that the dose is decreased gradually

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and pupils are unequal and sluggish. The most appropriate nursing action is to:

notify the health care provider immediately

A 9-month-old infant sustained a head injury during an automobile collision. The infant is quiet and has a prominent hematoma on the right temporal area. What assessment finding is most important for the nurse to report?

persistent vomiting

Major goals of the therapeutic management of juvenile rheumatoid arthritis are to prevent:

physical deformity and preserve joint function

Which measure is important in managing hypercalcemia in a child who is immobilized?

promoting adequate hydration

What is characteristic of fractures in children?

rapidity of healing is inversely related to the age of the child

The primary health care provider has prescribed intravenous (IV) antibiotic therapy for a client with acute osteomyelitis. After assessment, the nurse notes that the client is not responding to the therapy. Which treatment strategy would the nurse expect to be prescribed for the client?

surgery

The nurse is caring for an immobilized preschool child. During this period of immobilization, the nurse's best action is to:

take the child outside of the room by wagon

A mother is caring for a 7-year-old child who has been diagnosed with a concussion. The nurse instructed the mother to wake up the child every 2 hours to check the child's level of consciousness. The mother tells the nurse, "I am really afraid of letting my child go back to sleep." What is an appropriate response by the nurse?

waking your child up throughout the night should alert you to any changes

The treatment of brain tumors in children consists of which therapies

-surgery -chemo -radiation

Discharge planning for the child with juvenile arthritis includes the need for:

Routine ophthalmologic examinations to assess for visual problems

The primary method of treating osteomyelitis is:

Intravenous antibiotic therapy

The nurse is caring for a 10-year-old child with a head injury. The nurse finds that the child does not exhibit the usual signs of a head injury, other than a headache, even though 10 hours have passed since the child sustained the injury. What is a priority nursing action in this context?

monitor the level of consciousness for 2 hours

Which choice is most descriptive of rhabdomyosarcoma?

most common sites are head and neck

The nurse is caring for a 5-year-old child who had a craniotomy. The nurse is assessing the neurologic status of the child. The nurse has checked the level of consciousness, pupillary activity, and reflexes. What else does the nurse assess in the patient?

motor function

A nurse is caring for a young infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe?

-asymmetric thigh and gluteal folds -shortening of the limb on the affected side -positive Ortolani and Barlow tests

The most appropriate nursing interventions when caring for a child experiencing a seizure include:

-avoid suctioning the child during the seizure -describing and documenting the seizure activity observed

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed

-bulging anterior fontanel -weak cry -poor muscle tone

The nurse is conducting discharge teaching with parents of a preschool child with myelomeningocele, repaired at birth, who is being discharged from the hospital after a urinary tract infection (UTI). Which should the nurse include in the discharge instructions related to management of the childs genitourinary function

-continue to perform the clean intermittent catheterization at home -administer the oxybutin chloride (Ditropan) as prescribed -monitor for signs of a recurrent UTI

Clinical manifestations of increased intracranial pressure (ICP) in infants are

-diplopia and blurred vision -irritability -distended scalp veins

Which interventions does the nurse implement in the plan of care for a child with bacterial meningitis?

-ensure a quiet environment in the room -assess whether the child is febrile -placing the child in the side lying position

Which signs and symptoms indicate an increase in intracranial pressure (ICP) in a child?

-forceful vomiting -seizures -increased sleeping

Which cerebral complications is a child at risk for after a head trauma?

-hemorrhage -edema -brain herniation -infection

A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should plan to implement which interventions for this child

-instructions to avoid exposure to sunlight -teaching about body changes associated with SLE

Which diagnostic tests does the nurse evaluate to confirm the presence of bacterial meningitis in a child who shows symptoms of infection such as headache, photophobia, and nuchal rigidity?

-lumbar puncture -CSF glucose -blood cell count

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Which nursing care interventions are needed for this child

-monitoring and maintaining systemic blood pressure -administering corticosteroids -monitoring for respiratory complications

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the childs postoperative care

-observe closely for signs of infection -maintain an accurate record of intake and output -monitor for abdominal distension

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe

-positive ortolani sign -unequal gluteal folds

The nurse is preparing a care plan for a patient who has a large bilateral hip spica cast. Which interventions should the nurse include in the care plan to prevent physiologic complications in the patient?

