NCM 109 Care of Mother and Child Final Exam

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Questions and Answers

What disease is characterized by inflammation of the synovium in children aged 16 or younger?

Juvenile Idiopathic Arthritis (correct)

Rheumatoid Arthritis

Rheumatic Fever

None of the above

What is scoliosis?

Lordosis

Spina Occulta

Spina Bifida

Scoliosis (correct)

What disorder is characterized by refusal to maintain a minimally normal body weight due to a disturbance in perception of body size or appearance?

Bulimia Nervosa

Loss of Appetite

Aphasia

Anorexia Nervosa (correct)

What is the therapeutic management therapy for a patient with Candidiasis?

Vaginal suppositories or cream applications of antifungal preparations such as miconazole (Monistat) or clotrimazole (Lotrimin), once a day for 3 to 7 days Signup and view all the answers

What should a clinic nurse's first action be when a child reports a sore throat?

Examine the throat Signup and view all the answers

What is the early sign or symptom of increased intracranial pressure (ICP) that a nurse would monitor for in a 3-year-old child after a craniotomy?

Excessive vomiting Signup and view all the answers

What appropriate nursing response should be given to a client who came into direct contact with poison ivy shrubs?

Take a shower immediately, lathering and rinsing several times. Signup and view all the answers

How is pain medication typically administered for a client with extensive burns?

Intravenous Signup and view all the answers

Successful or adequate fluid resuscitation in a burn victim is best indicated by stable vital signs.

False Signup and view all the answers

What is the most frequently occurring type of cancer in children characterized by the distorted and uncontrolled proliferation of white blood cells (leukocytes)?

Leukemia Signup and view all the answers

Which disease affects the heart, joints, CNS, and subcutaneous system, if untreated, following group B-hemolytic streptococcus pharyngitis infection?

Rheumatic fever Signup and view all the answers

What is the preferred controller medicine for asthma in terms of anti-inflammatory effects?

Corticosteroids Signup and view all the answers

What is the term for the former name for juvenile diabetes?

DM1 Signup and view all the answers

Which of the following indicates that a child is bleeding after a tonsillectomy?

Frequent swallowing Signup and view all the answers

After cleft lip repair, in which position should an infant be placed to prevent rubbing of the surgical site on the mattress?

Left lateral position Signup and view all the answers

What should a child be encouraged to consume to prevent hypoglycemia before activities like soccer practice?

Eat a small box of raisins or drink a cup of orange juice Signup and view all the answers

What statement made by parents indicates understanding of antibiotic administration for a child after myringotomy with insertion of tympanostomy tubes?

Administer the antibiotics until they are gone. Signup and view all the answers

What should a mother encourage a child with type 1 diabetes mellitus and sick with positive ketones to drink?

Encourage the child to drink calorie-free liquids Signup and view all the answers

What indicates a worsening condition in a child with asthma during acute exacerbation?

Decreased wheezing Signup and view all the answers

What should the mother do if the child with right lower lobe pneumonia complains of discomfort on the right side?

Encourage the child to lie on the right side. Signup and view all the answers

What provides the most accurate guide to determine fluid resuscitation adequacy in a child with burns?

Neurological assessment Signup and view all the answers

What type of exercises should a child with painful exacerbation of juvenile idiopathic arthritis perform?

Have the child perform simple isometric exercises during this time Signup and view all the answers

SIDS is the unexpected death of an apparently healthy infant younger than 1 year.

True Signup and view all the answers

What position indicates possible airway obstruction in a child with epiglottitis?

The child is leaning forward, with the chin thrust out. Signup and view all the answers

In caring for a child after spinal fusion for scoliosis treatment with symptoms of abdominal discomfort and vomiting, what action should the nurse take based on these findings?

Notify the physician Signup and view all the answers

Which statement by parents regarding the use of a brace for a child with scoliosis indicates a need for further instructions?

