theories 2 exam 4

A school nurse identifies that a child has pediculosis capitis and educates the child's parents about the condition. Which of the following statements by the parents indicates an understanding of the teaching? A. "All recently used clothing, bedding, and towels must be washed in hot water." B. "My child must be free from nits before returning to school." C. "I will treat all the family members to be on the safe side." D. "Toys that can't be dry cleaned or washed must be thrown out."

"All recently used clothing, bedding, and towels must be washed in hot water." Rationale: Pediculosis capitis is commonly referred to as head lice. All recently used clothing, bed sheets, and towels need to be washed in hot water. Anything that cannot be washed should be sealed in a plastic bag for 10 to 14 days. Unwashable items can include jackets, sweaters, hats, pillows, bicycle helmets, and stuffed animals. Furniture, carpets, and car seats can be sprayed with a variety of over-the-counter products.

A nurse is caring for a child who has influenza. The nurse should identify that which of the following statements by the parent indicates the child has an increased risk for Reye Syndrome? "I give my child ibuprofen when his muscles are aching." "I am encouraging my child to drink grapefruit juice." "I give my child aspirin to reduce his fever." "I am leaving a humidifier on in my child's room when he naps."

"I give my child aspirin to reduce his fever." The administration of aspirin for fever associated with a viral illness increases the child's risk for Reye syndrome. Reye syndrome is a metabolic encephalopathy with manifestations of cerebral edema and fatty changes in the liver.

A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching?

"Red meat is a good option; he loves the hamburgers from the drive-thru." Explanation: While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive-thru as it is also high in fat, fillers, and sodium. The other statements are correct.

Assessment findings for diabetes insipidus

(abrupt onset) Polyuria, polydipsia, nocturia, enuresis, dehydration, constipation, fever

Nursing care of child with type 2 diabetes mellitus

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Hemoglobin A1C goals for kids with diabetes

0-6 yrs: 7.5-8.5% 6-12 yrs: <8% 12-18 yrs: <7.5%

Normal hemoglobin A1C in nondiabetic patients

6-9% is normal

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?

Antiemetic Explanation: Radiation has systemic effects. Radiation sickness that includes nausea and vomiting is the most frequently encountered systemic effect. It also occurs to some extent as a result of the release of toxic substances from destroyed tumor cells. To counteract this, a child is prescribed an antiemetic before each procedure. The child does not need an analgesic, antipyretic, or antineoplastic agent prior to receiving a radiation treatment.

A nurse is providing teaching to a parent of a preschooler who has eczema. Which of the following instructions should the nurse include in the teaching? a. Launder the child's clothing with fabric softener b. Give the child a bubble baths every day c. Dress the child in woolen clothes during cold months d. Apply topical corticosteroid ointment to the affected area

Apply topical corticosteroid ointment to the affected area. The child might require a topical corticosteroid ointment to use during flare-ups to decrease inflammation.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

What is the primary concern is congenital hypothyroidism goes untreated?

Brain damage/mental disabilities

A nurse is caring for a school-aged child who has a systemic disorder and is receiving antibiotics, immunosuppresants, and corticosteroids. Both of the child's parents have a smoking history. The child reports soreness in his mouth and refuses to eat. Inspection of his mouth reveals a white, milky plaque that does not come off with rubbing. The nurse should suspect which of the following conditions? A. Candidiasis B. Dermatitis C. Herpes simplex D. Squamous cell carcinoma

Candidiasis Manifestations of oral candidiasis include white patches that adhere to the inner cheeks, tongue, and palate that are painful and can cause the child to refuse to eat.

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system?

Child reports facial palsy and vision problems Explanation: The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising result from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? leaking cerebrospinal fluid increasing head circumference constipation and bladder dysfunction increasing ICP

Constipation and bladder dysfunction

The healthcare team can inflict this condition on patients through excessive or prolonged steroid therapy. What condition am I?

Cushing's

What conditions have short stature as a sign of them?

Cushing's and hypopituitarism

Assessment findings in hypopituitarism

Decreased activity of pituitary gland Nl birth wt and length - by 12 months often at or below the 3rd % Hypoglycemic seizures, neonatal jaundice, micropenis, undescended testicles Older-overweight, youthful facial features, high pitched voices, delayed dentition, skeletal & sexual maturation, hypoglycemia

Dietary considerations for PKU

Dietary control - formula Lofenalac HIGH - meat, eggs, milk LOW - OJ, bananas, potatoes, lettuce, spinach, peas Low-phenylalanine diet. Phenylalanine is found mostly in protein-containing foods such as meat and milk (including breast milk and formula).

True or False: It is ok to combine glargine and regular insulin in the same syringe.

False

True or False: Administering sublingual glucose tablets is appropriate for a hypoglycemic patient with a loss of consciousness.

False. You would give glucagon.

A nurse is assessing an adolescent who has an exacerbation of Graves' disease. Which of the following findings should the nurse expect? Weight gain Bradycardia Lethargy Heat intolerance

Heat intolerance rationale: An exacerbation of Graves' disease can cause heat intolerance due to an increased metabolic rate, which leads to warm flushed moist skin and extreme diaphoresis.

