NUR1305 Test #3 Study QUESTIONS Neuromuscular and Special Senses Pediatrics

A child with myasthenia gravis complains of difficulty with chewing and facial movements. The physician orders neostigmine to improve muscle tone. What time should the patient take this medication to improve muscle tone while chewing? 1. Thirty minutes before meals 2. Before bed 3. First thing in the morning 4. With the first bite of a meal

1. Thirty minutes before meals Neostigmine has a half life of only 50 minutes, so it should be taken about 30 minutes before meals to improve tone of the muscles of mastication. Neostigmine is an acetylcholinesterase inhibitor. It prevents the breakdown of acetylcholine to increase activation of nicotinic and muscarinic receptors, leading to muscle contraction.

A nurse is assisting with the development of an in-service about viral and bacterial meningitis. The nurse should include that the introduction of which of the following immunizations decreases the incidence of bacterial meningitis in children? Select all that apply 1. Inactivated polio vaccine IPV 2. Pneumococcal conjugate vaccine PCV 3. Diphtheria and tetanus toxoid and acellular pertussis vaccine DTaP 4. Trivalent inactivated influenza vaccine TIV

2 and 4

A nurse is caring for a child who sustained a fracture. Which of the following actions should the nurse take? Select all that apply 1. Place a heat pack on the site of the injury 2. Elevate the affected limb 3. Check neurovascular status frequently 4. Encourage range of motion of the affected limb 5. Stabilize the injury

2, 3 and 5

In diagnosing seizure disorder, which of the following is the most beneficial? 1. Skull radiographs 2. EEG 3. Brain scan 4. Lumbar puncture

2. EEG

An infant with clubfoot will have his final cast removed today. Which member of the health care team can the nurse expect to be consulted? 1. Pharmacist 2. Physical therapist 3. Occupational therapist 4. Respiratory therapist

2. Physical therapist

A nurse is caring for a child who is suspected of having Legg-Calve-Perthes disease. The nurse should prepare the child for which of the following diagnostic procedures? 1. Bone biopsy 2. Scoliometer measurement 3. Ultrasound 4. Radiographs

4. Radiographs A child with this disease exhibits necrosis of the femoral head which can be diagnosed by radiographs of the hip and pelvis.

A nurse is reinforcing teaching with a group of parents about the risk factors for seizures. Which of the following factors should the nurse include? Select all that apply 1. Febrile episodes 2. Hypoglycemia 3. Sodium imbalances 4. Low serum lead levels 5. Presence of diphtheria

1, 2 and 3 High lead levels are a risk for seizure activity. Diphtheria is a respiratory illness that causes difficulty breathing. It is not a risk factor for seizures.

A nurse is caring for a child who has cerebral palsy. Which of the following medications should the nurse expect to administer to treat painful muscle spasms? Select all that apply 1. Baclofen 2. Diazepam 3. Indomethacin 4. Methotrexate 5. Prednisone

1 and 2 Indomethacin is a NSAID used for JIA Methotrexate is an antirheumatic used for JIA Prednisone is a corticosteroid used for muscular dystrophy and JIA

A nurse is caring for a school age child who has juvenile idiopathic arthritis JIA. Which of the following home care actions should the nurse recommend? Select all that apply 1. Provide extra time for completion of ADLs 2. Use cold compresses for joint pain 3. Take ibuprofen on an empty stomach 4. Consider home schooling 5. Perform range of motion exercises

1 and 5 Warm compresses should be used. Ibuprofen on an empty stomach causes GI distress. Contact with peers will help meet developmental needs.

A nurse is caring for a child who has absence seizures. Which of the following findings should the nurse expect? Select all that apply 1. Loss of consciousness 2. Appearance of daydreaming 3. Dropping held objects 4. Falling to the floor 5. Having a piercing cry

1, 2 and 3 Loss of consciousness for 5 to 10 seconds, behavior resembling daydreaming and dropping held objects are all indications of absence seizures. Tonic clonic seizures commonly have falling on the floor. A piercing cry is a manifestation of an atonic-akinetic seizure

A nurse is reviewing cerebrospinal fluid analysis for a client who has suspected meningitis. Which of the following findings indicate viral meningitis? Select all that apply 1. Negative Gram stain 2. Blood glucose level within the expected reference range 3. Cloudy cerebrospinal fluid 4. Decreased white blood cell count 5. Protein level within the expected reference range

1, 2 and 5 Viral meningitis would have a negative Gram stain. Blood glucose levels would be within the expected reference range. Bacterial meningitis would have low glucose level. There should be a slightly elevated white blood cell count. The cerebrospinal fluid would be clear. The protein level would be WNL.

A nurse is reviewing treatment options with the parent of a child who has worsening seizures. Which of the following treatment options should the nurse include in the discussion? Select all that apply 1. Vagal nerve stimulator 2. Additional antiepileptic medications 3. Corpus callosotomy 4. Focal resection 5. Radiation therapy

1, 2, 3 and 4 Radiation therapy is used for cancer treatments.

A nurse is caring for a child who has a fracture. Which of the following are manifestations of a fracture? Select all that apply 1. Crepitus 2. Edema 3. Pain 4. Fever 5. Ecchymosis

1, 2, 3 and 5 Fractures can leave bone fragments that exhibit a grading sound. Swelling can occur related to the trauma. Bleeding under the skin can occur related to the trauma. Fever following a fracture is unexpected and usually indicates infections such as osteomyelitis.

Reggie is a teenager suffering from osteomyelitis; the nurse would expect which of the following symptoms? Select all that apply. 1. Fever 2. Irritability 3. Pallor 4. Tenderness 5. Swelling

1, 2, 4 and 5 The symptoms for acute and chronic osteomyelitis are very similar and include fever, irritability, fatigue, nausea, tenderness, redness and warmth in the area of the infection, swelling around the affected bone, and lost range of motion.

After several days in traction, the patient has a long leg fiber glass cast applied to his left leg. Before the patient is discharged, the nurse should instruct the patient on which of the following? 1. "Be sure to keep your cast dry" 2. "If itching occurs in the area that is unreachable, have a blunt object to scratch the area under the cast, and make sure to scratch gently" 3. "Reinforce the cast with adhesive tape if any cracks occur" 4. "Have your friends sign their names on your cast."

