Peds Exam#1- Intro, Respiratory, Cardiac, Musculoskeletal, Neuro, Newborn/Infant G&D, Med Calculations

Newborn age range

1-12 months old

Toddler age range

1-3 years old

Preschool age range

3-6 years old

School-Age range

6-12 years old

Adolescent age range

12-18 years old

Normal HR by age group

Infant:

Toddler:

Preschool:

School-Age:

Adolescent:

Infant: 80-150 bpm

Toddler: 70-120 bpm

Preschool: 65-110 bpm

School-Age: 60-100 bpm

Adolescent: 55-95 bpm

Normal RR by age group

Infant:

Toddler:

Preschool:

School-Age:

Adolescent:

Infant: 25-55

Toddler: 20-30

Preschool: 20-25

School-Age: 14-26

Adolescent: 12-20

Which age group is egocentric?

Toddlers

Which age group wants explanations and reasons for everything?

School-Age

How many ‘well-baby’ pediatric visits will a newborn make in their first year of life?

**7 visits**

Does the anterior or posterior fontanel close first? At what ages do these close?

**Posterior fontanel** closes first→ 4-6 weeks

\
Anterior fontanel closes→ up to 18 months

* better indicator of hydration bc open longer
* bulging vs sunken

\

What is the **Sucking reflex** and when is it expected to disappear?

baby opens mouth and begins sucking motion when object/finger placed on lips or in mouth

\
disappears at 4 months and becomes voluntary function

What is the **Moro reflex** and when is it expected to disappear?

Embrace reflex

Occurs when baby is startled by sudden loud noise or unexpected movement

Newborn throws arms outward and flex knees, then arms return to the chest

\
disappears at 3-6 months

What is the **Stepping** reflex and when is it expected to disappear?

Hold baby upright with soles of feet touching flat surface, baby should make stepping motion

\
disappears 1-2 months

\

What is the **Tonic neck reflex** and when is it expected to disappear?

Fencing reflex

Have baby lie on back, turn baby’s head to one side, arm towards which baby is facing should extend straight away from body with hand partially open, arm on side away from the face is flexed and fist clenched tightly

\
disappears 3-4 months

What is the **Rooting reflex** and when is it expected to disappear?

Elicit by stroking baby’s cheek, should turn towards the side that was stroked and make sucking movements

\
disappears 4-6 months

What is the **Babinski reflex** and when is it expected to disappear?

Elicit by stroking lateral sole of baby’s foot from heel toward and across the ball of foot, toes should fan out

\
disappears at 12 months

What are the **Palmar grasp** and **Plantar grasp** reflexes and when are they expected to disappear?

Place object in hand or on foot, fingers/toes should close around the object and attempt to grasp it

\
disappears 3-4 months

The nurse is teaching a group of new nurses how to assess bowel sounds. Which statement will the nurse include in the education?

A. You should auscultate all four quadrants for a full minute each

B. Hypoactive bowel sounds are expected in a patient with diarrhea

C. Bowel sounds should be present within the first few days of life

D. Bowel sounds will be audible by the naked ear unless distention is present

**A. You should auscultate all four quadrants for a full minute each**

* bowel sounds should be present within a few __hours__ of life

The nursing student is preparing to explain the appropriate steps for assessing an infant. The instructor determines the student’s presentation is successful after illustrating which location as appropriate for obtaining an apical pulse?

A. Between the sternum and the left nipple

B. Above the sternum, slightly to the right

C. Below the ribs about one half of an inch

D. Above the clavicle on the left side

**A. Between the sternum and the left nipple**

The nurse assesses the skin of a child and documents evidence of plethora. Which finding did the nurse observe?

A. bluish coloration of lips and nail beds

B. round flat lesions on the neck

C. black and blue areas on the skin

D. redness of the cheeks and lips

**D. redness of the cheeks and lips**

* __Plethora__→ described redness of skin, especially the cheeks and lips

The nurse is preparing to conduct the __cover test__ with a preschool-age child. Which body system is the nurse preparing to assess?

