Pediatrics Unit 4 Exam

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent?

"Applying ice to the area will reduce the pain and swelling." Explanation: Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, COMMON MEDICAL TREATMENTS 22.1, p. 755.

The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education?

"Because our child is being treated by using braces, the braces will have to be worn almost all the time." The Boston or the thoracolumbosacral orthosis (TLSO) brace is made of plastic and is customized to fit the child for treatment of scoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit. Halo traction may be used to treat clients with severe scoliosis, but not all clients. Children will be reassessed every 4 to 6 months to determine the prognosis for continuing brace therapy and potentially refitting. Bracing may be indicated for months or years. Surgery may be indicated, depending on the severity and complications resulting from the scoliosis; however, surgery is not the best option for all clients. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, pp. 789 - 790.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?

"Blowing cool air with a fan or hair dryer may relieve the feeling." Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Home Cast Care, p. 758.

The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education?

"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." Explanation: Fractures that occur in the epiphyseal plate, the area between the central shaft (diaphysis) and the rounded end portion (epiphysis), can halt growth, stimulate abnormal growth, or cause irregular or erratic growth. Fractures in the diaphysis and epiphysis will not interfere with growth. The outer layer of the bone, the periosteum, may be injured when infected, not from a fracture. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Slipped Capital Femoral Epiphysis, p. 788.

Which statement about cerebral palsy would be accurate?

"Cerebral palsy is a condition that doesn't get worse." By definition, cerebral palsy is a nonprogressive neuromuscular disorder. It can be mild or quite severe and is believed to be the result of a hypoxic event during pregnancy or the birth process and doesn't run in families. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Cerebral Palsy, p. 782.

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching?

"Check the skin that is covered by the braces for redness and breakdown." Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, INSPECTION AND OBSERVATION, p. 748.

The mother of a toddler tells the nurse during a routine well-child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse?

"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Head Size, p. 474.

The mother of a newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate?

"During delivery, your vaginal wall put pressure on the baby's head." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMPARISON CHART 16.2 Caput Succedaneum Versus Cephalohematoma, p. 515.

A pregnant client asks if there is any danger to the development of her fetus in the first few weeks of her pregnancy. How should the nurse respond?

"During the first 3 to 4 weeks of pregnancy, brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Brain and Spinal Cord Development, p. 474.

The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure?

"For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 16.1, p. 480.

Gabapentin has been prescribed for a pediatric client. Which statement by the client indicates an understanding of teaching related to the medication?

"I can't take this medication within 2 hours of taking my antacid medication." Explanation: Gabapentin is used in the treatment of seizure disorders. It is rapidly absorbed. It cannot be taken within 2 hours of the administration of antacid medications. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Common Anticonvulsant Medications, p. 492.

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?

"I hate to think that I will need to be worried about my child having seizures for the rest of his life." Explanation: Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Febrile Seizures, p. 494.

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching?

"I need to watch for any new bruises or bleeding and let my health care provider know about it." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, SEIZURE DISORDERS, p. 488.

The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond?

"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." Explanation: Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 504

While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education?

"I will cradle her in my arms after the procedure for at least 30 minutes." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 16.1, p. 480.

The nurse is caring for a school-age child diagnosed with transient synovitis. What statement by a parent indicates a need for further education regarding this diagnosis?

"I will get the prescription for the antibiotics filled as soon as we leave the office today." Explanation: Transient synovitis is an inflammatory disease, not an infection; therefore, antibiotics are not needed. NSAIDs such as ibuprofen and limited activity are prescribed. Surgical intervention is not needed. Ibuprofen can cause GI distress, so it should be administered with food to help reduce this distress. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Transient Synovitis of the Hip, p. 789.

The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education?

"I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain." Explanation: Children with JA should be encouraged to attend school, even if it is a shortened day because this increases activity. Using an elevated toilet seat may help decrease pain in the knees. A daily exercise program should be completed, and incorporating exercises into a game or dance can make them more enjoyable for the child. Warm baths can help reduce pain and increase movement in the involved joints. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Tibia Vara (Blount Disease), p. 775.

The nurse is educating a child and his family about what to expect during the child's electroencephalogram (EEG) exam. Which statement by a parent suggests a need for further education?

"I will make sure my child goes to bed early the night before the exam." Explanation: During an EEG, the client needs to be cooperative and quiet. Typically, parents are asked to keep their child up later the night before so that the child will fall asleep during the procedure. The room is also darkened to help them rest. If the child is unable to remain still, sedation may be used. The EEG reflects the electrical patterns of the brain. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 16.1 (Continued), p. 481.

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?

"In most cases treatment is not necessary, only observation." Explanation: The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Management, p. 794.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, p. 784.

A mother has just given birth to an infant born with anencephaly. The mother states, "With all of the technological advances in medicine, I am hopeful of a good prognosis for my baby." How should the nurse respond?

"It must be very difficult to deal with this diagnosis. Tell me what you know about the prognosis." Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Anencephaly, p. 496.

The nurse is reinforcing teaching with the caregivers of a child who has been placed in an external fixation device for the treatment of an orthopedic condition. Which statement made by the caregivers indicates an understanding of the external fixation device?

"It will be hard, but we know our child will be in this device for a long time." Explanation: External fixation devices are sometimes left in place for as long as 1 year. The pin sites are left open to the air and should be inspected and cleansed every 8 hours. The child and caregiver should be able to recognize the signs of infection at the pin sites. The appearance of the pins puncturing the skin and the unusual appearance of the device can be upsetting to the child. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, External Fixation, p. 747.

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida?

"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." Explanation: When a spinal cord lesion exists at birth, it commonly leads to altered development or function of other areas of the CNS. Spina bifida is a complex neurologic defect that heavily impacts the physical, cognitive, and psychosocial development of the child and involves collaborative, lifelong management due to the chronicity and multiplicity of the problems involved. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS, p. 750.

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention?

"Let's ask your parents to bring your friends for a visit." Explanation: After 2 weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the child's parent or supervised by the child-life specialist would help the client adapt to the immobilized state. Telling the client that he or she is too big to suck the thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as the child has likely grown tired of books and coloring after 2 weeks. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Traction, pp. 746 - 747.

An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image?

"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Types of Braces Used to Treat Scoliosis, p. 790.

A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents?

