Peds Prepu 40
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?
"Blowing cool air with a fan or hair dryer may relieve the feeling." Correct response: "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.
A mother is angry about her son's diagnosis of osteosarcoma. She is telling him that if he had not played football last year and broken his leg, this would not have happened. What is the nurse's best response to the mother's statement?
"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Correct response: "Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Explanation: Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 850. Chapter 40: The Child with a Musculoskeletal Disorder - Page 850
A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?
Auscultation Correct response: Auscultation Explanation: The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 842-844. Chapter 40: The Child with a Musculoskeletal Disorder - Page 842-844
While assessing a preadolescent child, the nurse notes curvature of the child's spine. Which statement by the child's parent supports this observation? "My child has such a hard time finding pants that fit right. They never seem to fit evenly over the hips." "My child has been taking ibuprofen daily for the last few weeks because of hip pain after walking so much at school." "My child has been reporting back pain for the last 2 or 3 months." "I've wondered why my child won't let me in the room when changing clothes."
Correct response: "My child has such a hard time finding pants that fit right. They never seem to fit evenly over the hips." Explanation: Curvature of the spine can indicate scoliosis. Scoliosis is a painless disorder that predominately presents during the rapid growth phase in preadolescence. A need for privacy is normal for this age group. The curvature of the spine can make the iliac crests uneven and make it difficult to find pants that fit correctly. Hip and back pain are not typical in this disorder.
The nurse is caring for a preschooler with a greenstick fracture. Which statement by a parent indicates an understanding of this type of fracture? "Crepitus (crackling) can be felt over this type of fracture." "I shouldn't have picked my child up by the arm. This fracture wouldn't have happened." "This type of fracture only occurs in the leg." "My child may need the arm broken completely prior to putting a cast on it."
Correct response: "My child may need the arm broken completely prior to putting a cast on it." Explanation: Greenstick fractures are incomplete fractures. They commonly occur in young children. Sometimes greenstick fractures are broken completely before casting to prevent the bone from resuming its "bent" position in the cast. This fracture does not always occur in leg. Crepitus (crackling) typically occurs over a clavicle fracture. A dislocation of the radial head is the typical injury that occurs when a child is picked up by one arm.
The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?
Correct response: "The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." Explanation: Bracing is the primary treatment for scoliosis. The braces used today are designed by computer-aided techniques and fit under the arms rather than extending to the neck. Braces must be worn 23 hours a day. Surgical intervention is only performed in severe cases.
When assisting parents plan home care for a child with Legg-Calvé-Perthes disease, the nurse would teach the parents that which is anticipated? Exercise to increase muscle strength of the knee joint Passive range-of-motion exercises TID A nonweight-bearing period initially occurs. Surgery with supporting rods
Correct response: A nonweight-bearing period initially occurs. Explanation: Resting the affected femoral epiphysis aids healing.
The nurse is caring for a child diagnosed with scoliosis. What actions by the child would indicate a need for intervention by the nurse? Select all that apply.
Correct response: Removal of the brace at bedtime The child loosens the straps on the brace prior to bedtime. Explanation: Placement of the brace over a t-shirt helps to prevent skin excoriation. The brace should only be removed 1 hour a day, during showering and participating in a sports activity. Straps should never be loosened on the braces. Children may state they feel taller with the brace on. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 853. Chapter 40: The Child with a Musculoskeletal Disorder - Page 853
A group of nursing students are reviewing information about types of skin traction and skeletal traction. The students demonstrate understanding of this information when they identify which of these as a type of skeletal traction? Buck traction Bryant traction Side arm 90-90 traction Russell traction
Correct response: Side arm 90-90 traction Explanation: Side arm 90-90 traction is a type of skeletal traction with force applied through a pin in the distal femur. Russell traction, Bryant traction, and Buck traction are types of skin traction.
The nurse is developing a teaching plan for a child who is to have his cast removed. What instruction would the nurse most likely include? Rubbing the skin vigorously to remove the dead skin Washing the skin with dilute peroxide and water Applying petroleum jelly to the dry skin Soaking the area in warm water every day
Correct response: Soaking the area in warm water every day Explanation: After a cast is removed, the child and family should be instructed to soak the area in warm water every day to help soften and remove the dry flaky skin. Moisturizing lotion, not petroleum jelly, should be applied to the skin. Vigorous rubbing would traumatize the skin and should be avoided. Warm soapy water, not dilute peroxide and water, should be used to wash the area.
Question 17 of 20 Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment? a school-age female a young adolescent female a teenage male a school-age male
Correct response: a young adolescent female Explanation: Mild scoliosis occurs between the genders equally, but idiopathic scoliosis requiring treatment occurs 10 times more often in females than males. Usually, treatment is initiated during early adolescence, around age 11 to 14 years.