1. "Be sure to keep your cast dry" Remind children that autographs are not allowed because fiberglass is a porous material. Be certain that the child knows not to put anything inside the cast. If itching occurs inside the cast, blowing some cool air into it from a hair dryer can be comforting. Damage to the cast should be reported.

A nurse is reinforcing teaching with the parent of a child who is to have an EEG. Which of the following responses should the nurse include? 1. "Offer decaffeinated beverages the morning of the procedure." 2. "Do not wash your child's hair the night before the procedure." 3. "Withhold all foods the morning of the procedure." 4. "Promote extra hours of sleep the night before the procedure."

1. "Offer decaffeinated beverages the morning of the procedure."

Nurse Cheryl is assessing Fred, a 14-year-old boy who had scoliosis; besides checking neurologic status directly after Harrington rod instrumentation and spinal fusion, she should be regarded with which of the following factors? 1. Comfort level 2. Dietary tolerance 3. Physical therapy needs 4. Understanding of the procedure

1. Comfort level Instrumentation and spinal fusion cause considerable pain. Therefore, the adolescent needs vigorous pain management, which involves assessment, administration of pain medication, and evaluation of the response. In the immediate postoperative period, the child is conscious of sensation and surroundings.

The nurse is caring for a patient with an autistic disorder. Upon assessment the nurse records that the child has a labile mood. Which of the following symptoms suggest a labile mood? 1. Crying suddenly followed immediately by giggling and laughing 2. Repetitive hand movements 3. Intensely preoccupied by objects that move 4. Repeating words or phrases spoken by others

1. Crying suddenly followed immediately by giggling and laughing Children with autistic disorders often have a labile mood. They also may react with over responsiveness to sensory stimuli, such as light or sound. The impairment in communication is shown in both verbal and nonverbal skills. Language may be totally absent. If a child does speak, grammatical structure may be impaired, such as the use of "you" when "I" is intended.

The nurse is preparing the mother for treatment of her newborn girl with hip dysplasia. Which of the following would the nurse do to assess a mother's ability to care for her child using a Pavlik harness? 1. Have the mother remove and reapply the harness before the discharge 2. Have the mother verbalize the purpose for using the device 3. Request a home health care nurse visit after discharge 4. Demonstrate to the mother how to remove and reapply the device

1. Have the mother remove and reapply the harness before the discharge

A 10-year-old male is admitted to the acute care facility after having a tonic-clonic seizure. What priority nursing action would the nurse do immediately after the seizure? 1. Maintain a patent airway with the child lying on his side until he is alert and responsive 2. Monitor vital signs and neurologic status every 15 minutes until the child is fully awake 3. Provide a calm, restful environment 4. Observe for signs and symptoms of respiratory distress

1. Maintain a patent airway with the child lying on his side until he is alert and responsive

A nurse is caring for a child who just experienced a generalized seizure. Which of the following is the priority action for the nurse to take? 1. Maintain the child in a side lying position 2. Check to see if the child bit his tongue 3. Re-orient the child to the environment 4. Document the time and characteristics of the child's seizure

1. Maintain the child in a side lying position

While examining a 2-year-old child, Nurse Galina sees that the anterior fontanel is open. She should: 1. Notify the doctor 2 Look out for other signs of abuse 3. Recognize this as a normal finding 4. Ask about a family history of Tay-Sachs disease

1. Notify the doctor

A newborn baby is diagnosed with a neural tube defect, specifically, meningocele. Which of the following definitions most accurately describes meningocele? 1. Out-pouching of the meninges through the cranium or vertebrea 2. Spinal cord and meninges protrude through the vertebrae defect 3. Posterior laminae of the vertebrae fail to fuse 4. Tumor of the spinal cord and accompanying nerve roots

1. Out-pouching of the meninges through the cranium or vertebrea A meningocele, a type of spina bifida, is a sac that contains meninges and CSF protruding outside the vertebrae. The spinal cord is not involved and therefore, there is usually no long-term neurological damage. The meningocele appears as a protruding mass at the center of the lumbar region. The protrusion may be covered by a layer of skin or only a clear dura matter. Myelomeningocele is a herniation of the spinal cord, meninges, and CSF into a sac that protrudes through a defect in the vertebral arch. The nerves are often exposed and at risk for developing meningitis.

A nurse is assisting with the care of a client who has suspected meningitis and a decreased level of consciousness. Which of the following actions should the nurse take? 1. Place the client on NPO status 2. Prepare the client for a liver biopsy 3. Position the client dorsal recumbent 4. Put the client in a protective environment

1. Place the client on NPO status To prevent aspiration the client should have nothing by mouth due to the decreased level of consciousness. Position the client without a pillow and slightly elevate the HOB to prevent increasing intracranial pressure. A client with suspected meningitis should be on respiratory isolation for at least 24 hours after the initiation of antibiotic therapy.

A nurse is caring for a child who is in skeletal traction. Which of the following actions should the nurse take? Select all that apply 1. Remove the weights to reposition the child. 2. Check the child's position frequently 3. Observe pin sites every four hours 4. Ensure the weights are hanging freely 5. Ensure the rope's knot is in contact with the pulley

2, 3 and 4

A nurse is collecting data from a child who has Legg-Calve-Perthes disease. Which of the following findings should the nurse expect? Select all that apply 1. Longer affected leg 2. Hip stiffness 3. Enlarged muscles in affected leg 4. Limited range of motion 5. Limp with walking

2, 4 and 5 Muscle wasting and shortening of the affected leg would be expected.

A nurse is assessing a 5-year-old with multiple deformities of the limbs and joints. She also has a thin upper lip, small teeth, and trouble learning in school. The nurse suspects that these signs are most likely the result of which of the following? 1. Klinefelter Syndrome 2. Fetal Alcohol Syndrome FAS 3. Mercury poisoning 4. Down's Syndrome

2, Fetal Alcohol Syndrome FAS Physical features of FAS include deformities such as a small head and brain, sunken nasal bridge, thin upper lip, small teeth, and an upturned nose. FAS can also cause vision difficulties, intellectual disability, short attention span, delayed mental development, and poor impulse control.

