Ch 33 Wong questions
Appears as a raising or bulging at the site of the fracture
Buckle, or torus, fracture
Fracture that is slanting and circular, twisting around the bone shaft
Spiral
59. The principal drugs used in SLE to control inflammation are the __________________
Corticosteroids
Escape of blood into the tissues
Ecchymosis
Fracture in which fracture fragments remain attached
Incomplete fracture
Microscopic tear to the musculotendinous unit
Strain
30. Johnny, a 12-year-old with fracture of the femur, has developed sudden chest pain and shortness of breath. The astute nurse suspects: a. pulmonary embolism. b. compartment syndrome. c. myocardial infarction. d. pneumonia.
A
34. Immediate treatment of sprains and strains includes: a. rest and cold application. d. compression of the area and heat application. C. rest, elevation, and pain medication. b. disregarding the pain and "working out" the sprain or strain.
A
39. Zac, a 16-year-old football star at the local high school, is at the school nurse practitioner's office for acne that is not clearing with the over-the-counter medications. During the physical examination, the nurse notes that Zac has achieved a marked increase in muscle and strength in a very short time. Which of the following would the nurse suspect caused these changes? a. Use of an ergogenic aid, anabolic steroids b. More frequent and more strenuous workouts in the gym c. Increased protein and vitamins in the diet d. Use of methylphenidate (Ritalin) or phenmetrazine (Preludin)
A
40. Commotio cordis: a. occurs after a blunt, nonpenetrating blow to the chest, which produces ventricular fibrillation. b. rarely causes death. c. occurs almost exclusively in athletes with hypertrophic cardiomyopathy. d. occurs in athletes who have a history of sudden death in a relative under the age of 50 years.
A
42. The condition recognized in the infant with limited neck motion, in which the neck is flexed and turned to the affected side as a result of shortening of the sternocleidomastoid muscle, is: a. torticollis. b. brachial plexus palsy. c. lordosis. d. kyphosis.
A
44. Slipped capital femoral epiphysis is suspected when: a. an adolescent or preadolescent begins to limp and complains of continuous or intermittent pain in the hip. b. an examination reveals no restriction on internal rotation or adduction but restriction on external rotation. c. referred pain goes into the sacral and lumbar areas. d. all of the above occur.
A
47. Osteomyelitis resulting from a bloodborne bacterium that could have developed from an infected lesion is termed: a. acute hematogenous osteomyelitis. b. exogenous osteomyelitis. c. subacute osteomyelitis. d. chronic osteomyelitis.
A
5. Major consequences of immobility in the pediatric patient include which of the following? a. Bone demineralization leading to osteoporosis b. Orthostatic hypertension c. Dependent edema in the lower extremities d. Increase in the metabolic rate
A
55. Nursing care directed toward nonsurgical management in a teenager with scoliosis primarily includes: a. promoting self-esteem and positive body image. b. preventing immobility. c. promoting adequate nutrition. d. preventing infection.
A
56. Which of the following goals of therapy is most appropriate for the child with juvenile idiopathic arthritis? b. Child will exhibit no signs of impaired skin integrity due to rash. a. Child will exhibit signs of reduced joint inflammation and adequate joint function. c. Child will exhibit normal weight and nutritional status. d. Child will exhibit no alteration in respiratory patterns or respiratory tract infection.
A
8. Nursing interventions aimed at preventing problems associated with immobility include which of the following? a. Encouraging self-care b. Restricting fluids with strict intake and output c. Limiting active range-of-motion exercises to once per day d. Decreasing sensory stimulation to allow adequate rest
A
Sandy, age 10 years, has developed joint and leg pain, some joint swelling, fever, malaise, and pleuritis. The provider has ordered laboratory testing to include sedimentation rate, rheumatoid factor, and a complete blood count. Tentative diagnosis has been established as juvenile idiopathic arthritis (JIA). 63. Which of the following is the most appropriate nursing intervention to promote adequate joint function in the child with JIA? a. Incorporate therapeutic exercises in play activities b. Provide heat to affected joints by use of tub baths c. Provide written information for all treatments ordered d. Explore and develop activities in which the child can succeed
A
Which of the following is a complication of immobility that is easily prevented with appropriate nursing intervention? a. Disuse atrophy b. Diarrhea c. Hypocalcemia d. Pain
A
17. The method of fracture reduction is not determined by: a. the child's age. b. the manner in which the fracture occurred. c. the degree of displacement. d. the amount of edema.
