Peds success ch.12 Orthopedic Disorders
the nurse is teaching an adolescent about ewing sarcoma and indicates which as a common site? a. shaft b. growth plate c. ball of the femur d. bone marrow
a
which is the definition of (talipes varus)? a. an inversion or bending inward of the foot b. an eversion or bending outward of the foot c. a high arch of the foot d. a turning in of the forefoot
a
which would be the best nursing intervention for a child with phantom pain after an amputation? a. tell the child that the pain does not exist b. request a PCA pump from the physician for pain management c. encourage the child to rub the stump d. provide amitriptyline (elavil) to help with pain
d
a spinal curve of less than ________ degrees that is nonprogressive does not require treatment for scoliosis.
20
a child is going to receive radiation for ewing sarcoma. which of the following is the best nursing intervention to prevent skin breakdown during therapy? a. advise the child to wear loose-fitting clothes to minimize irritation b. advise the child to use emollients to prevent dry skin c. apply cold packs nightly to reduce the warmth caused by the treatment d. apply hydrocortisone to soothe itching from dry skin
a
a nurse is caring for a 5 year old who has a fracture of the tibia involving the growth plate. when providing information to the parents, the nurse should indicate that: a. this is a serious injury that could cause long term growth issues b. the fracture usually heals within 6 weeks without further complications c. the child will never be able to play contact sports d. fractures involving the growth plate require pain medication
a
nursing care of an 8 year old with LCP disease should include: a. continuing to attend school b. continuing soccer practice c. learning to play several board games d. learning how to draw
a
the nurse is teaching about congenital clubfoot in infants. the nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? a. immediately after diagnosis b. at age 4 to 6 months c. prior to walking (age 9 to 12 months) d. after walking is established (age 15 to 18 months)
a
which nursing diagnosis is most important for a child with ewing sarcoma who will undergoing chemotherapy? a. risk for fluid volume deficit b. potential for chronic pain c. risk for skin impairment d. ineffective airway clearance
a
which would the nurse teach a patient when NSAIDs are prescribed for treating JIA? a. take with food b. take on an empty stomach c. blood levels are required for drug dosages d. good oral hygiene is needed
a
a 6 year old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. which is an early sign of compartment syndrome in this child? (select all that apply) a. edema b. numbness c. severe pain d. weak pulse e. annular rash
a and c
The nurse tells the parent that other conditions can be associated with congenital clubfoot. Select all that apply. a. myelomeningocele. b. cerebral palsy. c. diastrophic dwarfism. d. breech position in utero. e. prematurity. f. fetal alcohol syndrome.
a, b, c
which can occur in untreated DDH? (select all that apply) a. duck gait b. pain c. osteoarthritis in adulthood d. osteoporosis in adulthood e. increased flexibility of the hip joint in adulthood
a, b, c
the nurse on the pediatric floor is receiving a child with the possible diagnosis of septic arthritis of the elbow. which would the nurse expect on assessment? (select all that apply) a. resistance to bending the elbow b. nausea and vomiting c. fever d. bruising of the elbow e. swelling of the elbow f. a history of nursemaid's elbow as a toddler
a, b, c, e
which would the nurse assess in the child diagnosed with osteomyelitis? (select all that apply) a. unwillingness to move affected extremity b. severe pain c. fever d. previous closed fracture of an extremity e. redness and swelling at the site
a, b, c, e
a 13 year old just returned from surgery for scoliosis. which nursing intervention is appropriate in the first 24 hours? (select all that apply) a. assess for pain b. logroll to change positions c. get the teen to the bathroom 12 to 24 hours after surgery d. check neurological status e. monitor blood pressure
a, b, d, e
a 14 year old with OI uses a wheelchair. which nursing interventions will promote normal development? (select all that apply) a. encourage participation in groups with teens who have disabilities or chronic illnesses b. encourage decorating the wheelchair with stickers c. encourage transfer of primary care to an adult provider at age 18 years d. allow the teen to view the radiographs e. help the teen set realistic goals for the future f. discourage discussion of sexuality, because the child is not likely to date
a, b, d, e
nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes which of the following? (select all that apply) a. assess pain b. assess pulses c. elevate extremity above the level of the heart d. monitor capillary refill e. provide pain medication as needed
a, b, d, e
a 2 month old is noted to only turn his head partially to his right. which of the following is the best recommendation to the parent? (select all that apply) a. try two exercises every day b. keep the infant in a position of comfort c. refer to physical therapy d. place the infant in the crib so he has to turn away from the deformity e. switch holding arms at each formula feeding
d, e
where should the top of a crutch bar be in relation to the axilla?
should not put pressure on the nerves
A child with Ewing sarcoma is receiving chemotherapy and is experiencing severe nausea. The nurse has to administer Ativan at 0.04 mg/kg, and the child weighs 65 lb. What dose should the nurse administer?
