ch 48

54. What nursing intervention is included in the plan of care for a child with a newly fiberglass-casted left arm? a) Elevating the extremity b) Exposing the cast to air until dry c) Placing the extremity on a plastic pillow d) Engaging in quiet activities with the use of muscles

- Elevating the extremity Elevating the extremity will help promote venous return and decrease edema in the extremity in order to help prevent compartment syndrome. During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell to the extent that compartment syndrome occurs. A fiberglass cast does not need to dry. A wet plaster cast should be placed on a plastic pillow and handled by the palms of the hands to prevent indentation, which can create pressure areas. Engaging in quiet activities and encouraging use of muscles can be included in the long-term plan of care if needed.

20. The primary health care provider has prescribed ibuprofen (Advil) for a child with juvenile idiopathic arthritis. During the follow up visit, the nurse finds that the child has severe inflammation despite taking ibuprofen (Advil) daily. Which additional medication should be prescribed for this child?

- Methotrexate (MTX) Rational: Ibuprofen (Advil) is a nonsteroidal antiinflammatory drug (NSAID). If an NSAID is ineffective in alleviating all the inflammation of juvenile idiopathic arthritis, then the primary health care should prescribe methotrexate (MTX), which is a second-line medication and meant to be coadministered with an NSAID. Tolmetin (Tolectin), naproxen (Aleve), and indomethacin (Indocin) are NSAIDs themselves, so these drugs may not be more effective in alleviating the symptoms of juvenile idiopathic arthritis than ibuprofen (Advil).

37. What should the order of nursing interventions be for a patient who reports having a sprain in the left lower limb due to a football injury that took place 15 minutes ago?

1) Applying an ice pack at the site of injury 2) Applying a wet wrap to compress the injured area 3) Elevating the affected limb using pillows 4)Supporting the limb with an immobilizer

41. Which postoperative nursing interventions are useful to avoid secondary complications in a young patient who has undergone spinal surgery? Select all that apply. A. Assessing for signs indicating neurologic impairment B. Administering intravenous opioids on a regular basis C. Educating the patient on use and function of chest tube D. Assessing for the signs of superior mesenteric artery syndrome E. Teaching the patient to manage a patient-controlled analgesia (PCA) pump

A .Assessing for signs indicating neurologic impairment B. Administering intravenous opioids on a regular basis After a spinal surgery, the patient has a considerable amount of pain for a few days. Pain relief requires frequent administration of intravenous pain medicines, preferably opioids. Postoperative assessment of any neurologic impairment should be performed because delayed paralysis might occur after spinal surgery. Educating the patient on the management of a patient-controlled analgesia (PCA) pump is done to promote self-care to encourage the patient's participation in treatment and recovery. Superior mesenteric artery syndrome is likely to be seen after spinal surgery in which there is compression of the duodenum by aorta and superior mesenteric artery. Clinical symptoms are nausea, vomiting, and epigastric pain which aggravate in the supine position and are relieved in the prone position. Teaching the patient about the use and function of a chest tube is also part of patient education for self-care.

34. The nurse is preparing a care plan for a patient who has a large bilateral hip spica cast. Which interventions should the nurse include in the care plan to prevent physiologic complications in the patient? Select all that apply. A. Providing a high-calorie, high-protein diet B. Encouraging social contact with other patients C. Encouraging the patient to sit upright whenever possible D. Advising the patient to rest on a pressure-reduction mattress E. Suggesting that a family member stay overnight with the patient

A .Providing a high-calorie, high-protein diet C. Encouraging the patient to sit upright whenever possible D. Advising the patient to rest on a pressure-reduction mattress Rationale: Immobilization can lead to anorexia due to decreased gastrointestinal function. A high-protein, high-calorie diet should be given to the patient to maintain body functions. Immobilization can impair kidney function, so the patient is made to sit upright to maintain bowel and bladder function. The patient should be made to rest on a pressure-reduction mattress to prevent skin breakdown. Social interaction with other patients, friends, and family should be encouraged for the psychological well-being of the patient. A parent or sibling should be allowed to stay overnight with the patient to avoid family disruption caused due to hospitalization. These interventions aim at reducing psychological distress in the patient but do not prevent physiologic complications.

24. The nurse is teaching the parent of a 12month-old infant about assessing developmental dysplasia of the hip in babies. What instruction does the nurse give the parent to check the presence of a Trendelenburg sign? A. "Make the infant stand on the affected leg." B. "Put the infant supine with the back arched." C. "Lay the infant down on the unaffected side." D. "Make the infant sit upright with legs separated."

