Chapter 40- W&C

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected."

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?

"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."

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:

"These make a smooth edge on the cast so the skin is better protected."

Given knowledge of muscular dystrophy, the nurse would expect to see which form of this condition most commonly in children?

Duchennes

The nurse is concerned that a preschool-age child is demonstrating signs of Duchenne muscular dystrophy. What did the nurse assess in this child?

Gowers sign

A 14-year-old girl is diagnosed as having scoliosis. When doing scoliosis screening with her, an important observation would be to note:

Her posterior spine when she bends forward.

Idiopathic scoliosis is the most common form that occurs.

Idiopathic scoliosis, with the majority of cases occurring during adolescence, is the most common scoliosis.

A nurse is caring for a 10-year-old who is in skeletal traction following injuries sustained in a car accident. Which statement accurately describes a recommended nursing measure for this type of traction?

Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours.

The pediatric nurse practioner (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?

The boy rises from the floor by walking his hands up his legs.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours.

The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection?

drainage of the cast

Muscular dystrophy is a result of which cause?

gene mutation

Through which mechanism is Duchenne's muscular dystrophy acquired?

hereditary

How would the nurse best describe Gowers' sign to the parents of a child with muscular dystrophy?

transfer tecnique

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair?

wheelchair belt

The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries?

• Encourage 1 to 2 days off per week of competitive athletics.• Apply ice to the injured area to reduce inflammation.• Perform appropriate stretching during a 20-to 30-minute warmup.

The nurse is caring for a child who has just received a cast for a broken wrist. The parents ask, "Why do we need to keep the arm up on a pillow?" Which response by the nurse is appropriate?

"Keeping the arm raised helps to lessen the swelling."

The nurse is teaching a group of peers regarding different types of fractures seen in children. Which statement best describes a complete fracture?

A fracture in which the bone breaks into two pieces.

A teenager has been admitted to the hospital with respiratory complications related to Duchenne muscular dystrophy. How can the nurse best provide support for the parents, who are the caretakers of this adolescent?

Assume responsibility for the teen's daily care while accepting input from parents and the teen

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should she use to best describe this condition?

Degeneration of muscle fibers

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?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.

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?

Impaired physical mobility related to a cast on the leg

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?

Standing

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?

adolesence

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client?

bracing

The nurse is working with a group of caregivers of school-age children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

complete

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

createnine

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?

createnine kinase

A type of traction sometimes used in the treatment of the child with scoliosis is called:

halo traction

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?

idiopathic scoliosis

Which condition would alert the nurse that a child may be suffering from muscular dystrophy?

increased lumbar lordosis

Which of the following strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy?

long leg braces

A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care?

maintaining intravenous antibiotic therapy

When a child is suspected of having muscular dystrophy, a nurse should expect which muscles to be affected first?

muscles of the hip

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?

muscular biopsy

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction

An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse (child maltreatment). Which type of fracture would the radiograph most likely reveal?

spiral fracture

The nurse is working with a 6-year-old child recently diagnosed with Legg-Calvé-Perthes disease. The child's parents tells the nurse they understand exercise is important for their child but are not sure which activities are appropriate. Which activity will the nurse recommend for this client?

swimming

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unnhooking a weight while providing pin care

The nurse is caring for a child after an accident in which the child fractured his arm. A cast has been applied to the child's right arm. Which actions should the nurse implement?

• Document any signs of pain.• Monitor the color of the nail beds in the right hand.• Check radial pulse in the both arms.

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to:

prevent edema.

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?

spica cast

While an adolescent wears a body brace for scoliosis, you would teach her:

To continue with age-appropriate activities.

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed opioids. Which action would be the priority?

notify doctor immediately

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast?

Assess the fingers for warmth, pain, and function