I should apply lotion under the brace to prevent skin breakdown Signup and view all the answers

What nursing action is appropriate if a child with laryngotracheobronchitis is consistently crying in a cool mist tent?

Let the mother hold the child and direct the cool mist over the child’s face. Signup and view all the answers

What action should be avoided during the physical assessment of a child suspected of having Wilms' tumor?

Palpating the abdomen for a mass Signup and view all the answers

What is a clinical manifestation associated with imperforate anus in a newborn infant?

Failure to pass meconium stool in the first 24 hours after birth Signup and view all the answers

Based on a platelet count of 19,500 cells/mm3 in a child with leukemia receiving chemotherapy, what intervention should the nurse document in the plan of care?

Use a soft small toothbrush for mouth care Signup and view all the answers

Which symptom is expected in a child with intussusception?

Bright red blood and mucus in the stools Signup and view all the answers

Which symptom most likely led to the suspicion of Hirschsprung’s disease in an infant?

Foul-smelling ribbon-like stools Signup and view all the answers

What is cerebral palsy?

A chronic disability characterized by impaired muscle movement and posture Signup and view all the answers

What is the primary legal nursing responsibility when child abuse is suspected?

Report the case in which the abuse is suspected to the local authorities Signup and view all the answers

What is a late sign of increased intracranial pressure in a 5-year-old child?

Bradycardia Signup and view all the answers

What is a priority nursing intervention for an infant with hydrocephalus preoperatively?

Reposition the infant frequently Signup and view all the answers

What is decerebrate posturing characterized by?

Rigid extension and pronation of the arms and legs Signup and view all the answers

What CSF analysis results would verify the diagnosis of bacterial meningitis?

Cloudy CSF, elevated protein, and decreased glucose levels Signup and view all the answers

What precaution should be maintained for a child with acute bacterial meningitis based on the mode of transmission?

Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics Signup and view all the answers

What is the initial nursing action when a child vomits bright red blood after a tonsillectomy?

Turn the child to the side Signup and view all the answers

Which laboratory value is most significant to review for a child scheduled for tonsillectomy?

Prothrombin time Signup and view all the answers

What appropriate position should a child be placed in after a tonsillectomy?

Side-lying Signup and view all the answers

Which physician's postoperative prescription should a nurse question after a tonsillectomy?

Suction every 2 hours Signup and view all the answers

What is the rationale for the nurse to closely monitor the IV flow rate?

Preventing cardiac overload Signup and view all the answers

A nurse is caring for an infant with bacterial meningitis. The parents ask how their baby could have contracted the illness. What does the nurse consider as the most likely route of transmission to the central nervous system (CNS)?

Cranial apertures or sinuses Signup and view all the answers

The following are chromosomal aberrations EXCEPT:

Trisomy 15 Signup and view all the answers

When teaching the parent of a school-age child about signs and symptoms of fever that require immediate notification of the physician, which of the following descriptions should the nurse include?

Complaints of a stiff neck Signup and view all the answers

For acute otitis media, the treatment is prompt antibiotic therapy. Delayed treatment may result in complications of:

Brain damage Signup and view all the answers

A toddler is brought to the emergency department with sudden onset of abdominal pain, vomiting, and stools that look like red currant jelly. To confirm intussusception, the suspected cause of these findings, the nurse expects the physician to order:

A barium enema Signup and view all the answers

During a visit to the well-baby clinic, a mother who's breastfeeding her 2-month-old infant expresses concern over the infant's bowel movements. Which statement by the mother would lead the nurse to believe that the infant's bowel movements are normal?

"The baby's stools are bright yellow and soft." Signup and view all the answers

A nurse who is caring for an infant with a cleft lip is concerned about preventing an infection. Why does the cleft lip predispose the infant to infection?

Mouth breathing dries the oropharyngeal mucous membrane Signup and view all the answers

A 6-month-old client is admitted with possible intussusceptions. Which question during the nursing history is least helpful in obtaining information regarding this diagnosis?

