Peds – Flashcard
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Spastic cerebral palsy is characterized by which of the following? a. Hypertonicity and poor control of posture, balance, and coordinated motion b. Athetosis and dystonic movements c. Wide-based gait and poor performance of rapid, repetitive movements d. Tremors and lack of active movement
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a. Hypertonicity and poor control of posture, balance, and coordinated motion Rationale: Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy.
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The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on which of the following? a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.
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d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available. Rationale: Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation.
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A young boy has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. The management plan should include which of the following? a. Recommend genetic counseling. b. Explain that the disease is easily treated. c. Suggest ways to limit use of muscles. d. Assist family in finding a nursing facility to provide his care.
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a. Recommend genetic counseling. Rationale: Pseudohypertrophic (Duchenne) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents, female siblings, maternal aunts, and their female offspring.
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A young child who has an intelligence quotient (IQ) of 45 would be described as which of the following? a. Within the lower limits of the range of normal intelligence b. Mildly retarded but educable c. Moderately retarded but trainable d. Severely retarded and completely dependent on others for care
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c. Moderately retarded but trainable Rationale: Moderately retarded IQs range between 35 and 55.
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When a child with mild mental retardation reaches the end of adolescence, which of the following characteristics would be expected? a. Achieves a mental age of 5 to 6 years b. Achieves a mental age of 8 to 12 years c. Unable to progress in functional reading or arithmetic d. Acquires practical skills and useful reading and arithmetic to an eighth-grade level
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b. Achieves a mental age of 8 to 12 years Rationale: By the end of adolescence, the child with mild mental retardation can acquire practical skills and useful reading and arithmetic to a third- to sixth-grade level. A mental age of 8 to 12 years is obtainable, and the child can be guided toward social conformity.
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When should children with cognitive impairment be referred for stimulation and educational programs? a. As young as possible b. As soon as they have the ability to communicate in some way c. At age 3 years, when schools are required to provide services d. At age 5 or 6 years, when schools are required to provide services
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a. As young as possible Rationale: The child's education should begin as soon as possible. Considerable evidence exists that early intervention programs for children with disabilities are valuable for cognitively impaired children.
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Which of the following should be the major consideration when selecting toys for a child who is mentally retarded? a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills
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a. Safety Rationale: Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are mentally retarded.
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Appropriate interventions to facilitate socialization of the cognitively impaired child include which of the following? a. Provide age-appropriate toys and play activities. b. Provide peer experiences, such as scouting, when older. c. Avoid exposure to strangers who may not understand cognitive development. d. Emphasize mastery of physical skills because they are delayed more often than verbal skills.
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b. Provide peer experiences, such as scouting, when older. Rationale: The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to those of other children such as group outings, Boy and Girl Scouts, and Special Olympics.
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The nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. Which of the following should the nurse consider when dealing with this issue? a. Sterilization is recommended for any adolescent with cognitive impairment. b. Sexual drive and interest are limited in individuals with cognitive impairment. c. Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. d. Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused.
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c. Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. Rationale: Adolescents with moderate cognitive impairment may be easily persuaded and lack judgment. A well-defined, concrete code of conduct with specific instructions for handling certain situations should be laid out for the adolescent.
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When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is which of the following? a. Hypospadias b. Pyloric stenosis c. Congenital heart disease d. Congenital hip dysplasia
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c. Congenital heart disease Rationale: Congenital heart malformations, primarily septal defects, are the most common congenital anomaly in Down syndrome.
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Mark, a 9 year old with Down syndrome, is mainstreamed into a regular third grade for part of the school day. His mother asks the school nurse about programs, such as Cub Scouts, that he might join. The nurse's recommendation should be based on which of the following? a. Programs like Cub Scouts are inappropriate for children who are mentally retarded. b. Children with Down syndrome have the same need for socialization as other children. c. Children with Down syndrome socialize better with children who have similar disabilities. d. Parents of children with Down syndrome encourage programs, such as scouting, because they deny that their children have disabilities.
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b. Children with Down syndrome have the same need for socialization as other children. Rationale: Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics.
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What is one of the major physical characteristics of the child with Down syndrome? a. Excessive height b. Spots on the palms c. Inflexibility of the joints d. Hypotonic musculature
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d. Hypotonic musculature Rationale: Hypotonic musculature is one of the major characteristics.
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A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of which of the following? a. Microcephaly b. Down syndrome c. Cerebral palsy d. Fragile X syndrome
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b. Down syndrome Rationale: These are characteristics associated with Down syndrome.
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The child with Down syndrome should be evaluated for which of the following before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfield spots)
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c. Atlantoaxial instability Rationale: Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done.
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Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which of the following? a. Delay feeding solid foods until the tongue thrust has stopped. b. Modify diet as necessary to minimize the diarrhea that often occurs. c. Provide calories appropriate to child's age. d. Use a cool-mist vaporizer to keep mucous membranes moist.
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d. Use a cool-mist vaporizer to keep mucous membranes moist. Rationale: The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions.
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Fragile X syndrome is which of the following? a. Chromosomal defect affecting only females b. Chromosomal defect that follows the pattern of X-linked recessive disorders c. Second most common genetic cause of mental retardation d. Most common cause of noninherited mental retardation
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c. Second most common genetic cause of mental retardation Rationale: Fragile X syndrome is the second most common cause of mental retardation after Down syndrome.
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Distortion of sound and problems in discrimination are characteristic of what type of hearing loss? a. Conductive b. Sensorineural c. Mixed conductive-sensorineural d. Central auditory imperceptive
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b. Sensorineural Rationale: Sensorineural hearing loss, also known as perceptive or nerve deafness, involves damage to the inner ear structures or the auditory nerve. It results in distortion of sounds and problems in discrimination.
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The most common type of hearing loss, which results from interference of transmission of sound to the middle ear, is called: a. conductive. b. sensorineural. c. mixed conductive-sensorineural. d. central auditory imperceptive.
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a. conductive Rationale: Conductive or middle-ear hearing loss is the most common type. It results from interference of transmission of sound to the middle ear, most often from recurrent otitis media.
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Hearing is expressed in decibels (dB), or units of loudness. Which of the following is, in decibels, the softest sound a normal ear can hear? a. 0 b. 10 c. 40 to 50 d. 100
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a. 0 Ratioanle: By definition, 0 dB is the softest sound the normal ear can hear.
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The nurse should suspect a hearing impairment in an infant who demonstrates which of the following behaviors? a. Absence of the Moro reflex b. Absence of babbling by age 7 months c. Lack of eye contact when being spoken to d. Lack of gesturing to indicate wants after age 15 months
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b. Absence of babbling by age 7 months Rationale: The absence of babbling or inflections in voice by age 7 months is an indication of hearing difficulties.
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The nurse is talking with a 10-year-old boy who wears bilateral hearing aids. The left hearing aid is making an annoying whistling sound that the child cannot hear. Which of the following is the most appropriate nursing action? a. Ignore the sound. b. Ask him to reverse the hearing aids in his ears. c. Suggest he reinsert the hearing aid. d. Suggest he raise the volume of the hearing aid.
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c. Suggest he reinsert the hearing aid. Rationale: The whistling sound is acoustic feedback. The nurse should have the child remove the hearing aid and reinsert it, making certain no hair is caught between the ear mold and the ear canal.
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Which of the following is an implanted ear prosthesis for children with sensorineural hearing loss? a. Hearing aid b. Cochlear implant c. Auditory implant d. Amplification device
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b. Cochlear implant Rationale: Cochlear implants are surgically implanted, and they provide a sensation of hearing for individuals who have severe or profound hearing loss of sensorineural origin.
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Which of the following facilitates lip reading by the hearing-impaired child? a. Speak at an even rate. b. Exaggerate pronunciation of words. c. Avoid using facial expressions. d. Repeat in exactly the same way if child does not understand.
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a. Speak at an even rate. Rationale: The child should be helped to learn and understand how to read lips by speaking at an even rate.
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The most common cause of hearing impairment in children is which of the following? a. Auditory nerve damage b. Congenital ear defects c. Congenital rubella d. Chronic otitis media
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d. Chronic otitis media Rationale: Chronic otitis media is the most common cause of hearing impairment in children. It is essential that appropriate measures be instituted to treat existing infections and prevent recurrences.
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Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through which of the following? a. Being involved in immunization clinics for children b. Assessing a newborn for hearing loss c. Answering parents' questions about hearing aids d. Participating in hearing screening in the community
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a. Being involved in immunization clinics for children Rationale: Childhood immunizations can eliminate the possibility of acquired sensorineural hearing loss from rubella, mumps, or measles encephalitis.
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Which of the following terms refers to the ability to see objects clearly at close range but not at a distance? a. Myopia b. Amblyopia c. Cataract d. Glaucoma
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a. Myopia Rationale: Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not a distance.
