Peds Exam 4

A 3-month-old with spina bifida is admitted to the nurse's unit. Which of the following gross motor skills should the nurse assess at this age? 1. Head control. 2. Pincer grasp. 3. Sitting alone. 4. Rolling over.

1. A 3-month-old has good head control. TEST-TAKING HINT: The test taker must know normal developmental milestones.

9. A child is being evaluated in the emergency room for a possible diagnosis of meningitis. The nurse is assisting with the lumbar puncture and notes that the CSF is cloudy. The nurse is aware that cloudy CSF most likely means: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, as CSF is usually cloudy. 4. Sepsis.

2. The CSF in bacterial meningitis is usually cloudy.

A child with spastic CP had an intrathecal dose of baclofen in the early afternoon. What is the expected result 31/2 hours post dose that suggests the child would benefit from a baclofen pump? 1. The ability to self-feed. 2. The ability to walk with little assistance. 3. If the spasticity were decreased. 4. If the spasticity were increased.

3. If baclofen were going to work for this patient, one could tell because spasticity would be decreased. TEST-TAKING HINT: The test taker must know the purpose of baclofen

31. The nurse is caring for a 6-year-old female with a skull fracture who is unconscious and has severely increased ICP. The nurse notes the child's temperature to be 104°F (40°C). Which of the following should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer Tylenol via nasogastric tube. 3. Administer Tylenol rectally. 4. Place ice packs in the child's axillary areas.

31. 1. A cooling blanket will help cool the child quickly and at a controlled temperature.

37. A teen has a scoliosis curve of 35°. What treatment option does the nurse prepare the child and family for? A. Bracing B. Continued screening C. Exercise therapy D. Surgical intervention

ANS: A A curve of 35°is considered mild scoliosis. Bracing is the treatment of choice at this point. Continued screening is inappropriate, as the child has scoliosis. Research has shown that exercise alone does not improve outcomes. Surgical intervention is reserved for more serious cases.

47. A camp nurse reads on a medical history form that a camper has "drop attacks." What does the nurse understand about this condition? A. Atonic seizure activity B. Fainting spells C. Loss of consciousness D. Sudden muscle weakness

ANS: A "Drop attack" is an old term for atonic seizure activity.

18. What would the nurse assess for in a child with a disturbance in the basal ganglia? A. Ataxia B. Hyperthermia C. Hypotension D. Incontinence

ANS: A Ataxia, or uncoordinated movements, may been seen in a child with a problem of the basal ganglia, which controls movement. Changes in temperature and blood pressure are more likely related to problems with the hypothalamus, and incontinence could signify a spinal cord problem.

30. A nurse is preparing to discharge a 10-year-old child who was diagnosed with bacterial meningitis. Which action by the nurse takes priority? A. Arrange home health-care visits for antibiotic infusions. B. Consult with physical therapy about a home exercise plan. C. Ensure the parents can plan high-protein meals. D. Make a social work referral for long-term care placement.

ANS: A Children with bacterial meningitis are often discharged with a PICC line in place for home IV antibiotic infusions. Depending on the needs of the child, the other options may or may not be appropriate.

43. A nurse is caring for a patient in Crutchfield tongs. Which assessment finding requires immediate notification to the health-care provider? A. Altered mental status B. Crusted drainage at pin sites C. Irritability and pain D. WBCs of 98,000/mm3

ANS: A Crutchfield tongs are inserted into the skull. Any alteration in mental status could signify a serious complication, such as infection or intracranial bleeding (both are rare but possible). The nurse would not need to report crusted drainage, irritability and pain, or a normal white blood cell count.

33. The parents of a child recently diagnosed with Duchenne's muscular dystrophy want to know if their infant twin daughters should be tested for the disease too. Which response by the nurse is the most appropriate? A. "No, Duchenne's muscular dystrophy is a sex-linked genetic disorder rarely affecting females." B. "No, infants the age of your daughters are too young to undergo testing for Duchenne's muscular dystrophy." C. "Yes, the earlier the diagnosis of any type of muscular dystrophy is made, the better the child's quality of life." D. "Yes, females are equally likely to have Duchenne's muscular dystrophy as are boys."

ANS: A Duchenne's muscular dystrophy is a sex-linked recessive disease that usually only affects males. Females with Turner's syndrome, in which the child only inherits one X chromosome from the mother, can be affected, but females are usually carriers. The infant twin daughters do not need to be tested.

36. A woman is considering a second pregnancy, but tells the nurse she is not sure she wants to get pregnant again because her first child was born with spina bifida. She is taking folic acid on the advice of her health-care provider. Which information can the nurse provide this woman? A. Alpha-fetoprotein testing can be done in pregnancy. B. Genetic testing is available for this condition. C. It is rare for two children in one family to be affected. D. Usually spina bifida affects only female children.

ANS: A During pregnancy, testing of maternal blood for elevated alpha-fetoprotein is available for an early indication of spina bifida. The other options are incorrect.

22. A nurse is caring for four patients in the pediatric intensive care unit with head injuries or brain infections. Which child should the nurse see first? A. Blood pressure change from 110/58 to 134/40 mm Hg in a child with brain injury B. Child with brain injury who has vomited twice in 12 hours, now sleeping C. Child with meningitis who is irritable, complaining of a "bad" headache D. Oral temperature of 100.4°F (38°C) in a child with meningitis

ANS: A Hypertension (with widening pulse pressure), bradycardia, and changes in respiratory pattern are components of Cushing's triad, a late sign of increased intracranial pressure, indicative of impending herniation. The change in the child's blood pressure, including the widened pulse pressure (difference between systolic and diastolic pressures), is worrisome. A child with a head injury and minimal vomiting is not alarming. A child with a brain infection who is irritable with a headache needs attention, but not over the child with possible herniation. An oral temperature of 100°F would be expected in a child with a brain infection.

7. An ophthalmologist examining the eyes of a patient explains to the nurse that the patient has an irregular curvature or uneven contour of the eye, resulting in impaired light refraction that causes blurred vision at all distances. Which condition does the nurse inform the parents about? A. Astigmatism B. Hyperopia C. Myopia D. Strabismus

ANS: A In myopia, light rays do not reach the retina, causing blurred vision at a far range and clear vision at a close range. In hyperopia, vision is unclear at a close range and is clearer at a far range. Strabismus, or crossed-eye appearance, results in misalignment of the eyes. Astigmatism may be present at birth or acquired. Light rays are unevenly distributed in the eyes, causing blurred vision at all distances. This condition is associated with birth hyperopia and myopia.

37. An infant born with spina bifida with a repaired myelomeningocele is brought the emergency department, where the parents report that the infant is very fussy and is feeding poorly. Which nursing action takes priority? A. Assess the baby's fontanels for bulging. B. Attach a cardiac and respiratory monitor. C. Obtain and document the baby's vital signs. D. Try feeding the baby with sucrose water.

ANS: A Poor feeding and irritability are signs of increased intracranial pressure (ICP) in infants. A child with spina bifida is at risk for hydrocephalus, which can lead to increased ICP. A corroborating sign would be bulging fontanels. The nurse should quickly palpate the infant's fontanels. Monitoring the child and obtaining vital signs are important actions too, but palpating the fontanels can be done quickly as the nurse handles the child and performs other procedures. The nurse should not attempt to feed this baby now.

15. The pediatric nurse caring for hearing-impaired children teaches parents the recommended guidelines for communicating with their children. Which instruction is inconsistent with current guidelines? A. Ignoring any related stigmas B. Obtaining the child's attention before speaking C. Positioning yourself at the child's eye level D. Talking slowly and loudly to the child

ANS: A The following guidelines are used when communicating with the hearing-impaired child: obtain the child's attention prior to speaking, face the child when talking, position yourself at the child's eye level, talk slowly and loudly, modify the environment to reduce noise, and offer emotional support because the child may face stigmas related to his or her hearing loss.

31. A nurse is caring for a child who had a sudden onset of muscle weakness beginning in the legs and progressing in an ascending fashion, but who otherwise appears healthy. Which laboratory result would confirm the nurse's suspicion about the origin of this problem? A. Elevated CSF protein B. Increased liver enzymes C. Leukocytosis D. Low hemoglobin

ANS: A This child has manifestations of Guillain-Barré syndrome. Elevated CSF protein in the absence of infection supports this diagnosis.

17. A student nurse is tutoring another student on anatomy and physiology. What does the tutor explain is the function of myelin sheaths on certain nerves? A. Allow rapid transmission of nerve impulses B. Assist in long-term storage of memories C. Prevent "cross-communication" between nerves D. Protect the nerves from temperature changes

ANS: A White matter in the brain consists of nerves coated with myelin sheaths, which allow nerve impulses to travel rapidly.

8. The pediatric nurse caring for a 3-year-old child with cerebral palsy (CP) prepares a home care teaching plan for the caregivers on discharge. Which items will the nurse include in the teaching plan? (Select all that apply.) A. Apply splints and braces to facilitate muscle control. B. Buy toys that are appropriate for the child's abilities. C. Encourage the child to perform self-care tasks. D. Ensure the clothing has buttons to stimulate dexterity. E. Use skeletal muscle relaxants for short-term control.

ANS: A, B, C, D The child with CP has some degree of muscular dysfunction. The nurse encourages the child to perform self-care tasks. The child may exhibit muscular hypotonia (low tension) or hypertonia (high tension). Splints and braces may be necessary to facilitate muscle control and to improve body functioning. Clothing should be easy to manipulate. Skeletal muscle relaxants may be used for short-term control with older children and adolescents.

6. A 10-year-old child has had a sunken chest since birth, but has recently been noted to have activity intolerance when playing. Which diagnostic testing does the nurse teach the child and parents about? (Select all that apply.) A. Chest x-ray B. Chromosome analysis C. ECG and echocardiogram D. Pulmonary function studies E. Ultrasound of the chest

ANS: A, B, C, D This child has signs and symptoms of pectus excavatum, which manifests with a sunken chest. If the cardiac or respiratory systems are involved, the child will show exercise intolerance (changes in vital signs, changes on ECG, complaints of chest pain or shortness of breath with activity). Common diagnostic measures for this disorder include chest x-ray, chromosomal analysis or enzyme studies, ECG and/or echocardiogram, pulmonary function studies, and a stress test. Ultrasound is not used.

5. The pediatric nurse prepares a care plan for a patient admitted to the intensive care unit for meningitis. Which nursing interventions does the nurse include in the care plan for this patient? (Select all answers that apply.) A. Assess and treat pain as needed. B. Implement transmission-based precautions. C. Initiate and maintain IV access. D. Monitor vital signs every 4 hours. E. Monitor neurological status and symptoms.