A nurse is assessing an infant following a motor vehicle crash. Which of the following findings should the nurse monitor to identify increased intracranial pressure? Brisk pupillary reaction to light Increased sleeping Tachycardia Depressed fontanels

Increased sleeping. Following a head injury, an infant's level of consciousness can deteriorate, show signs of excessive sleeping, and eventually go into a coma.

A nurse is assessing a school-age child whose blood glucose level is 280 mg/dL. Which of the following findings should the nurse expect? Lethargy Pallor Tremors Shallow respirations

Lethargy rationale: A blood glucose of 280 mg/dL is above the expected reference range indicating hyperglycemia. The nurse should expect the child to appear lethargic, leading to a decreased level of consciousness and confusion.

In diabetes insipidus, would you expect the urine specific gravity to be high or low?

Low

A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report?

Mediastinal mass Explanation: Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph) in the client with Hodgkin disease. Hepatomegaly or splenomegaly may occur when there is advanced disease. Lymphadenopathy is present in the cervical and supraclavicular nodes. These could be palpated and do not require an x-ray to diagnose. Presence of a white reflection in the pupil of the eye may indicate retinoblastoma.

Assessment findings for PKU

Musty/mousy odor to urine and sweat seizures skin rashes

A nurse is assessing a child and notes several bruises. Which of the following actions should the nurse take? A. Report the suspected abuse to the authorities. B. Obtain a detailed history. C. Ask a psychiatrist to talk with the parents. D. Separate the child from the parents.

Obtain a detailed history. The nurse should obtain a detailed history in order to assess for other indicators of abuse.

what condition is characterized by a musty smell of urine

PKU

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?

Prepare to administer factor replacement medication Explanation: Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss.

When assessing a child who has recently had a cast removed from the arm, the child states that the elbow is sore and it hurts to move it. What is the appropriate action by the nurse?

Tell the child that this is normal and will get better as the child moves the elbow

The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? "These labs are just common labs for children with this disease." "I'm really not allowed to discuss these findings with you." "These values will help us monitor the disease." "The doctor will discuss these findings with you when he comes to the hospital."

These values will help us monitor the disease.

True or False: Adrenal crisis in the newborn often goes unrecognized. It presents within the first few days to weeks of life with vomiting, lethargy, and feeding problems.

True

A nurse is preparing to teach a parent how to care for a child who has impetigo contagiosa. Which of the following information should the nurse plan to include in the teaching? Keep the child on droplet precautions at home. Wash clothing in hot water. Immunize household contacts for the disease. Give the child a chlorine bath twice daily.

Wash clothing in hot water. The nurse should teach the parent to ensure the child changes her clothes every day and to wash all clothing in hot water.

The nurse is examining a child who was diagnosed with acute lymphoblastic leukemia (ALL) 6 months ago. The child exhibits pallor, ecchymoses, and petechiae. The nurse interprets these findings as indicating that the cancer has invaded which part of the body?

bone marrow Explanation: A child with cancer often appears pale and thin, with symptoms of lethargy and generalized malaise. The presence of pallor, ecchymoses, and petechiae may indicate that the cancer has invaded the bone marrow and is interrupting the normal production of red blood cells and platelets, as in leukemia.

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:

factor VIII. Explanation: In hemophilia A, the problem is with factor VIII, and in hemophilia B the problem lies with factor IX. Platelets are problematic in idiopathic thrombocytopenic purpura (ITP). Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation.

Dietary considerations for glycogen storage disease

high-carbs, with snacks, NG/GT night feeding, antihypoglycemic drug, liver transplant extends life/does not cure

A patient with DMI reports of weight loss and abdominal tenderness. The nurse notes hypoactive bowel sounds upon auscultation. what condition is this?

hyperglycemia

What is the most effective method of managing hemoglobin A1C?

insulin pump

Dietary considerations for diabetes mellitus

limit sweets, ensure consistent food intake (eat often and try to avoid skipping meals), monitor carbohydrate intake, eat whole grains and plenty of fruits and vegetables, and limit fat.

The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)?

macrocytic red blood cells (RBCs) Explanation: When the MCV is elevated, the RBCs are larger and referred to as macrocytic. The WBC count does not affect the MCV. The platelet count and Hgb are within normal ranges for a 7-year-old child.

Dietary considerations for galactosemia

milk and dairy products will be eliminated for life.

manifestations of congenital hypothyroidism

present at birth infant with low tone hoarse cry prolonged jaundice hypothermia constipation and large fontanels

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding: putting medicine away where children cannot reach it. removal or covering of flaking paint on the walls of the home. placing house plants out of reach of children. putting child safety locks on kitchen cabinets.

removal or covering of flaking paint on the walls of the home

What can happen if parents pick at milia or baby acne?

secondary infections

Nursing management of PKU

teach the family dietary protein restrictions (high protein foods are eliminated or restricted) any products containing aspartame should be avoided becomes more of a challange as the child ages include child in planning diet as soon as they are old enough. compliance declines during adolescence and young adulthood.

