Exam 3: Musculoskeletal Dysfunction NCLEX Questions
d
Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip? a. put socks on over the foot pieces of the harness to help stabilize the harness b. use lotions or powder on the skin to prevent rubbing of straps c. remove harness during diaper changes for ease of cleaning diaper area d. check under the straps at least 2-3 times daily for red areas
b
A young child has recently been fitted with a knee, ankle, and foot orthosis (brace). What would be included in care of the skin? a. Apply lotion or cream to soften the skin. b. Contact a practitioner or orthotist if skin redness does not disappear. c. Place padding between the skin and brace if the child experiences a burning sensation under the brace. d. If a small blister develops, apply rubbing alcohol and place padding between the skin and the brace.
c
Julie, age 10, has just returned from surgery for repair of an open fracture. She has a dressing and elastic bandage wrap on her leg form upper thigh to mid-calf. The nurse immediately notifies the physician if assessment findings 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
a
Major consequences of immobility in the pediatric patient include which of the following? a. bone demineralization leading to osteoporosis b. orthostatic hypoertension c. dependent edema in the lower extremities d. decrease in metabolic rate
c
What results when ice is applied immediately after a soft tissue injury, such as a sprained ankle? a. Increases the pain threshold. b. Increases metabolism in the tissues. c. Produces deep tissue vasoconstriction. d. Leads to release of more histamine-like substances.
a
A child with newly diagnosed osteomyelitis has nausea and vomiting. The parent wishes to give the child ginger cookies to help control the nausea. The nurse should tell the parent a. "you can try them and see how he does" b. "I will need to get a prescription" c. "your child needs medication for the vomiting" d. "we discourage the use of home remedies in children"
b
A child, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. What does the nurse consider when discussing this injury with her parents? a. This type of fracture is inconsistent with a fall. b. Bone growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. Healing is usually delayed in this type of fracture.
a b c e
A nurse is caring for a child who has a fracture. Which of the following are manifestations of a fracture? Select all that apply a. crepitus b. edema c. pain d. fever e. ecchymosis
d
A nurse is caring for a child who is in a plaster spica cast. Which of the following actions should the nurse take? a. use a heat lamp to facilitate drying b. avoid turning the child until the cast is dry c. assist the client with crutch walking after the cast is dry d. apply moleskin to the edges of the cast
b c d
A nurse is caring for a child who is in skeletal traction. Which of the following actions should the nurse take? Select all that apply a. remove the weights to reposition the client b. assess the child's position frequently c. assess pin sites every 4 hours d. ensure the weights are hanging freely e. ensure the rope's knot is in contact with the pulley
d
A nurse is caring for a child who is suspected of having Legg-Calve-Perthes disease. The nurse should prepare the child for which of the following diagnostic procedures? a. bone biopsy b. genetic testing c. CT scan d. Radiographs
b
A 4 year old child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further instruction? a. "the cast may feel warm as the cast dries" b. "I can use lotion or powder around the cast edges to relieve itching" c. "a small amount of white shoe polish can touch up a soiled white cast" d. "if the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast"
d
A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? a. administer an analgesic b. release the skin traction c. apply ice to the extremity d. notify the health care provider
d
A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? a. ensure that all ropes are outside the pulleys b. ensure that the weights are resting lightly on the floor c. restrict diversional and play activities until the child is out of traction d. check the health care provider's prescriptions for the amount of weight to be applied
d
A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distension. On the basis of these findings, the nurse should take which action? a. administer an antiemetic b. increase the intravenous fluids c. place the child in a Sim's position d. notify the health care provider
a b d e
Disordered eating patterns, which may be observed in the female athlete triad, may include which of the following? Select all that apply a. use of diet pills and laxatives b. fasting c. binge eating d. restriction of certain foods e. inadequate caloric intake f. excessive vitamin consumption
c
During the initial assessment of a child admitted to the pediatric unit with osteomyelitis of the left tibia, when assessing the area over the tibia, which is an expected finding? a. diffuse tenderness b. decreased pain c. increased warmth d. localized edema
b
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 ROM exercises for the affected area
b
The child in a new hip spica cast seems to be adjusting to the cast, except that after each meal the child tells the nurse that the cast is too tight. What should the nurse plan to do? a. administer a laxative prior to each meal b. offer smaller, more frequent meals c. give the child a mechanical soft diet d. offer the child more fruits and grains
a
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
