Mod 15 EAQs

A child with spina bifida presents with a rash and is also sneezing and coughing continuously. Which are the most appropriate questions to confirm whether the child has a latex allergy? Select all that apply. A. "Does your child have a history of allergic reaction to anything?" B. "Did your child come in contact with any rubber product recently?" C. "Did you watch your child undergoing the surgery?" D. "Has your child ever had any allergy testing at a certified clinic?" E. "Did you recently visit any clinic for counseling assistance of your child?" F. "Has your child ever had an allergic reaction during surgery?"

ANS- A. "Does your child have a history of allergic reaction to anything?" B. "Did your child come in contact with any rubber product recently?" D. "Has your child ever had any allergy testing at a certified clinic?" F. "Has your child ever had an allergic reaction during surgery?" Rationale: Latex allergy is a serious health hazard for a child with spina bifida. The most common symptoms of latex allergy are sneezing, coughing, and developing rashes. To know whether the child has come in contact with rubber, the nurse should find out about the child's history of allergic reactions. Sometimes food or other products can cause allergic reactions. If the child has come in contact with rubber, then the child should be immediately taken to a primary health care provider. Allergy testing and allergic reaction during surgery can also confirm latex allergy. However, inquiring about the presence of the parents during a surgery or their visit to a clinic for counseling is not appropriate to determine whether the child has latex allergy.

The nurse is teaching the parent of a 12-month-old infant about assessing developmental dysplasia of the hip in babies. What instruction does the nurse give the parent to check the presence of a Trendelenburg sign? A. "Make the infant stand on the affected leg." B. "Put the infant supine with the back arched." C. "Lay the infant down on the unaffected side." D. "Make the infant sit upright with legs separated."

ANS- A. "Make the infant stand on the affected leg." Rationale: When an affected older infant stands and bears weight on the affected hip, the pelvis tilts downward instead of upward, indicating a positive Trendelenburg sign. The supine position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis. The side-lying position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis. The sitting position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis

A child with Duchenne muscular dystrophy (DMD) is also suffering from obesity. What advice does the nurse give the parents so that they can manage the child's weight more appropriately? Select all that apply. A. "Obesity can lead to premature loss of ambulation and functional independence." B. "Family members should try to feed the child whenever possible to keep the child busy." C. "It is important to increase the physical and recreational activities in your child's life." D. "The child's IQ is 20 points, and thus it is best not to involve the child in learning." E. "Proper dietary intake and a diversified recreational program help reduce the likelihood of obesity."

ANS- A. "Obesity can lead to premature loss of ambulation and functional independence." C. "It is important to increase the physical and recreational activities in your child's life." E. "Proper dietary intake and a diversified recreational program help reduce the likelihood of obesity." Rationale: Obesity is a common complication in children with DMD. Obesity can lead to the premature loss of ambulation and functional independence. The nurse should recommend that the parents involve the child in different recreational and physical activities. Proper dietary intake and a diversified recreational program help reduce the likelihood of obesity and enable children to maintain ambulation and functional independence for a longer time. Overfeeding by well-meaning family and friends should be avoided, because this contributes to obesity. Additionally, the child with DMD should be involved in early learning programs and eventually moved into regular classrooms, even if their IQ is 20 points. This helps promote self-confidence and independence.

Which postoperative nursing interventions are useful to avoid secondary complications in a young patient who has undergone spinal surgery? Select all that apply. A. Assessing for signs indicating neurologic impairment B. Administering intravenous opioids on a regular basis C. Educating the patient on use and function of chest tube D. Assessing for the signs of superior mesenteric artery syndrome E. Teaching the patient to manage a patient-controlled analgesia (PCA) pump

ANS- A. Assessing for signs indicating neurologic impairment B. Administering intravenous opioids on a regular basis Rationale: After a spinal surgery, the patient has a considerable amount of pain for a few days. Pain relief requires frequent administration of intravenous pain medicines, preferably opioids. Postoperative assessment of any neurologic impairment should be performed because delayed paralysis might occur after spinal surgery. Educating the patient on the management of a patient-controlled analgesia (PCA) pump is done to promote self-care to encourage the patient's participation in treatment and recovery. Superior mesenteric artery syndrome is likely to be seen after spinal surgery in which there is compression of the duodenum by aorta and superior mesenteric artery. Clinical symptoms are nausea, vomiting, and epigastric pain which aggravate in the supine position and are relieved in the prone position. Teaching the patient about the use and function of a chest tube is also part of patient education for self-care

An examination reveals that an infant has spina bifida (SB). What in particular should the nurse be careful about while monitoring this infant? A. Avoid measuring rectal temperatures. B. Assess the level of neurologic involvement. C. Assess anal reflex for sensory impairment. D. Observe behavior in conjunction with stimuli.