A. Ears

B. Eyes

C. Nose

D. Neck

**B. Eyes**

* __Cover Test__→ screening procedure to determine eye alignment

The nurse is assessing a newborn child. The mother asks why the feet are blue. What is the best response by the nurse?

A. blue tint to skin means that there is a lack of oxygen. I will need to notify the physician of this immediately

B. when a foot or hand is blue, it’s called peripheral cyanosis. peripheral cyanosis is not normal in newborns

C. blueness of hands and feet is a common finding in newborns. it is a result of their circulatory system switching from being in the womb to life outside the mom’s body

D. blueness in the feet of a newborn is called pallor. this is a normal finding in babies up to several days old

**C. blueness of hands and feet is a common finding in newborns. it is a result of their circulatory system switching from being in the womb to life outside the mom’s body**

* known as acrocyanosis
* normal in babies up to several days of age

Measurements that tell us how a child is growing, such as height, weight, and head circumference are called ____ measurements.

**Anthropometric measurements**

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding?

A. gallop and rales

B. blood pressure discrepancies in the extremities

C. right ventricular hypertrophy on ECG

D. heart murmur

**D. heart murmur**

* systolic murmur
* best heard along left sternal border

Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem?

a. previous streptococcal throat infection

b. history of open-heart surgery at 5 years of age

c. playing too much soccer and not getting enough rest

d. exposure to a sibling with pneumonia

**a. previous streptococcal throat infection**

* rheumatic fever occurs as a sequela to Group A Streptococcal infection

T/F: The most common reason for admission to the hospital for children with congenital heart disease is heart failure.

**True**

The nurse is assessing an infant with heart failure. Which of the following findings should the nurse expect? SATA

a. bradycardia

b. cool extremities

c. peripheral edema

d. increased urinary output

e. nasal flaring

**b. cool extremities**

**c. peripheral edema**

**e. nasal flaring**

A 15-year-old is injured and sustains a fractured jaw. The fractured jaw has been surgically wired, and the primary health care provider (PHCP) has prescribed a full liquid diet. Which nursing action would **best** promote compliance and provide an adequate nutrient value with the full liquid diet for this teenager?

a. offer chocolate milkshake between meals

b. explain the importance of good nutrition to the teenager

c. offer commercial nutritional supplements 4 to 6 times per day

d. ask teenager for food preferences, and liquefy these using a blender

**d. ask teenager for food preferences, and liquefy these using a blender**

* think: it’s about giving them choice, “asking preferences”, allow them to participate in making decisions

A 7-year-old child is hospitalized with a fracture of the femur and is placed in traction. In meeting the psychosocial needs of the child, the nurse **most appropriately** selects which play activity for the child?

a. a board game

b. a large puzzle

c. a finger painting set

d. a coloring book with crayons

**a. a board game**

* __school-aged child__: drawing, construction, dolls, pets, guessing games, board games and computer games, riddles, hobbies, listening to tv or radio
* __preschool__: finger painting & coloring
* __toddler__: large puzzle

The nurse employed in a neonatal intensive care nursery receives a telephone call from the delivery room and is told that a newborn with spina bifida (myelomeningocele type) will be transported to the nursery. The maternity nurse prepares for the arrival of the newborn and places which **priority** item at the newborn's bedside?

a. rectal thermometer

b. blood pressure cuff

c. specific gravity urinometer

d. bottle of sterile normal saline

**d. bottle of sterile normal saline**

* sterile normal saline dressing placed over sac to maintain moisture
* priority with spina bifida is preventing sac from breaking down/opening

The nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which assessment finding would the nurse expect to note documented in the infant's record regarding this condition?

a. full range of motion in the affected hip

b. an apparent short femur on the unaffected side

c. asymmetrical adduction of the affected hip when placed supine, with knees and hips flexed

d. asymmetry of the gluteal skin folds when the infant is placed prone and legs are extended against the examination table

**d. asymmetry of the gluteal skin folds when the infant is placed prone and legs are extended against the examination table**

* asymmetrical __abduction__ of the affected hip when placed supine, with knees and hips flexed
* apparent short femur on the __affected__ side
* __limited__ range of motion in the affected hip

