PEDS MUSCULOSKELETAL SHERPATH

A child has a skeletal growth disorder. Which disorder occurs when the femoral neck is displaced from the femoral head? Scoliosis Osteomyelitis Legg-Calvé-Perthes disease Slipped Capital Femoral Epiphysis (SCFE)

Slipped Capital Femoral Epiphysis (SCFE) Increased body weight and height place more stress on the epiphyses, causing a relative displacement (slip) of the femoral neck from the femoral head.

The parents of a child newly diagnosed with a chronic illness ask the nurse how long the illness will last. How should the nurse respond? Select all that apply. "A chronic illness may have residual aspects that can last a lifetime." "A chronic illness is incurable, so the child will always struggle with the illness." "A chronic illness usually affects activities of daily living (ADLs) and lasts a long time." "A chronic illness can occur during a wide range of times and often spontaneously resolves." "A chronic illness lasts at least three months and up to a lifetime, depending on the illness."

"A chronic illness may have residual aspects that can last a lifetime." A chronic illness can have effects that last a lifetime, even if the active symptoms of the illness have resolved. "A chronic illness lasts at least three months and up to a lifetime, depending on the illness." Lasting at least three months is part of the definition of a chronic condition. Many chronic illnesses are incurable and therefore can last a lifetime.

The nurse is caring for a newborn with Down syndrome. The parents state, "The health care provider just informed us that our daughter has Down syndrome. How long will my child be sick?" How should the nurse respond? "All chronic conditions are lifelong conditions." "I am very sorry that your daughter was born with this lifelong illness." "Down syndrome is a chronic condition, so the child will always have this condition." "Your child is not sick but has a developmental disability that will require her to need care her entire life."

"Down syndrome is a chronic condition, so the child will always have this condition." The nurse knows that many chronic illnesses are lifelong and that Down syndrome is a type of chronic illness that lasts a lifetime.

A preschool-aged child with cancer has begun crying for her pacifier, which she stopped using 6 months ago. The parents voice concerns to the nurse. How should the nurse respond to the parents? "How do you feel about allowing her to use the pacifier while in the hospital?" "Explain to the child that she is a 'big girl' and does not need a pacifier anymore." "Do not give her the pacifier because this could cause her not to develop appropriately." "Your daughter may not be dealing well with the illness and treatment. She may need to meet with a psychologist."

"How do you feel about allowing her to use the pacifier while in the hospital?" Regression is typical and expected in young children who are undergoing a major illness. The child is trying to cope with stress related to the hospitalization and/or cancer, so allowing a pacifier is acceptable and can decrease the child's stress. The nurse should investigate how the parents feel about the child using the pacifier during the hospital admission.

The nurse is providing education to a child and family during a sports physical examination to explain the differences in the pediatric musculoskeletal system compared to adults. Which statement by the child indicates correct understanding of the education? "My bones are more likely to break because they are growing." "I don't need to worry about fractures because my bones will heal faster." "As new muscles develop, I will be able to run faster while playing sports." "I am not as likely to sprain my ankle when playing sports, but I should be careful."

"I am not as likely to sprain my ankle when playing sports, but I should be careful." This statement indicates correct understanding of the differences between the pediatric and adult musculoskeletal system, because the resiliency of soft tissues makes sprain less likely than in adults.

Which statement by the nurse can explain the normal function of joints in the pediatric patient? "Joints are converted to bone." "Joints help your bones grow." "Joints help your bones move." "Joints firmly bind bones together."

"Joints help your bones move." Many joints function to allow movement of bones.

A school-age child is admitted with osteomyelitis. Which statement by the parent will require further attention by the nurse and health care provider? "Our child has had several cavities." "Our child has been on antibiotics frequently." "Our child has poor coordination and falls often." "We have noticed a change in our child's energy levels."

"Our child has had several cavities." Children with poor oral hygiene, as may be indicated by several cavities, are at increased risk for systemic infections and illness, including osteomyelitis.

A nurse is caring for a young child who strained his ankle playing soccer at school that morning. After teaching the parents how to care for the ankle for the rest of the day, which statements by the parents indicate effective learning has occurred? Select all that apply. "We should administer NSAIDS for pain." "We should apply heat for 20 minutes at a time." "My child should rest his/her ankle as much as possible." "We should apply a compression bandage to support the ankle." "We should have him keep his ankle below the level of his heart to allow drainage of excess fluid."

"We should administer NSAIDS for pain." Analgesia and anti-inflammatory medications, such as NSAIDs, should be used in the treatment of soft tissue injury to relieve pain. "My child should rest his/her ankle as much as possible." Rest (R) prevents further damage or irritation to the injury site. "We should apply a compression bandage to support the ankle." Compression (C) will support the ligaments, muscles, and tendons in an injured joint.

The nurse receives a report on multiple patients newly admitted to the pediatric unit. Which patient should the nurse assess first? 5-year-old with mild muscle weakness 6-month-old with a fractured left femur 3-year-old with dislocated right shoulder 14-month-old with palpable anterior suture line

6-month-old with a fractured left femur Fractures in children younger than 1 year are unusual and may indicate child abuse; the nurse should assess this child first to evaluate the family situation.

A parent brings their 6-year-old child with Duchenne muscular dystrophy (DMD) to the primary care clinic for a well child visit. Upon assessing the patient, the nurse notes that the child displays signs of muscle weakness and difficulty walking. The nurse should ensure that the patient is using which assistive device correctly? Select all that apply. Hearing aids A back brace Soft, flexible soles Corrective lenses Compression socks

A back brace Lordosis, excessive inward curvature of the back, would be present in a patient who has DMD. A back brace would provide the necessary support to the patient and therefore this may be seen on assessment. Soft, flexible soles Foot deformities would be present in DMD secondary to muscle wasting. Soft, flexible shoes would provide adequate space for the child's foot and therefore these may be seen during the assessment.

The parents of a school-aged child newly diagnosed with asthma are receiving discharge education. What information should the nurse emphasize to address the need for follow-up appointments? Asthma is an illness that is unique because it requires close monitoring. The child with asthma will receive routine follow-up care during the annual check-up. The illness trajectory of asthma indicates that the child will need to follow-up more than other chronic illnesses usually require. A child with a chronic illness needs regular care monitoring and follow-up and should work to develop a positive relationship with the health care team.

A child with a chronic illness needs regular care monitoring and follow-up and should work to develop a positive relationship with the health care team. The need for regular assessment, monitoring, and follow-up is much greater in children with chronic illnesses than it is for the general population of children. Detecting issues in this population early is important to decrease long-term issues.

Why is it important to identify the special needs for children with chronic and terminal illness? The definition helps to define the illness trajectory that a chronic illness might take. The definition describes the specific types of support and interventions that a child and family will need. A specific definition of chronic and terminal illness allows for easier billing and obtaining insurance coverage for treatments. A clear definition can help families and caregivers obtain the support necessary to adequately care for children with special health care needs.

A clear definition can help families and caregivers obtain the support necessary to adequately care for children with special health care needs. A clear definition of special health needs allows for enhanced advocacy and planning care specific to this category of chronic conditions.

A nurse has been assigned to see four patients who are all recovering from soft tissue injuries in the orthopedic unit. Which patient should she see first? A patient who is 6 days post injury with bruising A patient who is 2 days post injury with swelling at the site A patient who was injured yesterday and has a tingling sensation A patient who is 5 days post injury and beginning to bear weight

A patient who was injured yesterday and has a tingling sensation A tingling sensation can be a sign of a more serious problem and the nurse should see this patient first.

