12 PEDIATRIC SUCCESS ORTHOPEDIC DISORDERS

16. The nurse expects the blood culture report of an 8-year-old with septic arthritis to grow which causative organism? 1. Streptococcus pneumoniae. 2. Escherichia coli. 3. Staphylococcus aureus. 4. Neisseria gonorrhoeae.

3. S. aureus is a common organism found on the skin and is frequently the cause of septic arthritis.

48. A child is diagnosed with stage IV rhabdomyosarcoma, and the parent asks what that means. The nurse provides which of the following explanations? 1. The tumor is limited to the organ site. 2. There is regional disease from the organ involved. 3. There is distant metastatic disease. 4. The disease is limited to the lymph nodes.

3. Stage IV disease means there is distant metastatic disease.

53. Which of the following would the nurse teach the adolescent is a complication of corticosteroids used in the treatment of JRA? 1. Fat loss. 2. Adrenal stimulation. 3. Immune suppression. 4. Hypoglycemia.

3. Steroids cause immune suppression, which is the reason behind its use in JRA; it reduces the body's attack on itself.

47. The nurse is explaining about rhabdomyosarcoma cancer to an adolescent. From which of the following muscles does the cancer arise? 1. Skeletal. 2. Cardiac. 3. Striated. 4. Connective.

3. Striated muscle is in many organs and sites of the body, thus leading to the multiple sites of the disease.

40. The best nursing intervention for a child with phantom pain after an amputation would be which of the following? 1. Tell the child that the pain does not exist. 2. Request a PCA pump from the physician for pain management. 3. Encourage the child to rub the stump. 4. Provide Elavil to help with pain.

4. Elavil is a medication for nerve pain that is helpful with relieving phantom pain.

10. Which of the following factors are associated with SCFE / Slipped capital femoral epiphysis? Select all that apply. 1. Obesity. 2. Female gender. 3. African descent. 4. Age of 5 to 10 years. 5. Pubertal hormonal changes. 6. Endocrine disorders.

10. 1. Obesity increases the risk of SCFE by stressing the physeal plate. 5. SCFE is most common during pubertal hormone changes. 6. SCFE is associated with endocrine disorders.

59. Which of the following is an important nursing intervention to teach about photo sensitivity to the parents of a child with Systemic lupus erythematosus? 1. Regular clothing is appropriate for sun exposure. 2. Sunscreen application is necessary for protection. 3. Teenage patients cannot participate in outdoor sports. 4. Water is important to reduce sensitivity.

2. Sunscreen helps reduce accelerated burning due to sensitivity.

58. A child is admitted to the pediatric unit with the diagnosis of Systemic lupus erythematosus. On assessment, the nurse expects the child to have: 1. Leukemia. 2. Malar rash. 3. Weight gain. 4. Heart failure.

2. The "butterfly," or malar, rash is the most common manifestation of SLE.

64. The parent of a toddler asks the nurse to define greenstick fracture. Which of the following is the nurse's best explanation? 1. It is a fracture located in the growth plate of the bone. 2. Because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture. 3. It is a fracture in which a complete break occurs in the bone, and small pieces of bone are broken off. 4. It is a fracture that does not go all the way through the bone.

4. It is a fracture that does not go all the way through the bone.

55. Chemotherapeutic agents such as methotrexate and cyclophosphamide are sometimes used to treat Juvenile rheumatoid arthritis. Why are these medications used? 1. Effective against cancer, like JRA. 2. Affect the immune system. 3. Are similar to NSAIDs. 4. Are absorbed into the synovial fluid.

2. These drugs affect the immune system to reduce its ability to attack itself, as in the case of JRA.

8. A pregnant mother is told her fetus has OI /osteogenesis imperfecta . Which of the following classifications of osteogenesis imperfecta is lethal in utero and in infancy? 1. Type I. 2. Type II. 3. Type III. 4. Type IV.

2. Type II is lethal in utero and in infancy because of multiple fractures and deformities and underdeveloped lungs.

20. Which parts of the body should the nurse assess on a child in a spica cast? See the following figure, and use the relevant label(s). A. Neck B. Arm C. Leg D. Ankle/Feet

20. C, D. The nurse needs to assess areas under the cast for drainage through the cast and assess neurocirculatory status of the feet.

