Pediatrics Chapter 44

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? The infant will have a poor sucking reflex. Assuming the usual feeding position will be difficult. Nausea and vomiting often follow repair of the cystic mass. Pain will interfere with the feeding process.

B Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic.

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client? Surgery Bracing Traction Exercise

B For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.

Through which mechanism is Duchenne muscular dystrophy acquired? virus heredity environmental toxins autoimmune factors

B Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? muscle biopsy assessment of ambulation X-ray EEG

A Explanation: Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered? pamidronate alendronate diazepam opioid analgesics

C Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Opioid analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.

A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used? Observation Inspection Auscultation Palpation

C The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired.

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? to stand absolutely still when not wearing the brace to wear the brace a maximum of 20 hours each day to continue with age-appropriate activities that secondary sex changes will stop until the brace is removed

C The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. Bracing is one way to do that. The brace should be worn for 23 hours per day. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. It is extremely important that the adolescent has compliance with the brace usage. The nurse can help by teaching the adolescent ways to help peers understand the need for the brace. Sex changes continue with or without bracing.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? Tendons Ligaments Joints Cartilage

D During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information? "Do you think he is simply fatigued?" "Has his pace of achieving milestones diminished?" "Has he achieved his developmental milestones on time?" "Would you please describe the weakness you are seeing in your son?"

D The nurse needs to obtain a clear description of weakness. This open-ended question would most likely elicit specific examples of weakness and shed light on whether the boy is simply fatigued. The other questions would most likely elicit a yes or no answer rather than any specific details about his weakness or development.

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? x-ray confirmation of adequate bone shape low alkaline phosphate levels high serum phosphate levels low serum calcium levels

D With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? Deficient diversional activities related to a need for imposed activity restriction for 6 weeks Pain related to chronic inflammation of the lower leg Situational low self-esteem related to the use of a walker Impaired physical mobility related to a cast on the leg

D Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele? There is protrusion of the spinal cord and meninges, with nerve roots embedded. There is no protrusion of the spinal cord, only soft-tissue inflammation occurs. There is a bony defect that occurs without soft-tissue involvement. The spinal meninges protrude through the bony defect and form a cystic sac.

D When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse? placing sterile cotton gauze squares around the ends of the pins using latex free sterile gloves mixing hydrogen peroxide with sterile water to make half-strength hydrogen peroxide unhooking a weight while providing pin care

A Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.

A group of students is 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? toddlerhood school age preschool age adolescence

D Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

The nurse is obtaining a health history on a woman of childbearing age who wants to become pregnant. What information in her health history places her at high risk for having a child with a myelomeningocele? history of a seizure disorder; taking phenobarbital history of asthma; taking montelukast history of scoliosis history of a previous abdominal surgery

A Maternal consumption of certain drugs that antagonize folic acid, such as anticonvulsants (carbamazepine and phenobarbital), places her at high risk for having a child with neural tube defect such as a myelomeningocele. A history of taking montelukast, previous abdominal surgery, or a history of scoliosis do not pose a risk for having a child with a myelomeningocele.

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? lordosis Gowers sign indications of hydrocephalus appearance of smaller than normal calf muscles

B A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child? Handling the cast with open palms when moving the arm. Using only a draw sheet to move the casted arm. Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm. Encouraging the child to move the arm slowly up and down to help the cast dry.

A A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process.

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to: prevent edema. ensure proper bone alignment. discourage infection. promote healing.

A Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg? Check the infant's toes for coldness or blueness. Change the infant's diapers frequently. Perform passive foot exercises. Apply Denis Browne splints to the infant each night.

A Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. The other answers are other interventions pertaining to caring for a child with clubfoot but are not associated specifically with ensuring good circulation.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? creatine kinase serum potassium bilirubin sodium

A Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? Spica cast External fixation device Stockinette Internal fixation device

A The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply. Calcium and vitamin D play important roles in bone growth and bone breakdown. Periosteum is the outer covering of the bone. The diaphysis is the rounded end portion of the bone. Adipose cell formation happens in the red bone marrow. Calcitonin plays a role in remodeling of bone.

A B E Calcium, vitamin D, and calcitonin are involved in original bone formation, replacement of old by new bone tissue (remodeling), and bone breakdown (resorption). Adipose cell formation happens in the yellow, not red, marrow. The diaphysis is the lengthy central shaft of the long bone; the epiphysis is the rounded end portion of the long bone.

