Perry Ch 48 & 49 Practice Questions
A 3-month-old w/ spina bifida is admitted to the nurse's unit. Which gross motor skills should the nurse assess at this age? a) Head control b) Pincer grasp c) Sitting alone d) Rolling over
A A 3-month-old has good head control.
A nurse is caring for a 5 y/o who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that: a) This is a serious injury that could cause long-term growth issues b) The fracture usually heals within 6 weeks without further complications c) The child will never be able to play contact sports d) Fractures involving the growth plate require pain medication
A Fractures of the growth plate are serious, as they can disrupt the growth process.
The parents of a preschooler diagnosed w/ muscular dystrophy are asking questions about the course of their child's disease. Which should the nurse tell them? a) "Muscular dystrophies usually result in progressive weakness" b) "The weakness that your child is having will probably not increase." c) "Your child will be able to function normally and not need any special accommodations." d) "The extent of weakness depends on doing daily physical therapy."
A Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder.
A neonate, who was delivered by C-section for a breech presentation, is being examined in the neonatal nursery. For which of the following complications should the nurse carefully assess the baby? a) Developmental dysplasia of the hips (DDH) b) Legg-Calves-Perthes (LCP) c) Duchenne muscular dystrophy (DMD) d) Slipped capital femoral epiphysis (SCFE)
A Neonates should be assessed in the neonatal nursery for DDH.
Which is the definition of talipes varus? a) An inversion or bending inward of the foot b) An eversion or bending outward of the foot c) A high arch of the foot d) A low arch (flatfoot) of the foot
A Talipes varus is an inversion of the foot.
4 y/o David is placed in Bucks extension traction for Legg-Calv-Perthes disease. He is crying w/ pain as the nurse assess that the skin of his right foot is pale with an absence of pulse. Which should hte nurse do first? a) Notify the practitioner of the changes noted b) Give the child medication to relieve pain c) Reposition the child and notify the physician d) Chart the observations and check the extremity again in 15 minutes
A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner.
Four-year-old David is placed in Bucks extension traction for Legg-Calv-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first? a) Notify the practitioner of the changes noted b) Give the child medication to relieve the pain c) Reposition the child and notify the physician d) Chart the observations and check the extremity again in 15 minutes
A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner.
The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? a) Immediately after diagnosis b) At age 4-6 months c) Prior to walking (age 9 to 12 months) d) After walking is established (age 15 to 18 months)
A The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made.
The mother of a child w/ Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening? Who should the nurse say must be tested? Select all that apply. a) Mother b) Sister c) Brother d) Aunts and all female cousins e) Uncles and all male cousins
A, B, D Women carry the disease, and males are affected. All female relatives should be tested.
Which instruction(s) should the nurse give the parents of an adolescent w/ SCFE? Select all that apply. a) Continue upper body exercises to limit loss of muscle strength b) Don't turn the teen in bed when complaining of pain c) Provide homework, computer games, and other activities to decrease boredom d) Do most activities of daily living for the teen e) Expect expressions of anger and hostility f) Continue setting limits on behavior
A, C, E, F Immobilization can lead to a decrease in muscle strength. Upper body exercises should be continued soon after surgery. It's important for this patient to continue as many normal activities as possible. Some expressions of anger and hostility are normal. Continuation of setting limits on behavior is important to keep as much normalcy as possible.
Which factor(s) is /are associated w/ slipped capital femoral epiphysis (SCFE)? Select all that apply. a) Obesity b) Female gender c) African descent d) Age 5-10 years e) Pubertal hormonal changes f) Endocrine disorder
A, E, F Obesity increases the risk of SCFE by stressing the epiphyseal plate. SCFE is most common during pubertal hormonal changes. SCFE is associated w/ endocrine disorders.
Which should the nurse tell the parent of an infant w/ spina bifida? a) "Bone growth will be more than that of babies who are not sick because your baby will be less active." b) "Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills." c) "Nutritional needs for your infant will be calculated based on activity level." d) "Fine motor skills will be delayed because of the disability."
B Children w/ decreased activity due to illness or trauma are helped by physical and occupational therapy. The varied activities stimulate the senses.
The nurse knows that teaching was successful when a parent states which of the following are early signs of muscular dystrophy? a) Increased muscle strength b) Difficulty climbing stairs c) High fevers and tiredness d) Respiratory infections and obesity
B Difficulty climbing stairs, running, and riding a bicycle are frequently the first symptoms of Duchenne muscular dystrophy.
