Nur 420 Exam 3

DA (Craniosynostosis is treated by surgery to release the fused suture and to achieve cosmetic improvements. Surgery is done before the infant is 6 mo and is minimally invasive, but it still requires that the infant wear a helmet afterward. Open surgery is reserved for infants older than 6 months and is done to reshape moderate to severe malformations. Infants receiving open surgery are typically hospitalized for 3 or 4 days because absorbable plates and screws are used to hold the repaired cranial sections in place. A molding helmet is indicated postoperatively for an infant who has a mild deformation or has had endoscopic surgery and should be worn for 23 hours per day for 2 to 6 months. An infant who has had open surgery does not need a helmet to form the cranium postoperatively. Repositioning the infant frequently is a conservative treatment used for infants with deformational plagiocephaly.)

1. A 3-month-old infant is diagnosed with mild craniosynostosis. When teaching the parents about treatment, which information would the nurse likely include? A) "Your infant will need to be hospitalized to have open surgery to completely correct this problem." B) "Treatment focuses on making sure to reposition your infant frequently when lying down." C) "It is likely your infant will need minimally invasive surgery once the infant reaches 6 months of age." D) "Your infant will need to wear a helmet after the defect is corrected for most hours of the day." 2. The nurse is performing a neurologic assessment on a 5-month-old infant. Which task should the nurse perform first? A) Palpate the cranium. B) Running a cotton swab over the extremities C) Whispering a word in the infant's ears D) Blow on the face

AAA

1. A child is brought to the emergency department after experiencing a series of continuous seizures. The nurse is reviewing the orders for care and treatment. Which order would be of the highest priority? A) serum glucose level B) hemoglobin level C) white blood cell count D) urinalysis 2. A nurse is caring for a baby admitted to the hospital with suspected abusive head trauma (shaken baby syndrome). Which assessment finding would confirm this suspicion? A) retinal hemorrhages B) periorbital edema C) bruising on the face D) drainage from the ear 3. During physical assessment of a 2-year-old child, the nurse suspects that the child may have a cataract in one eye based on assessment of which of the following? A) Absence of the red reflex. B) Sclera appears to be blue. C) Edema of the eyelids. D) Excess watering of the eyes.

AABBABABB

1. Clubfoot 2. Developmental dysplasia of the hip 3. Slipped Capital Femoral Epiphysis 4. Nursemaid's Elbow 5. Scoliosis 6. Legg-Calve-Perthes 7. Osteogenesis imperfecta 8. Rickets 9. Osteomyelitis A) Structural B) Acquired

AHDEBCGF

1. Consciousness is not impaired, can involve senses (flashing lights or a change in taste or speech) or motor function (uncontrolled stiffening or jerking in one part of the body such as the finger, mouth, hand, or foot), nausea, déjà vu feeling. 2. Loss of muscle tone; person suddenly drops. 3. Involve a loss of consciousness with vacant stare or unresponsiveness. 4.Involve sudden, forceful contractions of single or multiple groups of muscles. 5. Consciousness is impaired and variable (unconscious repetitive actions), staring gaze, hallucination/delusion. 6. Begins as focal seizure and becomes generalized. 7. Longer rhythmic jerking activity. 8. Include alternate contraction (tonic phase) and relaxation (clonic phase) of muscles, a loss of consciousness, and abnormal behavior. A. Simple B. Complex C. Focal evolving to generalized D. Absence E. Myoclonic F. Tonic-clonic G. Clonic H. Atonic

BCAACDAA (•Focal -motor onset; generalized -tonic-clonic: Carbamazepine -Tegretol, Valproic acid -Depakene, Phenytoin -Dilantin, Phenobarbital -Luminal) (-----------) (•Focal -motor onset: Fosphenytoin -Cerebyx, Gabapentin -Neurontin) (-----------) (Generalized -nonmotor onset: Ethosuximide -Zarontin) (-----------) (Focal -Nonmotor onset: Topiramate -Topamax)

1. Ethosuximide (Zarontin) 2. Fosphenytoin (Cerebyx) 3. Carbamazepine (Tegretol): 4. Valproic acid (Depakene): 5. Gabapentin (Neurontin) 6. Topiramate (Topamax) 7. •Phenobarbital (Luminal): 8. •Phenytoin (Dilantin): Indication: A) Focal (motor onset) and/or generalized (tonic-clonic): B) •Generalized (nonmotor onset): C) •Focal (motor onset): D) •Focal (Nonmotor onset):