What does his vomit look like? Signup and view all the answers

An infant is diagnosed with communicating hydrocephalus, the parents ask for clarification of the healthcare provider’s explanation of their baby’s problem. How should the nurse respond?

"There is a part of the brain surface that usually absorbs spinal fluid after its production that is not functioning adequately." Signup and view all the answers

The nurse formulates a nursing diagnosis of Risk for infection for a child with Down syndrome. Which condition typically seen in children with this syndrome supports this nursing diagnosis?

Muscular hypotonicity Signup and view all the answers

What does a nurse determine is the most serious complication of meningitis in young children?

Peripheral circulatory collapse Signup and view all the answers

What should a nurse use to feed an infant born with unilateral cleft lip and palate?

Rubber-tipped syringe Signup and view all the answers

Which assessment finding would the nurse find in a child with Hirschsprung’s Disease?

Foul-smelling, fatty stool Signup and view all the answers

A 1-year-old infant has been admitted with a tentative diagnosis of bacterial meningitis. A lumbar puncture is performed to confirm the diagnosis. What laboratory report in the spinal fluid supports this diagnosis?

Elevated protein level Signup and view all the answers

An infant with myelomeningocele is admitted to the pediatric intensive care unit (PICU). While the infant is awaiting surgical correction of the defect, what is the most appropriate nursing intervention?

Placing the infant in the prone position Signup and view all the answers

A 10-month-old child with recurrent otitis media (middle ear inflammation) is brought to the clinic for evaluation. To help determine the cause of the child's condition, the nurse should ask the parents:

"Do you give the baby a bottle to take to bed?" Signup and view all the answers

A neonate born 18 hours ago with myelomeningocele over the lumbosacral region is scheduled for corrective surgery. Preoperatively, what is the most important nursing goal?

Preventing infection Signup and view all the answers

What is the primary nursing intervention for an infant with a myelomeningocele before surgical correction?

Minimize infection Signup and view all the answers

What should the nursing care for an infant after the surgical repair of a cleft lip include?

Preventing crying Signup and view all the answers

When developing a postoperative plan of care for an infant scheduled for cleft lip repair, the nurse should assign the highest priority to which intervention?

Comforting the child as quickly as possible Signup and view all the answers

Twenty-four hours after birth, a neonate hasn't passed meconium. The nurse suspects which condition?

Hirschsprung's disease Signup and view all the answers

A baby boy has just had surgery to repair his cleft lip. Which nursing intervention is the most important during the immediate postoperative period?

Clean the suture line carefully with a sterile solution after every feeding Signup and view all the answers

The pediatric nurse is caring for an infant with spina bifida. Which technique is most important in recognizing possible hydrocephalus?

Performing a lumbar puncture Signup and view all the answers

A nurse in the pediatric clinic is assessing an infant who had a revision of ventriculoperitoneal shunt. What clinical finding alerts the nurse that intracranial pressure has increased?

Tension of the anterior fontanel Signup and view all the answers

A healthy infant has meningitis and is receiving IV and oral fluids. The nurse should monitor this client’s fluid intake because fluid overload may cause:

Pulmonary edema Signup and view all the answers

Study Notes

Cerebral Palsy

Cerebral palsy is a chronic disability characterized by impaired muscle movement and posture.
It results from an abnormality in the extrapyramidal or pyramidal motor system.

Child Abuse

Child abuse is the non-accidental physical injury or act of omission of care by a parent or person responsible for a child.
It includes neglect, physical, sexual, and emotional maltreatment.
The primary legal nursing responsibility when child abuse is suspected is to report the case to the local authorities.

Head Injury

A head injury can cause bleeding in the brain and result in increased intracranial pressure (ICP).
Late signs of increased ICP include:
- Decreased level of consciousness
- Bradycardia
- Decreased motor and sensory responses
- Alterations in pupil size and reactivity
- Posturing
- Cheyne-Stokes respirations
- Coma

Hydrocephalus

Hydrocephalus occurs when there is an imbalance of cerebrospinal fluid absorption or production.
It results in head enlargement and increased intracranial pressure.
In infants, the head grows at an abnormal rate, and if not repositioned frequently, pressure ulcers can occur on the back and side of the head.

