Peds Practice: Ch 43 (Urinary) & CH 44 (Musculoskeletal)

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."

What are the types of talipes equinovarus (clubfoot) 1. positional 2. neurogenic 3. syndromic 4. idiopathic

- positional - neurogenic - syndromic - idiopathic

Which of the following are treatment for phimosis? (select all that apply) a. circumcision b. topical vitamin E cream c. acetaminophen d. steroid cream

circumcision topical vitamin E cream steroid cream

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. Which of the following would the nurse expect to administer if ordered? a) Alendronate b) Pamidronate c) Narcotic analgesics d) Diazepam

Diazepam

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? a) Latex b) Cat dander c) Alcohol gel d) Peanuts

Latex

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a hip dysplasia. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which of the following symptoms? a) Pallor b) Paresthesia c) Pain d) Paralysis

Paresthesia

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

Risk for impaired skin integrity

We use Ortolani maneuver to diagnosis what? 1. hip dysplasia 2. cerebral palsy 3. talipes equinovarus (clubfoot) 4. spina bifida

hip dysplasia

Who is at risk for pathological phimosis? A. circumcised male child B. homeless male child C. clean male child D. a female child

homeless male child

What is phimosis?

inability to retract foreskin

What is pathological phimosis?

occurs due to scarring, infection, poor hygiene, or inflammation

When and where can a patient surgically repair hypospadias and epispadias? A. hospital between 24 to 36 months B. outpatient between 6 to 12 months C. hospital between 6 to 12 months D. outpatient between 24 to 36 months

outpatient between 6 to 12 months

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? A. "It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." B. "The contents of the sac you see only has fluid in it and should cause the child no problem." C. "Your child's defect involves only the nerves to the bladder and bowel and can be easily repaired." D. "The sac is a very small cyst and should resolve within the first year of life."

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved."

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) "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." b) "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." c) "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life." d) "It has little influence on the intellectual and perceptual abilities of the child."

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

Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer? a) Botulinum toxin b) Baclofen pump c) Vagal nerve stimulator d) Central venous catheter

Baclofen pump

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize which of the following as the primary goal? a) Development of gross motor movement b) Enhance feeding capabilities c) Promote optimal self-care ability d) Development of fine motor skills

Development of gross motor movement

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? A. Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns. B. Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. C. Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. D. Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C.

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.

The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality? 1. Encourage follow-through with physical therapy exercises 2. Restrict the child to a special needs classroom 3. Encourage after school activities within the limites of the child's abilities 4. Ensure the school is aware of the child's capabilities

Encourage after school activities within the limites of the child's abilities

A nurse palpates for testicles in scrotal sac and finds cryptorchidism (undescended testes). Which disorder is this? a) Bladder exstrophy! b) Hypospadias! c) Epispadias! d) Patent urachus!

Hypospadias!

Which characteristic is true of cerebral palsy? a) It results in mental retardation. b) It's progressive. c) It's reversible. 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.

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

Spina bifida occulta

What is physiological phimosis?

born with tight foreskin and it separates naturally over time

What nursing interventions should be implemented for someone with cryptorchidism post op? a. heat compression b. incision care and ice c. discuss fertility and cancer risk d. loose clothes

incision care and ice discuss fertility and cancer risk loose clothes

Neurogenic talipes equinovarus is found in what kind of patient? a. normal healthy infants b. infants with myelomeningocele c. sick toddlers d. healthy toddlers

infants with myelomeningocele

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.

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy is a condition that doesn't get worse." b) "Cerebral palsy is a condition that runs in families." c) "Cerebral palsy occurs because of too much oxygen to the brain." d) "Cerebral palsy means there will be many disabilities."

"Cerebral palsy is a condition that doesn't get worse."

The nurse is caring for the parents of a newborn who has an undescended testicle. Which comment by the parents indicates understanding of the condition? a. "Our son may have to go through life without two testes." b. "Our son's condition may resolve on its own." c. "Our son will likely have a high risk of cancer in his teen years as a result of this condition." d. "Our son may need surgery on his testes before we are discharged to go home."

"Our son's condition may resolve on its own."

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. 1. Prone 2. Right side lying 3. Left side lying 4. Semi-Fowler 5. Supine

- Prone - Right side lying - Left side lying

The nurse is caring for a 6-month-old boy in a spina cast. What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. 1. Color 2. Sensation 3. Pulse 4. Capillary refill 5. Vital signs

- Sensation - Pulse - Capillary refill - Color

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: a. "We put these on so the child will not pull the padding from under the cast." b. "These will help the cast look more attractive so the child won't feel self-conscious." c. "These make a smooth edge on the cast so the skin is better protected." d. "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry."

"These make a smooth edge on the cast so the skin is better protected."

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 further." d) "Dimpling, skin discoloration, and abnormal patches of hair are often indicators of spina bifida occulta."

"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 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."

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.

- "We should change her diaper without taking her out of the harness." - "We need to check the area behind her knees for redness and irritation." - "We need to call the doctor if she is not able to actively kick her legs."

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. a. The boy experiences mild pain when wiggling his toes. b. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. c. New drainage is seeping out from under the cast. d. The outside of the boy's cast got wet and had to be dried using a hair dryer. e. The boy's toes are light blue and very swollen.

- The boy's toes are light blue and very swollen. - 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.

When can a patient ride on toys with hypospadias or epispadias? A. before surgery B. right after surgery C. 2 to 3 week post op D. 6 to 12 month post op

2 to 3 week post op

At what age does pathological phimosis resolve by? a. 2 to 8 months b. never; need surgery c. 12 to 15 years old d. 5 to 7 years

5 to 7 years

The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child? Select all that apply.