The nurse prepares to administer baclofen to a child w/ CP who just had her hamstrings surgically released. The child's parents ask what the medication is for. Select the nurse's best response. a) "It's a medication that will help decrease the pain from her surgery" b) "It's a medication that will prevent her from having seizures" c) "It's a medication that will help control her spasms" d) "It's a medication that will help w/ bladder control"
C Baclofen is given to help control the spasms associated w/ CP.
The parent of a 3-week-old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? a) Give pain medication b) Reposition the infant in the crib c) Check the neurocirculatory status of the foot d) Use a cool blow-dryer to blow into the cast to control itching
C Checking the neurocirculatory status of the foot is the highest priority.
A child w/ spastic CP had an intrathecal dose of baclofen in the early afternoon. What is the expected result 3 1/2 hours post dose that suggests the child would benefit from a baclofen pump? a) The ability to self-feed b) The ability to walk w/ little assistance c) Decreased spasticity d) Increased spasticity
C If baclofen were going to work for this child, one could tell because spasticity would be decreased.
A nurse who works w/ overweight children monitors them carefully for S&S of which of the following musculoskeletal illnesses? a) Scoliosis b) Legg-Calve-Perthes c) Slipped capital femoral epiphysis d) Duchenne muscular dystrophy
C SCFE is seen more frequently in obese children.
The nurse should tell the parents of a child w/ Duchenne muscular dystrophy that some of the progressive complications include: a) Dry skin and hair, hirsutism, protruding tongue, and mental retardation b) Anorexia, gingival hyperplasia, and dry skin and hair c) Contractures, obesity, and pulmonary infections d) Trembling, frequent loss of consciousness, and slurred speech
C The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems.
An 8 y/o child has been diagnosed w/ Legg-Calves-Perthes disease. Which of the following information should the nurse include in the patient teaching regarding the illness? a) "You will have to stay home from school and learn from a tutor until you get better" b) "The infection in your bone will be treated w/ a special medicine that you will receive through your vein" c) "You will have to use crutches and be allowed only to walk on your healthy leg until your bones are all better" d) "The cast must stay on your ankle and calf for a few weeks until they're fully healed"
C This statement is correct. The child will have to use crutches and only walk on the healthy leg until the bones have healed.
Which should be included in teaching a family about post-surgical care for SCFE? Select all that apply. a) The patient will receive help w/ weight-bearing ambulation 24-48 hours after surgery b) Monitoring of pain medication to prevent drug dependence c) Instruction on pin site care d) Offering low-calorie meals to encourage weight loss e) Correct use of crutches by the patient f) Outpatient physical therapy for 6-8 weeks
C, E The parents will be assessing pin sites for infection and stability upon discharge. Instructions on care should be demonstrated for and then by the parents. Instruction on crutch usage will be given prior to discharge. Crutch walking will not be done during the early post-operative stage.
A 15 y/o child w/ spina bifida is seen in the clinic for a well-child checkup. The teen uses leg braces and crutches to ambulate. Which nursing diagnosis takes priority? a) Potential for infection b) Alteration in mobility c) Alteration in elimination d) Potential body image disturbance
D As an adolescent on crutches and wearing braces, the teen would have the issue of body image disturbance, which must be addressed.
Which foods would be best for a child w/ Duchenne muscular dystrophy? a) High-carbohydrate, high-protein foods b) No special food combinations c) Extra protein to help strengthen muscles d) Low-calorie foods to prevent weight gain
D As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation.
Which should be obtained to make a diagnosis of SCFE? a) A history hip trauma b) A physical examination of hip, thigh, and knees c) A CBC d) A radiographic examination of the hip
D Radiographic examination is the only definitive diagnostic tool for SCFE.
The nurse is caring for a school-aged child w/ Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis? a) Anticipatory grieving b) Anxiety reduction c) Increased pain d) Activity intolerance
D The child would not be able to keep up w/ peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength.
A 4 y/o child is newly diagnosed w/ Legg-Calve-Perthes disease. Nursing considerations should include which action? a) Encouraging normal activity for as long as possible b) Explaining the cause of the disease to the child and family c) Preparing the child and family for long-term, permanent disabilities d) Teaching the family the care and management of the corrective appliance
D The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome.
