PEDS CHAPTER 27 (PREPU LEVEL 8)

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." "Injuries that happen at the end of the bone, the epiphysis, are at a greater risk for becoming infected." "Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." "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." 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 child who has just received a cast for a broken wrist. The parents ask, "Why do we need to keep the arm up on a pillow?" Which response by the nurse is appropriate? "Keeping the arm raised helps to lessen the swelling." "Using a pillow helps to promote healing." "There is less chance of infection when the arm is kept elevated." "Positioning the arm like upward helps to make sure the bones stay aligned."

"Keeping the arm raised helps to lessen the swelling." Explanation: If an extremity has been casted, the client should 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.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? "You and your coaches need to understand that you cannot play soccer for at least six weeks." "Ice will help reduce the inflammation." "You will need to see a physical therapist for stretching and strengthening exercises." "NSAIDs can help with pain control and inflammation."

"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition? A 13-year-old boy who is on his school's cross-country team A 9-year-old boy who is sedentary A 15-year-old girl who dances ballet An 11-year-old girl who is obese

A 13-year-old boy who is on his school's cross-country team Explanation: Osgood-Schlatter disease is the thickening and enlargement of the tibial tuberosity resulting from microtrauma, probably caused from overuse. It occurs more often in boys than girls and at preadolescence or early adolescence, probably because of rapid growth at these times.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child? Handling the cast with open palms when moving the arm. Using only a draw sheet to move the casted arm. Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm. Encouraging the child to move the arm slowly up and down to help the cast dry.

Handling the cast with open palms when moving the arm. Explanation: A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process.

The nurse is caring for a child who is approximately 6 hours postoperative for surgical correction of scoliosis. What will the nurse include in the plan of care? Logroll the child periodically with arms crossed. Reposition the upper body first, then the lower body. Turn the child every 3 hours. Encourage the child to sit up.

Logroll the child periodically with arms crossed. Explanation: The nurse should plan to logroll the child with arms crossed to avoid bending and twisting the spine. Repositioning the upper body first, then the lower body, will result in twisting of the spine, which should be avoided after surgical correction of scoliosis. The child should be repositioned every 2 hours, not every 3 hours. The child should be encouraged to sit up on postoperative day 1, not only 6 hours postoperative (day 0).

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. Which of the following would the nurse do next? Reposition the child's foot on a pressure-reducing device. Apply lotion to his foot and avoid friction to the area. Make sure the skin and linens are clean and dry. Turn the child regularly.

Reposition the child's foot on a pressure-reducing device. Explanation: The nurse's first action is to remove continuous pressure from this area. Applying lotion, avoiding friction, keeping the skin and linens clean and dry and turning the child regularly can help decrease potential for skin breakdown, but the pressure must be relieved first.

The nurse is caring for an 8 year old in skeletal traction for a fractured femur. Which type of traction would be communicated in the shift hand-off?

Russell Traction

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? streptococcus group B Staphylococcus aureus Haemophilus influenzae mycobacterium

Staphylococcus aureus Explanation: Staphylococcus aureus is the most common cause of osteomyelitis; therefore, the nurse would expect the antibiotics to cover that bacteria.

In caring for a child being treated for scoliosis, the highest priority goal is which of the following? The child will participate in age-appropriate activities. The child's skin integrity will be maintained. The child will verbalize acceptance of the treatment. The child will remain free of injury.

The child will remain free of injury. Explanation: The highest priority goal for the child being treated for scoliosis is preventing injury. Other important goals, but with less priority, include minimizing the disruption of activities and maintaining skin integrity and self-image. Goals for the child and caregiver include accepting the treatment and complying with long-term care.

A 14-year-old male is brought to the emergency department by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. When describing this fracture to the child and his parents, the nurse would integrate knowledge of which of the following? The break occurs in a line that crosses the shaft at a 90-degree angle. There is a diagonal line across the bone. The bone is bent but not broken. There are three or more fracture fragments.

