Wongs Essentials of Pediatric Nursing 9 Part 2 of 2 By Maryln Test Bank

Wongs Essentials of Pediatric Nursing 9 Part 2 of 2 By Maryln  Test Bank
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WITH ANSWERS
Wongs Essentials of Pediatric Nursing 9 Part 2 of 2 By Maryln Test Bank

Chapter 14: Health Problems of Toddlers and Preschoolers

 

MULTIPLE CHOICE

 

  1. Which is described as the time interval between infection or exposure to disease and appearance of initial symptoms?
  2. Incubation period
  3. Prodromal period
  4. Desquamation period
  5. Period of communicability

 

 

ANS:      A

The incubation period is the interval between infection or exposure and appearance of symptoms. The prodromal period is the interval between the time when early manifestations of disease appear and the overt clinical syndrome is evident. Desquamation refers to the shedding of skin. The period of communicability is the time or times during which an infectious agent may be transferred directly or indirectly from an infected person to another person.

 

PTS:       1              DIF:        Cognitive Level: Remember        REF:       424

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Airborne isolation is required for a child who is hospitalized with:
  2. mumps.
  3. chickenpox.
  4. exanthema subitum (roseola).
  5. erythema infectiosum (fifth disease).

 

 

ANS:      B

Chickenpox is communicable through direct contact, droplet spread, and contaminated objects. Mumps is transmitted from direct contact with saliva of infected person and is most communicable before onset of swelling. The transmission and source of the viral infection exanthema subitum (roseola) is unknown. Erythema infectiosum (fifth disease) is communicable before onset of symptoms.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       424

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Safe and Effective Care Environment

 

  1. Acyclovir (Zovirax) is given to children with chickenpox to:
  2. minimize scarring.
  3. decrease the number of lesions.
  4. prevent aplastic anemia.
  5. prevent spread of the disease.

 

 

ANS:      B

Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia. Treating pruritus and discouraging itching minimizes scarring. Aplastic anemia is not a complication of chickenpox. Strict isolation until vesicles are dried prevents spread of disease.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       429-430

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. The single parent of a 3-year-old child who has just been diagnosed with chickenpox tells the nurse that she cannot afford to stay home with the child and miss work. The parent asks the nurse if some medication will shorten the course of the illness. Which is the most appropriate nursing intervention?
  2. Reassure the parent that it is not necessary to stay home with the child.
  3. Explain that no medication will shorten the course of the illness.
  4. Explain the advantages of the medication acyclovir (Zovirax) to treat chickenpox.
  5. Explain the advantages of the medication VCZ immune globulin (VariZIG) to treat chickenpox.

 

 

ANS:      C

Acyclovir is effective in treating the number of lesions; shortening the duration of fever; and decreasing itching, lethargy, and anorexia. It is important the parent stay with the child to monitor fever. Acyclovir lessens the severity of chickenpox. VariZIG is given only to high-risk children.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       429-430

TOP:      Integrated Process: Teaching/Learning

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Which may be given to high-risk children after exposure to chickenpox to prevent varicella?
  2. Acyclovir (Zovirax)
  3. Varicella globulin
  4. Diphenhydramine hydrochloride (Benadryl)
  5. VCZ immune globulin (VariZIG)

 

 

ANS:      D

VariZIG is given to high-risk children to prevent the development of chickenpox. Acyclovir decreases the severity, not the development, of chickenpox. Varicella globulin is not effective because it is not the immune globulin. Diphenhydramine may help pruritus but not the actual chickenpox.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       429

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Vitamin A supplementation may be recommended for the young child who has which disease?
  2. Mumps
  3. Rubella
  4. Measles (rubeola)
  5. Erythema infectiosum

 

 

ANS:      C

Evidence shows vitamin A decreases morbidity and mortality in measles. Mumps is treated with analgesics for pain and antipyretics for fever. Rubella is treated similarly to mumps. Erythema infectiosum is treated similarly to mumps and rubella.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       431

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A nurse is teaching parents about caring for their child with chickenpox. The nurse should let the parents know that the child is considered to be no longer contagious when which occurs?
  2. When fever is absent
  3. When lesions are crusted
  4. 24 hours after lesions erupt
  5. 8 days after onset of illness

