Peds Chapter 22
The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A)"I will help you become comfortable in caring for your daughter." B)"You must learn how to care for your daughter at home." C)"You will need to learn to collaborate with all the caregivers." D)"There is a lot to learn, and you need a positive attitude."
A. "I will help you become comfortable in caring for your daughter." The nurse needs to empower families to become the experts on their child's needs and conditions via education and participation in care. The most positive approach is to let the mother know the nurse will support her and help her become an expert on her daughter's care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs to collaborate with the caregivers is true, but does not address her fears.
An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A)Notifying the doctor immediately B)Applying ice C)Elevating the arm D)Giving additional pain medication as ordered
A. Notifying the dr. immediately The nurse should notify the doctor immediately because the girl's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation.
The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first? A)Reposition the child's foot on a pressure-reducing device. B)Apply lotion to his foot to maintain skin integrity. C)Make sure the skin is clean and dry. D)Gently massage his foot to promote circulation.
A. Reposition the child's foot on a pressure-reducing device. The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first.
The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis? A)Risk for impaired skin integrity due to cast and location B)Deficient knowledge related to cast care C)Risk for delayed development related to immobility D)Self-care deficit related to immobility
A. Risk for impaired skin integrity due to cast and location Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown.
The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? A)Sluggish deep tendon reflexes B)Full range of motion in extremities C)Absence of hypotonia D)Lack of purposeful muscular control
A. Sluggish deep tendon reflexes Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality. The newborn is capable of spontaneous movement but lacks purposeful control. Full range of motion is present at birth. Healthy infants and children demonstrate normal muscle tone; hypertonia or hypotonia is an abnormal finding.
A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statements by the parents demonstrate understanding of the instructions? Select all that apply. A)"We need to adjust the straps so that they are snug but not too tight." B)"We should change her diaper without taking her out of the harness." C)"We need to check the area behind her knees for redness and irritation." D)"We need to send the harness to the dry cleaners to have it cleaned." E)"We need to call the doctor if she is not able to actively kick her legs."
B, C, E Instructions related to use of a Pavlik harness include changing the child's diaper while in the harness; checking the areas behind the knees and diaper area for redness, irritation, or breakdown; and calling the doctor if the child is unable to actively kick her legs. The straps are not to be adjusted without checking with the physician or nurse practitioner first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting is used.
The nurse is assessing an 11-year-old girl with scoliosis. What would the nurse expect to find? Select all answers that apply. A)Complaints of severe back pain B)Asymmetric shoulder elevation C)Even curve at the waistline D)Pronounced one-sided hump on bending over E)Diminished motor function F)Hyperactive reflexes
B, D Assessment findings associated with scoliosis include asymmetric shoulder elevation, uneven curve at the waistline, rib hump on one side, and a pronounced hump on one side when bending over. Typically, only mild back discomfort is found and balance, motor strength, sensation, and reflexes are normal.
The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which finding would help confirm this diagnosis? A)Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B)A distinct "clunk" is heard with Barlow and Ortolani maneuvers. C)A high-pitched "click" is heard with hip flexion or extension. D)The thigh and gluteal folds are symmetric.
B. A distinct "clunk" is heard with Barlow and Ortolani maneuvers. A distinct "clunk" while performing Barlow and Ortolani maneuvers is caused as the femoral head dislocates or reduces back in to the acetabulum. A higher-pitched "click" may occur with flexion or extension of the hip. This is a benign, adventitious sound that should not be confused with a true "clunk" when assessing for developmental dysplasia of the hip. Abduction to 75 degrees, adduction within 30 degrees, and symmetric thigh and gluteal folds are normal findings.
When teaching a group of students about the skeletal development in children, what information would the instructor include? A)The growth plate is made up of the epiphysis. B)A young child's bones commonly bend instead of break with an injury. C)The infant's skeleton has undergone complete ossification by birth. D)Children's bones have a thin periosteum and limited blood supply.
B. A young child's bones commonly bend instead of break with an injury. A young child's bones are more flexible and more porous with a lower mineral count than adults. Thus, bones will often bend rather than break when an injury occurs. The growth plate is composed of the epiphysis and physis. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply.
