Exam 4: NUR230 / NUR 230 (Latest 2026/2027 Update) Concepts of Nursing: The Childbearing/Child Caring Family | Questions & Answers | 100% Correct | Galen

Exam 4: NUR230 / NUR 230 (Latest 2026/2027 Update) Concepts of Nursing: The Childbearing/Child Caring Family | Questions & Answers | 100% Correct | Galen Q: Name 3 things that are assessed in a child's cerebral function assessment Answer - Motor function - Posturing - Reflexes Q: The presence of Cushing reflex may indicate... Answer Increased intracranial pressure Q: A nurse is assessing a 12-month-old infant, what 2 things should she include in the cerebral function assessment? - Answer Assessment of posterior fontanelles - OFC (head circumference) Q: Posture may be referred to as ______________/flexion or ______________/extension Answer Decorticate; decerebrate Q: When is the treatment for any fine or gross motor skill deficits preferred? Answer Before the child is school-aged Q: Studies show that the most common cause of neural tube defects is... Answer Folic acid deficiency during pregnancy Q: Congenital deformity/neural tube defect where some or all of the fetal brain does not develop/is missing Answer Anencepahly Q: Type of neural tube defect where the spinal column does not close completely, brain is being pulled to the top of the spinal cord from the bottom, and nerves are enclosed Answer Spina bifida cystica/myelomeningocele Q: Type of neural tube defect where the membrane around the spinal cord is enlarged and a mass is created Answer Meningocele Q: Type of neural tube defect where a section of the spinal cord is malformed, but the nerves and rest of the spinal cord are normal Answer Spina bifida occulta Q: Type of spina bifida occulta where tissue attachments limit the movement of the spinal cord within the spinal column Answer Tethered cord syndrome Q: How and when can a neural tube defect be detected? What is 1 diagnostic sign of a neural tube defect? Answer - Can be detected in the prenatal period via ultrasound - Elevated maternal AFP level Q: What is the therapeutic management of a neural tube defect? Answer Surgical closure w/ a possible shunt placement 24-72hrs after birth Q: A nurse is caring for a child who is post-op from a surgical closure of a neural tube defect, what are 3 actions of the nurse? Answer - Perform clean intermittent catheterizations (CIC) Q4hrs - Perform bowel training - Place child in a prone or side-lying position Q: A nurse is caring for a child who is post-op from a surgical closure of a neural tube defect, what should the nurse promote to the family? Answer Encourage bonding Q: A child has been diagnosed with myelomeningocele, what should the nurse be aware of? Answer The child may have a Latex allergy Q: Cerebrospinal fluid collects in an abnormal pattern in the brain and ventricles dilate/enlarge, causing harmful pressure to be exerted upwards on fragile tissues of the brain, involves an imbalance in the production & absorption of CSF Answer Hydrocephalus Q: Name 3 S/S of hydrocephalus in infants Answer - "Sunset eyes" - Cre du Shaw - MacEwen sign Q: Cre du Shaw refers to... Answer High-pitched cry that is hard to soothe Q: Percussion of the skull near the junction of the frontal, temporal, and parietal bones will produce a cracked-pot sound, indicating sutures are separated Answer Macewen's sign Q: Name 3 S/S of hydrocephalus in children (early to late childhood) Answer - Papilledema - Changes in vision - New urinary incontinence Q: What is the treatment for hydrocephalus? Answer Cerebral spinal fluid shunt Q: What 2 things should a nurse caring for a child who has hydrocephalus monitor? Answer - Fontanel tension - Ventricle size Q: Name the 2 kind of shunts that can be placed in children who have neural tube defects Answer - Ventriculoperitoneal (VP) shunt - Ventriculoatrial (VA) shunt Q: A nurse is caring for a child who is post-op from a shunt placement surgery, what are 4 actions of the nurse? Answer - Place the child in a supine position or on their non-operated side - Auscultate for bowel sounds - Place child on seizure precautions - Monitor for any subdural hematomas Q: CSF fluid is displaced into the subarachnoid space to lumbar cistern + brain mass is displaced Answer Compensation (early stage of increased intracranial pressure) Q: Name 3 later S/S of increased intracranial pressure (ICP) - Answer Papilledema - Cheyne-stokes