Peds Exam 8 - Unit 8 and 9

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point?

"it is important that the harness be worn continuously"

What are the types of hip dysplasia?

acetabular, subluxation, dislocation

The nurse is caring for a 6-year-old boy with sensorineural hearing loss. Which is the least likely cause of the child's hearing loss?

acute otitis media

A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. What would the nurse include as a risk factor?

advanced maternal age

Scoliosis of 20-40 degrees requires:

bracing until skeleton is mature

A Glasgow Coma Score of 3 may indicate:

brain death

What are signs of increase intracranial pressure?

bulging fontanels, high pitched cry, separate suture lines, headache, irritability, head enlargement

The school nurse has performed scoliosis screening. Based on this assessment, which child(ren) requires the nurse to implement a referral to the health care provider?

child with asymmetric shoulder elevation child with a limb length discrepancy child with a lateral curve of the spine child with a one-sided hump upon bending over

A Glasgow Coma Score of 8 indicates:

coma

Which physical assessment finding would the physician be more likely to find in an examination of a client with Down syndrome than of other clients without Down syndrome?

congenital heart defects

How is amblyopia treated?

cover the good eye to make the lazy eye work better

What will labs look like with muscular dystrophy?

creatinine phosphokinase (SPK), SGOT, AST, aldolase are increased

The young child has been diagnosed with bacterial meningitis. Which nursing interventions are appropriate?

droplet isolation, identify close contacts of the child who will require post-exposure prophylactic medication, administer antibiotics as ordered, initiate seizure precautions

When does scoliosis occur?

during growth spurt

The nurse is caring for a 1-year-old boy with Down syndrome. Which intervention would the nurse be least likely to include in the child's plan of care?

educating parents about how to deal with seizures

What are interventions for Hydrocephalus?

elevate HOB

What are sxs of Downs Syndrome?

epicanthal folds, clanting of eyelids, short broad hands, mottled skin, transpalmar creases, decreased muscle tone, protruding tongue, flat nasal brudge, heart defects, delayed G&D, small hands, feet, ears, jaw, dry mucous membranes

What is important to know about cast care?

expose to air until dry, do not use fan to dry, elevate extremity, use palms to support wet cast, observe for 5 Ps

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess?

eye opening, motor response, verbal response

What are key factors of a neuro assessment in babies?

fontanels and head circumference

A young client in the intensive care unit is in a coma after a severe head injury. The primary nurse is teaching a nursing student how to assess the client's level of consciousness using a coma scale. What type of scale could be used for this purpose?

glasgow scale

A nursing student learning about autism spectrum disorders correctly identifies which mannerisms as common in affected clients?

hand wringing head banging rocking running in circles

Parents report that their neonate received intravenous antibiotics while in the newborn nursery. The nurse recognizes this as a potential risk factor for which health problem?

hearing impairment

What will labs be like with a patient with Reyes Syndrome?

high liver enzymes, increased PT, elevated ammonia

What will the CSF look like with bacterial meningitis?

high protein, high WBC, low glucose

How is a penetrating eye injury treated?

immobilize the object, do not remove it, stabilize it, patch both eyes, get pt to ER asap

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?

latex

What type of allergy do most myelomeningocele patients have?

latex allergy

The child diagnosed with muscular dystrophy often exhibits a forward curvature of the lumbar spine. What is this spinal condition called?

lordosis

What are labs that would signal hypothyroidism?

low T4 (<6), high TSH (>50)

What are SE of Stimulants?

low appetite, weight, height, HA, abd pain, tics, crying

What does a ketogenic diet consist of?

low carbs, low sugar, high fats

What diet does a PKU consist of?

low protein

Juvenille Rheumatoid Arthritis can be treated with:

moist heat and exercise

After a patient has myringotomy tubes, what should we be teaching?

no diving or complete submersion under the water, ear plugs when swimming or showeing

Which signs of CP are related to G&D?

