Orthopedic Disorders

Which should be obtained to make a diagnosis of slipped capital femoral epiphysis (SCFE)?

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.

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.

Which is most important when teaching a parent about preventing osteomyelitis?

1. Parents can stop worrying about bone infection once their child reaches school age. Parents need to clean open wounds thoroughly with soap and water. Children will always get a fever if they have osteomyelitis. Children should wear long pants when playing outside because their legs might get scratched.

A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long?

Self conscious about appearance

The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. Which is the nurse's best response?

1. "Direct inoculation of the bone from stepping barefoot on a sharp stick." "An infection from a scratched mosquito bite carried the infection through thebloodstream to the bone." "The blood supply to the bone was disrupted because of the child's diabetes." "An infection of the upper respiratory tract."

Which can occur in untreated developmental dysplasia of the hip (DDH)? 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.

Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is?

1. It is a fracture located in the growth plate of the bone. Because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture. It is a fracture in which a complete break occurs in the bone, and small pieces of bone are broken off. It is a fracture that does not go all the way through the bone.

Which factor(s) is/are associated with slipped capital femoral epiphysis (SCFE)? 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.

The nurse caring for a child with osteomyelitis assesses poor appetite. Which inter- vention(s) is/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.

Which should the nurse stress to the parents of an infant in a Pavlik harness for treat- ment of developmental dysplasia of the hip (DDH)?

1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the 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.

Which should be included in teaching a family about post-surgical care for slipped capital femoral epiphysis (SCFE)? Select all that apply.

1. The patient will receive help with weight-bearing ambulation 24 to 48 hours after surgery. Monitoring of pain medication to prevent drug dependence. Instruction on pin site care. Offering low-calorie meals to encourage weight loss. Correct use of crutches by the patient.

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.

Which 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. Previous closed fracture of an extremity. 5. Redness and swelling at the site.

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?

. 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.

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 is the primary reason for surgical treatment?

1. Young age. 2. Drug allergies. 3. Nonresponse to intravenous antibiotics. 4. Physician preference.

A 13-year-old just returned from surgery for scoliosis. Which nursing intervention(s) is/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.

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.

Which instruction(s) should the nurse give the parents of an adolescent with slipped capital femoral epiphysis (SCFE)? Select all that apply.

1. Continue upper body exercises to limit 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.

6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which is/are an early sign(s) of compartment syndrome in this child? Select all that apply.

1. Edema. 2. Numbness. 3. Severe pain. 4. Weak pulse. 5. Anular rash.

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)?

1. Excessive hip abduction .2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone.