prep U final -peds

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The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? absence of tonic neck reflex presence of Moro reflex presence of symmetrical spontaneous movement absence of Moro reflex

answer The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child.

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

answer During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child? Handling the cast with open palms when moving the arm. Using only a draw sheet to move the casted arm. Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm. Encouraging the child to move the arm slowly up and down to help the cast dry.

answer A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process.

CHAPTER 39

Chapter 39

CHAPTER 44

Chapter 44

Chapter 49

A nurse is providing care for a pregnant woman who will be scheduled for diagnostic testing. Place the tests in the order in which they would most likely be scheduled, starting with the earliest one. Fetal nuchal translucencyChorionic villi samplingQuadruple screenUltrasound

Answer Chorionic villi sampling 2) Fetal nuchal translucency 3) Quadruple screen 4) Ultrasound

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? Situational low self-esteem related to the use of a walker Deficient diversional activities related to a need for imposed activity restriction for 6 weeks Impaired physical mobility related to a cast on the leg Pain related to chronic inflammation of the lower leg

Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? bilirubin sodium serum potassium creatine kinase

ANSWER Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record? x-ray confirmation of adequate bone shape low alkaline phosphate levels high serum phosphate levels low serum calcium levels

Answer With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? Gowers sign lordosis indications of hydrocephalus appearance of smaller than normal calf muscles

ANSWER A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis? Family history of conjunctivitis Exposure to infective agents Recent upper respiratory infection Recently helped clean the basement

ANSWER Conjunctivitis may be classified as allergic, infectious or chemical. Allergic conjunctivitis may be induced by animal dander, dust mites, or some other ever-present antigen as might be found when cleaning unused spaces. Exposure to infective agents is related to infectious conjunctivitis. Recent upper respiratory infection and a family history of conjunctivitis are not contributing factors for allergic conjunctivitis.

The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education? "Since her fracture is in the central shaft of her leg, it may interfere with the growth of that leg." "Injuries that happen at the end of the bone, the epiphysis, are at a greater risk for becoming infected." "Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." "My child is at risk for abnormal growth of the leg because the break is in the outer layer of the bone."

Fractures that occur in the epiphyseal plate, the area between the central shaft (diaphysis) and the rounded end portion (epiphysis), can halt growth, stimulate abnormal growth, or cause irregular or erratic growth. Fractures in the diaphysis and epiphysis will not interfere with growth. The outer layer of the bone, the periosteum, may be injured when infected, not from a fracture.

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

Lordosis, a forward or inner curvature of the lumbar spine or swayback, is seen by school age in the child with muscular dystrophy. Kyphosis is also referred to as hunchback and demonstrates an outward curvature of the upper spine. Scoliosis is a sideways curvature of the spine. Synovitis is the inflammation of the synovial membrane, which can result in pain when moving an affected joint.

The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment? The infant blinks quickly when a bright light is shone in the eyes. The infant does not imitate facial expressions. The infant can "fix and follow." The infant makes eye contact.

ANSWER C Infants who have visual impairments may not "fix and follow," do not make eye contact, are unaffected by bright light, and do not imitate facial expressions.

A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause? Haemophilus influenzae Chlamydia trachomatis Streptococcus pneumoniae Staphylococcus aureus

ANSWER D S. aureus is the most common bacterial cause of conjunctivitis. Although a common cause, S. pneumoniae is not the most common cause of bacterial conjunctivitis. Although a common cause, H. influenzae is not the most common cause of bacterial conjunctivitis. Although a common cause, C. trachomatis is not the most common cause of bacterial conjunctivitis.

During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract? Absence of the red reflex Excess watering of the eyes Sclera appears to be blue Edema of the eyelids

ANSWER The absence of the red reflex and a white, opaque appearance of the lens are telltale signs of a cataract. A blue tinge to the sclera and excess watering of the eyes are signs of glaucoma. Edema of the eyelids is a sign of allergic conjunctivitis.

The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided? "This is caused by silver nitrate." "The liquid inside the eye can't drain." "It's an overgrowth of retinal blood vessels." "This can be genetic or acquired."

ANSWER C The pathophysiology of ROP is one of injury to the developing blood vessels and tissues of the retina, and the healing process of regrowth or overgrowth of retinal vessels. Cataracts may be caused by genetics or may be acquired after birth. The inability of the aqueous humor to drain from the eye is a result of glaucoma. Silver nitrate 1% is an antibacterial prophylaxis that may cause conjunctivitis.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? The nurse should be a contact person when the child is hospitalized. The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. The nurse should support the caregivers in restricting activity during the treatment. The nurse should provide information when the child or caregiver requests it.

ANSWER Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

The nurse is caring for a 6-year-old boy with sensorineural hearing loss. Which is the least likely cause of the child's hearing loss? Acute otitis media Excess noise exposure Ototoxic medication use Intrauterine exposure to rubella

ANSWER Acute otitis media can cause damage to the middle ear, bringing about conductive hearing loss. Ototoxic medications can damage the hair cells of the cochlea or along the auditory pathway, in turn causing sensorineural hearing loss. Intrauterine infection with rubella causes damage to the hair cells in the cochlea or along the auditory pathway, which in turn causes sensorineural hearing loss. Excess noise exposure causes damage to the hair cells in the cochlea or along the auditory pathway, which in turn causes sensorineural hearing loss.

A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent? Administer acetaminophen if needed for pain. Assure the parent that the scleral hemorrhages will resolve. Refer the child to an ophthalmologist for further evaluation. Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours.

The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse? a weak pedal pulse mild fussiness temperature 100.2°F (37.9°C) decreased oral intake

ANSWER A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Decreased oral intake and an elevated temperature could indicate an infection. However, circulation is priority over infection in the client and would be most concerning for the nurse. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically.

A 9-year-old boy who is blind is admitted to the hospital. When serving him a meal in bed, which statement would be most appropriate to increase his self-esteem? "Here is your tray; if you need help just call me." "I'll have to feed you lunch; spaghetti is very messy." "I have cut your meat for you. Do you need any other help?" "You have a sandwich on your plate, a glass of milk to your right, and an apple to your left."

ANSWER Helping children who are visually impaired remain as independent as possible increases self-esteem.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? "You and your coaches need to understand that you cannot play soccer for at least six weeks." "Ice will help reduce the inflammation." "NSAIDs can help with pain control and inflammation." "You will need to see a physical therapist for stretching and strengthening exercises."