B
41. List the three characteristics of the female athlete triad.
Amenorrhea, osteoporosis, low calloric intake(or disordered eating)
Used to prevent footdrop due to bed rest, trauma to the foot, or paralysis of muscles that flex the foot
Ankle-foot orthosis (AFO)
57. What should the nurse teach the patient and family of the child diagnosed with systemic lupus erythematosus (SLE) regarding each of the following topics? b. Sun exposure
Avoid excessive exposure; use sunscreen (with a sn protection factor of at least 30), hat, and protective clothing; schedule outdoor activities in morning and evening.
Used most frequently for temporary assistance
Axillary swing-through crutches
13. Continuous pressure on the radial nerve may result in: a. footdrop. b. wristdrop.
B
19. Emergency treatment for the child with a fracture includes: a. moving the child to allow removal of clothing from the area of injury. b. immobilization of the limb, usually including joints above and below the injury site. c. pushing the protruding bone under the skin. d. keeping the area of injury in a dependent position.
B
2. The nurse is suspicious of child abuse (nonaccidental injury) when: i. there is a delay in seeking medical assistance for the injury. ii. the parent's history of the injury is not congruent with the actual injury. iii. x-ray studies demonstrate previous fractures in different stages of healing. iv. the child is crying and fearful of separation from the parent. a. i, ii, iii, and iv b. i, ii, and iii c. ii and iii d. ii, ii, and iv
B
28. The nurse is caring for 7-year-old Charles after application of skeletal traction. Which of the following is contraindicated? a. Clean pin sites per hospital policy. b. Release the traction when repositioning Charles in bed. c. Inspect pin sites for bleeding or infection. d. Assess for alterations in neurovascular status.
B
29. The nurse is assessing carol, age8 years, for complications related to her recent fracture and the application of a fiberglass cast to her forearm and elbow. Carol is crying with pain, the nurse is unable to locate pulses in the affected extremity, and there is a lack of sensitivity to the area as well as some edmea. Which of the following wouldthe nurse suspect as most likely to be occuring? A. Normal occurence for the first few hours after application B. Volkmann contracture C. Nerve compression syndrome D. Epiphyseal damage
B
3. A nurse discovers 5-year-old Jimmy, a neighbor, lying in the street next to his bicycle. The nurse sends another witness to activate the emergency medical services (EMS) while the nurse begins a primary assessment of Jimmy. Which of the following best describes the primary assessment and its correct sequence? a. Body inspection, level of consciousness, head-to-toe survey, and airway patency b. Level of consciousness, airway patency, respiratory effectiveness, circulatory status c. Open airway, head-to-toe assessment for injuries, and chest compressions d. Weight estimation, symptom analysis, blood pressure measurement
B
31. The priority nursing action for Johnny (in question 30) is to: a. elevate the affected extremity. b. administer Oxygen. c. administer pain medication. d. start an intravenous (IV) infusion of heparin.
B
37. Which of the following statements made to the athlete by the nurse is correct? A. It is more important to replace sodium and chloride than water B. Recommended dietary energy intake for adolescents involved in sports is 50% of caloric intake from carbohydrates. C. Iron replacement is necessary only for the female athlete. D. Energy for prolonged exercise is best obtained from high-carbohydrate foods eaten two hours before the event.
B
38. Sixteen-year-old Ben has been brought to the school nurse's office for heatstroke. He has a temperature of 40° C (104 F) and is awake but disoriented. Which of the following is contraindicated? A. Immediate removal of clothing and application of cool water to the skin B. Administration of antipyretics C. Use of fans directed at ben D. Activation of EMS for transport to hospital.
B
48. The care plan for the child during the acute phase of osteomyelitis always includes: a. performing wound irrigations. b. ensuring administration of antibiotics. c. isolating the child. d. incorporating passive range-of-motion exercises for the affected area.
B
50. Nursing considerations for the patient diagnosed with osteogenesis imperfecta include: a. preventing fractures by holding on to the child's ankles when changing diapers. b. providing nonjudgmental support while parents may be dealing with accusations of child abuse. c. advising parents to limit touching or handling the child in order to prevent fractures. d. educating parents that the use of braces and splints can increase the rate of fracture.
B
54. Marilyn, age 12 years, has been diagnosed with scoliosis and placed in a thoracolumbosacral orthotic (TLSO) brace. Which of the following information provided by the nurse to marilyn is correct? a. "The brace will cure your curvature." b. "The brace is an underarm brace made of plastic that will be molded and shaped to your body to prevent worsen- ing of the curvature." c. "The brace includes a neck ring to extend the neck." d. "The brace will only be worn in bed, since it prevents walking because of the severity of the trunk bend."
