N410 Peds Ch 8 cleft lip

Question 1

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Postoperative nursing care should include which of the following?
Monitor closely for signs of infection.
Place the child with the operated side of the head on the bed.
Pump the shunt reservoir often to maintain patency.
Maintain a Trendelenburg position to decrease pressure on the shunt.

Answer 1

Infection is the greatest hazard in the postoperative period. The nurse is vigilant for signs of cerebrospinal fluid infection, including elevated temperature, poor feeding, vomiting, decreased responsiveness, and seizure activity.

The child is placed with the operative side of the head up to reduce pressure on the valve.

The shunt reservoir, when placed, is used for access to the ventricular system. It should not be pumped.

Maintaining a Trendelenburg position to decrease pressure on the shunt is contraindicated. The Trendelenburg position can increase intracranial pressure.
The child should be placed flat.

Question 2

Which of the following clinical manifestations of developmental dysplasia of the hip would be seen in a newborn?
  Lordosis
  Ortolani sign
  Trendelenburg sign
  Telescoping of the affected limb

Answer 2

During the Ortolani test, the examiner places forward and then backward pressure on the trochanter. If the femoral head is felt to slip, dysplasia may be present. This test is most reliable from birth to 2 to 3 months.

Lordosis, the Trendelenburg sign, and telescoping of the affected limb are signs that appear in older infants and children.

Question 3

Which of the following is the earliest clinical manifestation of biliary atresia?
  Jaundice
  Vomiting
  Hepatomegaly
  Absence of stooling

Answer 3

Jaundice is the earliest and most striking manifestation of biliary atresia. It is first observed in the sclera and may be present at birth, but it is usually not apparent until ages 2 to 3 weeks.

Vomiting is not associated with biliary atresia.

Hepatomegaly and abdominal distention are common but occur later.

Stools are large and lighter in color than expected because of the lack of bile.

Question 4

Hypospadias refers to which of the following?
Absence of a urethral opening
Penis shorter than usual for age
Urethral opening along dorsal surface of penis
Urethral opening along ventral surface of penis

Answer 4

Ventral

Dorsal side is epispadias