Peds Week 6

A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP? 1.Nausea 2.Irritability 3.Headache 4.Bradycardia

4.Bradycardia In a child, early signs include a slight change in level of consciousness, headache, nausea, vomiting, visual disturbances (diplopia), and seizures. Late signs of increased ICP include a significant decrease in level of consciousness, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity, posturing, Cheyne-Stokes respirations, and coma.

Daya's child is scheduled for surgery due to myelomeningocele; the primary reason for surgical repair is which of the following? A To prevent hydrocephalus B To reduce the risk of infection C To correct the neurologic defect D To prevent seizure disorders

B To reduce the risk of infection Surgical closure decreases the risk of infection stemming from damage to the fragile sac, which can lead to meningitis.

When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following? A Rheumatoid arthritis B Permanent nerve damage C Osteomyelitis D Bone growth disruption

D Bone growth disruption The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in limb shortening.

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

B Increase intrathoracic pressure Head elevation decreases, not increases, intrathoracic pressure.

The community health nurse has just completed a presentation to a group of parents regarding drowning prevention. Which statements by the parents indicate understanding of the teaching? Select all that apply. A) "I am so glad our 6-year-old child had swim lessons. We really can't afford a fence around our pool." B) "Since we have a 16-year-old I am really concerned about supervision when our child is swimming in the ocean." C) "We always make sure our babysitter keeps her CPR training up to date." D) "It is scary to think that we have a pool and drowning is the second leading cause of accidental death in children." E) "We make sure to keep our bathroom door closed when our 10-month-old is walking around the house since the door handle is too high to reach."

B) "Since we have a 16-year-old I am really concerned about supervision when our child is swimming in the ocean." C) "We always make sure our babysitter keeps her CPR training up to date." D) "It is scary to think that we have a pool and drowning is the second leading cause of accidental death in children." E) "We make sure to keep our bathroom door closed when our 10-month-old is walking around the house since the door handle is too high to reach." In children older than 15 years of age, most drownings occur in natural water settings, such as oceans or lakes. Most incidents of drowning are accidental and result from inadequately supervising children of any age. It is important for any caregivers of children to be current on CPR in case of any accident. Children younger than 1 year old most often drown in bathtubs, buckets, or toilets, so keeping the bathroom door closed helps decrease the risk of drowning.

A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statements by the parents demonstrate understanding of the instructions? Select all that apply. A) "We need to adjust the straps so that they are snug but not too tight." B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." D) "We need to send the harness to the dry cleaners to have it cleaned." E) "We need to call the doctor if she is not able to actively kick her legs."

B) "We should change her diaper without taking her out of the harness." C) "We need to check the area behind her knees for redness and irritation." E) "We need to call the doctor if she is not able to actively kick her legs." Instructions related to use of a Pavlik harness include changing the child's diaper while in the harness; checking the areas behind the knees and diaper area for redness, irritation, or breakdown; and calling the doctor if the child is unable to actively kick her legs. The straps are not to be adjusted without checking with the physician or nurse practitioner first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting is used.

A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? A) Growth plate B) Epiphysis C) Physis D) Metaphysis

B) Epiphysis

Which of the following is the most common permanent disability in childhood? A Scoliosis B Muscular dystrophy C Cerebral palsy D Developmental dysplasia of the hip (DDH)

C Cerebral palsy Option C: Cerebral palsy is the most common permanent disability of childhood. Cerebral palsy is a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy. Options A and D: Scoliosis and DDH should not cause permanent disability. Option B: Muscular dystrophy is a group of disorders that cause progressive degeneration and weakness of skeletal muscles.

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

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

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

C Plan for discharge in 12 to 24 hours. D Check for electrolyte imbalances. F Provide oxygen as ordered Children with Category A Near Drowning are awake with minimal injury. Care includes checking electrolyte status, administering oxygen and warming, and preparing for discharge in 12 to 24 hours.

A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization

C) Increased mobility of the spine Compared to the adult, a child's spine is very mobile, especially in the cervical spine region, resulting in a higher risk for cervical spine injury. Exposure to teratogens in utero may lead to altered growth and development of the brain or spinal cord. Immaturity of the central nervous system places the infant at risk for insults that may result in delayed motor skill attainment or cerebral palsy. Incomplete myelinization reflects the lack of motor control.