What other disorders should diabetes mellitus patients be screened for annually?

thyroid disorders

The oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition?

uncontrolled bleeding Explanation: DIC is a complex condition that is secondary to other problems such as sepsis. It is life-threatening. Symptoms of DIC include uncontrolled bleeding, petechiae, ecchymosis, purpuric rash, prolonged prothrombin time and partial thromboplastin time, an increased D-dimer assay, decreased antithrombin III levels, below-normal fibrinogen levels, and increased fibrin-degradation products. The platelet count is decreased in DIC. In moderate to severe cases it is less than 50,000/mm3 (50 ×109/L). The symptom the nurse would see first is uncontrolled bleeding. The remainder are laboratory results that would be used to make the diagnosis.

The nurse is caring for a child admitted with possible Legg-Calvé-Perthes disease. Which assessment question should the nurse ask the child's caregivers to help support this diagnosis? "Does your child have difficulty standing or walking?" "Are your child's knees every swollen and red?" "Have you ever been told your child has any malformed vertebrae?" "Does your child report pain in the groin that results in a limp?"

"Does she/he report pain in the groin that results in a limp?" Symptoms first noticed in Legg-Calvé-Perthes disease are pain in the hip or groin and a limp accompanied by muscle spasms and limitation of motion.

The nurse is obtaining a health history on a child diagnosed with idiopathic thrombocytopenic purpura (ITP). After asking about a viral illness, what question should the nurse ask next to gather more information?

"Has your child recently had the measles, mumps, rubella (MMR) vaccine?" Explanation: Idiopathic thrombocytopenic purpura (ITP) is caused by an immune response following a viral infection. Antiplatelet antibodies cause the development of petechiae, purpura, and excessive bruising. Besides a viral infection, ITP can follow an MMR immunization or the ingestion of certain drugs. The nurse would first want to know the child's history of illness, MMR immunization, or medications before examining the symptoms. Asking about the bruising, blood in the stools, and nose bleeds are all symptoms that need to be explored because they are part of ITP.

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response?

"I know this is scary, but leukemia has a high cure rate in children these days." Explanation: Although cancer in children is rare compared to unintentional injury or infection, it is the leading medical cause of death among persons younger than 25 years of age. Fortunately, the overall survival rate for children with cancer today has improved. The overall 5-year survival rate is 84.5%, and for acute lymphoblastic leukemia (the most common form of childhood cancer), the 5-year survival is 88.5%

A nurse is caring for a 7-year-old child who has an upper respiratory infection and type 1 diabetes mellitus. Which of the following statements by the mother indicates a need for further instruction? "I will encourage her to drink half a cup of water or sugar-free fluids every 30 minutes." "I will report a change in her breathing or any signs of confusion." "I will notify the doctor if her temperature is not controlled with acetaminophen." "I will continue to check his blood sugar two times every day."

"I will continue to check his blood sugar two times every day." Rationale: A client who has type 1 diabetes mellitus and is ill is at risk of developing DKA. DKA results in the breakdown of body fat for energy and the presence of ketones in the blood and urine. Because acute illness increases glucose levels, the child's glucose levels and the urine ketones should be checked every 3 hr. Checking the child's blood glucose two times per day is not enough to adequately monitor glucose levels.

A nurse is providing discharge teaching to the parents of a child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parents indicates an understanding of the teaching? "The onset of low blood glucose usually occurs slowly." "My son might complain of feeling shaky when he has a low blood glucose level." "Sweating can occur with hyperglycemia." "My son might have nausea and vomiting with hypoglycemia."

"My song might complain of feeling shaky when he has a low blood glucose level." Rationale: A shaky feeling is a consistent finding of hypoglycemia.

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide?

"Sickle cell disease is passed to a fetus when both parents have the gene." Explanation: Sickle cell disease is an inherited disease. The recessive gene is passed from both parents who either have the disease or the trait. There is no need for further testing to determine the cause. There are no other ways to pass the disease other than through genetics. Informing the parents that the gene was passed from both parents is most informative. Sickle cell anemia is not a dominant disease, which is passed when only one parent has the gene, nor is caused by a random mutation.

The nurse is caring for a child who has a hip spica cast. The child's mother asks why is there a hole cut in it. What is the best response by the nurse? "The hole is called a window. It allows us to assess the incision on the hip." "The window allows us to assess bowel sounds and helps to prevent abdominal distention." "The window helps to prevent a complication called compartment syndrome from happening." "The hole is called a window. They put them in areas where the hard cast isn't needed."

"The window allows us to assess bowel sounds and helps to prevent abdominal distention."

Patient/family education for acute adrenal insufficiency

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Sick Day Rules for Diabetic children

- q 3-6 hour glucose monitoring and urine ketone checks around the clock. - insulin must be taken even if anorexia, n/v - regular insulin supplemented if hyperglycemia and ketonuria are present - increased fluids, especially if ketosis, hyperglycemia, or fever present

The nurse is administering 10u of NPH insulin to a child at 8am. The nurse would expect the insulin to begin acting at what time?

9-10am

A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis. Which of the following actions is the nurse's priority? Administer antibiotics when available Reduce environmental stimuli Document intake and output Maintain seizure precautions

Administer antibiotics when available. Rationale: The priority nursing action is to administer antibiotics when available. Bacterial meningitis is an acute inflammation of the meninges and the CNS. Antibiotic therapy has a marked effect on the course and prognosis of the illness.

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform?

