peds exam #5
a child is recently diagnosed with epilepsy is being evaluated for AED therapy. which regimen is most likely? -a combo of oral and IV AEDs -1 oral AED to observe effectiveness and minimize side effects -2-3 oral AEDs -One rectal medication
-1 oral AED to observe effectiveness and minimize side effects
antiepileptic drug complications
-Can increase alcohol toxicity and interfere with adherence -can cause defects in an unborn child, ask female adolescent pt if pregnant -can cause dental issues
what are the isolation precautions for a patient with bacterial meningitis?
droplet
an infant who has been found to have developmental dysplasia of the hip is being examined in the clinic. what finding does the nurse expect to identify during the physical assessment? -downward and inward rotation of the affected hip -limited abduction of the affected hip -inability to flex and extend the hip on the affected side -free abduction on the affected hip when placed in the frog position
-limited abduction of the affected hip
what isolation precaution should be implemented for bacterial meningitis?
droplet precautions
how often should a child be brought back to the dr for serial casting for club foot?
every 2-3 weeks
what is the most serious s/s of increased ICP? pain or irritability?
irritability
which is not true of cerebral palsy? -it is reversible -it is non-progressive -it is permanent -it is a disorder of movement and posture
it is reversible
a 4 month old infant is being treated for clubfoot. the infant has a cast change every 2-3 weeks. when the infant is brought to the well baby clinic for a routine visit, a nurse elevates the foot in the cast. which assessments should the nurse include? -pedal pulses of both feet -color of the toes of the foot in the cast -ROM of the foot in the cast -movement of the toes in the foot in the cast -knee flexion and extension of the affected leg
-color of the toes of the foot in the cast -movement of the toes in the foot in the cast
a nurse is caring for an infant who has just undergone a myelomeningocele repair. what should the nursing plan of care include? -monitoring for CSF fluid leakage -maintaining a supine position -teaching clean catheterizations to the parents -applying sterile dressings to the incision
-monitoring for CSF fluid leakage (can mean incomplete closure of the defect)
an infant with hydrocephalus has a ventriculoperitoneal shunt surgically inserted. what nursing care is essential during the first 24 hrs after this procedure? -medicating the infant for pain -placing the infant in high fowler's position -monitoring the infant for increased ICP -positioning the infant on the side of the shunt
-monitoring the infant for increased ICP
what is the diagnostic test for muscular dystrophy? -electromyogram -creatine kinase level -muscle biopsy -nerve conduction velocity
-muscle biopsy
the Gower sign can be elicited by having the patient perform which of the following? -close the eyes and touch the nose with alternating index fingers -rise from a squatting position -hop on one foot and then the other -bend from the waist to touch the toes
-rise from a squatting position
a child is admitted with the diagnosis of meningitis. select the procedure the nurse should do first -send spinal fluid and blood samples to the lab for cultures -place a foley -administer IV antibiotics -administer IV fluids
-send spinal fluid and blood samples to the lab for cultures
an infant is scheduled for surgery due to myelomeningocele. what is the primary reason for surgical repair? -to prevent hydrocephalus -to prevent seizure disorders -to correct neurological defect -to reduce the risk of infection
-to reduce the risk of infection
when assessing a toddler with ASD, what characteristic findings or behaviors should the nurse expect? -flat, blank facial expression -the desire to hug th enurse -laughing when pulse is taken -enjoys climbing on stairs/furniture -inability to maintain eye contact
-flat, blank facial expression -laughing when pulse is taken -inability to maintain eye contact
a nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. which statement by the parents indicates a need for further instruction? -i will apply lotion under the brace to prevent skin breakdown -i will encourage my child to perform prescribed exercises -i will have my child wear soft fabric clothing under the brace -i will avoid the use of powder because it will cake under the brace
-i will apply lotion under the brace to prevent skin breakdown
what are the S/S of cushing's triad? (ICP)
1. bradycardia 2. hypertension w/ increased SBP 3. Irregular respirations
what are the s/s of the meningitis classic triad?
1. headache 2. fever 3. nuchal rigidity
Only assess head circumference until _____
2 years old
when should peak antibiotic levels be drawn?
30 mins after administration
what is the Kernig's sign?