ANS: A, B, C, E The nurse should initiate transmission-based precautions to help prevent transmission of infection. The nurse should initiate and maintain intravenous access (specify fluids and rate) as ordered. The nurse should monitor vital signs every 1 to 4 hours (depending on severity of symptoms) and place the patient on a cardiac monitor as indicated. The nurse should monitor neurological status and symptoms closely, comparing with baseline values for the child. Patients with meningitis often have pain, especially headaches, and the nurse should be prepared to assess and treat.

1. A parent asks about the process of bone growth. When explaining bone development to the parent, which substances does the nurse include in the teaching session as being necessary? (Select all that apply.) A. Calcitonin B. Calcium C. Estrogen D. Thyroid hormones E. Vitamin D

ANS: A, B, E Bone growth depends on several substances, including calcium, calcitonin, parathyroid hormone, vitamin D, and other minerals and enzymes. Estrogen and thyroid hormones are not required.

3. A nurse is caring for a 1-year-old child who was admitted for seizures. The parents ask what could have caused the child's seizure. The nurse explains that seizures can be caused by which problems? (Select all that apply.) A. Brain injury B. Central nervous system infection C. Hypertension D. Renal failure E. Unknown cause

ANS: A, B, E Seizures can be caused by many things, including traumatic brain injury, infection in the central nervous system, ingestion of toxins, endocrine dysfunction, atrial-venous malformation, or anoxia. The etiology may also be unknown.

1. A nurse assesses an infant for signs of increased intracranial pressure. Which signs would lead the nurse to notify the rapid response team? (Select all that apply.) A. Bulging fontanels B. Change in LOC C. Irregular respirations D. Posturing E. Seizures

ANS: A, C, D Bulging fontanels, irregular respirations, and posturing are among the late signs of increased intracranial pressure and would lead the nurse to intervene quickly by notifying the health-care provider or by activating the rapid response team. The other signs are early indicators of increased intracranial pressure.

9. Following hip surgery, a patient is placed in a spica cast. What nursing interventions are appropriate for this patient? (Select all that apply.) A. Cutting a window in the cast B. Icing the area over the incision C. Increasing fiber in the diet D. Increasing fluid intake E. Maintaining the same position

ANS: A, C, D Cast syndrome can be prevented by three nursing interventions: frequent repositioning, increasing fluids and fiber in the child's diet, and cutting a "belly hole" or a window in the cast to allow for abdominal expansion. The other two interventions do not help prevent cast syndrome.

3. A nurse is teaching parents how to care for their child who is undergoing serial casting for clubfoot. Which information does the nurse provide? (Select all that apply.) A. Cast care B. Cast drying techniques C. Neurovascular assessment D. Pain management E. Wound care

ANS: A, C, D Parents need to be taught how to properly care for their child's cast. The cast is left open to air for drying, so there are no special techniques needed. Specifically, the parents should not use a hair dryer, as this may cause burns. The parents should also be taught about managing the child's pain, as stretching the muscles and ligaments will be painful. They also need instruction on performing neurovascular checks and when to call the physician. Serial casting is not a surgical procedure, so wound care instructions are not needed.

2. The pediatric nurse is caring for a child with increased intracranial pressure (ICP). The nurse places priority on completing which interventions? (Select all that apply.) A. Administering mannitol (Osmitrol) B. Lowering the head of the bed C. Maintaining a patent airway D. Performing vigorous suctioning E. Preventing hyperthermia

ANS: A, C, E Hyperthermia is to be avoided because brain metabolic needs will be greatly increased. The nurse may use a hypothermic blanket if the child's temperature is over 102°F (39°C). The head of the bed can be elevated 15 to 30° to promote venous blood return, but a side effect of elevating the head is that the pressure of blood being delivered to the brain decreases, resulting in inadequate blood supply and perfusion. A priority nursing intervention is maintenance of a patent airway. Inadequate oxygenation or excess carbon dioxide causes cerebral blood vessels to dilate, resulting in increased intracranial pressure (ICP). The nurse may administer medications to decrease cerebral edema. A drug frequently prescribed is mannitol (Osmitrol). The patient should be suctioned if needed, but suctioning can increased ICP and should be done gently and only when necessary.

10. The nurse is providing care to a pediatric patient who suffered an ankle sprain. Which interventions are appropriate to include in the patient's plan of care? (Select all that apply.) A. Apply an Ace wrap to apply pressure and reduce swelling of the joint. B. Apply heat to the extremity for the first 48 hours at 15-minute intervals. C. Elevate and move the affected joint to reduce swelling and stiffness. D. Immediately perform range-of-motion exercises on the extremity. E. Place ice on the injury for 15 minutes at a time for the first 1 to 2 days.

ANS: A, C, E The nurse should teach the RICE acronym: Rest the injured extremity to prevent further injury and allow the ligament to heal; ice for the first 48 hours, keeping ice packs in place for 15-minute intervals to decrease swelling; compression with an Ace wrap or some other method to apply pressure to the affected joint to help reduce swelling of the joint; and elevation and early motion of the affected joint (elevation reduces swelling; early motion of the affected joint helps maintain full range of motion).

10. The clinic nurse is providing community education to a parent group. The topic is over-the-counter medications containing aspirin or aspirin compounds. Which products does the nurse advise the parents to avoid? (Select all that apply.) A. Kaopectate (bismuth subsalicylate) B. Lamictal (limotragine) C. Pedia-profen (ibuprofen) D. Pepto-Bismol (bismuth subsalicylate) E. Ventolin (albuterol)

ANS: A, D Common over-the-counter products containing aspirin include Kaopectate and Pepto-Bismol. Lamictal is not an over-the-counter drug. The other three medications do not contain aspirin compounds.

2. The nurse is caring for a child diagnosed with clubfoot. Which assessment findings does the nurse anticipate in the affected extremity? (Select all that apply.) A. Adducted forefoot B. Dorsiflexion C. Everted heel D. Plantar flexion E. Rigidity

ANS: A, D, E Signs of clubfoot include plantar flexion, inverted heel, adducted forefoot, and rigidity to the point that the foot cannot be manipulated into a neutral position.

35. A nurse is preparing to discharge an infant who has developmental dysplasia of the hip (DDH). What discharge instruction would be most important? A. How to correctly perform Ortolani's maneuver B. How to properly use the Pavlik harness C. When to return for corrective surgery D. Where to take the baby to be fit for corrective shoes

ANS: B A baby with DDH will be placed in a special splint, most often the Pavlik harness, to keep the legs in a position of abduction. The harness is worn continuously for 3-6 months, during which time bone growth helps create a normal hip joint. Ortolani's maneuver is an assessment for DDH. Surgery may be required, but not until it has been determined that bone growth is not creating a normally shaped hip joint. Corrective shoes are not needed.

20. A nurse is caring for a child who has intracranial pressure (ICP) monitoring. The nurse assesses the child and notes that the ICP is 9 mm Hg. Which action by the nurse is most appropriate? A. Activate the rapid response team. B. Document the finding in the chart. C. Hyperventilate the patient. D. Prepare to administer mannitol (Osmotrol).

ANS: B A normal ICP is 0-10 mm Hg. This finding is normal and the nurse needs only to document it and continue monitoring. No other actions are needed.

24. A child in traction is having muscle spasms. Which medication does the nurse prepare to administer? A. Acetaminophen (Tylenol) B. Diazepam (Valium) C. Morphine sulfate (Astromorph) D. Oxycodone (Percocet)

ANS: B Diazepam is a muscle relaxant and is used to treat muscle spasms. The other medications are for pain.

35. A nurse is caring for a child with Duchenne's muscular dystrophy (MD). The child's creatinine kinase level has dropped by over half since it was last measured. What assessment finding correlates with these results? A. Better respiratory functioning B. Decreased muscle strength C. Improved posture and walking D. Stabilizing muscle strength

ANS: B Early in MD creatinine kinase levels are elevated. As muscle wasting occurs and muscle bulk diminishes, creatinine kinase levels will drop. A finding of decreased muscle strength correlates with the laboratory results.

32. A nurse is caring for an 8-year-old with Guillain-Barré Syndrome (GBS). On hourly rounds, the nurse assesses that the child's lung sounds are diminished, respiratory rate is 8 breaths/min and shallow, and pulse oximeter is 88%. What action by the nurse takes priority? A. Administer high-flow oxygen by mask. B. Call the rapid response team; prepare for intubation. C. Encourage the patient to take slow, deep breaths. D. Have the patient use the incentive spirometer.

ANS: B In GBS, respiratory muscles can be affected, leading to respiratory failure. The nurse needs to prepare for intubation. The child's muscles are too weak for oxygen or the spirometer to help her, and she may be too weak to use the spirometer or to take deep breaths.

10. A nurse admits a 5-year-old child with bacterial meningitis to the pediatric intensive care unit. Which information obtained by the nurse during the intake history is most helpful for the nurse to document? A. Fell off swing hitting head 2 months ago B. History of recent sinus infection C. Mother with history of herpes simplex D. Sibling with upper respiratory infection

ANS: B In a child this age, common causes of bacterial meningitis include septicemia, surgical procedures involving the CNS, penetrating wounds, otitis media, sinusitis, cellulitis of the scalp or face, dental cavities, pharyngitis, and orthopedic diseases. Blunt trauma from falling off a swing and a sibling with a URI are noncontributory. Herpes simplex is an important cause of neonatal viral meningitis.

19. A child has been hospitalized with an acute-grade IV slipped femoral capital epiphysis (SFCE) and is on bedrest awaiting surgical correction. A new nurse places the following interventions on the child's care plan. Which intervention leads the experienced nurse to intervene? A. Consult child-life therapist for diversionary activities. B. Perform range-of-motion exercises to both lower extremities. C. Reinforce teaching on crutch-walking postoperatively. D. Teach child and family about non-weight-bearing status.

ANS: B In acute SFCE, range-of-motion exercises are not done to the affected extremity because they may cause further damage. The other interventions are appropriate for a child with this diagnosis.

38. A 6-week-old baby is brought to the clinic for a follow-up visit after having surgical repair of a myelomeningocele. His head circumference was 33 cm (12 inches) at birth. Now the nurse assesses his head circumference at 36 cm (14.1 inches). What action by the nurse is most appropriate? A. Assess the child for signs of hydrocephalus. B. Document the measurement in the child's chart. C. Educate the parents on possible shunt placement. D. Inquire about signs of increased intracranial pressure.

ANS: B Increasing head circumference is a sign of possible hydrocephalus. The average head circumference of an infant at birth is 33-38 cm (12-14 inches) and increases by 2 cm/month (0.75 inches/month). This child's head circumference is normal and the nurse should document the information; no other actions are needed.