After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A) Limb-girdle B) Myotonic C) Distal D) Duchenne

D) Duchenne

Nurse Kevin is assessing a newborn for developmental dysplasia of the hip (DDH); he would expect to assess which of the following? A Characteristic limp B Ortolani's sign C Symmetrical gluteal folds D Trendelenburg's signs

B Ortolani's sign

The nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled for surgical closure of the sac. In the preoperative period, which is the priority problem? 1.Infection 2.Choking 3.Inability to tolerate stimulation 4.Delayed growth and development

1.Infection

When providing care to a newborn infant who was born at 29 weeks' gestation, the nurse integrates knowledge of potential complications, being alert for signs and symptoms of what condition? A) Neonatal conjunctivitis B) Facial deformities C) Intracranial hemorrhage D) Incomplete myelinization

C) Intracranial hemorrhage

Hydrocephalus is suspected in a 4-month-old infant. Which would the nurse expect to assess? A) Sunken fontanels B) Diminished reflexes C) Lower extremity spasticity D) Skull symmetry

C) Lower extremity spasticity Hydrocephalus is manifested by spasticity of lower extremities, bulging fontanels, brisk reflexes, and skull asymmetry.

A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition? 1.Limited range of motion in the affected hip 2.An apparent lengthened femur on the affected side 3.Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 4.Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table

1.Limited range of motion in the affected hip In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical and restricted abduction of the affected hip, when the child is placed supine with the knees and hips flexed, would be an assessment finding in developmental dysplasia of the hip in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.

The nurse is reviewing a chart for a child with a head injury. The nurse notes that the level of consciousness has been documented as obtunded. Which finding should the nurse expect to note on assessment of the child? 1.Not easily arousable and limited interaction 2.Loss of the ability to think clearly and rapidly 3.Loss of the ability to recognize place or person 4.Awake, alert, interacting with the environment

1.Not easily arousable and limited interaction

Which nursing actions apply to the care of a child who is having a seizure? Select all that apply. 1.Time the seizure. 2.Restrain the child. 3.Stay with the child. 4.Insert an oral airway. 5.Loosen clothing around the child's neck. 6.Place the child in a lateral side-lying position.

1.Time the seizure. 3.Stay with the child. 5.Loosen clothing around the child's neck. 6.Place the child in a lateral side-lying position.

A child has just returned from surgery and has a hip spica cast. What is the nurse's priority action for this client? 1.Elevate the head of the bed. 2.Assess the circulatory status. 3.Abduct the hips using pillows. 4.Turn the child onto the right side.

2.Assess the circulatory status.

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1.Test the urine for protein. 2.Reposition the infant frequently. 3.Provide a stimulating environment. 4.Assess blood pressure every 15 minutes

2.Reposition the infant frequently. Hydrocephalus occurs as a result of an imbalance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracranial pressure (ICP). In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not repositioned frequently, pressure ulcers can occur on the back and side of the head. An egg crate mattress under the head is also a nursing intervention that can help to prevent skin breakdown. Proteinuria is not specific to hydrocephalus. Stimulus should be kept at a minimum because of the increase in ICP. It is not necessary to check the blood pressure every 15 minutes.

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 1."I will encourage my child to perform prescribed exercises." 2."I will have my child wear soft fabric clothing under the brace." 3."I should apply lotion under the brace to prevent skin breakdown." 4."I should avoid the use of powder because it will cake under the brace."

3. "I should apply lotion under the brace to prevent skin breakdown." A brace may be prescribed to treat scoliosis. Braces are not curative, but may slow the progression of the curvature to allow skeletal growth and maturity. The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation.