The nurse knows that developmental dysplasia of the hip differs between the infant and neonate in which way? Patellar subluxation Complete hip immobility Presence of a femur fracture Asymmetry of gluteal skinfolds

Asymmetry of gluteal skinfolds Infants beyond the neonatal period exhibit asymmetry of the gluteal skinfolds when lying with the legs extended against the examining table (or when the infant is held upright with the legs dangling).

A preteen with no previous issues is noted to have uneven shoulders, and when performing the Adam's forward bend test the nurse observes what appears to be a rib hump. On which condition does the nurse anticipate educating the patient? Scheuermann's Kyphosis Early onset scoliosis (EOS) Adolescent idiopathic scoliosis Previously undiagnosed congenital scoliosis

Adolescent idiopathic scoliosis Adolescent, idiopathic scoliosis would have onset at 10 years or older. A lack of previous history suggests this is idiopathic onset.

An 8-year-old has been found to have moderate cerebral palsy (CP). The child recently began participating in a regular classroom for part of the day. The child's mother asks the school nurse about joining the afterschool Scout troop. The nurse's response should be based on what knowledge? Most activities such as Scouting cannot be adapted for children with CP After-school activities usually result in extreme fatigue for children with CP Trying to participate in activities such as Scouting leads to lowered self-esteem in children with CP After-school activities often provide children with CP with opportunities for socialization and recreation

After-School activities often provide children with CP with opportunities for socialization and recreation Recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs as a means of promoting socialization. Most activities can be adapted for children with cerebral palsy. The child, family, and activity director should assess the degree of activity to ensure that it matches the child's capabilities. A supportive environment associated with after-school activities will add to the child's self-esteem.

The nurse notes that an adolescent that has been in the hospital for over a week has recently stopped talking to the staff when they enter the room. Which response by the nurse is most appropriate? Have the adolescent call a friend to talk about the illness and increase communication Allow the adolescent to make choices regarding how and when certain parts of care are completed Encourage the adolescent to have some peers come and visit during the hospitalization to decrease loneliness Tell the adolescent that interacting with staff and communicating needs must be done if treatment is going to be effective

Allow the adolescent to make choices regarding how and when certain parts of care are completed A lack of communication or change in communication can be an indication of a decrease in self-esteem and independence related to dealing with an illness. Allowing the adolescent to make some decisions regarding care can increase independence and self-esteem.

To prepare a 9-year-old child with muscular dystrophy for school, the school nurse should establish goals to help the child achieve maximum potential for normal socialization. What action will assist the school nurse in achieving these goals? Limiting recess activities to 30 minutes per day Providing the child with an assistant for all activities during school hours Keeping the child in a special education classroom with other children with similar disabilities Allowing the child to use assistive devices to move about independently through the school

Allowing the child to use assistive devices to move about independently through the school Allowing the child to use assistive devices for mobility encourages independence and allows the child opportunities to socialize and interact with peers.

A patient is being treated for osteomyelitis. What symptoms would the nurse report to the health care provider? Select all that apply. An elevated temperature Increased range of motion Complaints of localized pain Pain radiating away from site Increased redness and swelling around site

An elevated temperature An elevated temperature could indicate the antibiotic is not working. Pain radiating away from site Radiating pain to an adjacent joint necessitates an assessment for possible septic arthritis. Increased redness and swelling around site If signs and symptoms get worse, the health care provider should be notified.

A patient presents to the clinic with significant swelling, bruising, and pain around the ankle following a fall during a track meet 3 hours earlier. The athletic trainer provided initial treatment at the event. Which action by the trainer indicates a need for correction by the nurse? Kept the ankle elevated Application of a heat pack Encouraged rest until parents arrived Placement of a compression bandage

Application of a heat pack In the initial stages of an injury, ice should be applied to reduce swelling, not heat. This action indicates need for correction by the nurse.

A nurse is caring for a young girl who fell and injured her knee. The young girl is very upset because she doesn't want to have a swollen leg. The nurse should prioritize which nursing intervention to help reduce swelling? Applying ice Taking analgesics Stretch the leg joints Recommending bed rest

Applying ice Applying ice can help reduce swelling and inflammation.

The nurse is caring for a school-aged child with a chronic illness that requires the child to wear a mask when leaving the hospital room. The child does not want to attend social activities on the unit. Which action by the nurse can help encourage the child to participate? Ask the child why the hesitation to wear the mask when leaving the hospital room Bargain with the child to attend at least one activity a week to help increase the child's socialization on the unit Encourage the child to attend the social activities on the unit without the mask so that the child does not feel singled out Allow the child to decline attendance and participation in the social activities on the unit to decrease emotional distress and embarrassment

Ask the child why the hesitation to wear the mask when leaving the hospital room The nurse should question the child about the reason for not wanting to wear the mask and should allow the child to verbalize feelings.

A 3-month-old infant is seen in the emergency department and an x-ray shows a femur fracture. What is the primary nursing assessment? Assess pedal pulse in affected limb Assess parent knowledge on infant care Assess family home and financial situation Assess feeding schedule and weight gain of infant

Assess pedal pulse in affected limb Circulation of the injured limb is a priority assessment to detect potential serious complications.

The nurse is caring for a patient in a Pavlik harness. Which critical task specific to this harness should be performed by the nurse? Ensure immobility Assess the skin under the harness Assess the anxiety level of the parents Ensure the harness is tight against the chest

Assess the skin under the harness Monitoring the skin integrity of child in a Pavlik harness or spica cast is important because extended wear can lead to impaired skin integrity.

A nursing student is preparing to conduct a clinical conference regarding osteomyelitis. Which event triggering the inflammatory process should be included in the discussion? Pus accumulates under the periosteum. Bacteria enter the bone through blood vessels. Pus moves from the metaphyseal area into a joint. Pus accumulates and moves toward the medullary canal.

Bacteria enter the bone through blood vessels. In the initial stage, bacteria enter the metaphysis by small capillaries, and the inflammatory process begins. The presence of bacteria alerts the body's immunological defense system to react, resulting in an inflammatory reaction.

How should the nurse communicate with the family to educate them on a child's clubfoot condition? Be very descriptive but use lay terms. Be slightly vague to avoid causing distress. Give a handout and encourage self-directed reading. Use scientific verbiage to provide an in-depth explanation of the condition.

Be very descriptive but use lay terms. When talking with families, use descriptive lay language rather than scientific terms.

The nurse is assessing a newborn patient. Which musculoskeletal finding is most concerning? Dislocated left hip Cartilaginous hands Fused cranial sutures Crepitus at the clavicle

Fused cranial sutures Infants are born with open sutures that allow for growth of the brain; fused cranial sutures at birth would be the most concerning finding in a newborn.

The nurse is caring for a child with cerebral palsy. On electroencephalogram analysis, the nurse identifies that the child has epilepsy. Which drug should the nurse administer to manage the condition? Baclofen Reserpine Revodopa Carbamazepine

Carbamazepine Seizures are common in patients with cerebral palsy. Patients experiencing frequent seizures are given antiepileptic drugs for effective illness management. Carbamazepine is the preferred drug for patients with seizures. Baclofen is used for pain management in patients for postoperative care. Reserpine is used to treat chorea and athetosis. Levodopa is used to treat muscular disorders like dystonia.