31. A child has just been diagnosed with juvenile arthritis (JA). The parents want to know what caused this to happen. Which statement by the nurse is the most appropriate? A. "Genetic abnormalities are triggered by infection." B. "It seems to be an autoimmune disease." C. "Latent infections can recur and cause JA." D. "No one really understands how JA occurs."

ANS: B JA is an autoimmune, inflammatory process often thought to be triggered by an infection. The etiology is not genetic, caused by latent infections, or completely unknown.

40. A new nurse is caring for a child who had a ventriculoperitoneal shunt placed 2 days ago for hydrocephalus. Which action by the new nurse causes the experienced nurse to intervene? A. Administers IV antibiotics B. Asks for medication to treat nausea C. Palpates the shunt tract with assessments D. Raises the head of the bed to 30°

ANS: B Peritonitis is a complication of this procedure and manifestations of this include rebound tenderness, abdominal muscle rigidity, nausea, and vomiting. The new nurse should conduct a more thorough abdominal assessment instead of asking for anti-nausea medication. The other actions are appropriate and do not require the experienced nurse to intervene.

4. The pediatric nurse caring for patients in a trauma center examines a patient who has increased intracranial pressure as a result of a motor vehicle crash. The nurse is aware that secondary brain injuries can result from which factor? A. Acidosis B. Ischemia C. Infections D. Reduced oxygen

ANS: B Primary brain injury is irreversible, immediate, and can result from traumatic injuries (e.g., a blow to the head) or nontraumatic injuries (e.g., a tumor or infection). Secondary brain injuries include ischemia from hypoxia, hypercapnia, hypotension, acidosis, and reduced oxygen delivery.

42. The nurse is providing care to a pediatric patient who has orders for Crutchfield tongs. Which diagnosis does the nurse anticipate prior to reviewing the patient's medical record? A. Dislocated hip B. Femur fracture C. Osteopenia D. Spinal fracture

ANS: D Crutchfield tongs are used to treat cervical or thoracic fractures.

11. A nurse admits a child experiencing drowsiness and vomiting who has had a seizure at home. The parents state the child was healthy until 2 weeks ago when she had a viral illness. Which diagnostic testing does the nurse facilitate as a priority? A. Complete blood count B. Liver biopsy C. Lumbar puncture D. Serum glucose

ANS: B This child has manifestations of Reye syndrome. The definitive diagnosis of this disease is made via a liver biopsy.

48. A child is brought to the pediatric clinic by her mother, who reports redness, swelling, and pain around the child's right eye. Which information does the nurse give the mother? A. A steroid injection may be needed to reduce swelling. B. Intravenous antibiotic treatment for 7 days is usually curative. C. See an ophthalmologist to assess for any corneal damage. D. Use warm wet compresses to remove any crusting.

ANS: B This child has the manifestations of periorbital cellulitis, which is treated with a week of IV antibiotics. Steroid injections may be used for a chalazion. An ophthalmologist needs to assess the child with keratitis to assess for corneal damage. Warm moist soaks are used in conjunctivitis.

32. The pediatric nurse is caring for a child recently diagnosed with transient synovitis of the hip. Which medication order is most appropriate for this child? A. Acetaminophen (Tylenol) 10-15 mg/kg every 4 hours B. Ibuprofen (Motrin) 30-50 mg/kg/day in 3-4 divided doses C. Naproxen (Aleve) 20-30 mg/kg/dose every 4 hours D. Prednisone (Deltasone) 0.1-2 mg/kg/day in 1-4 divided doses

ANS: B This disorder is treated with NSAIDs. Acetaminophen is not an NSAID, although the dose listed is a safe dose. Prednisone is also not an NSAID, although the dose listed is a safe dose. Ibuprofen and Naproxen are both NSAIDs. The dose of ibuprofen is correct; the safe dose for naproxen is 10-15 mg/kg/dose every 12 hours.

15. A child's family history includes muscular dystrophy (MD). What diagnostic testing does the nurse prepare the child and family for? (Select all that apply.) A. Blood urea nitrogen B. Creatinine kinase C. Electromyelogram D. Muscle biopsy E. Ultrasound

ANS: B, C, D Common diagnostic tests for MD include creatinine kinase, electromyelogram, and muscle biopsy. Blood urea nitrogen and ultrasound are not used.

7. The nurse is preparing discharge teaching for the parents of a 7-year-old boy with hydrocephalus and a ventriculoperitoneal shunt. Which information does the nurse include in the discharge teaching? (Select all that apply.) A. After the shunt site has healed, contact sports are permitted B. How to accurately take the child's temperature when needed C. Monitoring for shunt infection is always a priority action. D. Report any nausea, vomiting, or change in behavior. E. Shunt removal can occur after hydrocephalus has been controlled.

ANS: B, C, D Parents are taught how to care for their child after shunt placement. They need to know common signs of infection (fever, nausea, vomiting, change in behavior), how to take a temperature, and that contact sports are not permitted. Because hydrocephalus is a lifelong condition, monitoring for infection is ongoing and the shunt stays in place permanently.

5. A nurse is teaching parents about caring for their child in a cast. Which information does the nurse provide? (Select all that apply.) A. Be sure the child does not move joints above and below the cast. B. Elevate the extremity above the heart as much as possible. C. Keep the child from playing with toys that have very small parts. D. Provide snacks high in calcium and vitamin D or provide supplements. E. Reinforce active or passive range of motion to unaffected joints.

ANS: B, C, D, E The nurse teaches parents how to care for a child in a cast, including moving the joints above and below the cast regularly, elevating the extremity above the heart as much as possible, keeping the child from putting objects down the cast (including toy parts), providing nutrition that encourages bone healing, and providing range of motion.

7. An 8-year-old girl has a third-degree sprain of the ankle. Based on this diagnosis, which teaching points will the nurse include in the teaching plan for this patient and family? (Select all that apply.) A. The ligament is only stretched and the affected joint is stable. B. The patient cannot bear weight or use the extremity. C. There is severe pain over the joint, making an exam difficult. D. There is full range of motion and weight bearing. E. Sprains and strains are unusual in a child this age.

ANS: B, C, E Sprains are less common in younger children than are fractures. In a third-degree sprain the injury is severe, the ligament is completely torn, and the joint is unstable. There is significant swelling and severe ecchymoses occurring within the first 30 minutes. There is also severe pain over the joint, making examination difficult. The person cannot bear weight or otherwise use the extremity.

41. A nurse is caring for a child and notes Battle's sign during the assessment. Which action by the nurse is the most appropriate? A. Assist with obtaining laboratory studies. B. Document the findings in the child's chart. C. Measure the child's abdominal girth. D. Notify the provider and facilitate a CT or an MRI.

ANS: D Battle's sign is indicative of a basilar skull fracture. The child will need a head CT or an MRI. The other actions are not needed as a result of this finding.

4. A nurse is preparing discharge teaching for an adolescent with a new diagnosis of epilepsy. What information should the nurse provide? (Select all that apply.) A. "Driving is not allowed while taking anti-seizure drugs." B. "Participating in sports again in the future is possible." C. "Several drugs will be tried at once, then reduced over time." D. "Wearing a Medic-Alert bracelet is not needed for seizures." E. "You should check the school's seizure action plan."

ANS: B, E Once drug levels are therapeutic and the child has been seizure-free for several months (usually at least 6 months), he or she can return to participating in sports. School nurses should be aware of a child's diagnosis of a seizure disorder and treatment plan; the parents should check on the school's seizure action plan so they are aware of actions that will be taken if their child has a seizure on campus. Driving is allowed (depending on state law) with therapeutic drug levels and a certain period of seizure-free time. Monotherapy is the optimal treatment plan, but if a single drug does not work to control seizures, other drugs may be added to the regimen. Anyone with epilepsy or a seizure disorder should wear a Medic-Alert bracelet or necklace.

23. A nurse is caring for a 10-year-old child with a brain injury. On assessing the child, the nurse finds the following data: opens eyes only to pain, mutters inappropriate words, has abnormal extension to stimulation. Which action by the nurse takes priority? A. Alert the operating room for emergent surgery. B. Document the findings; reassess in 15 minutes. C. Notify the provider; prepare for intubation. D. Raise the head of the child's bed to 45°.

ANS: C A child with a Glasgow Coma Score of less than 8 needs to be intubated and mechanically ventilated. This child's score is 7 (eye opening = 2, verbal response = 3, motor response = 2). The child may need an invasive procedure due to the increased intracranial pressure, but this would not take priority over managing the airway and providing adequate oxygenation. The findings need to be documented, but further action is needed. Raising the head of the bed may or may not be beneficial, but does not take priority over intubation.

27. A child has had an episode of lip smacking while staring into space, but did not seem to lose consciousness. She was confused afterward but said her hands felt tingly before the other symptoms started. How should the nurse document this event? A. Alteration in consciousness B. Convulsion C. Focal seizure D. Generalized seizure

ANS: C A focal seizure involves only one part of the brain and manifests with involuntary movements, sensory symptoms, possible staring into space, no loss of consciousness, and confusion afterward. "Alteration in consciousness" is too vague in this case to be a useful description. "Convulsion" is an outdated term. A generalized seizure involves both hemispheres of the brain and manifestations usually include loss of consciousness and tonic-clonic movements.

28. A child has been admitted with bacterial meningitis. Which action by the nurse takes priority? A. Administering broad-spectrum antibiotics B. Assessing and treating pain aggressively C. Facilitating blood cultures and lumbar puncture D. Maintaining a quiet, nonstimulating environment

ANS: C All actions are appropriate for the child with acute bacterial meningitis. However, the priority is obtaining cultures so that appropriate therapy can be identified. After cultures are obtained, the nurse will administer broad-spectrum antibiotics until the culture and sensitivity results are known.

18. A child is being cared for at home with modified bed rest for Legg-Calvé-Perthes disease. Which assessment finding indicates to the home health-care nurse that outcomes for a priority diagnosis have been met? A. The child maintains grades in school via tutoring. B. The family identifies effective coping strategies. C. Full range of motion is present in all joints. D. The family identifies appropriate diversionary activities.

ANS: C All assessment findings signify positive adaptation to this disorder. However, because the child is on bedrest, the priority is to prevent complications of immobility including contractures or decreased ROM in joints.

26. A child has an invasive intracranial pressure monitoring device in place. Which assessment finding indicates that goals for a priority nursing diagnosis have been met? A. Daily weight equals admission weight. B. Joints move freely during range of motion. C. No signs of infection are present at the insertion site. D. Skin is intact without redness or breakdown.

ANS: C All indications show that goals for various nursing diagnoses have been met; however, the priority here would be preventing infection at the intracranial pressure monitoring site, which would have a direct route to the brain.

