NURS 3 - Mod 18 Musculoskeletal (Peds) EAQ's

The parents of a child with cerebral palsy (CP) report that the child frequently chokes and aspirates during feedings. What advice does the nurse provide to the parents? Select all that apply. 1 "Assess the child's chewing and swallowing ability." 2 "Use jaw support, and control the jaw during feedings." 3 "Use baclofen (Lioresal) therapy with an implanted pump." 4 "Position your child on the cradle of your arm during feedings." 5 "Position your child in a semiupright position during and after feedings."

1 - "Assess the child's chewing and swallowing ability." 2 - "Use jaw support, and control the jaw during feedings." 5 - "Position your child in a semiupright position during and after feedings." The nurse asks the parents to assess the child's chewing and swallowing abilities to prevent the chances of aspiration. The parents should support the child's jaw by placing the middle finger of the nonfeeding hand posterior to the bony portion of the chin. The index finger is placed on the chin below the lower lip, and the thumb is placed obliquely across the cheek. The nurse should advise the parents to position the child in a semi-upright position during and after feedings to prevent choking. Baclofen (Lioresal) therapy with an implanted pump is not used in this case. Baclofen (Lioresal) is a medicine administered in a severely spastic child. It is a neurosurgical and pharmacologic approach to relieve the spasticity associated with CP. The child should not be placed in the cradle of the parent's arm during feeding because it may cause the child to choke.

A 6-year-old girl born with a myelomeningocele has a neurogenic bladder disorder. Her parents have been performing clean intermittent catheterization. What is the nurse's most appropriate action? 1 Teach the child to do self-catheterization. 2 Teach the child appropriate bladder control. 3 Continue having parents do catheterization. 4 Encourage the family to consider urinary diversion.

1 - Teach the child to do self-catheterization. At 6 years old, this child should be able to perform the intermittent catheterization herself. This will give her more control and mastery over her disability. Bladder control cannot be taught to a child with a neurogenic bladder. This would be a good time to have the child begin caring for herself. A urinary diversion is not necessary.

The nurse is planning the discharge of a child with myelomeningocele. The child's parents are ready and successfully coping with the condition. The nurse needs to involve the parents so that they can continue the care at home. What areas of complication should the nurse cover when teaching them home care? Select all that apply. 1 Urinary 2 Neurologic 3 Orthopedic 4 Psychological 5 Reproductive

1 - Urinary 2 - Neurologic 3 - Orthopedic The life expectancy of a child with myelomeningocele is well into adulthood. The parents usually need assistance if there are complications. Hence, knowing about these complications is a necessary step for home care. Generally these complications are neurologic or orthopedic, and sometimes they are related to the urinary system. Otherwise, the child is healthy, and there is no complication in his or her psychological or reproductive behavior. In fact, children with myelomeningocele after surgery can receive educational training, live independently, have a mate, have sexual relations, and bear children.

The parents find that their son has X-linked Duchenne muscular dystrophy (DMD). They also have a daughter and are concerned about their daughter's well-being. Neither parent has muscular dystrophy. Their daughter has not shown any symptoms. Which are the most appropriate statements to address their concerns? Select all that apply. 1 "Your daughter is surely a carrier of the disease." 2 "It can be a new mutation, and the mother need not be a carrier." 3 "Your daughter may be a carrier and could develop cardiomyopathy." 4 "It is a genetic disease caused by mutation of the gene that encodes dystrophin." 5 "Your son has inherited the disease from both parents."

2 - "It can be a new mutation, and the mother need not be a carrier." 3 - "Your daughter may be a carrier and could develop cardiomyopathy." 4 - "It is a genetic disease caused by mutation of the gene that encodes dystrophin." DMD is a genetic disease. It can be a new mutation that appears in any generation, and the mother need not be a carrier. In some cases, the daughter is a carrier and can later develop cardiomyopathy. In this mutation, the gene that encodes dystrophin is unable to produce the necessary protein. This condition follows an X-linked recessive inheritance pattern. When the father is unaffected and the mother is a carrier, there is a 50% chance that a son will be affected and a 50% chance that a daughter will be a carrier. Therefore, the daughter is not necessarily a carrier of the disease. The son cannot inherit the disease from the father if the latter is not showing signs of muscular dystrophy.

The nurse is caring for an infant with myelomeningocele and needs to keep the infant in the prone position. Which is the most appropriate way to keep the infant in the prone position while minimizing tension in the sac? 1 Hips extended with the legs in abduction and the child lying with back down 2 Hips kept slightly flexed with the legs in abduction and the child lying chest down 3 Legs kept well separated, thighs acutely flexed on the abdomen, and the child lying on the back 4 Child lying on the left side with the left thigh slightly flexed and the right thigh acutely flexed on the abdomen

2 - Hips kept slightly flexed with the legs in abduction and the child lying chest down In the prone position the child lies face down with hips slightly flexed and supported to reduce tension on the myelomeningocele sac. The legs are maintained in abduction with a pad between the knees to counteract hip subluxation. A small roll is placed under the ankles to maintain a neutral foot position. The child's back is kept upright. When the chest is kept in upright position, it creates a problem because there is a risk of trauma of the myelomeningocele sac. The child also cannot lie on the back with the legs well separated and thighs acutely flexed on the abdomen. Moreover, this position is known as lithotomy. The risks of trauma are also high if the child is kept on the left side-lying position with the left thigh slightly flexed and the right thigh acutely flexed on the abdomen. If the child tilts, it can injure the myelomeningocele sac.