The nurse is caring for an infant with spina bifida (myelomeningocele type) who had the sac on the back containing cerebrospinal fluid, the meninges, and the nerves (gibbus) surgically removed. The nursing plan of care for the postoperative period would include which action to maintain the infant's safety?

a. covering the back dressing with a binder

b. placing the infant in a head-down position

c. strapping the infant in a baby seat sitting up

d. elevating the head of the bed with the infant in the prone position

**d. elevating the head of the bed with the infant in the prone position**

* decreases the chance CSF will accumulate in the cranial cavity
* infant needs to be prone or side lying to decrease pressure on surgical site
* binders or baby seats would not be used because they put pressure on the surgical site

What is the name of the process describing the conversion of cartilage to bone? At what age is this complete?

**Ossification**

Complete in **adolescence**

What is the hardest and easiest bone to break?

Hardest→ femur

Easiest→ toe

What is the smallest bone?

bone of the ear

The most common fracture in child, that is hard to identify on x-rays, is a ____ fracture.

**Greenstick** fracture

A rib fracture is considered a ____ fracture, due to it being able to cause injury to other organs or tissues.

**Complicated** fracture

Which fractures should always alert nurses to possible child abuse?

**Spiral fracture of humerus, rib, femur**

Data that is based on personal opinion, judgement, feelings, or point of view is ____ data.

**Subjective data**

Data that is factual and based on observations and measurements is ____ data.

**Objective data**

Pain, muscle spasms, loss of function, refusal to crawl are examples of what kind of data?

**Subjective data**

Crepitus, deformity, visible muscle spasms, edema, and ecchymosis are examples of what kind of data?

**Objective data**

What bacterial most commonly causes osteomyelitis?

**Staph aureus**

What type of traction can be both intermittent and continuous?

**Skin traction**

Pain not relieved by medication, diminished capillary refill, and diminished pulses indicate what musculoskeletal complication?

**Compartment Syndrome**

Signs of Spina Bifida Occulta can include which of the S/S below? SATA

a. skin depression or dimple

b. swelling in the head

c. hemangioma

d. dark tufts of hair

e. twisted legs and feet

f. soft subcutaneous lipomas

**a. skin depression or dimple**

**c. hemangioma** (vascular birthmark made of extra blood vessels in skin)

**d. dark tufts of hair**

**f. soft subcutaneous lipomas**

Cases of Spina Bifida dramatically dropped after the introduction of what supplement given to expecting mothers early in pregnancy?

**Folic Acid**

The most common type of club foot is

a. talipes valgus

b. talipes equinovaris

c. talipes varus

d. talipes calcaneus

**b. talipes equinovaris**

The main type of treatment for club foot is ___ casting.

**serial casting**

Signs of Osteogenesis Imperfecta include which of the below? SATA

a. blue/purple sclerae

b. bladder incontinence

c. brittle teeth

d. deafness

e. twisted legs and feet

f. osteoporosis

**a. blue/purple sclera**

**c. brittle teeth**

**d. deafness**

**f. osteoporosis**

The diet of a child with Osteogenesis Imperfecta should include

a. high fat content to support bones

b. low vitamin D to allow calcium absorption

c. high vitamin C for production of healthy connective tissues

e. stable calcium when taking bisphosphonates

**c. high vitamin C for production of healthy connective tissues**

* low fat diet→ every pound puts more pressure on bones
* high vitamin D to promote calcium absorption
* calcium supplementation recommended when taking bisphosphonates

The nurse observes the parents of a child with Osteogenesis Imperfecta. Which action by the parents would indicate further education is needed?

a. parents gently turn the child

b. parents help perform passive range of motion exercises with the child

c. parents pick the child up softly under the armpits

d. parents monitor diet and weight of child

**c. parents pick up the child softly under the armpits**

* should never be lifted by armpits
* can damage the brittle bones
* lift baby by placing one hand under legs and butt and one hand under shoulders, head, and neck