respirations - Flexion or extension posturing Q: Abnormal breathing pattern w/ periods of apnea Answer Cheyne-stokes respirations Q: Measures best eye opening, motor & verbal response to test neurological status/function Answer Glascow coma scale Q: In pediatrics, the higher the Glascow coma scale score is... Answer The more "intact" the motor responses are Q: Infection of the dura mater, arachnoid mater, and/or pia mater of the meninges Answer Meningitis Infection of the meninges covering the brain Answer Encephalitis Infection of the meninges covering the spinal cord Answer Myelitis Name 2 ways meningitis can be acquired INDIRECTLY Answer - Respiratory infection - Gram-negative organisms Meningitis causes the formation of an ___________________ of _______________ & fibrin ____________ and _______________ Answer Exudation layer; purulent exudate; deposits; adhesions Name 3 S/S of meningitis Answer - Nuchal rigidity - Rash r/t to strep throat - Photophobia Child is placed in a supine position, hip & knee are flexed 90 degrees, and pain/resistance with knee extension presents Answer Kernig's sign Pain w/ deliberate flexion of the neck causes involuntary flexion of the knee and hip Answer Brudzinski's sign Positive Kernig's and Brudzinski's signs are diagnostic signs of what? Answer Nuchal rigidity/stiff neck related to meningitis What are 3 diagnostic signs that indicate the meningitis infection is bacterial? - Positive gram stain - Cloudy CSF - Elevated WBCs What are 3 diagnostic signs that indicate the meningitis infection is viral? - Negative gram stain - Clear CSF - Slightly elevated WBCs Is caused by Neisseria meningitidis, begins with a mild to severe meningococcal septicemia (sepsis) Meningococcal meningitis Name 1 S/S of meningococcal meningitis Petechial or purpuric skin rash A nurse is caring for a child who has been diagnosed with meningococcal meningitis, what are 3 actions the nurse should take? - Closely monitor I&Os + specific gravity - Elevate the head of the bed and make sure the child's head is midline What are 2 precautions a child with meningococcal meningitis should be placed on? Droplet & seizure precautions Children who have meningococcal meningitis are at a high risk for what? Aspiration What kind of movements may be involved in generalized seizures? (2) - Tonic (rigid) movements - Clonic (jerking) movements Involves a sudden loss of muscle tone and loss of consciousness Atonic seizures ("drop attacks") Involves sudden brief jerks of muscle groups w/ possible loss of consciousness Myoclonic seizures Name 2 kinds of medications that can be given to help manage seizures - Sodium channel blockers - Calcium channel inhibitors Vagal nerve is stimulated by an implanted device in the left chest wall to initiate seizure activity in the brain, while the seizure is happening, a magnet is held over the stimulator to lessen the seizure or abort it all together Vagal nerve stimulator What kind of motor state may an individual who just experienced a generalized or febrile seizure be in? Paresis or postictal paralysis Complex deformity of the ankle and foot Clubfoot Name 2 S/S of clubfoot - Foot bends inward or outward - Toes are higher or lower than the heels Abnormal development of the hip structures with or without dislocation Developmental dysplasia of the hip (DDH) What is 1 S/S of DDH in infants? Unequal gluteal and/or thigh creases What is the treatment for DDH in infants? What does it do? Pavlik harness; pulls the hips up and prevents the legs from extending What is the goal of putting children in harnesses, casts, and braces who have DDH? Keep/maintain hips in abduction A nurse is going to educate parents how to care for their child who has DDH, what should the nurse include in the teaching? - Adjust car seat - Double diaper - Assess neurovascular status Disease involving aseptic necrosis of the femoral head causing the thighbone (femur) and pelvis to meet in a ball-and-socket joint due to temporarily interrupted blood supply to the femoral head of the hip joint; bone begins to die Legg-Calve-Perthes disease Name 3 S/S of Legg-Calve-Perthes disease - Pain/stiffness in the hip and/or groin - Limited ROM of the hip joint - Limping Separation of the proximal femoral epiphysis in posterior and inferior directions, resulting in expanded sections within the hip(s) SCFE What is a big risk factor for SCFE? Obesity Name 