There are three or more fracture fragments. Explanation: In a comminuted fracture, there are three or more fracture fragments. With a transverse fracture, a line crosses the shaft at a 90-degree angle. In an oblique fracture, there is a diagonal line across the bone. With a greenstick fracture, the bone is bent, but not broken.

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 the shoulder blades for symmetry examination of the hips for symmetry examination of the shoulders for symmetry examination of leg length examination of the spine for curvature

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 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.

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child: cannot plantarflex his foot. feels increasing severe pain. has a weak femoral pulse. has blue-looking nail beds on the toes.

feels increasing severe pain. Explanation: Any reports of pain in a child with a new cast or immobilized extremity need to be explored and monitored closely for the possibility of compartment syndrome.

The nurse is caring for a child with osteomyelitis who has a leg wound. The highest priority nursing intervention for this child would be for the nurse to: minimize the movement of the leg. follow transmission-based precautions. monitor nutritional intake. encourage the child to avoid weight bearing.

follow transmission-based precautions. Explanation: All of these interventions are done for the child with osteomyelitis who has a wound, but the highest priority would be to follow transmission-based precautions to prevent the spread of infection, especially if the wound is open and draining.

The nurse is providing discharge teaching for a 12-year-old child undergoing bracing following surgical correction of scoliosis. The child expresses concern about body image. What will the nurse include in the teaching? Select all that apply size of scar lack of curve when bracing is completed increase in height when bracing is finished when to resume full activities importance of correcting cardiopulmonary compromise

lack of curve when bracing is completed increase in height when bracing is finished The nurse should review the size of the scar, the lack of curve of the spine following bracing, and the increase in height the child will have when bracing is completed. Resuming full activities and correcting cardiopulmonary compromise do not address the child's body image concerns.

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom? pain pallor paresthesia paralysis

paresthesia Explanation: Paresthesia is diminished or absent sensation or numbness or tingling. Pallor is paleness of color and paralysis is the loss of function.

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? to continue with age-appropriate activities to stand absolutely still when not wearing the brace to wear the brace a maximum of 20 hours each day that secondary sex changes will stop until the brace is removed

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.

The client 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? Arrange for the parents to come in for an evaluation for possible physical abuse. Evaluate the infant for an underlying musculoskeletal disorder. Evaluate the child for a seizure disorder, as that is probably why the infant is injured. Ask the babysitter to advocate for the child and report the incident to the authorities.

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 (child mistreatment), 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 child abuse (child mistreatment). 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 conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common? The foot is drawn up and inward. The sole of the foot faces backwards. dimpled skin, hair in lumbar region blue sclera

blue sclera Explanation: Blue sclera is not diagnostic of osteogenesis imperfecta, but it is a common finding. The foot drawn up and inward (talipes varus) and the sole of the foot facing backwards (talipes equinus) are associated with clubfoot (congenital talipes equinovarus). Dimpled skin and hair in the lumbar region are common findings with spina bifida occulta.

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. edema of the area localized tenderness pain on palpation coolness of the area drainage from the area

edema of the area localized tenderness pain on palpation 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 the involvement of lower extremities, a limp or a refusal to walk is seen in approximately half of pediatric patients.

Based on the chart note, which therapy will the nurse plan to include in the client's care who OI, has triangular shaped face, blue sclera, persisten hearing loss and twisting of fracture in right radius and ulna; cast is in place? palliation and mobility aids bracing serial casting Pavlik harness

palliation and mobility aids Explanation: The nurse should plan to include palliation and mobility aids in the child's plan of care, because these are commonly used for the treatment of osteogenesis imperfecta (OI). Bracing may be used for the treatment of other musculoskeletal disorders such as scoliosis. Serial casting may be used for the treatment of clubfoot. Pavlik harnessing is used to treat developmental dysplasia of the hip.

The nurse is assessing a child in the emergency department with a suspected wrist fracture. The health care provider has prescribed radiologic studies. What will the nurse include in the assessment? Select all that apply. swelling pain abnormal positioning sensation curvature of affected limb

swelling pain abnormal positioning sensation The nurse should assess for swelling, pain, sensation, and abnormal positioning of the affected joint. Curvature of the affected limb should be assessed for the child with Blount disease, which affects the legs, and is not part of the assessment for a suspected wrist fracture.