CEGHAFDB (Carbamazepine -Tegretol: Toxic epidermal necrosis, Steven J. S., aplastic anemia and depression) (------) (Valproic acid -Depakene: Hepatotoxic; risk for pancreatitis) (------) (Phenytoin -Dilantin: Cannot stop abruptly; interacts with over-the-counter medications) (------) (Phenobarbital -Lumina: May cause drowsiness; monitor drug levels) (------) (Levetiracetam -Keppra: Nonpsychotic behavior changes, suicidal thoughts) (-----------) (•Focal -motor onset: Fosphenytoin -Cerebyx, Gabapentin -Neurontin) (-----------) (Generalized -nonmotor onset: Ethosuximide -Zarontin) (-----------) (Focal -Nonmotor onset: Topiramate -Topamax)

1. Ethosuximide (Zarontin) 2. Fosphenytoin (Cerebyx) & Gabapentin (Neurontin) 3. Carbamazepine (Tegretol): 4. Valproic acid (Depakene): 5. Topiramate (Topamax) 6. •Phenobarbital (Luminal): 7. •Phenytoin (Dilantin): 8. •Levetiracetam (Keppra) A) Focal (Nonmotor onset) B) Nonpsychotic behavior changes, suicidal thoughts C) Generalized (nonmotor onset): D) Cannot stop abruptly; interacts with over-the-counter medications E) Focal (motor onset): F) May cause drowsiness; monitor drug levels G) Toxic epidermal necrosis, Steven J. S., aplastic anemia and depression H) Hepatotoxic; risk for pancreatitis

ABBCBBB (Develop at 34-36w: Moro/ startle reflex) (-------) (Develop at 38-40 weeks: Asymmetric Tonic Neck, Palmar grasp, Plantar grasp, Rooting, Trunk incurvation) (-------) (Develop at 8-9 mo: Parachute)

1. Moro (startle) 2. Plantar grasp 3. Asymmetric Tonic Neck 4. Parachute 5. Rooting 6. Palmar grasp 7. Trunk incurvation Expected Age of development: A) 34-36w B) 38-40w C) 8-9 mo

CEBFBCA (Moro -startle: 34-36w to 5-6 mo) (------------) (Plantar grasp: 38-40w to 9-10 mo) (------------) (Asymmetric Tonic Neck: 38-40w to 2-3mo) (------------) (Parachute: 8-9 mo and Persist all life) (------------) (Rooting: 38-40w to 2-3 mo ) (------------) (Palmar grasp: 38-40w to 5-6 mo) (------------) (Trunk incurvation: 38-40w to 1-2mo)

1. Moro (startle) 2. Plantar grasp 3. Asymmetric Tonic Neck 4. Parachute 5. Rooting 6. Palmar grasp 7. Trunk incurvation Expected Age of resolution: A) 1-2 mo B) 2-3 mo C) 5-6 mo D) 8-9 mo E) 9-10 mo F) Persist all life

ABCBABAAABB

1. Muscle wasting and progressive muscle weakness due to muscle fiber degeneration. 2. Progressive, symmetrical weakness and atrophy of the proximal muscles leading to premature death. due to a mutation in the survival motor neuron 3. Fatal 4. Characterized into four types based on age of onset and severity (type 1 presents in infancy and is most severe). 5. •Manifestations: generalized muscle weakness, toe walking, failure to meet developmental motor milestones, Gower sign, and lordotic posture. 6. Manifestations: muscle weakness, hypotonia, respiratory compromise, inadequate weight gain, contractures, and scoliosis. 7. Glucocorticoids can delay loss of ambulation, prevent scoliosis, and preserve lung function but cause osteoporosis and nutritional deficiencies. 8. Leads to pulmonary compromise and a weak myocardium (medications can improve cardiac function) 9. X-linked genetic defect. 10. Beta-2 adrenergic agonist to facilitate breathing, Medications for gastrointestinal reflux, Prophylactic antibiotics 11. Early pt improves outcomes, exercises and stretching, chest pt, non-invasive vent A) Duchenne and Becker Muscular Dystrophy B) Spinal Muscle Atrophy (SMA) C) Both

