Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder - ML4
Correct response: The nurse should monitor for decreased circulation every 4 hours. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, COMMON MEDICAL TREATMENTS 44.1, p. 1599.
In caring for a child in traction, which intervention is the highest priority for the nurse? The nurse should clean the pin sites at least once every 8 hours. The nurse should monitor for decreased circulation every 4 hours. The nurse should provide age-appropriate activities for the child. The nurse should record accurate intake and output.
Correct response: Cartilage Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Skeletal Development, p. 1589.
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? Joints Cartilage Tendons Ligaments
Correct response: "These make a smooth edge on the cast so the skin is better protected." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Caring for the Child with a Cast, p. 1601.
The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be: "We put these on so the child will not pull the padding from under the cast." "These will help the cast look more attractive so the child won't feel self-conscious." "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry." "These make a smooth edge on the cast so the skin is better protected."
Correct response: "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, p. 1633.
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 prevent torticollis." "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 wear the brace now to stabilize your spinal alignment, decreasing your symptoms."
Correct response: The posterior spine when bending forward Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, p. 1633.
A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note? The posterior spine when bending forward The posterior spine when bending sideways The angle of the lower chest when sitting down The angle of the iliac crest when bending forward
Correct response: significant bending without actual breaking. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, TABLE 44.7 The Salter-Harris Classification System, pp. 1638-1639.
A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as: incomplete fracture. bone that breaks into two pieces. significant bending without actual breaking. bone buckling due to compression.
Correct response: "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, pp. 1635-1636.
A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction? "I wear a t-shirt under my brace." "I leave my brace on for gym at school." "I do exercises after school." "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." "I check my brace daily to make sure there is no damage or change to it."
Correct response: Teach the client not to rest with the crutch pad pressing on the axilla. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, COMMON MEDICAL TREATMENTS 44.1, p. 1599.
A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client? Teach the client not to rest with the crutch pad pressing on the axilla. Caution parents to clear articles such as throw rugs out of paths at home. Be certain the child is walking with the crutches about 6 inches to the side of the foot. Assess the tips of the crutches to be certain the rubber tip is intact.
Correct response: a child's bones heal more quickly than those of an adult. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Skeletal Development, p. 1589.
A group of students is reviewing information about bone healing in children. The students demonstrate understanding of this information when they state: the process of breaking down and forming new bone is decreased in children compared with adults. a child's bones heal more quickly than those of an adult. callus production is slower (but greater in amount) in children than in adults. a fracture closer to the growth plate heals much slower than one in the metaphysis.
Correct response: Assess the fingers for warmth, pain, and function Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Caring for the Child with a Cast, p. 1601.
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? X-ray the cast to make sure the bones are aligned properly 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
Correct response: "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: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, BOX 44.2 Types of Braces Used to Treat Scoliosis, p. 1633.
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? "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." "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?"
Correct response: 1 Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Rickets, p. 1631.
The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place.
Correct response: Impaired physical mobility related to a cast on the leg Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Process Overview for the Child with a Neuromuscular or Musculoskeletal Disorder, p. 1596.
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 Pain related to chronic inflammation of the lower leg Situational low self-esteem related to the use of a walker
Correct response: Color Sensation Pulse Capillary refill Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Assisting with Cast Application, p. 1599.
The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. Vital signs Color Sensation Pulse Capillary refill
Correct response: Spica cast Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Developmental Dysplasia of the Hip, p. 1616. 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 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? Stockinette Internal fixation device External fixation device Spica cast
Correct response: significant level of alpha-fetoprotein present in amniotic fluid Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Myelomeningocele, p. 1609.
Which diagnostic measure is most accurate in detecting neural tube defects? flat plate of the lower abdomen after the 23rd week of gestation significant level of alpha-fetoprotein present in amniotic fluid presence of high maternal levels of albumin after 12th week of gestation amniocentesis for lecithin-sphingomyelin (L/S) ratio
Correct response: Gowers sign Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 1621.
The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? Gowers sign appearance of smaller than normal calf muscles indications of hydrocephalus lordosis
Correct response: Trendelenburg gait Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Legg-Calvé-Perthes Disease, p. 1632. The nurse would expect to note a Trendelenburg gait due to pain.
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 loss of strength in ankle dorsiflexion lordosis kyphosis
Correct response: creatine kinase Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, External Fixation, p. 1595. Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.
The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? serum potassium sodium creatine kinase bilirubin
Correct response: prevent edema. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Caring for the Child with a Cast, p. 1601.
The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to: prevent edema. promote healing. ensure proper bone alignment. discourage infection.
Correct response: Avoid sitting in one position for long periods of time. Tell the client to loosen the brace during meals if necessary. Wear a 100%-cotton T-shirt under the brace to absorb moisture. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, p. 1635.
A nurse caring for a child wearing a brace to correct scoliosis provides client and family teaching for home care of the brace. Which of these are accurate interventions for this situation? Select all that apply. Tell the client to loosen the brace during meals if necessary. Avoid sitting in one position for long periods of time. Gradually decrease wearing time so the skin can develop tolerance. Wear a 100%-cotton T-shirt under the brace to absorb moisture. Recommend a shower instead of a bath to stimulate the skin. Schedule brace wear for waking hours for best therapeutic results.
Correct response: Place the newborn in a prone or lateral position. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Myelomeningocele, p. 1608.
A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? Place petroleum jelly gauze on the spinal sac to keep it moist. Delay the parents from holding the newborn. Place a urine collection bag on newborn for the continuous leakage. Place the newborn in a prone or lateral position.
