Peds Week 6 success
The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. What should the nurse tell them?
"Muscular dystrophies usually result in progressive weakness" Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an x-linked recessive disorder. (the test taker should know that muscular dystrophy is a progressive degenerative disorder)
Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? Select all that apply
"Your child will need to wear a brace on the feet 23 hours a day for at least 2 months." "Your child should see an orthopedic surgeon regularly until the age of 18 years."
The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include
"contractures, obesity and pulmonary infections" Contractures, disuse atrophy, infections, obesity, respiratory complications and cardiopulmonary problems
Which can elicit the Gower sign? have the patient:
"walk like a duck and rise from the squatting position" Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from` a squatting position due to the lack of muscle strength.
When counseling the parents of a child with osteogenesis imperfecta (OI), the nurse should include which of the following? Select all that apply.
2. Provide education about the child's physical limitations. 3. Give the parents a letter signed by the primary care provider explaining OI. 4. Provide information on contacting the Osteogenesis Imperfecta Foundation.
The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the:
Immune-stimulated inflammatory response in the joint. The test taker must understand JIA is an immune-modulated disorder and how the body attacks itself, causing destruction of the joint spaces.
Which should be included in teaching a family about post-surgical care for slipped capital femoral epiphysis (SCFE)? Select all that apply.
Instruction on pin site care Correct use of crutches by patient
Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is?
It is a fracture that does not go all the way through the bone
Which symptoms will a child suffering from complete spinal cord injury experience?
Loss of motor and sensory function below the level of the injury. Children with complete spinal cord injury lose motor and sensory function below the level of the injury as a result of interruption of nerve pathways
The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following?
Muscle biopsy Muscle biopsy confirms the type of myopathy that the patient has (muscle biopsy is the definitive test for myopathies)
Which should the nurse include when teaching sexuality education to an adolescent with a spinal cord injury?
You can enjoy a healthy sex life and most likely conceive children. Spinal cord injuries have little to no effect on reproduction
Which should be obtained to make a diagnosis of slipped capital femoral epiphysis
A radiographic examination of the hip
A 13-year-old just returned from surgery for scoliosis. Which nursing intervention(s) is/are appropriate in the first 24 hours? Select all that apply.
Assess for pain, logroll to change positions, check neurological status, monitor blood pressure
Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes which of the following? Select all that apply.
Assess pain, assess pulses, monitor capillary refill, provide pain medication as needed
Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)?
Asymmetry of gluteal and thigh folds
The nurse knows that teaching was successful when a parent states which of the following are early signs of muscular dystrophy
Difficulty climbing stairs Difficulty climbing stairs, running, and riding a bicycle are frequently the first symptoms of Duchenne muscular dystrophy (early symptoms have to do with decreased ability to perform normal developmental tasks involving muscle strength)
A 5-year-old has been diagnosed with pseudohypertophic muscular dystrophy. Which nursing interventions would be appropriate?
Discuss with the parents the potential need for respiratory support. muscles become weaker, including those needed for respiration and a decision will need to be made about whether respiratory support will be provided
The nurse evaluates the teaching as successful when a parent states that which of the following can cause autonomic dysreflexia?
Distended bowel or bladder Autonomic dysreflexia results from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc due to stimulation of the sympathetic nervous system. It is a response that typically results from stimulation of sensory receptors such as a full bladder or bowel
A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which is/are an early sign(s) of compartment syndrome in this child? Select all that apply.
Edema, numbness and weak pulse
Which is the most appropriate nursing intervention when caring for a child newly admitted with a mild head concussion and no cervical spine injury?
Elevate head of bed, side rails up, and safety measures in place.
A 14-year-old with osteogenesis imperfecta (OI) is confined to a wheelchair. Which nursing interventions will promote normal development? Select all that apply.
Encourage participation in groups with teens who have disabilities or chronic illness. Encourage decorating the wheelchair with stickers. Allow the teen to view the radiographs. Help the teen set realistic goals for the future.
One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all that apply.
Give pain medication prior to ambulation. Assist with range-of-motion activities. Use nonpharmacological methods, such as heat.
The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when?
Immediately after diagnosis. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made
Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)?
Immune suppression Steroids cause immune suppression, which is the reason behind its use in JIA; it reduces the body's attack on itself.
When assessing the neurological status of an 8 month old, the nurse should check for which of the following?