1. The student nurse studying the neurological system learns that areas of gray matter are found deep in the brain. To determine damage to the basal ganglia, what will the nurse assess? A. Blood pressure B. Homeostasis C. Movement D. Sensory impulses

ANS: C Areas of gray matter are found deep in the brain. These areas include the basal ganglia (affect movement), the hypothalamus (maintains homeostasis and regulates blood pressure, heart rate, and temperature), and the thalamus (processes sensory impulses and sends them to the cerebral cortex).

39. An infant hospitalized with multiple fractures has just been diagnosed with osteogenesis imperfecta. The nurse finds the parents crying. Which response by the nurse is the most appropriate? A. "I know how you feel. I would be upset to find this out too." B. "There is medicine that can allow her to live a normal life." C. "Would you like me to help you with holding your baby?" D. "You are actually lucky; many of these babies die at birth."

ANS: C Causing more injury to their child is a common concern among parents of children with osteogenesis imperfecta. The nurse needs to show them how to hold, change, feed, and play with their babies. In this situation, the caring nurse offers to help the parents learn to hold their baby and offers support. The nurse should never assume to know how someone else is feeling. Medications will not help this child lead a normal life. Stating that the parents are lucky is belittling their feelings.

39. A nurse in a well-child clinic notes that a 5-month-old is not able to hold her head up. Which action by the nurse is the most appropriate? A. Ask about other developmental milestones . B. Document the finding in the child's chart. C. Measure the child's head circumference. D. Obtain the child's length and weight.

ANS: C Difficulty holding the head up by an appropriate age is a manifestation of hydrocephalus. Another sign of this disorder is an enlarging head, so the nurse measures the child's head and compares it to age-related norms. The other actions are appropriate, but not as specifically associated with hydrocephalus as measuring head circumference.

35. The high school nurse is teaching a healthy living class to high school seniors. One student asks why she should take folic acid now when she is not planning to become pregnant. Which response by the nurse is the most appropriate? A. "It is a good habit to get into while you are young and can develop good habits." B. "Most people in this country have a serious deficiency of vitamins and folic acid." C. "Neural tube defects occur so early that you might not know you are even pregnant." D. "There are no foods that contain folic acid so you have to take a supplement."

ANS: C Neural tube defects (NTDs) generally occur between the 18th and 28th days of pregnancy, often before the woman knows she is pregnant. All women of childbearing age should get 400 µg/day of folic acid to help prevent NTDs. It is a good habit to get into prior to contemplating pregnancy, but this answer does not give specific information. Most people do not have a serious deficiency of folic acid; however, pregnant women (and those who could be pregnant) need to have a minimal amount of folic acid. Several foods are good sources of folic acid, including green leafy vegetables, liver, legumes, orange juice, and fortified breakfast cereals; it is also contained in multivitamins.

8. A nurse is caring for a child with suspected epilepsy. Which diagnostic test does the nurse facilitate as the priority for this child? A. Cerebral angiogram B. Electrocardiogram (ECG) C. Electroencephalogram (EEG) D. Lumbar puncture (LP)

ANS: C The EEG is the gold standard diagnostic test for a seizure disorder.

14. A school-aged child wishes to learn embroidery from her grandmother, but the grandmother reports that the child can only concentrate on the projects for a short time and seems frustrated. What action by the nurse is the most appropriate? A. Advise that the child needs more physical activity. B. Explain that the child is too young for this project. C. Suggest that the child have a routine vision exam. D. Teach behavior modification to the grandmother.

ANS: C The most common refractive disorder in children is hyperopia (farsightedness). Symptoms include reports of objects being unclear at close range and clearer at a distance. Younger children may have trouble focusing on a project that requires close vision work. The nurse should suggest that the child have a routine eye examination. The other options may or may not be beneficial, but do not address the potential visual problem.

11. The pediatric nurse is caring for a patient with juvenile arthritis. The health-care provider tells the nurse the patient will be started on disease-modifying antirheumatic drugs (DMARDs). Which drugs does the nurse anticipate administering? (Select all that apply.) A. Acetaminophen (Tylenol) B. Indomethacin (Indocin) C. Infliximab (Remicade) D. Leflunomide (Arava) E. Methotrexate (Rheumatrex)

ANS: C, E DMARDs include methotrexate (Rheumatrex), cyclophosphamide (Cytoxan), sulfasalazine (Azulfidine), and infliximab (Remicade). Acetaminophen (Tylenol) has no anti-inflammatory effect and is not used to treat juvenile arthritis. Leflunomide is an immunosuppressant.

19. A nurse is caring for a child who only awakens to painful stimuli and produces no verbal responses. Which term is the most appropriate when documenting this child's status? A. Lethargy B. Obtundation C. Persistent vegetative state D. Stupor

ANS: D A child who is stuporous only responds to painful stimuli and has verbal responses that are either absent or slow. A lethargic patient opens his or her eyes to loud voices and appears confused and falls asleep without continued stimulation. Obtundation is demonstrated when a person is aroused by tactile stimulation, such as gentle shaking, but does not show great interest in surroundings. A persistent vegetative state is a coma-like condition that has lasted for over 4 weeks.

6. A pediatric nurse performs a physical examination on a neonate and notes a spinal lesion with the meninges protruding through the defect that contains spinal cord elements. The nurse documents which condition as being present? A. Hydrocephalus B. Meningitis C. Meningocele D. Myelomeningocele E. Spina bifida occulta

ANS: D A myelomeningocele is the most severe form of spina bifida and is evident on delivery. The meninges protrude through the defect, and they contain spinal cord elements. It appears as a very pronounced skin defect, usually covered by a transparent membrane, and neural tissue may be attached to the inner surface.

9. A hospitalized child is having a seizure. Which action by the nurse takes priority? A. Apply oxygen and oximeter. B. Give anti-seizure medications. C. Pad the side rails of the bed. D. Turn the child on his or her side.

ANS: D All actions are appropriate when a patient has a seizure. The priority, however, is on maintaining the child's airway. Placing the child in a side-lying position decreases the risk of aspiration and airway obstruction.

36. A home health-care nurse is visiting a child with Duchenne's muscular dystrophy (MD). The child has a new cough, poor appetite, fatigue, and a reddened area on his coccyx from sitting in his wheelchair all day. What intervention by the nurse takes priority? A. Assess the child for his favorite high-protein foods. B. Develop a protocol for changing positions more often. C. Encourage the family to allow the child plenty of rest. D. Notify the health-care provider and request antibiotics.

ANS: D All actions are appropriate; however, children with MD usually die of respiratory infections, so aggressive treatment at the first sign of a respiratory infection is warranted. The nurse should notify the health-care provider and request antibiotics.

16. The student nurse studying anatomy and physiology understands which of the following to be the function of axons? A. Bringing information to the brain B. Maintaining myelin sheaths on nerves C. Protecting sensory and motor pathways D. Taking information away from the brain

ANS: D Axons take information away from the brain.

5. The pediatric nurse caring for a patient with encephalitis explains to the parents that the most common origin of encephalitis is which of the following? A. Bacterial B. Fungal C. Parasitic D. Viral

ANS: D Encephalitis is usually viral in origin and occurs with an acute febrile illness that is characterized by cerebral edema and infection of surrounding meninges. Less common etiologies are fungal, bacterial, and parasitic infections; exposure to toxins or drugs; and cancer.

12. A neonate receives a diagnosis of hydrocephalus. The pediatric nurse assesses for congenital anomalies related to this condition. Which condition is inconsistent with the nurse's knowledge of hydrocephalus? A. Aqueductal stenosis B. Chiari I and II malformations C. Dandy-Walker malformation D. Folic acid deficiency

ANS: D Hydrocephalus develops when an impedance to cerebrospinal fluid (CSF) flow or absorption is present. It rarely occurs as a result of the overproduction of CSF. Congenital anomalies, including Chiari I and II malformations, Dandy-Walker malformation, and aqueductal stenosis, are the most common causes of hydrocephalus during the neonatal and early infancy periods. Acquired hydrocephalus occurs after birth and in infancy, usually resulting from intraventricular hemorrhage due to prematurity. Folic acid deficiency is related to neural tube deficits.

2. The pediatric nurse explains to the parents of a comatose child that which structure controls the child's level of consciousness? A. Basal ganglia B. Brainstem C. Central nervous system D. Reticular activating system

ANS: D Level of consciousness is controlled by the reticular activating system and the cerebral hemispheres of the brain. Cognitive cerebral function cannot occur without an active reticular activating system.

3. The pediatric nurse carefully monitors a patient's status by assessing the child's level of consciousness. The nurse understands that the Glasgow Coma Scale provides clues to which of the following? A. Encephalitis B. Irreversible coma C. Neurological impairment D. Neurological status

ANS: D The child's level of consciousness and the use of the Pediatric Glasgow Coma Scale, pupil response, and overall activity provide clues to the child's neurological status

25. A 4-year-old child is recovering from a modified Nuss procedure. Which is the priority intervention by the nurse? A. Ambulating the child as soon as allowed B. Encouraging food and fluids postoperatively C. Monitoring vital signs and wound drainage D. Playing with the child using pinwheels or bubbles

ANS: D The modified Nuss procedure is an open chest reconstruction for severe cases of pectus excavatum. Preventing pneumonia is a critical nursing action. Because this child is too young to use an incentive spirometer, "playing" with him or her using bubbles, pinwheels, or paper triangles the child can blow across the table accomplishes pulmonary hygiene. The other activities are important postoperative nursing interventions, but are not specific to this operation.

29. During assessment of a 6-year-old child with meningitis, the nurse places the child supine and attempts to put the child's chin on her chest. The child cries out in pain and flexes her knees. How does the nurse document this assessment finding in the medical record? A. Absent Moro reflex B. Exaggerated Grey-Turner sign C. Negative Kernig sign D. Positive Brudzinski sign

ANS: D Two assessment tests are used in evaluating a patient with meningitis: the Kernig sign and the Brudzinski sign. The nurse has demonstrated a positive Brudzinski sign. The Kernig sign is elicited by placing the patient supine with hips flexed and raising and straightening the leg. Pain behind the knee and resistance are abnormal findings possibly indicative of meningitis. The Moro reflex is done on infants. The Grey-Turner sign is bruising of the flanks, often accompanying pancreatitis.

27. A new nurse is placing an elastic wrap on a patient with an ankle sprain. Which action by this nurse causes an experienced nurse to intervene? A. Exerts moderate pull on the wrap B. Instructs the patient on wrapping the injury C. Starts wrapping distal to the injury D. Wraps in a proximal-to-distal fashion

ANS: D When using an elastic wrap, start wrapping distal to the injury, work up over the injury, and end the wrapping proximal to the injury. The other actions are correct.

1. The nurse is caring for a child who has been in an MVA. The child continues to fall asleep unless her name is called or she is gently shaken. The nurse knows that this state of consciousness is referred to as: 1. Coma. 2. Delirium. 3. Obtunded. 4. Confusion.

