The Child with Neuromuscular & Musculoskeletal Disorders Flashcards
A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material?
a.
Soak in a bathtub.
b.
Vigorously scrub the leg.
c.
Carefully pick material off the leg.
d.
Apply powder to absorb the material.
ANS: A
Simply soaking in the bathtub is usually sufficient for removal of the desquamated skin and sebaceous secretions. Several days may be required to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.
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?
a.
“All therapies require extended periods of bed rest.”
b.
“Conservative therapy will be required until puberty.”
c.
“Our child cannot attend school during the treatment phase.”
d.
“Surgical correction requires a 3- to 4-month recovery period.”
ANS: D
Surgical correction involves additional risks of anesthesia, infection, and possibly blood transfusion. The recovery period is only 3 to 4 months rather than the 2 to 4 years of conservative therapies. The use of non–weight-bearing appliances and surgical intervention does not require prolonged bed rest. Conservative therapy is indicated for 2 to 4 years. The child is encouraged to attend school and engage in activities that can be adapted to therapeutic appliances.
The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a.
Arthralgia
b.
Weight gain
c.
Polycythemia
d.
Abdominal pain
e.
Glomerulonephritis
ANS: A, D, E
Clinical manifestations of SLE include arthralgia, abdominal pain, and glomerulonephritis. Weight loss, not gain, and anemia, not polycythemia, are manifestations of SLE.
Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care?
a.
High-carbohydrate diet
b.
Meticulous dental hygiene
c.
Minimum use of fluoride
d.
Avoidance of medications that contribute to gingivitis
ANS: B
Meticulous oral hygiene is essential. Many children with CP have congenital enamel defects, high-carbohydrate diets, poor nutritional intake, and difficulty closing their mouths. These, coupled with the child’s spasticity or clonic movements, make oral hygiene difficult. Children with CP have high carbohydrate intake and retention, which contribute to dental caries. Use of fluoride should be encouraged through fluoridated water or supplements and toothpaste. Certain medications such as phenytoin do contribute to gingival hyperplasia. If that is the drug of choice, then meticulous oral hygiene must be used.
What functional ability should the nurse expect in a child with a spinal cord lesion at C7?
a.
Complete respiratory paralysis
b.
No voluntary function of upper extremities
c.
Inability to roll over or attain sitting position
d.
Almost complete independence within limitations of wheelchair
ANS: D
Individuals who sustain injuries at the C7 level are able to achieve a significant level of independence. Some assistance is needed with transfers and lower extremity dressing. Patients are able to roll over in bed and to sit and eat independently. Patients with injuries at C3 or higher have complete respiratory paralysis. Those with injuries at C4 or higher do not have voluntary function of higher extremities. Injuries at C5 or higher prevent rolling over or sitting.
A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal antiinflammatory drug (NSAID). What nursing consideration should be included?
a.
Monitor heart rate.
b.
Administer NSAIDs between meals.
c.
Check for abdominal pain and bloody stools.
d.
Expect inflammation to be gone in 3 or 4 days.
ANS: C
NSAIDs are the first-line drugs used in JIA. Potential side effects include gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI bleeding and elevated blood pressure. The heart rate is not affected by this drug class. NSAIDs should be given with meals to minimize gastrointestinal problems. The antiinflammatory response usually takes 3 weeks before effectiveness can be evaluated.
What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)?
a.
Apply ice packs to relieve acute swelling and pain.
b.
Administer acetaminophen to reduce inflammation.
c.
Teach the child and family correct administration of medications.
d.
Encourage range of motion exercises during periods of inflammation.
ANS: C
The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range of motion exercises should not be done during periods of inflammation.
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?
a.
“I should gently massage the skin under the straps once a day to stimulate circulation.”
b.
“I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation.”
c.
“I should remove the harness several times a day to prevent contractures.”
d.
“I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin.”
ANS: A
To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.
A young girl has just injured her ankle at school. In addition to notifying the child’s parents, what is the most appropriate, immediate action by the school nurse?
a.
Apply ice.
b.
Observe for edema and discoloration.
c.
Encourage child to assume a position of comfort.
d.