The nurse is performing a neurovascular assessment on a child in 90-90 skeletal traction. What will the nurse include in the assessment? Select all that apply. tactile sensation ability to wiggle fingers and toes capillary refill skin color ability to sit up in bed

tactile sensation ability to wiggle fingers and toes capillary refill skin color Explanation: The nurse should assess the child's tactile sensation, the ability to wiggle fingers and toes, capillary refill, and the child's skin color. The nurse should not assess the child's ability to sit up in bed; the child should remain flat in the supine position while undergoing 90-90 traction.

A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care? maintaining intravenous antibiotic therapy keeping the child quiet while in skeletal traction restricting fluid to encourage red cell production assisting the child with crutch walking

maintaining intravenous antibiotic therapy Explanation: Osteomyelitis is a serious infection. It is treated vigorously with intravenous antibiotics. It would not require traction. The stem does not indicate the location of the infection, so the child may not need crutches. Fluid restriction does not help red blood cell production.

The nurse is assessing the neurovascular status of a client recovering from surgery for Blount disease. What will the nurse include in the assessment? Select all that apply. pain pulses pallor paresthesia palliation

pain pulses pallor paresthesia Explanation: The nurse should assess the neurovascular status of the client using the five Ps of tissue ischemia: pain, pulses, pallor, paresthesia, and paralysis. Palliation is not one of the five Ps of tissue ischemia. Palliation assessment would determine if the symptoms, primarily pain, have been reduced with treatment provided.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Applying ice to the area will reduce the pain and swelling." "Apply ice to the injury for 60 minutes on and 60 minutes off." "Elevate the legs, and use bed rest for 24 hours." "Taking warm baths will help relax muscles and reduce pain."

"Applying ice to the area will reduce the pain and swelling." Explanation: Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.

An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image? "You should not worry about what everyone else is wearing. You look fine." "Kids can be cruel sometimes. Has anyone told you that you look different?" "Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." "Just hold your head up and be confident in how you look. Look for some after-school activities you can do wearing your brace."

"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." 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.

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby and concerned about holding and playing with him. Which response by the nurse would be most appropriate? "Let's put you in touch with other families who have experienced this." "The baby only needs the harness for twelve weeks." "The harness does not hurt the baby." "Do not attempt to adjust the harness yourself."

"Let's put you in touch with other families who have experienced this." Explanation: There are many helpful pointers and suggestions that are available from other parents and orthopedic organizations. Referring the parents to other families who have experienced a Pavlik harness will provide assurance and likely increase compliance with the regimen. Although the time frame for using the harness, telling the parents that the harness doesn't hurt the baby and not attempting to adjust the harness are factual, they do not address the parents' concerns.

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. What is most important for the nurse to do when she has finished applying the cast? Assess the fingers for warmth, pain, and function Apply a tube of stockinette over the cast Cut a window in the cast over the wrist X-ray the cast to make sure the bones are aligned properly

Assess the fingers for warmth, pain, and function Explanation: Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Before a cast is applied, not after, a tube of stockinette is stretched over the area, and soft cotton padding is placed over bony prominences. A "window" may be placed in a cast for an open fracture or if an infection is suspected—not to prevent an infection—so that the area can be observed; however, a window is not indicated in this case. The x-ray should be performed before casting, not after it, in order to diagnose the fracture.

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

Complete Explanation: If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? Internal fixation device External fixation device Spica cast Stockinette

Spica cast Explanation: The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

The nurse is assessing a 7-year-old child with right Legg-Calvé-Perthes (LCP) disease, and documents the findings shown in the chart note above. Which finding(s) is consistent with LCP disease? Select all that apply. pain in the leg right leg shorter than left leg limited hip mobility clothes draping unevenly slouched posture

pain in the leg right leg shorter than left leg limited hip mobility Pain in the leg, right leg shorter than the left leg, and limited hip mobility are all findings in the child that are consistent with Legg-Calvé-Perthes (LCP) disease. Clothes draping unevenly may be an indication of scoliosis, not LCP disease. Slouched posture is not a finding associated with LCP disease nor scoliosis.

