pedes questions (exam 3)

The primary diagnostic tool used in the developmental dyplasia of the hip in a newborn is. a. a radiograph b. an ultrasound c. MRI d. the Barlow and Ortolani maneuvers

d

Mrs. Lodge's child requires the use of Pavlik harness; which of the following would Nurse Betty do to best assess the mother's ability to care for her child? A Demonstrate to the mother how to remove and reapply the device. B Have the mother remove and reapply the harness before discharge. C Have the mother verbalize the purpose for using the device. D Request a home health care nurse visit after discharge.

B

Nurse Kevin is assessing a newborn for developmental dysplasia of the hip (DDH); he would expect to assess which of the following? A Characteristic limp B Ortolani's sign C Symmetrical gluteal folds D Trendelenburg's signs

B

The care plan for the child during the acute phase of osteomyelitis always includes a. performing wound irrigations b. ensuring administration of antibiotics c. isolating the child d. incorporating passive ROM exercises for the affected area

B

The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. Which is the nurse's best response? a. "direct inoculation of the bone from stepping barefoot on a sharp stick" b. "an infection from a scratched mosquito bite carried the infection through the bloodstream to the bone" c. "the blood supply to the bone was disrupted because of the child's diabetes" d. "an infection of the upper respiratory tract"

B

What is associated with infant botulism? A. Contaminated soil B. Honey and corn syrup C. Commercial infant cereals D. Improperly sterilized bottles

B

Which is important when teaching a parent about preventing osteomyelitis? a. parents can stop worrying about bone infection once their child reaches school age b. parents need to clean open wounds thoroughly with soap and water c. children will always get a fever if they have osteomyelitis d. children should wear long pants when playing outside because their legs might get scratched

B

Which statement is true regarding the genetic transmission of Duchenne muscular dystrophy (DMD)? A. Multiple gene expression B. X-linked recessive C. Autosomal dominant D. No carrier states exist

B

When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply a. pain medication is contrainidicated so that symptoms are not masked b. blood cultures will be obtained c. pus will be aspirated from the subperiosteum d. an intravenous line with antibiotics will be started e. surgery will be necessary

B, C, D

In working with parents who have a child diagnosed with cerebral palsy, which therapeutic management goals should be included in the plan of care? (Select all that apply.) A. Limit socialization to similar type affected children. B. Provide educational opportunities that are individualized to children's needs and abilities. C. To help support and maintain location, communication and self-help skills. D. To correct body image perception. E. To integrate motor function.

B, C, E

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

c

The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.

1. At least 80% of cases of CP result fromunknown prenatal factorsTEST-TAKING HINT: The test taker mustknow the latest information to answer thisquestion correctly.

Nurse Cheryl is assessing Fred. a 14-year-old boy who had scoliosis; besides checking neurologic status directly after Harrington rod instrumentation and spinal fusion. she should be regarded with which of the following factors? AComfort level B. Dietary tolerance C. Physical therapy needs D. Understanding of the procedure

A

Nursing care directed toward nonsurgical management of a teenager with scoliosis primarily includes a. promoting self-esteem and positive body image b. preventing immobility c. promoting adequate nutrition d. preventing infection

A

The nurse is preparing an adolescent girl for surgery to treat scoliosis. What would the nurse include? a. Blood administration may be an option. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

A

Which of the following nursing goals is most appropriate for the child with juvenile idiopathic arthritis? a. child will exhibit signs of reduced joint inflammation and adequate joint function b. child will exhibit no signs of impaired skin integrity due to rash c. child will exhibit normal weight and nutritional status d. child will exhibit no alteration in respiratory patterns or respiratory tract infection

A

Which statement is most accurate in describing tetanus? A. Acute infectious disease caused by an exotoxin produced by an anaerobic, gram-positive bacillus B. Inflammatory disease that causes extreme, localized muscle spasm C. Acute infection that causes meningeal inflammation, resulting in symptoms of generalized muscle spasm D. Disease affecting the salivary gland with resultant stiffness of the jaw

