Final Exam - Pediatric Impairment

A nurse reads the diagnosis of neurogenic clubfoot on an infant's chart. Which other diagnosis does the nurse expect to find when reviewing the medical record? a. Osteogenesis imperfecta b. Spina bifida c. Muscular dystrophy d. No associated diagnosis

B

A nurse visiting a day care notices a boy trying to get up off the floor by kneeling, rising, to his feet while keeping his hands on the floor, then walking his hands up hid legs until he is standing. Which assessment finding does this nurse document? a. Positional instability b. Gowers' maneuver c. Kernig's sign d. Grey turner's sign

B

An infant is born with a sac protruding through the spine. The sac contains CSF, a portion of the meninges, and nerve roots. The nurse knows that this is referred to as: a. Meningocele. b. Myelomeningocele. c. Spina bifida occulta. d. Anencephaly

B

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preop period? a. Test the urine for protein b. Reposition the infant frequently c. Provide a stimulating environment d. Assess blood pressure every 15 minutes

B

The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which? a. Take vital signs every hour. b. Place the infant on the side to decrease pressure on the spinal sac. c. Watch for signs that might indicate developing hydrocephalus. d. Apply a heat lamp to facilitate drying and toughening of the sac.

B

A 5-year-old has been diagnosed with pseudohypertrophic muscular dystrophy. Which nursing intervention(s) would be appropriate? (Select all that apply.) a. Discuss with the parents the potential need for respiratory support. b. Explain that this disease is easily treated with medication. c. Suggest exercises that will limit the use of muscles and prevent fatigue. d. Assist the parents in finding a nursing facility for future care. e. Encourage the parents to contact the school to develop an IEP.

A, C, E

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. Which should the nurse tell them? (Select all that apply.) a. "Muscular dystrophies usually result in progressive weakness." b. "The weakness that your child is having will probably not increase." c. "Your child will be able to function normally and not need any special accommodations." d. "The extent of weakness depends on doing daily physical therapy." e. "Your child may have pain in his legs with muscle weakness."

A, E

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate? a. Prone with the head turned to the side b. On the side c. Supine in an infant carrier d. Supine, with defect supported with rolled blankets

A

The nurse is caring for a neonate who has just been diagnosed with a meningocele. The parents ask what to expect. Which of the following is the nurse's best response? a. "After initial surgery to close the defect, most children experience no neurological dysfunction." b. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." c. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." d. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

A

The nurse is preparing to give preoperative teaching to the parents of an infant with hydrocephalus. The nurse knows that the most common treatment for hydrocephalus includes the surgical placement of a shunt connecting which of the following? a. The ventricle of the brain to the peritoneum. b. The ventricle of the brain to the right atrium of the heart. c. The ventricle of the brain to the lower esophagus. d. The ventricle of the brain to the small intestine.

A

The mother of a newborn with myelomeningocele asks if her baby is likely to have any other defects. The nurse responds based on the understanding that myelomeningocele is frequently associated with which of the following? a. Excessive CSF within the cranial cavity b. Abnormally small head c. Congenital absence of the cranial vault d. Overriding of the cranial sutures

A hydrocephalus

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? (Select all that apply) a. Baclofen b. Diazepam c. Oxybutynin d. Methotrexate e. Prednisone

A, B

The nurse is teaching the family with a child with cerebral palsy (CP) strategies to prevent constipation. What should the nurse include in the teaching session? (Select all that apply.) a. Increase fluid intake. b. Increase fiber in the diet. c. Administer stool softeners daily as prescribed. d. Increase the amount of dairy products in the diet. e. Allow the child to decide when to try to have a bowel movement.

A, B, C

A 6-month-old infant does not smile, has poor head control, has a persistent Moro reflex, and often gags and chokes while eating. These findings are most suggestive of a. Hypotonia. b. Cerebral palsy. c. Spinal cord injury. d. Neonatal myasthenia gravis.

B

A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention? 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 using a numeric rating scale. d. Provide total care for daily hygiene activities.

B

The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response: a. "We measure all babies' heads to ensure that their growth is on track." b. "Babies with myelomeningocele are at risk for hydrocephalus, which can show up with an increase in head circumference." c. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up with an increase in head circumference." d. "Many infants with myelomeningocele have microcephaly, which can show up with a decrease in head circumference."