EJKFLBMGHNACD

1. No bath for 3 days and keep arm straight for 4-6 hrs after 2. Glucocorticoids can delay loss of ambulation, prevent scoliosis, and preserve lung function but cause osteoporosis and nutritional deficiencies. 3. IVIG for 5 days or plasmapheresis 4. are diagnosed with ultrasound and AFP during pregnancy. Risk factors include hyperthermia in utero, infections, medications, and folate deficiency 5. This is fatal but, palliative treatment includes Beta Adrenergic Agonist to improve breathing, noninvasive ventilation, medications for GERD, stretching, & Braces 6. Small Teeth, IV Pamidronate, and blue sclera 7. Can cause Coronary Artery Aneurysms and pt needs IVIG and Aspirin 8. Hip Dislocates on Adduction 9. Hip Reduces on Abduction 10. Is a self-limiting condition that involves avascular necrosis of the femoral head. 18 Months for revascularization during which there is risk for fractures 11. Ductal Dependent lesion requiring PGE and 3 stages of palliative surgery at 7-10 days (norwood) , 3-6 months (glenn), and 18-24 months (fontan) 12. The most common cause of congenital HF and if it does not close spontaneously then it can be treated with surgery. With surgery children usually recover quickly and go home 4-5 days post-op if no complications 13. Giving oxygen can worsen S/S of crackles, murmurs, etc. A CXR will show pulmonary edema and an enlarged Heart. D/t pulmonary overcirculation A) HLHS (hypoplastic left heart syndrome) B) Osteogenesis Imperfecta C) VSD D) PDA E) Cardiac catheterization F) Neural Tube Defects G) Developmental Hip Dysplasia (Barlow Sign) H) Developmental Hip Dysplasia (Ortolani Sign) J) Duchenne Muscular Dystrophy & Becker Muscular Dystrophy K) Guillian-Barre Syndrome L) Spinal Muscular Atrophy M) Kawasaki's Disease N) Legg-Calvé-Perthes disease

CIFAEKLBGDHM

1. Over time, the femoral head reforms and during an 18 to 24 months revasculatization phase the bone is soft and more likely to fracture. 2. May need a to use a bivalve cast or Loosen dressing 3. Rapidly progressing joint damage with rheumatoid nodules 4. It usually occurs in teenagers during growth spurts. 5. Iritis, uneven leg growth, weight gain 6. Mild/Moderate anemia and Pale, red, nonpruritic macular rash 7. Encourage low impact exercise and Watch for hypokalemia, hypomagnesemia, hypocalcemia, hypophosphatemia, thrombocytopenia, neutropenia, dysrhythmias, kidney failure, general malaise from IV Pamidronate 8. It usually occurs in children younger than 5 years of age. 9. Pericarditis, pericardial effusion, pulmonary fibrosis 10. Weakening of bones that may occur as a result of nutritional deficiencies such as inadequate consumption of calcium or vitamin D or limited exposure to sunlight 11. Elevated CBC (^WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), blood cultures 12. Denis Browne bar, brace used to maintain correction, Serial casting & weekly stretching, Heel cord tenotomy A) Slipped Capital Femoral Epiphysis (SCFE) B) Nurse-Maids Elbow C) Legg-Calvé-Perthes disease D) Rickets E) Pauciarticular JIA F) Polyarticular JIA G) Systemic JIA H) Osteomyelitis I) Compartment Syndrome K) JIA L) Osteogenesis imperfecta M) Congenital Clubfoot

CDBFEGHA (1. Pulls to stand ------ c.. 9 mo) (--------) (2. Rolls over ------ d. 5-6 mo) (--------) (3. Pedals a tricycle ------ b. 3 y) (--------) (4. Climbs stairs without assistance ------ f. 2-2½ y) (--------) (5. Lifts head 45° when prone ------ e. Birth to 3 mo) (--------) (6. Sits independently ------ g. 5-8 mo) (--------) (7. Walks independently------ h. 9-16 mo) (--------) (8. Hops on one foot & Climbs stairs using alternating feet------ a. 4 y)

1. Pulls to stand 2. Rolls over 3. Pedals a tricycle 4. Climbs stairs without assistance 5. Lifts head 45° when prone 6. Sits independently 7. Walks independently 8. Climbs stairs using alternating feet & Hops on one foot a. 4 y b. 3 y c. 9 mo d. 5-6 mo e. Birth to 3 mo f. 2-2½ y g. 5-8 mo h. 9-16 mo

ACD (Although malnutrition and weight loss are of concern, inactivity and glucocorticoid use make the child with muscular dystrophy prone to obesity. The statements, "Long-term use of glucocorticoids may increase hunger," "Swallowing and nutrient absorption may become impaired," and "A feeding tube may be required later in my child's care," are accurate with regard to nutrition and muscular dystrophy and do not require further follow up by the nurse.)

1. The nurse is assessing a 6-year-old child. The nurse instructs the child, "Let me see all of your pretty white teeth." Which cranial nerve is the nurse assessing? A) VII B) IV C) II D) VI 2. The parents of a newly diagnosed 3-year-old boy with Duchenne muscular dystrophy (DMD) ask the nurse about the risks of their 1-year-old daughter having the same disease. How does the nurse best reply? A) "DMD is an autosomal recessive disorder, so your daughter has a 25% chance of having the disease." B) "DMD is an autosomal dominant disorder, so your daughter has a 50% chance of developing the disease." C) "DMD is an X-linked recessive disorder, so your daughter has a 50% chance of being a carrier, but she is unlikely to develop the disease." D) "DMD is an X-linked dominant disorder, so your daughter has a high chance of developing the disease." 3. 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) Monitor for signs of autonomic dysreflexia. B) Administer IV furosemide as prescribed. C) Assess the infant for Gower sign. D) Prepare the infant for spinal surgery.

