Question 1

A child with spina bifida is being admitted to the hospital for a shunt revision? The nurseadmitting the child anticipates which type of precautions to be ordered for the child?&#10;A) Latex&#10;B) Bleeding&#10;C) Seizure&#10;D) Isolation

Accepted Answer

Children with spina bifida are at high risk for developing latex allergies because of frequent exposure to latex during catheterizations, shunt placements, and other operations. The child with spina bifida does not have a risk for bleeding. Not all children with spina bifida are at risk for seizures and isolation would not be indicated in a child being admitted for a shunt revision.

Question 2

A child is admitted to the hospital with spastic cerebral palsy. The nurse will assess for whichmanifestations associated with this disorder?&#10;A) Tremulous movements at rest and with activity&#10;B) Sudden jerking movement caused by stimuli&#10;C) Writhing, uncontrolled, involuntary movements&#10;D) Clumsy, uncoordinated movements

Accepted Answer

Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The childs muscles are very tight and any stimuli may cause a sudden jerking movement. Tremulous movements are characteristic of rigid/tremor/atonic cerebral palsy. Slow, writhing, uncontrolled, involuntary movements occur with athetoid or dyskinetic cerebral palsy. Clumsy movements and loss of coordination, equilibrium, and kinesthetic sense occur in ataxic cerebral palsy.

Question 3

Which assessment noted in an infant 1 day after placement of a ventriculoperitoneal shunt is indicative of surgical complications?&#10;A) Hypoactive bowel sounds&#10;B) Congestion in upper airways&#10;C) Increasing lethargy&#10;D) Mild incisional pain

Accepted Answer

A decreasing level of consciousness indicates a problem with shunt function and should be reported immediately to the neurosurgeon. Peristalsis is depressed during surgery. Hypoactive bowel sounds may be evident after surgery as peristalsis returns to its preoperative function. Congestion in the upper airways may be evident after surgery. Mild incisional pain is a normal finding in the postoperative period.

Question 4

Which interventions should the nurse perform if a child is having a tonic-clonic seizure?Select all that apply.&#10;A) Place a padded tongue blade in the childs mouth.&#10;B) Place the child in a supine position.&#10;C) Time the seizure.&#10;D) Restrain the child.&#10;E) Stay with the child.&#10;F) Loosen the childs clothing.

Accepted Answer

As a seizure begins the nurse should look at his or her watch and time the seizure. The nurse should protect the child from injury by loosening clothing at the neck and turning the child gently onto the side, removing any obstacles in the childs environment. Do not restrain the child or insert any object into the childs mouth.

Question 5

Which statement by the parent of a 5-year-old child with acquired immunodeficiency syndrome (AIDS) regarding prescribed antiretroviral agents indicates that she has a goodunderstanding of disease management?

A) When my childs pain increases, I double the recommended dosage of antiretroviral medication.
B) Addiction is a risk, so I use the medication only as ordered.
C) Doses of the antiretroviral medication are selected on the basis of my childs age and growth.
D) By the time my child is an adolescent, she will not need her antiretroviral medications any longer.

Accepted Answer

Doses of antiretroviral medication to treat HIV infection for infants and children are based on individualized age and growth considerations. Antiretroviral medications are not administered for pain relief. Doubling the recommended dosage of any medication is not appropriate without an order from the physician. Addiction is not a realistic concern with antiretroviral medications. Antiretroviral medications are still needed during adolescence. Doses for adolescents are based on pubertal status by Tanner staging.

Question 6

A mother of a child in the terminal stages of AIDS tells the nurse that her child wants to celebrate his birthday early because he wont be here on his birthday. Which is the best response the nurse can make to this mother?

A) What does your husband think about giving the party for the child?
B) How does the family feel about your giving in to the child?
C) Ill children can be very manipulative.
D) Is this the first time he has spoken about death?

Accepted Answer

Dying children know they are dying. Disclosure of awareness of death comes in various ways and needs to be identified by the family and the nurse. The major concern is the childs disclosure of awareness of death, not the husbands reaction. Making statements such as giving in is inappropriate when seeking information. Manipulation is not a major concern during the terminal stage of disease.

Question 7

A child is having an anaphylactic response. Place in order the interventions a nurse should perform beginning with the initial (highest priority) intervention and ending with the lowest priority intervention. Use the following format for your answers: A, B, C, D

A) Administer steroids and antihistamines as prescribed.
B) Ensure an adequate airway.
C) Administer epinephrine as prescribed.
D) Administer oxygen.
E) Determine the cause of the reaction.

Accepted Answer

The airway should be stabilized first and then the epinephrine administered. Oxygen would be given next and the steroids and antihistamines given after the airway, epinephrine, and oxygen are initiated. Determining the cause of the reaction should be done last.

Deck 5: Alterations in Neuromuscular Function and Alterations in Immune Function