Which statement is true concerning osteogenesis imperfecta? 1 It is easily treated. 2 It is an inherited disorder. 3 Later-onset disease usually runs a more difficult course. 4 Braces and exercises are of no therapeutic value.

2 - It is an inherited disorder. Osteogenesis imperfecta is an inherited disorder. Osteogenesis imperfecta is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. The type of disease determines the course it will take. Lightweight braces and splints can help support limbs and fractures.

The parents of a child with cerebral palsy ask the nurse about the advantages of ankle-foot orthoses (AFOs). What is the most appropriate response by the nurse? 1 "AFOs have custom seats for dependent mobilization." 2 "AFOs are useful for independent mobility." 3 "AFOs are used to prevent deformity and increase energy efficiency of gait." 4 "AFOs provide sitting balance."

3 - "AFOs are used to prevent deformity and increase energy efficiency of gait." AFOs (or braces) are used to prevent deformity, increase the energy efficiency of gait, and control alignment. AFOs do not have custom seats for dependent mobilization. It is a supportive device for the ankle or a part of the foot. Custom seats cannot be adjusted within this device. They also do not allow independent mobility or provide sitting balance. It controls the ankle position and compensates for the muscle weakness.

The parents express concern to the nurse that they are not using the proper feeding techniques for their child with cerebral palsy (CP). After further discussion the nurse notes that the parents are using the appropriate diet and positioning during and after feedings and are performing suitable jaw control techniques. Which outcome confirms the parents are using adequate oral feeding efficiency for their child? 1 Improvement of mobility 2 Development of maturity 3 Gain of child's overall weight 4 Development of temperament

3 - Gain of child's overall weight The child's weight gain is a measure of adequate oral feeding efficiency. Once the child has an appropriate diet tailored to suit activity and metabolic needs, the child will gain adequate weight. Otherwise, a child with CP is at risk for growth failure and chronic malnutrition. Improvement of mobility and development of maturity and temperament are not considered outcomes of adequate oral feeding efficiency. They are part of general development and naturalization that the parents need to focus on developing in the child.

Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy? 1 It is inherited as an autosomal dominant disorder. 2 It is characterized by weakness of proximal muscles of both pelvic and shoulder girdles. 3 It is characterized by muscle weakness usually beginning about 3 years old. 4 Onset occurs in later childhood and adolescence.

3 - It is characterized by muscle weakness usually beginning about 3 years old. Children with Duchenne muscular dystrophy usually reach the early developmental milestones; the muscular weakness usually is observed in the third year of life. It is inherited as an X-linked recessive trait. The first weakness is usually noted in walking, then a progressive involvement of other muscle groups occurs. Onset usually develops in the third year of life.

What most accurately describes bowel function in children born with a myelomeningocele? 1 Incontinence cannot be prevented. 2 Enemas and laxatives are contraindicated. 3 Some degree of fecal continence can usually be achieved. 4 Colostomy is usually required by the time the child reaches adolescence.

3 - Some degree of fecal continence can usually be achieved. With diet modification and regular toilet habits to prevent constipation and impaction, some degree of fecal continence can be achieved. Although a lengthy process, continence can be achieved with modification of diet, use of laxatives, and/or enemas. There is no general contraindication. Colostomy usually is not required.

The nurse instructs the parents of the child with cerebral palsy to perform routine stretching exercises with the child after administration of oral pain medication. What is the most appropriate reason for this instruction that the nurse provides to the parents? 1 "It is an outlet for frustration related to chronic pain experience." 2 "It prevents aspiration and helps the child mobilize the food." 3 "It promotes self-care in the child and decreases muscle spasticity." 4 "It manages pain impulses. It is done for 60 minutes for oral medicines."

4 - "It manages pain impulses. It is done for 60 minutes for oral medicines." Stretching exercises are usually done for 60 minutes immediately after oral pain medication is administered to help manage the child's pain. This does not act as an outlet for frustration for the chronic pain experience. The child is encouraged to verbalize the effects of pain in an attempt to release frustration. Stretching exercises are also not part of the promotion of the self-care and the solution to decrease muscle spasticity. Self-care is taught to promote self-dependence in the child. There are separate exercises to decrease muscle spasticity. Parents are taught how to use jaw control movement in the child to prevent aspiration and mobilize the food.

Cerebral palsy may result from a variety of causes. It is now known that what is the most common cause of cerebral palsy? 1 Birth asphyxia 2 Neonatal diseases 3 Cerebral trauma 4 Prenatal brain abnormalities

4 - Prenatal brain abnormalities Cerebral palsy results from existing brain abnormalities during the prenatal period. Birth asphyxia, neonatal diseases, and cerebral trauma previously were thought to be factors.

What is a neural tube defect that is not visible externally in the lumbosacral area? 1 Meningocele 2 Myelomeningocele 3 Spina bifida cystica 4 Spina bifida occulta

4 - Spina bifida occulta Spina bifida occulta is completely enclosed. Often this defect will not be noticed. Meningocele contains meninges and spinal fluid but no neural tissue. Unless there are associated cutaneous findings, it is often not identified until later. Myelomeningocele is a neural tube defect that contains meninges, spinal fluid, and nerves. Spina bifida cystica is a cystic formation with an external saclike protrusion.

The nursing instructor is explaining Duchenne muscular dystrophy (DMD) to parents. Which statements does the nurse include in the explanation? Select all that apply. 1 "It is inherited as an X-linked recessive trait, and it is a single-gene defect." 2 "It is an autosomal recessive, autosomal dominant, or X-linked recessive trait." 3 "The female carriers are completely healthy without any symptoms of the illness." 4 "About 10% of female carriers develop cardiomyopathy with elevated creatine kinase." 5 "In about 30% of cases it is a new mutation, and in 65% of cases it is a positive family history."