Interaction with staff Assessment for alteration in developmentally expected behaviors, such as strangers, is helpful. Interaction with staff is not expected due to stranger anxiety.
What foods would be best for a child with Duchenne muscular dystrophy?
Low-calorie foods to prevent weight gain As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons-in addition to decreased ambulation
The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply
Mother, Sister, Aunts and all female cousins Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an x-linked recessive trait, meaning the defect is on the x chromosome. Women carry the disease, and males are affected. All female relatives should be tested.
A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia?
My child will be more at risk for infection
The nurse on the pediatric floor is receiving a child with the possible diagnosis of septic arthritis of the elbow. Which would the nurse expect on assessment? Select all that apply.
Resistance to bending the elbow Nausea and vomiting Fever Swelling of the elbow
Which should a nurse in the ED be prepared for in a child with possible spinal cord injury?
Respiratory depression A spinal cord injury can occur at any level. The higher the level of injury, the more likely the child is to have respiratory insufficiency or failure. The nurse should be prepared to support the child's respiratory system
A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long?
Self-consciousness about appearance.
Which assessment is most important after any injury in a child?
Serial assessments of level of consciousness.
The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. Which is the nurse's best response?
"An infection from a scratched mosquito bite carried the infection through the bloodstream to the bone." Osteomyelitis is caused from an infection in the bloodstream that progresses into the bone
Which would be the most appropriate discharge instructions for a child with a right wrist sprain 3 hours ago?
"You should rest, apply ice wrapped in a towel, elevate the wrist above the heart, and use the sling when walking."
The nurse is caring for a school-aged child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis?
Activity intolerance The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength
The nurse tells the parent that other conditions can be associated with congenital clubfoot. Select all that apply.
1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism.
When planning a rehabilitative approach for a child with osteogenesis imperfecta (OI), the nurse should prevent which of the following? Select all that apply.
1. Positional contractures and deformities 3. Muscle weakness. 4. Osteoporosis. 5. Misalignment of lower extremity joints
Which would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply
1. Unwillingness to move affected extremity. 2. Severe pain. 3. Fever. 5. Redness and swelling at the site.
Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply
1.Duck gait. 2. Pain. 3. Osteoarthritis in adulthood Due to abnormal hip joint function, the patient's gait is stiff and waddling. 2. Due to abnormal femoral head placement, the patient may experience pain and decreased flexibility in adulthood. 3. Due to abnormal femoral head placement, the patient may experience osteoarthritis in the hip joint in adulthood
A spinal curve of less than __________ degrees that is nonprogressive does not require treatment for scoliosis.
20. A 20-degree spinal curve that is nonprogressive will not disfigure or interfere with normal functioning, so it is not treated with bracing or surgery
Select the number of inches lateral to the heel where a crutch should be placed
6-8
Which placement does the plavik harness position the hips joints in
Abduction
Which is most important when teaching a parent about preventing osteomyelitis?
Parents need to clean open wounds thoroughly with soap and water
A 10-month-old is carried into the emergency department by her parents after she fell down 15 stairs in her walker. Which would be your highest priority nursing intervention?
Assess airway while simultaneously maintaining cervical spine precautions.
Which priority item should be placed at the bedside of a newborn with myelomeningocele?
A bottle of normal saline Before the surgical closure of the sac, the infant is at risk for infection. A sterile dressing is placed over the sac to keep it moist and help prevent it from tearing
Which should the nurse expect in a 2 week old with a brachial plexus injury?
Absent moro reflex on one side, no sensory loss, associated clavicle fracture
When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age group?
Adolescents
Why are chemotherapeutic agents such as methotrexate and cyclophosphamide sometimes used to treat juvenile idiopathic arthritis (JIA)?
Affect the immune system
Which is the definition of talipes varus?
An inversion or bending inward of the foot.
When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply.
Blood cultures will be obtained. 3. Pus will be aspirated from the subperiosteum. 4. An intravenous line with antibiotics will be started
Which is most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma?
Body image
After spinal cord injury, an adolescent suddenly complains of a severe headache. Which should be the nurse's first action?
Check for a full bladder The sympathetic nervous system responds to a full bladder or bowel resulting from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc. This response is usually from stimulation of sensory receptors (eg distended bladder or bowel)Because the efferent pulse cannot pass through the spinal cord, the vagus nerve is not turned off and profound symptomatic bradycardia may occur
The parent of a 3-week-old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first?