 

 

ANS:      B

When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. Chickenpox is still contagious when child has fever. Children are contagious after lesions erupt. If lesions are crusted at 8 days, the child is no longer contagious.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       424

TOP:      Integrated Process: Teaching/Learning

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A nurse is assessing a child and notes Koplik spots. In which of these communicable diseases are Koplik spots present?
  2. Rubella
  3. Measles (rubeola)
  4. Chickenpox (varicella)
  5. Exanthema subitum (roseola)

 

 

ANS:      B

Koplik spots are small irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Rubella occurs with rash on the face, which rapidly spreads downward. Varicella appears with highly pruritic macules, followed by papules and vesicles. Roseola is seen with rose-pink macules on the trunk, spreading to face and extremities.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       426

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Which is a common childhood communicable disease that may cause severe defects in the fetus when it occurs in its congenital form?
  2. Erythema infectiosum
  3. Roseola
  4. Rubeola
  5. Rubella

 

 

ANS:      D

Rubella causes teratogenic effects on the fetus. There is a low risk of fetal death to those in contact with children affected with fifth disease. Roseola and rubeola are not dangerous to the fetus.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       428

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Which is the causative agent of scarlet fever?
  2. Enteroviruses
  3. Corynebacterium organisms
  4. Scarlet fever virus
  5. Group A -hemolytic streptococci (GABHS)

 

 

ANS:      D

GABHS infection causes scarlet fever. Enteroviruses do not cause the same complications. Corynebacterium organisms cause diphtheria. Scarlet fever is not caused by a virus.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       428

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A parent reports to the nurse that her child has inflamed conjunctivae of both eyes with purulent drainage and crusting of the eyelids, especially on awakening. These manifestations suggest:
  2. viral conjunctivitis.
  3. allergic conjunctivitis.
  4. bacterial conjunctivitis.
  5. conjunctivitis caused by foreign body.

 

 

ANS:      C

Bacterial conjunctivitis has these symptoms. Viral or allergic conjunctivitis has watery drainage. Foreign body causes tearing and pain, and usually only one eye is affected.

 

PTS:       1              DIF:        Cognitive Level: Analyze               REF:       432

TOP:      Integrated Process: Nursing Process: Evaluation

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Which is an important nursing consideration when caring for a child with herpetic gingivostomatitis (HGS)?
  2. Apply topical anesthetics before eating.
  3. Drink from a cup, not a straw.
  4. Wait to brush teeth until lesions are sufficiently healed.
  5. Explain to parents how this is sexually transmitted.

 

 

ANS:      A

Treatment for HGS is aimed at relief of pain. Drinking bland fluids through a straw helps avoid painful lesions. Mouth care is encouraged with a soft toothbrush. HGS is usually caused by herpes simplex virus type 1, which is not associated with sexual transmission.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       433

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A parent has asked the nurse about how her child can be tested for pinworms. The nurse responds by stating that which is the most common test for diagnosing pinworms in a child?
  2. Lower gastrointestinal (GI) series
  3. Three stool specimens, at intervals of 4 days
  4. Observation for presence of worms after child defecates
  5. Laboratory examination of a fecal smear

 

 

ANS:      D

Laboratory examination of substances containing the worm, its larvae, or ova can identify the organism. Most are identified by examining fecal smears from the stools of persons suspected of harboring the parasite. Fresh specimens are best for revealing parasites or larvae. Lower GI series is not helpful for diagnosing enterobiasis. Stool specimens are not necessary to diagnose pinworms. Worms will not be visible after child defecates.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       433

TOP:      Integrated Process: Teaching/Learning

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. The nurse suspects that a child has ingested some type of poison. Which clinical manifestation would be most suggestive that the poison was a corrosive product?
  2. Tinnitus
  3. Disorientation
  4. Stupor, lethargy, coma
  5. Edema of lips, tongue, pharynx

 

 

ANS:      D

Edema of lips, tongue, and pharynx indicates a corrosive ingestion. Tinnitus is indicative of aspirin ingestion. Corrosives do not act on the central nervous system (CNS).