ANS- A. Avoid measuring rectal temperatures Rationale: Rectal temperatures are not measured in infants with spina bifida because bowel sphincter function is often affected, and the thermometer can cause irritation and rectal prolapse. Ideally, the patient's level of neurologic involvement and anal reflex for sensory impairment are assessed. In addition, nurses observe the infant's behavior in conjunction with stimuli

A home care nurse is caring for a 4-month-old infant with developmental dysplasia of the hip (DDH). The baby is in a Pavlik harness. The baby's mother tells the nurse, "I don't think my baby will be able to sleep while wearing the harness." What is an appropriate response by the nurse? A. "The harness can be removed during a short 30-minute nap." B. "You can reapply the harness after the baby falls asleep." C. "It is important for the harness to be worn continuously." D. "You can have the baby not take one of the daily naps."

ANS- C. "It is important for the harness to be worn continuously." Rationale: The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination, usually in 6 to 12 weeks. Some practitioners permit its removal for bathing. Removal or re-application of the harness will probably awaken the infant. Babies should not be prevented from taking naps, as such naps are essential for good health.

The nurse is caring for a child with a hip spica cast. Which nursing interventions will be beneficial to the child? Select all that apply. A. Change the child's position every 2 hours. B. Dry the cast with heated fans or dryers. C. Remove rings and any other accessories. D. Check for any cuts or abrasions on skin. E. Cover the cast with a polythene sheet.

ANS- A. Change the child's position every 2 hours. C. Remove rings and any other accessories. D. Check for any cuts or abrasions on skin. Rationale: While caring for a child with a spica cast, the nurse should change the position of the child every 2 hours. This practice helps the cast to dry evenly and prevents complications such as pressure ulcers and bedsores that occur due to immobility. To prevent constriction of blood vessels and swelling of the limbs, the nurse should remove rings and other accessories from the client's body before applying the cast. To prevent infections and discomfort, the nurse should check the client's skin for the presence of cuts or abrasions before applying the cast. The nurse should not use heated fans or dryers to dry the cast as it leads to irregular drying of the cast and may cause burns because of the conduction of heat from the cast to underlying tissues. The nurse should not cover the cast with a polythene sheet as polythene retains moisture and does not allow the cast to dry inside out

After assessment of an infant the nurse informs the primary health care provider that the child has a positive Ortolani test. Which finding obtained from the test enables the nurse to reach this conclusion? A. Decreased hip abduction B. Symmetric folds on the thighs C. Bacterial infection in the joint D. Displacement of the femoral epiphysis

ANS- A. Decreased hip abduction Rationale: A positive Ortolani test indicates that the infant has developmental dysplasia of the hip. While performing the Ortolani test the nurse abducts the child's thighs and checks whether the client has hip subluxation or dislocation. The presence of decreased hip abduction indicates a positive Ortolani test. A child with developmental dysplasia of the hip has asymmetrical folds of the thigh tissues, so the presence of symmetrical folds would not indicate a positive Ortolani test. The presence of bacterial infection in the joints can be diagnosed through a series of tests including gram stain cultures, leukocyte count, blood cultures, and a complete blood count. Anteroposterior and frogleg radiographic examination are useful in diagnosing the displacement of proximal femoral epiphysis

The nurse is explaining to the parents of a child with myelomeningocele that some degree of fecal continence can be achieved with diet modification. What steps does the nurse cover in the teaching? Select all that apply. A. Dietary fiber supplements B. Regular exercises and stretching routines C. Diet modification and regular toilet habits D. Limitation of fat to 30% of the total diet calories E. Administration of laxatives, suppositories, or enemas

ANS- A. Dietary fiber supplements C. Diet modification and regular toilet habits E. Administration of laxatives, suppositories, or enemas. Rationale: Dietary fiber supplements help in achieving fecal continence. The amount recommended is calculated based on the age of the child in years + 5 = g/day of fiber. Some degree of fecal continence can be achieved through diet modification, regular bathroom habits, and prevention of constipation and impaction with laxatives, suppositories, or enemas. It can be a lengthy process. Limiting fat to 30% of the total diet calories does not provide the assurance of fecal continence. Fecal continence does not have any relation to stretching routines and regular exercises

