NUR410 PEDS PREPU
The nurse has cared for a family of two boys with a progressive form of muscular dystrophy. The oldest boy died three years ago from complications of his condition at the age of 15. The younger boy is now 14. He confides to the nurse that he is becoming depressed and scared as he approaches the same age that his brother died. How should the nurse address the boy's concerns?
"Let's look at your health and how it differs from your brother's."
The nurse is caring for a 6-year-old Native American boy who has recently been diagnosed with a progressive neuromuscular disease. The parent's grief has been exacerbated due to the suspicion and distrust of many in their family and community. Numerous family members believe that the boy's condition is a curse. As a result, the family is being shunned by several members of their family. The parents ask for the nurse's help in educating their relatives. Which response by the nurse would be most appropriate?
"Let's meet with one of your spiritual advisers and develop a solution"
The nurse is conducting a health assessment of a 6-year-old girl with spina bifida. During the interview, the girl keeps interrupting and shouting to get her mother's attention. The mother instantly responds to every interruption and attempts to placate her with promises of a trip to the toy store. How should the nurse address the mother about the girl's apparent lack of discipline?
"How do you feel when your daughter interrupts you?"
A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?
"The cause is unknown and there are many environmental factors that may contribute to it."
An 8-year-old girl with cerebral palsy heard about handicapped horseback riding and is begging to try it. Her mother is frightened of her falling and talks to the nurse. What is the most helpful nursing response?
"The stable has specially trained staff and employs physical therapists to work with the children to provide a specific and safe program."
The nurse is caring for a 2-year-old girl with spina bifida. The mother confides that she is depressed and feels that she has somehow contributed to her daughter's condition. Her guilt is compounded by her mother-in-law's accusations that the mother's poor nutrition during pregnancy caused the spina bifida. What should the nurse tell the mother?
A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene?
The nurse is reviewing the history of a 3-year-old child diagnosed with cerebral palsy as an infant. Which factor from the child's history would the nurse identfy as placing this child at risk for this condition?
Birth at 26 weeks' gestation
The nurse is caring for a child with muscular dystrophy. Which prescription will the nurse question?
Clozapine
The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?
Creatine kinase
The parents of a 4-year-old child bring the child to the provider's office for an evaluation. The parents are concerned about the child's weakness and problems with stair climbing. The nurse assesses the child and documents the findings. Based on the findings, the nurse suspects Duchenne muscular dystrophy (DMD). When discussing the findings with the primary care provider, the nurse anticipates which laboratory test being prescribed to provide additional information?
Creatinine kinase (CK)
The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as:
Duchenne.
A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take?
Explain that children can take their first steps as late as 18 months of age.
The parent of a child with cerebral palsy asks how therapeutic horseback riding might benefit his adolescent. What benefits would the nurse describe? Select all that apply.
Flexibility, balance, and muscle strength tend to improve. Self-esteem and confidence usually get a boost.
Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing?
Head lag when pulled from supine to sitting
Through which mechanism is Duchenne muscular dystrophy acquired?
Heredity
The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high risk for having a child with a myelomeningocele?
History of a seizure disorder and taking phenobarbital
The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?
Muscle biopsy
A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?
Muscular wasting results in generalized immobility and difficulty feeding and breathing.
A 7-year-old is admitted to the hospital with complications related to cerebral palsy. The parents hover over the child and are hesitant to allow the nurse to provide the care necessary. What typical caregiver response are the parents displaying?
Overprotection
The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?
Presence of Moro reflex
A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment?
Quietly observe the child at play while interviewing the parent.
A nurse admits a 10-year-old with spina bifida who is confined to a wheelchair. When asking the parent and child questions, the parent appears disinterested and distant, allowing the child to answer all questions. What typical caregiver response is this parent displaying?
Rejection
Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?
Risk for impaired skin integrity
Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?
Risk for infection
Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?
STANDING
The pediatric nurse practioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this?
The boy rises from the floor by walking his hands up his legs.
The nurse is reviewing the therapist's documentation in the medical record of an assigned client who has cerebral palsy. The therapist has noted the parents may be experiencing vulnerable child syndrome. Which observation of the family unit best supports this potential diagnosis?
