Compound Fracture (Preschooler)

The rx dose of morphine reads, "admin morphine sulfate 0.2mg/kg IV q3-4h". The pt weighs 33 lbs. The tubex of morphine contains 5mg/mL. How many mL of med should the RN administer?

0.6 mL

The RN understands that which S/S are indicative of osteomyelitis? (SATA) a. Resistance to movement b. Bradycardia c. Hypothermia d. Edema e. Irritability

a. Resistance to movement d. Edema e. Irritability

The RN assess for pain. The kid points to the FACES pain scale rating indicating a high level of pain, but she's lying still and seems vague about the location of the pain when asked by the RN. A rx for IV morphine q4h is available. The kid is due a dose of morphine, and the transport team is en route to escort her to surgery. Based on this assessment, what is the best nursing intervention? a. Administer another dose of morphine STAT b. Ask the OR RN to admin the med once the kid arrives to the OR c. Use distraction methods rather than analgesics until she goes to surgery d. Hold the dose due and document that pain assessment findings are inconsistent

a. Administer another dose of morphine STAT

As the RN assumes care for the pt, which actions are most important for the RN to take? (SATA) a. Immobilize the injury b. Perform ROM exercises to the affected limb c. Assess neurovascular status q1h d. Realign the bone to reduce pain e. Elevate the affected extremity

a. Immobilize the injury c. Assess neurovascular status q1h e. Elevate the affected extremity

The UAP goes to the playroom to get the pt some toys. The UAP is planning to spend some time w/the pt. Which activity is the best choice for the pt? a. Pretend beauty parlor b. Monopoly board game c. 50 piece puzzle d. Looking at pic books

a. Pretend beauty parlor

The pt reports that her pain is still controlled and she's starting to get hungry. The RN sends the UAP to provide her w/a snack. Which snack selection is the best choice for the pt while she's immobilized? a. Yogurt b. Popsicle c. Blueberry muffin d. Graham crackers

a. Yogurt

The RN admins an additional dose of analgesic to the pt after conferring w/the HCP and the pt reports that her pain is tolerable. Other pts require assistance, so the RN needs to utilize her team members effectively to care for all pts. A pt w/a pelvic fracture is being transferred from the ED and a post-op pt w/crutches needs assistance ambulating to the bathroom. A LPN and a UAP are available to work w/the RN. Given the available medical personnel, what staff assignment is best? a. Ongoing monitoring of the pt's foot by the LPN, while the RN assists the post-op pt w/crutches and the UAP determines if the new pt has any immediate problems b. Ongoing monitoring of the pt's foot by the RN, while the UAP assists the post-op pt w/crutches and the LPN determines if the new pt has any immediate problems c. Ongoing monitoring of the pt's foot by the UAP, while the RN assists the post-op pt w/crutches and the LPN determines if the new pt has any immediate problems d. Ongoing monitoring of the pts foot by the LPN, while the UAP assists the post-op pt w/crutches and the RN determines if the new pt has any immediate problems

d. Ongoing monitoring of the pts foot by the LPN, while the UAP assists the post-op pt w/crutches and the RN determines if the new pt has any immediate problems

Which finding should the pts parents be instructed to report to the HCP? a. Cast sounds hollow when tapped b. Pt's cap refill is <2 secs c. Pt reports itching inside cast d. Pts toes are more swollen

d. Pts toes are more swollen

After resolving the other pt care needs, the RN returns to the pts room. Which task should be delegated to the LPN at this time? a. Revise the POC to reflect the recent complicaton b. Teach the pt's parents about compartment syndrome c. Eval the effectiveness of the dose of morphine admin d. Spend time w/the pt to distract her from the discomfort

d. Spend time w/the pt to distract her from the discomfort

When the pt returns for cast removal, the RN uses a doll that allows the pt to role-play the procedure of cast removal. The RN tells the pt that the cast-cutter makes a noise, but if it touches her leg, it will probably feel like a tickle. What instructions should the RN provide to the pt and her parents about care r/t the cast removal? (SATA) a. She may feel heat or vibration or a tickle during the removal b. The machine to remove the cast is very noisy c. Lotions shouldn't be applied on the legs for 1w after cast removal d. Skin might be scaly or dry after the cast is removed e. Pt will be ready to walk on her foot w/o issue once the cast is removed

a. She may feel heat or vibration or a tickle during the removal b. The machine to remove the cast is very noisy d. Skin might be scaly or dry after the cast is removed