22. Where should the top of the crutch bar be in relation to the axilla?

22. The crutch bar should not put pressure on nerves in the axilla.

39. A 13-year-old with osteosarcoma is going to have an amputation of the affected limb. Which of the following is most important to discuss with a teenage patient? 1. Pain. 2. Spirituality. 3. Body image. 4. Lack of coping.

3. Body image is a developmental issue for adolescents and influences their ac ceptance of themselves and by peers.

18. 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 of the following interventions should the nurse suggest the parent do first? 1. Give pain medication. 2. Reposition the infant in the crib. 3. Check the neurocirculatory status of the foot. 4. Use a cool blow-dryer to blow into the cast to control itching.

3. Checking the neurocirculatory status of the foot is the highest priority.

27. 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 duration? 1. Pain from the brace. 2. Difficulty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.

3. Children this age are very conscious of their appearance and of fitting in with their peers, so they might be very resistant to wearing a brace.

15. A 10-year-old with osteomyelitis has been on intravenous antibiotics for 48 hours. The child is allergic to amoxicillin. Vital signs are: T 101.8°F (38.8°C), BP 100/60, P 96, R 24. Which of the following is the primary reason for surgical treatment? 1. Young age. 2. Drug allergies. 3. Nonresponse to intravenous antibiotics. 4. Physician preference.

3. If a patient does not respond to an appropriate antibiotic within 48 hours, surgery may be indicated. This is the correct answer.

1. The nurse is assessing a 2-week-old for signs of DDH / Developmental Dysplasia of the Hip. The nurse should expect the infant to have which of the following? 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone.

3. In DDH, asymmetrical thigh and gluteal folds are frequently present.

52. The nurse is teaching the parent of a child newly diagnosed with JRA. The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by: 1. The breakdown of osteoclasts in the joint space causing bone loss. 2. The loss of cartilage in the joints. 3. The buildup of calcium crystals in joint spaces. 4. The immune-stimulated inflammatory response in the joint.

4. JRA is caused by an immune response by the body on the joint spaces.

37. When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age group? 1. Infancy. 2. Toddlers. 3. School-age children. 4. Adolescents.

4. Osteosarcoma is a common cancer of adolescents.

60. Renal involvement is a side effect of latent Systemic lupus erythematosus. Which of the following is an important nursing intervention to monitor in a child with renal involvement? 1. Push fluids or start IVF. 2. Check for uric salts in urine. 3. Watch for hypotension. 4. Check for protein in urine.

4. Protein in urine is a sign of renal impairment, even in nephrotic syndrome, in which the kidneys are losing protein.

11. Which of the following should be performed to make a diagnosis of SCFE / Slipped capital femoral epiphysis? 1. A history of hip trauma. 2. A physical examination of hip, thigh, and knees. 3. A complete blood count. 4. A radiographic examination of the hip.

4. Radiographic examination is the only definitive diagnostic tool for SCFE.

41. Use the following labels to name places on the bone 1. Epiphysis. 2. Diaphysis. 3. Epiphyseal plate. 4. Medullary cavity. 5. Calcaneus bone. 6. Compact bone.

41. Calcaneus bone Epiphysis Diaphysis Epiphyseal plate Medullary cavity Compact bone

42. The nurse is teaching an adolescent about Ewing sarcoma and indicates which of the following as a common site? 1. Shaft. 2. Growth plate. 3. Ball of the femur. 4. Bone marrow.

42. 1. Ewing sarcoma is a bone tumor that affects the shafts of long bones.

43. Which of the following nursing diagnoses is most important for a child with Ewing sarcoma who will be undergoing chemotherapy? 1. Risk for fluid volume deficit. 2. Potential for chronic pain. 3. Risk for skin impairment. 4. Ineffective airway clearance.

43. 1. Chemotherapy can cause nausea, vomiting, and possibly diarrhea, which contribute to fluid volume deficit.

44. 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? 1. Advise the child to wear loose-fitting clothes to minimize irritation. 2. Advise the child to use emollients to prevent dry skin. 3. Apply cold packs nightly to reduce the warmth caused by the treatments. 4. Apply hydrocortisone to soothe itching from dry skin.

44. 1. Loose clothing helps reduce irritation on the sensitive irradiated skin.