 

PTS:       1              DIF:        Cognitive Level: Analyze               REF:       437

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A young boy is found squirting lighter fluid into his mouth. His father calls the emergency department. The nurse taking the call should know that the primary danger is which result?
  2. Hepatic dysfunction
  3. Dehydration secondary to vomiting
  4. Esophageal stricture and shock
  5. Bronchitis and chemical pneumonia

 

 

ANS:      D

Lighter fluid is a hydrocarbon. The immediate danger is aspiration. Acetaminophen overdose, not hydrocarbons, causes hepatic dysfunction. Dehydration is not the primary danger. Esophageal stricture is a late or chronic issue of hydrocarbon ingestion.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       438

TOP:      Integrated Process: Nursing Process: Diagnosis

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Which is a clinical manifestation of acetaminophen poisoning?
  2. Hyperpyrexia
  3. Hepatic involvement
  4. Severe burning pain in stomach
  5. Drooling and inability to clear secretions

 

 

ANS:      B

Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach or pose an airway threat.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       438

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Acute salicylate (ASA, aspirin) poisoning results in:
  2. chemical pneumonitis.
  3. hepatic damage.
  4. retractions and grunting.
  5. disorientation and loss of consciousness.

 

 

ANS:      D

ASA poisoning causes disorientation and loss of consciousness. Chemical pneumonitis is caused by hydrocarbon ingestion. Hepatic damage is caused by acetaminophen overdose. ASA does not cause airway obstruction.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       438

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A young child has just arrived at the emergency department after ingestion of aspirin at home. The practitioner has ordered activated charcoal. The nurse administers charcoal in which way?
  2. Administer through a nasogastric tube because the child will not drink it because of the taste.
  3. Serve in a clear plastic cup so the child can see how much has been drunk.
  4. Give half of the solution, and then give the other half in 1 hour.
  5. Serve in an opaque container with a straw.

 

 

ANS:      D

Although the activated charcoal can be mixed with a flavorful beverage, it will be black and resemble mud. When it is served in an opaque container, the child does not have any preconceived ideas about its being distasteful. The nasogastric tube should be used only in children without a gag reflex. The ability to see the charcoal solution may affect the childs desire to drink it. The child should be encouraged to drink the solution all at once.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       440

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Which is the most frequent source of acute childhood lead poisoning?
  2. Folk remedies
  3. Unglazed pottery
  4. Lead-based paint
  5. Cigarette butts and ashes

 

 

ANS:      C

Lead-based paint in houses built before 1978 is the most frequent source of lead poisoning. Some folk remedies and unglazed pottery may contain lead, but they are not the most frequent source. Cigarette butts and ashes do not contain lead.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       441-442

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Chelation therapy for lead poisoning is initiated when a childs blood level is _____ g/dl.
  2. 10 to 14
  3. 15 to 19
  4. 20 to 44
  5. >45

 

 

ANS:      D

Chelation therapy is initiated if the childs blood level is greater than 45 g/dl. At 10 to 14 g/dl, the family should have lead-poisoning education and follow-up level. At 15 to 19 g/dl, the family should have lead-poisoning education and follow-up level but if it persists, initiate environmental investigation. At 20 to 44 g/dl environmental investigation and lead hazard control are necessary.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       444

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. Which describes a child who is abused by the parent(s)?
  2. Unintentionally contributes to the abusing situation
  3. Belongs to a low socioeconomic population
  4. Is healthier than the nonabused siblings
  5. Abuses siblings in the same way as child is abused by the parent(s)

 

 

ANS:      A

Childs temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contribute to the abusing situation. Abuse occurs among all socioeconomic levels. Children who are ill or have additional physical needs are more likely to be abused. The abused child may not abuse siblings.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       447

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Psychosocial Integrity

 

  1. Which is a common characteristic of those who sexually abuse children?
  2. Pressure victim into secrecy
  3. Are usually unemployed and unmarried
  4. Are unknown to victims and victims families
  5. Have many victims that are each abused once only

 

 

ANS:      A

Sex offenders may pressure the victim into secrecy regarding the activity as a secret between us that other people may take away if they find out. The offender may be anyone, including family members and persons from any level of society. Sex offenders are usually trusted acquaintances of the victims and victims families. Many victims are abused many times over a long period.