The pts mom tells the RN that she doesn't know how to respond to the pt when the kid expresses her anger. In teaching the mom, what response should the RN suggest she use w/the pt? a. "You shouldn't act out by throwing things at me" b. "I'm sad that you're throwing things at me" c. "I will not stay here if you keep throwing things" d. "Throwing things isn't the way good girls behave"

b. "I'm sad that you're throwing things at me"

The RN recognizes that the pt is at risk for the onset of osteomyelitis. Which nursing intervention should be included in the POC to prevent this complication? a. Petal the edges of the boot cast w/adhesive tape b. Cleanse the pin site w/half-strength hydrogen peroxide c. Increase intake of vitamin C in the pt's diet d. Apply an elastic stocking to the unaffected leg

b. Cleanse the pin site w/half-strength hydrogen peroxide

A 4 y.o. is brought to the ED by ambulance following an automobile accident that occurred while the kid was headed to the park w/her sister, who's also her babysitter. The kid sustained a compound fracture of the femur, which requires surgical reduction, followed by skeletal traction. The kid's teenage sister accompanies her to the hospital. She reports that their parents are both at work. If a staff member is unable to reach the kids parents, what guidelines will determine the staff's ability to provide needed care? a. A minor child can give permission and consent for care and is then considered emancipated. b. Emergency care may be provided after a reasonable attempt to reach the parents has been made c. Since the sister has responsibility for the child, she can give informed consent for needed procedures d. A minor child can assent to care, which is considered equivalent to an adult giving informed consent for care

b. Emergency care may be provided after a reasonable attempt to reach the parents has been made

The RN identifies that a priority nursing dx is injury risk for peripheral neurovascular compromise. Which lab value would be of most concern for the RN? a. WBC of 11500 b. Hgb of 9.5 g/dL c. Platelet count of 200 x 103/mcl d. Reticulocyte count of 2%

b. Hgb of 9.5 g/dL

The pt's parents invite the RN to attend a parenting class at her preschool to talk about car safety. A parent in the class states that her 5 y.o. son is very mature for his age and feels more grown up using an adult seatbelt. She states that he follows the rules much better when he gets to make decisions. Therefore, he's more willing to keep the seatbelt buckled. She goes on to say that he's large for his age, weighing almost 50 lbs. How should the RN respond? a. Reassure this parent that the kid is large enough to safely use an adult seatbelt. b. Instruct this parent that the kids age and size still require the use of a safety seat c. Support this parents desire to increase the kids independent decision making d. Redirect the topic to types of injuries that occur when car seats aren't used correctly

b. Instruct this parent that the kids age and size still require the use of a safety seat

Based on these assessment findings, the RN recognizes that the kid has developed compartment syndrome. In addition to notifying the HCP of this development, what action should the RN implement? a. Elevate the affected extremity b. Obtain equipment needed for cast removal c. Encourage the pt to keep wiggling her toes d. Place an ice pack over the affected area

b. Obtain equipment needed for cast removal

The pt goes to surgery, where reduction and fixation is performed. Following surgery, the pt is transferred to the orthopedic nursing unit where she'll be in skeletal traction for several weeks. Upon arrival to the unit, which RN assessment has the greatest priority? a. Inspect pin sites for redness b. Pull of the traction on the pins c. HR and BP d. Condition of the dressing

b. Pull of the traction on the pins

The RN notes that in addition to the pain, the kids foot is pale and cool. What additional assessment should the RN perform? (SATA) a. DTR b. Toe movement c. VS d. Skin turgor e. Integrity of the skin wouldn't add any assessment data r/t compartment syndrome

b. Toe movement e. Integrity of the skin wouldn't add any assessment data r/t compartment syndrome

The kid has been resting comfortably since surgery. She's receiving morphine 3mg IV q4h, and she's consistently indicated adequate pain control via the FACES pain scale and through remarks to her mom, who's been staying at her bedside. 20h after surgery, the RN admins the next scheduled dose of morphine. 2h later, the kid is crying and agitated. She points to her foot and cries, "There, there, it hurts there". Which nursing action has the highest priority? a. Admin a breakthrough dose of morphine b. Redirect the pt's attention to a new toy c. Assess the appearance of the pt's foot d. Monitor the pt's VS and O2 sats

c. Assess the appearance of the pt's foot

The pt arrives on the nursing unit w/her traction intact. She has a boot cast on her lower leg. Which nursing interventions should be included in the POC while the pt is in traction? (SATA) a. Remove the traction for 10mins every hour b. Keep weights securely positioned on the floor c. Assess toes for cap refill and edema d. Attach the ropes to the footboard to prevent sliding e. Ensure the amount of weight remains consistent

c. Assess toes for cap refill and edema e. Ensure the amount of weight remains consistent

