CH 47,48,49
A 6-year-old girl born with a myelomeningocele has a neurogenic bladder disorder. Her parents have been performing clean intermittent catheterization. The nurse's MOST appropriate action is to: A. teach the child to do self-catheterization. B. teach the child appropriate bladder control. C. continue having parents do catheterization. D. encourage the family to consider urinary diversion.
A
An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. The nurses most appropriate action is to: A. Explain the disorder so parents can explain it to others. B. Help parents understand that no one knows how this occurs C. Suggest that parents avoid family and friends until the gender is assigned. D. Encourage parents not to worry while the tests are being done.
A
During the summer, many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? A. Increased food intake B. Decreased food intake C. Increased risk of hyperglycemia D. Decreased risk of insulin shock
A
The most important nursing consideration related to congenital hypothyroidism is: A. Early identification of the disorder B. Facilitation if parent infant attachment C. Initiating referrals for cognitive impairment D. Helping parents deal with future prospects for the child.
A
The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. Which treatment option should be implemented to restore fluid volume? A. Provide hypertonic saline dextrose solution (5%) with parenteral hydrocortisone B. Increase rate of intravenous fluids. C. Restrict intake of fluids for 8 hours. D. Provide isotonic fluids as needed to restore fluid balance
A
The nurse is exposing that the destruction of pancreatic beta-cells is the cause of which disorder? A. Type 1 diabetes B. Type 2 diabetes C. Impaired glucose tolerance D. Gestational diabetes
A
The nurse is planning care for a child recently diagnosed with diabetes insipidus. The plan should include: A. Encouraging the child to wear medical identification B. Discussing with the child and family ways to limit fluid intake C. Teaching the child and family how to do required urine testing D. Reassuring the child and family that this is usually not a chronic or life-threatening illness.
A
The nurse should include which information when teaching a patient about Cushing's syndrome? A. It is caused by excessive production of cortisol B. The major clinical feature associated with this disease is exophthalmia C. Treatment involves replacement of cortisol D. Diagnosis is suspected with findings of hypotension, hyperkalemia and polyuria
A
Which statement is most accurate in describing tetanus? A. Acute infectious disease caused by an exotoxin produced by an anaerobic gram-positive bacillus B. Inflammatory disease that causes extreme, localized muscle spasm C. Acute infection that causes meningeal inflammation resulting in symptoms of generalized muscle spasm D. Disease affecting the salivary gland with resultant stiffness of the jaw
A
A nurse is caring for a child who has cerebral palsy. Which of the following medications should the nurse expect to administer to treat painful muscle spasms? SATA A. Baclofen B. Diazepam C. Oxybutynin D. Methotrexate E. Prednisone
A, B
A 15 year old is admitted to the intensive care unit (ICU) with a spinal cord injury. The MOST appropriate nursing interventions for this adolescent are: (Select all that apply.) A. monitoring neurologic status. B. administering corticosteroids. C. monitoring for respiratory complications. D. discussing long-term care issues with the family. E. monitoring and maintaining hemodynamic status.
A, B, C, E
A nurse is caing for an infant and notices an audible click in their left hip. Which of the following diagnostic test should the nurse expect the provder to perform? SATA A. Barlow test B. Babinski sign C. Manipulation of foot and ankle D. Ortolani test E. Ponseti method
A, D
A nurse is caring for a school-age child who has juvenile idiopathic arthritis. Which of the following home care instructions should the nurse include in the teaching? SATA A. Provide extra times for completion of ADLSs B. Use cold compresses for joint pain C. Take ibuprofen on an empty stomach D. Remain home during periods of exacerbation E. Perform ROM exercises
A, E
The nurse is teaching an adolescent, newly diagnosed with type 1 diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? SATA A. Do not reuse needles B. Inject insulin when it's cold C. Flex or tense the muscle during injection D. Rotate sites E. Do not move the direction of the needle-syringe during insertion or withdrawal
A,D,E
Which measure is important in managing hypercalcemia in a child who is immobilized? A. Promoting adequate hydration B. Changing position frequently C. Encouraging a diet high in calcium D. Providing a diet high in protein and calories
A.
