peds exam 2 mobility and endocrine
What does the nurse tell the parents of a newborn child with juvenile hypothyroidism about the treatment of the condition?
"If it is not treated, it may cause decreased mental capacity." Rational If juvenile hypothyroidism is not treated, it will cause decreased mental capacity. The treatment is started promptly to prevent hyperthyroidism. The treatment consists of administering L-thyroxine over a period of 4 to 8 weeks. Constipation and sleepiness are the symptoms of hypothyroidism.
The nurse suspects that the child has delayed growth. The nurse does not have serial height and weight records to assess the child's growth. What action does the nurse take?
Ask about the child's growth as compared to siblings. Rational: The nurse asks about the child's growth compared to the siblings to evaluate the growth delay in the child. The child's allergy status will help to identify the medication risks and not the child's height. Asking about the child's height and weight at birth will not help to identify the current growth delay, as the delay may be caused due to chronic illness after birth. Asking about the weight will not help to assess the child's growth pattern because the child's weight may differ from that of the siblings due to other factors such as diet.
An adolescent with type 1 diabetes is receiving regular insulin, Novolin R, and intermediate-acting insulin, Novolin N. The patient receives a combination of the two 30 minutes before breakfast and before the evening meal. At what time should the nurse anticipate a hypoglycemic reaction? Select all that apply. 1 Before breakfast 2 Within 30 minutes after breakfast 3 Within 90 minutes after the evening meal 4 Before supper or late afternoon 5 During the night after bedtime
Before breakfast Before supper or late afternoon Rational: Hypoglycemic episodes occur before meals or when the insulin effect is peaking. Therefore, the nurse should anticipate a hypoglycemic effect before breakfast and before supper or late afternoon. This is because with Novolin R, the insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours and Novolin N peaks 4 to 14 hours later. Within 30 minutes after breakfast and within 90 minutes after the evening meal, the insulin effect will still be there. During the night after bedtime, the insulin effect will be there because the child would take the insulin before the evening meal (late afternoon or supper time).
What are the adverse effects of systemic steroids? Select all that apply. 1 Osteoporosis 2 Adrenal insufficiency 3 Sleep changes 4 Hearing impairment 5 Hepatic failure
Correct 1 Osteoporosis Correct 2 Adrenal insufficiency Correct 3 Sleep change Rational: Corticosteroids are potent immunosuppressive drugs that are used for treating life-threatening complications such as incapacitating arthritis and uveitis. Corticosteroids are usually administered in very low dosages, but prolonged use of the medication may cause adverse effects like osteoporosis, adrenal insufficiency, and sleep changes. Corticosteroids do not impair auditory function and hepatic function, so these should not be seen in a client on corticosteroid therapy.
A child has just returned from surgery in a hip spica cast. What is the priority nursing intervention?
Check circulation. Rational: The chief concern is that the extremity may continue to swell, so the nurse should check circulation. This must be assessed to ensure that the cast does not become a tourniquet. Elevating the head of the bed might help with comfort. The child's position should be changed every 2 hours. Offering sips of water is acceptable, but only after the assessment of the extremities is completed.
The nurse is caring for a client with a slipped capital femoral epiphysis. Which clinical manifestations does the nurse observe in the client? Select all that apply.
Correct 2 Loss of abduction Correct 3 Limp on affected side Correct 5 Shortening of lower extremity Rational: A slipped capital femoral epiphysis is a spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction. This condition is most common in males and obese children. Due to the dislocation of the joint, the client will lose abduction, will limp on the affected side, and will show shortening of the lower extremity. Unlike acute osteomyelitis, a slipped capital femoral epiphysis is not associated with loss of fluids and hyperthermia, so a child with this condition should not have dehydration and fever.
The parent of a child tells the nurse that the child voids excessive urine and immediately drinks large amounts of water. The parent also says that the child's bed is often wet in the morning. Which condition does the nurse suspect in the child?
Diabetes insipidus (DI) Rational:A child with DI exhibits excessive thirst and excessive urination, which also causes bedwetting or enuresis. Chronic adrenocortical insufficiency is the nonfunctioning of the adrenal tissue and is indicated by weight loss, dehydration, increased sleeping, and muscular weakness. Cushing syndrome is often caused by excessive or prolonged steroid therapy, in which the child acquires a cushingoid appearance such as excessive hair growth, moon face, and fat red cheeks. CAH is indicated by the presence of ambiguous genitalia in infants at birth.
After assessing a child with a forearm injury, the nurse applies firm finger pressure to the head of the radius and then supinates and flexes the forearm. Which type of injury is the nurse managing?
Dislocation Dislocation occurs when force of stress on a ligament displaces the normal position of the bones forming a joint. It commonly occurs in children due to sudden traction in the forearm, which can be manipulated by applying finger pressure at the head of the radius. In case of strains, sprains, and contusions, there is injury to soft tissues such as ligaments, muscles, blood vessels, or nerves. The primary intervention in such injuries is application of an ice pack and compression.
When discussing a child's precocious puberty with the parents, what should the nurse tell them?
Dress and activities should be appropriate to chronologic age. Rational: Because of the early sexual maturation of the child, both family and child require extensive teaching. Included in this teaching is that the child should be engaged in activities according to chronologic age. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. The secondary sexual characteristics proceed in the usual order.
The nurse is explaining scoliosis to a 12-year-old boy who has been diagnosed with the disease. What should the nurse emphasize?
