Peds- Chapter 44, Mobility, Neuromuscular Disorder peds

The nurse is providing presurgical care for a newborn with myelomeningocele. Which action is the central nursing priority? a) Maintain infant in prone position b) Maintain infant's body temperature c) Keep lesion free from fecal matter or urine d) Prevent rupture or leaking of cerebrospinal fluid

Prevent rupture or leaking of cerebrospinal fluid

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? a) Inspect for precocious hair growth in the genital and underarm areas b) Record and refer the finding for follow-up to the pediatrician c) Move on to other assessments without calling attention to the difference d) Snip the tuft of hair off close to the skin for hygienic reasons

Record and refer the finding for follow-up to the pediatrician

What classification system is used to describe fractures involving the growth plate?

Salter-Harris

What is the most vulnerable portion of the child's bone and is frequently the site of injury?

The growth plate

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. 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.

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

The nurse should monitor for decreased circulation every 4 hours. 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. 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 assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? a) Risk for injury related to lack of muscle control b) Ineffective coping related to diagnosis of chronic condition c) Impaired physical mobility related to spinal cord defect d) Deficient knowledge related to diagnosis and condition

Deficient knowledge related to diagnosis and condition

Refers to abnormalities of the developing hip that include dislocation, subluxation, and dysplasia of the hip joint. In DDH, the femoral head has an abnormal relationship to the acetabulum. -May affect just one or both hips.

Developmental Dysplasia of the Hip (DDH)

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

Diazepam Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Narcotic analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.

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?

Drainage on the cast Drainage on the cast could indicate an infection. Pale fingers would suggest impaired circulation. Delayed capillary refill would suggest impaired circulation. Diminished pulse would suggest impaired circulation.

The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which finding would help confirm this diagnosis? A) Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B) A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C) A high-pitched "click" is heard with hip flexion or extension. D) The thigh and gluteal folds are symmetric.

B. A distinct "clunk" is heard with Barlow and Ortolani maneuvers. Rationale: A distinct "clunk" while performing Barlow and Ortolani maneuvers is caused as the femoral head dislocates or reduces back in to the acetabulum. A higher-pitched "click" may occur with flexion or extension of the hip. This is a benign, adventitious sound that should not be confused with a true "clunk" when assessing for developmental dysplasia of the hip. Abduction to 75 degrees, adduction within 30 degrees, and symmetric thigh and gluteal folds are normal findings. Reference: p. 1616

The nurse is assessing a child with a possible fracture. What would the nurse identify as the most reliable indicator? A) Lack of spontaneous movement B) Point tenderness C) Bruising D) Inability to bear weight

B. Point tenderness Rationale: Point tenderness is one of the most reliable indicators of a fracture in a child. Neglect of an extremity, inability to bear weight, bruising, erythema, and pain may be present, but these findings can also suggest other conditions. Reference: p. 1593

A nurse is caring for an 11-year-old with an Ilizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction?

"Cleansing by showering should be sufficient." The Ilizarov fixator uses wires that are thinner than ordinary pins, so simply cleansing by showering is usually sufficient to keep the pin site clean.

A higher-pitched "click" may occur with flexion or extension of the hip. When assessing for DDH, DO NOT confuse this benign, adventitial sound with a true " __________"

"Clunk"

The nurse is caring for 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? 1. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." 2. "I know it will be important for me to catheterize my child for the rest of his life." 3. "I will make sure that I always use latex-free catheters." 4. "I will wash the catheter with warm soapy water a

"I know it will be important for me to catheterize my child for the rest of his life."

The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which response from his mother indicates a need for further teaching? A) "He needs to get a medical alert identification." B) "I will need to discuss this with his caregivers." C) "A product's label indicates whether it is latex-free." D) "He must avoid all contact with latex."

C) "A product's label indicates whether it is latex-free." Rationale: The Food and Drug Administration (FDA) requires that all medical supplies be labeled if they contain latex, but this is not the case with consumer products. The mother must be familiar with products that contain latex. The Spina Bifida Association of America maintains an updated list of latex-containing products. Getting a medical alert identification, talking with his caregivers, and avoiding all contact with latex are correct. Reference: p. 1610

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

"Pale, cool, or blue skin coloration is to be expected." It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct.

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? a) "Older age at conception is one of the major causes of the defect." b) "It has been linked to maternal alcohol consumption during pregnancy." c) "It's a common complication of amniocentesis." d) "The cause is unknown and there are many environmental factors that may contribute to it."

"The cause is unknown and there are many environmental factors that may contribute to it."

The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state: a) "Before inserting the catheter, we need to wipe her labia with normal saline from back to front." b) "We need to insert the catheter about 6 inches so that we make sure the catheter is in the bladder." c) "We need to apply some petroleum jelly to her l

"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information? a) "Has he achieved his developmental milestones on time?" b) "Has his pace of achieving milestones diminished?" c) "Do you think he is simply fatigued?" d) "Would you please describe the weakness you are seeing in your son?"