Correct response: Deficient knowledge related to diagnosis and condition Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Spina Bifida Occulta, p. 1607.
The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? Deficient knowledge related to diagnosis and condition Risk for injury related to lack of muscle control Ineffective coping related to diagnosis of chronic condition Impaired physical mobility related to spinal cord defect
Correct response: a weak pedal pulse Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, TABLE 44.1 Types of Traction and Nursing Implications, p. 1604.
The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse? temperature 100.2°F (37.9°C) mild fussiness decreased oral intake a weak pedal pulse
Correct response: "Let's ask your parents to bring your friends for a visit." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Process Overview for the Child with a Neuromuscular or Musculoskeletal Disorder, p. 1598.
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? "Would you like a coloring book?" "Let's ask your parents to bring your friends for a visit." "Do you want a book to read?" "You are too big to suck your thumb."
Correct response: presence of Moro reflex Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, External Fixation, p. 1592.
The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? absence of tonic neck reflex presence of Moro reflex absence of Moro reflex presence of symmetrical spontaneous movement
Correct response: Duchenne muscular dystrophy Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Muscular Dystrophy, p. 1620.
The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client? Duchenne muscular dystrophy Juvenile arthritis Facioscapulohumeral muscular dystrophy Congenital myotonic dystrophy
Correct response: The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. New drainage is seeping out from under the cast. The boy's toes are light blue and very swollen. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, TABLE 44.2 Classification of Osteogenesis Imperfecta, p. 1615.
The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. The boy experiences mild pain when wiggling his toes. The boy's toes are light blue and very swollen. New drainage is seeping out from under the cast. The outside of the boy's cast got wet and had to be dried using a hair dryer.
Correct response: "Fiberglass casts are lighter in weight than plaster casts." "They can be waterproof when a special liner is used." "Kids like them because they come in different colors." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Caring for the Child with a Cast, p. 1601. Fiberglass casts are lighter, come in a variety of colors, and when a special liner is used, can be waterproof. Because of the cost, plaster casts are typically used when frequent cast changes are needed. Plaster casts, not fiberglass, take longer to dry.
The nurse is caring for a child requiring a cast. The mother asks why the doctor is recommending a fiberglass cast when it is more expensive. What information should the nurse share with the mother? Select all that apply "Casts made out of fiberglass take longer to dry." "They can be waterproof when a special liner is used." "Kids like them because they come in different colors." "Fiberglass casts are lighter in weight than plaster casts." "Fiberglass casts are typically used when the casts need to be changed often."
Correct response: Handling the cast with open palms when moving the arm. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, TEACHING GUIDELINES 44.1 Home Cast Care, p. 1602.
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? 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. Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm. Using only a draw sheet to move the casted arm.
Correct response: "If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Scoliosis, p. 1633.
The nurse is talking with the caregiver of a 13-year-old diagnosed with scoliosis. The child has come to the clinic to be fitted with a brace to begin her treatment. The child appears upset and angry and states, "I hate this brace; I hate it already." In an effort to support this child, which statement would be the most appropriate for the nurse to make to this child's caregiver? "Remind your child that her spine needs to be corrected in order to keep her whole musculoskeletal system healthy for a long, long time." "Take your daughter to an oncology floor for a few minutes so she can see children who are much sicker than she is." "Children her age often withdraw during stressful times; let her have some time alone to think about the situation and to get used to the brace." "If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good."
Correct response: pectus excavatum ("funnel chest") Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Spinal Muscular Atrophy, pp. 1624-1625.
A nurse is conducting a physical examination of a 5-year-old boy with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find? loss of strength in hip extension loss of strength in ankle dorsiflexion pectus excavatum ("funnel chest") pseudohypertrophy of the calves
Correct response: to continue with age-appropriate activities Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Preventing Complications, p. 1603.
An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? to stand absolutely still when not wearing the brace to continue with age-appropriate activities that secondary sex changes will stop until the brace is removed to wear the brace a maximum of 20 hours each day
Correct response: Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Nursing Process Overview for the Child with a Neuromuscular or Musculoskeletal Disorder, p. 1596. The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.
The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions? Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C. Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns.
Correct response: low serum calcium levels Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Rickets, p. 1631. With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.
The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record? low alkaline phosphate levels low serum calcium levels high serum phosphate levels x-ray confirmation of adequate bone shape
Correct response: "Applying ice to the area will reduce the pain and swelling." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Overuse Syndromes, p. 1642. 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 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.
A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Elevate the legs, and use bed rest for 24 hours." "Apply ice to the injury for 60 minutes on and 60 minutes off." "Taking warm baths will help relax muscles and reduce pain." "Applying ice to the area will reduce the pain and swelling."
Correct response: baclofen Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, DRUG GUIDE 44.1 Common Drugs for Neuromuscular Disorders, pp. 1600-1601.
After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? lorazepam prednisone botulin toxin baclofen
Correct response: 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: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, Spinal Cord Injury, p. 1636. Spiral fractures, which twist around the bone, are frequently associated with child abuse 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 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 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.
Correct response: "In most cases treatment is not necessary, only observation." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, COMMON MEDICAL TREATMENTS 44.1, p. 1599. The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.
The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate? "In most cases treatment is not necessary, only observation." "Have you seen any signs of improvement?" "Was this from pressure resulting from forceps?" "This is the most common facial nerve palsy."
Correct response: epiphysiolysis of the proximal humerus. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder, TABLE 44.9 Overuse Disorders, p. 1642.
The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be: epiphysiolysis of the distal radius. epiphysiolysis of the proximal humerus. Sever disease (calcaneal apophysitis). Osgood-Schlatter disease.