Effect of the scoliosis on the child's body image Rational: The identification of scoliosis as a "deformity," in combination with unattractive appliances and a significant surgical procedure, can have a negative effect on the already fragile adolescent body image. Establishing an identity is the major developmental task of the adolescent and is related to the affirmation of self-image. To achieve this task, there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling, the effect on body image is more important. Although it is important to maintain contact with peers, the effect on body image is more enduring.
What nursing intervention is included in the plan of care for a child with a newly fiberglass-casted left arm?
Elevating the extremity
The nurse is caring for an infant who has been diagnosed with talipes calcaneus. The affected foot has a plaster cast on it. What is an appropriate way to handle the infant when the cast is wet?
Handle the cast with the palms of the hands. Rational: The cast should be handled with the palms of the hands. The palm of the hand provides a wide base of support for infant's body and the casted extremity. Touching the cast with the fingertips will cause indentations that may create pressure areas; this may compromise the skin and neurovascular functioning. It is impossible to turn the child without touching the cast. Therefore, it is acceptable to touch the cast, but with the palms of the hands. The cast must be touched because the lower extremity and the cast must be supported.
A neonate with a goiter has just been admitted to the newborn nursery. What is a priority nursing intervention?
Have a tracheostomy set at the bedside. Rational:The presence of the goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including a tracheostomy set at the bedside. Positioning the infant on the left side is not indicated. Transient paralysis does not exist. There is no indication for suctioning.
During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise?
Increased food intake Rational: Food intake should be increased in the summer when the child is more active. Races and other competitions may require more food than other practice times. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid the administration of too much insulin during a time of reduced need.
The nurse should recognize that when a child develops diabetic ketoacidosis, what is true?
It is a life-threatening situation. Rational: Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated promptly, usually in an intensive care environment. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement.
A 12-year-old patient underwent a surgical procedure for the treatment of scoliosis. What is an appropriate postoperative nursing intervention for the patient?
Log-roll when changing position. Rational: After surgery, patients are monitored in an acute care setting and log-rolled when changing position to prevent damage to the fusion and surgically inserted hardware. Log-rolling is necessary to prevent movement of the newly aligned vertebrae, and should be done frequently to prevent skin breakdown. Checking the dressing is done for all postoperative patients; this action is nonspecific. Coughing and deep breathing are done by most postoperative patients; this action is nonspecific. The patient who had a spinal fusion can be turned and still be protected from injury by log-rolling. Remaining in one position for 3 days can lead to skin breakdown from unrelieved pressure.
The primary health care provider has prescribed ibuprofen (Advil) for a child with juvenile idiopathic arthritis. During the follow-up visit, the nurse finds that the child has severe inflammation despite taking ibuprofen (Advil) daily. Which additional medication should be prescribed for this child?
Methotrexate (MTX) Rational: Ibuprofen (Advil) is a nonsteroidal antiinflammatory drug (NSAID). If an NSAID is ineffective in alleviating all the inflammation of juvenile idiopathic arthritis, then the primary health care should prescribe methotrexate (MTX), which is a second-line medication and meant to be coadministered with an NSAID. Tolmetin (Tolectin), naproxen (Aleve), and indomethacin (Indocin) are NSAIDs themselves, so these drugs may not be more effective in alleviating the symptoms of juvenile idiopathic arthritis than ibuprofen (Advil).
What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis?
Move and turn the child carefully and gently to minimize pain.
An adolescent who had a lower leg amputated after a motorcycle accident complains of pain in the missing extremity. What is the nurse's most appropriate action?
Reassure the patient that it is normal and is called phantom limb sensation. Rational: Phantom limb sensation is an expected phenomena following amputation of an extremity. It is an expected experience because the nerve-brain connections are still present. They fade gradually. This should be discussed with the patient before surgery. Withholding pain medications because of narcotic addiction, referring the patient for psychological counseling, or teaching the parents and patient about nerve damage are not the most appropriate actions at this time.
The nurse is discharging a 10-year-old patient admitted to the hospital in diabetic ketoacidosis. The child has been newly diagnosed with type 1 diabetes mellitus (DM) on this admission. The nurse should teach the child and parents which signs of type 1 DM? Select all that apply. 1 Weight gain 2 Nocturia 3 Acidosis 4 Dry skin 5
Nocturia Dry skin Blurred vision Rational: Clinical manifestations of type 1 diabetes mellitus include the following: polyphagia, polyuria, polydipsia, weight loss, enuresis or nocturia, irritability; "not himself" or "herself," shortened attention span, lowered frustration tolerance, dry skin, blurred vision, poor wound healing, fatigue, flushed skin, headache, frequent infections, and hyperglycemia (elevated blood glucose levels and glucosuria). Manifestations of diabetic ketosis include ketones and glucose in urine and dehydration in some cases. Manifestations of diabetic ketoacidosis include dehydration, electrolyte imbalance, acidosis, and deep, rapid breathing (Kussmaul respirations).
Which tests confirm hypoparathyroidism in a child? Select all that apply. 1 Parathyroid hormone (PTH) test 2 Kidney function test 3 Magnesium test 4 Glucose tolerance test 5 Bone radiograper
Parathyroid hormone (PTH) test Correct 2 Kidney function test Correct 3 Magnesium test Correct 5 Bone radiograph Rational: A PTH test will help to evaluate the level of the parathyroid hormone in the blood. A kidney function test is performed to rule out renal insufficiency. A magnesium test is performed to test the magnesium levels in the blood. A bone radiograph helps to assess the bone density and growth. A glucose tolerance test is performed to assess blood glucose levels in a child with diabetes mellitus.
Which is the third radiographic stage of Legg-Calvé-Perthes disease?