Administer broad-spectrum antibiotics intravenously. Explanation: Typhlitis (neutropenic enterocolitis) is an inflammatory process of the gastrointestinal tract that occurs with the induction phase of leukemia chemotherapy. The recommended interventions for treatment are to administer broad-spectrum antibiotics or antifungals intravenously, provide supportive care to manage symptoms, and provide IV nutrition. The client should be kept NPO. The nurse should assess for any signs of bowel perforation or shock. Administering diuretics would not be needed and may cause harm. Monitoring sodium levels as well as other electrolytes would be necessary to evaluate IV nutrition.

A nurse is assessing an 11-month-old infant. Which of the following manifestations is associated with a CNS infection? Oliguria Bulging fontanel Negative Brudzinski sign Jaundice

Bulging fontanel. A CNS infection causes increased intracranial pressure. Therefore, a bulging fontanel is a manifestation of a CNS infection.

The nurse is caring for an extremely active 13-year-old adolescent who has recently been prescribed a back brace to treat scoliosis. Which intervention will be most critical to the success of treatment? Show the adolescent how the brace works and when to wear it. Emphasize and encourage compliance related to the use of a back brace. Teach the parents about the disease and its treatment. Ask for the adolescent's feelings about being in a brace.

Emphasize and encourage compliance related to the use of a back brace.

A nurse in a special education program is planning care for a child who has autism spectrum disorder. Which of the following interventions should the nurse include in the plan of care? Allow for adjustment of rules to correlate with the child's behavior. Provide a flexible schedule that adjusts to the child's interests. Allow for imaginative play with peers without supervision. Establish a reward system for positive behavior.

Establish a reward system for positive behavior. Children who have autism spectrum disorder benefit from a reward system for positive behavior.

The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of:

Ewing sarcoma. Explanation: Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors. Osteosarcoma is the most common type of bone malignancy in children. It occurs primarily in the long bones. Ewing sarcoma is a highly malignant bone cancer. It occurs in the pelvis, chest wall, vertebrae, and midshaft of the long bones. Neuroblastomas are seen in children younger than 5 years old and arise from immature nerve cells and the adrenal glands. Hodgkin disease develops from the immune system. Non-Hodgkin lymphoma is a blood cancer.

A nurse is providing teaching to a 17-year-old female client who has severe acne about the use of isotretinoin. Which of the following adverse effects should the nurse instruct the client is the priority to report to the provider? A. Frequent nosebleeds B. Itching of the skin C. Back pain D. Feelings of isolation

Feelings of isolation Feelings of isolation can indicate suicide ideation, which can lead to self-harm. Therefore, this adverse effect is the priority to report to the provider.

Nursing care for hypopituitarism

GH replacement - SQ 6-7 X/week Follow-up and monitoring growth Educate to treat child by age, not by size

What insulin can you NOT mix?

Glargine Long Acting Insulin Glargine LAI is incompatible with any other insulins.

This condition requires constant feeding:

Glycogen storage disease

A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant. The nurse should stress which teaching point? "The harness does not hurt the baby." "It is important that the harness be worn continuously." "Let me teach you how to make appropriate adjustments to the harness." "The baby needs the harness only for 2 to 3 weeks."

It is important that the harness be worn continuously.

Nursing management of hypothyroidism

Management: Early diagnosis and treatment-mental retardation is severe and permanent without treatment PO Levothyroxine (Synthroid) (Pediatric) Endocrine specialist Life long treatment Monitor growth and development (mental and physical)

What does the skin need to be coated with with scabies?

Medical pesticide

Griseofulin should be taken with a fat source like _____ or ____ ______.

Milk, Ice cream

A nurse is providing teaching to an adolescent who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? Administer glucagon for hyperglycemia. Obtain an influenza vaccine annually. Inject insulin in the deltoid muscle. Take glyburide with breakfast.

Obtain an influenza vaccine annually. Rationale: The client should obtain an influenza vaccine annually.

A nurse is providing care to a pediatric client hospitalized with a diagnosis of Duchenne muscular dystrophy (DMD). The nurse is reviewing the above laboratory results. Which laboratory result will have the greatest impact on the client's condition? glucose potassium creatinine calcium

Potassium

A school nurse is performing a routine health assessment for a school age child. Which of the following findings indicates the nurse should investigate for pediculosis capitis? Red patches on the scalp Blisters on the scalp Pruritus of the scalp Dry patches on the scalp

Pruritus of the scalp Pediculosis capitis is an infestation of head lice. Generally, the only manifestation is scalp itchiness.

Treatment of choice in DKA

Regular Insulin is THE treatment of choice in DKA hyperglycemia.

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?

Risk for infection Explanation: Removal of the spleen places the child at significant risk for infection. Although the child's skin integrity is disrupted due to the surgery, this is not the priority nursing diagnosis. Loss of fluids occurs during surgery and adequate hydration is important to prevent a sickle cell crisis, but this diagnosis is not the priority in the postoperative period. Although the child is at risk for delayed growth and development, the priority postoperatively is to prevent infection.

A nurse is teaching about neural tube defects to a group of females who are pregnant. Which of the following disease processes should the nurse include as an example of neural tube defect? Cerebral palsy Hydrocephalus Muscular dystrophy Spina bifida

Spina Bifida Neural tube defects, such as spina bifida, occur when the neural tube fails to close. In spina bifida, the osseous spine fails to close.