The nurse is explaining scoliosis to a 12-year-old boy who has been diagnosed with the disease. What should the nurse emphasize? A. Effect of the scoliosis on the child's body image B. The need to use the least invasive treatment available C. Treatment will not interfere with school D. Maintaining contact with peers

ANS- A. Effect of the scoliosis on the child's body image Rationale: The identification of scoliosis as a "deformity," in combination with unattractive appliances and a significant surgical procedure, can have a negative effect on the already fragile adolescent body image. Establishing an identity is the major developmental task of the adolescent and is related to the affirmation of self-image. To achieve this task, there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling, the effect on body image is more important. Although it is important to maintain contact with peers, the effect on body image is more enduring

What nursing intervention is included in the plan of care for a child with a newly fiberglass-casted left arm? A. Elevating the extremity B. Exposing the cast to air until dry C. Placing the extremity on a plastic pillow D. Engaging in quiet activities with the use of muscles

ANS- A. Elevating the extremity Rationale: Elevating the extremity will help promote venous return and decrease edema in the extremity in order to help prevent compartment syndrome. During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell to the extent that compartment syndrome occurs. A fiberglass cast does not need to dry. A wet plaster cast should be placed on a plastic pillow and handled by the palms of the hands to prevent indentation, which can create pressure areas. Engaging in quiet activities and encouraging use of muscles can be included in the long-term plan of care if needed.

A 12-year-old patient underwent a surgical procedure for the treatment of scoliosis. What is an appropriate postoperative nursing intervention for the patient? A. Log-roll when changing position. B. Assess the dressing frequently. C. Supervise deep breathing exercises. D. Maintain a supine position for 3 days.

ANS- A. Log-roll when changing position. Rationale: After surgery, patients are monitored in an acute care setting and log-rolled when changing position to prevent damage to the fusion and surgically inserted hardware. Log-rolling is necessary to prevent movement of the newly aligned vertebrae, and should be done frequently to prevent skin breakdown. Checking the dressing is done for all postoperative patients; this action is nonspecific. Coughing and deep breathing are done by most postoperative patients; this action is nonspecific. The patient who had a spinal fusion can be turned and still be protected from injury by log-rolling. Remaining in one position for 3 days can lead to skin breakdown from unrelieved pressure

The nurse is caring for an infant who has recently undergone surgery to correct myelomeningocele. What should be the nurse's basic focus during postoperative care? Select all that apply. A. Monitor vital signs, nourishment, signs of infection, and manage pain. B. Care for the operative site and monitor signs of cerebrospinal fluid leakage. C. Educate the parents on hydrocephalus and developing cognitive skills. D. Practice stretches and exercises to minimize muscle contractures and deformity. E. Educate parents on positioning, feeding, skin care, and exercise

ANS- A. Monitor vital signs, nourishment, signs of infection, and manage pain. B. Care for the operative site and monitor signs of cerebrospinal fluid leakage. E. Educate parents on positioning, feeding, skin care, and exercise Rationale: Postoperative care for a child who has undergone a surgery to correct myelomeningocele includes monitoring vital signs, nourishment, signs of infection, and managing pain. It is also important to take adequate steps in caring for the operative site and monitoring signs of cerebrospinal fluid leakage. The nurse also needs to educate the parents on positioning, feeding, skin care, and range-of-motion exercises after the child returns home. Parents are not taught about hydrocephalus or cognitive skill development. Similarly, they are not taught about stretches and exercises to minimize the muscle contractures and deformity.