Reossification stage Rational: There are four radiographic stages of Legg-Calvé-Perthes disease. The reossification stage is the third stage and includes the formation of a new bone. It is represented on radiographs as calcification and ossification of the bone. The avascular stage is the first radiographic stage of Legg-Calvé-Perthes disease during which the aseptic necrosis flattens the upper surface of the femoral head. The remodeling stage is the fourth radiographic stage during which the femoral head attains a spherical shape. The resorptive stage is the second radiographic stage that is associated with resorption of bone.
The nurse is assigned to care for a child with type 1 diabetes mellitus and needs to determine the amount of morning regular insulin to administer. How should the nurse determine the dosage?
The dosage of morning regular insulin is determined by blood glucose patterns in the late morning and lunchtime blood glucose values.
The nurse is consulting with a client with systemic lupus erythematosus. Which is the best instruction to prevent an exacerbation of the disease?
Use sunscreen and wear sun-resistant clothes. Rational: Sunlight can exacerbate the symptoms of systemic lupus erythematosus, so the nurse should instruct the client to use sunscreen and wear sun-resistant clothes to reduce the effects of sunlight. Instructing the client to go out only at night may not be practical and will impair the client's social interactions. Continuous exposure to sunlight may aggravate the client's inflammatory response, so the nurse would not instruct the client to get 1 hour of sun each morning. Loose clothing may be most comfortable for the client, but does not prevent the exacerbation of systemic lupus erythematosus.
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
Which intervention does the nurse implement if steroid therapy causes cushingoid features in a child?
Administers the drug in the morning Rational: If steroid therapy causes cushingoid features in a child, the nurse administers the medication early in the morning, so that the medication is secreted in the normal diurnal pattern. Dietary salt is increased in children with congenital adrenal hyperplasia for aldosterone replacement. Reducing fluid intake will not enable the child to excrete the medications. Glucocorticoids are administered to a child after the surgical removal of pheochromocytoma.
The nurse is responsible for the therapeutic management of a 5-year-old child with type 1 diabetes mellitus. In which areas should the nurse educate the child's parents? Select all that apply. 1 Adjusting nutritional intake based on daily activity and understanding meal planning and proper hygiene 2 Identifying medications such as α-adrenergic blocking agents 3 Supporting the child emotionally during life events, illnesses, and puberty and developing good attitudes toward learning 4 Monitoring blood glucose levels, administering insulin, and managing hyperglycemia and hypoglycemia 5 Managing illnesses such as diabetic ketoacidosis (DKA), providing pulmonary aspiration, and applying gastric suction to an unconscious child
Adjusting nutritional intake based on daily activity and understanding meal planning and proper hygiene Supporting the child emotionally during life events, illnesses, and puberty and developing good attitudes toward learning Correct 4 Monitoring blood glucose levels, administering insulin, and managing hyperglycemia and hypoglycemia Rational: It is important that the parents of a child diagnosed with type 1 diabetes mellitus know about meal planning, proper hygiene, and nutritional intake based on daily activity. Supporting the child emotionally during various life events is also important. Therefore, the parents must have a good attitude toward learning. To maintain health, it is essential to know how to monitor blood glucose levels, administer insulin, and manage hyperglycemia and hypoglycemia. Alpha adrenergic blocking agents are not indicated in the care of diabetes. Illnesses such as DKA are life threatening. A child must be admitted to a hospital if diagnosed with such illnesses. In addition, processes such as pulmonary aspiration and gastric suction must be done by a trained, certified practitioner, not a parent.
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? Select all that apply. 1 Lordosis 2 Negative Babinski sign 3 Asymmetric thigh and gluteal folds 4 Positive Ortolani and Barlow tests 5 Shortening of limb on affected side
Asymmetric thigh and gluteal folds Correct 4 Positive Ortolani and Barlow tests Correct 5 Shortening of limb on affected side
Therapeutic management of the patient with systemic lupus erythematosus includes what?
Corticosteroids to control inflammation Rational: Using corticosteroids to control inflammation is the primary mode of therapy. Cold salts will not affect the inflammatory process. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation.
Which condition does a dexamethasone (cortisone) suppression test confirm?
Cushing syndrome Rational: A dexamethasone (cortisone) suppression test is performed to confirm Cushing syndrome and to differentiate between obesity and cushingoid features in the child. Hypoparathyroidism is confirmed by the parathyroid hormone blood test. Hyperparathyroidism is confirmed by blood tests. Congenital adrenal hyperplasia is confirmed by DNA analysis and ultrasonography.
An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What is the nurse's most appropriate action?
Explain the disorder so parents can explain it to others. Rational: Explaining the disorder is the most therapeutic approach while the parents await the gender assignment of their child. The disorder is caused by decreased enzyme activity required for adrenal cortical production of cortisol. Suggesting that the parents avoid family and friends is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling the parents not to worry without giving them specific alternative actions would not be effective.
What lifestyle changes does the nurse advise for a child diagnosed with type 1 diabetes?
"Plan an exercise schedule according to the child's capabilities." Rational: The nurse instructs the parents to plan an exercise routine according to the child's interests and capabilities. Exercise decreases the blood glucose level, so the child should have snacks before or during prolonged activities to prevent any decrease in the glucose levels. The child is provided simple carbohydrates such as orange juice to increase the blood glucose levels in case of hypoglycemia. In case of hypoglycemia, 1 Tbsp of sugar is provided to the child to increase the glucose levels.
The nurse is assessing a 1-month-old infant for the presence of skeletal abnormalities. What statement by the baby's mother suggests the presence of such an abnormality?