A

The nurse caring for the child with osteomyelitis assesses poor appetite. Which intervention is most appropriate for this child? Select all that apply a. offer high-calorie liquids b. offer favorite foods c. do not worry about intake, because appetite loss is expected d. suggest removal of the intravenous line to encourage oral intake e. decrease pain medication that might cause nausea f. offer frequent small meals

A, B, F

Which can occur in untreated developmental dysplasia of the hip? Select all that apply a. duck gait b. pain c. osteoarthritis in adulthood d. osteoporosis in adulthood e. increased flexibility of the hip joint in adulthood

A,B,C

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome). When explaining this disease process to the parents, what should the nurse consider? A. Paralysis is progressive, with little hope for recovery. B. Muscle function will gradually return, and recovery is possible in most children. C. Guillain-Barré syndrome results from an apparently toxic reaction to certain medications. D. Guillain-Barré syndrome is inherited as an autosomal recessive, sex-linked gene.

B

Mrs. Cooper is concerned about her 4-month-old son's unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy? a. "He holds his left leg so stiff that I have a hard time putting on his diapers." b. "My baby won't lift his head up and look at me; he's so floppy." c. "My baby's left hip tilts when I pull him to standing position." d. "I'm very worried because my baby has not rolled all the way over yet."

B

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 e. Poor muscle tone

c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone 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.

Osteomyelitis resulting from a blood-borne bacterium that could have developed from an infected lesion is termed a. acute hematogeneous osteomyelitis b. exogenous osteomyelitis c. subacute osteomyelitis d. chronic osteomyelitis

A

A newborn has been diagnosed with spinal bifida. Which allergy documentation should the nurse include in a plan of care for this child? A. Penicillin B. Cloth tape C. Latex D. Augmentin

C

The nurse is assessing the client diagnosed with meningococcal meningitis. Which assessment data would warrant notifying the HCP?1. Purpuric lesions on the face. 2. Complaints of light hurting the eyes .3. Dull, aching, frontal headache. 4. Not remembering the day of the week.

1( In clients with meningococcalmeningitis, purpuric lesions over the face and extremity are the signs of a fulminating infection that can lead to death within a few hours.)

The nurse is caring for a client diagnosed with meningitis. Which collaborativeintervention should be included in the plan of care? 1. Administer antibiotics. 2. Obtain a sputum culture. 3. Monitor the pulse oximeter. 4. Assess intake and output.

1(. A nurse administering antibiotics is acollaborative intervention because theHCP must write an order for theintervention; nurses cannot prescribemedications unless they have additionaleducation and licensure and are nursepractitioners with prescriptiveauthority.)

A nurse is receiving an infant with myelomeningocele from an outside hospital.Which of the following priority items should be placed at the newborn's bedside? 1. A bottle of normal saline. 2. A rectal thermometer. 3. Extra blankets. 4. A blood pressure cuff.

1. Before the surgical closure of the sac,the infant is at risk for infection. Asterile dressing is placed over the sacto keep it moist and help prevent itfrom tearing.TEST-TAKING HINT: Focus on the care andpotential complications of an infant withspina bifida to answer the questioncorrectly

Which of the following will help a school-aged child with muscular dystrophy stayactive longer? 1. Normal activities, such as swimming. 2. Using a treadmill every day. 3. Several periods of rest every day. 4. Using a wheelchair on getting tired.

1. Children who are active are usuallyable to postpone use of the wheelchairlonger. It is important to keep usingmuscles for as long as possible, andaerobic activity is good for a child.TEST-TAKING HINT: Appropriate interventionsfor different kinds of chronically illchildren can be similar, so think aboutwhat would be best for this child.

The mother of a child with Duchenne muscular dystrophy asks the nurse who in thefamily should have genetic screening. Who should the nurse say must be tested?Select all that apply. 1. The mother and father. 2. The sister. 3. The brother. 4. The aunts and all female cousins. 5. The uncles and all male cousins.