Any area on the cast that is warm to the touch A foul odor under the cast Drainage from under the cast Looseness of the cast on the extremity

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? 1. The infant will have a poor sucking reflex. 2. Pain will interfere with the feeding process. 3. Assuming the usual feeding position will be difficult. 4. Nausea and vomiting often follow repair of the cystic mass.

Assuming the usual feeding position will be difficult.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? 1. Baclofen 2. Prednisone 3. Lorazepam 4. Botulin toxin

Baclofen

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) Deficient knowledge related to diagnosis and condition b) Ineffective coping related to diagnosis of chronic condition c) Impaired physical mobility related to spinal cord defect d) Risk for injury related to lack of muscle control

Deficient knowledge related to diagnosis and condition

The nurse is assessing a male neonate and notes that the urethral opening is on the dorsal aspect of the penis. The nurse documents this finding as which of the following? a) Bladder exstrophy b) Hypospadias c) Epispadias d) Patent urachus

Epispadias

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 to 0.4 mg/day b. Folic acid above 0.4 mg/day c. Ascorbic acid to 0.4 mg/day d. Ascorbic acid to 4 mg/day

Folic acid above 0.4 mg/day

A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history? 1. Age that the child learned to walk. 2. Parents' expectation of the child's development 3. Functional status related to eating and mobility 4. Birth history to identify cause of cerebral palsy

Functional status related to eating and mobility

The nurse performing a focused health history on a newborn asks the parents if there are any hereditary disorders affecting musculoskeletal function in the family history. These disorders include (select all answers that apply): a) Hip dysplasia b) Scoliosis c) Clubfoot d) Brachial plexus injury

Hip dysplasia Clubfoot

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as which of the following? a) Bladder exstrophy b) Hypospadias c) Epispadias d) Patent urachus

Hypospadias

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? 1. Snip the tuft of hair off close to the skin for hygienic reasons 2. Move on to other assessments without calling attention to the difference 3. Record and refer the finding for follow-up to the pediatrician 4. Inspect for precocious hair growth in the genital and underarm areas

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

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) Constipation c) Delayed growth and development d) Risk for infection

Risk for infection

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. Amniocentesis for lecithin-sphingomyelin (L/S) ratio d. Presence of high maternal levels of albumin after 12th week of gestation

Significant level of alpha-fetoprotein present in amniotic fluid

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as which of the following? a) Spastic hemiplegia b) Athetoid or dyskinetic c) Spastic diplegia d) Ataxic

Spastic hemiplegia

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which of the following forms 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? a) Internal fixation device b) Stockinette c) Spica cast d) External fixation device

Spica cast

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism? Fluid detected in scrotal sac Testis can briefly be brought into scrotum Venous varicosity detected along the spermatic cord Testis cannot be "milked" down inguinal cana

Testis cannot be "milked" down inguinal cana

A newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse? a) The foreskin is needed for repair. b) Circumcision is usually performed after 1 year old. c) Circumcision with a hypospadias will cause meatal stenosis. d) The circumcision may predispose the child to renal failure.

The foreskin is needed for repair.

A parent asks if their newborn's undescended testicles will need surgery to repair. What is the best response by the nurse?

There is a chance the testicles will descend on their own.

Why does the nurse suspect cerebral palsy in the 8-month-old just assessed? a) The baby drools almost constantly. b) The child sits independently with a straight back. c) The child does not crawl. d) When startled, a strong Moro reflex is noted.

When startled, a strong Moro reflex is noted.

The most important assessment of neurovascular status to make after spinal surgical instrumentation would be to

assess the legs for warmth.

The condition in which one or both of the testes does not descend in the male infant is referred to as: hydrocele. cryptorchidism. enuresis. orchiopexy.

cryptorchidism.

Who is most likely to be diagnosed with cryptorchidism? (select all that apply) a. newborn born at 5 lb b. newborn born with hypospadias c. newborn born at 7.8 lb d. newborn born at 32 week

newborn born at 5 lb newborn born with hypospadias newborn born at 32 week

Idipathic talipes equinovarus is found in what kind of patient? a. normal healthy infants b. infants with myelomeningocele c. sick toddlers d. healthy toddlers

normal healthy infants

A child is administered oxybutynin (Ditropan) following surgical repair of a hypospadias. The purpose of this drug is to a) prevent nausea and vomiting. b) stimulate kidney function. c) acidify urine. d) relieve bladder spasms.

relieve bladder spasms

A 3-year-old child is scheduled for a surgery to correct undescended testes. For what postoperative consideration would the nurse want to prepare the parents? the need for maintaining a semi-Fowler position a liquid diet for 3 days the need for complete bed rest for 10 days some discomfort at the surgery site

some discomfort at the surgery site

What is the treatment process for an infant with talipes equinovarus?

surgery, then cast for 12 weeks, then corrective shoes or dennis browne splint

You care for a 3-year-old with hypospadias. After a surgical repair, he has a urethral urinary catheter inserted. You would want to teach his parents that a) He will always have tenderness on penile erection. b) the catheter insertion site will leave only a minimal scar. c) He must be reevaluated at puberty for testicular function. d) back pressure from such drainage may result in nephrotic syndrome.

the catheter insertion site will leave only a minimal scar.

The nurse is assessing a child with spastic cerebral palsy. Which of the following would the nurse expect to assess? Select all that apply. a) Poor control of balance b) Dysarthria c) Exaggerated deep tendon reflexes d) Hypertonicity e) Hemiplegia f) Drooling

• Poor control of balance • Exaggerated deep tendon reflexes • Hypertonicity • Hemiplegia