PEDI: CH: 22 Neurovascular disorders

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Apply ice to the injury for 60 minutes on and 60 minutes off." "Elevate the legs, and use bed rest for 24 hours." "Taking warm baths will help relax muscles and reduce pain." "Applying ice to the area will reduce the pain and swelling."

"Applying ice to the area will reduce the pain and swelling." Explanation: 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 the 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.

The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education? "Because our child is being treated by using braces, the braces will have to be worn almost all the time." "The most successful treatment for scoliosis is surgery before reaching adult age." "Because our child has scoliosis, treatment will include halo traction." "The treatment for our child's scoliosis is anticipated to last between 3 to 4 months."

"Because our child is being treated by using braces, the braces will have to be worn almost all the time." Explanation: The Boston or the thoracolumbosacral orthosis (TLSO) brace is made of plastic and is customized to fit the child for treatment of scoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit. Halo traction may be used to treat clients with severe scoliosis, but not all clients. Children will be reassessed every 4 to 6 months to determine the prognosis for continuing brace therapy and potentially refitting. Bracing may be indicated for months or years. Surgery may be indicated, depending on the severity and complications resulting from the scoliosis; however, surgery is not the best option for all clients.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? "Blowing cool air with a fan or hair dryer may relieve the feeling." "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." "A small amount of lotion or baby oil can be poured in the cast to moisturize the area." "Itching is common. It's nothing to worry about."

"Blowing cool air with a fan or hair dryer may relieve the feeling." Explanation: Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education? "Injuries that happen at the end of the bone, the epiphysis, are at a greater risk for becoming infected." "Since her fracture is in the central shaft of her leg, it may interfere with the growth of that leg." "Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." "My child is at risk for abnormal growth of the leg because the break is in the outer layer of the bone."

"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." Explanation: Fractures that occur in the epiphyseal plate, the area between the central shaft (diaphysis) and the rounded end portion (epiphysis), can halt growth, stimulate abnormal growth, or cause irregular or erratic growth. Fractures in the diaphysis and epiphysis will not interfere with growth. The outer layer of the bone, the periosteum, may be injured when infected, not from a fracture.

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching? "Check the skin that is covered by the braces for redness and breakdown." "If the brace is painful, feel free to take it off." "It is very important to comply with the use of this brace." "Please try and follow the therapist's on and off schedule."

"Check the skin that is covered by the braces for redness and breakdown." Explanation: Assessing skin integrity should be the priority, as braces can lead to pressure ulcers and infection. Compliance is important, but attention to skin care is the priority teaching. Following the schedule is important for compliance, but skin integrity is the priority. Advising the parents to remove the brace if it is painful is inaccurate; the child may require pain management or further consultation with the physical therapist.

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? "Have you seen any signs of improvement?" "In most cases treatment is not necessary, only observation." "This is the most common facial nerve palsy." "Was this from pressure resulting from forceps?"

"In most cases treatment is not necessary, only observation." Explanation: 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.

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 wear the brace now to stabilize your spinal alignment, decreasing your symptoms." "It is important to prevent herniation of a spinal disk, which is painful." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent torticollis."

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." Explanation: It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear.

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? "Kids can be cruel sometimes. Has anyone told you that you look different?" "You should not worry about what everyone else is wearing. You look fine." "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."

"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: A positive self-image is very important for adolescents wearing a brace. They want to look like their peers and wear the same clothing, but often that is not possible when wearing a brace. Assisting the adolescent in selecting clothing that looks stylish but still hides the brace is one of the best ways to help this client. Telling her she looks fine, to be confident, or bringing up the times she has been embarrassed does not help the client.

While assessing a preadolescent child, the nurse notes curvature of the child's spine. Which statement by the child's parent supports this observation? "My child has been reporting back pain for the last 2 or 3 months." "My child has such a hard time finding pants that fit right. They never seem to fit evenly over the hips." "I've wondered why my child won't let me in the room when changing clothes." "My child has been taking ibuprofen daily for the last few weeks because of hip pain after walking so much at school."

"My child has such a hard time finding pants that fit right. They never seem to fit evenly over the hips." Explanation: Curvature of the spine can indicate scoliosis. Scoliosis is a painless disorder that predominately presents during the rapid growth phase in preadolescence. A need for privacy is normal for this age group. The curvature of the spine can make the iliac crests uneven and make it difficult to find pants that fit correctly. Hip and back pain are not typical in this disorder.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching? "We need be aware of odor or drainage from the cast." "The casted arm must be kept still." "Pale, cool, or blue skin coloration is to be expected." "We must avoid causing depressions in the cast."