The main intervention used to treat torticollis is ____

**passive stretching**

The healthcare provider has ordered mannitol (Osmitrol) for a child with a head injury. The nurse will notice that this medication has been effective when they see:

a. increased urine output

b. decreased intercranial pressure

c. improved level of consciousness

d. decreased facial swelling

**c. improved level of consciousness**

What notable sign may indicate increased intracranial pressure in an infant?

a. overflow voiding

b. bulging fontanel when crying

c. high-pitched cry

d. minimal lower extremity movement

**c. high-pitched cry**

* normal for anterior fontanel to bulge during periods of crying

T or F: The Pediatric Glascow Coma Scale can provide a score from 0 to 15

**False**→ can provide score from __**3**__ to 15

Which signs best indicate increased intracranial pressure (ICP) in an infant? SATA

a. sleeping more than usual

b. increased appetite

c. sunken anterior fontanel

d. complaints of blurred vision

e. high-pitched cry

**a. sleeping more than usual**

**e. high-pitched cry**

The nurse is caring for a 6-month old infant diagnosed with meningitis. When the child is placed in the supine position and flexes his neck, the nurse notes he flexes his knees and hips. This is referred to as:

a. Brudzinski sign

b. Cushing triad

c. Kernig sign

d. Nuchal rigidity

**a. Brudzinski sign**

If a child awakens easily but exhibits limited responsiveness, his level of consciousness is described as:

a. confused

b. disoriented

c. lethargic

d. stuporous

**c. lethargic**

stuporous→ requires considerable stimulation to arouse

disoriented→ lacks ability to recognize place or person

confused→ lacks ability to think clearly and rapidly

An expected finding in an analysis of CSF in the child with bacterial meningitis is:

a. low protein levels

b. cloudy appearance

c. high glucose levels

d. increased RBCs

**b. cloudy appearance**

* expect __high__ protein levels & __low__ glucose levels

T or F: The pupils **dilate** as ICP increases

**True**

* pupils **dilated & fixed**
* compression of oculomotor nerve (CN III)

Which nursing action should be a priority when the parents first meet their infant with an open spinal defect?

a. have parents feed the infant

b. encourage discussion of fears and concerns

c. provide written information reinforcing health care provider education

d. emphasize the infants normal and positive features

**d. emphasize the infants normal and positive features**

A child with a known seizure disorder is hospitalized for an unrelated procedure. Upon walking the child back from the restroom, the nurse notes tonic-clonic movements. Which action should the nurse take first?

a. note the time

b. ease the child to the floor

c. clear the area of objects and pad the head

d. roll the child to side-lying position to protect the airway

**a. note the time**

The nurse is caring for a child who has been in a motor vehicle accident (MVA). The child falls asleep unless her name is called or she is gently shaken. This state of consciousness is referred to as:

a. coma

b. delirium

c. obtunded

d. confusion

**c. obtunded**

* sleeps unless aroused by verbal or tactile stimulation

Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed?

a. semi-fowler in an infant seat

b. flat in the crib

c. trendelenburg

d. in the crib with the head elevated to 90 degrees

**b. flat in crib**

* want to lay as flat as possible for 24 hours after shunt placement
* make sure emptying is at a controlled pace

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking, and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan?

a. obtain testing for respiratory syncytial virus

b. screen for the “allergic salute”

c. obtain vital signs to determine an infection

d. draw a blood count to see if the client is septic

a. obtain testing for respiratory syncytial virus

• symptoms are acute nasopharyngitis

• many times this is viral

  • test completed by taking nasal secretions to send to lab

A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse’s understanding of oxygen delivery methods what would the nurse expect to be used to deliver the highest concentration of oxygen to the child?

a. nonrebreather (face) mask

b. oxygen hood

c. partial rebreather mask

d. venturi mask

a. nonrebreather (face) mask

• provides 95% oxygen concentration

The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. What would be the best intervention?

a. suction the back of the throat

b. encourage the child to cough

c. continue to assess for bleeding

d. notify the health care provider immediately

c. continue to assess for bleeding

• will have small amount of blood mixed with saliva following tonsillectomy

The nurse has assesses a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment?

