PEDIEXAM 3
bone scan.
"Before the exam, my child will need an IV." "This scan can show bone changes before they are visible on an X-ray." "A radioactive substance is used in this test."
The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?
"In most cases treatment is not necessary, only observation."
The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents?
"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection."
The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education?
: "My child loves to dance so we can add exercises into a dance routine."
Botulinum toxin is injected by a practitioner into specified muscle groups to reduce spasticity.
A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures.
Muscular dystrophy is a result of which cause?
A group of genetic diseases that cause progressive weakness and loss of muscle mass.
The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? latex
A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Children at risk for latex sensitivity should wear medical alert identification.
What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.
A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment
Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?
Assuming the usual feeding position will be difficult.
Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer?
Baclofen pump A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally.
The nurse is caring for a teenager recently diagnosed with Addison disease. Which findings can be anticipated by the nurse? Select all that apply.
Hyponatremia, hyperkalemia and muscle weakness are all symptoms of Addison disease. Rapid weight gain and acne are present in Cushing disorder, not Addison.
A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks."
In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.
The adolescent with diabetes reports ketones in the urine when testing at home. The adolescent states to the nurse, "I forget what that means, but I do not think it is good." What is the best response from the nurse?
Ketones are a product of fat metabolism. In the diabetic client this often means that the blood glucose level is not well controlled and the body is breaking down fats for energy use
Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful.
Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic.
. Correlating ketones in the urine with what the finger stick levels are running is helpful in determining the control of the diabetes.
Telling the client that this is "not good" or "this is very dangerous" would not be the best responses.
Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken.
The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand. T
The nurse is providing presurgical care for a newborn with myelomeningocele. Which action is the central nursing priority?
The central nursing priority is to prevent rupture or leaking of cerebrospinal fluid. Keeping infant in prone position will help prevent pressure on lesion. Keeping lesion free from fecal matter or urine is important as well, but the priority is to prevent rupture or leakage.
Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down.
The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until area is numb. Cold causes vasoconstriction to reduce the pain and swelling.
In caring for a child in traction, which intervention is the highest priority for the nurse?
The nurse should monitor for decreased circulation every 4 hours.
A parent, distressed to learn that her school-aged child is diagnosed with type 2 diabetes mellitus, asks the nurse how this could happen because no one in the family has diabetes. What instruction is most accurate?
Type 2 diabetes is now seen in overweight adolescents and those who eat a diet high in fats and carbohydrates and do not exercise regularly.
Legg-Calvé-Perthes disease (LCPD), Trendelenburg gait
is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies (osteonecrosis or avascular necrosis) and stops growing. Symptoms: Pain in the hip, knee, ankle (hip pa... Usual onset: 4 to 8 years
A type V fracture
is a crushing injury to the physis.
type II fracture
is partially through the physis extending into the metaphysis.
type IV fracture
is through the metaphysis, physis, and epiphysis.
A type I fracture
is through the physis, widening it.
The nursing is caring for a child recently admitted with an endocrine disorder. The child's mother asks the nurse what the term metabolism means. Which is the best response by the nurse?
Metabolism refers to all physical and chemical reactions occurring in the body's cells that are necessary to sustain life.
Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder.
Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle.
Sever disease causes pain over the posterior aspect of the calcaneus.
also known as calcaneal apophysitis) is a type of bone injury in which the growth plate in the lower back of the heel, where the Achilles tendon (the heel cord that attaches to the growth plate) attaches, becomes inflamed and causes pain.
Duchenne muscular dystrophy
The boy has a large tan skin lesion on his torso. Severe lordosis is evident in the lumbar spine. The head is held tilted with limited side-to-side motion.
Type 2 diabetes is not caused by the pancreas not making enough insulin. This disorder is not linked to an inadequate ingestion of daily calories.
This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development.
For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion.
Exercise may be implemented for very mild curvatures to strengthen the back muscles.
Which symptom might be an early warning signal that the child has developed compartment syndrome? The child:
feels increasing severe pain.
Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A
simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.
