1. In newborns, what other unexplained body issue is frequently associated with urinary tract anomalies?
    malformed or low-set ears
  2. It is often impossible to localize the infection, so the presence of significant numbers of organisms anywhere with the urinary tract, except AAA, constitutes a UTI. If it is a febrile UTI, what else can typically be implied? BBB
    A) distal third of the urethra, which is usually colonized with bacteria.

    B) pyelonephritis - an ascending urinary tract infection that has reached the pyelum or pelvis of the kidney
  3. Organism responsible for 80% of UTIs?
    E. coli

    Others are usually gram negative.
  4. The key to preventing UTI is to...
    maintain adequate blood supply to the bladder walls by avoidance of over distention and high bladder pressure.
  5. Diagnosis of UTI is confirmed by AAA. BBB can lead to false positives. CCC can lead to false negatives.
    • A) detection of bacteria in the urine.
    • B) organisms from the perineal or perianal area, not the urine.
    • C) Diluted urine. Either not a first morning catch or worse yet, having the child drink large volumes of water to obtain a specimen quickly.
  6. Before urine cultures are completed, what quick and inexpensive method can be used?
    Dipstick tests for leukocyte esterase or nitrite.
  7. What is vesicoureteral reflux (VUR)? Types? Associated with? Which usually are very symptomatic with?
    During voiding, urine is swept up into the ureters and then flows back into the empty bladder.

    Primary (congenital) and secondary (acquired condition).

    Kidney infections or pyelonephritis, versus bladder infection (cystitis).

    High fevers, vomiting and chills.
  8. Reflux with UTI is the most common cause of?
    renal scarring in children, which may occur with the first episode of the combination.
  9. Pt with nephrotic syndrome
    proteinuria, hypoalbuminemia and in some cases, edema; high cholesterol (hyperlipidemia) and a predisposition for coagulation.

    The cause is damage to the glomeruli, which can be the cause of the syndrome or caused by it, that alters their capacity to filter the substances transported in the blood.

    However, patients suffering from the syndrome have a good prognosis under suitable treatment.

    Kidneys affected by nephrotic syndrome have small pores in the podocytes, large enough to permit proteinuria but not large enough to allow cells through. By contrast, in nephritic syndrome red blood cells pass through the pores, causing hematuria.
  10. acute glomerulonephritis
    1) common complication of infections, typically streptococcal skin infection.

    2) Hematuria

    3) Oliguria - Urine output is less than 400 ml/day (normally 600 to 2500 ml/day).

    4) Edema

    5) Hypertension

    6) Fever, headache, malaise, anorexia, nausea, and vomiting

    7) Acute renal necrosis due to injury of capillary or capillary thrombosis
  11. Up to AAA% of children have a febrile UTI during the first BBB years of life.
    • A) 10
    • B) 2
  12. The objectives in management of UTIs are to... (4 items)
    • (1) eliminate the current infection
    • (2) identify contributing factors to reduce the risk of recurrence
    • (3) prevent urosepsis
    • (4) preserve renal function.
  13. Common defects of the genitourinary tract include
    • phimosis - too tight foreskin
    • cryptorchidism - missing testes
    • inguinal hernia - thru canal to scrotum
    • hydrocele - fluid in scrotum
    • hypospadias - early out urethra
  14. phimosis
    Condition in males where the foreskin cannot be fully retracted over the glans penis.

    The term may also refer to clitoral phimosis in women.
  15. cryptorchidism
    Absence of one or both testes from the scrotum
  16. hypospadias
    A birth defect of the urethra in the male that involves an abnormally placed urinary meatus.

    A hypospadic urethra opens anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum.
  17. Nephrogenic diabetes insipidus (NDI)
    Defect in the ability to concentrate urine. In this disorder, the distal tubules and collecting ducts are insensitive to the action of antidiuretic hormone or its exogenous counterpart, vasopressin. Although several inheritance patterns have been identified, more than 90% of patients have an X-linked defect of the vasopressin receptor. Therapy involves provision of adequate volumes of water to compensate for urinary losses and minimize urinary output through diet and medication.
  18. oliguria: quantified...
    Generally a urinary output of less than 1 ml/kg/hr.
  19. The child with a kidney transplant who exhibits any of the following should be evaluated immediately for possible rejection:
    • Fever
    • Swelling and tenderness over graft area
    • Diminished urinary output
    • Elevated blood pressure
    • Elevated serum creatinine
  20. Sam is a 17-year-old male who was admitted to the hospital 3 days ago after a motor vehicle accident. He has undergone surgery to repair a fractured femur and several large lacerations. In addition, Sam experienced severe abdominal pain caused by blunt force trauma during the accident, but it is now subsiding. However, Sam is experiencing high blood pressure and decreased urinary output.

    Sam is diagnosed with acute renal failure (ARF). His mother and father are concerned about his condition and inquire about the cause of his ARF. Based on the nurse's knowledge of trauma and Sam's medical history, what is the most appropriate response by the nurse?
    There are many causes of ARF. In Sam's case, trauma to his kidney during his accident can lead to hypoperfusion (not enough blood) of the kidneys and acute tubular necrosis. In addition, Sam's kidneys have been hypoperfused as a result of large amount of blood loss (hemorrhage) from the accident.
  21. Sam is a 17-year-old male who was admitted to the hospital 3 days ago after a motor vehicle accident. He has undergone surgery to repair a fractured femur and several large lacerations. In addition, Sam experienced severe abdominal pain caused by blunt force trauma during the accident, but it is now subsiding. However, Sam is experiencing high blood pressure and decreased urinary output.

    The most appropriate nursing interventions needed to monitor Sam's renal function are

    A) strict intake and output records.

    Ideally, the amount of his intake and output would be almost equal. In ARF, his intake will be much higher than his output. Monitoring his intake and output closely will allow the physician to determine whether further intervention is needed to remove excess fluid. Daily weights can also be obtained to monitor fluid status.

    As Sam's renal function worsens, he will retain fluid and become edematous. However, abdominal girth changes are more indicative of ascites and liver function.

    Although monitoring intake of sodium and potassium is important, this does not provide any information regarding Sam's renal function. Obtaining serum electrolyte levels would be more helpful.
  22. Sam is a 17-year-old male who was admitted to the hospital 3 days ago after a motor vehicle accident. He has undergone surgery to repair a fractured femur and several large lacerations. In addition, Sam experienced severe abdominal pain caused by blunt force trauma during the accident, but it is now subsiding. However, Sam is experiencing high blood pressure and decreased urinary output.

    As Sam's condition worsens, he becomes edematous and increasingly hypertensive. The health care provider orders a dose of albumin followed by furosemide (Lasix) intravenously. As the nurse discusses these medications with Sam's parents, what information is pertinent?

    A- The albumin is a blood product that will improve Sam's condition by increasing his blood volume, leading to increased renal perfusion. Lasix is then given to promote diuresis.
    B- Albumin is used to move fluid from the interstitial space back into the intravascular space. Lasix is then given to promote diuresis.
    C- After taking the medications, Sam will have to void.
    D- A and C
    E- B and C
    E- B and C

    Albumin can be given as a plasma volume expander to maintain cardiac output in the treatment of certain types of shock. However, it is not used for this purpose in ARF.

    Albumin's ability to mobilize fluid back into the intravascular space and the diuresis caused by Lasix can be used to treat edema and fluid overload in ARF.

    This is an appropriate statement following administration of any diuretic.
  23. Sam is a 17-year-old male who was admitted to the hospital 3 days ago after a motor vehicle accident. He has undergone surgery to repair a fractured femur and several large lacerations. In addition, Sam experienced severe abdominal pain caused by blunt force trauma during the accident, but it is now subsiding. However, Sam is experiencing high blood pressure and decreased urinary output.

    After 10 days in the hospital, Sam is making progress and will be discharged home tomorrow on a sodium- and potassium-restricted diet, until his renal function returns to normal. What are the most appropriate topics to discuss with Sam regarding this diet?

    C) Canned foods should be avoided.

    This statement is indicative of a healthy diet for most patients. However, some fruits and vegetables are high in sodium and potassium.

    Fresh meat is appropriate for this diet. He should avoid any smoked, breaded, or packaged meat because salt is used as a preservative.

    Most canned foods contain a large amount of sodium as a preservative. In general, foods with more than 200 mg of sodium in a serving should be limited or avoided.
  24. Tara is a 4-year-old girl who has been toilet trained for about 9 months. She loves the water, has been enrolled in swimming classes, and likes to take bubble baths. She is brought to the emergency department after having fever up to 102° F for 2 days and abdominal pain. Her mother states that Tara has been complaining of pain since yesterday and that she had two toileting "accidents."

    Tara's probable diagnosis is urinary tract infection (UTI). Which of the following are factors that place Tara at risk for developing UTIs?

    D) All of the above

    Very young girls have a urethra only 2 cm in length, which allows easier means for bacteria to enter the urinary tract. At this age the anus is closely approximated to the urethra, which can lead to fecal contamination of the urethra.

    Tara's recent toilet training and inexperience with proper hygiene can increase her risk of UTI, especially if she has poor wiping techniques. Girls should be taught to wipe from front to back to decrease the probability of fecal contamination of the urethra.

    Taking bubble baths can lead to UTIs. As children sit in the water, the urethra dilates, allowing bacteria present on the bathtub's surface to enter the urinary tract. Showering is preferred, since the water does not remain stagnant. The risk is not as great during swimming, if the pool is properly sanitized and children are reminded to leave the pool to void.
  25. Tara is a 4-year-old girl who has been toilet trained for about 9 months. She loves the water, has been enrolled in swimming classes, and likes to take bubble baths. She is brought to the emergency department after having fever up to 102° F for 2 days and abdominal pain. Her mother states that Tara has been complaining of pain since yesterday and that she had two toileting "accidents."

    Based on the Tara's presentation, what type of physician orders would the nurse anticipate receiving first?

    B) Urinalysis and urine culture

    A urinalysis and urine culture must be obtained by either clean catch or catheterization to correctly diagnose the probable UTI. The presence of nitrites and leukocytes on the urinalysis will confirm the diagnosis. The urine culture will be needed to identify the organism to ensure the appropriate antibiotic is used to treat the infection.

    A blood culture and CBC would be necessary if the patient had fever of unknown origin. Although a WBC count would reveal infection, the urinalysis and urine culture tests are more focused on Tara's physical findings and chief complaint.

