Peds neuro and muscular

A nurse is providing instructions to the parents of an infant with a ventriculoperitoneal shunt. The nurse plans to include which of the following instructions?

"Call the health care provider if the infant has a high-pitched cry."

A nursing student is asked to discuss juvenile idiopathic arthritis (JIA) at a clinical conference scheduled for the end of the clinical day. Which statement by the nursing student indicates the need to further research this disorder?

"This disease is twice as likely to occur in boys rather than girls."

A nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse monitors for the most serious complication associated with this type of traction by checking for:

An elevated temperature

Which of the following assessment findings may indicate that a child had a tonic-clonic seizure during the night?

Blood on the pillow

A nurse is monitoring a child with a cast on the forearm for signs of compartment syndrome. The nurse understands that which data collection technique is unlikely to provide information about this complication?

Checking the child's ability to perform range of motion to the shoulder area of the affected extremity

A nurse is providing information to the family of a child about a synthetic cast that has been applied to the child for the treatment of a clubfoot. Which information should the nurse provide to the mother?

The synthetic cast allows for greater mobility than a plaster cast.

A nurse assists in monitoring for early signs of meningitis in a child and assists with attempting to elicit Kernig's sign. The appropriate procedure to elicit Kernig's sign is to:

Extend the leg and knee and check for pain.

A 4-year-old child sustains a fall at home and is brought to the emergency department by the mother. After an x-ray, it is determined that the child has a fractured arm, and a plaster cast is applied. The nurse provides instructions to the mother regarding cast care for the child. Which statement by the mother indicates the need for further instructions?

"I can use lotion or powder around the cast edges to relieve itching."

A nurse is providing instructions to the mother of a child with juvenile idiopathic arthritis regarding measures to take if a painful exacerbation of the disease occurs. Which statement by the mother indicates the need for further instruction?

"The full range-of-motion (ROM) exercises must be performed every day, even during the exacerbations."

A mother of a 5-year-old child brings the child to the emergency department and tells the nurse that the child fell. A fracture is suspected and an x-ray is taken. The results indicate that the child has a comminuted fracture of the right humerus. The mother asks the nurse to describe this type of fracture, and the nurse draws a picture for the mother. Which picture identifies this type of a fracture? Refer to figure.

2

A nurse is caring for a child recently diagnosed with cerebral palsy. The parents of the child ask the nurse about the disorder. The nurse bases the response to the parents on the understanding that cerebral palsy is:

A chronic disability characterized by a difficulty in controlling the muscles

A nurse is assigned to care for a child with a compound (open) fracture of the arm that occurred as a result of a fall. The nurse plans care, knowing that this type of fracture involves:

A greater risk of infection than a simple fracture

A nurse assists the health care provider in performing a lumbar puncture on a 3-year-old child with leukemia suspected of central nervous system (CNS) disease. In which position will the nurse place the child during this procedure?

Lateral recumbent with the knees flexed to the abdomen and head bent with the chin resting on the chest

A nurse is reviewing a chart of a child with a head injury. The nurse notes that the level of consciousness has been documented as obtunded. Which of the following would the nurse expect to note on data collection of the child?

Sleeps unless aroused and, once aroused, interacts poorly with the environment

A nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which assessment finding would the nurse expect to note documented in the infant's record regarding this condition?

Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

A nurse employed in the emergency department is collecting data on a 7-year-old child with a fractured arm. The child is hesitant to answer questions that the nurse is asking and consistently looks at the parents in a fearful manner. The nurse suspects physical abuse and continues with the data collection procedures. Which of the following findings would most likely assist in verifying the suspicion?

Bald spots on the scalp

A child has a basilar skull fracture. Which of the following health care provider's prescriptions should the nurse question?

Suction via the nasotracheal route as needed.

A nurse provides home care instructions to the mother of a child recovering from Reye's syndrome. Which statement by the mother indicates a need for further instruction?

"I need to give frequent, small, nutritious meals if my child starts to vomit."

When instructing the caregiver of a child about cast care, the nurse anticipates the need for further teaching when the caregiver states:

"I will allow my child to put cotton balls inside the cast to relieve pressure."

When checking a child's trochlear nerve function, the nurse would perform which data collection technique?

Have the child look down and in.

A nurse is developing a plan of care for a child with autism. The nurse identifies which of the following as the priority problem for this child?