 

PTS:       1              DIF:        Cognitive Level: Understand       REF:       447

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Psychosocial Integrity

 

  1. A 3-month-old infant dies shortly after arrival to the emergency department. The infant has subdural and retinal hemorrhages but no external signs of trauma. The nurse should suspect:
  2. unintentional injury.
  3. shaken-baby syndrome.
  4. sudden infant death syndrome (SIDS).
  5. congenital neurologic problem.

 

 

ANS:      B

Shaken-baby syndrome causes internal bleeding but may have no external signs. Unintentional injury would not cause these injuries. SIDS and congenital neurologic problems would not appear this way.

 

PTS:       1              DIF:        Cognitive Level: Analyze               REF:       446

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Psychosocial Integrity

 

  1. Which is probably the most important criterion on which to base the decision to report suspected child abuse?
  2. Inappropriate parental concern for the degree of injury
  3. Absence of parents for questioning about childs injuries
  4. Inappropriate response of child
  5. Incompatibility between the history and injury observed

 

 

ANS:      D

Conflicting stories about the accident are the most indicative red flags of abuse. Inappropriate response of caregiver or child may be present, but is subjective. Parents should be questioned at some point during the investigation.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       449

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Psychosocial Integrity

 

  1. A nurse is admitting a child to the hospital with a diagnosis of giardiasis. Which medication should the nurse expect to be prescribed?
  2. Metronidazole (Flagyl)
  3. Amoxicillin clavulanate (Augmentin)
  4. Clarithromycin (Biaxin)
  5. Prednisone (Orapred)

 

 

ANS:      A

The drugs of choice for treatment of giardiasis are metronidazole (Flagyl), tinidazole (Tindamax), and nitazoxanide (Alinia). These are classified as antifungals. Amoxicillin and clarithromycin are antibiotics that treat bacterial infections. Prednisone is a steroid and is used as an anti-inflammatory medication.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       435

TOP:      Integrated Process: Nursing Process: Planning

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A nurse is beginning chelation therapy on a child for lead poisoning. Which intervention should the nurse implement during the time the child is receiving chelation therapy?
  2. Calorie counts
  3. Strict intake and output
  4. Telemetry monitoring
  5. Contact isolation

 

 

ANS:      B

Because calcium disodium edetate (EDTA) and lead are toxic to the kidneys, a nurse should keep strict records of intake and output to monitor renal functioning. Adequate hydration is essential during therapy because the chelates are excreted via the kidneys. Calorie counts, telemetry, or contact isolation would not be nursing interventions appropriate for a child undergoing chelation therapy.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       444

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A child has been admitted to the emergency department with an acetaminophen (Tylenol) poisoning. An antidote is being prescribed by the health care provider. Which antidote should the nurse prepare to administer?
  2. Naloxone (Narcan)
  3. N-acetylcysteine (Mucomyst)
  4. Flumazenil (Romazicon)
  5. Digoxin immune Fab (Digibind)

 

 

ANS:      B

Antidotes available to treat toxin ingestion include N-acetylcysteine for acetaminophen poisoning, naloxone for opioid overdose, flumazenil (Romazicon) for benzodiazepines (diazepam [Valium], midazolam [Versed]) overdose, and digoxin immune Fab (Digibind) for digoxin toxicity.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       440

TOP:      Integrated Process: Nursing Process: Planning

MSC:     Area of Client Needs: Physiologic Integrity

 

  1. A clinic nurse is assessing a child with erythema infectiosum (fifth disease). Which figure depicts the rash the nurse should expect to assess?
  2. c.
  3. d.