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 left side lying semi-Fowler supine prone

A B E Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. New drainage is seeping out from under the cast. The outside of the boy's cast got wet and had to be dried using a hair dryer. The boy's toes are light blue and very swollen. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. The boy experiences mild pain when wiggling his toes.

A C D The parents should call the physician when the following things occur: The child has a temperature greater than 101.5° F (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele? impaired physical mobility risk for infection constipation delayed growth and development

B All of these diagnoses are important for a child with a myelomeningocele. However, during the first 12 hours of life, the most life-threatening event would be an infection. The other diagnoses will be addressed as the child develops.

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? botulin toxin baclofen prednisone lorazepam

B Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy.

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? listening for a shrill cry careful supine positioning auscultation for bowel sounds inspection of the cystic sac on the child's back for leakage

D Leakage from the cystic area indicates loss of cerebrospinal fluid (CSF) and risk of infection of the central nervous system. Prompt intervention is needed, probably surgical. Listening for bowel sounds confirms intestinal peristalsis but is not necessary with each infant contact. A shrill cry may indicate increased intracranial pressure (ICP). This is important to note yet is not as pressing as being aware of leakage. The baby would be positioned prone, not supine, to protect the sac.

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is: skin traction. Buck extension traction. Russell traction. skeletal traction.

D Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction.

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? presence of Moro reflex presence of symmetrical spontaneous movement absence of tonic neck reflex absence of Moro reflex

A The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child.

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction? "I wear a t-shirt under my brace." "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." "I check my brace daily to make sure there is no damage or change to it." "I leave my brace on for gym at school."

B Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily for all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort, a lightweight t-shirt may be worn under the brace.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this? Spiral Epiphyseal Complete Greenstick

D Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? Move on to other assessments without calling attention to the difference. Record and refer the finding for follow-up to the pediatrician. Inspect for precocious hair growth in the genital and underarm areas. Snip the tuft of hair off close to the skin for hygienic reasons.

B Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. Magnetic resonance imaging (MRI) is often the diagnostic tool used. No hygienic concerns need prevail. These findings do not suggest development of precocious puberty or any other hormonal problem. The dimpling and hair tuft must be clearly explained to the parents.

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be: Greenstick Complete Spiral Incomplete

B If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation? A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating.

B Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed. Plan to add additional weights as the fracture heals, usually once per day. Ensure traction weights are hanging freely, not touching the bed or floor. Remove traction weights once per shift for 30 minutes and then replace them.

C Traction is used as a pulling force on an extremity or body part. For it to be effective, the weights need to hang freely at all times and the ropes need to remain in the pulley grooves. The weights are not replaced or removed during traction. The child can move all extremities except the affected one(s). The child remains in traction until healing occurs, a cast is applied, or surgical repair is performed.

A nurse is preparing a class on neural tube disorders to present to a community group. What information regarding prevention is most important for the nurse to include in the teaching? dietary considerations early prenatal care genetic screening updated immunizations

A Regarding the prevention of neural tube disorders, the most important information to include concerns dietary considerations. Folic acid deficiency is a major risk factor for neural tube disorders. Childbearing women are advised to take 400 mcg of folic acid daily. Although genetic influences may play a part in the development of neural tube disorders, genetic screening is not always done prior to pregnancy; it is done during pregnancy if the woman is at high risk for a genetic disorder. Early prenatal care is important to any pregnancy but does nothing to prevent a neural tube disorder. These disorders occur during the first 27 days of pregnancy long before most women realize they are pregnant. Keeping up-to-date with immunizations is important but does nothing to prevent neural tube disorders.

A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client? Teach the client not to rest with the crutch pad pressing on the axilla. Assess the tips of the crutches to be certain the rubber tip is intact. Be certain the child is walking with the crutches about 6 inches to the side of the foot. Caution parents to clear articles such as throw rugs out of paths at home.

A Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child.

The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions? Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns. Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C.

A The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

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 make sure she keeps her arm above heart level." "We'll apply a warm moist compress to the wrist for 20 minutes at a time." "She'll need to limit any activity that involves the wrist." "We can wrap the wrist in an elastic bandage to help reduce the swelling."

B Care for a sprain includes rest, ice, compression, and elevation. Cold therapy, not heat, is used for 20 to 30 minutes at a time, then removed for 1 hour and repeated for the first 24 to 48 hours. Compression via an elastic bandage, elevating above heart level, and limiting activity are appropriate measures.