A. "Make the infant stand on the affected leg." Rationale: When an affected older infant stands and bears weight on the affected hip, the pelvis tilts downward instead of upward, indicating a positive Trendelenburg sign. The supine position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis. The side-lying position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis. The sitting position does not accomplish the desired effect because weight bearing is needed to tilt the pelvis

3. A nursing student is helping to care for a client with lower extremity venous stasis. The student places three pillows under the client's legs and instructs the client to rest in only one position. The student measures the circumference of the client's extremities periodically and administers anticoagulants as prescribed. Which intervention of the student indicates the need for additional teaching? A. Advising the client to rest in only one position B. Placing three pillows under the client's legs C. Preparing client for administration of anticoagulants D. Measuring the circumference of the extremities

A. Advising the client to rest in only one position Venous stasis in the leg can result in pulmonary embolism and thrombi formation. To reduce the risk of the venous stasis, the nurse should instruct the client to change positions frequently rather than staying in one position. The nurse is correct in elevating the extremities to promote the circulation and reduce the risk of emboli formation. Venous stasis is caused by blood coagulation; therefore, anticoagulants reduce the risk of developing blood clots. The nurse should measure the circumference of the extremities periodically, as an increase in circumference of the extremities indicates thromboembolism.

18. A 5 year old child fractured the left elbow while playing with friends. The health care provider has prescribed regular cast changes and bed rest. What should the nurse educate the parents about cast care? a) Apply lotion to the skin after cast removal. b) Scrub away residual material on the skin. c) Immerse the cast briefly in a tub bath. d) Cover the damp cast edges with adhesive.

A. Apply lotion to the skin after cast removal. After the cast is removed, the skin surface will be caked with desquamated skin and sebaceous secretions. Application of mineral oil or lotion may remove the particles and provide comfort. The parents and child should be instructed not to pull or forcibly remove this material with vigorous scrubbing because it may cause excoriation and bleeding. The skin under the cast may become macerated from inadequate drying after water immersion. Adhesive will not adhere to a damp cast even if the cast is composed of fiberglass; it takes about a half-hour for it to dry.p. 1432

21. A newborn baby has been diagnosed with talipes equines. How often should the parents be taught to do a cast change? A. Change the cast weekly. B. Change the cast monthly. C. Change the cast when its edges fray. D. Change the cast if it becomes soiled.

A. Change the cast weekly Weekly gentle manipulation and serial long-leg casts allow for gradual repositioning of the foot. Casts are changed weekly to accommodate the rapid growth in early infancy. Once a month is not frequent enough in early infancy; the cast may become too tight because of the infant's rapid growth. The cast is not on the foot long enough for fraying to occur. Soiling usually is not a problem because casts for clubfoot do not extend to the perineal area.

46. The nurse is caring for a child with a hip spica cast. Which nursing interventions will be beneficial to the child? Select all that apply. A. Change the child's position every 2 hours. B. Dry the cast with heated fans or dryers. C. Remove rings and any other accessories. D. Check for any cuts or abrasions on skin. E. Cover the cast with a polythene sheet.

A. Change the child's position every 2 hours. C. Remove rings and any other accessories. D. Check for any cuts or abrasions on skin While caring for a child with a spica cast, the nurse should change the position of the child every 2 hours. This practice helps the cast to dry evenly and prevents complications such as pressure ulcers and bedsores that occur due to immobility. To prevent constriction of blood vessels and swelling of the limbs, the nurse should remove rings and other accessories from the client's body before applying the cast. To prevent infections and discomfort, the nurse should check the client's skin for the presence of cuts or abrasions before applying the cast. The nurse should not use heated fans or dryers to dry the cast as it leads to irregular drying of the cast and may cause burns because of the conduction of heat from the cast to underlying tissues. The nurse should not cover the cast with a polythene sheet as polythene retains moisture and does not allow the cast to dry inside out.

22. After assessment of an infant the nurse informs the primary health care provider that the child has a positive Ortolani test. Which finding obtained from the test enables the nurse to reach this conclusion? A. Decreased hip abduction B. Symmetric folds on the thighs C. Bacterial infection in the joint D. Displacement of the femoral epiphysis

A. Decreased hip abduction Rationale: A positive Ortolani test indicates that the infant has developmental dysplasia of the hip. While performing the Ortolani test the nurse abducts the child's thighs and checks whether the client has hip subluxation or dislocation. The presence of decreased hip abduction indicates a positive Ortolani test. A child with developmental dysplasia of the hip has asymmetrical folds of the thigh tissues, so the presence of symmetrical folds would not indicate a positive Ortolani test. The presence of bacterial infection in the joints can be diagnosed through a series of tests including gram stain cultures, leukocyte count, blood cultures, and a complete blood count. Anteroposterior and frogleg radiographic examination are useful in diagnosing the displacement of proximal femoral epiphysis