AABAAABBB

1. •Postictal state and loss of consciousness 2. •Absence 3. •Simple 4. •Atonic 5. •Tonic-clonic 6. •Myoclonic 7. •Complex 8. •One side of the brain 9. Usually no loss of consciousness A) Generalized seizure B) Focal seizure (partial)

ABD (Rationale: After a febrile seizure, it is important to determine the cause of the fever, avoid extreme cooling measures, and delay oral medications to prevent the risk of aspiration.)

A nurse is instructing a parent on how to care for a child following a febrile seizure. Which of the following should the nurse include? Select all that apply. (Slide 31) A) Seek a medical evaluation to determine the cause of the fever. B) If the fever is due to a viral illness, the child may be managed at home. C) You can place your child in a cool bath to help reduce the fever. D) Do not use alcohol rubs or cold water as this can lead to shock in children. E) Avoid giving oral fever-reducing medications immediately after a seizure

BCD

A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation? A) Intense physical therapy can aide the infant in learning to sit and walk independently. B) Muscular wasting results in generalized immobility and difficulty feeding and breathing. C) This is an autosomal dominant disorder that affects motor and cognitive development. D) The slow progression of the disorder will allow the infant to have a fairly normal childhood. 2. The nurse is caring for a school-age child diagnosed with Duchenne muscular dystrophy who is receiving glucocorticoid therapy. When teaching the parents about this therapy, the nurse would emphasize which aspect? A) importance of yearly cardiac exams B) techniques for assisted coughing C) safety measures for injury prevention D) steps for active and passive range-of-motion exercises 3. The nurse is providing education for the parents of a child with muscular dystrophy about nutrition. Which statement by the parent requires further follow up by the nurse? A) "Swallowing and nutrient absorption may become impaired." B) "Long-term use of glucocorticoids may increase hunger." C) "A feeding tube may be required later in my child's care." D) "Becoming overweight is not a concern; I should encourage high-calorie foods whenever possible."

ACDE

A nurse is providing education to parents of a child diagnosed with Reye Syndrome. Which of the following statements should be included to ensure successful education? Select all that apply. (Slide 19) A) "It's important to read labels on over-the-counter medications to avoid those containing aspirin/salicylates, as it can exacerbate your child's condition." B) "It is unlikely that your child will return to baseline neurologic status." C) "Your child's liver function tests should return to baseline as a sign of recovery." D) "I will not Administer aspirin for young children especially if they have a viral illness due to risk of reye syndrome." E) "Make sure to report any changes in your child's behavior or signs of illness immediately to your healthcare provider."

ABD (When a child has a febrile seizure associated with a high fever, it is important to seek medical evaluation. Medical evaluation will identify the source of the high fever. If the fever is viral, the child may be able to be managed at home. Advise the parent not to put the child in a bathtub of water because it would be easy for the child to slip under water should a second seizure occur. Caution the parent not to apply alcohol or cold water as extreme cooling causes shock to an immature nervous system. The parent should not attempt to give oral medications such as acetaminophen, because the child will be in a drowsy, or postictal, state after the seizure and might aspirate the medicine.)

A parent brings a child to the clinic after experiencing a febrile seizure. Which of the following instructions should the nurse provide to the parent for managing the child's condition at home? Select all that apply. A) Seek immediate medical evaluation to determine the source of the fever. B) If the seizure is related to a viral infection, the child can be managed safely at home. C) Goal is to manage temperature by Placing the child in a bathtub of water to reduce the fever. D) Avoid applying alcohol or cold water to the child to prevent shock. E) Give oral acetaminophen following a seizure to prevent second seizures.

C (Rationale: MRI scans are crucial for identifying encephalitic changes in the brain, offering detailed images that can pinpoint inflammation and other abnormalities associated with encephalitis. Encpehalitis can lead to long lasting problems such as tremors which can have a lasting psychosocial impact and a decrease in autonomy )

A patient with suspected encephalitis presents with symptoms of headache, photophobia, and stiff neck. What diagnostic tool is primarily used to identify encephalitic changes in the brain? (Slide 20) A) Lumbar puncture B) Complete blood count (CBC) C) Magnetic Resonance Imaging (MRI) D) Computed Tomography (CT) scan

C (Rationale: Early recognition and treatment, including repositioning and the use of orthotic helmets for 20 to 23 hours a day for 2 to 6 months, are crucial. The effectiveness of helmets diminishes after 12 months of age.)