"It difficult to put the diaper between the baby's legs." Rational: Restricted abduction of hip on the affected side indicates the presence of developmental dysplasia of the hip (DDH). Flexion of the extremities is a young infant's typical position when sleeping. Flat feet are an expected finding in a young infant. Failure to straighten the legs is an expected finding in a young infant.
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." Rational: The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination, usually in 6 to 12 weeks. Some practitioners permit its removal for bathing. Removal or re-application of the harness will probably awaken the infant. Babies should not be prevented from taking naps, as such naps are essential for good health.
The nurse is assessing a child with delayed growth. Which questions does the nurse include in the assessment while interviewing the parents? Select all that apply. 1 "Tell me about diseases in your family." 2 "What behavioral therapies is the child undergoing now?" 3 "What kind of developmental issues did the child have?" 4 "Have there been changes in the child's appetite?" 5 "What kind of medications does the child take?"
"Tell me about diseases in your family." "What kind of developmental issues did the child have?" Correct 4 "Have there been changes in the child's appetite?" Correct 5 "What kind of medications does the child take?" Rational: The nurse asks about diseases in the family to assess any hereditary causes for delayed growth. The nurse also asks about any developmental issues in the past to evaluate if it is linked to growth delay. Asking about medications will help to assess the child's health status. Asking about child's appetite may help to identify if nutritional inadequacy has led to delayed growth. Behavioral therapies do not have an impact on the child's growth.
What is the healing time for a femoral shaft fracture in late childhood?
6 to 8 weeks Rational: Fractures heal faster in children than in adults because of the rapid development of the periosteum and richer blood supply. Therefore, healing time for a femoral shaft in late childhood is between 6 and 8 weeks. Healing time for a femoral shaft in early childhood is only 4 weeks. Healing time for a femoral shaft in the neonatal period is 2 to 3 weeks. Healing time for a femoral shaft in adolescence is 8 to 12 weeks.
What are the signs and symptoms associated with acute osteomyelitis? Select all that apply. 1 Irritability 2 Restlessness 3 Fluid overload 4 Bradycardia 5 Onset of fever
Correct 1 Irritability Correct 2 Restlessness Correct 5 Onset of fever Rational: Osteomyelitis is the infection of bone and is a condition that is more common in boys than in girls. Irritability, restlessness, and fever are the general manifestations of acute osteomyelitis. Dehydration occurs in clients with acute osteomyelitis, so fluid overload would not be a concern. Clients with acute osteomyelitis will have a rapid pulse rate due to trauma and dehydration, but not bradycardia.
Which measure is important in managing hypercalcemia in a child who is immobilized?
Promoting adequate hydration Rational: Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia. Changing position frequently will help manage skin integrity but will not affect calcium levels. The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia. The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.
Which nursing interventions should be included in the care plan for a patient with osteoporosis? Select all that apply. 1 Ensuring adequate intake of fluids 2 Changing the patient's position frequently 3 Ensuring proper care while positioning the patient 4 Assessing for signs of urinary tract infection regularly 5 Measuring circumference of the extremities regularly
Ensuring adequate intake of fluids Ensuring proper care while positioning the patient Assessing for signs of urinary tract infection regularly
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) Rational: Methotrexate (MXT) is a second-line medication that helps treat juvenile idiopathic arthritis. If the child has persistent inflammation in spite of taking methotrexate (MXT), then the primary health care provider would prescribe etanercept (Enbrel) for the child. Etanercept (Enbrel) is a tumor necrosis factor-α receptor blocker and alleviates the symptoms of arthritis in the child. Methotrexate (MXT) is prescribed for the child when the child is unresponsive to nonsteroidal antiinflammatory drugs (NSAIDs). Aspirin (Acuprin), meloxicam (Mobic), and celecoxib (Celebrex) are the examples of NSAIDs.
A 15-year-old patient underwent surgery to have the right foot amputated. The amputation was done to remove a cancerous growth. What is an appropriate postoperative nursing intervention to promote psychological adjustment and mobility?
Help the patient adjust to the temporary prosthesis. Rational: If there is no vascular or neurologic deficit, a cast is applied to the stump immediately after the procedure, and a pylon, metal extension, and artificial foot are attached so the patient can walk on the temporary prosthesis within a few hours. A temporary prosthesis allows the adolescent to walk within several hours and helps start the adjustment process. The first dressing change usually is done by a member of the surgical team; also, this is too early to expect the adolescent to be ready to observe the surgical site. Assigning the adolescent to a particular room is usually done out of necessity and not to promote psychological adjustment. It is too early to have another cancer survivor visit the patient; this can be done later in the recovery process.
Which statement is true concerning osteogenesis imperfecta?
It is an inherited disorder. Rational: Osteogenesis imperfecta is an inherited disorder. Osteogenesis imperfecta is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. The type of disease determines the course it will take. Lightweight braces and splints can help support limbs and fractures.
Which information should the nurse include when teaching a patient about Cushing syndrome?
It is caused by excessive production of cortisol. Rational: Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol. Exophthalmia is a manifestation of hyperthyroidism, not Cushing syndrome. The treatment is the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated. Hypertension and hypokalemia are expected findings.
A 2-month-old infant has been diagnosed with developmental dysplasia of the hip. The health care provider has prescribed immediate treatment for the baby using a Pavlik harness. What is the rationale behind this urgency?
It is easier to get the hip into a more abducted position.
What is characteristic of fractures in children compared to adults?
