Peds Exam 5
The nurse is assessing a neonate who was born 1 hour ago to healthy white parents in their early forties. Which finding should be most suggestive of Down syndrome? a. Hypertonia b. Low-set ears c. Micrognathia d. Long, thin fingers and toes
b
An injury to which part of the brain will cause a coma? a. Brainstem b. Cerebrum c. Cerebellum d. Occipital lobe
A
The mother of a young child with cognitive impairment asks for suggestions about how to teach her child to use a spoon for eating. The nurse should make which recommendation? A. Do a task analysis first. B. Do not expect this task to be learned. C. Continue to spoon feed the child until the child tries to do it alone. D. Offer only finger foods so spoon feeding is unnecessary.
A
A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. What is the most appropriate initial action by the school nurse? A. Stay with child and have someone else call emergency medical services (EMS). B. Notify the parent and regular practitioner. C. Notify the parent that the child should go home. D. Stay with the child, offering calm reassurance.
A
A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed? A. Position changes are made by log rolling. B. Assistance is needed to use the bathroom. C. The head of the bed is elevated to minimize spinal headache. D. Passive range of motion is instituted to prevent neurologic injury.
A
A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child? A. Infant stimulation program B. Stretching exercises to decrease contractures C. Limited physical contact to minimize seizures D. Encouraging parents to have additional children
A
A child develops syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a complication to meningitis. What action should be verified before implementing? A. Forcing fluids B. Daily weights with strict input and output (I and O) C. Strict monitoring of urine volume and specific gravity D. Close observation for signs of increasing cerebral edema
A
A child has been admitted with status epilepticus. An emergency medication has been ordered. What medication should the nurse expect to be prescribed? A. Lorazepam (Ativan) B. Phenytoin (Dilantin) C. Topiramate (Topamax) D. Ethosuximide (Zarontin)
A
A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material? A. Soak in a bathtub. B. Vigorously scrub the leg. C. Carefully pick material off the leg. D. Apply powder to absorb the material.
A
A lumbar puncture (LP) is being done on an infant with suspected meningitis. The nurse expects which results for the cerebrospinal fluid that can confirm the diagnosis of meningitis? A. WBCs; ̄glucose B. RBCs; normal WBCs C. glucose; normal RBCs D. Normal RBCs; normal glucose
A
A young child's parents call the nurse after their child is bitten by a raccoon in the woods. The nurse's recommendation should be based on what knowledge? A. Antirabies prophylaxis must be initiated immediately. B. The child should be hospitalized for close observation. C. No treatment is necessary if thorough wound cleaning is done. D. Antirabies prophylaxis must be initiated as soon as clinical manifestations appear.
A
An 18-month-old child is brought to the emergency department after being found unconscious in the family pool. What does the nurse identify as the primary problem in drowning incidents? a. Hypoxia b. Aspiration c. Hypothermia d. Electrolyte imbalance
A
If an intramuscular (IM) injection is administered to a child who has Reye syndrome, the nurse should monitor for what? a. Bleeding b. Infection c. Poor absorption d. Itching at the injection site
A
The community nurse is planning prevention measures designed to avoid conditions that can cause cognitive impairment. Taking folic acid supplements during pregnancy to prevent neural tube defects is which type of prevention strategy? a. Primary b. Secondary c. Tertiary d. Rehabilitative
A
The nurse is caring for a 10-year-old child who has an acute head injury, has a pediatric Glasgow Coma Scale score of 9, and is unconscious. What intervention should the nurse include in the child's care plan? A. Elevate the head of the bed 15 to 30 degrees with the head maintained in midline. B. Maintain an active, stimulating environment. C. Perform chest percussion and suctioning every 1 to 2 hours. D. Perform active range of motion and nontherapeutic touch every 8 hours.
A
The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate? A. Prone with the head turned to the side B. On the side C. Supine in an infant carrier D. Supine, with defect supported with rolled blankets
A
The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. How should the nurse interpret these findings? A. Neurologic health B. Severe brain damage C. Decorticate posturing D. Decerebrate posturing
A
The nurse is planning care for a school-age child with bacterial meningitis. What intervention should be included? A. Keep environmental stimuli to a minimum. B. Have the child move her head from side to side at least every 2 hours. C. Avoid giving pain medications that could dull sensorium. D. Measure head circumference to assess developing complications.