A nurse is assisting with a group discussion about fractures. Which of the following information should the nurse include? 1. "Children need a longer time to heal from a fracture than an adult." 2. "Epiphyseal plate injuries can result in altered bone growth." 3. "A greenstick fracture is a complete break in the bone." 4. "Bones are unable to bend, so they break."

2. "Epiphyseal plate injuries can result in altered bone growth." Children heal quicker than adults. A greenstick fracture is a partial break. Children's bones are soft and pliable and can bend up to 45° before breaking.

The nurse is assessing a 4-month-old suspected of having cerebral palsy. Upon initial interview, which of the following statements by the mother would indicate that the infant may have cerebral palsy? 1. "My baby cannot sit without support" 2. "My baby cannot lift her head up, she is floppy" 3. "My baby has not rolled all the way over yet" 4. "My baby's left hip tilts if I hold her upright"

2. "My baby cannot lift her head up, she is floppy" Hypotonia is an early manifestation of cerebral palsy. The infant should be able to support their head by age 4 months. Infants with cerebral palsy may also have an irregular posture, muscle stiffness, and spasticity.

Mrs. Cooper is concerned about her 4-month-old son's unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy? 1. "He holds his left leg so stiff that I have a hard time putting on his diapers." 2. "My baby won't lift his head up and look at me; he's so floppy." 3. "My baby's left hip tilts when I pull him to standing position." 4. "I'm very worried because my baby has not rolled all the way over yet."

2. "My baby won't lift his head up and look at me; he's so floppy." Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to 90-degree angle by age 4 months with only a partial head lag by age 2 months. Although rigidity and tenseness are possible signs cerebral palsy, a limitation in one leg suggests DDH. Tilting of the hip is an indication of developmental dysplasia of the hip (DDH). Rolling completely over usually does not occur until the infant is age 6 months.

Among toddlers and children up to age five, femur fractures usually result from a low energy fall. In most cases, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide and immobilizes the leg in a type of cast called a spica cast. Approximately how many weeks does it take for a fractured femur to heal in a 3-year-old? 1. 2 weeks 2. 4 weeks 3. 8 weeks 4. 10 weeks

2. 4 weeks

A 6-year-old is scheduled for brain surgery for the removal of a tumor. What preoperative nursing intervention is a priority? 1. Shave the patient's head 2. Administer stool softeners as prescribed 3. Administer Solu-Medrol as prescribed 4. Administer a cleansing enema

2. Administer stool softeners as prescribed Before and after brain surgery, the child should receive stool softeners to prevent straining with bowel movements. Straining will increase intracranial pressure (ICP).

A 15-year-old male's left leg is placed in skeletal traction. The primary purpose of this measure for him is to: 1. Reduce pain 2. Align the ends of the fractured bone 3. Promote bone healing 4. Control bleeding into tissues

2. Align the ends of the fractured bone Skeletal traction is used primarily to align the ends of the fracture. Skeletal traction involves the use of a pin or wire passed through the skin into the end of a long bone. With skeletal traction, ropes and pulleys are attached to weights to exert a pull on the extremity at the pin site. Cotton gauze squares usually are placed around the ends of the pins. Immobilization also prevents further trauma to tissue and will reduce pain.

A 14-year-old adolescent with moderate cognitive impairment is admitted for knee surgery. During the rehabilitation period, the nurse's first nursing action is to: 1. Encourage the mother to have family members and friends visit often 2. Assess the child's daily routine 3. Instruct the child to use the call light when she needs to use the bathroom 4. Encourage the mother to bring in personal care items from home

2. Assess the child's daily routine Obtaining information about the adolescent's usual routine helps in providing suggestions in modifying the hospital routine. Maintaining a normal routine helps minimize the amount of stress to which the adolescent is exposed and helps her adjust to hospitalization.

Nurse Lorna is assessing infantile reflexes in a 9-month-old baby; which of the following would she identify as normal? 1. Persistent rooting 2. Bilateral parachute 3. Absent moro reflex 4. Unilateral grasp

2. Bilateral parachute The parachute reflex appears to about 9 months of age is normal. All of the following are considered abnormal when evaluating infantile reflexes: Reflexes that persist after they should have disappeared (rooting), reflexes are absent when they should be present (Moro), and reflexes that are unilateral (grasp).

An X-ray confirms that the epiphyseal plate of a 10-year-old is fractured. The nurse would anticipate that the damage may result in which of the following? 1. Osteomyelitis 2. Bone growth disruption 3. Permanent nerve damage 4. Rheumatoid arthritis

2. Bone growth disruption

A nurse is collecting data from a preschool age child for developmental dysplasia of the hip. Which of the following should the nurse include? 1. Barlow test 2. Check for Trendelenburg sign 3. Manipulation of foot and ankle 4. Ortolani test

2. Check for Trendelenburg sign The preschooler should bear weight on the affected leg while holding onto something for balance. The nurse observes from behind for abnormal downward tilting of the pelvis on the unaffected side. The Ortolani test is used for infants. Manipulation of the foot and ankle is used for clubfoot. The Barlow test is used for infants.

A patient has been taking naproxen for 6 months for the treatment of tendinitis. The nurse should assess the patient for signs of: 1. Hypoglycemia 2. Gastrointestinal bleed 3. Hyperglycemia 4. Hypertension

2. Gastrointestinal bleed Naproxen, like all nonsteroidal anti-inflammatories (NSAID), increases the risk of gastric ulcers and GI bleeds. The nurse should assess for tarry stools, coffee-ground emesis, and signs of anemia (fatigue, dizziness, shortness of breath, rapid heart rate, pale skin).

Mrs. Lodge's child requires the use of Pavlik harness; which of the following would Nurse Betty do to best assess the mother's ability to care for her child? 1. Demonstrate to the mother how to remove and reapply the device. 2. Have the mother remove and reapply the harness before discharge. 3. Have the mother verbalize the purpose for using the device. 4. Request a home health care nurse visit after discharge.

2. Have the mother remove and reapply the harness before discharge.

A nurse is contributing to a plan of care for a toddler who has cerebral palsy. Which of the following actions should the nurse recommend? 1. Structure interventions according to chronological age 2. Identify the need for an evaluation of hearing ability 3. Monitor pain level routinely using a numeric scale 4. Provide total care for daily hygiene activities

2. Identify the need for an evaluation of hearing ability Interventions should be according to developmental age. A FACES pain scale would be more appropriate. Independence should be promoted as much as possible.

