ch.46 practice questions
471. The nurse is assisting a health care provider (HCP) examining an infant with developmental dysplasia of the hip perform an Ortolani maneuver. The nurse understands that this maneuver is performed for which purpose? 1.To assess for hip instability 2.To assess for movement of the hips 3.To push the femoral head out of the acetabulum 4.To ensure that hyperextension and full range of motion exist
1 In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Ortolani's maneuver is a test to assess for hip instability. The examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A "clicking" sensation indicates a dislocated femoral head moving into the acetabulum. This maneuver does not assess for hip movement or ensure that hyperextension and full range of motion exist. Pushing the femoral head out of the acetabulum is not the purpose of Ortolani's maneuver.
472. A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition? 1.Limited range of motion in the affected hip 2.An apparent lengthened femur on the affected side 3.Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 4.Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table
1. In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical and restricted abduction of the affected hip, when the child is placed supine with the knees and hips flexed, would be an assessment finding in developmental dysplasia of the hip in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.
The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? Select all that apply. 1.Use the fingertips to lift the cast while it is drying. 2.Keep small toys and sharp objects away from the cast. 3.Use a padded ruler or another padded object to scratch the skin under the cast if it itches. 4.Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold. 5.Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling. 6.Contact the health care provider (HCP) if the child complains of numbness or tingling in the extremity.
2,5,6 While the cast is drying, the palms of the hands are used to lift the cast. If the fingertips are used, indentations in the cast could occur and cause constant pressure on the underlying skin. Small toys and sharp objects are kept away from the cast, and no objects (including padded objects) are placed inside the cast because of the risk of altered skin integrity. The extremity is elevated to prevent swelling, and the HCP is notified immediately if any signs of neurovascular impairment develop. A heating pad is not applied to the cast or fingers. Cold fingers could indicate neurovascular impairment, and the HCP should be notified.
A 4-year-old child sustains a fall at home and after an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further instruction? 1."The cast may feel warm as the cast dries." 2."I can use lotion or powder around the cast edges to relieve itching." 3."A small amount of white shoe polish can touch up a soiled white cast." 4."If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast."
2. Teaching about cast care is essential to prevent complications from the cast. The parents need to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast. Lotions or powders can become sticky or caked and cause skin irritation. Options 1, 3, and 4 are appropriate statements.
473. Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? 1."Treatment needs to be started as soon as possible." 2."I realize my infant will require follow-up care until fully grown." 3."I need to bring my infant back to the clinic in 1 month for a new cast." 4."I need to come to the clinic every week with my infant for the casting."
3 Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; the defect may be unilateral or bilateral. Treatment for clubfoot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved in 3 to 6 months, surgery usually is indicated. Because clubfoot can recur, all children with clubfoot require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome.
The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse should make which response? 1."Avoid all exercise during painful periods." 2."Range-of-motion exercises must be performed every day." 3."Have the child perform simple isometric exercises during this time." 4."Administer additional pain medication before performing range-of-motion exercises."
3 Juvenile idiopathic arthritis is an autoimmune inflammatory disease affecting the joints and other tissues, such as articular cartilage. During painful episodes of juvenile idiopathic arthritis, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Although resting the extremity is appropriate, beginning simple isometric or tensing exercises as soon as the child is able is important. These exercises do not involve joint movement.
470. The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 1."I will encourage my child to perform prescribed exercises." 2."I will have my child wear soft fabric clothing under the brace." 3."I should apply lotion under the brace to prevent skin breakdown." 4."I should avoid the use of powder because it will cake under the brace."
3. A brace may be prescribed to treat scoliosis. Braces are not curative, but may slow the progression of the curvature to allow skeletal growth and maturity. The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation. Options 1, 2, and 4 are appropriate interventions in the care of a child with a brace.
. A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1.Administer an analgesic. 2.Release the skin traction. 3.Apply ice to the extremity. 4.Notify the health care provider (HCP).
4 An absent pulse to an extremity of the affected limb after a bone fracture could mean that the child is developing or experiencing compartment syndrome. This is an emergency situation, and the HCP should be notified immediately. Administering analgesics would not improve circulation. The skin traction should not be released without an HCP's prescription. Applying ice to an extremity with absent perfusion is incorrect. Ice may be prescribed when perfusion is adequate to decrease swelling.
A child is placed in skeletal traction for treatment of a fractured femur. The nurse develops a plan of care and includes which intervention? 1.Ensure that all ropes are outside the pulleys. 2.Ensure that the weights are resting lightly on the floor. 3.Restrict diversional and play activities until the child is out of traction. 4.Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied.
4 When a child is in traction, the nurse would check the HCP's prescription to verify the prescribed amount of traction weight. The nurse would maintain the correct amount of weight as prescribed, ensure that the weights hang freely, check the ropes for fraying and ensure that they are on the pulleys appropriately, monitor the neurovascular status of the involved extremity, and monitor for signs and symptoms of immobilization. The nurse would provide therapeutic and diversional play activities for the child.
A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1.Administer an antiemetic. 2.Increase the intravenous fluids. 3.Place the child in a Sims's position. 4.Notify the health care provider (HCP).
4. Scoliosis is a three-dimensional spinal deformity that usually involves lateral curvature, spinal rotation resulting in rib asymmetry, and hypokyphosis of the thorax. A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome. This disorder is caused by mechanical changes in the position of the child's abdominal contents, resulting from lengthening of the child's body. The disorder results in a syndrome of emesis and abdominal distention similar to that which occurs with intestinal obstruction or paralytic ileus. Postoperative vomiting in children with body casts or children who have undergone spinal fusion warrants attention because of the possibility of superior mesenteric artery syndrome. Options 1, 2, and 3 are incorrect.