a. the child is pale and has vomited

b. the child is pale, elevated patches on skin

c. the child is irritable and tachycardic

d. the child is in tripod position

d. the child is in tripod position

• attempts to improve airway by sitting forward extending neck forward with jaw up

• “sniffing position” (tripod position)

other classic signs of epiglottitis:

• rapid onset

• tachycardia

  • stridor

Parents call the “on call” line stating that her infant has had a bark-like cough for the past three nights. The parent states no fever or cold symptoms. Which suggestions may save a trip to the emergency department? SATA

a. use a cool mist humidifier in the infant’s room

b. take the infant into a steamy shower

c. provide the infant cold oral fluids

d. use the coolness of the night air

e. assess throat for throat obstuction

a. use a cool mist humidifier in the infant’s room

b. take the infant into a steamy shower

d. use the coolness of the night air

• cold fluids may cause further spasm

The nurse is providing discharge teaching to the parents of a child who had a tonsillectomy. Which statements by the parents indicate learning has occurred? SATA

a. warm soup should be easy to swallow and will help with controlling the pain

b. if our child starts to swallow a lot, we may need to call the health care provider

c. milkshakes should be drunk with straws so that not too much is swallowed at a time

d. fluids are very important. our child loves popsicles so we will get a variety of flavors except cherry and strawberry

e. we can use an ice collar on the throat as long as we do not leave it on too long at a time

b. if our child starts to swallow a lot, we may need to call the health care provider

d. fluids are very important. our child loves popsicles so we will get a variety of flavors except cherry and strawberry

e. we can use an ice collar on the throat as long as we do not leave it on too long at a time

• hot or warm liquids and use of straws would cause bleeding to occur and should be avoided

Which electrolyte does the client with cystic fibrosis need in abundance?

a. potassium

b. sodium

c. chlorine

d. magnesium

b. sodium

• dietary intake of sodium encouraged due to increased sodium lost (why infant tastes salty)

  • patients encouraged to eat salty pretzels, potato chips during hot weather or when sodium losses are anticipated

Order: The child has been diagnosed with asthma and the child’s physician is using a stepwise approach to rank the order in which the nurse should administer these medications as the patients condition worsens

a. low-dose inhaled corticosteroids

b. medium-dose inhaled corticosteroid and salmeterol

c. albuterol as needed

d. medium-dose inhaled corticosteroids

1. albuterol as needed

2. low-dose inhaled corticosteroids

3. medium-dose inhaled corticosteroids

   1. medium-dose inhaled corticosteroids and salmeterol (LABA)

The nurse is caring for a child with thickened pulmonary secretions. Which actions would the nurse use to assist the child breathe with less effort? SATA

a. encourage oral fluids

b. avoid humidification of oxygen if oxygen is in use

c. assess pulse oximetry every 12 hours

d. perform chest physiotherapy

e. observe for cyanosis and labored breathing every 12 hours

a. encourage oral fluids

d. perform chest physiotherapy

• if oxygen is in use it should be humidified to avoid drying out the mucosa

  • child should be observed for cyanosis and have pulse oximetry readings taken more frequenly than every 12 or 24 hours→ observed hourly or more

A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which patient goal would be priority in the plan of care?

a. the infant will attain oxygen saturation of 90% on room air

b. the infant’s airway will remain clear and free of mucus

c. the infant’s breathing will be less labored

d. the infant will have decreased nasal stuffiness

b. the infant’s airway will remain clear and free of mucus

The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia?

a. the child is a triplet

b. the child was a postmaturity date infant

c. the child has diabetes

d. the child attends day care

d. the child attends day care

• triplet→ risk factor for bronchiolitis

• prematurity→ risk factor for pneumonia

  • diabetes→ risk factor for influenza

What type of traction is used to treat fractures of the hip, femur, or knee?

a. buck traction

b. bryant traction

c. russel traction

d. halo collar

c. russel traction

• “russel up the knee”

buck→ ‘buck down the leg’

• for hip and knee fracture

• and slipped capital femoral epiphysis (SCFE)

bryant→ ‘pull bryans legs straight up in the air”