 

 

ANS:      A

Erythema infectiosum rash appears in three stages: erythema on face, chiefly on cheeks (slapped face appearance); disappears by 1-4 days. Chicken pox rash begins as macule, rapidly progresses to papule and then vesicle (surrounded by erythematous base; becomes umbilicated and cloudy; breaks easily and forms crusts); all three stages (papule, vesicle, crust) present in varying degrees at one time. Roseola rash is discrete rose-pink macules or maculopapules appearing first on trunk and then spreading to neck, face, and extremities; nonpruritic; fades on pressure; lasts 1-2 days. Rubeola rashappears 3-4 days after onset of prodromal stage; begins as erythematous maculopapular eruption on face and gradually spreads downward; more severe in earlier sites (appears confluent) and less intense in later sites (appears discrete); after 3-4 days, assumes brownish appearance, and fine desquamation occurs over area of extensive involvement.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       425

TOP:      Integrated Process: Nursing Process: Assessment

MSC:     Area of Client Needs: Physiologic Integrity

 

MULTIPLE RESPONSE

 

  1. A nurse is teaching parents methods to reduce lead levels in their home. Which should the nurse include in the teaching? (Select all that apply.)
  2. Plant bushes around the outside of the house.
  3. Ensure your child eats frequent meals.
  4. Use hot water from the tap when boiling vegetables.
  5. Food can be stored in ceramic in the refrigerator.
  6. Ensure that your childs diet contains sufficient iron and calcium.

 

 

ANS:      A, B, E

Methods to reduce lead levels in homes include: planting bushes around the outside of the house, if soil is contaminated with lead, so children cannot play there; ensuring that children eat regular meals because more lead is absorbed on an empty stomach; and ensuring that childrens diets contain sufficient iron and calcium. Cold water should only be used for drinking, cooking, and reconstituting powder infant formula. Hot water dissolves lead more quickly than cold water and thus contains higher levels of lead. Do not use pottery or ceramic ware that was inadequately fired or is meant for decorative use for food storage or service.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       445

TOP:      Integrated Process: Teaching/Learning

MSC:     Area of Client Needs: Health Promotion and Maintenance

 

ESSAY

 

  1. Place in order the correct sequence for emergency treatment of poisoning in a child. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d).
  2. Locate the poison.
  3. Assess the child.
  4. Prevent absorption of poison.
  5. Terminate exposure to the toxic substance.

 

ANS:

b, d, a, c

The initial step in treating poisonings is to assess the child, treat immediate life-threatening conditions, and initiate cardiopulmonary resuscitation (CPR) if indicated. Terminating the exposure to the toxic substance is the second step. Locating the poison for identification is the third step. Preventing absorption of poison is the fourth step.

 

PTS:       1              DIF:        Cognitive Level: Apply   REF:       437

TOP:      Integrated Process: Nursing Process: Implementation

MSC:     Area of Client Needs: Physiologic Integrity

 

Chapter 32: The Child with Neuromuscular or Muscular Dysfunction

 

MULTIPLE CHOICE

 

  1. The nurse is planning a staff in-service on childhood spastic cerebral palsy. Spastic cerebral palsy is characterized by:
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.

 

 

ANS:  A

Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy. Athetosis and dystonic movements are part of the classification of dyskinetic (athetoid) cerebral palsy. Wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic cerebral palsy. Tremors and lack of active movement may indicate other neurologic disorders.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1092

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their childs spasticity. The nurses response should be based on which statement?
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.

 

 

ANS:  D

Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1094

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

 

  1. The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborns defect?
a. Fissure in the spinal column that leaves the meninges and the spinal cord exposed
b. Herniation of the brain and meninges through a defect in the skull
c. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements
d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

 

 

ANS:  D

A myelomeningocele is a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid, but no neural elements.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1098

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is conducting a staff in-service on common problems associated with myelomeningocele. Which common problem is associated with this defect?
a. Hydrocephalus
b. Craniosynostosis
c. Biliary atresia
d. Esophageal atresia

 

 

ANS:  A

Hydrocephalus is a frequently associated anomaly in 80% to 90% of children. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresia is not associated with myelomeningocele.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1100

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is teaching a group of nursing students about newborns born with the congenital defect of myelomeningocele. Which common problem is associated with this defect?
a. Neurogenic bladder
b. Mental retardation
c. Respiratory compromise
d. Cranioschisis

 

 