A
The nurse is preparing a school-age child for computed tomography (CT) scan to assess cerebral function. The nurse should include what statement in preparing the child? A. "The scan will not hurt." B. "Pain medication will be given." C. "You will be able to move once the equipment is in place." D. "Unfortunately no one can remain in the room with you during the test."
A
The nurse is teaching a preschool child with a cognitive impairment how to throw a ball over- hand. What teaching strategy should the nurse use for this child? A. Demonstrate how to throw a ball overhand. B. Explain the reason for throwing a ball overhand. C. Show pictures of children throwing balls overhand. D. Explain to the child how to throw the ball overhand.
A
The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching? A. "I should gently massage the skin under the straps once a day to stimulate circulation." B. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." C. "I should remove the harness several times a day to prevent contractures." D. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."
A
What condition can result from the bone demineralization associated with immobility? A. Osteoporosis B. Pooling of blood C. Urinary retention D. Susceptibility to infection
A
What is important to incorporate in the plan of care for a child who is experiencing a seizure? A. Describe and record the seizure activity observed. B. Suction the child during a seizure to prevent aspiration. C. Place a tongue blade between the teeth if they become clenched. D. Restrain the child when seizures occur to prevent bodily harm.
A
What measure is important in managing hypercalcemia in a child who is immobilized? A. Provide adequate hydration. B. Change position frequently. C. Encourage a diet high in calcium. D. Provide a diet high in calories for healing.
A
What observation in a child should indicate the need for a referral to a specialist regarding a communication impairment? A. At 2 years of age, the child fails to respond consistently to sounds. B. At 3 years of age, the child fails to use sentences of more than five words. C. At 4 years of age, the child has impaired sentence structure. D. At 5 years of age, the child has poor voice quality.
A
What type of seizure may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial
A
The nurse is preparing to admit a 5-year-old with an epidural hemorrhage. What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Headache B. Vomiting C. Irritability D. Cephalhematoma E. Pallor with anemia
ABC
The nurse understands that which gestational disorders can cause a cognitive impairment in the newborn? (Select all that apply.) A. Prematurity B. Postmaturity C. Low birth weight D. Physiological jaundice E. Large for gestational age
ABC
What functional goal should the nurse expect for a child who has a T1 to T10 spinal cord in- jury? (Select all that apply.) A. May be braced for standing B. Able to drive automobile with hand controls C. Can manage adapted public transportation D. Some able to use regular public transportation E. Ambulates well, often with short leg braces with or without cane
ABC
The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session? (Select all that apply.) A. Pin care B. Crutch walking C. Modifications in activity D. Observing pin sites for infection E. Full weight bearing will be allowed after 24 hours
ABCD
The nurse is preparing to admit a 2-year-old child with spina bifida occulta. What clinical manifestations of spina bifida occulta should the nurse expect to observe? (Select all that apply.) A. Dark tufts of hair B. Skin depression or dimple C. Port-wine angiomatous nevi D. Soft, subcutaneous lipomas E. Bladder and sphincter paralysis
ABCD
The nurse is preparing to admit a 6-month-old infant with increased intracranial pressure (ICP). What clinical manifestations should the nurse expect to observe in this infant? (Select all that apply.) A. High-pitched cry B. Poor feeding C. Setting-sun sign D. Sunken fontanel E. Distended scalp veins F. Decreased head circumference
ABCE
The nurse is preparing to admit a neonate with bacterial meningitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Jaundice B. Cyanosis C. Poor tone D. Nuchal rigidity E. Poor sucking ability
ABCE
The nurse is preparing to admit an adolescent with bacterial meningitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) A. Fever B. Chills C. Headache D. Poor tone E. Drowsiness
ABCE
The nurse is preparing to admit a 10-year-old child with Duchenne muscular dystrophy. What clinical features of Duchenne muscular dystrophy should the nurse recognize? (Select all that apply.) A. Calf muscle hypertrophy B. Late onset, usually between 6 and 8 years of age C. Progressive muscular weakness, wasting, and contractures D. Loss of independent ambulation by 9 to 12 years of age E. Slowly progressive, generalized weakness during adolescence
ACDE
The nurse is caring for a child with meningitis. What acute complications of meningitis should the nurse continuously assess the child for? (Select all that apply.) A. Seizures B. Cerebral palsy C. Cerebral edema D. Hydrocephalus E. Cognitive impairments
ACE
The clinic nurse is assessing an infant. What are early signs of cognitive impairment the nurse should discuss with the health care provider? (Select all that apply.) A. Head lag at 11 months of age B. No pincer grasp at 4 months of age C. Colicky incidents at 3 months of age D. Unable to speak two to three words at 24 months of age E. Unresponsiveness to the environment at 12 months of age
ADE
The nurse is caring for a child with increased intracranial pressure (ICP). What interventions should the nurse plan for this child? (Select all that apply.) A. Avoid jarring the bed. B. Keep the room brightly lit. C. Keep the bed in a flat position. D. Administer prescribed stool softeners. E. Administer a prescribed antiemetic for nausea.