"Let's put you in touch with other families who have experienced this." Explanation: A Pavlik harness is used to reduce and stabilize the hip by preventing hip extension and adduction and maintaining the hip in flexion and abduction. It can be very daunting for parents to care for their child in this device. There are many helpful pointers and suggestions that are available from other parents and orthopedic organizations. Referring the parents to other families who have experienced a Pavlik harness will provide assurance and likely increase compliance with the regimen. The other responses are factual but do not address the parent's concerns. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Therapeutic Management, p. 772.

A nurse is performing crutch training for an adolescent who has a fractured tibia. What statement by the adolescent indicates successful teaching?

"My mom is going to have to pick up all of her throw rugs so I don't slip on them." Explanation: Throw rugs, small footstools, and toys need to be cleared out of paths at home so the crutches do not slip. Children should not rest their axilla on the crutch pads when standing; this can cause damage to the brachial nerve plexus. When the child is walking, crutches need to be approximately 6 inches (15 cm) to the side of the foot to maintain a wide, balanced base for support. It is okay to utilize a backpack to carry books and supplies because the client's hands will not be free due to the crutches. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Positional Alterations, p. 745.

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching?

"My son's activity is too limited to stimulate his bowels." Explanation: The nurse needs to point out to the mother that even minimal activity increases peristalsis. Together they can come up with appropriate activities within the child's limits or restrictions to promote peristalsis. It is important to determine the usual pattern for passing stool so that the mother and nurse can determine the best program. Palpating the abdomen can reveal distention, suggesting constipation. Adequate fluid is necessary to stimulate peristalsis. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Meningocele, p. 764.

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents?

"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection." Explanation: Parents need to understand that lack of urinary control is not the greatest problem. The larger threat is of urinary tract infection, which can result in kidney damage. Only one of the responses by the nurse carries the infection message. Continence is important. This along with the infection risk can be managed by clean intermittent catheterization (CIC) or other procedures. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Myelomeningocele, p. 764.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected." Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, COMMON MEDICAL TREATMENTS, p. 746.

The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status?

"She has been irritable for the last hour....seems like she is just upset for some reason." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 479

The parents of a child with a history of seizures who has been taking phenytoin ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate?

"Small increments in dosage lead to sharp increases in plasma drug levels." Explanation: Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Health History, p. 489.

The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent?

"Sometimes it is hard to tell what products may contain aspirin." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Reye Syndrome, p. 508.

A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse?

"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Laboratory and Diagnostic Testing, p. 480.

A 1-year-old infant has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents?

"The surgery was successful. Do you have any questions?" Explanation: Often what parents need most is someone to listen to their concerns. Although this is a good time for education, the parents are more concerned about the success of the surgery than their infant's appearance. Watching the hemoglobin, hematocrit and swelling are important nursing functions but they do not address the parents' psychosocial needs. The parents do not need to be taught statistics about their infant's condition. They more than likely know this from health care provider visits, the Internet, and parent support groups. Following surgery, this knowledge is not what parents are concerned about. Parents want to know their infant is safe and well. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 502

A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond?

"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond?

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." Explanation: Dimpling and skin discoloration in the child's lumbosacral area can be an indication of spina bifida occulta. It would be best to respond that the dimpling and discoloration is possibly a normal variation with no problems and indicate that the doctor will want to take a closer look; this response will not alarm the parent, but it also does not ignore the findings. Spina bifida is a term that is often used to generalize all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. It is probably best to avoid the use of the term initially until a diagnosis is confirmed. Nursing care would then focus on educating the family. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Assessment, p. 763.

A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse?

"This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." Explanation: Reye syndrome usually occurs after a viral illness, particularly after an upper respiratory infection or varicella (chickenpox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children with viral infections. The symptoms appear within 3 to 5 days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, and confusion occur. Immediate intervention is needed to prevent serious insult to the brain, including respiratory arrest. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Reye Syndrome, p. 508.

The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction?

"This shunt is the only surgery my baby will need." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Hydrocephalus, p. 498.

The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope?

"Use this information to teach family and friends." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Epilepsy, p. 488.

The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?

"Watch for changes in his behavior or eating patterns." Explanation: Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Hydrocephalus, p. 498.

The nurse is teaching new parents about cephalohematoma. Which statement by the parents suggests the need for further teaching?

"We should expect to see some discoloration on our child's scalp." Explanation: Characteristics of cephalohematoma include swelling that does not cross the midline and typically no discoloration. Causes of cephalohematoma include pressure against the mother's pelvis and commonly a forceps-assisted delivery. In most cases of cephalohematoma, only observation is necessary and resolution occurs within 2 to 9 weeks. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMPARISON CHART 16.2 Caput Succedaneum Versus Cephalohematoma, p. 515.

The emergency room nurse is taking a history of a 1-year-old child whose parent said that she had a "fit" at home. Which inquiry would be best to start with?

"What happened just before the seizures?" Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, SEIZURE DISORDERS, p. 488.

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction?

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, p. 789.

An infant was born with a severely deformed hand. He is now 6 months old. The nurse informs the parents that the orthopedic surgeon has recommended amputation of the hand and fitting of a prosthesis. The mother objects and tells the nurse that they would like to wait and see how the hand develops. Which of the following should the nurse say in response?

"With a deformity such as this, the hand is highly unlikely to improve." Explanation: Depending on the condition, in many children, there is a potential for better function if the malformed portion of an extremity is amputated before a prosthesis is fitted. This creates a difficult decision for parents because it is one they cannot undo later. They need assurance that hands with malformed fingers, for example, will not later grow to become normal and a well-fitted prosthesis will allow their child a more usual childhood (and adult life) than if the original disorder was left unchanged. It is not the nurse's place to insert her opinion about the matter. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Limb Deficiencies, p. 768.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?

"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, TABLE 22.10 Overuse Disorders, p. 800.

A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement?

"You look funny. Well, both of you do. I see two of you." Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 511

A pediatric client's parent calls the nurse and states, "My child fell off the bike. My child was wearing a helmet, but did scrape the knee and it is bleeding a lot. What should I do?" Which response by the nurse is best?

"You should apply pressure to the site and then bring your child in to be evaluated." Explanation: First, the nurse needs to address the client's bleeding by having the parent apply pressure to the site. Then, the child needs to be evaluated to determine if additional treatment is needed, such as stitches. Measures including rest, ice, compression, and elevation (RICE) will be further discussed with the parent and child after the bleeding is stopped and the wound has been evaluated. There is no indication the child needs immediate evaluation, nor is there indication the child cannot move other extremities or has an altered level of consciousness. Bleeding is priority for this client. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Sprains, p. 798.

A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.

13.3 mg (Don't type 'mg' into the answer blank). Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Cerebral Palsy, p. 782.