    Like the blood culture and CBC, a lumbar puncture may be indicated if the child had a fever of unknown origin and headache or dizziness. However, her symptoms are strictly related to her urinary tract.

    An abdominal x-ray is indicated only if Tara experienced abdominal pain without a probable cause. Her symptoms suggest a UTI as the cause.
  26. Tara is a 4-year-old girl who has been toilet trained for about 9 months. She loves the water, has been enrolled in swimming classes, and likes to take bubble baths. She is brought to the emergency department after having fever up to 102° F for 2 days and abdominal pain. Her mother states that Tara has been complaining of pain since yesterday and that she had two toileting "accidents."

    After Tara has remained afebrile for 24 hours, she is discharged from the hospital on oral antibiotics. What is the most appropriate teaching priority to discuss with Tara's mother?

    B) Tara should complete all her medication.

    Appropriate toileting and wiping are important to reduce the risk of UTI, but not the most important in treating the current infection.

    Many oral antibiotics require increased fluid intake, but this is not the highest priority.

    Tara should continue her course of antibiotics and finish all her medication, even if her condition improves and she no longer feels ill. Failure to complete the antibiotic therapy could result in recurring infection.

    Although discussing proper hand washing is always a priority, it is not the most important information to discuss with Tara's mother.
  27. Tara is a 4-year-old girl who has been toilet trained for about 9 months. She loves the water, has been enrolled in swimming classes, and likes to take bubble baths. She is brought to the emergency department after having fever up to 102° F for 2 days and abdominal pain. Her mother states that Tara has been complaining of pain since yesterday and that she had two toileting "accidents."

    Tara is admitted to the hospital for intravenous antibiotic therapy. Her urine culture is positive for Escherichia coli, and her antibiotics are changed to better treat this organism. Tara's mother asks for information regarding this bacterium. What is an appropriate response?
    E. coli is the most common bacterium that leads to UTIs, causing approximately 80% of these infections. It is a very common bacterium in the intestines that is excreted in the stool. Improper wiping and poor hand washing after toileting can lead to E. coli UTIs.
  28. Normal specific gravity range of urine?
    1.015 to 1.030
  29. Protein should not be present in the urine. Its presence would indicate
    an abnormality in glomerular filtration
  30. Glucose should not be present in the urine. If present, it could indicate...
    • diabetes mellitus
    • glomerulonephritis
    • a response to infusion of fluids with high glucose concentrations.
  31. expected pH of urine is ...
    4.8 to 7.8
  32. Oncotic pressure, or colloid osmotic pressure, is ...
    a form of osmotic pressure exerted by proteins in a blood vessel's plasma (blood/liquid) that usually tends to pull water into the circulatory system. It is the opposing force to hydrostatic pressure.

    In conditions where plasma proteins are reduced, e.g. from being lost in the urine (proteinuria from glomerular disease one of which is nephrotic syndrome), there will be a reduction in oncotic pressure and an increase in filtration out of the capillary, resulting in excess fluid buildup in the tissues (edema).
  33. In addition to presenting symptoms, what laboratory finding indicates nephrosis?

    B) Hypoalbuminemia

    Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine in a child with nephrosis.

    The specific gravity is increased due to the large amount of protein in a child with nephrosis.

    The hematocrit would be elevated secondary to nephrosis. (As plasma leaves vasculature to interstitial spaces to cause edema, the relative % of RBC will increase.)

    The hemoglobin would be elevated secondary to the hypovolemia in a child with nephrosis.
  34. The parent of a child hospitalized with acute glomerulonephritis (AGN) asks the nurse why blood pressure readings are being taken so often. Based on the nurse’s knowledge of AGN, the most appropriate response by the nurse is

    B) acute hypertension must be anticipated and identified.

    Vital signs, in particular the blood pressure, provide information about the severity of AGN and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention.

    Blood pressure does not commonly fluctuate with antibiotic therapy.

    Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover.

    Hypertension, not hypotension, is more likely with AGN.
  35. A 3-year-old child is scheduled for surgery to remove a Wilms’ tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on knowledge that

    D) chemotherapy with or without radiotherapy is indicated.

    The determination of chemotherapy and/or radiotherapy as treatment modalities will be made based on the histologic pattern of the tumor. Chemotherapy with or without radiotherapy is usually indicated.

    Additional therapy of some type is indicated after the tumor is removed.

    Chemotherapy or radiotherapy, or both, may be indicated as a postsurgical intervention.

    Most children with Wilms’ tumor do not require renal transplants.
  36. Wilms’ tumors are encapsulated. It is extremely important to AAA of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. A sign should be placed over the bed indicating that BBB should be conducted.
    • A) avoid any palpation
    • B) no abdominal palpation
  37. A toddler is hospitalized with acute renal failure (ARF) secondary to severe dehydration. The nurse should assess the child for what possible complications?

    A) Water intoxication

    The child with acute renal failure has the tendency to develop water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes.

    The child needs to be monitored for hypertension, not hypotension, when hospitalized with acute renal failure.

    Hyperkalemia, not hypokalemia, is a concern in acute renal failure.

    Hyponatremia, not hypernatremia, may develop in acute renal failure as the sodium is diluted in large amounts of water.
  38. A 6-year-old child with acute renal failure (ARF) is being transferred out of the intensive care unit. Which children, considering their diagnoses, would be the most appropriate roommate for this child?

    A) 5-year-old child who has a fractured femur

    The 5-year-old orthopedic patient would be the best choice for a roommate. This child does not have an illness of viral or bacterial origin.

    A child with pneumonia has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.

    A child with gastroenteritis has an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.

    A child who has had surgery for a ruptured appendix may have an illness of viral or bacterial origin and should not be placed in the same room as a child with ARF.
  39. Cyclosporine is given to ...
    suppress rejection in transplant patients
  40. AAA, BBB, and CCC are high in potassium.
    • A) Bananas
    • B) carrots
    • C) green leafy vegetables
  41. A nurse is caring for an infant with a suspected urinary tract infection (UTI). Based on the nurse’s knowledge of UTIs, which clinical manifestation would be observed? (Select all that apply)

    A) Vomiting
    B) Jaundice
    C) Swelling of the face
    D) Persistent diaper rash
    E) Failure to gain weight
    A, D, and E

    Vomiting is a clinical manifestation observed in an infant with a urinary tract infection (UTI) and can be related to poor feeding.

    Persistent diaper rash is a clinical manifestation of UTI in an infant.

    Failure to gain weight is a clinical manifestation of UTI in an infant related to poor feeding and vomiting.

    Jaundice is not a clinical manifestation of UTI in an infant.

    Swelling of the face is not a clinical manifestation of UTI in an infant. (This is not a GLOMERULAR DISEASE.)
  42. Obtundation
    refers to less than full mental capacity in a medical patient, typically as a result of a medical condition or trauma.

    The root word, obtund, means "dulled or less sharp".
  43. Encephalitis
    an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis. Symptoms include headache, fever, confusion, drowsiness, and fatigue. More advanced and serious symptoms include seizures or convulsions, tremors, hallucinations, and memory problems.

    Adult patients with encephalitis present with acute onset of fever, headache, confusion, and sometimes seizures. Younger children or infants may present irritability, poor appetite and fever.
  44. Carbon dioxide has a potent AAA effect and will BBB cerebral blood flow and CCC.
    • A) vasodilating
    • B) increase
    • C) intracranial pressure (ICP)
  45. Cerebral hypoxia at normal body temperature that lasts longer than AAA minutes nearly always causes irreversible brain damage.
    A) 4
  46. Fractures resulting from head injuries may be classified as AAA, BBB, CCC, and DDD.
    A) depressed - comminuted (fracture in which the bone has broken into several pieces) fractures in which broken bones are displaced inward

    B) compound - A fracture which occurs in conjunction with an overlying laceration which tears the epidermis and the meninges or runs through the paranasal sinuses and the middle ear structures, resulting in the outside environment being in contact with the cranial cavity.

    C) basilar - linear fractures that occur in the floor of the cranial vault (skull base), which require more force to cause than other areas of the neurocranium

    D) diastatic - when the fracture line transverses one or more sutures of the skull causing a widening of the suture. Often in children, but possible in adults since the lambdoidal suture does not fully fuse in adults until about the age of 60.
  47. Epidural (extradural) hematoma is a hemorrhage into ...
    the space between the dura and the skull.
  48. subdural hemorrhage is bleeding AAA, which overlies the brain and the subarachnoid space. The hemorrhage may be from two sources: BBB and CCC. Subdural hematomas are DDD common than epidural hematomas and occur most often in infancy, with a peak incidence at 6 months.
    • A) between the dura and the arachnoid membrane
    • B) tearing of the veins that bridge the subdural space
    • C) hemorrhage from the cortex of the brain caused by direct brain trauma
    • D) much more
  49. Some degree of cerebral edema is expected after craniocerebral trauma. It peaks at AAA hours after injury and may account for changes in a child’sneurologic status.
    A) 24 to 72
  50. Cerebral edema associated with traumatic brain injury may be a result of two different mechanisms: AAA edema or BBB edema.
    A) cytotoxic - the BBB (blood brain barrier) remains intact. It occurs due to a disruption in cellular metabolism that impairs functioning of the sodium and potassium pump in the glial cell membrane, leading to cellular retention of sodium and water

    B) vasogenic - Vasogenic edema occurs due to a breakdown of the tight endothelial junctions which make up the blood–brain barrier (BBB). This allows intravascular proteins and fluid to penetrate into the parenchymal extracellular space.
  51. All children who have a submersion injury should be admitted to the hospital for observation. Although many patients do not appear to have suffered adverse effects from the event, complications (e.g., respiratory compromise, cerebral edema) may occur AAA after the incident.
    A) 24 hours
  52. However, the most common symptoms of infratentorial brain tumors are AAA, and BBB.
    • A) headache, especially on awakening
    • B) vomiting that is not related to feeding
  53. Image Upload 1
    Most childhood primary brain tumors are AAA, while most adult primary brain tumors are BBB.
    • A) infratentorial
    • B) supratentorial
  54. AAA is the most common BBB tumor of childhood and the most common cancer diagnosed in infancy.
    • A) Neuroblastoma
    • B) extracranial solid
  55. Neuroblastomais a “AAA” tumor. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site, usually the lymph nodes, bone marrow, skeletal system, skin, or liver.
    A) silent
  56. Routine immunization of infants with AAA and BBB vaccines has reduced the incidence of bacterial meningitis, which is CCC.
    • A) Haemophilus influenzae type b
    • B) pneumococcal conjugate
    • C) a medical emergency that requires early recognition and immediate therapy to prevent death and avoid residual disabilities. The child is isolated from other children, usually in an intensive care unit for close observation. An IV infusion is started to facilitate administration of antimicrobial agents, fluids, antiepileptic drugs, and blood, if needed. The child is placed on a cardiac monitor and in respiratory isolation.
  57. Aseptic meningitis refers to the onset of meningeal symptoms: fever and AAA without bacterial growth from CSF cultures.
    A) pleocytosis

    - an increased cell count, particularly an increase in white blood cell (WBC) count, in a bodily fluid, such as cerebrospinal fluid (CSF). It is often defined specifically as an increased WBC count in CSF.
  58. Nursing Care for Reye Syndrome?
    1) No aspirin, esp. in varicella (small pox).