The nurse is examining a child suspected of having autism. What assessment findings would the nurse expect? 1. IQ above 115 2. Inappropriate or decreased emotional expressions 3. A high level of impulsiveness 4. Exaggerated eye contact and facial expressions

2. Inappropriate or decreased emotional expressions Assessment findings with autism may include social isolation, lack of eye contact, lack of emotional expression, resistance to change, abnormal responses to sensory stimuli, insensitivity to pain, poor speech development, and repetitive movements. Autistic disorder is marked by severe deficits in language, perceptual, and motor development, as well as an inability to function in social settings. These problems are evident before the age of 3 years. Lower IQs are associated with autism. Only 3% of people with autism spectrum disorders have an above average IQ (>115). Many argue that IQ tests do not measure the full intellectual potential of a child with autism, but rather tell us about their communication and motor deficits.

Tiffany is diagnosed with increased intracranial pressure (ICP); which of the following if stated by her parents would indicate a need for Nurse Charlie to reexplain the purpose for elevating the head of the bed at a 10 to 20-degree angle? 1. Help alleviate headache 2. Increase intrathoracic pressure 3. Maintain neutral position 4. Reduce intra-abdominal pressure.

2. Increase intrathoracic pressure Head elevation decreases, not increases, intrathoracic pressure. Elevating the head of the bed in a child with increased ICP helps to alleviate headache, maintain neutral position, and reduce intra-abdominal pressure, which may contribute to increased ICP.

The nurse is assessing a 5-month-old girl who is confined due to congenital clubfoot. The infant is scheduled for corrective serial casting. Which of the following deformities would be present? 1. Abduction of the ankle 2. Inversion and adduction of the foot 3. Dorsiflexion of the foot 4. Pronation and abduction of the foot

2. Inversion and adduction of the foot In clubfoot, the infant will have inversion, adduction, and equinus (plantar flexion) of the foot and ankle. The feet of many newborns turn in because of intrauterine position. This simple deviation needs no correction if the feet can be brought into the midline position by easy manipulation. Non-surgical treatment with the Ponseti Method is the standard. This involves foot manipulations over time to correct the deformities. It was invented by Ignacio Ponseti of the University of Iowa.

A child diagnosed with intellectual disability (ID) is under the supervision of Nurse Tasha. The nurse is aware that the signs and symptoms of mild ID include which of the following? 1. Few communication skills 2. Lateness in walking 3. Mental age of a toddler 4. Noticeable developmental delay

2. Lateness in walking Mild intellectual disability is minimally noticeable in young children, with one of the signs being a delay in achieving developmental milestones, such as walking at a later stage. Severe intellectual disability is marked by the mental age of a toddler and little or no communication skills. Children with moderate intellectual disability have noticeable developmental delays.

A 6-month-old infant with hydrocephalus is admitted to the hospital due to an enlarged head circumference, bulging fontanelles, and sunset eyes. What is the priority nursing care? 1. Promote normal growth and development of the child 2. Monitor for signs of increased intracranial pressure 3. Monitor vital signs 4. Measure head circumference

2. Monitor for signs of increased intracranial pressure Hydrocephalus can cause an increase in intracranial pressure. To prevent complications of increased ICP, the nurse should assess for: frontal bossing, dilated scalp veins, diplopia, vomiting, tense fontanels, irritability, decreased level of consciousness, and changes in vital signs. Increase in intracranial pressure can cause brain stem compression, which could result in respiratory or cardiac failure. Measuring head circumference regularly will help indicate if the condition is improving.

Nurse Kevin is assessing a newborn for developmental dysplasia of the hip (DDH); he would expect to assess which of the following? 1. Characteristic limp 2. Ortolani's sign 3. Symmetrical gluteal folds 4. Trendelenburg's signs

2. Ortolani's sign Ortolani's sign is felt and heard when newborn's or neonate's hip is flexed and abducted. A characteristic limp would be noted in the ambulatory child. Asymmetrical gluteal folds would be noted in DDH. Trendelenburg's sign is noted in the weight-bearing child when the child stands on the affected hip and the pelvis tilts downward on the normal side instead of upward.

The nurse is caring for a 14-year-old girl with scoliosis and a curvature greater than 50 degrees. The patient underwent a posterior spinal fusion with implants. Postoperatively, the priority nursing action to prevent complications is: 1. Maintain skin integrity 2. Prevent neurologic deficit 3. Promote adequate bowel and bladder elimination 4. Promote comfort

2. Prevent neurologic deficit Perform a neurovascular assessment of the lower extremities frequently. Assess the lower extremities for warmth, sensation, movement, and pulse strength. Neurologic dysfunction may result from bleeding or compression caused by a bone particle dislodged during the spinal fusion.

Nurse Gloria is teaching the Mr. and Mrs. Diaz about the early signs and symptoms of lead poisoning; which of the following if stated by the couple would indicate the need for further understanding of the case? 1. Anemia 2. Seizures 3. Irritability 4. Anorexia

2. Seizures Seizures usually are associated with encephalopathy, a late sign of lead poisoning. Typically, lead levels have already exceeded 70 mg/dl. Anemia, irritability, and anorexia are early signs.

An eight-month-old infant recently had a seizure and is lethargic and bradycardic upon arriving at the emergency room. The X-ray result revealed a retinal hemorrhage. The nurse suspects that the child is showing signs and symptoms of: 1. Sexual abuse 2. Shaken baby syndrome 3. Munchausen syndrome by proxy 4. Mastoid bone fracture

2. Shaken baby syndrome Characteristic signs of shaken baby syndrome include retinal hemorrhages, multiple fractures of long bones, and subdural hematomas. There is usually no external signs of injury. Risk factors for parents include substance abuse, unrealistic expectations for the child, and high levels of emotional stress.