"Would you please describe the weakness you are seeing in your son?"

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.

- Color - Sensation - Pulse - Capillary refill 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 nurse is caring for a child who fractured his harm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.

- Document any signs of pain. - Check radial pulse in the both arms. - Monitor the color of the nail beds in the right hand. Monitoring for signs of pain, decreased circulation, or change or variation in pulses in the extremity is important for the child in a cast. Pain can indicate serious complications, such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary. Checking posterior pulses would be appropriate when a lower extremity is casted.

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. - New drainage is seeping out from under the cast. - The boy's toes are light blue and very swollen. The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (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.

Physical assessment of DDH includes: SATA A) Inspection B) Observation C) Palpation D) Percussion

A) Inspection B) Observation C) Palpation

Any type of fracture can be the result of child abuse, but which types particularly in the child younger than 2 years of age, should ALWAYS be investigated to rule out the possibility of abuse? A) Rib Fractures B) Humerus fractures C) Arm fractures D) Spiral Femur fractures

A) Rib Fractures B) Humerus fractures D) Spiral Femur fractures

Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step.

False If a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step, the head of the radius may escape the ligament surrounding it and become dislocated (nursemaid's elbow). Fracture of the femur is rare and is typically caused by an automobile accident, a fall from a considerable height, or child maltreatment.

The nurse is teaching a health and wellness course to young women of childbearing age. Which vitamin will the nurse encourage all to take daily? a) Folic acid b) Niacin c) Ascorbic acid d) Calcium

Folic acid

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? a) Folic acid above 0.4 mg/day b) Ascorbic acid to 4 mg/day c) Folic acid to 0.4 mg/day d) Ascorbic acid to 0.4 mg/day

Folic acid above 0.4 mg/day

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? a) Inspection of the cystic sac on the child's back for leakage b) Auscultation for bowel sounds c) Listening for a shrill cry d) Careful supine positioning

Inspection of the cystic sac on the child's back for leakage

Which characteristic is true of cerebral palsy? a) It's progressive. b) It's reversible. c) It results in mental retardation. d) It appears at birth or during the first 2 years of life.

It appears at birth or during the first 2 years of life.

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

Latex 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 type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction. Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction.

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 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.

The child has a meningocele and a neurogenic bladder. Which of the following topics should the nurse include in the teaching plan when educating the child and the child's caregivers? Select all that apply. a) Signs and symptoms of a urinary tract infection b) Different types of surgeries used to treat this condition c) The importance of antibiotic use to prevent urinary tract infections from occurring d) How and when to perform clean intermittent urinary catheterization e) How and when

• How and when to administer oxybutynin chloride • How and when to perform clean intermittent urinary catheterization • Signs and symptoms of a urinary tract infection • Different types of surgeries used to treat this condition

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? a) "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life." b) "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." c) "It has little influence on the intellectual and perceptual abilities of the child." d)

"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching? a) "I can palpate his abdomen to assess for constipation" b) "My son's activity is too limited to stimulate his bowels." c) "He must have an adequate amount of fluid." d) "I need to figure out his usual pattern for passing stool."

"My son's activity is too limited to stimulate his bowels."

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents? a) "Your child cannot properly control holding urine or emptying the bladder. " b) "While your child is young, urine leaking from the bladder will not be a problem because diapering is expected." c) "Your child dribbles urine because the bladder either is overactive, pushing urine out, or is not active enough, becoming overfilled and causing urine to le

"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection."

A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching? a) "We must be careful to use latex-free catheters." b) "My son may someday learn how to do this for himself." c) "We need to soak the catheter in a vinegar and water solution daily." d) "The very first step is to apply water-based lubricant to the catheter."

"The very first step is to apply water-based lubricant to the catheter."

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:

"These make a smooth edge on the cast so the skin is better protected." If the cast has no protective edge, it should be petaled with adhesive tape strips. These help keep the skin protected from the rough edge of the cast. If the cast is near the genital area, plastic should be taped around the edge to prevent wetting and soiling of the cast; petaling the cast does not provide protection to keep the cast dry.

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond? a) "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." b) "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica." c) "This could be an indicator of spina bifida; we need to evaluate this furth

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."

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 in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Spiral fractures, which twist around the bone, are frequently associated with child abuse 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.

What is included in inspection/observation of child? SATA A) Motor function B) Reflexes C) Speech D) Sensory Function

A) Motor function B) Reflexes D) Sensory Function

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

Adolescence Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

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

Advise the child that this is to be expected. Plaster becomes hot as it sets. This effect is reduced with newer plastic casts. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, notify the provider. Infection would not present in this way with a cast application. Never moisten a cast.

