when developing the plan of care for a child with cerebral palsy which treatment would the nurse expect as least likely
Logo

Nursing Elites

HESI LPN

Pediatric Practice Exam HESI

1. When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely?

Correct answer: A

Rationale: In caring for a child with cerebral palsy, skeletal traction is least likely to be a part of the treatment plan. Cerebral palsy is a neurological disorder affecting movement and muscle coordination, and skeletal traction, which involves applying a pulling force on a bone to correct alignment, is not a common intervention for this condition. Physical therapy, orthotics, and occupational therapy are more commonly used in the management of cerebral palsy. Physical therapy helps improve mobility and strength, orthotics assist in supporting and aligning the body, and occupational therapy focuses on enhancing daily living skills and independence. Therefore, skeletal traction is the least likely treatment option among the choices provided.

2. While assessing an 18-month-old child, a nurse observes that the toddler can crawl upstairs but needs assistance when climbing the stairs upright. What does this action indicate to the nurse?

Correct answer: C

Rationale: At 18 months of age, needing assistance to climb stairs upright is considered normal behavior for a toddler. Crawling upstairs is a different motor skill and does not necessarily correlate with the ability to climb stairs. The child is still developing gross motor skills, and climbing stairs upright typically requires more coordination and strength, which may not be fully developed at this age. Choices A, B, and D are not relevant in this scenario as the observed behavior is within the expected range of development for an 18-month-old child.

3. A child with a diagnosis of celiac disease is being discharged. What dietary instructions should the nurse provide?

Correct answer: B

Rationale: The correct answer is to 'Avoid gluten.' Celiac disease is an autoimmune disorder triggered by gluten consumption, a protein found in wheat, barley, and rye. By avoiding gluten-containing foods, individuals with celiac disease can prevent damage to their small intestine and manage their symptoms effectively. Choice A, 'Avoid dairy products,' is incorrect as dairy is not directly related to celiac disease. Choice C, 'Avoid high-fat foods,' and Choice D, 'Avoid foods high in sugar,' are incorrect as they are not primary dietary concerns in managing celiac disease. The main focus should be on eliminating gluten sources from the diet.

4. A nurse is caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis (HPS). What is most important for the nurse to assess?

Correct answer: B

Rationale: The correct answer is B: Signs of dehydration. Assessing for signs of dehydration is crucial in infants with hypertrophic pyloric stenosis (HPS) because they are at high risk due to frequent vomiting. Dehydration can lead to serious complications if not promptly addressed. Choices A, C, and D are not the priority assessments for HPS. While the quality of the cry can provide some information on the infant's distress level, dehydration assessment takes precedence. Coughing up feedings may not be specific to HPS, and characteristics of the stool, although important in general assessments, are not the priority in this situation.

5. Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse’s knowledge of congenital heart defects, this system in clinical practice is

Correct answer: D

Rationale: The classification is problematic because children with acyanotic heart defects may develop cyanosis, complicating the differentiation between acyanotic and cyanotic defects. Choice A is incorrect because the system is not solely based on explaining hemodynamics. Choice B is incorrect because the classification is not based on the ease of identifying children with cyanotic defects. Choice C is incorrect because cyanosis can indeed be present in children with congenital heart defects, especially acyanotic defects that may lead to cyanosis under certain circumstances.

Similar Questions

A 4-year-old child is admitted to the hospital with a diagnosis of epiglottitis. What is the priority nursing intervention?
A 2-year-old child who was admitted to the hospital for further surgical repair of a clubfoot is standing in the crib, crying. The child refuses to be comforted and calls for the mother. As the nurse approaches the crib to provide morning care, the child screams louder. Knowing that this behavior is typical of the stage of protest, what is the most appropriate nursing intervention?
A child with a diagnosis of bronchiolitis is admitted to the hospital. What is the most important nursing intervention?
The nurse is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the mother indicates a need for further teaching?
Based on developmental norms for a 5-year-old child, a healthcare professional decides to withhold a scheduled dose of digoxin (Lanoxin) elixir and notify the healthcare provider. Below what apical pulse did the healthcare professional withhold the medication?

Access More Features

HESI LPN Basic
$69.99/ 30 days

  • 5,000 Questions with answers
  • All HESI courses Coverage
  • 30 days access

HESI LPN Premium
$149.99/ 90 days

  • 5,000 Questions with answers
  • All HESI courses Coverage
  • 30 days access

Other Courses