1.2 mg
which should the nurse include in the teaching plan of a child who had surgery to correct bilateral clubfeet and had the casts removed? (select all that apply) a. "your child will need to wear a brace on the feet 23 hours a day for 12 months" b. "your child should see an orthopedic surgeon regularly until the age of 18 months" c. "your child will not be able to participate in sports that require a lot of running" d. "your child may have recurrence of clubfoot in a year or more" e. "most children treated for clubfoot develop feet that appear and function normally" f. "most children treated for clubfeet require surgery at puberty"
a, b, d, e
one nursing diagnosis for JIA is impaired physical mobility. which would be appropriate nursing interventions? (select all that apply) a. give pain medication prior to ambulation b. assist with range of motion activities c. encourage the child to eat a high fat diet d. provide oxygen as necessary e. use nonpharmacological methods, such as heat
a, b, e
which of the following applies to the care of a child with a retroperitoneal rhabdomyosarcoma? (select all that apply) a. acute pain b. risk for impaired urinary elimination c. impaired gas exchange d. self care deficit e. risk for constipation
a, b, e
the nurse caring for a child with osteomyelitis assesses poor appetite. which intervention is most appropriate for this child? (select all that apply) a. offer high calorie liquids b. offer favorite foods c. do not worry about intake, because appetite loss is expected d. suggest removal of the IV line to encourage oral intake e. decrease pain medication that might cause nausea f. offer frequent small meals
a, b, f
the female athlete triad consists of: a. amenorrhea, osteoporosis b. disordered eating, amenorrhea, osteoporosis c. pregnancy, disordered eating d. hyperthyroidism, pregnancy, weight loss
a, c, d
when planning a rehabilitative approach for a child with OI, the nurse should prevent which of the following? (select all that apply) a. positional contractures or deformities b. bone infection c. muscle weakness d. osteoporosis e. misalignment of lower extremity joints
a, c, d, e
which factor is associated with SCFE? (select all that apply) a. obesity b. female c. family history of SCFE d. age of 5 to 9 years e. pubertal hormonal changes f. endocrine disorders
a, c, e, f
which instruction should the nurse give the parents of an adolescent with SCFE? (select all that apply) a. continue upper body exercises to limit loss of muscle strength b. do not turn the teen in bed when complaining of pain c. provide homework, computer games, and other activities to decrease boredom d. do most activities of daily living for the teen e. expect expressions of anger and hostility f. continue setting limits on behavior
a, c, e, f
after the birth of an infant with clubfoot, the nursery nurse should do which of the following when instructing the parents? (select all that apply) a. speak in simple language about the defect b. avoid the parents unless providing direct care so that they can grieve privately c. keep the infant's feet covered at all times d. present the infant as precious; emphasize the well formed parts of the body e. tell the parents that defects could be much worse f. be prepared to answer questions multiple times
a, d, f
A child with Ewing sarcoma is undergoing a limb salvage procedure. Which statement indicates the parents understand the procedure? a. "Our child will have a bone graft to save the limb." b. "Our child will need follow-up lengthening procedures." c. "Our child will need shorter shirt sleeves." d. "Our child will not need chemotherapy."
b
a 9 year old is in a spica cast and complains of pain 1 hour after receiving IV opioid analgesia. what should the nurse do first? a. give more pain medication b. perform a neuromuscular assessment c. call the surgeon for orders d. change the child's position
b
a child with osteosarcoma is going to receive chemotherapy before surgery. which statement by the parents indicates they understand the side effect of neutropenia? a. "my child will be more at risk for diarrhea" b. "my child will be more at risk for infection" c. "my child's hair will fall out" d. "my child will need to drink more"
b
it is recommended that a child with metastatic rhabdomyosarcoma undergo a bone marrow transplant. education regarding life-threatening side effects should include: a. diarrhea b. fever c. skin breakdown d. tumor shrinkage
b
the parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. which is the nurse's best response? a. "direct inoculation of the bone from stepping barefoot on a sharp stick" b. "an infection from a scratched mosquito bite carried the infection through the blood stream to the bone" c. "the blood supply to the bone was disrupted because of the child's diabetes" d. "an infection of the upper respiratory tract"
b
when are chemotherapeutic agents such as methotrexate (trexall) and cyclophosphamide (cytoxan) sometimes used to treat JIA? these agents: a. are effective against cancer like JIA b. suppress the immune system c. are similar to NSAIDs d. are absorbed into the synovial fluid
b
which classification of OI is lethal in utero and in infancy? a. type 1 b. type 2 c. type 3 d. type 4
b
which is most important when teaching a parent about preventing osteomyelitis? a. parents can stop worrying about bone infections once their child reaches school age b. parents need to clean open wounds thoroughly with soap and water c. children will always get a fever if they have osteomyelitis d. children should wear long pants when playing outside because their legs might get scratched
b
the nurse is weighing a 1 month old and notices the left side of the head is flatter than the right. which is the best advice to give the parent? (select all that apply) a. lay the infant on his right side b. this will self-correct in time c. refer now to physical therapy d. your baby will need to wear a helmet
b, c, d
when a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? (select all that apply) a. pain medication is contraindicated so that symptoms are not masked b. blood cultures will be obtained c. pus will be aspirated from the subperiosteum d. an IV line with antibiotics will be started e. surgery will be necessary
b, c, d
when counseling the parents of a child with OI, the nurse should include which of the following? (select all that apply) a. discourage future children because the condition is inherited b. provide education about the child's physical limitations c. give the parents a letter signed by the primary care provider explaining OI d. provide information on contacting the Osteogenesis Imperfecta Foundation e. encourage the parents to treat the child like their other children f. encourage use of calcium to decrease risk of fractures
b, c, d
A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long? a. pain from the brace. b. difficulty in putting the brace on. c. self-consciousness about appearance. d. not understanding what the brace is for.
