NCLEX-Style Chapter 22

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching?

"Check the skin that is covered by the braces for redness and breakdown."

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The parent is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?

"In most cases treatment is not necessary, only observation."

The nurse is caring for a 6-year-old child with myelomeningocele. The nurse is teaching the parent how to promote appropriate bowel elimination and avoid constipation. Which response from the parent indicates a need for further teaching?

"My child's activity is too limited to stimulate the bowels."

The emergency department nurse is caring for a 3-year-old child with an arm injury. The parent is very upset because the parent believes she broke her child's arm. "I was lifting her by her hands and felt a pop in her wrist. She instantly started screaming." The child is now guarding and refusing to move the arm. Which response by the nurse would be most appropriate?

"The arm isn't broken. This injury is common and easily fixed with no complications."

After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching?

"We'll apply a warm moist compress to the wrist for 20 minutes at a time."

The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state:

"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

The nurse is caring for an 8-month-old in Bryant traction for developmental dysplasia of the hip and is monitoring for complications. Which assessment finding would alert the nurse to a possible complication?

A weak pedal pulse

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?

Adolescence

A 9-year old child is scheduled for a computed tomography with contrast medium. What would be most important for the nurse to assess?

Allergies

The nurse is caring for a 6-year-old child with Russell traction applied to the left leg. Which intervention would be most appropriate to prevent complications?

Assess the popliteal region carefully for skin breakdown.

A nurse is performing a physical examination of a child with a suspected musculoskeletal dysfunction. Which assessment technique would the nurse assume would not be used?

Auscultation

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant?

Baclofen

A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests. Which test would the nurse identify as most important to be completed first?

Creatine kinase

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. Our child will never be able to walk." The nurse identifies which nursing diagnosis as the priority?

Deficient knowledge related to diagnosis and condition

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal?

Development of gross motor movement

The nurse is caring for a 10-year-old child in traction. The child is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered?

Diazepam

The nurse is assessing a 10-year-old child recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection?

Drainage on the cast

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects?

Folic acid supplementation

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? (Select all that apply.)

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

An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care?

Keeping the buttocks slightly elevated

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record?

Low serum calcium levels

A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor?

Obesity

A 7-year-old child is suspected of having transient synovitis of the hip. What findings would the nurse expect to assess? (Select all that apply.)

Pain worse in the morning on arising, History of recent otitis media, Complaint of acute onset of moderate pain

A nurse is conducting a physical examination of a 5-year-old child with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find?

Pectus excavatum

The nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which action would be most appropriate to help reduce friction resulting from this paralysis?

Place a folded diaper in between the legs.

The nurse is caring for a 14-year-old child in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? (Select all that apply.)

Pulse, Color, Capillary refill, Sensation

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? (Select all that apply.)

Right side lying, Prone, Left side lying

A nurse is conducting a physical examination on an 11-year-old child with Legg--Calvé--Perthes disease. Which assessment finding would be expected?

Trendelenburg gait

The nurse is caring for a 3-year-old child with a fracture of the humerus. The chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter--Harris classification?

Type II

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

epiphysiolysis of the proximal humerus.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking.

The nurse is caring for a 2-year-old child with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as:

spastic.

A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as:

syndactyly.

A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state:

A child's bones heal more quickly than those of an adult.