Decerebrate Posturing

Decerebrate posturing is characterized by the rigid extension and pronation of the arms and legs.
It is a sign of increased intracranial pressure.

Meningitis

Meningitis is an infectious process of the central nervous system caused by bacteria and viruses.
It may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections.
Diagnosis is made by testing cerebrospinal fluid obtained by lumbar puncture.
Findings in bacterial meningitis include:
- Elevated pressure
- Turbid or cloudy cerebrospinal fluid
- Elevated leukocyte, protein, and glucose levels

Tonsillectomy

Tonsillectomy is the surgical removal of the tonsils.
Postoperative care includes:
- Maintaining NPO status
- Administering prescribed antibiotics
- Turning the child to the side to prevent aspiration
- Suctioning only when necessary
Prothrombin time results are important to review preoperatively to identify potential bleeding risks.

Otitis Media

Otitis media is a middle ear infection.
Treatment includes antibiotics and myringotomy with insertion of tympanostomy tubes.
Antibiotics should be taken as prescribed, and the full course needs to be completed.

Asthma

Asthma is a chronic inflammatory disease of the airways.
Decreased wheezing may be a sign of worsening condition.
A "silent chest" is an ominous sign during an asthma episode.

Pneumonia

Pneumonia is an inflammation of the pulmonary parenchyma or alveoli or both.
Splinting of the affected side by lying on that side may decrease discomfort.

Sudden Infant Death Syndrome (SIDS)

SIDS is the unexpected death of an apparently healthy infant younger than 1 year.
Nurses should encourage parents to place the infant on the back (supine) for sleep.

Epiglottitis

Epiglottitis is a bacterial form of croup.
Clinical manifestations suggestive of airway obstruction include:
- Tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open)
- Nasal flaring
- The use of accessory muscles for breathing
- Stridor
Treatment includes placing the child in a cool mist tent.

Laryngotracheobronchitis (Croup)

Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi.
Treatment includes placing the child in a cool mist tent.
If the child is frightened or uncomfortable, the mother may hold the child and direct the cool mist over the child's face.### Respiratory Therapy
Cool mist therapy can be prescribed to liquefy secretions and assist with breathing
If using a tent or hood causes distress, the child can be held by the parent and a cool mist can be directed towards the child's face
A mild sedative should not be administered to the child, as crying can increase hypoxia and aggravate laryngospasm, leading to airway obstruction

Imperforate Anus

Imperforate anus is a congenital anomaly characterized by the incomplete development or absence of the anus
Clinical manifestations include failure to pass meconium stool in the first 24 hours after birth
Other assessment findings may include absence or stenosis of the anal rectal canal, presence of an anal membrane, and an external fistula to the perineum

Intussusception

Intussusception is a telescoping of one portion of the bowel into another
Clinical manifestations include severe abdominal pain that is crampy and intermittent, causing the child to draw their knees up to their chest
Vomiting may be present, but is not projectile
Bright red blood and mucus are passed through the rectum and are commonly described as currant jelly-like stools

Hirschsprung's Disease

Hirschsprung's disease is a congenital anomaly characterized by the absence of ganglion cells in the rectum and other areas of the affected intestine
Clinical manifestations include chronic constipation beginning in the first month of life, resulting in pellet-like or ribbon-like stools that are foul-smelling
Delayed passage or absence of meconium stool in the neonatal period is also a sign
Bowel obstruction, especially in the neonatal period, abdominal pain, and failure to thrive are also clinical manifestations

Post-Surgical Care

After cleft lip repair, the infant should be positioned on the side lateral to the repair to prevent rubbing of the surgical site on the mattress
The nurse should position the infant to prevent airway obstruction by secretions, blood, or the tongue

