Exam #4 Peds

Waddling gait; difficult walking up stairs

. . .Duchenne Muscular Dystrophy

This occurs with severe dysfunction of the several cortex or lesions on the corticospinal tracts and looks like flexion of elbows; writs; and fingers "toward the cord"

Decorticate

Infant - shortening of the limb on the affected side; restricted abduction of the affected side; unequal gluteal folds Older children - affected leg a spears shorter than the . . .

Developmental dysplasia of the hip

The 3 parts of assessment included in the GCS

Eye opening, verbal response, and motor response

Assessment tool used to determine LOC. It is an early indicator of improvement or deterioration in neurologic status

Glascow coma scale (GCS)

High pitched cry; irritability; poor feeding; bulging fontanels in a n infant

Increased Intracranial Pressure (IICP)

A splint that helps keep the hip flexed and abducted (used up to 6 months)

Pavlik harness (for developmental dysplasia of the hip.

Priority nursing intervention for a child having a seizure

Protect the child from injury

Priority nursing intervention for a child diagnosed with a myelomeningocele awaiting surgery

Protect the myelomeningocele sac

Do not stop medications without speaking to your physician; wear a medical alert bracelet; avoid triggers like emotional stress; sleep deprivation; bright lights; blinking lights

Pt teaching for seizures

Symptoms follow a viral illness and include lethargy; irritability; combativeness; confusion; delirium; profuse vomiting; seizures; and loss of consciousness

Reye syndrome

This diagnostic test provides reliable evidence of recent streptococcal infection and is used when diagnosing rheumatic fever/post-streptococcal glomerulonephritis

Serum streptococcal antibodies

Pain

pulses, pallor, paresthesia, paralysis, pressure,The 6 P's

C (A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure-free for 2 years and has a normal electroencephalogram. Medications must be gradually reduced to minimize the recurrence of seizures. Seizure medications can be safely discontinued. The risk of recurrence is greatest within the first year.)

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. The nurse includes which intervention in the response? 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 stepwise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.

B (Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.)

A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show: a. Bacteriuria and hematuria. b. Hematuria and proteinuria. c. Bacteriuria and increased specific gravity. d. Proteinuria and decreased specific gravity.

C (Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures. The treatment of epilepsy involves a thorough assessment to determine the type of seizure the child is having and the cause of events, followed by individualized therapy to allow the child to have as normal a life as possible. The nurse should not make generalized comments like "Very few children have actual epilepsy" and "Your child has had only one convulsion; it probably won't happen again" until further assessment is made.)

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is: a. "Epilepsy is easily treated." b. "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."

D, E (Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.)

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what condition (Select all that apply)? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. Urinary tract infection (UTI) e. Diabetes mellitus

D) This could indicate a sprain or fracture, and nursemaid's elbow is common in toddlers and preschoolers. This statement should be further investigated since it indicates pain/discomfort. It is not uncommon for infants to have flat feet, although the arch of the foot should begin to form after walking begins. However, some infants never develop an arch and have flat feet as adults. Genu valgum, or "knock knees", are commonly seen around the ages 2-3, and this will often resolve by ages 7-8. It is not uncommon for a toddler to dislike broccoli. Who does like broccoli.

A concerned mother calls the and tells you the following pieces of information about her 2-year-old son. Which statement by the mother most concerns you? A) "I noticed that when my son is standing, his knees touch but his feet seem really far apart." B) "My son's feet are so flat, even though he's been waking for 9 months now." C) "My baby really hates it when I try to feed him broccoli and keeps spitting it out onto his plate." D) "This morning when I was trying to dress him, my son cried nonstop when I tried to put his shirt on."

D. (Serial casting is begun shortly after birth and before discharge from nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy.)

A newborn with congenital clubfoot is being treated with successive casts. The parents ask why so many casts are required. The nurse should explain that: A. casts are needed for the traction. B. each cast is good for only 6 weeks. C. surgical intervention will not be necessary. D. They allow for gradual stretching of tight structures.

