Chapter 22 PREP U
"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed."
A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction?
Teach the client not to rest with the crutch pad pressing on the axilla.
A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client?
hypertonia in the upper extremities
A 3-month-old infant is seen in the pediatric clinic. The infant's parent expresses concern that the child has developed cerebral palsy. The nurse assesses the infant. Which assessment finding indicates to the nurse that the parent's concern is valid?
a flexed, abducted position to press the femur head against the acetabulum
A baby with developmental dysplasia of the hip is placed in a Pavlik harness. The harness positions the hip in which position?
muscles of the hip
A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests. Which test would the nurse identify as most important to be completed first?
halo traction.
A type of traction sometimes used in the treatment of the child with scoliosis is called:
"We'll apply a warm moist compress to the wrist for 20 minutes at a time."
After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching?
back with hips up off the bed.
An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:
keeping the buttocks slightly elevated.
An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care?
Standing -Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last.
Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?
a transfer technique
How would the nurse best describe Gowers sign to the parents of a child with muscular dystrophy?
Cartilage
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?
gene mutation
Muscular dystrophy is a result of which cause?
coordinating care by specialists
Other than providing direct care to children, what is the major role of nurses in the care of nearly all children with neuromuscular disorders?
Baclofen pump
Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer?
"These make a smooth edge on the cast so the skin is better protected."
The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:
lordosis
The child diagnosed with muscular dystrophy often exhibits a forward curvature of the lumbar spine. What is this spinal condition called?
Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.
The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?
presence of Moro reflex
The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?
prevent rupture or leaking of cerebrospinal fluid
The nurse is providing preoperative care for a newborn with myelomeningocele. Which action is the central nursing priority?
Latex
The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?
Impaired physical mobility related to a cast on the leg
The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?
Greenstick
The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?
The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. New drainage is seeping out from under the cast. The boy's toes are light blue and very swollen.
The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.
"I feel sort of dizzy." "I need to take a nap."
The young child is experiencing muscle spasms and has been given lorazepam. Which statements by the child indicate that the child may be experiencing some common side effects? Select all that apply.
Hereditary
Through which mechanism is Duchenne muscular dystrophy acquired?
heredity
Through which mechanism is Duchenne muscular dystrophy acquired?
Observe the child in developmentally appropriate play. Elicit from the parent a description of fine and gross motor activities. Look for symmetric motion in the arms and legs.
What methods can a nurse use to evaluate extremity function in an 18-month-old? Select all that apply.
serial casting
What treatment can the nurse anticipate assisting with for a newborn with clubfoot (congenital talipes equinovarus)?
It appears at birth or during the first 2 years of life.
Which characteristic is true of cerebral palsy?
long leg braces
Which of these strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy?
"Cerebral palsy is a condition that doesn't get worse."
Which statement about cerebral palsy would be accurate?
spina bifida occulta
Which type of spinal neural tube defect does the nurse recognize as common and usually benign?
13.3 mg/dose
nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.
to continue with age-appropriate activities
An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?
creatine kinase
The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?
Balanced suspension traction
The nurse is caring for an 8 year old in skeletal traction for a fractured femur. Which type of traction would be communicated in the shift hand-off?
significant level of alpha-fetoprotein present in amniotic fluid
Which diagnostic measure is most accurate in detecting neural tube defects?
Barlow sign and Ortolani click -This includes ROM of the hip
Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn?
Risk for impaired skin integrity
Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?
Assuming the usual feeding position will be difficult.
Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?
A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray
A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental bowlegs (genu varum)?
a child's bones heal more quickly than those of an adult.
A group of students is reviewing information about bone healing in children. The students demonstrate understanding of this information when they state:
"My mom is going to have to pick up all of her throw rugs so I don't slip on them."
A nurse is performing crutch training for an adolescent who has a fractured tibia. What statement by the adolescent indicates successful teaching?
dietary considerations
A nurse is preparing a class on neural tube disorders to present to a community group. What information regarding prevention is most important for the nurse to include in the teaching?
prone right side lying left side lying
A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply.
1 mL/day
The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place.
"Your baby's feet are normal. The longitudinal arch will develop after your baby walks for several months."
The nurse is assessing an infant at a well-check visit. The infant's parent expresses worry about the infant's feet because they are so flat and wide. What is the appropriate response by the nurse?
"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved.
The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?
"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved."
The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?
abduction
When examining a newborn for developmental dysplasia of the hip (DDH), which motion would the newborn's hip be unable to accomplish?
During adolescence, muscle growth is influenced by increased production of androgenic hormones.
When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which statement regarding these variations is true?
a young adolescent female
Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment?
Adolescence
A group of students is reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?
adolescence
A group of students is reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?
syndactyly.
A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as:
"It is important that the harness be worn continuously."
A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point?
"Let's put you in touch with other families who have experienced this."
A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents?
Place the newborn in a prone or lateral position.
A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?
"When the strips start to dry, they can get warm, but they won't burn you."
A nurse is caring for an adolescent who is having a plaster cast applied. When the plaster strips are applied, the adolescent complains of it feeling hot. What is the best response by the nurse?
Instruct the parents on performing the technique of chest percussion.
A nurse is caring for an infant with spinal muscle atrophy (SMA) type 1. What will the nurse include in the plan of care for the child?
flexible passively past neutral, but only to midline actively.
A nurse is conducting a physical examination of an infant with suspected metatarsus adductus. Type II metatarsus adductus is indicated when the forefoot is:
Trendelenburg gait
A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected?
significant bending without actual breaking.