A newly hired nurse caring for an infant who has myelomeningocele asks the senior nurse for assistance. The senior nurse tells the new nurse to focus on what areas? Select all that apply. A. Neurologic and behavioral development and measurement of the head circumference and fontanels B. Meningeal sac protection and intervention plans to optimize the child's development C. Constraint-induced movement therapy to induce the weaker extremities to function D. Infection and skin breakdown occurrence and signs of urologic and bowel complications E. Changes in hemodynamic status, joint contractures, disuse atrophy, and obesity

ANS- A. Neurologic and behavioral development and measurement of the head circumference and fontanels B. Meningeal sac protection and intervention plans to optimize the child's development D. Infection and skin breakdown occurrence and signs of urologic and bowel complications Rationale: The nurse caring for an infant who has myelomeningocele should assess for neurologic and behavioral development. The nurse should also measure the head circumference and assess the fontanels from time to time. For a child with myelomeningocele, it is important to protect the meningeal sac and plan appropriate interventions to optimize the child's development. It is also important for the nurse to prevent infection and skin breakdown and observe for signs of urologic and bowel complications. Constraint-induced movement therapy is not used to treat myelomeningocele. The nurse should monitor hemodynamic status, joint contractures, disuse atrophy, and obesity in case the child has Duchenne muscular dystrophy. However, monitoring is not done if the child has myelomeningocele

The nurse is caring for a newborn who has a sac containing meninges, spinal fluid, and a portion of the spinal cord with its nerves at the lower back. What would be included as the most appropriate nursing care steps for the infant? Select all that apply. A. Place the infant in an incubator. B. Apply sterile, moist, and nonadherent dressing. C. Roll over the child every 2 to 3 hours. D. Involve the parents in the nursing care. E. Change dressings frequently. F. Closely inspect for infections and irritations

ANS- A. Place the infant in an incubator. B. Apply sterile, moist, and nonadherent dressing. E. Change dressings frequently. F. Closely inspect for infections and irritations Rationale: The infant is always placed in an incubator so that the temperature can be maintained without clothing or covers that irritate the spinal lesion. The myelomeningocele is prevented from drying through the application of a sterile, moist, and nonadherent dressing over the sac. Dressings are changed frequently, and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The child is in a delicate condition. Hence, the child is not moved. If the child is rolled over every 2 to 3 hours, the risk of rupturing the myelomeningocele sac increases. Moreover, involving the parent in the nursing care is not advised. It is best if a certified nurse and primary health care provider take care of the infant.

Which assessment findings support the nurse's conclusion that a 2-week-old neonate has hip dysplasia? Select all that apply. A. Positive Barlow test B. Positive Ortolani test C. Positive Galeazzi sign D. Piston mobility of hip joint E. Positive Trendelenburg sign

ANS- A. Positive Barlow test B. Positive Ortolani test C. Positive Galeazzi sign Rationale: Barlow, Ortolani, and Galeazzi tests are the most reliable for confirming the presence of hip dysplasia in a 2-week-old child. If the hip gets dislocated due to adduction, it indicates a positive Barlow test. If the hip is reduced by abduction, then it indicates a positive Ortolani test. If the affected limb appears to be shorter than that of the other limb, then it indicates a positive Galeazzi test. A positive Trendelenburg sign and piston mobility of joint are assessment findings which indicate hip dysplasia in older infants and children

What areas of initial care does the nurse provide for a newborn with spina bifida (SB)? Select all that apply. A. Prevention of infection B. Dental care techniques C. Neurologic assessment D. Impact of the anomaly on the family E. Tetanus immunoglobulin F. Anomalies of spinal bifida

ANS- A. Prevention of infection C. Neurologic assessment D. Impact of the anomaly on the family F. Anomalies of spinal bifida Rationale: The initial care of the newborn includes prevention of infection, neurologic assessment, learning about associated anomalies of SB, and dealing with the impact of the anomaly on the family. It is not necessary to know about the techniques of dental care. SB is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. This condition does not hamper dental health. Tetanus immunoglobulin is necessary only if the child suffers a wound with C. tetani bacteria

A nurse is caring for a young infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? Select all that apply. A. Lordosis B. Negative Babinski sign C. Asymmetric thigh and gluteal folds D. Positive Ortolani and Barlow tests E. Shortening of limb on affected side

ANS- C. Asymmetric thigh and gluteal folds D. Positive Ortolani and Barlow tests E. Shortening of limb on affected side Rationale: Asymmetric thigh and gluteal folds are a clinical manifestation of DDH and seen from birth to 2 months old. Positive Ortolani and Barlow tests are clinical manifestations of DDH. The Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation.The Barlow test is the adducting to feel if the femoral head slips out of the socket posterolaterally. Shortening of limb on affected side is another clinical manifestation of DDH. Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH. A negative Babinski sign is not a clinical manifestation of DDH. It is a neurologic reflex