Answer A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note? The posterior spine when bending forward The angle of the lower chest when sitting down The posterior spine when bending sideways The angle of the iliac crest when bending forward

Diagnosis of scoliosis is best made with inspection and observation. When inspecting the back with the child in a standing position, the nurse should note asymmetries such as shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. A lateral curvature of the spine is best revealed when the child bends forward. The child should bend forward with the arms hanging freely. The curve and asymmetry of the back can be observed. The height of the iliac crest, not the angle, is measured on both sides and the difference is noted. Bending to the side would not provide an accurate assessment of the spine because the curvature cannot be seen from the side. The lower chest angle would not be an accurate assessment as it would be more associated with the ribs as opposed to the spine.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Apply ice to the injury for 60 minutes on and 60 minutes off." "Taking warm baths will help relax muscles and reduce pain." "Elevate the legs, and use bed rest for 24 hours." "Applying ice to the area will reduce the pain and swelling."

Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be: Osgood-Schlatter disease. Sever disease (calcaneal apophysitis). epiphysiolysis of the distal radius. epiphysiolysis of the proximal humerus.

answer Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease (calcaneal apophysitis) causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

A nurse is assessing a child diagnosed with Sturge-Weber syndrome. What finding would the nurse expect to find when assessing the skin? Pigmented nevi Port wine stain Tumors Café-au-lait spots

Answer Rationale: Facial nevus or port wine stain is most often seen on the forehead and on one side of the face. Café-au-lait spots are commonly associated with neurofibromatosis. Tumors are associated with tuberous sclerosis and neurofibromatosis. Pigmented nevi are associated with neurofibromatosis.

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding? idiopathic scoliosis sway back kyphosis lordosis

Answer Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? X-ray muscle biopsy EEG assessment of ambulation

answer Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion? tendency to act silly in the classroom suddenly doing poorly in school playing the radio loudly prevention and treatment of otitis media

ANSWER The most common cause of conductive hearing impairment is otitis media. Hearing loss can be associated with intermittent bouts of acute otitis media and can hinder language development. Suddenly doing poorly in school, acting silly in the classroom, and playing the radio loudly are symptoms of hearing loss in children but they are symptoms after loss has occurred. The preventive education would include helping the child not develop otitis media.

A child diagnosed with acute otitis media has been given a prescription for benzocaine. The nurse is correct when she makes which statement? "Benzocaine is an antibiotic for your ear infection." "Benzocaine is an antibiotic for your eye infection." "Benzocaine drops should be placed in your eye to numb it and reduce pain." "Benzocaine drops should be placed in your ear to numb it and reduce pain."

ANSWER Benzocaine numbing eardrops can be prescribed for acute otitis media to help with severe pain. Benzocaine is not an antibiotic and when prescribed for otitis media should be placed in the ear.

The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection? diminished pulse pallor of the fingers delayed capillary refill drainage on the cast

Drainage on the cast

In caring for a child in traction, which intervention is the highest priority for the nurse? The nurse should record accurate intake and output. The nurse should monitor for decreased circulation every 4 hours. The nurse should clean the pin sites at least once every 8 hours. The nurse should provide age-appropriate activities for the child.

The nurse should monitor for decreased circulation every 4 hours.

The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place.

answer The supplement has 5 mcg of vitamin D in each 0.5 ml. The child is supposed to receive 10 mcg each day of supplemental vitamin D.Desired/Have x Quantity = dose 10 mcg/5 mcg x 0.5 ml = 1.0 mL Ratio/proportion: 0.5 mL/5 micrograms = x/10 micrograms = 1.0 ml

The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis? Exposure to infective agents Recently helped clean the basement Family history of conjunctivitis Recent upper respiratory infection

The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this? The head is held tilted with limited side-to-side motion. Severe lordosis is evident in the lumbar spine. The boy has a large tan skin lesion on his torso. The boy rises from the floor by walking his hands up his legs.

ASWER Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand. The other options do not describe Gowers' sign, although lordosis is often a manifestation of Duchenne muscular dystrophy.

The nurse is performing a physical examination on a 1-week-old girl with trisomy 13. What would the nurse expect to assess? Inspection reveals hypoplastic fingernails. Observation discloses severe hypotonia. Inspection shows a clenched fist with overlapping fingers. Observation reveals a microcephalic head.

Answer Rationale: Children with trisomy 13 have microcephalic heads with malformed ears and small eyes. Severe hypotonia, hypoplastic fingernails, and clenched fists with index and small fingers overlapping the middle fingers are typical symptoms of trisomy 18.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? cat dander peanuts alcohol gel latex

answer A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

The nurse is conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common? dimpled skin, hair in lumbar region The foot is drawn up and inward. blue sclera The sole of the foot faces backwards.

answer Blue sclera is not diagnostic of osteogenesis imperfecta, but it is a common finding. The foot drawn up and inward (talipes varus) and the sole of the foot facing backwards (talipes equinus) are associated with clubfoot (congenital talipes equinovarus). Dimpled skin and hair in the lumbar region are common findings with spina bifida occulta.

The nurse is preparing a nursing care plan for a 2-year-old child with hearing impairment. Which intervention will be part of the plan? Teach parents to make vinegar and alcohol eardrops. Assess vision to determine functional capability. Explain botulinum injection procedure and risks. Assess the child's ability to convey information.

ANSWER Children who are unable to hear during the first 36 months of life are unable to learn the language necessary for normal verbal communication; therefore, it will be important to assess the child's ability to convey information. Visual assessment is not indicated. Educating parents about botulinum injections is an intervention for strabismus. Vinegar and alcohol eardrops are a treatment for swimmer's ear.

A child has recently been diagnosed with cataracts. The treatment for cataracts is: eye drops to lower the pressure. surgery. there is no treatment for childhood cataracts. wearing a patch until the cloudiness clears.

ANSWER A cataract is marked opacity of the lens. It can be present at birth. Treatment for childhood cataracts is surgical removal of the cloudy lens, followed by insertion of an internal intraocular lens.