A child is in skeletal traction. What nursing interventions will decrease the risk of infection? Select all that apply. Check pin sites for signs of redness and inflammation. Use soap and water to cleanse the area around the pins. Leave drainage in place to keep from disrupting the area where the pins are arranged on the skin. Careful examination of the pin entry sites to view any signs of loose pins. Remove the patient from traction for a short period of time to improve circulation.

Check pin sites for signs of redness and inflammation. Check the pin entry sites for redness and inflammation that may indicate infection. Use soap and water to cleanse the area around the pins. Cleanse the area around the pin entry sites with soap and water. Other approved cleanser may also be used. Careful examination of the pin entry sites to view any signs of loose pins. To decrease the likelihood of an infection in a patient with pins from traction, meticulous assessment of entry sites for signs of loose pins is needed.

The parents of a preschooler with a developmental delay come into the health care provider's office for help with recent tantrums. The parents want to know how they should discipline the child. How should the nurse respond? Select all that apply. The child should be left alone to calm down and gain control. Discipline might not be the answer because the child may be trying to communicate frustration. Punishment is important to decrease the child's use of tantrums to gain attention and get what is wanted. The tantrum might indicate that the child has a need that is not being met, and disciplining the child could make this situation worse. Ignoring the behavior and withdrawing attention from the child will help to decrease the tantrums and help the child learn to talk about needs. Instead of disciplining the child, help the child to better communicate needs by using a picture board that can be used to initiate getting the child's personal needs met.

Discipline might not be the answer because the child may be trying to communicate frustration. The child with a chronic illness may experience many frustrations with no known way to communicate them. Discipline may increase frustration because it does not address what is frustrating the child. The tantrum might indicate that the child has a need that is not being met, and disciplining the child could make this situation worse. The use of punishment in a developmentally delayed preschool-aged child could increase the frustration level in the child and make behaviors worse. Children this age may act out when they do not know how to get their needs met. The parents should determine if the child is trying to communicate a need first. Instead of disciplining the child, help the child to better communicate needs by using a picture board that can be used to initiate getting the child's personal needs met. If the tantrums are indicating frustration, making communication easier can decrease frustration. Let the child gain some independence by being able to initiate getting own personal needs met.

A 14-year-old female patient with a newly diagnosed chronic illness presents to the nurse with feelings of worthlessness and showing signs of decreased self-esteem. What action by the nurse should help to strengthen this adolescent's feeling of autonomy as the patient learns to cope with a chronic illness? Select all that apply. Ensure that the teen is involved in care decisions and meetings with the health care team Give the adolescent opportunities to discuss needs and fears related to coping with the illness Encourage the patient to do as many of the usual activities with friends as the teen's condition allows Allow the adolescent to ask questions and give honest answers regarding the illness to increase understanding of the condition Stress that adherence is important and that making decisions is a privilege that can be lost if the treatment regimen is not followed

Ensure that the teen is involved in care decisions and meetings with the health care team Being involved in care decisions and care planning can increase the patient's sense of control and self-esteem. Give the adolescent opportunities to discuss needs and fears related to coping with the illness Some adolescents, especially younger teens, might have feelings of guilt related to the illness. Expression of these feelings can decrease sadness and help the teen gain back some control in life. Encourage the patient to do as many of the usual activities with friends as the teen's condition allows Assisting the teen to maintain contact with peer group and maintain usual activities can increase coping and age-appropriate development. Allow the adolescent to ask questions and give honest answers regarding the illness to increase understanding of the condition The adolescent should be an integral decision maker, which cannot be possible without an adequate understanding of the illness.

A patient is nervous about having the pins used for traction removed and asks the nurse what to expect. Which statement is correct about pin removal? General anesthesia is used for skeletal traction removal; the patient won't be conscious during the procedure. The patient will receive local anesthetics to relieve pain and the area will be draped to prevent visualization of the procedure. General anesthesia is used for the procedure but the patient will be conscious for immediate mobility assessment. Topical analgesics will be used for the procedure. The bone does not contain pain receptors so the patient feels no pain as the pin is removed.

General anesthesia is used for skeletal traction removal; the patient won't be conscious during the procedure. Pin removal can be scary for a patient. Inform the patient of the use of general anesthesia to decrease anxiety.

The nurse is caring for two patients, one with a fracture that has not broken the skin and one with a fracture that has pierced the skin. The nurse will need to monitor for which complication that can occur with both fractures? Infection Hemorrhaging Impaired skin integrity Compartment syndrome

Hemorrhaging Hemorrhaging is a complication for both simple (fracture that has not broken the skin) and compound (fracture that has broken the skin) fractures. The patient with the simple fracture is at risk for internal hemorrhaging, while the patient with compound fracture is at risk for external hemorrhaging.

The nurse is performing a musculoskeletal examination of a pediatric patient. Which findings indicate normal function? Select all that apply. Unequal muscle size Involuntary muscle movement Hip rotation without resistance Increased movement in the sutural joints Unrestricted range of motion in the ball and socket joints

Hip rotation without resistance Joints, such as the hip, enable movement and indicate normal function of the musculoskeletal system. Unrestricted range of motion in the ball and socket joints Ball and socket joints should have near 360 degrees of movement; this would be a normal finding.

A school-age child is admitted for treatment of osteomyelitis. Which complication would the nurse expect to see in this patient? Depression Social isolation Impaired mobility Fluid volume insufficiency

Impaired mobility The nurse would expect the child to have difficulty with mobility secondary to the infection of the bone in the right leg. It is most often accompanied by pain.

An adolescent with a seizure disorder is admitted to the hospital after a fall. The child is increasingly withdrawn and depressed. Which action should the nurse take to best care for this adolescent? Sit with the patient on the nurse's breaks and lunch period to decrease the teen's withdraw Accept the changes in behavior as a temporary regression in an adolescent patient that will quickly resolve on their own Encourage the family to visit with the adolescent more often and help make decisions for the teen to decrease the teen's stress level Make arrangements for more peer interaction opportunities that might include increased visitation, social media, or other opportunities to connect

Make arrangements for more peer interaction opportunities that might include increased visitation, social media, or other opportunities to connect The child is showing signs of depression, which could be from missed socialization with peers. If the nurse can accommodate extra visitors safely, then it should be done with permission from administration. If peers are not allowed in the hospital unit, a phone may be provided to allow the child to speak with friends.

The nurse is performing a musculoskeletal assessment on a pediatric patient. Which action is the most appropriate? Schedule a radiography Review laboratory tests Ask the child draw a circle Measure the child's height

Measure the child's height Measuring the child's height should be done at every well-check visit and is the most appropriate intervention to assess for potential musculoskeletal disorders by comparing height measurements over time.

A child in traction complains of tingling, intensifying pain in the extremity and requests additional pain medication. Which immediate action should the nurse take to care for this patient? Increase the pain medication as requested by the patient. Remove the patient from the traction device to relieve symptoms. Notify the health care provider that the patient has signs of compartment syndrome. Notify the health care provider that the patient has developed osteomyelitis.

Notify the health care provider that the patient has signs of compartment syndrome. The patient is displaying signs of compartment syndrome. The HCP should be notified right away and treatment initiated in order to prevent further injury and/or loss of limb.