According to the presentation, what is a critical factor in the management and treatment of Deformational Plagiocephaly (DP)? (Slide 9) A) Using orthotic helmets 3 to 4 days per week for 12 months B) Allowing the the head to grow for 6 to 12 months before using orthotic helmets up to 12 hours a day C) Use of orthotic helmets up to 23 hours a day for 2 to 6 months D) Early surgical intervention in the first month of life

8, 2, 7, 6 (Pigeon-toed walking normal until 8 -------Varus "bow-leg" appearance normal until 2 ------- Valgus "knock-knees" normal until 7 -------Flat feet normal until 6)

Anatomic Differences in the Musculoskeletal System in Children: Expected: 1. Pigeon-toed walking normal until ___ y/o 2. Varus "bow-leg" appearance normal until __ y/o 3. Valgus "knock-knees" normal until ___ y/o 4. Flat feet normal until __ y/o

FBCEJKADLGIH (CN I = olfactory) (-------) (CN II = optic) (-------) (CN III = oculomotor (-------) (CN IV = trochlear) (-------) (CN V = trigeminal (-------) (CN VI = abducens) (-------) (CN VII = facial (-------) (CN VIII = vestibulocochlear) (-------) (CN IX = glossopharyngeal) (-------) (CN X = vagus) (-------) (CN XI =accessory) (-------) (CN XII = hypoglossal)

CN I CN II CN III CN IV CN V CN VI CN VII CN VIII CN IX CN X CN XI CN XII A) facial B) •optic C) •oculomotor D) •vestibulocochlear E) •trochlear F) •olfactory G) •vagus H) •hypoglossal I) •accessory J) •trigeminal K) •abducens L) •glossopharyngeal

ADEHBHFICCGJ (CN I = Reaction to unpleasant odor) (CN II = Ability to rxn a person's face, maintain eye contact, reach for an object, and pupillary response) (CN III = Move a brightly colored toy through the visual fields to assess tracking, corneal light reflex, and pupillary response) (CN IV = Symmetric eye movements and corneal light reflex ) (CN V = Response to light touch on face) (CN VI = Symmetric eye movements and corneal light reflex ) (CN VII = Facial symmetry during crying -motor, and response to salt solution on tongue -sensory) (CN VIII = Ability to startle to loud noises and turn to a familiar voice) (CN IX = Observe strength and quality of cry, ability to suck and swallow, and gag reflex) (CN X = Observe strength and quality of cry, ability to suck and swallow, and gag reflex) (CN XI = Ability to perform coordinated movements of neck and shoulders) (CN XII = Symmetrical movements of tongue)

CN I -olfactory CN II -optic CN III -oculomotor CN IV -trochlear CN V -trigeminal CN VI -abducens CN VII -facial CN VIII -vestibulocochlear CN IX -glossopharyngeal CN X -vagus CN XI -accessory CN XII -hypoglossal A) •Reaction to unpleasant odor B) •Response to light touch on face C) •Observe strength and quality of cry, ability to suck and swallow, and gag reflex (USED TWICE) D) •Ability to rxn a person's face, maintain eye contact, reach for an object, and pupillary response E) •Move a brightly colored toy through the visual fields to assess tracking, corneal light reflex, and pupillary response F) •Facial symmetry during crying (motor) and response to salt solution on tongue (sensory) G) •Ability to perform coordinated movements of neck and shoulders H) •Symmetric eye movements and corneal light reflex (USED TWICE) I) •Ability to startle to loud noises and turn to a familiar voice J) •Symmetrical movements of tongue

C (Rationale: Early adversity negatively affects cognitive, language, and emotional development, but it does not enhance emotional resilience.)

Early adversity, such as poverty, child abuse, and caregiver mental illness, can impact a child's development in several ways according to Harvard University. Which of the following is NOT listed as an impact on cognitive, language, and emotional development? (Slide 3) A) Decreased cognitive abilities B) Delayed language development C) Enhanced emotional resilience D) Emotional development issues

7, 101.2, C (Febrile seizures are usually self limiting)

Febrile Seizures: 1. Acute seizures triggered by fever in children younger than___ years of age 2. Body temperature greater than_____ F (38.4°C) 3. Which statement(s) are false? a) Use encephalogram (EEG) for diagnostic testing b) May also develop epilepsy c) Lead to generalized damage d) The parent should not attempt to give oral medications such as acetaminophen

ABC (The umbilical vein carries what type of blood? oxygenated.............The umbilical arteries carry what type of blood? deoxygenated)

Fetal circulation bypasses the lungs: 1. Connects umbilical vein to inferior vena cava; oxygenated blood enters right atrium 2. opening between right and left atrium; Oxygenated blood shunted to left atrium and closes at delivery due to increased blood returning to the left atrium after birth. 3. Connects pulmonary artery with descending aorta; Oxygenated blood shunted to aorta via DA; Constricts after birth due to blood oxygen levels and prostaglandins. A) Ductus venosus: B) Foramen ovale: C) Ductus arteriosus: **The umbilical vein carries what type of blood? **The umbilical arteries carry what type of blood?