The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection?
Drainage on the cast Correct response: Drainage on the cast Explanation: Drainage on the cast could indicate an infection. Pale fingers would suggest impaired circulation. Delayed capillary refill would suggest impaired circulation. Diminished pulse would suggest impaired circulation. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 843. Chapter 40: The Child with a Musculoskeletal Disorder - Page 843
The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?
Duchenne muscular dystrophy Correct response: Duchenne muscular dystrophy Explanation: By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 848. Chapter 40: The Child with a Musculoskeletal Disorder - Page 848
A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area?
Epiphysis Correct response: Epiphysis Explanation: Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 841. Chapter 40: The Child with a Musculoskeletal Disorder - Page 841
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 Correct response: 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. Reference: Hatfield, N. T., Kincheloe, C. A. (2018). Introductory Maternity & Pediatric Nursing, 4th ed, Philadelphia: Wolters Kluwer, Chapter 40: The Child with a Musculoskeletal Disorder , p. 846. Chapter 40: The Child with a Musculoskeletal Disorder - Page 846
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?
Notify the health care provider of the findings immediately. Correct response: 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. Reference: Hatfield, N. T., Kincheloe, C. A. (2018). Introductory Maternity & Pediatric Nursing, 4th ed, Philadelphia: Wolters Kluwer, Chapter 40: The Child with a Musculoskeletal Disorder, p. 843. Chapter 40: The Child with a Musculoskeletal Disorder - Page 843
A preschool-aged client is in an external fixator for a fractured pelvis and the mother is frightened of performing pin site care for the child. How would the nurse help this parent learn to care for her child? Select all that apply.
Observe for any signs of inflammation such as odor or drainage. Have the mother do a return demonstration of cleaning the pins. Correct response: Have the mother do a return demonstration of cleaning the pins. Observe for any signs of inflammation such as odor or drainage. Explanation: Pin sites are easy targets for infection and must be kept clean. Pins are cleaned every 8 hours, not 4 hours. Each institution has policy and procedure to guide the methodology of pin site care but alcohol is never used since it would burn and be painful. Since the child is young, he will not do his own pin site care; the parent needs opportunities to practice cleaning the pins while still in the hospital so as to be comfortable doing it at home alone. The nurse always looks for signs of infection while doing pin site care.
The nurse is evaluating a school-age child's ability to crutch walk so that no weight is placed on an injured leg. Which walking technique indicates that teaching has been effective?
Three-point swing-through gait Correct response: Three-point swing-through gait Explanation: A three-point swing-through gait is used when no weight bearing is allowed on one foot. A two-point gait is used when a child needs support for weakened muscles or balance but may bear weight on both lower extremities. Walking gait and single-crutch support gait are not identified crutch walking approaches.
Idiopathic scoliosis is the most common form that occurs.
True Correct response: True Explanation: Idiopathic scoliosis, with the majority of cases occurring during adolescence, is the most common scoliosis. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 852. Chapter 40: The Child with a Musculoskeletal Disorder - Page 852
A 7-year-old is seen with pauciarticular juvenile idiopathic arthritis. She notices extreme pain when she wakes in the morning. The best advice you can give her parents would be to:
encourage her to take a warm bath each morning before school. Correct response: encourage her to take a warm bath each morning before school. Explanation: Warmth is soothing to arthritic joints. Taking aspirin on an empty stomach could lead to gastric irritation. Exercise may worsen the pain. Slow movement and warm moist heat are the best options to assist in relieving the pain. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 851. Chapter 40: The Child with a Musculoskeletal Disorder - Page 851
The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?
idiopathic scoliosis Correct response: idiopathic scoliosis Explanation: Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis. Reference: Hatfield, N. T., Kincheloe, C. A. (2018). Introductory Maternity & Pediatric Nursing, 4th ed, Philadelphia: Wolters Kluwer, Chapter 40: The Child with a Musculoskeletal Disorder, p. 852. Chapter 40: The Child with a Musculoskeletal Disorder - Page 852
An adolescent girl has spinal instrumentation surgery at 16 years of age. Immediately after this procedure, the nurse would teach her to:
wait to be log rolled before turning from one side to the other. Correct response: wait to be log rolled before turning from one side to the other. Explanation: Spinal instrumentation means rods are placed beside the spine, and the vertebrae are fused. Log rolling is necessary to prevent injury until the fusion is complete. She will be flat for a specific period of time depending on the amount of fusion in the surgery; she will be allowed to sleep in different positions, and the hospital stay is not 6 months. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 854. Chapter 40: The Child with a Musculoskeletal Disorder - Page 854
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 Correct response: 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.