A patient is admitted for surgery due to complication of osteomyelitis. As the nurse monitors the wound after surgery, which assessment would cause the nurse to be concerned that the antibiotic is not effective? Scab formation is noted at the affected site. Thick discharge is present at the affected site. The patient complains of discomfort at the affected site. A temperature change to 99.9° F from a previous recording of 101.8° F.

Thick discharge is present at the affected site. Redness, inflammation, and discharge indicate worsening of an infection. This would indicate the antibiotics are not effective.

A 5-year-old patient presents with a rib hump and visible curvature of the spine measuring 20 degrees. Which is the preferred treatment that the nurse can anticipate for this patient? Brace Surgery Exercise Observation

Observation Observation is recommended for a curve less than 25 degrees. Patients closer to 25 degrees who are skeletally immature will require more frequent radiographic observation than a patient with a smaller curvature who is skeletally mature.

A nurse is caring for a patient who presented with a soft tissue injury. What should the nurse document as part of her assessment of neurovascular involvement? Select all that apply. Pain Pallor Pruritus Paresthesia Pulselessness

Pain Pain is evidence of neurovascular impairment. Pallor Pallor is evidence of neurovascular impairment. Paresthesia Paresthesia is evidence of neurovascular impairment. Pulselessness Pulselessness is evidence of neurovascular impairment.

A patient with an external fixation device placed in the tibia is being discharged. The parents describe their anxiety about caring for the child at home to the nurse. Which information should the nurse provide to increase their confidence? Select all that apply. Provide information regarding the removal of the fixator pins. Provide information and request return demonstration on pin entry site care. Provide information regarding when to contact the health care provider. Provide information regarding community resources (PT, OT, school personnel). Provide information and request return demonstration on how to perform the neurovascular assessment and what the findings indicate.

Provide information and request return demonstration on pin entry site care. Pin entry site care, including cleansing and observation for possible infection, should be provided. Provide information regarding when to contact the health care provider. Information regarding specific signs that require health care provider attention need to be communicated effectively. Provide information regarding community resources (PT, OT, school personnel). Provide additional resources to help the family cope with the current lifestyle change they are experiencing and to provide the best treatment options for the child. Provide information and request return demonstration on how to perform the neurovascular assessment and what the findings indicate. The neurovascular assessment should be performed frequently. The parents should be comfortable with the assessment process and understand the implications of the findings.

A child with clubfoot experiences discomfort every time TAL (tendoachillis lengthening) is required and care is implemented. Which actions can the nurse take to help the child feel more comfortable? Select all that apply. Provide soft music Dim the lights and reduced loud sound Administer IV pain medication as ordered Pre-medicate with local anesthetic if required Have the parents hold the child during treatment

Provide soft music Providing soft music can help to reduce the discomfort experienced by the child. Dim the lights and reduced loud sound This action will help to reduce the child's discomfort and make the atmosphere calm. Pre-medicate with local anesthetic if required TAL (tendoachillis lengthening) can be painful and uncomfortable. Local anesthetic can be applied do reduce the pain. Have the parents hold the child during treatment Having the parents involved in the procedure will help to relieve the discomfort experienced by the child.

In which ways can a nurse help to relieve anxiety in an adolescent having surgery for a spine abnormality? Select all that apply. Reassure the adolescent to allay fears. Allow the adolescent to have quite time for reflection. Discuss activity limitations and provide ideas for alternatives. Correct any misunderstandings the adolescent has about the surgery. Determine the adolescent's need for specific information, particularly about postoperative care.

Reassure the adolescent to allay fears. Patient's anxiety is reduced when fears are addressed by the nurse. Discuss activity limitations and provide ideas for alternatives. The patient will have limited mobility and therefore activity limitations after surgery. Discussing alternatives for activities requiring mobility can put the patient at ease and provide a sense of control. Correct any misunderstandings the adolescent has about the surgery. When able to ask questions, it helps the adolescent to think through the process and deal with the anxiety. Ensuring the patient has factual information is key to decreasing the patient's stress. Determine the adolescent's need for specific information, particularly about postoperative care. Being able to determine the adolescent's understanding of what is taking place will give the ability to assist in decreasing anxiety. When interventions are explained, the adolescent's understanding increases.

A child in halo traction reports severe and unrelenting pain, is very pale, and reports a tingling feeling. Which should be the nurse's response to these findings? Obtain an order for IV fluids for the patient. Document complaints and reassess the patient in an hour. Encourage the patient to use guided imagery to decrease pain. Report the findings to the health care provider immediately.

Report the findings to the health care provider immediately. Prompt referral to a health care provider and intervention is crucial if neurovascular impairment is to be prevented.

A child in traction is frustrated because of feeling trapped. The child is experiencing constipation and says breathing feels hard at times. Which nursing interventions would benefit this patient? Select all that apply. Decrease fluid intake. Reposition the body. Provide a high fiber diet. Move the bed to play area. Play with bubbles or an incentive spirometer. Encourage more rest to decrease movement.

Reposition the body. Repositioning the body is useful to prevent skin damage, promote defecation, and facilitate breathing. Provide a high fiber diet. A high fiber diet should decrease constipation. Move the bed to play area. Moving the bed to the play area provides a new environment for the child. Play with bubbles or an incentive spirometer. Playing with bubbles or an incentive spirometer will encourage deep breaths and better lung function.

The nurse is caring for a 7-year-old child with a suspected left radius/ulna fracture who presents to the pediatric emergency room. The nurse notes a painful, bruised, edematous area on the left lower arm, but the assessment is otherwise normal. Which provider orders would the nurse anticipate? Select all that apply. Computed tomography of left arm Administration of intravenous fluids Single view radiograph of the left arm Assess pain level every 1 hour and as needed Notify social services of a consult for suspected non-accidental injury

Single view radiograph of the left arm A single view radiography would be an order the nurse would anticipate. Assess pain level every 1 hour and as needed The child reports pain at the injured site, therefore, the nurse should anticipate an order to assess pain level in the child.

Which type of traction should the nurse anticipate for a patient with hemarthrosis? Halo traction Skin traction Femoral traction Skull tongs traction

Skin traction Skin traction is preferred for conditions in which invasive procedures are contraindicated, such as hemarthrosis (collection of blood in the joint) as a result of hemophilia.

The nurse is caring for an immobilized preschool child. Which action is most helpful during this period of immobilization? Encouraging the child to wear pajamas Letting the child have few behavioral limitations Taking the child for a "walk" by wagon outside the room Keeping the child away from other immobilized children if possible

Taking the child for a "walk" by wagon outside the room It is important for children to have activities outside the room if possible. This gives them opportunities to meet their normal growth and developmental needs. The child should be encouraged to wear street clothes during the day. Limit-setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.

What anatomical features of pediatric bone reduce the risk of fracture compared to adults? Select all that apply. Thick periosteum Articular cartilage Epiphyseal (growth) plate Presence of calcium salts Increased cartilage to bone ratio

Thick periosteum Children have an increased thickness of the periosteum compared to adults. This provides additional protection against fracture. Epiphyseal (growth) plate The epiphyseal (growth) plate is not sealed in the child. It still contains hyaline cartilage, which acts as a shock absorber. Increased cartilage to bone ratio There is an increased cartilage to bone ratio in pediatric bone. The bone is more flexible and therefore less likely to fracture.