Daya's child is scheduled for surgery due to myelomeningocele; the primary reason for surgical repair is which of the following? 1. To prevent hydrocephalus 2. To reduce the risk of infection 3. To correct the neurologic defect 4. To prevent seizure disorders

2. To reduce the risk of infection Surgical closure decreases the risk of infection stemming from damage to the fragile sac, which can lead to meningitis. Surgical repair does not help relieve hydrocephalus. In fact, some researchers believe that repair exaggerates the Arnold-Chiari malformation and decreases the absorptive surface for cerebrospinal fluid, leading to more rapid development of hydrocephalus. The neurologic deficit cannot be corrected. However, some surgeons believe that early surgery reduces risk of stretching spinal nerves and preventing further damage. Surgical repair of the sac doesn't prevent seizure disorder, an impairment of the brain neuron tissue.

A nurse is collecting data from a child that has muscular dystrophy MD. Which of the following findings should the nurse expect? Select all that apply 1. Purposeless, involuntary, abnormal movements 2. Spinal defect and saclike protrusion 3. Muscular weakness in lower extremities 4. Unsteady, waddling gait 5. Kyphosis of the back

3 and 4 CP has purposeless, involuntary movements Spinal myelomingocele has saclike protrusions Lordosis of the back would be expected

A patient with a history of congestive heart failure is prescribed naproxen for the treatment of rheumatoid arthritis. The nurse should instruct the patient to report which of the following symptoms? Select all that apply Select all that apply. 1. Diarrhea 2. Constipation 3. Edema 4. Weight loss 5. Weight gain

3 and 5 Fluid retention and edema is a major concern with NSAIDs, especially in patients with cardiovascular compromise, such as heart failure. They can have a significant deterioration of hemodynamic function. Patients should report any signs of weight gain, edema, and fluid retention.

Nurse Maritza is caring for a child with Category A Near Drowning; she should do which of the following? (Select all that apply.) 1. Give furosemide as ordered. 2. Check for increased intracranial pressure 3. Plan for discharge in 12 to 24 hours. 4. Check for electrolyte imbalances. 5. Keep mechanical ventilation. 6. Provide oxygen as ordered

3, 4 and 6 Children with Category A Near Drowning are awake with minimal injury. Care includes checking electrolyte status, administering oxygen and warming, and preparing for discharge in 12 to 24 hours.

Neurovascular assessment for a fracture patient includes: Select all that apply. 1. Prosthesis 2. Polyps 3. Pain 4. Pallor 5. Pulselessness 6. Paresthesia 7. Paralysis 8. Poikilothermia

3, 4, 5, 6, 7, 8 The 6 P's of compartment syndrome

A child with a history of seizures, controlled with an anticonvulsant, is brought to the clinic. His mother states that he has been very sleepy. To correct this, she reported that she cut his anticonvulsant dosage in half. How would you respond to the mother? 1. "You should have increased the dose" 2. "You should have discontinued the drug" 3. "You should not change the dosage without talking to the physician first" 4. "You are correct in cutting the dosage in half, but next time you should bring your child to have a drug level drawn first"

3. "You should not change the dosage without talking to the physician first" Anticonvulsants often cause drowsiness, interfering with daily activities. Anticonvulsants should not be stopped or reduced without consulting the physician, as this may increase the risk of seizures. Anticonvulsant dosages should be tapered, never stopped suddenly, because the body becomes dependent on it. Rapid withdrawal may precipitate a seizure.

A nurse is reinforcing preoperative teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis. Which of the following information should the nurse include? 1. "You will go home the same day of surgery." 2. "You will have minimal pain after your surgery." 3. "You will probably need to receive blood after surgery." 4. "You will be assisted to walk eight hours after surgery."

3. "You will probably need to receive blood after surgery." Clients who have spinal instrumentation for scoliosis have a lengthy surgery with blood loss and often require postoperative blood transfusions. Typically they have a PCA pump for the significant pain, they require acute postoperative care and do not usually ambulate for two or three days.

Match the traction methods to their corresponding descriptions: 1. Buck's traction 2. Russell's traction 3. Bryant's traction A. legs in an extended position B. leg extended, knee flexed C. hips flexed 90degrees, both legs 1. 1C, 2B, 3A 2. 1B, 2A, 3C 3. 1A, 2B, 3C 4. 1A, 2C, 3B

3. 1A, 2B, 3C Buck's traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease. Russell's traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Bryant's traction is skin traction with the legs flexed at a 90-degree angle at the hip.

A 5-year-old with severe osteomyelitis has not been responding to first line therapy. The nurse is ordered to initiate vancomycin I.V. every 6 hours to the patient. If the recommended dose is 10 mg/kg, what is the total daily dose of vancomycin if the patient weighs 44 lbs? 1. 888 mg 2. 200 mg 3. 800 mg 4. 440 mg

3. 800 mg

A frantic father presents to the emergency room holding a limp child bleeding from the head. The nurse takes them back to the treatment room. What should the nurse do next? 1. Call the physician 2. Call security 3. Assess the child for circulation and breathing 4. Ask the father to leave and go to the waiting room

3. Assess the child for circulation and breathing

Janae has a seizure disorder; which of the following would be the lowest priority when caring for her? 1. Observing and taking down data on all seizures 2. Assuring safety and protection from injuring 3. Assessing for signs and symptoms of increased intracranial pressure (ICP) 4. Educating the family about anticonvulsant therapy

3. Assessing for signs and symptoms of increased intracranial pressure (ICP) Signs and symptoms of increased intracranial pressure (ICP) are not associated with seizure activity and therefore would be the lowest priority.

A child is brought to the emergency room with a high fever, photophobia, and a headache. What important sign would a nurse use to check for meningeal irritation? 1. McBurney's sign 2. Ortolani sign 3. Brudzinski's sign 4. Cullen sign

3. Brudzinski's sign Meningeal irritability is assessed by illiciting a positive Brudzinski's and Kernig's signs, as well as an inability to flex the neck forward (nuchal rigidity). Brudzinski's sign: after forced flexion of the neck there is a reflex flexion of the hip and knee and abduction of the leg. Kernig's sign: After flexing the hip and knee at 90 degree angles, pain and resistance are noted. Cullen's sign is the presence of superficial edema and bruising around the umbilicus. It is suggestive of acute pancreatitis or an intraabdominal bleed. Ortolani's sign is a distinctive "clunk" heard after flexing and abducting a newborns hips. This is indicative of hip dysplasia. McBurney's sign is deep tenderness or pain at McBurney's point, one-third the distance from the right anterior iliac spine and the navel. This is indicative of acute appendicitis.