Rapidity of healing is inversely related to the age of the child. Rational: Fractures heal in children in less time than they do in adults. As the child ages, the healing time increases. The cartilage epiphyseal plate is the weakest point of the long bone. Therefore, it is a frequent site of damage. The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs. Bone healing in children is rapid because of the thickened periosteum and generous blood supply.
What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle?
Reduces edema formation Rational: Elevating the extremity uses gravity to facilitate venous return to reduce edema. Elevating the extremity should have no effect on the pain threshold and should not affect metabolism. Venous return to the heart, not vasodilation, is facilitated.
The nurse is caring for an immobilized preschool child. During this period of immobilization, what is the nurse's best action?
Take the child outside of the room by wagon. Rational: It is important for children to have activities outside of the room if possible. This increases environmental stimuli and provides social contact with others. The child should be encouraged to wear street clothes during the daytime. Limit setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.
What orthopedic finding suggests the presence of developmental dysplasia of the hip (DDH)?
The affected limb shorter than the other Rational: The affected leg appears to be shorter because the femoral head is displaced upward. There is a limited ability to abduct, not adduct, the affected leg. An anal stricture is not expected with DDH. When the femoral head slips out of the acetabulum, it is easily palpable.
A 4-month-old infant has been diagnosed with developmental dysplasia of the hip (DDH). What appropriate intervention will follow the diagnosis?
The baby will be set up to be fitted with a Pavlik harness. Rational: Of the numerous devices available, the Pavlik harness is the most widely used; and with time, motion, and gravity, the hip works into a more abducted, reduced position. The Pavlik harness promotes hip abduction and flexion. Swaddling limits hip abduction and puts stress on the hip joint. Strapping the infant to a cradleboard limits hip abduction and puts stress on the hip joint. Although placing the infant in an infant seat allows movement in the flexed position, it does not promote abduction.
The nurse observes on the cardiac monitor that a child admitted with diabetic ketoacidosis has a widening of the QT interval and the appearance of U wave after a flattened T wave. What should the nurse conclude from such an observation?
The child has hypokalemia. Rational: The cardiac monitor is used on patients admitted with diabetic ketoacidosis because the serum potassium level can be elevated on admission and decrease during treatment. The monitor is used to configure T waves every 30 to 60 minutes. Changes such as widening of the QT interval and the appearance of U wave after a flattened T wave indicate hypokalemia. Hypovolemia is low blood volume, which is not monitored through the cardiac monitor. Hypercalcemia is an elevated level of calcium in the blood, which is a strictly asymptomatic laboratory finding. An elevated and spreading T wave and shortening of the QT interval indicate hyperkalemia.
What does the nurse evaluate to determine the amount of morning regular insulin that needs to be administered to a child with type 1 diabetes mellitus?
The child's lunchtime blood glucose levels. Rational: The student needs to evaluate the patient's lunchtime or late morning blood glucose levels to determine the necessary amount of morning regular insulin. The patient's fasting blood glucose levels at breakfast are evaluated to determine the evening dose of intermediate-acting insulin. The patient's late afternoon blood glucose levels are evaluated to determine the morning intermediate-acting dosage. The patient's bedtime blood glucose levels are evaluated to determine the evening dose of rapid-acting (regular) insulin.
Which clinical findings in the blood reports of a child indicate diabetes mellitus?
The fasting blood glucose level is 126 mg/dL. Rational: A fasting blood glucose level of 126 mg/dL or more indicates that the child has diabetes mellitus. Ketoacidosis is a lack of insulin in the body. Hypopituitarism is caused by deficient secretion of pituitary hormones. Hypoglycemia indicates low blood sugar levels. Glycosuria is an indication of diabetes mellitus, but it can also be caused by infection, trauma, or endocrine diseases.
What is a defining characteristic of scoliosis?
There is a rotary deformity of the lateral curvature of the spine. Rational: Scoliosis is the most common spinal deformity. A rotary deformity of the lateral curvature of the spine is the correct description of scoliosis. A concave lumbar curvature that is exaggerated is a description of lordosis. There are no bacterial infections in the vertebrae with scoliosis. A curvature of the thoracic spine that has an increased convex angulation is a description of kyphosis.
What is the purpose of adding dextrose to the intravenous (IV) solution when the child's blood glucose levels fall between 250 to 300 mg/dL?
To maintain blood glucose levels between 120 and 240 mg/dL Rational: The nurse adds dextrose to the IV solution to maintain the blood glucose levels between 120 and 240 mg/dL. Sodium bicarbonate is used to increase the serum pH and maintain cardiac stability. Hypoglycemia is rectified by providing a simple carbohydrate like orange juice. Insulin is administered to maintain glycosylated hemoglobin of 7% or less.
The nurse is teaching the parent of a 12-month-old infant about assessing developmental dysplasia of the hip in babies. What instruction does the nurse give the parent to check the presence of a Trendelenburg sign?
"Make the infant stand on the affected leg." Rational: When an affected older infant stands and bears weight on the affected hip, the pelvis tilts downward instead of upward, indicating a positive Trendelenburg sign. The supine position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis. The side-lying position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis. The sitting position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis.
The nurse plans to teach an adolescent diagnosed with type 1 diabetes about exercise and lifestyle changes that can help manage the diabetic condition. What information should the nurse include in the teaching plan? Select all that apply. 1 "The type and duration of exercise should be planned around your interests and capabilities." 2 "You can have snacks before you exercise to compensate for decreasing blood glucose levels." 3 "You can administer oral hypoglycemic agents before you start your exercise regimen." 4 "You should not exercise."
