Pedia Musculoskeletal

Pediatric Success Musculoskeletal
Study online at https://quizlet.com/_3gqvow
1. An adolescent presents with sudden-onset unilateral 4. This patient has

facial weakness with drooping of Bell's palsy, which
one side of the mouth. The teen is unable to close the is an
eye on the affected side, but has idiopathic
no other symptoms and otherwise feels well. The mononeuritis of
nurse could summarize the condition CN VII (the
by which of the following? facial nerve) that
1. The prognosis is poor. innervates the
2. This may be a stroke. face and
3. It is a fifth CN palsy. muscles of expres-
4. This is paralysis of the facial nerve. sion.
TEST-TAKING
HINT: The test
taker must
know CNs and
their actions.
2. The nurse is performing an admission assessment on 2. Fever, malaise,

a 9-year-old who has just been and weight loss
diagnosed with systemic lupus erythematosus. Which are common
assessment findings should the presenting signs.
nurse expect?
1. Headaches and nausea. TEST-TAKING
2. Fever, malaise, and weight loss. HINT: The test
3. A papular rash covering the trunk and face. taker must
4. Abdominal pain and dysuria. know the pre-
senting signs and
symptoms
of systemic lupus
erythematosus
3. The parents of a preschooler diagnosed with muscu- 1. Muscular dys-

lar dystrophy are asking questions trophies are pro-
about the course of their child's disease. Which gressive
should the nurse tell them? degenerative dis-
1. "Muscular dystrophies usually result in progressive orders. The most
weakness." common
2. "The weakness that your child is having will proba- is Duchenne mus-
bly not increase." cular dystrophy,
1 / 34
3. "Your child will be able to function normally and not which is an
need any special X-linked recessive
accommodations." disorder.
4. "The extent of weakness depends on doing daily TEST-TAKING
physical therapy." HINT: The test
taker should
know that muscu-
lar dystrophy is a
progressive
degenerative dis-
order.
4. The nurse should tell the parents of a child with 3. The major com-
Duchenne (pseudohypertrophic) plications of mus-
muscular dystrophy that some of the progressive cular
complications include: dystrophy include
1. Dry skin and hair, hirsutism, protruding tongue, and contractures, dis-
mental retardation. use
2. Anorexia, gingival hyperplasia, and dry skin and atrophy, infections,
hair. obesity, respirato-
3. Contractures, obesity, and pulmonary infections. ry
4. Trembling, frequent loss of consciousness, and complications, and
slurred speech. cardiopulmonary
problems.
TEST-TAKING
HINT: The test
taker should be
able to identify
signs and symp-
toms attributable
to the loss of mus-
cle function.
5. Which can elicit the Gower sign? Have the patient: 4. Children with
1. Close the eyes and touch the nose with alternating muscular dystro-
index fingers. phy display
2. Hop on one foot and then the other. the Gower sign,
3. Bend from the waist to touch the toes. which is great diffi-
4. Walk like a duck and rise from a squatting position. culty
2 / 34
rising and stand-
ing from a squat-
ting position
due to the lack of
muscle strength.
TEST-TAKING
HINT: By
eliminating
cerebellar
activities, the test
taker would know
that the Gower
sign assists in
measuring
leg strength.
6. A 5-year-old has been diagnosed with pseudohyper- 1. Muscles be-

trophic muscular dystrophy. come weaker, in-
Which nursing intervention would be appropriate? cluding those
1. Discuss with the parents the potential need for needed for respi-
respiratory support. ration, and a deci-
2. Explain that this disease is easily treated with med- sion
ication. will need to
3. Suggest exercises that will limit the use of muscles be made about
and prevent fatigue. whether
4. Assist the parents in finding a nursing facility for respiratory sup-
future care. port will be provid-
ed
TEST-TAKING
HINT:
Pseudohyper-
trophic
muscular dystro-
phy is a progres-
sive neuromuscu-
lar
disease with no
cure.
3 / 34
7. Which foods would be best for a child with Duchenne 4. As the child be-
muscular dystrophy? comes less ambu-
1. High-carbohydrate, high-protein foods. latory,
2. No special food combinations. moving the child
3. Extra protein to help strengthen muscles. will become more
4. Low-calorie foods to prevent weight gain. of a
problem. It is not
good for the child
to
become over-
weight for several
health reasons
in addition to de-
creased ambula-
tion.
TEST-TAKING
HINT: Nutrition is
important
for every child; as
the child becomes
less
ambulatory,
weight concerns
arise.
8. Which will help a school-aged child with muscular 1. Children who

dystrophy stay active longer? are active are usu-
1. Normal activities, such as swimming. ally
2. Using a treadmill every day. able to postpone
3. Several periods of rest every day. use of a wheel-
4. Using a wheelchair upon getting tired. chair. It
is important to
keep using mus-
cles for
as long as pos-
sible, and aerobic
activity
is good for a child.
TEST-TAKING
4 / 34
HINT: Appropriate
interventions
for different kinds
of chronically ill
children can be
similar, so think
about
what would be
best for this child.
9. The mother of a child with Duchenne muscular dystro- 1, 2, 4.

