Pediatric Exam 2: Chapter 44 Nursing Care of Child With Alteration in Mobility/Neuromuscular Musculoskeletal Disorder (3)
A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Apply ice to the injury for 60 minutes on and 60 minutes off." "Elevate the legs, and use bed rest for 24 hours." "Applying ice to the area will reduce the pain and swelling." "Taking warm baths will help relax muscles and reduce pain."
"Applying ice to the area will reduce the pain and swelling." Explanation: Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.
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? "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." "A small amount of lotion or baby oil can be poured in the cast to moisturize the area." "Blowing cool air with a fan or hair dryer may relieve the feeling." "Itching is common. It's nothing to worry about."
"Blowing cool air with a fan or hair dryer may relieve the feeling." Explanation: Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.
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? "Check the skin that is covered by the braces for redness and breakdown." "Please try and follow the therapist's on and off schedule." "It is very important to comply with the use of this brace." "If the brace is painful, feel free to take it off."
"Check the skin that is covered by the braces for redness and breakdown." Explanation: Assessing skin integrity should be the priority, as braces can lead to pressure ulcers and infection. Compliance is important, but attention to skin care is the priority teaching. Following the schedule is important for compliance, but skin integrity is the priority. Advising the parents to remove the brace if it is painful is inaccurate; the child may require pain management or further consultation with the physical therapist.
The nurse is providing postoperative care for a boy who has undergone surgical correction for pectus excavatum ("funnel chest"). The nurse should emphasize which instruction to the child's parents? "Do not allow him to lie on his stomach." "Do not allow him to lie on either side." "Be sure to monitor his vital capacity." "Please watch for signs of infection."
"Do not allow him to lie on either side." Explanation: The nurse should emphasize that the child should not be allowed to lie on his side for 4 weeks following the surgery to ensure the bar does not shift. The parents should be aware of signs of infection; but the position must be emphasized to protect the bar. The nurse would be expected to monitor the child's vital capacity, not the parents. The prone position is acceptable.
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? "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." "Remind your child that her spine needs to be corrected in order to keep her whole musculoskeletal system healthy for a long, long time." "Children her age often withdraw during stressful times; let her have some time alone to think about the situation and to get used to the brace." "Take your daughter to an oncology floor for a few minutes so she can see children who are much sicker th
"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." Explanation: Help the child select clothing that blends with current styles but is loose enough to hide the brace. Self-image and the need to be like others are very important at this age. Wearing a brace creates a distinct change in body image, especially in the older child or adolescent, at a time when body consciousness is at an all-time high. The need to wear the brace and deal with the limitations it involves may cause anger; the change in body image can cause a grief reaction. Handling these feelings successfully requires understanding support from the nurse, family, and peers. It is important for the child to have an opportunity to talk about his or her feelings.
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? "The contents of the sac you see only has fluid in it and should cause the child no problem." "The sac is a very small cyst and should resolve within the first year of life." "It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." "Your child's defect involves only the nerves to the bladder and bowel and can be easily repaired."
"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." Explanation: A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year.
An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent torticollis." "It is important to prevent herniation of a spinal disk, which is painful."
"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." Explanation: It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.
An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image? "You should not worry about what everyone else is wearing. You look fine." "Just hold your head up and be confident in how you look. Look for some after-school activities you can do wearing your brace." "Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." "Kids can be cruel sometimes. Has anyone told you that you look different?"
"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." Explanation: A positive self-image is very important for adolescents wearing a brace. They want to look like their peers and wear the same clothing, but often that is not possible when wearing a brace. Assisting the adolescent in selecting clothing that looks stylish but still hides the brace is one of the best ways to help this client. Telling her she looks fine, to be confident, or bringing up the times she has been embarrassed does not help the client.
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." "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry." "We put these on so the child will not pull the padding from under the cast." "These will help the cast look more attractive so the child won't feel self-conscious."
"These make a smooth edge on the cast so the skin is better protected." Explanation: If the cast has no protective edge, it should be petaled with adhesive tape strips. These help keep the skin protected from the rough edge of the cast. If the cast is near the genital area, plastic should be taped around the edge to prevent wetting and soiling of the cast; petaling the cast does not provide protection to keep the cast dry.
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." "This medication will help to increase bone mineral density." "My child's risk for fractures will hopefully be decreased as by taking this medication." "This medication doesn't prevent fractures from happening."
"This medication will cure my child of this disorder." Explanation: Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. 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 is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? "Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon." "At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better." "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." "Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own."
"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." Explanation: When a parent describes a child as always falling over the feet or awkward, the nurse needs to assess for toeing-in or metatarsus adductus. One way to assess for this is to have the child stand on a copier and make a print of the feet. It will show any inward turning of the feet. For most instances, it resolves without therapy. If it persists past 1 year, passive stretching exercises may be prescribed. It is not a severe bone disorder and typically does not need surgical intervention.