"The type and duration of exercise should be planned around your interests and capabilities." "You can have snacks before you exercise to compensate for decreasing blood glucose levels." Rational: It is advisable to plan the exercise type and duration based on the child's interests and capabilities. Because exercise decreases blood glucose levels, the child should have snacks before or during prolonged activity to compensate. Oral hypoglycemic agents will reduce the glucose levels further if taken while exercising, so the child should not do this. Exercise is not harmful to patients with diabetes, so nurses or medical providers should not advise against it.
A 15-year-old child has type 2 diabetes mellitus and needs dietary instruction from the nurse. Which statements from the nurse would provide the child with important information on nutritional needs? Select all that apply. 1 "You should have enough calories for your energy, growth, and development." 2 "You can regularly have soft drinks, concentrated sweets, and high-calorie meals." 3 "Food intake should correspond to the timing and action of the insulin prescribed." 4 "You can have pizza, homemade apple pie, and hot chocolate before bedtime." 5 "You should plan to incorporate snacks between meals and at bedtime.
"You should have enough calories for your energy, growth, and development." "Food intake should correspond to the timing and action of the insulin prescribed." "You should plan to incorporate snacks between meals and at bedtime." Rational: The nutritional needs of a 15-year-old child with type 2 diabetes mellitus are no different from those of other healthy children. The child would need sufficient calories for daily energy expenditure, growth, and development. However, unlike children without diabetes mellitus, they need insulin injected subcutaneously, coordinated with their food intake so that peak effect, duration of action, and absorption rate are optimized to regulate their blood glucose levels. Snacks are also necessary to prevent hypoglycemia, and they should be timed between meals and at bedtime depending on the activity time and action of the insulin prescribed. The child cannot have soft drinks, concentrated sweets, and high-calorie meals. They should not eat pizza, homemade apple pie, and hot chocolate anytime they feel hungry because it may increase their blood glucose levels.
A nursing student is helping to care for a client with lower extremity venous stasis. The student places three pillows under the client's legs and instructs the client to rest in only one position. The student measures the circumference of the client's extremities periodically and administers anticoagulants as prescribed. Which intervention of the student indicates the need for additional teaching?
Advising the client to rest in only one position Rational: Venous stasis in the leg can result in pulmonary embolism and thrombi formation. To reduce the risk of the venous stasis, the nurse should instruct the client to change positions frequently rather than staying in one position. The nurse is correct in elevating the extremities to promote the circulation and reduce the risk of emboli formation. Venous stasis is caused by blood coagulation; therefore, anticoagulants reduce the risk of developing blood clots. The nurse should measure the circumference of the extremities periodically, as an increase in circumference of the extremities indicates thromboembolism.
The nurse is caring for a child with a hip spica cast. Which nursing interventions will be beneficial to the child? Select all that apply. 1 Change the child's position every 2 hours. 2 Dry the cast with heated fans or dryers. 3 Remove rings and any other accessories. 4 Check for any cuts or abrasions on skin. 5 Cover the cast with a polythene sheet
Change the child's position every 2 hours. Correct 3 Remove rings and any other accessories. Correct 4 Check for any cuts or abrasions on skin Rational: While caring for a child with a spica cast, the nurse should change the position of the child every 2 hours. This practice helps the cast to dry evenly and prevents complications such as pressure ulcers and bedsores that occur due to immobility. To prevent constriction of blood vessels and swelling of the limbs, the nurse should remove rings and other accessories from the client's body before applying the cast. To prevent infections and discomfort, the nurse should check the client's skin for the presence of cuts or abrasions before applying the cast. The nurse should not use heated fans or dryers to dry the cast as it leads to irregular drying of the cast and may cause burns because of the conduction of heat from the cast to underlying tissues. The nurse should not cover the cast with a polythene sheet as polythene retains moisture and does not allow the cast to dry inside out.
Which postoperative nursing interventions are useful to avoid secondary complications in a young patient who has undergone spinal surgery? Select all that apply. 1 Assessing for signs indicating neurologic impairment 2 Administering intravenous opioids on a regular basis 3 Educating the patient on use and function of chest tube 4 Assessing for the signs of superior mesenteric artery syndrome 5 Teaching the patient to manage a patient-controlled analgesia (PCA) pump
Correct 1 Assessing for signs indicating neurologic impairment Correct 2 Administering intravenous opioids on a regular basis Rational: After a spinal surgery, the patient has a considerable amount of pain for a few days. Pain relief requires frequent administration of intravenous pain medicines, preferably opioids. Postoperative assessment of any neurologic impairment should be performed because delayed paralysis might occur after spinal surgery. Educating the patient on the management of a patient-controlled analgesia (PCA) pump is done to promote self-care to encourage the patient's participation in treatment and recovery. Superior mesenteric artery syndrome is likely to be seen after spinal surgery in which there is compression of the duodenum by aorta and superior mesenteric artery. Clinical symptoms are nausea, vomiting, and epigastric pain which aggravate in the supine position and are relieved in the prone position. Teaching the patient about the use and function of a chest tube is also part of patient education for self-care.
Which assessment findings support the nurse's conclusion that a 2-week-old neonate has hip dysplasia? Select all that apply. 1 Positive Barlow test 2 Positive Ortolani test 3 Positive Galeazzi sign 4 Piston mobility of hip joint 5 Positive Trendelenburg sign
Correct 1 Positive Barlow test Correct 2 Positive Ortolani test Correct 3 Positive Galeazzi sign
Which assessment findings support the nurse's conclusion that a 2-week-old neonate has hip dysplasia? Select all that apply. 1 Positive Barlow test 2 Positive Ortolani test 3 Positive Galeazzi sign 4 Piston mobility of hip joint 5 Positive Trendelenburg sign
Correct 1 Positive Barlow test Correct 2 Positive Ortolani test Correct 3 Positive Galeazzi sign Rational: Barlow, Ortolani, and Galeazzi tests are the most reliable for confirming the presence of hip dysplasia in a 2-week-old child. If the hip gets dislocated due to adduction, it indicates a positive Barlow test. If the hip is reduced by abduction, then it indicates a positive Ortolani test. If the affected limb appears to be shorter than that of the other limb, then it indicates a positive Galeazzi test. A positive Trendelenburg sign and piston mobility of joint are assessment findings which indicate hip dysplasia in older infants and children.
When a child experiences decreased muscle strength, tone, and endurance from immobilization, what is a secondary effect?
Decreased exercise tolerance Rational: Muscle disuse leads to tissue breakdown and loss of muscle mass. It may take weeks or months to recover. Metabolism decreases during periods of immobility. There is decreased venous return because of decreased muscle activity. There is decreased cardiac output.
After assessment of an infant the nurse informs the primary health care provider that the child has a positive Ortolani test. Which finding obtained from the test enables the nurse to reach this conclusion?
Decreased hip abduction Rational: A positive Ortolani test indicates that the infant has developmental dysplasia of the hip. While performing the Ortolani test the nurse abducts the child's thighs and checks whether the client has hip subluxation or dislocation. The presence of decreased hip abduction indicates a positive Ortolani test. A child with developmental dysplasia of the hip has asymmetrical folds of the thigh tissues, so the presence of symmetrical folds would not indicate a positive Ortolani test. The presence of bacterial infection in the joints can be diagnosed through a series of tests including gram stain cultures, leukocyte count, blood cultures, and a complete blood count. Anteroposterior and frogleg radiographic examination are useful in diagnosing the displacement of proximal femoral epiphysis.
During the assessment of a child, the nurse finds that the child has pain and sacral dimpling in the lumbosacral region along with bladder incontinence. The nurse suspects that the child may need a magnetic resonance imaging (MRI) scan. Which complication does the nurse suspect in the child?
Diastematomyelia Rational: Diastematomyelia is an intraspinal abnormality that can result in scoliosis. Signs of pain in the lumbosacral region, sacral dimpling, and bladder incontinence indicate the presence of an intraspinal abnormality. Clubfoot involves ankle and foot deformity and is associated with forefoot adduction, midfoot supination, and hind foot varus, but not sacral dimpling. Meromelia is a skeletal limb deficiency where the entire extremity is absent. This condition is not associated with sacral dimpling or bladder incontinence. Septic arthritis is a bacterial infection in the joint, which is marked by severe joint pain, swelling, and erythema but not with sacral dimpling and bladder incontinence.
A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurse's response should be based on what knowledge?
Exercise is not restricted unless indicated by other health conditions. Rational: Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercises. The level of activity does not depend on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events.
The primary health care provider prescribes methotrexate (MTX) to a child with juvenile idiopathic arthritis. Which function should the nurse monitor in the child to ensure safe drug administration?
Liver function Rational: Methotrexate (MTX) is the second-line medication that helps in the treatment of juvenile idiopathic arthritis, particularly in children who are less responsive to nonsteroidal antiinflammatory drugs (NSAIDs) alone. The adverse effects of methotrexate (MTX) include liver toxicity and changes in complete blood cell count so the nurse should monitor the child's liver function to ensure safe administration of this drug. MTX does not interfere with the renal, cardiac, or pulmonary function, so the nurse does not need to carefully monitor these systems to ensure safe administration of the drug.
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 Rational: Acute osteomyelitis is infection in the bone caused by a blood-borne bacterium. If a client is unresponsive to IV antibiotic therapy, the primary health care provider would recommend surgery. Chemotherapy is used in cancer treatment, but is not indicated in the treatment of osteomyelitis since it may cause bone deformation. Phototherapy may not be effective in treating infection because it does not have any antibacterial activity. Oral antibiotic therapy is less effective than IV therapy, so oral antibiotics would not be a suitable treatment when IV antibiotics fail.
A child is undergoing hormone replacement therapy. The nurse observes that the child appears younger than the chronologic age. What does the nurse include in the child's plan of care? Select all that apply. 1 The nurse provides education to the child for self-management. 2 The nurse instructs the parents to treat the child in infantile ways. 3 The nurse instructs the family how to administer prescribed baclofen (Kemstro). 4 The nurse instructs the family about injection sites and techniques. 5 The nurse instructs the family on how to prepare medications.
The nurse provides education to the child for self-management. Correct 4 The nurse instructs the family about injection sites and techniques. Correct 5 The nurse instructs the family on how to prepare medications. Rational: The nurse provides self-care education to the child to increase the child's confidence. The nurse instructs the parents about injection sites, injection technique, and syringe disposal to ensure safe and effective administration of medicines. The nurse also instructs the family about medication preparation and dosage calculation to ensure safety during administration of the medicines. The child taking the therapy may appear younger than the chronologic age, but the child must be treated according to the age and abilities and not in infantile ways. Baclofen (Kemstro) is primarily used to treat spasticity. Therefore, it is not prescribed.