Check the neurocirculatory status of the foot
An adolescent with a T4 spinal cord injury suddenly becomes dangerously hypertensive and bradycardic. Which intervention is appropriate?
Check to be certain that the patient's bladder is not distended A full bladder would trigger autonomic dysreflexia
Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)?
Check under the straps at least two to three times daily for red areas
Why does spinal cord injury without radiographic abnormality sometimes occur in children?
Children can suffer momentary severe subluxation and trauma to the spinal cord Spinal cord injury w/o radiographic abnormality results from the spinal cord sliding between the vertebrae and then sliding back into place without injury to the bony spine. It is thought to be the result of an immature spinal column that allows for reduction after momentary subluxation
When instructing a family about care of an orthosis, the nurse should emphasize which of the following?
Clean the brace weekly with mild soap and water.
Which instruction(s) should the nurse give the parents of an adolescent with slipped capital femoral epiphysis (SCFE)? Select all that apply
Continue upper body exercises to limit loss of muscle strength Provide homework, computer games, and other activities to decrease boredom Expect expressions of anger and hostility. Continue setting limits on behavior.
A child with a newly applied left leg cast initially feels fine, then starts to cry and tells his mother his leg hurts. Which assessment would be the nurse's first priority?
Neurovascular integrity Neurovascular integrity should be assessed first and frequently because neurovascular compromise may cause serious consequences. Neurovascular integrity should be assessed using the 5 Ps: increased Pain out of proportion with injury, Pallor of extremity, Paresthesia, Pulselessness at distal part of extremity, and Paralysis post cast application.
A 10-year-old with osteomyelitis has been on intravenous antibiotics for 48 hours. The child is allergic to amoxicillin. Vital signs are T 101.8°F (38.8°C), BP 100/60, P 96, R 24. Which is the primary reason for surgical treatment?
Nonresponse to intravenous antibiotics . If a patient does not respond to an appropriate antibiotic within 48 hours, surgery may be indicated.
A 10-year-old with osteomyelitis has been on intravenous antibiotics for 48 hours. The child is allergic to amoxicillin. Vital signs are T 101.8°F (38.8°C), BP 100/60, P 96, R 24. Which is the primary reason for surgical treatment?
Nonresponse to intravenous antibiotics. Surgery may be indicated if no response to antibiotics within 48 hours
Which will help a school-aged child with muscular dystrophy stay active longer?
Normal activities, such as swimming Children who are active are usually able to postpone use of a wheelchair. It is important to keep using muscles for as long as possible, and aerobic activity is good for a child
The nurse caring for a child with osteomyelitis assesses poor appetite. Which intervention(s) is/are most appropriate for this child? Select all that apply.
Offer high calorie liquids, offer favorite foods, offer frequent, small meals
A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do first?
Perform a neuromuscular assessment.
Which would be the best nursing intervention for a child with phantom pain after an amputation?
Provide Elavil to help with pain.
The nurse is planning care for a child with a T12spinal cord injury. Which lifelong complications should the family and the child know about?
Skin integrity and incontinence Spinal cord injury patients experience many issues due to loss of innervation below the level of the injury. Skin integrity and incontinence are issues because of immobility and loss of pain receptors below the level of the injury. Skin integrity and incontinence are issues because of immobility and loss of pain receptors below the level of the inury
After the birth of an infant with clubfoot, the nursery nurse should do which when instructing the parents? Select all that apply.
Speak in simple language about the defect. Present the infant as precious; emphasize the well-formed parts of the body. Be prepared to answer questions multiple times
The nurse expects the blood culture report of an 8-year-old with septic arthritis to grow which causative organism?
Staphylococcus aureus S. aureus is a common organism found on the skin and is frequently the cause of septic arthritis
Which assessment of an 18-month-old with burns on his feet would cause suspicion of child abuse?
Symmetrical burns on both feet
Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis (JIA)?
Take with food
Where should the top of the crutch bar be in relation to the axilla?
The crutch bar should not put pressure on nerves in the axilla. TEST-TAKING HINT: The axillae do not rest on the crutch bar.
A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that:
This is a serious injury that could cause long-term growth issues.
Which classification of osteogenesis imperfecta (OI) is lethal in utero and in infancy?
Type II Type II is lethal in utero and in infancy because of multiple fractures and deformities and underdeveloped lungs