A group of students are 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 Correct response: Adolescence Explanation: Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 841. Chapter 40: The Child with a Musculoskeletal Disorder - Page 841
The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?
Advise the child that this is to be expected. Correct response: Advise the child that this is to be expected. Explanation: Plaster becomes hot as it sets. Even with fiberglass casts, there will be a warm feeling inside the cast when it is drying. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, the nurse should notify the health care provider. Infection would not present in this way with a cast application. A cast should not be moistened. If it does become wet, the cast should be dried with a hair dryer. There are some newer types of casts which can get wet but the nurse should know this before applying any moisture. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 854-855. Chapter 40: The Child with a Musculoskeletal Disorder - Page 854-855
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 Color Pulse Correct response: 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. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 844-845. Chapter 40: The Child with a Musculoskeletal Disorder - Page 844-845
Which nursing intervention is the priority for the immobilized child in an acute care setting? Ambulate the child up and down the hall twice a day. Encourage active and passive range of motion exercises once a day. Offer age-appropriate toys and diversional activities. Take the child to the playroom at least once a day.
Correct response: Offer age-appropriate toys and diversional activities. Explanation: The immobilized child should be offered age-appropriate toys and diversional activities to stimulate the mind. An immobilized child is not able to walk or be taken to the playroom; they are bedfast. Passive and active range of motion exercises should be performed at least 3 to 4 times a day, not just once daily.
A nurse is caring for a 10-year-old who is in skeletal traction following injuries sustained in a car accident. Which statement accurately describes a recommended nursing measure for this type of traction?
Correct response: Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours. Explanation: At sites with mechanically stable bone-pin interfaces, pin-site care should be done on a daily or weekly basis (after the first 48 to 72 hours). The nurse should never remove or add traction weights without specific physician orders, or allow weights to touch the floor or drag on the bed parts; weights should hang free. A chlorhexidine 2 mg/mL solution may be the most effective cleansing solution for pin care. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 845, 847.
In caring for a child in traction, which intervention is the highest priority for the nurse?
The nurse should monitor for decreased circulation every 4 hours. Correct response: 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. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 845. Chapter 40: The Child with a Musculoskeletal Disorder - Page 845
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. Correct response: 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. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 843-844. Chapter 40: The Child with a Musculoskeletal Disorder - Page 843-844
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?
"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." Correct response: "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. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 855. Chapter 40: The Child with a Musculoskeletal Disorder - Page 855
The nurse is caring for a child who is using crutches due to a leg injury. The child's parents state that child reports pain in the axilla when using the crutches. What is the best response by the nurse?
"We need to make sure the crutches are not too tall; there should be about an inch of space between the crutch pad and the axilla." Correct response: "We need to make sure the crutches are not too tall; there should be about an inch of space between the crutch pad and the axilla." Explanation: Axilla pain is a common report and should not be ignored or just medicated. Proper fitting crutches should have 1 to 1.5 inches (2.5 to 3.8 cm) between the crutch pad and the axilla. This should help to prevent axilla pain. When crutches fit properly, padding should not be needed on the crutch pad. Reference: Hatfield, N. T., Kincheloe, C. A. (2018). Introductory Maternity & Pediatric Nursing, 4th ed, Philadelphia: Wolters Kluwer, Chapter 40: The Child with a Musculoskeletal Disorder, p. 847. Chapter 40: The Child with a Musculoskeletal Disorder - Page 847
The mother of a child who has sustained a fractured leg is worried how long her child will be unable to walk without crutches. The nurse would explain to the mother that the child should be walking independently soon due to what reason?
Children's bones heal faster than adults. Correct response: Children's bones heal faster than adults. Explanation: Fractures in children heal faster, are generally less complicated, and occur for different reasons than fractures in adults. Thus, children rehabilitate faster than most adults. Children feel pain just like adults. Weight does not lessen the time required for crutches. Compliance is not an issue. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 841. Chapter 40: The Child with a Musculoskeletal Disorder - Page 841
The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education? "Since her fracture is in the central shaft of her leg, it may interfere with the growth of that leg." "My child is at risk for abnormal growth of the leg because the break is in the outer layer of the bone." "Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." "Injuries that happen at the end of the bone, the epiphysis, are at a greater risk for becoming infected."
Correct response: "Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." Explanation: Fractures that occur in the epiphyseal plate, the area between the central shaft (diaphysis) and the rounded end portion (epiphysis), can halt growth, stimulate abnormal growth, or cause irregular or erratic growth. Fractures in the diaphysis and epiphysis will not interfere with growth. The outer layer of the bone, the periosteum, may be injured when infected, not from a fracture.