The parent of a child being screened for developmental dysplasia of the hip (DDH) asks the nurse why ultrasonography, not radiography, is being used. Which statement could the nurse use to explain the reason for selecting ultrasonography? Ultrasonography is more sensitive because it uses low dose radiation. Radiography is more sensitive because it uses high intensity radiation. Radiography is more sensitive because it can be used to view the dislocation at any age. Ultrasonography is more sensitive because it allows for a penetrating look at hip abnormalities.

Ultrasonography is more sensitive because it allows for a penetrating look at hip abnormalities. Ultrasonography provides the ability to view the entire anatomy. Current research supports the concept that ultrasonography is a more sensitive indicator of abnormalities of the infant hip than radiography

A school-aged child with a seizure disorder asks the nurse, "Will I have this for a long time?" What is the nurse's best response? "All chronic illnesses are lifelong conditions." "It just depends. Hopefully your disorder will go away as you get older." "A seizure disorder is a chronic illness, which means it will require long-term care." "Seizures are sometimes just a one-time occurrence. You will likely not have to deal with seizures your entire life."

"A seizure disorder is a chronic illness, which means it will require long-term care." Any chronic illness will require long-term care, although the severity of the illness can vary over time.

A nurse is caring for a male child with Duchenne muscular dystrophy (DMD) and the mother shares that she is pregnant again. She expresses concern that her second child is a girl and asks about the possibility that her daughter will also have DMD. How does the nurse respond? "Your daughter will likely have DMD because your son has it and it is a genetic disorder." "Your daughter may have DMD because she needs just one copy of the affected X chromosomes to have the disorder." "There is a 50% chance that your daughter will have DMD because only one dominant gene is required for her to have it." "It is unlikely that your daughter will have DMD because she would need to have two 'X' chromosomes with the gene, making the condition much more likely in male children."

"It is unlikely that your daughter will have DMD because she would need to have two 'X' chromosomes with the gene, making the condition much more likely in male children." Duchenne muscular dystrophy is an X-linked disorder. Both X chromosomes would need to be afflicted with the DMD gene in order for the daughter to have the disease.

Which statement can the nurse use to explain to parents why nonsurgical treatments are used instead of surgical treatments when treating clubfoot? "The surgical method takes too long to complete." "Nonsurgical methods allow for a faster correction of the deformity." "Nonsurgical treatment will limit long-term complications and recurrence." "The surgical method has a limited coverage by the insurance company."

"Nonsurgical treatment will limit long-term complications and recurrence." Because long-term complications and recurrence were found to occur after surgical correction, nonoperative treatment modalities are now used.

The nurse is caring for a child with poor gastrointestinal tract muscle tone who complains of constipation. Which suggestion of the nurse helps the child in relieving constipation? "You should eat a high-fat diet." "You should eat a high-fiber diet." "You should eat a high-vitamin diet." "You should eat a high-protein diet."

"You should eat a high-fiber diet" The patient has constipation due to decreased gastrointestinal muscle strength and muscle tone. High-fiber diets increase the bulk of feces and help to relieve constipation. High-fat, high-protein, or high-vitamin diets do not aid in relieving constipation, because they do not affect gastrointestinal motility.

A 13-year-old patient is admitted with a fractured femur. For which signs and symptoms should the nurse evaluate the patient to identify potential systemic complications? Select all that apply. Arrhythmia Immobility Color changes Axillary petechiae Shallow rapid breathing

Color changes Color changes can be a symptom of a blocked vessel (emboli) or shock and should be further investigated. Axillary petechiae Axillary petechiae can be an indication of fat emboli, a systemic complication of a fracture (particularly a femur fracture). When a bone is fractured, fat tissue from the bone marrow can leak into the blood. Long bones (like the femur) especially have more marrow than shorter bones, increasing the risk of fat emboli. Shallow rapid breathing A fractured femur will result in a large amount of bleeding that can lead to hypovolemic shock, which may be indicated by shallow, rapid breathing.

Which statements describe functions of the musculoskeletal system? Select all that apply. Allows movement Protects the heart Regulates mineral imbalances Produces hormones for growth Provides a skeletal framework

Allows movement Providing movement is a function of the musculoskeletal system. Protects the heart Protecting vital organs, including the heart, is a function of the musculoskeletal system. Provides a skeletal framework Providing a skeletal framework to support the body is a function of the musculoskeletal system.

A school-aged patient has a lateral spine curvature of 25 degrees. The nurse anticipates which intervention according to these results? Education on use of a brace Immediate surgical repair Education on core strengthening Monitor for a year for changes

Education on use of a brace Nonoperative management is the preferred treatment for patients with spine curvature ≥ 25 degrees and who are still skeletally immature. The nurse would anticipate providing patient teaching on use of a brace.

A nurse is caring for a four-year-old child who must have surgery. The child will require an IV and an indwelling urinary catheter. How can the nurse best prepare the child for this experience? Select all that apply. Assure the child that a nurse or parent will be caring for him or her at all times. Let the child know that everything will be fine and that worrying is not necessary. Ensure that the child is told about the IV and urinary catheter right before going to surgery. Show the child a doll that has an IV and a urinary catheter in place while explaining what each is for. Give simple explanations about the surgery and what the child should expect a few days before the surgery.

Assure the child that a nurse or parent will be caring for him or her at all times. Preschool-aged children often fear being left alone, so accurately assuring the child that someone will be with him or her would be an important nursing intervention. Show the child a doll that has an IV and a urinary catheter in place while explaining what each is for. Preschool-aged children need more than just a verbal explanation. They need visual aids such as dolls or pictures to understand information. Give simple explanations about the surgery and what the child should expect a few days before the surgery. Simple explanations are important and should be started days before a major procedure to allow the preschool-aged child to process the information.

A child was just diagnosed with benign postural kyphosis. What should the nurse emphasize to facilitate correction of this type of kyphosis? Importance of wearing a brace every day Importance of standing rather than sitting Importance of following and maintaining a core muscle strengthening program Importance of scheduling surgery as soon as possible to prevent further injury

Importance of following and maintaining a core muscle strengthening program By strengthening the core muscles, proper postural techniques will improve and the postural kyphosis will resolve.

Which statements would the nurse use to explain the relationship between complex fractures and external fixators? Select all that apply. Complex fractures may require external fixators to lengthen bones. External fixators keep the bone ends separated and in alignment. External fixators shorten the healing time by decreasing the bone length in complex fractures. External fixators correct angular deformities that involve bone and soft tissue in complex fractures. External fixators do not allow for periodic changes in alignment and bone length which is necessary for complex fractures.

Complex fractures may require external fixators to lengthen bones. External fixators are pins or wires inserted through skin, soft tissue, and bone and secured to a rigid metal frame to lengthen bones. External fixators keep the bone ends separated and in alignment. The external fixator keeps the bone ends separated and in alignment, which promotes proper healing. External fixators correct angular deformities that involve bone and soft tissue in complex fractures. Because the external fixator secures the bone to a frame, it can correct angular deformities that involve bone and soft tissue.

Which is the main action involved in the movement of muscle? Spasticity Relaxation Contraction Articulation

Contraction Movement of the skeletal muscles are produced by contraction of the elongated fibers.