ANS:  A

Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children. Risk of mental retardation is minimized through early intervention and management of hydrocephalus. Respiratory compromise is not a common problem in myelomeningocele. Cranioschisis is a skull defect through which various tissues protrude. It is not associated with myelomeningocele.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1101

TOP:   Integrated Process: Teaching/Learning

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. The nurse is reviewing prenatal vitamin supplements with an expectant client. Which supplement should be included in the teaching?
a. Vitamin A throughout pregnancy
b. Multivitamin preparations as soon as pregnancy is suspected
c. Folic acid for all women of childbearing age
d. Folic acid during the first and second trimesters of pregnancy

 

 

ANS:  C

The widespread use of folic acid among women of childbearing age has decreased the incidence of spina bifida significantly. Vitamin A is not related to the prevention of spina bifida. Folic acid supplementation is recommended for the preconception period and during the pregnancy. Only 42% of women actually follow these guidelines.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1102

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

 

  1. How much folic acid is recommended for women of childbearing age?
a. 1.0 mg
b. 0.4 mg
c. 1.5 mg
d. 2.0 mg

 

 

ANS:  B

It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of cases of neural tube defects; 1.0 mg is too low a dose; 1.5 to 2.0 mg are not the recommended dosages of folic acid.

 

PTS:   1                    DIF:    Cognitive Level: Remember           REF:   1102

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

 

  1. The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is which position?
a. Prone and tube-fed
b. Prone, head turned to side, and nipple-fed
c. Supine in an infant carrier and nipple-fed
d. Supine, with defect supported with rolled blankets, and nipple-fed

 

 

ANS:  B

In the prone position, feeding is a problem. The infants head is turned to one side for feeding. If the child is able to nipple-feed, tube feeding is not needed. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   1103

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

 

  1. The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching?
a. My child will have an allergic reaction if he comes in contact with yeast products.
b. My child may have an upset stomach if he eats a food made with wheat or barley.
c. My child will probably develop an allergy to peanuts.
d. My child should not eat bananas or kiwis.

 

 

ANS:  D

There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts. Children with a latex allergy will not develop allergies to other food products such as yeast, wheat, barley, or peanuts.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   1104

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which action?
a. Avoid using any latex product.
b. Use only nonallergenic latex products.
c. Administer medication for long-term desensitization.
d. Teach family about long-term management of asthma.

 

 

ANS:  A

Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. There are no nonallergenic latex products. At this time, desensitization is not an option. The child does not have asthma. The parents must be taught about allergy and the risk of anaphylaxis.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   1104

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease?
a. Spinal muscular atrophy
b. Neural atrophy of muscles
c. Progressive weakness and wasting of skeletal muscle
d. Pseudohypertrophy of certain muscle groups

 

 

ANS:  C

Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). It is characterized by progressive weakness and wasting of skeletal muscle caused by degeneration of anterior horn cells. Kugelberg-Welander disease is a juvenile spinal muscular atrophy with a later onset. Charcot-Marie-Tooth disease is a form of progressive neural atrophy of muscles supplied by the peroneal nerves. Progressive weakness is found of the distal muscles of the arms and feet. Duchenne muscular dystrophy is characterized by muscles, especially in the calves, thighs, and upper arms, which become enlarged from fatty infiltration and feel unusually firm or woody on palpation. The term pseudohypertrophy is derived from this muscular enlargement.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1105

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. Which clinical manifestations in an infant would be suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)?
a. Hyperactive deep tendon reflexes
b. Hypertonicity
c. Lying in the frog position
d. Motor deficits on one side of body

 

 

ANS:  C

The infant lies in the frog position with the legs externally rotated, abducted, and flexed at knees. The deep tendon reflexes are absent. The child has hypotonia and inactivity as the most prominent features. The motor deficits are bilateral.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1105

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

 

  1. A 4-year-old child has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. The management plan should include which action?
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.

 

 

ANS:  A

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. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimal function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid wheelchair confinement for a longer time. Assisting the family in finding a nursing facility to provide his care is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated, the family may consider home-based care, a skilled nursing facility, or respite care to provide the necessary care.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1109

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. Therapeutic management of a child with tetanus includes the administration of:
a. nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation.
b. muscle stimulants to counteract muscle weakness.
c. bronchodilators to prevent respiratory complications.
d. tetanus immunoglobulin therapy.