The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education? "I'm glad my mom saved her elevated toilet seat she used when she had her knee replacement surgery." "I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain." "I will encourage my child to take a warm bath before school every morning." "My child loves to dance so we can add exercises into a dance routine."
Correct response: "I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain." Explanation: Children with JA should be encouraged to attend school, even if it is a shortened day because this increases activity. Using an elevated toilet seat may help decrease pain in the knees. A daily exercise program should be completed, and incorporating exercises into a game or dance can make them more enjoyable for the child. Warm baths can help can help reduce pain and increase movement in the involved joints.
The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." "Let's talk to the doctor about your treatment options." "The good news is that you have very minimal curvature of your spine." "If you wear your brace properly, you may not need surgery."
Correct response: "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." Explanation: Because this boy is concerned about limiting his participation in water polo and perceives scoliosis as a disease that does not affect "jocks," putting the child in contact with someone with the same problem would be helpful. Telling the adolescent about not needing surgery if he wears his brace or that his curvature is minimal may or may not be true in his case and thus would be false reassurance. Although these suggestions and also the suggestion about talking to the doctor about treatment options could be helpful by engaging his input in the treatment, these do not address his specific concerns about his body image.
A nurse is performing crutch training for an adolescent who has a fractured tibia. What statement by the adolescent indicates successful teaching? "When I'm walking with my crutches, the crutches need to be at least 12 inches (30.5 cm) from the side of my feet." "My mom is going to have to pick up all of her throw rugs so I don't slip on them." "I'm going to need a friend to carry by books at school. I can't use a backpack because it may throw me off balance." "I will make sure to rest my axilla on the crutches when I am standing so I can rest my hands and wrists."
Correct response: "My mom is going to have to pick up all of her throw rugs so I don't slip on them." Explanation: Throw rugs, small footstools, and toys need to be cleared out of paths at home so the crutches do not slip. Children should not rest their axilla on the crutch pads when standing; this can cause damage to the brachial nerve plexus. When the child is walking, crutches need to be approximately 6 inches (15 cm) to the side of the foot to maintain a wide, balanced base for support. It is okay to utilize a backpack to carry books and supplies because the client's hands will not be free due to the crutches.
The nurse is observing a child walk down stairs using a swing-through gait. What action by the child would indicate a need for intervention by the nurse? "One crutch is placed on the lower step, and then the good foot is placed next to the crutch." "The child balances on the crutches while placing the good foot on the lower step." "Both crutches are placed on the lower step, and then the good foot is placed on the step below the crutches." "The child places the crutches on the lower step before placing the good foot down."
Correct response: "The child places the crutches on the lower step before placing the good foot down." Explanation: To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs.
A 14-year-old boy was diagnosed with a closed fracture of the ulna at approximately 9 a.m. The fracture was reduced in the emergency department and his arm placed in a cast. At 6 p.m. his mother has brought him back to the emergency department due to unrelenting pain that has not been relieved by his prescribed narcotics. Which of the following would the nurse do next?
Correct response: Alert the primary health care provider immediately and apply ice. Explanation: The nurse should notify the primary health care provider immediately because the boy's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 843. Chapter 40: The Child with a Musculoskeletal Disorder - Page 843
Maria is a 9-month-old whose babysitter brings her to the ER. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. How should the nurse respond to this situation?
Correct response: Arrange for the parents to come in for an evaluation for possible physical abuse. Explanation: Any type of fracture can be the result of child abuse, but spiral femur fractures, rib fractures, and humerus fractures, particularly in the child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of abuse. The parents should be contacted first, and the family should undergo an evaluation for possible physical abuse since femoral fractures in nonambulating infants, particularly spiral fractures, are believed to be highly specific for inflicted injury. If physical abuse is not found, the infant should be evaluated for an underlying musculoskeletal disorder and not a seizure disorder.
The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?
Correct response: Assess the popliteal region carefully for skin breakdown. Explanation: The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 844-845. Chapter 40: The Child with a Musculoskeletal Disorder - Page 844-845
The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply. The diaphysis is the rounded end portion of the bone. Periosteum is the outer covering of the bone. Adipose cell formation happens in the red bone marrow. Calcitonin plays a role in remodeling of bone. Calcium and vitamin D play important roles in bone growth and bone breakdown.
Correct response: Calcium and vitamin D play important roles in bone growth and bone breakdown. Calcitonin plays a role in remodeling of bone. Periosteum is the outer covering of the bone. Explanation: Calcium, vitamin D, and calcitonin are involved in original bone formation, replacement of old by new bone tissue (remodeling), and bone breakdown (resorption). Adipose cell formation happens in the yellow, not red, marrow. The diaphysis is the lengthy central shaft of the long bone; the epiphysis is the rounded end portion of the long bone.