A nurse is making an initial home care visit for a child with muscular dystrophy. What should be part of her assessment? Select all that apply. Coping skills Presence of pets Height and weight Food in the pantry Width of the doorways

Coping skills It is important for the nurse to assess how the patient and family are coping with the child's diagnosis. The nurse may need to provide support and referrals as needed. Height and weight The patient's height and weight should be measured due to the risk of obesity. Food in the pantry Dietary changes are often needed in patients with muscular dystrophy. The nurse should assess what foods are typical in the family diet. Width of the doorways The nurse should assess the house to see if it could accommodate a wheelchair or other assistive devices.

A nurse is assessing a young child who, the parents state, is walking with a wide gait. Which laboratory test does the nurse anticipate that the physician will order? Sodium Creatine kinase Leukocyte esterase Complete blood count (CBC)

Creatine kinase During the early stages of the onset of MD, the muscle fibers begin to leak the protein creatine kinase (CK).

Identify the lab test that would best indicate muscle damage. C-reactive protein (CRP) Rheumatoid factor (RF) Alkaline phosphatase (ALP) Creatine phosphokinase (CPK)

Creatine phosphokinase (CPK) CPK is found in heart and skeletal muscle. Specific forms of CPK can be tested to determine what muscle type is damaged.

A child with a chronic health condition is having trouble coping with the hospital setting and becomes upset when informed of a room change. Which action by the nurse is most appropriate? Do not change the room for several hours and introduce the change to the child slowly Encourage the child to do some deep breathing to cope with the stress of having to change rooms Discuss comfort measures with the child's parents that might help the child cope with the distress Change the room while the child is off the floor so that the child does not have to deal with the stress of the room change

Discuss comfort measures with the child's parents that might help the child cope with the distress It is important for the nurse to collaborate with parents to identify the child's preferences and actions that may help to pacify the child during times of stress.

During a physical assessment the nurse evaluates the hip of an infant and finds the head of the femur is outside of the acetabulum. How would this dysplasia be classified? Fracture of the hip Instability of the hip Dislocation of the hip Subluxation of the hip

Dislocation of the hip Dislocation of the hip occurs when the head of the femur lies outside the acetabulum. In DDH the acetabulum is shallow which does not all the femur to fit adequately in the joint. This can occur as a late stage of developmental dysplasia of the hip and it can occur in children with certain neuromuscular disorders.

A nurse is observing children in the unit's playroom. She notices a child placing his/her hands on the knees and moving the hands up the legs in order to stand up from a seated position on the floor. The nurse suggests further assessment for what condition? Becker Muscular Dystrophy Steinert Muscular Dystrophy Duchenne Muscular Dystrophy Congenital Myotonic Muscular Dystrophy

Duchenne Muscular Dystrophy This maneuver is called Gower's maneuver and is a classic sign of Duchenne Muscular Dystrophy.

A child presents to the clinic with a sprained ankle. The parent asks why the child needs to elevate his leg. What is the most appropriate response from the nurse? Elevating a sprained ankle helps reduce edema. Elevating a sprained ankle helps raise the pain threshold. Elevating a sprained ankle helps produce deep tissue vasodilation. Elevating a sprained ankle helps increase metabolism in the tissues.

Elevating a sprained ankle helps reduce edema Elevating the extremity makes it possible for gravity to facilitate venous return and reduces edema. Elevation of an extremity after a soft tissue injury should have no effect on the pain threshold. Venous return to the heart is facilitated when a sprained ankle is elevated; this is not a result of vasodilation. Elevation of an extremity after a soft tissue injury will not affect metabolism.

A 5-year-old child is having trouble coping in the hospital and behaviors have become increasingly problematic to the nurse and staff. What actions by the nurse should help to alleviate this problem? Select all that apply. Encourage the child to express feelings through drawings Give the child different ways to communicate needs such as a picture board Allow the child to help with some aspects of personal care and with keeping the room tidy Remind parents the child's behavior is a normal part of dealing with an illness in a school-aged child Keep the child in the hospital room as a time-out until the child is able to stop having disruptive behaviors

Encourage the child to express feelings through drawings Drawing provides a different outlet for frustration that can decrease problematic behaviors, and therefore this should be encouraged by the nurse. Give the child different ways to communicate needs such as a picture board The nurse should be providing different ways to communicate needs that can decrease frustration. Allow the child to help with some aspects of personal care and with keeping the room tidy Giving responsibilities and some chores is helpful to school-age children to maintain control and normalcy.

The infant with congestive heart failure needs to have an IV inserted. To increase the comfort of the baby, what should the nurse do? Encourage the parents to stay with the child as long as they are comfortable. Do not allow the anxious parents to leave the room because this can cause the infant to have separation anxiety. Ensure that the infant has the IV started in the crib because that is where the child is most comfortable and feels safest. The nurse should give a detailed explanation to the parents to decrease anxiety of what steps are involved in inserting the IV.

Encourage the parents to stay with the child as long as they are comfortable. The parents should stay if they are comfortable to decrease the infant's anxiety. If they are not comfortable, then they can transmit their anxiety to the infant.

The nurse is caring for a pediatric patient with abnormal laboratory values for rheumatoid factor (RF), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Which assessment findings correspond with the abnormal laboratory results? Select all that apply. Enlarged knee joints Limping when walking Pain when moving joints Hip rotates without resistance Accelerated closure of the epiphyseal plates

Enlarged knee joints Abnormal RF, CRP, and ESR laboratory results can be indicative of arthritis in children, and enlarged joints are a symptom of arthritis. Limping when walking Abnormal RF, CRP, and ESR laboratory results can be indicative of arthritis in children, and limping when walking is a symptom of arthritis. Pain when moving joints Abnormal RF, CRP, and ESR laboratory results can be indicative of arthritis in children, and pain when moving joints is a symptom of arthritis.

The nurse is performing the initial assessment of a 6-year-old pediatric patient. Which components of the nursing process should be included in the musculoskeletal assessment? Select all that apply. Evaluating motor development Checking proper movement of the eyes Measuring the child's head circumference Plotting the child's height on a growth chart Comparing child's current weight to previous results

Evaluating motor development Evaluating the motor developmental milestones of children is a critical component of the musculoskeletal assessment to evaluate for potential musculoskeletal disorders. Checking proper movement of the eyes Movement of the eyes would be part of the eye evaluation when assessing extraocular muscle movement. Plotting the child's height on a growth chart Plotting the child's height on a growth chart is a critical component of the musculoskeletal assessment to evaluate for variations in height. Comparing child's current weight to previous results Comparing the child's current weight to previous results is a critical component of the musculoskeletal assessment to evaluate for variations in weight that could impact the musculoskeletal system.

Which assessment findings indicate appropriate development of the musculoskeletal system of a 5-year-old patient? Select all that apply. Fused cranial sutures Smaller muscular size Normal curvature of the neck Incomplete lumbar curvature of the spine Decreased range of motion in the knee joint

Fused cranial sutures Fused cranial sutures are normal by the time the child is 12-18 months old and is an assessment finding that indicates appropriate development of the musculoskeletal system in a 5-year-old pediatric patient. Smaller muscular size Muscles grow in size as the child ages; smaller muscle size is an assessment finding that indicates appropriate development of the musculoskeletal system in a 5-year-old pediatric patient. Normal curvature of the neck Cervical curvature develops in the first few months of life; normal cervical curvature is an assessment finding that indicates appropriate development of the musculoskeletal system in a 5-year-old pediatric patient. Incomplete lumbar curvature of the spine Lumbar curvature may not be fully developed until age 8-10 years; incomplete lumbar curvature is an assessment finding that indicates appropriate development of the musculoskeletal system in a 5-year-old pediatric patient.