    2) Teach to watch for hidden salicylates, e.g. Pepto-Bismol.

    3) Since cerebral edema w/ inc ICP is most immediate threat to life, carefully monitor I/O to prevent it as well as dehydration.

    4) Because of related liver dysfunction, watch labs for impaired coagulation via prolonged bleeding time.
  59. Epilepsy is a condition characterized by AAA or more unprovoked seizures.
    A) two

    A single seizure event should not be classified as epilepsy and is generally not treated with long-term antiepileptic drugs.
  60. A seizure is a symptom of an underlying pathologic condition and may be manifested by sensory-hallucinatory phenomena, motor effects, sensorimotor effects, or loss of consciousness. The manifestation of seizures depends on the region of the brain in which they originate and may include ...
    unconsciousness or altered consciousness

    involuntary movements

    changes in perception, behaviors, sensations, and posture.
  61. Partial seizures are categorized as simple (meaning AAA) or complex(BBB); both types may become generalized.
    • A) without associated impairment of consciousness
    • B) with impaired consciousness
  62. Aphasia
    speechlessness - may be one of the varied symptoms of the postictal state (the period after a seizure).
  63. For wound healing, when possible, eliminate factors that contribute to the dermatitis and prolong the course of the disease. The most common offenders in pediatrics are environmental factors (AAA) and natural elements (BBB).
    • A) such as soaps, bubble baths, shampoos, rough or tight clothing, wet diapers, blankets, and toys
    • B) such as dirt, sand, heat, cold, moisture, and wind
  64. Parents can generally manage small wounds to the skin at home. Instruct parents to wash their hands and then wash the wound gently with AAA. Caution them to avoid BBB because these products are toxic to wounds.
    • A) mild soap and water or with normal saline
    • B) povidone-iodine, alcohol, and hydrogen peroxide
  65. Ringworm (aka AAA)) are infections caused by a group of closely related filamentous fungi that invade primarily the stratum corneum, hair, and nails. These are superficial infections by organisms that live on, not in, the skin. When teaching families about the care of children with ringworm, emphasize good health and hygiene. Both BBB and CCC shampoos may reduce colony counts of dermatophytes. These shampoos can be used in combination with oral therapy to reduce the transmission of the disease to others.
    • A) dermatophytoses
    • B) 2% ketoconazole
    • C) 1% selenium sulfide
  66. Scabies is an endemic infestation caused by the scabies mite, Sarcoptes scabiei. Lesions are created as the impregnated female scabies mite burrows into the AAA of the epidermis (never into living tissue), where she deposits her eggs and feces. The treatment of scabies is the application of a scabicide. The drug of choice in children and infants older than BBB months is CCC.
    • A) stratum corneum
    • B) 2
    • C) permethrin 5% cream (Elimite)
  67. Because of its efficacy and lack of toxicity, the drug of choice for infants and children is AAA, which kills adult lice and nits.
    A) permethrin 1% cream rinse (Nix)
  68. Lyme disease is the most common tick-borne disorder in the United States. It is caused by the spirochete Borrelia burgdorferi, which enters the skin and bloodstream through the saliva and feces of ticks, especially the deer tick.

    At the time the rash appears or shortly thereafter, children over AAA years of age are treated with BBB, and children under AAA years of age are given CCC.
    • A) 8
    • B) oral doxycycline or amoxicillin
    • C) amoxicillin
  69. A complete neurologic examination includes...
    • level of consciousness
    • posture
    • motor, sensory, cranial nerve, and reflex testing
    • vital signs.
  70. In the Glasgow Coma Scale (GCS), the highest score is AAA. BBB or below is generally accepted as the definition of a coma, and CCC is the lowest score representing DDD.
    • A) 15
    • B) 8
    • C) 3
    • D) deep coma
  71. Fast growing and highly malignant

    C. Medulloblastoma
  72. Most common pediatric brain tumor

    D. Low-grade astrocytoma
  73. Often grows to a very large size before causing symptoms

    D. Brainstem glioma
  74. Invades ventricles, obstructing flow of CSF

    D. Ependymoma
  75. Surgical excision is very difficult due to tumor location.

    E. Brainstem glioma
  76. Presenting signs may include seizures and bizarre behavior such as staring spells and automatic movements.

    A. Low-grade astrocytoma
  77. Slow-growing tumor (if low grade) and has a 70% to 90% chance of cure if totally removed surgically

    E. Cerebellar astrocytoma
  78. Presenting signs of headache and vomiting are uncommon.

    E. Brainstem glioma
  79. Period for risk of recurrence is age at diagnosis plus 9 months.

    D. Medulloblastoma
  80. Presenting signs may include weakness in one hand and stumbling to one side.

    C. Cerebellar astrocytoma
  81. Presenting signs may include papilledema and hydrocephalus (in infants).

    E. Ependymoma
  82. Discuss why the most common presenting symptoms of a brain tumor are headache and vomiting.
    The headache occurs from traction on pain-sensitive areas, such as the large blood vessels and cranial nerves, and possibly from dural stretching. The headache is worse in the morning from the compression of these structures during sleep. It typically subsides or improves during the day. Vomiting occurs from increased intracranial pressure that compresses the brainstem, directly stimulating the vomiting center in the medulla. (In infants, whose sutures are still open, there may not be any early symptoms.)
  83. The treatment of choice is total removal of the (brain) tumor surgically. Discuss some preoperative teaching that should be given to the child and family.
    Deliver information in small amounts. Be honest about the surgical procedure (may or may not be able to remove the whole tumor; presurgical conditions such as ataxia (lack of voluntary coordination of muscle movements) and headaches may persist or be temporarily worse after surgery). Hair will be shaved before surgery (consider braiding the hair if it is long, show child how he or she looks at different stages of the shaving process, offer a cap or scarf to cover the head, consider the idea of a wig). Discuss the size of the dressing after the surgery (usually covers the entire scalp). Give brief explanation of how the child will feel and where he or she will be after surgery (usually will be sleepy and have a headache and will be in the intensive care unit).
  84. In the postoperative period, all of the following are normal findings, except

    D) presence of colorless drainage on the dressing.

    The presence of colorless drainage is reported immediately because it most likely is cerebrospinal fluid from the incision area.
  85. What are the clinical symptoms of increased ICP in a child 6 years of age?
    Headache, nausea, forced vomiting, diplopia, blurred vision, seizures
  86. Choose and list the following vital sign changes that are associated with brainstem injury following acute head trauma:
    • Rapid or intermittent respirations
    • Wide fluctuations in pulse
    • Widening pulse pressure
    • Extreme fluctuations in blood pressure
    • Elevated temperature
  87. One of Tummy’s nursing diagnoses is Risk for Injury related to physical immobility, depressed sensorium, and intracranial pathologic condition. List four nursing interventions for this nursing diagnosis that focus on maintaining a stable ICP.
    • Elevate HOB 15 to 30 degrees
    • Maintain head in midline position
    • Avoid pressure on neck veins
    • Avoid flexion or hyperextension of the neck
    • Avoid respiratory procedures such as suctioning
    • Prevent constipation
    • Minimize emotional stress and crying
    • Prevent or relieve pain
    • Monitor ICP
  88. During prenatal ultrasonography, it is discovered that Mrs. Abbott’s fetus has a myelomeningocele. Provide answers to Mrs. Abbott’s questions about the defect, which are as follows:

    How often does myelomeningocele happen?
    The incidence of neural tube defects in the United States declined from 1.3 per 1000 births in 1970 to 0.6 per 1000 births in 1989. Myelomeningocele accounts for 90% of all spinal cord lesions. Therefore, the incidence of myelomeningocele is inferred to be less than 1 per 1000 live births in the United States.
  89. During prenatal ultrasonography, it is discovered that Mrs. Abbott’s fetus has a myelomeningocele. Provide answers to Mrs. Abbott’s questions about the defect, which are as follows:

    I heard someone say that my baby will have water on the brain. What is that? Is this always true?
    Hydrocephalus is the correct term, which means that there is obstruction to cerebrospinal fluid (CSF), caused by downward displacement of the brainstem and cerebellum. Of children with myelomeningocele, 90% to 95% have hydrocephalus. Uncorrected, the fluid buildup causes increasing head size in an infant, brain damage, and possibly death.

    Rationale: The anomaly most frequently associated with myelomeningocele is hydrocephalus. Hydrocephalus can occur because the myelomeningocele itself disrupts the flow of CSF. Although present at birth, hydrocephalus may not be detected until shortly thereafter.
  90. During prenatal ultrasonography, it is discovered that Mrs. Abbott’s fetus has a myelomeningocele. Provide answers to Mrs. Abbott’s questions about the defect, which are as follows:

    How is hydrocephalus corrected?
    In most cases, a shunting procedure is done surgically to provide drainage of the CSF from the ventricles to an extracranial compartment, usually the peritoneum. This is called a VP shunt.

    Rationale: Surgical treatment is the therapy of choice for hydrocephalus, and most children require a shunt procedure. The preferred shunt procedure in neonates and young infants is the ventriculoperitoneal (VP) shunt because it allows more excess tubing, which minimizes the number of revisions needed as the child grows.
  91. During prenatal ultrasonography, it is discovered that Mrs. Abbott’s fetus has a myelomeningocele. Provide answers to Mrs. Abbott’s questions about the defect, which are as follows:

    What kinds of problems do children with myelomeningocele have?
    Hydrocephalus, paralysis, orthopedic deformities, and bowel and bladder control problems

    Rationale: The location and magnitude of the defect determines the nature and extent of neurologic impairment. Hydrocephalus is the most common anomaly associated with myelomeningocele, occurring in 90% to 95% of the children with spina bifida. The largest number of myelomeningoceles occur in the lumbar or lumbosacral area. Lesions in these regions result in various types of sensory and motor nerve involvements, leading to orthopedic deformities and bowel and bladder control problems.
  92. What clinical behaviors are expected in an infant with meningitis?
    • Fever
    • Poor feeding
    • Vomiting
    • Irritability
    • Seizures
    • High-pitched cry
    • Bulging fontanel
    • Nuchal rigidity - inability to flex the neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.