phy asks the nurse who in the 1. Genetic coun-
family should have genetic screening. Who should the seling is important
nurse say must be tested? in all
Select all that apply. inherited diseases.
1. Mother Duchenne muscu-
2. Sister. lar
3. Brother. dystrophy is inher-
4. Aunts and all female cousins. ited as an X-linked
5. Uncles and all male cousins. recessive trait,
meaning the de-
fect is
on the X chromo-
some. Women car-
ry
the disease, and
males are affect-
ed. All
female relatives
should be tested.
2. Women carry
the disease, and
males
are affected. All
female relatives
should
be tested.
3. Women carry
the disease, and
5 / 34
males are affect-
ed.
All female relatives
should be tested.
4. Women carry
the disease, and
males
are affected. All
female relatives
should
be tested.
5. Women carry
the disease, and
males are affect-
ed.
All female relatives
should be tested.
TEST-TAKING
HINT: Knowing
that Duchenne
muscular dystro-
phy is inherited as
an Xlinked
trait excludes fa-
ther, brother, un-
cle,
and male cousins
as carriers.
10. The nurse knows that teaching was successful when 2. Difficulty climb-
a parent states which of the ing stairs, running,
following are early signs of muscular dystrophy? and riding a bicy-
1. Increased muscle strength. cle are frequently
2. Difficulty climbing stairs. the
3. High fevers and tiredness. first symptoms of
4. Respiratory infections and obesity. Duchenne muscu-
lar
dystrophy.
TEST-TAKING
6 / 34
HINT: Early
symptoms have
to do with de-
creased ability to
perform
normal develop-
mental tasks in-
volving
muscle strength.
11. The nurse is caring for a school-aged child with 4. The child would
Duchenne muscular dystrophy in not be able to keep
the elementary school. Which would be an appropriate up
nursing diagnosis? with peers be-
1. Anticipatory grieving. cause of weak-
2. Anxiety reduction. ness, progressive
3. Increased pain. loss of muscle
4. Activity intolerance. fibers, and loss
of muscle
strength.
TEST-TAKING
HINT: Knowing
that the child
has decreased
strength helps to
answer
the question.
12. The nurse knows that teaching has been successful 3. Muscle biopsy
when the parent of a child with confirms the type
muscle weakness states that the diagnostic test for of
muscular dystrophy is which of the myopathy that the
following? patient has.
1. Electromyelogram. TEST-TAKING
2. Nerve conduction velocity. HINT: Muscle
3. Muscle biopsy. biopsy is the
4. Creatine kinase level. definitive test for
myopathies.
7 / 34
13. Why does spinal cord injury without radiographic ab- 1. Spinal cord in-
normality sometimes occur in jury without radi-
children? ographic
1. Children can suffer momentary severe subluxation abnormality re-
and trauma to the spinal cord. sults from the
2. The immature spinal column in children does not spinal
allow for quality films. cord sliding be-
3. The hemorrhaging that occurs with injury obscures tween the verte-
radiographic abnormalities. brae and
4. Radiographic abnormalities are not evident be- then sliding back
cause of incomplete ossification of into place without
the vertebrae. injury to the bony
spine. It is thought
to be the result
of an immature
spinal
column that allows
for reduction after
momentary sub-
luxation.
TEST-TAKING
HINT: The test
taker must
understand the
physiology of
spinal cord
injuries in children.
14. Which should a nurse in the ED be prepared for in a 3. A spinal cord in-
child with a possible spinal jury can occur at
cord injury? any
1. Severe pain. level. The higher
2. Elevated temperature. the level of the in-
3. Respiratory depression. jury,
4. Increased intracranial pressure the more likely the
child is to
have respirato-
ry insufficiency or
failure.
8 / 34
The nurse should
be prepared to
support the child's
respiratory sys-
tem.
TEST-TAKING
HINT: The test
taker must
know the signs of a
spinal cord injury.
15. The nurse evaluates the teaching as successful when 2. Autonomic dys-
a parent states that which of the reflexia results
following can cause autonomic dysreflexia? from an
1. Exposure to cold temperatures. uncontrolled,
2. Distended bowel or bladder. paroxysmal,
3. Bradycardia. continuous
4. Headache. lower motor neu-
ron reflex arc due
to
stimulation of the
sympathetic ner-
vous
system. It is a re-
sponse that typi-
cally
results from stim-
ulation of sensory
receptors
such as a full blad-
der or bowel.
TEST-TAKING
HINT: The test
taker must
know what triggers
autonomic dysre-
flexia
and what the
symptoms are.
9 / 34
16. When assessing the neurological status of an 2. Assessment for
8-month-old, the nurse should check alteration in devel-
for which of the following? opmentally
1. Clarity of speech. expected behav-
2. Interaction with staff. iors, such as
3. Vision test. stranger anxiety, is
4. Romberg test. helpful. Interaction
with staff is not to
be expected due
to
stranger anxiety.
TEST-TAKING
HINT: The test
taker must
know what is ap-
propriate infant
development.
17. Which symptoms will a child suffering from complete 1. Children with
spinal cord injury experience? complete spinal
1. Loss of motor and sensory function below the level cord injury
of the injury. lose motor and
2. Loss of interest in normal activities. sensory function
3. Extreme pain below the level of the injury. below the level of
4. Loss of some function, with sparing of function the injury as a re-
below the level of the injury. sult
of interruption of
nerve pathways.
TEST-TAKING
HINT: A spinal
cord injury
causes loss of mo-
tor and sensory
function
below the level of
the injury
18. The nurse is planning care for a child with a T12 spinal 1, 2.
cord injury. Which lifelong 1. Spinal cord-in-
10 / 34
complications should the child and family know jury patients expe-
about? Select all that apply. rience
1. Skin integrity. many issues due
2. Incontinence. to loss of innerva-
3. Loss of large and small motor activity. tion
4. Loss of voice. below the level of
5. Flaccid paralysis. the injury. Skin in-
tegrity
and incontinence
are issues
because of immo-
bility and loss of
pain
receptors below
the level of the in-
jury.
2. Skin integrity
and incontinence
are issues
because of immo-
bility and loss of
pain receptors be-
low the level of the
injury.
3. Loss of motor
activity is also a re-
sult of
loss of innervation
below the level of
the
injury.
4. Loss of voice is
not a complication
of T12
injury.
5. Flaccid paraly-
sis occurs initially
but changes
to spasticity dur-
11 / 34
ing the rehabilita-
tion stage.
TEST-TAKING
HINT: The test
taker must
know the
long-term effects
of spinal cord
injuries.
19. After spinal cord surgery, an adolescent suddenly 2. The sympathet-