• used to reduce femur fractures in kids <2 or developmental dysplasia of hip

T/F: Cerebral Palsy is a progressive neurological condition in children

False→ nonprogressive

Which medication can be given intrathecally via a pump for severe spasticity seen in cerebral palsy?

a. diazepam

b. baclofen

c. scopolamine

d. aspirin

b. baclofen

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching?

a. my son’s activity is too limited to stimulate his bowels

b. I need to figure out his usual pattern for passing stool

c. I can palpate his abdomen to assess for constipation

d. he must have an adequate amount of fluid

a. my son’s activity is too limited to stimulate his bowels

• even minimal activity increases peristalsis

• palpating the abdomen can reveal distention, suggesting constipation

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? SATA

a. semi fowler

b. prone

c. supine

d. right side lying

e. left side lying

b. prone

d. right side lying

e. left side lying

• all of these allow the incision to heal

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

a. tendons

b. ligaments

c. cartilage

d. joints

c. cartilage

• type of connective tissue consisting of cells implanted in a gel-like substance during fetal life

The nurse is caring for a 6-year-old boy with Russel traction applied to his left leg. Which intervention would be most appropriate to prevent complications?

a. adjust the weight as needed

b. assess the popliteal region carefully for skin breakdown

c. clean and massage his entire leg daily

d. provide pin care as needed

b. assess the popliteal region carefully for skin breakdown

• sling placed on knee in this type of traction

• type of skin traction→ no pins placed

What medication can be used to help slow the progression of Duchenne muscular dystrophy?

a. baclofen

b. lorazepam

c. prednisone

d. botulin toxin

c. prednisone

• corticosteroid

• protects muscle fibers from damage to the sarcolemma

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant?

a. baclofen

b. prednisone

c. lorazepam

d. botulin toxin

a. baclofen

• used to treat painful spasms and decrease spasticity in chuldren with motor neuron lesions

The nurse is caring for a child requiring a cast. The mother asks why the doctor is recommending a fiberglass cast when it is more expensive. What information should the nurse share with the mom? SATA

a. fiberglass casts are lighter in weight than plaster casts

b. casts made out of fiberglass take longer to dry

c. kids like them because they come in different colors

d. fiberglass casts are typically used when the casts need to be changed often

e. they can be waterproof when a special liner is used

a. fiberglass casts are lighter in weight than plaster casts

c. kids like them because they come in different colors

e. they can be waterproof when a special liner is used

• plaster casts typically used when need to change often because cost less

• plaster casts take longer to dry

What characteristic is true of cerebral palsy?

a. it’s reversible

b. it’s progressive

c. it results in intellectual disability

d. it appears at birth or during the first 2 years of life

d. it appears at birth or during the first 2 years of life

• irreversible, non-progressive

• some are intellectually disabled, many have normal intelligence

The young child is experiencing muscle spasms and has been given lorazepam. Which statements by the child indicate that the child may be experiencing some common side effects? SATA

a. I need to take a nap

b. my belly hurts

c. I feel sort of dizzy

d. my muscle cramps are getting worse

e. I think I’m going to throw up

a. I need to take a nap

c. I feel sort of dizzy

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

a. back with the injured hip flexed and the uninjured one extended

b. back with hips up off the bed

c. back with hips flat on the bed

d. stomach with both legs extended

b. back with hips up off the bed

• used to reduce fractures or with DDH

• infant’s hips must be off the bed

The nurse has reinforced teaching for a parent and a school-aged child who was given a brace to wear for the treatment of scoliosis. The nurse determines that the child needs further teaching if the child makes which statement?

a. this brace will correct my curve

b. I will wear my brace under my clothes

c. I may not need surgery if I wear my brace

d. I will do back exercises at least five times a week

a. this brace will correct my curve

• bracing halts the progression of most curvatures but is not curative

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates a need for further teaching?

a. I cannot place powder under the brace

b. I need to place a soft shirt on my child under the brace

c. I need to be sure to apply lotion on the skin under the brace

d. I need to encourage my child to perform prescribred exercises

c. I need to be sure to apply lotion on the skin under the brace

• avoided because they can become sticky or cake under the brace and cause irritation