ADE
The nurse is preparing to admit a 10-year-old child with absence seizures. What clinical fea- tures of absence seizures should the nurse recognize? (Select all that apply.) A. There is no aura. B. There is a postictal state. C. They usually last longer than 30 seconds. D. There is a brief loss of consciousness. E. There is an occasional clonic movement.
ADE
The nurse is teaching parents of a child with a cognitive impairment signs that indicate the child is developmentally ready for dressing training. What signs should the nurse include that indicate the child is developmentally ready for dressing training? (Select all that apply.) A. Can follow verbal commands B. Can sit quietly for 1 to 2 minutes C. Can master every task of dressing D. Can follow physical gestures or cues E. Can relate clothing to the appropriate body part
ADE
A 2-year-old child starts to have a tonic-clonic seizure. The child's jaws are clamped. What is the most important nursing action at this time? A. Place a padded tongue blade between the child's jaws. B. Stay with the child and observe his respiratory status. C. Prepare the suction equipment. D. Restrain the child to prevent injury.
B
A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first? A. Reposition the child and notify the practitioner. B. Notify the practitioner of the changes noted. C. Give the child medication to relieve the pain. D. Chart the observations and check the extremity again in 15 minutes.
B
A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions? A. No restrictions of activity are indicated. B. Elevate casted arm when both upright and resting. C. The shoulder should be kept as immobile as possible to avoid pain. D. Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.
B
A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take? A. Call the health care provider to report the edema. B. Elevate the foot and leg on pillows. C. Apply a warm moist pack to the foot. D. Encourage movement of toes.
B
A child is on phenytoin (Dilantin). What should the nurse encourage? A. Fluid restriction B. Good dental hygiene C. A decrease in vitamin D intake D. Taking the medication with milk
B
A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents' discharge teaching? A. Turn every 8 hours. B. Specially designed car restraints are necessary. C. Diapers should be avoided to reduce soiling of the cast. D. Use an abduction bar between the legs to aid in turning.
B
A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention? A. Recommend allergy testing. B. Provide a latex-free environment. C. Use only powder-free latex gloves. D. Limit use of latex products as much as possible.
B
A recommendation to prevent neural tube defects (NTDs) is the supplementation of what? A. Vitamin A throughout pregnancy B. Folic acid for all women of childbearing age C. Folic acid during the first and second trimesters of pregnancy D. Multivitamin preparations as soon as pregnancy is suspected
B
A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy will begin when? A. After the diagnosis is confirmed B. When the medication is received from the pharmacy C. After the child's fluid and electrolyte balance is stabilized D. As soon as the practitioner is notified of the culture results
B
A woman, age 43 years, is 6 weeks pregnant. It is important that she be informed of which? A. The need for a therapeutic abortion B. Increased risk for Down syndrome C. Increased risk for Turner syndrome D. The need for an immediate amniocentesis
B
An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device? A. As soon as possible after birth B. When the infant is developmentally ready to stand up C. At about ages 12 to 15 months, when most children are walking D. At about 4 years, when the healthy limb is not growing so rapidly
B
Immobilization causes what effect on metabolism? A. Hypocalcemia B. Decreased metabolic rate C. Positive nitrogen balance D. Increased levels of stress hormones
B
The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved? A. Use of protective equipment at the family's discretion B. Education of adults to recognize signs that indicate a risk for injury C. Sports medicine program to help student athletes work through overuse injuries D. Arrangements for multiple sports to use same athletic fields to accommodate more children
B
The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which? A. Take vital signs every hour. B. Place the infant on the side to decrease pressure on the spinal sac. C. Watch for signs that might indicate developing hydrocephalus. D. Apply a heat lamp to facilitate drying and toughening of the sac.