15. The nurse is explaining scoliosis to a 12 year-old boy who has been diagnosed with the disease. What should the nurse emphasize? - a) Effect of the scoliosis on the child's body image b) The need to use the least invasive treatment available c) Treatment will not interfere with school d) Maintaining contact with peers

A. Effect of the scoliosis on the child's body image The identification of scoliosis as a "deformity," in combination with unattractive appliances and a significant surgical procedure, can have a negative effect on the already fragile adolescent body image. Establishing an identity is the major developmental task of the adolescent and is related to the affirmation of self-image. To achieve this task, there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling, the effect on body image is more important. Although it is important to maintain contact with peers, the effect on body image is more enduring.p. 1447

7. What are the signs and symptoms associated with acute osteomyelitis? Select all that apply. a. Irritability b. Restlessness c. Fluid overload d. Bradycardia e. Onset of fever

A. Irritability B. Restlessness E. Onset of fever

9. A 12 year-old patient underwent a surgical procedure for the treatment of scoliosis. What is an appropriate postoperative nursing intervention for the patient? - a) Log-roll when changing position. b) Assess the dressing frequently. c) Supervise deep breathing exercises. d) Maintain a supine position for 3 days.

A. Log-roll when changing position. After surgery, patients are monitored in an acute care setting and log-rolled when changing position to prevent damage to the fusion and surgically inserted hardware. Log-rolling is necessary to prevent movement of the newly aligned vertebrae, and should be done frequently to prevent skin breakdown. Checking the dressing is done for all postoperative patients; this action is nonspecific. Coughing and deep breathing are done by most postoperative patients; this action is nonspecific. The patient who had a spinal fusion can be turned and still be protected from injury by log-rolling. Remaining in one position for 3 days can lead to skin breakdown from unrelieved pressure.p. 1447

36. Which assessment findings support the nurse's conclusion that a 2 week old neonate has hip dysplasia? Select all that apply. A. Positive Barlow test B. Positive Ortolani test C. Positive Galeazzi sign D. Piston mobility of hip joint E. Positive Trendelenburg sign

A. Positive Barlow test B. Positive Ortolani test - C. Positive Galeazzi sign Barlow, Ortolani, and Galeazzi tests are the most reliable for confirming the presence of hip dysplasia in a 2-week-old child. If the hip gets dislocated due to adduction, it indicates a positive Barlow test. If the hip is reduced by abduction, then it indicates a positive Ortolani test. If the affected limb appears to be shorter than that of the other limb, then it indicates a positive Galeazzi test. A positive Trendelenburg sign and piston mobility of joint are assessment findings which indicate hip dysplasia in older infants and children.

10. The primary health care provider has prescribed intravenous (IV) antibiotic therapy for a client with acute osteomyelitis. After assessment, the nurse notes that the client is not responding to the therapy. Which treatment strategy would the nurse expect to be prescribed for the client? A. Surgery B. Chemotherapy C. Phototherapy D. Oral antibiotic therapy

A. Surgery Acute osteomyelitis is infection in the bone caused by a blood-borne bacterium. If a client is unresponsive to IV antibiotic therapy, the primary health care provider would recommend surgery. Chemotherapy is used in cancer treatment, but is not indicated in the treatment of osteomyelitis since it may cause bone deformation. Phototherapy may not be effective in treating infection because it does not have any antibacterial activity. Oral antibiotic therapy is less effective than IV therapy, so oral antibiotics would not be a suitable treatment when IV antibiotics fail.

51. What orthopedic finding suggests the presence of developmental dysplasia of the hip (DDH)? A. The affected limb shorter than the other B. Has a limited ability to adduct the affected leg C. Narrowing of the perineum with an anal stricture D. Inability to palpate movement of the femoral head

A. The affected limb shorter than the other Rationale: The affected leg appears to be shorter because the femoral head is displaced upward. There is a limited ability to abduct, not adduct, the affected leg. An anal stricture is not expected with DDH. When the femoral head slips out of the acetabulum, it is easily palpable

35. A patient with juvenile idiopathic arthritis has been prescribed steroid medications. During the follow up assessment, the nurse finds that the patient may have developed side effects from the drugs. Which findings are consistent with the nurse's conclusion? Select all that apply. A. The patient has weight gain. B. The patient has low bone density. C. The patient has a low white blood cell count. D. The patient has antinuclear antibodies in the blood. E The patient has an elevated erythrocyte sedimentation rate.