2) (This fever could indicate aspiration pneumonia, and this needs to be investigated further immediately with questioning of coughing, respiratory difficulty, or sputum production. Seizures are common with cerebral palsy. The child's symptoms have likely worsened because of the stress due to a clinic visit. Standing on the toes or scooting on the back (instead of crawling on the abdomen) are both commonly seen in a patient with cerebral palsy.)

A nurse admits a child who has a history cerebral palsy. Which assessment finding by the nurse is most concerning? A) The mother reports the child had a seizure 5 hours ago. B) The child has a fever of 100.3. C) The child is standing on his toes. D) The mother reports the child's twisting movements seem to have worsened since arriving at the clinic.

B, D, F (Nothing should be inserted into the cast, and lotions and powders should not be used. If the cast gets wet, a blow dryer with COLD air should be used. There is no need to adjust the child's diet, but the cast should be covered while the child eats or drinks.)

A nurse has just finished providing discharge teaching to the family of a child going home with a cast that was applied 30 minutes prior. Which statement by the family indicates that further teaching is necessary? Select all that apply: A) "For the next couple of days, we should keep the casted arm above the level of the heart and apply ice." B) "If my child's arm starts to itch, we can apply lotion if we can reach into the cast." C) "We will tape a plastic bag around his cast before he takes a bath." D) "If my child gets his cast wet, we'll blow dry it with the lowest heat setting on our blow dryer." E) "We will make sure we regularly press the skin back around the edge of the cast." F) "We will make sure our child does not eat anything messy while he has this cast on."

B. (This condition, known as genu valgum or knock-knees, a common finding in children aged 2-3 and would not be concerning to the nurse. Refusal to use a limb could be a sign of damage or fracture to that limb. Trendelenberg's sign, or the drop of the pelvis when walking, could be a sign of hip dysplasia. Being in the shortest percentile for his age group could be a sign of a growth delay possibly caused by an underlying condition.)

A nurse is assessing a 3 year old child in the pediatrics wellness clinic, which of the following would be least concerning to the nurse? a) The child is holding his right arm close to his chest and refusing to use it b) When the child stands with his knees together, his ankles are far apart c) The child's pelvis drops slightly whenever he walks d) The child is in the shortest percentile for his age group

B, C, D (Others are characteristic of spastic cerebral palsy. The infant may also appear limp or flaccid with the face, neck, and tongue possibly affected.)

A nurse prepares to care for a patient diagnosed with athetoid, or dyskinetic, cerebral palsy. Which of the following does the nurse expect to see? Select all that apply: A) Hypertonicity of affected extremities B) Drooling C) Worsening of symptoms when the child gets stressed D) Worm-like writhing E) Exaggerated deep tendon reflexes

A, C, D (The CSF laboratory results for bacterial meningitis include elevated WBC counts, cloudy or milky in color, and decreased glucose. The protein is elevated and there should be no RBCs present. RBCs are present when the tap was traumatic.)

A nurse should expect which cerebrospinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis (Select all that apply)? a. Elevated white blood cell (WBC) count b. Decreased protein c. Decreased glucose. d. Cloudy in color. e. Increase in red blood cells (RBCs)

B, D, E (A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy, smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.)

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess (Select all that apply)? a. Weight loss b. Facial edema c. Cloudy, smoky brown-colored urine d. Fatigue e. Frothy-appearing urine

A (The child's history of the fall, brief loss of consciousness, and vomiting four times necessitate evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan. The need for the CT scan is related to the injury and symptoms, not the child's age, and is necessary to determine whether a brain injury has occurred.)

A toddler fell out of a second-story window. She had brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she "seems fine." The nurse should explain that the toddler:a. May have a brain injury. b. May start having seizures. c. Needs this because of her age. d. Probably has a skull fracture.