B
The nurse is caring for a family whose infant was just born with anencephaly. What is the most important nursing intervention? A. Implement measures to facilitate the attachment process. B. Help the family cope with the birth of an infant with a fatal defect. C. Prepare the family for extensive surgical procedures that will be needed. D. Provide emotional support so the family can adjust to the birth of an infant with problems.
B
The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching? A. "I should have the affected limb hang in a dependent position." B. "I will use an ice pack to relieve the itching." C. "I should avoid keeping the injured arm elevated." D. "I will expect the fingers to be swollen for the next 3 days."
B
The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what? A. "We'll keep the cast dry." B. "We're happy this is the only cast our baby will need." C. "We'll watch for any swelling of the foot while the cast is on." D. "We're getting a special car seat to accommodate the cast."
B
The nurse stops to assist an adolescent who has experienced severe trauma when hit by a mOtorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. What should the nurse do related to the tourniquet? A. Loosen the tourniquet. B. Leave the tourniquet in place. C. Remove the tourniquet and apply direct pressure if bleeding is still present. D. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.
B
What clinical manifestations suggest hydrocephalus in an infant? A. Closed fontanel and high-pitched cry B. Bulging fontanel and dilated scalp veins C. Constant low-pitched cry and restlessness D. Depressed fontanel and decreased blood pressure
B
What finding is characteristic of fractures in children? A. Fractures rarely occur at the growth plate site because it absorbs shock well. B. Rapidity of healing is inversely related to the child's age. C. Pliable bones of growing children are less porous than those of adults. D. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.
B
What intervention should be included in the nursing care of a child with autism spectrum disorder (ASD)? A. Assign multiple staff to care for the child. B. Communicate with the child at his or her developmental level. C. Provide a wide variety of foods for the child to try. D. Place the child in a semiprivate room with a roommate of a similar age.
B
What is a primary goal in caring for a child with cognitive impairment? a. Developing vocational skills b. Promoting optimum development c. Finding appropriate out-of-home care d. Helping child and family adjust to future care
B
What is an appropriate nursing intervention when caring for a child in traction? A. Removing adhesive traction straps daily to prevent skin breakdown B. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles C. Providing active range of motion exercises to affected extremity three times a day D. Keeping child prone to maintain good alignment
B
What statement best describes a subdural hematoma? A. Bleeding occurs between the dura and the skull. B. Bleeding occurs between the dura and the cerebrum. C. Bleeding is generally arterial, and brain compression occurs rapidly. D. The hematoma commonly occurs in the parietotemporal region.
B
What statement is true concerning osteogenesis imperfecta (OI)? A. It is easily treated. B. It is an inherited disorder. C. Braces and exercises are of no therapeutic value. D. Later onset disease usually runs a more difficult course.
B
What term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a. Coma b. Stupor c. Obtundation d. Persistent vegetative state
B
What test is never performed on a child who is awake? a. Doll's head maneuver b. Oculovestibular response c. Assessment of pyramidal tract lesions d. Funduscopic examination for papilledema
B
When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised if a week ago the child had recovered from what? a. Measles b. Influenza c. Meningitis d. Hepatitis
B
Which is characteristic of X-linked recessive inheritance? A. There are no carriers. B. Affected individuals are principally males. C. Affected individuals are principally females. D. Affected individuals will always have affected parents.
B
What findings should the nurse expect to observe in a 7-month-old infant with Werdnig-Hoffman disease? (Select all that apply.) A. Noticeable scoliosis B. Absent deep tendon reflexes C. Abnormal tongue movements D. Failure to thrive E. Prominent pectus excavatum F. Significant leg involvement
BCD
What functional goal should the nurse expect for a child who has a C7 spinal cord injury? (Select all that apply.) A. Able to drive automobile with hand controls B. Complete independence within limitations of a wheelchair C. Can roll over in bed, sit up in bed, and eat independently D. Requires some assistance in transfer and lower extremity dressing E. Ambulation with bilateral long braces using four-point or swing-through crutch gait
BCD
A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.) A. Relieve itching with heat. B. Elevate the arm when resting. C. Observe the fingers for any evidence of discoloration. D. Do not allow the child to put anything inside the cast. E. Examine the skin at the cast edges for any breakdown.