A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition?

A 13-year-old boy who is on his school's cross-country team Explanation: Osgood-Schlatter disease is the thickening and enlargement of the tibial tuberosity resulting from microtrauma, probably caused from overuse. It occurs more often in boys than girls and at preadolescence or early adolescence, probably because of rapid growth at these times. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Management, p. 799.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Explanation: Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Health History, p. 797.

How would the nurse best describe Gowers sign to the parents of a child with muscular dystrophy?

A Transfer Technique Explanation: Gowers sign is a description of a transfer technique present during some phases of muscular dystrophy. The child turns on the side or abdomen, extends the knees, and pushes on the torso to an upright position by walking his hands up the legs. The child's gait is unrelated to the presence of Gowers sign. Muscle twitching present after a quick stretch is described as clonus. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, INSPECTION AND OBSERVATION, p. 778.

The nurse is assessing the neurological functioning of a preschool child. What actions will best review functioning of cranial nerve III?

A bright-colored toy is moved in the child's visual fields. Explanation: Cranial nerve III, the oculomotor nerve, is assessed by using a brightly colored object to assess the child's ability to watch its movement. Cranial nerve I (olfactory nerve) controls the sense of smell. Asking the child to smell objects would be an assessment of this cranial nerve. Cranial nerve VII (facial nerve) is assessed by monitoring symmetry of facial movements. Cranial nerve VIII (acoustic nerve) is assessed by whispering. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Cranial Nerve Function, p. 477.

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room?

A private room near the nurses' station Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Bacterial Meningitis, p. 504.

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental bowlegs (genu varum)?

A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray. Explanation: Blount disease is retardation of growth of the epiphyseal line on the medial side of the proximal tibia (inside of the knee) that results in bowlegs (genu varum). Unlike the normal developmental aspect of genu varum, Blount disease is usually unilateral and is a serious disturbance in bone growth that requires treatment. In those with Blount disease, the medial aspect of the proximal tibia will show a sharp, beaklike appearance. The other answers all describe genu varum, not Blount disease. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Tibia Vara (Blount Disease), p. 775.

The nurse is caring for a 3-year-old child who experienced a febrile seizure for the first time. What statements by the parents of the child should the nurse address further? Select all that apply. A.) "I am thankful that our child won't have to be on anti-seizure medication." B.) "I am afraid that our 10-year-old will start having febrile seizures." C.) "It is so scary to think that our child will likely develop epilepsy now." D.) "It's important to manage fevers in the future in order to decrease the risk of febrile seizures." E.) "We have never had anyone in our family have a febrile seizure so I was so surprised when this happened."

A.) "I am thankful that our child won't have to be on anti-seizure medication." B.) "I am afraid that our 10-year-old will start having febrile seizures." Explanation: It is very unlikely that the 10-year-old child will develop febrile seizures. Febrile seizures usually affect children who are younger than 5 years of age, with the peak incidence occurring in children between 12 and 18 months old; it is rare to see febrile seizures in children younger than 6 months and older than 5 years of age. Children who experience one or more simple febrile seizures have a slightly greater risk of developing epilepsy than the general population, so it is not "likely" that the child will develop epilepsy. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Febrile Seizures, p. 494.

The young child is experiencing muscle spasms and has been given lorazepam. Which statements by the child indicate that the child may be experiencing some common side effects? Select all that apply. A.) "I feel sort of dizzy." B.) "I need to take a nap." C.) "My muscle cramps are getting worse." D.) "I think I'm going to throw up." E.) "My belly hurts."

A.) "I feel sort of dizzy." B.) "I need to take a nap." Explanation: This child has taken a benzodiazepine. Common side effects associated with this medication are dizziness and sedation. The skeletal muscle relaxes and the spasms will diminish. Nausea and upper gastrointestinal pain are not common side effects associated with this medication. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Common Drugs for Neuromuscular Disorders, p. 756.

The nurse is talking with a teen and her parents about triggers for her frequent headaches. Which statements indicate an understanding? Select all that apply. A.) "I may experience headaches during certain periods in my menstrual cycle." B.) "Change in weather can trigger my headaches." C.) "Giving up cola may be beneficial to helping me avoid headaches." D.) "Spicy foods are associated with headaches." E.) "Chocolate may trigger my headaches."

A.) "I may experience headaches during certain periods in my menstrual cycle." B.) "Change in weather can trigger my headaches." C.) "Giving up cola may be beneficial to helping me avoid headaches." E.) "Chocolate may trigger my headaches." Explanation: Teaching about headaches should include a discussion about possible triggers. Foods containing chocolate and caffeine should be restricted in the diet as they may trigger headache pain. Changes in the menstrual cycle may also be tied to headaches. Spicy foods are not tied to headaches. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Headaches, p. 518.

The nurse is caring for an adolescent with Sever disease (calcaneal apophysitis). What treatment would be prescribed for this disorder? Select all that apply. A.) Application of ice before/ after athletic events B.) Heel-stretching exercises after the pain has subsided C.) Acetaminophen administration D.) Addition of a lift or cup to the heel of the shoe of the affected size E.) Immobilization with a cast for 4 to 6 weeks

A.) Application of ice before/ after athletic events B.) Heel-stretching exercises after the pain has subsided D.) Addition of a lift or cup to the heel of the shoe of the affected size Explanation: Sever disease (calcaneal apophysitis) is an overuse injury common in overweight children between ages 8 and 15 years. Treatment includes adding a lift or cup to the heal of the shoe, ice application before and after sporting events, NSAIDs such as ibuprofen, and once the pain has subsided, heel stretching exercises. Acetaminophen does not have anti-inflammatory properties and would not be indicated for this disorder. Immobilization and/or casting is not required. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Overuse Disorders, p. 800.

The nurse is caring for a child diagnosed with a sprain of the lower extremity. Which health care prescription(s) would the nurse clarify with the provider before implementing? Select all that apply. A.) Apply a heating pad four times daily for 20 minutes per application B.) Offer aspirin (ASA) three times daily orally to the child for pain and inflammation C.) Avoid bearing weight on the affected extremity for 3 to 4 days D.) Compress the site using an elastic bandage to wrap the area E.) Assure parents understand when to return & call/ follow-up with concerns

A.) Apply a heating pad four times daily for 20 minutes per application B.) Offer aspirin (ASA) three times daily orally to the child for pain and inflammation Explanation: For a sprain or strain, ice is applied to the site to reduce swelling. Heat is not applied as this would increase swelling. Aspirin is rarely used to relieve pain and swelling in children due to the risk of Reye syndrome. If the provider prescribed either heat or aspirin, the nurse would clarify these prescriptions before implementing them. Compression and rest of the extremity (non-weight bearing), and teaching about follow-up needs are typical and expected prescriptions. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Sprains, p. 798.