Parents have just given birth to a child diagnosed with trisomy 21 (Down syndrome). The couple are parents of 3 other children under the age of 8 years old with no genetic disorders. What would be a priority nursing diagnosis at this time? Interrupted family processes Risk for delayed growth and development Deficient knowledge regarding trisomy 21 Decisional conflict

Answer Rationale: Based on the child just being born and the parents dealing with 3 other children, the highest priority is Deficient knowledge regarding trisomy 21, followed by interrupted family processes.

A child with Turner syndrome is being seen in the clinic for an annual examination. What assessment would be most important for the nurse to complete? Conduct eye screening examination Auscultate heart sounds Obtain blood pressure Measure the height

Answer Rationale: Turner syndrome is caused by an abnormality in the sex chromosome. The female will have only one X chromosome. The syndrome is associated with many problems such as cardiovascular, thyroid, skeletal, and renal systems and cognitive impairment. Most children are diagnosed at birth or in early childhood when there is slow growth or growth failure. It may also not be diagnosed until the pubertal growth spurt fails to occur. It is essential for the nurse to measure the child's height at each health care visit. The administration of growth hormone is the gold standard of care. It is started when the child's growth is less than 5% on the growth curve. Auscultating heart sounds should be done due to the possibility of cardiovascular problems but the problems associated with the syndrome are congenital defects, not unusually issues like murmurs or heart failure. Renal problems can occur with the syndrome, so blood pressure needs to be assessed each visit. Vision problems can also occur with the syndrome so periodic vision screening should be done. Not every child will have multiple defects with the syndrome, but every child will have growth retardation. This makes height measurement the most important.

The nurse is caring for a 6-year-old girl who has been diagnosed with neurofibromatosis. What is the priority intervention? Pointing out the child's positive attributes to her Urging the parents to schedule yearly physical examinations Providing postoperative care when tumors are removed Referring the parents to a neurofibromatosis support group

Answer Rationale: Yearly physical examinations with blood pressure, scoliosis and developmental screening, ophthalmology, and neurologic examinations should be promoted. Most children with neurofibromatosis do not develop disfiguring tumors but rather have mild to moderate symptoms and lead normal lives. Postoperative care will be necessary if tumors need to be removed. The nurse does not need to build the child's self-esteem because the disease is not likely to have progressed very far at this age. The family may benefit from a support group, but the child's physiologic needs are more important.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation? A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating.

Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele? There is protrusion of the spinal cord and meninges, with nerve roots embedded. The spinal meninges protrude through the bony defect and form a cystic sac. There is no protrusion of the spinal cord, only soft-tissue inflammation occurs. There is a bony defect that occurs without soft-tissue involvement.

When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta.

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which statement regarding these variations is true? During adolescence, muscle growth is influenced by increased production of androgenic hormones. Rapid bone and muscle growth in adolescents increase their agility, thereby decreasing the incidence of injuries. The young child has rigid soft tissue, so dislocations and sprains are common occurrences. The infant's muscles account for 45% of total body weight as opposed to 25% of adult body weight.

answer During adolescence, muscle growth is influenced by hormonal changes, primarily the increased production of androgenic hormones. The infant's muscles account for only 25% of total body weight, whereas they account for 40% to 45% in an adult. The young child has resilient soft tissue, so dislocations and sprains are unusual occurrences. Rapid bone and muscle growth may contribute to the appearance of "clumsy" and awkward motions of the adolescent who is trying to adjust to new body dimensions.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? "Itching is common. It's nothing to worry about." "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." "A small amount of lotion or baby oil can be poured in the cast to moisturize the area." "Blowing cool air with a fan or hair dryer may relieve the feeling."

answer Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Apply ice to the injury for 60 minutes on and 60 minutes off." "Applying ice to the area will reduce the pain and swelling." "Elevate the legs, and use bed rest for 24 hours." "Taking warm baths will help relax muscles and reduce pain."

answer Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.

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

answer The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? Place petroleum jelly gauze on the spinal sac to keep it moist. Delay the parents from holding the newborn. Place a urine collection bag on newborn for the continuous leakage. Place the newborn in a prone or lateral position.

answer The nurse should place the newborn in a prone or lateral position to keep pressure off the spinal sac and avoid newborn injury. Parents should be allowed to hold the stable infant with assistance. The spinal sac should be kept covered and moist until surgery to avoid rupture. Collecting urine decreases the risk of urine stasis, which is sometimes common in spinal defects.

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

answer The nurse will divide the number of doses per day into the total amount prescribed for each day. 40 mg ÷ 3 doses = 13.3 mg/dose

A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent? Administer acetaminophen if needed for pain. Refer the child to an ophthalmologist for further evaluation. Assure the parent that the scleral hemorrhages will resolve. Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours.

ANSWER A black eye is caused by a simple contusion to the eye. It affects the surrounding tissue of the eye but does not affect the eye itself. It produces swelling and bruising. It also causes scleral hemorrhage due to rupture of the blood vessels. The best treatment for the contusion is to place ice on for 20 minutes then off for 20 minutes for a 24-hour period. This helps reduce the swelling and pain. The bruising (the "black" eye) occurs from the vessels broken and leaking into the tissue. This may take about 3 weeks to go away. The nurse should assure the parent that scleral hemorrhages are benign but may take several weeks to resolve. The child would not need to be referred to an ophthalmologist unless the vision is impaired. Acetaminophen can be given for pain, but it is not the most important form of treatment for the problem.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? "Ice will help reduce the inflammation." "You and your coaches need to understand that you cannot play soccer for at least six weeks." "You will need to see a physical therapist for stretching and strengthening exercises." "NSAIDs can help with pain control and inflammation."

ANSWER A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? "This medication will help to increase bone mineral density." "This medication will cure my child of this disorder." "My child's risk for fractures will hopefully be decreased as by taking this medication." "This medication doesn't prevent fractures from happening."

Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening.

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

By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

While assessing a preadolescent child, the nurse notes curvature of the child's spine. Which statement by the child's parent supports this observation? "My child has been taking ibuprofen daily for the last few weeks because of hip pain after walking so much at school." "My child has been reporting back pain for the last 2 or 3 months." "My child has such a hard time finding pants that fit right. They never seem to fit evenly over the hips." "I've wondered why my child won't let me in the room when changing clothes."

Curvature of the spine can indicate scoliosis. Scoliosis is a painless disorder that predominately presents during the rapid growth phase in preadolescence. A need for privacy is normal for this age group. The curvature of the spine can make the iliac crests uneven and make it difficult to find pants that fit correctly. Hip and back pain are not typical in this disorder.