The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education? "The most successful treatment for scoliosis is surgery before reaching adult age." "Because our child is being treated by using braces, the braces will have to be worn almost all the time." "Because our child has scoliosis, treatment will include halo traction." "The treatment for our child's scoliosis is anticipated to last between 3 to 4 months."

B The Boston or the thoracolumbosacral orthosis (TLSO) brace is made of plastic and is customized to fit the child for treatment of scoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit. Halo traction may be used to treat clients with severe scoliosis, but not all clients. Children will be reassessed every 4 to 6 months to determine the prognosis for continuing brace therapy and potentially refitting. Bracing may be indicated for months or years. Surgery may be indicated, depending on the severity and complications resulting from the scoliosis; however, surgery is not the best option for all clients

A 7-year-old child diagnosed with Duchenne muscular dystrophy (DMD) uses a wheelchair for mobility. The child's parent tells the nurse "I want my child to participate in activities with peers but I am so concerned about my child's health." Which comment(s) is appropriate for the nurse to make? Select all that apply. "Each day engage in active or passive range-of-motion exercises." "Wheelchair team sports might be something your child would enjoy." "You can assist your child in riding a stationary bicycle." "Your child's diagnosis will not allow him or her to engage in activities with peers." "Encourage your child to remain active but to also take time to rest."

B E The most appropriate comments would be to suggest wheelchair team sports and to encourage the child to remain active but take time to rest. Because the child has lower extremity involvement and uses a wheelchair, riding a stationary bicycle would not be possible. Engaging in daily active and passive range-of-motion exercises are important but this response does not address the parent's desire for the child to engage in activities with peers. Telling the parent that the child will not be able to engage in activities with peers is inappropriate and not true.

The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply? "The contents of the sac you see only has fluid in it and should cause the child no problem." "Your child's defect involves only the nerves to the bladder and bowel and can be easily repaired." "It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." "The sac is a very small cyst and should resolve within the first year of life."

C A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year.

A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond? "You need to remain as active as possible and have a positive attitude." "There are many things that you can do like crafts, computers or art." "There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." "You have to go to a support group; it will be very helpful."

C The best response would be to remind the boy that there are many children with muscular dystrophy that could be found at the local support group. Teenagers do not like to be told that they "have" to do anything. Telling the boy that he needs to be active or simply suggesting activities does not address his concerns.

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? Place petroleum jelly gauze on the spinal sac to keep it moist. Delay the parents from holding the newborn. Place the newborn in a prone or lateral position. Place a urine collection bag on newborn for the continuous leakage.

C The nurse should place the newborn in a prone or lateral position to keep pressure off the spinal sac and avoid newborn injury. Parents should be allowed to hold the stable infant with assistance. The spinal sac should be kept covered and moist until surgery to avoid rupture. Collecting urine decreases the risk of urine stasis, which is sometimes common in spinal defects.

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate? "This is the most common facial nerve palsy." "Have you seen any signs of improvement?" "In most cases treatment is not necessary, only observation." "Was this from pressure resulting from forceps?"

C The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

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." "It is very important to comply with the use of this brace." "Please try and follow the therapist's on and off schedule." "If the brace is painful, feel free to take it off."

A Assessing skin integrity should be the priority, as braces can lead to pressure ulcers and infection. Compliance is important, but attention to skin care is the priority teaching. Following the schedule is important for compliance, but skin integrity is the priority. Advising the parents to remove the brace if it is painful is inaccurate; the child may require pain management or further consultation with the physical therapist.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? cat dander latex peanuts alcohol gel

B Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention? a 4-year-old preschool-age child who consistently walks on tiptoes a 2-month-old infant who reaches for a rattle several times before connecting with it a 10-month-old infant who is able to ambulate with assistance a 2-year-old toddler who can walk up the steps one at a time

A At 4 years of age, a child should not consistently walk on tiptoes. This is a common manifestation of muscular dystrophy and requires intervention. At 2 months of age, an infant's movements are uncoordinated and it may take several attempts to touch objects the infant reaches for. Infants begin to walk between 9 and 18 months of age, and may begin by walking while holding a caregiver's hands. At 2 years of age, a toddler is able to walk up the steps one step at a time.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client? Duchenne muscular dystrophy Juvenile arthritis Facioscapulohumeral muscular dystrophy Congenital myotonic dystrophy

A By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse? Notify the health care provider of the findings immediately. Apply ice bags to the child's foot and ankle. Reposition the leg on pillows so that it is above the level of the child's heart. Administer prescribed pain medication.

A Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective? Inspect the child's skin for rashes, redness, irritation, or pressure injuries. Assess neurovascular status on the affected extremity once every shift. Gently massage the child's back to stimulate circulation. Keep the child's skin distal to the traction clean and dry.

A It is important to be vigilant in inspecting the child's skin for rashes, redness, and irritation to uncover areas where pressure injuries are likely to develop. Applying lotion, gentle massage, and keeping the skin dry and clean are part of the routine skincare regimen. However, performing these interventions without first performing a skin assessment can cause the nurse to miss important signs that can potentially result in more injury to the child. Neurovascular assessment should be performed frequently as prescribed by the health care provider or at least every 4 hours to evaluate skin integrity and venous circulation.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." "It is important to prevent herniation of a spinal disk, which is painful." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent torticollis."

A It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

The nurse is working with a 6-year-old child recently diagnosed with Legg-Calvé-Perthes disease. The child's parents tells the nurse they understand exercise is important for their child but are not sure which activities are appropriate. Which activity will the nurse recommend for this client? Swimming Soccer Jumping jacks Brisk walking

A Legg-Calvé-Perthes disease occurs when blood supply to the femoral head of the hip joint is temporarily interrupted and the bone begins to die. The child with Legg-Calvé-Perthes disease will experience limited range of motion in the hip. Thus, swimming and tricycle or bicycle riding are excellent exercises because they provide smooth joint action and will help to reduce joint destruction. In contrast, activities that place excessive strain on joints, such as running, jumping, prolonged walking, and kicking, should be avoided.

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 high serum phosphate levels low alkaline phosphate levels x-ray confirmation of adequate bone shape

A With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment? a short heel cord caused by walking on the toes when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand the presence of a waddling gait and difficulty climbing stairs meeting motor milestones such as sitting, walking, and standing but at a later age than the average child

B A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? "Ice will help reduce the inflammation." "You and your coaches need to understand that you cannot play soccer for at least six weeks." "You will need to see a physical therapist for stretching and strengthening exercises." "NSAIDs can help with pain control and inflammation."

B A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

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

B Explanation: According to the Salter-Harris classification, a type II fracture is partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? "Itching is common. It's nothing to worry about." "Blowing cool air with a fan or hair dryer may relieve the feeling." "A small amount of lotion or baby oil can be poured in the cast to moisturize the area." "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there."

B Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns? "Your daughter will likely wear a Pavlik harness." "Don't worry; this is a relatively common diagnosis." "This is not your fault and we will help you with her care and treatment." "There are simple noninvasive treatment options."

C Because the mother is crying and experiencing the initial shock of the diagnosis, the nurse's primary concern is to support the mother and assure her that she is not to blame for the DDH. While education is important, the nurse should let the mother adjust to the diagnosis and assure her that the baby and her family will be supported now and throughout the treatment period.

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse? "Braces have been replaced with surgical intervention. Your child will only wear a brace for a few weeks after the surgery." "The newer braces only have to be worn while the child is asleep and don't have to be worn at school." "The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." "Unfortunately, bracing is the only option for treating this disorder. I'm sure your child will get used to it after a few weeks."

C Bracing is the primary treatment for scoliosis. The braces used today are designed by computer-aided techniques and fit under the arms rather than extending to the neck. Braces must be worn 23 hours a day. Surgical intervention is only performed in severe cases.

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated? Observe the child for infection. Suggest removal of the cast to the orthopedist. Advise the child that this is to be expected. Moisten the cast with cool water.

C Plaster becomes hot as it sets. Even with fiberglass casts, there will be a warm feeling inside the cast when it is drying. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, the nurse should notify the health care provider. Infection would not present in this way with a cast application. A cast should not be moistened. If it does become wet, the cast should be dried with a hair dryer. There are some newer types of casts which can get wet but the nurse should know this before applying any moisture.

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 distal radius. Osgood-Schlatter disease. Sever disease (calcaneal apophysitis). epiphysiolysis of the proximal humerus.

D Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease (calcaneal apophysitis) causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.