The nurse is assessing a 5-year-old after having a seizure. The patient's symptoms include headache, vision changes, vomiting, and papilledema. Which of the following diagnostics tests will support the diagnosis? 1. X-ray 2. Bone marrow biopsy 3. CT Scan 4. Lumbar puncture

3. CT Scan The child is showing signs and symptoms of a brain tumor. A CT scan is a noninvasive method of supporting the diagnosis. A definitive diagnosis can only be confirmed by histological examination of biopsy tissue.

Which of the following is the most common permanent disability in childhood? 1. Scoliosis 2. Muscular dystrophy 3. Cerebral palsy 4. Developmental dysplasia of the hip (DDH)

3. Cerebral palsy Scoliosis and DDH should not cause permanent disability.

After explaining to the parents about their child's unique psychological needs related to a seizure disorder and possible stressors, which of the following interests uttered by them would indicate further teaching? 1. Feeling different from peers 2. Poor self-image 3. Cognitive delays 4. Dependency

3. Cognitive delays

The American Association on Mental Deficiency (AAMD), now American Association on Intellectual and Developmental Disabilities (AAIDD) definition of mental retardation emphasizes which of the following? 1. An IQ level that must be below 50 2. Cognitive impairment occurring after age 22 years 3. Deficits in adaptive behavior with intellectual impairment 4. No responsiveness to contact

3. Deficits in adaptive behavior with intellectual impairment Mental retardation is part of a broad category of developmental disability and is defined by the American Association of Mental Deficiency as "significantly subaverage, general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period (18 years of age)." IQ of 70 or below is considered significantly subaverage intellectual functioning. Cognitive impairment isn't part of the definition. However, the definition does states that the impairment or compromise must occur before age 18 years old.

Mr. and Mrs. Andrews' child was diagnosed with Duchenne's muscular dystrophy; which of the following usually is the first indication of the condition? 1. Inability to suck in the newborn 2. Lateness in walking in the toddler 3. Difficulty running in the preschooler 4. Decreasing coordination in the school-age child

3. Difficulty running in the preschooler Usually, sign and symptoms of Duchenne's muscular dystrophy are not noticed until ages 3 to 5 years. Typically weakness starts with the pelvic girdle, evidenced as difficulty running in the preschooler. Duchenne's muscular dystrophy usually is not diagnosed in the infant or toddler period.

A 10-year-old male is admitted to the hospital with a fracture of the left femur. The patient is placed in skeletal traction for 2 days. The nurse immediately suspects peripheral neurovascular impairment due to: 1. Abnormal mobility 2. Tenderness and pain 3. Muscle spasms 4. Pallor, numbness, and absent peripheral pulses

4. Pallor, numbness, and absent peripheral pulses

The nurse is caring for a 10-year-old girl diagnosed with meningitis. The nurse would expect which of the following symptoms? 1. Confusion, tinnitus, and blurred vision 2. Neck stiffness, headache, and diarrhea 3. Fever, headache, photophobia 4. Neck stiffness, fever, and respiratory distress

3. Fever, headache, photophobia Fever, headache, photophobia, nausea, vomiting, confusion, lethargy, and irritability are the most common symptoms in children.

The physician has ordered lorazepam, 4 mg I.V. for a child with status epilepticus. The nurse plans to: 1. Mix it with a vasopressor to reduce hypotension 2. Give the prescribed dose over 60 minutes 3. Give no more than 2 mg per minute 4. Give it through a central venous catheter only

3. Give no more than 2 mg per minute Lorazepam should be administered no faster than 2 mg per minute to prevent hypotension and respiratory depression.

Angie is an adolescent who has seizure disorder; which of the following would not be a focus of a teaching program? 1. Ability to obtain a driver's license 2. Drug and alcohol abuse 3. Increased risk of infections 4. Peer pressure

3. Increased risk of infections

A newborn baby with myelomeningocele is scheduled for surgical closure within 24 hours. The main reason for surgical repair is to do which of the following? 1. Decrease the risk of developing seizures 2. Prevent hydrocephalus 3. Minimize infection and prevent further damage to the spinal cord and roots 4. Correct the neurologic deficit

3. Minimize infection and prevent further damage to the spinal cord and roots Surgery for neural tube disorders is done as soon after birth as possible (usually within 24 to 48 hours) to reduce the risk of infection through the exposed meninges and to prevent further damage to the nervous tissue.

A physician prescribes acetaminophen, 200 mg every 6 hours for a 12-month-old child who weighs 8 kg. The bottle concentration is 100 mg/ml and has a maximum dosage of 60 mg/kg/day. What should the nurse do next? 1. Administer 4 ml 2. Ask the physician for an increase dose 3. Notify the physician and question the dosage 4. Administer 2 ml

3. Notify the physician and question the dosage Pediatric dosing of acetaminophen should not exceed 60 mg/kg/day, which is equivalent to 480 mg for this patient. The prescribed dose was 800 mg a day. Hence, the physician should be notified and the dose should be changed.

A 7-year-old with cerebral palsy is hospitalized for complications. Before discharge, the patient's mother expresses concern over the child's ability to use utensils while eating. Which of the following people should be consulted to assist in patient care and education? 1. Physical therapist 2. Dietician 3. Occupational therapist 4. Palliative care nurse

3. Occupational therapist An occupational therapist has specialized training to help patients adapt to their physical limitations in order to perform their activities of daily living.

The nurse is caring for a neonate diagnosed with congenital hip dysplasia. When examining a newborn for dysplasia of the hip, the nurse would assess for which of the following? 1. Trendelenburg's sign 2. Characteristic limp 3. Ortolani sign 4. Symmetrical gluteal folds

3. Ortolani sign Ortolani sign assists in detecting congenital hip dysplasia (also known as "developmental hip dysplasia"). While the infant lies flat, flex the hips and knees to 90 degrees. Place the index fingers over the greater trochanter of the femur and your thumb on the internal side of the thigh over the lesser trochanter. Abduct the hips while applying upward pressure over the greater trochanter, and listen for a clicking sound. A clicking or clunking sound is a positive Ortolani's sign and occurs when the femoral head relocates into the acetabulum. Normally, no sound is heard.