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. A.) Color B.) Sensation C.) Pulse D.) Capillary refill E.) Vital signs

A.) Color B.) Sensation C.) Pulse D.) Capillary refill Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Assisting With Cast Application, p. 755.

The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply. A.) Document any signs of pain. B.) Check capillary refill time in the both arms. C.) Monitor the color of the nail beds in the right hand. D.) Wear a protective gown when moving the child's arm. E.) Wear sterile gloves when removing or touching the cast.

A.) Document any signs of pain. B.) Check capillary refill time in the both arms. C.) Monitor the color of the nail beds in the right hand. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Casts, p. 746.

The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries? Select all that apply. A.) Encourage 1 to 2 days off per week of competitive athletics. B.) Apply ice to the injured area to reduce inflammation. C.) Avoid using NSAIDs for pain control. D.) Immobilize the muscles that are involved. E.) Have the coach monitor the treatment program for sports injuries. F.). Perform appropriate stretching during a 20-to 30-minute warmup.

A.) Encourage 1 to 2 days off per week of competitive athletics. B.) Apply ice to the injured area to reduce inflammation. F.). Perform appropriate stretching during a 20-to 30-minute warmup. Explanation: Conservative treatment methods for the child with an overuse injury include encouraging 1 to 2 days off per week of competitive athletics, performing appropriate stretching during a 20-to 30-minute warmup, and applying ice to the injured area to reduce the inflammation and irritation. NSAIDs (ibuprofen) are used for inflammation and pain control. The physical therapist institutes a stretching and strengthening program for the appropriate muscle groups. Parents and coaches may not understand that the level of activity that causes overuse symptoms varies from child to child. Notes or telephone conversations from the physician or nurse to the child's coach can clarify any misconceptions about what is expected during the recovery and recuperative periods. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Assessment, p. 799.

When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply. A.) The nurse pads the crib or side rails before a seizure. B.) The nurse positions the child on the side during a seizure. C.) The nurse places a washcloth in the mouth to prevent injury during seizure. D.) The nurse stays with the child and calls for help when a seizure begins. E.) The nurse has oxygen available to use during a seizure. F.) The nurse teaches the caregivers regarding seizure precautions.

A.) The nurse pads the crib or side rails before a seizure. B.) The nurse positions the child on the side during a seizure. D.) The nurse stays with the child and calls for help when a seizure begins. E.) The nurse has oxygen available to use during a seizure. F.) The nurse teaches the caregivers regarding seizure precautions. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Preventing Injury (interventions with rationale, p. 484.

The nurse is preparing an education program for parents of a child diagnosed with Legg-Calvé-Perthes disease (LCPD) disorder. What information does the nurse need to include? Select all that apply. A.) The second stage can last up to 2 years and includes breakdown or fragmentation of the bone in the head of the femur. B.) In children over 6, surgical placement of a containment device over the head of the femur is the typical treatment. C.) If left untreated, the femur head will deform, which can lead to chronic pain. D.) The initial stage symptoms include a limp and guarding of the hip while moving. E.) This disorder has four stages that last over several years.

A.) The second stage can last up to 2 years and includes breakdown or fragmentation of the bone in the head of the femur. B.) In children over 6, surgical placement of a containment device over the head of the femur is the typical treatment. E.) This disorder has four stages that last over several years. Explanation: Children with Legg-Calvé-Perthes disease pass through four stages: synovitis, necrotic, fragmentation, and reconstruction. The necrotic state lasts between 6 to 12 months, and the fragmentation stage can last 1 to 2 years with the entire process lasting several years. Treatment for children under, not over, 6 years is to place a containment device over the head of the femur. Children over 6 years typically have reconstructive surgery to the femur head. If left untreated, the femur head will deform, which can lead to chronic pain and disability. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Transient Synovitis of the Hip, p. 789.

A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply. A.) oxygen gauge and tubing B.) suction at bedside C.) tongue blade D.) padding for side rails E.) smelling salts

A.) oxygen gauge and tubing B.) suction at bedside D.) padding for side rails Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 484

The nurse is caring for a school-age child who has been having a continuous seizure for the last 40 minutes. What is the priority action by the nurse?

Administer lorazepam IV as prescribed. Explanation: A seizure lasting longer than 30 minutes is considered status epilepticus and is an emergency situation. An IV benzodiazepine such as lorazepam is administered to help stop the seizure. Checking blood glucose levels, monitoring length and type of seizure, and administration of anti-seizure medication such as carbamazepine all are correct interventions for clients with seizures, but these are not the priority action. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, SEIZURE DISORDERS, p. 488.

A group of students is reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?

Adolescence Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Skeletal Development, p. 745.

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?

Advise the child that this is to be expected. Explanation: Plaster becomes hot as it sets. Even with fiberglass casts, there will be a warm feeling inside the cast when it is drying. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, the nurse should notify the health care provider. Infection would not present in this way with a cast application. A cast should not be moistened. If it does become wet, the cast should be dried with a hair dryer. There are some newer types of casts which can get wet but the nurse should know this before applying any moisture. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Casts, p. 746.

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke?

Arteriovenous Malformations (AVMs) Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMPARISON CHART 16.3 Risk Factors and Causes of Stroke in Children and Adults, p. 517.

The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority?

Assess the client's respiratory status. Explanation: The nurse would place priority on monitoring the client's respiratory status since the client is on a ventilator and at risk for intracranial pressure. The nurse would educate the family on the shunt, monitor for infection, and measure head circumference; however, these actions are not priority over ensuring the client maintains a patent airway. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Hydrocephalus, p. 498.

A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform?

Assess the level of consciousness (LOC). Explanation: Decreased LOC is frequently the first sign of a major neurologic problem after head trauma. The nurse would assess the client's LOC before notifying the health care provider. The child may need to be placed on fall precaution, depending on the results of the assessment. The child's eyes will correct themselves when the ICP is reduced; therefore, an eye patch is not necessary. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 509

The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?

Assess the popliteal region carefully for skin breakdown. Explanation: The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Types of Traction and Nursing Implications, p. 760.

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?

Assuming the usual feeding position will be difficult. Explanation: Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Diagnosis, p. 752.

A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?

Auscultation Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Auscultation, p. 751.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis?