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Which of the following terms refers to opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina? a. Myopia b. Amblyopia c. Cataract d. Glaucoma
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c. Cataract Rationale: This is the definition of a cataract.
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A nurse would suspect possible visual impairment in a child who displays which of the following? a. Excessive rubbing of the eyes b. Rapid lateral movement of the eyes c. Delay in speech development d. Lack of interest in casual conversation with peers
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a. Excessive rubbing of the eyes Rationale: Excessive rubbing of the eyes is a clinical manifestation of visual impairment.
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When assessing the eyes of a neonate, the nurse observes opacity of the lens. This represents which of the following? a. Blindness b. Glaucoma c. Cataracts d. Retinoblastoma
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c. Cataracts Rationale: A cataract is opacity of the lens of the eye.
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The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which of the following? a. Apply a regular eye patch. b. Apply a Fox shield to affected eye and any type of patch to the other eye. c. Apply ice until the physician is seen. d. Irrigate eye copiously with a sterile saline solution.
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b. Apply a Fox shield to affected eye and any type of patch to the other eye Rationale: The nurse's role in a penetrating eye injury is to prevent further injury to the eye. A Fox shield (if available) should be applied to the injured eye, and a regular eye patch to the other eye to prevent bilateral movement.
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A father calls the emergency department nurse saying that his daughter's eyes burn after getting some dishwasher detergent in them. The nurse recommends that the child be seen in the emergency department or by an ophthalmologist. The nurse also should recommend which of the following before the child is transported? a. Keep eyes closed. b. Apply cold compresses. c. Irrigate eyes copiously with tap water for 20 minutes. d. Prepare a normal saline solution (salt and water) and irrigate eyes for 20 minutes.
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c. Irrigate eyes copiously with tap water for 20 minutes Rationale: The first action is to flush the eyes with clean tap water. This will rinse the detergent from the eyes.
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An adolescent gets hit in the eye during a fight. The school nurse, using a flashlight, notes the presence of gross hyphema (hemorrhage into anterior chamber). The nurse should: a. apply a Fox shield. b. instruct the adolescent to apply ice for 24 hours. c. have adolescent rest with eye closed and ice applied. d. notify parents that adolescent needs to see an ophthalmologist.
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d. notify parents that adolescent needs to see an ophthalmologist. Rationale: The parents should be notified that the adolescent needs to see an ophthalmologist as soon as possible.
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The nurse is talking to the parent of a 13-month-old child. The mother states, "My child does not make noises like 'da' or 'na' like my sister's baby, who is only 9 months old." Which of the following statements by the nurse would be most appropriate to make? a. "I am going to request a referral to a hearing specialist." b. "You should not compare your child to your sister's child." c. "I think your child is fine, but we will check again in 3 months." d. "You should ask other parents what noises their children made at this age."
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a. "I am going to request a referral to a hearing specialist." Rationale: By 11 months of age a child should be making well-formed syllables such as 'da' or 'na' and should be referred to a specialist if not.
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The diagnosis of intellectual disability is based on the presence of a. intelligence quotient (IQ) of 75 or less. b. IQ of 70 or less. c. subaverage intellectual functioning, deficits in adaptive skills, and onset at any age. d. subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.
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d. subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.
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The primary goal in caring for the child with cognitive impairment is to a. encourage play. b. promote optimum development. c. help families develop a care plan and have them stay with it. d. develop vocational skills
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b. promote optimum development.
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The parents of a cognitively impaired child ask the nurse for guidance with discipline. The most appropriate recommendation by the nurse is that a. discipline is ineffective with cognitively impaired children. b. discipline is not necessary for cognitively impaired children. c. behavior modification is an excellent form of discipline. d. physical punishment is the most appropriate form of discipline.
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c. behavior modification is an excellent form of disciplin
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The genetic testing of a child with Down syndrome showed that the disorder was caused by chromosomal translocation. The parents ask about further genetic testing. Based on the nurse's knowledge of genetics, the most appropriate recommendation is a.no further genetic testing of the family is indicated. b. the child should be retested to confirm the diagnosis of Down syndrome. c. the mother should be tested if she is over age 35. d. the parents can be tested, since it might be hereditary.
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d. the parents can be tested, since it might be hereditary.