Incomplete development of teeth, bones, and ligaments is the result of: 1. Congenital hip dysplasia 2. Duchenne's muscular dystrophy 3. Osteogenesis imperfecta 4. Osteomyelitis

3. Osteogenesis imperfecta Osteogenesis imperfecta (OI), also known as brittle bone disease, is a group of genetic disorders that principally affect the bones. It results in bones that break quickly. The severity may be mild to severe. Other symptoms may include problems with the teeth, loose joints, a blue tinge to the whites of the eye, short height, hearing loss, and breathing problems.

After the corrective casting is done, an infant's congenital club foot is exposed to potential problems. Which of the following is an appropriate nursing diagnosis for her? 1. Fear of stranger 2. Risk for infection related to an incision 3. Potential for alteration in tissue perfusion 4. Alteration in skin integrity

3. Potential for alteration in tissue perfusion

A nurse is reviewing the medical history of a school-age client who possibly has Reye syndrome. The nurse should identify which of the following findings is a risk factor for Reye syndrome? 1. Recent history of infectious cystitis caused by candida 2. Recent history of bacterial otitis media 3. Recent episode of varicella 4. Recent episode of haemophilus influenza meningitis

3. Recent episode of varicella Viral illnesses are a risk factor for developing Reye syndrome. It typically follows a viral illness such as influenza, gastroenteritis or varicella Bacterial infections are not a risk factor for Reye syndrome

Spina bifida is one of the possible neural tube defects that can occur during early embryological development. Which of the following definitions most accurately describes meningocele? 1. Complete exposure of spinal cord and meninges 2. Herniation of spinal cord and meninges into a sac 3. Sac formation containing meninges and spinal fluid 4. Option 2 and 3 5. Spinal cord tumor containing nerve roots

3. Sac formation containing meninges and spinal fluid Meningocele doesn't involve complete exposure of the spinal cord and meninges

Veronica is a 14-year-old girl who wears a brace for structural scoliosis; which of the following statements indicate effective use of the brace? 1. "I sure am glad that I only have to wear this awful thing at night." 2. "I'm really glad that I can take this thing off whenever I get tired." 3. "I wonder if I can take the brace off when I go to the homecoming dance." 4. "I'll look forward to taking this thing off to take my bath every day."

4. "I'll look forward to taking this thing off to take my bath every day." The brace should be dropped for simply 1 hour of every 24-hour period for hygiene and skin care. Wearing the brace at night would be true only following radiologic studies indicate the spine has bone marrow maturity and the adolescent has been weaned from off whenever 1 to 2 years.

A nurse is caring for a toddler who has dysplasia of the hip and hip spica cast in place. The child's mother asked the nurse why a Pavlik harness is not being used. Which of the following responses should the nurse make? 1. "The Pavlik harness is use for children with scoliosis, not hip dysplasia." 2. "The Pavlik harness is used for school-age children." 3. "The Pavlik harness cannot be used for your child because her condition is too severe." 4. "The Pavlik harness is used for infants less than six months of age."

4. "The Pavlik harness is used for the treatment of an infant up to six months of age." Surgical closed reduction with placement of a hip spica cast is the treatment for a toddler.

The nurse is caring for an 8-year-old with increased intracranial pressure (ICP). Which statement by the parent would indicate the need for the nurse to reinforce the purpose for elevating the head of the bed 15 to 30 degrees? 1. "Keeping the head of the bed elevated will decrease the pressure in his brain." 2. "The head of bed elevation helps increase venous outflow." 3. "This will maintain an adequate cerebral perfusion pressure." 4. "When the head is raised it reduces the risk of blood clots."

4. "When the head is raised it reduces the risk of blood clots." DVTs are prevented with the use of anticoagulation, compression stockings, sequential compression devices, and exercise. Having the head of bed at 15 to 30 degrees will not affect the risk for lower extremity thrombosis. This statement by the parent indicates the need for further teaching. A patient with an increased intracranial pressure SHOULD have their bed elevated to 15-30 degrees for optimal outcome. This will help increase venous outflow, which decreases ICP. Elevating the head of bed too much can decrease cerebral perfusion pressure, causing hypoxia and ischemia.

An 8-year-old sustained a femur fracture with an open wound. What type of traction should the nurse expect to be used? 1. Fisk 2. Buck's 3. Thomas Splint 4. 90-90

4. 90-90 90-90 degree traction is often used for femur or tibia fractures. This involves suspending the thigh in the vertical plane and bending the knee at a 90 degree angle.

A nurse is caring for an infant who has a myelomeningocele and is schedule for a surgical repair. Which of the following actions should the nurse take? 1. Encourage the parents to cuddle the infant 2. Check the infant's temperature rectally 3. Place the infant in the supine position 4. Apply a sterile, moist dressing on the sac

4. Apply a sterile, moist dressing on the sac Cuddling and supine position could cause pressure and could cause rupture Rectal temp could cause irritation or prolapse

A nurse is caring for a child who is in a plaster shoulder spica cast which of the following actions should the nurse take? 1. Use a heat lamp to facilitate drying 2. Avoid turning the child until the cast is dry 3. Position the cast below heart level during the drying time 4. Apply moleskin to the edges of the cast

4. Apply moleskin to the edges of the cast Turning a cool fan on will facilitate drying. Turning the child every two hours will expose all areas of the cast to air which will facilitate drying. Elevating the cast above heart level will prevent swelling of the extremity.

A 8-year-old is prescribed clindamycin for the treatment of osteomyelitis. Which of the following symptoms indicates to the nurse that the patient is having an adverse reaction? 1. Shortness of breath 2. Tendon pain 3. Constipation 4. Bitter or metallic taste

4. Bitter or metallic taste The most common side effects of clindamycin include diarrhea, abdominal pain, nausea, and vomiting. High doses, both oral and I.V. can cause a metallic or bitter taste.