After teaching a group of nursing students about osteogenesis imperfecta (OI), the instructor determines that the teaching was successful when the group identifies which type as the most common? type I type II type III type IV

type I Explanation: A classification system has been developed that identifies four main types of OI. Type I mid nondeforming is the most common and mildest form. Children with type I have bones that are predisposed to fractures. Other than spinal curvature, bone deformity is minimal. Type II perinatal lethal is the most severe type and is frequently lethal at or shortly after birth. Type III severely deforming and type IV moderately deforming are more serious than type I but not as lethal as type II.

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? "Itching is common. It's nothing to worry about." "Blowing cool air with a fan or hair dryer may relieve the feeling." "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." "A small amount of lotion or baby oil can be poured in the cast to moisturize the area."

"Blowing cool air with a fan or hair dryer may relieve the feeling." Explanation: Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

The nurse is caring for a child with a newly placed plaster cast who is postoperative from surgery for Blount disease. What will the nurse include in the plan of care? Teach the child and parents to cover the cast while bathing. Handle the cast carefully with the fingertips during the first 24 hours. Apply ice packs to the interior of the cast. Elevate the affected limb to the level of the diaphragm.

Teach the child and parents to cover the cast while bathing. Explanation: The nurse should teach the parents to cover the cast while bathing. The cast should be handled carefully with open palms during the first 24 hours of plaster cast placement to avoid deforming the cast. Ice packs should not be applied to the interior of the cast; nothing should be inserted into the cast. The affected limb should be elevated above the level of the heart, not to the level of the diaphragm.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? Tendons Ligaments Joints Cartilage

Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected? Trendelenburg gait lordosis kyphosis loss of strength in ankle dorsiflexion

Trendelenburg gait Explanation: The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition.

While examining a 4-year-old child, the nurse notes a decrease in hip motion that causes pain upon movement. The nurse interprets this finding as indicating Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. True False

True Explanation: Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 850 children in northern Europe and the United States, occurring four times more often in males.

The child is recovering from multiple leg fractures in Buck extension traction and reports pain out of proportion to the injury. The child's parent reports that the pain is unrelieved by the opioid treatment. Which action will the nurse perform first? Notify the health care provider. Increase the elevation of the affected limb. Administer an additional dose of opioids as prescribed. Remove the limb from the traction apparatus.

Notify the health care provider. Explanation: The nurse will notify the health care provider first, because pain out of proportion to the injury which is unrelieved by opioids is often the first and cardinal sign of compartment syndrome, a medical emergency. Adjusting the position of the limb, additional opioid therapy, and removing the limb from the traction device may be performed later in the child's plan of care.

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention? "Let's ask your parents to bring your friends for a visit." "Would you like a coloring book?" "You are too big to suck your thumb." "Do you want a book to read?"

"Let's ask your parents to bring your friends for a visit." Explanation: After 2 weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the child's parent or supervised by the child-life specialist would help the client adapt to the immobilized state. Telling the client that he or she is too big to suck the thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as the child has likely grown tired of books and coloring after 2 weeks.

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation? A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating.

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Explanation: Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

The caregiver of a child with a recent puncture wound on the arm calls the pediatrician's office reporting that after seeming well at bedtime last night, the child now has a temperature of 101℉ (38.3℃), pain at the site of the injury, and is unable to fully bend the elbow of the arm which had been injured. The nurse recommends the child be brought in to see the health care provider. What would likely be ordered for this child? an x-ray a muscle biopsy blood work a surgical consult

blood work Explanation: In osteomyelitis, diagnosis is based on laboratory findings of leukocytosis (15,000 to 25,000 cells or more), an increased ESR, and positive blood cultures. Radiographic examination does not reveal the process until 5 to 10 days after the onset. A biopsy is not indicated with these symptoms.