Obtain parental permission for administration of acetaminophen or aspirin.
ANS: A
Soft tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. The nurse observes for the edema while placing a cold pack. The applying of ice can reduce the severity of the injury. Maintaining the ankle at a position elevated above the heart is important. The nurse helps the child be comfortable with this requirement. The nurse obtains parental permission for administration of acetaminophen or aspirin after ice and rest are assured.
The nurse is teaching the girls’ varsity sports teams about the “female athlete triad.” What is essential information to include?
a.
They should take low to moderate calcium to avoid hypercalcemia.
b.
They have strong bones because of the athletic training.
c.
Pregnancy can occur in the absence of menstruation.
d.
A diet high in carbohydrates accommodates increased training.
ANS: C
Sexually active teenagers, regardless of menstrual status, need to consider contraceptive precautions. Increased calcium (1500 mg) is recommended for amenorrheic athletes. The decreased estrogen in girls with the female athlete triad, coupled with potentially inadequate diet, leads to osteoporosis. Diets high in protein and calories are necessary to avoid potentially long-term consequences of intensive, prolonged exercise programs in pubertal girls.
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?
a.
Families adjust better to life-threatening injuries when information is given over time.
b.
Immediate loss of function is indicative of the long-term consequences of the injury.
c.
Extent and severity of damage cannot be determined for several weeks or even months.
d.
Numerous diagnostic tests will be done immediately to determine extent and severity of damage.
ANS: C
The extent and severity of damage cannot be determined initially. The immediate loss of function is caused by anatomic and impaired physiologic function, and improvement may not be evident for weeks or months. It is essential to provide information about the adolescent’s status to the parents. Immediate treatment information should be provided. Long-term rehabilitation and prognosis can be addressed after the child is stabilized. During the immediate postinjury period, physiologic responses to the injury make an accurate assessment of damage difficult.
When a child develops latex allergy, which food may also cause an allergic reaction?
a.
Yeast
b.
Wheat
c.
Peanuts
d.
Bananas
ANS: D
There are cross-reactions between allergies to latex and to a number of foods such as bananas, avocados, kiwi, and chestnuts. Although yeast, wheat, and peanuts are potential allergens, currently they are not known to cross-react with latex allergy.
The nurse is preparing to admit a 5-year-old with spina bifida cystica that was below the second lumbar vertebra. What clinical manifestations of spina bifida cystica below the second lumbar vertebra should the nurse expect to observe? (Select all that apply.)
a.
No motor impairment
b.
Lack of bowel control
c.
Soft, subcutaneous lipomas
d.
Flaccid, partial paralysis of lower extremities
e.
Overflow incontinence with constant dribbling of urine
ANS: B, D, E
The clinical manifestations of spina bifida cystica below the second lumbar vertebra include lack of bowel control, flaccid, partial paralysis of lower extremities, and overflow incontinence with constant dribbling of urine. No motor impairment occurs with spina bifida cystica that was below the third lumbar vertebra, and soft, subcutaneous lipomas occur with spina bifida occulta.
The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.)
a.
Less bulky
b.
Drying time is faster
c.
Molds readily to body part
d.
Permits regular clothing to be worn
e.
Can be cleaned with small amount of soap and water
ANS: A, B, D, E
The advantages of synthetic casts over plaster of Paris casts are that they are less bulky, dry faster, permit regular clothes to be worn, and can be cleaned. Plaster of Paris casts mold readily to a body part, but synthetic casts do not mold easily to body parts.
What is a physiologic effect of immobilization on children?
a.
Metabolic rate increases.
b.
Venous return improves because the child is in the supine position.
c.
Circulatory stasis can lead to thrombus and embolus formation.
d.
Bone calcium increases, releasing excess calcium into the body (hypercalcemia).
ANS: C
The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. With the loss of muscle contraction, there is a decreased venous return to the heart. Calcium leaves the bone during immobilization, leading to bone demineralization and increasing the calcium ion concentration in the blood.
What functional goal should the nurse expect for a child who has a C7 spinal cord injury? (Select all that apply.)
a.