B

What clinical manifestations suggest hydrocephalus in an infant? a. Closed fontanel and high-pitched cry b. Bulging fontanel and dilated scalp veins c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

B

The most common complication associated with myelomeningocele is: a. Learning disability. b. Urinary tract infection. c. Hydrocephalus. d. Decubitus ulcers and skin breakdown.

B Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection.

The nurse is preparing to admit a 5-year-old with spina bifida cystica that was below the second lumbar vertebra. What clinical manifestations of spina bifida cystica below the second lumbar vertebra should the nurse expect to observe? (Select all that apply.) a. No motor impairment b. Lack of bowel control c. Soft, subcutaneous lipomas d. Flaccid, partial paralysis of lower extremities e. Overflow incontinence with constant dribbling of urine

B, D, E

The mother of a toddler with cerebral palsy comes to the clinic for developmental screening. The nurse explains that the major reason that these tests are done is to recognize primary delays early so as to accomplish which of the following? a. Encourage health maintenance b. Facilitate communication c. Prevent secondary developmental delays d. Maintain current development

C

The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. Which of the following signs best indicates increased ICP in this child? a. Sunken anterior fontanel. b. Complaints of blurred vision. c. High-pitched cry. d. Increased appetite.

C

When positioning the neonate with an unrepaired myelomeningocele, which of the following positions would be most appropriate? a. Supine with the hips at a 90 degree flexion b. Right side lying position with the knees flexed c. Prone with hips in abduction d. Semi fowlers position with the chest and abdomen elevated

C

Which of the following would alert the nurse initially to suspect hydrocephalus in an infant who has undergone surgical repair of a myelomeningocele? a. Seizures and vomiting b. Frontal bossing and sunset eyes c. Increased head circumference and bulging fontanel d. Irritability and shrill cry

C

A nurse is caring for a child who has muscular dystrophy. For which of the following findings should the nurse assess? (Select all that apply) a. Purposeless, involuntary, abnormal movements b. Spinal 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

The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include: (Select all that apply.) a. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. b. Anorexia, gingival hyperplasia, dry skin and hair. c. Contractures, obesity, and pulmonary infections. d. Trembling, frequent loss of consciousness, and slurred speech. e. Increasing difficulty swallowing and shallow breathing.

C, E

A nurse is caring for an infant who has a myelomeningocele. Which of the following actions should the nurse include in the preoperative plan of care? a. Assist the caregiver with cuddling the infant. b. Assess the infant's temperature rectally. c. Place the infant in a supine position. d. Apply a sterile, moist dressing on the sac.

D

The nurse is caring for a newborn infant who has just been diagnosed with a myelomeningocele. Which of the following is included in the child's plan of care? a. Place the child in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. b. Place the child in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. c. Place the child in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. d. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

D

The nurse receives a phone call from the parents of a 9-year-old female who is complaining of a headache and blurry vision. The child has been healthy but has a history of hydrocephalus and received a ventriculoperitoneal shunt at the age of 1 month. The parents also state that she is not acting like herself, is irritable, and sleeps more than she used to. They ask the nurse what they should do. Select the nurse's best response. a. "Give her some acetaminophen, and see if her symptoms improve. If they do not improve, bring her to the pediatrician's office." b. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." c. "You are probably worried that she is having a problem with her shunt. This is very unlikely as it has been working well for 9 years." d. "You should immediately bring her to the emergency room as these may be symptoms of a shunt malfunction."

D

The parents of a child recently diagnosed with cerebral palsy ask the nurse about this disorder. The nurse bases the response on the understanding that cerebral palsy is which type of condition? a. An infectious disease of the CNS b. An inflammation of the brain as a result of a viral illnessterm-9 c. A congenital condition that results in moderate to severe retardation d. A chronic disability characterized by impaired muscle movement and posture

D

When assessing the development of a 15 month old child with cerebral palsy, which of the following milestones would the nurse expect a toddler of this age to have achieved? a. Walking up steps b. Using a spoon c. Copying a circle d. Putting a block in a cup

D a: 18-24 month old b: 18 months c: 3-4 year old