B (No lumbar punctures are indicated for noncommunicating hydrocephalus. Non Communicating hydrocephalus is the result of an obstruction leading to excess CSF. In general, Frequent lumbar punctures are not part of the postoperative care for hydrocephalus treatment with shunt placement. Care focuses on monitoring head circumference, infection signs, and safe positioning.)

For a child diagnosed with hydrocephalus, what is NOT included in postoperative care following ventriculoperitoneal shunt placement? (Slide 12) A) Daily measurement of head circumference B) Lumbar puncture 1 week after surgery to assess CSF levels C) Monitoring for signs of infection D) Careful positioning to prevent pressure on the surgical site

ADE (Rationale: IV antibiotics are crucial for bacterial meningitis, isolation helps prevent the spread of infection, and prophylactic antibiotics for close contacts can prevent further cases. Isolate the child if bacterial meningitis is confirmed until IV antibiotics have been administered for 24 hours. Prone positioning is not recommended, and fluid intake management should be closely monitored due to potential complications with ICP.)

For a child diagnosed with meningitis, what are critical nursing interventions to manage the disease? Select all that apply. (Slides 14-15) A) Administer IV antibiotics as prescribed. B) Place the child in a prone position to reduce discomfort. C) Isolate the child if bacterial meningitis is confirmed until IV antibiotics have been administered for 72 hours. D) Provide prophylactic antibiotics to close contacts. E) All close contacts should receive prophylactic antibiotics for septic meningitis.

C (Rationale: Lumbar punctures are not performed if noncommunicating hydrocephalus is present, as the focus is on managing CSF production, infection prevention, and ensuring proper positioning.)

In treating hydrocephalus, what is NOT a part of preoperative care? (Slide 12) A) Administering IV antibiotics B) Decreasing CSF production with medications C) Performing frequent lumbar punctures D) Changing head position

C (Rationale: Increased ICP typically results in a decreased pulse rate, not an increased one. Other manifestations include increased body temperature, decreased respiratory rate, and increased blood pressure.)

Increased intracranial pressure (ICP) in children can manifest as all of the following EXCEPT: (Slide 8) A) Increased body temperature B) Decreased respiratory rate C) Increased pulse rate D) Increased blood pressure

B (Rationale: AVMs are commonly found in the posterior fossa, basal ganglia, and thalamus, areas that are critical for the brain's functioning and control of various bodily functions.)

Intracranial Arteriovenous Malformations (AVMs) are most commonly located in which area(s) of the brain? (Slide 13) A) Frontal and temporal lobes B) Posterior fossa, basal ganglia, and thalamus C) Cerebellum and spinal cord D) Pituitary gland and optic chiasm

ABCBCAACB

Juvenile Idiopathic Arthritis (JIA) Definition: 1. Involvement of four or fewer joints; quite often the knee is involved. Most common type. 2. Involvement of five or more joints; frequently involves small joints and often affects the body symmetrically. 3. In addition to joint involvement, fever and rash may be present at diagnosis. Non Joint manifestations: 4. Malaise, lymphadenopathy, organomegaly, poor growth. 5. Enlarged spleen, liver, and lymph nodes; myalgia; severe anemia. 6. Eye inflammation, malaise, poor appetite, poor weight gain. Complications: 7. Iritis, uveitis, uneven leg bone growth. 8. Pericarditis, pericardial effusion, pleuritis, pulmonary fibrosis. 9. Often a severe form of arthritis; rapidly progressing joint damage, rheumatoid nodules. A) Pauciarticular B) Polyarticular C) Systemic

CDBA (Rationale: Craniosynostosis involves early suture closure, Deformational Plagiocephaly is caused by external forces on the head, Encephalocele is a condition where the skull doesn't fuse properly, and Hydrocephalus is a buildup of CSF in the brain.)