Avoid making noise when in the child's room. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Bacterial Meningitis, p. 504.

The nurse is caring for a child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What action(s) by the nurse should be performed now? Select all that apply. A.) Check the child's temperature. B.) Check tubing clamps to ensure they are open. C.) Ensure the tubing is not kinked. D.) Ensure the drip chamber is below the child's clavicles. E.) Encourage the child to cough and deep breathe to facilitate drainage.

B.) Check tubing clamps to ensure they are open. C.) Ensure the tubing is not kinked. Explanation: Nursing care of an external ventricular drainage device requires the nurse to ensure all connections are secure and labeled. The amount of drainage requires close observation. If drainage is absent or minimal, the nurse must assess the tubing to make certain it is not clamped or kinked. The level of the drip chamber must be set at the height of the child (at the clavicle). Taking the temperature will be useful to assess for the presence of infection, but that is not currently a concern. Asking the child to cough and deep breathe should not be done. Deep breathing is beneficial for all postoperative clients, but coughing may increase pressures and should be avoided. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Nursing Management of External Ventricular Drainage (EVD) Device, p. 501.

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. A.) Semi-Fowler B.) Prone C.) Left Side-lying D.) Right Side-lying E.) Supine

B.) Prone C.) Left Side-lying D.) Right Side-lying Explanation: Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Management, p. 768.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. A.) The boy experiences mild pain when wiggling his toes. B.) The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. C.) New drainage is seeping out from under the cast. D.) The outside of the boy's cast got wet and had to be dried using a hair dryer. E.) The boy's toes are light blue and very swollen.

B.) The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. C.) New drainage is seeping out from under the cast. E.) The boy's toes are light blue and very swollen. Explanation: The parents should call the physician when the following things occur: The child has a temperature greater than 101.5° F (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Home Cast Care, p. 758.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

Back with hips up off the bed. Explanation: Bryant traction is used to reduce fractures or with developmental dysplasia of the hip (DDH) in children younger than 2 years of age. In this type of traction, both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed. The position of having the child on the back with the hips flat is describing Buck traction. The position where the hip is flexed on the injured side and the uninjured extended is 90-90 traction. There is no traction when the child would be on the stomach. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Types of Traction and Nursing Implications, p. 760.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant?

Baclofen Explanation: Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Common Drugs for Neuromuscular Disorders, p. 756.

Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer?

Baclofen pump Explanation: A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practitioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, PHARMACOLOGIC MANAGEMENT, p. 785.

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as:

Battle sign. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, TABLE 16.6 Common Head Injuries Seen in Children, p. 510.

The nurse is caring for an adolescent who suffered an injury during a diving accident. During assessment the client is demonstrating the posturing in the figure. The nurse is aware that this type of posturing is the result of injury to what area?

Brainstem Explanation: Decerebrate posturing is seen with injuries occurring at the level of the brain stem. Decorticate posturing occurs with damage of the cerebral cortex. Both types of posturing are characterized by extremely rigid muscle tone. Injuries to the frontal lobe of the brain and the mid-cervical spine would not cause these types of posturing. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Motor Function, p. 478.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Development, p. 744.

To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority?

Cerebral edema Explanation: The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of IV therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 486

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?

Check the infant's toes for coldness or blueness. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Home Cast Care, p. 758.

Antibiotic therapy to treat meningitis should be instituted immediately after which event?

Collection of cerebrospinal fluid (CSF) and blood for culture. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Physical Examination, p. 493.

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Fracture, p. 794.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse will be correct in telling the parent which information in regard to seizures?

Convulsive activity often occurs in seizures. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, SEIZURE DISORDERS, p. 488.

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way?

Cover the sac with a saline-moistened dressing. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Assessment, p. 764.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

Creatine Kinase (CK) Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Laboratory and Diagnostic Tests, p. 778.

The nurse is educating the parents of a child newly diagnosed with slipped capital femoral epiphysis. The nurse would be correct in including which information in the teaching plan? Select all that apply. A.) This condition is self-limiting, usually within 4 to 8 weeks. B.) Treatment involves administration of strong antibiotics via a port or PICC line. C.) This disorder is most common in school-aged females who are gymnasts or play other sports. D.) A limp and swelling at the groin/hip area is often the first symptom noted by parents. E.) The diagnosis involves imaging studies of the femoral head and hip joint to provide confirmation.

D.) A limp and swelling at the groin/hip area is often the first symptom noted by parents. E.) The diagnosis involves imaging studies of the femoral head and hip joint to provide confirmation. Explanation: The onset of symptoms occurs gradually. Children begin to limp as well as hold the leg on the affected side externally rotated to relieve stress and pain in the hip joint. Although the involvement is actually in the hip, they may report pain first in the knee because favoring the hip joint puts abnormal stress on the knee. On physical examination, internal rotation of the hip is difficult and painful. An X-ray reveals the slipped epiphysis at the femoral head. This disorder occurs twice as frequently in young Blacks than in children of other races and twice as frequently in boys as in girls. Percutaneous in situ fixation remains the standard of care for stable slipped capital femoral epiphysis. The goal of this treatment is to prevent further slippage and achieve stable closure of the proximal femoral physis while avoiding potentially devastating complications such as osteonecrosis and chondrolysis. In some children, a total hip replacement is advised to fully restore hip function. Pharmacologic treatment may include NSAIDs for pain control, not antibiotics. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Pathophysiology, p. 772.

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?

Decrease environmental stimulation Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Bacterial Meningitis, p. 504.

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?

Deficient knowledge related to diagnosis and condition. Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for health care professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Spina Bifida Occulta, p. 763.

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition?

Degeneration of muscle fibers Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal?

Development of gross motor movement Explanation: Physical therapy focuses on assisting in the development of gross motor movements, such as walking and positioning, and helps the child develop independent movement. Occupational therapy assists in the development of fine motor skills and fashioning orthotics and splints. Occupational therapy assists the child in performing optimal self-care ability by working on skills such as activities of daily living. Speech therapy assists with feeding techniques for the child who has swallowing problems. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, COMMON MEDICAL TREATMENTS, p. 756.

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered?

Diazepam Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, PHARMACOLOGIC MANAGEMENT, p. 784.

A nurse is preparing a class on neural tube disorders to present to a community group. What information regarding prevention is most important for the nurse to include in the teaching?