1 - "It is inherited as an X-linked recessive trait, and it is a single-gene defect." 4 - "About 10% of female carriers develop cardiomyopathy with elevated creatine kinase." 5 - "In about 30% of cases it is a new mutation, and in 65% of cases it is a positive family history." DMD is inherited as an X-linked recessive trait, and the single-gene defect is located on the short arm of the X chromosome. Female carriers have an elevated serum creatine kinase, and about 10% develop cardiomyopathy. Although this condition has a positive family history in about 65% of the cases, in about 30% of the cases it is a new mutation. These are common facts about DMD that nurses need to know and often have to convey to the families. DMD is not an autosomal recessive or autosomal dominant trait. Even though this condition is a recessive trait, it is not that the female carriers are entirely normal. Female carriers do suffer from mild cardiomyopathy and an elevated serum creatine kinase condition in a few cases.

The nurse is teaching the parent of a 12-month-old infant about assessing developmental dysplasia of the hip in babies. What instruction does the nurse give the parent to check the presence of a Trendelenburg sign? 1 "Make the infant stand on the affected leg." 2 "Put the infant supine with the back arched." 3 "Lay the infant down on the unaffected side." 4 "Make the infant sit upright with legs separated."

1 - "Make the infant stand on the affected leg." When an affected older infant stands and bears weight on the affected hip, the pelvis tilts downward instead of upward, indicating a positive Trendelenburg sign. The supine position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis. The side-lying position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis. The sitting position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis.

A child with Duchenne muscular dystrophy (DMD) is also suffering from obesity. What advice does the nurse give the parents so that they can manage the child's weight more appropriately? Select all that apply. 1 "Obesity can lead to premature loss of ambulation and functional independence." 2 "Family members should try to feed the child whenever possible to keep the child busy." 3 "It is important to increase the physical and recreational activities in your child's life." 4 "The child's IQ is 20 points, and thus it is best not to involve the child in learning." 5 "Proper dietary intake and a diversified recreational program help reduce the likelihood of obesity."

1 - "Obesity can lead to premature loss of ambulation and functional independence." 3 - "It is important to increase the physical and recreational activities in your child's life." 5 - "Proper dietary intake and a diversified recreational program help reduce the likelihood of obesity." Obesity is a common complication in children with DMD. Obesity can lead to the premature loss of ambulation and functional independence. The nurse should recommend that the parents involve the child in different recreational and physical activities. Proper dietary intake and a diversified recreational program help reduce the likelihood of obesity and enable children to maintain ambulation and functional independence for a longer time. Overfeeding by well-meaning family and friends should be avoided, because this contributes to obesity. Additionally, the child with DMD should be involved in early learning programs and eventually moved into regular classrooms, even if their IQ is 20 points. This helps promote self-confidence and independence.

A child with cerebral palsy (CP) is experiencing repeated muscle contractures. What advice does the nurse convey to the family to prevent this condition? Select all that apply. 1 "Perform stretching exercises on the affected muscles of the child." 2 "Teach activities of daily living (ADLs) and encourage self-help skills." 3 "Use assistive devices, such as wrist splits and ankle-foot orthoses." 4 "Use jaw control during and after feeding, and remove thick carpeting." 5 "Avoid throw rugs and thick carpeting, and use padded furniture."

1 - "Perform stretching exercises on the affected muscles of the child." 3 - "Use assistive devices, such as wrist splits and ankle-foot orthoses." The family members of the child and the child's parents should be well aware of the different stretching exercises for the affected muscles. It ensures that the child does not have muscle contractures. Assistive devices, such as wrist splints and ankle-foot orthoses, are excellent to prevent muscle contracture. However, it is essential that such devices be used according to the specification of the primary health care provider and at a safety level appropriate for the child's age. ADLs and self-help skills should be promoted so the child becomes self-dependent. This is not done to prevent muscle contracture. The technique of jaw control during and after feeding is used to prevent choking, and it assists in the mobilization of the food. The family of the child is advised to remove thick carpeting to prevent injuries during mobilization in home.

A 2-month-old infant is showing slow, twisting movements of the trunk and abnormal posture. The health care provider detects the condition as dystonic cerebral palsy (CP). What statement would confirm the diagnosis of CP? 1 "The child has CP in which upper motor neuron muscular weakness occurs." 2 "The child has CP in which altered skeletal muscle performance occurs." 3 "The child shows disintegration of movements of the upper extremities." 4 "The child has CP in which combination of spastic and dyskinetic CP symptoms occur."

1 - "The child has CP in which upper motor neuron muscular weakness occurs." There are different types of CP. The dystonic CP is a condition in which involuntary muscle contractures and abnormal posture occurs in the child. This spastic CP represents an upper motor neuron muscular weakness. Athetoid and dystonic CP are non-spastic CP. Therefore, the nurse should not describe the condition as one in which altered skeletal muscle performance occurs. Disintegration of movements of the upper extremities is noted during ataxic CP. In such a condition the common symptoms are wide-based gait and rapid, repetitive movement. Again, the child does not have mixed CP. In mixed CP, symptoms of spastic and dyskinetic CP are observed.