A. The patient has weight gain B. The patient has low bone density. C. The patient has a low white blood cell count. Side effects of corticosteroids include weight gain, osteoporosis, and increased risk of infection. Low bone density is indicative of osteoporosis. Low white blood cell count indicates increased risk of infections. The presence of antinuclear antibodies in blood and elevated erythrocyte sedimentation rate are signs associated with juvenile idiopathic arthritis.

25. Which finding would the nurse observe during the fourth radiographic stage of Legg-Calvé-Perthes disease? A. The reformation of a spherical femoral head B. A mottled appearance of the affected bone C. The filling in and formation of new bone D. The flattening of the upper surface of the femoral head

A. The reformation of a spherical femoral head Legg-Calvé-Perthes disease is a self-limiting disorder affecting children, which is associated with aseptic necrosis of the femoral head. By reviewing radiographs, the nurse can observe the bones and determine the stage of the disease. During the fourth radiographic stage of the disorder, the nurse would observe gradual reformation of the femur head and a spherical shape. The second stage of the disorder is associated with the resorption and revascularization of capital bone, which gives it a mottled appearance. The third phase is associated with the formation of new bone. During the first stage of the disorder, aseptic necrosis of the capital femoral epiphysis with degenerative changes takes place and flattens the upper surface of the femoral head

52. The nurse is assessing a 1 month old infant for the presence of skeletal abnormalities. What statement by the baby's mother suggests the presence of such an abnormality? A. "The baby always prefers sleeping while curled up." B. "It difficult to put the diaper between the baby's legs." C. "The baby's feet look flat when I put on the booties." D. "When I try to stand my baby up, the legs won't straighten."

B. "It difficult to put the diaper between the baby's legs." Rationale: Restricted abduction of hip on the affected side indicates the presence of developmental dysplasia of the hip (DDH). Flexion of the extremities is a young infant's typical position when sleeping. Flat feet are an expected finding in a young infant. Failure to straighten the legs is an expected finding in a young infant.

26. A young child is brought into the emergency room with a partial dislocation of the radial head in the right arm. The health care provider manipulates the arm back into position. Following the treatment provided by the hcp, what is the nurse's priority action? A. Administer a narcotic for pain. B. Administer a mild pain reliever. C. Prepare to immobilize the arm. D. Prepare the child for a radiographic evaluation.

B. Administer a mild pain reliever The nurse's priority action following a successful treatment of a dislocation is to administer a mild pain reliever. Upon successful manipulation, the use of the arm returns within minutes. Narcotics or anesthesia are usually not needed. It is not necessary to immobilize the arm. A radiographic evaluation is only needed if the injury is not a subluxation or if the treatment attempt is unsuccessful.

8. Which statement is true concerning osteogenesis imperfecta? a. OI is easily treated. b. OI is an inherited disorder. c. With a later onset, the disease usually runs a more difficult course. d. Braces and exercises are of no therapeutic value.

B. It is an inherited disorder. OI is an autosomal dominant inherited disorder.OI is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture.OI has a predictable course that is determined by the pathophysiologic processes, not the time of onset.Lightweight braces and splints can help support limbs and fractures.

47. The nurse is caring for a client with a slipped capital femoral epiphysis. Which clinical manifestations does the nurse observe in the client? Select all that apply. A. Dehydration B. Loss of abduction C. Limp on affected side D. Elevated temperature E. Shortening of lower extremity

B. Loss of abduction C. Limp on affected side E. Shortening of lower extremity A slipped capital femoral epiphysis is a spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction. This condition is most common in males and obese children. Due to the dislocation of the joint, the client will lose abduction, will limp on the affected side, and will show shortening of the lower extremity. Unlike acute osteomyelitis, a slipped capital femoral epiphysis is not associated with loss of fluids and hyperthermia, so a child with this condition should not have dehydration and fever.

38. The nurse manager on the orthopedic unit is preparing an in service about types of traction at the next staff meeting. What information should the nurse manager include in the presentation? Select all that apply. A. Skeletal traction is most likely used when closed reduction is performed. B. Skin traction can be applied using a pulling mechanism attached with adhesive material. C. Soft, foam-backed traction straps are used to distribute manual traction pull. D. Pins are commonly used with skeletal traction. E. Manual traction involves using wires or tongs inserted through the diameter of the bone distal to the fracture.

B. Skin traction can be applied using a pulling mechanism attached with adhesive material. D. Pins are commonly used with skeletal traction. Types of traction include: (1) Manual traction—Applied to the body part by the hands placed distal to the fracture site. Manual traction may be provided during application of a cast but more commonly when a closed reduction is performed. (2) Skin traction—Applied directly to the skin surface and indirectly to the skeletal structures. The pulling mechanism is attached to the skin with adhesive material or an elastic bandage. Both types are applied over soft, foam-backed traction straps to distribute the traction pull. (3) Skeletal traction—Applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture.