Risk for injury

A nurse working in the day care center is told that a child with autism will be attending the center. The nurse collaborates with the staff of the day care center and assists in planning activities that will meet the child's needs. The nurse understands that the priority consideration in planning activities for the child is to ensure:

Safety with activities

A nurse is reinforcing information to parents regarding the signs of meningitis. The nurse informs the parents that the primary signs of meningitis include:

Severe headache and neck stiffness

The mother of a child with juvenile idiopathic arthritis calls the nurse because the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if the child should perform range-of-motion (ROM) exercises at this time. The nurse makes which response to the mother?

"Have the child perform simple isometric exercises during this time."

A client has been prescribed valproic acid (Depakene) for the treatment of generalized seizures, and the nurse teaches the child about the potential side effects of the medication. Which statement by the client would indicate that further teaching is required?

"I am so glad that I won't lose any of my hair. I was worried what my friends would think."

A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates the need for further instruction?

"I will apply lotion under the brace to prevent skin breakdown."

A nurse is evaluating the parent's understanding of discharge care regarding the functioning of the infant's ventricular peritoneal shunt. Which statement by a parent indicates an understanding of the shunt complications?

"If my baby has a high-pitched cry, I should call the doctor."

A child is brought to the emergency department, and a fracture of the left lower arm is suspected. The mother states that the child was rollerblading and attempted to break a fall with an outstretched arm. The child receives diagnostic x-rays, from which it has been determined that a fracture is present. A plaster of Paris cast is applied to the arm, and the nurse provides instructions to the mother regarding cast care at home. Which of the following instructions would the nurse provide to the mother?

"The cast needs to be kept dry because, when wet, it will begin to disintegrate."

A 13-year-old child is diagnosed with osteogenic sarcoma of the femur. Following a course of chemotherapy, it is decided that leg amputation is necessary. Following the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which statement made by the nurse will best assist in alleviating the child's fear?

"This aching and cramping is normal and temporary and will subside."

A nurse has reinforced prior teaching of a school-age child who was given a brace to wear for the treatment of scoliosis. The nurse interprets that the client has not fully understood the information presented if the child makes which statement?

"This brace will correct my curve."

Which statement should the nurse include when providing safety instructions to the parents of an infant with a diagnosis of hydrocephalus?

"When picking up your infant, support the infant's neck and head with the open palm of your hand."

A nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Choose the instructions that would be included on the list. Select all that apply.

*Keep small toys and sharp objects away from the cast. *Contact the health care provider if the child complains of numbness or tingling in the extremity. *Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling.

A nurse is collecting data from a child suspected of having juvenile idiopathic arthritis (JIA). Which findings would the nurse expect to note if JIA were present? Select all that apply.

*Malaise, fatigue, and lethargy *Painful, stiff, and swollen joints *Limited range of motion of the joints *History of late afternoon temperature, with temperature spiking up to 105° F

A nurse is assisting in preparing a plan of care for a child who is being admitted to the pediatric unit with a diagnosis of seizures. Which of the following would be a component of the plan of care? Select all that apply.

*Pad the side rails of the bed with blankets. *Maintain the bed in a low position. *Place the child in a side-lying lateral position if a seizure occurs. *Protect the child's head, body, and extremities if a seizure occurs.

A 1-year-old child is admitted to the hospital for control of tonic-clonic seizures. The nurse would do which of the following in order to protect the child from injury? Select all that apply.

*Remove toys that have bright, blinking lights on them. *Keep side rails and other hard objects padded. *Turn the client to the side during a seizure.

The nurse should implement which of the following in the care of a child who is having a seizure? Select all that apply.

*Time the seizure. *Stay with the child. *Loosen clothing around the child's neck.

A nurse is caring for a 3-year-old child with suspected bacterial meningitis. Which signs and symptoms would the nurse expect to find during the initial data collection? Select all that apply.

*fever *irritability *nuchal rigidity

A nurse in a newborn nursery is told that a newborn with spina bifida (myelomeningocele type) will be transported from the delivery room. The nurse is asked to prepare for the arrival of the newborn. The nurse places which of the following priority items at the newborn's bedside?

A bottle of sterile normal saline

A nurse is assisting in preparing to care for a child with a brain tumor who will be returning from the recovery room following debulking of the tumor. Which of the following items will the nurse place at the bedside in preparation for the child's return from surgery?

A cooling blanket

A nurse is initiating seizure precautions for a child being admitted to the nursing unit. Which of the following items should the nurse place at the bedside?

A suction apparatus and oxygen

An infant is seen in a clinic and is diagnosed with unilateral hip dysplasia. Which finding is associated with this condition?

Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected, and a nurse is monitoring the child continuously for signs of increased intracranial pressure (ICP). Which of the following is a late sign of increased ICP in this child?