46. 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? __________________

46. 1.1 mg. Change pounds to kilograms (2.2 lb 1 kg: 65/2.2 29.5 kg). Then multiply kilograms by the dose of 0.04 mg/kg: 29.5 0.04 1.1 mg.

5. A parent asks the nurse to define talipes varus. The nurse tells the parent that it is which of the following? 1. An inversion or bending inward of the foot. 2. An eversion or bending outward of the foot. 3. A high arch of the foot. 4. A low arch (flatfoot) of the foot.

5. 1. Talipes varus is an inversion of the foot.

51. You are caring for a child with a retroperitoneal rhabdomyosarcoma. Select all the nursing diagnoses that apply. 1. Acute pain. 2. Risk for impaired urinary elimination. 3. Impaired gas exchange. 4. Self-care deficit. 5. Risk for constipation.

51. 1. Pain occurs due to pressure on the organs in the lower abdomen. 2. A retroperitoneal tumor affects the organs of the lower abdomen, including the bowel and bladder. 5. Because this tumor is in the lower abdomen, it puts pressure on the bowel causing constipation.

54. Which of the following would the nurse teach a patient when NSAIDs are prescribed for treating Juvenile rheumatoid arthritis? 1. Take with food. 2. Take on an empty stomach. 3. Blood levels are required for drug dosages. 4. Good oral hygiene is needed.

54. 1. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining.

7. When planning a rehabilitative approach for a child with osteogenesis imperfecta, the nurse should prevent which of the following? Select all that apply. 1. Positional contractures and deformities. 2. Bone infection. 3. Muscle weakness. 4. Osteoporosis.

7. 1. A long-term goal in caring for a patient with OI is to prevent contractures and deformities. 3. A long-term goal in caring for a patient with OI is to prevent muscle weakness. 4. A long-term goal in caring for a patient with OI is to prevent osteoporosis.

Epiphysis of bone

Expanded ends of bones. Spongy bone interior. Contains articular cartilage.

Compact Bone

Hard, dense bone tissue that is beneath the outer membrane of a bone

Calcaneus bone

heel bone

Diaphysis of bone

shaft

12. Which of the following should be included in teaching a family about postsurgical care for SCFE / Slipped capital femoral epiphysis? Select all that apply. 1. The patient will receive help with weight-bearing ambulation 24 to 48 hours after surgery. 2. Monitoring of pain medication to prevent drug dependence. 3. Instruction on pin site care. 4. Offering low-calorie meals to encourage weight loss. 5. Correct use of crutches by the patient. 6. Outpatient physical therapy for 6 to 8 weeks.

12. 3. The parents will be assessing pin site for infection and stability upon dis charge. Instructions on care should be demonstrated for and then by the parents. 5. Instruction on crutch usage will be given prior to discharge. Crutch walk ing will not be done during the early postoperative stage.

13. Which of the following would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply. 1. Unwillingness to move affected extremity. 2. Severe pain. 3. Fever. 4. Following a closed fracture of an extremity. 5. Redness and swelling at the site.

13. 1. Pain in an extremity leads to resistance to movement. 2. Pain is frequently severe in osteomyelitis. 3. Fever is present in the acute phase of the illness. 5. Redness and swelling occur because of the infection.

17. A 15-year-old is immobilized after SCFE / Slipped capital femoral epiphysis surgery. Which of the following instructions should the nurse give the parents? Select all that apply. 1. Continue upper body exercises to decrease loss of muscle strength. 2. Do not turn the teen in bed when complaining of pain. 3. Provide homework, computer games, and other activities to decrease boredom. 4. Do most activities of daily living for the teen. 5. Expect expressions of anger and hostility. 6. Continue setting limits on behavior.

17. 1. Immobilization can lead to a decrease in muscle strength. Upper body exer cises should be continued soon after surgery. 3. It is important for this patient to con tinue as many normal activities as possible. This should include school work and leisure activities. 5. Some expressions of anger and hostil ity are normal, as this adolescent is losing some independence with this immobility. 6. Continuation of setting limits on behavior is important to keep as much normalcy as possible.

19. A child has had surgery to correct bilateral clubfeet, and the cast has been removed. While instructing the parents about their child's future, the nurse should include which of the following statements? Select all that apply. 1. "Your child will need to wear a brace on the feet 23 hours a day for at least 2 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 3. "Your child will not be able to participate in sports that require a lot of running." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally." 6. "Most children treated for clubfeet require surgery at puberty."