complains of a severe headache. ic nervous system
Which should be the nurse's first action? responds
1. Check the blood pressure. to a full bladder or
2. Check for a full bladder. bowel resulting
3. Ask if pain is present somewhere else. from an uncon-
4. Ask if other symptoms are present. trolled, paroxys-
mal,
continuous lower
motor neuron
reflex arc. This re-
sponse is usually
from stimulation of
sensory receptors
(e.g., distended
bladder or bowel).
Because the effer-
ent pulse cannot
pass
through the spinal
cord, the vagus
nerve is not
"turned off," and
profound
symptomatic
bradycardia may
occur.
TEST-TAKING
HINT: Autonomic
12 / 34
dysreflexia
is usually caused
by a full bladder or
bowel.
20. An adolescent with a T4 spinal cord injury suddenly 2. Check to be cer-

becomes dangerously hypertensive tain that the blad-
and bradycardic. Which intervention is appropriate? der
1. Call the neurosurgeon immediately, as this sounds is not distended,
like sudden intracranial which would trig-
hypertension. ger
2. Check to be certain that the patient's bladder is not autonomic dysre-
distended. flexia.
3. Administer Hyperstat to treat the blood pressure. TEST-TAKING
4. Administer atropine for bradycardia. HINT: The test
taker must
know which symp-
toms are sugges-
tive of
autonomic dysre-
flexia.
21. Which priority item should be placed at the bedside of 1. Before the sur-
a newborn with gical closure of the
myelomeningocele? sac,
1. A bottle of normal saline. the infant is at risk
2. A rectal thermometer. for infection. A
3. Extra blankets. sterile dressing is
4. A blood pressure cuff. placed over the
sac
to keep it moist
and help prevent it
from tearing.
TEST-TAKING
HINT: The test
taker should
focus on the care
and potential com-
plications
13 / 34
of an infant with
spina bifida to
answer the ques-
tion correctly.
22. The nurse is caring for an infant with myelomeningo- 3. A normal saline
cele who is going to surgery dressing is placed
later today for closure of the sac. Which would be a over
priority nursing diagnosis before the sac to pre-
surgery? vent tearing, which
1. Alteration in parent-infant bonding. would
2. Altered growth and development. allow the cere-
3. Risk of infection. brospinal fluid to
4. Risk for weight loss escape
and microorgan-
isms to enter and
cause
an infection.
TEST-TAKING
HINT: The
pre-operative
priority
is risk of infection,
especially when
effort is necessary
to keep a sterile
saline
dressing on the
sac.
23. Which should the nurse include when teaching sexu- 1. The reproduc-
ality education to an adolescent tive system contin-
with a spinal cord injury? ues to
1. "You can enjoy a healthy sex life and most likely function properly
conceive children." after a spinal cord
2. "You will never be able to conceive if you have no injury.
genital sensation." Much sexual activ-
3. "Development of secondary sex characteristics is ity and response
delayed." occurs in the brain
14 / 34
4. "A few females have regular menstrual periods after as well.
injury." TEST-TAKING
HINT: Spinal cord
injuries
have little effect on
reproduction
24. A child with a repaired myelomeningocele is in the 1. Tethered cord is