A nurse is caring for a child who has a fracture. Whcih of the following are manifestations of a fracture? SATA A. Crepitus B. Edema C. Pain D. Fever E. Ecchymosis
A. B. C. E.
A 3-year-old male child has cerebral palsy and is currently hospitalized for orthopedic surgery. His mother says that he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. The MOST appropriate nursing action related to feeding this child is to: A. bottle- or tube-feed him a specialized formula until he gains sufficient weight. B. stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing. C. place him in a well-supported, semireclining position to make use of gravity flow. D. place him in a sitting position with his neck hyperextended to make use of gravity flow.
B
A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. A PRIORITY nursing intervention is to: A. recommend allergy testing. B. provide a latex-free environment. C. use only powder-free latex gloves. D. limit use of latex products as much as possible.
B
A nurse is developing a plan of care for a toddler who has cerebral palsy. Which of the following actions should the nurse include? A. Structure interventions according to the toddler's chronological age B. Evaluate the toddler's need for an evaluation of hearing ability C. Monitor the toddler's pain level routinely usinga numeric rating scale D. Provide total care for dialy hygiene activities
B
A youngster has just returned from surgery in a hip spica cast. The PRIORITY nursing intervention is to: A.elevate the head of the bed. B.check circulation. C. turn the child to the right side D.offer sips of water
B
A nurse is teaching a group of caregivers about fractures. Which of the following information should the nurse include in the teaching? A. "Children need a longer time to heal from a fracture than an adult." B. "Epiphyseal plate injuries can result in altered bone growth." C. "A greenstick fracture is a complete break in the bone." D. "Bones are unable to bend, so they break."
B.
An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome). When explaining this disease process to the parents, the nurse should consider that: A. paralysis is progressive with little hope for recovery. B. muscle function will gradually return, and recovery is possible in most children. C. disease results from an apparently toxic reaction to certain medications. D. disease is inherited as an autosomal, sex-linked, recessive gene.
B
The most common cause of secondary hyperparathyroidism is: A. Diabetes mellitus B. Chronic renal disease C. Congenital heart disease D. Growth hormone deficiency
B
The nurse should recognize that when a child develops diabetic ketoacidosis, it is: A. An expected outcome B. A life-threatening situation C. Best treated at home D. Best treated at the practitioners office/clinic
B
What is frequently associated with infant botulism? A. Contaminated soil B. Honey and corn syrup C. Commercial infant cereals D. Improperly sterilized bottles
B
Which is characteristic of fractures in children? A. Fractures rarely occur at the growth plate site, because it absorbs shock well B. Rapidity of healing is inversely related to the age of the child C. Pliable bones of growing children are less porous than those of the adult D. Periosteum of a child's bone is thinner, weaker, and has less osteogenic potential compared with that of the adult
B
Which statement is true concerning osteogenesis imperfecta? A.it is easily treated B. It is an inherited disorder C. Later onset disease usually runs a more difficult course D. Braces and exercises are of no therapeutic value
B
A nurse is assessing a child who has Legg-Calve-Perthes disease. Which of the following findings should the nurse expect? SATA A. Longer affected lef B. Hip stiffness C. Back pain D. Limited ROM E. Limp with walking
B, C, D, E
The nurse manager on the orthopedic unit is preparing an in-service about types of traction at the next staff meeting. The nurse manager should include which information in the presentation? (Select all that apply.) A.skeletal yea traction is most likely used when closed reduction is performed B. Skin traction can be applied using a pulling mechanism attached with adhesive material C. Soft, foam based traction straps are used to distribute manual traction pull D. Pins are commonly used with skeletal traction E. Manual traction involves using wires of tongs I inserted through the diameter of the bone distal to the fracture
B, D
The pediatric clinic nurse completes an assessment on a 4-month-old infant brought in because the parents are concerned that something is "just not right" with their baby. The nurse should alert the health care provider to which assessment findings? (Select all that apply.) A. Inability to sit up without support. B. Poor head control and clenched fists. C. Inability to crawl. D. Failure to smile. E. Extreme irritability.
B, D, E
The nurse is discharging a 10-year-old patient admitted to the hospital in diabetic ketoacidosis. The child has been newly diagnosed with type 1 diabetes mellitus on this admission. The nurse should teach the child and parents which signs of type 1? SATA A. weight gain B. Nocturia C. Irritability D. Cool, clammy skin E. Blurred vision
B,C,E
An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a prosthetic device? A. As soon as possible after birth B. When the infant begins sitting up and can maintain balance. C. At about age 12 to 15 months, when most children are walking. D. At about 4 years, when the healthy limb is not growing so rapidly.