19. 1. After the final casting, bracing is required for 23 to 24 hours per day for 2 months. This decreases the likelihood of a recurrence. 2. Because clubfoot can recur, it is impor tant to have regular follow-up with the orthopedic surgeon until age 18 years. 4. Even with proper bracing, there may be a recurrence. 5. Most children treated for clubfeet develop normally appearing and functioning feet.

24. Which of the following is most important when teaching a parent about preventing osteomyelitis? 1. Parents can stop worrying about bone infection once their child reaches school age. 2. Parents need to clean open wounds thoroughly with soap and water. 3. Children will always get a fever if they have osteomyelitis. 4. Children should wear long pants when playing outside because their legs might get scratched.

2. Because bacteria from an open wound can lead to osteomyelitis, thorough cleaning with soap and water is the best prevention.

21. When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply. 1. Pain medication is contraindicated so that symptoms are not masked. 2. Blood cultures will be obtained. 3. Pus will be aspirated from the subperiosteum. 4. An intravenous line with antibiotics will be started. 5. Surgery will be necessary.

2. Blood cultures will be obtained. 3. Pus will be aspirated from the subperiosteum. 4. Antibiotics will be given via an intravenous line.

61. Because estrogen is a possible trigger for a Systemic lupus erythematosus flare, advice for a teenager who may become sexually active includes which of the following. Select all that apply. 1. Use Ortho Tri-Cyclen. 2. Use Depo-Provera. 3. Practice abstinence. 4. Use condoms. 5. Become pregnant. 6. Use Ortho Evra.

2. Depo-Provera is progesterone, the only contraceptive that is approved for use. 3. Abstinence is always recommended to prevent pregnancy. 4. Condoms are always recommended.

50. It is recommended that a child with metastatic rhabdomyosarcoma undergo a bone marrow transplant. Education regarding life-threatening side effects should discuss: 1. Diarrhea. 2. Fever. 3. Skin breakdown. 4. Tumor shrinkage.

2. Fever indicates infection that can be life-threatening after a bone marrow transplant.

14. The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. What is the nurse's best response? 1. "Direct inoculation of the bone from stepping barefoot on a sharp stick." 2. "An infection from a scratched mosquito bite carried the infection through the bloodstream to the bone." 3. "The blood supply to the bone was disrupted because of the child's diabetes." 4. "An infection of the upper respiratory tract."

2. Infection through the bloodstream is the most likely cause of osteomyelitis in a child.

45. A child with Ewing sarcoma is undergoing a limb salvage procedure. Which of the following statements indicates the parents understand the procedure? 1. "Our child will have a bone graft to save the limb." 2. "Our child will need follow-up lengthening procedures." 3. "Our child will need shorter shirt sleeves." 4. "Our child will not need chemotherapy."

2. Limb salvage requires the lengthening procedures to encourage the bone to continue to grow so the child will not have a short limb.

38. A child with osteosarcoma is going to receive chemotherapy before surgery. Which of the following statements by the parents indicates they understand the side effect of neutropenia? 1. "My child will be more at risk for diarrhea." 2. "My child will be more at risk for infection." 3. "My child's hair will fall out." 4. "My child will need to drink more."

2. Neutropenia makes a patient more at risk for infection, because the immune system is compromised due to the chemotherapy.

30. A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do first? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Tell the child to wait another hour for the medication to work.

2. The nurse looks for the source of the pain by performing a neuromuscular assessment.

9. When counseling the parents of a child with osteogenesis imperfecta, the nurse should do which of the following? Select all that apply. 1. Discourage future children, because the condition is inherited. 2. Provide education about the child's physical limitations. 3. Give the parents a letter signed by the primary care provider explaining osteogenesis imperfecta . 4. Provide information on contacting the Osteogenesis Imperfecta Foundation. 5. Encourage the parents to treat the child like their other children. 6. Encourage use of calcium to decrease risk of fractures.

2. The nurse should provide education about the child's physical limitations so that physical therapy and appropriate activity can be encouraged. 3. OI is frequently confused with child abuse. Carrying a letter stating that the child has OI and what that condition looks like can ease the stressors of an emergency department visit. 4. Osteogenesis Imperfecta Foundation is an organization that can provide infor mation and support for a family with a child with the condition.