clinic for a regular examination. caused by scar tis-
The child has frequent constipation and has been sue
crying at night because of pain in formation from the
the legs. After an MRI, the diagnosis of a tethered cord surgical repair of
is made. Which should the the
nurse tell the parent? myelomeningo-
1. Tethered cord is a post-surgical complication. cele and may
2. Tethered cord occurs during times of slow growth. affect bowel,
3. Release of the tethered cord will be necessary only bladder, or lower
once. extremity function-
4. Offering laxatives and acetaminophen daily will ing.
help control these problems. TEST-TAKING
HINT: Tethering is
caused by
scar tissue from
any surgical inter-
vention
and may recur as
the child grows.
25. Which should be included in the plan of care for a 3. Priority care for
newborn with a myelomeningocele an infant with a
who will have a surgical repair tomorrow? myelomeningo-
1. Offer formula every 3 hours. cele is to protect
2. Turn the infant back to front every 2 hours. the
3. Place a wet dressing on the sac. sac. A wet dress-
4. Provide pain medication every 4 hours. ing keeps it moist
with
less chance of
tearing.
TEST-TAKING
15 / 34
HINT: Realizing
the defect is
on the back elim-
inates answer 2.
Knowing
newborns are
sleepy and do not
eat on a
schedule elimi-
nates answer 1.
26. Which should the nurse do first when caring for an 2. Hydrocephalus
infant who just had a repair of a occurs in about
myelomeningocele? 90% of
1. Weigh diapers for 24-hour urine output. infants with
2. Measure head circumference. myelomeningo-
3. Offer clear fluids. cele, so
4. Assess for infection. measuring the
head circumfer-
ence daily
and watching for
an increase are
important.
Accumulation of
cerebrospinal
fluid can occur af-
ter closure of the
sac.
TEST-TAKING
HINT: The
dynamics of the
cerebrospinal fluid
change after clo-
sure of
the sac.
27. Which should be the priority nursing diagnosis for a 2. Because this in-
12-hour-old newborn with a fant has not had a
myelomeningocele at L2? repair,
16 / 34
1. Altered bowel elimination related to neurological the sac is exposed.
deficits. It could rupture,
2. Potential for infection related to the physical defect. allowing organ-
3. Altered nutrition related to neurological deficit. isms to enter the
4. Disturbance in self-concept related to physical dis- cerebrospinal
ability. fluid, so this is the
priority.
TEST-TAKING
HINT: Before
surgery, the
myelomeningo-
cele is exposed,
so risk of
infection is much
higher.
28. Over the last week, an infant with a repaired 2. The increase in
myelomeningocele has had a highpitched head size is one of
cry and been irritable. Length, weight, and head cir- the
cumference have been at first signs of in-
the 50th percentile. Today length is at the 50th per- creased intracra-
centile, weight is at the 70th percentile, nial
and head circumference is at the 90th percentile. The pressure; other
nurse should do which signs include high-
of the following? pitched
1. Tell the parent this is normal for an infant with a cry and irritability.
repaired myelomeningocele. TEST-TAKING
2. Tell the parent this might mean the baby has in- HINT: The test
creased intracranial pressure. taker should
3. Suspect the baby's intracranial pressure is low be- know how fast an
cause of a leak. infant's head size
4. Refer the baby to the neurologist for follow-up care. changes
29. Which should the nurse tell the parent of an infant with 2. Children with
spina bifida? decreased activity
1. "Bone growth will be more than that of babies who due to
are not sick because your illness or trau-
baby will be less active." ma are helped by
2. "Physical and occupational therapy will be helpful physical
17 / 34
to stimulate the senses and and occupational
improve cognitive skills." therapy. The varied
3. "Nutritional needs for your infant will be calculated activities stimulate
based on activity level." the senses.
4. "Fine motor skills will be delayed because of the TEST-TAKING
disability." HINT: The test
taker should
know normal
growth patterns.
30. A 3-month-old with spina bifida is admitted to the **1. A 3-month-old