The nurse is preparing a care plan for a patient who has a large bilateral hip spica cast. Which interventions should the nurse include in the care plan to prevent physiologic complications in the patient? Select all that apply. A. Providing a high-calorie, high-protein diet B. Encouraging social contact with other patients C. Encouraging the patient to sit upright whenever possible D. Advising the patient to rest on a pressure-reduction mattress E. Suggesting that a family member stay overnight with the patient

ANS- A. Providing a high-calorie, high-protein diet C. Encouraging the patient to sit upright whenever possible D. Advising the patient to rest on a pressure-reduction mattress Rationale: Immobilization can lead to anorexia due to decreased gastrointestinal function. A high-protein, high-calorie diet should be given to the patient to maintain body functions. Immobilization can impair kidney function, so the patient is made to sit upright to maintain bowel and bladder function. The patient should be made to rest on a pressure-reduction mattress to prevent skin breakdown. Social interaction with other patients, friends, and family should be encouraged for the psychological well-being of the patient. A parent or sibling should be allowed to stay overnight with the patient to avoid family disruption caused due to hospitalization. These interventions aim at reducing psychological distress in the patient but do not prevent physiologic complications.

A 6-year-old girl born with a myelomeningocele has a neurogenic bladder disorder. Her parents have been performing clean intermittent catheterization. What is the nurse's most appropriate action? A. Teach the child to do self-catheterization. B. Teach the child appropriate bladder control. C. Continue having parents do catheterization. D. Encourage the family to consider urinary diversion

ANS- A. Teach the child to do self-catheterization. Rationale: At 6 years old, this child should be able to perform the intermittent catheterization herself. This will give her more control and mastery over her disability. Bladder control cannot be taught to a child with a neurogenic bladder. This would be a good time to have the child begin caring for herself. A urinary diversion is not necessary.

The primary health care provider asks the nurse to watch for signs of developing hydrocephalus in a toddler with spina bifida. The nurse should look for what signs? A. Temperature instability, irritability, and lethargy, and elevated intracranial pressure B. Intactness of the membranous cyst, anal reflex inactivity, and motor or sensory impairment C. Behavioral instability, and inactivity in spinal cord reflex and limb movement with stimuli D. Cognitive impairment, pain, and tension or bulging in any part of the body

ANS- A. Temperature instability, irritability, and lethargy, and elevated intracranial pressure Rationale: Early signs of hydrocephalus include signs of infection, such as temperature instability (axillary), irritability, and lethargy, and elevated intracranial pressure. Children with spina bifida are placed in an incubator so their temperature can be maintained without clothing. Signs of intactness of the membranous cyst, anal reflex inactivity, and motor or sensory impairment leading to immobility are not signs of developing hydrocephalus. Similarly, behavioral instability, impaired limb movement in conjunction with stimuli, and spinal cord reflex inactivity also are not signs of developing hydrocephalus. In addition to this, cognitive impairment, pain, and tension or bulging in any part of the body are also looked for, but these are not signs of developing hydrocephalus.

What orthopedic finding suggests the presence of developmental dysplasia of the hip (DDH)? A. The affected limb shorter than the other B. Has a limited ability to adduct the affected leg C. Narrowing of the perineum with an anal stricture D. Inability to palpate movement of the femoral head

ANS- A. The affected limb shorter than the other Rationale: The affected leg appears to be shorter because the femoral head is displaced upward. There is a limited ability to abduct, not adduct, the affected leg. An anal stricture is not expected with DDH. When the femoral head slips out of the acetabulum, it is easily palpable

A 4-month-old infant has been diagnosed with developmental dysplasia of the hip (DDH). What appropriate intervention will follow the diagnosis? A. The baby will be set up to be fitted with a Pavlik harness. B. The baby will be tightly swaddled in warm blankets. C. The baby will be strapped to a cradleboard. D. The baby will be scheduled time to sit in an infant seat

ANS- A. The baby will be set up to be fitted with a Pavlik harness. Rationale: Of the numerous devices available, the Pavlik harness is the most widely used; and with time, motion, and gravity, the hip works into a more abducted, reduced position. The Pavlik harness promotes hip abduction and flexion. Swaddling limits hip abduction and puts stress on the hip joint. Strapping the infant to a cradleboard limits hip abduction and puts stress on the hip joint. Although placing the infant in an infant seat allows movement in the flexed position, it does not promote abduction