Nursing management of hyperthyroidism

Support and educate parents and child Caloric intake Scheduled rest periods Cool, quiet environment - few clothes (layers) Medication side effects Thyroid storm (surge of thyroid hormone is release) - life threatening

A school nurse is assessing an adolescent who reports feeling shaky and is having difficulty speaking and concentrating on the questions the nurse is asking. The nurse checks the adolescent's blood glucose level and identifies a value of 55 mg/dL. Which of the following findings should the nurse expect? Dry, flushed skin Deep, rapid respirations Tachycardia Polyuria

Tachycardia rationale: A blood glucose level of 55 mg/dL is below the expected reference range and an adolescent with this blood glucose level is likely to have tachycardia due to increased circulating catecholamines and increased adrenergic activity.

What condition: Fatal with no cure or effective treatment

Tay-Sach's Disease

True or False: Families with children that have CAH must keep extra steroids in an injectable form, such as Solu-Cortef or Decadron, at home to give during an emergency.

True

The nurse is caring for a client who was diagnosed with a sickle cell crisis and currently reports acute back and joint pain. Upon examination, the nurse noted the following assessments: dry mucous membranes; poor skin turgor; poor capillary refill, and pale nail beds. Which nursing concern will the nurse identify as the priority?

acute pain related to effects of sickling Explanation: Although all the noted concerns apply, acute pain is the priority for this child. Once pain is relieved, the child will be able to relax, thus reducing the metabolic demand for oxygen and helping to end the sickling. A child with sickle cell pain generally does not like to move because movement increases the oxygen demand of the body that results in the sickling of more cells. The increased sickling of cells causes an increase in pain. This decreased mobility increases the risk of developing pressure injuries.

If cradle cap (SD) does not improve with the loosening with petroleum jelly or baby oil and using a small comb, then a topical _______________ ointment may be needed.

antifungal

A patient with PKU should avoid which foods?

avoid: - high-protein foods (such as meat, eggs and dairy products) - artificial sweeteners - anything high in phenyl alanine

The nurse will select which meal as the best choice for a child with iron-deficiency anemia?

cheeseburger, broccoli, and fresh strawberries Explanation: Children with iron-deficiency anemia require diets rich in iron and vitamin C (vitamin C enhances iron absorption). Meats are excellent sources of iron. Broccoli is a good source of iron, and strawberries are a good source of vitamin C. To help the body absorb the most iron from the meal, tea and foods rich in calcium (such as milk and cheese) should be avoided.

Patient presents to the ED with confusion and fruity breath. Hyper or Hypo glycemia?

hyperglycemia

Characterized by exophthalmos, heat intolerance, hyperreflexia, inability to sleep

hyperthyroidism

Maintains youthful features, dentition does not progress, and delayed puberty is common

hypopituitarism

Nursing care of child with type 1 diabetes mellitus

infants: Prevent extreme fluctuations in blood glucose. Prevent hypoglycemia and, if present, treat promptly. Attempt to achieve consistent dietary intake. Establish rituals/routines with home management. toddlers: Prevent hypoglycemia and if present, treat promptly. Assist parents in managing a picky eater. Let toddler choose foods. Get toddler to find a word or phrase to use to describe feelings when hypoglycemic. Help parents to provide appropriate discipline and protection while continuing to promote normal development. Establish rituals/routines with home management. preschoolers: Use concise and concrete terms when instructing. Allow child to proceed at his or her own rate. Assist family to incorporate the testing and injections into school day and plan for field trips. Involve the school nurse in helping with the school plan. Encourage the child's participation but emphasize importance of continued adult supervision. Encourage regular attendance at school and participation in extracurricular activities. Assist in the development of a care schedule that is flexible enough to allow for participation in school activities. Assist with education of other care providers as needed. adolescents: Slowly, care is turned over to the adolescent with minor supervision from the family. Encourage parents and teen to find the right balance of shared management. Encourage parents to continue to provide guidance and supervision and be actively involved in the plan of care. Assess adherence to diabetic care regimen. Assess for signs/symptoms of depression, eating disorders, or evidence of risky behaviors. In later adolescence, assist teen in transitioning to independent self-management and adult diabetes physician or nurse practitioner.

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for:

leukemic cells. Explanation: Acute lymphoblastic leukemia (ALL) is a rapidly progressive cancer affecting the undifferentiated or immature cells. It is the most common form of cancer in children. Throughout the course of the disease and treatment the child will be tested regularly for complete blood counts, bone marrow aspirations, lumbar punctures, and testing for renal and liver function. Lumbar punctures are performed to determine if leukemic cells have infiltrated the central nervous system. The white blood cells, temperature, and other symptoms would be indicative of meningitis and septicemia. The platelet count would be assessed for the possibility of bleeding.

The school nurse is providing information to parents of adolescents about prevention of cervical cancer. Which information is included in the teaching?

vaccine against human papillomavirus (HPV) Explanation: Reminding parents that both boys and girls should receive the vaccine against HPV is an important preventive measure to reduce the incidence of cervical cancer. Papanicolaou tests are not recommended until age 21. Abstinence from intercourse and use of condoms will help, but do not prevent exposure through other sexual contact.