The nurse determines that teaching about the correct use of a Boston brace to treat scoliosis has been effective if the child and family state they will remove the brace at which times? a. when bathing, for about 1 hour per day b. while eating, for a total of 3 hours a day c. during school, for about 8 hours a day d. when sleeping, for a total of 10 hours a day
c
The nurse in the emergency department is caring for a 3 year old child with a fractured humerus. The child is crying and screaming: "I hate you!" Which action would be the most appropriate? a. tell the parents they will need to wait out in the lobby b. ask the charge nurse to assign this client to another nurse c. reassure the parents that this is a normal behavior under the circumstances d. ask the parents to discipline the child so that the team can treat her
b
The nurse is helping a family plan for the discharge of their child who will be going home in a spica cast. Which information would be most important for the nurse to consider? a. the bathrooms are all on the second floor b. the child's bedroom is on the second floor c. a 16 year old sister will care for the child during the day d. there are three steps up to the front door
c
The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? a. "I will encourage my child to performed prescribed exercises" b. "I will have my child wear soft fabric clothing under the brace" c. "I should apply lotion under the brace to prevent skin breakdown" d. "I should avoid the use of powder because it will cake under the brace"
a
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
b
The parents of a child who requires skeletal traction are unable to visit their child because there are five other children at home and both parents work outside of the home. The nurse recognizes expressions of guilt in both parents. To help alleviate this guilt, the nurse should make which statement? a. "I am sure you feel guilty about not being able to visit often" b. "It is important that you visit even for 1 hour" c. "Not all parents can stay all the time" d. "Perhaps you could take turns visiting for a bit longer"
c
The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range of motion exercises at this time. The nurse should make which response? a. "avoid all exercises during painful periods" b. "range of motion exercises must be performed every day" c. "have the child perform simple isometric exercises during this time" d. "administer additional pain medication before performing range of motion exercises"
a
To meet the developmental needs of an 8 year old child who is confined to home with osteomyelitis, what goal should the nurse include in the care plan? a. encourage the child to communicate with school mates b. encourage the parents to stay with the child c. allow siblings to visit freely throughout the day d. talk to the child about his interests twice daily
a
When assessing an adolescent for scoliosis, what should the nurse ask the client to do? a. bend forward at the waist with arms hanging freely b. lie flat on the floor and extend the legs straight from the trunk c. sit in a chair while lifting the feet and legs to a right angle with the trunk d. stand against a wall while pressing the length of the back against the wall
d
When teaching the child with scoliosis being treated with a Boston brace about exercises, the nurse explains that the exercises are performed primarily for what reason? a. to decrease back muscle spasms b. to improve the brace's traction effect c. to prevent spinal contractures d. to strengthen the back and abdominal muscles
a b c
Which can occur in untreated developmental dysplasia of the hip? Select all that apply a. duck gait b. pain c. osteoarthritis in adulthood d. osteoporosis in adulthood e. increased flexibility of the hip joint in adulthood
a
Which of the following is a complication of immobility that is easily prevented with appropriate nursing intervention? a. disuse atrophy and loss of muscle mass b. constipation c. hypocalcemia d. pain
a
Which of the following nursing goals is most appropriate for the child with juvenile idiopathic arthritis? a. child will exhibit signs of reduced joint inflammation and adequate joint function b. child will exhibit no signs of impaired skin integrity due to rash c. child will exhibit normal weight and nutritional status d. child will exhibit no alteration in respiratory patterns or respiratory tract infection
a
While assessing a 3 year old who has had an injury to the leg, has pain, and refuses to walk, the nurse notes that the child's left thigh is swollen. What should the nurse do next? a. assess the neurologic status of the toes b. determine the circulatory status of the upper thigh c. obtain the child's vital signs d. notify the health care provider immediately
a
A 1 month old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition? a. limited range of motion in the affected hip b. an apparent lengthened femur on the affected side c. asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed d. symmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table
c
A 10 year old with scoliosis has to wear a brace. The nurse should develop a teaching plan with the client to include which instruction? a. wear the brace during waking hours b. use lotions to relieve skin irritations c. wear a form-fitting t shirt under the brace d. bathe the skin under the brace once per week
a