C (Absence seizures are brief losses of consciousness. Generalized seizures are the most common of seizures. They have a tonic phase of approximately 10 to 20 seconds. They involve both hemispheres of the brain. Status epilepticus is a generalized seizure that lasts more than 30 minutes. Simple partial seizures are characterized by varying sensations.)

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. The nurse should recognize that this is: A. absence seizure. B. generalized seizure. C. status epilepticus. D. simple partial seizure.

Periorbital edema; tea-colored urine; anorexia; proteinuria; hematuria; anorexia are signs of they GU disorder

Acute glomerulonephritis, (on test nephrotic syndrome and nephrosis are used interchangeably

The test used to evaluate a child for scoliosis. Examine from behind

Adams forward bend test

A (When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child should not be restrained, and nothing should be placed in his or her mouth. This may cause injury. To prevent aspiration, if possible, the child should be placed on his or her side, facilitating drainage.)

An important nursing intervention when caring for a child who is experiencing a seizure is to: a. Describe and record the seizure activity observed. b. Restrain the child when seizure occurs to prevent bodily harm. c. Place a tongue blade between the teeth if they become clenched. d. Suction the child during a seizure to prevent aspiration.

A, E, F (Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping the shunt reservoir, administering sedation, and maintaining Trendelenburg position are not interventions associated with this condition.)

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care (Select all that apply)? a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt.e. Maintain an accurate record of intake and output.f. Monitor for abdominal distention.

B (The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased excretion of urinary protein and increased ability of tissues to retain fluid are part of the disease process and must be reversed.)

An objective of care for the child with nephrosis is to: a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.

SE of this medication include constipation;drowsiness; weakness; headache; nausea; and increased urination

Baclofen (used for muscle spasticity)

Bone healing is more rapid in which age population

Children

C and D. (Hydrocephalus could be present with either meningocele or myelomeningocele. Leakage of CSF would indicate a serious complication, not a common finding. The absence of deep tendon reflexes or the constant dribbling of urine indicates some neural involvement, differentiating it from meningocele. Meninges in the sac occurs in both myelomeningocele and meningocele. In myelomeningocele, the cord itself also protrudes into the sac)

Little baby joe was born with an outer sac on his spine. Which of the following would correlate with a diagnosis of myelomeningocele? SATA: A) Accompanying hydrocephalus B) Leakage of the CSF C) Absence of deep tendon reflexes D) Constant dribbling of urine E) Meninges of the spine in the sac

Two nursing interventions for a child with viral meningitis

Monitor for seizures, assess for petechiae or purpuric type rash; place in isolation; place child in a comfortable position; decrease environmental stimuli; maintain comfort measures including pain medication; maintain safety

A child admitted with proteinuria; hypoalbuminemia; edema; facial edema; ascites; irritability

Nephrosis (nephrotic syndrome)

Priority nursing action with a patient with a new cast

Neurovascular assessment

A, B, C, and D. (The cast/extremity under the cast could begin to feel warm during the cast removal process. The saw could be loud, but the nurse should demonstrate on him/herself that the saw can't won't cut the child. Once the cast is removed, it will be soaked and washed in warm soapy water, and it should be soaked in warm water daily. All of these need to be communicated to the child on the level of their understanding. The child should be told to start increasing activity the limb to regain strength and range of motion.)

The 7 year old patient has had a cast on to heal his fracture of his arm. After the expected time period, the nurse is teaching a child about what to expect when removing his cast. Which of the following teaching points should the nurse include? Select All that Apply: A) "The cast could begin to feel really warm as the striker saw is taking the cast off" B) "The striker saw will be very loud" C) "Look, see, the saw won't be able to cut your skin" D) "Once the cast is removed we will soak your leg in warm water" E) "you will still need to keep your leg very still even after the cast is removed"

C, D (The priority nursing intervention is to observe the child and seizure, and document the activity observed. The child should not be restrained, because this may cause an injury. Nothing should be placed in the child's mouth, because this may cause an injury not only to the child but also to the nurse. To prevent aspiration, the child should be placed on the side if possible to facilitate drainage.)