no smiling by 3 months old, no sitting up alone by 8 months

Which ADHD medications may cause dental caries and dry mouth?

non stimulants, like Stratera, TCAs, Trofranil

A Glasgow Coma Score of 12-15 is:

normal

What will the CSF look like with viral meningitis?

normal glucose and high lymphocytes

A 12-year-old child has suffered a concussion after being in an automobile accident. What will be included in the plan of care/treatment?

observation of level of consciousness, rest

What are sxs of Tourettes syndrome?

obsessive compulsive actions like tying and retying shoes, personality changes, dry mouth, parkinsonian sxs, anticholinergic sxs, confusion

The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's level of consciousness?

obtunded

Which word may be used to describe a patient that must be stimulated, such as by yelling or shaking them, to be aroused?

obtunded

What is the treatment for hip dysplasia?

restore proper hip alignment with the Pavlik harness, Spica cast, or skin traction

What is important teaching with a Downs Syndrome patient?

swaddle tightly, prevent injury, infection, and skin breakdown, suction nares when feeding, tongue thrust common, push food to back adn side of mouth, small frequent feedings, increase fluid adn fiber

What does an autistic pt look like?

sxs manifest in first 1-2 years, mom may notice something is wrong, tip-toe walking, does not imitate, lack of interest, eye contact issues, delyaed language, failure to develop symbolic play, repetitive movements

What are signs of complications with a VP shunt?

temperate increase

Which seizure medications are a sugary liquid that can cause respiratory depression?

Phenobarbital

Which seizure medication should be given IV with normal saline and pushed over 17 minutes d/t risk of cardiac arrest?

Phenytoin/ Dilantin

A nurse is caring for a newborn with anencephaly. Which intervention will the nurse use?

Place a cap or similar covering on the newborn's head.

What is the ultimate goal of school phobia?

return the child to school and ensure that there is nothing serious going on

What is the treatment for congenital clubfoot?

serial casting and manipulation then surgical correctiona t 6-12 months

The nurse is assessing a young boy who has been brought to the health care provider for mobility and balance issues by his parents. Which findings are positively associated with the presence of Duchenne muscular dystrophy?

serum creatine kinase levels are elevated a muscle biopsy shows an abscense of dystrophin the child is unable to rise easily into a standing position when placed on the floor

A child is brought to the emergency department after experiencing a series of continuous seizures. The nurse is reviewing the orders for care and treatment. Which order would be of the highest priority?

serum glucose level

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction

The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction?

skin traction

Which type of CP is the most common and causes rigidity?

spastic

Which medications for ADHD are the first line of treatment?

stimulants (ritalin, concerta, adderall, cylert)

What is priority for seizures?

suction

Scoliosis of >45 degrees requires:

surgical interventions

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note?

the posterior spine when bending forward

An 8-year-old child is diagnosed as having tonic-clonic seizures. The nurse would want to teach the parents that:

their child should maintain an active lifestyle

Why is it important to spend time holding a cerebral palsy patient on the parent's hip?

to avoid the scissor (crossed leg) position

Why is traction used?

to stabilize injury, maintain alignment, promote rest, decrease muscle spasm

What are the three categories of the Glasgow coma scale?

verbal response, eye opening, and motor response

What should the nurse do if the myelomeningocele sac is no longer intact?

wet sterile gauze, sterile water, this is a surgical emergency

A female client is a carrier of the Duchenne muscular dystrophy gene. Her male partner does not have the gene. The couple is planning to conceive and wants to understand the chances of the child acquiring the disease. What information should the nurse give to the couple?

a female child will not be affected by the condition

A Glasgow Coma Score of 5 indicates:

a severe patient

When should PKU testing be done?

after the infant has had 24 hours + worth of milk

What are priorities with status epilepticus?

airway, quick assessment, anticonvulsants

A school nurse is working with the parents of an 8-year-old who has Tourette syndrome on how best to accommodate the child. What advice would be most helpful?

allowing for breaks when tics occur using a tape recorder to take notes

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"pale, cool, or blue skin coloration is to be expected"

A child with a seizure disorder has been prescribed phenytoin to control the seizures. While providing teaching about the medication, what dietary instructions should the nurse provide the parent?