The parents report they feel their child requires more therapy than the care team has indicated will be needed.
The nurse is assessing a 6-year-old child. The nurse instructs the child, "Let me see all of your pretty white teeth." Which cranial nerve is the nurse assessing?
VII
A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair?
Wheelchair belt
Why does the nurse suspect cerebral palsy in the 8-month-old just assessed?
When startled, a strong Moro reflex is noted.
The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningeocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?
"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved."
The nurse has cared for a family of two boys with a progressive form of muscular dystrophy. The oldest boy died 3 years ago from complications of his condition at the age of 15. The younger boy is now 14. He tells the nurse, "I'm scared and depressed because I'm getting to be the same age as my brother was when he died. I don't know what to do." Which response by the nurse would be most appropriate?
"Let's look at your health and how it differs from your brother's"
A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond?
"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group."
The nurse is conducting a wellness examination on a 12-year-old boy with cerebral palsy and starts discussing about transitioning into adult health care services. The boy is able to speak, but the mother does most of the talking. Which response by the nurse would be most appropriate?
"Tom, what is important to you as you look to the future?"
The nurse is conducting a wellness examination on a 12-year-old boy with cerebral palsy and starts discussing about transitioning into adult healthcare services. The boy is able to speak but the mother does most of the talking. Which response by the nurse would be most appropriate?
"Tom, what is important to you as you look to the future?"
The nurse is providing care to a school-age child with cerebral palsy who has difficulty swallowing. The child is receiving nutrition by mouth. Which intervention(s) would the nurse include when assisting the child to meet nutritonal needs? Select all that apply.
1. Place food far back in the mouth. 2. Encourage the child to self-feed as appropriate.
The nurse is assessing a child who is suspected of having Guillain-Barré syndrome. Which assessment findings would the nurse correlate as supporting this diagnosis? Select all answers that apply.
1. Recent cytomegalovirus infection 2. Numbness in the lower extremities 3. Difficulty swallowing
A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene?
3-year-old preschool-aged child who goes up stairs on hands and knees
A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention?
A 4-year-old preschool-age child who consistently walks on tip toes
A 7-year-old child with cerebral palsy comes to the clinic for an evaluation. The child is prescribed medications to address muscle spasticity and seizures. When assessing the child's mouth, which condition would the nurse associate with the child's medication regimen?
Gingival hyperplasia
A nursery nurse is providing care to a newborn diagnosed with an open neural tube disorder. What is the nurse's initial priority in providing care to the newborn?
Injury prevention
Parents of a 7-year-old with spina bifida inform the nurse that they never go out unless one of the parents is at home with the child, because they are afraid to leave the child with anyone. What intervention can the nurse provide to assist them with this issue?
Encourage the parents to express their anxieties about leaving the child with someone else.
The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?
Gowers sign
The nurse is caring for a school-age child diagnosed with Duchenne muscular dystrophy who is receiving glucocorticoid therapy. When teaching the parents about this therapy, the nurse would empasize which aspect?
Safety measures for injury prevention
A newborn is diagnosed with spina bifida. What initial reactions might the nurse expect to observe in the parents of the newborn? Select all that apply.
Shock Disbelief Denial
In caring for the child with Guillain-Barré syndrome, the nurse will provide much supportive care while watching carefully for signs of deterioration in which body system?
Respiratory
The nurse is conducting a health assessment of a 6-year-old girl with spinal bifida. During the interview, the girl keeps interrupting and shouting to get her mother's attention. The mother instantly responds to every interruption and attempts to placate her with promises of a trip to the ice cream store. Which response by the nurse would be most appropriate to address the mother's response to her daughter's demands?
"How do you feel when your daughter interrupts you?"
The nurse is caring for a 2-year-old girl with spina bifida. The mother confides that she is depressed and feels that she has somehow contributed to her daughter's condition. Her guilt is compounded by her mother-in-law's accusations that the mother's poor nutrition during pregnancy caused the spina bifida. What should the nurse tell the mother?
"Your feelings are normal, and it is important to talk about this"