The MOST appropriate nursing interventions when caring for a child experiencing a seizure include: (Select all that apply.) A. restraining the child when a seizure occurs to prevent bodily harm. B. placing a padded tongue between the teeth if they become clenched. C. avoid suctioning the child during the seizure. D. describing and documenting the seizure activity observed. E. applying supplemental oxygen after inserting an artificial oral airway.

D) (Spinal cord injury is a medical emergency that requires immediate assessment. A fever and difficulty swallowing in a child with cerebral palsy may indicate aspiration pneumonia, so this child should be seen next. Absent deep tendon reflexes are expected in a child with myelomeningocele, related to the paralysis seen below the sac. A child with Duchenne muscular dystrophy may be sad or withdrawn due to corticosteroid medication side effects or chronicity of the disease.)

The day shift pediatric nurse receives report on the following 4 patients. After receiving report, which patient should the nurse assess first? A) The 4-year-old female with cerebral palsy who admits with difficulty swallowing and a fever of 101.9. B) The 9-month-old male with myelomeningocele who has absent deep tendon reflexes in bilateral lower extremities. C) The 6-year-old male with Duchenne muscular dystrophy who appears sad and withdrawn. D) The 7-year-old female with a spinal cord injury who reports numbness and tingling in her feet.

4) (Spinal cord injury is a medical emergency that requires immediate assessment. A fever and difficulty swallowing in a child with cerebral palsy may indicate aspiration pneumonia, so this child should be seen next. Absent deep tendon reflexes are expected in a child with myelomeningocele, related to the paralysis seen below the sac. A child with Duchenne muscular dystrophy may be sad or withdrawn due to corticosteroid medication side effects or chronicity of the disease.)

The day shift pediatric nurse receives report on the following 4 patients. After receiving report, which patient should the nurse assess first? A) The 4-year-old female with cerebral palsy who admits with difficulty swallowing and a fever of 101.9. B) The 9-month-old male with myelomeningocele who has absent deep tendon reflexes in bilateral lower extremities. C) The 6-year-old male with Duchenne muscular dystrophy who appears sad and withdrawn. E) The 7-year-old female with a spinal cord injury who reports numbness and tingling in her feet.

B (Salt is usually restricted (but not eliminated) during the edema phase. The child has vey little appetite during the acute phase. Favorite foods are provided (with exception of high-salt ones) in an attempt to provide nutritionally complete meals.)

The diet of a child with nephrosis usually includes: a. High protein b. salt restriction c. Low fat d. High carbohydrate

C (Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.)

The initial clinical manifestation of generalized seizures is: a. Being confused. b. Feeling frightened. c. Losing consciousness. d. Seeing flashing lights.

C (Glomerulonephritis has a decreased filtration of plasma. The decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration, not fluid accumulation.)

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is: a. Risk for Injury related to malignant process and treatment. b. Deficient Fluid Volume related to excessive losses. c. Excess Fluid Volume related to decreased plasma filtration. d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.

C (Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestations of brain tumors in children. Irritability, seizures, and fever and poor fine motor control are clinical manifestations of brain tumors, but headaches and vomiting are the most common.)

The most common clinical manifestation of brain tumors in children is: a. Irritability. b. Seizures. c. Headaches and vomiting. d. Fever and poor fine motor control.

D (H. influenzae type B meningitis has virtually been eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms. Meningitis is an extension of a variety of bacterial infections. No genetic predisposition exists. Vaccinations are not available for all of the potential causative organisms.)

The mother of a 1-month-old infant tells the nurse that she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on knowing that: 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. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children.

A, B, and E. (Corticosteroids are thought to help slow the progression of the disease. Calcium supplements are provided to help with the long-term effects of osteoporosis caused by the corticosteroids. Chest percussion can help remove excess secretions from the respiratory tract that the patient may be too weak to expel by themselves. Bedrest or use of botulinum toxin would not be recommended for this patient.)

