Exam 3 Flashcards
(201 cards)
1
Q
A chest radiography examination is ordered for a child with suspected cardiac problems. The child’s parent asks the nurse, “What will the x-ray show about the heart?” The nurse’s response should be based on knowledge that the radiograph provides which information?
A
Supplies information on heart size and pulmonary blood flow patterns
2
Q
After returning from cardiac catheterization, the nurse monitors the child’s vital signs. The heart rate should be counted for how many seconds?
A
60
3
Q
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is “too wet.” The nurse finds the bandage and bed soaked with blood. What nursing action is most appropriate to institute initially?
A
Apply direct pressure above the catheterization site.
4
Q
What drug is an angiotensin-converting enzyme (ACE) inhibitor?
A
Captopril (Capoten)
5
Q
A 2-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which rate?
A
90 beats/min
6
Q
What clinical manifestation is a common sign of digoxin toxicity?
A
Vomiting
7
Q
The parents of a young child with heart failure (HF) tell the nurse that they are nervous about giving digoxin. The nurse’s response should be based on which knowledge?
A
Parents need to learn specific, important guidelines for administration of digoxin.
8
Q
Decreasing the demands on the heart is a priority in care for the infant with heart failure (HF). In evaluating the infant’s status, which finding is indicative of achieving this goal?
A
Appropriate weight gain for age
9
Q
A 3-month-old infant has a hypercyanotic spell. What should be the nurse’s first action?
A
Place the child in the knee–chest position.
10
Q
What blood flow pattern occurs in a ventricular septal defect?
A
Increased pulmonary blood flow
11
Q
The physician suggests that surgery be performed for patent ductus arteriosus (PDA) to prevent which complication?
A
Pulmonary vascular congestion
12
Q
What cardiovascular defect results in obstruction to blood flow?
A
Aortic stenosis
13
Q
What structural defects constitute tetralogy of Fallot?
A
Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
14
Q
The parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. How should the nurse reply to this concern?
A
The child needs opportunities to play with peers.
15
Q
What preparation should the nurse consider when educating a school-age child and the family for heart surgery?
A
Let the child hear the sounds of a cardiac monitor, including alarms.
16
Q
What nursing consideration is important when suctioning a young child who has had heart surgery?
A
Administer supplemental oxygen before and after suctioning.
17
Q
The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be the nurse’s initial intervention?
A
Notify the practitioner of these findings.
18
Q
What primary nursing intervention should be implemented to prevent bacterial endocarditis?
A
Counsel parents of high-risk children.
19
Q
What sign/symptom is a major clinical manifestation of rheumatic fever (RF)?
A
Polyarthritis
20
Q
When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care?
A
Therapeutic management includes administration of gamma globulin and salicylates.
21
Q
The diagnosis of hypertension depends on accurate assessment of blood pressure (BP). What is the appropriate technique to measure a child’s BP?
A
Measure BP with the child in the sitting position on three separate occasions.
22
Q
What type of drug reduces hypertension by interfering with the production of angiotensin II?
A
Angiotensin-converting enzyme (ACE) inhibitors
23
Q
The nurse is giving discharge instructions to the parent of a 6-year-old child who had a cardiac catheterization 4 hours ago. What statement by the parent indicates a correct understanding of the teaching?
A
“I should change the bandage every day for the next 2 days.”
24
Q
A child with heart failure is on Lanoxin (digoxin). The laboratory value a nurse must closely monitor is which?
A
Serum potassium
25
What child has a cyanotic congenital heart defect?
A 2-month-old infant with tetralogy of Fallot
26
The nurse is teaching parents about administering digoxin (Lanoxin). What instructions should the nurse tell the parents?
Give the medication at regular intervals.
27
The health care provider suggests surgery be performed for ventricular septal defect to prevent what complication?
Pulmonary hypertension
28
A 1-year-old has been admitted for complete repair of a tetralogy of Fallot. What assessment finding should the nurse expect to be documented?
Increasing cyanosis
29
A 6-month-old infant presents to the clinic with failure to thrive, a history of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what?
Ventricular septal defect
30
What medication used to treat heart failure (HF) is a diuretic?