A child has been tentatively diagnosed with rheumatic fever. The nurse interprets that this diagnosis is consistent with which laboratory result obtained for this child?

a. elevated antistreptolysin O titer

b. decreased ESR

c. negative result on antinuclear antibody assay

d. negative result on C-reactive protein determination

a. elevated antistreptolysin O titer

• will see elevated ASO titer, elevated ESR, leukocytosis, and positive result on C-reactive protein determination

The nurse is collecting data on a child with a diagnosis of rheumatic fever. Which question would the nurse initially ask the parent of the child?

a. has the child been vomiting

b. has the child had any diarrhea

c. does the child complain of chest pain and numbness in the right arm

d. has the child complained of a sore throat within the past few months

d. has the child complained of a sore throat within the past few months

• RF typically presents 2-6 weeks following an untreated or partially treated group A beta-hemolytic streptococcal infection of the upper respiratory tract (pharyngitis)

• ask about sore throat or unexplained fever

A child is admitted to the pediatric unit with a diagnosis of acute stage Kawaski disease. Which assessment finding by the nurse are characteristic of this disorder? SATA

a. red throat

b. cracking lips

c. conjunctival hyperemia

d. desquamation of the skin

e. enlargement of the cervical lymph nodes

a. red throat

c. conjunctival hyperemia

e. enlargement of the cervical lymph nodes

acute stage: fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of cervical lymph nodes

subacute stage: desquamation of the skin, cracking lips, joint pain, cardiac manifestations, and thrombocytosis

The nurse is providing discharge teaching to the parents of a child who has recovered from Kawasaki disease. The child received intravenous immunoglobulin (IVIG) and aspirin as part of the treatment plan. Which statement from the parents would indicate a need for further teaching?

a. we can give warm baths to help with any joint pain

b. we need to take the temperature daily for the next week or two

c. we will still plan for my child to receive the MMR vaccine at the doctor’s appointment in 2 weeks

d. if the skin on my child’s hands and feet begins to peel, this is normal and does not need to be reported to the doctor

c. we will still plan for my child to receive the MMR vaccine at the doctor’s appointment in 2 weeks

• administration of live vaccines (measles, mumps, rubella, varicella) needs to be deferred for 11-12 months after administration of IVIG

• IVIG can diminish body’s ability to produce antibodies and decrease vaccine efficacy

Cerebral palsy is suspected in an infant, and the parents ask the nurse about potential warning signs of CP. The nurse would provide which information? SATA

a. the infant’s arms or legs are stiff or rigid

b. a high risk factor for CP is very low birth weight

c. by 8 months of age, the infant can sit without support

d. the infant has strong head control but a limp body posture

e. the infant has feeding difficulties, such as poor sucking and swallowing

f. if the infant is able to crawl, only one side us used to propel themselves

a. the infant’s arms or legs are stiff or rigid

b. a high risk factor for CP is very low birth weight

e. the infant has feeding difficulties, such as poor sucking and swallowing

f. if the infant is able to crawl, only one side us used to propel themselves

• if infant could not sit without support by 8 months

• if infant has poor head control and limp body posture

The nurse is assisting a PCP in the examination of a 3-week old infant with developmental dysplasia of the hip. Which test or sign would the nurse expect the PCP to assess?

a. babinski’s sign

b. the moro reflex

c. ortolani’s maneuver

d. the palmar-plantar grasp

c. ortolani’s maneuver

Parents bring their 2-week-old infant to a clinic for treatment after diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder?

a. treatment needs to be started as soon as possible

b. I realize my infant will require follow-up care until fully grown

c. I need to bring my infant back to the clinic in 1 month for a new cast

d. I need to come to the clinic every week with my infant for the casting

c. I need to bring my infant back to the clinic in 1 month for a new casting

• serial manipulation and casting performed at least weekly

Preterm infants have more fragile capillaries in the periventricular area than term infants. This puts infants at risk for which problem?

a. moderate closed-head injury

b. early closure of the fontanelles

c. congenital hydrocephalus

d. intracranial hemorrhaging

d. intracranial hemorrhaging