Match the following pediatric neurological system defects/disorders with their correct descriptions: (Slide 7-11) -Early closure of cranial suture(s), possibly leading to increased ICP. -Asymmetry and flattening of the head from external forces. -Skull fails to fuse, allowing brain and membranes to protrude. -Buildup of CSF in the brain, possibly due to obstruction or absorption issues. A) Hydrocephalus B) Encephalocele C) Craniosynostosis D) Deformational Plagiocephaly

CABBCACAB

Non Joint manifestations: 1. severe anemia. 2. Eye inflammation 3 Malaise, lymphadenopathy 4. organomegaly, poor growth. 5. Enlarged spleen, liver, and lymph nodes; myalgia; 6. Malaise, poor appetite, poor weight gain. 7. Pericarditis, pericardial effusion, pleuritis, pulmonary fibrosis. 8. uneven leg bone growth. 9. rapidly progressing joint damage, rheumatoid nodules. A) Pauciarticular B) Polyarticular C) Systemic

EBDCAFG (Rationale: The progression of Reye Syndrome from Stage 0 to Stage 6 demonstrates worsening symptoms from being asymptomatic to severe outcomes such as seizures, paralysis, and altered consciousness due to medication effects.)

Reye Syndrome Stages Match from (Slide 19) Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 (Special Category) A) Deep coma B) Vomiting and lethargy C) Coma with abnormal posturing D) Restlessness and disorientation E) Asymptomatic F) Seizures and paralysis (seizure precautions!) G) Children affected by medications altering consciousness

BBD (1.Ductus venosus: Connects umbilical vein to inferior vena cava; oxygenated blood enters right atrium ------- 2. Foramen ovale: opening between right and left atrium; Oxygenated blood shunted to left atrium and closes at delivery due to increased blood returning to the left atrium after birth. ------- 3. Ductus arteriosus: Connects pulmonary artery with descending aorta; Oxygenated blood shunted to aorta via DA; Constricts after birth due to blood oxygen levels and prostaglandins.) (_-----------) (Ductus venosus= Oxygenated blood in umbilical vein ---> Fetal Inferior VC) ( Foramen ovale= Oxygenated blood from right atrium ---> left atrium) (Ductus arteriosus=Oxygenated blood from pulmonary artery---> descending aorta) (Goal of these features= Bypass fetal lungs with mother's oxygenated blood into fetal circulation)

The Ductus venosus: a) Allows deoxygenated blood to flow from the fetal IVC, back into the umbilical artery, sending deoxygenated blood back to the mother b) Allows oxygenated blood to flow from the umbilical vein into fetal IVC, supplying oxygenated blood to the right atrium c) Allows oxygenated blood to flow from the umbilical vein into fetal SVC, supplying oxygenated blood to the right atrium d) Allows oxygenated blood to reach fetal circulation by connecting the pulmonary artery with the descending aorta 2. The Foramen ovale: a) Is a hole between the left and right atrium, allowing deoxygenated blood into the left atrium b) Is a hole between the left and right atrium, allowing oxygenated blood into the left atrium c) Is a hole between the left and right ventricle, allowing oxygenated blood into the left ventricle d) Is a hole between the left and right ventricle, allowing deoxygenated blood into the left ventricle 3. The Ductus arteriosus: a) Allows deoxygenated blood to flow from the fetal IVC, back into the umbilical artery, sending deoxygenated blood back to the mother b) Allows oxygenated blood to flow from the umbilical vein into fetal IVC, supplying oxygenated blood to the right atrium c) Allows oxygenated blood to flow from the umbilical vein into fetal ascending aorta, supplying oxygenated to the fetus d) Allows oxygenated blood to reach fetal circulation by connecting the pulmonary artery with the descending aorta

A

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

B (Rationale: Microcephaly is defined by a head circumference two standard deviations below the mean, often accompanied by cognitive impairments. Management is primarily supportive care.)

What characterizes microcephaly and what is its primary management? (Slide 10) A) An small cerebrum; treated with surgery B) An abnormally small head circumference; managed with supportive care C) Small head size with delayed cognitive development; managed with surgery D) Excessive cerebrospinal fluid in the brain; treated with ventriculoperitoneal shunt placement

C (Rationale: Communicating hydrocephalus occurs due to increased CSF production or decreased absorption, while non-communicating hydrocephalus is caused by an obstruction in the CSF flow.)

What is the primary difference between communicating and non-communicating hydrocephalus? (Slide 12) A) Communicating hydrocephalus is caused by an obstruction within the ventricular system. B) Non-communicating hydrocephalus is related to increased CSF production. C) Communicating hydrocephalus results from increased CSF production or decreased absorption. D) Non-communicating hydrocephalus does not affect the CSF flow.

C (Rationale: The first step involves observing the child's interaction, including evaluating speech clarity, mood, coordination, comprehension of instructions, and appropriateness of interactions for age.)

When assessing the pediatric neurological system, the sequence of evaluation should proceed from least invasive to most invasive. Which of the following is the first step in this sequence? (Slide 4) A) Motor Development Assessment B) Non-invasive Neurological Assessment C) Observation of Child's Interaction D) Palpation of the cranium

D (Pigeon-toed walking normal until 8 -------Varus "bow-leg" appearance normal until 2 ------- Valgus "knock-knees" normal until 7 -------Flat feet normal until 6) (---------) (Valgus: knock knees & Varus: Bow leg)

Which finding would a nurse document as unexpected? A) Pigeon-toed walking normal at age 8 B) Flat feet normal at age 6 C) "knock-knees" at age 7 D) "bow-leg" appearance at age 3 **What is the difference between valgus and Varus?