After a plaster cast has been applied to the arm of a child with a fractured right humerus, the nurse completes discharge teaching. The nurse should evaluate the teaching as successful when the mother agrees to seek medical advice if the child experiences which symptom? a. inability to extend fingers on the right hand b. vomiting after the cast is applied c. coolness and dampness of the cast after 5 hours d. fussiness with statements that the cast is heavy
c
Anticipating that a 3 year old child in traction will have a need for diversion, what should the nurse offer to the child? a. a video game b. blocks c. hand puppets d. remote-controlled car
b e f
The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? Select all that apply a. use the fingertips to lift the cast while it is drying b. keep small toys and sharp objects away from the cast c. use a padded ruler or another padded object to scratch the skin under the cast if it itches d. place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold e. elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling f. contact the health care provider if the child complains of numbness or tingling in the extremity
b
The nurse should teach the parent of a child who has a new cast for a fractured radius to do which intervention for the first few days at home? a. use a hair dryer to dry the cast more quickly b. have the child refrain from strenuous activity c. check movement and sensation of the child's fingers once a day d. administer acetaminophen every 8-12 hours for discomfort
a
Nursing care directed toward nonsurgical management of a teenager with scoliosis primarily includes a. promoting self-esteem and positive body image b. preventing immobility c. promoting adequate nutrition d. preventing infection
d
A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include what? a. Encourage normal activity for as long as possible. b. Explain the cause of the disease to the child and family. c. Prepare the child and family for long-term, permanent disabilities. d. Teach the family the care and management of the corrective appliance.
b
16 year old Ben has been brought to the school nurse's office for heatstroke. He has a temperature of 104 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
a
Osteomyelitis resulting from a blood-borne bacterium that could have developed from an infected lesion is termed a. acute hematogeneous osteomyelitis b. exogenous osteomyelitis c. subacute osteomyelitis d. chronic osteomyelitis
b
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
d
Which of the following statements about "nursemaid's elbow" is correct? a. this most common partial discloation of the radial head of the elbow is usually found in children ages 1-3 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
b
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 2 hours before the event
d
Which would be the best nursing intervention for a child with phantom pain after an amputation? a. tell the child that the pain does not exist b. request a PCA pump from the physician for pain management c. encourage the child to rub the stump d. provide amitriptyline (Elavil) to help with pain
a b c e
Which would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply a. unwillingness to move affected extremity b. severe pain c. fever d. previous closed fracture of an extremity e. redness and swelling at the site
c e
Which would the nurse expect to assess on a 3 week old infant with developmental dysplasia of the hip? Select all that apply a. excessive hip abduction b. femoral lengthening of an affected leg c. asymmetry of gluteal and thigh folds d. pain when lying prone e. positive Ortolani test
a
Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis? a. take with food b. take on an empty stomach c. blood levels are required for drug dosages d. good oral hygiene is needed
c
Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis? a. fat loss b. adrenal stimulation c. immune suppression d. hypoglycemia
a
Zac, a 16 year old football star at the local high school, is at the school nurse's office for acne that is not clearing with the OTC 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 proteins and vitamins in the diet d. use of methylphenidate (Ritalin)
a b d e
A 14 year old with osteogenesis imperfecta is confined to a wheelchair. Which nursing interventions will promote normal development? Select all that apply a. encourage participation in groups with teens who have disabilities or chronic illness b. encourage decorating the wheelchair with stickers c. encourage transfer of primary care to an adult provider at age 18 years d. allow the teen to view the radiographs e. help the teen set realistic goals for the future f. discourage discussion of sexuality, because the child is not likely to date
c
A 2 day old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip, and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include a. return to the orthopedist's office in 2 weeks to remove the hip spica cast b. the infant's bilateral foot cats should be elevated on pillows as much as possible c. remove the Pavlik harness once a day for no more than 2 hours and inspect skin d. remove the Pavlik harness while the infant is awake to allow "tummy time"
a c
A 6 year old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which is an early sign of compartment syndrome in this child? Select all that apply a. edema b. numbness c. severe pain d. weak pulse e. anular rash
b
A 9 year old is given morphine for postoperative pain. As the nurse is assessing the client for pain 4 hours later, his parent leaves the room, and the child begins to cry. The nurse's initial assessment of the child's pain is that he is a. not in pain because the crying began after the parent leaves b. less tolerant of pain because he is upset c. in pain because he is crying d. not in pain because he was medicated 4 hours ago