The nurse is instructing the mother of a school-age child with a leg cast about cast care at home. What should the nurse include in this teaching? Select all that apply. Cover the cast with a plastic bag to bathe. Remind the mother that nothing is to be put down the cast. Recommend using magic markers for autographs. Use the cool setting on a hair dryer to ease itchy skin. Encourage usual activities but restrict strenuous actions.

Cover the cast with a plastic bag to bathe. Remind the mother that nothing is to be put down the cast. Use the cool setting on a hair dryer to ease itchy skin. Encourage usual activities but restrict strenuous actions. When teaching the mother about cast care at home, the nurse should include covering the cast with a plastic bag while bathing so the cast does not get wet; not placing anything down the cast; using the cool setting on a hair dryer to ease itching; and encourage usual activities but reducing strenuous activities while the cast is in place. Magic markers should not be used for autographs because the ink can seep into the cast material.

A nurse is conducting an assessment of a 13-month-old infant. The parent notes that the infant cannot pull oneself into a standing position. To help determine a cause, which assessment will the nurse conduct? Observe symmetry of gluteal skin folds. Perform a Weber test. Elicit a Babinski sign. Palpate the anterior fontanel (fontanelle).

Observe symmetry of gluteal skin folds. Explanation: An infant can pull oneself to a standing position generally by 10 months of age, and begins walking generally by 15 months of age. If these developmental milestones are not reached, then physical and neurologic symptoms should be assessed. One common physical reason for not standing or walking is developmental dysplasia of the hip (DDH). The nurse can easily assess if this is a contributing factor by observing the symmetry of the gluteal folds. If the folds are unequal, the finding should be reported to the health care provider for further evaluation. The Weber test is a test for hearing. The Babinski test determines neurologic impairment and would be present until 18 months of age. Assessing the anterior fontanel (fontanelle) would determine if it is closed prematurely or bulging, which indicates a neurological disorder.

The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child? Select all that apply. Any area on the cast that is warm to the touch A foul odor under the cast Any itching under or around the edges of the cast Drainage from under the cast Any pink color in the fingers or toes of casted extremity Looseness of the cast on the extremity

Any area on the cast that is warm to the touch A foul odor under the cast Drainage from under the cast Looseness of the cast on the extremity In addition to the five Ps, any foul odor or drainage on or under the cast, "hot spots" on the cast (areas warm to the touch), looseness or tightness, or any elevation of temperature must be noted, documented, and reported. Family caregivers should be instructed to watch carefully for these same danger signals. Itching is common and does not need to be reported. Pink coloration of fingers and toes would be normal and not a concern.

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? kyphosis lordosis idiopathic scoliosis sway back

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.

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? Impaired physical mobility related to a cast on the leg Deficient diversional activities related to a need for imposed activity restriction for 6 weeks Situational low self-esteem related to the use of a walker Pain related to chronic inflammation of the lower leg

Impaired physical mobility related to a cast on the leg Explanation: Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point? "The baby needs the harness only for 2 to 3 weeks." "It is important that the harness be worn continuously." "The harness does not hurt the baby." "Let me teach you how to make appropriate adjustments to the harness."

"It is important that the harness be worn continuously." Explanation: The baby will most likely wear the harness for 3 months. Telling the parents that the harness does not hurt the baby is appropriate, but stressing the importance of wearing the harness continuously is a higher priority to ensure proper care and effective treatment. Only the physician or nurse practitioner can make adjustments to the harness.

The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment? "At least when I take a shower I have a few minutes out of this brace." "I am so glad I can take this brace off for the school dance." Wearing this brace only during the night will not be so embarrassing." "When I start feeling tired, I can just take my brace off for a few minutes."

"At least when I take a shower I have a few minutes out of this brace." Explanation: The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. For curves 25-40 degrees the recommended treatment is bracing. The brace must be worn 23 hours per day. The child needs to be taught that the brace must be worn at all times, during the day as well as the night. Compliance, especially with adolescents, is difficult due to peer pressure. The other issues with compliance include being hot and being uncomfortable.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent herniation of a spinal disk, which is painful." "It is important to prevent torticollis."