1. Genetic counseling is important in allinherited diseases. Duchenne musculardystrophy is inherited as an X-linkedrecessive trait, meaning the defect ison the X chromosome. Women carrythe disease, and males are affected. Allfemale relatives should be tested. 2. Women carry the disease, and malesare affected. All female relatives shouldbe tested. 4. Women carry the disease, and malesare affected. All female relatives shouldbe testedTEST-TAKING HINT: Knowing thatDuchenne muscular dystrophy is inheritedas a X-linked trait excludes brother,uncle, and male cousins as carriers.

The parents of a preschooler diagnosed with muscular dystrophy are asking questionsabout the course of their child's disease. The nurse should tell them which ofthe following? 1. Muscular dystrophies are disorders associated with progressive degeneration of muscles, resulting in relentless and increasing weakness. 2. The weakness that the child is currently experiencing will probably not increase. 3. The child will be able to function normally and require no special accommodations. 4. The extent of degeneration depends on performing daily physical therapy

1. Muscular dystrophies are progressivedegenerative disorders. The most commonis Duchenne muscular dystrophy,which is an X-linked recessive disorder.TEST-TAKING HINT: The test taker shouldknow that muscular dystrophy is a progressivedegenerative disorder

The nurse is preparing a client diagnosed with rule-out meningitis for a lumbarpuncture. Which interventions should the nurse implement? Select all that apply. 1. Obtain an informed consent from the client or significant other. 2. Have the client empty the bladder prior to the procedure. 3. Place the client in a side-lying position with the back arched. 4. Instruct the client to breathe rapidly and deeply during the procedure. 5. Explain to the client what to expect during the procedure.

1235(. A lumbar puncture is an invasiveprocedure; therefore, an informedconsent is required.2. This could be offered for clientcomfort during the procedure.3. This position increases the spacebetween the vertebrae, which allowsthe HCP easier entry into the spinalcolumn.5. The nurse should always explain to theclient what is happening prior to andduring a procedure.)

When assessing a child for developmental dysplasia of the hip, the nurse feels a "clunk" when the child's hip is abducted and relocated. Which of the following did the nurse perform? 1) Braxton's maneuver 2) Ortolani's sign 3) Trendelenburg's sign 4) Barlow's test

2) Barlow's is when the hip is adducted and dislocated.

A nurse admits a child who has a history cerebral palsy. Which assessment finding by the nurse is most concerning? 1) The mother reports the child had a seizure 5 hours ago. 2) The child has a fever of 100.3. 3) The child is standing on his toes. 4) The mother reports the child's twisting movements seem to have worsened since arriving at the clinic.

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.

The nurse is caring for a patient diagnosed with a meningocele. The nurse should perform all of the following actions except: 1) Documenting the presence of a sac protruding from the lower spinal column. 2) Documenting the presence of clear fluid draining from the meningocele. 3) Encouraging fluids hourly. 4) Measuring head circumference every shift.

2) This may indicate a CSF leak and should be reported

While caring for a patient with a myelomeningocele, which of the following actions, if made by the pediatric nurse, is incorrect? Select all that apply: 1) The nurse reports the presence of clear fluid from the lesion. 2) The nurse places the child in supine position to prevent skin breakdown. 3) The nurse encourages that light-weight blankets be used in place of heavy blankets or coverings. 4) The nurse places a piece of plastic wrap below the meningocele.5) The nurse moistens the sac with a saline-soaked piece of gauze.

2, 3 A warmer or isolette should be used in place of blankets, which may place too much pressure on the sac. Supine positioning should be avoided in patients with myelomeningocele, as this places excessive pressure on the spinal cord sac. Prone positioning is preferred.

The nurse is teaching family members of a child newly diagnosed with musculardystrophy about early signs. The nurse knows that teaching was successful when aparent states that which of the following signs may indicate the condition early? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity.

2. Difficulty climbing stairs, running, andriding a bicycle are frequently the firstsymptoms of Duchenne musculardystrophyTEST-TAKING HINT: Early symptoms haveto do with decreased ability to performnormal developmental tasks involvingmuscle strength

Which of the following should the nurse do first when caring for an infant who justhad a repair of a myelomeningocele? 1. Weigh diapers for 24-hour urine output. 2. Measure head circumference. 3. Offer clear fluids. 4. Assess for infection

2. Hydrocephalus occurs in about 90% ofinfants with myelomeningocele, someasuring the head circumferencedaily and watching for an increaseare important. Accumulation of cerebrospinalfluid can occur after closureof the sac.TEST-TAKING HINT: The dynamics of thecerebrospinal fluid change after closure ofthe sac.