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

The parents should call the physician when the following things occur: The child has a temperature greater than 101.5° F (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client? Press firmly on the lower lid with the fingertip until it turns out Touch the glass fragment in the eye with a moistened, sterile, cotton-tipped applicator Grasp the eyelashes of the upper eyelid and evert it Instill a few drops of a topical anesthetic into the affected eye

answer Children who have eye injuries are usually in acute pain immediately after the injury. A few drops of a topical anesthetic instilled into the eye may be necessary to relieve the pain and allow the eye to be opened for examination. To visualize the inner surface of the lower lid and the bottom half of the eye globe, press firmly on the lower lid with your fingertip until it turns out. Grasp the eyelashes and gently stretch the upper eyelid downward. Place the stick of a cotton-tipped applicator horizontally against the center of the upper lid. While still grasping the eyelashes, pull the eyelid upward and over the applicator until it is everted. A foreign body, such as a speck of dirt or a fragment of glass, often clings to the inside of the upper lid and can be readily removed by touching it with a moistened, sterile, cotton-tipped applicator while the lid is everted.

The nurse is educating the parents of a 5-year-old girl with infectious conjunctivitis about the disorder. Which information is most important to provide to prevent the spread of the disorder? keeping hands away from eyes washing hands frequently staying home from school properly applying the prescribed antibiotic

answer Proper handwashing is the single most important factor to reduce the spread of acute infectious conjunctivitis. Proper application of the antibiotic is important for the treatment of the infection, not prevention of transmission; keeping the child home from school until she is no longer infectious and encouraging the child to keep her hands away from her eyes are sound preventive measures, but not as important as frequent handwashing.

A toddler has been diagnosed with otitis media with effusion. The parents tell the nurse, "We really don't understand what that diagnosis means." How should the nurse respond? "It would probably be best if you talked to the doctor again about the diagnosis." "It's just a medical term that means an infection of the middle ear." "The diagnosis means unwanted fluid is within the middle ear space, and there may or may not be an infection present." "There is an infection somewhere in the ear canal and their is fluid in the canal."

answer C Otitis media with effusion refers to the presence of fluid within the middle ear space, without signs or symptoms of infection. It may occur independent of acute otitis media (AOM) or may persist after the infectious process of AOM has resolved.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as: bone that breaks into two pieces. bone buckling due to compression. significant bending without actual breaking. incomplete fracture.

ANSWER A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is: Hyperopia Refraction Astigmatism Myopia

ANSWER Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina. Myopia is nearsightedness; hyperopia is farsightedness.

The nurse is performing a physical assessment for an 8-year-old child with an earache. Which sign or symptom indicates external otitis (acute otitis externa or swimmer's ear)? The child cries out when the ear is grasped. Symptoms of upper respiratory infection are present. The tympanic membrane reacts to a puff of air. The ear canal is devoid of cerumen.

ANSWER External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. The classic sign of external otitis is pain on movement of the pinna or pain on pressure over the tragus. Upon examination, the ear canal is red and swollen. Many times the tympanic membrane cannot be visualized because the swelling does not allow the insertion of an otoscope. Symptoms of upper respiratory infection many times accompany otitis media but are not seen in external otitis. The tympanic membrane reacting to a puff of air is a sign that there is no fluid buildup in the middle ear. The absence of cerumen in the ear canal is not related to external otitis.

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate? "What you are describing may be what is called myopia." "These reports are consistent with hyperopia." "Your child will need to be evaluated for an accommodation disorder." "This may signal your child is having difficulty paying attention rather than a visual disorder."

ANSWER Myopia (nearsightedness) occurs when light rays focus anterior to the retina, causing objects that are far away to be unfocused. Typically, this develops around age 8 years and then progresses. These children can read a book or a computer screen immediately in front of them but are unable to read the blackboard clearly from a distance. There is no indication that the child is experiencing issues with paying attention. This suggestion does not address the parent's initial complaint. Accommodation disorders present with complaints of diplopia and headaches. Hyperopia (farsightedness) presents with vision that is blurry at a close range and clear at a far range, which is opposite of what is being reported for this child.

The 12-year-old child has developed a stye. Which may be included in the child's care? Apply cool, dry compresses to the affected area. Apply petroleum jelly to reduce irritation. Manually express the lesion when a head forms. Apply hot, moist compresses to the affected area.

ANSWER The stye is an infection of a ciliary gland (a modified sweat gland) that enters the hair follicle at the lid margin, most commonly caused by Staphylococcus. Management of the stye includes the use of hot, moist compresses. Manual expression is not indicated. Petroleum jelly will not be appropriate nor will it reduce inflammation. Cool, dry compresses will not be therapeutic. Heat provides for vasodilation, which will be useful in the resolution of the inflammation.

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response? "It has been linked to maternal alcohol consumption during pregnancy." "The cause is unknown and there are many environmental factors that may contribute to it." "Older age at conception is one of the major causes of the defect." "It's a common complication of amniocentesis."

ANSWER There is no one known cause of spina bifida, but scientists believe that it's linked to hereditary and environmental factors. Neural tube defects, including spina bifida, have been strongly linked to low dietary intake of folic acid. Maternal age doesn't have an impact on spina bifida. An amniocentesis is performed to help diagnose spina bifida in utero but doesn't cause the disorder. Maternal alcohol intake during pregnancy has been linked to intellectual disability, craniofacial defects, and cardiac abnormalities, but not spina bifida.

The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification? "I will need to apply heat to the eye four times a day." "Our child will probably have a black eye for at least a couple of weeks." "The blood in the white part of the eye is normal with this type of injury." "For the first 24 hours I will apply ice for 20 minutes, then leave it off for 20 minutes."

ANSWER To decrease edema in the child with a simple contusion, instruct the parent to apply an ice pack to the area for 20 minutes, then remove it for 20 minutes, and continue to repeat the cycle as often as possible during the first 24 hours. Tell the parents and child that bruising of the surrounding eye area may take up to 3 weeks to resolve. Scleral hemorrhage is natural history of resolution without intervention over a period of a few weeks with this type of injury.