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." Explanation: It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

A child has a chronic degenerative musculoskeletal condition. The parents are having difficulty providing personal care to the child. What education will the nurse provide this family? Select all that apply. "Obtain assistive devices to help with mobility." "Have the child participate by placing hygiene products within reach." "Start care after the child has rested for optimal muscle strength." "Set a goal for the child to be able to wash the face independently." "Teach your other children to help with care such as diaper changes."

"Obtain assistive devices to help with mobility." "Have the child participate by placing hygiene products within reach." "Start care after the child has rested for optimal muscle strength." Providing personal care to a child with a musculoskeletal chronic condition can be challenging because as the child's muscles deteriorate the more lifting and moving the caregivers will have to perform. In addition, the child grows in length and weight. Thus, as the child grows, the lifting is more challenging. The nurse should suggest assistive devices that could be helpful. The family should strive to allow the child to assist in care. This is best done when care is provided after the child rests and the products used are close to the child. Depending where the child is in the degenerative process, the goal of "independence" may not be achievable. The child's siblings may help with care, but the choices of care the siblings provide should not be actions that will affect the child's self-esteem or make the child feel more different than the siblings.

The nurse is reviewing the plan of care with the parents of a 1-year-old child undergoing the Ponseti method for the treatment of clubfoot. What statement will the nurse include in the teaching? "This method involves a cast being applied several times." "Daily stretching is needed." "Massaging of the foot will be performed by a physical therapist." "The foot will be taped into a molded plastic splint."

"This method involves a cast being applied several times." Explanation: The nurse will include the statement "This method involves a cast being applied several times," in the teaching, because this is a practice used in the Ponseti method. The statements, "Daily stretching is needed," "Massaging of the foot will be performed by a physical therapist," and "The foot will be taped into a molded plastic splint," should not be included in the teaching because these refer to the French functional physical therapy method, not the Ponseti method. The Ponseti method of clubfoot treatment is the preferred method of treatment with the highest success rate, and stretching, massaging the foot, and taping the foot into a molded splint are precluded by serial casting.

The nurse is conducting a neuromuscular assessment on a toddler. What assessment technique(s) is important for the nurse to include in this assessment? Select all that apply. Compare muscle strength and tone bilaterally. Observe for involuntary muscle contractions. Perform passive range-of-motion on all extremities. Assess the hips for extension and abduction. Observe the stepping reflex.

Compare muscle strength and tone bilaterally. Observe for involuntary muscle contractions. Perform passive range-of-motion on all extremities. Musculoskeletal development continues as the newborn grows. The newborn has all the ligaments, muscles, tendons and cartilage present at birth and they are functional, but the newborn does not have control over them. This comes with growth and age. It is important for the nurse to complete a musculoskeletal assessment at each clinic visit in the physical assessment. Thus, for this toddler, muscle strength and tone should be compared bilaterally. Strength is assessed by the toddler's ability to move muscles against gravity. This is done by the toddler pushing the feet against the nurse's hands or by grasp. The nurse will observe for involuntary muscle contractions. Involuntary contractions could indicate spasticity. Range-of-motion should be done to determine if a joint position is fixed. When assessing the hips, they should be flexed, abducted and externally rotated. The stepping reflex is seen when the infant is held upright and moves the legs as is stepping or walking. This reflex should be gone by about 2 months.

The nurse is instructing the mother of a school-age child with a leg cast about cast care at home. What should the nurse include in this teaching? Select all that apply. Cover the cast with a plastic bag to bathe. Remind the mother that nothing is to be put down the cast. Recommend using magic markers for autographs. Use the cool setting on a hair dryer to ease itchy skin. Encourage usual activities but restrict strenuous actions.