-provide high calorie, high protein diet -advise pt to rest on pressure reduction mattress -encourage pt to sit upright whenever possible

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome

-severe pain not relieved by analgesics -tingling of extremity -inability to move extremity

The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant

-temperature instability -irritability -lethargy

How much folic acid is recommended for women of childbearing age?

0.4 mg

What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition?

There may be no definitive cause identified.

The nurse is performing a Glasgow Coma Scale (GCS) on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record?

15

What is the healing time for a femoral shaft fracture in late childhood?

6-8 weeks

The nurse has received report on four children. Which child should the nurse assess first?

A preschool child with a head injury and decreasing level of consciousness

A child has been seizure-free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which intervention in the response?

A stepwise approach will be used to reduce the dosage gradually.

Which type of seizure may be difficult to detect?

Absence

The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which healthcare provider prescriptions should the nurse clarify with the health care provider before implementing?

Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours

Therapeutic management of a child with tetanus includes the administration of:

Antibiotics to control bacterial proliferation at the site of injury

A young childs parents call the nurse after their child was bitten by a raccoon in the woods. The nurses recommendation should be based on knowing that:

Antirabies prophylaxis must be initiated.

A young girl has just injured her ankle at school. In addition to calling the childs parents, the most appropriate immediate action by the school nurse is to:

Apply ice

Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy?

Arrangements for tutoring and schoolwork

When infants are seen for fractures, which nursing intervention is a priority?

Assess for child abuse. Fractures in infants are often nonaccidental

An appropriate nursing intervention when caring for a child in traction is to

Assess for tightness, weakness, or contractures in uninvolved joints and muscles

The nurse is admitting a school-age child with suspected Guillain-Barr syndrome (GBS). Which nursing intervention is a priority in the care for this child?

Assessing respiratory efforts

The nurse uses the palms of the hands when handling a wet cast to:

Avoid indenting the cast

What action may be beneficial in reducing the risk of Reyes syndrome?

Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include:

Avoiding using any latex product.

Which statement is accurate concerning a childs musculoskeletal system and how it may be different from an adults?

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

An adolescent boy is brought to the emergency department after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure. Pupils are dilated and fixed. What type of head injury should the nurse suspect?

Brainstem

Which clinical manifestations would suggest hydrocephalus in a neonate?

Bulging fontanel and dilated scalp veins

What is most descriptive of the therapeutic management of osteosarcoma?

Treatment usually consists of surgery and chemotherapy

Which neurologic diagnostic test gives a visualized horizontal and vertical cross section of the brain at any axis?

Computed tomography (CT) scan

The nurse should recommend medical attention if a child with a slight head injury experiences:

Confusion or abnormal behavior.

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac?

Covered with a sterile, moist, nonadherent dressing

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complications should the nurse monitor?

Decreased metabolic rate

An important nursing intervention when caring for a child who is experiencing a seizure is to:

Describe and record the seizure activity observed.

Which statement best describes a neuroblastoma?

Diagnosis is usually made after metastasis occurs.

Which type of fracture describes traumatic separation of cranial sutures?

Diastatic

When assessing the child with osteogenesis imperfecta, the nurse should expect to observe:

Discolored teeth

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The childs level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is to:

Discuss with practitioner what analgesia can be safely administered.

An advantage to using a fiberglass cast instead of a plaster cast is that a fiberglass cast:

Dries rapidly

When does idiopathic scoliosis become most noticeable?

During preadolescent growth spurt

Osteosarcoma is the most common bone cancer in children. Where are most of the primary tumor sites?

Femur

A current recommendation to prevent neural tube defects is the supplementation of:

Folic acid for all women of childbearing age

Which type of seizure involves both hemispheres of the brain?

Generalized

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement?

Growth can be affected by this type of fracture

The most common clinical manifestation of brain tumors in children is:

Headaches and vomiting.

What would cause a nurse to suspect that an infection has developed under a cast?

Hot spots felt on cast surface

Which problem is most often associated with myelomeningocele

Hydrocephalus

Spastic cerebral palsy is characterized by:

Hypertonicity and poor control of posture, balance, and coordinated motion

A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. Which statement made by the mother indicates a correct understanding of the teaching?

I should expect my child to have some behavioral changes after the accident.