"Pale, cool, or blue skin coloration is to be expected." Explanation: It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately.

A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond? "You have to go to a support group; it will be very helpful." "You need to remain as active as possible and have a positive attitude." "There are many things that you can do like crafts, computers or art." "There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group."

"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." Explanation: The best response would be to remind the boy that there are many children with muscular dystrophy that could be found at the local support group. Teenagers do not like to be told that they "have" to do anything. Telling the boy that he needs to be active or simply suggesting activities does not address his concerns.

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns? "This is not your fault and we will help you with her care and treatment." "Don't worry; this is a relatively common diagnosis." "Your daughter will likely wear a Pavlik harness." "There are simple noninvasive treatment options."

"This is not your fault and we will help you with her care and treatment." Explanation: Because the mother is crying and experiencing the initial shock of the diagnosis, the nurse's primary concern is to support the mother and assure her that she is not to blame for the DDH. While education is important, the nurse should let the mother adjust to the diagnosis and assure her that the baby and her family will be supported now and throughout the treatment period.

After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching? "We'll apply a warm moist compress to the wrist for 20 minutes at a time." "She'll need to limit any activity that involves the wrist." "We can wrap the wrist in an elastic bandage to help reduce the swelling." "We'll make sure she keeps her arm above heart level."

"We'll apply a warm moist compress to the wrist for 20 minutes at a time." Explanation: Care for a sprain includes rest, ice, compression, and elevation. Cold therapy, not heat, is used for 20 to 30 minutes at a time, then removed for 1 hour and repeated for the first 24 to 48 hours. Compression via an elastic bandage, elevating above heart level, and limiting activity are appropriate measures.

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 check my brace daily to make sure there is no damage or change to it." "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." "I leave my brace on for gym at school."

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Explanation: Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily for all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort, a lightweight t-shirt may be worn under the brace.

An infant was born with a severely deformed hand. He is now 6 months old. The nurse informs the parents that the orthopedic surgeon has recommended amputation of the hand and fitting of a prosthesis. The mother objects and tells the nurse that they would like to wait and see how the hand develops. Which of the following should the nurse say in response? "With a deformity such as this, the hand is highly unlikely to improve." "I agree. You should wait until your son is older and let him decide whether he would like to have it done." "If we perform the amputation and you change your mind later, the hand can always be surgically reattached." "An alternative to amputation and prosthesis is administration of a new drug that can help regenerate the hand."

"With a deformity such as this, the hand is highly unlikely to improve." Explanation: Depending on the condition, in many children, there is a potential for better function if the malformed portion of an extremity is amputated before a prosthesis is fitted. This creates a difficult decision for parents because it is one they cannot undo later. They need assurance that hands with malformed fingers, for example, will not later grow to become normal and a well-fitted prosthesis will allow their child a more usual childhood (and adult life) than if the original disorder was left unchanged. It is not the nurse's place to insert her opinion about the matter.

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? "NSAIDs can help with pain control and inflammation." "Ice will help reduce the inflammation." "You and your coaches need to understand that you cannot play soccer for at least six weeks." "You will need to see a physical therapist for stretching and strengthening exercises."

"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

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 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. 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 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: Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) 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.

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? Apply a tube of stockinette over the cast Cut a window in the cast over the wrist Assess the fingers for warmth, pain, and function X-ray the cast to make sure the bones are aligned properly

Assess the fingers for warmth, pain, and function Explanation: Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Before a cast is applied, not after, a tube of stockinette is stretched over the area, and soft cotton padding is placed over bony prominences. A "window" may be placed in a cast for an open fracture or if an infection is suspected—not to prevent an infection—so that the area can be observed; however, a window is not indicated in this case. The x-ray should be performed before casting, not after it, in order to diagnose the fracture.

The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications? Adjust the weights as needed. Provide pin care as needed. Clean and massage his entire leg daily. Assess the popliteal region carefully for skin breakdown.

Assess the popliteal region carefully for skin breakdown. Explanation: The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care.

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? The infant will have a poor sucking reflex. Nausea and vomiting often follow repair of the cystic mass. Pain will interfere with the feeding process. Assuming the usual feeding position will be difficult.

Assuming the usual feeding position will be difficult. Explanation: Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area.

