Final Pedi

A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.)

- Elevate arm when resting - Observe the fingers for any evidence of discoloration - Do not allow the child to put anything inside - Examine skin @ cast edges for any breakdown - Ice to relieve itching

The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.)

- Less bulky - Drying time faster -permit regular clothes to be worn - can be cleaned with small amount of soap & water -Do not mold easily to body parts

The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi? (Select all that apply.)

- Monitor output - Ensure adequate fluids - Encourage cranberry juice - Stay away from apple juice & milk

The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session? (Select all that apply.)

- Pin care - Crutch walking - modification in activity (full weight bearing is not allowed) - observing pin sites for infection

Fractures

- Spiral: slanting & circular, twisting around the bone shaft - Comminuted: small fragments of bone are broken from fractured shaft & lie in surrounding tissue - Transverse: crosswire @ right angles to the long axis of the bone - Oblique: slanting but straight between a horizontal & perpendicular direction

Gastrointestinal

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Musculo/Ortho

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A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long?

4 weeks

What statement is correct regarding sports injuries during adolescence?

Adolescents may not possess insight & judgement to recognize when a sports activity is beyond their capabilities

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation?

Allow child to assume comfortable position - usually with legs flexed - Trendelenburg doesn't help - dangerous to give enemas or apply heat

What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis?

Anorexia, malaise, lethargy, easy fatiguability - jaundice = late sign - dark urine and pale stools = post jaundice

A young girl has just injured her ankle at school. In addition to notifying the child s parents, what is the most appropriate, immediate action by the school nurse?

Apply ice - Rest - Elevate - Apply compression

What is an appropriate nursing intervention when caring for a child in traction?

Assessing for tightness, weakness, or contractors in uninvolved joints & muscles - adhesive straps should be released/replaced only when absolutely needed - AROM on unaffected extremity only - movement is expected: maintain proper alignment

What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)?

Assist the child to dorsiflex the feet & rotate the ankles - sit in chair - ambulate - pillow under knee = impair circulation

A 2-year-old child has a chronic history of constipation and is brought to the clinic for evaluation. What should the therapeutic plan initially include?

Bowel cleansing - too young for structured toilet training - return distended rectum to normal size

Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time?

Calmly ask the child to point where the pain is worst & wiggle fingers

The nurse is preparing a staff education in-service session for a group of new graduate nurses who will be working in a long-term care facility for children; many of the children have cerebral palsy (CP). What statement should the nurse include in the training?

Children with spastic pyramidal CP have a positive Babinski sign & ankle clonus

What is a physiologic effect of immobilization on children

Circulatory stasis --> thrombus & embolus formation - metabolic decrease - decrease venous return - increased serum calcium

The nurse is caring for a child with tetanus during the acute phase. What should the nurse plan in the care for this child?

Clustering care to limit distraction - darkened room = ideal - light less irritating than vibratory/auditory

Clinical manifestation most suggestive acute appendicitis

Colicky, cramping, abdominal pain around umbilicus - generalized - periumbilical - rebound tenderness = not reliable & painful

What statement best describes Hirschsprung disease?

Colon has an aganglionic segment - liquid stool around the blockage - does not affect meconium production

The nurse is teaching parents the proper use of a hip knee ankle foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement?

Condition of the skin in contact with the brace should be checked Q4 hours - Alcohol should not be used on the skin - if burning sensation --> removal of brace

The nurse is preparing to admit a 2-year-old child with spina bifida occulta. What clinical manifestations of spina bifida occulta should the nurse expect to observe? (Select all that apply.)

Dark tufts of hair Skin depression or dimple Port wine angiomatous nevi Soft, subcutaneous lipomas

Immobilization causes what effect on metabolism?

Decreased metabolic rate

The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved?

Education of adults to recognize signs that indicate a risk for injury - fatigue - dehydration - mandatory protective equipment

A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions?

Elevate casted arm when both upright and resting - increases venous return - do not engage in strenuous activity for first few days - joints above/below should be moved -swelling of fingers may indicate neuromuscular damage (report immediately) --> perm damage 6-8 hrs

A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take?

Elevate the foot & leg on pillows - provider notified if edema does not go down despite treatment

The mother of a child with cognitive impairment calls the nurse because her son has been gagging and drooling all morning. The nurse suspects foreign body ingestion. What physiologic occurrence is most likely responsible for the presenting signs?

Esophageal obstruction - aspiration --> cough/choke/unable to speak

A 3-year-old child with Hirschsprung disease is hospitalized for surgery. A temporary colostomy will be necessary. How should the nurse prepare this child?

Essential b/c it will be an adjustment

The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula?

Excessive frothy saliva

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain?

Frequent, serial casting is tried first

The nurse is caring for a family whose infant was just born with anencephaly. What is the most important nursing intervention?

Help the family cope with the birth of an infant with a fatal defect - hours - weeks

What immunization is recommended for all newborns?

Hep B - Hep A > 12 months

Nutritional management of the child with Crohn disease includes a diet that has which component?

