Peds PrepU Quizzes Ch. 22

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching?

"My son's activity is too limited to stimulate his bowels."

When assisting parents plan home care for a child with Legg-Calvé-Perthes disease, the nurse would teach the parents that which is anticipated?

A nonweight-bearing period initially occurs. Explanation: Resting the affected femoral epiphysis aids healing.

The nurse is caring for an 8 year old in skeletal traction for a fractured femur. Which type of traction would be communicated in the shift hand-off?

Balanced suspension traction Explanation: Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Examples of skeletal traction are 90-degree traction and balanced suspension traction. 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's extension traction, and Russell traction.

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

Cartilage Explanation: 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 caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

Creatine kinase Explanation: 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.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.

Muscular dystrophy is a result of which cause?

Gene mutation Explanation: Muscular dystrophy is a result of a gene mutation. It isn't from a chromosome aberration or environmental factors. It's genetic and there's a known origin of the disease.

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 Explanation: 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.

Which characteristic is true of cerebral palsy?

It appears at birth or during the first 2 years of life. Explanation: Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are mentally retarded, many have normal intelligence.

The nurse performing a focused health history on a newborn asks the parents if there are any hereditary disorders affecting musculoskeletal function in the family history. These disorders include what? Select all that apply.

Scoliosis Clubfoot Hip dysplasia Explanation: The nurse should explore the family history for any hereditary disorders. The presence of scoliosis, clubfoot, hip or skeletal dysplasia, or neuromuscular disorders in family members may help in diagnosing genetically linked orthopedic disorders.

Which diagnostic measure is most accurate in detecting neural tube defects?

Significant level of alpha-fetoprotein present in amniotic fluid Explanation: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

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 II 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.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

back with hips up off the bed. Explanation: For there to be traction, the infant's hips must be off the bed. On the stomach or hips on the bed are not the correct positions for this child.

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 proximal humerus. Explanation: 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 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.

A nurse is conducting a physical examination of an infant with suspected metatarsus adductus. Type II metatarsus adductus is indicated when the forefoot is:

flexible passively past neutral, but only to midline actively. Explanation: In type II metatarsus adductus, the forefoot is flexible passively past neutral, but only to midline actively. The forefoot is flexible past neutral actively and passively in type I. The forefoot is rigid, does not correct to midline even with passive stretching in type III. An inverted forefoot turned slightly upward is indicative of clubfoot.

A type of traction sometimes used in the treatment of the child with scoliosis is called:

halo traction. Explanation: When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking. Explanation: A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as:

spastic. Explanation: Spastic involves hypertonicity and permanent contractures on both extremities on one side. Athetoid (dyskinetic) involves abnormal involuntary movements affecting all four extremities and sometimes the face, neck, and tongue. Ataxic affects balance and depth perception. Spastic affects the lower extremities. Mixed is a combination of spastic, athetoid and ataxic.

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?

Advise the child that this is to be expected. Explanation: Plaster becomes hot as it sets. This effect is reduced with newer plastic casts. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, notify the provider. Infection would not present in this way with a cast application. Never moisten a cast.

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?

Baclofen Explanation: 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.

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

Serum creatine kinase levels are elevated. An electromyogram demonstrates the problem is within the nerves, not the muscles. The child is unable to rise easily into a standing position when placed on the floor. Explanation: Significant muscle wasting is associated with this diagnosis. Creatine kinase levels increase with muscle wasting. A muscle biopsy will show an absence of dystrophin. Gowers sign will be positive. An electromygoram will indicate the problem is with the muscles, not the nerves. Genetic testing will reveal the presence of the gene associated with Duchenne muscular dystrophy.

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental genu varum?

A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray Explanation: Blount disease is retardation of growth of the epiphyseal line on the medial side of the proximal tibia (inside of the knee) that results in bowed legs. Unlike the normal developmental aspect of genu varum, Blount disease is usually unilateral and is a serious disturbance in bone growth that requires treatment. In those with Blount disease, the medial aspect of the proximal tibia will show a sharp, beaklike appearance. The other answers all describe genu varum, not Blount disease.

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. These variations include:

During adolescence, muscle growth is influenced by increased production of androgenic hormones. Explanation: During adolescence, muscle growth is influenced by hormonal changes, primarily the increased production of androgenic hormones. The infant's muscles account for only 25% of total body weight, whereas they account for 40% to 45% in an adult. The young child has resilient soft tissue, so dislocations and sprains are unusual occurrences. Rapid bone and muscle growth may contribute to the appearance of "clumsy" and awkward motions of the adolescent who is trying to adjust to new body dimensions.

An emergency room nurse prepares a pamphlet to use as a teaching tool for the proper care of sprains. What information might be included in this guide? Select all that apply.

Promote early motion after acute injury of the soft tissue. Perform quadriceps and hamstring exercises for knee sprains. Perform ROM exercises for ankle and wrist injuries. Wrap the extremity starting distal from the affected area. Explanation: Early motion after acute injury of the soft tissue will help the child make a more rapid recovery. Physical therapists instruct the client in quadriceps and hamstring exercises for knee sprains and strains. For ankle and wrist injuries, a ROM program is implemented. In grade I and II ankle sprains, rehabilitation can begin immediately; prolonged immobilization is not recommended. When crutch walking, the child should bear weight on the hands and not the underarms, to avoid nerve damage. Wrapping the injury should be started distal from the affected area.

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?

Deficient knowledge related to diagnosis and condition Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for healthcare professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.