A 2-month-old has had a myelomeningocele repair and has been brought in by a parent for the well-child checkup and shots. Over the last week, the baby has had a high-pitched cry and has been irritable. Height, weight, and head circumference have been at the 50th percentile. Today height is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following? 1. Tell the parent this is normal for an infant with a repaired myelomeningocele. 2. Tell the parent this might mean the baby has increased intracranial pressure. 3. Suspect the baby's intracranial pressure is low because of a leak. 4. Refer the baby to the neurologist for follow-up care.

2. The increase in head size is one of thefirst signs of increased intracranialpressure; other signs include highpitchedcry and irritabilityTEST-TAKING HINT: The test taker shouldknow how fast an infant's head sizechanges

A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea.The nurse's assessment follows: awake, pale, thin child lying in bed, multiple contractures, drooling, coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which of the following nursing diagnoses is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: mother sole caretaker 4. Alteration in elimination: diarrhea.

2. This is the priority nursing diagnosisfor this severely underweight child.Weight is average for a 4-month-old.The coughing episodes while feedingmay indicate aspiration. The parentneeds help to learn how to feed so lesscoughing occurs.TEST-TAKING HINT: The test taker shouldconvert the weight in kilograms to pounds

The nurse is assessing the client diagnosed with bacterial meningitis. Which clinicalmanifestations would support the diagnosis of bacterial meningitis? 1. Positive Babinski's sign and peripheral paresthesia. 2. Negative Chvostek's sign and facial tingling. 3. Positive Kernig's sign and nuchal rigidity. 4. Negative Trousseau's sign and nystagmus.

3

While caring for a 9-year-old female in Buck's traction, which of the following actions by the nurse is correct? 1) The nurse encourages the child's 3 year-old sibling to sit on the bed and visit with the child. 2) The nurse helps the child learn how to raise and lower the head of her bed so she can complete her homework. 3) The nurse checks the capillary refill on the child's extremities every 4 hours. 4) The nurse teaches the child's mother to place the weights on the bedside table before the child uses the bedpan.

3)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.

The nurse is caring for an infant with myelomeningocele who is going to surgerylater today for closure of the sac. Which of the following would be a priority nursingdiagnosis before surgery? 1. Alteration in parent-infant bonding. 2. Altered growth and development. 3. Risk of infection. 4. Risk for weight loss.

3. A normal saline dressing is placed overthe sac to prevent tearing, which wouldallow the cerebrospinal fluid to escapeand microorganisms to enter and causean infection.TEST-TAKING HINT: The preoperative priorityis risk of infection, especially wheneffort is necessary to keep a sterile salinedressing on the sac.

A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Whatwould the nurse expect if the infant has hydrocephalus? 1. Low-pitched cry and depressed fontanel. 2. Low-pitched cry and bulging fontanel. 3. Bulging fontanel and downwardly rotated eyes. 4. Depressed fontanel and upwardly rotated eyes.

3. An alteration in the circulation of thecerebrospinal fluid causes hydrocephalus.The anterior fontanel bulgesbecause of an increase in cerebrospinalfluid, and an increase in intracranialpressure causes a high-pitched cry ininfants and downward deviation of theeyes, also called sunset eyes. Withsunset eyes the sclera can be seenabove the iris.TEST-TAKING HINT: The test taker mustknow the difference in clinical signs ofhydrocephalus in infants and older children.Infants' heads expand, whereasolder children's skulls are fixed. Theanterior fontanel closes between 12 and18 months

The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which of the following is the nurse's best response? 1. "Children with CP have some amount of mental retardation." 2. "Approximately 20% of children with CP have normal intelligence. 3. "Many children with CP have normal intelligence. 4. "Mental retardation is expected if motor and sensory deficits are severe."