 

 

ANS:  D

Tetanus immunoglobulin therapy, to neutralize toxins, is the most specific therapy for tetanus. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants, opioids, and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

 

PTS:   1                    DIF:    Cognitive Level: Understand          REF:   1112

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

 

  1. The nurse is conducting reflex testing on infants at a well-child clinic. Which reflex finding should be reported as abnormal and considered as a possible sign of cerebral palsy?
a. Tonic neck reflex at 5 months of age
b. Absent Moro reflex at 8 months of age
c. Moro reflex at 3 months of age
d. Extensor reflex at 7 months of age

 

 

ANS:  D

Establishing a diagnosis of cerebral palsy (CP) may be confirmed with the persistence of primitive reflexes: (1) either the asymmetric tonic neck reflex or persistent Moro reflex (beyond 4 months of age) and (2) the crossed extensor reflex. The tonic neck reflex normally disappears between 4 and 6 months of age. The crossed extensor reflex, which normally disappears by 4 months, is elicited by applying a noxious stimulus to the sole of one foot with the knee extended. Normally, the contralateral foot responds with extensor, abduction, and then adduction movements. The possibility of CP is suggested if these reflexes occur after 4 months.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   1091

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac?
a. Open to air
b. Covered with a sterile moist nonadherent dressing
c. Reinforcement of the original dressing if drainage noted
d. A diaper secured over the dressing

 

 

ANS:  B

Before surgical closure, the myelomeningocele is prevented from drying by the application of a sterile, moist, nonadherent dressing over the defect. The moistening solution is usually sterile normal saline. Dressings are changed frequently (every 2 to 4 hours), and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The sac must be carefully cleansed if it becomes soiled or contaminated. The original dressing would not be reinforced but changed as needed. A diaper is not placed over the dressing because stool contamination can occur.

 

PTS:   1                    DIF:    Cognitive Level: Apply                  REF:   1102

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is admitting a school-age child with suspected Guillain-Barr syndrome (GBS). Which is a priority in the care for this child?
a. Monitoring intake and output
b. Assessing respiratory efforts
c. Placing on a telemetry monitor
d. Obtaining laboratory studies

 

 

ANS:  B

Treatment of GBS is primarily supportive. In the acute phase, patients are hospitalized because respiratory and pharyngeal involvement may require assisted ventilation, sometimes with a temporary tracheotomy. Treatment modalities include aggressive ventilatory support in the event of respiratory compromise, intravenous (IV) administration of immunoglobulin (IVIG), and sometimes steroids; plasmapheresis and immunosuppressive drugs may also be used. Intake and output, telemetry monitoring and obtaining laboratory studies may be part of the plan of care but are not the priority.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   1110

TOP:   Integrated Process: Nursing Process: Evaluation

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescriptions should the nurse clarify with the health care provider before implementing?
a. Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time.
b. Provide total parenteral nutrition (TPN) at 25 ml/hr intravenously.
c. Titrate oxygen to keep pulse oximetry saturations greater than 92.
d. Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

 

 

ANS:  D

The nurse should clarify the administration of an aminoglycoside antibiotic. Antibiotic therapy is not part of the management of infant botulism because the botulinum toxin is an intracellular molecule, and antibiotics would not be effective; aminoglycosides in particular should not be administered because they may potentiate the blocking effects of the neurotoxin. Treatment consists of immediate administration of botulism immune globulin intravenously (BIG-IV) without delaying for laboratory diagnosis. Early administration of BIG-IV neutralizes the toxin and stops the progression of the disease. The human-derived botulism antitoxin (BIG-IV) has been evaluated and is now available nationwide for use only in infant botulism. Approximately 50% of affected infants require intubation and mechanical ventilation; therefore, respiratory support is crucial, as is nutritional support because these infants are unable to feed.

 

PTS:   1                    DIF:    Cognitive Level: Analyze               REF:   1113-1114

TOP:   Integrated Process: Nursing Process: Evaluation

MS

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