45. An infant is born with one lower limb deficiency. When is the optimum time for the infant to be fitted with a prosthetic device? a. As soon as possible after birth b. When the infant is developmentally ready to stand up c. At about age 12 to 15 months, when most children are walking d. At about 4 years, when the healthy limb is not growing so rapidly

B. When the infant begins sitting up The optimum time for the child to be fitted with a prosthetic device is when he or she is developmentally ready to stand up. The prosthetic device will be integrated into the child's capabilities.Fitting the infant for a prosthesis as soon as possible after birth will not be useful, because the child is not ready to use the leg.Waiting until age 12 to 15 months to fit the child for a prosthesis may be too late. The fitting should be provided when the child is showing readiness to stand.Waiting until age 4 years to fit the child for a prosthesis may be too late. The fitting should be provided when the child is showing readiness to stand.

19. What is the healing time for a femoral shaft fracture in late childhood? a) 2 to 3 weeks b) 4 to 6 weeks c) 6 to 8 weeks d) 8 to 12 weeks

C. 6 to 8 weeks

50. The nurse is caring for an infant who has been diagnosed with talipes calcaneus. The affected foot has a plaster cast on it. What is an appropriate way to handle the infant when the cast is wet? A. Touch the cast using only the fingertips. B. Turn the infant without touching the cast. C. Handle the cast with the palms of the hands. D. Move the infant's body while sliding the cast.

C. Handle the cast with the palms of the hands. The cast should be handled with the palms of the hands. The palm of the hand provides a wide base of support for infant's body and the casted extremity. Touching the cast with the fingertips will cause indentations that may create pressure areas; this may compromise the skin and neurovascular functioning. It is impossible to turn the child without touching the cast. Therefore, it is acceptable to touch the cast, but with the palms of the hands. The cast must be touched because the lower extremity and the cast must be supported.

56. What is a defining characteristic of scoliosis? A. The concave lumbar curvature present is immensely exaggerated. B. There is a long-term bacterial infection present in the vertebrae. C. There is a rotary deformity of the lateral curvature of the spine. D. The thoracic spine has an increased convex angulation

C. There is a rotary deformity of the lateral curvature of the spine. Rationale: Scoliosis is the most common spinal deformity. A rotary deformity of the lateral curvature of the spine is the correct description of scoliosis. A concave lumbar curvature that is exaggerated is a description of lordosis. There are no bacterial infections in the vertebrae with scoliosis. A curvature of the thoracic spine that has an increased convex angulation is a description of kyphosis.

2. Which is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? a. Increased metabolism b. Increased venous return c. Increased cardiac output d. Decreased exercise tolerance

D. Decreased exercise tolerance Muscle disuse leads to tissue breakdown and loss of muscle mass or muscle atrophy. It may take weeks or months to recover.Metabolism decreases during periods of immobility.There is decreased venous return due to decreased muscle activity secondary to immobility.There is decreased cardiac output secondary to immobility.

30. A 2 month-old infant has been diagnosed with developmental dysplasia of the hip (DDH). The health care provider has prescribed immediate treatment for the baby using a Pavlik harness. What is the rationale behind this urgency? A. Mobility will be delayed if correction is postponed. B. Traction is effective if it is used before toddlerhood. C. Infants are easier to manage in spica casts than are toddlers. D. It is easier to get the hip into a more abducted position.

D. It is easier to get the hip into a more abducted position. In infants, with time, motion, and gravity, the hip works into a more abducted, reduced position with the help of a Pavlik harness. The harness is worn continuously until the hip is proved stable on clinical and ultrasound examination. Congenital hip dysplasia does not limit ambulation for the young child, although the gait will be affected. Traction is not used to correct developmental dysplasia of the hip. Although casted infants are easier to manage than toddlers, this is not the key reason for early treatment.

48. What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis? a. Provide active range-of-motion exercises of the affected extremity. b. Administer pain medication with meals. c. Encourage frequent ambulation. d. Move and turn the child carefully and gently to minimize pain.

D. Move and turn the child carefully and gently to minimize pain. Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently.Active range-of-motion exercises are contraindicated until pain has subsided.Pain medication should be administered as needed.Ambulation is contraindicated until pain has subsided.

6. The nurse is consulting with a client with systemic lupus erythematosus. Which is the best instruction to prevent an exacerbation of the disease? A. Go outside only after the sun has set at night. B. Get 1 hour of early-morning sunlight per day. C. Wear loose clothing to increase comfort. D. Use sunscreen and wear sun-resistant clothes.