3. Obtunded describes a state of conscious ness in which the child has a limited re sponse to the environment and can be aroused by verbal or tactile stimulation.

The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.

1. At least 80% of cases of CP result from unknown prenatal factors TEST-TAKING HINT: The test taker must know the latest information to answer this question correctly.

A nurse is receiving an infant with myelomeningocele from an outside hospital. Which of the following priority items should be placed at the newborn's bedside? 1. A bottle of normal saline. 2. A rectal thermometer. 3. Extra blankets. 4. A blood pressure cuff.

1. Before the surgical closure of the sac, the infant is at risk for infection. A sterile dressing is placed over the sac to keep it moist and help prevent it from tearing. TEST-TAKING HINT: Focus on the care and potential complications of an infant with spina bifida to answer the question correctly

Which of the following will help a school-aged child with muscular dystrophy stay active longer? 1. Normal activities, such as swimming. 2. Using a treadmill every day. 3. Several periods of rest every day. 4. Using a wheelchair on getting tired.

1. Children who are active are usually able to postpone use of the wheelchair longer. It is important to keep using muscles for as long as possible, and aerobic activity is good for a child. TEST-TAKING HINT: Appropriate interventions for different kinds of chronically ill children can be similar, so think about what would be best for this child.

A child is admitted to the pediatric unit with spastic CP. Which of the following would the nurse expect this child to demonstrate? Select all that apply. 1. Increased deep tendon reflexes. 2. Decreased muscle tone. 3. Scoliosis. 4. Contractures. 5. Scissoring. 6. Good control of posture. 7. Good fine motor skills

1. Children with spastic CP have increased deep tendon reflexes. 3. Children with spastic CP have scoliosis. 4. Children with spastic CP have contractures of the Achilles tendons, knees, and adductor muscles. 5. Children with spastic CP have scissoring when walking. TEST-TAKING HINT: The test taker must know the typical signs of CP.

The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. The mother and father. 2. The sister. 3. The brother. 4. The aunts and all-female cousins. 5. The uncles and all male cousins.

1. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. 2. Women carry the disease, and males are affected. All female relatives should be tested. 4. Women carry the disease, and males are affected. All female relatives should be tested TEST-TAKING HINT: Knowing that Duchenne muscular dystrophy is inherited as a X-linked trait excludes brother, uncle, and male cousins as carriers.

Which of the following developmental milestones should the nurse be concerned about if a 10-month-old could not do it? 1. Crawl. 2. Cruise. 3. Walk. 4. Have a pincer grasp

1. Most infants are able to crawl unassisted by 8 months. TEST-TAKING HINT: The test taker must know developmental milestones

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. The nurse should tell them which of the following? 1. Muscular dystrophies are disorders associated with progressive degeneration of muscles, resulting in relentless and increasing weakness. 2. The weakness that the child is currently experiencing will probably not increase. 3. The child will be able to function normally and require no special accommodations. 4. The extent of degeneration depends on performing daily physical therapy

1. Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder. TEST-TAKING HINT: The test taker should know that muscular dystrophy is a progressive degenerative disorder

A school-aged child is admitted to the unit preoperatively for bladder reconstruction. The child is latex-sensitive. Which of the following interventions should the nurse implement? 1. Post a sign on the door and chart that the child is latex-allergic. 2. Use powder-free latex gloves when giving care. 3. Keep personal items such as stuffed animals in a plastic bag to avoid latex contamination. 4. Use a disposable plastic-covered blood pressure cuff that will stay in the child's room.

1. Posting a sign on the door and charting that the child has a latex allergy is important so others will be aware of the allergy. TEST-TAKING HINT: The test taker must know which supplies have latex and about contact allergies.

11. The nurse is caring for a 6-month-old infant diagnosed with meningitis. When she places the infant in the supine position and flexes his neck, she notes that the infant flexes his knees and hips. The nurse knows that this is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

11. 1. Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees.

18. The nurse is caring for a child with meningitis. The parents call for the nurse as "something is wrong." When the nurse arrives, she notes that the child is having a generalized tonic-clonic seizure. Which of the following should the nurse do first? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child's temperature and blood pressure.

18. 1. The child experiencing a seizure usually requires more oxygen as the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's air way, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help.

19. A 5-year-old female has been diagnosed with a seizure disorder. Her teacher noticed that she has been having episodes where she drops her pencil and simply appears to be daydreaming. This is most likely called: 1. An absence seizure. 2. An akinetic seizure. 3. A non-epileptic seizure. 4. A simple spasm seizure.

19. 1. Absence seizures occur frequently and last less than 30 seconds. The child ex periences a brief loss of consciousness where she may have a change in activ ity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming.

5. The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. Which of the following signs best indicates increased ICP in this child? 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite.

3. A high-pitched cry is often indicative of increased ICP in infants.

The nurse is doing a follow-up assessment of a 9-month-old. The infant rolls both ways, sits with some support, pushes food out of the mouth, and pushes away when held. The parent asks about the infant's development. The nurse responds by saying which of the following? 1. "Your child is developing normally." 2. "Your child needs to see the primary care provider." 3. "You need to help your child learn to sit unassisted." 4. "Push the food back when your child pushes food out."

2. A 9-month-old should be able to sit alone, crawl, pull up, not push food out of the mouth (tongue thrust), and push away when held when wanting to get down. This child is not developing normally and must see the primary care provider TEST-TAKING HINT: The test taker must know normal developmental milestones. Rolling occurs about 4 months, sitting alone occurs at 6 months, and pushing food out of the mouth decreases by 4 months when the tongue thrust reflex wanes.

35. An infant is born with a sac protruding through the spine. The sac contains CSF, a portion of the meninges, and nerve roots. The nurse knows that this is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly.

2. A myelomeningocele is a sac that con tains a portion of the meninges, the CSF, and the nerve roots.

60. The nurse is working in the emergency room caring for a 10-year-old who was in an MVA. The child is currently on a backboard with a cervical collar in place. The child is diagnosed with a cervical fracture. Which of the following would the nurse expect to find in the child's plan of care? 1. Remove the cervical collar, keep the backboard in place, and administer high dose methlyprednisolone. 2. Continue with all forms of spinal stabilization, and administer high-dose methylprednisolone and ranitidine. 3. Remove the backboard and cervical collar, and prepare for halo traction placement. 4. Remove the cervical collar and backboard, place the child on spinal precautions, and administer high-dose methylprednisolone and ranitidine.

2. All forms of spinal stabilization should be continued while methylprednisolone and Zantac are administered.

45. The nurse is caring for several children. She knows that which of the following children is at increased risk for CP? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with sepsis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.

2. Any infection of the central nervous system increases the infant's risk of CP.

2. The nurse is caring for a 3-year-old female with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: 1. Name the president of the United States. 2. Identify her parents and state her own name. 3. State her full name and phone number. 4. Identify the current month but not the date.

2. Asking the 3-year-old to identify her parents and state her name is a devel opmentally appropriate way to assess orientation.

The nurse receives a call from the local Emergency Medical Services stating that an ambulance is arriving with an 8-month-old with a decreased level of consciousness. When assessing the neurological status of an 8-month-old, the nurse should check for which of the following? 1. Clarity of speech. 2. Interaction with staff. 3. Developmental delay. 4. Ability to follow instructions

2. Assessment for alteration in developmentally expected behaviors, such as stranger anxiety, is helpful. Interaction with staff is not to be expected due to stranger anxiety. TEST-TAKING HINT: The test taker must know about infant development

A newborn is diagnosed with a myelomeningocele at L2. Which of the following should be the priority nursing diagnosis for this infant at 12 hours of age? 1. Altered bowel elimination related to neurological deficits. 2. Potential for infection related to the physical defect. 3. Altered nutrition related to neurological deficit. 4. Disturbance in self-concept related to physical disability.

2. Because this infant has not had a repair, the sac is exposed. It could rupture, allowing organisms to enter the cerebrospinal fluid, so this is the priority. TEST-TAKING HINT: Before surgery, the myelomeningocele is exposed, so risk of infection is much higher.

50. A 3-year-old male with CP has just been fitted for braces and is beginning physical therapy to assist with ambulation. His parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse's best response: 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child ages and grows, the CP can manifest in different ways, and different muscle groups can need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are lesslikely to fall."

2. CP can be manifested in different ways as the child grows. It does not progress,

Which of the following should the nurse tell the parent of an infant with spina bifida? 1. Bone growth will be more than that of babies who are not sick, because your baby will be less active. 2. Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills. 3. Nutritional needs for your infant will be calculated based on activity level. 4. Fine motor skills will be delayed because of the disability

2. Children with decreased activity due to illness or trauma are helped by physical and occupational therapy. The varied activities stimulate the senses. TEST-TAKING HINT: The test taker should know normal growth patterns

37. The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response: 1. "We measure all babies' heads to ensure that their growth is on track." 2. "Babies with myelomeningocele are at risk for hydrocephalus, which can show up with an increase in head circumference." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up with an increase in head circumference." 4. "Many infants with myelomeningocele have microcephaly, which can show up with a decrease in head circumference."

2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an in crease in head circumference.

The nurse is teaching family members of a child newly diagnosed with muscular dystrophy about early signs. The nurse knows that teaching was successful when a parent states that which of the following signs may indicate the condition early? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity.

2. Difficulty climbing stairs, running, and riding a bicycle are frequently the first symptoms of Duchenne muscular dystrophy TEST-TAKING HINT: Early symptoms have to do with decreased ability to perform normal developmental tasks involving muscle strength

8. The nurse is working in the PICU caring for an infant who has just returned from having a ventriculoperitoneal shunt placed. Which position initially will be most beneficial for this child? 1. Semi-Fowler in an infant seat. 2. Flat in the crib. 3. Trendelenburg. 4. In the crib with the head elevated to 90 degrees.

2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates.

Which of the following should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? 1. Weigh diapers for 24-hour urine output. 2. Measure head circumference. 3. Offer clear fluids. 4. Assess for infection

2. Hydrocephalus occurs in about 90% of infants with myelomeningocele, so measuring the head circumference daily and watching for an increase are important. Accumulation of cerebrospinal fluid can occur after closure of the sac. TEST-TAKING HINT: The dynamics of the cerebrospinal fluid change after closure of the sac.

13. The nurse is caring for a child who has just been admitted to the pediatric floor with a diagnosis of bacterial meningitis. When reviewing the child's plan of care, which of the following orders would the nurse question? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fluids at 11/2 times regular maintenance. 3. Neurological checks every 4 hours. 4. Administer acetaminophen for temperatures higher than 38°C (100.4°F).