Which postoperative nursing interventions are useful to avoid secondary complications in a young patient who has undergone spinal surgery? Select all that apply. 1 Assessing for signs indicating neurologic impairment 2 Administering intravenous opioids on a regular basis 3 Educating the patient on use and function of chest tube 4 Assessing for the signs of superior mesenteric artery syndrome 5 Teaching the patient to manage a patient-controlled analgesia (PCA) pump

1 - Assessing for signs indicating neurologic impairment 2 - Administering intravenous opioids on a regular basis After a spinal surgery, the patient has a considerable amount of pain for a few days. Pain relief requires frequent administration of intravenous pain medicines, preferably opioids. Postoperative assessment of any neurologic impairment should be performed because delayed paralysis might occur after spinal surgery. Educating the patient on the management of a patient-controlled analgesia (PCA) pump is done to promote self-care to encourage the patient's participation in treatment and recovery. Superior mesenteric artery syndrome is likely to be seen after spinal surgery in which there is compression of the duodenum by aorta and superior mesenteric artery. Clinical symptoms are nausea, vomiting, and epigastric pain which aggravate in the supine position and are relieved in the prone position. Teaching the patient about the use and function of a chest tube is also part of patient education for self-care.

An examination reveals that an infant has spina bifida (SB). What in particular should the nurse be careful about while monitoring this infant? 1 Avoid measuring rectal temperatures. 2 Assess the level of neurologic involvement. 3 Assess anal reflex for sensory impairment. 4 Observe behavior in conjunction with stimuli.

1 - Avoid measuring rectal temperatures. Rectal temperatures are not measured in infants with spina bifida because bowel sphincter function is often affected, and the thermometer can cause irritation and rectal prolapse. Ideally, the patient's level of neurologic involvement and anal reflex for sensory impairment are assessed. In addition, nurses observe the infant's behavior in conjunction with stimuli.

A newborn baby has been diagnosed with talipes equines. How often should the parents be taught to do a cast change? 1 Change the cast weekly. 2 Change the cast monthly. 3 Change the cast when its edges fray. 4 Change the cast if it becomes soiled.

1 - Change the cast weekly. Weekly gentle manipulation and serial long-leg casts allow for gradual repositioning of the foot. Casts are changed weekly to accommodate the rapid growth in early infancy. Once a month is not frequent enough in early infancy; the cast may become too tight because of the infant's rapid growth. The cast is not on the foot long enough for fraying to occur. Soiling usually is not a problem because casts for clubfoot do not extend to the perineal area.

After assessment of an infant the nurse informs the primary health care provider that the child has a positive Ortolani test. Which finding obtained from the test enables the nurse to reach this conclusion? 1 Decreased hip abduction 2 Symmetric folds on the thighs 3 Bacterial infection in the joint 4 Displacement of the femoral epiphysis

1 - Decreased hip abduction A positive Ortolani test indicates that the infant has developmental dysplasia of the hip. While performing the Ortolani test the nurse abducts the child's thighs and checks whether the client has hip subluxation or dislocation. The presence of decreased hip abduction indicates a positive Ortolani test. A child with developmental dysplasia of the hip has asymmetrical folds of the thigh tissues, so the presence of symmetrical folds would not indicate a positive Ortolani test. The presence of bacterial infection in the joints can be diagnosed through a series of tests including gram stain cultures, leukocyte count, blood cultures, and a complete blood count. Anteroposterior and frogleg radiographic examination are useful in diagnosing the displacement of proximal femoral epiphysis.

The nurse is explaining to the parents of a child with myelomeningocele that some degree of fecal continence can be achieved with diet modification. What steps does the nurse cover in the teaching? Select all that apply. 1 Dietary fiber supplements 2 Regular exercises and stretching routines 3 Diet modification and regular toilet habits 4 Limitation of fat to 30% of the total diet calories 5 Administration of laxatives, suppositories, or enemas

1 - Dietary fiber supplements 3 - Diet modification and regular toilet habits 5 - Administration of laxatives, suppositories, or enemas Dietary fiber supplements help in achieving fecal continence. The amount recommended is calculated based on the age of the child in years + 5 = g/day of fiber. Some degree of fecal continence can be achieved through diet modification, regular bathroom habits, and prevention of constipation and impaction with laxatives, suppositories, or enemas. It can be a lengthy process. Limiting fat to 30% of the total diet calories does not provide the assurance of fecal continence. Fecal continence does not have any relation to stretching routines and regular exercises.

The nurse is explaining scoliosis to a 12-year-old boy who has been diagnosed with the disease. What should the nurse emphasize? 1 Effect of the scoliosis on the child's body image 2 The need to use the least invasive treatment available 3 Treatment will not interfere with school 4 Maintaining contact with peers

1 - Effect of the scoliosis on the child's body image The identification of scoliosis as a "deformity," in combination with unattractive appliances and a significant surgical procedure, can have a negative effect on the already fragile adolescent body image. Establishing an identity is the major developmental task of the adolescent and is related to the affirmation of self-image. To achieve this task, there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling, the effect on body image is more important. Although it is important to maintain contact with peers, the effect on body image is more enduring.

The nurse is planning therapeutic management for optimal development of a child with cerebral palsy (CP). What key areas of prevention and normalization should the nurse focus on during the therapy? Select all that apply. 1 Establish optimal mobility, communication, and self-help skills. 2 Prevent hydrocephalus condition and Duchenne muscular dystrophy (DMD). 3 Provide educational opportunities tailored to the child's needs and abilities. 4 Provide genetic counseling and aggressive supportive care of immunizations. 5 Promote socialization experiences with other affected and unaffected children.