The nurse is planning the discharge of a child with myelomeningocele. The child's parents are ready and successfully coping with the condition. The nurse needs to involve the parents so that they can continue the care at home. What areas of complication should the nurse cover when teaching them home care? Select all that apply. A. Urinary B. Neurologic C. Orthopedic D. Psychological E. Reproductive

ANS- A. Urinary B. Neurologic C. Orthopedic Rationale: The life expectancy of a child with myelomeningocele is well into adulthood. The parents usually need assistance if there are complications. Hence, knowing about these complications is a necessary step for home care. Generally these complications are neurologic or orthopedic, and sometimes they are related to the urinary system. Otherwise, the child is healthy, and there is no complication in his or her psychological or reproductive behavior. In fact, children with myelomeningocele after surgery can receive educational training, live independently, have a mate, have sexual relations, and bear children

Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy? A. It is inherited as an autosomal dominant disorder. B. It is characterized by weakness of proximal muscles of both pelvic and shoulder girdles. C. It is characterized by muscle weakness usually beginning about 3 years old. D. Onset occurs in later childhood and adolescence.

ANS- C. It is characterized by muscle weakness usually beginning about 3 years old. Rationale: Children with Duchenne muscular dystrophy usually reach the early developmental milestones; the muscular weakness usually is observed in the third year of life. It is inherited as an X-linked recessive trait. The first weakness is usually noted in walking, then a progressive involvement of other muscle groups occurs. Onset usually develops in the third year of life.

The parents find that their son has X-linked Duchenne muscular dystrophy (DMD). They also have a daughter and are concerned about their daughter's well-being. Neither parent has muscular dystrophy. Their daughter has not shown any symptoms. Which are the most appropriate statements to address their concerns? Select all that apply. A. "Your daughter is surely a carrier of the disease." B. "It can be a new mutation, and the mother need not be a carrier." C. "Your daughter may be a carrier and could develop cardiomyopathy." D. "It is a genetic disease caused by mutation of the gene that encodes dystrophin." E. "Your son has inherited the disease from both parents."

ANS- B. "It can be a new mutation, and the mother need not be a carrier." C. "Your daughter may be a carrier and could develop cardiomyopathy." D. "It is a genetic disease caused by mutation of the gene that encodes dystrophin." Rationale: DMD is a genetic disease. It can be a new mutation that appears in any generation, and the mother need not be a carrier. In some cases, the daughter is a carrier and can later develop cardiomyopathy. In this mutation, the gene that encodes dystrophin is unable to produce the necessary protein. This condition follows an X-linked recessive inheritance pattern. When the father is unaffected and the mother is a carrier, there is a 50% chance that a son will be affected and a 50% chance that a daughter will be a carrier. Therefore, the daughter is not necessarily a carrier of the disease. The son cannot inherit the disease from the father if the latter is not showing signs of muscular dystrophy

The nurse is assessing a 1-month-old infant for the presence of skeletal abnormalities. What statement by the baby's mother suggests the presence of such an abnormality? A. "The baby always prefers sleeping while curled up." B. "It difficult to put the diaper between the baby's legs." C. "The baby's feet look flat when I put on the booties." D. "When I try to stand my baby up, the legs won't straighten."

ANS- B. "It difficult to put the diaper between the baby's legs." Rationale: Restricted abduction of hip on the affected side indicates the presence of developmental dysplasia of the hip (DDH). Flexion of the extremities is a young infant's typical position when sleeping. Flat feet are an expected finding in a young infant. Failure to straighten the legs is an expected finding in a young infant.

A child has just returned from surgery in a hip spica cast. What is the priority nursing intervention? A. Elevate the head of the bed. B. Check circulation. C. Turn the child to the right side. D. Offer sips of water.

ANS- B. Check circulation Rationale: The chief concern is that the extremity may continue to swell, so the nurse should check circulation. This must be assessed to ensure that the cast does not become a tourniquet. Elevating the head of the bed might help with comfort. The child's position should be changed every 2 hours. Offering sips of water is acceptable, but only after the assessment of the extremities is completed.