2. Intravenous fluids at 11/2 times regular maintenance could cause fluid overload and lead to increased ICP.

23. The nurse is providing discharge teaching to the parents of a toddler who has experienced a febrile seizure. The nurse knows that clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2. Most children over the age of 5 years do not have febrile seizures.

24. The nurse is caring for a 5-year-old female recently diagnosed with epilepsy. She is being evaluated for anticonvulsant medication therapy. The nurse knows that the child will likely be placed on which kind of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensure compliance.

2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels.

3. The nurse is preparing to assess a 6-year-old male with altered consciousness in thePICU. His parents ask if they can stay during his morning assessment. Select the nurse's best response. 1. "Your child is more likely to answer questions and cooperate with any procedures if you are not present." 2. "Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside." 3. "It is our policy to ask parents to leave during the first assessment of the shift." 4. "Many children fear that their parents will be disappointed if they do not do well with procedures, so we recommend that no parents be present at this time."

2. Parents should be encouraged to remain with their child for mutual comfort.

22. The nurse is working in the emergency room when an ambulance arrives with a 9-year-old male who has been having a generalized seizure for 35 minutes. The paramedics have provided blow-by oxygen and monitored vital signs. The patient does not have intravenous access yet. Which of the following medications should the nurse anticipate administering first? 1. Establish an intravenous line, and administer intravenous lorazepam. 2. Administer rectal diazepam. 3. Administer an oral glucose gel to the side of the child's mouth. 4. Place a nasogastric tube, and administer oral diazepam.

2. Rectal diazepam is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.

15. The nurse is providing education concerning Reye syndrome to a mothers' group. She knows that further education is needed when a mother states: 1. "I will have my children immunized against varicella and influenza." 2. "I will make sure not to give my child any products containing aspirin when my child is ill." 3. "Because I do not give my child aspirin, my child will probably never get Reye syndrome, but if that happens, it will be a very mild case." 4. "Children with Reye syndrome are admitted to the hospital."

2. The administration of aspirin or products containing aspirin have been associated with the development of Reye syndrome.

46. The nurse is working in the pediatric developmental clinic. Which of the children requires continued follow-up because of behaviors suspicious of CP? 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

2. The clinical characteristic of hemiple gia can be manifested by the early pref erence of one hand. This may be an early sign of CP.

A 2-month-old has had a myelomeningocele repair and has been brought in by a parent for the well-child checkup and shots. Over the last week, the baby has had a high-pitched cry and has been irritable. Height, weight, and head circumference have been at the 50th percentile. Today height is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following? 1. Tell the parent this is normal for an infant with a repaired myelomeningocele. 2. Tell the parent this might mean the baby has increased intracranial pressure. 3. Suspect the baby's intracranial pressure is low because of a leak. 4. Refer the baby to the neurologist for follow-up care.

2. The increase in head size is one of the first signs of increased intracranial pressure; other signs include highpitched cry and irritability TEST-TAKING HINT: The test taker should know how fast an infant's head size changes

26. An 8-year-old child is attending a Cub Scout camp picnic. He has a history of epilepsy and has had generalized seizures since the age of 3. The child falls to the ground and has a generalized seizure. Which of the following is the best action for the nurse to take during the child's seizure? 1. Administer the child's rescue dose of oral valium. 2. Loosen the child's clothing, and call for help. 3. Place an oral tongue blade in the child's mouth to prevent aspiration. 4. Carry the child to the infirmary to call 911 and start an intravenous line.

2. The nurse should remain with the child and observe the seizure. The child should be protected from his environ ment, and clothing should be loosened.

25. The nurse is providing discharge instructions to the parents of a 13-year-old girl who has been diagnosed with epilepsy. Her parents ask if there are any activities that she should avoid. Select the nurse's best response. 1. "She should avoid swimming, even with a friend." 2. "She should avoid being in a car at night." 3. "She should avoid any strenuous activities." 4. "She should not return to school right away as her peers will likely cause her to feel inadequate."

2. The rhythmic reflection of other car lights can trigger a seizure in some children.

A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse's assessment follows: awake, pale, thin child lying in bed, multiple contractures, drooling, coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which of the following nursing diagnoses is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: mother sole caretaker. 4. Alteration in elimination: diarrhea.

2. This is the priority nursing diagnosis for this severely underweight child. Weight is average for a 4-month-old. The coughing episodes while feeding may indicate aspiration. The parent needs help to learn how to feed so less coughing occurs. TEST-TAKING HINT: The test taker should convert the weight in kilograms to pounds

38. The most common complication associated with myelomeningocele is: 1. Learning disability. 2. Urinary tract infection. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown.

2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neuro genic bladder that leads to incomplete emptying of the bladder and subse quent urinary tract infections. Fre quent catheterization also increases the risk of urinary tract infection.

20. The school nurse is called to the preschool classroom to evaluate a child. He has been noted to have periods where he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse's best response. 1. "Have the parents follow up with his pediatrician as this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life, as it could be attention-seeking behavior." 3. "Have the parents follow up with his pediatrician as this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him, and see if it continues."

20. 1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.

29. The emergency room nurse is caring for an unconscious 6-year-old girl who has had a severe closed-head injury and notes the following changes in her vital signs. Her heart rate has dropped from 120 to 55, her blood pressure has increased from 110/44 to 195/62, and her respirations are becoming more irregular. After calling the physician, which of the following should the nurse expect to do? 1. Call for additional help, and prepare to administer mannitol. 2. Continue to monitor the patient's vital signs, and prepare to administer a bolus of isotonic fluids. 3. Call for additional help, and prepare to administer an antihypertensive. 4. Continue to monitor the patient, and administer supplemental oxygen.

29. 1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respira tions. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP.

The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following? 1. Electromyelogram. 2. Nerve conduction velocity. 3. Muscle biopsy. 4. Creatine kinase level.

3. Muscle biopsy confirms the type of myopathy that the patient has. TEST-TAKING HINT: Muscle biopsy is the definitive test for myopathies.

17. The nurse is caring for a child with Reye syndrome stage III. The child is comatose with sluggish pupils. The child is currently maintaining his own respirations, and all vital signs are within normal range. In order to treat a common manifestation, what medication would the nurse expect to have readily available? 1. Lasix. 2. Insulin. 3. Glucose. 4. Morphine.

3. A common manifestation is hypo glycemia, which is treated with the ad ministration of intravenous glucose.

The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which of the following would be a priority nursing diagnosis before surgery? 1. Alteration in parent-infant bonding. 2. Altered growth and development. 3. Risk of infection. 4. Risk for weight loss.

3. A normal saline dressing is placed over the sac to prevent tearing, which would allow the cerebrospinal fluid to escape and microorganisms to enter and cause an infection. TEST-TAKING HINT: The preoperative priority is risk of infection, especially when effort is necessary to keep a sterile saline dressing on the sac.

12. A toddler is being admitted to the hospital with a diagnosis of bacterial meningitis. Select the best room assignment for the patient. 1. A semiprivate room with a roommate who also has bacterial meningitis. 2. A semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. A private room that is dark and quiet with minimal stimulation. 4. A private room that is bright and colorful and has developmentally appropriate activities available.

3. A quiet private room with minimal stimulation is ideal as the child with meningitis should be in a quiet envi ronment to avoid cerebral irritation.

A newborn with a repaired myelomeningocele is assessed for hydrocephalus. What would the nurse expect if the infant has hydrocephalus? 1. Low-pitched cry and depressed fontanel. 2. Low-pitched cry and bulging fontanel. 3. Bulging fontanel and downwardly rotated eyes. 4. Depressed fontanel and upwardly rotated eyes.

3. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. With sunset eyes the sclera can be seen above the iris. TEST-TAKING HINT: The test taker must know the difference in clinical signs of hydrocephalus in infants and older children. Infants' heads expand, whereas older children's skulls are fixed. The anterior fontanel closes between 12 and 18 months

28. The emergency room nurse is caring for a 5-year-old child who fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which of the following statements is a priority for the nurse at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"

3. Asking specific questions will give the nurse the information needed to deter mine the level of care for the child.

48. The nurse is caring for a 2-month-old male infant who is at risk for CP due to extreme low birth weight and prematurity. There is a multidisciplinary team caring for him. His parents ask why there is a speech therapist involved in his care. Select the nurse's best response. 1. "Your child is likely to have speech problems because of his early birth. Involving the speech therapist at this point will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "It is the hospital routine to involve as many members of the health-care team in your child's care so that we will know if he has any unmet needs."

3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements.

The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which of the following is the nurse's best response? 1. "Children with CP have some amount of mental retardation." 2. "Approximately 20% of children with CP have normal intelligence." 3. "Many children with CP have normal intelligence." 4. "Mental retardation is expected if motor and sensory deficits are severe."

3. Many children with CP have normal intelligence. TEST-TAKING HINT: Children with CP have a wide range of intellectual abilities.

30. The nurse is caring for a 2-year-old male in the PICU with a head injury. The child is comatose and unresponsive at this time. The parents ask if he needs pain medication. Select the nurse's best response. 1. "Pain medication is not necessary as he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." 3. "Pain medication is necessary to promote comfort." 4. "Although pain medication is necessary for comfort, we use it cautiously as it increases the demand for oxygen."

3. Pain medication promotes comfort and ultimately decreases ICP.

41. The nurse is caring for a 9-year-old with myelomeningocele who has just had surgery to release a tight ligament to the lower extremity. Which of the following does the nurse include in the child's postoperative plan of care? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.

3. Preventing skin breakdown is important in the child with myelomeningocele, as pressure points are not felt easily.

The nurse is caring for a newborn with a myelomeningocele who will have a surgical repair tomorrow. The nurse should do which of the following? 1. Offer formula every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours.

3. Priority care for an infant with a myelomeningocele is to protect the sac. A wet dressing keeps it moist with less chance of tearing. TEST-TAKING HINT: Realizing the defect is on the back eliminates answer 2. Knowing newborns are sleepy and do not eat on a schedule eliminates answer 1.

16. The nurse is caring for a child with Reye syndrome in the PICU. At noon, the nurse notes that the child is comatose with sluggish pupils. When stimulated, the child demonstrates decerebrate posturing. At 2 p.m., the nurse notes that the child remains unchanged except that the child now demonstrates decorticate posturing when stimulated. The nurse concludes that: 1. The child's condition is worsening and progressing to a more advanced stage of Reye syndrome. 2. The child's condition is worsening, and the child may likely experience cardiac and respiratory failure. 3. The child's condition is improving and progressing to a less advanced stage of Reye syndrome. 4. The child's condition remains unchanged as posturing reflexes are similar.

3. Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child's condition.