c
Select the number of inches lateral to the heel where a crutch should be placed. a. 1 to 3. b. 4 to 5. c. 6 to 8. d. 9 to 10.
c
The nurse expects the blood culture report of an 8-year-old with septic arthritis to grow which causative organism? a. streptococcus pneumoniae. b. escherichia coli. c. staphylococcus aureus. d. neisseria gonorrhoeae.
c
The parent of a 3-week-old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? a. give pain medication. b. reposition the infant in the crib. c. check the neurocirculatory status of the foot. d. use a cool blow-dryer to blow into the cast to control itching.
c
a 10 year old with osteomyelitis has been on IV antibiotics for 48 hours. the child is allergic to amoxicillin. vital signs are T 101.8F, BP 100/60, P 96, R 24. which is the primary reason for surgical treatment? a. young age b. drug allergies c. nonresponsive to IV antibiotics d. health care provider preference
c
a child is diagnosed with stage IV rhabdomyosarcoma, and the parent asks what that means. the nurse provides which of the following explanations? a. the tumor is limited to the organ site b. there is regional disease form the organ involved c. there is distant metastatic disease d. the disease is limited to the lymph nodes
c
the nurse evaluates teaching as successful when the parent explains that an excisional biopsy is done for which reason? a. to find metastatic disease b. to remove all metastatic disease c. to confirm the type of metastatic disease d. to treat metastatic disease
c
the nurse is explaining rhabdomyosarcoma cancer to an adolescent. from which of the following muscles does the cancer arise? a. skeletal b. cardiac c. striated d. connective
c
when instructing a family about care of an orthosis, the nurse should emphasize which of the following? a. clean the brace with diluted bleach b. dry the brace over a heater or in the sun c. clean the brace weekly with mild soap and water d. return the brace to the orthopedic surgeon for cleaning
c
which is the most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? a. pain b. spirituality c. body image d. lack of coping
c
which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of JIA? a. fat loss b. adrenal stimulation c. immune suppression d. hypoglycemia
c
which would the nurse expect to assess on a 3 week old infant with DDH? (select all that apply) a. excessive hip abduction b. femoral lengthening of an affected leg c. asymmetry of gluteal and thigh folds d. pain when lying prone e. positive ortolani test
c and e
which should be included in teaching a family about postsurgical care for SCFE? (select all that apply) a. the client will receive help with weight bearing ambulation 24 to 48 hours after surgery b. monitoring of pain medication to prevent drug dependence c. instruction on pin site care d. offering low calorie meals to encourage weight loss e. correct use of crutches by client f. exercises to strengthen hip and leg muscles
c, e, f
a child has been diagnosed with LCP disease. the initial treatment is: a. IV antibiotics b. high dose steroids c. increased activity d. rest and non-weight bearing
d
the nurse is teaching the parent of a child newly diagnosed with JIA. the nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: a. breakdown of osteoclasts in the joint space causing bone loss b. loss of cartilage in the joints c. buildup of calcium crystals in joint spaces d. immune-stimulated inflammatory response in the joint
d
when teaching parents about osteosarcoma, the nurse knows instructions has been successful when a parent says that this type of cancer is common in which age group? a. infants b. toddlers c. school age children d. adolescents
d
which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is? a. it is a fracture located in the growth plate of the bone b. because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture c. it is a fracture in which a complete break occurs in the bone, and small pieces of bone are broken off d. it is a fracture that does not go all the way through the bone
d
which should be obtained to make a diagnosis of SCFE? a. a history of hip trauma b. a physical examination of hip, thigh, and knees c. a complete blood count d. a radiographic examination of the hip
d
which should the nurse stress to the parents of an infant in a pavlik harness for treatment of DDH? a. put socks on over the foot pieces of the harness to help stabilize the harness b. use lotions or powder on the skin to prevent rubbing of straps c. remove harness during diaper changes for ease of cleaning diaper area d. check under the straps for at least two to three times daily for red areas
d