3. Many children with CP have normalintelligence.TEST-TAKING HINT: Children with CP havea wide range of intellectual abilities.

The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following? 1. Electromyelogram. 2. Nerve conduction velocity. 3. Muscle biopsy. 4. Creatine kinase level.

3. Muscle biopsy confirms the type ofmyopathy that the patient has.TEST-TAKING HINT: Muscle biopsy is thedefinitive test for myopathies.

The nurse is caring for a newborn with a myelomeningocele who will have a surgicalrepair tomorrow. The nurse should do which of the following? 1. Offer formula every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours.

3. Priority care for an infant with amyelomeningocele is to protect thesac. A wet dressing keeps it moist withless chance of tearing.TEST-TAKING HINT: Realizing the defect ison the back eliminates answer 2. Knowingnewborns are sleepy and do not eat on aschedule eliminates answer 1.

A child with GBS is admitted to the pediatric unit. The child has had lots of oral fluids but has not urinated for 8 hours. The nurse's first action would be to do which of the following? 1. Check the child's serum blood-urea-nitrogen level. 2. Check the child's complete blood count. 3. Catheterize the child in and out. 4. Run water in the bathroom to stimulate urination

3. The child must be catheterized in andout to avoid the possibility of developinga urinary tract infection from urinein the bladder for too long.TEST-TAKING HINT: Urinary retention occurswith GBS and catheterization is necessaryin a child who has had lots of fluidsbut not voided in 8 hours

The nurse is planning care for a child who was recently admitted with GBS. Which of the following is a priority nursing diagnosis? 1. Risk for constipation related to immobility. 2. Chronic sorrow related to presence of chronic disability. 3. Impaired skin integrity related to infectious disease process. 4. Activity intolerance related to ineffective cardiac muscle function

3. The goal is to prevent complications related to immobility. Efforts include maintaining skin integrity, maintain respiratory function, and preventing contractures. TEST-TAKING HINT: The test taker must have a basic understanding of GBS and know that it affects the peripheral nervous system.

The nurse is teaching the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy. The nurse should tell them that some of the progressive complications include which of the following? 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, and dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech.

3. The major complications of musculardystrophy include contractures, disuseatrophy, infections, obesity, respiratorycomplications, and cardiopulmonaryproblems.TEST-TAKING HINT: The test taker should beable to identify signs and symptoms attributableto the loss of muscle function.

A child presents with a history of having had an upper respiratory tract infection2 weeks ago; complains of symmetrical lower extremity weakness, back pain, and muscle tenderness; and has absent deep tendon reflexes in the lower extremities.Which of the following is true regarding this condition? 1. The disease process is probably bacterial. 2. The recent upper respiratory infection is not important information. 3. This may be an acute inflammatory demyelinating neuropathy. 4. CN involvement is rare.

3. This child probably has GBS, which isan acute inflammatory demyelinating neuropathy.TEST-TAKING HINT: Having a prior upperr espiratory infection usually means this condition is not caused by bacteria,which eliminates answers 1 and 2. That leaves the choice between answers 3and 4.

The parent of a young child with CP brings the child to the clinic for a checkup. Which of the parent's following statements indicates an understanding of the child's long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I'm the one who knows the most about my child and can do the most for my child."

3. This statement indicates that the parentunderstands the long-term needsof the child.TEST-TAKING HINT: The test taker mustunderstand the goals for children withchronic illnesses or disorders. One goal isto ensure that the child be diagnosed asearly as possible so that interventions canbe started. Another is to help the childrealize as much potential as possible.

Which diagnostic exam does the nurse know will best aid in the diagnosis of Duchenne muscular dystrophy? 1) EEG 2) CT Scan 3) MRI 4) EMG

4

The nurse is discussing nutrition with the parents of a child with Duchenne musculardystrophy. The nurse tells the parents that which of the following foods would bebest for their child? 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain.

4. As the child becomes less ambulatory,moving the child will become more of aproblem. It is not good for the child tobecome overweight for several healthreasons in addition to decreasedambulation.TEST-TAKING HINT: Knowing that nutritionis important for every child as is awarenessthat as the child becomes less ambulatory,weight concerns arise.