"Increase your child's intake of whole milk and orange juice."

The clinic nurse talks with the parent of a child with Down syndrome. The parent states, "I thought my 1-year-old would be walking by now. I am concerned." What response by the nurse is best?

"Milestones are often delayed for children with Down Syndrome."

Which cranial nerve is deemed intact when the baby's heart and lungs are functioning properly?

10 (Vagus)

Which cranial nerves can be assessed by observing an infant suck and swallow?

5, 7, 9

An IQ of _________ is indicative of mental retardation.

70-75 or less

______ is also known as talipes equinovarus

Congenital clubfoot

A mother has just given birth to an infant born with anencephaly. The mother states, "With all of the technological advances in medicine, I am hopeful of a good prognosis for my baby." How should the nurse respond?

"It must be very difficult to deal with this diagnosis. Tell me what you know about the prognosis."

Which precautions are meningitis patients placed on?

droplet

The nurse is providing education to the parents of a child with phenylketonuria (PKU). Which statement(s) demonstrates an understanding of proper nutrition for PKU?

" we will avoid meat and poultry" :foods high in phenylalanine are to be avoided" "we need to check nutrition labels for aspartame"

During a well-child visit, the caregiver expresses concern that the 3-year-old child often stutters when speaking. Which response should the nurse prioritize to best assist this family?

"Children of this age may stutter while they search for just the right word."

A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful?

"He should wear earplugs when swimming in a pool or a lake."

A pediatric client is prescribed methotrexate for the treatment of juvenile rheumatoid arthritis. Which statement by the child's parent indicates to the nurse additional teaching is needed?

"If my child develops a fever, I will give ibuprofen."

The nurse is performing phenylketonuria (PKU) screening for a 1-day-old infant. The parent asks the nurse why this screening was not performed at birth. Which response by the nurse is most accurate?

"The infant needs to receive enough feeding first."

The nurse is conducting a wellness examination of a 6-month-old infant. The parent points out some dimpling and skin discoloration in the infant's lumbosacral area. What is the nurse's best response?

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."

A parent asks why a physical therapist is needed for the 6-month-old child diagnosed with Down syndrome. What is the best response by the nurse?

"To optimize the child's development and functioning"

The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?

"Watch for changes in his behavior or eating patterns."

A nurse is providing instructions to the parents of a 3-month-old infant with developmental dysplasia of the hip (DDH) who is being treated with a Pavlik harness. Which statement(s) by the parents demonstrates an understanding of the instructions?

"We should change the diaper without taking our infant out of the harness." "We need to check the area behind our infant's knees for redness and irritation." "We need to call the health care provider if our infant is not able to actively kick the legs."

A child is brought to the emergency center after sustaining a seizure at home. When taking the child's history, which question(s) would the nurse ask the parents?

"What time did the seizure occur?" "Can you describe to me the movements your child experienced?" "How long did the seizure last?" "Did your child lose bladder or bowel control?" "Did your child stop breathing during the seizure?"

Which cranial nerve is assessed by watching a child shrug their shoulders and turn their head?

11 (spinal accessory)

The 6 cardinal fields of gaze is used to assess which cranial nerves?

2, 3, 4, 6

What is therapeutic phenylalanine level?

2-8 mg/dL

Which cranial nerve is deemed intact when an infant turns in response to sound?

8

What will a patient with Reye's Syndrome's blood glucose look like?

<50

The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip (DDH). Which finding would help confirm this diagnosis?

A distinct "clunk" is heard with Barlow and Ortolani maneuvers.