Hydrochlorothiazide (Diuril)
31
The nurse is preparing to give digoxin (Lanoxin) to a 9-month-old infant. The nurse checks the dose and draws up 4 ml of the drug. The most appropriate nursing action is which?
Do not give the dose; suspect a dosage error.
32
Bacterial infective endocarditis (IE) should be treated with which protocol?
IV antibiotics (penicillin type) for 2 to 8 weeks
33
A child is recovering from Kawasaki disease (KD). The child should be monitored for which?
Electrocardiograph (ECG) changes
34
The test that provides the most reliable evidence of recent streptococcal infection is which?
Antistreptolysin O test
35
The regulation of red blood cell (RBC) production is thought to be controlled by which physiologic factor?
Tissue hypoxia
36
What physiologic defect is responsible for causing anemia?
Decreased oxygen-carrying capacity of blood
37
A mother states that she brought her child to the clinic because the 3-year-old girl was not keeping up with her siblings. During physical assessment, the nurse notes that the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on admission is 6.4 g/dl. After notifying the practitioner of the results, what nursing priority intervention should occur next?
Minimize energy expenditure to decrease cardiac workload.
38
A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason?
Increase her energy so she will not be so tired.
39
An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of what complication?
Circulatory overload
40
What information should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations?
Adequate dosage will turn the stools a tarry green color.
41
What condition occurs when the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin?
Sickle cell anemia
42
The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. What statement most accurately reflects inheritance of SCA?
Each sibling has a 25% chance of having SCA.
43
The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration?
Increased red blood cell (RBC) destruction
44
A child with sickle cell anemia (SCA) develops severe chest and back pain, fever, a cough, and dyspnea. What should be the first action by the nurse?
Notify the practitioner because chest syndrome is suspected.
45
What therapeutic intervention is most appropriate for a child with B-thalassemia major?
Frequent blood transfusions
46
In which condition are all the formed elements of the blood simultaneously depressed?
Aplastic anemia
47
For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention?
Immunosuppressive therapy
48
What statement is descriptive of most cases of hemophilia?
X-linked recessive inherited disorder in which a blood clotting factor is deficient
49
What condition is an acquired hemorrhagic disorder that is characterized by excessive destruction of platelets?
Idiopathic thrombocytopenic purpura
50
A toddler is diagnosed with chronic benign neutropenia. The parents are being taught about caring for their child. What information is important to include?
Avoid large indoor crowds and people who are ill.
51
The majority of children in the United States with human immunodeficiency virus (HIV) infection acquired the disease by which means?
Perinatally from their mothers
52
A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs. What is the purpose of these drugs?
Delay disease progression.
53
The school nurse is informed that a child with human immunodeficiency virus (HIV) infection will be attending school soon. What is an important nursing intervention to include in the plan of care?
Carefully follow universal precautions.
54
What condition is an inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity?
Severe combined immunodeficiency syndrome (SCIDS)
55
The nurse is preparing a community outreach program about the prevention of iron-deficiency anemia in infants. What statement should the nurse include in the program?
Breast milk or iron-fortified formula should be used for the first 12 months.
56
A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement?
Notify the health care provider.
57
What pain medication is contraindicated in children with sickle cell disease (SCD)?
Meperidine (Demerol)
58
A child with hemophilia A is scheduled for surgery. What precautions should the nurse institute with this child?
Handle the child gently when transferring to a cart.
59
What condition precipitates polycythemia?
Prolonged tissue hypoxia
60
The clinic nurse is evaluating lab results for a child. What recorded hematocrit (Hct) result is considered within the normal range?
40%
61
The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child?
Playing board or card games
62
What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia?
Prolonged use of oxygen can decrease erythropoiesis.
63
The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food. What amount should the nurse teach to the parent?
1000 ml
64
What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis?
Retinoblastoma
65
As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. What statement explains what staging means?
Extent of the disease at the time of diagnosis
66
What side effect commonly occurs with corticosteroid (prednisone) therapy?
Susceptibility to infection
67
The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. What nursing action is most appropriate to initiate?
Stop the drug infusion immediately.