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast?

Assess the fingers for warmth, pain, and function Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Before a cast is applied, not after, a tube of stockinette is stretched over the area, and soft cotton padding is placed over bony prominences. A "window" may be placed in a cast for an open fracture or if an infection is suspected—not to prevent an infection—so that the area can be observed; however, a window is not indicated in this case. The x-ray should be performed before casting, to diagnose the fracture, not afterward.

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

Assuming the usual feeding position will be difficult.

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

Auscultation 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.

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

B. Epiphysis Rationale: Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis. Reference: p. 1589

An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast? A) The cast will take a day or two to dry completely. B) The edges will be covered with a soft material to prevent irritation. C) The child initially may experience a very warm feeling inside the cast. D) The child will need to keep his arm down at his side for 48 hours.

C. The child initially may experience a very warm feeling inside the cast. Rationale: A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge so they usually do not cause skin rubbing at the edges and don't require petaling. The child should be instructed to elevate his arm above the level of the heart for the first 48 hours. Reference: p. 1599

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? a) Increasing ICP b) Leaking cerebrospinal fluid c) Increasing head circumference d) Constipation and bladder dysfunction

Constipation and bladder dysfunction

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? a) Change position from side to side hourly b) Cover the sac with a saline-moistened dressing c) Keep the mass uncovered and dry d) Prevent cold stress using an Isolette and blankets

Cover the sac with a saline-moistened dressing

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

D. Side arm 90-90 traction Rationale: Side arm 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin traction. Reference: p. 1604

Significant swelling may occur initially after immobilization with a splint. ______________ casting for a few days provides time for some of the swelling to subside, allowing for successful casting a few days after the injury.

Delaying

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects? a) Ultrasound screening at 16 weeks' gestation b) Folic acid supplementation c) Maternal serum α-fetoprotein levels screening d) Genetic testing for gene identification

Folic acid supplementation

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

Greenstick Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks.

The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high-risk for having a child with a myelomeningocele? a) History of a previous abdominal surgery. b) History of asthma taking montelukast. c) History of scoliosis. d) History of a seizure disorder and taking phenobarbital.

History of a seizure disorder and taking phenobarbital.

The ________________ infant will feel rigid, extending the trunk and legs.

Hypertonic

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

Impaired physical mobility related to a cast on the leg 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.

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

It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms . It is important to have the adolescent understand the treatment and how the treatment will benefit them currently. Body bracing helps to hold the spine in alignment and prevent further curvature decreasing symptoms. The brace will not correct the problem. Herniation and torticollis are not associated with scoliosis.

A ___________ free environment should be created for all procedures performed on children with myelomeningocele to prevent allergy.

Latex

Sensitivity to __________ or natural rubber is very common among children with myelomeningocele.

Latex

Children who are at high risk for latex sensitivity should wear a _____________ alert identification.

Medical

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse?

Notify the health care provider of the findings immediately. Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.

The nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which action would be most appropriate to help reduce friction resulting from this paralysis? a) Place the child on a special care mattress. b) Place a pad beneath the diaper area and change frequently. c) Place a folded diaper in between the legs. d) Place synthetic sheepskin under the infant's chest.

Place a folded diaper in between the legs.

Note sluggish or brisk deep tendon reflexes. Note persistence of primitive reflexes in the older infant or child, such as Moro or tonic neck.

Reflexes

The capacity for ________________ (the process of breaking down and forming new bone) is increased in children as compared with adults. This means the straightening of the bone over time occurs more easily in children.

Remodeling

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? a) Risk for impaired skin integrity b) Disorganized infant behavior c) Peripheral neurovascular dysfunction d) Risk for activity intolerance

Risk for impaired skin integrity

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

Risk for impaired skin integrity The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele? a) Impaired physical mobility b) Delayed growth and development c) Risk for infection d) Constipation

Risk for infection

Alterations in what function accompany many neuromuscular disorders? -Assess similarly to adults- light touch, pain, vibration, heat, cold, all should be distinguishable by a child. -Usually child should withdrawal from the stimulus.

Sensory function

Which diagnostic measure is most accurate in detecting neural tube defects? a) Flat plate of the lower abdomen after the 23rd week of gestation b) Significant level of alpha-fetoprotein present in amniotic fluid c) Presence of high maternal levels of albumin after 12th week of gestation d) Amniocentesis for lecithin-sphingomyelin (L/S) ratio

Significant level of alpha-fetoprotein present in amniotic fluid

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

Spica cast 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.

Which type of spinal neural tube defect does the nurse recognize as common and usually benign? a) Meningocele b) Spina bifida c) Spina bifida occulta d) Myelomeningocele

Spina bifida occulta

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

Trendelenburg gait The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition.

A neonatal nurse examines an infant and notes decreased hip motion that causes pain upon movement. This nurse suspects Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity.

True Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 1,200 live births, with some hereditary factors influencing incidence.

The nurse is caring for a child who has had an open reduction with cast placement on the forearm. While assessing the cast, the nurse notes serosanguineous fluid on the cast. What action by the nurse is appropriate?

Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined. Although oozing of serosanguineous fluid after an open reduction is a common, it does need to be noted and documented. The nurse should outline the stain with a ballpoint pen or crayon rather than a marker, mark the time so it can be determined how rapidly the spot is increasing. If the stain is small, notification of the health care provider and replacement of the cast is not necessary.

A 5-year-old girl, diagnosed with myelomeningocele, is admitted to the hospital for a corrective surgical procedure. Choose four questions below that the nurse shouls ask when obtaining the health history that would assist in planning the child's care? 1. What is the child's current mobility status? 2. Is there a family hx of myelomeningocele? 3. What is the child's genitorurinary and bowel function and regimen? 4. Does this child have a hx of hydrocephalus with presence of shunt? 5. Does she h

What is the child's current mobility status? What is the child's genitorurinary and bowel function and regimen? Does this child have a hx of hydrocephalus with presence of shunt? Does she have kown latex sensitivity? (These questions will help develop a plan of care for the girl)

The closer the fracture is to the growth plate (epiphysis), the more quickly the fracture _______________.

heals

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

• Prone • Left side lying • Right side lying

Common drugs for neuromuscular disorders include which of the folllowing? SATA A) Benzodiazepines (diazepam, lorazepam) B) Baclofen (oral or intrathecal) C) Corticosteroids D) Botulin toxin E) Acetaminophen F) Narcotic analgesics G) NSAIDS (ibuprofen, ketorlac) H) Bisphosphonate I) Oxytocin

A) Benzodiazepines (diazepam, lorazepam) B) Baclofen (oral or intrathecal) C) Corticosteroids D) Botulin toxin E) Acetaminophen F) Narcotic analgesics G) NSAIDS (ibuprofen, ketorlac) H) Bisphosphonate

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

Complete If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

During this part of the assessment for the child with DDH the nurse should: - Ensure the infant is on a flat surface and is relaxed - Note asymmetry of thigh or gluteal folds w/infant in prone position - Document shortening of affected femur observed as limb-length discrepancy. - Older children may exhibit Trendelenburg gait- due to weakness of hip abductors, child's trunk is shifted over the affected hip during ambulation

Inspection and Observation

During observation of what, you should observe spontaneous activity, posture, and balance, and assess for asymmetric movements? -Infant's posture should be slightly flexed, and should be able to extend extremitites to a normal stretch.

Motor function

During this part of the assessment for the child with DDH the nurse should: - Note limited hip abduction while performing passive range of motion. - Abduction should normally= 75 degrees; adduction= 30 degrees w/child's pelvis stabilized - Perform Barlow and Ortolani tests, feeling for, or noting a "clunk" as the femoral head dislocates (positive Barlow) or reduces (positive Ortolani) back into the acetabulum. - Force is NOT necessary when performing the Barlow and Ortolani maneuveurs.

Palpation

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

epiphysiolysis of the proximal humerus. 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 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.

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns?

"This is not your fault and we will help you with her care and treatment." Because the mother is crying and experiencing the initial shock of the diagnosis, the nurse's primary concern is to support the mother and assure her that she is not to blame for the DDH. While education is important, the nurse should let the mother adjust to the diagnosis and assure her that the baby and her family will be supported now and throughout the treatment period.

Preventing complications for children confined to bed in traction includes: SATA A) Ensure that unaffected extremities are exercised to prevent contractures (shortening and hardening of muscles, tendons, or tissues leading to fixated and stiff joints) and atrophy may result from disuse of muscles. B) Assist child to exercise the unaffected joints and to use the unaffected extremity if this does not disrupt traction alignment. C) Place age-appropriate toys w/in child's reach D) Encourage visits

A) Ensure that unaffected extremities are exercised to prevent contractures (shortening and hardening of muscles, tendons, or tissues leading to fixated and stiff joints) and atrophy may result from disuse of muscles. B) Assist child to exercise the unaffected joints and to use the unaffected extremity if this does not disrupt traction alignment. C) Place age-appropriate toys w/in child's reach D) Encourage visits from friends E) Provide diversional activities such as drawing, coloring, or video games

Preventing Infection for the child with Myelonmeningocele includes: SATA A) Prevent rupture/leakage of CSF from the sac B) Use sterile saline-soaked nonadhesive gauze or antibiotic soaked gauze to keep sac moist C) Immediately report any seepage of clear fluid from lesion (could indicate an opening in sac/provide portal of entry for microorganisms) D) To keep infant warm, place infant in warmer or isolette to avoid use of blankets, which could exert too much pressure on the sac. E) Keep lesio