The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysiological process? 1.An infectious disease of the central nervous system 2.An inflammation of the brain as a result of a viral illness 3.A chronic disability characterized by impaired muscle movement and posture 4.A congenital condition that results in moderate to severe intellectual disabilities

3. A chronic disability characterized by impaired muscle movement and posture

The nurse is creating a plan of care for a newborn infant with spina bifida (myelomeningocele type). The nurse includes assessment measures in the plan to monitor for increased intracranial pressure. Which assessment technique should be performed that will best detect the presence of an increase in intracranial pressure? 1.Check urine for specific gravity. 2.Monitor for signs of dehydration. 3.Assess anterior fontanel for bulging. 4.Assess blood pressure for signs of hypotension

3.Assess anterior fontanel for bulging.

An alert child, who is crying loudly, is brought to the hospital emergency department for a simple fracture to the lower right arm that occurred after a fall off a bicycle. What is the nurse's priority assessment? 1.Mobility 2.Skin integrity 3.Neurovascular 4.Level of consciousness

3.Neurovascular A simple fracture is a fracture of the bone across its entire shaft with some possible displacement but without breaking the skin. The priority assessment is the neurovascular status in the affected arm. The affected arm should be immobilized. Skin integrity is a higher priority in a compound fracture since there is an open wound. The level of consciousness is already established, as the child is alert and crying.

An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? A) Plastic deformity B) Buckle fracture C) Spiral fracture D) Greenstick fracture

C) Spiral fracture

The nurse is assisting a health care provider (HCP) during the examination of an infant with developmental hip dysplasia. The HCP performs the Ortolani maneuver. The nurse determines that the infant exhibits a positive response to this maneuver if which finding is noted? 1.A shrill cry from the infant 2.Asymmetry of the affected hip 3.Reduced range of motion in the right and left hip 4.A palpable click during abduction of the affected hip

4.A palpable click during abduction of the affected hip

An adolescent is seen in the emergency department for a suspected sprain of the ankle. X-rays have been obtained, and a fracture has been ruled out. Which instruction should the nurse provide to the adolescent regarding home care for treatment of the sprain? 1. Elevate the extremity, and maintain strict bed rest for a period of 7 days. 2.Immobilize the extremity, and maintain the extremity in a dependent position. 3.Apply heat to the injured area every 4 hours for the first 48 hours, and then begin to apply ice. 4.Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 to 48 hours.

4.Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 to 48 hours. The injured area should be wrapped immediately to support the joint and control the swelling. Ice is applied to reduce the swelling and should be applied for not longer than 30 minutes every 4 to 6 hours for the first 24 to 48 hours. The joint should be immobilized and elevated, but strict bed rest for a period of 7 days is not required. A dependent position will cause swelling in the affected area.

The nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which assessment finding should the nurse expect to note documented in the infant's record regarding this condition? 1.Full range of motion in the affected hip 2.An apparent short femur on the unaffected side 3.Asymmetrical adduction of the affected hip when placed supine, with the knees and hips flexed 4.Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

4.Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? A) Sluggish deep tendon reflexes B) Full range of motion in extremities C) Absence of hypotonia D) Lack of purposeful muscular control

A) Sluggish deep tendon reflexes

When teaching a group of students about the skeletal development in children, what information would the instructor include? A) The growth plate is made up of the epiphysis. B) A young child's bones commonly bend instead of break with an injury. C) The infant's skeleton has undergone complete ossification by birth. D) Children's bones have a thin periosteum and limited blood supply.

B) A young child's bones commonly bend instead of break with an injury.

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion? A) The child's risk for cognitive problems is greatly increased. B) Structural damage occurs with febrile seizure. C) The child's risk for epilepsy is now increased. D) Febrile seizures are benign in nature.

D) Febrile seizures are benign in nature. Parents need reassurance that febrile seizures, although frightening, are benign in nature. Children who experience one or more febrile seizures are at no greater risk of developing epilepsy than the general population. No evidence exists that febrile seizures cause structural damage or cognitive declines.

What finding would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? A) Bradycardia B) Cheyne-Stokes respirations C) Fixed, dilated pupils D) Projectile vomiting

D) Projectile vomiting Projectile vomiting is an early sign of increased intracranial pressure. Bradycardia, Cheyne-Stokes respirations, and fixed dilated pupils are late signs of increased intracranial pressure.

A group of nursing students are reviewing information about the type of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction? A) Russell traction B) Bryant traction C) Buck traction D) Side arm 90-90 traction

D) Side arm 90-90 traction