B.
A nurse is caing for achild who is in skeletal traction. Which of the following actions should the nurse take? SATA A. Remove the weights to reposition the client B. Assess the chil's position frequently C. Assess pin sites every 4 hours D. Ensure the weights are hanging freely E. Ensure the rope's knot is in contact with the pulley
B. C. D.
A nurse is caring for a child who sustained a fracture. Which of the following actions should the nurse take? SATA A. Place a heat pack on the site of injury B. Elevate the affected limb. C. Assess neurovascular status frequently D. Encourage ROM of the affected limb E. Stabilize the injury
B. C. E.
A 17-year-old boy with diabetes Mel lotus tells the school nurse that he has recently started drinking alcohol with his friends on weekends. The nurse should: A. Tell him not to do this B. Ask him why he is drinking alcohol C. Teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake D. Provide an immediate referral for counseling so he understands the serious consequences of alcohol consumption
C
A neonate with a goiter has just been admitted to the newborn nursery. A priority nursing intervention is to: A. Position the infant on the left side B. Explain transient paralysis to parents C. Have tracheostomy set at bedside D. Suction the infant at least every 5-10 minutes
C
A nurse is completing preoperative teaching with an adolescent client who is scheduled to receive a spinal instrumentation for scoliosis. Which of the following information should the nures include in the teaching? A. You will go home the same day of surgery B. You will have minimal pain C.You will need to receive blood D. You will not be able to eat until the day after surgery
C
A school-age chid recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurses response should be based on knowledge that: A. Exercise is contraindicated B. Soccer and baseball are too strenuous, but swimming is acceptable C. Exercise is not restricted unless indicated by other health conditions D. The level of activity depends on the type of insulin required.
C
Major goals of the therapeutic management of juvenile idiopathic arthritis are to: A. Prevent joint discomfort and regain proper alignment B. Prevent loss of joint function and achieve cure C. Prevent physical deformity and preserve joint function D. Prevent skin breakdown and relieve symptoms
C
The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The nurse's best reply is: A. The pills work with an adult pancreas only B. The drugs affect fat and protein metabolism, not sugar C. Your child needs insulin replaced and the oral hypoglycemics only add to an existing supply of insulin D. Perhaps when your child is older the pancreas will produce its own insulin and then your child can take oral hypoglycemics
C
What most accurately describes bowel function in children born with a myelomeningocele? A. Incontinence cannot be prevented. B. Enemas and laxatives are contraindicated. C. Some degree of fecal continence can usually be achieved. D. Colostomy is usually required by the time the child reaches adolescence.
C
When discussing a child's precocious puberty with the parents, the nurse should tell them that: A. The child is not yet fertile B. Heterosexual interest is usually advanced C. Dress and activities should be approval chronologic age D. Appearance of secondary sexual characteristics does not proceed in the usual order
C
A nurse is caring for a child who has muscular dystrophy. For which of the following findings should the nurse assess? SATA A. Purposeless, involuntary abnormal movements B. Spnal defect and saclike protrusion C. Muscular weakness in lower extremities D. Unsteady wide-based or waddling gait E. Upward slant to the eyes
C, D
A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? (Select all that apply.) A.Lordosis B. Positive Babinski sign C. Asymmetric thigh and gluteal folds D. Positive Ortolani and Barlow tests E. Shortening of limb on affected side
C, D, E
Which statement BEST describes pseudohypertrophic (Duchenne) muscular dystrophy? A. It is inherited as an autosomal dominant disorder. B. It is characterized by weakness of proximal muscles of both pelvic and shoulder girdles. C. It is characterized by muscle weakness usually beginning about 3 years old. D. Onset occurs in later childhood and adolescence.
C.
Therapeutic management of the patient with systemic lupus erythematosus includes A.cold salts to suppress the inflammatory process. B.a high-protein, low-salt diet C.an exercise regimen focusing on weight training D. corticosteroids to control inflammation
D
A neural tube defect that is not visible externally in the lumbosacral area would be called: A. meningocele. B. myelomeningocele. C. spina bifida cystica. D. spina bifida occulta.