1 S/S of SCFE Outward turning of the leg For scoliosis to be diagnosed... The spinal curvature must be a certain degree Name 1 S/S of scoliosis Sides of back appear different in height when bending forward A nurse is caring for a child who is post-operative from a posterior spinal fusion b/c of having scoliosis, what are 2 nursing interventions? - Do "log rolls" when moving the patient - Assess bowel motility A fracture to the epiphyseal growth plate will result in what 2 things? - Bone not growing - Bone deformity Immobility may cause... Possible psychosis What are the 6 P's? - Pain - Pallor - Pulselessness - Paresthesia - Paralysis - Pressure Name 2 early behavioral signs of cognitive impairment - Poor or slow feeding - Poor eye contact during feeding Intellectual disability is diagnosed when the IQ is... Less than 70-75 What is 1 primary nursing prevention of cognitive impairment? Get Rubella immunization Name 1 way ADHD can be therapeutically managed; where is it commonly managed at? Manipulate environment; in the classroom - ADHD medication - Med long-term adverse effect - Nursing considerations (2) - Ritalin - Growth suppression - Usually given 2x a day (AM and PM) + may need to take med break in the summer What 2 things are assessed to diagnostically evaluate ADHD and learning disabilities? - Hand-eye coordination - Quality of motor activities Complex neurodevelopmental disorders with spectrum behaviors affecting an individual's ability to communicate and interact with others in a social setting Autism (spectrum disorder) Name 2 early signs of autism in babies/toddlers - Inappropriate playing with toys - Oversensitive or under sensitive to touch Name 2 possible educational interventions for a child who may have autism (spectrum disorder) - Applied behavioral analysis - Speech therapy Risperidone and Aripiprazole are medications to help manage _____________ and can help reduce some ____________________ Autism (spectrum disorder); behavior symptoms in autism The most common chromosomal abnormality of a generalized syndrome & most common cause of intellectual disability Down syndrome/Trisomy 21 Name 5 S/S of Down syndrome/Trisomy 21 - Conductive hearing loss - Strabismus - Myopia - Frequent conjunctivitis - Weak respiratory musculature A nurse is caring for a child who has autism spectrum disorder, what 2 things should the nurse monitor/educate to the family to monitor? Why? Monitor weight & nutrition d/t them being higher in weight and shorter in stature Nonprogressive impairment of motor function, especially that of muscle control, coordination, and posture; is distinguished by mobility, can cause abnormal perception and sensation such as visual, hearing, and speech impairments, cognitive disabilities, and 80% develop seizures Cerebral palsy If cerebral palsy is suspected, when is the careful assessment done? What may indicate CP? In early infancy; no development within the first 2yrs may indicate CP Name 3 motor signs of cerebral palsy - Persistent primitive reflexes - Poor head control after 3 months - Hypotonia (floppy tone) Excessive irritability, no smiling by 3 months, and persistent tongue thrusting are all what kind of signs of what? Behavioral signs of cerebral palsy Name 1 possible medication that may be given to help manage cerebral palsy Antispasmodic - Botox injection Opening in the septum between the right and left atria of the fetal heart, usually closing when the umbilical cord is clamped Foramen ovale Harsh blowing sounds caused by disruption of blood flow into the heart Heart murmurs Palpable vibration over the pericardium or artery that may accompany valve or vessel stenosis Thrills A distal heart defect affects what is ________________ and may specifically affect _________, __________, and ______________ - Below the heart - Pulses - Skin color - Temperature A proximal heart defect may result in... Hypertension What 2/3 things should a nurse monitor regarding a cardiac assessment post-birth? - Central discoloration/mottling - Edema (indicates CHF) Diagnostic and interventional procedure that can determine oxygen saturation, cardiac output, pressures in chambers and great vessels, and structural defects Cardiac catheterization What are 3 nursing considerations/interventions in post-cardiac catheterization? - Place child on bedrest for 6hrs (keep affected leg straight) - Do not raise the head of the bed - Allow child to only participate in quiet play for 24hrs Heart failure may result in ___________ on the _________ in babies Sweating; scalp Name 3 general clinical manifestations of heart failure - Cardiomegaly - Clubbing of fingers - Polycythemia Heart defect that involves a hole in the septum between the right and left ventricle that results in increased pulmonary blood flow Ventricular septal defect (VSD) Heart defect that has a loud, harsh murmur auscultated at the left sternal border VSD Ventricular septal defect (VSD) medical management Complete repair with "drawstring" patch Heart defect that involves a hole in the septum between the right and left atria that results in increased pulmonary blood flow; mixes blood and involves less blood shunts than VSD Atrial septal defect (ASD) Heart defect that has a loud, harsh murmur with a fixed split-second heart sound ASD Atrial septal defect (ASD) medical management (2) - Closure with cardiac catheterization - Surgical patch closure Heart defect that occurs when the fetal artery that connects the aorta to the pulmonary artery fails to close after birth Patent ductus arteriosus (PDA) Name 2 key S/S of PDA - Machine-like murmur - Bounding pulses Patent ductus arteriosus (PDA) medical management (2) - Administer Indomethacin - Coil insertion (occludes PDA during catheterization) Heart defect that involves 4 different defects that result in decreased pulmonary blood flow with unoxygenated blood Tetralogy of Fallot (TOF) What are the 4 heart defects involved in TOF? - Pulmonary stenosis - Right ventricular hypertrophy - Overriding aorta - Ventricular septal defect Name 2 key S/S of TOF - Cyanosis/"Tet" spells - Systolic murmur A nurse is caring for a child who has TOF heart defect, what is the nurse's intervention? Place the child in a knee-chest position (increase blood flow to the lungs) Episode of acute cyanosis and hypoxia resulting from further decreased pulmonary blood flow "Tet" spell What is the compensatory mechanism during a "Tet" spell Squatting Heart defect that involves narrowing of the aorta after blood has been supplied to the upper extremities, results in obstruction of blood flow from the ventricle Coarctation of aorta (COA) Describe the S/S in COA Elevated BP and bounding pulses in the upper extremities; low BP, weak/absent pulses, and cool skin in the lower extremities Coarctation of aorta (COA) medical management (2) - Balloon angioplasty - Stent(s) placement Heart defect that involves narrowing of the pulmonary valve which separates the right ventricle from the pulmonary artery, resulting in blood obstruction to the lungs Pulmonary stenosis Name 1 S/S of pulmonary stenosis Systolic ejection murmur Pulmonary stenosis medical management Balloon dilation or valvotomy Heart defect where the aorta and pulmonary artery connections to the heart are reversed (aorta is connected to the right ventricle, instead of the left & the pulmonary artery is connected to the left ventricle, instead of the right), resulting in mixed blood flow Transposition of the Great Arteries (TGA) What one or 2 things must exist in a TGA heart defect to oxygenate the blood a little bit for survival? - Septal defect - Patent ductus arteriosus Cyanosis, fatigue, murmurs, cardiomegaly, shortness of breath, hypoxia, and poor growth are symptoms of what heart defect? TGA Transposition of the Great Arteries (TGA) medical management (2) - Administer prostaglandins (keeps patent ductus arteriosus open) - Arterial switch surgery Heart defect that involves a single vessel/trunk that comes off the heart and then branches to the lungs and rest of the body d/t failure of septum formation to create a separate pulmonary artery and aorta, resulting in mixed blood flow Truncus arteriosus (TA) Name 1 S/S of TA Poor feeding habits When should surgical repair of truncus arteriosus be done? Within the first month of life Heart defect where the left side of the heart, along with associated structures on the left side, is underdeveloped, resulting in mixed blood flow Hypoplastic left heart syndrome Name 2 S/S of hypoplastic left heart syndrome - Cold hands and feet - Lethargy Hypoplastic left heart syndrome SURGICAL management (3) Norwood, Glenn shunt, and Fontan Right sided heart failure may involve... Hepatic/splenomegaly A nurse is caring for a child who was prescribed digoxin for a cardiac dysfunction, what should the