    Rationale: The classic presentation of meningitis is rarely seen in infants and children between 3 months and 2 years; thus, the symptoms seen in the infant include fever, poor feeding, vomiting, marked irritability, toxic appearance, and frequent seizures accompanied by a high-pitched cry. The most significant findings include a bulging fontanel and nuchal rigidity.
  93. A definitive diagnosis of meningitis is made on the basis of what test?
    Examination of cerebrospinal fluid by means of lumbar puncture.

    Rationale: Spinal fluid is analyzed for culture, Gram stain, blood cell count, and determination of glucose and protein count. These findings are usually diagnostic for the following reasons: The culture and Gram stain identify the causative organism. The white blood cell count is usually elevated and glucose level is reduced. Protein concentration is usually increased.
  94. Marshall is a 9-month-old child admitted to the pediatric nursing unit for Haemophilus influenzae meningitis. Marshall has had no childhood immunizations.

    Marshall may be kept on low-maintenance levels of fluids to prevent what two conditions?
    Cerebral edema; increased intracranial pressure

    Rationale: An increased intracranial pressure is avoided because it results in the reduction of cerebral perfusion pressure, which causes harmful neurologic consequences of the illness.
  95. Marshall is a 9-month-old child admitted to the pediatric nursing unit for Haemophilus influenzae meningitis. Marshall has had no childhood immunizations.

    Could this case of meningitis have been prevented?
    Yes, with immunization with Hib vaccine.

    Rationale: Routine vaccinations for H. influenzae type b are recommended for all children beginning at 2 months of age. A declining incidence of H. influenzae type b disease has occurred since the introduction of the Hib vaccine.
  96. Moro reflex
    an infantile reflex normally present in all infants/newborns up to 4 or 5 months of age as a response to a sudden loss of support, when the infant feels as if it is falling. It involves 3 distinct components:

    • spreading out the arms (abduction)
    • unspreading the arms (adduction)
    • crying (usually)

    It is distinct from the startle reflex, and is believed to be the only unlearned fear in human newborns.
  97. tonic neck
    or 'fencing posture' is present at one month of age and disappears at around four months.
  98. Status epilepticus
    a continuous seizure lasting 30 minutes or more, or a series of seizures from which the child does not regain a premorbid LOC.

    ABCs are critical

    Treat with IV diazepam in hospital or suppositories at home.
  99. Signs of seizures in newborns are subtle. They include symptoms such as
    • lip smacking
    • tongue thrusting
    • eye rolling
    • arching of the back

    The newborn's central nervous system is not sufficiently developed to maintain a tonic-clonic (generalized) seizure.
  100. What is a clinical manifestation of increased intracranial pressure (ICP) in infants?

    D) Shrill, high-pitched cry

    A shrill, high-pitched cry is a common clinical manifestation of increased ICP in infants. The characteristic cry occurs secondary to the pressure being placed on the meningeal nerves, causing pain.

    Photophobia is not indicative of increased ICP in infants.

    A pulsating anterior fontanel is normal in infants. The infant with increased ICP would be seen with a bulging anterior fontanel.

    Vomiting is one of the signs of increased ICP in children, but when present with diarrhea, it is more indicative of a gastrointestinal disturbance.
  101. The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. What is the priority assessment for this child?

    B) Reactivity of pupils

    Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity.

    The doll's head maneuver should not be performed if there is a cervical spine injury.

    Assessing for an oculovestibular response is a painful test that should not be done for a child who is having variable levels of consciousness.

    Papilledema (optic disc swelling that is caused by increased ICP) does not develop for 24 to 48 hours in the course of unconsciousness.
  102. Differentiate oculovestibular response from oculovestibular reflex.
    Reflex: e.g. eyes move left if head moves right

    Response: Irrigation of e.g. left auditory canal with ice water for 10 seconds normally causes conjugate movement of the eyes toward the side of stimulation. If not, the pontines centers of the brain are impaired, which is important for the assessment of the comatose patient.
  103. Decorticate posturing or AAA is indicative of BBB.
    • A) flexion posturing
    • B) severe dysfunction of the cerebral cortex
  104. Decerebrate posturing or AAA is indicative of BBB.
    • A) extension posturing
    • B) dysfunction at the level of the midbrain
  105. The temperature of an unconscious adolescent is 105º F (40.5º C). The priority nursing intervention is to

    B) apply a hypothermia blanket.

    Brain damage can occur at temperatures as high as 105º F (40.5º C). It is extremely important to institute temperature-lowering interventions such as hypothermia blankets and tepid water baths immediately.

    The temperature needs to be monitored, but lowering the temperature is the priority.

    Pain assessments should be ongoing, but this is not the priority at this time. Lowering the body temperature is the priority.

    Aspirin should never be administered to a child, because of the risk of Reye syndrome. Antipyretics, such as acetaminophen or ibuprofen, usually are not effective with temperatures as high as 105º F (40. 5ºC).
  106. To prevent increased ICP in children head should not be turned side to side because...
    if the jugular vein is compressed, the ICP can rise.
  107. The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and the pupils are unequal and sluggish. The most appropriate nursing action is to

    B) notify the practitioner immediately.

    The worsening of symptoms may indicate that the ICP is increasing. The practitioner should be notified immediately because this is considered a medical emergency.

    Assessing for the LOC should be done as part of the assessment.

    The nurse is noting signs of potentially increased ICP as described; therefore, this has already been completed.

    Pain medication should not be given, because it can often mask the signs of increasing ICP. The priority nursing intervention is to consult with the practitioner immediately.
  108. The postoperative care of a preschool child who has had a brain tumor removed should include

    B) close supervision of the child while he or she is regaining consciousness.

    Analgesics can be used for postoperative pain as needed.
  109. The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. What is the major priority of nursing care?

    D) Administer antibiotic therapy as soon as it is ordered.

    Initiation of antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to prevent death and to avoid resultant disabilities.

    Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued.

    Pain should be managed on an as-needed basis.
  110. A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. Based on the nurse’s knowledge of seizures, the nurse recognizes this as

    C) status epilepticus.

    Status epilepticus is a generalized seizure that lasts more than 30 minutes. This is considered a medical emergency and requires immediate treatment.

    Absence seizures are generalized seizures that are characterized by brief losses of consciousness, blank staring, and fluttering of the eyelids.

    Generalized seizures are the most common form of seizures. They include tonic-clonic (grand mal) seizures and absence (petit mal) seizures. Tonic-clonic seizures have tonic-clonic activity and loss of consciousness and involve both hemispheres of the brain.

    Simple partial seizures are characterized by varying sensations and motor behaviors.
  111. The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. An important part of the discussion with the parents is that

    A) shunt malfunction or infection requires immediate treatment.

    Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present.

    Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions.

    The development of mental retardation depends on the extent of damage before the shunt was placed.
  112. A 3-year-old child is status post shunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? (Select all that apply.)

    A) Personality change
    B) Bulging anterior fontanel
    C) Vomiting
    D) Dizziness
    E) Fever
    A, C, and E

    Personality change can be a sign of shunt malformation related to increased intracranial pressure.

    Vomiting can be a sign of shunt malformation related to increased intracranial pressure.

    Fever can be a sign of shunt malformation and is a very serious complication.
  113. The adrenal cortex secretes three important groups of hormones:
    • glucocorticoids
    • mineralocorticoids
    • sex steroids
  114. Cushing syndrome is a characteristic group of manifestations caused by excessive circulating free AAA. The five categories of Cushing syndrome are BBB.
    • A) cortisol
    • B) pituitary, adrenal, ectopic, iatrogenic, and food-dependent
  115. In Cushing syndrome because the actions of cortisol are widespread, clinical manifestations are equally profound and diverse. The physiologic disturbances, such as AAA, BBB, CCC, and DDD may have life-threatening consequences unless recognized early and treated successfully.
    • A) hyperglycemia
    • B) susceptibility to infection
    • C) hypertension
    • D) hypokalemia
  116. Type AAA diabetes is characterized by destruction of the pancreatic BBB cells, which produce insulin. This usually leads to CCC insulin deficiency.
    • A) 1
    • B) beta
    • C) absolute
  117. Type AAA diabetes usually arises because of BBB, in which the body fails to CCC, combined with relative (rather than absolute) insulin deficiency. People with type 2 diabetes can range from predominantly insulin resistant with relative insulin deficiency to predominantly deficient in insulin secretion with some insulin resistance.
    • A) 2
    • B) insulin resistance
    • C) use insulin properly
  118. Diabetes is a great imitator; AAA, BBB, and CCC are the conditions most often diagnosed when it turns out that the disease is really diabetes.
    • A) influenza
    • B) gastroenteritis
    • C) appendicitis

    The sequence of chemical events results in hyperglycemia and acidosis, which produce weight loss and the three “polys” of diabetes—polyphagia, polydipsia, and polyuria—the cardinal symptoms of the disease.
  119. AAA, the most complete state of insulin deficiency, is a life-threatening situation. Management consists of BBB, CCC, DDD, and EEE.
    • A) Diabetic ketoacidosis
    • B) rapid assessment
    • C) adequate insulin to reduce the elevated blood glucose level
    • D) fluids to overcome dehydration
    • E) electrolyte replacement (especially potassium).
  120. Select the following symptoms that are associated with DI.

