Peds: PrepU Ch. 22
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? -"Itching is common. It's nothing to worry about." -"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."
"Blowing cool air with a fan or hair dryer may relieve the feeling." 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.
A group of students are 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? -Adolescence -School age -Preschool age -Toddlerhood
Adolescence Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? -Tendons -Ligaments -Joints -Cartilage
Cartilage 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.
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 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.
Through which mechanism is Duchenne muscular dystrophy acquired? -Virus -Heredity -Autoimmune factors -Environmental toxins
Heredity Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.
A 3-month-old infant is seen in the pediatric clinic. The infant's parent expresses concern that the child has developed cerebral palsy. The nurse assesses the infant. Which assessment finding indicates to the nurse that the parent's concern is valid? -Hypertonia in the upper extremities -Exhibits Gower sign -Unable to sit without support -Turns head toward sounds
Hypertonia in the upper extremities Cerebral palsy manifests as hyper- or hypotonia, and cognitive and developmental delays. Gower sign is a manifestation of muscular dystrophy not cerebral palsy. A 3-month-old infant should be developmentally able to turn toward a voice or sound but is too young to sit without support.
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 serum calcium levels -Low alkaline phosphate levels -High serum phosphate levels -X-ray confirmation of adequate bone shape
Low serum calcium levels 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 -Muscle biopsy -EEG -Assessment of ambulation
Muscle biopsy 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 -Absence of tonic neck reflex -Presence of Moro reflex
Presence of Moro reflex 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 reflex are expected in a normally developing 9-month-old child.
Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? -Peripheral neurovascular dysfunction -Disorganized infant behavior -Risk for activity intolerance -Risk for impaired skin integrity
Risk for impaired skin integrity 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? -Internal fixation device -External fixation device -Spica cast -Stockinette
Spica cast 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.
Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? -Breathing -Sitting -Standing -Swallowing
Standing 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 nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. What is the mostimportant nursing intervention for the nurse to include in working with this child and his caregivers? -The nurse should provide information when the child or caregiver requests it. -The nurse should be a contact person when the child is hospitalized. -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.
The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. 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.
The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child: -cannot plantarflex his foot. -feels increasing severe pain. -has a weak femoral pulse. -has blue-looking nail beds on the toes.
feels increasing severe pain. Any reports of pain in a child with a new cast or immobilized extremity need to be explored and monitored closely for the possibility of compartment syndrome.
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 -lordosis -idiopathic scoliosis -sway back
idiopathic scoliosis 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.
The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place.
1 The supplement has 5 mcg of vitamin D in each 0.5 mL. The child is supposed to receive 10 mcg each day of supplemental vitamin D. Desired/Have x Quantity = dose 10 mcg/5 mcg x 0.5 mL = 1.0 mL Ratio/proportion: 0.5 mL/5 micrograms = x/10 micrograms = 1.0 mL
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? -Auscultation -Palpation -Inspection -Observation
Auscultation 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.
Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer? -Baclofen pump -Vagal nerve stimulator -Central venous catheter -Botulinum toxin
Baclofen pump A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practioner 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.
The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: -Duchenne. -facioscapulohumeral. -limb-girdle. -myotonia.
Duchenne. Studies have shown that Duchenne is the most severe form of muscular dystrophy. Myotonia isn't a form of the disease; it's a symptom.
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. -Prone -Right side lying -Left side lying -Semi-Fowler -Supine
Prone Right side lying Left side lying Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.
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 -Extended breaks -Headrest support -Wheelchair belt
Wheelchair belt 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.
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: -promote healing. -prevent edema. -discourage infection. -ensure proper bone alignment.
prevent edema. 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 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. -bone buckling due to compression. -incomplete fracture. -bone that breaks into two pieces.
significant bending without actual breaking. 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.
An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? -to continue with age-appropriate activities -to stand absolutely still when not wearing the brace -to wear the brace a maximum of 20 hours each day -that secondary sex changes will stop until the brace is removed
to continue with age-appropriate activities 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? -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
unhooking a weight while providing pin care 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.
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? -"In most cases treatment is not necessary, only observation." -"Have you seen any signs of improvement?" -"Was this from pressure resulting from forceps?" -"This is the most common facial nerve palsy."