BCDE
What effects of an altered pituitary secretion in a child with meningitis indicates syndrome of inappropriate antidiuretic hormone (SIADH)? (Select all that apply.) A. Hypotension B. Serum sodium is decreased C. Urinary output is decreased D. Evidence of overhydration E. Urine specific gravity is increased
BCDE
The nurse is preparing to admit a 5-year-old with spina bifida cystica that was below the second lumbar vertebra. What clinical manifestations of spina bifida cystica below the second lumbar vertebra should the nurse expect to observe? (Select all that apply.) A. No motor impairment B. Lack of bowel control C. Soft, subcutaneous lipomas D. Flaccid, partial paralysis of lower extremities E. Overflow incontinence with constant dribbling of urine
BDE
What cerebrospinal fluid (CSF) analysis should the nurse expect with viral meningitis? (Select all that apply.) A. Color is turbid. B. Protein count is normal. C. Glucose is decreased. D. Gram stain findings are negative. E. White blood cell (WBC) count is slightly elevated.
BDE
A 10-year-old boy on a bicycle has been hit by a car in front of a school. The school nurse im- mediately assesses airway, breathing, and circulation. What should be the next nursing action? A. Place the child on his side. B. Take the child's blood pressure. C. Stabilize the child's neck and spine. D. Check the child's scalp and back for bleeding.
C
A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. What nursing intervention is a priority for this child? A. Minimizing environmental stimuli B. Administering immunoglobulin C. Monitoring and maintaining systemic blood pressure D. Discussing long-term care issues with the family
C
A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture? A. It will create difficulty because the child is left handed. B. It will heal slowly because this is the weakest part of the bone. C. This type of fracture requires different management to prevent bone growth complications. D. This type of fracture necessitates complete immobilization of the shoulder for 4 to 6 weeks.
C
A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold, that "he's like a rag doll. He doesn't cuddle up to me like my other babies did." What is the nurse's best interpretation of this lack of clinging or molding? A. Sign of detachment and rejection B. Indicative of maternal deprivation C. A physical characteristic of Down syndrome D. Suggestive of autism associated with Down syndrome
C
A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for dis- charge, the nurse is discussing home care with her mother. What sign or symptom is considered a manifestation of post concussion syndrome and does not necessitate medical attention? A. Vomiting B. Blurred vision C. Behavioral changes D. Temporary loss of consciousness
C
The nurse is teaching feeding strategies to a parent of a 12-month-old infant with Down syndrome. What statement made by the parent indicates a need for further teaching? A. "If the food is thrust out, I will reefed it." B. "I will use a small, long, straight-handled spoon." C. "I will place the food on the top of the tongue." D. "I know the tongue thrust doesn't indicate a refusal of the food."
C
A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. How should the nurse respond? A. Medications can be discontinued at this time. B. The child will need to take the drugs for 5 years after the last seizure. C. A step-wise approach will be used to reduce the dosage gradually. D. Seizure disorders are a lifelong problem. Medications cannot be discontinued.
C
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be correct- ed, what should the nurse explain? A. Traction is tried first. B. Surgical intervention is needed. C. Frequent, serial casting is tried first. D. Children outgrow this condition when they learn to walk.
C
A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse? A. "For as long as you have been told." B. "Most preadolescents use the brace for 6 months." C. "Until your vertebral column has reached skeletal maturity." D. "It will be necessary to wear the brace for the rest of your life."
C
A pregnant woman asks about prenatal diagnosis of hydrocephalus. The nurse's response should be based on which knowledge? A. It can be diagnosed only after birth. B. It can be diagnosed by chromosome studies. C. It can be diagnosed with fetal ultrasonography. D. It can be diagnosed by measuring the lecithin-to-sphingomyelin ratio.
C
A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. What is the most appropriate nursing action? A. Explain that analgesia is contraindicated with a head injury. B. Have the parents describe the child's previous experiences with pain. C. Consult with a practitioner about what analgesia can be safely administered. D. Teach the parents that analgesia is unnecessary when the child is not fully awake and alert.
C
After a tonic-clonic seizure, what symptoms should the nurse expect the child to experience? A. Diarrhea and abdominal discomfort B. Irritability and hunger C. Lethargy and confusion D. Nervousness and excitability
C
After spinal fusion surgery the nurse should check for signs of what? A. Seizure activity B. Increased intracranial pressure C. Impaired color, sensitivity, and movement to the lower extremities D. Impaired pupillary response during neurologic checks
C
An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when request- ed. What is the first action the nurse should take? A. Wait for the child's parents to arrive. B. Move the child out of the parking lot. C. Have someone notify the emergency medical services (EMS) system. D. Help the child stand to return to play.