D. Use sunscreen and wear sun-resistant clothes Sunlight can exacerbate the symptoms of systemic lupus erythematosus, so the nurse should instruct the client to use sunscreen and wear sun-resistant clothes to reduce the effects of sunlight. Instructing the client to go out only at night may not be practical and will impair the client's social interactions. Continuous exposure to sunlight may aggravate the client's inflammatory response, so the nurse would not instruct the client to get 1 hour of sun each morning. Loose clothing may be most comfortable for the client, but does not prevent the exacerbation of systemic lupus erythematosus.

5. Therapeutic management of the patient with systemic lupus erythematosus includes: a. application of cold salts to suppress the inflammatory process .b. a high-protein, low-salt diet. c. a rigorous exercise regimen to build up muscle strength and endurance. d. administration of corticosteroids to control inflammation.

D. corticosteroids to control inflammation Corticosteroid administration is the primary mode of therapy currently for SLE.The application of cold salts will not affect the inflammatory process associated with SLE.A balanced diet without exceeding caloric expenditures is recommended.Exercise should be done in moderation.

59. An adolescent who had a lower leg amputated after a motorcycle accident complains of pain in the missing extremity. The nurse's most appropriate action is to: a. indicative of narcotic addiction b. indicative of the need for psychological counseling c. abnormal and suggests nerve damage d. normal and called phantom limb sensation

D. reassure the child that it is normal and is called phantom limb sensation Phantom limb sensation is an expected experience because the nerve-brain connections are still present. They gradually fade. This should be discussed preoperatively with the child.There is no indication of narcotic addiction by the adolescent complaining of pain in the amputated extremity.Phantom limb pain is expected after an amputation; psychological counseling is not required for the adolescent experiencing it.Phantom limb pain is expected after an amputation and is not suggestive of nerve damage.

12. During the assessment of a child, the nurse finds that the child has pain and sacral dimpling in the lumbosacral region along with bladder incontinence. The nurse suspects that the child may need a magnetic resonance imaging (MRI) scan. Which complication does the nurse suspect in the child?

Diastematomyelia

11. After assessing a child with a forearm injury, the nurse applies firm finger pressure to the head of the radius and then supinates and flexes the forearm. Which type of injury is the nurse managing?

Dislocation Dislocation occurs when force of stress on a ligament displaces the normal position of the bones forming a joint. It commonly occurs in children due to sudden traction in the forearm, which can be manipulated by applying finger pressure at the head of the radius. In case of strains, sprains, and contusions, there is injury to soft tissues such as ligaments, muscles, blood vessels, or nerves. The primary intervention in such injuries is application of an ice pack and compression.

39. Which nursing interventions should be included in the care plan for a patient with osteoporosis? Select all that apply.

Ensuring adequate intake of fluids - Ensuring proper care while positioning the patient- Assessing for signs of urinary tract infection regularly

28. The nurse is assessing a child with juvenile idiopathic arthritis who is receiving methotrexate (MXT). The nurse finds that the child has persistent inflammation. Which drug does the nurse expect to be prescribed for the child?

Etanercept (Enbrel) Rational: Methotrexate (MXT) is a second-line medication that helps treat juvenile idiopathic arthritis. If the child has persistent inflammation in spite of taking methotrexate (MXT), then the primary health care provider would prescribe etanercept (Enbrel) for the child. Etanercept (Enbrel) is a tumor necrosis factor-α receptor blocker and alleviates the symptoms of arthritis in the child. Methotrexate (MXT) is prescribed for the child when the child is unresponsive to nonsteroidal antiinflammatory drugs (NSAIDs). Aspirin (Acuprin), meloxicam (Mobic), and celecoxib (Celebrex) are the examples of NSAIDs.

42. A 15 year old patient underwent surgery to have the right foot amputated. The amputation was done to remove a cancerous growth. What is an appropriate postoperative nursing intervention to promote psychological adjustment and mobility?

Help the patient adjust to the temporary prosthesis.

13. The primary health care provider prescribes methotrexate (MTX) to a child with juvenile idiopathic arthritis. Which function should the nurse monitor in the child to ensure safe drug administration?

Liver function

40. During an assessment, the nurse notes a butterfly rash on a client's nose and across the cheeks. The nurse also observes esophageal dysfunction and nephrotic syndrome in the client. The client reports occasional seizures, abdominal pain, headache, and nausea. Which medications should the nurse expect to be prescribed for the client? Select all that apply.