A) Prevent rupture/leakage of CSF from the sac B) Use sterile saline-soaked nonadhesive gauze or antibiotic soaked gauze to keep sac moist C) Immediately report any seepage of clear fluid from lesion (could indicate an opening in sac/provide portal of entry for microorganisms) D) To keep infant warm, place infant in warmer or isolette to avoid use of blankets, which could exert too much pressure on the sac. E) Keep lesion free of feces and urine to help avoid infection. F) Position infant so that urine and feces flow away from the sac (prone position, or place a folded towel under abdomen) to help prevent infection G) Place piece of plastic wrap below the meningocele can also prevent feces from coming into contact with lesion H) After surgery, position infant in the prone or side-lying position to allow the incision to heal.

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

A. Sluggish deep tendon reflexes Rationale: Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality. The newborn is capable of spontaneous movement but lacks purposeful control. Full range of motion is present at birth. Healthy infants and children demonstrate normal muscle tone; hypertonia or hypotonia is an abnormal finding. Reference: p. 1588

Physical examination on children with scoliosis include which of the following? SATA A) Observe child at rest, sitting, and standing for evidence of poor posture B) Inspect child's back in standing position. C) Note asymmetries such as shoulder elevation, prominence of scapula, uneven curve at waistline, or a rib hump on one side. D) Measure shoulder levels from floor to the acromioclavicular joints. E) With child bending forward, arms hanging freely, note asymmetry of back (pronounced hip o

ALL OF THE ABOVE! A) Observe child at rest, sitting, and standing for evidence of poor posture B) Inspect child's back in standing position. C) Note asymmetries such as shoulder elevation, prominence of scapula, uneven curve at waistline, or a rib hump on one side. D) Measure shoulder levels from floor to the acromioclavicular joints. E) With child bending forward, arms hanging freely, note asymmetry of back (pronounced hip on one side) F) Note leg-length discrepancy if present G) During neurological exam- balance, motor strength, sensation, and reflexes should all be normal.

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

B. A young child's bones commonly bend instead of break with an injury. Rationale: A young child's bones are more flexible and more porous with a lower mineral count than adults. Thus, bones will often bend rather than break when an injury occurs. The growth plate is composed of the epiphysis and physis. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply. Reference: p. 1589

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

C) Increased mobility of the spine Rationale: Compared to the adult, a child's spine is very mobile, especially in the cervical spine region, resulting in a higher risk for cervical spine injury. Exposure to teratogens in utero may lead to altered growth and development of the brain or spinal cord. Immaturity of the central nervous system places the infant at risk for insults that may result in delayed motor skill attainment or cerebral palsy. Incomplete myelinization reflects the lack of motor control. Reference: p. 1588

The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A) "I know it is boring, but you must remain immobile for 2 more weeks." B) "If there are no complications, you only have 2 more weeks here." C) "Let's

C. "Let's come up with things for you to do and see if your friends can come visit." Rationale: After 2 weeks in traction, an adolescent can become easily bored and isolated from usual peer interaction. The most helpful intervention would be to engage the help of the client to develop a list of books, games, movies, and other activities the client would enjoy. The nurse should also encourage visitation and phone calls from friends. Telling the client friends can come spend the night in the hospital is not most appropriate as minors are not typically encouraged to stay overnight. Telling the adolescent the condition will worsen if the client resists treatment is threatening and inappropriate. Reference: p. 1590-1591

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

C. Spiral fracture Rationale: A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse. Reference: p. 1640

During palpation, a ________________ infant will feel as though he/she is slipping through the examiner's hands.

Hypotonic

The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis? A) Risk for impaired skin integrity due to cast and location B) Deficient knowledge related to cast care C) Risk for delayed development related to immobility D) Self-care deficit related to immobility

A. Risk for impaired skin integrity due to cast and location Rationale: Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown. Reference: p. 1597-1598

The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningeocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year.

What allows for the visualization of the femoral head and the outer edge of the acetabulum? -This falls into lab/diagnostic testing for children with DDH What also can be used in the infant or child older than 6 months of age to determine DDH?

-Ultrasound -Plain Hip X-rays

A 10-year-old girl is brought to the emergency department by her father after tripping over a rock while running in the yard. She tells the nurse, "I think I twisted my ankle." When assessing the child, what would the nurse most likely assess? A) Bruising B) Edema C) Limited range of motion D) Absent pulse

B) Edema The girl is describing a sprain, which is frequently accompanied by edema. Bruising may or may not be present. The nurse should not attempt to perform passive range of motion on the affected body part. A pulse should be present; if one is not, neurovascular compromise is present.

A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state:

A child's bones heal more quickly than those of an adult. Bone healing occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.

The nurse is caring for an 8-month-old in Bryant traction for developmental dysplasia of the hip and is monitoring for complications. Which assessment finding would alert the nurse to a possible complication?