68
Total-body irradiation is indicated for what reason?
Preparation for bone marrow transplant
69
The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family?
Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.
70
An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which method?
Intravenous infusion
71
After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention?
Hydration
72
In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes what information?
Meticulous mouth care is essential to avoid mucositis.
73
A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?
Give an antiemetic before chemotherapy begins.
74
A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try?
Relax any eating pressures.
75
The nurse is preparing a child for possible alopecia from chemotherapy. What information should the nurse include?
Hair may have a slightly different color or texture when it regrows.
76
What pain management approach is most effective for a child who is having a bone marrow test?
Conscious or unconscious sedation
77
What immunization should not be given to a child receiving chemotherapy for cancer?
Measles, mumps, rubella (MMR)
78
What description identifies the pathophysiology of leukemia?
Unrestricted proliferation of immature white blood cells (WBCs)
79
A parent tells the nurse that 80% of children with the same type of leukemia as his son’s have a 5-year survival. He believes that because another child on the same protocol as his son has just died, his son now has a better chance of success. What is the best response by the nurse?
“Each child has an 80% likelihood of 5-year survival.”
80
What is a common clinical manifestation of Hodgkin disease?
Non-tender enlargement of lymph nodes
81
What are the most common clinical manifestations of brain tumors in children?
Headaches and vomiting
82
Essential postoperative nursing management of a child after removal of a brain tumor includes which nursing care?
Measuring all fluid intake and output
83
What is an important priority in dealing with the child suspected of having Wilms tumor?
Ensuring the abdomen is protected from palpation
84
The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL). The parent states, “My child has a low platelet count, and we are being discharged this afternoon. What do I need to do at home?” What statement is most appropriate for the nurse to make?
“Your child should avoid contact sports or activities that could cause bleeding.”
85
A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include?
Careful bathing and handling
86
What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy?
Mouthwashes with plain saline
87
A child is receiving vincristine (Oncovin). The nurse should monitor for which side effect of this medication?
Diarrhea
88
What chemotherapeutic agent can cause an anaphylactic reaction?
L-Asparaginase (Elspar)
89
A child with cancer being treated with chemotherapy is receiving a platelet transfusion. The nurse understands that the transfused platelets should survive the body for how many days?
1 to 3 days
90
Daily toothbrushing and flossing can be encouraged for the child on chemotherapy when the platelet count is above which?
40,000/mm3
91
A parent of a hospitalized child on chemotherapy asks the nurse if a sibling of the hospitalized child should receive the varicella vaccination. The nurse should give which response?
The sibling can get a varicella vaccination.
92
A child with osteosarcoma is experiencing phantom limb pain after an amputation. What prescribed medication is effective for short-term phantom pain relief?
Gabapentin (Neurontin)
93
What finding is a clinical manifestation of increased intracranial pressure (ICP) in children?
Diplopia, blurred vision
94
What term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?
Stupor
95
What term is used to describe a child’s level of consciousness when the child is arousable with stimulation?
Obtundation
96
The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. How should the nurse interpret this?
Neurosurgical emergency
97
The nurse is caring for a child with severe head trauma after a car accident. What is an ominous sign that often precedes death?
Periodic or irregular breathing
98
What test is never performed on a child who is awake?
Oculovestibular response
99
What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP) in an unconscious child?
Avoid activities that cause pain or crying.
100
What nursing intervention is appropriate when caring for an unconscious child?
Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.
101
What statement is descriptive of a concussion?
It is a transient and reversible neuronal dysfunction.
102
What statement best describes a subdural hematoma?
Bleeding occurs between the dura and the cerebrum.
103
A 10-year-old boy on a bicycle has been hit by a car in front of a school. The school nurse immediately assesses airway, breathing, and circulation. What should be the next nursing action?
Stabilize the child’s neck and spine.
104
The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What clinical manifestation is the most essential part of the nursing assessment to detect early signs of a worsening condition?
Level of consciousness
105
The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the child’s younger brother had when he was an infant. The nurse should base a response on which information?
Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.
106
A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy will begin when?