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A 2-week-old infant with Down syndrome is being seen in the clinic. The mother tells the nurse that the infant is difficult to hold. "The baby is like a rag doll and doesn't cuddle up to me like my other babies did." The nurse interprets the infant's behavior as a a. sign of maternal deprivation. b. sign of detachment and rejection. c. sign of autism associated with Down syndrome. d. result of the physical characteristics of Down syndrome.
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d. result of the physical characteristics of Down syndrome.
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The parents of a child with fragile X syndrome want to have another baby. They tell the nurse that they worry another child might be similarly affected. What is the most appropriate nursing action? a. Reassure them that the syndrome is not inherited. b. Assess for family history of the syndrome. c. Recommend that they do not have another child. d. Explain that prenatal diagnosis of the syndrome is now available.
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d. Explain that prenatal diagnosis of the syndrome is now available.
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A 6-year-old has difficulty hearing faint or distant speech. The child's speech is normal, but the child is having problems with school performance. This hearing loss would most likely be classified as a. slight. b. severe. c. moderate. d. inattentiveness rather than hearing loss.
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a. slight.
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Early detection of a hearing impairment is critical because of its effect on a variety of areas of a child's life. Which one is of primary importance? a. Reading development b. Speech development c. Relationships with peers d. Performance at school
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b. Speech development
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What is defined as reduced visual acuity in one eye despite appropriate optical correction? a. Myopia b. Hyperopia c. Amblyopia d. Astigmatism
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c. Amblyopia
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A 5-year-old has bilateral eye patches in place after surgery one day earlier. Today, the child can be out of bed. The most appropriate nursing intervention is to a. reassure the child and allow the parents to stay b. allow the child to assist in self-feeding c. speak to the child when entering the room d. orient the child to the immediate surroundings
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d. orient the child to the immediate surroundings
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The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. What is the priority assessment for this child? a. Reactivity of pupils b. Doll's head maneuver c. Oculovestibular response d. Funduscopic examination to identify papilledema
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a. Reactivity of pupils
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The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain a. cannot occur if the child is comatose. b. may occur if the child regains consciousness. c. requires astute nursing assessment and management. d. is best assessed by family members who are familiar with the child.
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c. requires astute nursing assessment and management.
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The nurse is caring for a 2-year-old child who is unconscious but stable after a car accident. The child's parents are staying at the bedside most of the time. What is an appropriate nursing intervention? a. Suggest that the parents go home until the child is alert enough to know they are present. b. Use ointment on the lips but do not attempt to cleanse the teeth until swallowing returns. c. Encourage the parents to hold, talk to, and sing to the child as they usually would. d. Position the child with proper body alignment and the head of the bed lowered 15 degrees.
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c. Encourage the parents to hold, talk to, and sing to the child as they usually would.
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Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is a. birth asphyxia b. neonatal diseases c. cerebral trauma d. prenatal brain abnormalities
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d. prenatal brain abnormalities
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The major goal of therapy for children with cerebral palsy (CP) is a. reversing degenerative processes that have occurred. b. curing the underlying defect causing the disorder. c. preventing spread to individuals in close contact with the children. d. recognizing the disorder early and promoting optimal development.
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d. recognizing the disorder early and promoting optimal development.
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A 3-year-old has cerebral palsy (CP) and is hospitalized for orthopedic surgery. The child's mother states the child has difficulty swallowing and cannot hold a utensil to self-feed. The child is slightly underweight for height. What is the most appropriate nursing action related to feeding? a. Bottle-feed or tube-feed the child with a specialized formula until sufficient weight is gained. b. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing. c. Place the child in a well-supported, semireclining position to make use of gravity flow. d. Place the child in a sitting position with the neck hyperextended to make use of gravity flow.
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b. Stabilize the child's jaw with one hand (either from a front or side position) to facilitate swallowing.
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An 8-year-old has been diagnosed with moderate cerebral palsy (CP). The child recently began participation in a regular classroom for part of the day. The child's mother asks the school nurse about joining the after-school Scout troop. The nurse's response should be based on knowledge that a. most activities such as Scouts cannot be adapted for children with CP. b. after-school activities usually result in extreme fatigue for children with CP. c. trying to participate in activities such as Scouts leads to lowered self-esteem in children with CP. d. after-school activities often provide children with CP with opportunities for socialization and recreation.
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d. after-school activities often provide children with CP with opportunities for socialization and recreation.
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A neural tube defect that is not visible externally in the lumbosacral area would be called a. meningocele. b. myelomeningocele. c. spina bifida cystica. d. spina bifida occulta.
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d. spina bifida occulta.
