Orthopedic Disorders

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

1 (1. Ewing sarcoma is a bone tumor that affects the shafts of long bones. 2. Pediatric bone sarcomas do not affect the growth plate 3. This is a specifi c location of a specifi c bone. Ewing sarcoma can affect multiple bones. 4. The bone marrow is a site for hematological cancers.)

46. A child with Ewing sarcoma is receiving chemotherapy and is experiencing severe nausea. The nurse has to administer lorazepam (Ativan) at 0.04 mg/kg, and the child weighs 65 lb. What dose should the nurse administer? ___________

1.2 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 = 1.18 mg or round to 1.2 mg.)

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

20. (A 20-degree spinal curve that is nonprogressive will not disfi gure or interfere with normal functioning, so it is not treated with bracing or surgery.)

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

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

5. Which is the defi nition of "talipes varus"? 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 turning in of the forefoot.

1 (1. "Talipes varus" is an inversion of the entire foot. 2. "Talipes valgus" is an eversion of the foot. 3. "Pes cavus" is a high arch of the foot. 4. Inversion of the forefoot is "metatarsus adductus.)

43. Which nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy? 1. Risk for fl uid volume defi cit. 2. Potential for chronic pain. 3. Risk for skin impairment. 4. Ineffective airway clearance.

1 (1. Chemotherapy can cause nausea, vomiting, and possibly diarrhea, which contribute to fl uid volume defi cit. 2. Chemotherapy itself does not cause chronic pain. 3. Radiation therapy has the potential for skin impairment. 4. This is not an acute problem with chemotherapy.)

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.

1 (1. Fractures of the growth plate are serious because they can disrupt the growth process. 2. Long-term follow-up is usually needed to evaluate limb discrepancies and potential joint abnormalities. 3. The ability to participate in contact sports depends on many potential complications. 4. The amount of pain medication needed in all fractures is determined by the client.)

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-fi tting 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.

1 (1. Loose clothing helps reduce irritation on the sensitive irradiated skin. 2. Emollients are contraindicated during radiation because they can refl ect the rays. 3. Irradiated skin is very sensitive to extreme temperatures; a cold pack could cause pain. 4. Hydrocortisone is not helpful for the radiation-induced itching; it is for atopic itching.)

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

1 (1. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining. 2. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining. 3. NSAIDs do not require a blood level because they are available over the counter. 4. NSAIDs do not interfere with the oral cavity; however, other medications used for JIA cause oral ulcers.)

57. The nurse is teaching the parent of a child diagnosed with systemic lupus erythematosus (SLE). 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."

1 (1. SLE is a complex disease; there are many triggers, but how the disease develops is not known. 2. There is some correlation with family history. 3. There are multiple triggers for SLE, including prescription drugs. 4. Antibodies have nothing to do with SLE outcome.)

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).

1 (1. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made, usually at birth. 2. Although casting helps if started in the newborn period, the delay of even 4 to 6 months postpones the positive outcome. 3. Infants of 9 months are already pulling up to stand and taking steps. Clubfoot puts weight on surfaces of the feet that are not meant for weight-bearing. 4. Clubfoot does not allow for normal gait, and the delay will decrease the likelihood of a successful outcome.)

26. The nurse on the pediatric fl oor is receiving a child with the possible diagnosis of septic arthritis of the elbow. Which 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.

1, 2, 3, 5. (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. 4. There is no bruising with septic arthritis. 5. Septic arthritis can cause swelling of the joint. 6. There is no increased risk with a history of nursemaid ' s elbow.)

13. 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.

1, 2, 3, 5. (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. 4. Osteomyelitis can sometimes be seen after a direct inoculation of an open fracture. There is no increased risk after a closed fracture. 5. Redness and swelling occur because of the infection.)

3. 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 fl exibility of the hip joint in adulthood.

1, 2, 3. (1. Due to abnormal hip joint function, the client ' s gait is stiff and waddling. 2. Due to abnormal femoral head placement, the client may experience pain and decreased fl exibility in adulthood. 3. Due to abnormal femoral head placement, the client may experience osteoarthritis in the hip joint in adulthood. 4. There is no increased risk for osteoporosis. 5. There is no increased fl exibility of the hip joint in adulthood.)