Dietary considerations Explanation: Regarding the prevention of neural tube disorders, the most important information to include concerns dietary considerations. Folic acid deficiency is a major risk factor for neural tube disorders. Childbearing women are advised to take 400 mcg of folic acid daily. Although genetic influences may play a part in the development of neural tube disorders, genetic screening is not always done prior to pregnancy; it is done during pregnancy if the woman is at high risk for a genetic disorder. Early prenatal care is important to any pregnancy but does nothing to prevent a neural tube disorder. These disorders occur during the first 27 days of pregnancy long before most women realize they are pregnant. Keeping up-to-date with immunizations is important but does nothing to prevent neural tube disorders. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Spina Bifida Occulta, p. 763.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger?

Drinking three cans of diet cola. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 518

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

A nurse who is discussing Duchenne Muscular Dystrophy characterizes it correctly using which descriptors?

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Explanation: Duchenne muscular dystrophy is the most common of several muscular dystrophies and is a progressive, fatal disorder. It involves mainly skeletal muscles, but other muscles are affected over time. Onset occurs in early childhood. The disorder is X-linked recessive. An enzyme is lacking that is necessary for the maintenance of muscle cells. No structural abnormalities of the spinal cord or peripheral nerves are noted. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as:

Duchenne. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which statement regarding these variations is true?

During adolescence, muscle growth is influenced by increased production of androgenic hormones. Explanation: During adolescence, muscle growth is influenced by hormonal changes, primarily the increased production of androgenic hormones. The infant's muscles account for only 25% of total body weight, whereas they account for 40% to 45% in an adult. The young child has resilient soft tissue, so dislocations and sprains are unusual occurrences. Rapid bone and muscle growth may contribute to the appearance of "clumsy" and awkward motions of the adolescent who is trying to adjust to new body dimensions. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Process Overview for the Child With a Neuromuscular or Musculoskeletal Disorder, p. 748. Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - Page 748

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

Epiphysiolysis of the Proximal Humerus. Explanation: Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease (calcaneal apophysitis) causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Management, p. 799.

The nurse is teaching a health and wellness course to young women of childbearing age. Which vitamin will the nurse encourage all to take daily?

Folic acid Explanation: It is recommended that all women of childbearing age ingest 0.4 mg of folic acid daily. Ascorbic acid is vitamin C, niacin is a B vitamin, and calcium is a mineral, not a vitamin. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, NEURAL TUBE DEFECTS, p. 763.

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?

Gowers sign Explanation: A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Pathophysiology, p. 794.

A type of traction sometimes used in the treatment of the child with scoliosis is called:

Halo Traction. Explanation: When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, pp. 789 - 790.

Through which mechanism is Duchenne muscular dystrophy acquired?

Heredity Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

The mother of an infant reports that her child is frequently choking when breastfeeding or taking a bottle. The nurse plans on assessing which cranial nerve when addressing the mother's concerns?

IX Explanation: Cranial nerve IX (glossopharyngeal) would be assessed to test the swallowing and gag reflex. Cranial nerve VIII is the acoustic nerve which is involved in hearing. Cranial nerve VII is the facial nerve and controls facial muscles, salivation and taste. Cranial nerve VI is the abducens nerve and controls and is related to eye movements. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Cranial Nerve Function, p. 477.

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?

Impaired physical mobility related to a cast on the leg Explanation: Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, CONGENITAL AND DEVELOPMENTAL DISORDERS, p. 762.

The nurse is caring for a child who has suffered a head injury and has had an ICP monitor placed. Which prescription by the health care provider would the nurse question?

Initiate an IV of 0.9% NS to run at 250 ml/hr. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Caring for the Child With Severe Head Injury, pp. 511 - 512.

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective?

Inspect the child's skin for rashes, redness, irritation, or pressure injuries. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, INSPECTION AND OBSERVATION, p. 748.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially?

Institute droplet precautions in addition to standard precautions. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Nursing Assessment, p. 507.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2°F (39°C). What is the nurse's highest priority?

Institute safety precautions. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Febrile Seizures, p. 494.

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem?

Intracranial hemorrhaging. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Nursing Assessment, p. 501.

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for?

Irritability, fever, and vomiting. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Bacterial Meningitis, p. 504.

Which characteristic is true of cerebral palsy?

It appears at birth or during the first 2 years of life. Explanation: Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are intellectually disabled, many have normal intelligence. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Cerebral Palsy, p. 782.

What is a true statement regarding status epilepticus?

It is a common neurologic emergency in children. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Epilepsy, p. 488.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?

Latex Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Preventing Latex Allergic Reaction, p. 766.

Which of these strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy?

Long Leg Braces Explanation: Long leg braces are functional assistive devices that provide increased independence and increased use of upper and lower body strength. Wheelchairs, both motorized and manual, provide less independence and less use of upper and lower body strength. Walkers are functional assistive devices that provide less independence than braces. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Pathophysiology, p. 776.

The child diagnosed with muscular dystrophy often exhibits a forward curvature of the lumbar spine. What is this spinal condition called?

Lordosis Explanation: Lordosis, a forward or inner curvature of the lumbar spine or swayback, is seen by school age in the child with muscular dystrophy. Kyphosis is also referred to as hunchback and demonstrates an outward curvature of the upper spine. Scoliosis is a sideways curvature of the spine. Synovitis is the inflammation of the synovial membrane, which can result in pain when moving an affected joint. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 776.

Absence seizures are marked by what clinical manifestation?

Loss of motor activity accompanied by a blank stare. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, TABLE 16.2 Common Types of Seizures, p. 490.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record?

Low Serum Calcium Levels Explanation: With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Assessment, p. 788.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position?

Lying on one side, with the back curved Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 16.1, p. 480.

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?

Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 488

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?

Moving the infant's head every 2 hours. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Craniosynostosis, p. 502.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?

Muscle Biopsy Explanation: Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS, p. 751.

A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?

Muscular wasting results in generalized immobility and difficulty feeding and breathing. Explanation: SMA type 1 is the most severe form of spinal muscle atrophy that results in muscle wasting, generalized immobility and difficulty feeding. This is an autosomal recessive genetic disorder that affects motor but not cognitive development. SMA type 1 has a rapid progression; these infants do not usually live past 2 years of age. Infants diagnosed with SMA type 1 will not sit unassisted and will not walk. Physical therapy is beneficial in strengthening some muscles, especially in those with the less severe SMA types 2, 3 or 4. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, CONGENITAL AND DEVELOPMENTAL DISORDERS, p. 762.

The nurse is assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client?