High calorie & high protein - helps stunted growth - low fiber

What information should the nurse include when teaching an adolescent with Crohn disease (CD)?

How to cope with stress and adjust to chronic illness - no cure - not infectious

Spastic cerebral palsy (CP) is characterized by which clinical manifestations?

Hypertonicity, poor control posture/balance/coordination - most common type

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching?

I should gently massage the skin under the straps 1x daily to stimulate circulation - no lotions or powder - do not remove harness except for bath -diaper placed under straps

The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching?

I will use an ice pack to relieve the itching - do not allow to hang in dependent position for > 30 minutes - should be kept elevated - notify if redness, swelling in fingers

What is the primary method of treating osteomyelitis?

IV antibiotic therapy - usually s. aureus

An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer?

Ice, rest, NSAIDs to relieve pain

After spinal fusion surgery the nurse should check for signs of what?

Impaired color, sensitivity & movement to the lower extremities - wound, circulation & VS

A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child?

Infant stimulation program - frequent position changes - change in environment - verbal, tactile, auditory stim

What term describes invagination of one segment of bowel within another?

Intussusception - atresia = no closure of natural opening in body - stenosis = narrowing/closure - herniation = protrusion of organ through CT or cavity wall

What statement is true concerning osteogenesis imperfecta (OI)?

It is an inherited disorder - excessive fractures --> bone deformity - Tx = supportive - Primary goal = rehabilitative

What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?

Kyphosis - Scoliosis = on 3 planes - Lordosis = cervical/lumbar - Ankylosis = joint immobility

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.)

Lack of bowel control Flaccid, partial paralysis of lower extremities Overflow incontinence with constant dribbling of urine

What procedure is most appropriate for assessment of an abdominal circumference related to a bowel obstruction?

Marking point of measurement with a pen - before feedings - umbillicus

A child with pyloric stenosis is having excessive vomiting. The nurse should assess for what potential complication?

Metabolic alkalosis

What nursing intervention is most appropriate when caring for the child with osteomyelitis?

Move & turn child carefully & gently to minimize pain - weight bearing is a no no - food not needed (parenteral therapy) - PROM < AROM

The nurse should suspect a child has cerebral palsy (CP) if the parent says what?

My 4 month old doesn't lift his head when on tummy - 6 month rolling from back/prone = normal - 8 month sitting without support = normal - 10 month old not walking = normal

Neuropathic bladder disorders are common among children with which disorder?

Myelomeningocele

What refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column?

Myelomeningocele - Rachischisis = fissure of spinal column leaving SC exposed

What is the most common type CP

Neonatal encephalopay

After surgery yesterday for gastroesophageal reflux, the nurse finds that the infant has somehow removed the nasogastric (NG) tube. What nursing action is most appropriate to perform at this time?

Notify practitioner

A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse. What should the nurse do first?

Notify practitioner of changes noted - emergency condition

A woman who is 6 weeks pregnant tells the nurse that she is worried that, even though she is taking folic acid supplements, the baby might have spina bifida because of a family history. The nurse s response should be based on what?

Open neural tube defects result in elevated concentrations of fetoprotein in amniotic fluid

What condition can result from bone demineralization associated with immobility?

Osteoporosis

The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign?

Paresthesia - notify immediately - perm damage within 6 hours

The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which?

Place the infant on the side to decrease pressure on the spinal sac - Early spinal closure recommended to prevent local trauma and infection - kept moist until surgical intervention is done

A school-age child with celiac disease asks for guidance about snacks that will not exacerbate the disease. What snack should the nurse suggest?

Popcorn

What is a high-fiber food that the nurse should recommend for a child with chronic constipation?

Popcorn

A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed?

Position changes are made by log rolling - flat in bed for first 12 hours - ambulatory 2-3 days out - placement of urinary catheter - HOB elevated 2nd day - ROM started day 2

A child has a nasogastric (NG) tube after surgery for Hirschsprung disease. What is the purpose of the NG tube?

Prevent abdominal distention

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?

Prone with head turned to side - protects spinal sac - allows for feeding without trauma -avoid said lying (tension on sac)

What measure is important ant in managing hypercalcemia in a child who is immobilized?

Provide adequate hydration

The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication?

Pulmonary embolism

The nurse is caring for a 4-year-old child with cerebral palsy (CP). The child, developmentally, is at an infant stage. Appropriate developmental stimulation for this child should be what?

Putting a colorful mobile with music on the bed - incorporating play

What finding is characteristic of fractures in children?

Rapidity of healing is inversely related to the child's age - epiphyseal plate = weakest point - bones more pliable & porous - bend > break - periosteum stronger w/ more osteogenic potential

One of the major differences in clinical presentation between Crohn disease (CD) and ulcerative colitis (UC) is that UC is more likely to cause which clinical manifestation?

Rectal bleeding - common in UC > Crohn's

A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture?