A weak pedal pulse A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Brisk capillary refill is a normal finding. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically. Bryant traction is a type of skin traction and does not use pins.

Anatomic areas of growing bone include: SATA A) Metatarsal B) Metaphysis C) Diaphysis D) Growth plate (physis) E) Epiphysis

B) Metaphysis C) Diaphysis D) Growth plate (physis) E) Epiphysis

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A) "I will help you become comfortable in caring for your daughter." B) "You must learn how to care for your daughter at home." C) "You will need to learn to collaborate with all the caregivers." D) "T

A) "I will help you become comfortable in caring for your daughter." Rationale: The nurse needs to empower families to become the experts on their child's needs and conditions via education and participation in care. The most positive approach is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs to collaborate with the caregivers is true, but does not address her fears. Reference: p. 1611

Educating parents for children with muscular dystrophy includes which of the following? SATA A) Teach parents the use of positioning, exercises, orthoses, and adaptive equipment. B) Use of a wheelchair full time typically by age 12 C) Administer corticosteroids and calcium supplements as ordered D) Encourage at least minimal weight bearing in a standing position to promote improved circulation, healthier bones, and a straight spine. E) Perform passive stretching/strengthening exercises as rec

A) Teach parents the use of positioning, exercises, orthoses, and adaptive equipment. B) Use of a wheelchair full time typically by age 12 C) Administer corticosteroids and calcium supplements as ordered D) Encourage at least minimal weight bearing in a standing position to promote improved circulation, healthier bones, and a straight spine. E) Perform passive stretching/strengthening exercises as recommended by physical therapist. F) Position child for maximum chest expansion usually in upright position. G) Teach family deep-breathing exercises to strengthen/maintain respiratory muscles and encourage coughing to clear the airways. H) Develop a schedule for diversional activities that provide appropriate developmental stimulation but avoid overexertion or frustration. I) Administer antidepressants as ordered; managing depression may increase the child's desire to participate in activities and self-care.

A child is brought to the clinic after tripping over a rock. The child states "I twisted my ankle" and is given a diagnosis of a sprain. What intervention is most important for the nurse to include in the discharge instructions for this child? A. For the first 24 hours apply ice for 20 minutes and remove for 60 minutes B. Bedrest with leg elevated for 36 hours C. May take an NSAID for pain as prescribed D. Use compression dressing for 72 hours

A. For the first 24 hours apply ice for 20 minutes and remove for 60 minutes Rationale: A sprain results from twisting or a turning motion of the affected body part. Usually that is an ankle or a knee. The tendons and ligaments stretch excessively and may tear slightly. Edema, bruising and the inability to bear weight are the most common symptoms. Interventions for care include RICE (rest, ice, compression, elevation), activity restrictions and/or splints or crutches. The most important intervention is the use of RICE. In this process the ice is applied for 20-30 minutes and then removed for 60 minutes. This can be done for up to 48 hours. This causes vasoconstriction to decrease the pain and swelling. Bedrest is not required, only limiting activities. Compression dressings, such as an elastic wrap are used, but there is no time limit as to how long they are needed. It depends upon the amount of swelling decreases. NSAIDs may be taken for pain if needed but the ice will produce a bett

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A) Notifying the doctor immediately B) Applying ice C) Elevating the arm D) Giving additional pain medication as ordered

A. Notifying the doctor immediately Rationale: The nurse should notify the doctor immediately because the girl's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation. Reference: p. 1640

The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first? A) Reposition the child's foot on a pressure-reducing device. B) Apply lotion to his foot to maintain skin integrity. C) Make sure the skin is clean and dry. D) Gently massage his foot to promote circulation.

A. Reposition the child's foot on a pressure-reducing device. Rationale: The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first. Reference: p. 1590

The school nurse has performed scoliosis screening. Based on this assessment, which children require the nurse to implement a referral to the healthcare provider? Select all that apply. A. The child with asymetric shoulder elevation B. The child with a limb length discrepancy C. The child with a lateral curve of the spine D. The child with a one-sided hump upon bending over E. The child who's sibling had scoliosis surgically corrected F. The child who has uneven balance

A. The child with asymetric shoulder elevation B. The child with a limb length discrepancy C. The child with a lateral curve of the spine D. The child with a one-sided hump upon bending over Rationale: Scoliosis is defined by a lateral curve of the spine greater than 10 degrees. This curve causes displacement of the ribs. The nurse would first inspect the back in a standing position and note any asymmetric shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. While standing the nurse could also assess for leg length discrepancy and this could be measured. The nurse would then have the child bend over and observe for a pronounced hump on one side. The nurse should notify the parents and refer the child to the healthcare provider for evaluation if any of these symptoms are found. The sibling with a scoliosis repair would not be a concern unless it was known the family had a genetic diagnosis. Most scoliosis is idiopathic. Uneven

During this stage of assessment the nurse should listen to the child's lungs; adventitious sounds are often present when respiratory muscle function is impaired.