NSAIDs, ice, and limiting exercise Explanation: The child's symptoms suggest Osgood-Schlatter disease, which is a thickening and enlargement of the tibial tuberosity probably from overuse. Treatment includes administration of NSAIDS, ice, and limiting strenuous activity. Ankle and knee strengthening exercises, applications of ice, and use of acetaminophen is not indicated for this disorder. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Common Drugs for Neuromuscular Disorders, p. 757.

Any individual taking phenobarbital for a seizure disorder should be taught:

Never to discontinue the drug abruptly. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Common Anticonvulsant Medications, p. 492.

A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor?

Obesity Explanation: Obesity is a risk factor for the development of tibia vara. Tibia vara occurs most frequently in children who are early walkers. Limited or lack of exposure to sunlight may lead to rickets. Hormonal alterations during puberty may play a role in the development of slipped capital femoral epiphysis. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Tibia Vara (Blount Disease), p. 776.

The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's level of consciousness?

Obtunded Explanation: Obtunded is defined as a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Fully conscious describes a child who has no neurologic changes. Stupor exists when the child only responds to vigorous stimulation. Decreased level of consciousness is a vague term that does not describe the assessment findings. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Level of Consciousness, p. 476.

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?

Place the newborn in a prone or lateral position. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Myelomeningocele, p. 764.

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?

Positive Kernig sign. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 504

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges?

Positive Kernig sign. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Bacterial Meningitis, p. 504.

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

Presence of Moro Reflex Explanation: The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Reflexes, p. 748.

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to:

Prevent edema. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Assessment, p. 798.

The nurse is providing preoperative care for a newborn with myelomeningocele. Which action is the central nursing priority?

Prevent rupture or leaking of cerebrospinal fluid Explanation: The central nursing priority is to prevent rupture or leaking of cerebrospinal fluid. Keeping the infant in a prone position will help prevent pressure on the lesion. Keeping the lesion free from fecal matter or urine is important as well, but the priority is to prevent rupture or leakage. The nurse should consider the lesion first when maintaining the infant's body temperature. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Management, p. 764.

While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority?

Protect the child from hitting the arms against the bed. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Pathophysiology, p. 489.

A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment?

Quietly observe the child at play while interviewing the parent. Explanation: The best way to assess a young child's neuromuscular system is to observe the child from a distance. Observing the child at play will allow the nurse to assess the child's gross and fine motor skills, as well as cognitive abilities. Asking the parent to describe the child's motor development may be appropriate in some cases such as the ability to feed. Getting down to the child's level may help assess the child's social development but observing the child play at a distance is best to assess a child's fine and gross motor development. Reviewing the child's history will give the nurse a sense of the child's past developmental level but will not give information about the child's current status. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Cerebral Palsy, p. 782.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination?

Record and refer the finding for follow-up to the pediatrician. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Spina Bifida Occulta, p. 763.

During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take?

Report the findings to the pediatric health care provider. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, p. ____

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?

Risk For Infection Explanation: All of these diagnoses are important for a child with a myelomeningocele. However, during the first 12 hours of life, the most life-threatening event would be an infection. The other diagnoses will be addressed as the child develops. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Myelomeningocele, p. 764.

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

Risk for impaired skin integrity Explanation: The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, skin integrity, p. 753.

In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care?

Risk for injury related to seizure activity Explanation: The child's risk for injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and if the child has a history of seizures, it would specifically impact airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Therapeutic Management, p. 489.

A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure?

Semi-Fowler position with a parent at the bedside Explanation: Proper positioning for an infant after a ventricular tap is to place the child in a semi-Fowler position to prevent additional drainage from the puncture site. Allow the parents or caregivers to comfort the child. Placing the child in the prone or supine position could allow for additional drainage from the puncture site. High-Fowler position is contraindicated immediately after this procedure. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMMON MEDICAL TREATMENTS 16.1 (Continued), p. 487.

A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure?

Semi-Fowler position with a parent at the bedside Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMMON MEDICAL TREATMENTS 16.1 (Continued), p. 487.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

Significant bending without actual breaking. Explanation: A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Types of Fractures in Children, p. 796.

Which diagnostic measure is most accurate in detecting neural tube defects?

Significant level of alpha-fetoprotein present in amniotic fluid Explanation: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, CONGENITAL AND DEVELOPMENTAL DISORDERS, p. 762.

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis?

Signs of increased intracranial pressure (ICP). Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Increased Intracranial Pressure, p. 479.

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?

Spica cast Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Therapeutic Management, p. 772.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?

Spina Bifida Occulta Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Spina Bifida Occulta, p. 763.

Which type of spinal neural tube defect does the nurse recognize as common and usually benign?

Spinal Bifida Occulta Explanation: Spina bifida occulta usually is benign and is estimated to affect 10% to 20% of the population. It is a defect in the vertebral body without protrusion of the spinal cord or its coverings. Spina bifida is a general term that is often used to refer to all neural tube disorders of the spinal cord. Meningocele and myelomeningocele do involve protrusion of elements of the spinal portion of the central nervous system and require treatment. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Spina Bifida Occulta, p. 763.

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?

Standing Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular dystrophy, p. 776.

The nurse is working with a 6-year-old child recently diagnosed with Legg-Calvé-Perthes disease. The child's parents tells the nurse they understand exercise is important for their child but are not sure which activities are appropriate. Which activity will the nurse recommend for this client?

Swimming Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Management, p. 789.

A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as:

Syndactyly. Explanation: Syndactyly refers to webbing of the fingers and toes. Polydactyly refers to the presence of extra digits on the hand or foot. Metatarsus adductus is a medial deviation of the forefoot. Pectus carinatum is a protuberance of the chest wall. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Polydactyly/Syndactyly, p. 768.

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate?

Teach the child and his parents to keep a headache diary. Explanation: A headache diary can help identify any triggers so that the child can avoid them. Triggers can include foods eaten, amount of sleep the night before, or activities at home or school that might be causing stress. Reviewing signs of increased intracranial pressure would be inappropriate because increased intracranial pressure is not associated with headaches. Having the child sleep without a pillow is an intervention to reduce pain from meningitis. Vomiting more than twice is an indication that the parents should notify the physician or nurse practitioner when the child has a head injury. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMMON MEDICAL TREATMENTS, p. 474.

The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?

Tell me your concerns about your child's shunt. Explanation: Always start by assessing the family's knowledge. Ask them what they feel they need to know. Knowing when to call the doctor and how to raise the child's head are important, but they might not be listening if they have another question on their minds. "Autoregulation" is too technical; base information on the parents' level of understanding. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Hydrocephalus, p. 498.

The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?

Tell me your concerns about your child's shunt. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Hydrocephalus, p. 498.