B
b. Besides conducting educational programs, what methods can the nurse use to promote injury prevention in children?
Become active in legislative. Efforts, assist with public awareness campaigns, provide individual prevention counseling for children and family, implement home visits to identify potential sources of danger in the home, administer screening questions about safety issues on admission and discharge from the hospital or health care visits.
An underarm orthosis customized from prefabricated plastic shells, with corrective forces for each patient sup- plied by lateral pads; prevent progression of curves in the spine
Boston brace
11. Which of the following is not included in the teaching plan of a child witha brace or prosthesis? A. Frequent assessment of all areas in contact with the brace for signs of skin irritation B. Assessment of the stump area before application of the prosthesis C. Removal of the prosthesis limited to bedtime unless skin breakage occurs D. Use of protective clothing under the brace
C
25. To reduce anxiety in the child undergoing cast removal, which of the following nursing interventions would the nurse expect to be least effective? a. Demonstrate how the cast saw works before beginning the procedure. b. Describe cast saw as feelling '"tickly" and warm c. Explain that it will take only a few minutes. d. Continue to reassure that all is going well and that the child's behavior is accepted during the removal process.
C
26. Julie, age 10, has just returned from surgery for repair of an open fracture; she has a dressing and elastic bandage thigh to midcalf. The nurse immediately notifies the physician if assessment findings wrap on her leg from upper include which of the following? a. Appearance of blood-stained area the size of a dime on the dressing b. 2+ pedal pulse c. Inability to move the toes d. Report of pain level of 4/10 on Wong-Baker Faces Pain Rating Scale
C
36. BN, a 15-year-old high school student, is at a track event. He has been running multiple events. He was feeling unwell before the event and has been vomiting. Now he is complaining of thirst, headache, Fatigue, dizziness, and nausea. He seems to be somewhat disoriented and is sweating. Ben's temperature is normal. Which of the following is the most likely to describe ben's condition? A. Heat cramps B dehydration C. Heat exhaustion D. Heat stroke
C
46. The recommended treatment for DDH in an infant 2 months old is: a. surgical fixation. b. hip spica cast. c. Pavlik harness. d. hip abduction orthosis.
C
Sandy, age 10 years, has developed joint and leg pain, some joint swelling, fever, malaise, and pleuritis. The provider has ordered laboratory testing to include sedimentation rate, rheumatoid factor, and a complete blood count. Tentative diagnosis has been established as juvenile idiopathic arthritis (JIA). 62. A group of drugs prescribed for JIA are nonsteroidal antiinflammatory drugs. Education regarding the use of these drugs should include which of the following? a. They produce excellent analgesic and antiinflammatory effects but little antipyretic effect. b. They are administered in the lowest effective dose and given on alternate days rather than daily. c. Antiinflammatory effects require larger doses and more time to achieve. d. Because there is a narrow margin between effective and toxic dosage, levels need to be monitored regularly until therapeutic dosage is established.
C
Sandy, age 10 years, has developed joint and leg pain, some joint swelling, fever, malaise, and pleuritis. The provider has ordered laboratory testing to include sedimentation rate, rheumatoid factor, and a complete blood count. Tentative diagnosis has been established as juvenile idiopathic arthritis (JIA). 64. An expected outcome for the change in perceived body image related to the disease process of JIA is: a. the patient and family members are able to explain the disease process. b. the patient is accepted by peers. c. the patient will express feelings and concerns about how the condition affects her life. d. the child will understand and use effective communication techniques.
C
22. A 10-year-old presents to the ED with a suspected radial fracture incurred in a fall from a treehouse, List three nursing interventions for the initial care of this child.
Calm and reassure the chid and parents. Inquire about the method of injury. Immobilize the affected side. Appy a temporary splint if not already in place. Evaluate the extent of the injury.
Fracture in which small fragments of bone are broken from the fractured shaft and lie in surrounding tissue
Comminuted fracture
Fracture in which bone fragments are separated
Complete fracture
Fracture in which bone fragments cause damage to surround- ing organs or tissue
Complicated fracture
Damage to the soft tissue, subcutaneous structures, and muscle
Contusion
Usual selection for children who anticipate permanent use; used for paraplegic children who are unable to use braces
Forearm crutches
60. What is the primary nursing goal for the child with SLE?
Fostering adaptation and self-advocacy skills.