"In most cases treatment is not necessary, only observation." 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.
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." -"When he broke his leg last year, it may have weakened the bone, allowing cancer to start there." -"Does bone cancer run in your family? Maybe he inherited it through his genes." -"Cancer in the bone can result from old injuries so it probably was not caused from getting hurt last year, but an earlier injury."
"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma.
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 check my brace daily to make sure there is no damage or change to it." -"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." -"I wear a t-shirt under my brace." -"I do exercises after school."
"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." 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 or 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 work under the brace.
The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What the appropriate response by the nurse? -"You don't need to worry about your child's feet. They will change as your child grows." -"Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." -"Flat feet are normal in infants. Their longitudinal arch doesn't appear until they are 3 to 5 years old." -"When your child starts walking, encourage walking on the heels. This will help to develop the arch more so your child doesn't have a problem with flat feet as an adult."
"Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." A newborn's foot is flatter and proportionately wider than an adult's foot. Feet do change as a child grows, but this answer does not address the mother's concern. The longitudinal arch may not be present until the child has been walking for a few months, not at 3 to 5 years of age. Encouraging a child to walk on the heels does not help with arch development.
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 -Vital signs
Color Sensation Pulse Capillary refill A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.
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? -Gowers sign -Appearance of smaller than normal calf muscles -Indications of hydrocephalus -Lordosis
Gowers sign 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 weakeness. 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.
Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing? -Head lag when pulled from supine to sitting -Bilaterally open rather than closed hands -Supporting own weight when placed in standing position -Equal withdrawal of lower extremities from pain
Head lag when pulled from supine to sitting 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 other assessment findings are normal for age, indicating no need for referral.
The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high risk for having a child with a myelomeningocele? -History of asthma taking montelukast -History of a seizure disorder and taking phenobarbital -History of a previous abdominal surgery -History of scoliosis
History of a seizure disorder and taking phenobarbital Maternal consumption of certain drugs that antagonize folic acid, such as anticonvulsants (carbamazepine and phenobarbital), places her at high risk for having a child with neural tube defect such as a myelomeningocele. A history of taking montelukast, previous abdominal surgery, or a history of scoliosis does not pose a risk for having a child with a myelomeningocele.
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 priorityfor this client? -Impaired physical mobility related to a cast on the leg -Deficient diversional activities related to a need for imposed activity restriction for 6 weeks -Situational low self-esteem related to the use of a walker -Pain related to chronic inflammation of the lower leg
Impaired physical mobility related to a cast on the leg 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.
An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? -Inspection of the cystic sac on the child's back for leakage -Auscultation for bowel sounds -Listening for a shrill cry -Careful supine positioning
Inspection of the cystic sac on the child's back for leakage Leakage from the cystic area indicates loss of cerebrospinal fluid (CSF) and risk of infection of the central nervous system. Prompt intervention is needed, probably surgical. Listening for bowel sounds confirms intestinal peristalsis but is not necessary with each infant contact. A shrill cry may indicate increased intracranial pressure (ICP). This is important to note yet is not as pressing as being aware of leakage. The baby would be positioned prone, not supine, to protect the sac.
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: -epiphysiolysis of the proximal humerus. -Osgood-Schlatter disease. -Sever disease. -epiphysiolysis of the distal radius.
epiphysiolysis of the proximal humerus. 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 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 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 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. -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's toes are light blue and very swollen.
-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. The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (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.
A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention? -A 2-month-old infant who reaches for a rattle several times before connecting with it -A 10-month-old infant who is able to ambulate with assistance -A 2-year-old toddler who can walk up the steps one at a time -A 4-year-old preschool-age child who consistently walks on tip toes
A 4-year-old preschool-age child who consistently walks on tip toes At 4 years of age, a child should not consistently walk on tip toes. This is common manifestation of muscular dystrophy and requires intervention. At 2 months of age, an infant's movements are uncoordinated and may take several attempts to touch objects the infant reaches for. Infants begin to walk between 9 and 18 months of age, and may begin by walking while holding a caregiver's hands. At 2 years of age, a toddler is able to walk up the steps one step at a time.