A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used? Observation Inspection Auscultation Palpation

Auscultation Explanation: The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client? Surgery Bracing Traction Exercise

Bracing Explanation: For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? Ligaments Joints Tendons Cartilage

Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg? Apply Denis Browne splints to the infant each night. Change the infant's diapers frequently. Perform passive foot exercises. Check the infant's toes for coldness or blueness.

Check the infant's toes for coldness or blueness. Explanation: Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. The other answers are other interventions pertaining to caring for a child with clubfoot but are not associated specifically with ensuring good circulation.

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 Ineffective coping related to diagnosis of chronic condition Risk for injury related to lack of muscle control Impaired physical mobility related to spinal cord defect

Deficient knowledge related to diagnosis and condition Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for health care professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors? Duchenne muscular dystrophy is diagnosed in boys who develop gait changes during the late school-age years. Duchenne muscular dystrophy is a nonprogressive disorder that severely affects muscle function through spinal cord atrophy. Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Duchenne muscular dystrophy is a progressive disease of muscles and nerves that affects males and females equally.

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Explanation: Duchenne muscular dystrophy is the most common of several muscular dystrophies and is a progressive, fatal disorder. It involves mainly skeletal muscles, but other muscles are affected over time. Onset occurs in early childhood. The disorder is X-linked recessive. An enzyme is lacking that is necessary for the maintenance of muscle cells. No structural abnormalities of the spinal cord or peripheral nerves are noted.

The nurse is teaching a health and wellness course to young women of childbearing age. Which vitamin will the nurse encourage all to take daily? Calcium Ascorbic acid Niacin Folic acid

Folic acid Explanation: It is recommended that all women of childbearing age ingest 0.4 mg of folic acid daily. Ascorbic acid is vitamin C, niacin is a B vitamin, and calcium is a mineral, not a vitamin.

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? lordosis appearance of smaller than normal calf muscles indications of hydrocephalus Gowers sign

Gowers sign Explanation: A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this? Spiral Complete Epiphyseal Greenstick

Greenstick Explanation: Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. Spiral fractures are seen when the fracture goes around the bone instead of through (i.e., looks like someone twisted the bone, and can occur in skiing injuries, falls, or abuse). A complete fracture is when the bone is actually broken in two pieces. An epiphyseal fracture occurs at the epiphyseal growth plate.

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? Using only a draw sheet to move the casted arm. 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.

Handling the cast with open palms when moving the arm. Explanation: A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process.

A parent brings the infant to the clinic for a well-child visit. During the assessment the nurse notes that the infant has an area of dark pigmentation with a tuft of hair on the sacrum. Which action should the nurse take? Ask the parent if the child has sustained an injury. Have the health care provider assess the finding. Ask the parent how long the tuft of hair has been there. Document the finding as a congenital dermal melanocytosis (slate gray nevus).

Have the health care provider assess the finding. Explanation: The dark pigmentation and tuft of hair on the sacrum suggests that the infant has spina bifida occulta, which will require follow up with diagnostic testing to confirm the diagnosis (ultrasound and/or magnetic resonance imaging). A congenital dermal melanocytosis (slate gray nevus, previously known as Mongolian spot) is a dark pigmented area commonly found on darker skinned infants on the sacrum, buttocks and sometimes the scapula. The tuft of hair is what leads to the suspicion of spina bifida occulta. There is no indication to ask the parent how long the tuft of hair has been there or if the infant sustained an injury.

Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing? Supporting own weight when placed in standing position Equal withdrawal of lower extremities from pain Bilaterally open rather than closed hands Head lag when pulled from supine to sitting

Head lag when pulled from supine to sitting Explanation: Head lag in the child requires referral. By 4 to 5 months, the infant should be able to maintain the head in a neutral position.

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? Pain related to chronic inflammation of the lower leg Deficient diversional activities related to a need for imposed activity restriction for 6 weeks Impaired physical mobility related to a cast on the leg Situational low self-esteem related to the use of a walker

Impaired physical mobility related to a cast on the leg Explanation: Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective? Gently massage the child's back to stimulate circulation. Inspect the child's skin for rashes, redness, irritation, or pressure injuries. Assess neurovascular status on the affected extremity once every shift. Keep the child's skin distal to the traction clean and dry. SUBMIT ANSWER

Inspect the child's skin for rashes, redness, irritation, or pressure injuries. Explanation: It is important to be vigilant in inspecting the child's skin for rashes, redness, and irritation to uncover areas where pressure injuries are likely to develop. Applying lotion, gentle massage, and keeping the skin dry and clean are part of the routine skincare regimen. However, performing these interventions without first performing a skin assessment can cause the nurse to miss important signs that can potentially result in more injury to the child. Neurovascular assessment should be performed frequently as prescribed by the health care provider or at least every 4 hours to evaluate skin integrity and venous circulation.