nurse's unit. Which gross motor has good head
skills should the nurse assess at this age? control.
1. Head control. 2. Pincer grasp oc-
2. Pincer grasp. curs at about 9
3. Sitting alone. months.
4. Rolling over. 3. Sitting alone oc-
curs at about 6
months.
4. Rolling over oc-
curs at about 4
months.
31. A 15-year-old with spina bifida is seen in the clinic for 4. As an adoles-
a well-child checkup. The teen cent on crutches
uses leg braces and crutches to ambulate. Which and wearing
nursing diagnosis takes priority? braces, the teen
1. Potential for infection. would have the
2. Alteration in mobility. issue of body im-
3. Alteration in elimination. age disturbance,
4. Potential body image disturbance. which
must be ad-
dressed. This is a
priority.
TEST-TAKING
HINT: The test
taker must
know normal de-
velopment.
18 / 34
32. A school-aged child is admitted to the unit pre-opera- 1. Posting a sign
tively for bladder reconstruction. on the door and
The child is latex-sensitive. Which intervention should charting
the nurse implement? that the child has a
1. Post a sign on the door and chart that the child is latex allergy is im-
latex-allergic. portant
2. Use powder-free latex gloves when giving care. so others will be
3. Keep personal items such as stuffed animals in a aware of the
plastic bag to avoid latex allergy.
contamination. TEST-TAKING
4. Use a disposable plastic-covered blood pressure HINT: The test
cuff that will stay in the child's room. taker must
know which sup-
plies have latex
and about
contact allergies.
33. Which should the nurse prepare the parents of an 4. Although imme-
infant for following surgical repair diate surgical re-
and closure of a myelomeningocele shortly after pair decreases
birth? The infant will: infection, morbidi-
1. Not need any long-term management and should be ty, and mortality
considered cured. rates, these chil-
2. Not be at risk for urinary tract infections or move- dren will require
ment problems. lifelong manage-
3. Have continual drainage of cerebrospinal fluid, ment of neurologi-
needing frequent dressing cal,
changes. orthopedic, and
4. Need lifelong management of urinary, orthopedic, elimination prob-
and neurological problems. lems.
TEST-TAKING
HINT: The test
taker can
eliminate answer 1
due to the com-
plexity
of myelomeningo-
cele
19 / 34
34. A newborn with a repaired myelomeningocele is as- 3. An alteration in
sessed for hydrocephalus. Which the circulation of
would the nurse expect in an infant with hydro- the
cephalus? cerebrospinal flu-
1. Low-pitched cry and depressed fontanel. id causes hydro-
2. Low-pitched cry and bulging fontanel. cephalus.
3. Bulging fontanel and downwardly rotated eyes. The anterior
4. Depressed fontanel and upwardly rotated eyes. fontanel bulges
because of an in-
crease in cere-
brospinal
fluid, and an in-
crease in intracra-
nial
pressure causes a
high-pitched cry in
infants and down-
ward deviation of
the
eyes, also called
sunset eyes. With
sunset
eyes the sclera
can be seen above
the iris.
TEST-TAKING
HINT: The test
taker must
know the differ-
ence in clinical
signs of hydro-
cephalus
in infants and older
children.
Infants' heads ex-
pand, whereas
older
children's skulls
are fixed. The an-
20 / 34
terior
fontanel closes be-
tween 12 and 18
months
35. The nurse is developing a plan of care for a child 4. The priority for
recently diagnosed with cerebral all children is to de-
palsy (CP). Which should be the nurse's priority goal? velop
1. Ensure the ingestion of sufficient calories for to their full poten-
growth. tial.
2. Decrease intracranial pressure. TEST-TAKING
3. Teach appropriate parenting strategies for a spe- HINT: All of these
cial-needs child. are important
4. Ensure that the child reaches full potential. goals, but deter-
mining the priority
goal for a spe-
cial-needs child is
the key.
36. The nurse evaluates teaching of parents of a child 4. The primary dis-
newly diagnosed with cerebral order is of muscle
palsy (CP) as successful when the parents state that tone,
CP is which of the following? but there may be
1. Inability to speak and uncontrolled drooling. other neurological
2. Involuntary movements of lower extremities only. disorders such as
3. Involuntary movements of upper extremities only. seizures, vision
4. An increase in muscle tone and deep tendon reflex- disturbances,
es. and impaired intel-
ligence.
Spastic CP is
the most common
type
and is character-
ized by a general-
ized
increase in mus-
cle tone, increased
deep
tendon reflexes,
21 / 34
and rigidity of the
limbs on both flex-
ion and extension.
TEST-TAKING
HINT: The test
taker must
know the definition
of CP.
37. The parent of a toddler newly diagnosed with cerebral 1. At least 80% of
palsy (CP) asks the nurse cases of CP result
what caused it. The nurse should answer with which from
of the following? unknown prenatal
1. Most cases are caused by unknown prenatal fac- factors.
tors.
2. It is commonly caused by perinatal factors.
3. The exact cause is not known.
4. The exact cause is known in every instance.
38. Which developmental milestone should the nurse be ***1. Most infants
concerned about if a 10-month-old are able to crawl
could not do it? unassisted
1. Crawl. by 8 months.
2. Cruise. 2. Infants learn
3. Walk. to cruise (walk
4. Have a pincer grasp. around
holding onto furni-
ture) at about 9 to
10 months.
3. Walking occurs
on average at
about
12 months.
4. Pincer grasp
(thumb and fore-
finger)
occurs at about 9
to 10 months.
TEST-TAKING
22 / 34
HINT: The test
taker must
know develop-
mental mile-
stones.
39. The parent of an infant asks the nurse what to watch 1. Children with
for to determine if the infant CP frequently
has CP. Which is the nurse's best response? have developmen-
1. "If the infant cannot sit up without support before 8 tal
months." delays, including
2. "If the infant demonstrates tongue thrust before 4 not being able
months." to sit alone by
3. "If the infant has poor head control after 2 months." 8 months. Sitting
4. "If the infant has clenched fists after 3 months." alone
usually occurs by
6 months, so 8
months
would be the outer
limit of normal de-
velopment
and cause for con-
cern.
2. Tongue thrust is
common in infants
younger than 6
months, but if it
goes on
after 6 months it is
of concern.
3. Good head con-
trol is normally at-
tained by
3 months.
*****4. Clenched
fists after 3 months
of age
may be a sign of
CP.****
23 / 34
40. The parent of a young child with CP brings the child 3. This statement
to the clinic for a checkup. indicates that the
Which parent's statement indicates an understanding parent
of the child's long-term needs? understands the
1. "My child will need all my attention for the next 10 long-term needs
years." of the child.
2. "Once in school, my child will catch up and be like
the other children."
3. "My child will grow up and need to learn to do things
independently."
4. "I'm the one who knows the most about my child
and can do the most for my child."
41. A child with spastic CP had an intrathecal dose of 3. If baclofen were