A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:
"The very first step is to apply water-based lubricant to the catheter."
A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching?
A 13-year-old boy who is on his school's cross-country team
A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition?
Quietly observe the child at play while interviewing the parent.
A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment?
"Applying ice to the area will reduce the pain and swelling."
A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent?
"You should apply pressure to the site and then bring your child in to be evaluated."
A pediatric client's parent calls the nurse and states, "My child fell off the bike. My child was wearing a helmet, but did scrape the knee and it is bleeding a lot. What should I do?" Which response by the nurse is best?
Halo traction
A type of traction sometimes used in the treatment of the child with scoliosis is called:
"Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing."
A young child with Duchenne muscular dystrophy is placed on both prednisone and calcium. Parents view these two medications as rather "common" and question their importance for the child. What explanation by the nurse will be most helpful to the parents?
Handling the cast with open palms when moving the arm.
The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child?
Spica cast
The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?
spina bifida occulta
A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?
Auscultation
A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?
Muscular wasting results in generalized immobility and difficulty feeding and breathing.
A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?
"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."
A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida?
obesity
A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor?
"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."
An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?
inspection of the cystic sac on the child's back for leakage
An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant?
Holding feet/ankles in position for casting
The nurse is caring for a neonate in the newborn nursery with clubfoot (congenital talipes equinovarus). If nonsurgical treatment is chosen, which nursing action is anticipated?
"In most cases treatment is not necessary, only observation."
The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?
"My child may need the arm broken completely prior to putting a cast on it."
The nurse is caring for a preschooler with a greenstick fracture. Which statement by a parent indicates an understanding of this type of fracture?
Gowers sign
The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?
"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."
The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond?
increased lumbar lordosis
Which condition would alert the nurse that a child may be suffering from muscular dystrophy?
Check the infant's toes for coldness or blueness.
A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?
development of gross motor movement
A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal?
Administration of IV antibiotics at the hospital Instruct the parents on how to care for an IV line at home Instruct the parents regarding the importance of maintaining bed rest Institute infection-control precautions related to drainage tubes
A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented? Select all that apply.
Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.
A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?
"I give it to her first thing in the morning before breakfast." "We are taking her to Disney in the summer."
A young female has been prescribed corticosteroids for dermatomyositis. Which statements by her mother indicate the need for further education? Select all that apply.
1 mL/dsy
The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place.
The spinal meninges protrude through the bony defect and form a cystic sac.
The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele?
Advise the child that this is to be expected.
The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?
feels increasing severe pain.
The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child:
muscle biopsy
The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?
"This medication will cure my child of this disorder."
The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education
"This medication will cure my child of this disorder." -The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening.
The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education?
"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future."
The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education?
idiopathic scoliosis
The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?
Deficient knowledge related to diagnosis and condition
The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?
Limited abduction of the affected hip
The nurse is assessing a newborn and suspects developmental dysplasia of the hip (DDH). For which sign is the nurse prioritizing in this potential diagnosis?
NSAIDs, ice, and limiting exercise
The nurse is assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client?
"We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet."
The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse?
"You and your coaches need to understand that you cannot play soccer for at least six weeks."
The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?
Color Sensation Pulse Capillary refill NOT: vital signs
The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.
spastic.
The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as
Type II
The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?
Assess the popliteal region carefully for skin breakdown.
The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?
"My son's activity is too limited to stimulate his bowels."
The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching?
when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand
The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?
"Check the skin that is covered by the braces for redness and breakdown."
The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching?
Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined.
The nurse is caring for a child who has had an open reduction with cast placement on the forearm. While assessing the cast, the nurse notes serosanguineous fluid on the cast. What action by the nurse is appropriate?
clozapine
The nurse is caring for a child with muscular dystrophy. Which prescription will the nurse question?
low serum calcium levels
The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record?
A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate.
The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation?
epiphysiolysis of the proximal humerus.
The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:
A weak pedal pulse
The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse?
"Let's ask your parents to bring your friends for a visit."
The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention?
Emphasize and encourage compliance related to the use of a back brace.
The nurse is caring for an extremely active 13-year-old adolescent who has recently been prescribed a back brace to treat scoliosis. Which intervention will be most critical to the success of treatment?
Duchenne muscular dystrophy
The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?
Any area on the cast that is warm to the touch A foul odor under the cast Drainage from under the cast Looseness of the cast on the extremity
The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child? Select all that apply.
"It will be hard, but we know our child will be in this device for a long time."
The nurse is reinforcing teaching with the caregivers of a child who has been placed in an external fixation device for the treatment of an orthopedic condition. Which statement made by the caregivers indicates an understanding of the external fixation device?
"Blowing cool air with a fan or hair dryer may relieve the feeling."
The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?
"Would you please describe the weakness you are seeing in your son?"
The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information?
"If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good."
The nurse is talking with the caregiver of a 13-year-old diagnosed with scoliosis. The child has come to the clinic to be fitted with a brace to begin her treatment. The child appears upset and angry and states, "I hate this brace; I hate it already." In an effort to support this child, which statement would be the most appropriate for the nurse to make to this child's caregiver?
"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."
The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state:
Complete
The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:
Developmental dysplasia of the hip (DDH)
The parent has brought a 2-year-old to the public clinic for immunizations. The nurse documents the following characteristics: A duck waddle gait Shortened extremity Asymmetry of the gluteal folds Protruding abdomen The nurse then refers the toddler to the health care provider for potential diagnosis of which?
The boy rises from the floor by walking his hands up his legs.
The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this?