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their childs spasticity. The nurses response should be based on knowing that:

Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available

A home care nurse is caring for an adolescent with a T1 spinal cord injury. The adolescent suddenly becomes flushed, hypertensive, and diaphoretic. Which intervention should the nurse perform first?

Implement a standing prescription to empty the bladder with a sterile in-and-out Foley catheter

Which statement is most descriptive of a concussion?

It is a transient, reversible neuronal dysfunction.

Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?

Kyphosis

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests:

Leaking of cerebrospinal fluid (CSF).

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of the nursing assessment to detect early signs of a worsening condition is:

Level of consciousness.

The initial clinical manifestation of generalized seizures is:

Losing consciousness.

Which drug would be used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema?

Mannitol

A toddler fell out of a second-story window. She had brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she seems fine. The nurse should explain that the toddler:

May have a brain injury.

What does the nurse assess in a child who shows other symptoms of hydrocephalus such as sluggish pupils and dilation of scalp veins during crying?

Measure the child's head circumference.

An appropriate nursing intervention when caring for an unconscious child should be to:

Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.

When caring for the child with Reyes syndrome, the priority nursing intervention is to:

Monitor intake and output.

The vector reservoir for agents causing viral encephalitis in the United States is:

Mosquitoes and ticks.

The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching?

My child should not eat bananas or kiwis.

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure. Which consideration should the nurse include?

Nasogastric intubation and urinary catheter may be required

The most common problem of children born with a myelomeningocele is:

Neurogenic bladder

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as:

Neurosurgical emergency.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him:

Prone, turn head to side, and nipple feed

A young boy has just been diagnosed with pseudohypertrophic (Duchennes) muscular dystrophy. The management plan should include:

Recommending genetic counseling

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. What should be included?

Return to the clinic every 1 to 2 weeks

Which type of traction uses skin traction on the lower leg and a padded sling under the knee?

Russell

Which term is used to describe a type of fracture that does not produce a break in the skin?

Simple

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 should the nurse suggest to remove this material?

Soak in a bathtub

A 10-year-old boy has been hit by a car while riding his bicycle in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action should be to:

Stabilize neck and spine.

Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?

Stupor

Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy?

Sudden jerking movement caused by stimuli

An important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA) is to:

Teach child and family the correct administration of medications

A 4-year-old child is newly diagnosed with Legg-Calv-Perthes disease. Nursing considerations should include which action?

Teaching the family the care and management of the corrective appliance

The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease?

The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease?

A 3-year-old child is hospitalized after a near-drowning accident. The childs mother complains to the nurse, This seems unnecessary when he is perfectly fine. The nurses best reply is:

The reason for this is that complications could still occur.

The nurse is preparing a school-age child for a computed tomography (CT) scan to assess cerebral function. When preparing the child for the scan, which statement should the nurse include?

The scan will not hurt.

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurses best response is:

The seizure may or may not mean that your child has epilepsy.

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm?

The skin color, temperature, movement, sensation, and capillary refill of the extremity

The mother of a 1-month-old infant tells the nurse that she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on knowing that:

Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children.

When taking the history of a child hospitalized with Reyes syndrome, the nurse should not be surprised that a week ago the child had recovered from:

Varicella

What effect does immobilization have on the cardiovascular system?

Venous stasis

The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborns defect?

Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI).Further teaching is indicated if the parents make which statement?

Were glad there is a cure for this disorder

How should the nurse explain positioning for a lumbar puncture to a 5-year-old child?

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

Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain?

Your head will be restrained during the procedure.

The postoperative care of a preschool child who has had a brain tumor removed should include which information?

close supervision is needed while the child is regaining consciousness

Therapeutic management of the patient with systemic lupus erythematosus includes:

corticosteroids to control inflammation

The nurse who is concerned about increased intracranial pressure in an infant should assess for:

irritability

Which statement is true concerning osteogenesis imperfecta?

it is an inherited disorder

A home care nurse is caring for a 4-month-old infant with developmental dysplasia of the hip (DDH). The baby is in a Pavlik harness. The baby's mother tells the nurse, "I don't think my baby will be able to sleep while wearing the harness." What is an appropriate response by the nurse?

it is important for the harness to be worn continuously

An infant is born with one lower limb deficiency. When is the optimum time for the infant to be fitted with a prosthetic device?

when the infant begins sitting up and can maintain balance