1 - Establish optimal mobility, communication, and self-help skills. 3 - Provide educational opportunities tailored to the child's needs and abilities. 5 - Promote socialization experiences with other affected and unaffected children. They should focus on establishing optimal mobility, communication, and self-help skills. To attain normalization it is also important to focus on providing educational opportunities adapted to the child's needs and capabilities. Additionally, there is a need to improve the child's socialization experiences with other affected and unaffected children, instead of keeping the child alone at home. Hydrocephalus is a frequently associated anomaly in 80% to 90% of children with spina bifida (SB). DMD is applicable to children with spinal muscular atrophy (SMA). There is no need to provide aggressive supportive care of immunizations to the child with CP. The immunization approach would be the same as for any healthy child.

A 12-year-old patient underwent a surgical procedure for the treatment of scoliosis. What is an appropriate postoperative nursing intervention for the patient? 1 Log-roll when changing position. 2 Assess the dressing frequently. 3 Supervise deep breathing exercises. 4 Maintain a supine position for 3 days.

1 - Log-roll when changing position. After surgery, patients are monitored in an acute care setting and log-rolled when changing position to prevent damage to the fusion and surgically inserted hardware. Log-rolling is necessary to prevent movement of the newly aligned vertebrae, and should be done frequently to prevent skin breakdown. Checking the dressing is done for all postoperative patients; this action is nonspecific. Coughing and deep breathing are done by most postoperative patients; this action is nonspecific. The patient who had a spinal fusion can be turned and still be protected from injury by log-rolling. Remaining in one position for 3 days can lead to skin breakdown from unrelieved pressure.

The nurse is caring for an infant who has recently undergone surgery to correct myelomeningocele. What should be the nurse's basic focus during postoperative care? Select all that apply. 1 Monitor vital signs, nourishment, signs of infection, and manage pain. 2 Care for the operative site and monitor signs of cerebrospinal fluid leakage. 3 Educate the parents on hydrocephalus and developing cognitive skills. 4 Practice stretches and exercises to minimize muscle contractures and deformity. 5 Educate parents on positioning, feeding, skin care, and exercise.

1 - Monitor vital signs, nourishment, signs of infection, and manage pain. 2 - Care for the operative site and monitor signs of cerebrospinal fluid leakage. 5 - Educate parents on positioning, feeding, skin care, and exercise. Postoperative care for a child who has undergone a surgery to correct myelomeningocele includes monitoring vital signs, nourishment, signs of infection, and managing pain. It is also important to take adequate steps in caring for the operative site and monitoring signs of cerebrospinal fluid leakage. The nurse also needs to educate the parents on positioning, feeding, skin care, and range-of-motion exercises after the child returns home. Parents are not taught about hydrocephalus or cognitive skill development. Similarly, they are not taught about stretches and exercises to minimize the muscle contractures and deformity.

A newly hired nurse caring for an infant who has myelomeningocele asks the senior nurse for assistance. The senior nurse tells the new nurse to focus on what areas? Select all that apply. 1 Neurologic and behavioral development and measurement of the head circumference and fontanels 2 Meningeal sac protection and intervention plans to optimize the child's development 3 Constraint-induced movement therapy to induce the weaker extremities to function 4 Infection and skin breakdown occurrence and signs of urologic and bowel complications 5 Changes in hemodynamic status, joint contractures, disuse atrophy, and obesity

1 - Neurologic and behavioral development and measurement of the head circumference and fontanels 2 - Meningeal sac protection and intervention plans to optimize the child's development 4 - Infection and skin breakdown occurrence and signs of urologic and bowel complications The nurse caring for an infant who has myelomeningocele should assess for neurologic and behavioral development. The nurse should also measure the head circumference and assess the fontanels from time to time. For a child with myelomeningocele, it is important to protect the meningeal sac and plan appropriate interventions to optimize the child's development. It is also important for the nurse to prevent infection and skin breakdown and observe for signs of urologic and bowel complications. Constraint-induced movement therapy is not used to treat myelomeningocele. The nurse should monitor hemodynamic status, joint contractures, disuse atrophy, and obesity in case the child has Duchenne muscular dystrophy. However, monitoring is not done if the child has myelomeningocele.

The nurse is caring for a newborn who has a sac containing meninges, spinal fluid, and a portion of the spinal cord with its nerves at the lower back. What would be included as the most appropriate nursing care steps for the infant? Select all that apply. 1 Place the infant in an incubator. 2 Apply sterile, moist, and nonadherent dressing. 3 Roll over the child every 2 to 3 hours. 4 Involve the parents in the nursing care. 5 Change dressings frequently. 6 Closely inspect for infections and irritations.

1 - Place the infant in an incubator. 2 - Apply sterile, moist, and nonadherent dressing. 5 - Change dressings frequently. 6 - Closely inspect for infections and irritations. The infant is always placed in an incubator so that the temperature can be maintained without clothing or covers that irritate the spinal lesion. The myelomeningocele is prevented from drying through the application of a sterile, moist, and nonadherent dressing over the sac. Dressings are changed frequently, and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The child is in a delicate condition. Hence, the child is not moved. If the child is rolled over every 2 to 3 hours, the risk of rupturing the myelomeningocele sac increases. Moreover, involving the parent in the nursing care is not advised. It is best if a certified nurse and primary health care provider take care of the infant.