    A) Excessive urination
    B) Compensatory insatiable thirst
    C) Dehydration
    D) Electrolyte imbalance
    E) Circulatory collapse
  121. What medication is given to Jody for the treatment of DI?
  122. DI results in AAA(inc/dec) urinary output and BBB(inc/dec) serum sodium.
    • A) inc
    • B) dec
  123. SIADH results in AAA(inc/dec) urinary output and BBB(inc/dec) serum sodium.
    • A) dec
    • B) inc
  124. Compare type 1 and type 2 diabetes mellitus on the following characteristics:

    A) Age of onset
    B) Percentage of population
    C) Nutritional status
    D) Islet cell antibodies
    E) Insulin therapy
    • Q                                 Type 1       Type 2
    • A. Age of onset           <20 yr       >40 yr
    • B. % of population      5%-8%      85%-90%
    • C. Nutritionally  Underweight  Overweight
    • D. Islet antibodies      80%-85%      <5%
    • E. Insulin therapy        Always      20%-30%
  125. What are the chief signs of diabetes type 1?
    Polyuria, polydipsia, polyphagia

    The increased concentration of glucose produces an osmotic gradient that causes the movement of body fluid from the intracellular space to the interstitial space, then to the extracellular space and into the glomerular filtrate in order to “dilute” the hyperosmolar filtrate. The resulting “spilling” of glucose into the urine with an osmotic diversion of water causes the classic signs of diabetes mellitus: polyuria, an excessive urinary output; polydipsia, the body’s attempt to replenish intravascular fluid volume; and polyphagia, the body’s attempts to meet its energy needs.
  126. ketoacidosis
    Fats used for energy; glycerol from fat cells converted by the liver to ketone bodies; limited rate; excess eliminated in the urine (ketonuria) or the lungs (acetone breath); ketone bodies are strong acids; lower serum pH. The definition of ketoacidosis is provided in the text.
  127. What is the expected daily insulin management for Jennifer, a type 1 diabetic?
    Twice-daily doses of regular and NPH insulin (before breakfast and before evening meal)

    Rationale: A twice-daily insulin regimen is the conventional method of control. The management regimen usually includes a rapid-acting (regular) insulin and intermediate-acting (NPH) insulin to provide consistent blood glucose levels.
  128. Adenoma
    a benign tumor of glandular origin.

    Adenomas can grow from many organs including the adrenal glands, pituitary gland, thyroid, prostate, etc. Although these growths are benign, over time they may progress to become malignant, at which point they are called adenocarcinomas. Even while benign, they have the potential to cause serious health complications by compressing other structures (mass effect) and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner (paraneoplastic syndrome).
  129. The newborn diagnosed with phenylketonuria (PKU) will require long-term follow-up to assess for the development of

    C) mental retardation.
  130. A breastfed newborn has just been diagnosed with galactosemia. The therapeutic management for this newborn is to

    A) stop breastfeeding.

    All milk- and lactose-containing formulas, including breast milk, must be stopped during infancy.

    Soy protein is the formula of choice for newborns and infants with galactosemia.
  131. What statement should the nurse include when discussing a child's precocious puberty with the parents?

    B) Dress and activities should be appropriate to the chronologic age.
  132. The nurse is planning care for a child recently diagnosed with diabetes insipidus. Which nursing intervention should be planned?

    B) Encourage the child to wear medical identification.

    Because of the unstable nature of the child's fluid and electrolyte balance, wearing a medical alert bracelet or carrying a medical identification card is an extremely important intervention.

    With diabetes insipidus, the child should have unrestricted access to fluids because the child will characteristically have polyuria due to a hyposecretion of antidiuretic hormone. (SIADH is with ways to avoid fluids)

    No urine testing is required with diabetes insipidus. This disorder should not be confused with diabetes mellitus.

    Diabetes insipidus is both lifelong and life-threatening. Medication must be taken and the effects monitored closely.
  133. What is the most important nursing consideration related to congenital hypothyroidism?

    C) Early identification of the disorder

    Early diagnosis of congenital hypothyroidism is imperative. Because brain growth is complete by 2 to 3 years of age, the thyroid hormone deficiency must be detected and replacement therapy begun as soon as possible to prevent long-term or life-threatening complications.
  134. What is the most common cause of secondary hyperparathyroidism?

    A) Chronic renal disease

    Chronic renal disease is the most common cause of secondary hyperparathyroidism. The parathyroid gland plays an integral role in the maintenance of calcium in the body, as do the kidneys.
  135. The nurse is caring for a child hospitalized with acute adrenocortical insufficiency. The acute phase seems to be over when ascending flaccid paralysis occurs. What is the most appropriate nursing action?

    A) Reassure the family that this condition is temporary.

    During the recovery phase, paralysis may develop. It is a temporary, quickly reversible clinical manifestation.

    Flaccid paralysis is problematic if not reversible. Flaccidity can indicate impending death in a child with neurologic deficits but is not associated with adrenocortical insufficiency.

    Ascending flaccid paralysis is a reversible condition when associated with adrenocortical insufficiency.

    Paralysis is a temporary, quickly reversible clinical manifestation.
  136. Which statement best describes Cushing syndrome?

    A) It is caused by excessive production of cortisol.

    Cushing syndrome is a description of the clinical manifestations caused by too much circulating cortisol.

    Exophthalmia [also called proptosis, is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor).] and pigmentary changes are manifestations of hyperthyroidism, not Cushing syndrome.

    The treatment for Cushing syndrome involves the reduction of circulating cortisol. If the cause is a pituitary tumor, surgery is indicated.

    Hypertension and hypokalemia—not hypotension, hyperkalemia, or polyuria—are expected findings with Cushing syndrome.
  137. Ambiguous genitalia are caused by
    decreased enzyme activity required for adrenocortical production of cortisol.
  138. DKA is the complete state of insulin deficiency. It is a medical emergency that must be diagnosed and treated immediately. The child is usually admitted to an AAA for assessment, BBB, and CCC.
    • A) intensive care unit
    • B) intravenous insulin administration
    • C) fluid and electrolyte replacement.
  139. Contact with the dry or succulent portions of any of three poisonous plants (ivy, oak, or sumac) produces localized, streaked or spotty, oozing, and painful impetiginous lesions.

    AAA has an effect as soon as it touches the skin. It penetrates through the epidermis as a mixture of compound molecules called catechols. These catechols bond skin proteins, where they initiate an immune response.

    Treatment of the lesions includes application of calamine lotion, soothing Burow solution compresses, and/or Aveeno baths to relieve discomfort. Topical corticosteroid gel is effective for prevention or relief of inflammation, especially when applied before blisters form. BBB may be needed for severe reactions, and a sedative such as CCC may be ordered.
    • A) Urushiol
    • B) Oral corticosteroids
    • C) diphenhydramine
  140. No sun or sun screen use until a child is AAA old.
    A) 6 months
  141. Brian, 16 years of age, has acne vulgaris. He is beginning to use tretinoin (retinoic acid, Retin-A) and benzoyl peroxide (Acne-Clear) as topical medications.

    The nurse should explain that significant improvement usually takes how long after initiation of therapy?

    C) 2 to 3 months

    Tretinoin (Retin-A) interrupts the abnormal follicular keratinization that produces microcomedones, the precursors of comedones, and takes at least 2 to 3 months for significant improvement to be apparent.
  142. Brian, 16 years of age, has acne vulgaris. He is beginning to use tretinoin (retinoic acid, Retin-A) and benzoyl peroxide (Acne-Clear) as topical medications.

    When giving instructions for application of these two topical medications, the nurse instructs Brian to apply

    C) benzoyl peroxide (Acne-Clear) in the morning and tretinoin (Acne-Clear) at bedtime.

    Benzoyl peroxide and tretinoin should not be applied at the same time because the benzoyl peroxide may oxidize the tretinoin and render it impotent.

    The preferred regimen is to apply one medication at night and one in the morning.

    Side effects of the medications may be minimized by delaying application of the medications until the skin is completely dry (20 to 30 minutes after cleansing).

    Comedones should not be expressed because this has been shown to increase scarring.

    The medications are applied to the entire face, not just lesions, to kill Propionibacterium acnes organisms and interrupt the abnormal follicular keratinization that produces microcomedones, the invisible precursors of the visible comedones.
  143. Brian, 16 years of age, has acne vulgaris. He is beginning to use tretinoin (retinoic acid, Retin-A) and benzoyl peroxide (Acne-Clear) as topical medications.

    After using the topical medications for 1 week, Brian calls the nurse to report that his skin is red and peeling. The nurse should recommend that Brian

    A) continue using both medications because erythema and peeling are normal at this time.

    Both medications cause redness and peeling with initial use. Treatment usually begins with graded increases in concentration and/or frequency of application.
  144. Brian, 16 years of age, has acne vulgaris. He is beginning to use tretinoin (retinoic acid, Retin-A) and benzoyl peroxide (Acne-Clear) as topical medications.

    Instructions for Brian should include

    B) use sunscreen and wear a hat or visor to minimize sun exposure.

    Harsh soaps and solutions are not used because they increase dryness of the skin.

    Tretinoin has been known to cause photosensitivity. This recommendation is appropriate to reduce exposure to potentially harmful ultraviolet rays.

    Comedones should not be expressed because this may cause scarring.

    There is no evidence to implicate any single dietary item or combination of foods in exacerbation of acne.
  145. Tyler, a 3-year-old boy, was burned over 30% of his body by pulling a pot of hot coffee off the counter onto himself. His upper torso, right arm, and hand are burned. Tyler is admitted to the burn unit emergency center.

    It is determined that Tyler’s injury includes both full- and partial-thickness burns. How would this burn be classified?

    A) Major
  146. Tyler, a 3-year-old boy, was burned over 30% of his body by pulling a pot of hot coffee off the counter onto himself. His upper torso, right arm, and hand are burned. Tyler is admitted to the burn unit emergency center.

    Tyler weighs 15 kg (33 pounds). Fluid replacement therapy is considered minimally adequate when hourly urinary output is

    B) 15 ml.

    Fluid replacement is maintained at a rate that will provide an hourly urinary output of 1 to 2 ml/kg for children weighing less than 30 kg (66 pounds). This would be a minimum urinary output of 15 ml for a child weighing 15 kg (33 pounds).
  147. Tyler, a 3-year-old boy, was burned over 30% of his body by pulling a pot of hot coffee off the counter onto himself. His upper torso, right arm, and hand are burned. Tyler is admitted to the burn unit emergency center.

    The analgesic of choice for Tyler’s pain is:

    B) Morphine (Duramorph)

    Acetaminophen is used in combination with an opioid such as codeine only in children with less severe injuries.

    Codeine is used in combination with a nonopioid such as acetaminophen only in children with less severe injuries.

    Demerol is not recommended for chronic use (or for more than 48 hours at a time) because of the accumulation of its metabolite, normeperidine. Normeperidine is a central nervous system stimulant that can produce anxiety, tremors, myoclonus, and generalized seizures.