baclofen in the early afternoon. going to work for
What is the expected result 31/2 hours post dose that this
suggests the child would child, one could
benefit from a baclofen pump? tell
1. The ability to self-feed.
2. The ability to walk with little assistance.
3. Decreased spasticity.
4. Increased spasticity
42. The nurse is doing a follow-up assessment of a 2. A 9-month-old

9-month-old. The infant rolls both should be able to
ways, sits with some support, pushes food out of the sit
mouth, and pushes away when alone, crawl, pull
held. The parent asks about the infant's development. up, not push food
The nurse responds by saying out
which of the following? of the mouth
1. "Your child is developing normally." (tongue thrust),
2. "Your child needs to see the primary care provider." and push
3. "You need to help your child learn to sit unassisted." away when held
4. "Push the food back when your child pushes food when wanting to
out." get
down. This child is
not developing
normally and must
24 / 34
see the primary
care provider.
43. A child is admitted to the pediatric unit with spastic 1, 3, 4, 5.

CP. Which would the nurse 1. Children with
expect a child with spastic CP to demonstrate? Select spastic CP have
all that apply. increased
1. Increased deep tendon reflexes. deep tendon re-
2. Decreased muscle tone. flexes.
3. Scoliosis. 2. Children with
4. Contractures. spastic CP have
5. Scissoring. increased
6. Good control of posture. muscle tone.
7. Good fine motor skills. 3. Children with
spastic CP have
scoliosis.
4. Children with
spastic CP have
contractures
of the Achilles ten-
dons, knees,
and adductor mus-
cles.
5. Children with
spastic CP have
scissoring
when walking.
6. Children with
spastic CP have
poor control
of posture.
7. Children with
spastic CP have
poor fine
motor skills.
TEST-TAKING
HINT: The test
taker must
25 / 34
know the typical
signs of CP.
44. A 3-year-old child with CP is admitted for dehydration 2. This is the prior-
following an episode of diarrhea. ity nursing diagno-
The nurse's assessment follows: awake, pale, thin sis
child lying in bed, multiple for this severely
contractures, drooling, coughing spells noted when underweight child.
parent feeds. T 97.8°F (36.5°C), Weight is average
P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 for a 4-month-old.
hours. Which nursing diagnosis The coughing
is most important? episodes while
1. Potential for skin breakdown: lying in one position. feeding
2. Alteration in nutrition: less than body requirements. may indicate aspi-
3. Potential for impaired social support: mother sole ration. The parent
caretaker. needs help to
4. Alteration in elimination: diarrhea. learn how to feed
so less
coughing occurs.
45. The parent of an infant with CP asks the nurse if the 3. Many children
infant will be mentally retarded. with CP have nor-
Which is the nurse's best response? mal
1. "Children with CP have some amount of mental intelligence.
retardation."
2. "Approximately 20% of children with CP have nor-
mal intelligence."
3. "Many children with CP have normal intelligence."
4. "Mental retardation is expected if motor and senso-
ry deficits are severe."
46. Parents bring their 2-month-old into the clinic with 1. This baby
concerns that the baby seems may have Werd-
"floppy." The parents say the baby seems to be work- nig-Hoffman
ing hard to breathe, eats very disease, which is
slowly, and seems to fatigue quickly. The nurse as- characterized by
sesses intercostal retractions, progressive
although the baby is otherwise in no distress. They generalized mus-
add there was a cousin whose cle weakness
26 / 34
baby had similar symptoms. The nurse would be most that eventually
concerned with what possible leads to respirato-
complications? ry failure.
1. Respiratory compromise. Respiratory com-
2. Dehydration. promise is the
3. Need for emotional support for the family. most important
4. Feeding intolerance. complication.
47. The mother of a newborn relates that this is her first 1. Babies can lose
child, the baby seems to sleep a up to 10% of birth
lot, and does not cry much. Which question would the weight but should
nurse ask the mother? regain it by 2
1. "How many ounces of formula does your baby take weeks
at each feeding?" of age. Knowing
2. "How many bowel movements does your baby have how much the
in a day?" baby
3. "How much sleep do you get every night?" eats can help the
4. "How long does the baby stay awake at each feed- nurse determine if
ing?" the
infant is receiv-
ing adequate nutri-
tion.
48. The mother of an infant diagnosed with Werdnig-Hoff- 3. Werdnig-Hoff-