15. All children who are immobilized for a prolonged period are at risk for skin breakdown. Identify three factors that play a major role in skin breakdown in immobilized children.
Moisture, friction, shear, pressure
Occurs from deep contusions to the biceps or quadriceps muscles, resulting in a restriction of the flexibility of the affected limb
Myositis ossificans
7. List four symptoms of neurologic impairment that should be immediately evaluated in an immobilized child.
Numbness, tingling, changes in sensation, loss of motion
Partial dislocation of the radial head in the elbow
Nursemaid's elbow
Fracture with an open wound from which the bone has protruded
Open, or compound, fracture
6. What are the three major cardiovascular consequences of immobility?
Orthostatic intolerance, incrased workload of the heart, and thrombus formation
The fabrication and fitting of braces
Orthotics
43. Bob, age 7 years, is diagnosed with Legg-Calvé-Perthes disease. Which of the following manifestations is nor consistent with this diagnosis? a. Intermittent appearance of a limp on the affected side b. Hip soreness, ache, or stiffness that can be constant or intermittent c. Pain and limp most evident on arising and at the end of a long day of activities d. Specific history of injury to the area
D
45. The primary diagnostic tool used in developmental dysplasia of the hip (DDH) in a newborn is: a. a radiograph. b. an ultrasound. c. magnetic resonance imaging. d. the Barlow and Ortolani maneuvers.
D
49. Which of the following statements about septic arthritis is true? a. The most common causative agent in children under 2 years of age is Haemophilus influenzae. b. Knees, hips, ankles, hands, and feet are the joints most commonly affected. c. Early radiographic findings show soft tissue swelling and erosions of the bone. d. IV antibiotic use is based on Gram stain and clinical presentation.
D
51. In addition to the prevention of fractures, the nursing care of a child with osteogenesis imperfecta should include: a. oral and dental care. b. meticulous skin care. c. care related to the effects of drug treatment. d. all of the above.
D
27. List five possible clinical manifestations of compartment syndrome.
Severe pain(not always present) Absence of pulses in the extremity Pallor or cyanosis of the extremity Edema Loss of sensation Motor weakness
52. Diagnostic evaluation is important for early recognition of scoliosis. Which of the following is the correct procedure for the school nurse conducting this examination? b. View all children from the left and right side to look mainly for asymmetry of the hip height. a. View the child, who is standing and walking fully clothed, to look for uneven hanging of clothing. c. Completely undress all children before the examination. d. View the child, who is wearing underpants/shorts, from behind when the child bends forward at the waist.
D
Sandy, age 10 years, has developed joint and leg pain, some joint swelling, fever, malaise, and pleuritis. The provider has ordered laboratory testing to include sedimentation rate, rheumatoid factor, and a complete blood count. Tentative diagnosis has been established as juvenile idiopathic arthritis (JIA). 61. If the diagnosis is correct, which of the following would represent the expected laboratory results? a. Leukocytosis b. Elevated sedimentation rate c. Negative rheumatoid factor d. All of the above
D
16. Bone healing is characteristically more rapid in children than in adults because: a. children have less constant muscle contraction associated with the fracture. b. children's fractures are less severe than adult fractures. c. children have an active growth plate that helps speed repair with less likelihood of deformity. d. children have thickened periosteum and a more generous blood supply.
D
21. An appropriate nursing intervention for the care of a child with an extremity in a new cast is to: a. keep the cast covered with a sheet. b. use the fingertips when handling the cast to prevent pressure areas. c. use heated fans or dryers to circulate air and speed the cast-drying process. d. turn the child at least every 2 hours to help dry the cast evenly.
D
33. Which of the following statements about "nursemaid's elbow" is correct? a. This most common partial dislocation of the radial head of the elbow is usually found in children ages 1 to 4 years. b. This condition is caused by a sudden pull at the wrist while the arm is fully extended and the forearm is pronated. c. The longer the dislocation is present, the longer it takes the child to recover mobility after treatment. d. All of the above statements are correct.
D
Occurs when the force of stress on the ligament is so great that it displaces the normal position of the opposing bone ends or the bone end in relation to its socket
Dislocation
57. What should the nurse teach the patient and family of the child diagnosed with systemic lupus erythematosus (SLE) regarding each of the following topics? a. Diet
Eat a well-balanced diet without exceedig caloric expenditure and maintain appropriate weight on corticosteroids. A low-salt diet may be required if the patient becomes nephritic or hypertensive. A low-fat diet is indicated in children with dyslipidemia. Maximizing peak bone mass in adolescent SLE is essential with a diet rich in calcium and vitamin D.