Which of the following should the nurse expect as an intervention in a child in the recovery phase of GBS? 1. Assess for respiratory compromise. 2. Assess for swallowing difficulties. 3. Evaluate neuropsychological functioning. 4. Begin an active physical therapy program

4. Beginning active physical therapy is important for helping muscle recovery and preventing contractures. TEST-TAKING HINT: The test taker mustknow the normal progress of the disease.A hint is provided by the word "recovery"in the question

The Gower sign for assessing Duchenne muscular dystrophy can be elicited byhaving a patient do which of the following? 1. Close the eyes and touch the nose with alternating index fingers. 2. Hop on one foot and then the other. 3. Bend from the waist to touch the toes. 4. Walk like a duck and rise from a squatting position.

4. Children with muscular dystrophy displaythe Gower sign, which is great difficultyrising and standing from a squattingposition due to the lack of musclestrength.TEST-TAKING HINT: By eliminating cerebralactivities, the test taker would know thatthe Gower sign assists in measuring legstrength

The parent of an infant asks the nurse what to watch for to determine if the infant has CP. The nurse should reply which of the following? 1. If the infant cannot sit up without support before 8 months. 2. If the infant demonstrates tongue thrust before 4 months. 3. If the infant has poor head control after 2 months. 4. If the infant has clenched fists after 3 months.

4. Clenched fists after 3 months of agemay be a sign of CP.TEST-TAKING HINT: The test taker mustknow normal developmental milestones toidentify those that are abnormal.

The nurse is caring for a school-aged child with Duchenne muscular dystrophy in the elementary school. Which of the following would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

4. The child would not be able to keep upwith peers because of weakness, progressiveloss of muscle fibers, and lossof muscle strength.TEST-TAKING HINT: Knowing that the childhas decreased strength helps to answerthe question

The nurse knows that teaching of parents of a child newly diagnosed with CP is successful when the parents state that CP is which of the following? 1. Inability to speak and drooling. 2. Poor dentition due to poor hygiene. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon reflexes

4. The primary disorder is of muscletone, but there may be otherneurological disorders such as seizures,vision disturbances, and impaired intelligence.Spastic CP is the most commontype and is characterized by ageneralized increase in muscle tone,increased deep tendon reflexes, andrigidity of the limbs on both flexionand extension.TEST-TAKING HINT: The test taker mustknow the definition of CP.

The nurse is developing a plan of care for a child recently diagnosed with CP. Whichof the following should be the nurse's priority goal? 1. Ensure the ingestion of sufficient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.

4. The priority for all children is todevelop to their full potential.TEST-TAKING HINT: All of these are importantgoals, but determining the prioritygoal for a special-needs child is the key

A 3-year-old child is status post-shunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? Select all that apply A. Personality change B. Bulging anterior fontanel C. Vomiting D. Dizziness E. Fever

A. Personality change C. Vomiting E. Fever Personality change can be a sign of shunt malformation related to increased intracranial pressure. Vomiting can be a sign of shunt malformation related to increased intracranial pressure. Fever can be a sign of shunt malformation and is a very serious complication. The anterior fontanel closes between 12 and 18 months old. Dizziness is difficult to assess in a 3-year-old and is not necessarily a sign of shunt malformation.

The nurse who is concerned about increased intracranial pressure in an infant should assess for: A. irritability B. photophobia. C. pulsating anterior fontanel. D. vomiting and diarrhea.

A. irritability Irritability is one of the changes that may indicate increased intracranial pressure. Photophobia does not indicate increased intracranial pressure in infants. Frequently pulsations are visible in the anterior fontanel. It is not an indication of increased intracranial pressure. Vomiting is one of the signs in children but, when present with diarrhea, indicates a gastrointestinal disturbance.

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.

A. keeping environmental stimuli at a minimum. 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 a 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 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

Answer: 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.

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

Answer: 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.

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

Answer: 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.