Able to drive automobile with hand controls
b.
Complete independence within limitations of a wheelchair
c.
Can roll over in bed, sit up in bed, and eat independently
d.
Requires some assistance in transfer and lower extremity dressing
e.
Ambulation with bilateral long braces using four-point or swing-through crutch gait
ANS: B, C, D
A child with a C7 spinal cord injury can expect to be completely independent within the limitations of a wheelchair, can roll over in bed, sit up in bed, and eat independently, and will require some assistance in transfer and lower extremity dressing. The ability to drive an automobile with hand controls is a functional goal for a T1 to T10 spinal cord injury. Ambulation with bilateral long braces using four-point or swing-through crutch gait is a functional goal for a T10 to L2 injury.
What finding is characteristic of fractures in children?
a.
Fractures rarely occur at the growth plate site because it absorbs shock well.
b.
Rapidity of healing is inversely related to the child’s age.
c.
Pliable bones of growing children are less porous than those of adults.
d.
The periosteum of a child’s bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.
ANS: B
Healing is more rapid in children. The younger the child, the more rapid the healing process. Nonunion of bone fragments is uncommon except in severe injuries. The epiphyseal plate is the weakest point of long bones and a frequent site of injury during trauma. Children’s bones are more pliable and porous than those of adults. This allows them to bend, buckle, and break. The greater porosity increases the flexibility of the bone and dissipates and absorbs a significant amount of the force on impact. The adult periosteum is thinner, is weaker, and has less osteogenic potential than that of a child.
The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication?
a.
Sepsis
b.
Osteomyelitis
c.
Pulmonary embolism
d.
Acute respiratory tract infection
ANS: C
Fat emboli are of greatest concern in individuals with fractures of the long bones. Fat droplets from the marrow are transferred to the general circulation, where they are transported to the lung or brain. This type of embolism usually occurs within the second 12 hours after the injury. Sepsis would manifest with fever and lethargy. Osteomyelitis usually is seen with pain at the site of infection and fever. A child with an acute respiratory tract infection would have nasal congestion, not chest pain.
The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi? (Select all that apply.)
a.
Monitor output.
b.
Encourage the patient to drink apple juice.
c.
Encourage milk intake.
d.
Ensure adequate fluids.
e.
Encourage the patient to drink cranberry juice.
ANS: A, D, E
To prevent renal calculi in a child who is immobilized, a nurse should monitor output; ensure adequate fluids; and encourage cranberry juice, which acidifies urine. Apple juice and milk alkalize the urine, so they should not be encouraged.
A feeding technique the nurse can teach to parents of a child with cerebral palsy to improve use of the lips and the tongue to facilitate speech is which?
a.
Feeding pureed foods
b.
Placing food on the tongue
c.
Placing food at the side of the tongue
d.
Placing food directly into the mouth with a spoon
ANS: C
Feeding techniques such as forcing the child to use the lips and tongue in eating facilitate speech. An example of this technique is placing food at the side of the tongue, first one side and then the other, and making the child use the lips to take food from a spoon rather than placing it directly on the tongue. Feeding pureed foods would not encourage use of the lips and tongue.
What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)?
a.
It has an autosomal dominant inheritance pattern.
b.
Onset occurs in later childhood and adolescence.
c.
It is characterized by presence of Gower sign, a waddling gait, and lordosis.
d.
Disease stabilizes during adolescence, allowing for life expectancy to approximately age 40 years.
ANS: C
DMD is characterized by a waddling gait and lordosis. Gower sign is a characteristic way of rising from a squatting or sitting position on the floor. DMD is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring. Onset occurs usually between ages 3 and 5 years. DMD has a progressive and relentless loss of muscle function until death by respiratory or cardiac failure.
Neuropathic bladder disorders are common among children with which disorder?
a.
Plagiocephaly
b.
Meningocele
c.
Craniosynostosis
d.
Myelomeningocele
ANS: D
Myelomeningocele is one of the most common causes of neuropathic bladder dysfunction among children. Plagiocephaly is the flattening of a side of the child’s head. This is not associated with neuropathic bladder. Children with meningocele usually do not have neuropathic bladder. Craniosynostosis is the premature closure of one or more cranial sutures. It is not associated with neuropathic bladder.