The nurse is teaching the parents of a visually impaired infant about development for their child. What education would the nurse add to the standard education on development milestones? learning how to participate in a group learning to use facial expressions learning physical fitness skills learning to dress, feed, and bathe themselves

ANSWER Visually impaired children may need to be taught to purposefully use facial expressions more frequently in order to improve interpersonal communication. Learning how to dress, feed, and bathe themselves, learning physical fitness skills, and learning how to participate in a group are common to the needs of all children. Parents of visually impaired children should also be aware that their child may show reactions such as increased eyelid movement, motor activity, or a change in breathing patterns as the child reacts to stimuli. The parents should also be taught to display affection through touch and the tone of their voices.

The parents of a 4-year-old boy tell the nurse, "We're really worried that our child doesn't have 20/20 vision. It seems that he doesn't always see clearly at a distance." What is the best response by the nurse? "20/20 vision isn't usually achieved until the age of 6 or 7 years but I will let the physician know your concerns." "Until your child can read we can't check the visual acuity." "Vision continues to improve as the child ages. Hopefully you will notice improvement in your child's vision." "We don't check a child's vision until they are 6 to 7 years old because their visual acuity hasn't peaked until then."

ANSWER While 20/20 vision isn't usually achieved until the age of 6 or 7 years, it is important to notify the physician in case there is another cause for the lack of vision clarity. Visual acuity can be assessed prior to the child's ability to read.

During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract? Absence of the red reflex Sclera appears to be blue Edema of the eyelids Excess watering of the eyes

ANSWER A black eye is caused by a simple contusion to the eye. Itks to go away. The nurse should assure the parent that scleral hemorrhages are benign but may take several weeks to resolve. The child would not need to be referred to an ophthalmologist unless the vision is impaired. Acetaminophen can be given for pain, but it is not the most important form of treatment for the problem. affects the surrounding tissue of the eye but does not affect the eye itself. It produces swelling and bruising. It also causes scleral hemorrhage due to rupture of the blood vessels. The best treatment for the contusion is to place ice on for 20 minutes then off for 20 minutes for a 24-hour period. This helps reduce the swelling and pain. The bruising (the "black" eye) occurs from the vessels brok

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

ANSWER A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate? "This may signal your child is having difficulty paying attention rather than a visual disorder." "These reports are consistent with hyperopia." "What you are describing may be what is called myopia." "Your child will need to be evaluated for an accommodation disorder."

A toddler is diagnosed with acute otitis media and prescribed antipyretics and numbing ear drops. Which instruction is most important to teach the parents about treatment? option of administering acetaminophen or ibuprofen as needed how to administer the ear drops option of using heat or cool compresses for comfort importance of administering antibiotics as prescribed

ANSWER Acute otitis media is diagnosed when there is an acute onset of fever and ear pain. The fluid in the middle ear can be infected by either viruses or bacteria. It occurs more often in younger children due to the short length and the horizontal positioning of the Eustachian tube, the limited response to antigens, and the lack of exposure to pathogens. Treatment includes acetaminophen or ibuprofen for pain or fever, warm or cool compresses, and numbing ear drops. When giving instructions about treatment, it is most important for the nurse to teach the parent the correct way to position the pinna to administer the drops. Most parents know how to administer oral medications or apply a cool compress; however, it is rare for parents to know how to pull the pinna to place the ear drops correctly. Depending on the child's age and the severity of the infection, antibiotics may or may not be used.

When teaching a parent about amblyopia, it would be most important to explain that: amblyopia is correctable if the child is properly treated before 6 years of age. amblyopia is a rapid irregular movement of the eye. if the child is not treated, he or she is likely to resent it later on. amblyopia can result from a refractive error in one eye.

ANSWER Amblyopia is poor vision which develops in an otherwise structurally normal eye. With this condition the vision in one eye is decreased because the eye and the brain are not working together. The condition is known as "lazy eye" because one eye is stronger than the other. Amblyopia can be treated if discovered before 6 years of age. This is the reason early detection is so important. Strabismus, not amblyopia, is the rapid movement of the eye. Amblyopia is not caused by a refractive error in the eye. Telling the parent that if the child does not get treated, the child will resent it is not educating the parent. It is the nurse forcing judgment onto the parent, which should not happen.

The nurse is discussing communication options with the parents of a 2-year-old girl with congenital hearing loss. The nurse integrates knowledge of what form of communication as having no verbal component? American Sign Language oral deaf education total communication cued speech

ANSWER American Sign Language is entirely communicated through hand signs, gestures, and facial expression. It has its own grammar and syntax. Oral deaf education uses technology to boost auditory potential and teaches children to notice sound and give it meaning. It helps develops oral speech. Cued speech is a system using hand signs to clarify lip-reading. It gives the person clues about the sounds the speaker is making. Total communication combines auditory training and teaching spoken language with signing exact English, which corresponds to the words and syntax of English.

A child has been diagnosed with bacterial conjunctivitis. Which statement(s) by the child's parent indicates the need for further education? Select all that apply. "All of us at home need to wash our hands really well." "This is really contagious." "We should not use a towel that our child has used." "Our child can go back to school in 4 hours, after that thick yellow drainage is gone." "I will continue to use eye drops until the redness is gone."

ANSWER Antibiotic eye drops or ointment should be used until the full course of treatment has been completed. The parent should not stop just because the redness is gone. The child can go back to school 24 to 48 hours, after the mucopurulent drainage is no longer present. The other choices are correct responses.

A child has been diagnosed with bacterial conjunctivitis. Which statement(s) by the child's parent indicates the need for further education? Select all that apply. "We should not use a towel that our child has used." "All of us at home need to wash our hands really well." "This is really contagious." "Our child can go back to school in 4 hours, after that thick yellow drainage is gone." "I will continue to use eye drops until the redness is gone."

The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement? administering antibiotics as soon as they're available obtaining a culture of fluid from the middle ear determining if the girl's balance is shaky when walking administering antivirals to ensure broad coverage of all organisms

ANSWER Because of the severity of the symptoms, the child will be treated with antibiotics immediately. This decision is based on the clinical practice guideline developed by the American Academy of Pediatrics and American Academy of Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. A 20-month-old's gait would most likely appear as swaying from side to side while moving forward. It is not until the toddler is around 3 years of age that he or she demonstrates walking in a heel-to-toe fashion with a steady gait. Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than age 2 years.