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

Answer: 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

Tommy is a young child who is started walking early in life and usually is very active and happy. His mother tells you of a slow change that has happened to her son, and that he is less active than he has been. He now seems tired a lot and has difficulty doing things he used to do, such as running and playing. Which of the following would the nurse want to assess first? a) Check the child's back for dimpling or a tuft of hair at the base of the spine b) Assess the child's pain level and level of consciousness c) The child's ability to stand up and walk d) The presence of infantile reflexes

Answer: C. This child is presenting signs that most line up with a form of progressive muscular dystrophy, and it would be important for the nurse to follow up on the mother's claims that the child has difficulty ambulating and playing.

Which of the following actions of the pregnant woman would be most likely to affect the neuromuscular development of her unborn child in utero? A) The mother who says, "I drank a few alcoholic beverages in my second trimester, I just couldn't help it!" B) The 22 year old mother who started taking folic acid before she ever got pregnant C) The 27 year old mother who was involved in a car accident which caused her to go into labor D) The 19 year old who says, "I did drugs pretty bad, but I stopped as soon as I knew I was pregnant,"

Answer: D. Early in gestation, during 3-4 weeks of pregnancy, the neural tubes of the embryo begin to develop and differentiate. This is a critical time for the unborn child, and things like drug or alcohol use are most likely to cause developmental disorders during this time period.

Which of the following clinical manifestations of developmental dysplasia of the hip would be seen in the newborn? A. Lordosis B. Ortolani sign C. Trendelenburg sign D. Telescoping of the affected limb

Answer: b. In the newborn period, the dysplasia usually appears as hip joint laxity. During the Ortolani test, the examiner places forward pressure and then backward pressure on the trochanter. If the femoral head is felt to slip, dysplasia may be present. This test is most reliable from birth to 2 to 3 months.

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.

Answer: 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 3-year-old has cerebral palsy (CP) and is hospitalized for orthopedic surgery. The child's mother states the child has difficulty swallowing and cannot hold a utensil to self-feed. The child is slightly underweight for height. What is the most appropriate nursing action related to feeding? A. Bottle-feed or tube-feed the child with a specialized formula until sufficient weight is gained. B. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. C. Place the child in a well-supported, semireclining position to make use of gravity flow. D. Place the child in a sitting position with the neck hyperextended to make use of gravity flow.

B

A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. A priority nursing intervention is to A. recommend allergy testing. B. provide a latex-free environment. C. use only powder-free latex gloves. D. limit the use of latex products as much as possible.

B

A 2 day old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip, and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include a. return to the orthopedist's office in 2 weeks to remove the hip spica cast b. the infant's bilateral foot cats should be elevated on pillows as much as possible c. remove the Pavlik harness once a day for no more than 2 hours and inspect skin d. remove the Pavlik harness while the infant is awake to allow "tummy time"

C

Mr. and Mrs. Andrews' child was diagnosed with Duchenne's muscular dystrophy; which of the following usually is the first indication of the condition? A. Inability to suck in the newborn B. Lateness in walking in the toddler C. Difficulty running in the preschooler D. Decreasing coordination in the school-age child

C

The parent of a 3 week old states the the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? a. give pain medication b. reposition the infant in the crib c. check the neurocirculatory status of the foot d. use a cool blow-dryer to blow into the cast to control itching

C

The recommended treatment for DDH in an infant 2 months old is a. surgical fixation b. hip spica cast c. Pavlik harness d. hip abduction orthosis

C

What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis? a. Apply ice packs to relieve stiffness and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family the correct administration of medications. d. Encourage range of motion exercises during periods of inflammation.

C

Which of the following is the most common permanent disability in childhood? A. Scoliosis B. Muscular dystrophy C. Cerebral palsy D. Developmental dysplasia of the hip (DDH)

C

Which would the nurse expect to assess on a 3 week old infant with developmental dysplasia of the hip? Select all that apply a. excessive hip abduction b. femoral lengthening of an affected leg c. asymmetry of gluteal and thigh folds d. pain when lying prone e. positive Ortolani test

C, E

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

C. Losing consciousness.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 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. administer antibiotic therapy as soon as it is ordered. 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 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.