Cover the cast with a plastic bag to bathe. Remind the mother that nothing is to be put down the cast. Use the cool setting on a hair dryer to ease itchy skin. Encourage usual activities but restrict strenuous actions. Explanation: When teaching the mother about cast care at home, the nurse should include covering the cast with a plastic bag while bathing so the cast does not get wet; not placing anything down the cast; using the cool setting on a hair dryer to ease itching; and encourage usual activities but reducing strenuous activities while the cast is in place. Magic markers should not be used for autographs because the ink can seep into the cast material.

The nurse is preparing the adolescent with a left lower extremity cast for cast removal. What action(s) will the nurse take? Select all that apply. Inform the adolescent that the cast removal device is loud. State that lotion may be used to rehydrate the skin. Advise that the extremity may be smaller than before the cast was placed. Teach that the skin under the cast may be dry in appearance. Use the term "cast saw" as a developmentally appropriate descriptor of the cast removal device.

Inform the adolescent that the cast removal device is loud. State that lotion may be used to rehydrate the skin. Advise that the extremity may be smaller than before the cast was placed. Teach that the skin under the cast may be dry in appearance. The nurse should prepare the adolescent for cast removal by informing the adolescent that the cast removal device is loud, advising to use lotion to rehydrate the skin, and informing the adolescent that the limb may be smaller than before the cast was place and that the skin under the cast may be dry in appearance. These actions will prepare the adolescent for the cast removal process. The term "cast saw" should not be used, because this term may evoke images of a saw cutting the limb for the adolescent and parents.

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective? Inspect the child's skin for rashes, redness, irritation, or pressure injuries. Assess neurovascular status on the affected extremity once every shift. Gently massage the child's back to stimulate circulation. Keep the child's skin distal to the traction clean and dry.

Inspect the child's skin for rashes, redness, irritation, or pressure injuries. Explanation: It is important to be vigilant in inspecting the child's skin for rashes, redness, and irritation to uncover areas where pressure injuries are likely to develop. Applying lotion, gentle massage, and keeping the skin dry and clean are part of the routine skincare regimen. However, performing these interventions without first performing a skin assessment can cause the nurse to miss important signs that can potentially result in more injury to the child. Neurovascular assessment should be performed frequently as prescribed by the health care provider or at least every 4 hours to evaluate skin integrity and venous circulation.

The nurse is assessing a school-aged child at the emergency department. The child is limping and reports pain in the hip, groin, and knee. The symptoms worsened gradually over time. The health care provider has prescribed radiologic studies to assess for slipped capital femoral epiphysis (SCFE). What action will the nurse perform first? Instruct the parents and child to take weight off the affected leg. Provide the child with crutches. Prepare the child and family for surgery. Suggest developmentally appropriate activities that can be done while on bed rest.

Instruct the parents and child to take weight off the affected leg. Explanation: The nurse should instruct the parents and child to take the weight off the affected leg first, because putting weight on the leg could result in further injury. The use of crutches in the child with slipped capital femoral epiphysis (SCFE) is controversial and varies by health care provider preference; therefore, the nurse should not provide the child with crutches first. The diagnosis of SCFE is confirmed by radiologic studies, so the nurse should not yet prepare the child and family for surgery. While the nurse should suggest developmentally appropriate activities that can be done while on bed rest, this is not the first action the nurse should perform.

An 8-year-old child presents with the parent for a child visit: Kyphosis and protruding chest are notes, no inward curvature of the lower leg is present. The child exhibits weakness and difficulty walking and is afebrile with no localized areas of redness or swelling. Based on the chart note above, which therapy will the nurse anticipate in the plan of care for the child? vitamin D3 cefazolin pamidronate clindamycin

vitamin D3 Explanation: Based on the chart note, the nurse should anticipate therapy with vitamin D3, because the findings are consistent with rickets, a musculoskeletal disorder in which young bones fail to calcify. Vitamin D supports calcium metabolism by increasing calcium and phosphorus absorption. Cefazolin and clindamycin are antibiotics used in the treatment of infections such as osteomyelitis and would not be anticipated in the plan of care. Pamidronate would not be anticipated in the plan of care, because this is an agent used for the treatment of Blount disease, which is a disorder of the growth plate affecting the lower leg that causes inward curvature of the extremity.