25. The nurse caring for a child with osteomyelitis assesses poor appetite. Which of the following interventions are most appropriate for this child? Select all that apply. 1. Offer high-calorie liquids. 2. Offer favorite foods. 3. Do not worry about intake, as appetite loss is expected. 4. Suggest intravenous removal to encourage oral intake. 5. Decrease pain medication that might cause nausea. 6. Offer frequent small meals.

25. 1. High-calorie liquids are sometimes re ceived better when the child has a poor appetite. 2. Offering favorite foods can sometimes tempt the child to eat, even with a poor appetite. 6. Small, frequent meals might increase daily caloric intake.

26. The nurse on the pediatric floor is receiving a child with the possible diagnosis of septic arthritis of the elbow. Which of the following would the nurse expect on assessment? Select all that apply. 1. Resistance to bending the elbow. 2. Nausea and vomiting. 3. Fever. 4. Bruising of the elbow. 5. Swelling of the elbow. 6. A history of nursemaid's elbow as a toddler.

26. 1. Infection of the elbow joint can cause pain that leads to protecting the joint and resisting movement. 2. Infection of the elbow may cause generalized nausea and vomiting. 3. Infection of the elbow frequently causes fever. 5. Septic arthritis can cause swelling of the joint.

28. A spinal curve of less than _________degrees that is nonprogressive does not require treatment for scoliosis.

28. 20. A 20-degree spinal curve that is non progressive will not disfigure or interfere with normal functioning, so it is not treated with bracing or surgery.

29. A 13-year-old just returned from surgery for scoliosis. What nursing interventions are appropriate in the first 24 hours? Select all that apply. 1. Assess for pain. 2. Logroll to change positions. 3. Get the teen to the bathroom 12 to 24 hours after surgery. 4. Check neurological status. 5. Monitor blood pressure.

29. 1. General postoperative nursing inter ventions include assessing for pain. 2. Specific to scoliosis surgery, logrolling is the means of changing positions. 4. It is essential to check neurological status in a patient who just had scoliosis surgery. 5. General postoperative nursing inter ventions include assessing vital signs.

3. Which of the following conditions can occur in untreated DDH / Developmental Dysplasia of the Hip? Select all that apply. 1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. 4. Osteoporosis in adulthood. 5. Increased flexibility of the hip joint in adulthood.

3. 1. Due to abnormal hip joint function, the patient's gait is stiff and waddling. 2. Due to abnormal femoral head place ment, the patient may experience pain and decreased flexibility in adulthood. 3. Due to abnormal femoral head place ment, the patient may experience os teoarthritis in the hip joint in adulthood.

35. What condition is the pavlik harness used for_________________

35. It is used for DDH / Developmental Dysplasia of the Hip. The Pavlik harness is used to treat DDH in neonates.

49. The nurse evaluates teaching as successful when the parent explains that an excisional biopsy is done to do which of the following? 1. To find metastatic disease. 2. To remove all metastatic disease. 3. To confirm the type of metastatic disease. 4. To treat metastatic disease.

3. A biopsy confirms the histology of the tumor.

36. When instructing a family about care of an orthosis, the nurse should emphasize which of the following? 1. Clean the brace with diluted bleach. 2. Dry the brace over a heater or in the sun. 3. Clean the brace weekly with mild soap and water. 4. Return the brace to the orthopedic surgeon for cleaning.

3. An orthosis should be cleaned weekly with mild soap and water.

23. Select the numbers of inches lateral to the heel where a crutch should be placed. 1. 1 to 3. 2. 4 to 5. 3. 6 to 8. 4. 9 to 10.

3. This position provides the best protection for balance and stability.

31. A 14-year-old with osteogenesis imperfecta is confined to a wheelchair. Which nursing interventions will promote normal development? Select all that apply. 1. Encourage participation in groups with teens who have disabilities or chronic illness. 2. Encourage decorating the wheelchair with stickers. 3. Encourage transfer of primary care to an adult provider at age 18 years. 4. Allow the teen to view the radiographs. 5. Help the teen set realistic goals for the future. 6. Discourage discussion of sexuality, as the child is not likely to date.