The nurse is caring for a 7-year-old with Tourette syndrome. The nurse would be alert for which comorbid condition?

ADHD

JRA may lead to inflammation of the iris and cilliary body in which case __________ is required

ophthalmological treatment

A baby that smiles and coos appropriately could be described as _______-

oriented x3

How is increased intracranial pressure treated?

osmotic diuretics, like Mannitol, reduce stimuli, do not overhydrate, avoid hypoxia

A 6-year-old child with hydrocephalus had a ventriculoperitoneal (VP) shunt placed 6 weeks ago and now has experienced a seizure, vomiting, and loss of appetite. Which intervention will target the child's priority need?

Administer intravenous antibiotics as prescribed.

Which test for hip dysplasia is done by flexing the knees and comparing to see if one is shorter, comparing gluteal folds, and asymmetric toe walking?

Allis sign

A nurse develops a plan of care for a child that includes patching the eye. This plan of care would be most appropriate for which condition?

Amblyopia

_______ is also known as a lazy eye

Amblyopia

_____ is a condition in which the upper portion of the neural tube does not close, in which case the baby will be missing its cerebrum and forebrain.

Anencephaly

Which seizure medications cause respiratory suppression?

Antiepileptics/ Benzos

A 13-year-old adolescent is being released from the hospital following examination for a concussion. The parent has agreed to monitor the adolescent at home for the next 24 hours. Which instruction(s) should the nurse provide?

Assess the adolescent's level of consciousness every 1 to 2 hours while awake. Wake the adolescent once during the night to assess consciousness. Ask the adolescent to name a familiar object. Ask the adolescent to state where he or she lives.

Which type of CP is characterized by uncoordinated/ altered gait, tip-toe walking?

Ataxic

Which type of CP is characterized by wormlike movements and tremors?

Athetoid/ Dyskinetic

________ is a developmental disorder of the brain function, characterized by the inability to relate, communicate, and limited activity.

Autism

The nurse is planning an education program on ear infections in children. What information should be included?

otitis media occurs more in winter and in males

What are the 5 P's? (dealing with casts)

palor, pain, pulselessness, paresthesia, paralysis

Which tests are done for Congenital Hip Dysplasia?

Barlow test, if positive hear Ortalani click, Allis sign, Trendelenburg sign

Which test for hip dysplasia is done by measuring the laxity of the hip joint?

Barlows

What is the treatment for scoliosis?

Boston brace, TLSO, Milwaukee brace, Harrington surgery (spinal fusion)

Who should we avoid giving aspirin to?

patients under 16 yo

______ is a diagnostic test in which the nurse should check for allergies to iodine and shellfish when contrast is used

CT

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.

Which position should myelomeningocele patients be placed in?

prone

The nurse is assigned an infant with a possible neurological disorder. Which assessment finding would the nurse communicate to the health care provider as a late sign of increased intracranial pressure?

Decorticate posturing and fixed and dilated pupils

_______ is the msot common chromosomal abnormality

Down Syndrome

What is an example of an X-linked recessive condition?

Duchenne msucular dystrophy

How can anencephaly be prevented?

Folic acid (400 mcg daily pre-conception)

Which medications can cause sensorineural hearing loss?

Gentamicin, Tobramycin

A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching?

Give the crushed medication in a syringe mixed with a small amount of formula

What are sxs of muscular dystrophy>

Gowers sign (using hands to brace self on legs when rising from floor)

How does PKU testing work?

Guthrie test is performed, if it comes back >4, serum PKU test is performed

The mother of an infant reports that her child is frequently choking when breastfeeding or taking a bottle. The nurse plans on assessing which cranial nerve when addressing the mother's concerns?

IX

The characteristics of the child with autism spectrum disorder fall into three categories. What are these three categories?

Inability to relate to others Inability to communicate with others Obviously limited activities and interests

What are risk factors for otitis media?

propped bottles, cigarette smoke exposure, URIs, feeding supine, facial abnormalities, hx of ear infection

Which seizure medications are not safe when breastfeeding or pregnant?