The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply. Wear a protective gown when moving the child's arm. Check radial pulse in the both arms. Document any signs of pain. Monitor the color of the nail beds in the right hand. Wear sterile gloves when removing or touching the cast.
Correct response: Document any signs of pain. Check radial pulse in the both arms. Monitor the color of the nail beds in the right hand. Explanation: The most important function for the nurse in caring for a child in a cast is frequent neurovascular checks. The nurse should monitor for increased pain and edema, a pale or blue color to the extremities, skin coolness, numbness or tingling, poor capilaary refill and decreased pulse strength. Increased pain, especially not relieved with pain medications, can indicate serious complications such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary as cast is not sterile.
The nurse is assessing a group of early adolescents for scoliosis. One of the teenagers asks the nurse what will be done. The nurse explains that which of the following will be included in the assessment? Select all that apply. Examination of leg length Examination of the shoulders for symmetry Examination of the shoulder blades for symmetry Examination of the hips for symmetry Examination of the spine for curvature
Correct response: Examination of the shoulder blades for symmetry Examination of the hips for symmetry Examination of the shoulders for symmetry Examination of the spine for curvature Explanation: Leg length is not affected by scoliosis, but may appear so because of asymmetry of hips. The other responses are part of the assessment for scoliosis.
An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care? Keeping the buttocks slightly elevated Provide range of motion to the unaffected extremity Wrapping the bandages from the ankle to the knee Removing the traction boot every 8 hours
Correct response: Keeping the buttocks slightly elevated Explanation: With Bryant traction, the buttocks should be slightly elevated and clear of the bed. The bandages are wrapped from the ankles to midthigh in Bryant traction. The legs are wrapped from the ankle to knee. A traction boot is not used with Bryant traction. This action would be appropriate for Buck traction. With Bryant traction, both legs are extended vertically, so range of motion would not be appropriate.
An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. What information would the nurse include when teaching the child about the cast? The child will need to keep his arm down at his side for 48 hours. The child initially may experience a very warm feeling inside the cast. The edges will be covered with a soft material to prevent irritation. The cast will take a day or two to dry completely.
Correct response: The child initially may experience a very warm feeling inside the cast. Explanation: A fiberglass cast usually takes only a few minutes to dry and will cause a very warm feeling inside the cast. Therefore, the nurse needs to warn the child that this will occur. Fiberglass casts usually have a soft fabric edge so they usually do not cause skin rubbing at the edges and don't require petaling. The child should be instructed to elevate his arm above the level of the heart for the first 48 hours.
The nurse is planning teaching for the parents of a child with Legg-Calvé-Perthes disease. On what should the nurse emphasize when conducting this teaching? The child will need to exercise to increase muscle strength of the knee joint. Surgery is needed with supporting rods. The child will need passive range-of-motion exercises three times a day. The child will have a non-weight-bearing period.
Correct response: The child will have a non-weight-bearing period. Explanation: For Legg-Calvé-Perthes disease, both parents and the child need thorough education about treatment and care because it can be difficult for young children to accept the extended treatment period involved with this disorder. There are long-term consequences if rest is not followed conscientiously. Parents may need assistance with devising appropriate activities for the child during the time that activity is limited and weight bearing is not allowed. Surgery with supporting rods is used to treat scoliosis. The child will not have passive range-of-motion exercises nor knee joint exercises in the treatment of this disease.
The most important assessment of neurovascular status to make after spinal surgical instrumentation is: check the nailbeds of the fingers for capillary refill. ask if the child has pain. determine the presence of brachial pulses. assess the legs for warmth.
Correct response: assess the legs for warmth. Explanation: The edema that accompanies spinal instrumentation surgery can impair circulation to lower extremities. The lower extremities are affected and need to be assessed over the nail beds of the fingers; brachial pulse is in the arm. Most all children will have pain after surgery.
The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?
Correct response: unhooking a weight while providing pin care Explanation: Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze. Reference: Hatfield, N. T., Kincheloe, C. A. (2018). Introductory Maternity & Pediatric Nursing, 4th ed, Philadelphia: Wolters Kluwer, Chapter 40: The Child with a Musculoskeletal Disorder, p. 845. Chapter 40: The Child with a Musculoskeletal Disorder - Page 845
The nurse is caring for a child who has just received a cast for a broken wrist. Why should the nurse elevate the limb onto a pillow?