C
An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident. The parents keep asking the nurse, "How bad is it?" The nurse's response should be based on which knowledge? A. Families adjust better to life-threatening injuries when information is given over time. B. Immediate loss of function is indicative of the long-term consequences of the injury. C. Extent and severity of damage cannot be determined for several weeks or even months. D. Numerous diagnostic tests will be done immediately to determine extent and severity of damage.
C
An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents de- scribe her as being angry, hostile, and uncooperative. The nurse should recognize that this is suggestive of which psychosocial state? A. Normal phase of adolescent development B. Severe depression that will require long-term counseling C. Normal response to her situation that can be redirected in a healthy way D. Denial response to her situation that makes rehabilitative efforts more difficult
C
Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which area with onset before age 3 years? A. Parallel play B. Gross motor development C. Ability to maintain eye contact D. Growth below the fifth percentile
C
Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time? A. Send the child to radiology so radiography can be performed. B. Initiate an intravenous line and administer morphine for the pain. C. Calmly ask the child to point to where the pain is worst and to wiggle fingers. D. Have the parents hold the child so that the nurse can examine the arm thoroughly.
C
The American Association on Intellectual and Developmental Disabilities (AAIDD), formerly the American Association on Cognitive Impairment, classifies cognitive impairment based on what parameter? A. Age of onset B. Subaverage intelligence C. Adaptive skill domains D. Causative factors for cognitive impairment
C
The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication? A. Sepsis B. Osteomyelitis C. Pulmonary embolism D. Acute respiratory tract infection
C
The nurse is counseling a pregnant 35-year-old woman about estimated risk of Down syndrome. What is the estimated risk for a woman who is 35 years of age? A. One in 1200 B. One in 900 C. One in 350 D. One in 100
C
The nurse is discussing sexuality with the parents of an adolescent girl who has a moderate cognitive impairment. What factor should the nurse consider when dealing with this issue? A. Sterilization is recommended for any adolescent with cognitive impairment. B. Sexual drive and interest are very limited in individuals with cognitive impairment. C. Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. D. Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused.
C
The nurse is teaching infant care to parents with an infant who has been diagnosed with osteo- genesis imperfecta (OI). What should the nurse include in the teaching session? A. "Bisphosphonate therapy is not beneficial for OI." B. "Physical therapy should be avoided as it may cause damage to bones." C. "Lift the infant by the buttocks, not the ankles, when changing diapers." D. "The infant should meet expected gross motor development without assistive devices."
C
The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic- clonic seizures. What statement by the parent should indicate a correct understanding of the teaching? A. "I should attempt to restrain my child during a seizure." B. "My child will need to avoid contact sports until adulthood." C. "I should place a pillow under my child's head during a seizure." D. "My child will need to be taken to the emergency department [ED] after each seizure."
C
The parents of a child with cognitive impairment ask the nurse for guidance with discipline. What should the nurse's recommendation be based on? A. Discipline is ineffective with cognitively impaired children. B. Cognitively impaired children do not require discipline. C. Behavior modification is an excellent form of discipline. D. Physical punishment is the most appropriate form of discipline.
C
What are quick, jerky, grossly uncoordinated, irregular movements that may disappear on re- laxation called? a. Twitching b. Spasticity c. Choreiform movements d. Associated movements
C
What finding is a clinical manifestation of increased intracranial pressure (ICP) in children? a. Low-pitched cry b. Sunken fontanel c. Diplopia, blurred vision d. Increased blood pressure
C
What intervention is most appropriate to facilitate social development of a child with a cognitive impairment? A. Provide age-appropriate toys and play activities. B. Avoid exposure to strangers who may not understand cognitive development. C. Provide peer experiences, such as infant stimulation and preschool programs. D. Emphasize mastery of physical skills because they are delayed more often than verbal skills.
C
What is a physiologic effect of immobilization on children? A. Metabolic rate increases. B. Venous return improves because the child is in the supine position. C. Circulatory stasis can lead to thrombus and embolus formation. D. Bone calcium increases, releasing excess calcium into the body (hypercalcemia).