mann disease asks the nurse mann disease is
what she could have done during her pregnancy to inherited
prevent this. The nurse explains as an
that the cause of Werdnig-Hoffmann is which of the autosomal-reces-
following? sive trait.
1. Unknown.
2. Restricted movement in utero.
3. Inherited as an autosomal-recessive trait.
4. Inherited as an autosomal-dominant trait.
49. The parents of a toddler diagnosed with Werdnig-Hoff- 2. Chicken is a

mann disease ask the nurse good source of
what they can feed their child that would be quality protein,
food. Which would be good and broccoli is a
choices for the nurse to recommend? good choice for
27 / 34
1. A hot dog and chips. naturally
2. Chicken and broccoli. occurring vita-
3. A banana and almonds. mins.
4. A milkshake and a hamburger
50. The parent of a child diagnosed with Werdnig-Hoff- 2. The first inter-
mann disease notes times of not vention is to check
being able to hear the child breathing. Which should the
the nurse do first? respiratory rate of
1. Check pulse oximetry on the child. the child to see if it
2. Count the child's respirations. is abnormal, then
3. Listen to the child's lung sounds. listen to the lung
4. Ask the parent if the child coughs at night. sounds, and
then check pulse
oximetry.
51. A child presents with a history of having had an upper 3. This child prob-
respiratory tract infection 2 ably has GBS,
weeks ago; complains of symmetrical lower extremity which is
weakness, back pain, muscle an acute inflam-
tenderness; and has absent deep tendon reflexes in matory demyeli-
the lower extremities. Which is nating
important regarding this condition? neuropathy.
1. The disease process is probably bacterial.
2. The recent upper respiratory infection is not impor-
tant information.
3. This may be an acute inflammatory demyelinating
neuropathy.
4. CN involvement is rare.
52. A child with GBS has had lots of oral fluids but has not 3. The child
urinated for 8 hours. Which must be in-and-out
is the nurse's first action? catheterized
1. Check the child's serum blood-urea-nitrogen level. to avoid the possi-
2. Check the child's complete blood count. bility of developing
3. Catheterize the child in and out. a urinary tract in-
4. Run water in the bathroom to stimulate urination. fection from urine
left in the bladder
for too long
28 / 34
53. The nurse is planning care for a child who was recent- 3. The goal is to
ly admitted with GBS. Which prevent complica-
is a priority nursing diagnosis? tions
1. Risk for constipation related to immobility. related to immobil-
2. Chronic sorrow related to presence of chronic dis- ity. Efforts include
ability. maintaining skin
3. Impaired skin integrity related to infectious disease integrity, maintain-
process. ing
4. Activity intolerance related to ineffective cardiac respiratory func-
muscle function. tion, and prevent-
ing
contractures.
54. Which should the nurse expect as an intervention in 4. Beginning active

a child in the recovery phase of physical therapy is
GBS? important for help-
1. Assess for respiratory compromise. ing muscle recov-
2. Assess for swallowing difficulties. ery
3. Evaluate neuropsychological functioning. and preventing
4. Begin an active physical therapy program. contractures.
55. A child has a provisional diagnosis of myasthenia 1, 2, 3.

gravis. Which should the nurse 1. Symptoms in a
expect in this child? Select all that apply. child with myas-
1. Double vision. thenia
2. Ptosis. gravis include fa-
3. Fatigue. tigue, double vi-
4. Ascending paralysis. sion,
5. Sensory disturbance. ptosis, and difficul-
ty swallowing and
chewing. This is an
autoimmune dis-
ease
triggered by a viral
or bacterial infec-
tion.
Antibodies attack
acetylcholine
receptors and
29 / 34
block their func-
tioning.
2. Symptoms in a
child with myas-
thenia
gravis include fa-
tigue, double vi-
sion,
ptosis, and difficul-
ty swallowing and
chewing.
3. Symptoms in a
child with myas-
thenia
gravis include fa-
tigue, double vi-
sion,
ptosis, and difficul-
ty swallowing and
chewing.
4. Symptoms in a
child with myas-
thenia
gravis include fa-
tigue, double vi-
sion, ptosis,
and difficulty swal-
lowing and chew-
ing.
5. Symptoms in a
child with myas-
thenia
gravis include fa-
tigue, double vi-
sion, ptosis,
and difficulty swal-
lowing and chew-
ing
30 / 34
56. The nurse judges teaching as successful when the 2. Meditation is a
parent of a child with myasthenia good strategy to
gravis states which of the following? learn
1. "My child should play on the school's basketball to decrease
team." stress.
2. "My child should meditate every day."
3. "My child should be allowed to do what other kids
do."
4. "My child should be watched carefully for signs of
illness."
57. Which is the best advice to offer the parent of a 1. Constipation