1. a. What topics does the community nurse include in the educational plan to promote injury prevention among children?
Falls; being struck by or against an object; motor vehicle or transportation-related accidents; overexertion; bites or stings; fires and burns; submersion injury; bicycle injuries; sports injuries, especially for school-age children and adolescents
12. List five effects that prolonged immobilization or disability of the child may have on the family.
Financial strains decrease or eliminate family resources; focus of attention is placed on the affected child ad other family members needs may not be met; family members may have difficulty accepting child's perceived body image; family members may be unable to express feelings and may have difficulty coping with crises; parents often experience guilt and have the perception of failing to protect the child.
Occurs when a bone is angulated beyond the limits of bending; compressed side bends, tension side fails
Greenstick fracture
Provides support for the knee, ankle, and hip; used for flail lower limb and paralysis
Hip-knee-ankle-foot orthosis (HKAFO)
20. What are the four goals of fracture management?
To regain alignment and length of the bony fragments by reduction; to retain alignment and length by immobilization; to restore function to the injured parts; to prevent furthr injury and deformity
58. What are the two goals of therapeutic management for SLE?
To reverse or minimize disease acivity with appropriate medications; to help child and family cope with the complications of the disease and treatment
14. List five interventions aimed at preventing circulatory stasis and development of DVT in an immobilized child.
Instruct patients to change position frequently; sit in a bedside chair or ambulate; dorsiflex feet and rotate ankles; wear antiembolism stockings or intermittent compression device; use ROM of upper and lower extremities; have anticoagulant therapy.
Sometimes used to support the spine and trunk during ambulation to prevent compression after fracture of the spinal column
Jewett-Taylor brace
A 9-vear-old with a new long arm cast is discharged home with a prescription for pain medication. What main points should the nurse include in the home care of the chilld in a cast?
Keep the extremity elevated. Assess the neurovascular integrity by checking peripheral pulses, assessing the color and temperature of the extremity, having the child wiggle fingers, evaluate for swelling/edema. Contact the practitioner if there are abnormal findings such as cool extremity, absence of pulse, color changes. If the extremity becomes edematous, have parents call the practitioner who placed the cast. Avoid inserting anything in the cast if it itches. Instead, take a mild antihistamine. Keep the cast dry.
Used to prevent buckling of the knee, to support the ex- tremity when there is paralysis or marked weakness of the knee extension or quadriceps muscle
Knee-ankle-foot orthosis (KAFO)
35. Major sprains or tears to the ligamentous tissues rarely occur in growing children because the _____________ are stronger than bone. The _________________ or _______________ _________________ is the weakest part of the bone and the usual site of injury.
Ligaments; physis; growth plate
Repetitive microtrauma to tissue over a long time period
Overuse injury
18. What are the "five Ps" of ischemia that are considered when assessing fractures to rule out vascular injury?
Pain, paralysis, paresthesia, pallor, pulselessness
Occurs when bone is bent but not broken
Plastic deformation
57. What should the nurse teach the patient and family of the child diagnosed with systemic lupus erythematosus (SLE) regarding each of the following topics? c. Birth control medication
Pregnancy is a potential trigger for disease flare; because estrogen can trigger disease flare, low dose estrogen or progesterone-only contraceptives are preferred. Some SLE medications(mycophenolate and methotrexate) are also associated with birth defects.
The fabrication and fitting of artificial limbs
Prosthetics
53. What does the surgical technique for the correction of scoliosis (arthrodesis) entail?
Realignment and straightening with internal fixation and instrumentation, along with bony fusion of the realigned spine
Allows children with paraplegia to walk on a flat surface; used in children with spinal cord injury, sacral agenesis, and spina bifida
Reciprocal gait orthosis (RGO)
Fracture that has not produced a break in the skin
Simple, or closed, fracture
Occurs when trauma to a joint is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched
Sprain
Occurs as a result of repeated muscle contraction from repetitive weight-bearing sports
Stress fracture
4. The nurse suspects that Jimmy (from question 3) has a spinal cord injury. Describe the safest immobilization technique.
The cervical spine is immobilized by holding the head in a neutral position and not allowing movement of the head or body in any direction.
Fracture that is crosswise, at right angles to the long axis of the bone
Transverse fracture
Allows the weight to be assumed by the elbow
Trough crutches
Custom-molded and fits snugly around the trunk of the body to exert pressure on the ribs and back to support the spine in a straight position
Thoracolumbosacral orthosis (TLSO)