PEDS Ch. 51 PREPU
The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment?
"At least when I take a shower I have a few minutes out of this brace."
The caregiver of a 2-year-old who has a polyurethane resin cast on her arm calls the clinic to report that her child is crying and says that the cast has sand in it. The caregiver states that she has had casts herself and knows how badly they can itch. She says she always used a hanger to scratch but is worried that it will be too sharp for the child. Which statement would be appropriate for the nurse to make to this caregiver?
"Nothing should be put into the cast. You can blow cool air into it with a hair dryer."
A mother is angry about her son's diagnosis of osteosarcoma. She is telling him that if he had not played football last year and broken his leg, this would not have happened. What is the nurse's best response to the mother's statement?
"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."
The nurse is caring for a child who has a hip spica cast. The child's mother asks why is there a hole cut in it. What is the best response by the nurse?
"The window allows us to assess bowel sounds and helps to prevent abdominal distention."
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 in which situation?
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.
The nurse is caring for an 8-month-old in Bryant traction for developmental dysplasia of the hip and is monitoring for complications. Which assessment finding would alert the nurse to a possible complication?
A weak pedal pulse
When teaching a group of parents about the skeletal development in children, what information is most helpful?
A young child's bones commonly bend instead of break with an injury.
When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all that apply.
African American ethnicity Obesity
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?
Bracing
The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply.
Calcium and vitamin D play important roles in bone growth and bone breakdown. Calcitonin plays a role in remodeling of bone. Periosteum is the outer covering of the bone.
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?
Cartilage
A child is born with a talipes disorder. 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?
Check the infant's toes for coldness or blueness.
The mother of a child who has sustained a fractured leg is worried how long her child will be unable to walk without crutches. The nurse would explain to the mother that the child should be walking independently soon due to what reason?
Children's bones heal faster than adults.
The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.
Color Sensation Pulse Capillary refill
The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:
Complete
Complications associated with bleeding most often involve joints and muscles. Adjunct measures to control bleeding include:
Compression
The nurse is caring for a child who fractured his arm in an accident. A cast has been applied to the child's right arm. Which actions should the nurse implement? Select all that apply.
Document any signs of pain. Check radial pulse in the both arms. Monitor the color of the nail beds in the right hand.
The nurse is caring for a child admitted with juvenile idiopathic arthritis (JIA). Which of the clinical manifestation would likely have been noted in the child with this diagnosis?
Inflammation of the joints
In understanding the physiology of the musculoskeletal system, the nurse recognizes that which of the following are stored in the bones?
Minerals
The school nurse is doing a presentation to a group of caregivers of children diagnosed with scoliosis. One of the caregivers asks the nurse about structural scoliosis. Which condition is involved with the diagnosis of structural scoliosis?
Rotated and malformed vertebrae
The nurse is caring for a child in the postanesthesia care unit following a surgical procedure to place pins in the child's fractured femur. This pin placement is an example of which type of traction?
Skeletal
A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis?
Staphylococcus aureus
A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion?
Swelling and point tenderness
A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client?
Teach the client not to rest with the crutch pad pressing on the axilla.
The nurse is caring for a child in a type of traction in which weights are being used. What is true regarding the weights?
The weights must be hanging freely, not touching the bed or floor.
The nurse is caring for a child who has had a cast applied to treat a fracture of the fibula. To monitor the pulse of the child's involved extremity the nurse will monitor which of the following?
Tibial pulse
Idiopathic scoliosis is the most common form that occurs.
True
The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:
skeletal traction.
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
The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?
when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand
The nurse is caring for a child who is using crutches due to a leg injury. The child's parents state that child reports pain in the axilla when using the crutches. What is the best response by the nurse?
"We need to make sure the crutches are not too tall; there should be about an inch of space between the crutch pad and the axilla."
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?
Assess the fingers for warmth, pain, and function
The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first?
Reposition the child's foot on a pressure-reducing device.
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:
significant bending without actual breaking.
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?
Greenstick
The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?
Impaired physical mobility related to a cast on the leg
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?
Spica cast
The child diagnosed with muscular dystrophy uses a method of rising from the floor which is referred to as which of the following?
Gowers sign
In understanding the function of the musculoskeletal system, the nurse recognizes that which of the following allows for movement of the body parts?
Joints
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.
The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention?
Reposition the child's foot on a pressure-reducing device.
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?
idiopathic scoliosis
The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education?
"This medication will cure my child of this disorder."
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."
The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?
Duchenne muscular dystrophy
The nurse is caring for a 1-year-old hospitalized child who is in Bryant traction. Which nursing intervention would be the highest priority for this child?
Monitor for excessive crying and irritability.
The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom?
Paresthesia
The nurse is caring for a number of children with bone fractures who are being treated with casts, traction, or external fixation. Which consideration is unique to external fixation?
Preventing further injury
The nurse is working with an 6-year-old boy who recently was diagnosed with Legg-Calvé-Perthes disease. The mother of the boy tells the nurse that she understands that exercise is important to help preserve muscle and joint function and asks the nurse for recommendations on types of exercise that would be appropriate. What exercise should the nurse recommend?
Swimming
A 14-year-old male is brought to the ER by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. Which of the following best describes this type of fracture?
There are three or more fracture fragments.
A neonatal nurse examines an infant and notes decreased hip motion that causes pain upon movement. This nurse suspects Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity.
True
The nurse working in orthopedics knows that a torsional deformity is a musculoskeletal condition in which the bone is "twisted."
True
In discussing the treatment for children with scoliosis, a group of pediatric nurses makes the following statements. Which statement is most accurate related to the treatment of scoliosis?
"Children treated for scoliosis by using braces have to wear the brace almost all the time."
The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?
"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."
A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state:
A child's bones heal more quickly than those of an adult.
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?
Assess the popliteal region carefully for skin breakdown.
Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step.
false
The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:
"These make a smooth edge on the cast so the skin is better protected."
The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. 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 is caring for a child with a possible diagnosis of muscular dystrophy. The nurse explains to the parents that which of the following will likely be used to confirm this child's diagnosis?
A muscle biopsy