6-month-old with Werdnig-Hoffman means hard stools
disease on how to treat the infant's constipation? and infrequent
1. Offer extra water every day. passage. Adding
2. Add corn syrup to two bottles a day. extra water
3. Give the infant a glycerine suppository today. to the diet helps
4. Let the infant go 3 days without a stool before make the stool
intervening. softer
in this age child.
58. Which should the nurse do for a 6-year-old living in a 1. A child less than
rural area who is missing 7 years of age and
school shots and who has sustained a puncture not
wound? fully immunized
1. Administer DTaP vaccine who has a tetanus-
2. Start the child on an antibiotic. prone
3. Clean the wound with hydrogen peroxide. wound should re-
4. Send the child to the emergency department. ceive DTaP
vaccine to prevent
tetanus. Tetanus-
prone
wounds include
puncture
wounds and those
contaminated with
dirt, feces, or soil.
59.
31 / 34
Which should the nurse expect in a 2-week-old with a 3, 4, 5.
brachial plexus injury? Select 1. A brachial
all that apply. plexus injury in an
1. History of a normal vaginal delivery. infant (resulting
2. Small infant. from tearing or
3. Absent Moro reflex on one side. stretching of a
4. No sensory loss. nerve) usually oc-
5. Associated clavicle fracture. curs with large ba-
bies and
breech delivery.
2. A brachial
plexus injury in an
infant (resulting
from tearing or
stretching of a
nerve) usually oc-
curs with large ba-
bies and
breech delivery.
3. The infant will
have an absent
Moro
reflex on one side
and no sensory
loss.
4. The infant will
have an absent
Moro
reflex on one side
and no sensory
loss.
5. The injury may
be associated with
a
fractured clavicle.
TEST-TAKING
HINT: The test
taker must
know what a
32 / 34
brachial plexus is
and how an
injury would affect
it.
60. After surviving a motor vehicle accident but enduring 3. Damage at

a spinal cord injury, an adolescent T1-T4 manifests at
is unable to walk but can use his arms, has no bowel or just
or bladder control, and has below the nipple
no sensation below the nipple line. Referring to the line. Every area
following figure, identify the below
vertebral/spinal cord area most likely injured. would be affected
1. Cervical, C1-C5.
2. Cervical, C5-C7.
3. Thoracic, T1-T4.
4. Thoracic, T5-T12.
5. Lumbar, L2-L5.
6. Sacral, S1-S5.
61. Causes of autonomic dysreflexia include which of the 2, 3, 5.

following? Select all that apply. 1. A decrease
1. Decrease in blood pressure. in blood pressure
2. Abdominal distention. does not
3. Bladder distention. contribute to auto-
4. Diarrhea. nomic dysreflexia.
5. Tight clothing. Increased
6. Hypothermia. blood pressure
usually occurs
with
autonomic dysre-
flexia.
2. Autonomic dys-
reflexia may be
caused
by abdominal
pressure from a fe-
cal
impaction.
3. An overdistend-
33 / 34
ed bladder is usu-
ally the
precipitating fac-
tor causing an in-
crease
in abdominal pres-
sure.
4. Fecal impaction
and constipation,
not diarrhea,
can be causes of
autonomic dysre-
flexia.
5. Tight clothing
can increase pres-
sure to
the central core of
the body.
6. Hyperthermia
does not cause
autonomic
dysreflexia.
TEST-TAKING
HINT: Autonomic
dysreflexia
most often occurs
due to an irritating
stimulus within the
body below the
level
of spinal cord in-
jury.
34 / 34

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Pediatric Success Musculoskeletal

Study online at https://quizlet.com/_3gqvow

1. An adolescent presents with sudden-onset unilateral 4. This patient has

2. The nurse is performing an admission assessment on 2. Fever, malaise,

3. The parents of a preschooler diagnosed with muscu- 1. Muscular dys-

6. A 5-year-old has been diagnosed with pseudohyper- 1. Muscles be-

8. Which will help a school-aged child with muscular 1. Children who

9. The mother of a child with Duchenne muscular dystro- 1, 2, 4.

19. After spinal cord surgery, an adolescent suddenly 2. The sympathet-

20. An adolescent with a T4 spinal cord injury suddenly 2. Check to be cer-

24. A child with a repaired myelomeningocele is in the 1. Tethered cord is

30. A 3-month-old with spina bifida is admitted to the **1. A 3-month-old

41. A child with spastic CP had an intrathecal dose of 3. If baclofen were

42. The nurse is doing a follow-up assessment of a 2. A 9-month-old

43. A child is admitted to the pediatric unit with spastic 1, 3, 4, 5.

48. The mother of an infant diagnosed with Werdnig-Hoff- 3. Werdnig-Hoff-

49. The parents of a toddler diagnosed with Werdnig-Hoff- 2. Chicken is a

54. Which should the nurse expect as an intervention in 4. Beginning active

55. A child has a provisional diagnosis of myasthenia 1, 2, 3.

57. Which is the best advice to offer the parent of a 1. Constipation

60. After surviving a motor vehicle accident but enduring 3. Damage at

61. Causes of autonomic dysreflexia include which of the 2, 3, 5.

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