The kid has an open fracture. What is the priority RN intervention? a. Administer oral pain meds hourly b. Apply heat to the affected area c. Cover the wound loosely w/a sterile dressing d. Discuss the post-op ambulation schedule w/the kid

c. Cover the wound loosely w/a sterile dressing

The pt usually snacks on animal crackers in the AM. She has a box at her bedside. She asks the RN if she can have some while her mom is away from the bedside. What action should the RN take? a. Tell the pt that she'll need to wait for her mom to return before she can have a snack b. Give the pt crackers to play with, but tell her not to eat any until her mom returns c. Give the pt a few crackers and stay w/her while she eats them d. Give the pt a few crackers, and leave her alone to enjoy her snack while watching TV

c. Give the pt a few crackers and stay w/her while she eats them

The RN monitors the pt's lab values. Which change in serum lab values would most likely indicate the onset of osteomyelitis? a. Decreased hgb b. Decreased WBC c. Increased ESR d. Increased CPK

c. Increased ESR

The pt insists that the play activity include Elsa, her invisible friend. While playing, the pt throws some toys on the floor and scolds Elsa for dropping them. The pt's mom tells her that the activity cannot continue if she's going to throw toys. How should the RN respond to this situation? a. Remind the mom that the pt's actions are normal and to be expected b. Help the mom develop a plan to reduce the pts need for an imaginary friend c. Support the moms decision to hold the pt accountable for her own misbx d. Advise the mom that imaginary playmates at this age indicate regressive bx

c. Support the moms decision to hold the pt accountable for her own misbx

Since the kid's parents are divorced, which parent should the RN try to contact first? a. Parent whose house the sister assumed care of the kid (physical custody) b. Parent in whose home the kid lives majority of the time (physical custody) c. The parent who's been assigned legal custody by court d. Both parents must be contacted, even if they don't share joint custody of the kid

c. The parent who's been assigned legal custody by court

Several days later, the pt throws her toys at her mom. Her mom is in tears and asks the RN, "Why does she only get angry w/me? She never yells at the RNs or her father" What is the best response by the RN? a. "You're the one providing all the discipline. It's natural for her to be angry at you" b. "Do you believe she would be happier being w/her father rather than w/you?" c. "You shouldn't allow her to become that angry because it's harmful for both of you" d. "It's natural to be upset when your kid expresses anger toward you"

d. "It's natural to be upset when your kid expresses anger toward you"

After 3w the traction is d/c, a long leg cast is applied, and the pt is scheduled for d/c from the hospital. The pt had a plaster cast applied an hour ago. The parents demonstrate lifting the cast by holding it w/the palms of their hands. How should the RN respond? a. Ask the parents if they feel too overwhelmed to learn cast care at this time b. Demo the correct technique for moving the cast using only the fingertips c. Instruct the parents to use only one hand to lift the cast d. Acknowledge the parents have correctly learned how to move the cast while it's wet

d. Acknowledge the parents have correctly learned how to move the cast while it's wet

The RN talks to the pts parents about preparing her for cast removal. Which technique is most beneficial when preparing a preschooler for a procedure that may be frightening? a. Call the child life therapy team to explain the procedure b. Remind the kid that removing the cast means she can return to normal activities c. Reassure the kid that there's nothing scary about the procedure d. Describe what the kid will experience shortly before the procedure takes place

d. Describe what the kid will experience shortly before the procedure takes place

The kid's parents are reached and they are both on their way to the hospital. They both give telephone consent for her emergency care. The RN performs an assessment of the affected leg and notes leg deformity, swelling, and ecchymosis. EMS documentation indicates the presence of crepitus. How is the presence of crepitus r/t this femur fracture determined? a. Observe the area around the fracture for swelling, pain, and tenderness b. Observe the area distal to the fracture for spasms or rigidity c. Gently palpate over or around the wound and listen for a crackling sound d. Listen for a grating sound when the affected area is moved

d. Listen for a grating sound when the affected area is moved

Another parent explains to the RN that her 6 y.o. son prefers sitting in the front seat. She feels this is the safest place because her car is equipped w/front and side airbags. What advice should the RN provide this parent? a. The kid can sit in a booster seat in the front passenger seat of a car w/airbags b. The kid can sit in the front passenger seat of a car w/o airbags, using the manufacturers shoulder belt c. The kid can sit in the back seat of a car w/o a booster seat, but only if using the manufacturers lap belt d. The kid can sit in the back seat of a car while using the manufacturers manual lap and shoulder belts

d. The kid can sit in the back seat of a car while using the manufacturers manual lap and shoulder belts