A child with GBS is admitted to the pediatric unit. The child has had lots of oral fluids but has not urinated for 8 hours. The nurse's first action would be to do which of the following? 1. Check the child's serum blood-urea-nitrogen level. 2. Check the child's complete blood count. 3. Catheterize the child in and out. 4. Run water in the bathroom to stimulate urination

3. The child must be catheterized in and out to avoid the possibility of developing a urinary tract infection from urine in the bladder for too long. TEST-TAKING HINT: Urinary retention occurs with GBS and catheterization is necessary in a child who has had lots of fluids but not voided in 8 hours

47. The nurse is caring for a 13-month-old with meningitis. The child has experienced increased ICP and multiple seizures. The child's parents ask if the child is likely to develop CP. Select the nurse's best response. 1. "When your daughter is stable, she'll undergo computed tomography and magnetic resolution imaging. The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications of meningitis develop some amount of CP."

3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made.

The nurse is planning care for a child who was recently admitted with GBS. Which of the following is a priority nursing diagnosis? 1. Risk for constipation related to immobility. 2. Chronic sorrow related to presence of chronic disability. 3. Impaired skin integrity related to infectious disease process. 4. Activity intolerance related to ineffective cardiac muscle function

3. The goal is to prevent complications related to immobility. Efforts include maintaining skin integrity, maintain respiratory function, and preventing contractures. TEST-TAKING HINT: The test taker must have a basic understanding of GBS and know that it affects the peripheral nervous system.

The nurse is teaching the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy. The nurse should tell them that some of the progressive complications include which of the following? 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, and dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech.

3. The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems. TEST-TAKING HINT: The test taker should be able to identify signs and symptoms attributable to the loss of muscle function.

14. The nurse is caring for a 1-year-old female who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted. Select the nurse's best response. 1. "Your child will likely be sent home because encephalitis is usually caused by a virus and not bacteria." 2. "Your child will likely be admitted to the pediatric floor for intravenous antibiotics and observation." 3. "Your child will likely be admitted to the PICU for close monitoring and observation." 4. "Your child will likely be sent home because she is only 1 year old. We tend to see fewer complications and a shorter disease process in the younger child."

3. The young child with encephalitis should be admitted to a PICU where close observation and monitoring are available. The child should be ob served for signs of increased ICP and for cardiac and respiratory compromise.

A child presents with a history of having had an upper respiratory tract infection 2 weeks ago; complains of symmetrical lower extremity weakness, back pain, and muscle tenderness; and has absent deep tendon reflexes in the lower extremities. Which of the following is true regarding this condition? 1. The disease process is probably bacterial. 2. The recent upper respiratory infection is not important information. 3. This may be an acute inflammatory demyelinating neuropathy. 4. CN involvement is rare.

3. This child probably has GBS, which is an acute inflammatory demyelinating neuropathy. TEST-TAKING HINT: Having a prior upper respiratory infection usually means this condition is not caused by bacteria, which eliminates answers 1 and 2. That leaves the choice between answers 3 and 4.

The parent of a young child with CP brings the child to the clinic for a checkup. Which of the parent's following statements indicates an understanding of the child's long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I'm the one who knows the most about my child and can do the most for my child."

3. This statement indicates that the parent understands the long-term needs of the child. TEST-TAKING HINT: The test taker must understand the goals for children with chronic illnesses or disorders. One goal is to ensure that the child be diagnosed as early as possible so that interventions can be started. Another is to help the child realize as much potential as possible.

33. A 2-month-old infant is brought to the emergency room after experiencing a seizure. The nurse notes that the infant appears lethargic with very irregular respirations and periods of apnea. The parents report that the child is no longer interested in feeding and that, prior to the seizure, the infant rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography scan of the head and dilation of the eyes. 2. Computed tomography scan of the head and EEG. 3. Close monitoring of vital signs. 4. X-rays of all long bones.

33. 1. A computed tomography scan of the head will reveal trauma. Dilating the eyes is performed to check for retinal hemorrhages that are seen in an infant who has experienced SBS.

36. The nurse is caring for a neonate who has just been diagnosed with a meningocele. The parents ask what to expect. Which of the following is the nurse's best response? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

36. 1. Because a meningocele does not con tain any nerve endings, most children experience no neurological problems after surgical correction.

32. The nurse is caring for a 16-year-old female who remains unconscious 24 hours after sustaining a closed-head injury in an MVA. She responds to deep painful stimulation with decorticate posturing. The child has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the child's peers to visit and talk to the child about school and other pertinent events. 2. Encourage the child's parents to hold her hand and speak loudly to her in an attempt to help her regain consciousness. 3. Attempt to keep a normal day/night pattern by keeping the child in a bright lively environment during the day and dark quiet environment at night. 4. Attempt to keep the environment dark and quiet, and encourage minimal stimulation.

4. A dark, quiet environment and minimal stimulation will decrease oxygen con sumption and ICP.

Following surgical repair and closure of a myelomeningocele shortly after birth, which of the following is true of an infant? 1. The infant will not need any long-term management and should be considered cured. 2. The infant will no longer be at risk of urinary tract infections or movement problems. 3. The infant will have continual drainage of cerebrospinal fluid, needing frequent dressing changes. 4. The infant will need lifelong management of urinary, orthopedic, and neurological problems

4. Although immediate surgical repair decreases infection, morbidity, and mortality rates, these children will require lifelong management of neurological, orthopedic, and elimination problems. TEST-TAKING HINT: The test taker can eliminate answer 1 due to the complexity of myelomeningocele.

53. The nurse is caring for a 5-year-old male with CP. His weight is in the fifth percentile, and he has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube put in. Which of the following would be the nurse's best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4. An open-ended question will encour age family members to share what they know and potentially clear any misconceptions.

A 15-year-old with spina bifida is seen in the clinic for a well-child checkup. The teen uses leg braces and crutches to ambulate. Which of the following nursing diagnoses takes priority? 1. Potential for infection. 2. Alteration in mobility. 3. Alteration in elimination. 4. Potential body image disturbance

4. As an adolescent on crutches and wearing braces, the teen would have the issue of body image disturbance, which must be addressed. This is a priority. TEST-TAKING HINT: The test taker must know normal development

The nurse is discussing nutrition with the parents of a child with Duchenne muscular dystrophy. The nurse tells the parents that which of the following foods would be best for their child? 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain.

4. As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation. TEST-TAKING HINT: Knowing that nutrition is important for every child as is awareness that as the child becomes less ambulatory, weight concerns arise.

Which of the following should the nurse expect as an intervention in a child in the recovery phase of GBS? 1. Assess for respiratory compromise. 2. Assess for swallowing difficulties. 3. Evaluate neuropsychological functioning. 4. Begin an active physical therapy program

4. Beginning active physical therapy is important for helping muscle recovery and preventing contractures. TEST-TAKING HINT: The test taker must know the normal progress of the disease. A hint is provided by the word "recovery" in the question

The Gower sign for assessing Duchenne muscular dystrophy can be elicited by having a patient do which of the following? 1. Close the eyes and touch the nose with alternating index fingers. 2. Hop on one foot and then the other. 3. Bend from the waist to touch the toes. 4. Walk like a duck and rise from a squatting position.

4. Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from a squatting position due to the lack of muscle strength. TEST-TAKING HINT: By eliminating cerebral activities, the test taker would know that the Gower sign assists in measuring leg strength

The parent of an infant asks the nurse what to watch for to determine if the infant has CP. The nurse should reply which of the following? 1. If the infant cannot sit up without support before 8 months. 2. If the infant demonstrates tongue thrust before 4 months. 3. If the infant has poor head control after 2 months. 4. If the infant has clenched fists after 3 months.

4. Clenched fists after 3 months of age may be a sign of CP. TEST-TAKING HINT: The test taker must know normal developmental milestones to identify those that are abnormal.

10. The nurse is caring for a child who is being admitted with a diagnosis of meningitis. The child's plan of care includes the following: administration of intravenous antibiotics, administration of maintenance intravenous fluids, placement of a Foley catheter, and obtaining cultures of spinal fluid and blood. Select the procedure the nurse should do first. 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fluids. 3. Placement of a Foley catheter. 4. Send the spinal fluid and blood cultures to the laboratory.

4. Cultures of spinal fluid and blood should be obtained, followed by admin istration of intravenous antibiotics.

27. The nurse is caring for a child who has sustained a closed-head injury. The nurse knows that brain damage can be caused by which of the following factors? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4. The nurse is caring for a 9-year-old female who is unconscious in the PICU. The child's mother has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response. 1. "I think your daughter hears you, and she is attempting to reach out to you." 2. "Your child is responding to you; please continue trying to stimulate her." 3. "It appears that your child is having a seizure." 4. "Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."

4. Posturing is a reflex that often indicates that the child is receiving too much stimulation.

39. The nurse is caring for a newborn infant who has just been diagnosed with a myelomeningocele. Which of the following is included in the child's plan of care? 1. Place the child in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the child in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the child in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

4. The child is placed in the prone posi tion to avoid any pressure on the de fect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fluids are begun after the surgery.

The nurse is caring for a school-aged child with Duchenne muscular dystrophy in the elementary school. Which of the following would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength. TEST-TAKING HINT: Knowing that the child has decreased strength helps to answer the question

The nurse knows that teaching of parents of a child newly diagnosed with CP is successful when the parents state that CP is which of the following? 1. Inability to speak and drooling. 2. Poor dentition due to poor hygiene. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon reflexes

4. The primary disorder is of muscle tone, but there may be other neurological disorders such as seizures, vision disturbances, and impaired intelligence. Spastic CP is the most common type and is characterized by a generalized increase in muscle tone, increased deep tendon reflexes, and rigidity of the limbs on both flexion and extension. TEST-TAKING HINT: The test taker must know the definition of CP.

The nurse is developing a plan of care for a child recently diagnosed with CP. Which of the following should be the nurse's priority goal? 1. Ensure the ingestion of sufficient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.

4. The priority for all children is to develop to their full potential. TEST-TAKING HINT: All of these are important goals, but determining the priority goal for a special-needs child is the key

7. The nurse receives a phone call from the parents of a 9-year-old female who is complaining of a headache and blurry vision. The child has been healthy but has a history of hydrocephalus and received a ventriculoperitoneal shunt at the age of 1 month. The parents also state that she is not acting like herself, is irritable, and sleeps more than she used to. They ask the nurse what they should do. Select the nurse's best response. 1. "Give her some acetaminophen, and see if her symptoms improve. If they do not improve, bring her to the pediatrician's office." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely as it has been working well for 9 years." 4. "You should immediately bring her to the emergency room as these may be symptoms of a shunt malfunction."

4. These are symptoms of a shunt malfunc tion and should be evaluated immediately.

44. The nurse is caring for a child with CP. The nurse knows that since the 1960s the incidence of CP has: 1. Increased. 2. Decreased. 3. Remained the same. 4. Has decreased due to early misdiagnosis.