Methotrexate (MTX) - Azathioprine (Imuran)

44. What are the adverse effects of systemic steroids? Select all that apply.

Osteoporosis - Adrenal insufficiency - Sleep change

31. The nurse is caring for a child disuse atrophy of the left arm. What is the most effective nursing intervention that can be implemented to decrease muscle catabolism? a) Maintaining correct body alignment b) Performing range-of-motion exercises c) Providing a high-protein, high-fiber diet d) Planning play activities to use the uninvolved extremity

Performing range-of-motion exercises Rationale Performing range-of-motion exercises will help decrease muscle catabolism. Exercises incorporated into the care of this patient can include active, passive, and stretching exercises. Maintaining correct body alignment helps preserve joint mobility and prevent contractures. A high-protein high-fiber diet is beneficial for a patient with a decreased metabolic rate or a decreased food intake. Planning play activities to use the uninvolved extremity is an excellent intervention for the child who has a decreased tolerance for exercise due to decreased muscle tone, strength, and endurance.p. 1422

57. What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle? a. Elevation increases the pain threshold. b. Elevation increases metabolism in the tissues. c. Elevation produces deep tissue vasodilation. d. Elevation reduces edema formation.

Reduces edema formation Elevating the extremity uses gravity to facilitate venous return to reduce edema.Elevation should have no significant effect on the pain threshold.Elevation should not affect metabolism.Venous return to the heart, not vasodilation, is facilitated by elevation.

27. Which is the third radiographic stage of Legg Calvé Perthes disease?

Reossification stage Rational: There are four radiographic stages of Legg-Calvé-Perthes disease. The reossification stage is the third stage and includes the formation of a new bone. It is represented on radiographs as calcification and ossification of the bone. The avascular stage is the first radiographic stage of Legg-Calvé-Perthes disease during which the aseptic necrosis flattens the upper surface of the femoral head. The remodeling stage is the fourth radiographic stage during which the femoral head attains a spherical shape. The resorptive stage is the second radiographic stage that is associated with resorption of bone.

29. The nurse is caring for a client who has severe orthostatic hypotension with syncope. Diagnostic tests indicate a decrease in cerebral blood flow. What is the best nursing intervention in this situation?

Teach the client to use antigravitational pants.

53. The primary health care provider diagnoses a client with slipped capital femoral epiphysis and instructs the nurse to prepare the client for surgery immediately. What is the rationale for this instruction?

To prevent avascular necrosis

43. During an assessment, the nurse finds that the client has a fracture at the metaphysis and a bulging projection at the fracture site. Which condition is likely to be found in the client?

Torus fracture

32. During an assessment, the nurse notes that an infant's forefoot is rigid. The nurse further observes that the infant's foot does not stretch and remains in a neutral position with manipulation. What clinical finding should the nurse infer from these findings?

Type III (3) metatarsus adductus

17. Which instructions should the nurse provide the patient and the family about the management of systemic lupus erythematosus (SLE)? Select all that apply. a. "Avoid exposure to sunlight." b ."Consume a diet with low protein." c. "Perform moderate-intensity exercises daily." d. "Take prescribed antimalarial drugs on a regular basis." e. "Always carry medical identification indicating the disease and steroid dependence."

a. "Avoid exposure to sunlight." b. "Take prescribed antimalarial drugs on a regular basis." e "Always carry medical identification indicating the disease and steroid dependence." Exposure to sunlight may lead to exacerbation of symptoms of SLE. Thus, the nurse should ask the patient to avoid exposure to sunlight. Antimalarial drugs are helpful in reducing rashes and arthritis, and thus should be taken in prescribed doses regularly. Steroids are the chief drugs for treatment of SLE since they are useful for reducing inflammation, and patients should be advised to always carry identification with this information included. Patients with SLE should consume a balanced diet. A diet deficient in proteins would prevent building up of tissues and worsen the prognosis. Moderate-intensity exercise would not be possible for the patient. The nurse should encourage the patient to perform mild exercise regularly.

14. Which measure is important in managing hypercalcemia in a child who is immobilized? a. Promote adequate hydration b. Change position frequently c. Encourage a diet high in calcium d. Provide a diet high in protein and calories

a. Promoting adequate hydration Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia.Changing the child's position frequently will help with managing skin integrity but will not affect calcium levels.The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia.The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.

58. A 4 month-old infant has been diagnosed with developmental dysplasia of the hip (DDH). What appropriate intervention will follow the diagnosis? a. The baby will be set up to be fitted with a Pavlik harness. b. The baby will be tightly swaddled in warm blankets. c. The baby will be strapped to a cradleboard. d. The baby will be scheduled time to sit in an infant seat.

a. The baby will be set up to be fitted with a Pavlik harness.