The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a.
Erythema over joints
b.
Soft tissue contractures
c.
Swelling in multiple joints
d.
Morning stiffness of the joints
e.
Loss of motion in the affected joints
ANS: B, C, D, E
Whether single or multiple joints are involved, stiffness, swelling, and loss of motion develop in the affected joints in JIA. The swelling results from soft tissue edema, joint effusion, and synovial thickening. The affected joints may be warm and tender to the touch, but it is not uncommon for pain not to be reported. The limited motion early in the disease is a result of muscle spasm and joint inflammation; later it is caused by ankylosis or soft tissue contracture. Morning stiffness of the joint(s) is characteristic and present on arising in the morning or after inactivity. Erythema is not typical, and a warm, painful, red joint is always suspect for infection.
The nurse is preparing to admit a 7-year-old child with ataxic cerebral palsy. What clinical manifestations of ataxic cerebral palsy should the nurse expect to observe? (Select all that apply.)
a.
Wide-based gait
b.
Rapid, repetitive movements performed poorly
c.
Slow, twisting movements of the trunk or extremities
d.
Hypertonicity with poor control of posture, balance, and coordinated motion
e.
Disintegration of movements of the upper extremities when the child reaches for objects
ANS: A, B, E
Clinical manifestations of ataxic cerebral palsy include a wide-based gait; rapid, repetitive movements performed poorly; and disintegration of movements of the upper extremities when the child reaches for objects. Slow, twisting movements of the trunk are seen with dyskinetic cerebral palsy, and hypertonicity with poor control of posture, balance, and coordinated motion are seen with spastic cerebral palsy.
The nurse is caring for a child with tetanus during the acute phase. What should the nurse plan in the care for this child?
a.
Playing music on a radio
b.
Giving frequent back rubs
c.
Providing bright lighting in the room
d.
Clustering nursing care to limit distractions
ANS: D
In caring for a child with tetanus during the acute phase, every effort should be made to control or eliminate stimulation from sound, light, and touch. Although a darkened room is ideal, sufficient light is essential so that the child can be carefully observed; light appears to be less irritating than vibratory or auditory stimuli. The infant or child is handled as little as possible, and extra effort is expended to avoid any sudden or loud noise to prevent seizures.
A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. What nursing intervention is a priority for this child?
a.
Minimizing environmental stimuli
b.
Administering immunoglobulin
c.
Monitoring and maintaining systemic blood pressure
d.
Discussing long-term care issues with the family
ANS: C
Spinal cord injury patients are physiologically labile, and close monitoring is required. They may be unstable for the first few weeks after the injury. Increased blood pressure may be an indication of autonomic dysreflexia. It is not necessary to minimize environmental stimuli for this type of injury. Spinal cord injury is not an infectious process. Immunoglobulin is not indicated. Discussing long-term care issues with the family is inappropriate. The family is focusing on the recovery of their child. It will not be known until the rehabilitation period how much function the child may recover.
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?
a.
Normal phase of adolescent development
b.
Severe depression that will require long-term counseling
c.
Normal response to her situation that can be redirected in a healthy way
d.
Denial response to her situation that makes rehabilitative efforts more difficult
ANS: C
During the rehabilitation phase, it is desirable for adolescents to begin to express negative feelings toward the situation. The rehabilitation team can redirect the negative energy toward learning a new way of life. The injury has interrupted the normal adolescent process of achieving independence, triggering these negative behaviors. Severe depression can occur, but it indicates that the child is no longer in denial. Long-term therapy is not indicated. Being angry, hostile, and uncooperative are behaviors that are indications that the adolescent understands the severity of the injury and need for rehabilitation.
What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)?
a.
Elevate the child’s legs.
b.
Place a foot cradle on the bed.
c.
Place a pillow under the child’s knees.
d.
Assist the child to dorsiflex the feet and rotate the ankles.