To prevent edema Correct response: To prevent edema Explanation: If an extremity has been casted, keep it elevated with a pillow to prevent edema in the fractured area. Elevating a casted extremity does not promote healing or discourage infection. The cast will ensure proper bone alignment. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 843-844. Chapter 40: The Child with a Musculoskeletal Disorder - Page 843-844
An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?
to continue with age-appropriate activities Correct response: to continue with age-appropriate activities Explanation: The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. Bracing is one way to do that. The brace should be worn for 23 hours per day. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. It is extremely important that the adolescent has compliance with the brace usage. The nurse can help by teaching the adolescent ways to help peers understand the need for the brace. Sex changes continue with or without bracing. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 854-855. Chapter 40: The Child with a Musculoskeletal Disorder - Page 854-855
A nurse assesses a client who is complaining of calf pain, has a temperature of 101°F (38.3°C) and reports that his leg is very sore. X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and his erythrocyte sedimentation rate is elevated. What problem do these symptoms suggest?
Correct response: Osteomyelitis Explanation: Osteomyelitis is a bone infection usually caused by Staphylococcus aureus, which causes leg pain and fever. Labwork reflects an elevated leukocyte count and an increased erythrocyte sedimentation rate. X-rays look normal until 5 to 10 days after onset of symptoms. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 847-848. Chapter 40: The Child with a Musculoskeletal Disorder - Page 847-848
The nurse is caring for a child who has had an open reduction with cast placement on the forearm. While assessing the cast, the nurse notes serosanguineous fluid on the cast. What action by the nurse is appropriate? Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined. Nothing needs to be done at this time. This is a normal assessment finding after this type of surgery. Using a magic marker, color over the entire spot of fluid. Mark the date and time. Notify the health care provider of the drainage and prepare to place a new cast.
Correct response: Using a ballpoint pen, outline the fluid stain. Mark the time it is outlined. Explanation: Although oozing of serosanguineous fluid after an open reduction is a common, it does need to be noted and documented. The nurse should outline the stain with a ballpoint pen or crayon rather than a marker, mark the time so it can be determined how rapidly the spot is increasing. If the stain is small, notification of the health care provider and replacement of the cast is not necessary.
The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis?
Risk for impaired skin integrity due to cast and location Correct response: Risk for impaired skin integrity due to cast and location Explanation: Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, pp. 842-844. Chapter 40: The Child with a Musculoskeletal Disorder - Page 842-844
The nurse caring for a 13-year-old female with late onset type II pauciarticular juvenile idiopathic arthritis explains to the parents the prognosis for their child's condition. Which of the following statements best describes this prognosis? "This disease responds well to therapy; your daughter will most likely not experience crippling disease." "With this type of juvenile arthritis, 50% of patients will recover and 50% will have severe, chronic arthritis." "With this type of juvenile arthritis, at least 60% go into remission and 10% to 50% will have ocular damage." "About 25% of patients with this type of juvenile arthritis will have disabling arthritis throughout their lives."
Correct response: "This disease responds well to therapy; your daughter will most likely not experience crippling disease." Explanation: Type II pauciarticular juvenile arthritis responds well to therapy and does not generally lead to crippling disease. With type I (early onset), at least 60% go into remission and 10% to 50% will have ocular damage. In subtype I polyarticular juvenile arthritis, 50% will have disabling arthritis. In systemic arthritis, 50% will recover and 50% will have severe chronic arthritis.
A child and mother come into the orthopedic clinic. The mother is concerned about her child who has recently been diagnosed with scoliosis. The mother asks about surgical treatment and if it will be necessary. The nurse bases her response on knowledge that surgery is implicated for curvatures greater than:
Correct response: 40 degrees. Explanation: Nonsurgical treatment is attempted first for spinal curvatures less than 40 degrees. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 853. Chapter 40: The Child with a Musculoskeletal Disorder - Page 853
When teaching a group of parents about the skeletal development in children, what information is most helpful? The growth plate is made up of the epiphysis. Children's bones have a thin periosteum and limited blood supply. The infant's skeleton has undergone complete ossification by birth. A young child's bones commonly bend instead of break with an injury.
Correct response: A young child's bones commonly bend instead of break with an injury. Explanation: A young child's bones are more flexible and more porous with a lower mineral count than adults. Thus, bones will often bend rather than break when an injury occurs. The growth plate is composed of the epiphysis and physis. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply.
A school-age child has difficulty getting from a sitting position to a standing position and must brace the legs to rise. Which lab test would the nurse expect the provider to order? Creatinine phosphokinase Rheumatoid factor Erythrocyte sedimentation rate C-reactive protein
Correct response: Creatinine phosphokinase Explanation: The hallmark physical sign for muscular dystrophy is Gowers sign, which is described as using the hands to brace the legs when moving from a sitting to a standing position. Elevated creatinine phosphokinase is the hallmark lab value for the diagnosis of muscular dystrophy. Elevated C-reactive protein can indicate an infection. Elevated erythrocyte sedimentation rate can indicate an inflammatory process. Elevated rheumatoid factor can indicate an autoimmune response to an antigen.