A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation? The slow progression of the disorder will allow the infant to have a fairly normal childhood. Intense physical therapy can aide the infant in learning to sit and walk independently. This is an autosomal dominant disorder that affects motor and cognitive development. Muscular wasting results in generalized immobility and difficulty feeding and breathing.

Muscular wasting results in generalized immobility and difficulty feeding and breathing. Explanation: SMA type 1 is the most severe form of spinal muscle atrophy that results in muscle wasting, generalized immobility and difficulty feeding. This is an autosomal recessive genetic disorder that affects motor but not cognitive development. SMA type 1 has a rapid progression; these infants do not usually live past 2 years of age. Infants diagnosed with SMA type 1 will not sit unassisted and will not walk. Physical therapy is beneficial in strengthening some muscles, especially in those with the less severe SMA types 2, 3 or 4.

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse? Notify the health care provider of the findings immediately. Apply ice bags to the child's foot and ankle. Administer prescribed pain medication. Reposition the leg on pillows so that it is above the level of the child's heart.

Notify the health care provider of the findings immediately. Explanation: Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.

What methods can a nurse use to evaluate extremity function in an 18-month-old? Select all that apply. Ask the child to squeeze the nurse's fingers simultaneously. Look for symmetric motion in the arms and legs. Observe the child in developmentally appropriate play. Have the child push against resistance with both feet. Elicit from the parent a description of fine and gross motor activities.

Observe the child in developmentally appropriate play. Elicit from the parent a description of fine and gross motor activities. Look for symmetric motion in the arms and legs. Explanation: Observing play, eliciting parental descriptions, and looking for symmetry in motion are all developmentally appropriate and effective methods of assessing extremity function in this toddler. Expecting the child to cooperate in squeezing fingers or pushing feet against resistance is not realistic and is likely to cause reluctance to participate in later assessments.

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 the newborn in a prone or lateral position. Place a urine collection bag on newborn for the continuous leakage.

Place the newborn in a prone or lateral position. Explanation: The nurse should place the newborn in a prone or lateral position to keep pressure off the spinal sac and avoid newborn injury. Parents should be allowed to hold the stable infant with assistance. The spinal sac should be kept covered and moist until surgery to avoid rupture. Collecting urine decreases the risk of urine stasis, which is sometimes common in spinal defects.

A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment? Get down to the child's level and interact with the child. Quietly observe the child at play while interviewing the parent. Ask the parent to describe the child's development. Review the child's health history to determine if the child is on track developmentally.

Quietly observe the child at play while interviewing the parent. Explanation: The best way to assess a young child's neuromuscular system is to observe the child from a distance. Observing the child at play will allow the nurse to assess the child's gross and fine motor skills, as well as cognitive abilities.

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? Risk for activity intolerance Disorganized infant behavior Peripheral neurovascular dysfunction Risk for impaired skin integrity

Risk for impaired skin integrity Explanation: The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

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? External fixation device Spica cast Stockinette Internal fixation device

Spica cast Explanation: 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 working with a 6-year-old child recently diagnosed with Legg-Calvé-Perthes disease. The child's parents tells the nurse they understand exercise is important for their child but are not sure which activities are appropriate. Which activity will the nurse recommend for this client? Swimming Brisk walking Jumping jacks Soccer

Swimming Explanation: Legg-Calvé-Perthes disease occurs when blood supply to the femoral head of the hip joint is temporarily interrupted and the bone begins to die. The child with Legg-Calvé-Perthes disease will experience limited range of motion in the hip. Thus, swimming and tricycle or bicycle riding are excellent exercises because they provide smooth joint action and will help to reduce joint destruction. In contrast, activities that place excessive strain on joints, such as running, jumping, prolonged walking, and kicking, should be avoided.

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'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. The boy experiences mild pain when wiggling his toes. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours.

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: The parents should call the physician when the following things occur: The child has a temperature greater than 101.5° F (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

The nurse is observing a child walk down stairs using a swing-through gait. What action by the child is correct? The child tries to walk without the crutches. Both crutches are placed on the lower step, and then the good foot is placed on the step below the crutches. The child places the crutches on the lower step before placing the good foot down between the crutches. One crutch is placed on the lower step, and then the good foot is placed next to the crutch.

The child places the crutches on the lower step before placing the good foot down between the crutches. Explanation: To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. The nurse should be a contact person when the child is hospitalized. The nurse should provide information when the child or caregiver requests it. The nurse should support the caregivers in restricting activity during the treatment.

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. Explanation: Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

In caring for a child in traction, which intervention is the highest priority for the nurse? The nurse should record accurate intake and output. The nurse should monitor for decreased circulation every 4 hours. The nurse should provide age-appropriate activities for the child. The nurse should clean the pin sites at least once every 8 hours.

The nurse should monitor for decreased circulation every 4 hours. Explanation: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.

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

The posterior spine when bending forward Explanation: Diagnosis of scoliosis is best made with inspection and observation. When inspecting the back with the child in a standing position, the nurse should note asymmetries such as shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. A lateral curvature of the spine is best revealed when the child bends forward. The child should bend forward with the arms hanging freely. The curve and asymmetry of the back can be observed. The height of the iliac crest, not the angle, is measured on both sides and the difference is noted. Bending to the side would not provide an accurate assessment of the spine because the curvature cannot be seen from the side. The lower chest angle would not be an accurate assessment as it would be more associated with the ribs as opposed to the spine.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele? There is no protrusion of the spinal cord, only soft-tissue inflammation occurs. There is protrusion of the spinal cord and meninges, with nerve roots embedded. The spinal meninges protrude through the bony defect and form a cystic sac. There is a bony defect that occurs without soft-tissue involvement.

The spinal meninges protrude through the bony defect and form a cystic sac. Explanation: When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta.

The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification? Type IV Type I Type V Type II

Type II Explanation: According to the Salter-Harris classification, a type II fracture is partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis.

A group of students is reviewing information about bone healing in children. The students demonstrate understanding of this information when they state: callus production is slower (but greater in amount) in children than in adults. 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. a fracture closer to the growth plate heals much slower than one in the metaphysis.

a child's bones heal more quickly than those of an adult. Explanation: Bone healing in children occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.

he 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? decreased oral intake a weak pedal pulse temperature 100.2°F (37.9°C) mild fussiness

a weak pedal pulse Explanation: A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Decreased oral intake and an elevated temperature could indicate an infection. However, circulation is priority over infection in the client and would be most concerning for the nurse. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically.

A group of students is reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age? preschool age adolescence toddlerhood school age

adolescence Explanation: Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

A 9-year-old child is scheduled for a computed tomography with contrast medium. What would be most important for the nurse to assess? swelling white blood cell count allergies pain

allergies Explanation: Assessing for allergies would be the priority because a contrast medium is being used. Pain is an important assessment but is unrelated to the test scheduled. Swelling is an important assessment finding, but this is unrelated to the test scheduled. Although a white blood cell count is important for determining an infection, it is unrelated to the test scheduled.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the: back with hips flat on the bed. stomach with both legs extended. back with the injured hip flexed and the uninjured one extended. back with hips up off the bed.

back with hips up off the bed. Explanation: Bryant traction is used to reduce fractures or with developmental dysplasia of the hip (DDH) in children younger than 2 years of age. In this type of traction, both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed. The position of having the child on the back with the hips flat is describing Buck traction. The position where the hip is flexed on the injured side and the uninjured extended is 90-90 traction. There is no traction when the child would be on the stomach.

The nurse is teaching the parents of a preschool-aged child with cerebral palsy about the upcoming surgery that is planned for the child to help control their spasticity. The nurse discusses that the surgeon will be inserting which item in their child during this procedure? botulinum toxin vagal nerve stimulator central venous catheter baclofen pump

baclofen pump Explanation: A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practitioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures.

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? increasing ICP leaking cerebrospinal fluid constipation and bladder dysfunction increasing head circumference

constipation and bladder dysfunction Explanation: Symptoms of constipation and bladder dysfunction may result due to an increasing size of the lesion. Increasing ICP and head circumference would point to hydrocephalus. Leaking cerebrospinal fluid would indicate the sac is leaking.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? bilirubin creatine kinase serum potassium sodium

creatine kinase Explanation: 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 is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered? diazepam pamidronate alendronate opioid analgesics

diazepam Explanation: Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Opioid analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.

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: Sever disease (calcaneal apophysitis). epiphysiolysis of the proximal humerus. epiphysiolysis of the distal radius. Osgood-Schlatter disease.

epiphysiolysis of the proximal humerus. Explanation: Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease (calcaneal apophysitis) causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding? kyphosis sway back lordosis idiopathic scoliosis

idiopathic scoliosis Explanation: Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.