C
What is a priority of care when a child has an external ventricular drain (EVD)? A. Irrigation of drain to maintain flow B. As-needed dressing changes if dressing becomes wet C. Frequent assessment of amount and color of drainage D. Maintaining the EVD below the level of the child's head
C
What is the initial clinical manifestation of generalized seizures? A. Confusion B. Feeling frightened C. Loss of consciousness D. Seeing flashing lights
C
What most accurately describes bowel function in children born with a myelomeningocele? A. Incontinence cannot be prevented. B. Enemas and laxatives are contraindicated. C. Some degree of fecal continence can usually be achieved. D. Colostomy is usually required by the time the child reaches adolescence.
C
What nursing intervention is appropriate when caring for an unconscious child? A. Avoid using narcotics or sedatives to provide comfort and pain relief. B. Change the child's position infrequently to minimize the chance of increased intracranial pressure (ICP). C. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. D. Give tepid sponge baths to reduce fevers above 38.3° C (101° F) because antipyretics are contraindicated.
C
What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)? A. It has an autosomal dominant inheritance pattern. B. Onset occurs in later childhood and adolescence. C. It is characterized by presence of Gower sign, a waddling gait, and lordosis. D. Disease stabilizes during adolescence, allowing for life expectancy to approximately age 40 years.
C
What term is used to describe a child's level of consciousness when the child is arousable with stimulation? a. Stupor b. Confusion c. Obtundation d. Disorientation
C
What term refers to seizures that involve both hemispheres of the brain? a. Absence b. Acquired c. Generalized d. Complex partial
C
When does idiopathic scoliosis become most noticeable? A. In the newborn period B. When the child starts to walk C. During the preadolescent growth spurt D. During adolescence
C
he nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign? a. Petaling b. Posturing c. Paresthesia d. Positioning
C
The nurse is assessing a child with Down syndrome. The nurse recognizes that which are possible comorbidities that can occur with Down syndrome? (Select all that apply.) A. Diabetes mellitus B. Hodgkin's disease C. Congenital heart defects D. Respiratory tract infections E. Acute megakaryoblastic leukemia
CDE
The nurse is caring for a child with a subdural hematoma. The nurse should assess for what signs that can indicate brainstem compression? (Select all that apply.) A. Coma B. Lethargy C. Hemiplegia D. Hemiparesis E. Unequal pupils
CDE
The nurse is caring for a child with an epidural hematoma. The nurse should assess for what signs that can indicate Cushing triad? (Select all that apply.) A. Fever B. Flushing C. Bradycardia D. Systemic hypertension E. Respiratory depression
CDE
The nurse is preparing to admit a 7-year-old child with complex partial seizures. What clinical features of complex partial seizures should the nurse recognize? (Select all that apply.) A. They last less than 10 seconds. B. There is usually no aura. C. Mental disorientation is common. D. There is frequently a postictal state. E. There is usually an impaired consciousness.
CDE
The nurse is teaching the parents of a child with a seizure disorder about the triggers that can cause a seizure. What should the nurse include in the teaching session? (Select all that apply.) A. Cold B. Sugared drinks C. Emotional stress D. Flickering lights E. Hyperventilation
CDE
A 23-month-old child is admitted to the hospital with a diagnosis of meningitis. She is lethar- gic and very irritable with a temperature of 102° F. What should the nurse's care plan include? A. Observing the child's voluntary movement B. Checking the Babinski reflex every 4 hours C. Checking the Brudzinski reflex every 1 hour D. Assessing the level of consciousness (LOC) and vital signs every 2 hours
D
A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What sign or symptom does the child have that indicates a revision is necessary? a. Tachycardia b. Gastrointestinal upset c. Hypotension d. Alteration in level of consciousness
D
A child has a seizure disorder. What test should be done to gather the most specific informa- tion about the type of seizure the child is having? A. Sleep study B. Skull radiography C. Serum electrolytes D. Electroencephalogram (EEG)
D
A child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What is a common reason for elective revision of this shunt? A. Meningitis B. Gastrointestinal upset C. Hydrocephalus resolution D. Growth of the child since the initial shunting
D
A woman who is 6 weeks pregnant tells the nurse that she is worried that, even though she is taking folic acid supplements, the baby might have spina bifida because of a family history. The nurse's response should be based on what? A. Prenatal detection is not possible yet. B. There is no genetic basis for the defect. C. Chromosome studies done on amniotic fluid can diagnose the defect prenatally. D. Open neural tube defects (NTDs) result in elevated concentrations of a-fetoprotein in amniotic fluid.