    Morphine sulfate is the drug of choice because of its extensive distribution.
  148. Tyler, a 3-year-old boy, was burned over 30% of his body by pulling a pot of hot coffee off the counter onto himself. His upper torso, right arm, and hand are burned. Tyler is admitted to the burn unit emergency center.

    After debridement of the wound, a human cadaver dressing is used to cover some of the wound. This type of graft is called a(n)

    C) allograft.

    Allograft (also known as homograft) skin is processed by commercial skin banks. Allograft is particularly useful in the coverage of surgically excised, deep partial-thickness and full-thickness wounds in extensive burns when available donor sites are limited.

    Xenograft is from a variety of species, most notably pigs. It adheres less successfully than allografts because of a progressive, degenerative necrosis.

    Autograft is a permanent graft of tissue obtained from undamaged areas of the patient’s own body.

    Isograft is a permanent graft of histocompatible tissue obtained from genetically identical individuals.
  149. Tyler, a 3-year-old boy, was burned over 30% of his body by pulling a pot of hot coffee off the counter onto himself. His upper torso, right arm, and hand are burned. Tyler is admitted to the burn unit emergency center.

    Tyler had his last diphtheria-tetanus-pertussis (DTP) vaccine at age 18 months. Does he need tetanus prophylaxis now?

    A) Yes
    B) No
    B) No

    When given according to schedule, the diphtheria and tetanus vaccines provide protective antitoxin for 10 years or more.
  150. Burns classified as mild involve AAA burns over BBB of the total body surface area.
    • A) only partial-thickness
    • B) 10%
  151. Burns classified as moderate involve AAA, involving BBB of the total body surface area.
    • A) only partial-thickness burns
    • B) 10% to 20%
  152. Major burns include AAA involving BBB of the total body surface area and full-thickness burns.
    • A) partial-thickness burns (and/or full-thickness)
    • B) greater than 20%
  153. Joey is a 7-year-old boy who comes to the school nurse's office with the complaint of an itchy rash on his face. You, the school nurse, assess the rash and find reddened papules and pustules with a yellowish crust occurring around his mouth and nose.

    As the school nurse, what is your first priority?

    B) Have the child wash his hands and call his parents to have Joey see the doctor immediately.

    Impetigo is a bacterial infection of the skin. Symptoms do not usually include an elevated temperature or respiratory complications.

    Impetigo is easily spread by self-inoculation; therefore, strict handwashing and having the child avoid touching the areas will help prevent spread of the infection.

    The infected area should be kept clean and dry. A 1:20 Burow solution on compresses can be used to soften and remove undermined skin, crusts, and debris. Calamine lotion, however, should not be applied to the affected area.
  154. Joey is a 7-year-old boy who comes to the school nurse's office with the complaint of an itchy rash on his face. You, the school nurse, assess the rash and find reddened papules and pustules with a yellowish crust occurring around his mouth and nose.

    Which statement demonstrates effective learning by Joey's parents regarding his treatment?

    A) "I should keep Joey's towels separate from those of my other children."

    Impetigo is highly contagious, and keeping Joey's towels separate will prevent spreading the infection to the rest of the family.

    Itching is not a common clinical manifestation of impetigo.

    Impetigo is spread through direct contact with the lesions. Cleanliness and handwashing are important to prevent spreading of the bacteria. Washing linens in hot water and soaking combs in boiling water, however, are not necessary.

    Acyclovir is an antiviral agent that would not be effective against a bacterial infection such as impetigo.
  155. Joey is a 7-year-old boy who comes to the school nurse's office with the complaint of an itchy rash on his face. You, the school nurse, assess the rash and find reddened papules and pustules with a yellowish crust occurring around his mouth and nose.

    Which medication would you expect Joey's health care provider to order?

    B) Penicillin

    Acyclovir is an antiviral agent that would not be effective against a bacterial infection such as impetigo.

    Griseofulvin is an antifungal agent and is not used for bacterial infections.

    Although vancomycin is an antibacterial agent, it is not the drug of choice for the treatment of impetigo.

    Penicillin is the antibacterial agent of choice for the treatment of severe or extensive impetigo.
  156. If the contact with poison ivy was in the past 15 minutes, which action should the nurse recommend to the mother?

    A) Flush the skin with cold running water.

    Harsh detergents should not be used to cleanse an area contaminated with poison ivy because they irritate the skin; remove protective skin oils; and dilute the urushiol, allowing it to spread.

    Flushing the skin with cold running water within 15 minutes of contamination will neutralize the urushiol not yet bonded to the skin.

    Warm (or hot) water is not effective in neutralizing the urushiol.
  157. Clothing the child was wearing during the poison ivy encounter should be

    D) washed in hot water and detergent.

    Burning the child’s clothing is not necessary; careful laundering with hot water and detergent will sufficiently cleanse any clothing that has come in contact with the poison ivy plant.

    Clothing that has come in contact with the poison ivy plant contains urushiol, which can spread to other clothing if placed in the laundry hamper. Contaminated clothing should be handled carefully and laundered separately.

    Washing the clothing in hot water (seperately) and detergent will remove the urushiol received from the poison ivy plant.
  158. A full-blown reaction to poison ivy will be evident in approximately

    D) 2 days

    Redness, swelling, and itching at the site of contact will be evident after about 2 days.
  159. If the child has a severe reaction top poison ivy, which medication may be necessary?

    C) Oral corticosteroids

    Aveeno baths can soothe the skin and relieve discomfort; however, they are not effective in treating a severe reaction.

    Topical corticosteroid gel is effective for prevention or relief of inflammation, especially when applied before formation of blisters; it is not used to treat a severe reaction.

    Burow solution compresses are used to soothe the skin and relieve discomfort; they are not effective in treating a severe reaction.

    Oral corticosteroids suppress the inflammatory response and may be used for a severe reaction.
  160. Pt has several round scaly patches in her scalp. Sally's mother states they have gotten worse in the past month and that Sally seems to be losing her hair where the patches are located.

    What is the most likely cause of Sally's scalp lesions?

    D) Fungal infection
  161. Tinea corporis infects the
  162. Tinea cruris infects the
    thigh fold
  163. Name at least two types of treatment prescribed for children that would be appropriate for Sally, who has tinea capitis.
    • Oral griseofulvin
    • Selenium sulfide shampoos
    • Topical antifungal agents
    • Oral ketoconazole for difficult cases
  164. Sally's mother is worried about the other two younger children and hopes that they will not get the tinea capitis lesions. Name four things that would be important to instruct Sally's mother at this time.
    It is often transmitted from one person to another or from animals to humans.

    Emphasize good hygiene.

    Do not allow children to exchange grooming items, headgear, scarves, or hats.

    Do not share towels.

    Infected children should wear a cap at bedtime if they sleep with another to prevent spread.
  165. Sally’s pediatrician decides to treat her tinea capitis with griseofulvin (Gris-PEG, Grifulvin V). What are important considerations to teach Sally’s mother about this medication?
    The medication is frequently ordered for weeks to months.

    The medication should not be discontinued until the prescribed time.

    Emphasize the importance of maintaining the prescribed dosing schedule.

    High-fat foods are best for the drug’s absorption.

    Headaches, gastrointestinal upset, fatigue, insomnia, and photosensitivity may occur from the medications.

    Periodic laboratory work may be needed to monitor leukocytes and liver and renal function.
  166. Antiseptics, such as hydrogen peroxide and povidone–iodine, have a AAA on healthy cells and BBB infections.
    • A) cytotoxic effect
    • B) little effect on controlling
  167. An occlusive dressing (air- and water-tight), is applied to a large abrasion. This is advantageous because the dressing will

    B) maintain a moist environment for healing.
  168. When applying wet compresses or dressings to the skin, what should the nurse do?

    B) Apply the desired solution on cotton gauze or soft cotton cloths, such as clean cloths.

    The desired solution should be applied to Kerlix gauze; soft cotton cloths; or strips from cloth diapers, sheets, or pillowcase material.

    The moist dressing should be laid flat on the area with an attempt to not restrict movement.

    After immersion in the solution, the dressings are wrung out to avoid dripping.

    The material should be moistened and then reapplied. When the solution dries, concentrated residue is left in the dressing. The addition of fluid may result in a more concentrated soak being placed on the sensitive tissue.
  169. A nurse should explain that ringworm is

    B) spread by direct and indirect contact.

    Ringworm is spread by both direct and indirect contact. Children should wear protective caps at night to avoid transfer of ringworm to bedding.

    Ringworm is an infectious disorder.

    Because ringworm is easily transmitted, it is not a sign of uncleanliness. It can be acquired from theater seats or gym mats and by animal-to-human transmission.

    The drug griseofulvin (Fulvicin) is indicated for a prolonged course, possibly several months.
  170. When giving instructions to a parent whose child has scabies, the school nurse should tell the parent to

    D) be prepared for symptoms to last 2 to 3 weeks.

    The mite responsible for scabies will most likely be killed with the administration of medications. It will take 2 to 3 weeks for the stratum corneum to heal. That is when the symptoms will abate.

    Only the affected child needs to be treated for scabies.

    A scabicide is used. Permethrin and lindane are currently used for topical administration.

    Permethrin is applied to all skin surfaces in the treatment of scabies.
  171. What is most descriptive of atopic dermatitis (eczema) in the infant?

    B) Eczema is associated with hereditary allergies.

    The majority of children with atopic dermatitis have a family history of eczema, asthma, food allergies, or allergic rhinitis. This suggests a genetic predisposition.

    Atopic dermatitis worsens in fall and winter months.

    Eczema improves in humid climates.

    Eczema is associated with allergies.
  172. Enteral feedings are ordered for a young child with burns covering 40% of the total body surface area. The nurse should know that

    A) paralytic ileus precludes use of enteral feedings.

    Enteral feedings can begin when the paralytic ileus resolves.

    Oral feedings are not contraindicated. Oral feedings are encouraged. Most children with burns are unable to consume sufficient calories by mouth, but every possible effort is made to encourage oral feeding.

    Enteral feedings can continue during procedures.

    A high-protein, high-calorie diet is recommended to compensate for the increased basal metabolic rate that occurs after a burn injury.
  173. During the rehabilitative phase of care, pressure dressings are primarily applied to burned areas to

    A) decrease blood supply to scar.

    Uniform pressure to the scar decreases the blood supply. The use of pressure garments serves to decrease the blood supply to the hypertrophic tissue. This is done to prevent scarring and contractures.

    The goal of the pressure dressing is to improve the appearance of scars by decreasing the blood supply to the area.