D
A nurse is caring for a child who is suspected of having Legg-Calve-Perthes disease. The nurse should prepare teh child for which of the following diagnostic procedures? A. Bone bipsy B. Genetic testing C. CT scan D. Radiographs
D
A nurse is caring for an infant who has a myelomeningocele. Which of the followng actions should the nurse include in the preoperative plan of care? A. Assist the caregiver with cuddling the infant B. Assess the infants temperature rectally C. Place the infant in a supine position D. Apply a sterile moist dressing on the sac
D
A woman who is 6 weeks' pregnant tells the nurse that she is worried that the baby might have spina bifida because of a family history. The nurse's BEST response is: A. "There is no genetic basis for the defect." B. "Prenatal detection is not possible yet." C. "Chromosome studies done on amniotic fluid can diagnose the defect prenatally." D. "The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally."
D
An 8-year-old female child is diagnosed with moderate cerebral palsy (CP). She recently began participation in a regular classroom for part of the day. Her mother asks the school nurse about having her daughter join the after-school Girl Scout troop. The nurse's response should be based on knowledge that: A. most activities such as Girl Scouts cannot be adapted for children with CP. B. after-school activities usually result in extreme fatigue for children with CP. C. trying to participate in activities such as Girl Scouts leads to lowered self-esteem in children with CP. D. after-school activities often provide children with CP opportunities for socialization and recreation.
D
An adolescent who had a lower leg amputated after a motorcycle accident complains of pain in the missing extremity. The nurse's MOST appropriate action is to: A. withhold pain medications because of narcotic addiction. B. refer the patient for psychologic counseling. C. teach the parents and adolescent child about nerve damage. D. reassure the child that it is normal and is called phantom limb sensation.
D
Cerebral palsy may result from a variety of causes. It is now known that the most common cause of cerebral palsy is: A. birth asphyxia. B. neonatal diseases. C. cerebral trauma. D. prenatal brain abnormalities.
D
The major goals of therapy for children with cerebral palsy include: A. reversing degenerative processes that have occurred. B. curing underlying defect causing the disorder. C. preventing spread to individuals in close contact with the child. D. recognizing the disorder early and promoting optimal development.
D
A nurse is caring for a child who is in a plaster spica cast. Which of the following actions should the nurse take? A. Use a heat lamp to facilitate drying. B. Avoid turning the child until the cast is dry. C. Assist the client with crutch walking after the cast is dry. D. Apply moleskin to the edges of the cast
D.
A nurse is caring for a toddler who has hip dysplasia and has been placed in a hip spica cast. The child's guardian asks the nurse why a Pavlik harness is not being used. Which of the following responses should the nurse make? A. " The Pavlik harness is used for chlidren with scoliosis, not hip dysplasia." B. " The Pavlik harness is used for school-aged children" C. " The Pavlik harness cannot be used fro your child because her condition is too severe" D. " The Pavlik harness is used for infants less than 6 months of age
D.
An appropriate nursing intervention when caring for the child with chronic osteomyelitis is to: A. provide active range-of-motion exercises for the affected extremity. B. administer pain medications with meals. C. encourage frequent ambulation. D. move and turn the child carefully and gently to minimize pain.
D.
An important nursing intervention when caring for a child with myelomeningocele in the postoperative stage is to: A. place child on his or her side to decrease pressure on the spinal cord. B. apply a heat lamp to facilitate drying and toughening of the sac. C. keep skin clean and dry to prevent irritation from diarrheal stools. D. measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.
D.
The callus that develops at the fracture site is important because it provides: A. functional use of injured part. B. sufficient support for weight bearing. C. means for adequate blood supply. D. means for holding bone fragments together.
D.
The nurse is caring for an immobilized preschool child. During this period of immobilization, the nurse's BEST action is to: A. encourage wearing pajamas. B. let the child have few behavioral limitations. C. keep child away from other immobilized children if possible. D. take child for a "walk" by wagon outside the room.
D.
What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle? A. Increases the pain threshold. B. Increases metabolism in the tissues. C. Produces a deep tissue vasodilation. D. Reduces edema formation.
D.
Which is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? A. Increased metabolism B. Increased venous return C. Increased cardiac output D. Decreased exercise tolerance
D.