The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement? obtaining a culture of fluid from the middle ear administering antivirals to ensure broad coverage of all organisms administering antibiotics as soon as they're available determining if the girl's balance is shaky when walking

A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent? Prophylactic acetic acid instillations may be helpful. Prophylactic myringotomy tubes can be inserted at birth. The frequency of otitis media is reduced in breastfed infants. Starting immunizations at birth rather than age 2 months might help.

ANSWER Breastfeeding is a way to help prevent acute otitis media in infants. Acute otitis media tends to occur less often in breastfed than bottle-fed infants. One reason is the immunologic benefits from the breast milk. An infant should not start immunizations until 2 months of age, because the organs and immune system are not mature enough at birth. Placing medications and tubes are never done prophylactically.

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

ANSWER Children with Legg-Calvé-Perthes disease pass through four stages: synovitis, necrotic, fragmentation, and reconstruction. The necrotic state lasts between 6 to 12 months, and the fragmentation stage can last 1 to 2 years with the entire process lasting several years. Treatment for children under, not over, 6 years is to place a containment device over the head of the femur. Children over 6 years typically have reconstructive surgery to the femur head. If left untreated, the femur head will deform, which can lead to chronic pain and disability.

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching? "Check the skin that is covered by the braces for redness and breakdown." "If the brace is painful, feel free to take it off." "Please try and follow the therapist's on and off schedule." "It is very important to comply with the use of this brace."

ANSWER Compliance is important, but attention to skin care is the priority teaching. Following the schedule is important for compliance, but skin integrity is the priority. Advising the parents to remove the brace if it is painful is inaccurate; the child may require pain management or further consultation with the physical therapist.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? Inspect for precocious hair growth in the genital and underarm areas. Snip the tuft of hair off close to the skin for hygienic reasons. Record and refer the finding for follow-up to the pediatrician. Move on to other assessments without calling attention to the difference.

ANSWER Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. Magnetic resonance imaging (MRI) is often the diagnostic tool used. No hygienic concerns need prevail. These findings do not suggest development of precocious puberty or any other hormonal problem. The dimpling and hair tuft must be clearly explained to the parents.

A child comes to the clinic with an eye injury. The nurse conducts an assessment of the eye. Which assessment finding(s) would require the nurse to seek a referral for the child to obtain immediate care by an ophthalmologist? Select all that apply. The child reports seeing double. The child denies any eye pain. The pupils are dilated to 8 cm. There is redness of the sclera and conjunctiva. Nystagmus is noted on eye examination.

ANSWER Eye injuries are common, and the nurse's assessment can help obtain immediate care when needed. With eye injuries, the nurse will assess the child for acute eye pain, eyelid placement, bleeding, edema, redness of the sclera and conjunctiva, and excessive tearing. The nurse will also use a penlight and assess for pupil response to light and accommodation. If there are abnormal reactions to pupil reaction, if the child reports diplopia or blurred vision, or if extraocular eye movements are assessed, the child will need the immediate care of an ophthalmologist.

The nurse is caring for a newborn and knows that his vision, unlike his hearing, is not fully developed. Which aspect of the child's vision would the nurse expect to be similar to his father's vision? monocular vision visual acuity of 20/100 nearsightedness adequate color detection

ANSWER If the child's father has lost visual acuity, he and his new son could possibly have the same 20/100 vision. Poor color detection, nearsightedness, and monocular vision are characteristic of newborns and are the result of their lack of development.

The vision impairment in which the child can see objects at close range but not at a distance is known as: Esotropia Hyperopia Exotropia Myopia

ANSWER Myopia is nearsightedness, which means that the child can see objects clearly at close range but not at a distance. It occurs because the light entering the eye focuses in front of the retina. Hyperopia is farsightedness. Esotropia is better known as "cross-eyed." It is a form of strabismus in which one or both eyes focus inward. Exotropia is a form of strabismus where the eyes are deviated outward.

The nurse is caring for a child who has conductive hearing loss. What is true regarding this type of hearing loss? It is caused by chronic otitis media or another infection. It is often undetected until the child goes to school. It is generally severe and unresponsive to medical treatment. It is caused by maternal rubella.

ANSWER In conductive hearing loss, the transmission of sound through the middle ear is disrupted. Structures fail to carry sound waves to the inner ear. Fluid fills the ear so the tympanic membrane is unable to move properly. This type of impairment most often results from chronic serious otitis media or other infection. Infants have hearing tests before being discharged from the hospital to determine hearing loss, especially premature infants. Hearing loss can be detected early because language development will be impaired. This type of hearing loss is treatable with the use of hearing aids, cochlear implants and communication devices. Rubella causes sensorineural hearing loss.

A 13-year-old reports she recently saw a television program showing surgery to correct vision problems. She states she hates wearing glasses and wants to have this procedure done. What is the best response by the nurse? "Lots of girls your age wear glasses without issues." "Although there are surgeries for vision, they are not normally recommended for someone your age." "We can talk with the doctor about referring you to a surgeon to get this taken care of." "Let's talk with your mother about getting contact lenses."

ANSWER In most cases, laser surgery for someone this young is not recommended. Explaining that other girls wear glasses does not answer the teen's original question. While contact lenses may be an option for consideration, this response does not address the teen's question.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to prevent herniation of a spinal disk, which is painful." "It is important to prevent torticollis." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."

ANSWER It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

The nurse is educating the parents of a 7-year-old boy who has hearing loss due to otitis media with effusion. Which statement by the parents indicates that further education is needed? "We need to raise the volume of our voices significantly so he can hear us." "Using hand gestures as visual cues should help our child understand a little better." "We need to face our son when we are speaking." "We need to make sure we are speaking clearly."

ANSWER It is not necessary for the parents to raise their voices more than slightly in order to be heard. Speaking clearly is an appropriate technique for communicating with the child. Facing the child when speaking is an effective method for communicating with the child. Using visual clues, such as hand gestures, is an effective technique for communicating with this child.

The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement? encouraging the child to keep his hands away from his eyes making sure the child showers and shampoos before bedtime rinsing the child's eyelids with a clean washcloth and cool water washing the child's hands and face when returning from outdoors

ANSWER Keeping a 6-year-old child's hands away from his face is a difficult task, particularly when he is playing by himself or is at school. Washing the child's hands and face when returning from outdoors, rinsing the child's eyelids, and showering and shampooing before bedtime are all things the parents can supervise and ensure occurs, and thus would be less difficult to implement.