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 dwarfi sm. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol spectrum disorder.

1, 2, 3. (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 diastrophic dwarfi sm and congenital clubfoot. 4. Breech position is not associated with congenital clubfoot. It is associated with DDH. 5. There is no association between prematurity and congenital clubfoot. 6. Fetal alcohol spectrum disorder is not associated with clubfoot.)

19. Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? Select all that apply. 1. "Your child will need to wear a brace on the feet 23 hours a day for 12 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."

1, 2, 4, 5. (1. After the fi nal casting, bracing is required for 12 months. This decreases the likelihood of a recurrence. 2. Because clubfoot can recur, it is important to have regular follow-up with the orthopedic surgeon until age 18 years. 3. After treatment, most children are able to participate in any sport. 4. Even with proper bracing, there may be a recurrence. 5. Most children treated for clubfeet develop normally appearing and functioning feet. 6. Most children do not require surgery at puberty.)

29. A 13-year-old just returned from surgery for scoliosis. Which nursing intervention is appropriate in the fi rst 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.

1, 2, 4, 5. (1. General postoperative nursing interventions include assessing for pain. 2. Specifi c to scoliosis surgery, logrolling is the means of changing positions. 3. Patients may not be upright less than 24 hours postoperatively. 4. It is essential to check neurological status in a patient who just had scoliosis surgery. 5. General postoperative nursing interventions include assessing vital signs.)

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 refi ll. 5. Provide pain medication as needed.

1, 2, 4, 5. (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. 3. Elevating the extremity is important to decrease edema prior to the onset of compartment syndrome. However, once compartment syndrome is suspected, the extremity should be kept at the level of the heart to facilitate arterial and venous fl ow. 4. Weak or absent pulse is a sign of compartment syndrome, so monitoring capillary refi ll is important in assessment. 5. Pain, pallor, and weak or absent pulses are signs of compartment syndrome. Pain should be treated.)

31. A 14-year-old with osteogenesis imperfecta (OI) is confi ned 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, because the child is not likely to date.

1, 2, 4, 5. (1. This client is trying to become more independent and trying to fi t in with the peer group. Encouraging socializing with peers who face similar challenges alleviates feelings of isolation. 2. Decorating the wheelchair encourages the client to assume independence in self-care. 3. It is not necessarily appropriate to transfer health care at age 18 years. If the teen is with a provider who has known the client and family most of the teen ' s life, it might be best to remain with that provider for several more years. 4. Allowing the patient to view radiographs encourages the patient to assume self-care. 5. Helping the patient set realistic goals for the future encourages independence. 6. It is appropriate for the nurse to discuss sexuality with this client. Being confi ned to a wheelchair does not preclude dating or becoming intimate.)

58. A child is admitted to the pediatric unit with the diagnosis of systemic lupus erythematosus (SLE). On assessment, the nurse expects the child to have which of the following signs and symptoms? Select all that apply. 1. Oral ulcers. 2. Malar rash. 3. Weight gain. 4. Heart failure. 5. Anemia

1, 2, 5. (1. Oral ulcers are a common early symptom. Typically, at least four symptoms must be present for the diagnosis of SLE. 2. The "butterfl y," or malar, rash is the most common manifestation of SLE. 3. Weight loss, not weight gain, is a symptom of SLE. 4. Heart failure is not a common manifestation, but it can occur after long-term disease that affects the heart muscle. 5. Anemia is often a presenting symptom of SLE.)

51. Which of the following applies to the care of a child with a retroperitoneal rhabdomyosarcoma? Select all that apply. 1. Acute pain. 2. Risk for impaired urinary elimination. 3. Impaired gas exchange. 4. Self-care defi cit. 5. Risk for constipation.

1, 2, 5. (1. Pain occurs because of pressure on the organs in the lower abdomen. 2. A retroperitoneal tumor affects the organs of the lower abdomen, including the bowel and bladder. 3. A retroperitoneal tumor affects the organs of the lower abdomen, including the bowel and bladder. This tumor does not affect the lungs. 4. There is no indication the child cannot administer self-care. 5. Because this tumor is in the lower abdomen, it puts pressure on the bowel, causing constipation.)