A child with cerebral palsy has postural instability and difficulty during meals. The nurse teaches the parent the preferred way to facilitate eating. The most important areas the nurse should advise the parent to be careful about are what? Select all that apply. 1 Position of the child after feeding 2 Jaw control during feeding 3 Bowel activity during feeding 4 Respiratory action during feeding 5 Chewing and swallowing during feeding

1 - Position of the child after feeding 2 - Jaw control during feeding 5 - Chewing and swallowing during feeding The nurse must advise the parent to keep the child in a semi-upright position after feeding. It is also important to encourage the parent to use jaw control while feeding by carefully assessing the child's ability to manage oral feeding. To do this, the parent must assess the child's chewing and swallowing capability. It is not necessary to assess bowel activity or monitor respiratory action during feeding.

Which assessment findings support the nurse's conclusion that a 2-week-old neonate has hip dysplasia? Select all that apply. 1 Positive Barlow test 2 Positive Ortolani test 3 Positive Galeazzi sign 4 Piston mobility of hip joint 5 Positive Trendelenburg sign

1 - Positive Barlow test 2 - Positive Ortolani test 3 - Positive Galeazzi sign Barlow, Ortolani, and Galeazzi tests are the most reliable for confirming the presence of hip dysplasia in a 2-week-old child. If the hip gets dislocated due to adduction, it indicates a positive Barlow test. If the hip is reduced by abduction, then it indicates a positive Ortolani test. If the affected limb appears to be shorter than that of the other limb, then it indicates a positive Galeazzi test. A positive Trendelenburg sign and piston mobility of joint are assessment findings which indicate hip dysplasia in older infants and children.

What areas of initial care does the nurse provide for a newborn with spina bifida (SB)? Select all that apply. 1 Prevention of infection 2 Dental care techniques 3 Neurologic assessment 4 Impact of the anomaly on the family 5 Tetanus immunoglobulin 6 Anomalies of spinal bifida

1 - Prevention of infection 3 - Neurologic assessment 4 - Impact of the anomaly on the family 6 - Anomalies of spinal bifida The initial care of the newborn includes prevention of infection, neurologic assessment, learning about associated anomalies of SB, and dealing with the impact of the anomaly on the family. It is not necessary to know about the techniques of dental care. SB is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. This condition does not hamper dental health. Tetanus immunoglobulin is necessary only if the child suffers a wound with C. tetani bacteria.

Which measure is important in managing hypercalcemia in a child who is immobilized? 1 Promoting adequate hydration 2 Changing position frequently 3 Encouraging a diet high in calcium 4 Providing a diet high in protein and calories

1 - Promoting adequate hydration Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia. Changing position frequently will help manage skin integrity but will not affect calcium levels. The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia. The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.

The nurse is preparing a care plan for a patient who has a large bilateral hip spica cast. Which interventions should the nurse include in the care plan to prevent physiologic complications in the patient? Select all that apply. 1 Providing a high-calorie, high-protein diet 2 Encouraging social contact with other patients 3 Encouraging the patient to sit upright whenever possible 4 Advising the patient to rest on a pressure-reduction mattress 5 Suggesting that a family member stay overnight with the patient

1 - Providing a high-calorie, high-protein diet 3 - Encouraging the patient to sit upright whenever possible 4 - Advising the patient to rest on a pressure-reduction mattress Immobilization can lead to anorexia due to decreased gastrointestinal function. A high-protein, high-calorie diet should be given to the patient to maintain body functions. Immobilization can impair kidney function, so the patient is made to sit upright to maintain bowel and bladder function. The patient should be made to rest on a pressure-reduction mattress to prevent skin breakdown. Social interaction with other patients, friends, and family should be encouraged for the psychological well-being of the patient. A parent or sibling should be allowed to stay overnight with the patient to avoid family disruption caused due to hospitalization. These interventions aim at reducing psychological distress in the patient but do not prevent physiologic complications.

A child has been recently diagnosed with cerebral palsy (CP), and the nurse is explaining how to care for the child to the child's parents. What major areas should the nurse focus on when speaking with the parents? Select all that apply. 1 Reinforce the therapeutic plan and activities necessary for the child. 2 Reinforce genetic counseling and family planning in group meetings. 3 Provide guidance on devising and modifying equipment and activities. 4 Provide guidance on the immunization procedure and insulin treatment. 5 Reinforce correct handling, home care, and role change from parent to caregiver.

1 - Reinforce the therapeutic plan and activities necessary for the child. 3 - Provide guidance on devising and modifying equipment and activities. 5 - Reinforce correct handling, home care, and role change from parent to caregiver. The nurse should reinforce the therapeutic plan and activities necessary for the child. The nurse should also assist the family in devising and modifying equipment and activities to continue the therapy program at home. All family members should be trained on proper handling, home care, and change of role from parent to caregiver. This is done so that the change of role can be properly melded with the already established relationship between the child and the family members. Genetic counseling is recommended for mothers who have borne a child with neural tube defect. It is not necessary to provide guidance on the immunization procedure and insulin treatment. A child with CP receives immunizations like a healthy child.

The primary health care provider asks the nurse to watch for signs of developing hydrocephalus in a toddler with spina bifida. The nurse should look for what signs? 1 Temperature instability, irritability, and lethargy, and elevated intracranial pressure 2 Intactness of the membranous cyst, anal reflex inactivity, and motor or sensory impairment 3 Behavioral instability, and inactivity in spinal cord reflex and limb movement with stimuli 4 Cognitive impairment, pain, and tension or bulging in any part of the body

1 - Temperature instability, irritability, and lethargy, and elevated intracranial pressure Early signs of hydrocephalus include signs of infection, such as temperature instability (axillary), irritability, and lethargy, and elevated intracranial pressure. Children with spina bifida are placed in an incubator so their temperature can be maintained without clothing. Signs of intactness of the membranous cyst, anal reflex inactivity, and motor or sensory impairment leading to immobility are not signs of developing hydrocephalus. Similarly, behavioral instability, impaired limb movement in conjunction with stimuli, and spinal cord reflex inactivity also are not signs of developing hydrocephalus. In addition to this, cognitive impairment, pain, and tension or bulging in any part of the body are also looked for, but these are not signs of developing hydrocephalus.