The nurse is caring for a child with muscular dystrophy. Which prescription will the nurse question? -Calcium supplement -Vitamin D -Prednisone -Clozapine
Clozapine Duchenne muscular dystrophy is the most common neuromuscular disorder of childhood, mostly affecting males. There is no cure, but treatments are available to slow progression and provide symptom management. Corticosterioids, such as prednisone, may be prescribed to protect muscle fibers from damage to the sarcolemma. Studies have shown males treated with prednisone have increased strength and function. Calcium supplements and vitamin D are prescribed to prevent osteoporosis. Antidepressants, not antipsychotics (such as clozapine), may be helpful when depression occurs related tothe chronicity of the disease and/or as an effect of corticosteroid use.
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 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. -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. Spiral fractures, which twist around the bone, are frequently associated with child abuse 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.
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 -Facioscapulohumeral muscular dystrophy -Congenital myotonic dystrophy -Juvenile arthritis
Duchenne muscular dystrophy By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.
The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? -Folic acid to 0.4 mg/day -Folic acid above 0.4 mg/day -Ascorbic acid to 0.4 mg/day -Ascorbic acid to 4 mg/day
Folic acid above 0.4 mg/day The American Academy of Pediatrics recommends that a woman who has had a child with a neural tube defect increase her intake of folic acid to above 0.4 mg per day 1 month before becoming pregnant and continue this regimen through the first trimester. A woman who has no family history of neural tube defects should take 0.4 mg/day. All women of childbearing age should be encouraged to take a folic acid supplement because the majority of pregnancies in the United States are unplanned. Ascorbic acid hasn't been shown to have any effect on preventing neural tube defects.
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 -Spiral -Complete -Epiphyseal
Greenstick 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.
A nurse is caring for an adolescent who is having a plaster cast applied. When the plaster strips are applied, the adolescent complains of it feeling hot. What is the best response by the nurse? -"When the strips start to dry, they can get warm, but they won't burn you." -"That is a normal feeling when casts are applied." -"Your temperature may be going up. I'll check it when they are done applying the cast." -"That is unusual. Most people complain of feeling cold."
"When the strips start to dry, they can get warm, but they won't burn you." As the plaster strips are applied, they initially feel cool but almost immediately they will begin to feel warm. This is due to evaporation. The statement that it is a "normal" feeling is not the best answer because it does not give enough information. The client having a temperature would not cause the cast to feel hot.
The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions? -Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns. -Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. -Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. -Give the client large, frequent meals with decreased fiber and increased protein and Vitamin C.
Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.
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 improve your spinal alignment, decreasing your symptoms." -"It is important to correct spinal curvature before it gets too bad, causing you problems." -"It is important to prevent herniation of a spinal disk, which is painful." -"It is important to prevent torticollis."
"It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms." 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. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.
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 help to increase bone mineral density." -"My child's risk for fractures will hopefully be decreased as by taking this medication." -"This medication will cure my child of this disorder." -"This medication doesn't prevent fractures from happening."
"This medication will cure my child of this disorder." Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening.
The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? -"At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better." -"Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon." -"We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." -"Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own."
"We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." When a parent describes a child as always falling over the feet or awkward, the nurse needs to assess for toeing-in or metatarsus adductus. One way to assess for this is to have the child stand on a copier and make a print of the feet. It will show any inward turning of the feet. For most instances, it resolves without therapy. If it persists past 1 year, passive stretching exercises may be prescribed. It is not a severe bone disorder and typically does not need surgical intervention.
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? -"You and your coaches need to understand that you cannot play soccer for at least six weeks." -"Ice will help reduce the inflammation." -"You will need to see a physical therapist for stretching and strengthening exercises." -"NSAIDs can help with pain control and inflammation."
"You and your coaches need to understand that you cannot play soccer for at least six weeks." 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.
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. -Assess the tips of the crutches to be certain the rubber tip is intact. -Be certain the child is walking with the crutches about 6 inches to the side of the foot. -Caution parents to clear articles such as throw rugs out of paths at home.
Teach the client not to rest with the crutch pad pressing on the axilla. Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child.