What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A)Positioning supine with a pillow under the buttocks B)Covering the sac with saline-soaked nonadhesive gauze C)Wrapping the infant snugly in a blanket D)Applying a diaper to prevent fecal soiling of the sac
B. Covering the sac with saline-soaked nonadhesive gauze. For the infant with a myelomeningocele, saline-soaked nonadhesive gauze or antibiotic-soaked gauze is used to keep the sac moist. The infant is positioned prone, with a folded towel under the abdomen, so that the urine and feces flow away from the sac. A warmer or isolette is used to keep the infant warm. Blankets are avoided because they could place excess pressure on the sac. Diapering may be contraindicated to avoid placing pressure on the sac.
A 10-year-old girl is brought to the emergency department by her father after tripping over a rock while running in the yard. She tells the nurse, "I think I twisted my ankle." When assessing the child, what would the nurse most likely assess? A)Bruising B)Edema C)Limited range of motion D)Absent pulse
B. Edema The girl is describing a sprain, which is frequently accompanied by edema. Bruising may or may not be present. The nurse should not attempt to perform passive range of motion on the affected body part. A pulse should be present; if one is not, neurovascular compromise is present.
A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? A)Growth plate B)Epiphysis C)Physis D)Metaphysis
B. Epiphysis Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis.
A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action? A)Monitoring for a decrease in spasticity B)Observing for signs of meningeal irritation C)Assessing motor function D)Observing for mental confusion or hallucinations
B. Observing for signs of meningeal irritation Following myelography, the nurse should carefully observe for signs of meningeal irritation because of what is involved in this procedure. Monitoring for a decrease in muscle spasticity, assessing motor function, and observing for mental confusion or hallucinations is appropriate following an intrathecal test dose of baclofen.
The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A)Myelinization is completed by 4 years of age. B)The process occurs in a head-to-toe fashion. C)The speed of nerve impulses slows as myelinization occurs. D)Nerve impulses become less specific in focus with myelinization.
B. The process occurs in a head-to-toe fashion Myelinization occurs in a cephalocaudal, proximodistal manner and is completed by 2 years of age. As myelinization proceeds, nerve impulses become faster and more accurate.
The nurse is assessing a child with a possible fracture. What would the nurse identify as the most reliable indicator? A)Lack of spontaneous movement B)Point tenderness C)Bruising D)Inability to bear weight
B. point tenderness Point tenderness is one of the most reliable indicators of a fracture in a child. Neglect of an extremity, inability to bear weight, bruising, erythema, and pain may be present, but these findings can also suggest other conditions.
The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which response from his mother indicates a need for further teaching? A)"He needs to get a medical alert identification." B)"I will need to discuss this with his caregivers." C)"A product's label indicates whether it is latex-free." D)"He must avoid all contact with latex."
C. "A product's label indicates whether it is latex-free." The Food and Drug Administration (FDA) requires that all medical supplies be labeled if they contain latex, but this is not the case with consumer products. The mother must be familiar with products that contain latex. The Spina Bifida Association of America maintains an updated list of latex-containing products. Getting a medical alert identification, talking with his caregivers, and avoiding all contact with latex are correct.
The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A)"I know it is boring, but you must remain immobile for 2 more weeks." B)"If there are no complications, you only have 2 more weeks here." C)"Let's come up with things to do like books, movies, games, and friends to visit." D)"If you resist your treatment, your condition will only get worse."
C. "Let's come up with things to do like books, movies, games and friends to visit." After 2 weeks in traction, a teenager can become easily bored and isolated from usual peer interaction. The most helpful intervention would be to engage the help of the child to develop a list of books, games, movies, and other activities that he would enjoy. The nurse should also encourage visitation and phone calls from friends. Telling the adolescent that he needs to remain immobile or telling him that he has only 2 more weeks do not address the adolescent's issue. Telling the adolescent that his condition will worsen if he resists is threatening and inappropriate.