c
A 12 year old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long? a. pain from the brace b. difficulty in putting the brace on c. self-consciousness about appearance d. not understanding what the brace is for
c
A 14 year old has just had a plaster cast placed on his lower left leg. To provide safe cast care, the nurse should a. petal the cast as soon as it is put on b. keep the child in the same position for 24 hours until the cast is dry c. use only the palms of the hand when handling the cast d. notify the healthcare provider if the client feels heat
a b e
A child is admitted to the pediatric unit with the diagnosis of lupus erythematosus. On assessment, the nurse expects the child to have which of the following signs and symptoms? Select all that apply a. oral ulcers b. malar rash c. weight gain c. heart failure e. anemia
b
A nurse discovers a 5 year old lying in the street next to his bicycle. The nurse sends another witness to activate the EMS while the nurse begins a primary assessment of the child. Which of the following best describes the primary assessment and its correct sequence? a. body inspection, head to toe survey, and airway patency b. 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 c d e
A nurse is assessing a child who has Legg-Calve-Perthes disease. Which of the following findings should the nurse expect? Select all that apply a. longer affected leg b. hip stiffness c. back pain d. limited ROM e. limp with walking
a
A nurse is caring for a 5 year old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that a. this is a serious injury that could cause long-term growth issues b. the fracture usually heals within 6 weeks without further complications c. the child will never be able to play contact sports d. fractures involving the growth plate require pain medication
b c e
A nurse is caring for a child who sustained a fracture. Which of the following actions should the nurse take? Select all that apply a. place a heat pack on the site of injury b. elevate the affected limb c. assess neurovascular status frequently d. encourage ROM of the affected limb e. stabilize the injury
d
A nurse is caring for a toddler who has hip dysplasia and has been placed in a hip spica cast. The child's guardian asks the nurse why a Pavlik harness is not being used. Which of the following responses should the nurse make? a. "The Pavlik harness is used for children with scoliosis, not hip dysplasia" b. "The Pavlic harness is used for school-age children" c. "The Pavlic harness cannot be used for your child because her condition is too severe" d. "The Pavlic harness is used for infants less than 6 months of age"
a d
A nurse is caring for an infant and notices an audible click in their left hip. Which of the following diagnostic test should the nurse expect the provider to perform? Select all that apply a. Barlow test b. Babinski sign c. Manipulation of foot and ankle d. Ortolani test e. Ponseti method
b
Nursing considerations for the patient diagnosed with osteogenesis imperfecta include a. preventing fractures by holding onto the child's ankles when changing diapers b. providing nonjudgmental support while parents may be dealing with accusations of child abuse c. providing guidelines to the parents in avoiding all exercise and sports for the child d. educating parents that the use of braces and splints can increase the rate of fracture
d
An adolsecent is on the football team and practices in the morning and afternoon before school starts for the year. The temperature on the field has been high. The school nurse has been called to the practice field because the adolescent is now reporting that he has muscle cramps, nausea, and dizziness. Which action should the school nurse do first? a. administer cold water with ice cubes b. take the adolescent's temperature c. have the adolescent lie supine d. move the adolescent to a cool environment
d
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
a b e
One nursing diagnosis for juvenile idiopathic arthritis is impaired physical mobility. Select all that apply a. give pain medication prior to ambulation b. assist with range-of-motion activities c. encourage the child to eat a high fat diet d. provide oxygen as necessary e. use nonpharmacological methods, such as heat
b c d
Because estrogen is a possible trigger for a systemic lupus erythematosus flare, advice for a teenage girl who may become sexually active include which of the following? Select all that apply a. use ortho tri-cyclen b. use depo-provera c. practice abstinence d. use condoms e. use ortho evra
c
Ben, a 15 year old high school student, is at a track event. He has been running multiple events and was feeling underwell before the event and has been vomiting. Now he is complaining of thirst, headache, fatigue, dizziness, and nausea. He seems to be 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. heatstroke
d
Bob, age 7, is diagnosed with Legg-Calve-Perthes disease. Which of the following manifestations is not 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
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 adults' 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
c
What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis? a. Apply ice packs to relieve stiffness and pain. b. Administer acetaminophen to reduce inflammation. c. Teach the child and family the correct administration of medications. d. Encourage range of motion exercises during periods of inflammation.
