Compound Fracture (Preschooler)

The UAP goes to the playroom to get toys for an immobilized 4 year old after reduction and traction surgery. Which activity is the best choice? a. pretend beauty parol b. monopoly board game c. fifty-piece puzzle d. looking at picture books

a (a 4 year old can put together sentences and a picture book is not appropriate, it would be better to read a story book. dramatic play, like beauty parlor are enjoyable forms of "make believe that help with fine motor skills. The puzzle and board game are for older children with more developed intellectual skills)

After reduction and fixation surgery the nurse monitors lab values. Which change in serum lab values would most likely indicate the onset of osteomylitis? a. decreased hemoglobin (Hgb) b. decreased calcium c. increased erythrocyte sedimentation rate (ESR) d. increased creatine phosphokinase (CPK)

c (WBC = infection)

Three weeks after reduction and traction surgery on a 4 year old, the traction is discontinued. A long leg cast is applied and the patient is ready for scheduled discharge. For which problem should the parents be instructed to contact the HCP? a. the cast sounds hollow when tapped b. The patients cap refill is less than 2 seconds c. the patient complains of itching d. warm spots are felt on the cast

d (Warm spots, drainage, bleeding, or an unusual odor are signs of infection or skin breakdown)

What snack is appropriate for an immobilized 4 year old after reduction and traction surgery? a. pudding b. popsicle c. vanilla wafers d. saltine crackers

a (pudding provides both protein and calories, which are important for an immobile child who is at risk for negative nitrogren balance)

The nurse assesses for pain with the FACES scale. The patient points to a higher pain rating, but is lying still and is vague about the location of pain. A prescription of IV morphine every 3-4 hours is available and patient received a dose 3 hours ago. The patient will go to surgery for a fracture in one hour. What should the nurse do? a. administer another dose of morphine immediately b. administer a dose of morphine right before the patient goes to surgery c. use distraction rather than analgesics until the patient goes to surgery d. document that pain assessment findings are inconsistent

a (you always believe the patient report of pain and you don't keep a child in pain)

After reduction and fixation surgery the nurse recognizes that the patient is at risk for osteomylitis. Which nursing intervention should be included in the plan of care to prevent this complication? a. petal the edges of the boot cast with adhesive tape b. cleanse around the pin site with half-strength hydrogen peroxide c. place an eggcrate mattress on the bed under the bed sheet d. apply an elastic stocking to the unaffected leg

b (a may reduce skin irritation, but would not limit osteomylitis, c would help with pressure ulcers, and d would help with venus status)

A 4 year old goes to surgery for a fracture where they perform reduction and fixation. Following surgery the patient is transferred to the orthopedic nursing unit where they will be in skeletal traction of several weeks. Which traction is a skeletal traction? a. buck extension b. 90-90 femoral c. russell d. bryant

b (buck's traction is a type of skin traction in which a boot or wrap is applied and used to pull with weight. a 90-90 femoral traction is where a pin or wire is placed in the femur and a cast applied below the pin. Russell traction is a skin traction with a sling. Bryan is a skin traction for supine positioning)

A parents in the pre-procedure class has a 5 year old son and states that their son is very mature and feels more grown-up using an adult seat belt. She states that he follows the rules better then he gets to make decisions and that he weighs almost 50 pounds. How should the nurse respond? a. reassure this parent that the child is large enough to use an adult seatbelt b. instruct this parent that the child's age and size still require the use of a safety seat c. support this parent's desire to increase the child's independent decision-making d. redirect the topic to types of injuries that occur when car seats are not used correctly

b (children should be in car seats until 40 lbs. After they should be in a booster seat until 60 lbs or until they are 8 years old. This is because of height because seat belts are designed for adult height.)

Madison is 4 years old and brought into the ER by ambulance after a car accident with her babysitter. She has a compound fracture of the femur, which will require surgical reduction, followed by skeletal traction. If a staff member is unable to reach Madison's parents, what guidelines will determine the staff's ability to provide needed care? a. a minor child can give permission and consent for care and is then considered emancipated b. emergency care may be provided after a reasonable attempt to reach the parents has been made c. since the babysitter has responsibility for the child, she can give informed consent for needed procedures d. a minor child can assent to care, which is considered equivalent to an adult giving informed consent for care

b (life-saving medical care may be performed without parental consent)

What features would identify a fracture as an open fracture? a. depressed area over the fracture site b. bone fragments protruding through the skin c. a partially bent appearance on x-ray d. multiple bone fragments visible on x-ray

b (open fractures means that the skin over the fracture is disrupted)