What orthopedic finding suggests the presence of developmental dysplasia of the hip (DDH)? 1 The affected limb shorter than the other 2 Has a limited ability to adduct the affected leg 3 Narrowing of the perineum with an anal stricture 4 Inability to palpate movement of the femoral head

1 - The affected limb shorter than the other The affected leg appears to be shorter because the femoral head is displaced upward. There is a limited ability to abduct, not adduct, the affected leg. An anal stricture is not expected with DDH. When the femoral head slips out of the acetabulum, it is easily palpable.

A 4-month-old infant has been diagnosed with developmental dysplasia of the hip (DDH). What appropriate intervention will follow the diagnosis? 1 The baby will be set up to be fitted with a Pavlik harness. 2 The baby will be tightly swaddled in warm blankets. 3 The baby will be strapped to a cradleboard. 4 The baby will be scheduled time to sit in an infant seat.

1 - The baby will be set up to be fitted with a Pavlik harness. Of the numerous devices available, the Pavlik harness is the most widely used; and with time, motion, and gravity, the hip works into a more abducted, reduced position. The Pavlik harness promotes hip abduction and flexion. Swaddling limits hip abduction and puts stress on the hip joint. Strapping the infant to a cradleboard limits hip abduction and puts stress on the hip joint. Although placing the infant in an infant seat allows movement in the flexed position, it does not promote abduction.

The pediatric clinic nurse completes an assessment on a 4-month-old infant brought in because the parents are concerned that something is "just not right" with their baby. To which assessment findings should the nurse alert the health care provider? Select all that apply. 1 Inability to sit up without support 2 Poor head control and clenched fists 3 Inability to crawl 4 Failure to smile 5 Extreme irritability

2 - Poor head control and clenched fists 4 - Failure to smile 5 - Extreme irritability The infant would not be expected to sit up without support until 6 or 7 months old. Crawling would not be an expected finding in a 4-month-old infant. Early signs of cerebral palsy include failure to meet any developmental milestones such as rolling over, raising head, sitting up, crawling; persistent primitive reflexes such as Moro, asymmetric tonic neck reflex; poor head control (head lag) and clenched fists after 3 months old; stiff or rigid arms or legs; scissoring legs; pushing away or arching back; stiff posture; floppy or limp body posture, especially while sleeping; inability to sit up without support by 8 months; using only one side of the body or only the arms to crawl; feeding difficulties; persistent gagging or choking when fed; after 6 months old, tongue pushing soft food out of the mouth; extreme irritability or crying; failure to smile by 3 months old; and lack of interest in surroundings.

A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. What is a priority nursing intervention? 1 Recommend allergy testing. 2 Provide a latex-free environment. 3 Use only powder-free latex gloves. 4 Limit use of latex products as much as possible.

2 - Provide a latex-free environment. Providing a latex-free environment is the most important nursing intervention. From birth on, limiting exposure to latex is essential in an attempt to minimize sensitization. Allergy testing may expose the child to the allergen; it is not recommended. Powder-free latex gloves contain latex and will contribute to sensitization. Latex products should be avoided.

A 3-year-old male child has cerebral palsy and is currently hospitalized for orthopedic surgery. His mother says that he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. What is the most appropriate nursing action related to feeding this child? 1 Bottle- or tube-feed him a specialized formula until he gains sufficient weight. 2 Stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing. 3 Place him in a well-supported, semireclining position to make use of gravity flow. 4 Place him in a sitting position with his neck hyperextended to make use of gravity flow.

2 - Stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing. The neuromuscular compromise of the jaw interferes with the child's ability to eat. Because the jaw is compromised, more normal control can be achieved if the feeder provides stability. Manual jaw control assists with head control, correction of neck and trunk hyperextension, and jaw stabilization. Age 3 is too old for bottle-feeding. The child should be sitting up for meals. For swallowing, the neck should not be hyperextended.

The nurse is assessing the level of neurologic involvement in a child with spina bifida (SB). What are the most appropriate areas for assessment? Select all that apply. 1 Determine cognitive impairment. 2 Assess behavioral modification. 3 Measure skin response, especially anal reflex. 4 Assess the limb movement with stimulus. 5 Evaluate urinary retention and bladder distention.

3 - Measure skin response, especially anal reflex. 4 - Assess the limb movement with stimulus. 5 - Evaluate urinary retention and bladder distention. An important nursing care approach of infants with SB is assessing the level of neurologic involvement. This is done by measuring the skin response, especially the anal reflex. Moreover, limb movement in conjunction with stimulus is observed. The nurse also assesses for urinary retention and bladder distention. Cognitive development in most of the children with SB is near normal and would not be assessed for neurologic involvement. Any modification in the child's behavior is also uncommon. The most common issues include hydrocephalus, paralysis, orthopedic deformities, meningitis, seizures, and hypoxia, which are due to neurologic impairment.

What is a defining characteristic of scoliosis? 1 The concave lumbar curvature present is immensely exaggerated. 2 There is a long-term bacterial infection present in the vertebrae. 3 There is a rotary deformity of the lateral curvature of the spine. 4 The thoracic spine has an increased convex angulation.