Requires different management to prevent bone growth complications -early & complete assessment - prevention angular deformities & longitudinal growth problems - rapid healing - complete immobilization is not needed -surgically repaired with internal fixation

A child with acute gastrointestinal bleeding is admitted to the hospital. The nurse observes which sign or symptom as an early manifestation of shock?

Restlessness - slow cap refill - cold - BP decline

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material?

Soak in a bathtub - several days to remove completely - do not scrub the leg vigorously or forcibly --> excoriation/bleeding - use oil or lotion --> not powder

What most accurately describes bowel function in children born with myelomeningocele?

Some degree of fecal continence can usually be achieved - diet modification -regular toileting -prevention constipation/impaction

A child with a hip spica cast is being prepared for discharge. Recognizing that caring for a child at home is complex, the nurse should include what instructions for the parents discharge teaching?

Specially designated car restraints are necessary - position changes < Q8 - diapers may be used to maintain cleanliness - abductor bar never used as an aid for turning

A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he heard a pop, that the pain is pretty bad, and that the ankle feels as if it is coming apart. Based on this description, the nurse suspects what injury?

Sprain - ligament trauma: stretched or torn - Fracture: cross section of bone - Dislocation: force of stress on ligaments disrupts positioning of bone ends -Stress fracture: repeated muscular contraction

A child, age 3 years, has cerebral palsy (CP) and is hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. What is the most appropriate nursing action related to feeding this child?

Stabilize jaw with caregiver hand to facilitate swallowing

An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason?

Stimulate adaptation of the small intestine

What test is used to screen for carbohydrate malabsorption?

Stool pH - Urine ketones: assess glucose - C urea: assess carbon dioxide excretion - ELISA: antibodies/antigens

An adolescent with irritable bowel syndrome comes to see the school nurse. What information should the nurse share with the adolescent?

Stress management may be helpful - high fiber - milk products can make worse - PPI does nothing - Anti diarrheal, antispasmotic, simethicone

The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization?

Take the child for a walk by wagon outside the room - increases environmental stimuli & contact

The nurse is discussing home care with a mother whose 6-year-old child has hepatitis A. What information should the nurse include?

Teach infection control measures to the family - transferred via fecal-oral route - rest & quiet activities are good - bed rest not needed - not infectious 1 week post onset of jaundice - return to school as activity level allows

A toddler s mother calls the nurse because she thinks her son has swallowed a button type of battery. He has no signs of respiratory distress. The nurse s response should be based on which premise?

The location needs to be confirmed by radiographic examination - damage if lodged in esophagus - in stomach = pass without a hitch - surg is not indicated

A mother tells the clinic nurse that she often puts honey on her infant s pacifier to soothe the infant. What response should the nurse make to the mother?

There is still a risk for infant botulism from honey - don't give < 12 months

A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?

Thicken feedings & enlarge nipple hole - does not decrease pH - surgical therapy = last resort - prone = SIDs - smaller, frequent feeds

The clinic nurse is assessing infant reflexes. What assessment indicates a persistence of primitive reflexes?

Tonic neck reflex at 8 months of age - Palmar grasp gone by 6 months - Plantar gone by 12 months - rooting by 4 months

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse?

Until your vertebral column has reached skeletal maturity

The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what?

We're happy this is the only cast our baby will need -Treatment = serial casting - 6-10 weeks

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device?

When the infant is developmentally ready to stand up

The nurse is preparing to admit a 7-year-old child with ataxic cerebral palsy. What clinical manifestations of ataxic cerebral palsy should the nurse expect to observe? (Select all that apply.)

Wide based gait rapid, repetitive movement disintegration of movements of upper extremities when child reaches for objects

The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal?

You will feel a tickly sensation as the cast is removed

What findings should the nurse expect to observe in a 7-month-old infant with Werdnig-Hoffman disease? (Select all that apply.)

absent deep tendon reflexes absent tounge movements failure to thrive

What statement is most accurate in describing tetanus?

acute infectious disease caused by exotoxin produced by an anaerobic spore forming, gram + bacillus

What functional ability should the nurse expect in a child with a spinal cord lesion at C7?

almost complete independence within limitations of wheel chair

When does idiopathic scoliosis become most noticeable?

during preadolescent growth spurt - rarely before age 10

What statement is most descriptive of Meckel diverticulum?

intestinal bleeding may be mild or profuse - most common congenital malformation of GI - males > females - therapy = surgery

The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session?

lift the infant by the buttocks, not by the ankles when changing diapers - careful handling to prevent fractures - support when turn, position, move, held - never hold by ankles

What therapeutic intervention provides the best chance of survival for a child with cirrhosis?

liver transplantation

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome [GBS]). When explaining this disease process to the parents, what should the nurse consider?

muscle strength slowly returns and most children recover

An 8-year-old girl with moderate cerebral palsy (CP) recently began joining a regular classroom for part of the day. Her mother asks the school nurse about joining the after-school Girl Scout troop. The nurse s response should be based on which knowledge?

recreational activity = socialization and recreation

When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation?

sudden relief of pain - fever - tachycardia - increased abdominal distention - rigid guarding of abdomen