4-year-old presented to the ER with the parents with complaints of bowel incontinence, extremity weakness and neck pain. Child has a history of Trisomy 21 with atlantoaxial stability. began having neck pain 24 hours ago after falling off the steps. No injuries reported

The nurse is caring for a client diagnosed with Down Syndrome and a history

of hypotonia and atlantoaxial instability. Which of the following symptoms require priority interventions? (Select All that Apply.)

Pain of the facial bones

Continuous neck pain

Lower extremity pain

Loss of established bladder control

Loss of established motor skills

Answer and Explanation

Correct Answer : C,D,E

A.   Although facial pain could be concerning, it is not the immediate priority when the child has a history of atlantoaxial instability and is presenting with signs that could indicate spinal cord compression. Facial pain does not suggest a direct threat to the spinal cord, which is a more critical concern in this case.
B.   Continuous neck pain in a child with atlantoaxial instability is a significant priority and requires immediate intervention. This could be a sign of spinal cord compression or injury to the cervical spine, which can occur after trauma such as a fall. Since this child has a predisposition for atlantoaxial instability, there is a high risk for neck instability and spinal cord injury, making this a top priority.
C.   While lower extremity pain may be concerning, it is not as high a priority as neck pain in this context. The primary concern here is potential spinal cord compression or neurological injury. If the child is able to move their extremities or does not have severe pain or weakness, this may not require as urgent intervention. However, it should still be monitored closely.
D.   Loss of bladder control is a red flag in children with suspected spinal cord injury. It can indicate nerve involvement in the spinal cord or cauda equina, which can be caused by injury or compression, particularly in a child with atlantoaxial instability. This requires priority intervention to prevent further damage and to initiate appropriate care (e.g., neurological assessment, imaging, and potentially surgical intervention).
E.   The loss of established motor skills is another concerning sign. In this child, it may indicate neurological impairment or spinal cord injury. Since the child has atlantoaxial instability, this is a critical symptom that suggests the possibility of spinal cord compression or injury, requiring immediate evaluation and intervention to prevent permanent neurological damage.

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Correct Answer is []

Explanation

Condition:

Acute Laryngotracheobronchitis (Croup)

The harsh, bark-like cough and hoarse cry are classic symptoms of croup (acute laryngotracheobronchitis), a viral infection that typically affects young children. Mild work of breathing and stridor (a high-pitched sound during inspiration) indicate upper airway narrowing, which is characteristic of croup.

Actions to Take

Prepare to administer IV steroids:

Steroids (e.g., dexamethasone) are used to reduce airway inflammation in croup and are considered first-line treatment. They help reduce the swelling in the upper airways, making breathing easier and improving stridor and cough. IV steroids are often used in more severe cases, such as in an emergency department setting.

Administer racemic epinephrine:

Racemic epinephrine is a bronchodilator used to treat moderate to severe cases of croup. It works by reducing inflammation and relaxing the muscles of the upper airway, which helps relieve stridor and airway obstruction. This medication is typically given via nebulizer in the emergency department to provide rapid relief.

Parameters to Monitor

Oxygen saturation:

It is important to monitor oxygen saturation (SpO2) to assess if the child is getting enough oxygen. Croup can lead to hypoxia if the airway becomes severely narrowed. Monitoring oxygen levels ensures that the child is not deteriorating and allows for appropriate interventions if oxygen levels fall below normal (typically below 92% or 90%, depending on clinical guidelines).

Respiratory rate:

Monitoring the respiratory rate provides insight into how well the child is maintaining adequate ventilation. In cases of croup, increased work of breathing and distress can cause a higher respiratory rate. If the rate becomes very high or very low, it may indicate worsening distress or impending respiratory failure. Regular monitoring helps guide treatment and reassessment.

A. Trisomy 21 B. Fragile X C. Turners Syndrome D. Williams Syndrome

Correct Answer is B

Explanation

A. Trisomy 21, or Down syndrome, typically presents with features like intellectual disability, a flat facial profile, upward slanting eyes, and a small mouth. The elongated facial structure and ear protrusion are not characteristic of this condition.
B. Fragile X syndrome is associated with developmental delays, autistic behaviors, and distinct physical features such as a long face, large ears, and a prominent jaw. These characteristics are consistent with the child’s presentation.
C. Turner’s syndrome primarily affects females and is characterized by short stature, webbed neck, and gonadal dysgenesis, but it does not typically involve autistic behaviors or elongated facial features.
D. Williams syndrome involves a distinct set of features including a broad forehead, short nose, and full lips. It is not primarily associated with elongated facial features and ear protrusion.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is []

Explanation

Actions to Take

Parameters to Monitor

A nurse is assessing a 3-year-old child with autistic behaviors, an elongated facial structure, and protrusion of the ears. The nurse suspects that the child may have which of the following syndromes?

Correct Answer is B

Explanation

A nurse is caring for a 5-year-old child who is 3 hours post-operative uncomplicated tonsillectomy. Which of the following actions are appropriate post op care? (SELECT ALL THAT APPLY)

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A nurse is speaking with the parent of a 6-year-old child. Which of the following statements made by the parent should concern the nurse?

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A nurse is providing teaching to a parent of a 5-year-old client diagnosed with celiac disease. The nurse should include which of the following food choices in the teaching plan?

A nurse is providing post-operative tonsillectomy instructions to the parents of a child. The nurse informs the parents that the greatest risk for postoperative hemorrhage can occur during which of the following time frames?

A nurse is caring for a 4-year-old client diagnosed with Fragile X Syndrome. Which information should be included in the teaching plan for the parents?