An immobilized 4 year old after reduction and traction surgery throws her toys at her mother. The mother tells the nurse that she doesn't know how to respond to the child when they express anger. In teaching the mother, what response should the nurse suggest she use with the child? a. You shouldn't act out by throwing things at me b. I am sad that you are throwing things at me c. I will not stay here if you keep throwing things d. Throwing things is not the way good girls behave

b (preschoolers need limit-setting guidelines and discipline. A good way to express emotions and focus on the behavior is to make I statements)

The nurse identifies that a priority nursing diagnosis is "Injury risk for peripheral neurovascular compromise". Implementation of which nursing intervention will reduce this risk? a. perform hourly assessment of level of consciousness b. initiate hourly assessment of foot distal to the fracture site c. assign an unlicensed assistive personnel (UAP) to measure vital signs hourly d. evaluate for the presence of orthostatic hypotension

b (the other options are for neurologic or cardiovascular issues)

For several hours after reduction and fixation surgery a patient is comfortable with 1.5 mg of IV morphine every 4 hours. Two hours after the most recent administration of morphine the patient is crying and agitated stating, "there, there, it hurts there" while pointing to the site of healing. After assessment the nurse notes that the site is cool, pale and has a capillary refill of 5 seconds. What additional assessment should the nurse perform? a. deep tendon reflexes b. toe movement c. skin turgor d. lack of hair growth

b (to check for compartment syndrome you want to assess the 5 P's: pain, pallor, pulse, paresthesia, and paralysis)

After reduction and fixation surgery a patient develops compartment syndrome. In addition to notifying the healthcare provider of this development, what action should the nurse implement? a. apply a pressure dressing over the affected area b. obtain equipment needed for cast removal c. encourage the patient to keep trying to move her toes d. place an ice pack over the affected area

b (you never want to put anything on compartment syndrome becasue the arteries and nerves are already compressed. The cast needs to be removed and potentially a fasciotomy is needed)

Madison is 4 years old and brought into the ER by ambulance after a car accident with her babysitter. She has a compound fracture of the femur, which will require surgical reduction, followed by skeletal traction. Since Madison's parents are divorced, which parent should the nurse try to contact first? a. the parent from whose house the baby assumed care of madison (physical custody) b. the parent in whose home Madison lives the majority of the time (physical custody) c. the parent who has been assigned legal custody of madison by the court d. both parents mus be contact, even if they do not share joint legal custody of madison

c (assigned legal custody is responsible for consent)

A UAP is playing with an immobilized 4 year old after reduction and traction surgery. The child insists on playing with her invisible friend, Eugenia. While playing, the patient throws some toys on the floor and scolds Eugenia for dropping them. The patient's mother tells the patient that the activity cannot continue if she is going to throw toys. How should the nurse respond? a. remind the mother that the patient is seeking ways to maintain control b. help the mother develop a plan to reduce the patient's need for an imaginary friend c. support the mother's decision to hold the patient accountable for the behavior d. advise the mother that imaginary playmates at this age indicate regressive behavior

c (imaginary friends serve a useful purpose for this age group, but there should be boundaries on behaviors)

An immobilized 4 year old after reduction and traction surgery usually snacks on animal crackers in the morning and has a box at the bedside. They ask the nurse if they can have some while her mother is away. What action should the nurse take? a. tell the patient that she will need to wait for her mother to return b. give the patient the crackers to play with, but not eat c. give the patient a few crackers and stay with her while she eats them d. give the patient a few crackers and leave her alone to enjoy her snack while watching TV

c (it is important for children to maintain their routine and the patient could choke and cannot be alone while eating the snack)

For several hours after reduction and fixation surgery a patient is comfortable with 1.5 mg of IV morphine every 4 hours. Two hours after the most recent administration of morphine the patient is crying and agitated stating, "there, there, it hurts there" while pointing to the site of healing. Which nursing action has the highest priority? a. administer a breakthrough dose of morphine b. redirect the patients attention to a new toy c. assess the appearance of the site d. monitor vital signs and O2 sats

c (the other options treat the pain and monitor cardiac/respiratory health, but the patient is at risk for compartment syndrome)

A patient arrives to the unit after surgery in a skeletal traction with a boot case on the lower leg. Which nursing intervention should be included in the plan of care while the patient is in traction? (select all) a. remove the traction for 10 minutes every hour b. keep weights securely positioned on the floor c. assess toes for capillary refill and edema d. attach the ropes to the footboard to prevent sliding e. ensure that the amount of weight remains consistent

c and e (remove the traction could cause muscle spasms and bone displacement, weights must be free hanging)