D
Many of the clinical features of Down syndrome present challenges to caregivers. Based on these features, what intervention should be included in the child's care? A. Delay feeding solid foods until the tongue thrust has stopped. B. Modify the diet as necessary to minimize the diarrhea that often occurs. C. Provide calories appropriate to the child's mental age. D. Use a cool-mist vaporizer to keep the mucous membranes moist and secretions liquefied.
D
Neuropathic bladder disorders are common among children with which disorder? a. Plagiocephaly b. Meningocele c. Craniosynostosis d. Myelomeningocele
D
One of the techniques that has been especially useful for learners having cognitive impairment is called fading. What description best explains this technique? A. Positive reinforcement when tasks or behaviors are mastered B. Repeated verbal explanations until tasks are faded into the child's development C. Negative reinforcement for specific tasks or behaviors that need to be faded out D. Gradually reduces the assistance given to the child so the child becomes more independent
D
Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement? A. "All therapies require extended periods of bed rest." B. "Conservative therapy will be required until puberty." C. "Our child cannot attend school during the treatment phase." D. "Surgical correction requires a 3- to 4-month recovery period."
D
Secondary prevention for cognitive impairment includes what activity? a. Genetic counseling b. Avoidance of prenatal rubella infection c. Preschool education and counseling services d. Newborn screening for treatable inborn errors of metabolism
D
The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the child's younger brother had when he was an infant. The nurse should base a response on which information? A.Meningitis rarely occurs during infancy. B. Often a genetic predisposition to meningitis is found. C. Vaccination to prevent all types of meningitis is now available. D. Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.
D
The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What clinical manifestation is the most essential part of the nursing assessment to detect early signs of a worsening condition? A. Posturing B. Vital signs C. Focal neurologic signs D. Level of consciousness
D
The nurse is caring for a child with severe head trauma after a car accident. What is an ominous sign that often precedes death? a. Delirium b. Papilledema c. Flexion posturing d. Periodic or irregular breathing
D
The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization? A. Encourage wearing pajamas. B. Let the child have few behavioral limitations. C. Keep the child away from other immobilized children if possible. D. Take the child for a "walk" by wagon outside the room.
D
The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. How should the nurse interpret this? A. Eye trauma B. Brain death C. Severe brainstem damage D. Neurosurgical emergency
D
The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt. What issues should be addressed? A. Most childhood activities must be restricted. B. Cognitive impairment is to be expected with hydrocephalus. C. Wearing head protection is essential until the child reaches adulthood. D. Shunt malfunction or infection requires immediate treatment.
D
What functional ability should the nurse expect in a child with a spinal cord lesion at C7? A. Complete respiratory paralysis B. No voluntary function of upper extremities C. Inability to roll over or attain sitting position D. Almost complete independence within limitations of wheelchair
D
What intervention should be beneficial in reducing the risk of Reye syndrome? A. Immunization against the disease B. Medical attention for all head injuries C. Prompt treatment of bacterial meningitis D. Avoidance of aspirin for children with varicella or those suspected of having influenza
D
What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP) in an unconscious child? A. Suction the child frequently. B. Turn the child's head side to side every hour. C. Provide environmental stimulation. D. Avoid activities that cause pain or crying.
D
What is the antiepileptic medication that requires monitoring of vitamin D and folic acid? A. Topiramate (Topamax) B. Valproic acid (Depakene) C. Gabapentin (Neurontin) D. Phenobarbital (Luminal)
D
What refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column? a. Rachischisis b. Meningocele c. Encephalocele d. Myelomeningocele
D
What statement is correct regarding sports injuries during adolescence? A. Conditioning does not help prevent many sports injuries. B. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. C. More injuries occur during organized athletic competition than during recreational sports participation. D. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.
D
What suggestion by the nurse for parents regarding stuttering in children is most helpful? A. Offer rewards for proper speech. B. Encourage the child to take it easy and go slow when stuttering. C. Help the child by supplying words when he or she is experiencing a block. D. Give the child plenty of time and the impression that you are not in a hurry.
D
A newborn assessment shows a separated sagittal suture, oblique palpebral fissures, a de- pressed nasal bridge, a protruding tongue, and transverse palmar creases. These findings are most suggestive of which condition? a. Microcephaly b. Cerebral palsy c. Down syndrome d. Fragile X syndrome
c