d
What statement is correct regarding sports injuries during adolescence? a. Rapidly growing bones, muscles, joints, and tendons offer some protection from unusual strain. b. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. c. More injuries occur during organized athletic competition than during recreational sports participation. d. Adolescents may not possess the insight and judgment to recognize when an activity is beyond their capabilities.
c
Which is the most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? a. pain b. spirituality c. body image d. lack of coping
c
When instructing a family about care of an orthosis, the nurse should emphasize which of the following? a. clean the brace with diluted bleach b. dry the brace over a heater or in the sun c. clean the brace weekly with mild soap and water d. return the brace to the orthopedic surgeon for cleaning
a c d e
When planning a rehabilitation approach for a child with osteogenesis imperfecta, the nurse should prevent which of the following? Select all that apply a. positional contractures and deformities b. bone infection c. muscle weakness d. osteoporosis e. misalignment of lower extremity joints
b
A nurse is teaching a group of caregivers about fractures. Which of the following information should the nurse include in the teaching? a. children need a longer time to heal from a fracture than an adult b. epiphyseal plate injuries an result in altered bone growth c. a greenstick fracture is a complete break in the bone d. bones are unable to bend, so they break
a b d e
Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes with of the following? Select all that apply a. assess pain b. assess pulses c. elevate extremity above the level of the heart d. monitor capillary refill e. provide pain medication as needed
c
A nurse is completing preoperative teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis. Which of the following information should the nurse include in the teaching? a. "you will go home the same day of surgery" b. "you will have minimal pain" c. "you will need to receive blood" d. "you will not be able to eat until the day after surgery"
a
A child is admitted with a fracture of the femur and placed in skeletal traction. What should the nurse assess first? a. the pull of traction on the pin b. the Ace bandage c. the pin sites for signs of infection d. the dressings for tightness
d
A child who limps and has pain has been found to have Legg-Calve-Perthes disease. What should the nurse expect to include in the child's plan of care? a. initiation of pain control measures, especially at night when acute b. promotion of ambulation despite the child's discomfort in the affected hip c. prevention of flexion in the affected hip and knee d. avoidance of weight bearing on the head of the affected femur
b
A parent asks the nurse about using a car seat for a toddler who is in a hip spica cast. The nurse should tell the parent a. "you can use a seat belt because of the spica cast" b. "you will need a specially designed car seat for your toddler" c. "you can still use the car seat you already have" d. "you will need to get a special release from the police so that a car seat will not be needed"
d
A preschool age child with juvenile idopathic arthritis has become withdrawn, and the mother asks the nurse what she should do. Which suggestion by the nurse would be the most appropriate? a. introduce the child to other children her age who also have JIA b. tell the mother to spend extra time with her other children c. recommend that the mother send the child to see a counselor for therapy d. encourage the mother to be supportive and understanding of the child
c
A preschooler with a fractured femur of the left leg in traction tells the nurse that his leg hurts. It is too early for pain medication. The nurse should a. place a pillow under the child's buttocks to provide support b. remove the weight from the left leg c. assess the feet for signs of neurovascular impairment d. reposition the pulleys so the traction is looser
a
Slipped capital femoral epiphysis is suspected when a. an adolescent begins to limp and complain 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
Commotio cordis a. occurs after a bunt, 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
d
Diagnostic evaluation is important for early recognition of scoliosis. Which of the following is the correct procedure for the school nurse conducting this examination? a. view the child, who is standing and walking fully clothed, to look for uneven hanging of clothing b. view all children form the left and right side to look mainly for asymmetry of the hip height c. completely undress all children before the examination d. view the child, who is wearing underpants, from behind when the child bends forward at the hips
b
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
a
Immediate treatment of sprains and strains includes a. rest and cold application b. disregarding the pain and "working out" the sprain or strain c. rest, elevation, and pain medication d. compression of the area and heat application
a
Immobilization causes what effects on the cardiovascular system? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes
b
Johnny, a 12 year old with fracture of the femur, has developed sudden chest pain and shortness of breath. The nurse suspects a. pulmonary embolism b. compartment syndrome c. myocardial infarction d. pneumonia
b
Mary, age 12, has been diagnosed with scoliosis and placed in a thoracolumbosacral orthotic (TLSO) brace. Which of the following information provided by the nurse to Mary 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 correct 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
a b f
The nurse caring for the child with osteomyelitis assesses poor appetite. Which intervention is most appropriate for this child? Select all that apply a. offer high-calorie liquids b. offer favorite foods c. do not worry about intake, because appetite loss is expected d. suggest removal of the intravenous line to encourage oral intake e. decrease pain medication that might cause nausea f. offer frequent small meals
b
The nurse is assessing Carol, age 8, 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 lack of sensitivity to the area as well as some edema. Which of the following would the nurse suspect as most likely to be occurring? a. normal occurrence for the first few hours after application of traction b. Volkmann contracture c. nerve compression syndrome d. epiphyseal damage
b
The nurse is caring for 7 year old charles after application of skeletal traction. Which of the following is contraindicated? a. gently massage over the pressure areas to stimulate circulation b. release the traction when repositioning charles in bed c. inspect pin sites for bleeding or infection d. assess for alterations in neurovascular status
a
The nurse is preparing an adolescent girl for surgery to treat scoliosis. What would the nurse include? a. Blood administration may be an option. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.