Keppra

Which seizure medications should you watch a patient's gate with?

Keppra

What are signs of meningitis?

Kernigs, Brudinskis, purpura

Which diet has been found to lessen seizures?

Keto

_________ is a diagnostic test in which there is no metal allowed in the magnet room.

MRI

Which type of CP is characterized by a combination of multiple types?

Mixed/ Dystonic

_____ is a group of genetic disorders characterized by a defect of dystrophin proteins.

Muscular dystrophy

________ is also known as "cross-eyed"

Strabismus

What is the priority for myelomeningocele patients?

protect the sac, watch for infection

What is priority for feedings in CP patients?

put the feedings in different parts of the mouth

What are seizure precautions?

Oxygen Suction equipment Airway IV access Side rails up and padded

____ is a diagnostic test in which vitals and IV access are necessary prior to the test and the nurse should check for iodine and shellfish allergies.

PET scan

_____ is a sign of increased ICP in which the patient's optic disc is swollen and looks like a golf ball in the eye

Papilledema

The nurse is caring for a 2-year-old girl with persistent otitis media with effusion. Which intervention is most important to the developmental health of the child?

Reassessing for language acquisition

The parent of a 7-year-old client tells the school nurse, "My child is afraid of going to school. I am not sure what to do." Which intervention is best for the nurse to suggest?

Return the child to school and investigate the cause of the fear.

________ is toxic encephalopathy associated with hepatic dysfunction after a viral infection. It is associated with taking Aspirin or ASA containing medications.

Reye's Syndrome

The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis?

Risk for impaired skin integrity due to cast and location

_______ is lateral curvature of the spine of 10 degrees or more.

Scoliosis

What is status epilepticus?

Seizures that last longer than 5 minutes or 2 or more seizures between which the patient does not regain consciousness

______ is normal in pre-school but patients should grow out of this.

Stuttering

Which ADHD medications may cause increased suicidal ideations?

TCAs like Tofranil

Which seizure medications should be given with meals and CBC should be monitored?

Tegretol

The parents of a 12-year-old girl report their daughter is missing an increasing amount of school. They further share that the child says she feels ill and begs to stay home. What action by the parents will be most therapeutic?

The parents need to attempt to determine why the child is avoiding school.

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?

The spinal meninges protrude through the bony defect and form a cystic sac.

_______ is the most complex and severe tic disorder.

Tourettes Syndrome

Which test for hip dysplasia is done by standing on one foot and holding onto a chair?

Trendelenburg

What can cause conductive hearing loss?

recurrent otitis media

The mother of a 9-month-old child reports her child's eyes are often crossed. The nurse confirms this during the examination. What action is indicated?

report the findings to the physician

Which medications are given for Tourettes Syndrome?

antidepressants, psychostimulants

The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child?

any area on the cast that is warm to the touch, a foul odor under the cast, drainage from under the cast, looseness of the case on the extremity

A parent brings a preschooler to the behavioral clinic for evaluation. Upon entering the room, the child appears not to notice the nurse's presence. The child screams upon the nurse's touch. What condition should the nurse suspect?

autism spectrum disorder

What is nursing care for child who stutters?

avoid criticism, avoid stopping the child, finishing their sentences, showing great concern, promising a reward when they don't stutter

A nurse in the pediatrician's office is providing teaching to a parent of a 24-month-old child who has been diagnosed with muscular dystrophy (MD). The nurse educates the parent regarding their child's risk for developing _____ and _______.

respiratory infections, cardiomyopathy

The nurse is teaching the parents of an infant newly diagnosed with congenital hypothyroidism about the disease. Which information should the nurse include?

the disease is due to a nonfunctioning thyroid gland, often presents with few to no clinical sings in first few weeks of life, symptoms evident during the first 12 months of life