The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A)"If you wear your brace properly, you may not need surgery." B)"The good news is that you have very minimal curvature of your spine." C)"Let's talk to another boy with scoliosis, who is winning trophies for his swim team." D)"Let's talk to the doctor about your treatment options."
C. "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." Because this boy is concerned about limiting his participation in water polo and perceives scoliosis as a disease that does not affect "jocks," putting the child in contact with someone with the same problem would be helpful. Telling the adolescent about not needing surgery if he wears his brace or that his curvature is minimal may or may not be true in his case and thus would be false reassurance. Although these suggestions and also the suggestion about talking to the doctor about treatment options could be helpful by engaging his input in the treatment, these do not address his specific concerns about his body image.
The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate? A)"If you don't follow the therapy, your daughter could develop severe bowing of her legs." B)"It's important to use the brace or your daughter may need surgery." C)"You are doing a great job. Let's put our heads together on how to keep her busy." D)"You'll need to accept this since treatment may be required for several years."
C. "You are doing a great job. Let's put our heads together on how to keep her busy." The nurse should support the parents by encouraging and praising their compliance with bracing. It is also important to work with the parents to help develop age-appropriate diversions to promote normal growth and development. Telling the parents that they must be compliant or their daughter could develop severe bowing does not teach, does not offer solutions, and does not address the parents' concerns. Telling the parents that they must simply accept this and that the treatment could take years is likely to upset them and does not teach. It also does not address their concerns.
A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child? A)Exposure to teratogens while in utero B)Immaturity of the central nervous system C)Increased mobility of the spine D)Incomplete myelinization
C. Increased mobility of the spine Compared to the adult, a child's spine is very mobile, especially in the cervical spine region, resulting in a higher risk for cervical spine injury. Exposure to teratogens in utero may lead to altered growth and development of the brain or spinal cord. Immaturity of the central nervous system places the infant at risk for insults that may result in delayed motor skill attainment or cerebral palsy. Incomplete myelinization reflects the lack of motor control.
The nurse is developing a teaching plan for a child who is to have his cast removed. What instruction would the nurse most likely include? A)Applying petroleum jelly to the dry skin B)Rubbing the skin vigorously to remove the dead skin C)Soaking the area in warm water every day D)Washing the skin with dilute peroxide and water
C. Soaking the area in warm water every day After a cast is removed, the child and family should be instructed to soak the area in warm water every day to help soften and remove the dry flaky skin. Moisturizing lotion, not petroleum jelly, should be applied to the skin. Vigorous rubbing would traumatize the skin and should be avoided. Warm soapy water, not dilute peroxide and water, should be used to wash the area.
An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? A)Plastic deformity B)Buckle fracture C)Spiral fracture D)Greenstick fracture
C. Spiral fracture A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse.
An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast? A)The cast will take a day or two to dry completely. B)The edges will be covered with a soft material to prevent irritation. C)The child initially may experience a very warm feeling inside the cast. D)The child will need to keep his arm down at his side for 48 hours.
C. The child initially may experience a very warm feeling inside the cast. A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge so they usually do not cause skin rubbing at the edges and don't require petaling. The child should be instructed to elevate his arm above the level of the heart for the first 48 hours.
A group of nursing students are reviewing information about the type of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction? A)Russell traction B)Bryant traction C)Buck traction D)Side arm 90-90 traction
D. Side arm 90-90 traction Side arm 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin traction.
The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. What information would the nurse include? A)Applying petroleum jelly to lubricate the catheter B)Cleaning the reusable catheter with peroxide after each use C)Storing the reusable cleaned catheter in a brown paper bag D)Soaking the catheter in a vinegar and water solution to sterilize
D. Soaking the catheter in a vinegar and water solution to sterilize When teaching parents how to perform clean intermittent catheterization, the nurse would instruct the parents to apply a water-based lubricant to the catheter, clean the reusable catheter with soap and water after each use, store the reusable clean catheter in a zip-top bag or other clean storage container, and soak the catheter in a 1:1 vinegar and water solution for about 30 minutes weekly, rinsing well before the next use or placing the catheter in boiling water for 10 minutes.