A 3-year-old child is admitted to the hospital with osteomyelitis of the right femur. The nurse would expect to start an IV and antibiotic after blood is drawn for which lab test? Culture Hemoglobin and hematocrit White blood cell count Platelets
Correct response: Culture Explanation: Only the culture will indicate which antibiotic is the correct medication to give for the infection.
The mother of a 9-year-old boy brings the boy to the clinic for an evaluation because he has a fever. The history reveals a recent trauma to the knee. The nurse inspects the joint. Which of the following would lead the nurse to suspect osteomyelitis? Select all that apply. Pain on palpation Coolness of the area Drainage from the area Localized tenderness Edema of the area
Correct response: Edema of the area Localized tenderness Pain on palpation Explanation: With osteomyelitis, physical examination of the affected area reveals localized tenderness, redness, warmth, and pain on palpation of the area. Occasionally, children have soft-tissue swelling around the area. With involvement of the lower extremities, limp or refusal to walk is seen in approximately half the patients.
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 Greenstick Spiral Epiphyseal
Correct response: 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.
A child has just been received into the clinic, and the nurse is assigned to her care. The physician determines that the child has a broken left radius, and the arm is placed in a short cast. The nurse should give the mother which of the following instructions to care for the child's cast properly? Select all that apply. Handle the cast only with the open palms as it drys. Use a padded hanger to scratch inside the cast if itching. Check the child's hand function by moving the fingers and extending the thumb. Report a foul odor around the cast. Check to see whether the fingers are warm to the touch.
Correct response: Handle the cast only with the open palms as it drys. Check the child's hand function by moving the fingers and extending the thumb. Check to see whether the fingers are warm to the touch. Report a foul odor around the cast. Explanation: Nothing should be placed inside the cast. The other selections are appropriate to teach the mother.
A young boy fell off of his bike and injured his arm. X-rays indicate that he has a greenstick fracture. His parents ask the nurse the meaning of this term. What is the nurse's best response? The fractured bone is totally separated from the other part of the bone in his forearm. The fracture occurred from the bone bending and then breaking apart. Your son's arm has sustained a twisting fracture. The two parts of the fractured bone are only partially separated in his forearm.
Correct response: The two parts of the fractured bone are only partially separated in his forearm. Explanation: A greenstick fractures is a type of incomplete fracture that occurs when the bone bends and partially cracks due to decreased ossification. The bone fragments remain partially connected.
The nurse is caring for an 9-year-old girl in traction. She has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. She is showing signs of regression with thumb sucking and pleas for her tattered baby blanket. Which of the following would be the most helpful intervention?
"Let's ask your mom to bring your friends for a visit" Correct response: "Let's ask your mom to bring your friends for a visit" Explanation: After two weeks in traction, a child can become easily bored and regress in social and personal skills. The child is most likely needs some diversional activity. A visit from friends arranged by the girl's mother or supervised by the child-life specialist would help her adapt to her immobilized state. Telling the girl she is too big to suck her thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as she has likely grown tired of books and coloring after two weeks. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, Care Plan 40-1, pp. 846-847. Chapter 40: The Child with a Musculoskeletal Disorder - Page 846-847
A 12-year-old girl has been recently diagnosed with juvenile idiopathic arthritis (JIA). She is eager to resume physical activity. The girl's mother is excessively concerned about her safety and has completely limited the daughter's activities. Which of the following would be the best way to address the mother's concerns and encourage activity?
"What are your daughter's favorite activities?" Correct response: "What are your daughter's favorite activities?" Explanation: Because the mother is so fearful, it is best to determine the girl's favorite activities and address each one specifically to determine if any modifications are required. This eliminates any vague concerns and addresses the needs of the girl with input from both mother and daughter. The mother might interpret the instruction to avoid gymnastics and high-impact sports to include her daughter's favorite activities. Telling the mother that activity is encouraged for children with JIA will likely fall on deaf ears as she has already demonstrated that she would prefer limiting activity altogether. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 851. Chapter 40: The Child with a Musculoskeletal Disorder - Page 851
At an obstetric visit 28 weeks into her pregnancy, an expectant mother tells the nurse that her friend's newborn has a soft spot on his head. She is concerned that something is wrong with this baby and is worried the same thing could happen to her child. The best explanation the nurse could offer this expectant mother regarding the bones in the skull would be which statement? "Most babies are born without the soft spot, but if they have one it will be checked." "Bone takes a long time to develop; the skull bones will be stronger and more solid than bones that are completely formed at birth." "The softer spot and unclosed sutures in the skull allow the bones to move as they need to so that the baby's head can move through the narrow birth canal." "The bones remain soft until the brain is completely developed to make sure the skull is large enough to accommodate a large brain."