PKU appropriate foods

veggies cereal potatoes bananas juices

While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate?

vitamin B12 injections Explanation: Children with pernicious anemia have a vitamin B12 deficiency and have symptoms such as pallor, irritability, beefy red tongue, and diarrhea. Children with iron-deficiency anemia require ferrous sulfate. Folic acid is needed for children with macrocytic anemia. Hydroxyurea could be prescribed for a child with sickle cell anemia.

When a skin infection is involved, if the rash extends into the skin folds, then ___________ is involved.

yeast

A nurse is providing teaching about lice to the parents of a school-age child at a well-child visit. Which of the following information should the nurse include in the teaching? A. "Lice can jump from one child to another." B. "Encourage your child to avoid sharing hats with other children." C. "Live lice can survive for 2 weeks away from the host." D. "Washing your child's hair daily will prevent lice."

"Encourage your child to avoid sharing hats with other children." Rationale: Lice are transmitted from person to person on personal items, such as hats, hair ornaments, scarves, combs, and brushes.

A young child with Duchenne muscular dystrophy is placed on both prednisone and calcium. Parents view these two medications as rather "common" and question their importance for the child. What explanation by the nurse will be most helpful to the parents?

"Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing." Explanation:Studies have shown that boys treated with prednisone have improved muscle strength and function. This is thought to be due to the protection that prednisone provides to muscle fibers. Calcium is needed to prevent osteoporosis, which is a side effect of prednisone that also occurs when weight bearing is limited. Respiratory infection is a risk in that those muscles weaken with progression of the disease, but reactive airway disease is not a particular risk. No peripheral nerve involvement is observed in Duchenne muscular dystrophy. Side effects of prednisone include weight gain and appetite stimulation, but these are not the reasons for the prednisone therapy. Calcium does augment dietary intake of the mineral and is important for tooth development, and it may play a role in prevention of muscle cramps, but these are not the main reasons for taking the calcium supplement.

A nurse is teaching a school-age child who has type 1 diabetes mellitus and his parents about illness management. Which of the following instructions should the nurse include? "Withhold insulin dose if feeling nauseous." "Notify the provider if blood glucose levels are over 350 milligrams/deciliter." "Test the urine for ketones." "Limit fluid intake during meal time."

"Test the urine for ketones." rationale: The parent or child should test the urine for ketones and report the presence of them in the urine. Ketonuria can indicate that the child does not have enough glucose for energy and is breaking down fats to provide glucose to cells.

Patient/family education for CAH

- Teach that meds will be required all of the child's life to sustain life. - Teach the appropriate oral dosages of hydrocortisone and fludrocortisone and that it is important to maintain tight control over these levels in the blood, as underdosing or overdosing can lead to short stature. - Teach that these drugs can be given orally or IM. Teach how to give hydrocortisone IM if the child is vomiting and cannot hold down oral meds. - Teach that if child becomes sick, under stress, or needs surgery, that the kid may need additional doses. - Encourage family to obtain a medical ID bracelet or necklace for kid.

When to contact provider with diabetic kids

- treatment of precipitating infection - assistance with insulin dosage requirements - glucose levels remaining >240 or <80 despite following guidelines - presence of ketones in urine - n/v with inability to tolerate fluids - diarrhea more than 5 times/day - change in mental status - labored respirations or dyspnea

What angle should you instruct patients to administer their insulin injections?

90 degrees

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?

A 15-year-old adolescent who has heavy menstrual periods Explanation: Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.

Hyperglycemia vs. Hypoglycemia

Hyper - deep kusmaul breathing, hot/dry - sugar high. AMS. weakness. dry flushed skin. blurred vision. fruity breath. abdominal pain, n/v. Hypo - shallow breathing, cold/clammy - needs candy. Behavior changes; irritability or confusion and slurring. tremors. diaphoresis. tachycardia.

A nurse is caring for a child who is having a tonic-clonic seizure and vomiting. Which of the following actions is the nurse's priority? Place a pillow under the child's head. Position the child side-lying. Loosen restrictive clothing. Clear the area of hazards.

Position the child side-lying. This is the priority nursing action. To prevent aspiration due to vomiting, the nurse should place the child in a side-lying position.

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?

Slightly yellow sclera Explanation: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.

Nursing management of diabetes insipidus

Treatment - correct the cause if possible Neurogenic: Desmopressin acetate (DDAVP) PO or intranasal spray, strict I and O, daily weights, caution with PO fluids (can overload fluids with DDAVP treatment) Nephrogenic: IV fluids, thiazide diuretics (inc sodium excretion), close monitoring of sodium and potassium levels

True or False: Glucophage is the only approved medication to treat type 2 diabetes in children.

True.

True or False: Rapid insulin is the ONLY type of insulin that can be used in insulin pumps.

True.

Wilms tumor is suspected in a 5-year-old child. Which action would be avoided? rectal suppository use abdominal palpation fiber intake aspirin administration

abdominal palpation

Wilms tumor is suspected in a 5-year-old child. Which action would be avoided?

abdominal palpation Explanation: If Wilms tumor is suspected, the abdomen should not be palpated. Palpating the abdomen may cause the tumor capsule to rupture, resulting in tumor spillage. Tumor spillage can change the tumor from stage I to stage II or III, depending on the amount of spillage that occurs.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Iliac crest Anterior tibia Sternum Femur

iliac crest

The only type of insulin suitable for an insulin pump:

rapid insulin

The young child is experiencing muscle spasms and has been given lorazepam. Which statements by the child indicate that the child may be experiencing some common side effects? Select all that apply. "My muscle cramps are getting worse." "My belly hurts." "I think I'm going to throw up." "I need to take a nap." "I feel sort of dizzy."