ANS: D
For a child who is immobilized, circulatory stasis and DVT development are prevented by instructing patients to change positions frequently, dorsiflex their feet and rotate the ankles, sit in a bedside chair periodically, or ambulate several times daily. Elevating the legs or placing a foot cradle on the bed will not prevent DVTs. A pillow under the knee would impair circulation, not improve it.
What is the primary method of treating osteomyelitis?
a.
Joint replacement
b.
Bracing and casting
c.
Intravenous antibiotic therapy
d.
Long-term corticosteroid therapy
ANS: C
Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus infection. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.
What is an appropriate nursing intervention when caring for a child in traction?
a.
Removing adhesive traction straps daily to prevent skin breakdown
b.
Assessing for tightness, weakness, or contractures in uninvolved joints and muscles
c.
Providing active range of motion exercises to affected extremity three times a day
d.
Keeping child prone to maintain good alignment
ANS: B
Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.
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?
a.
Bottle or tube feed him a specialized formula until he gains sufficient weight.
b.
Stabilize his jaw with caregiver’s hand (either from a front or side position) to facilitate swallowing.
c.
Place him in a well-supported, semireclining position.
d.
Place him in a sitting position with his neck hyperextended to make use of gravity flow.
ANS: B
Jaw control is compromised in many children with CP. More normal control is achieved if the feeder stabilizes the oral mechanisms from the front or side of the face. Bottle or tube feeding will not improve feeding without jaw support. The semireclining position and hyperextended neck position increase the chances of aspiration.
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?
a.
“Bisphosphonate therapy is not beneficial for OI.”
b.
“Physical therapy should be avoided as it may cause damage to bones.”
c.
“Lift the infant by the buttocks, not the ankles, when changing diapers.”
d.
“The infant should meet expected gross motor development without assistive devices.”
ANS: C
Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Bisphosphonate and physical therapy are beneficial for OI. Lightweight braces will be used when the child starts to ambulate.
The nurse is caring for a family whose infant was just born with anencephaly. What is the most important nursing intervention?
a.
Implement measures to facilitate the attachment process.
b.
Help the family cope with the birth of an infant with a fatal defect.
c.
Prepare the family for extensive surgical procedures that will be needed.
d.
Provide emotional support so the family can adjust to the birth of an infant with problems.
ANS: B
Anencephaly is the most serious neural tube defect. The infants have an intact brainstem and, if born alive, may be able to maintain vital functions for a few hours to several weeks. The family requires emotional support and counseling to cope with the birth of an infant with a fatal defect. The parents should be encouraged to hold their infant and provide comfort measures. This facilitates the grieving process because the infant has a limited life expectancy. Infants with anencephaly do not have cerebral hemispheres. There is no surgical correction available for this defect. Emotional support is needed as the family adjusts to the birth of a child who has a fatal defect.
What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)?
a.
High calorie diet because of increased metabolic needs
b.
Home schooling to decrease the risk of infections
c.
Protection from sun and fluorescent lights to minimize rash
d.
Intensive exercise regimen to build up muscle strength and endurance
ANS: C
The photosensitive rash is a major concern for individuals with SLE. Adolescents who spend time outdoors need to use sunscreens with a high SPF, hats, and clothing. Uncovered fluorescent lights can also cause a photosensitivity reaction. The diet should be sufficient in calories and nutrients for growth and development. The use of steroids can cause increased hunger, resulting in weight gain. This can present additional emotional issues for the adolescent. Normal functions should be maximized. The individual with SLE is encouraged to attend school and participate in peer activities. A balance of rest and exercise is important; excessive exercise is avoided.
An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department. She has completed the tetanus immunization series, receiving the last tetanus toxoid booster 8 years ago. What care is necessary for therapeutic management of this adolescent to prevent tetanus?
a.
Tetanus toxoid booster is needed because of the type of injury.
b.
Human tetanus immunoglobulin is indicated for immediate prophylaxis.
c.
Concurrent administration of both tetanus immunoglobulin and tetanus antitoxin is needed.
d.
No additional tetanus prophylaxis is indicated. The tetanus toxoid booster is protective for 10 years.