31. 1. This patient is trying to become more independent and trying to fit in with the peer group. Encouraging socializ ing with peers who face similar chal lenges alleviates feelings of isolation. 2. Decorating the wheelchair encourages the patient to assume independence in self-care. 4. Allowing the patient to view radi ographs encourages the patient to assume self-care. 5. Helping the patient set realistic goals for the future encourages independence.

32. 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. 1. Speak in simple language about the defect. 2. Avoid the parents unless providing direct care so they can grieve privately. 3. Keep the infant's feet covered at all times. 4. Present the infant as precious; emphasize the well-formed parts of the body. 5. Tell the parent that defects could be much worse. 6. Be prepared to answer questions multiple times.

32. 1. The parents will likely be shocked immediately after the birth of the child. To facilitate their understanding, the nurse should speak in simple terms. 4. The baby should be shown to the parents like all newborns, emphasiz ing the well-formed parts of the body. 6. Information may need to be repeated as the family begins to absorb the information.

33. The nurse should be suspicious of what condition in the following figure?_________________________________________________________________

33. DDH /Developmental Dysplasia of the Hip . The asymmetry of the thigh folds suggests DDH.

34. Name the harness in the following figure.________________________________

34. Pavlik harness. The Pavlik harness is used to treat DDH / Developmental Dysplasia of the Hip diagnosed in the newborn period.

4. 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? 1. Immediately after diagnosis. 2. At age 4 to 6 months. 3. Prior to walking (age 9 to 12 months). 4. After walking is established (age 15 to 18 months).

4. 1. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made.

2. An infant is in a Pavlik harness for treatment of DDH / Developmental Dysplasia of the Hip. While instructing the parents on preventing skin breakdown, the nurse should stress which of the following? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.

4. Checking under straps frequently is suggested to prevent skin breakdown.

56. One nursing diagnosis for Juvenile rheumatoid arthritis is impaired physical mobility. Select all nursing interventions that apply. 1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 3. Encourage the child to eat a high-fat diet. 4. Provide oxygen as necessary. 5. Use nonpharmacological methods, such as heat.

56. 1. Providing pain medication prior to ambulation helps decrease pain during ambulation. 2. Children with JRA need to do range of-motion exercises to prevent joint stiffness. 5. Using nonpharmacological methods such as heat helps with flexibility and pain.

57. The nurse is teaching the parent of a child diagnosed with SLE / Systemic lupus erythematosus. The nurse evaluates the teaching as effective when the parent states: 1. "The cause is unknown." 2. "There is no genetic involvement." 3. "Drugs are not a trigger for the illness." 4. "Antibodies improve disease outcome."

57. 1. SLE / Systemic lupus erythematosus is a complex disease; there are many triggers, but how the disease develops is not known.

6. The nurse tells the parent that other conditions can be associated with congenital clubfoot? Select all that apply. 1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol syndrome.

6. 1. There is an association between myelomeningocele and congenital clubfoot. 2. There is an association between some forms of cerebral palsy and congenital clubfoot. 3. There is an association between dia strophic dwarfism and congenital clubfoot.

62. A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which of the following are early signs of compartment syndrome in this child? Select all that apply. 1. Edema. 2. Numbness. 3. Severe pain. 4. Weak pulse. 5. Anular rash

62. 1. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 2. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 3. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 4. A weak pulse is a late sign of compart ment syndrome.

63. 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. 1. Assess pain. 2. Assess pulses. 3. Elevate extremity above the level of the heart. 4. Monitor capillary refill. 5. Provide pain medication as needed.

63. 1. In a recent fracture, the nurse should assess pain and provide treatment. 2. Pain, pallor, and weak or absent pulses are all signs of compartment syndrome. 4. Weak or absent pulse is a sign of compartment syndrome, so monitoring capillary refill is important in assessment. 5. Pain, pallor, and weak or absent pulses are signs of compartment syndrome. Pain should be treated.

65. 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: 1. This is a serious injury that could cause long-term growth issues. 2. The fracture usually heals within 6 weeks without further complications. 3. The child will never be able to play contact sports. 4. Fractures involving the growth plate require pain medication.

65. 1. Fractures of the growth plate are serious, as they can disrupt the growth process.

Epiphyseal Plate of bone

cartilage layer between epiphysis and diaphysis

Medullary Cavity

central cavity located in the shaft of a long bone and is surrounded by compact bone