Correct response: "The softer spot and unclosed sutures in the skull allow the bones to move as they need to so that the baby's head can move through the narrow birth canal." Explanation: The bones of the skull give shape to the head. The areas where these bones meet are called suture lines. These suture lines have not yet ossified, or hardened into bone, during fetal life. Because these suture lines are not fused, during delivery the bones of the skull can move and overlap, allowing for the head to pass through the birth canal. Within the first 2 years of life, these suture lines or fontanels fuse together.
The nurse is concerned that a preschool-age child is demonstrating signs of Duchenne muscular dystrophy. What did the nurse assess in this child?
Gower sign Correct response: Gower sign Explanation: Children with Duchenne muscular dystrophy usually have a history of meeting motor milestones, but by about 3 years of age, symptoms are more acute and obvious. Rising from the floor is done by rolling onto the stomach and then pushing up to the knees. To stand, the hands are pressed against the ankles, knees, and thighs. This is Gower sign. Facial weakness and inability to whistle are manifestations of facioscapulohumeral muscular dystrophy. Inadequate use of respiratory muscles is a manifestation of congenital myotonic dystrophy. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 848. Chapter 40: The Child with a Musculoskeletal Disorder - Page 848
The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first?
Reposition the child's foot on a pressure-reducing device. Correct response: Reposition the child's foot on a pressure-reducing device. Explanation: The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease the potential for skin breakdown, but the pressure must be relieved first. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, Care Plan 40-1, p. 846. Chapter 40: The Child with a Musculoskeletal Disorder - Page 846
The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction?
Skin traction Correct response: Skin traction Explanation: Traction is used to provide immobilization to reduce or immobilize a fracture, align an injured extremity or allow the extremity to be restored to the normal length. The types of traction include skin, skeletal and suspension. The types of skin traction include Bryant, Russell, Buck, cervical and side arm 90-90. In these types of traction some type of tape, rubber, plastic or manufactured material is attached to the skin. A weight is attached via pulley which indirectly exerts pull on the musculoskeletal system. Dunlop is a form of skeletal traction and balanced suspension uses a series of weight and pulleys to align the hip, femur or tibia. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 844. Chapter 40: The Child with a Musculoskeletal Disorder - Page 844
A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis?
Staphylococcus aureus Correct response: Staphylococcus aureus Explanation: Staphylococcus aureus is the most common cause of osteomyelitis; therefore, the nurse would expect the antibiotics to cover that bacteria. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 847. Chapter 40: The Child with a Musculoskeletal Disorder - Page 847
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 improve your spinal alignment, decreasing your symptoms." Correct response: "It is important to wear the brace now to improve 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. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 855. Chapter 40: The Child with a Musculoskeletal Disorder - Page 855
The nurse is providing teaching about the disease to a client newly diagnosed with juvenile idiopathic arthritis (JIA) and his family. Which facts are accurate and should be shared with this family? Select all that apply. It is most commonly seen in children 4 to 8 years of age. JIA can affect any number of joints. The client will need to take several medications, including NSAIDS. Administer NSAIDS with food to decrease the incidence of gastric irritation. Exercise is discouraged to not trigger increased pain.
Correct response: JIA can affect any number of joints. The client will need to take several medications, including NSAIDS. Administer NSAIDS with food to decrease the incidence of gastric irritation. Explanation: Patients with JIA have painful swollen joints in varying numbers from one to more than five. The most common age is from 1 to 3 years and from 8 to 10 years. NSAIDS are the drug of choice for reduction of inflammation. Clients are encouraged to exercise as long as it does not increase the pain of the disease. Since NSAIDS are very irritating to the GI tract, it is recommended that NSAIDS be taken with food or milk.
An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:
Correct response: back with hips up off the bed. Explanation: Bryant traction is used to reduce fractures or with developmental dysplasia of the hips in children younger than 2 years of age. In this type of traction both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed. The position of having the child on the back with the hips flat is describling Buck's traction. The position where the hip is flexed on the injured side and the uninjured extended is 90-90 traction. There is no traction when the child would be on the stomach. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, Fig. 40-7, p. 845. Chapter 40: The Child with a Musculoskeletal Disorder - Page 845
The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?
Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. Correct response: 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. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, Care Plan 40-1, p. 846. Chapter 40: The Child with a Musculoskeletal Disorder - Page 846
An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal?
Spiral fracture Correct response: Spiral fracture Explanation: A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse. Reference: Hatfield, N. T., Kincheloe, C. A. Introductory Maternity & Pediatric Nursing, 4th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 40: The Child with a Musculoskeletal Disorder, p. 842. Chapter 40: The Child with a Musculoskeletal Disorder - Page 842