3 - There is a rotary deformity of the lateral curvature of the spine. Scoliosis is the most common spinal deformity. A rotary deformity of the lateral curvature of the spine is the correct description of scoliosis. A concave lumbar curvature that is exaggerated is a description of lordosis. There are no bacterial infections in the vertebrae with scoliosis. A curvature of the thoracic spine that has an increased convex angulation is a description of kyphosis.

A home care nurse is caring for a 4-month-old infant with developmental dysplasia of the hip (DDH). The baby is in a Pavlik harness. The baby's mother tells the nurse, "I don't think my baby will be able to sleep while wearing the harness." What is an appropriate response by the nurse? 1 "The harness can be removed during a short 30-minute nap." 2 "You can reapply the harness after the baby falls asleep." 3 "It is important for the harness to be worn continuously." 4 "You can have the baby not take one of the daily naps."

3 - "It is important for the harness to be worn continuously." The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination, usually in 6 to 12 weeks. Some practitioners permit its removal for bathing. Removal or re-application of the harness will probably awaken the infant. Babies should not be prevented from taking naps, as such naps are essential for good health.

A nurse is caring for a young infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? Select all that apply. 1 Lordosis 2 Negative Babinski sign 3 Asymmetric thigh and gluteal folds 4 Positive Ortolani and Barlow tests 5 Shortening of limb on affected side

3 - Asymmetric thigh and gluteal folds 4 - Positive Ortolani and Barlow tests 5 - Shortening of limb on affected side Asymmetric thigh and gluteal folds are a clinical manifestation of DDH and seen from birth to 2 months old. Positive Ortolani and Barlow tests are clinical manifestations of DDH. The Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation.The Barlow test is the adducting to feel if the femoral head slips out of the socket posterolaterally. Shortening of limb on affected side is another clinical manifestation of DDH. Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH. A negative Babinski sign is not a clinical manifestation of DDH. It is a neurologic reflex.

A parent brings her 8-month-old infant to the clinic for a well-child visit. The parent reports that the infant has not yet rolled over, has poor head control, and is using only one side of the body when trying to crawl. During the assessment, the nurse notes the infant also has stiff arms and scissoring of the legs. What diagnosis does the nurse expect the health care provider to give to the parents? 1 Tetanus 2 Spina bifida (SB) 3 Cerebral palsy (CP) 4 Duchenne muscular dystrophy (DMD)

3 - Cerebral palsy (CP) The infant's failure to meet the developmental milestones, such as the inability to roll over, poor head control, and use of only one side of the body, are all early warning signs of CP. Early symptoms of tetanus include progressive stiffness in neck and jaw muscles, along with difficulty in opening the mouth. SB is a condition in which abnormalities occur in the neural tube. DMD is a form of progressive muscle disease. Children with DMD typically reach their appropriate developmental milestones.

An 8-year-old female child is diagnosed with moderate cerebral palsy (CP). She recently began participation in a regular classroom for part of the day. Her mother asks the school nurse about having her daughter join the after-school Girl Scout troop. On what knowledge should the nurse's response be based? 1 Most activities such as Girl Scouts cannot be adapted for children with CP. 2 After-school activities usually result in extreme fatigue for children with CP. 3 Trying to participate in activities such as Girl Scouts leads to lowered self-esteem in children with CP. 4 After-school activities often provide children with CP opportunities for socialization and recreation.

4 - After-school activities often provide children with CP opportunities for socialization and recreation. Recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs. Most activities can be adapted for children. The child, family, and activity director should assess the degree of activity to ensure that it meets the child's capabilities. A supportive environment will add to the child's self-esteem.

A 2-month-old infant has been diagnosed with developmental dysplasia of the hip. The health care provider has prescribed immediate treatment for the baby using a Pavlik harness. What is the rationale behind this urgency? 1 Mobility will be delayed if correction is postponed. 2 Traction is effective if it is used before toddlerhood. 3 Infants are easier to manage in spica casts than are toddlers. 4 It is easier to get the hip into a more abducted position.

4 - It is easier to get the hip into a more abducted position. In infants, with time, motion, and gravity, the hip works into a more abducted, reduced position with the help of a Pavlik harness. The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination. Congenital hip dysplasia does not limit ambulation for the young child, although the gait will be affected. Traction is not used to correct developmental dysplasia of the hip. Although casted infants are easier to manage than toddlers, this is not the key reason for early treatment.

What is an important nursing intervention when caring for a child with myelomeningocele in the postoperative stage? 1 Place child on his or her side to decrease pressure on the spinal cord. 2 Apply a heat lamp to facilitate drying and toughening of the sac. 3 Keep skin clean and dry to prevent irritation from diarrheal stools. 4 Measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.

4 - Measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus. Hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of head circumference will aid in early detection. Before surgery, the child is kept in a prone position to decrease tension on the sac and reduce risk of trauma. The sac must be kept moist. Sterile, moist, nonadherent dressings are placed over the sac. Most infants do not have diarrheal stools.

What do the major goals of therapy for children with cerebral palsy include? 1 Reversing degenerative processes that have occurred 2 Curing underlying defect causing the disorder 3 Preventing spread to individuals in close contact with the child 4 Recognizing the disorder early and promoting optimal development

4 - Recognizing the disorder early and promoting optimal development Because cerebral palsy is currently a permanent disorder, the goal of therapy is to promote optimal development. This is done through early recognition and beginning of therapy. It is very difficult to reverse degenerative processes. The underlying defect cannot be cured. Cerebral palsy is not contagious.