Three weeks after reduction and traction surgery on a 4 year old, the traction is discontinued. A long leg cast is applied and the patient is ready for scheduled discharge. The nurse reminds the parents that the cast will take 1 to 2 days to dry completely. The parents demonstrate lifting the cast by holding it with the palms of their hands. what action should the nurse take? a. ask the parents if they feel too overwhelmed to learn cast care b. demonstrate the correct technique for moving the cast using only the fingertips c. suggest that the patient might be more comfortable if a pillow is used when moving the cast d. acknowledge that the parents have correctly learned how to move the cast while it is wet

d

A parents in the pre-procedure class has a 5 year old son and states that their son is very mature and feels more grown-up using an adult seat belt. She states that he follows the rules better then he gets to make decisions and that he weighs almost 50 pounds. They go on to say that the son prefers sitting in the front seat and states that this is the safest place because her car is equipped with front and side airbags. When an older child is sitting on a booster seat, where is the best place to locate the seat? a. front passenger seat of a car with airbags b. front passenger seat of a car without airbags c. back seat of a car with only a lap belt d. back seat of a car with a lap and shoulder belt

d (The CDC recommends that children younger than 12 sit in the back to prevent injury from airbags or the head hitting the dashboard.)

An immobilized 4 year old after reduction and traction surgery throws her toys at her mother. The mother is in tears and asks the nurse, "Why does she only get angry with me? She never yells at the nurses or her father." What is the best response by the nurse? a. You are the one providing all the discipline. It is natural for her to be angry with you b. Do you believe she would be happier being with her father rather than with you? c. You should not allow her to become that angry because it is harmful for you both d. It is natural to be upset when your child expresses anger toward you

d (This open ended statement offers an opportunity for the mother to continue expressing feelings and it offers empathy and reassurance)

Three weeks after reduction and traction surgery on a 4 year old, the traction is discontinued. A long leg cast is applied and the patient is ready for scheduled discharge. The nurse talks to the parents about preparing for cast removal. Which technique is most beneficial when preparing a preschooler for a procedure that may be frightening? a. begin to talk to the child about the procedure several days in advance b. remind the child that removing the cast means that she can return to normal activities c. reassure the child that there is nothing scary about the procedure d. describe what the child will experience shortly before the procedure takes place

d (advanced preparation increases fantasized and undue fears in preschoolers. the younger the child, the closer to the procedure the preparation should occur. b and c are appropriate, but not the best choice.)

A patient with compartment syndrome after surgery is given a dose of analgesic. The nurse learns about other client care needs on the unit. A client with a pelvic fracture is being transferred from the ED and a postoperative client with crutches needs assistance to ambulate to the bathroom. After resolving the other client care needs, the RN returns to the patient with compartment syndrome. Which task should be delegated to the LPN at this time? a. revise the plan of care to reflect the recent complication b. teach the parents about compartment syndrome c. evaluate the effectiveness of the dose of morphine administered d. spend time with the patient to distract her from the discomfort

d (nothing else is appropriate for an LPN to do)

How is the presence of crepitus related to a 4 year old's femur fracture determined? a. observe the area around the fracture for swelling, pain, and tenderness b. observe the area distal to the fracture for spasms or rigidity c. gently palpate over or around the wound and listen for crackling sound d. listen for a grating sound when the affected area is moved

d (palpation would not assess for bone related crepitus)

A patient with compartment syndrome after surgery is given a dose of analgesic. The nurse learns about other client care needs on the unit. A client with a pelvic fracture is being transferred from the ED and a postoperative client with crutches needs assistance to ambulate to the bathroom. An LPN and UAP are available to work with the RN. Which assignments are best for these staff? a. ongoing monitoring of compartment syndrome by LPN, RN assists postoperative client with crutches and UAP determines if the new client has any immediate problems b. ongoing monitoring of the compartment syndrome by the UAP, while RN assists the postoperative client with crutches and the LPN determines if the new client has any immediate problems. c. ongoing monitoring of the compartment syndrome by the RN while the UAP assists the postoperative client with crutches and the LPN determines if the new client has any immediate problems d. ongoing monitoring of the compartment syndrome by the LPN, UAP assists with crutches, and RN determines in the new client has any immediate problems

d (the LPN may monitor the compartment syndrome patient now that the RN has completed the initial assessment, the doctor notified, and an treatment plan made)