After flexing the hip and knee at 90 degree angles, back pain and resistance are noted.
which nursing actions should be initiated for adolescents diagnosed with generalized tonic clonic seizure? SATA -teach parents care and safety measures at home -obtaining an oropharyngeal airway and placing it near the kids bed -padding the side rails of the bed -setting up suction equipment in the kids room
all of the above
which antibiotics can cross the BBB?
ampicillin, gentamicin, cefotaxime, penicillin G, vanc
the mother of a child with duchenne's asks about genetic testing. who should be tested? SATA -the mother and father -the sister -the brother -the aunts and uncles
any of the answers are valid
Never give _____ to a child with s/s of viral disease
aspirin. is okay to give once viral disease ruled out.
what are the class of rescue meds for seizures?
benzos
what is genu varum?
bowlegs
what does 90-90 traction do?
maintains flexion of the hip
what vaccine is needed for college aged kids to be able to live in dorms?
meningococcal polysaccharide vaccine (for bacterial meningitis)
what complications can gentamicin cause?
ototoxicity and renal toxicity
what are the maintenance meds for epilepsy?
phenytoin and valproic acid
main muscle groups affected in duchenne that lead to death?
pulmonary and cardiac muscles
what s/s will be present if a VP shunt is occluded or infected?
s/s of increased ICP and hydrocephalus
what results from an epiphyseal growth plate fracture?
slowed vertical growth in that extremity
characteristic sign of an absent seizure
staring spells
what is the brudzinski sign?
the patient flexes their knees/hips when the neck is flexed
a ventriculoperitoneal shunt is inserted in a 4 month old infant with hydrocephalus. which S/S of shunt failure should the nurse teach the parents? -vomiting -dehydration -sunken eyeballs -distended fontanelles -abdominal distention
vomiting -distended fontanelles
main s/s of compartment syndrome
-acute pain that is not controlled by pain meds -compromised distal perfusion: increased capillary refill, weak pulse -stretched skin d/t swelling
which instruction should the nurse provide to an adolescent with an ankle sprain? -apply ice to the injured area for 30 mins q4-6 hrs -apply heat q 4 hours for 48 hours then switch to ice -elevate the extremity and maintain bed rest for 7 days
-apply ice to the injured area for 30 mins q4-6 hrs
which is the lowest priority when caring for a child with seizure disorder? -educating the family about anticonvulsant therapy -assessing for s/s of increased ICP -observing and staying with the child during a seizure -assessing safety and protection from injury
-assessing for s/s of increased ICP
if a newborn with repaired myelomeningocele has hydrocephalus the nurse expects: -bulging fontanelle and downwardly rotated eyes -low pitched cry and depressed fontanelle -depressed fontanelle and upwardly rotated eyes -low pitched cry and bulging fontanelle
-bulging fontanelle and downwardly rotated eyes
what are the lumbar puncture lab findings in meningitis?
-cloudy CSF -increased # WBCs -increased opening pressure (100-180) -increased protein -decreased glucose
while assessing a school aged pt who just had a short arm cast applied to a fractured right wrist, the nurse discovers that the fingers of the right hand are cool. what should the nurse do first? -compare the temperature of the two hands -clip the edge of the cast to reduce pressure -elevate the right arm to reduce swelling -inform the HCP of the circulatory impairment
-compare the temperature of the two hands
a child with a fracture has had a reduction and casting. the child complains of tingling, burning, and inability to move the extremity. there is a weak pulse and the skin is pale gray. which should the nurse report? -malunion -osteomyelitis -infection -compartment syndrome
-compartment syndrome
the nurse is teaching the parents of a child with duchenne MD. some of the progressive complications include: -dry skin, protruding tongue, cognitive impairment -contractures, obesity, pulmonary infection -anorexia, gingival hyperplasia -trembling, frequent loss of consciousness
-contractures, obesity, pulmonary infection
a nurse is developing a plan of care for a child with cerebral palsy which of the following is the priority goal? -decrease ICP -ensure the child reaches full potential -ensure the ingestion of sufficient calories for growth -teach appropriate parenting strategies for a special needs child
-ensure the child reaches full potential
a 9 year old has a fractured tibia and a full leg cast is applied. which assessment findings should the nurse immediately report to the healthcare provider? SATA -inability to move the toes -increased urine output -pedal pulse of 90 beats/min -tingling sensation in the foot
-inability to move the toes -tingling sensation in the foot
a child is admitted to the unit with spastic cerebral palsy. which of the following would the nurse expect? -increased deep tendon reflexes -good control of posture -contractures -decreased muscle tone
-increased deep tendon reflexes -contractures
hip dysplasia characteristic symptoms
-increased skin folds -shorter leg at knee level
during a newborn assessment for developmental dysplasia of the hip, the nurse elicits the ortolani sign. how does the nurse explain this finding to the child's mother? -it is a broadening of the perineum -it is shortening of the affected leg -it is a clicking of the hip when it is manipulated -it is a drooping of the hip on one side of the body
-it is a clicking of the hip when it is manipulated