ANS: A
Protective levels of antibody are maintained for at least 10 years. Children with serious “tetanus-prone” wounds, including contaminated, crush, puncture, or burn wounds, should receive a tetanus toxoid booster prophylactically as soon as possible. This adolescent has circulating antibodies. The immunoglobulin is not indicated.
What are some of the associated disabilities seen with cerebral palsy? (Select all that apply.)
a.
Visual impairment
b.
Hearing impairment
c.
Speech difficulties
d.
Intellectual impairment
e.
Associated heart defects
ANS: A, B, C, D
Some of the disabilities associated with CP are visual impairment, hearing impairment, behavioral problems, communication and speech difficulties, seizures, and intellectual impairment. Additional sensory deficits such as hypersensitivity, hyposensitivity, and balance difficulties may occur in children with CP.
A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions?
a.
No restrictions of activity are indicated.
b.
Elevate casted arm when both upright and resting.
c.
The shoulder should be kept as immobile as possible to avoid pain.
d.
Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.
ANS: B
The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. The child should not engage in strenuous activity for the first few days. Rest with elevation of the extremity is encouraged. Joints above and below the cast on the affected extremity should be moved. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours.
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?
a.
Reposition the child and notify the practitioner.
b.
Notify the practitioner of the changes noted.
c.
Give the child medication to relieve the pain.
d.
Chart the observations and check the extremity again in 15 minutes.
ANS: B
The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. This is an emergency condition. Pain medication should be given after the practitioner is notified. The findings should be documented with ongoing assessment.
What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)?
a.
Control pain and preserve joint function.
b.
Minimize use of joint and achieve cure.
c.
Prevent skin breakdown and relieve symptoms.
d.
Reduce joint discomfort and regain proper alignment.
ANS: A
The goals of therapy are to control pain, preserve joint range of motion and function, minimize the effects of inflammation, and promote normal growth and development. There is no cure for JIA at this time. Skin breakdown is not an issue for most children with JIA. Symptom relief and reduction in discomfort are important. When the joints are damaged, it is often irreversible.
A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.)
a.
Relieve itching with heat.
b.
Elevate the arm when resting.
c.
Observe the fingers for any evidence of discoloration.
d.
Do not allow the child to put anything inside the cast.
e.
Examine the skin at the cast edges for any breakdown.
ANS: B, C, D, E
Cast care involves elevating the arm, observing the fingers for evidence of discoloration, not allowing the child to put anything inside the cast, and examining the skin at the edges of the cast for any breakdown. Ice, not heat, should be applied to relieve itching.
The nurse is preparing to admit a 2-year-old child with spina bifida occulta. What clinical manifestations of spina bifida occulta should the nurse expect to observe? (Select all that apply.)
a.
Dark tufts of hair
b.
Skin depression or dimple
c.
Port-wine angiomatous nevi
d.
Soft, subcutaneous lipomas
e.
Bladder and sphincter paralysis
ANS: A, B, C, D
Clinical manifestations of spina bifida occulta include dark tufts of hair; skin depression or dimple; port-wine angiomatous nevi; and soft, subcutaneous lipomas. Bladder and sphincter paralysis are present with spina bifida cystica but not occulta.
What statement is most accurate in describing tetanus?
a.
Inflammatory disease that causes extreme, localized muscle spasm.
b.
Disease affecting the salivary gland with resultant stiffness of the jaw.
c.
Acute infectious disease caused by an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus.
d.
Acute infection that causes meningeal inflammation resulting in symptoms of generalized muscle spasm.
ANS: C
Tetanus results from an infection by the anaerobic spore-forming, gram-positive bacillus Clostridium tetani. The organism forms two exotoxins that affect the central nervous system to produce the clinical manifestations of the disease. Tetanus is not an inflammatory process. The toxin acts at the neuromuscular junction to produce muscular stiffness and to lower the threshold for reflex excitability. It is usually a systemic disease. Initial symptoms are usually a progressive stiffness and tenderness of the muscles of the neck and jaw. The sustained contraction of the jaw-closing muscles provides the name lockjaw. Meningeal inflammation is not the cause of the muscle spasms.