Diabetes Management

When a child with type 1 diabetes mellitus has a high level of physical activity, they should eat a small snack of 15-30g of carbohydrates to prevent hypoglycemia
If the child is sick, the mother should test for urinary ketones with each voiding, and the child should drink calorie-free liquids to aid in clearing the ketones

Burn Care

When caring for a child with burns, the nurse should monitor for signs of adequate fluid resuscitation, such as sensorium
The nurse should not administer pain medication orally, intramuscularly, or subcutaneously, as it may not be absorbed consistently due to the burn injury
Instead, pain medication should be administered intravenously

Scoliosis

Scoliosis is a three-dimensional spinal deformity that usually involves lateral curvature, spinal rotation, and hypokyphosis of the thorax
A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome, which causes abdominal discomfort and vomiting
The nurse should take action if the child complains of abdominal discomfort and begins to have episodes of vomiting

Juvenile Idiopathic Arthritis

During painful episodes of juvenile idiopathic arthritis, the child should perform simple isometric exercises as soon as possible
The nurse should not instruct the child to avoid all exercise during painful periods

Wilms' Tumor

Wilms' tumor is a cancer of the kidney that usually occurs in children under the age of 5
The nurse should not palpate the abdomen for a mass, as excessive manipulation can cause seeding of the tumor and spread of the cancerous cells### Burn Care
During the resuscitation/emergent phase of burn injury, hematocrit levels increase due to hemoconcentration from fluid shifts, with levels of 50-55% expected in the first 24 hours, returning to normal by 36 hours.
Pulse rates are typically higher than normal, and blood pressure is decreased due to large fluid shifts.
Urine output is initially low due to decreased renal perfusion and glomerular filtration.
If an inhalation injury is suspected, administration of 100% oxygen via a tight-fitting non-rebreather face mask is prescribed until carboxyhemoglobin levels fall.

Fluid Resuscitation

Successful fluid resuscitation is signaled by stable vital signs, adequate urine output, palpable peripheral pulses, and clear sensorium.
Urine output is the most reliable indicator of adequate fluid resuscitation, with a target of 30-50 mL/hour in adults.

Protective Isolation

Protective garb, including gloves, cap, mask, shoe covers, gowns, and plastic apron, must be worn when in the client's room and when directly caring for the client.
Thorough handwashing is essential before and after each contact with the burn-injured client.
Sterile sheets and linens are used due to the high risk of infection.

Autograft and Grafting

Autografts placed over joints or on the lower extremities often require immobilization for 3-7 days to allow the graft to adhere to the wound bed.

Miscellaneous

Cerebral palsy is a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction.
Leukemia is a malignant disorder characterized by the uncontrolled proliferation of white blood cells.
Asthma is a chronic inflammatory disease characterized by airway obstruction, inflammation, and bronchospasm.
Corticosteroids are the preferred controller medication for asthma, reducing inflammation and airway obstruction.

Pediatric Nursing

Rheumatic fever is an inflammatory disease that affects the heart, joints, central nervous system, and subcutaneous tissues, following group A beta-hemolytic streptococcal pharyngitis.
Juvenile idiopathic arthritis is a disease characterized by inflammation of the synovium in children aged 16 or younger.
Scoliosis is a lateral curvature of the spine that may involve all or only a portion of the spinal column.
Anorexia nervosa is a disorder characterized by a distorted body image and refusal to maintain a minimally normal body weight.

Diabetes Management

Range of motion exercises are prescribed for children with juvenile idiopathic arthritis to preserve joint function.
For a child with type 1 diabetes, a ready source of glucose should be available to rapidly counteract hypoglycemia.
An adolescent with type 1 diabetes should carry a source of simple sugar, such as soda or a hamburger, to rapidly counteract hypoglycemia.

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Description

This is a final grading exam in NCM 109, covering care of mother and child at risk with acute and chronic problems. Review your knowledge and skills in this field.