The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this?

The boy rises from the floor by walking his hands up his legs. Explanation: Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand. The other options do not describe Gowers' sign, although lordosis is often a manifestation of Duchenne muscular dystrophy. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, INSPECTION AND OBSERVATION, p. 778.

The nurse is caring for an 8-year-old girl who was in a car accident. What would lead the nurse to suspect a concussion?

The child is easily distracted and can't concentrate. Explanation: A child with a concussion will be distracted and unable to concentrate. Signs and symptoms of contusions include disturbances to vision, strength, and sensation. Vomiting and bruising behind the ear are signs of a subdural hematoma. Bleeding from the ear and otorrhea are signs of a basilar skull fracture. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurological Disorder, TABLE 16.6 Common Head Injuries Seen in Children, p. 510.

The nurse is observing a child walk down stairs using a swing-through gait. What action by the child is correct?

The child places the crutches on the lower step before placing the good foot down between the crutches. Explanation: To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Health History, p. 748.

The nurse is observing a child walk down stairs using a swing-through gait. What action by the child is correct?

The child places the crutches on the lower step before placing the good foot down between the crutches. Explanation: To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Health History, p. 748.

During the trial period to determine the efficacy of an anticonvulsant drug, which caution should be explained to the parents?

The child shouldn't participate in activities that could be hazardous if a seizure occurs Explanation: Until seizure control is certain, clients shouldn't participate in activities (such as riding a bicycle) that could be hazardous if a seizure were to occur. Plasma levels need to be monitored periodically over the course of drug therapy; daily monitoring isn't necessary. Dosage changes are usually based on plasma drug levels as well as seizure control. Anticonvulsant drugs should be withdrawn over a period of 6 weeks to several months, never immediately, as doing so could precipitate status epilepticus. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Therapeutic Management, p. 489.

A school-aged child with seizures is prescribed phenytoin sodium, 75 mg four times per day. What instruction would the nurse give the parents regarding this medication?

The child will have to adhere to good tooth brushing. Explanation: A side effect of phenytoin sodium is gingival hyperplasia. Good tooth brushing helps prevent inflammation under the hypertrophied tissue. Dizziness and tingling and numbness of the fingers are not side effects of this drug. Television watching will not elicit a seizure in a child with a known seizure disorder. A seizure occurs as an electrical interference in the brain. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Common Anticonvulsant Medications, p. 492.

A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. Complete the following sentence(s) by choosing from the lists of options. The nurse should first _____________________ followed by ___________________.

The nurse should first: ensure proper oxygenation. Followed by: administer intravenous (IV) or intramuscular (IM) benzodiazepine. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 488-495

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours. Explanation: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Traction, pp. 746 - 747.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele?

The spinal meninges protrude through the bony defect and form a cystic sac. Explanation: When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Meningocele, p. 764.

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?

To continue with age-appropriate activities Explanation: The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. Bracing is one way to do that. The brace should be worn for 23 hours per day. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. It is extremely important that the adolescent has compliance with the brace usage. The nurse can help by teaching the adolescent ways to help peers understand the need for the brace. Sex changes continue with or without bracing. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, p. 789.

Which of these age groups has the highest actual rate of death from drowning?

Toddlers. Explanation: Toddlers and older adolescents have the highest actual rate of death from drowning. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Near-Drowning, p. 514.

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected?

Trendelenburg gait Explanation: The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Assessment, p. 789.

The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?

Type II Explanation: According to the Salter-Harris classification, a type II fracture is partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Fracture, p. 794.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?

Understanding the side effects of medications Explanation: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Epilepsy, p. 488.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

Unhooking a weight while providing pin care Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Providing Pin Care, p. 762.

The nurse is preparing a child experiencing new-onset seizures for an electroencephalogram (EEG) test. How can the nurse best explain this procedure to the child?

Use a doll with electrodes attached to the head. Explanation: An electroencephalogram (EEG) is a test to measure the electrical activity of the brain. It is conducted by attached electrodes over sections of the head and obtains an electrical reading via a monitor. There is no pain involved in the procedure, but the child must lie still. The best way for the nurse to explain the procedure to the child is via a doll with attached electrodes that the child can play with, feel, and manipulate. This helps to reduce the child's anxiety and aids in cooperation. Videos can help with the education process but they do not allow for interaction and physical touching. The child can take a nap during the procedure but this does not prepare the child for the procedure. Assuring the child that the procedure will not hurt is not the best way to prepare the child. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, 16.1 Common Laboratory and Diagnostic Tests, p. 481.

A 12-year-old child has been prescribed phenytoin. What information should be included in discussion about this medication?

Use a soft toothbrush. Explanation: Phenytoin is an anticonvulsant medication. It can be used in the management of seizure disorders. This medication is associated with gingival hyperplasia. This may result in tender and bleeding gums. The use of a soft toothbrush will reduce pain, bleeding and discomfort. There is no need to take this medication on an empty stomach or with citrus foods and beverages. The medication does not make an individual photosensitive. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Common Anticonvulsant Medications - Page 492

The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain?

Video electroencephalogram Explanation: A video electroencephalogram can determine the precise localization of the seizure area in the brain. Cerebral angiography is used to diagnose vessel defects or space-occupying lesions. Lumbar puncture is used to diagnose hemorrhage, infection, or obstruction in the spinal canal. Computed tomography is used to diagnose congenital abnormalities such as neural tube defects. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 16.1 (Continued), p. 481.

The nurse is assessing a toddler for motor function. Which activity will be the most valuable?

Watch the child reach for a toy. Explanation: Watching the child reach for a toy would be most valuable for assessing motor function because the infant should be able to extend extremities to a normal stretch. Catching a ball or kicking a ball forward is too advanced for a toddler to accomplish. Looking at a picture book would help assess visual acuity and eye movement. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder, Motor Function, p. 478.

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)?

While assessing the child's pupils, there is no change in diameter in response to a light. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 509

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects?

folic acid supplementation Explanation: Strong evidence exists that folic acid supplementation by the mother before conception decreases the incidence of neural tube defects by 50%. Ultrasound screening at 16 to 18 weeks' gestation can help identify fetuses at risk, but this would not prevent neural tube defects. Screening of maternal serum alpha-fetoprotein levels can help identify fetuses at risk, but this would not prevent neural tube defects. Neural tube defects are not related to genetic dysfunction, so genetic testing would be of no value. Reference: Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, NEURAL TUBE DEFECTS, p. 763.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem?

head trauma Explanation: A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long. Reference: Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - Page 509