56. One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all 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.

1, 2, 5. (1. Providing pain medication prior to ambulation helps decrease pain during ambulation. 2. Children with JIA need to do rangeof- motion exercises to prevent joint stiffness. 3. A high-fat diet is not helpful for mobility. 4. Oxygen is usually not necessary with the diagnosis of JIA. 5. Using nonpharmacological methods such as heat helps with fl exibility and pain.)

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

1, 2, 6. (1. High-calorie liquids are sometimes received better when the child has a poor appetite. 2. Offering favorite foods can sometimes tempt the child to eat, even with a poor appetite. 3. Although decreased appetite is expected, it is something that needs nursing intervention in order to promote healing. 4. An intravenous line is necessary for antibiotics, so it cannot be removed to encourage oral intake. 5. Although some pain medications cause nausea, their use is important. If clients are in pain, they are not likely to want to eat. 6. Frequent small meals might increase daily caloric intake.)

7. When planning a rehabilitative approach for a child with osteogenesis imperfecta (OI), 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. 5. Misalignment of lower extremity joints.

1, 3, 4, 5. (1. A long-term goal in caring for a child with OI is to prevent contractures and deformities. 2. There is no increased risk for bone infection in OI. 3. A long-term goal in caring for a child with OI is to prevent muscle weakness. 4. A long-term goal in caring for a child with OI is to prevent osteoporosis. 5. A long-term goal in caring for a child with OI is to prevent misalignment of lower extremity joints.)

17. Which instruction 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.

1, 3, 5, 6. (1. Immobilization can lead to a decrease in muscle strength. Upper body exercises should be continued soon after surgery. 2. Although turning the client in bed after surgery may be painful, it is essential that parents and the client know that it is necessary to prevent skin ulcerations and promote healing. 3. It is important for this client to continue as many normal activities as possible. This should include schoolwork and leisure activities. 4. To promote independence that is essential for a teenager, this client should be encouraged to continue activities of daily living. 5. Some expressions of anger and hostility are normal, because this adolescent is losing some independence with this immobility. 6. Continuation of setting limits on behavior is important to keep as much normality as possible.)

10. Which factor is associated with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Obesity. 2. Female gender. 3. Family history of SCFE. 4. Age of 5 to 9 years. 5. Pubertal hormonal changes. 6. Endocrine disorders.

1, 3, 5, 6. (1. Obesity increases the risk of SCFE by stressing the epiphyseal plate. 2. SCFE is more common in males. 3. Risk factors include a family history of SCFE. 4. SCFE is most common from the ages of 10 to 16 years. 5. SCFE is most common during pubertal hormonal changes. 6. SCFE is associated with endocrine disorders such as hyperthyroidism.)

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

1, 3. (1. Edema and pain are early signs of compartment syndrome. 2. Numbness and tingling are late signs of compartment syndrome. 3. Edema and pain are early signs of compartment syndrome. 4. A weak pulse is a late sign of compartment syndrome. 5. There is no rash with early compartment syndrome.)

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 that 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.

1, 4, 6. (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. 2. Avoiding the parents is not therapeutic. 3. The baby should be shown to the parents as are all newborns, without hiding the clubfoot. 4. The baby should be shown to the parents as are all newborns, emphasizing the well-formed parts of the body. 5. Negating the parents ' grieving is not therapeutic. 6. Information may need to be repeated as the family begins to absorb the information.)

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 fi rst? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Change the child ' s position.

2 (1. The nurse needs to assess the child prior to giving more pain medication. 2. The nurse looks for the source of the pain by performing a neuromuscular assessment. 3. If the neuromuscular assessment is normal, the nurse might need to call the surgeon for further orders. 4. The child ' s position should be changed to determine whether that helps with pain management after the neuromuscular assessment is performed.)

14. 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." 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 (1. Although osteomyelitis can occur from direct inoculation, inoculation is not the most common cause. 2. Infection through the bloodstream is the most likely cause of osteomyelitis in a child. 3. Although osteomyelitis can occur because of blood supply disruption, that is more likely to occur in older adults. Diabetes does increase the risk of osteomyelitis, but diabetes is more common in older adults. 4. A viral upper respiratory infection is not the most likely cause.)