A preteen has been diagnosed with scoliosis and the nurse suspects it is an idiopathic scoliosis. How does the nurse come to this conclusion? Congenital scoliosis is present at birth and idiopathic scoliosis occurs after age 10 years. Congenital scoliosis typically involves a curvature 20-45 degrees. Idiopathic scoliosis involves a curvature > 45 degrees. Congenital scoliosis is present at birth and then resolves shortly after birth. Idiopathic scoliosis appears later in adolescence. Idiopathic scoliosis can be diagnosed for the first time in older children, whereas congenital scoliosis is present at birth.

Idiopathic scoliosis can be diagnosed for the first time in older children, whereas congenital scoliosis is present at birth. Congenital scoliosis is present at birth and idiopathic scoliosis can occur at any point in a child's growth and is classified by age at presentation.

The nurse provides education on home care for a child in a cast. Which of the following statements demonstrate parental understanding regarding indications to contact the health care provider? Select all that apply. If the child has persistent inflammation, contact the health care provider. If the cast feels hot or has an unusual odor, contact the health care provider. If the child can move the digits distal to the cast, contact the health care provider. If the child develops a sporadic itch under the cast, contact the health care provider. If the child complains of pain, burning, numbness, or tingling, contact the health care provider

If the child has persistent inflammation, contact the health care provider. Contact the health care provider if inflammation persists. Inflammation should peak 24-28 hours after the application of the cast. If the cast feels hot or has an unusual odor, contact the health care provider. Contact the physician if a cast feels warm or hot or has an unusual smell because this may indicate neurovascular compromise and infection. If the child complains of pain, burning, numbness, or tingling, contact the health care provider. Contact the physician if the child complains of pain, burning, numbness, or tingling because this may indicate neurovascular compromise.

In whom are serious sports injuries most likely to occur? In children given extra fluids on a hot day In children who are physically fit but tired In children who take the appropriate safety precautions In children who are not physically prepared for the activity

In children who are not physically prepared for the activity Children who are not physically prepared for a particular sporting activity are more likely to sustain a serious injury than are those who are prepared for the activity. Children who are physically fit but tired are not more likely to suffer a serious sports injury than children who are not physically prepared. The administration of extra fluids on hot days is not associated with an increased risk of serious sports injuries. Appropriate safety precautions do not increase a child's risk of sustaining a serious sports injury.

The nurse develops a discharge plan for a teen who is overweight with slipped capital femoral epiphysis (SCFE). Which instructions should the nurse include in the plan? Select all that apply. Instruct the patient on the proper use of crutches. Teach the child how to perform isometric exercises. Instruct that patient to wear a Pavlik harness to protect the hip. Provide instructions regarding the use of an abduction orthosis. Provide information to help the patient develop good nutritional habits to reduce weight.

Instruct the patient on the proper use of crutches. The patient will require the use of crutches to limit weight bearing down on the affected hip. Crutches are typically used for 4-6 weeks. Teach the child how to perform isometric exercises. The isometric exercises will improve strength in muscles that support the hip joint. Provide information to help the patient develop good nutritional habits to reduce weight. Weight reduction will help reduce the risk of SCFE. The nurse should help the patient identify high-calorie foods that should be avoided.

A patient diagnosed with Legg-Calvé-Perthes (LCP) disease is informed that the disease has progressed to a point where necrosis is occurring in the joint. Which statement demonstrates the nurse's knowledge of LCP progression? Necrosis occurs after bone is reabsorbed by the body during Stage 4. Necrosis occurs after the fragmentation stage and is Stage 3 of the disease. LCP is caused by ischemia of the head of the femur. This leads to extensive reconstitution before the onset of necrosis, stage 5. LCP is caused by limited blood supply to the ball of the femur. As blood flow decreases, the tissue begins to die, entering necrosis or Stage 2 of the disease.

LCP is caused by limited blood supply to the ball of the femur. As blood flow decreases, the tissue begins to die, entering necrosis or Stage 2 of the disease. LCP is caused by ischemia of the head of the femur. As tissues receive less blood, the cells die, which is necrosis and Stage 2 of LCP.

A child has a painful limp and the X-ray was negative for fracture and dislocation. An MRI reveals increased bone density of the femoral head. Based on these findings, which does the nurse suspect as the pathology for this patient? Osteomyelitis Osgood-Schlatter disease Legg-Calvé-Perthes disease Slipped Capital Femoral Epiphysis (SCFE)

Legg-Calvé-Perthes disease Legg-Calvé-Perthes disease occurs when blood flow to the femoral head is diminished which leads to eventual necrosis. During this process, x-rays may be negative but MRI will reveal the damage to the femoral head.

During the musculoskeletal assessment of a pediatric patient, the child complains of pain at the elbow when the nurse passively pronates the left radius/ulna. Which diagnostic test would the nurse expect the provider to order? Radiography Creatine phosphokinase Radionuclide scintigraphy Magnetic resonance imaging

Magnetic resonance imaging The child is complaining of joint pain with movement; the nurse would anticipate magnetic resonance imaging (MRI) being used to assess for soft tissue damage, including bones, ligaments, and joints.

An adolescent presents to the urgent care clinic with a suspected fracture in the lower extremity. What are the priority assessments? Select all that apply. Pain assessment Ability to properly use crutches for ambulation Ability to bear weight on the affected extremity Sensation, color and pulse of the affected extremity Thorough review of pain medication that was taken prior to arriving to the clinic

Pain assessment Pain should be addressed in the immediate assessment of the patient's suspected fracture. The presence of pain is part of the neurovascular assessment. Sensation, color and pulse of the affected extremity Sensation, color and pulse are part of the 5Ps that should be immediately addressed with suspected fractures in order to assess the neurovascular status.

A nurse performs a neurovascular assessment on a leg in a cast. Which assessment findings warrant immediate interventions? Select all that apply. Paresthesia Normal mobility Decreased capillary refill Minor pain (relieved by analgesics) Difference between proximal and distal pulse

Paresthesia Paresthesia is a tingling or prickly sensation caused by pressure on or damage to peripheral nerves and is an indication for immediate intervention. Decreased capillary refill Decreased capillary refill means there was an increase in the time it took for the capillary to refill. This is an indication that blood flow is impaired and intervention is required. Difference between proximal and distal pulse A difference between the proximal and distal pulse indicates that there is impairment in blood flow which requires further investigation and intervention.

A school-age child is admitted with osteomyelitis. What assessments would the nurse expect to perform if erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are elevated? Vital sign assessment Patient allergy history Evaluation of patient dressing Patient history of recent falls

Patient allergy history The given laboratory results, along with patient symptoms, indicate infection, which will require IV antibiotics. Prior to antibiotic administration, the nurse should take a patient history to evaluate allergies and any problems the child experienced during previous antibiotic administration.

A child is observed limping and walking on his toes. An x-ray reveals subluxation of the femoral head. Which nursing care plan is indicated for this patient? Have the patient walk for 30 minutes to monitor gait. Provide ways to alleviate the anxiety of the diagnosis. Monitor neurovascular status of the affected extremity. Teach the patient how to walk straight without limping.

Provide ways to alleviate the anxiety of the diagnosis. After diagnosis, nursing interventions focus on the parents' anxiety and coping abilities.