The primary goals of the nurse caring for a child with illness and diabetic mellitus are to restore euglycemia, treat urinary ketones, and maintain hydration. What steps should the nurse take to provide effective care? Select all that apply. The nurse should monitor the glucose levels and urinary ketones every 3 hours and encourage intake of fluids. 2 The nurse should determine whether a computed tomography (CT) scan or magnetic resonance imaging (MRI) is needed. 3 The child's food intake and insulin dosage should be adjusted depending on glucose levels and degree of illness. 4 The health care provider should be notified if the child vomits or if blood glucose levels and urinary ketones rise. 5 The nurse should identify medications such as α-adrenergic blocking agents with or without β-adrenergic blocking agents
The nurse should monitor the glucose levels and urinary ketones every 3 hours and encourage intake of fluids. The child's food intake and insulin dosage should be adjusted depending on glucose levels and degree of illness. The health care provider should be notified if the child vomits or if blood glucose levels and urinary ketones rise. Rational: The nurse should monitor blood glucose levels and urinary ketones every 3 hours and encourage fluid intake to prevent dehydration and flush out ketones. Simple carbohydrates may be substituted for carbohydrate-containing exchanges in the meal plan. These substitutes ensure that the level of glucose in the blood does not increase to an unhealthy limit. The fluid intake should be consistent with the diabetic diet and the illness. If the child vomits more than once, if blood glucose levels remain above 240 mg/dL, or if urinary ketones remain high, the health care provider should be notified. The primary health care provider determines which tests are needed, such as a CT scan or MRI. While the nurse can identify types of medication pharmacologic categories, there is no clinical indication for this type of medication as being required in the patient's treatment plan as they could lead to significant complications with an increase in blood sugar.
The primary health care provider diagnoses a client with slipped capital femoral epiphysis and instructs the nurse to prepare the client for surgery immediately. What is the rationale for this instruction?
To prevent avascular necrosis Rational: The primary health care provider instructs the nurse to prepare the client for surgery immediately because a slipped epiphysis can exert pressure on the femoral artery and block circulation, leading to avascular necrosis. Surgery may not decrease the risk of venous stasis; use of anticoagulant drugs can decrease venous stasis. Idiopathic scoliosis is a spine deformity and does not relate to the slipped capital femoral epiphysis in the client. Use of antiembolism stockings can prevent orthostatic intolerance in the client and is not related to slipped capital femoral epiphysis.
What are major goals of the therapeutic management of juvenile rheumatoid arthritis?
To prevent physical deformity and preserve joint function Rational: Preventing physical deformity and preserving joint function are the goals of treatment. A third goal is to control pain. After the joint is damaged, it may not be possible to regain proper alignment. It may not be possible to achieve a cure. Skin breakdown is usually not an issue in juvenile rheumatoid arthritis.
During an assessment, the nurse finds that the client has a fracture at the metaphysis and a bulging projection at the fracture site. Which condition is likely to be found in the client?
Torus fracture Rational: The presence of a bulging projection at the site of a fracture indicates that the client has a torus fracture, which is caused by compression of the porous bone. In case of a complete fracture, the bone divides into fragments. A greenstick fracture is caused by the bending of bones to extreme limits and is characterized by the presence of angulated bone. In a plastic deformation, the bone is bent but not broken.
The nurse is explaining that the destruction of pancreatic β-cells is the cause of which disorder?
Type 1 diabetes Rational: Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic β-cells. Type 2 diabetes is a result of insulin resistance. The description of type 1 diabetes is not applicable to impaired glucose tolerance or gestational diabetes.
During an assessment, the nurse notes that an infant's forefoot is rigid. The nurse further observes that the infant's foot does not stretch and remains in a neutral position with manipulation. What clinical finding should the nurse infer from these findings?
Type III metatarsus adductus Rational: Metatarsus adductus is a congenital foot deformity that is classified into three types based on the flexibility of the foot. The infant with type III metatarsus adductus has a rigid forefoot that does not stretch and remains neutral. The infant with meromelia may have partial or complete absence of extremities. The infant with club foot may have a twisted foot either bending outwards or inwards. In type II metatarsus adductus, the forefoot is partial flexible and it corrects passively.
The patient is diagnosed with diabetes insipidus. The health care provider has prescribed antidiuretic hormone (ADH) replacement with vasopressin tannate in peanut oil to help the patient get a full night's sleep. How should the nurse administer the medication? Select all that apply. 1 Vasopressin should be resuspended in the oil by being held under warm running water for 10 to 15 minutes. 2 Vasopressin should be held under warm running water for 10 to 15 minutes before the medication is administered. 3 Vasopressin should not be administered if small brown particles, which indicate drug dispersion, are seen in the suspension. 4 Vasopressin should be injected in such a way that the oil is injected without the ADH. 5 Vasopressin must be shaken vigorously before being drawn into the syringe and small brown particles should be observed.
Vasopressin should be resuspended in the oil by being held under warm running water for 10 to 15 minutes. Vasopressin must be shaken vigorously before being drawn into the syringe and small brown particles should be observed. Rational:Vasopressin must be thoroughly resuspended in the oil by being held under warm running water for 10 to 15 minutes and then shaken vigorously before being drawn into the syringe. It is necessary that small brown particles, denoting drug dispersion, are seen in the suspension. This confirms that oil is not injected without the ADH. If vasopressin is held under warm running water for 10 to 15 minutes without being resuspended in the oil, the medicine will not be effective. It is also necessary to confirm that brown particles form, indicating drug dispersion, and oil is injected with the ADH. Otherwise, the medicine will not be effective. There is no mention of whether the patient has allergies and as ADH is being administered in peanut oil, this may be a concern. The prudent nurse would be alert to the patient's allergy status.
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 Rational: The optimum time for the infant to be fitted with a prosthetic device is when the infant begins sitting up and can maintain balance. The device should be provided when the infant is showing readiness to stand; the prosthetic device will be integrated into the infant's capabilities. The device will not be useful until the infant is developmentally ready to use the leg.