An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care? provide range of motion to the unaffected extremity removing the traction boot every 8 hours wrapping the bandages from the ankle to the knee keeping the buttocks slightly elevated.

keeping the buttocks slightly elevated. Explanation: With Bryant traction, the buttocks should be slightly elevated and clear of the bed. The bandages are wrapped from the ankles to mid-thigh in Bryant traction. The legs are wrapped from the ankle to knee. A traction boot is not used with Bryant traction. This action would be appropriate for Buck traction. With Bryant traction, both legs are extended vertically, so range of motion would not be appropriate.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? latex alcohol gel peanuts cat dander

latex Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

Which of these strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy? manual wheelchair long leg braces motorized wheelchair walker

long leg braces Explanation: Long leg braces are functional assistive devices that provide increased independence and increased use of upper and lower body strength. Wheelchairs, both motorized and manual, provide less independence and less use of upper and lower body strength. Walkers are functional assistive devices that provide less independence than braces.

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 x-ray confirmation of adequate bone shape high serum phosphate levels

low serum calcium levels Explanation: 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 caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? X-ray assessment of ambulation muscle biopsy EEG

muscle biopsy Explanation: Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? presence of symmetrical spontaneous movement absence of Moro reflex presence of Moro reflex absence of tonic neck reflex

presence of Moro reflex Explanation: The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child.

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: ensure proper bone alignment. promote healing. discourage infection. prevent edema.

prevent edema. Explanation: Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. supine prone semi-Fowler left side lying right side lying

prone right side lying left side lying Explanation: Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele? risk for infection impaired physical mobility delayed growth and development constipation

risk for infection Explanation: All of these diagnoses are important for a child with a myelomeningocele. However, during the first 12 hours of life, the most life-threatening event would be an infection. The other diagnoses will be addressed as the child develops.

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: bone that breaks into two pieces. incomplete fracture. bone buckling due to compression. significant bending without actual breaking.

significant bending without actual breaking. Explanation: A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

Which diagnostic measure is most accurate in detecting neural tube defects? flat plate of the lower abdomen after the 23rd week of gestation amniocentesis for lecithin-sphingomyelin (L/S) ratio presence of high maternal levels of albumin after 12th week of gestation significant level of alpha-fetoprotein present in amniotic fluid

significant level of alpha-fetoprotein present in amniotic fluid Explanation: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is: Buck extension traction. skeletal traction. Russell traction. skin traction.

skeletal traction. Explanation: Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates? spina bifida occulta spina bifida with myelomeningocele spina bifida with meningocele a normal spinal closure

spina bifida occulta Explanation: Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arouse suspicion of its presence, or it may be overlooked entirely.

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? breathing standing sitting swallowing

standing Explanation: Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a client would have difficulty standing before having difficulty sitting.

The parents of a preschool-aged child learn their child is diagnosed with Duchenne muscular dystrophy (DMD), based on the nurse noting Gower sign during a well-child visit. How should the nurse explain Gower sign to these parents? muscle twitching present during a quick stretch a waddling-type gait the pelvis position during gait the way the child stands up

the way the child stands up Explanation: Gower sign is a description of a transfer technique present during some phases of muscular dystrophy. The child turns on the side or abdomen, extends the knees, and pushes on the torso to an upright position by walking their hands up the legs. The child's gait is unrelated to the presence of Gower sign. Muscle twitching present after a quick stretch is described as clonus.

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? to wear the brace a maximum of 20 hours each day to continue with age-appropriate activities that secondary sex changes will stop until the brace is removed to stand absolutely still when not wearing the brace

to continue with age-appropriate activities Explanation: The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. Bracing is one way to do that. The brace should be worn for 23 hours per day. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. It is extremely important that the adolescent has compliance with the brace usage. The nurse can help by teaching the adolescent ways to help peers understand the need for the brace. Sex changes continue with or without bracing.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse? unhooking a weight while providing pin care using latex free sterile gloves mixing hydrogen peroxide with sterile water to make half-strength hydrogen peroxide placing sterile cotton gauze squares around the ends of the pins

unhooking a weight while providing pin care Explanation: Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair? antitip device headrest support wheelchair belt extended breaks

wheelchair belt Explanation: This client has poor trunk control; a belt will prevent him from falling out of the wheelchair. Antitip devices, head rest supports, and extended breaks are all important options but aren't the most important options in this situation.