45. A child with Ewing sarcoma is undergoing a limb salvage procedure. Which statement 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 (1. Bone grafts are not part of limb salvage. 2. Limb salvage requires lengthening procedures to encourage the bone to continue to grow so that the child will not have a short limb. 3. This does not indicate understanding by the parents. 4. Having a limb salvage does not mean the child will never require chemotherapy as part of the treatment.)

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

2 (1. Diarrhea can be a side effect of chemotherapy, but it is not usually life threatening. 2. Fever indicates infection that can be life threatening after a bone marrow transplant. 3. Skin breakdown is usually not life threatening. 4. Tumor shrinkage is expected with treatment, but it is not life threatening.)

38. A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement 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 (1. Diarrhea is a side effect of chemotherapy, not neutropenia. 2. Neutropenia makes a child more at risk for infection because the immune system is compromised by the chemotherapy. 3. Alopecia is a side effect of chemotherapy, not neutropenia. 4. Dehydration is a potential side effect of chemotherapy, not neutropenia.)

55. Why are chemotherapeutic agents such as methotrexate (Trexall) and cyclophosphamide (Cytoxan) sometimes used to treat juvenile idiopathic arthritis (JIA)? 1. Are effective against cancer-like JIA. 2. Suppress the immune system. 3. Are similar to NSAIDs. 4. Are absorbed into the synovial fl uid.

2 (1. JIA is not a type of cancer. 2. These drugs affect the immune system to reduce its ability to attack itself, as in the case of JIA. 3. These medications are not the same as NSAIDs. 4. They are not absorbed into the synovial fl uid to treat JIA; they suppress the immune system.)

24. 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. 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 (1. Osteomyelitis can occur in children older than school age. 2. Because bacteria from an open wound can lead to osteomyelitis, thorough cleaning with soap and water is the best prevention. 3. Children with osteomyelitis do not always have a fever. 4. It is not necessary to require children to wear long pants whenever playing outside.)

59. Which is an important nursing intervention to teach about photosensitivity to the parents of a child with systemic lupus erythematosus (SLE)? 1. Regular clothing is appropriate for sun exposure. 2. Sunscreen application is necessary for protection. 3. Teenage patients cannot participate in outdoor sports. 4. Uncovered fl uorescent lights offer no danger.

2 (1. Sun-protective clothing is important, including hats. 2. Sunscreen helps reduce accelerated burning due to sensitivity. 3. Participating in sports is important for normality and should be encouraged. 4. Protection from uncovered fl uorescent lights is as important as protection from ultraviolet A and B light.)

8. Which classifi cation of osteogenesis imperfecta (OI) is lethal in utero and in infancy? 1. Type I. 2. Type II. 3. Type III. 4. Type IV

2 (1. Type I is the most common form. It is characterized by little deformity, variable fractures, blue sclera, hearing loss common in the 20s, and a normal life span. 2. Type II is lethal in utero and in infancy because of multiple fractures and deformities and underdeveloped lungs. 3. Type III is characterized by fractures, deformities, and short stature. Patients rarely live to age 30 years. 4. Type IV is similar to type I but not associated with blue sclera.)

9. When counseling the parents of a child with osteogenesis imperfecta (OI), the nurse should include 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 OI. 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, 3, 4. (1. Genetic counseling should be provided as part of long-term care so that the parents can make an informed decision about future children. 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. The Osteogenesis Imperfecta Foundation is an organization that can provide information and support for a family with a child with the condition. 5. Children with OI must be treated with careful handling and cannot be allowed to participate in all activities that unaffected siblings are allowed.)

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, 3, 4. (1. Medication will be given regularly to help with the pain. 2. Blood cultures will be obtained to determine the organism causing the infection. 3. Pus will be aspirated from the subperiosteum. 4. Antibiotics will be given via an intravenous line. 5. Surgery is indicated only when medication fails.)

61. Because estrogen is a possible trigger for a systemic lupus erythematosus (SLE) fl are, advice for a teenage girl 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. Use Ortho Evra.

2, 3, 4. (1. Ortho Tri-Cyclen contains estrogen; therefore, it is contraindicated. 2. Depo-Provera contains progesterone and is the only contraceptive that is approved for use in sexually active women with SLE. 3. Abstinence is always recommended to prevent pregnancy. 4. Condoms are always recommended. 5. Ortho Evra ("the patch") contains estrogen and is therefore not recommended.)

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 is the primary reason for surgical treatment? 1. Young age. 2. Drug allergies. 3. Nonresponse to intravenous antibiotics. 4. Health-care provider preference.

3 (1. All children with osteomyelitis are treated initially with intravenous antibiotics, regardless of age. 2. Although drug allergies are a concern, antibiotic choices can be made to accommodate clients with specifi c drug allergies. 3. If a client does not respond to an appropriate antibiotic within 48 hours, surgery may be indicated. 4. Although there is some difference of opinion about the use of surgery in the treatment of osteomyelitis, the standard initial treatment is intravenous antibiotics.)

53. Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)? 1. Fat loss. 2. Adrenal stimulation. 3. Immune suppression. 4. Hypoglycemia.

3 (1. Long-term corticosteroid use causes fat deposits, especially in the back, face, and trunk. 2. With the use of corticosteroids, there is adrenal suppression because the exogenous steroid causes the body to lower production of its own steroids. 3. Steroids cause immune suppression, which is the reason behind its use in JIA; it reduces the body ' s attack on itself. 4. Steroids cause hyperglycemia.)

49. The nurse evaluates teaching as successful when the parent explains that an excisional biopsy is done for which reason? 1. To fi nd metastatic disease. 2. To remove all metastatic disease. 3. To confi rm the type of metastatic disease. 4. To treat metastatic disease.

3 (1. Metastatic disease is confi rmed by a combination of tests. 2. A biopsy removes only a small piece of the tumor. 3. A biopsy confi rms the histology of the tumor. 4. Chemotherapy, radiation, and surgery are required for treatment)

39. Which is most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? 1. Pain. 2. Spirituality. 3. Body image. 4. Lack of coping.

3 (1. Pain is a common concern, but adolescents are more concerned about their body image 2. In general, adolescents are more concerned with their body image and not with spirituality. 3. Body image is a developmental issue for adolescents and infl uences their acceptance of themselves and by peers. 4. Body image is more of a concern for adolescents and should be addressed fi rst by the nurse. Lack of coping is not a priority at this time.)

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 (1. S. pneumoniae is more common in children younger than age 5 years, but it is not the most common organism. 2. E. coli is more common in neonates, but it is also not the most common cause. 3. S. aureus is a common organism found on the skin and is frequently the cause of septic arthritis. 4. N. gonorrhoeae should be considered in sexually active patients, but it is not the most common organism.)

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

3 (1. Striated muscle is in many organs and sites of the body, thus leading to the multiple sites of the disease. 2. Striated muscle is in many organs and sites of the body, thus leading to the multiple sites of the disease. 3. Striated muscle is in many organs and sites of the body, thus leading to the multiple sites of the disease. 4. There is no such muscle.)

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 intervention should the nurse suggest the parent do fi rst? 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 (1. The cause of the crying needs to be determined prior to administering pain medication. 2. Although this is a good choice, it is not the fi rst intervention. 3. Checking the neurocirculatory status of the foot is the highest priority. 4. Although this is a good choice for cast discomfort, it is not the fi rst choice.)

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 (1. The use of bleach can damage the brace. 2. Drying the brace in direct sunlight or on a heater can warp it. 3. An orthosis should be cleaned weekly with mild soap and water. 4. The brace can be safely cleaned at home.)

23. Select the number 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 (1. This position does not provide the best protection for balance and stability. 2. This position does not provide the best protection for balance and stability. 3. This position provides the best protection for balance and stability. 4. This position does not provide the best protection for balance and stability)

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 long? 1. Pain from the brace. 2. Diffi culty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.

3 (1. Wearing the brace is not painful. 2. Putting on the brace is not diffi cult. 3. Children this age are very conscious of their appearance and fi tting in with their peers, so they might be very resistant to wearing a brace. 4. Although a child this age might not fully understand how the brace helps the condition, that would not be the most likely cause of noncompliance.)

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 (2. This is stage II disease. 3. Stage IV disease means there is distant metastatic disease. 4. Lymph node involvement is not used as part of staging for rhabdomyosarcoma.)