Auscultation

When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all answers that apply. A) Age younger than 8 years B) African American ethnicity C) History of cystic fibrosis D) Excessive activity E) Obesity

B) African American ethnicity (black race) E) Obesity Rationale: Risk factors associated with slipped capital femoral epiphysis include age between 9 and 16 years, black race, sedentary lifestyle, and being overweight or obese. A history of cystic fibrosis may contribute to rickets. Reference: p. 1631

The nurse is assessing an 11-year-old girl with scoliosis. What would the nurse expect to find? Select all answers that apply. A) Complaints of severe back pain B) Asymmetric shoulder elevation C) Even curve at the waistline D) Pronounced one-sided hump on bending over E) Diminished motor function F) Hyperactive reflexes

B) Asymmetric shoulder elevation D) Pronounced one-sided hump on bending over Assessment findings associated with scoliosis include asymmetric shoulder elevation, uneven curve at the waistline, rib hump on one side, and a pronounced hump on one side when bending over. Typically, only mild back discomfort is found and balance, motor strength, sensation, and reflexes are normal.

A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action? A) Monitoring for a decrease in spasticity B) Observing for signs of meningeal irritation C) Assessing motor function D) Observing for mental confusion or hallucinations

B) Observing for signs of meningeal irritation Rationale: Following myelography, the nurse should carefully observe for signs of meningeal irritation because of what is involved in this procedure. Monitoring for a decrease in muscle spasticity, assessing motor function, and observing for mental confusion or hallucinations is appropriate following an intrathecal test dose of baclofen. Reference: p. 1594

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

B. "We should change the diaper without taking our infant out of the harness." C. "We need to check the area behind our infant's knees for redness and irritation." E. "We need to call the health care provider if our infant is not able to actively kick the legs." Rationale: Instructions related to use of a Pavlik harness include changing the child's diaper while in the harness; checking the areas behind the knees and diaper area for redness, irritation, or breakdown; and calling the health care provider if the child is unable to actively kick the legs. The straps are not to be adjusted without checking with the health care provider first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting (no heat) is used. Reference: p. 1617

What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A) Positioning supine with a pillow under the buttocks B) Covering the sac with saline-soaked nonadhesive gauze C) Wrapping the infant snugly in a blanket D) Applying a diaper to prevent fecal soiling of the sac

B. Covering the sac with saline-soaked non adhesive gauze Rationale: For the infant with a myelomeningocele, saline-soaked non adhesive gauze or antibiotic-soaked gauze is used to keep the sac moist. The infant is positioned prone, with a folded towel under the abdomen, so that the urine and feces flow away from the sac. A warmer or isolette is used to keep the infant warm. Blankets are avoided because they could place excess pressure on the sac. Diapering may be contraindicated to avoid placing pressure on the sac. Reference: p. 1608

The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve? A) Optic B) Facial C) Acoustic D) Trigeminal

B. Facial Rationale: The most common cranial nerve injury occurring during birth trauma involves facial nerve palsy. The optic, acoustic, and trigeminal nerves are not typically injured during birth trauma. Reference: p. 1592

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A) Myelinization is completed by 4 years of age. B) The process occurs in a head-to-toe fashion. C) The speed of nerve impulses slows as myelinization occurs. D) Nerve impulses become less specific in focus with myelinization.

B. The process occurs in a head-to-toe fashion. Rationale: Myelinization occurs in a cephalocaudal, proximodistal manner and is completed by 2 years of age. As myelinization proceeds, nerve impulses become faster and more accurate. Reference: p. 1588

A nursing instructor is preparing for a class discussion on spinal muscular atrophy (SMA). When describing type 2 SMA, which information would the instructor include? Select all answers that apply. A)Onset before 6 months of age B) Weakness most severe in shoulders and hips C) Difficulty with swallowing D) Slowly progressing condition E) Genetic disease with autosomal recessive inheritance

B. Weakness most severe in shoulders and hips D. Slowly progressing condition E) Genetic disease with autosomal recessive inheritance Rationale: Any type of spinal muscular atrophy is a genetic motor neuron disease due to autosomal recessive inheritance. Type 2 SMA usually occurs between 6 and 18 months of age, with weakness that is most severe in the shoulders, hips, thighs, and upper back. It is slower in progression than type 1. Survival into adulthood is common if respiratory status is maintained appropriately. Type 1 SMA occurs before birth to 6 months of age and the child usually has difficulty swallowing, sucking, and breathing. Reference: p. 1624

The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A) "If you wear your brace properly, you may not need surgery." B) "The good news is that you have very minimal curvature of your spine." C) "Let's talk to another boy with scoliosis, who is winning trop