The nurse anticipates which of the following orders for the patient with Duchenne Muscular Dystrophy? Select all that apply: A) Prednisone B) Calcium supplements C) Bedrest D) Botulinum Toxin E) Chest percussion

A (Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection, but it is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.)

The nurse closely monitors the temperature of a child with nephrosis. The purpose of this is to detect an early sign of: a. Infection. b. Hypertension. c. Encephalopathy. d. Edema.

C (Isolation should be instituted as soon as diagnosis is anticipated. Isolation should be instituted as soon as diagnosis is anticipated. This is the priority action. Antibiotics are begun as soon as possible to prevent death and avoid resultant disabilities. Antibiotics are the priority function; pain should be managed if it occurs.)

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. The PRIORITY of nursing care is to: A. initiate isolation precautions as soon as the diagnosis is confirmed. B. initiate isolation precautions as soon as the causative agent is identified. C. administer antibiotic therapy as soon as it is ordered. D. administer sedatives/analgesics on a preventive schedule to manage pain.

C, D, E (Assessment findings in a neonate with meningitis include bulging anterior fontanel, weak cry, and poor muscle tone. Headache and photophobia are signs seen in an older child.)

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed (Select all that apply)? a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry. Poor muscle tone

A, B, and E. (With all traction, the weights should remain off of the floor at all times and should not be released periodically or stopped for any reason unless emergent. A foot support will be needed for this patient because foot drop could develop related to the heel being elevated without support. The heel should be off of the bed at all times, not resting on it. Neurovascular status should be assessed often on this patient (as often as vitals are done).)

The nurse is caring for the patient with Russel's traction. Which of the following should the nurse include in this patients plan of care? SATA: A) Weight should remain off of the floor at all times B) Place a foot support to prevent foot drop C) Release traction for 5 minutes of every hour to provide skin care D) Ensure heel is resting on bed at all times E) Assess neurovascular status q 4 hours

C (Limits should be appropriate to the developmental age of the child. Except for contact sports, the child will have few restrictions. Cognitive impairment depends on the extent of damage before the shunt was placed. Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the developmental age of the child. Except for contact sports, the child will have few restrictions.)

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. In the discussion the nurse should include that: A. parental protection is essential until the child reaches adulthood. B. cognitive impairment is to be expected with hydrocephalus. C. shunt malfunction or infection requires immediate treatment. D. most usual childhood activities must be restricted.

Answer: B, C, and E.

The nurse is especially concerned to assess for adequate respiratory function in which of the following disease processes? Select all that apply: a) Spina bifida occulta b) Duchene muscular dystrophy c) Spinal Muscular Atrophy d) Brachial plexus injurye) Cerebral Palsy

A (Children with meningitis are sensitive to noise, bright lights, and other external stimuli. The nurse should keep the room as quiet as possible, with a minimum of external stimuli. After consultation with the practitioner, pain medications can be used if necessary. A school-age child will have closed sutures. Head circumference should not change. The child is placed in side-lying position with the head of the bed slightly elevated. The nurse should avoid measures such as lifting the child's head that would increase discomfort.)

The nurse is planning care for a school-age child with bacterial meningitis. The plan should include: A. keeping environmental stimuli at a minimum. B. avoiding giving pain medications that could dull sensorium. C. measuring head circumference to assess developing complications. D. having child move head side to side at least every 2 hours.

C. (Diapering is not done for infants with myelomeningocele in order to prevent putting pressure on the sac. An overhead warmer should be used with this baby for temperature control. It is important to keep the perineum clean and dry. The child can be propped onto the side with a towel slightly to prevent skin breakdown from being in the prone position for long periods of time.)

