Exam 4 Module 6

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (SELECT ALL THAT APPLY). a)Frothy-appearing urine b)Fatigue c)Facial edema d)Cloudy, smoky brown-colored urine e)Weight loss

a)Frothy-appearing urine b)Fatigue c)Facial edema Rationale: A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy smoky brown-colored urine is seen with acute glomerulonephritis but not with nephrotic because there is no gross hematuria associated with nephrotic syndrome.

The nurse is conducting reflex testing on infants at a well-child clinic. Which reflex finding should be reported as abnormal and considered as a possible sign of cerebral palsy? a. Extensor reflex at 7 months of age b. Moro reflex at 3 months of age c. Absent Moro reflex at 8 months of age d. Tonic neck reflex at 3 months of age

a. Extensor reflex at 7 months of age Rationale: Establishing a diagnosis of cerebral palsy (CP) may be confirmed with the persistence of primitive reflexes: (1) either the asymmetric tonic neck relex or persistent Moro reflex (beyond 4 months of age) and (2) the crossed extensor reflex. The tonic neck reflex normally disappears between 4 and 6 months of age. The crossed extensor reflex, which normally disappears by 4 months, is elicited by applying a noxious stimulus to the sole of one foot with the knee extended. Normally, the contralateral foot responds with extensor, abduction, and the adduction movements. The possibility of CP is suggested if these reflexes occur after 4 months.

Four-year old David is placed in Buck extension traction for Legg-Calve-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. Which action should the nurse take first? a. Notify the practitioner of the changes noted immediately. b. Chart the observation and check the extremity again in 15 minutes. c. Reposition the child and notify physician in 30 minutes. d. Give the child medication to relieve the pain.

a. Notify the practitioner of the changes noted immediately. Rationale: a. Notify the practitioner of the changes noted immediately.

A child is upset because when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which should the nurse suggest to remove this material? a. Soak in a bathtub b. Apply power to absorb material c. Vigorously scrub the leg d. Carefully pick material off leg

a. Soak in a bathtub Rationale: Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? a. "Circumcision can never be performed in a child with hypospadias." b. "Circumcision is an option, but it cannot be done at this time." c. "Circumcision is a fading practice and is now contraindicated in most children." d. "Circumcision in children with hypospadias is recommended because it helps prevent infection."

b. "Circumcision is an option, but it cannot be done at this time." Rationale: Routine circumcision is recommended by the American Academy of Pediatrics; it is not contraindicated in most children. However, it is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

Which should cause a nurse to suspect than an infection has developed under a cast? a. Cold toes b. "Hot spots" felt on cast surface c. Increased respirations d. Complaint of paresthesia

b. "Hot spots" felt on cast surface Rationale: If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may be indicative of a respiratory tract infection or pulmonary emboli. This should be reported, and child should be evaluated.

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. "Your child's diet will need an increased amount of protein." b. "You will need to avoid adding salt to your child's food." c. "You will need to decrease the number of calories in your child's diet." d. "Your child's diet will consist of low-fat, low-carbohydrate foods.

b. "You will need to avoid adding salt to your child's food." Rationale: For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

When teaching the family of an older infant who has had a spica cast applied for developmental dysplasia of the hip, which information should the nurse include when describing the abduction stabilizer bar? a. t is necessary to use when turning the child. b. It adds strength to the cast. c. It can be adjusted to a position of comfort. d. It is used to lift the child.

b. It adds strength to the cast. Rationale: The abduction bar is incorporated into the cast to increase the cast's strength and maintain the legs in proper alignment. The bar cannot be removed or adjusted until the cast is removed, and a new cast is applied with the bar again placed by the provider as part of the cast. The bar should never be used to lift or turn the child because doing so will weaken the cast.

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate primary nursing goal related to this treatment? a. Detect evidence of edema b. Prevent infection c. Ensure compliance with prophylactic antibiotic therapy d. Stimulate appetite

b. Prevent infection Rationale: High-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy, but that's not related to a primary nursing goal. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.

A 9-year old child with cerebral palsy is to be taught the four-point alternate crutch gait. The parents ask why this gait was chosen. How should the nurse respond? a. "It provides two points of support on the floor between steps." b. "Your child has more power in the arms than in the legs." c. "It provides for equal, but partial weight-bearing on each limb." d. "Your child doesn't have power or step ability in the legs."

c. "It provides for equal, but partial weight-bearing on each limb." Rationale: The four-point alternative crutch gait is a simple and slow, but stable gait because there are always three points of support on the floor, with equal but partial weight-bearing on each limb. Telling the parent that their child has more power in the arms than in the legs may or may not be true; the data are insufficient to justify this conclusion. Some power and step ability is required to use the four-point alternate crutch gait. The child has uncoordinated movement in the legs because of the cerebral palsy.

The neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation? a. Children outgrow this condition when they learn to walk. b. Traction is tried first. c. Frequent, serial casting is tried first. d. Surgical intervention is needed.

c. Frequent, serial casting is tried first. Rationale: Serial casting is begun shortly after birth before discharge from nursery. Successive casts alllow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove harness several times a day to prevent contractures. c. Return to the clinic every 1 to 2 weeks for harness adjustment. d. Place diaper over harness, preferably using a superabsorbent, thin, disposable diaper

c. Return to the clinic every 1 to 2 weeks for harness adjustment. Rationale: Infants have a rapid growth pattern. The child needs to be assessed by the practitioner every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness.

The nurse is caring for a 4-year old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child's immobilization status? a. Metabolic rate increases b. Bone calcium increases and hypercalcemia c. Venous stasis leading to thrombi/emboli formation d. Increased joint mobility leading to contractures

c. Venous stasis leading to thrombi/emboli formation Rationale: The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. Loss of joint mobility leads to contractures. Bone demineralization with osteoporosis and hypercalcemia occur with immobilization.

The healthcare provider prescribes carbamazepine extended release (Tegretol XR) for a client with cerebral palsy who has a seizure disorder. The client has a gastrostomy feeding tube, and carbamazepine is on the hospital's "no crush" list. In order to administer the medication, the nurse should: a. Cut the medication into four smaller pieces so it can fit through the feeding tube. b. Dissolve the medication in 30mL of juice. c. Ask the pharmacist for an oral liquid suspension. d. Contact the healthcare provider to change the prescription.

d. Contact the healthcare provider to change the prescription. Rationale: The coating on an extended-release medication helps assure slow absorption of the medication. If the nurse crushes or breaks up the medication, the medication may enter the client's system too quickly and result in toxic levels. The only appropriate action is to contact the prescriber and ask that the prescription be changed. Carbamazepine comes as an oral suspension, but it is not extended release, therefore, a prescription would be needed to address dosing if switching to this form.

The nurse is conducting teaching to parents of a 7-year old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Allow the affected limb to hang down for 1 hour each day. c. Immobilize the shoulder to decrease pain in the arm. d. Elevate casted arm when resting and when sitting up.

d. Elevate casted arm when resting and when sitting up. Rationale: The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The affected limb should not hang down for any length of time.

While preparing to examine a 6-week old infant's scrotal sac and testes for possible undescended testes, which would be most important for the nurse to do? a. Give the infant a pacifier. b. Check the diaper for recent urination. c. Tap lightly on the left inguinal ring. d. Ensure that the room is kept warm.

d. Ensure that the room is kept warm. Rationale: A cold environment can cause the testes to retract. Cold and touch stimulate the cremasteric reflex, which causes a normal retraction of the testes toward the body. Therefore, the nurse should warm the hands and make sure that the environment also is warm. Checking the diaper for urination provides information about the infant's voiding and urinary function, not information about the testes. Giving the infant a pacifier may help to calm the infant and possibly make the examination easier, but the concern here is with the temperature of the environment. Tapping the inguinal ring would not be helpful in assessing the infant.

A nurse is caring for a 5-year old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that: a. The child will never be able to play contact sports. b. The fracture usually heals within 6 weeks without further complications. c. It is a fracture that does not go all the way through the bone. d. This is a serious injury that could cause long-term growth issues.

d. This is a serious injury that could cause long-term growth issues. Rationale: Fractures of the growth plate are serious because they can disrupt the growth process. Long-term follow-up is usually needed to evaluate limb discrepancies and potential joint abnormalities. The ability to participate in contact sports depends on many potential complications. The amount of pain medication needed in all fractures is determined by the client.

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? (SELECT ALL THAT APPLY) a) Tingling of extremity b) Capillary refill to extremity less than 3 seconds c) Inability to move extremity d) Palable distal pulse e) Severe pain not relieved by analgesics

a) Tingling of extremity c) Inability to move extremity e) Severe pain not relieved by analgesics

A 12-yr old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long? a. Difficulty putting on the brace b. Not understanding the purpose of the brace c. Self-consciousness about appearance d. Pain from the brace

c. Self-consciousness about appearance Rationale: Children at this age are very conscious of their appearance and fitting in with their peers, so they might be very resistant to wearing a brace. Wearing the brace is not painful and putting on the brace is not difficult. Although a child this age might not fully understand the purpose for this brace in this condition, that would not be the most likely cause of noncompliance.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. What is the nurse's best response? a. The child will have more energy. b. Urine will be free of protein. c. Urinary output will increase. d. Blood pressure will stabilize.

c. Urinary output will increase. Rationale: An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.