C. avoid suctioning the child during the seizure. D. describing and documenting the seizure activity observed. 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 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.

C. shunt malfunction or infection requires immediate treatment. 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.

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.

C. status epilepticus. 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 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include what? a. Encourage normal activity for as long as possible. b. Explain the cause of the disease to the child and family. c. Prepare the child and family for long-term, permanent disabilities. d. Teach the family the care and management of the corrective appliance.

D

Bob, age 7, is diagnosed with Legg-Calve-Perthes disease. Which of the following manifestations is not consistent with this diagnosis? a. intermittent appearance of a limp on the affected side b. hip soreness, ache, or stiffness that can be constant or intermittent c. pain and limp most evident on arising and at the end of a long day of activities d. specific history of injury to the area

D

Diagnostic evaluation is important for early recognition of scoliosis. Which of the following is the correct procedure for the school nurse conducting this examination? a. view the child, who is standing and walking fully clothed, to look for uneven hanging of clothing b. view all children form the left and right side to look mainly for asymmetry of the hip height c. completely undress all children before the examination d. view the child, who is wearing underpants, from behind when the child bends forward at the hips

D

The major goal of therapy for children with cerebral palsy (CP) is A. reversing degenerative processes that have occurred. B. curing the underlying defect causing the disorder. C. preventing spread to individuals in close contact with the children. D. recognizing the disorder early and promoting optimal development.

D

Veronica is a 14-year-old girl who wears a brace for structural scoliosis; which of the following statements indicate effective use of the brace? a"I sure am glad that I only have to wear this awful thing at night." B"I'm really glad that I can take this thing off whenever I get tired." C"I wonder if I can take the brace off when I go to the homecoming dance." D"I'll look forward to taking this thing off to take my bath every day."

D

When a child injures the epiphyseal plate from a fracture. the damage may result in which of the following? ARheumatoid arthritis B. Permanent nerve damage C.Osteomyelitis D. Bone growth disruption

D

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip? a. put socks on over the foot pieces of the harness to help stabilize the harness b. use lotions or powder on the skin to prevent rubbing of straps c. remove harness during diaper changes for ease of cleaning diaper area d. check under the straps at least 2-3 times daily for red areas

D

Which would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply a. unwillingness to move affected extremity b. severe pain c. fever d. previous closed fracture of an extremity e. redness and swelling at the site

a,b,c,e

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

a. AbsenceAbsence 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 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

a. Bulging fontanel and dilated scalp veins 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.

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. Describe and record the seizure activity observed.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.

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)

a. Elevated white blood cell (WBC) count c. Decreased glucose d. Cloudy in color 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.

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.

a. Observe closely for signs of infection. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention. 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.

Clinical manifestations of increased intracranial pressure (ICP) in infants are: SATA a. Low-pitched cry. b. Sunken fontanel. c. Diplopia and blurred vision. d. Irritability. e. Distended scalp veins. f. Increased blood pressure.

c. Diplopia and blurred vision. d. Irritability. e. Distended scalp veins. Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Low-pitched cry, sunken fontanel, and increased blood pressure are not clinical manifestations associated with ICP in infants.

The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis. The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by a. breakdown of osteoclasts in the joint space causing bone loss b. loss of cartilage in the joints c. buildup of calcium crystals in joint spaces d. immune-stimulated inflammatory response in the join

d

How should the nurse explain positioning for a lumbar puncture to a 5-year-old child? a. "You will be on your knees with your head down on the table. "b. "You will be able to sit up with your chin against your chest." c. "You will be on your side with the head of your bed slightly raised." d. "You will lie on your side and bend your knees so that they touch your chin."

d. "You will lie on your side and bend your knees so that they touch your chin." The child should lie on his or her side with knees bent and chin tucked into the knees. This position exposes the area of the back for the lumbar puncture. The knee-chest position is not appropriate for a lumbar puncture. An infant can be placed in a sitting position with the infant facing the nurse and the head steadied against the nurse's body. A side-lying position with the head of the bed elevated is not appropriate for a lumbar puncture.