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? "Would you please describe the weakness you are seeing in your son?" "Has his pace of achieving milestones diminished?" "Has he achieved his developmental milestones on time?" "Do you think he is simply fatigued?"
"Would you please describe the weakness you are seeing in your son?" Explanation: The nurse needs to obtain a clear description of weakness. This open-ended question would most likely elicit specific examples of weakness and shed light on whether the boy is simply fatigued. The other questions would most likely elicit a yes or no answer rather than any specific details about his weakness or development.
A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition? An 11-year-old girl who is obese A 15-year-old girl who dances ballet A 13-year-old boy who is on his school's cross-country team A 9-year-old boy who is sedentary
A 13-year-old boy who is on his school's cross-country team Explanation: Osgood-Schlatter disease is the thickening and enlargement of the tibial tuberosity resulting from microtrauma, probably caused from overuse. It occurs more often in boys than girls and at preadolescence or early adolescence, probably because of rapid growth at these times.
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? A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating. A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. 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.
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. Explanation: Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.
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 buckles rather than breaks A fracture in which the bone breaks into two pieces A fracture in which the bone bends without breaking An incomplete fracture of the bone
A fracture in which the bone breaks into two pieces Explanation: A fracture in which the bone breaks into two pieces is called a complete fracture. A fracture in which the bone bends without breaking is called a plastic or bowing deformity. A fracture in which the bone buckles rather than breaks is called a buckle fracture. An incomplete fracture of the bone is called a greenstick fracture.
Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? Nausea and vomiting often follow repair of the cystic mass. The infant will have a poor sucking reflex. Assuming the usual feeding position will be difficult. Pain will interfere with the feeding process.
Assuming the usual feeding position will be difficult. Explanation: Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic.
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? Ligaments Cartilage Joints Tendons
Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.
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. Capillary refill Sensation Vital signs Pulse Color
Color Sensation Pulse Capillary refill Explanation: A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.
The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: myotonia. facioscapulohumeral. Duchenne. limb-girdle.
Duchenne. Explanation: Studies have shown that Duchenne is the most severe form of muscular dystrophy. Myotonia isn't a form of the disease; it's a symptom.
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? Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns. Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C.
Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. Explanation: The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.
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? Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C. Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns
Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. Explanation: The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.
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? Complete Spiral Epiphyseal Greenstick
Greenstick Explanation: Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.
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? Spiral Greenstick Epiphyseal Complete
Greenstick Explanation: Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.
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 Deficient diversional activities related to a need for imposed activity restriction for 6 weeks Situational low self-esteem related to the use of a walker Pain related to chronic inflammation of the lower leg
Impaired physical mobility related to a cast on the leg Explanation: Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.
A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective? Keep the child's skin distal to the traction clean and dry. Gently massage the child's back to stimulate circulation. Assess neurovascular status on the affected extremity once every shift. Inspect the child's skin for rashes, redness, irritation, or pressure injuries.
Inspect the child's skin for rashes, redness, irritation, or pressure injuries. Explanation: It is important to be vigilant in inspecting the child's skin for rashes, redness, and irritation to uncover areas where pressure injuries are likely to develop. Applying lotion, gentle massage, and keeping the skin dry and clean are part of the routine skincare regimen. However, performing these interventions without first performing a skin assessment can cause the nurse to miss important signs that can potentially result in more injury to the child. Neurovascular assessment should be performed frequently as prescribed by the health care provider or at least every 4 hours to evaluate skin integrity and venous circulation.
Which characteristic is true of cerebral palsy? It results in intellectual disability. It's progressive. It's reversible. It appears at birth or during the first 2 years of life.
It appears at birth or during the first 2 years of life. Explanation: Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are intellectually disabled, many have normal intelligence.
The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse? Apply ice bags to the child's foot and ankle. Reposition the leg on pillows so that it is above the level of the child's heart. Administer prescribed pain medication. Notify the health care provider of the findings immediately.
Notify the health care provider of the findings immediately. Explanation: Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.
What methods can a nurse use to evaluate extremity function in an 18-month-old? Select all that apply. Look for symmetric motion in the arms and legs. Observe the child in developmentally appropriate play. Ask the child to squeeze the nurse's fingers simultaneously. Elicit from the parent a description of fine and gross motor activities. Have the child push against resistance with both feet.
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. Explanation: Observing play, eliciting parental descriptions, and looking for symmetry in motion are all developmentally appropriate and effective methods of assessing extremity function in this toddler. Expecting the child to cooperate in squeezing fingers or pushing feet against resistance is not realistic and is likely to cause reluctance to participate in later assessments.
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? Jumping jacks Soccer Brisk walking Swimming
Swimming Explanation: Legg-Calvé-Perthes disease occurs when blood supply to the femoral head of the hip joint is temporarily interrupted and the bone begins to die. The child with Legg-Calvé-Perthes disease will experience limited range of motion in the hip. Thus, swimming and tricycle or bicycle riding are excellent exercises because they provide smooth joint action and will help to reduce joint destruction. In contrast, activities that place excessive strain on joints, such as running, jumping, prolonged walking, and kicking, should be avoided.