A nurse receives orders that state a 9-year-old patient should be placed in traction after returning to the unit. Surgery was performed for a femoral fracture. Based on this information, which type of traction should the nurse prepare? Select all that apply. Skin traction Skeletal traction Continuous traction Intermittent traction Cervical (halo) traction

Skeletal traction Skeletal traction is indicated because the patient is older than 3 years and has had a bone fracture. Continuous traction The nurse should always assume that traction is continuous unless otherwise stated by the health care provider.

An overweight adolescent complains of knee pain and limps while walking. Radiographs have been obtained to confirm the condition. The nurse would anticipate educating the patient on which condition? Scoliosis Osteomyelitis Legg-Calvé-Perthes disease Slipped Capital Femoral Epiphysis (SCFE)

Slipped Capital Femoral Epiphysis (SCFE) The classic symptoms of SCFE include a limp and pain. Radiographs confirm the diagnosis.

A nurse is caring for an infant with a clubfoot. When planning care, what should the nurse consider regarding the Ponseti casting method? Select all that apply. Stretch the misaligned bones on a weekly basis. Forced stretching is performed to soften the tissue. After weekly manipulation, apply a long-leg plaster cast. Limit manipulation to allow the foot to contract before applying the cast. Surgery is performed 3 weeks after manipulation of the misaligned bones to prepare the foot for casting.

Stretch the misaligned bones on a weekly basis. The misaligned bones are stretched on a weekly basis to aid in realigning the bones. After weekly manipulation, apply a long-leg plaster cast. The misaligned bones are manipulated on a weekly basis followed by the application of a well-molded long-leg plaster cast to hold the bones in place.

A child presents with signs of developmental dysplasia of the hip. Which statement shows the nurse understands the dysplasia? Dislocation has a femur that is partially in place but still stable. Subluxation has a femur that is fully displaced from the acetabulum. Dislocation has a partial displacement of the femur from the acetabulum. Subluxation has a partial displacement of the femur from the acetabulum.

Subluxation has a partial displacement of the femur from the acetabulum. Subluxation is a partial displacement of the femur from the acetabulum, whereas dislocation is a complete displacement.

How is the treatment environment related to the anxiety levels of an infant going through casting for clubfoot? Making the parents leave the room helps to decrease the anxiety of the infant. A treatment environment with a loud noise level decreases the anxiety of the infant. A cold environment helps to calm the infant, which will decrease the anxiety level. When parental involvement is incorporated, the anxiety level of the infant is decreased.

When parental involvement is incorporated, the anxiety level of the infant is decreased. Parental involvement is comforting to infants and helps them relax, or even sleep during the session.

An adolescent presents with a severe knee sprain accompanied by edema and pain. Based on the severity of the injury and involvement of the knee ligaments, surgery is required. What should the nurse include in the preoperative teaching? Select all that apply. To anticipate being out of bed while in recovery That bearing weight is gradually increased as pain subsides The 5 P's so they can assess for complications at home Stretching and strengthening exercises to regain mobility To only ask for pain medication as needed to reduce risk of addiction

That bearing weight is gradually increased as pain subsides As the patient goes through the healing process, the pain will subside and therefore increase tolerance for more mobility. The 5 P's so they can assess for complications at home If the child is being discharged to home shortly after surgery, the parents should be taught about the signs of neurovascular impairment (the 5 P's) so they can monitor for complications after surgery at home. Stretching and strengthening exercises to regain mobility Stretching and strengthening exercises are recommended to help the child regain mobility and strength of the affected joint.

A nurse is caring for a child with impaired physical mobility. What is an appropriate outcome for this child? The child has decreased mobility and strength in unaffected joints. The child will maintain mobility but will have decreased strength in the unaffected joints. The child will not be able to maintain strength in unaffected joints but will tolerate activity restriction. The child will maintain mobility and strength of all unaffected joints and tolerate activity restrictions.

The child will maintain mobility and strength of all unaffected joints and tolerate activity restrictions. Maintaining mobility and strength of all unaffected joints and tolerating activity restrictions is the expected outcome of a child with an impaired physical mobility diagnosis. Working towards this goal will help to improve the physical mobility of the child.

A child with clubfoot was treated with Ponseti casting. Following completion of the casting treatments, the patient has the final cast removed. The parents are upset because the foot appears overcorrected. Which explanation can the nurse provide regarding the rationale for the overcorrection? Overcorrection is necessary so that surgery will be possible. The foot is purposefully overcorrected and a brace will be used to prevent the recurrence of the deformity. Unfortunately, the overcorrection was not intended and an additional cast will be used to fix the problem. The overcorrection will prevent recurrence and is the last step before initiating the French physiotherapy treatment.

The foot is purposefully overcorrected and a brace will be used to prevent the recurrence of the deformity. The foot is overcorrected and the correction is maintained by using abduction orthosis full-time for 3 weeks, followed by 12-hour nightly use until at least 2 years of age.

A teenaged patient with leukemia is frustrated by the amount of time spent in the hospital and expresses anger to the nurse. Which nursing intervention is most appropriate? The teen should be encouraged to calm down and decrease anger. The teen should be allowed to express anger and frustration through talking. The teen should be left alone to process feelings until frustration and anger is eliminated. The teen should be allowed to leave the hospital because hospitalization is the source of the frustration.

The teen should be allowed to express anger and frustration through talking. Encouraging discussion of difficult topics like those that trigger anger and frustration provide an appropriate outlet for feelings and decrease those feelings with support and subsequent intervention by the nurse.

The charge nurse is assisting a new nurse to prepare a toddler for skin traction. What interventions will help prevent skin damage? Select all that apply. Use an egg-crate-type mattress for comfort. Use alcohol to clean areas that are prone to irritation. Use lotion, powder, or talc on areas prone to irritation. Provide a trapeze to facilitate independent repositioning. Applying tincture of benzoin to the intact skin that has potential for irritation.

Use an egg-crate-type mattress for comfort. Egg-crate-type or sheepskin mattress provides comfort under the back and lower legs. Additionally, it will wick moisture from the skin to decrease skin irritation. Provide a trapeze to facilitate independent repositioning. Providing a trapeze to facilitate independent repositioning would be an appropriate intervention in this situation. Applying tincture of benzoin to the intact skin that has potential for irritation. Applying tincture of benzoin to the intact skin before the traction is applied may protect against skin irritation.

Which order of pathological events describes the development of osteomyelitis? Connective tissue of the bone is displaced from the accumulation of pus Pus spreads to the outside of the bone (under periosteum) Abscess forms Rupture of small capillaries

Which order of pathological events describes the development of osteomyelitis? Rupture of small capillaries Pus spreads to the outside of the bone (under periosteum) Connective tissue of the bone is displaced from the accumulation of pus Abscess forms

An 8-year-old patient comes to the emergency department with a femur fracture. The health care provider has obtained x-rays of the fractured femur and the unaffected femur. The nurse knows that both x-rays need to be done for the patient for which reason? X-rays of both extremities allows for observation of bone growth. X-rays of both extremities is part of the hospital protocol for children. X-rays of both extremities allows for the comparison between the extremities. X-rays of both extremities allows the health care provider to observe inflammation.

X-rays of both extremities allows for the comparison between the extremities. A radiograph of the unaffected extremity may be obtained for comparison purposes, especially when trying to determine whether a line on the radiograph represents a fracture or merely an epiphyseal line.