The nurse is caring for an infant with myelomeningocele and needs to keep the infant in the prone position. Which is the most appropriate way to keep the infant in the prone position while minimizing tension in the sac? A. Hips extended with the legs in abduction and the child lying with back down B. Hips kept slightly flexed with the legs in abduction and the child lying chest down C. Legs kept well separated, thighs acutely flexed on the abdomen, and the child lying on the back D. Child lying on the left side with the left thigh slightly flexed and the right thigh acutely flexed on the abdomen

ANS- B. Hips kept slightly flexed with the legs in abduction and the child lying chest down Rationale: In the prone position the child lies face down with hips slightly flexed and supported to reduce tension on the myelomeningocele sac. The legs are maintained in abduction with a pad between the knees to counteract hip subluxation. A small roll is placed under the ankles to maintain a neutral foot position. The child's back is kept upright. When the chest is kept in upright position, it creates a problem because there is a risk of trauma of the myelomeningocele sac. The child also cannot lie on the back with the legs well separated and thighs acutely flexed on the abdomen. Moreover, this position is known as lithotomy. The risks of trauma are also high if the child is kept on the left side-lying position with the left thigh slightly flexed and the right thigh acutely flexed on the abdomen. If the child tilts, it can injure the myelomeningocele sac

Which statement is true concerning osteogenesis imperfecta? A. It is easily treated. B. It is an inherited disorder. C. Later-onset disease usually runs a more difficult course. D. Braces and exercises are of no therapeutic value

ANS- B. It is an inherited disorder Rationale: Osteogenesis imperfecta is an inherited disorder. Osteogenesis imperfecta is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. The type of disease determines the course it will take. Lightweight braces and splints can help support limbs and fractures.

A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. 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

ANS- B. Provide a latex-free environment. Rationale: Providing a latex-free environment is the most important nursing intervention. From birth on, limiting exposure to latex is essential in an attempt to minimize sensitization. Allergy testing may expose the child to the allergen; it is not recommended. Powder-free latex gloves contain latex and will contribute to sensitization. Latex products should be avoided.

The nurse manager on the orthopedic unit is preparing an in-service about types of traction at the next staff meeting. What information should the nurse manager include in the presentation? Select all that apply. A. Skeletal traction is most likely used when closed reduction is performed. B. Skin traction can be applied using a pulling mechanism attached with adhesive material. C. Soft, foam-backed traction straps are used to distribute manual traction pull. D. Pins are commonly used with skeletal traction. E. Manual traction involves using wires or tongs inserted through the diameter of the bone distal to the fracture.

ANS- B. Skin traction can be applied using a pulling mechanism D. Pins are commonly used with skeletal traction. Rationale: Types of traction include: (1) Manual traction—Applied to the body part by the hands placed distal to the fracture site. Manual traction may be provided during application of a cast but more commonly when a closed reduction is performed. (2) Skin traction—Applied directly to the skin surface and indirectly to the skeletal structures. The pulling mechanism is attached to the skin with adhesive material or an elastic bandage. Both types are applied over soft, foam-backed traction straps to distribute the traction pull. (3) Skeletal traction—Applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture.

The nurse is assessing the level of neurologic involvement in a child with spina bifida (SB). What are the most appropriate areas for assessment? Select all that apply. A. Determine cognitive impairment. B. Assess behavioral modification. C. Measure skin response, especially anal reflex. D. Assess the limb movement with stimulus. E. Evaluate urinary retention and bladder distention

ANS- C. Measure skin response, especially anal reflex. D. Assess the limb movement with stimulus. E. Evaluate urinary retention and bladder distention Rationale: An important nursing care approach of infants with SB is assessing the level of neurologic involvement. This is done by measuring the skin response, especially the anal reflex. Moreover, limb movement in conjunction with stimulus is observed. The nurse also assesses for urinary retention and bladder distention. Cognitive development in most of the children with SB is near normal and would not be assessed for neurologic involvement. Any modification in the child's behavior is also uncommon. The most common issues include hydrocephalus, paralysis, orthopedic deformities, meningitis, seizures, and hypoxia, which are due to neurologic impairment.

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.

ANS- C. Some degree of fecal continence can usually be achieved. Rationale: With diet modification and regular toilet habits to prevent constipation and impaction, some degree of fecal continence can be achieved. Although a lengthy process, continence can be achieved with modification of diet, use of laxatives, and/or enemas. There is no general contraindication. Colostomy usually is not required

What is a defining characteristic of scoliosis? A. The concave lumbar curvature present is immensely exaggerated. B. There is a long-term bacterial infection present in the vertebrae. C. There is a rotary deformity of the lateral curvature of the spine. D. The thoracic spine has an increased convex angulation

ANS- C. There is a rotary deformity of the lateral curvature of the spine. Rationale: Scoliosis is the most common spinal deformity. A rotary deformity of the lateral curvature of the spine is the correct description of scoliosis. A concave lumbar curvature that is exaggerated is a description of lordosis. There are no bacterial infections in the vertebrae with scoliosis. A curvature of the thoracic spine that has an increased convex angulation is a description of kyphosis.