    Motion is encouraged because it prevents contractures. Movement should take place to the point of pain, but no further.

    The goal of the pressure dressing is to minimize the development of scar tissue.
  174. Based on the nurse’s knowledge of wounds and wound healing, what are factors that can delay or cause dysfunctional wound healing? (Select all that apply)

    A) Overweight
    B) Hypoxemia
    C) Hypervolemia
    D) Prolonged infection
    E) Corticosteroid therapy
    A, C, and E

    Poor nutrition without proper protein and calorie intake affects healing more than being overweight itself.

    Hypovolemia, not hypervolemia, inhibits wound healing due to low circulating blood volume and oxygenation of tissues.

    Corticosteroid therapy or other immunocompromising therapy prevents macrophages from migrating to the site of injury, thus suppressing epithelialization.

    Hypoxemia makes tissues more susceptible to infection due to insufficient oxygenation.

    Prolonged infection affects the healing process and causes increased scarring
  175. contracture
     a permanent shortening of a muscle or joint. Contractures are essentially muscles or tendons that have remained too tight for too long, thus becoming shorter. Once this occurs they cannot be stretched or exercised away; they must be released with orthopedic surgery.
  176. Orthostatic intolerance
    the development of symptoms when standing upright which are relieved when sitting back down again.

    Orthostatic intolerance occurs in humans because standing upright is a fundamental stressor and requires rapid and effective circulatory and neurologic compensations to maintain blood pressure, cerebral blood flow, and consciousness. When a human stands, approximately 750 mL of thoracic blood is abruptly translocated downward.
  177. Three major cardiovascular consequences of immobility are
    • orthostatic intolerance
    • increased workload of the heart
    • thrombus formation
  178. Features of children’s fractures not observed in the adults include
    • presence of growth plate
    • thicker and stronger periosteum
    • bone porosity
    • more rapid healing
    • less joint stiffness.
  179. The five Ps of ischemia from a vascular injury that should be included in the assessment are
    • pain
    • pallor
    • pulselessness
    • paresthesia (pins & needles)
    • paralysis.
  180. The goals of fracture management are to
    • regain alignment and length of bony fragments
    • retain alignment and length
    • restore function to injured parts.
  181. Reduction
    bringing back to normal
  182. Simple nondisplaced fractures in children may be managed with immobilization in a cast or splint forAAA weeks.
    A)  4 to 6
  183. Pain management with AAA has been shown to reduce fracture painin children.
    A) ibuprofen
  184. The primary purposes of traction are to AAA, BBB, and CCC. The two main types of traction are DDD and EEE.
    • A) fatigue involved muscles and reduce muscle spasm
    • B) position bone ends in desired realignment
    • C) immobilize the fracture site until realignment has been achieved to permit casting or splinting
    • D) skin traction
    • E) skeletal traction
  185. Potential complications of traction and casts include ...
    • circulatory impairment
    • nerve compression
    • nonunion of bones
    • skin breakdown
  186. A AAA is an injury in a joint, caused by the ligament being stretched beyond its own capacity. A muscular tear caused in the same manner is referred to as a BBB.
    • A) sprain
    • B) strain
  187. Basic principles for managing sprains and other soft tissue injuries are summarized in the mnemonic AAA: meaning BBB.
    • A) RICES
    • B) Rest, Ice, Compression (elastic bandage), Elevation, and Support
  188. The primary treatment of congenital hipdysplasia in infancy is the use of a AAA. Older children may require a hip spica cast, traction, or a surgical hip reduction.
    A) Pavlik harness

    A cast which includes the trunk of the body and one or more limbs is called a spica cast, just as a cast which includes the "trunk" of the arm and one or more fingers or the thumb is.
  189. The syndrome known as female athlete triad consists of
    • amenorrhea
    • osteoporosis
    • disordered eating
  190. Treatment of clubfoot consists of manipulation and AAA to correct the deformity, maintenance of the correction, surgical heel cord release, and prevention of possible recurrence of the deformity.
    serial casting
  191. Legg-Calvé-Perthes disease is a self-limiting disorder in which there is
    aseptic necrosis of the femoral head
  192. Scoliosis is managed by bracing or surgicalcorrection. Bracing is not curative, and surgical intervention may be requiredfor correction of severe curves (usually AAA degrees or more).
    A) 40
  193. AAA is the most common bone cancer in children and most commonly affects patients in the second decade of life during their growth spurt. Optimum treatment of AAA includes surgery and chemotherapy.
    A) Osteosarcoma (osteogenic sarcoma)
  194. AAA is the most common soft tissue sarcoma in children. The initial signs and symptoms are related to the site of the tumor and compression of adjacent organs. All AAA are high-grade tumors with the potential for metastases. Therefore multimodal therapy is recommended for all patients.
    A) Rhabdomyosarcoma (rhabdo, striated)
  195. Bone infections such as AAA include inoculation with a large number of organisms, presence of a foreign body, bone injury, high virulence of an organism, immunosuppression, and malnutrition. Certain types and locations of bone are also more vulnerable to infection. AAA is managed with vigorous antibiotic therapy, immobilization of the affected part, and (sometimes) surgical drainage.
    A) osteomyelitis
  196. AAA is the most common osteoporosis syndrome in children, characterized by excessive fractures and bone deformity. AAA has an autosomal dominant inheritance pattern in the majority of cases, although the most severe form demonstrates autosomal recessive inheritance. Clinical features may include varying degrees of bone fragility, deformity, and fracture; blue sclerae; hearing loss; and dentinogenesis imperfecta (hypoplastic discolored teeth). Medical management is primarily supportive. Children with OI may be erroneously identified as victims of child abuse as a result of numerous fractures.
    A) Osteogenesis imperfecta (OI)
  197. The word "synovium" is the clear, viscid, lubricating fluid secreted by synovial membranes in between synovial joints.
  198. AAA is achronic autoimmune disorder that affects the collagen tissues of the body.  The cause of AAA is not known but it appears to result from a complex interaction of genetics with an unidentified trigger that activates the disease.  Suspected triggers include exposure to ultraviolet light, estrogen, pregnancy, infections, and drugs.
    A) Systemic lupus erythematosus (SLE)
  199. Carey Ortolani was diagnosed with left developmental dysplasia of the hip (DDH) at her 2-month-old well-baby visit. The diagnosis was made because she exhibited all the classic signs of DDH. Casey was placed in a hip spica cast to achieve medical management.

    What are the signs of DDH specific to this age group?
    Asymmetry of gluteal and thigh folds, limited hip abduction, and shortening of femur

    Rationale: Adduction contractures develop at about 6 to 10 weeks, and the Ortolani sign disappears. The most sensitive test at this time is limited abduction along with visible signs, including shortening of the limb on the affected side (Galeazzi sign, Allis sign), asymmetry of the thigh and gluteal folds, and broadening of the perineum in bilateral dislocation.
  200. AAA, in functional anatomy, is a movement which draws a limb out to the side, away from the median sagittal plane of the body. It is thus opposed to BBB.
    • A) Abduction
    • B) adduction
  201. What are the risk factors for DDH?
    Developmental Dysplasia of the Hip: Females affected more than males (6:1); left hip affected three times more often than right; 80% unilateral

    Rationale: DDH has an incidence of 1 to 2 cases per 1000 live births in the United States; it occurs more commonly in females (6:1), and one fifth of the cases involve both hips; when only one hip is involved, the left hip is affected three times more often than the right.
  202. Discuss the differences between the following terms: Preluxation, Subluxation and Dislocation of the hip.
    Acetabular dysplasia, which is the mildest form; apparent delay in development, but the femoral head remains in the acetabulum.

    The most common form; incomplete dislocation where the head of the femur is partially displaced and a flattening of the socket occurs.

    The femoral head loses contact with the acetabulum; the ligaments are elongated and taut.
  203. In addition to casting, what other type of reduction device is used in the management of DDH?
    DDH (Developmental Dysplasia of the Hip) - The Pavlik harness is the most widely used abduction device. It is worn continuously until the hip is clinically and radiographically stable, usually 3 to 6 months.
  204. Carey Ortolani was diagnosed with left developmental dysplasia of the hip (DDH) at her 2-month-old well-baby visit. The diagnosis was made because she exhibited all the classic signs of DDH. Casey was placed in a hip spica cast to achieve medical management.

    List specific home care instructions directed toward maintaining Carey’s skin integrity.
    Petal cast edges; waterproof cast openings; keep skin clean and dry with mild soap and water.

    Rationale: Petaling cast edges is done to provide a continuous waterproof bridge between the perineum and the cast to prevent leakage. Making the cast openings waterproof and keeping the skin clean and dry will minimize the risk of skin breakdown.
  205. Which diagnostic studies are most useful for assessing skeletal trauma?
    Radiography - The calcium deposits in bone make the entire structure radiopaque, making visualization and diagnosis of injury possible.

    Blood studies - Severe soft tissue, muscle, and bone injury often results in the destruction of red blood cells with a rise in bilirubin and a fall in the hemoglobin or hematocrit reading.
  206. What is the pathogen most frequently associated with infection of the bone (osteomyelitis)?
    Staphylococcus aureus

    Rationale: Osteomyelitis is often secondary to a bloodstream infection and can be caused by any bacterial organism; however, S. aureus is the most common pathogen.
  207. What is Legg-Calvé-Perthes disease, and what causes it?
    sumptom: limping

    The cause of this disease is unknown. There is a disruption in blood flow to the femoral capital epiphysis that results in ischemic aseptic necrosis of the head of the femur. Circulation to this area is more susceptible during middle childhood.
  208. There are four stages of Legg-Calvé-Perthes disease. Describe each stage.
    Stage I: Aseptic necrosis or infarction of the femoral capital epiphysis with degenerative changes producing flattening of the upper surface of the femoral head— the avascular stage

    Stage II: Capital bone absorption and revascularization with fragmentation (vascular resorption of the epiphysis) that gives a mottled appearance on radiographs— the fragmentation, or revascularization, stage

    Stage III: New bone formation, which is represented on radiographs as calcification and ossification or increased density in the areas of radiolucency; this filling-in process appears to take place from the periphery of the head centrally —the reparative stage

    Stage IV: Gradual reformation of the head of the femur without radiolucency and, it is hoped, to a spherical form— the regenerative stage
  209. What diagnostic test is used to definitively diagnose Legg-Calvé-Perthes disease?