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? Be certain the child is walking with the crutches about 6 inches to the side of the foot. Caution parents to clear articles such as throw rugs out of paths at home. Teach the client not to rest with the crutch pad pressing on the axilla. Assess the tips of the crutches to be certain the rubber tip is intact.
Teach the client not to rest with the crutch pad pressing on the axilla. Explanation: Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child.
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. The boy experiences mild pain when wiggling his toes. The outside of the boy's cast got wet and had to be dried using a hair dryer. The boy's toes are light blue and very swollen. New drainage is seeping out from under the cast. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours.
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. Explanation: The parents should call the physician when the following things occur: The child has a temperature greater than 101.5° F (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.
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? The head is held tilted with limited side-to-side motion. The boy rises from the floor by walking his hands up his legs. Severe lordosis is evident in the lumbar spine. The boy has a large tan skin lesion on his torso.
The boy rises from the floor by walking his hands up his legs. Explanation: Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand. The other options do not describe Gowers' sign, although lordosis is often a manifestation of Duchenne muscular dystrophy.
In caring for a child in traction, which intervention is the highest priority for the nurse? The nurse should record accurate intake and output. The nurse should monitor for decreased circulation every 4 hours. The nurse should clean the pin sites at least once every 8 hours. The nurse should provide age-appropriate activities for the child.
The nurse should monitor for decreased circulation every 4 hours. Explanation: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.
A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note? The posterior spine when bending forward The angle of the iliac crest when bending forward The angle of the lower chest when sitting down The posterior spine when bending sideways
The posterior spine when bending forward Explanation: Diagnosis of scoliosis is best made with inspection and observation. When inspecting the back with the child in a standing position, the nurse should note asymmetries such as shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. A lateral curvature of the spine is best revealed when the child bends forward. The child should bend forward with the arms hanging freely. The curve and asymmetry of the back can be observed. The height of the iliac crest, not the angle, is measured on both sides and the difference is noted. Bending to the side would not provide an accurate assessment of the spine because the curvature cannot be seen from the side. The lower chest angle would not be an accurate assessment as it would be more associated with the ribs as opposed to the spine.
A group of students is reviewing information about bone healing in children. The students demonstrate understanding of this information when they state: a fracture closer to the growth plate heals much slower than one in the metaphysis. the process of breaking down and forming new bone is decreased in children compared with adults. callus production is slower (but greater in amount) in children than in adults. a child's bones heal more quickly than those of an adult.
a child's bones heal more quickly than those of an adult. Explanation: Bone healing in children occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.
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? a weak pedal pulse decreased oral intake temperature 100.2°F (37.9°C) mild fussiness
a weak pedal pulse Explanation: A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Decreased oral intake and an elevated temperature could indicate an infection. However, circulation is priority over infection in the client and would be most concerning for the nurse. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically.
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 toddlerhood preschool age school age
adolescence Explanation: Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.
A 9-year-old child is scheduled for a computed tomography with contrast medium. What would be most important for the nurse to assess? allergies white blood cell count swelling pain
allergies Explanation: Assessing for allergies would be the priority because a contrast medium is being used. Pain is an important assessment but is unrelated to the test scheduled. Swelling is an important assessment finding, but this is unrelated to the test scheduled. Although a white blood cell count is important for determining an infection, it is unrelated to the test scheduled.
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? diminished pulse delayed capillary refill pallor of the fingers drainage on the cast
drainage on the cast Explanation: Drainage on the cast could indicate an infection. Pale fingers, delayed capillary refill, and diminished pulse would suggest impaired circulation.
A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects? ultrasound screening at 16 weeks' gestation maternal serum alpha-fetoprotein screening folic acid supplementation genetic testing for gene identification
folic acid supplementation Explanation: Strong evidence exists that folic acid supplementation by the mother before conception decreases the incidence of neural tube defects by 50%. Ultrasound screening at 16 to 18 weeks' gestation can help identify fetuses at risk, but this would not prevent neural tube defects. Screening of maternal serum alpha-fetoprotein levels can help identify fetuses at risk, but this would not prevent neural tube defects. Neural tube defects are not related to genetic dysfunction, so genetic testing would be of no value.
The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? cat dander alcohol gel peanuts latex
latex Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.
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? x-ray confirmation of adequate bone shape low serum calcium levels high serum phosphate levels low alkaline phosphate levels
low serum calcium levels Explanation: With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.
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. promote healing. discourage infection. ensure proper bone alignment.
prevent edema. Explanation: Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.
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. semi-Fowler right side lying prone left side lying supine
prone right side lying left side lying Explanation: Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.
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?
when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand Explanation: A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.