When the medication is received from the pharmacy
107
A young child’s parents call the nurse after their child is bitten by a raccoon in the woods. The nurse’s recommendation should be based on what knowledge?
Antirabies prophylaxis must be initiated immediately.
108
What intervention should be beneficial in reducing the risk of Reye syndrome?
Avoidance of aspirin for children with varicella or those suspected of having influenza
109
What is the initial clinical manifestation of generalized seizures?
Loss of consciousness
110
What type of seizure may be difficult to detect?
Absence
111
What is important to incorporate in the plan of care for a child who is experiencing a seizure?
Describe and record the seizure activity observed.
112
A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. What is the most appropriate initial action by the school nurse?
Stay with child and have someone else call emergency medical services (EMS).
113
The nurse is caring for a 10-year-old child who has an acute head injury, has a pediatric Glasgow Coma Scale score of 9, and is unconscious. What intervention should the nurse include in the child’s care plan?
Elevate the head of the bed 15 to 30 degrees with the head maintained in midline.
114
What is a priority of care when a child has an external ventricular drain (EVD)?
Frequent assessment of amount and color of drainage
115
The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt. What issues should be addressed?
Shunt malfunction or infection requires immediate treatment.
116
After a tonic-clonic seizure, what symptoms should the nurse expect the child to experience?
Lethargy and confusion
117
What is the antiepileptic medication that requires monitoring of vitamin D and folic acid?
Phenobarbital (Luminal)
118
A 2-year-old child starts to have a tonic-clonic seizure. The child’s jaws are clamped. What is the most important nursing action at this time?
Stay with the child and observe his respiratory status.
119
A child has been admitted with status epilepticus. An emergency medication has been ordered. What medication should the nurse expect to be prescribed?
Lorazepam (Ativan)
120
A child is on phenytoin (Dilantin). What should the nurse encourage?
Good dental hygiene
121
If an intramuscular (IM) injection is administered to a child who has Reye syndrome, the nurse should monitor for what?
Bleeding
122
A 23-month-old child is admitted to the hospital with a diagnosis of meningitis. She is lethargic and very irritable with a temperature of 102° F. What should the nurse’s care plan include?
Assessing the level of consciousness (LOC) and vital signs every 2 hours
123
Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved?
Autonomic
124
A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?
Replacement therapy requires daily subcutaneous injections.
125
A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?
At bedtime
126
Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition?
Diabetes insipidus (DI)
127
Exophthalmos (protruding eyeballs) may occur in children with which condition?
Hyperthyroidism
128
A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately?
Fever, sore throat
129
The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child’s weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate?
Blurred vision and loss of acuity
130
A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which signs or symptoms of vitamin D toxicity?
Weakness and lassitude
131
Congenital adrenal hyperplasia (CAH) is suspected in a newborn because of ambiguous genitalia. The parents are appropriately upset and concerned about their child’s gender. In teaching the parents about CAH, what should the nurse explain?
Sexual assignment should wait until genetic sex is determined.
132
What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency?
Type 1 diabetes
133
What clinical manifestation is considered a cardinal sign of diabetes mellitus?
Frequent urination
134
What blood glucose measurement is most likely associated with diabetic ketoacidosis?
330 mg/dl
135
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention?
Milk and peanut butter on bread
136
A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician?
Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride.
137
What clinical manifestation occurs with hypoglycemia?
Weakness and dizziness
138
A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program?
Essential information is presented initially.
139
The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption?
Abdomen
140
A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed?
Additional snacks are needed to compensate for increased activity.
141
To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence?
Need to be perfect and similar to peers
142
What statement applies to the current focus of the dietary management of children with diabetes?
The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.
143
The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone?
Low levels of circulating thyroid hormone
144
The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent?
Hypopituitarism
145
The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder?
Growth hormone deficiency
146
The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe?
Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.
147
The nurse is taking care of a child who had a thyroidectomy. The nurse recognizes what as a positive Chvostek sign?
Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland
148
The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs?
Calcium gluconate
149
An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take?
Have someone notify the emergency medical services (EMS) system.
150
What condition can result from the bone demineralization associated with immobility?