When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following? 1. Rheumatoid arthritis 2. Permanent nerve damage 3. Osteomyelitis 4. Bone growth disruption

4. Bone growth disruption

The physician just applied a cast to a 6-year-old with a broken leg. Which of the following should the nurse do first? 1. Instruct the patient that he must wait 72 hours before his friends can sign the cast 2. Dispose of used supplies 3. Rest the cast on a stainless steel tray 4. Clean the surrounding skin before the cast dries

4. Clean the surrounding skin before the cast dries

A 9-year-old boy is rushed to the emergency room after falling from his bicycle. While assessing the child, the nurse should observe the extremities closely for which of the following signs and symptoms of a fracture? 1. Abrasions, tachypnea, and pain 2. Deformity, tachypnea and, cyanosis 3. Fever, pain, and cyanosis 4. Deformity, edema, and pain

4. Deformity, edema, and pain

Bennett was rushed to the emergency department with possible increased intracranial pressure (ICP); which of the following is an early clinical manifestation of increased ICP in older children? 1. Macewen's sign 2. Setting sun sign 3. Papilledema 4. Diplopia

4. Diplopia Macewen's sign (cracked-pot sound) and the setting sun appearance of the eyes are noted in infants with increased ICP. Papilledema is a late sign of increased ICP.

A three-month-old, developmentally-delayed infant was admitted to the pediatrics unit. The nurse evaluates the infant for manifestations of cerebral palsy. Which of the following would the nurse note as a sign of CP? 1. When pulled to a sitting position, there's a slight head lag 2. Less than the 50th percentile measurement of head circumference 3. Hypoactive reflexes 4. Exaggerated arching of the neck

4. Exaggerated arching of the neck A child with cerebral palsy may show opisthotonic posturing (exaggerated arching of the back) and rigidity. Increased or decreased resistance to passive movement is a sign of abnormal muscle tone, which is typical of children with cerebral palsy. When pulled to a sitting position, the child with CP may extend his/her entire body, rigid and unbending at the hip and knee joints. Children with cerebral palsy often have exaggerated reflexes due to an upper motor neuron lesion.

A 6-month-old infant with hydrocephalus is admitted to an acute care facility for insertion of a ventriculoperitoneal shunt. What is the best position for this patient post-operatively? 1. High Fowler's 2. Semi Fowler's 3. Trendelenburg 4. Flat

4. Flat

A nurse is collecting data from a four month old infant who has meningitis. Which of the following findings should the nurse expect? 1. Depressed anterior fontanel 2. Constipation 3. Presence of the rooting reflex 4. High-pitched cry

4. High-pitched cry A bulging fontanel and vomiting are expected findings.

A 17-year-old patient with scoliosis is being cared for by a nurse. Which of the following will be most difficult for this patient? 1. ADLs 2. Adequate social support 3. Physical therapy compliance 4. Looking different from her friends

4. Looking different from her friends

The nurse is caring for a 3-year-old toddler diagnosed with cerebral palsy. What teaching measures to prevent contractures should the nurse reinforce to the toddler's parents? 1. Give medication to reduce spasticity and rigidity 2. Help the child with self-care activities to reduce fatigue 3. Encourage their children to reach their fullest potential 4. Parents understand passive exercises and games to play with the child that encourage active exercise

4. Parents understand passive exercises and games to play with the child that encourage active exercise Preventing contractures is important to maintain motor function. Contractures can be prevented with the use of leg braces, passive exercises, and active exercises. These exercises can be incorporated into play activities.

A 3-year-old is rushed to the emergency room due to a seizure. The parents state that the seizure started with a twitch in the fingers and progressed to the arm and face. What type of seizure is the parent describing? 1. Status epilipticus 2. Petit mal seizures 3. Tonic-clonic seizures 4. Partial (Focal seizures)

4. Partial (Focal seizures) Partial seizures originate from a specific brain area and often only affect a part of the brain. Clonic jerking may start in the hand or toe and then spread. A partial seizure with sensory signs may include numbness, tingling, paresthesia, or pain originating in one area and spreading to other parts of the body. Petit mal (absence seizure) is classified as a generalized seizure. They usually last less than 20 seconds and always involve loss of consciousness. Rhythmic blinking and twitching of the mouth or an extremity often indicate a petit mal seizure is starting. Typical tonic-clonic seizures are generalized seizures. There is usually 3 stages. 1) Aura--strange, dizzy, ominous feeling that can last minutes or hours. 2) Tonic phase--person loses consciousness and muscles tense. This only lasts a few seconds. 3) Clonic phase-- Muscles contract and relax rapidly in convulsions. Status epilepticus refers to a seizure that lasts continuously for more than 5 minutes. Or a series of seizures from which the child does not return to his or her previous level of consciousness. This is a medical emergency.

A spica cast was put on Baby Betty after an unfortunate incident to immobilize her hips and thighs; which of the following is the priority nursing action immediately after application? 1. Keep the cast dry and clean. 2. Cover the perineal area. 3. Elevate the cast. 4. Perform neurovascular checks.

4. Perform neurovascular checks.

Which of the following is the priority nursing action to minimize risk of infection for a child with skeletal traction? 1. Anticipate antibiotic administration 2. Provide a well balanced diet 3. Frequently assess vital signs and inspect insertion site 4. Perform pin site care

4. Perform pin site care To minimize the risk of infection at the pin sites, perform pin site care according to the institution's policy. Adhere to standard precautions and use aseptic technique. Pin site care helps keep the area clean.

You have learned that in babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. Which of the following is the most common form of DDH? 1. Acetabular dysplasia 2. Dislocation 3. Preluxation 4. Subluxation

4. Subluxation DDH is a group of congenital abnormalities of the hip joints, which includes subluxation, dislocation, and preluxation. Of the types of congenital hip abnormalities, subluxation is the most common.

A 7-month-old infant suspected of cerebral palsy is being assessed by the nurse. Which of the following activities, as stated by the patient's mother, indicates the possible presence of cerebral palsy? 1. The infant does not move when startled 2. The infant does not react to loud noises 3. The infant is unable to use a spoon 4. The infant is unable to roll over

4. The infant is unable to roll over In cerebral palsy, damage to the motor centers of the brain cause abnormal muscle tone, reflexes, and motor skills. The infant should be able to roll over by 6 months of age.

Reye's syndrome is a rare and severe illness affecting children and teenagers. Its development has been linked with the use of aspirin and which of the following? 1. Meningitis 2. Encephalitis 3. Strep throat 4. Varicella

4. Varicella Reye's syndrome has been linked with the ingestion of aspirin in children with viral infections like varicella. Encephalitis is a symptom of Reye's syndrome