The nurse is teaching the family of a 6-year-old boy with allergic conjunctivitis how to minimize his exposure to allergens. What action would the nurse anticipate as being most difficult for the family to implement? washing the child's hands and face when returning from outdoors rinsing the child's eyelids with a clean washcloth and cool water encouraging the child to keep his hands away from his eyes making sure the child showers and shampoos before bedtime

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

ANSWER Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a client would have difficulty standing before having difficulty sitting.

The parents of an 8-year-old child report that the child's teachers noted the child is having problems seeing the board in school but state they do not understand this since the child is able to read from the computer with no difficulty. Which response from the nurse is most appropriate? "These reports are consistent with hyperopia." "This may signal your child is having difficulty paying attention rather than a visual disorder." "What you are describing may be what is called myopia." "Your child will need to be evaluated for an accommodation disorder."

The nurse recognizes that if the infant is following normal development, the infant will be able to focus and follow an object with the eyes by what age? 1 month of age 2 months of age 21 days of age 7 days of age

ANSWER Newborns are born nearsighted. They prefer the human face to other objects. At 1 month they can recognize by site the people they know. By 2 months of age, the infant can focus and follow an object with the eyes. Binocularity develops at 6 months and color vision follows at 7 months.

A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client? Teach the client not to rest with the crutch pad pressing on the axilla. Assess the tips of the crutches to be certain the rubber tip is intact. Be certain the child is walking with the crutches about 6 inches to the side of the foot. Caution parents to clear articles such as throw rugs out of paths at home.

ANSWER Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child.

The nurse is educating the parents of a 5-year-old girl with infectious conjunctivitis about the disorder. Which information is most important to provide to prevent the spread of the disorder? properly applying the prescribed antibiotic staying home from school washing hands frequently keeping hands away from eyes

ANSWER Proper handwashing is the single most important factor to reduce the spread of acute infectious conjunctivitis. Proper application of the antibiotic is important for the treatment of the infection, not prevention of transmission; keeping the child home from school until she is no longer infectious and encouraging the child to keep her hands away from her eyes are sound preventive measures, but not as important as frequent handwashing.

A child returns to the clinic after an episode of external otitis (acute otitis externa or swimmer's ear) that has resolved. What would the nurse emphasize as the priority for preventing future episodes? Avoiding upper respiratory tract infections Keeping ear canals dry Performing handwashing Adhering to regular follow-up to assess for hearing loss

ANSWER Since moisture contributes to external otitis (acute otitis externa or swimmer's ear), the priority is to keep the ear canals dry. Handwashing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not external otitis (acute otitis externa or swimmer's ear). Hearing loss is not associated with otitis externa.

A child returns to the clinic after an episode of external otitis (acute otitis externa or swimmer's ear) that has resolved. What would the nurse emphasize as the priority for preventing future episodes? Keeping ear canals dry Avoiding upper respiratory tract infections Performing handwashing Adhering to regular follow-up to assess for hearing loss

ANSWER Since moisture contributes to external otitis (acute otitis externa or swimmer's ear), the priority is tterm-6o keep the ear canals dry. Handwashing would be a priority for preventing infections such as conjunctivitis. Upper respiratory tract infections are associated with otitis media, not external otitis (acute otitis externa or swimmer's ear). Hearing loss is not associated with otitis externa.

A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent? Antiviral therapy can be prescribed to manage this condition. Most of these conditions will spontaneously resolve. Once the child is 6 to 9 months old a specialist will be able to drain the duct. Over-the-counter drops can be used sparingly.

ANSWER Stenosis or simple obstruction of the nasolacrimal duct is a common disorder of infancy, occurring in about 6% to 20% of newborns and infants. It is unilateral in about 65% of cases. Chronic tearing occurs and buildup in the lacrimal sac causes a mucoid or mucopurulent drainage. Over 90% of all cases resolve spontaneously by 1 year of age.

A child with poor eye alignment cannot establish single binocular vision but has double vision. Which nursing action is most appropriate for this client? Discuss surgical options for treatment Ask if the child has had a computed tomography (CT) before Refer the child to a pediatric ophthalmologist Schedule the child for botulinum toxin injections

ANSWER The nurse would refer the child experiencing diplopia (double vision) to a pediatric ophthalmologist for further testing; it is imperative to determine the cause to properly treat diplopia. Treatment may be as simple as eye exercises or glasses or could entail surgery. CT or magnetic resonance imaging (MRI) may be prescribed to assist in determining the cause. Knowledge of previous testing would not be a priority at this time. Botulinum toxin injections may be prescribed for treatment. Surgery may be discussed once the underlying cause is identified.

The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? Plan to add additional weights as the fracture heals, usually once per day. Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed. Ensure traction weights are hanging freely, not touching the bed or floor. Remove traction weights once per shift for 30 minutes and then replace them.

ANSWER Traction is used as a pulling force on an extremity or body part. For it to be effective, the weights need to hang freely at all times and the ropes need to remain in the pulley grooves. The weights are not replaced or removed during traction. The child can move all extremities except the affected one(s). The child remains in traction until healing occurs, a cast is applied, or surgical repair is performed.

The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be most appropriate regarding the child's vision? "He might be suffering from hyperopia and probably will need glasses now." "A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness." "His vision problem will get in the way of his learning, so he will probably have to have glasses before he starts school." "He is likely to have a slight astigmatism, which almost always needs to be corrected by glasses."

ANSWER Visual acuity of children gradually increases from birth, when the visual acuity is usually between 20/100 and 20/400, until about 5 years of age, when most children have 20/20 vision. Hyperopia (farsightedness) is a refractive condition in which the person can see objects better at a distance than close up. Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse? mixing hydrogen peroxide with sterile water to make half-strength hydrogen peroxide using latex free sterile gloves placing sterile cotton gauze squares around the ends of the pins unhooking a weight while providing pin care

ANSWER Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.