    D) Magnetic resonance imaging (MRI)

    definitive diagnosis is confirmed by MRI, which demonstrates osteonecrosis
  210. Describe the two sources for acquiring osteomyelitis.
    An infection and inflammation of the bone or bone marrow.

    Exogenous— acquired by invasion of bone by direct extension from outside as a result of penetrating wound, open fracture, contamination during surgery

    Hematogenous— spread of organisms from preexisting focus, such as furuncles, skin abrasions, impetigo, otitis media, tonsillitis, infected burns, poor injection technique

    Rationale: Osteomyelitis can be acquired from exogenous or hematogenous sources. These terms are defined in the text.
  211. What signs and symptoms might be seen in a child with acute osteomyelitis?
    • Irritability, restlessness
    • Elevated temperature
    • Rapid pulse
    • Dehydration
    • Localized tenderness
    • Increased warmth and diffuse swelling over affected bone
    • Pain

    Rationale: The signs and symptoms of acute osteomyelitis begin abruptly and commonly accompany a history of trauma to the affected bone.
  212. Which bones are most affected in children with osteomyelitis?
    Most cases involve the femur or tibia. To a lesser extent, the humerus and hip are affected.           
  213. How long is typical antibiotic therapy for osteomyelitis? By which route should the antibiotics be administered?
    Three to four weeks. Often the medication is given intravenously, and a venous access device or a peripheral intravenous central catheter is placed.

    Rationale: The length of antibiotic therapy is determined by the duration of symptoms, the initial response to treatment, and the sensitivity of the organism in the specific case. Intravenous antibiotic therapy is indicated because of the seriousness of the infection causing potential destruction to the child’s bone. The intravenous mode of administration ensures high blood and tissue levels of the antibiotic.
  214. Curvature of the thoracic spine
  215. Accentuation of the lumbar spine
  216. Caused by chronic arthritis
  217. Caused by contractures of the hip
  218. Caused by obesity
  219. Describe how to do a physical assessment for scoliosis
    Observe the position of the spine by having the child stand in front of you while undressed. First note asymmetry of the shoulder height, scapula and hip height, and alignment. Next have the child bend forward at the waist (Adams test) while hanging the arms down. Observe for asymmetry of the ribs and flanks. Remember, a curve of less than 10 degrees is considered a postural variation.
  220. What causes hypercalcemia in a child who is immobilized?
    The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia.
  221. Which statement is true concerning osteogenesis imperfecta (OI)?

    A) OI is an inherited disorder.

    • OI is an autosomal dominant inherited disorder.
    • OI is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture.
    • OI has a predictable course that is determined by the pathophysiologic processes, not the time of onset.
    • Lightweight braces and splints can help support limbs and fractures.
  222. What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis?

    B) Move and turn the child carefully and gently to minimize pain.

    Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently.

    Active range-of-motion exercises are contraindicated until pain has subsided.

    Pain medication should be administered as needed.

    Ambulation is contraindicated until pain has subsided.
  223. Which statement is the most descriptive of rhabdomyosarcoma?

    A) The most common sites are the head and neck.

    Although striated muscle fibers from which this tumor arises can be found anywhere in the body, the most common sites are the head and neck.

    Rhabdomyosarcoma is not known to be hereditary.

    Rhabdomyosarcoma arises from skeletal muscle tissue, not bone.

    Rhabdomyosarcoma is highly malignant.
  224. One of the major risk factors for development of CP is
    preterm birth
  225. Spinal muscular atrophy type 1 (Werdnig-Hoffmann disease) is characterized by progressive weakness and wasting of skeletal muscles caused by AAA. In early infancy, spinal muscular atrophy may initially appear similar to BBB. Most affected children do not live past 3 to 4 years of age, and respiratory failure is the eventual outcome of this disorder.
    • A) degeneration of anterior horn cells of the spinal cord
    • B) infant botulism
  226. Key concepts for: infant botulism
    Honey is the only known dietary reservoir of C. botulinum spores linked to infant botulism. For this reason honey should not be fed to infants less than one year of age.

    Clostridium botulinum is a ubiquitous soil-dwelling bacterium. Many infant botulism patients have been demonstrated to live near a construction site or an area of soil disturbance.

    The case fatality rate is less than 1% for hospitalized infants with botulism.

    Typical symptoms of infant botulism include constipation, lethargy, weakness, difficulty feeding and an altered cry, often progressing to a complete descending flaccid paralysis. Although constipation is usually the first symptom of infant botulism, it is commonly overlooked.
  227. Muscular dystrophies are AAA of neuromuscular dysfunction of childhood.
    A) the greatest and most important cause
  228. Duchenne muscular dystrophy is the most severe and the most common musculardystrophy of childhood. It is inherited as an ...
    X-linked recessive trait, and thesingle-gene defect is located on the short arm of the X chromosome
  229. Guillain-Barré syndrome is an ascending paralysis often first manifesting as AAA. Nursing care of the child withGuillain-Barré syndrome consists of ...
    A) falling down or clumsiness in walking

    maintaining a patent airway; monitoring vital signs and neurologic signs;ensuring proper body alignment and positioning; and providing physical therapy, etc.
  230. Tetanus occurs when tetanus spores or vegetative bacilli enter a wound and multiply in a susceptible host. Primary prevention is key and occurs through immunization and boosters. Specific treatment to prevent tetanus after trauma includes ...
    administration of tetanus immunoglobulin and tetanus toxoid intramuscularly at a separate site.
  231. Symptoms of infant botulism include constipation, decreased activity, poor feeding, and lethargy. 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.
  232. Identify five clinical signs or symptoms that are seen in children with spastic CP.
    Increased muscle tone

    Increased deep tendon reflexes and clonus (sudden dorsiflexion of the ankle or rapid distal movement of the patella resulting in alternating spasm and relaxation of the muscles being stretched)

    Flexor, adductor, and internal rotator muscles more involved than extensor, abductor, and external rotator muscles

    Difficulty with fine and gross motor skills

    Most common contracture is that of the heel cord.

    Hip adductor contractures leading to progressive subluxation and dislocation

    Knee contractures

    Scoliosis common

    Typical gait is crouched, in-toeing, and scissoring.

    Elbow, wrist, and fingers in flexed position with thumb adducted

    Motor weakness of antagonist muscle groups
  233. Identify at least six warning (pre-clinical?)  signs associated with CP
    • Physical Signs
    • Poor head control after 3 months of age
    • Stiff or rigid arms or legs
    • Pushing away or arching back
    • Floppy or limp body posture
    • Inability to sit up without support by 8 months
    • Use of only one side of the body, or only the arms to crawl

    • Behavioral Signs
    • Extreme irritability or crying
    • Failure to smile by 3 months
    • Feeding difficulties
    • Persistent gagging or choking when fed
    • After 6 months of age, tongue pushing soft food out of the mouth
  234. Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is

    D) prenatal brain abnormalities
  235. Because CP is currently a permanent disorder, the goal of therapy is to promote optimal development.

    This is done through early recognition and beginning of therapy.

    It is difficult to reverse the degenerative processes associated with CP.

    The underlying defect(s) associated with the development of CP cannot be cured.

    CP is not contagious.
  236. A 3-year-old has cerebral palsy (CP) and is hospitalized for orthopedic surgery. The child’s mother states the child has difficulty swallowing and cannot hold a utensil to self-feed. The child is slightly underweight for height. What is the most appropriate nursing action related to feeding?

    C) Stabilize the child’s jaw with one hand (either from a front or side position) to facilitate swallowing.
  237. A neural tube defect that is not visible externally in the lumbosacral area would be called

    D) Correctspina bifida occulta.

    Spina bifida occulta is completely enclosed. Often, this disorder will not be noticed. A clue to the presence of this internal disorder will be a dimple or tuft of hair on the lumbosacral area.

    A meningocele contains meninges and spinal fluid but no neural tissue and is evident at birth as a sac in the lumbosacral area. Transillumination of light will be present.

    A myelomeningocele is a neural tube defect that contains meninges, spinal fluid, and nerves and is evident at birth as a sac in the lumbosacral area. Transillumination of light will not be present.

    Spina bifida cystica is a cystic formation with an external saclike protrusion.
  238. A woman who is 6 weeks pregnant tells the nurse that she is worried her baby might have spina bifida because of a family history. What should the nurse's response be based on?

    B) The concentration of α-fetoprotein in amniotic fluid can potentially indicate the presence of the defect prenatally.

    There are no chromosomal studies currently that can diagnose spina bifida prenatally.
  239. What most accurately describes bowel function in children born with a myelomeningocele?

    B) Some degree of fecal continence can usually be achieved.

    Enemas and stool softeners are part of the strategy to achieve continence. Laxatives should be used only as a last resort, although they may be used in some instances.
  240. What is important when caring for a child with myelomeningocele in the preoperative stage?

    D) Measure the head circumference and examine the fontanels for signs that might indicate developing hydrocephalus.

    Obstructive hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of the head circumference will aid in early detection of associated increased intracranial pressure.

    Preoperatively, the child is kept in a prone position to decrease tension on the sac and reduce the risk of trauma or sac tearing.

    The sac must be kept moist. Sterile, moist, nonadherent dressings are placed over the sac as prescribed by the physician.

    Most infants do not have diarrheal stools. The sac area, though, should be kept clean and dry and out of contact with urine and stools.
  241. Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy (DMD)?

    C) DMD is characterized by muscle weakness, usually beginning at about age 3 years.

    Usually, children with DMD reach the early developmental milestones, but the muscular weakness is usually observed in the third year of life.

    DMD is inherited as an X-linked recessive disorder.

    Weakness in a child with DMD is usually first noted in walking. Progressive muscle weakness in other muscle groups then follows.
  242. An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome). When explaining this disease process to the parents, what should the nurse consider?

    B) Muscle function will gradually return, and recovery is possible in most children.

    Most patients regain full muscle strength following recovery from Guillain-Barré syndrome. The return of function is in reverse order of onset. Onset occurs as ascending paralysis; recovery occurs as descending return of function.

    The paralysis is progressive in Guillain-Barré syndrome, but most children have full recovery. Supportive nursing care is essential.

    Guillain-Barré syndrome is an immune-mediated disease most often associated with viral infections. During the history, the parents should be asked about the child's having a cold or viral infection within the past 2 weeks.
  243. Tetanus is an acute, preventable disease caused by ...
    an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus, Clostridium tetani
Card Set
genitourinary, cerebral, endocrine, integumentary, musculoskeletal, and neuromuscular