The nursing student is helping to take care of the infant with myelomeningocele. Which of the following actions, if made by the student nurse, should the nurse intervene? a) The nursing student uses and overhead radiant heater to warm the baby b) The student keeps the perineum clean and dry c) The student puts an absorbent diaper on the baby to keep it dry d) The nursing student turns props the baby slightly to the side with a towel under the abdomen

B, C, D, E (Can also use botulinum toxin, but this is administered by a nurse practitioner or physician.)

The pediatric nurse knows that which of the following medications are commonly used for patients with cerebral palsy? Select all that apply: A) Docusate sodium B) Diazepam C) Dantrolene sodium D) Baclofen E) Atropine

A (Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.)

Therapeutic management of nephrosis includes: a. Corticosteroids. b. Antihypertensive agents. c. Long-term diuretics. d. Increased fluids to promote diuresis.

Use of pulling force to redduce a fracture

Traction

A nursing interventions o complete with a child who's an extremity in a new plaster cast

Turn q 2 hrs to help cast dry evenly;Elevate cast above heart level to prevent swelling

Wiping from front to back with urination can help prevent this

UTI

Recurrent UTI's can lead to this GU disorder

Vesicoureteral reflux

D (Although the etiology of Reye's syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye's syndrome; thus use of aspirin is avoided. No immunization currently exists for Reye's syndrome. Reye's syndrome is not correlated with head injuries or bacterial meningitis.)

What action may be beneficial in reducing the risk of Reye's syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza

D (Although the etiology of Reye's syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye's syndrome; thus use of aspirin is avoided. No immunization currently exists for Reye's syndrome. Reye's syndrome is not correlated with head injuries or bacterial meningitis.) What action may be beneficial in reducing the risk of Reye's syndrome?a. Immunization against the diseaseb. Medical attention for all head injuriesc. Prompt treatment of bacterial meningitisd. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza

What action may be beneficial in reducing the risk of Reye's syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza

A (Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema. Preventing skin breakdown, observing for petechiae, and doing ROM exercises are important interventions in the care of a critically ill or comatose child.

When caring for the child with Reye's syndrome, the priority nursing intervention is to: a. Monitor intake and output. b. Observe for petechiae. c. Prevent skin breakdown. d. Do range-of-motion (ROM) exercises.

B (Most cases of Reye's syndrome follow a common viral illness such as varicella or influenza. Measles, meningitis, and hepatitis are not associated with Reye's syndrome.)

When taking the history of a child hospitalized with Reye's syndrome, the nurse should not be surprised that a week ago the child had recovered from: a. Measles. b. Varicella. c. Meningitis. d. Hepatitis.

A (Bulging fontanel, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.)

Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

D)

Which diagnostic exam does the nurse know will best aid in the diagnosis of Duchenne muscular dystrophy? A) EEG B) CT Scan C) MRI D) EMG

D (Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the liver's inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.)

Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyper albuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

A and D. (Neurogenic bladder is the failure of the bladder to either store urine properly or empty itself of urine. Because of this urinary stasis occurs in the bladder placing the child at risk for infection. In myelomeningocele, the spinal cord is exposed, placing the child at high risk for infection. Immediate surgery is needed to help prevent infection from occurring. Bowel incontinence often occurs in children with myelomeningocele, but does not pose the same health risks as urinary incontinence. Latex allergy, although common, would not promote risk for infection alone. Corticosteroid use is not common in children with myelomeningocele.)

Which of the following does the nurse understand places the child with myelomeningocele at high risk for infection? A) Neurogenic bladder B) Bowel incontinence C) Latex allergy D) Exposure of sac E) Corticosteroid use

b. (Hydrocephalus is a frequently associated anomaly in 80% to 90% of children.)

Which of the following problems is most often associated with myelomeningocele? A. Biliary atresia B. Hydrocephalus C. Craniosynostosis D. Tracheoesophageal fistula

A, C, D, and E. (To protect balance, which is impaired in this disorder, the child may often have their belly sticking out with their shoulders pulled back. They often have a waddling gait and walk on the toes or on the balls of the feet. Gower's sign is the use of a special technique in order to rise off of the floor. Spinal curvatures often occur as the muscles in the body atrophy (including lordosis, kyphosis, and scoliosis). Intelligence is rarely affected by this disorder.)

