Chapter 44 - Practice questions PDF

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MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

Maternity and Pediatric Nursing - Third Edition Chapter 44 Nursing Care of the Child With an Alteration in Mobility / Neuromuscular or Musculoskeletal Disorder 1. The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which of the following responses from his mother indicates a need for further teaching? A) “He needs to get a medical alert identification.” B) “I will need to discuss this with his caregivers.” C) “A product's label indicates whether it is latex-free.” D) “He must avoid all contact with latex.”

2. The nurse is caring for an 8-year-old boy with myasthenia gravis and is teaching his parents about the signs of cholinergic crisis. Which of the following responses by the parents indicates a need for further teaching? A) “Low blood pressure is a sign of crisis.” B) “He might have difficulty swallowing.” C) “He may start to sweat a lot.” D) “More saliva in the mouth is a common sign.” NURSINGTB.COM 3. The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A) “I will help you become comfortable in caring for your daughter.” B) “You must learn how to care for your daughter at home.” C) “You will need to learn to collaborate with all the caregivers.” D) “There is a lot to learn, and you need a positive attitude.”

4. The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A) Deep-breathing exercises B) Upright positioning C) Coughing D) Chest percussion

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5. A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A) “Would you like me to bring you a blanket and pillow?” B) “You are doing such a wonderful job with your son.” C) “He's in good hands; consider going home to get some sleep.” D) “Are you planning to spend the night or to go home?”

6. A nurse is caring for a 14-year-old girl following myelography. Which of the following would be the priority nursing action? A) Monitoring for a decrease in spasticity B) Observing for signs of meningeal irritation C) Assessing motor function D) Observing for mental confusion or hallucinations

7. The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? A) Recommend the bed's side rails be raised throughout the day and night. B) Suggest a caregiver be present continuously to prevent falls from bed. C) Encourage a loose restraint to be used when he is in bed. NURSINGTB.COM D) Recommend raising the bed's side rails when a caregiver is not present.

8. The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. Which of the following would the nurse use when documenting these observations? A) Spastic B) Athetoid C) Ataxic D) Mixed

9. The nurse is caring for a child with a spinal cord injury and providing instruction to the parents on promoting skin integrity. Which response from the mother indicates a need for further teaching? A) “I need to monitor his skin at least twice a week.” B) “I must monitor skin affected by his adaptive equipment.” C) “He must change positions frequently.” D) “We must avoid harsh cleaning products.”

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10. The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A) Myelinization is completed by 4 years of age. B) The process occurs in a head-to-toe fashion. C) The speed of nerve impulses slows as myelinization occurs. D) Nerve impulses become less specific in focus with myelinization.

11. When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A) Skeletal traction B) Physical therapy C) Orthotics D) Occupational therapy

12. A nurse is preparing a program for a group of parents about injury prevention. Which of the following would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization NURSINGTB.COM

13. A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching? A) “We should give this drug before he eats anything.” B) “We need to keep a close eye for possible infection.” C) “The drug should not be stopped suddenly.” D) “He might gain some weight with this drug.”

14. Which of the following would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A) Positioning supine with a pillow under the buttocks B) Covering the sac with saline-soaked nonadhesive gauze C) Wrapping the infant snugly in a blanket D) Applying a diaper to prevent fecal soiling of the sac

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15. Which of the following would the nurse expect to find initially in a child with Guillain-Barré syndrome? A) Symmetric flaccid weakness B) Ataxia C) Sensory disturbances D) Lower extremity pain

16. The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve? A) Optic B) Facial C) Acoustic D) Trigeminal

17. A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? A) Oral B) Subcutaneous injection C) Intramuscular injection D) Intravenous infusion NURSINGTB.COM

18. The nurse is assessing the neuromusculoskeletal system of a newborn. Which of the following would the nurse identify as an abnormal finding? A) Sluggish deep tendon reflexes B) Full range of motion in extremities C) Absence of hypotonia D) Lack of purposeful muscular control

19. The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. Which of the following would the nurse include? A) Applying petroleum jelly to lubricate the catheter B) Cleaning the reusable catheter with peroxide after each use C) Storing the reusable cleaned catheter in a brown paper bag D) Soaking the catheter in a vinegar and water solution to sterilize

MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

20. A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which of the following would the nurse include when teaching the parents about caring for their child? A) Waiting 48 hours before allowing the child to take a tub bath B) Not allowing the child to sleep on his side for about 4 weeks C) Calling the physician if the child's temperature is over 100.5°F D) Discouraging the child from stretching or bending forward for 4 weeks

21. A group of students are reviewing information about neuromuscular disorders. The students demonstrate understanding of the information when they identify which of the following as examples of autoimmune neuromuscular disorders? Select all answers that apply. A) Cerebral palsy B) Guillain-Barré syndrome C) Myasthenia gravis D) Spinal muscular atrophy E) Dermatomyositis

22. A nursing instructor is preparing for a class discussion on spinal muscular atrophy (SMA). When describing type 2 SMA, which of the following would the instructor include? Select all answers that apply. NURSINGTB.COM A) Onset before 6 months of age B) Weakness most severe in shoulders and hips C) Difficulty with swallowing D) Slowly progressing condition E) Genetic disease with autosomal recessive inheritance

23. The nurse is assessing a child who is suspected of having Guillain-Barré syndrome. Which assessment findings would the nurse correlate as supporting this diagnosis? Select all answers that apply. A) Recent cytomegalovirus infection B) Hyperactive deep tendon reflexes C) Numbness in the lower extremities D) Sustained clonus E) Difficulty swallowing

MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

24. A child with myasthenia gravis is brought to the emergency department by his parents. The parents have noticed a sudden increase in respiratory difficulty. The nurse suspects myasthenic crisis based on which statement by the parents? A) “We gave him an extra dose of his medication earlier today.” B) “He was coughing and had a slight fever yesterday and today.” C) “Things have been pretty stress-free lately.” D) “He's been resting when he gets tired.”

25. After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A) Limb-girdle B) Myotonic C) Distal D) Duchenne

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MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

Answer Key 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

C B A B C B D B A B A C A B D B C A D D B, C, E B, D, E A, C, D B D

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MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

Musculoskeletal Disorder ONLY

Extra:

1. An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A) Notifying the doctor immediately B) Applying ice C) Elevating the arm D) Giving additional pain medication as ordered

2. The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a “jock” like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A) “If you wear your brace properly, you may not need surgery.” B) “The good news is that you have very minimal curvature of your spine.” C) “Let's talk to another boy with scoliosis, who is winning trophies for his swim team.” D) “Let's talk to the doctor about your treatment options.” NURSINGTB.COM

3. The nurse is caring for a female infant with torticollis and is providing instructions to the parents about how to help their daughter. Which statement by the parents indicates a need for further teaching? A) “We must encourage our daughter to turn her head both ways.” B) “Flatness on one side of the head is a common side effect.” C) “We must apply firm pressure and stretching every other day.” D) “We will do a daily stretching regimen with multiple sessions.”

4. The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse do first? A) Reposition the child's foot on a pressure-reducing device B) Apply lotion to his foot to maintain skin integrity C) Make sure the skin is clean and dry D) Gently massage his foot to promote circulation

MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

5. The nurse is caring for a 14-month-old boy with rickets who was recently adopted from overseas. His condition was likely a result of a diet very low in milk products. The nurse is providing teaching regarding treatment. Which response by the parents indicates a need for further teaching? A) “We must give him calcium and phosphorus with food every morning.” B) “He must take vitamin D as prescribed and spend some time in the sunlight.” C) “He must take calcium at breakfast and phosphorus at bedtime.” D) “We should encourage him to have fish, dairy, and liver if he will eat it.”

6. The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which response by the nurse would be most appropriate? A) “I know it is boring, but you must remain immobile for 2 more weeks.” B) “If there are no complications, you only have 2 more weeks here.” C) “Let's come up with things to do like books, movies, games, and friends to visit.” D) “If you resist your treatment, your condition will only get worse.”