Osteoporosis
151
What measure is important in managing hypercalcemia in a child who is immobilized?
Provide adequate hydration.
152
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.
153
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 every 4 hours.”
154
Immobilization causes what effect on metabolism?
Decreased metabolic rate
155
What finding is characteristic of fractures in children?
Rapidity of healing is inversely related to the child’s age.
156
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?
This type of fracture requires different management to prevent bone growth complications.
157
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
158
What statement is correct regarding sports injuries during adolescence?
Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.
159
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
160
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
161
The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention?
Apply towels wet with cool water.
162
The nurse is teaching the girls’ varsity sports teams about the “female athlete triad.” What is essential information to include?
Pregnancy can occur in the absence of menstruation.
163
Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement?
“Surgical correction requires a 3- to 4-month recovery period.”
164
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 the practitioner of the changes noted.
165
What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?
Kyphosis
166
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.
167
What nursing intervention is most appropriate when caring for the child with osteomyelitis?
Move and turn the child carefully and gently to minimize pain.
168
What statement is true concerning osteogenesis imperfecta (OI)?
It is an inherited disorder.
169
What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)?
Teach the child and family correct administration of medications.
170
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 once a day to stimulate circulation.”
171
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.”
172
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 and leg on pillows.
173
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 and rotate the ankles.
174
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 the ankles, when changing diapers.”
175
What is the most common cause of cerebral palsy (CP)?
Neonatal encephalopathy
176
Spastic cerebral palsy (CP) is characterized by which clinical manifestations?
Hypertonicity; poor control of posture, balance, and coordinated motion
177
What type of cerebral palsy (CP) is the most common type?
Spastic
178
The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment. The nurse’s response should be based on which knowledge?
About 45% of affected children have normal intelligence.
179
Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care?
Meticulous dental hygiene
180
What is a major goal of therapy for children with cerebral palsy (CP)?
Recognize the disorder early and promote optimum development.
181
The parents of a child with spastic cerebral palsy (CP) state that their child seems to have significant pain. In addition to systemic pharmacologic management, the nurse includes which teaching?
Positions to reduce spasticity
182
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 his jaw with caregiver’s hand (either from a front or side position) to facilitate swallowing.
183
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 activities often provide children with CP with opportunities for socialization and recreation.
184
What statement is most accurate in describing tetanus?
Acute infectious disease caused by an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus.
185
During a well-child visit, the mother tells the nurse that her 4-month-old infant is constipated, is less active than usual, and has a weak-sounding cry. The nurse suspects botulism and questions the mother about the child’s diet. What factor should support this diagnosis?
Infant cereal with honey
186
An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident. The parents keep asking the nurse, “How bad is it?” The nurse’s response should be based on which knowledge?
Extent and severity of damage cannot be determined for several weeks or even months.
187
What functional ability should the nurse expect in a child with a spinal cord lesion at C7?
Almost complete independence within limitations of wheelchair
188
An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents describe her as being angry, hostile, and uncooperative. The nurse should recognize that this is suggestive of which psychosocial state?
Normal response to her situation that can be redirected in a healthy way
189
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.
190
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
191
What most accurately describes bowel function in children born with a myelomeningocele?
Some degree of fecal continence can usually be achieved.
192
A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention?
Provide a latex-free environment.
193
When a child develops latex allergy, which food may also cause an allergic reaction?
Bananas
194
The clinic nurse is assessing infant reflexes. What assessment indicates a persistence of primitive reflexes?
Tonic neck reflex at 8 months of age
195
A toddler with spastic cerebral palsy needs to be transported to the radiology department. What transportation method should the nurse use to take the toddler to the radiology department?
A wagon with pillows
196
What is the rationale for orthopedic surgery for a child with cerebral palsy?
To improve function
197
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 nursing care to limit distractions
198
The nurse is caring for a child with myasthenia gravis (MG). What health care prescription should the nurse verify before administering?
Garamycin (gentamicin)
199
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.
200
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 (NTDs) result in elevated concentrations of a-fetoprotein in amniotic fluid.
201
Neuropathic bladder disorders are common among children with which disorder?
Myelomeningocele