nurse educate to the parents about dosing? (3) - Doses are based on weight - Med is given 2x a day - If a dose is missed, pick back up with the next dose, never re-dose or try to catch up on doses A nurse is caring for a child who was prescribed digoxin for a cardiac dysfunction, what should the nurse educate to the parents about before and during administration? (2) - Take child's pulse before - Give med with a dig dropper and formula afterwards What may be the cause of bacterial/infective endocarditis? Strep throat/scarlet fever Infection of the inner lining of the heart and valves from bacteria entering the bloodstream Bacterial/infective endocarditis Inflammatory disease of the heart, blood vessels, and joints that occurs as a reaction to Group A beta-hemolytic streptococcus (infection of the throat) Rheumatic fever Rheumatic fever medical management Long-term administration of Penicillin (as prophylaxis) What is the key risk factor in the development of rheumatic fever? An untreated or partially treated GABHS infection Pericardial friction rub, cardiomegaly, arrhythmias, polyarthritis, non-itchy erythema, chorea, and nontender subcutaneous nodules are _______________ of what disease? Major S/S; rheumatic fever Arthralgia, fever, prolonged PR intervals, and elevated c-reactive protein and ESR are ____________ of what disease? Minor S/S; rheumatic fever Name the 5 S/S of Kawasaki disease (CREAM in motorcycle accident) - Conjunctivitis - Rash - Extremity changes - Adenopathy (enlarged lymph nodes) - Mucosal changes Kawasaki disease medical management (2) - IV Gamma globulin - High dose aspirin For a child with Kawasaki disease, what teaching do you need to provide the child's family regarding vaccinations? The child cannot receive any live virus vaccinations for 11 months Mineral disturbance that involves a decrease in hemoglobin due to insufficient iron intake or malabsorption syndrome that prevents iron absorption Iron deficient anemia What is the key risk factor for iron deficient anemia in young children? Large intake of fresh cow's milk in diet What oral medication can be given to those with iron deficient anemia? When and with that should this be given? Ferrous sulfate; give between meals with orange juice for better absorption Name 3 foods that are rich in iron - Green vegetables - Meat - Raisins Periodic exacerbation episodes that can be aplastic, hyper hemolytic, or vaso-occlusive involving the spleen and liver Sickle cell crises During a sickle cell crisis, what does the nurse need to do? (4-HOPS) Hydrate, oxygenate, pain management, support Autosomal recessive genetic disorder that causes chronic anemia, pain, infection, and organ damage Sickle cell anemia What INCREASES and DECREASES iron absorption? Vitamin C increases iron absorption & dairy decreases iron absorption How should pain be treated in a patient with sickle cell anemia experiencing a vaso-occlusive crisis? With opioid analgesics around the clock Severe inherited hemorrhagic disorder that is x-linked recessive and causes a deficiency in clotting factors necessary for coagulation of blood; does not affect platelet count or PT Hemophilia Name 3 S/S of hemophilia - Excessive bruising - Joint pain/swelling - Decreased ROM Hemophilia treatment IV factor replacement Hemophilia A is caused by a deficiency in ____________; lab work will show an __________ in _________ Factor 8 (VIII); increase; aPTT A nurse is caring for a child who has hemophilia, what 3 things should the nurse educate to the family? - The child should participate in physical therapy, but no contact sports - Avoid IM injections - Do not give the child aspirin (Tylenol instead!) Triad in which all formed elements of the blood are simultaneously depressed, leading to profound anemia, leukopenia, and thrombocytopenia Aplastic anemia Viral infection in which the virus primarily infects a specific subset of T-lymphocytes causing immune dysfunction leading to organ dysfunction and a variety of opportunistic infections in a weakened host HIV Illness is characterized by hepatosplenomegaly, chronic or recurrent diarrhea, and parotitis HIV infection Disorder that is characterized by a decrease in the number of RBCs and/or hemoglobin (less than 10 or 11) concentration below normal which causes diminished oxygen-carrying capacity of blood Anemia Anemia is a __________, not a disease in and of itself Symptom