C. "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." Rationale: Because this boy is concerned about limiting his participation in water polo and perceives scoliosis as a disease that does not affect "jocks," putting the child in contact with someone with the same problem would be helpful. Telling the adolescent about not needing surgery if he wears his brace or that his curvature is minimal may or may not be true in his case and thus would be false reassurance. Although these suggestions and also the suggestion about talking to the doctor about treatment options could be helpful by engaging his input in the treatment, these do not address his specific concerns about his body image. Reference: p. 1635-1636

The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate? A) "If you don't follow the therapy, your daughter could develop severe bowing of her legs." B) "It's important to use the brace or your daughter may need surgery." C) "You are doing a great job. Let's put our heads together on how to keep her busy." D) "You'll need to accept this since treatment may be

C. "You are doing a great job. Let's put our heads together on how to keep her busy." Rationale: The nurse should support the parents by encouraging and praising their compliance with bracing. It is also important to work with the parents to help develop age-appropriate diversions to promote normal growth and development. Telling the parents that they must be compliant or their daughter could develop severe bowing does not teach, does not offer solutions, and does not address the parents' concerns. Telling the parents that they must simply accept this and that the treatment could take years is likely to upset them and does not teach. It also does not address their concerns. Reference: p. 1619

The nurse is developing a teaching plan for a child who is to have his cast removed. What instruction would the nurse most likely include? A) Applying petroleum jelly to the dry skin B) Rubbing the skin vigorously to remove the dead skin C) Soaking the area in warm water every day D) Washing the skin with dilute peroxide and water

C. Soaking the area in warm water every day Rationale: After a cast is removed, the child and family should be instructed to soak the area in warm water every day to help soften and remove the dry flaky skin. Moisturizing lotion, not petroleum jelly, should be applied to the skin. Vigorous rubbing would traumatize the skin and should be avoided. Warm soapy water, not dilute peroxide and water, should be used to wash the area. Reference: p. 1602-1603

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

Check the infant's toes for coldness or blueness. Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. The other answers are other interventions pertaining to caring for a child with a talipes disorder but are not associated specifically with ensuring good circulation.

The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. What information would the nurse include? A) Applying petroleum jelly to lubricate the catheter B) Cleaning the reusable catheter with peroxide after each use C) Storing the reusable cleaned catheter in a brown paper bag D) Soaking the catheter in a vinegar and water solution to sterilize

D) Soaking the catheter in a vinegar and water solution to sterilize When teaching parents how to perform clean intermittent catheterization, the nurse would instruct the parents to apply a water-based lubricant to the catheter, clean the reusable catheter with soap and water after each use, store the reusable clean catheter in a zip-top bag or other clean storage container, and soak the catheter in a 1:1 vinegar and water solution for about 30 minutes weekly, rinsing well before the next use or placing the catheter in boiling water for 10 minutes.

A child has undergone surgery using steel bar placement to correct pectus excavatum. What position would the nurse instruct the parents to avoid? A) Semi-Fowler B) Supine C) High Fowler D) Side-lying

D. Side-lying Rationale: After surgery to correct pectus excavatum, the nurse would instruct the parents to avoid positioning the child on either side because this could disrupt the bar's position. Semi- or high Fowler's position and the supine position would be appropriate. Reference: p. 1612

The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

The most severe form of neural tube defect. This is a type of spina bifida cystica, and may be diagnosed in utero w/ an ultrasound (otherwise it's visually obvious at birth) The child w/ this is at increased risk for meningitis, hypoxia, and hemorrhage. Usually require multiple surgical procedures Usually develop latex allergy

Myelonmeningocele

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

NSAIDs, ice, and limiting exercise The child's symptoms suggest Osgood-Schlatter disease, which is a thickening and enlargement of the tibial tuberosity probably from overuse. Treatment includes administration of NSAIDS, ice, and limiting strenuous activity. Ankle and knee strengthening exercises, applications of ice, and use of acetaminophen is not indicated for this disorder.

Assess muscle tone and strength in infant/child, compare bilaterally -Evaluate neck tone by pulling infant from a supine position to a sitting position.

Palpation

A nurse is caring for a 10-year-old who is in skeletal traction following injuries sustained in a car accident. Which statement accurately describes a recommended nursing measure for this type of traction?

Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours. At sites with mechanically stable bone-pin interfaces, pin-site care should be done on a daily or weekly basis (after the first 48 to 72 hours). The nurse should never remove or add traction weights without specific physician orders, or allow weights to touch the floor or drag on the bed parts; weights should hang free. A chlorhexidine 2 mg/mL solution may be the most effective cleansing solution for pin care.

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention?

Reposition the child's foot on a pressure-reducing device. The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease potential for skin breakdown, but the pressure must be relieved first.