ANSWER A Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina. Myopia is nearsightedness; hyperopia is farsightedness

A young child in the clinic has watery eyes and reddened conjunctiva. The child keeps the eyes closed a lot, because it hurts to have them open. Which problem does the nurse suspect for this client? Conjunctivitis Stye Chalazion Blepharitis marginalis

ANSWER A Conjunctivitis is inflammation of the conjunctiva and is demonstrated by watery eyes with reddened conjunctiva and sensitivity to light. Sticking of eyelids with pustular drainage is also a sign. It is very contagious and requires antibiotics for treatment. Blepharitis is a chronic scaling with discharge along the eyelid margin. A stye is a localized infection of the sebaceous gland of the eyelid. A chalazion is a chronic painless infection of the meibomian gland. The stye and blepharitis will require antibiotic treatment. A chalazion will clear on its own.

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education? "I will use Visine drops in his infected eye to help reduce redness." "I will wash my hands immediately after caring for him." "I will encourage my son to not touch his eyes." "I will use a warm compress to help loosen crust that accumulated on his eyelid overnight."

ANSWER A Using a warm compress to remove crust from eyelids, washing hands frequently, and refraining from touching infected eyes are all ways to help manage bacterial conjunctivitis and prevent spreading the infection. Visine should not be used as it does not treat the cause of the infection and can cause rebound redness.

A parent brings a 12-month-old child diagnosed with congenital cerebral palsy to the clinic. The nurse completes an assessment. Which assessment finding requires immediate intervention by the nurse? sits with assistance suspected failure to thrive babbling speech spastic movements of the extremities

ANSWER B The finding that requires the nurse's immediate attention is the suspicion of failure to thrive (FTT). FTT refers to inadequate growth in infants and children. Children diagnosed with cerebral palsy (CP) often have difficulty maintaining adequate nutrition due to muscle spasticity and difficulty chewing and swallowing. The nurse who suspects FTT in a child with CP should refer the child to a dietitian and/or speech therapist. Parents should also be taught the most effective way to feed their child. Spastic movements are common findings in CP and in this case do not require immediate intervention by the nurse. Babbling speech may also be found in the infant diagnosed with CP. The infant should be referred to a speech therapist but in this case does not require immediate intervention. A 12-month-old child with CP may need assistance to sit related to muscle spasticity.

The 12-year-old child has developed a stye. Which may be included in the child's care? Manually express the lesion when a head forms. Apply cool, dry compresses to the affected area. Apply hot, moist compresses to the affected area. Apply petroleum jelly to reduce irritation.

ANSWER C The stye is an infection of a ciliary gland (a modified sweat gland) that enters the hair follicle at the lid margin, most commonly caused by Staphylococcus. Management of the stye includes the use of hot, moist compresses. Manual expression is not indicated. Petroleum jelly will not be appropriate nor will it reduce inflammation. Cool, dry compresses will not be therapeutic. Heat provides for vasodilation, which will be useful in the resolution of the inflammation.

The parent of a child having tympanoplasty tubes placed asks, "Will my child lose hearing while the tubes are in place?" What is the nurse's best answer? "Have you asked your child's surgeon about that?" "There is some risk of permanent deafness, but the benefit of decreasing the infection is worth it." "The tubes are inserted into a section of eardrum in which the hearing is not affected." "Your child's hearing will decrease while the tubes are in place."

ANSWER C Tymanostomy tubes help to ventilate the cavities of the middle ear and balance the pressure on each side of the tympanic membrane..Tympanoplasty tubes do not interfere with hearing because they are inserted into a portion of the tympanic membrane that is not instrumental to hearing. There is no risk of permanent deafness and hearing will be increased while the tubes are in place, not decreased. The nurse should answer the parent's question honestly without dismissing it or referring to another health care provider. This indicates to the parent that something may be wrong or serious. The nurse can refer the parent to the surgeon if the parent's questions have not been adequately addressed.

A 12-year-old girl tells the nurse that she is so embarrassed that she is going to have to start wearing glasses. What is the best response by the nurse? "You really don't have a choice if you want to see better." "You look adorable in your glasses. Everyone will love them." "I wore glasses when I was 12. It wasn't so bad." "Let's talk about what it will be like wearing them for the first time."

ANSWER D Stating, "Let's talk about what it will be like wearing them for the first time" opens up dialogue with the child so that she can explore her feelings. This allows the nurse to provide support and help the client feel more at ease with the situation. Telling the client that the nurse "wore glasses when I was 12" and that there is "no choice" doesn't acknowledge the child's anxiety. Complimenting her on how she looks in her glasses may make her feel good temporarily, but it doesn't allow for exploration of her feelings.

The nurse has finished teaching the mother of a 5-year-old male diagnosed with bacterial conjunctivitis how to manage her son's infection at home. Which statement by the mother would indicate a need for further education? "I will encourage my son to not touch his eyes." "I will wash my hands immediately after caring for him." "I will use a warm compress to help loosen crust that accumulated on his eyelid overnight." "I will use Visine drops in his infected eye to help reduce redness."

ANSWER D Using a warm compress to remove crust from eyelids, washing hands frequently, and refraining from touching infected eyes are all ways to help manage bacterial conjunctivitis and prevent spreading the infection. Visine should not be used as it does not treat the cause of the infection and can cause rebound redness.

Answer Shin splints are a form of an over use syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.

Answer Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arouse suspicion of its presence, or it may be overlooked entirely.

In caring for a child in traction, which intervention is the highest priority for the nurse? The nurse should record accurate intake and output. The nurse should provide age-appropriate activities for the child. The nurse should clean the pin sites at least once every 8 hours. The nurse should monitor for decreased circulation every 4 hours.

Answer Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? The nurse should support the caregivers in restricting activity during the treatment. The nurse should be a contact person when the child is hospitalized. The nurse should provide information when the child or caregiver requests it. The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

Answer Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Apply ice to the injury for 60 minutes on and 60 minutes off." "Taking warm baths will help relax muscles and reduce pain." "Applying ice to the area will reduce the pain and swelling." "Elevate the legs, and use bed rest for 24 hours."

Answer Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate? "This is the most common facial nerve palsy." "Was this from pressure resulting from forceps?" "Have you seen any signs of improvement?" "In most cases treatment is not necessary, only observation."

Answer The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse? unhooking a weight while providing pin care using latex free sterile gloves mixing hydrogen peroxide with sterile water to make half-strength hydrogen peroxide placing sterile cotton gauze squares around the ends of the pins

Answer Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? Nausea and vomiting often follow repair of the cystic mass. Assuming the usual feeding position will be difficult. Pain will interfere with the feeding process. The infant will have a poor sucking reflex.

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

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