Which of the following symptoms would the nurse expect to possibly see in the child with Duchenne muscular dystrophy? Select all that apply a) Protuberant belly b) Diminished intelligence c) Walking on the toes or balls of feet d) Gower's sign e) Spinal curvatures

C (Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Focal seizures may arise from any area of the cerebral cortex, but the frontal, temporal, and parietal lobes are most commonly affected. Partial seizures are caused by abnormal electrical discharges from epileptogenic foci limited to a circumscribed region of the cerebral cortex. A seizure disorder that is acquired is a result of a brain injury from a variety of factors; it does not specify the type of seizure.)

Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

A (Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, and complex partial seizures all have clinical manifestations that are observable.)

Which type of seizure may be difficult to detect? a. Absence b. Simple partial c. Generalized d. Complex partial

d. (it would be important to educate the family on the presence of spina bifida occulta, a neural tube defect that typically is benign and is often considered a normal defect. It would be important to differentiate this form of spina bifida from the highly stigmatized forms of spina bifida such as myelomingocele)

While assessing the newborn infant, the nurse notices a dimple with a tuft of hair at the bottom of the spine. What is the nurse's priority action? a) Place the child in the prone position to protect the area b) Soak a sterile dressing and place it over the area c) Notify the physician d) Educate the family on what this means for the child

C) (Extra visitors should not be invited on the bed- especially a toddler who may think the weights at the end of the bed are toys. The head of the bed should only be raised or lowered with physician's orders, and this should be done minimally. The weights should ALWAYS be hanging freely.)

While caring for a 9-year-old female in Buck's traction, which of the following actions by the nurse is correct? A) The nurse encourages the child's 3 year-old sibling to sit on the bed and visit with the child. B) The nurse helps the child learn how to raise and lower the head of her bed so she can complete her homework. C) The nurse checks the capillary refill on the child's extremities every 4 hours. D) The nurse teaches the child's mother to place the weights on the bedside table before the child uses the bedpan.

C. (Cerebral Palsy is a term used to describe a range of nonspecific clinical symptoms characterized by abnormal motor pattern and postures caused by nonprogressive abnormal brain function.)

You are the nurse taking care of the infant just diagnosed with cerebral palsy. The mother of the child asks you, "What does this mean for my child?" What is the best response by the nurse? A) This means that you child will gradually lose more and more muscle mass until eventually they will be unable to sustain their respiratory function B) This is a disorder related to how your child was born. Most likely they sustained injury during the birthing process C) There really is no specific way to tell how this disease will affect your child other than it will affect the muscle tone and control in some way. D) Why are you asking me? I ain't no doctor!

A. (Tachycardia in the patient with Duchenne Muscular Dystrophy is a sign of heart muscle weakening, a serious complicating of this disorder. Scoliosis often occurs in patients with cerebral palsy. Cloudy, foul-smelling is a sign of a UTI, which is a complication of neurogenic bladder. This is concerning, but not as concerning as the heart trouble with Duchenne. An absent Moro's reflex would be expected in the patient with a brachial plexus injury.)

You are the nurse working at a pediatrics clinic in Miami. You are assessing four amazingly awesome patients today. Which assessment finding concerns the nurse the most? A) The patient diagnosed with Duchenne Muscular Dystrophy demonstrating Gower's sign, waddling gait, and tachycardia B) The patient with cerebral palsy with scoliosis who is need of bracing C) The patient with myelomeningocele whose urine is cloudy and smells foul D) The patient with a brachial plexus injury who has an absent Moro's reflex

Specific gravity 1.016-1.022

clear, pale yellow to deep gold amber color, pH 6, absent/negative protein, glucose, ketones, nitrates, leukocyte esterase,Normal lab values for urinalysis