the nurse discussing nutrition with parents of a child with duchenne's MD suggests which of the following are the best foods to eat? -low calorie foods to prevent weight gain -no special food combinations -high carb high protein foods -extra protein to strengthen muscles
-low calorie foods to prevent weight gain
after closure of a newborn's myelomeningocele, what essential nursing interventions must be in the plan of care? -monitoring for serous drainage from the nares -limited leg movement -measuring head circumference daily -decreasing environmental stimuli
-measuring head circumference daily
which action should the nurse take when providing postoperative nursing care to a child after insertion of a VP shunt? -administer narcotics for pain control -monitor for increased temperature -check urine for glucose and protein -test CSF for leakage of protein
-monitor for increased temperature
while in the playroom , a school aged child exhibits twitching of the right arm and leg that almost immediately progresses to a generalized tonic clonic seizure with clenched jaws. what is the best action for the nurse to take after moving the child to the floor? -taking the other children to their rooms -inserting a plastic airway into the child's mouth -positioning a large pillow under the child's head -moving objects away from the child
-moving objects away from the child
when caring for a newborn with pre-op myrlonicogeke the priority is -offer formula Q 3 hours -turn the infant back to front every 2 hours -place a wet, sterile, non adherent dressing on the sac -provide pain medication Q 4 hours
-place a wet, sterile, non adherent dressing on the sac
an infant with myelomeningocele is admitted to the PICU, while the infant is awaiting surgical correction, what is the most appropriate nursing intervention? -placing the infant in a prone position -use disposable diapers -performing neuro checks above the sit of the lesion -washing the area below the defect with a nontoxic antiseptic
-placing the infant in a prone position
select the best room assignment for a newly admitted child with bacterial meningitis -semiprivate room with other pt with bacterial meningitis -private room with bright lights and many activities -private room that is dark and quiet with minimal stimulation
-private room that is dark and quiet with minimal stimulation
after orthopedic surgery, a 15 year old girl adolescent reports pain and rates it a 5 on a scale of 1-10. a nurse administers the prescribed 5 mg of oxycodone Q 3 hours PRN. two hours after having the oxy, the patient reports pain and rates it a 10/10. what action should the nurse take next? -administer another dose of oxy within 30 mins -report the pts idiosyncratic reaction -request that the HCP evaluate the need for additional medication -tell the pt that additional pain meds ant be given for another hour
-request that the HCP evaluate the need for additional medication
a 2 month old infant at risk for cerebral palsy due to extreme prematurity is receiving speech therapy because -he is likely to have speech problems -speech therapy will help tongue movements to assist with babbling -speech therapy helps the tongue and jaw movements that assist with feeding -many members of the health care team will be involved with child's care
-speech therapy helps the tongue and jaw movements that assist with feeding
which organisms usually causes osteomyelitis? -staph aureus -streptococcal -necrotising fasciitis -vanc resistant organism
-staph aureus
which safety instruction should a nurse teach a 10 year old child with diminished sensation in the legs because of cerebral palsy? -test the temperature of the water before a bath -tighten the brace straps securely before ambulating -set the clock twice during the night to change position -look down at the legs when crutch walking to check how they are positioned
-test the temperature of the water before a bath
a nurse is concerned about helping the parents of an infant with cerebral palsy set long term goals for the family. what is the most important to understand when setting long term goals? =cognitive impairments require special education -unknown extent of the disability requires continual adjustments -progressive deterioration requires future institutionalization -diminished immune response requires protection from infection
-unknown extent of the disability requires continual adjustments
a mother whose infant was found to have cerebral palsy at 6 months asks why she was not told that her baby had this when the baby was born. how should the nurse respond? -until there's control of voluntary movement, a diagnosis cannot be confirmed -the neurological lesions have changed as your baby has matured -joint deformities don't appear until 6 months of age -the staff member didn't want o alert you until it was necessary
-until there's control of voluntary movement, a diagnosis cannot be confirmed
the gower sign for assessing duchenne's MD can be elicited by having a patient do which of the following? -close the eyes and touch the nose with alternating fingers -hop on one foot and then the other -walk like a duck and rise from a squatting position -bend from the waist to touch the toes
-walk like a duck and rise from a squatting position
what confirms spina bifida diagnosis in prenatal period?
increased alpha fetoprotein
what is the main concern for an open fracture?
infection/osteomyelitis
what effect do stalter harris fractures have on growth?
inhibit/delay vertical growth
what is unique about complex partial seizures?
it involves loss of consciousness
what does a pavlik harness do?
keeps hips abducted and flexed
what does bucks traction do?
keeps the knee/leg in an extended position
what is genu valgum?
knock knees
what is the preferred position for a lumbar puncture?
lateral recumbent position