16. The nurse is caring for a client with systemic lupus erythematosus. Which clinical manifestations might the nurse find in the client? Select all that apply. a. Epistaxis b. Atelectasis c. Abdominal crisis d. Joint deformity e. Thrombophlebitis

b. Atelectasis c. Abdominal crisis e. Thrombophlebitis Systemic lupus erythematosus is a chronic autoimmune disease. Due to the immunogenic reactions, the client with systemic lupus erythematosus may develop atelectasis, abdominal crisis, and thrombophlebitis. Epistaxis is a sign of rhabdomyosarcoma. The client with rhabdomyosarcoma may have a bleeding nose due to the compression of blood vessels with the tumor. The client with juvenile idiopathic arthritis has joint deformities due to osteoporosis.

49. What is characteristic of fractures in children compared to adults? a. Fractures rarely occur at the growth plate site because it absorbs shock well. b. Rapidity of healing is inversely related to the child's age. c. Pliable bones of growing children are less porous than those of adults. d. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared with that of the adult.

b. Rapidity of healing is inversely related to the age of the child. Fractures heal in less time in children than in adults. As the child ages, the healing time increases.The cartilage epiphyseal plate is the weakest point of the long bone. Therefore, it is a frequent site of damage and fractures.The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs.Bone healing in children is rapid due to the thickened periosteum and generous blood supply.

33. A nurse is caring for a young infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? Select all that apply. a. Lordosis b. Negative Babinski sign c. Asymmetric thigh and gluteal folds d. Positive Ortolani and Barlow tests e. Shortening of limb on affected side

c. Asymmetric thigh and gluteal folds d. Positive Ortolani and Barlow tests e. Shortening of limb on affected side Asymmetric thigh and gluteal folds are a clinical manifestation of DDH and seen from birth to 2 months old. Positive Ortolani and Barlow tests are clinical manifestations of DDH. The Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation.The Barlow test is the adducting to feel if the femoral head slips out of the socket posterolaterally. Shortening of limb on affected side is another clinical manifestation of DDH. Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH. A negative Babinski sign is not a clinical manifestation of DDH. It is a neurologic reflex.

60. A home care nurse is caring for a 4 month-old infant with developmental dysplasia of the hip (DDH). The baby is in a Pavlik harness. The baby's mother tells the nurse, "I don't think my baby will be able to sleep while wearing the harness." What is an appropriate response by the nurse? . a. "The harness can be removed during a short 30-minute nap." b. "You can reapply the harness after the baby falls asleep." c. "It is important for the harness to be worn continuously." d. "You can have the baby not take one of the daily naps."

c. It is important for the harness to be worn continuously

55. What are major goals of the therapeutic management of juvenile rheumatoid arthritis? a. Prevent joint discomfort; regain proper alignment. b. Prevent loss of joint function; achieve cure. c. Prevent physical deformity; preserve joint function. d. Prevent skin breakdown; relieve symptoms.

c. To prevent physical deformity and preserve joint function The goals of treatment for JRA include the prevention of physical deformity, the preservation of joint function, and the control of pain.Once the joint is damaged from the physiologic processes of JRA, it may not be possible to regain proper alignment.Children with JRA may be cured of the disease.Skin breakdown is usually not an issue in JRA.

1. A youngster has just returned from surgery in a hip spica cast. The PRIORITY nursing intervention is to: a. elevate the head of the bed. b. offer sips of water. c. check circulation, sensation, and motion of toes. d. turn the child to the right side, then the left side every 4 hours.

c. check circulation, sensation, and motion of toes. The chief concern is that the extremity may continue to swell. The circulation, sensation, and motion of the toes must be assessed to ensure that the cast does not become a tourniquet and cause complications.Elevating the head of the bed might help with comfort, but it is not a priority. The nurse must be observant to the risk of increased swelling in the extremities.Offering sips of water is acceptable once assessment of the extremities has been completed.The child's position should be changed every 2 hours. Positioning a child with a spica cast is important to prevent injury.

23. The callus that develops at the fracture site is important because it provides what? a. use of the injured part. b. sufficient support for weight bearing. c. means for adequate blood supply. d. means for holding bone fragments together.

d. Means for holding bone fragments together New bone cells are formed in large numbers and stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus.Functional use cannot occur until the fracture site is stable.Sufficient support for weight bearing cannot occur until the fracture site is stable.The callus does not provide an adequate blood supply.

4. The nurse is caring for an immobilized preschool child. During this period of immobilization, the nurse's best action is to: a. Encourage the child to wear pajamas. b. Let the child have few behavioral limitations. c. Keep the child away from other immobilized children if possible. d. Take the child for a "walk" by wagon outside the room.

take the child outside of the room by wagon It is important for children to have activities outside of the room if possible. This can give them opportunities to meet their normal growth and developmental needs.The child should be encouraged to wear street clothes during the day.Limit setting is necessary with all children.There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.