7. A nurse is caring for a 10-year-old girl following joint fluid aspiration. The nurse would expect to perform which of the following immediately after the procedure? A) Transporting the aspirated fluid to the lab within 30 minutes NURSINGTB.COM B) Encouraging the child to drink fluids postprocedure C) Applying cold therapy and a pressure dressing to the site D) Elevating the extremity on a heating pad with several pillows

8. The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate? A) “If you don't follow the therapy, your daughter could develop severe bowing of her legs.” B) “It's important to use the brace or your daughter may need surgery.” C) “You are doing a great job. Let's put our heads together on how to keep her busy.” D) “You'll need to accept this since treatment may be required for several years.”

9. The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which of the following findings would help confirm this diagnosis? A) Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). B) A distinct “clunk” is heard with Barlow and Ortolani maneuvers. C) A high-pitched “click” is heard with hip flexion or extension. D) The thigh and gluteal folds are symmetric.

MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

10. The nurse is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the mother indicates a need for further teaching? A) “I need to avoid pushing or pulling on an arm or leg.” B) “I must carefully lift the baby from under the armpits.” C) “I should not bend an arm or leg into an awkward position.” D) “We must avoid lifting the legs by the ankles to change diapers.”

11. The nurse is developing a teaching plan for a child who is to have his cast removed. Which of the following would the nurse most likely include? A) Applying petroleum jelly to the dry skin B) Rubbing the skin vigorously to remove the dead skin C) Soaking the area in warm water every day D) Washing the skin with dilute peroxide and water

12. When teaching a group of students about the skeletal development in children, which of the following would the instructor include? A) The growth plate is made up of the epiphysis. B) A young child's bones commonly bend instead of break with an injury. C) The infant's skeleton has undergone complete ossification by birth. D) Children's bones have a thinNURSINGTB.COM periosteum and limited blood supply.

13. A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion? A) Swelling and point tenderness B) Decreased erythrocyte sedimentation rate C) Coolness of the affected site D) Increased range of motion

14. The school nurse is presenting a class to a group of students about common overuse disorders. Which of the following would the school nurse include? A) Dislocated radial head B) Transient synovitis of the hip C) Osgood-Schlatter disease D) Scoliosis

MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

15. The nurse is assessing a child with a possible fracture. Which of the following would the nurse identify as the most reliable indicator? A) Lack of spontaneous movement B) Point tenderness C) Bruising D) Inability to bear weight

16. Which of the following would the nurse be least likely to assess in a 6-year-old with septic arthritis of the hip? A) Moderate to severe pain of the affected hip B) Previous otitis media infection C) Refusal to straighten the affected extremity D) Full range of motion of the hip

17. An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. Which of the following would the nurse include when teaching the child about the cast? A) The cast will take a day or two to dry completely. B) The edges will be covered with a soft material to prevent irritation. C) The child initially may experience a very warm feeling inside the cast. D) The child will need to keep his arm down at his side for 48 hours. NURSINGTB.COM

18. A child has undergone surgery using steel bar placement to correct pectus excavatum. Which of the following would the nurse instruct the parents to avoid? A) Semi-Fowler B) Supine C) High Fowler D) Side-lying

19. A newborn is diagnosed with metatarsus adductus. The parents ask the nurse about how this occurred. Which response by the nurse would be most appropriate? A) “This condition is due to a genetic defect in the bones.” B) “It's most likely from how the baby was positioned in utero.” C) “They really don't know what causes this condition.” D) “There is probably an underlying deformity of the baby's hip.”

MATERNITY AND PEDIATRIC NURSING 3RD EDITION RICCI TEST BANK

20. A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? A) Growth plate B) Epiphysis C) Physis D) Metaphysis

21. A group of nursing students are reviewing information about the type of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of the following as a type of skeletal traction? A) Russell traction B) Bryant traction C) Buck traction D) 90-90 traction

22. The nurse is providing care to a child with a long-leg hip spica cast. Which of the following would be a priority nursing diagnosis? A) Risk for impaired skin integrity due to cast and location B) Deficient knowledge related to cast care C) Risk for delayed development related to immobility NURSINGTB.COM D) Self-care deficit related to immobility

23. A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statement by the parents demonstrates understanding of the instructions? Select all answers that apply. A) “We need to adjust the straps so that they are snug but not too tight.” B) “We should change her diaper without taking her out of the harness.” ...