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Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy (DMD)? a. DMD is inherited as an autosomal dominant disorder. b. DMD is characterized by weakness of the proximal muscles of both the pelvic and shoulder girdles. c. DMD is characterized by muscle weakness, usually beginning at about age 3 years. d. The onset of DMD occurs in later childhood and adolescence.
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c. DMD is characterized by muscle weakness, usually beginning at about age 3 years.
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An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome). When explaining this disease process to the parents, what should the nurse consider? a. Paralysis is progressive, with little hope for recovery. b. Muscle function will gradually return, and recovery is possible in most children. c. Guillain-Barré syndrome results from an apparently toxic reaction to certain medications. d. Guillain-Barré syndrome is inherited as an autosomal recessive, sex-linked gene.
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b. Muscle function will gradually return, and recovery is possible in most children.
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Mr. and Mrs. Foster have come to a genetics clinic because she is 40 years old and pregnant for the first time. They seek advice regarding Down syndrome (DS). Provide answers to the following questions about Down syndrome that the Fosters ask. (1 of 4 questions) We understand there are different types of DS. What is the most frequent type?
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92% to 95% of cases are due to an extra chromosome 21, or trisomy 21 Rationale: Although the etiology is unknown, the cytogenetics of the disorder is well established. Additional forms of DS include translocation of chromosome 21 and mosaicism, which refers to cells with both normal and abnormal chromosomes.
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Mr. and Mrs. Foster have come to a genetics clinic because she is 40 years old and pregnant for the first time. They seek advice regarding Down syndrome (DS). Provide answers to the following questions about Down syndrome that the Fosters ask. (2 of 4 questions) Is there a test that can provide a prenatal diagnosis of DS?
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Amniocentesis with chromosomal analysis or chorionic villus sampling with chromosomal analysis Rationale: These tests allow for chromosomal analysis of fetal cells, which can detect the presence of trisomy or translocation.
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Mr. and Mrs. Foster have come to a genetics clinic because she is 40 years old and pregnant for the first time. They seek advice regarding Down syndrome (DS). Provide answers to the following questions about Down syndrome that the Fosters ask. (3 of 4 questions)
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Rationale: A variety of congenital anomalies, sensory problems, and other physical disorders occur in children with DS, including: • Congenital heart defect in 30% to 40% • Renal agenesis • Duodenal atresia • Patella dislocation • Hip subluxation • Atlantoaxial instability • Tracheoesophageal fistula • Hirschsprung disease • Strabismus • Nystagmus • Astigmatism • Myopia • Hyperopia • Altered immune function
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Mr. and Mrs. Foster have come to a genetics clinic because she is 40 years old and pregnant for the first time. They seek advice regarding Down syndrome (DS). Provide answers to the following questions about Down syndrome that the Fosters ask. (4 of 4 questions) What is the risk of having a child with DS when a mother is 40?
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1 in 106 Rationale: This statistic is the relationship between the maternal age at the expected time of delivery and the estimated risk of DS.
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Case #1: Cerebral Palsy (1 of 3) Tony is a 2-year-old boy who was born 8 weeks prematurely. He has been diagnosed with spastic cerebral palsy (CP). Identify five clinical signs or symptoms that are seen in children with spastic CP.
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1. Increased muscle tone 2. Increased deep tendon reflexes and clonus (sudden dorsiflexion of the ankle or rapid distal movement of the patella resulting in alternating spasm and relaxation of the muscles being stretched) 3. Flexor, adductor, and internal rotator muscles more involved than extensor, abductor, and external rotator muscles 4. Difficulty with fine and gross motor skills 5. Most common contracture is that of the heel cord. 6. Hip adductor contractures leading to progressive subluxation and dislocation 7. Knee contractures 8. Scoliosis common 9. Typical gait is crouched, in-toeing, and scissoring. 10. Elbow, wrist, and fingers in flexed position with thumb adducted 11. Motor weakness of antagonist muscle groups
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Case #1: Cerebral Palsy (2 of 3) Tony is a 2-year-old boy who was born 8 weeks prematurely. He has been diagnosed with spastic cerebral palsy (CP).
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Poor head control after 3 months of age Stiff or rigid arms or legs Pushing away or arching back Floppy or limp body posture Inability to sit up without support by 8 months Use of only one side of the body, or only the arms to crawl Behavioral Signs Extreme irritability or crying Failure to smile by 3 months Feeding difficulties Persistent gagging or choking when fed After 6 months of age, tongue pushing soft food out of the mouth