12. Which should be included in teaching a family about postsurgical care for slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. The client 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 client. 6. Exercises to strengthen hip and leg muscles.

3, 5, 6. (1. Ambulation is to be non-weight-bearing with crutches until range of motion is painless. This is usually 4 to 8 weeks. 2. Pain medication is to be administered regularly during hospitalization to provide comfort to the patient and encourage cooperation with daily activities and ambulation. Drug dependence for the postoperative patient is not a signifi cant concern. 3. The parents will be assessing pin sites for infection and stability upon discharge. Instructions on care should be demonstrated for and then by the parents. 4. Although obesity is often a factor in SCFE, the patient requires adequate caloric intake for healing and recovery postoperatively. Obesity issues can be addressed after surgical recovery. 5. Instruction on crutch usage will be given prior to discharge. Crutch walking will not be done during the early postoperative stage. 6. The physical therapist will give the client exercises to strengthen the hip and leg muscles.)

1. Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? Select all that apply. 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone. 5. Positive Ortolani test.

3, 5. (1. In DDH, a newborn can have excessive hip adduction. 2. In DDH, an appearance of femoral shortening is frequently present on the affected side. 3. In DDH, asymmetrical thigh and gluteal folds are frequently present. 4. Infants do not experience pain from this condition. 5. The Ortolani maneuver moves a disclocated hip back into the socket with a distinct clunk.)

60. Which is an important nursing intervention to monitor in a child with systemic lupus erythematosus (SLE) and renal involvement? 1. Monitor weight. 2. Check for uric salts in urine. 3. Watch for hypotension. 4. Check for protein in urine.

4 (1. For renal impairment due to SLE, monitoring the child ' s weight is important, but checking the urine is a priority. 2. Uric salts are a normal concentrate of urine. 3. Hypertension, not hypotension, is a problem with renal involvement. 4. Protein in urine is a sign of renal impairment, even in nephrotic syndrome, in which the kidneys are losing protein.)

11. 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.

4 (1. In most cases of SCFE, there is no history of trauma to the hip. There is sudden onset of pain, often after a fall. 2. Physical examination may reveal some restriction of rotation of the hip, but it is not diagnostic. 3. There is no change in blood laboratory values with SCFE. Radiographic examination is the only defi nitive tool for diagnosis of SCFE. 4. Radiographic examination is the only defi nitive diagnostic tool for SCFE.)

64. 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. 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 (1. It is a fracture that does not go all the way through the bone. 2. It is a fracture that does not go all the way through the bone. 3. 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.)

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. Infants. 2. Toddlers. 3. School-age children. 4. Adolescents.

4 (1. Osteosarcoma is a common cancer of adolescents. 2. Osteosarcoma is a common cancer of adolescents. 3. Osteosarcoma is a common cancer of adolescents. 4. Osteosarcoma is a common cancer of adolescents.)

2. Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment 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.

4 (1. Socks should be put on under the straps to prevent rubbing of the skin. The harness is stable if fi tted correctly. 2. Lotions and powders tend to cake and irritate under the straps. Their use is not recommended. 3. The harness is not to be removed except in specifi c conditions and after instruction on removal and refi tting. Diapering is easily done with the harness in place. 4. Checking under straps frequently is suggested to prevent skin breakdown.)

40. Which would be the best nursing intervention for a child with phantom pain after an amputation? 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 amitriptyline (Elavil) to help with pain.

4 (1. This is not a helpful intervention. 2. PCA is not necessary for phantom pain. 3. Rubbing the stump is not helpful and possibly harmful to healing. 4. Amitriptyline (Elavil) is a medication for nerve pain that is helpful in relieving phantom pain.)

52. The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: 1. Breakdown of osteoclasts in the joint space causing bone loss. 2. Loss of cartilage in the joints. 3. Buildup of calcium crystals in joint spaces. 4. Immune-stimulated infl ammatory response in the joint.

4 (1. This is part of the normal breakdown and buildup of bone in the body. 2. This is part of the process for osteoarthritis. 3. This is the pathophysiology of calcium chondrosis. 4. JIA is caused by an immune response by the body on the joint spaces.)