Bradycardia

A school nurse is preparing a physical education plan for a child with Down syndrome. Before preparing the plan, the nurse obtains a copy of an x-ray report of the child's:

Cervical spine

A nurse is caring for a child who sustained a head injury in an automobile accident and is monitoring the child for signs of increased intracranial pressure (ICP). The nurse plans to monitor for the earliest sign of increased ICP by assessing for:

Changes in level of consciousness (LOC)

A nurse is preparing to perform a neurovascular check for tissue perfusion in the child with an arm cast. Which of the following is the priority when performing this procedure?

Checking the peripheral pulse in the affected arm

A nurse is caring for a newborn with a diagnosis of spina bifida (myelomeningocele). To monitor for a major symptom associated with this disorder, the nurse:

Checks for responses to painful stimuli from the torso downward

A child is admitted to the hospital, and a diagnosis of bacterial meningitis is suspected. A lumbar puncture is performed, and the results reveal cloudy cerebrospinal fluid (CSF) with high protein and low glucose levels. The nurse determines that these results are indicative of:

Confirmation of the diagnosis

A nurse is caring for a child diagnosed with Down syndrome. In describing the disorder to the parents, the nurse bases the explanation on the fact that Down syndrome is a:

Congenital condition that results in moderate to severe retardation and has been linked to an extra chromosome 21 (group G)

A nurse is monitoring a child with a head injury. On data collection, the nurse notes an abnormal flexion of the upper extremities and an extension of the lower extremities. The nurse documents that the child is experiencing:

Decorticate posturing

A nurse is caring for a hospitalized infant and is monitoring for increased intracranial pressure (ICP). The nurse notes that the anterior fontanel bulges when the infant cries. Based on this finding, which of the following actions would the nurse take?

Document the findings.

To ensure a safe environment for a child admitted to the hospital for a craniotomy to remove a brain tumor, the nurse should include which of the following in the plan of care?

Initiating seizure precautions

A nursing student is asked to discuss the topic of clubfoot at a clinical conference. The student plans to tell the group that clubfoot:

Is a congenital anomaly

A child with a fractured femur is placed in Buck's skin traction and the nurse is planning care for the client. Which information about this type of traction is correct?

Is a type of skin traction that pulls the hip and leg into extension

A child is seen in the clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The mother asks the nurse about the diagnosis. The nurse bases the response on the fact that primary nocturnal enuresis:

Is common and most children will outgrow bed-wetting without therapeutic intervention

A nurse is caring for a newborn with spina bifida (myelomeningocele type) who is scheduled for the removal of the gibbus (sac on the back filled with cerebrospinal fluid, meninges, and some of the spinal cord). In the preoperative period, the priority nursing action is to monitor:

Moisture of the normal saline dressing on the gibbus area

A nurse is performing a neurovascular check on a child with a cast applied to the lower leg. The child complains of tingling in the toes distal to the fracture site. Which action should be taken by the nurse?

Notify the health care provider (HCP).

A nurse is assigned to care for a child after a spinal fusion for the treatment of scoliosis. The child complains of abdominal discomfort and begins to have episodes of vomiting. On data collection, the nurse notes abdominal distention. Which action should the nurse take?

Notify the registered nurse (RN).

A licensed practical nurse (LPN) is bathing a neonate and notices small dark tufts of fine hair on the neonate's lower back. The LPN should take which best action?

Notify the registered nurse of the finding.

A nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which instruction provided by the nurse is accurate?

The harness needs to be removed to check the skin and for bathing.

A nurse is assigned to care for a child with a spica cast. Which action should be avoided when caring for the child?

Using pillows to elevate the head and shoulders

A nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement, if made by one of the parents, indicates an understanding of the use of the harness?

"I can remove the harness to bathe my infant."

A nurse provides information to the mother of a 2-week-old infant who was diagnosed with clubfoot at the time of birth. Which statement by the mother indicates the need for further instruction regarding this disorder?

"I need to bring my child back to the clinic in 1 month for a new cast."

A nursing student is caring for a child with increased intracranial pressure. On review of the chart, the student nurse notes that a transtentorial herniation has occurred. A nursing instructor asks the student about this type of herniation. Which statement by the student indicates a need for further research about this condition?

"It involves only the anterior portions of the client's brain."

A nurse is assisting in collecting data on a child with seizures. The nurse is interviewing the child's parents to establish their adjustment to caring for their child with a chronic illness. Which statement by a parent would indicate a need for further teaching?

"Our child sleeps in our bedroom at night."

A nurse is developing a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply.

*Time the seizure. *Stay with the child. *Move furniture away from the child.

An adolescent is seen in the emergency department following an athletic injury, and it is suspected that the child sprained an ankle. X-rays are taken, and a fracture has been ruled out. The nurse provides instructions to the adolescent regarding home care for treatment of the sprain and tells the adolescent which of the following?

Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 hours.

A child is to be admitted to the orthopedic unit following a Harrington rod insertion for the treatment of scoliosis. The nurse is assisting in preparing a plan of care for the child. The nurse plans to monitor which priority item in the immediate postoperative period?

Capillary refill, sensation, and motion in all extremities

A nurse is checking the capillary refill of a child with a cast applied to the left arm. The nurse compresses the nail bed of a finger and it returns to its original color in 2 seconds. Which action should be taken by the nurse?

Document the findings.

A nurse is preparing to care for a child with a head injury. On review of the records, the nurse notes that the health care provider has documented decorticate posturing. The nurse plans care, knowing that this type of posturing indicates which of the following?

Dysfunction in the cerebral hemisphere

A child with a brain tumor returns from the recovery room following "debulking" of the tumor. The nurse assigned to care for the child monitors the child for brainstem involvement. Which of the following signs would indicate that brainstem involvement occurred during the surgical procedure?

Elevated temperature

A diagnostic workup is performed on a 1-year-old child suspected of a diagnosis of neuroblastoma. Which finding specifically associated with this type of tumor should the nurse expect to find documented in the child's record?

Elevated vanillylmandelic acid (VMA) levels in the urine

Which of the following represents a primary characteristic of autism?

Lack of social interaction and awareness

The primary goal to be included in the plan of care for a child who has cerebral palsy is to:

Maximize the child's assets and minimize the limitations.

A nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle accident for signs of increased intracranial pressure (ICP). The nurse assesses the child frequently for which early sign of increased ICP?

Nausea

A nurse is caring for a child following surgical removal of a brain tumor. The nurse is monitoring the child and notes that the pulse rate has increased and the blood pressure has dropped significantly. Bloody drainage also is noted on the posterior dressing. The initial nursing action is to:

Notify the registered nurse (RN).

A nurse is collecting data about a child who has been admitted to the hospital with a diagnosis of seizures. The nurse checks for causes of the seizure activity by:

Obtaining a history regarding factors that may occur before the seizure activity

A nurse is assisting with data collection from an infant who has been diagnosed with hydrocephalus. If the infant's level of consciousness diminishes, a priority intervention is:

Palpating the anterior fontanel

A child has been diagnosed with Reye's syndrome. The nurse understands that a major symptom associated with Reye's syndrome is:

Persistent vomiting

A nurse is assigned to care for a child who is in skeletal traction. The nurse avoids which of the following when caring for the child?

Placing the bed linens on the traction ropes

A nurse reviews the plan of care for a child with Reye's syndrome. The nurse prioritizes the nursing interventions included in the plan and prepares to monitor for:

Signs of increased intracranial pressure

The nurse is caring for a pediatric client in skin traction. To prevent skin breakdown, the best nursing intervention for this child is to:

Stimulate circulation with gentle massage over pressure areas.

A child with cerebral palsy (CP) is working to achieve maximum potential for locomotion, self-care, and socialization in school. The nurse would work with the child to meet these goals by:

Placing the child on a wheeled scooter board

The nurse assists with preparing a nursing care plan for a child who has Reye's syndrome. Which of the following is the priority nursing intervention?

Providing a quiet atmosphere with dimmed lights

A nurse is assisting a health care provider (HCP) during the examination of an infant with hip dysplasia. The HCP performs the Ortolani maneuver. Which of the following best describes the action/purpose of the Ortolani maneuver?

Reducing the dislocated femoral head back into the acetabulum

A nurse collecting data on a child suspects physical abuse. The nurse understands that which of the following is a primary and legal nursing responsibility?

Report the case in which the abuse is suspected.

A nurse is monitoring an infant for signs of increased intracranial pressure (ICP) and notes that the anterior fontanel bulges when the infant is sleeping. Based on this finding, which of the following is the priority nursing action?

Notify the registered nurse.

A 4-year-old child sustains a fall at home and is brought to the emergency department by the mother. Following x-ray examination, it has been determined that the child has a fractured arm, and a plaster cast is applied. The nurse provides instructions to the mother regarding cast care for the child. Which statement by the mother indicates a need for further instruction?

"The cast will feel warm when it is dried."

When checking a child's glossopharyngeal nerve function, the nurse would perform which data collection technique?

Test sense of sour or bitter taste on the posterior segment of the tongue.

A licensed practical nurse is providing care for a child with hydrocephalus who has had a ventriculoperitoneal shunt revision. Which data collection finding should be reported to the registered nurse immediately?

Temperature 100.9° F