44. 1. The incidence of CP has increased partly due to the increased survival of extreme low-birth-weight and premature infants.

51. The parents of a 12-month-old with CP ask the nurse if they should teach their child sign language because he has not begun any vocalization yet. The nurse bases her response on which of the following? 1. Sign language may be a very beneficial way to help children with CP communicate. 2. Sign language may cause confusion and further delay verbalization. 3. Most children with CP will have great difficulty learning sign language. 4. Sign language may be beneficial, but it would be best to wait until the child is closer to the preschool age.

51. 1. Sign language may help the child with CP communicate and ultimately de crease frustration. Children with CP may have difficulty verbalizing because of weak tongue and jaw muscles. They may be able to have sufficient motor skills to communicate with their hands.

52. The parents of a 2-year-old with CP are learning how to feed their child and avoid aspiration. When reviewing the teaching plan, the nurse should question which of the following? 1. Place the food on the tip of the tongue, as the child will be less likely to choke. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

52. 1. The food should be placed far back in the mouth to avoid tongue thrust.

6. The nurse is preparing to give preoperative teaching to the parents of an infant with hydrocephalus. The nurse knows that the most common treatment for hydrocephalus includes the surgical placement of a shunt connecting which of the following? 1. The ventricle of the brain to the peritoneum. 2. The ventricle of the brain to the right atrium of the heart. 3. The ventricle of the brain to the lower esophagus. 4. The ventricle of the brain to the small intestine.

6. 1. The ventriculoperitoneal is the most common shunt used to treat hydrocephalus.

61. Which of the following has the potential to alter a child's level of consciousness? Select all that apply. 1. Metabolic disorders. 2. Trauma. 3. Hypoxic episode. 4. Dehydration. 5. Endocrine disorders.

61. 1, 2, 3, 4, 5. 1. Many metabolic disorders are associ ated with hypoglycemia. The hypo glycemic child experiences a decreased level of consciousness as the brain does not have stores of glucose. 2. Trauma can lead to generalized brain swelling with resultant increased ICP. 3. Hypoxemia leads to a decreased level of consciousness as the brain is intoler ant to the lack of oxygen. 4. Dehydration can lead to inadequate perfusion to the brain, which can result in a decreased level of consciousness. 5. Endocrine disorders often result in a decreased level of consciousness as they can lead to hypoglycemia, which is poorly tolerated by the brain.

10. A nurse is conducting a sports fitness class for volunteer coaches. Which information provided by the nurse is the most appropriate? A. "Fractures heal more quickly in children because the bones are still growing." B. "Children are prone to fractures because their bones are weaker than adults' bones." C. "Ligaments are bands of fibrous tissue that hold muscles to the bones." D. "Once a child reaches adult height, bone development eventually stops."

ANS: A Although children are more prone to fractures than adults due to continued bone growth, because their bones are still growing, fractures heal quickly. Ligaments hold two or more bones or cartilages together. Bone is a dynamic tissue and continues to be developed and reabsorbed throughout life.

17. A child who has been limping for several weeks is brought to the clinic and undergoes radiological studies. The results show osteonecrosis. Which information does the nurse plan to teach the parents about their child's condition? A. Non-weight-bearing status and mobility limitations B. Overcorrection with serial casting for 2-3 years C. Surgical correction with the Z-plasty technique D. Wearing and caring for a Browne splint

ANS: A Osteonecrosis is a cardinal sign of Legg-Calvé-Perthes disease. This disorder is frequently treated with non-weight-bearing status and bracing or casting. The other treatment modalities are used to treat clubfoot.

14. A parent calls the clinic to report that his child's cast seems to be looser than it was yesterday. Which instruction is most appropriate for the nurse to provide to the parent? A. "Bring your child in so we can evaluate the cast." B. "If the cast is loose, circulation won't be compromised." C. "Pad the top of the cast with a small towel so it fits." D. "This is not unusual; just keep your next appointment."

ANS: A Parents should be instructed to take their child to a health-care provider if a cast appears loose, damaged, or soft. The other answers are not appropriate.

8. A new nurse is caring for a child after spinal fusion to correct scoliosis. Which action by the new nurse causes the experienced nurse to intervene? A. Assesses neurological status and vital signs every hour B. Instructs patient to turn by pulling on side rails C. Monitors chest tube for air leakage and drainage D. Promotes use of the incentive spirometer each hour

ANS: B After spinal fusion, the patient must be logrolled to turn. Logrolling involves two nurses turning the patient as one single unit so that the spine is maintained in a straight line. The other actions are appropriate.

1. The pediatric nurse explains to the student nurse that alterations in musculoskeletal functioning may be related to a congenital defect or an acquired defect. Which disorder is an example of a congenital defect? A. Juvenile arthritis B. Muscular dystrophy C. Osgood-Schlatter disease D. Osteomyelitis

ANS: B Alterations in musculoskeletal functioning may be related to a congenital defect such as muscular dystrophy, clubfoot, or osteogenesis imperfecta. Other musculoskeletal alterations may be related to an acquired defect such as Legg-Calvé-Perthes disease, slipped femoral capital epiphysis, Osgood-Schlatter disease, scoliosis, sprains, strains, fractures, osteomyelitis, juvenile arthritis, or tetanus.

2. The student nurse studying the anatomy of the musculoskeletal system understands that bones are classified by their size and shape. How does the student classify the pelvis? A. Flat bone B. Irregular bone C. Long bone D. Short bone

ANS: B Flat bones are located in the skull, scapulae, ribs, sternum, and clavicle. Long bones are found in the extremities, and include the fingers and toes. Short bones are located in the ankles and wrists. Irregular bones are the vertebrae, pelvis, and facial bones.

12. A nurse working in an inpatient pediatric unit cares for many children with musculoskeletal impairments. Which outcome takes priority for these children? A. Adapting to changing activity restrictions B. Continuing their growth and development C. Resuming ambulation as soon as possible D. Staying current with schoolwork with tutors

ANS: B Growth and development are dependent upon being able to interact with the environment. Any child with a musculoskeletal disorder is at risk for impaired growth and development. A priority outcome for any of these children is to maintain normal growth and development. Some children may need to adapt to changing activity restrictions. For some children, ambulation will be delayed or not possible. Staying current with education is important, but does not take priority over maintaining normal growth and development.

3. An adolescent patient is prescribed a brace to treat scoliosis. Which assessment finding by the nurse indicates that outcomes for a priority nursing diagnosis have been met by the patient? A. Is able to explain the rationale for the bracing B. No redness or breakdown seen under the brace C. Participates in social activities with friends D. Wears brace continuously for 20 hours each day

ANS: B The skin under the brace worn to treat scoliosis needs to be assessed for breakdown, especially when the brace is new. An important diagnosis would be risk for impaired skin integrity. Seeing no skin breakdown under the brace indicates the outcomes have been met for this goal. Being able to explain the rationale for the bracing and participating in social activities also indicate that outcomes for appropriate diagnoses have been met, but these do not take priority over a possible injury to the child. The brace needs to be worn continuously for 23 hours each day.

6. A 15-year-old boy is brought to the emergency room by his parents following an injury to his arm that occurred during football practice. The x-ray shows a diagonal line that coils around the bone. Based on this x-ray, which type of fracture does the nurse prepare to teach the family about? A. Greenstick B. Oblique C. Spiral D. Transverse

ANS: C A spiral break is caused by a twisting force and shows a diagonal line that coils around the bone. An oblique break shows a diagonal line across the bone. A transverse break shows a line that crosses the shaft at a 90-degree angle. In a greenstick-type break, the bone is bent but not broken.

15. A parent calls the nursing call center stating that his child, who has a cast after surgical treatment of a clubfoot, is very fussy even after acetaminophen (Tylenol) administration and that the child's toes seem cool. What advice does the nurse give the parent? A. "Elevate the affected extremity and apply ice for 20 minutes." B. "Make four cuts to the top of the cast, each about 1 inch long." C. "Take your child to the nearest emergency department now." D. "Try giving your child a dose of ibuprofen (Pediaprofen) instead."

ANS: C Parents always need to observe for complications of casting, including neurovascular compromise. A child who is excessively fussy and whose toes are cool should be seen by a health-care provider to assess circulation and possibly modify or change the cast. The parent should be told to take the child to the nearest emergency department (ED). The other answers are inappropriate. If circulation is compromised, elevation and ice will make the problem worse. The parent should not be instructed to modify the cast. Although ibuprofen may manage the child's pain better than acetaminophen, the priority instruction is to send the parent to the ED.

16. A mother brings her daughter to the clinic after noticing the child's new swimsuit fits baggily on one side of her bottom and the child's right thigh looks quite odd compared to the other one. Which assessment question would provide the nurse the most important information? A. "Do her joints dislocate easily?" B. "Does she fatigue easily?" C. "Has your child been limping?" D. "When did you see her in a swimsuit last?"

ANS: C The mother seems to have noticed thigh and buttock muscle wasting, which are signs of Legg-Calvé-Perthes disease. Other signs and symptoms include hip or knee soreness or stiffness, pain that increases with activity and decreases with rest, a painful limp, joint dysfunction, and limited ROM. Asking about a limp would be the most important question, as it is specific to this disease process.

11. The student nurse studying anatomy knows that red blood cells are produced where? A. Growth plates B. Periosteum C. Red marrow D. Yellow marrow

ANS: C The red marrow produces red and white blood cells and platelets. Yellow marrow produces fat cells. The growth plates and periosteum are not involved in producing different cells.

5. A pediatric nurse is caring for a 1-year-old child who is in a spica cast. The nurse teaches the parents that modifications need to be made for this child. Which modification does the nurse teach? A. Using a baby bath with shallow water to clean the child B. Using a car seat with sturdy sides to transport the child C. Using a sitting position on the floor to feed the child D. Using a wagon instead of a stroller to move the child

ANS: D Placing the child in the prone position on the floor makes it easier for feeding the child. Mobilizing a child in a wagon is a good modification for a stroller while the child is in the spica cast. Toddler car seats that do not have sides are also a good modification for a child in a spica cast. The parents will need to modify the bath by giving the child a sponge bath.

13. A woman who wishes to become pregnant again consults with the nurse about preventing her child from being born with clubfoot. She has two other children, both treated for this disorder. Which information does the nurse provide about preventing clubfoot? A. Avoid secondhand cigarette smoke while pregnant B. Fetal positioning in utero cannot be controlled C. Getting enough folic acid early in pregnancy is advisable. D. The disorder is genetic so no prevention is available.

ANS: D Recent research shows that clubfoot is genetic, so no prevention is possible. In utero positioning can possibly influence the disorder as well. Second-hand smoke exposure is not related. Folic acid is important for preventing neural tube disorders.