• "I feel sort of dizzy." • "I need to take a nap." This child has taken a benzodiazepine. Common side effects associated with this medication are dizziness and sedation. The skeletal muscle relaxes and the spasms will diminish. Nausea and upper gastrointestinal pain are not common side effects associated with this medication.

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? Select all that apply. a) Any pink color in the fingers or toes of casted extremity b) Any area on the cast that is warm to the touch c) A foul odor under the cast d) Drainage from under the caste) Looseness of the cast on the extremity e) Any itching under or around the edges of the cast

• 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 cast on the extremity In addition to the five Ps, any foul odor or drainage on or under the cast, "hot spots" on the cast (areas warm to the touch), looseness or tightness, or any elevation of temperature must be noted, documented, and reported. Family caregivers should be instructed to watch carefully for these same danger signals. Itching is common and does not need to be reported. Pink coloration of fingers and toes would be normal and not a concern.

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning?

"I mix ferrous sulfate with milk in a bottle." Explanation: Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.

A nurse is providing teaching to a school-age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the child indicates an understanding of the teaching? "My morning blood glucose should be between 90 and 130." "I should eat a snack half an hour before playing soccer." "I should not take my regular insulin when I am sick." "I can store unopened bottles of insulin in the freezer."

"I should eat a snack half an hour before playing soccer." Exercise lowers blood glucose levels. The child should eat a snack half an hour prior to physical activity. If the exercise is prolonged, the child might require a snack during the activity.

A nurse is providing teaching about self-administration of insulin to the parent of a school-age child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parent indicates a need for further teaching? "I will be sure my child aspirates before injecting the insulin." "The insulin can be injected anywhere there is adipose tissue." "I will be sure my child rotates sites after 5 injections in one area." "The insulin should be injected at a 90-degree angle."

"I will be sure my child aspirates before injecting the insulin." Rationale: It is not necessary to aspirate before injecting the insulin.

A nurse is caring for an adolescent who is having a plaster cast applied. When the plaster strips are applied, the adolescent complains of it feeling hot. What is the best response by the nurse? "Your temperature may be going up. I'll check it when they are done applying the cast." "That is unusual. Most people complain of feeling cold." "When the strips start to dry, they can get warm, but they won't burn you." "That is a normal feeling when casts are applied."

"When the strips start to dry, they can get warm, but they won't burn you." As the plaster strips are applied, they initially feel cool but almost immediately they will begin to feel warm. This is due to evaporation. The statement that it is a "normal" feeling is not the best answer because it does not give enough information. The client having a temperature would not cause the cast to feel hot.

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child?

"You may feel pressure on your hip during the procedure." Explanation: The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow aspirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.

Assessment findings in Cushing's

Alters metabolism: Catabolism of protein, dec. absorption of Ca, inc. appetite, salt-retaining Poor wound healing, easily bruised, muscle wasting, demineralization of bone, osteoporosis, fat accumulation (protruding abdomen, "buffalo hump", "moon face"), striae, edema, HTN, fatigue, hirsutism, acne, impaired glucose tolerance, mood swings, oligomenorrhea/amenorrhea Cushingoid appearance reversible with treatment

The nurse is creating a care plan for a child with a leg cast. What interventions would be appropriate for the nursing diagnosis of Risk for ineffective peripheral tissue perfusion related to pressure from cast? Select all that apply. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. Remind the parents to not allow the child to put anything in the cast. Keep leg elevated by a pillow at all times. Assess capillary refill of toes every 4 hours. Educate the child's parents on use of good body mechanics when repositioning the child.

Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. Keep leg elevated by a pillow at all times. Assess capillary refill of toes every 4 hours.

A nurse is caring for a child who is having a seizure. Which of the following actions should the nurse take? SATA Assess the client's airway patency. Place a tongue depressor in the client's mouth. Remove objects from the client's bed. Place the client in a side-lying position. Restrain the client.

Assess the client's airway patency is correct. The nurse should continually assess the client's airway during a seizure. Remove objects from the client's bed is correct. The nurse should remove objects that can cause injury to the client during a seizure. Place the client in a side-lying position is correct. The client should be positioned side-lying to prevent aspiration of secretions or vomit.

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority?

Assessing the child's level of consciousness. Explanation: The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

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. 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 E. We need to call the doctor if she is not able to actively kick her legs 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.

.A school nurse is assessing a child for pediculosis capitis. Which of the following manifestations should the nurse recognize as an indication of this condition? A. Firmly attached white particles on the hair B. Itching and scratching of the head C. Patchy areas of hair loss D. Thick yellow crusted lesion on a red base

Firmly attached white particles on the hair Rationale: Pediculus capitis, or head lice, are tiny parasitic insects that live on the scalp and can be spread by close contact with other people. Their eggs (nits) appear much like flakes of dandruff but stick firmly to the hair shaft instead of flaking off of the scalp.