D (Wheelchair is used for fractures of the lower extremities in children 4-8 y/o)

Which is NOT important for education of 5 y/o with a cast on the upper arm/shoulder? A) A sitting position may be more comfortable than a supine position. B) Do not wear when you are sleeping. C) Keep two feet on the ground, do not play with any balls D) Use a wheelchair to move around. E) Apply ice for the first 24 hours and elevate the cast for the first 24-48 hours.

ABEG (•Occurs after Group-A beta-hemolytic strep infection of throat or Scarlett fever-----Left untreated, will spread to bloodstream, usually 20 days after onset of infection, and can damage heart valves----------Subcutaneous nodules over bony prominences----- Swelling of large joints -polyarthritis, --------- Macular rash over trunk and inner surfaces of extremities that appears and disappears rapidly-----Chorea and muscle weakness----- Treat pain ----------Teach clients to seek treatment for future strep throat infections and importance of completing antibiotic course)

Which letter(s) are characteristic of rheumatic heart disease? a) Subcutaneous nodules over bony prominences b) Swelling of large joints (polyarthritis) c) Macular rash over trunk and inner surfaces of extremities that appears over 5 days d) pericarditis, pericardial effusion, cardiac tamponade e) Damaged Heart Valves f) joint pain g) Chorea and muscle weakness

AEHLBCFIK (TOF: Pulmonary stenosis --- Right ventricular hypertrophy ---- VSD ----- Overriding aorta) (----------_) (HLHS: Mitral valve stenosis or atresia----Aortic valve stenosis or atresia----Hypoplastic left ventricle----Arch hypoplasia +/- coarctation of the aorta---ASD allows blood to go back to right atrium when mitral valve is broke )

Which letter(s) are included in the tetralogy of fallot A) Pulmonary stenosis B) Aortic Stenosis C) Mitral valve stenosis E) Overriding aorta F) Arch hypoplasia with or without coarctation of the aorta G) Left ventricular hypertrophy H) Right ventricular hypertrophy I) Hypoplastic left ventricle J) Hypoplastic right ventricle K) ASD L) VSD Which letter(s) are included in the Hypoplastic left heart syndrome (HLHS)? A) Pulmonary stenosis B) Aortic Stenosis C) Mitral valve stenosis E) Overriding aorta F) Arch hypoplasia with or without coarctation of the aorta G) Left ventricular hypertrophy H) Right ventricular hypertrophy I) Hypoplastic left ventricle J) Hypoplastic right ventricle K) ASD L) VSD

DDDABCDAD

Which medications are matched with the correct seizure type they are typically used to treat? (Slide 30) 1. Carbamazepine (Tegretol) 2. Valproic acid (Depakene) 3. Phenobarbital (Luminal) 4. Fosphenytoin (Cerebyx) 5. Ethosuximide (Zarontin) 6. Topiramate (Topamax) 7. Phenytoin (Dilantin) 8. Gabapentin (Neurontin) 9. Levetiracetam (Keppra) A) Focal (motor onset) B) Generalized (nonmotor onset) C) Focal (Nonmotor onset) D) Focal (motor onset); generalized (tonic-clonic)

B (Rationale: Vomiting and lethargy are initial signs seen in Stage 1, while restlessness and disorientation mark the progression into Stage 2 of Reye Syndrome.)

Which stages of Reye Syndrome are characterized by vomiting and lethargy, and restlessness and disorientation, respectively? (Slide 19) A) Stage 0 and Stage 1 B) Stage 1 and Stage 2 C) Stage 3 and Stage 4 D) Stage 4 and Stage 5

CDFI

Which statement(s) are true? A) The skeleton completely ossified at 2 y/o B) The skeleton is not completely ossified until early adolescence. C) The skeleton is not completely ossified until late adolescence. D) Growth of bones occurs primarily at specialized growth plates at the end of the long bones. E) Growth of bones occurs primarily at specialized growth plates at the end of the short bones. F) Children's bones are more vascular than adults. G) Children's bones are less vascular than adults. H) Children's bones tend to heal slower than adults. I) Children's bones tend to heal faster than adults.

CEDAB

•Astigmatism: •Nystagmus: •Strabismus: •Infantile glaucoma: •Congenital cataracts: A) Increase in intraocular pressure B) Cloudiness over corneal lens C) Unequal refractory curvatures D) "Cross eye" and is Treated with occlusion therapy E) Abnormal movement