A patient who is 6 weeks pregnant tells the nurse that she is worried that the baby might have spina bifida because of a family history. What is the nurse's best response? A. "There is no genetic basis for the defect." B. "Prenatal detection is not possible yet." C. "Chromosome studies done on amniotic fluid can diagnose the defect prenatally." D. "The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally."

ANS- D. "The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally." Rationale: Fetal ultrasound and elevated concentrations of alpha-fetoprotein in amniotic fluid may indicate the presence of anencephaly or myelomeningocele. The origin of neural tube defects is unknown, but it appears to have a multifactorial inheritance pattern. Prenatal detection is possible through amniotic fluid or chorionic villi sampling. There is no chromosome study at this time

A 2-month-old infant has been diagnosed with developmental dysplasia of the hip. The health care provider has prescribed immediate treatment for the baby using a Pavlik harness. What is the rationale behind this urgency? A. Mobility will be delayed if correction is postponed. B. Traction is effective if it is used before toddlerhood. C. Infants are easier to manage in spica casts than are toddlers. D. It is easier to get the hip into a more abducted position

ANS- D. It is easier to get the hip into a more abducted position Rationale: In infants, with time, motion, and gravity, the hip works into a more abducted, reduced position with the help of a Pavlik harness. The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination. Congenital hip dysplasia does not limit ambulation for the young child, although the gait will be affected. Traction is not used to correct developmental dysplasia of the hip. Although casted infants are easier to manage than toddlers, this is not the key reason for early treatment

What is an important nursing intervention when caring for a child with myelomeningocele in the postoperative stage? A. Place child on his or her side to decrease pressure on the spinal cord. B. Apply a heat lamp to facilitate drying and toughening of the sac. C. Keep skin clean and dry to prevent irritation from diarrheal stools. D. Measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.

ANS- D. Measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus. Rationale: Hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of head circumference will aid in early detection. Before surgery, the child is kept in a prone position to decrease tension on the sac and reduce risk of trauma. The sac must be kept moist. Sterile, moist, nonadherent dressings are placed over the sac. Most infants do not have diarrheal stools.

The nurse is caring for an immobilized preschool child. During this period of immobilization, what is the nurse's best action? 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 outside of the room by wagon

ANS- D. Take the child outside of the room by wagon Rationale: It is important for children to have activities outside of the room if possible. This increases environmental stimuli and provides social contact with others. The child should be encouraged to wear street clothes during the daytime. Limit setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.

The nursing instructor is explaining Duchenne muscular dystrophy (DMD) to parents. Which statements does the nurse include in the explanation? Select all that apply. A. "It is inherited as an X-linked recessive trait, and it is a single-gene defect." B. "It is an autosomal recessive, autosomal dominant, or X-linked recessive trait." C. "The female carriers are completely healthy without any symptoms of the illness." D. "About 10% of female carriers develop cardiomyopathy with elevated creatine kinase." E. "In about 30% of cases it is a new mutation, and in 65% of cases it is a positive family history."

Ans- A. "It is inherited as an X-linked recessive trait, and it is a single-gene defect." D. "About 10% of female carriers develop cardiomyopathy with elevated creatine kinase." E. "In about 30% of cases it is a new mutation, and in 65% of cases it is a positive family history." Rationale: DMD is inherited as an X-linked recessive trait, and the single-gene defect is located on the short arm of the X chromosome. Female carriers have an elevated serum creatine kinase, and about 10% develop cardiomyopathy. Although this condition has a positive family history in about 65% of the cases, in about 30% of the cases it is a new mutation. These are common facts about DMD that nurses need to know and often have to convey to the families. DMD is not an autosomal recessive or autosomal dominant trait. Even though this condition is a recessive trait, it is not that the female carriers are entirely normal. Female carriers do suffer from mild cardiomyopathy and an elevated serum creatine kinase condition in a few cases