Assessment findings for hyperthyroidism

Goiter Exophthalmos (bulging eyes) Tachycardia, sweating, tremors, warm skin Nervousness, irritability, mood swings Decreasing school performance- decreased concentration Increased appetite with weight loss Heat intolerance, muscle weakness Fine hair, hyperreflexia Easily fatigued, unable to sleep

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?

Have the parent bring the child to the pediatric oncology clinic as soon as possible. Explanation: The preschooler is considered immunosuppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.

Radiation or removal is a more effective treatment, but methimazole is also prescribed for this condition?

Hyperthyroidism

Patient presents to a school nurse with diaphoresis, pallor, and shakiness. Hyper or Hypo glycemia?

Hypoglycemia

Assessment findings for hypothyroidism

Hypothermia, lg fontanels, umbilical hernia, hypotonia, hoarse cry, respiratory distress, prolonged jaundice, lethargy, constipation, feeding difficulties

The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching?

No routine live vaccines are administered while on chemotherapy. Explanation: Children with cancer need much of the same well-child maintenance care that all children do, with one exception. While they are undergoing chemotherapy, which causes a decreased immune response, they should not receive "routine" vaccines, especially live vaccines. The siblings in the home can receive all nonlive vaccines, and the entire family (including the child undergoing treatment) is encouraged to receive a yearly flu vaccine. Growth and development are monitored during well-child visits, but it is not necessarily true that growth and development may be stunted. It is always a good idea to eliminate second-hand smoke for all children, not just for children with cancer. Childhood cancers do not seem to be related to environmental contaminants.

A nurse is caring for a child who is postoperative following ventriculoperitoneal (VP) shunt placement. In which of the following positions should the nurse place the client? Trendelenburg Semi-Fowler's Prone On the unoperated side

On the unoperated side (The nurse should position the child flat on the on operated side to prevent a rapid reduction of intracranial fluid and to protect the child from injuring the operative site)

A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy?

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Explanation: Methotrexate is a chemotherapeutic agent; one of its side effects is oral mucositis. Oral ulcerations can interfere with nutrition because of pain and leave a portal for infection. Mucositis can be treated with oral swish and swallow agents or swish and spit agents (diphenhydramine, lidocaine, nystatin). Mucositis is very painful and children will not be able to eat, so alternate ways of delivering nutrition may be necessary. The child receiving methotrexate may need large volumes of hydration to prevent dehydration from the medication effects. The nursing diagnosis of fluid overload from aldosterone production would be incorrect. Methotrexate works on specific cells. It does not affect the central nervous system. The child may have decreased mobility from the cancer effects and any side effects of many drugs the child is receiving as a result of a weakened state, but methotrexate is not a depressant.

A school nurse is conducting a screening for Pediculosis capitis identifies several children who require treatment. Which of the following is an appropriate instruction for the nurse to get the child's parents? 1. Soak all combs and hairbrushes in alcohol 2. Inspect any dogs or cats at home for lice 3. Seal all non-washable items in airtight plastic bags 4. Spray countertops and sinks with insecticide

Seal nonwashable items in airtight plastic bags. Parents should seal items they cannot wash, vacuum, or dry clean in airtight plastic bags for 14 days to kill any lice on them.

A nurse is caring for a preschooler who has a partial-thickness burn on her right forearm. Which of the following findings should the nurse expect? (SATA) Dry surface Sensitive to touch Would blanches with pressure Intact epidermis Blisters

Sensitive to touch Wound blanches with pressure Blisters Sensitive to touch is correct. A partial-thickness burn is sensitive to touch. Wound blanches with pressure is correct. A partial-thickness burn blanches with pressure. Blisters present on skin is correct. A partial-thickness degree burn has blisters.

A group of nursing students are reviewing information about types of skin traction and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction? Side arm 90-90 traction Bryant traction Buck traction Russell traction

Side arm 90-90 traction

A nurse is assessing an 8-month-old infant for cerebral palsy. Which of the following findings is a manifestation of the condition? Tracks an object with eyes. Sits with pillow props. Smiles when a parent appears. Uses a pincer grasp to pick up a toy.

Sits with pillow props. Infants who have cerebral palsy require support when sitting up.

A nurse is caring for a child who has Addison's disease. Which of the following actions should the nurse take? Teach the parents about cortisol replacement therapy. Place the child on a low-sodium diet. Monitor the child for fluid volume excess. Discuss the manifestations of hyperglycemia with the parents.

Teach the parents about cortisol replacement therapy. Rationale: The nurse should plan to teach the child's parents about cortisol replacement therapy. Administration of glucocorticoids and mineralocorticoids is necessary because inadequate supplies or a sudden cessation of the medications can cause acute adrenal crisis.

A nurse is caring for an infant who has diaper dermatitis. Which of the following actions should the nurse take? Apply a light layer of talcum power with each diaper change. Change to cloth diapers until the skin is healed. Expose the excoriated area to hot air frequently. Use a moisturizer to wipe urine from the skin.

Use a moisturizer to wipe urine from the skin. It is appropriate for the nurse to use a moisturizer to wipe urine from the skin. This will prevent further breakdown of the skin.

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? Select all that apply. child who has uneven balance child with asymmetric shoulder elevation child with a lateral curve of the spine child with a limb length discrepancy child with a one-sided hump upon bending over child whose sibling had scoliosis surgically corrected

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