a
The nurse is teaching the parent of a child diagnosed with lupus erythematosus. The nurse evaluates the teaching as effective when the parent states a. "the cause is unknown" b. "there is no genetic involvement" c. "drugs are not a trigger for the illness" d. "antibodies improve disease outcome"
d
The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis. The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by a. breakdown of osteoclasts in the joint space causing bone loss b. loss of cartilage in the joints c. buildup of calcium crystals in joint spaces d. immune-stimulated inflammatory response in the joint
a
The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse would consider what in caring for this child who has experienced severe trauma? a. Rapid assessment should begin with ABC status: airway, breathing, and circulation. b. Assessment should begin with the area injured; assessment of other areas can wait. c. The possibility of spinal cord injury should be ruled out before transporting the child to the hospital. d. Temperature maintenance is more difficult than in adults because young children have a larger surface area related to body mass.
a
The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which care is most appropriate? a. fit the diaper under the straps b. leave the harness off while the infant sleeps c. check for skin redness under straps every other day d. put powder on the skin under the straps every day
c
The parent of a 3 week old states the the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? a. give pain medication b. reposition the infant in the crib c. check the neurocirculatory status of the foot d. use a cool blow-dryer to blow into the cast to control itching
b
The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. Which is the nurse's best response? a. "direct inoculation of the bone from stepping barefoot on a sharp stick" b. "an infection from a scratched mosquito bite carried the infection through the bloodstream to the bone" c. "the blood supply to the bone was disrupted because of the child's diabetes" d. "an infection of the upper respiratory tract"
d
The parent of a preschooler with a tentative diagnosis of juvenile idopathic arthritis asks about a test to definitively diagnose it. The nurse's response is based on knowledge of what information? a. the latex fixation is diagnostic b. an increased erythrocyte sedimentation rate is diagnostic c. a positive synovial fluid culture is diagnostic d. no specific laboratory testing is diagnostic
a
The parents of a child just diagnosed with juvenile idopathic arthritis tell the nurse that the diagnosis frightens them because they know nothing about the prognosis. What information should the nurse include when teaching the parents about the disease? a. the more joints affected, the more severe the disease will be b. many affected children go into long remissions but have severe deformities c. the disease usually progresses to crippling rheumatoid arthritis d. most affected children recover completely within a few years
a b c d f h
The potential physiologic and psychologic effects of prolonged immobilization on a 9 year old child who has experienced significant trauma in a MVA include which of the following? Select all that apply a. orthostatic intolerance b. deep vein thrombosis c. pressure ulcer formation d. pneumonia e. diarrhea f. kidney stones g. sense of euphoria and elation h. constipation
d
The primary diagnostic tool used in the developmental dyplasia of the hip in a newborn is a. a radiograph b. an ultrasound c. MRI d. the Barlow and Ortolani maneuvers
c
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
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 cutter works before beginning the procedure b. use the analogy of having fingernails or hair cut 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
What information should the nurse include when developing the teaching plan for the parents of a child with juvenile idopathic arthritis who is being treated with naproxen? a. anti-inflammatory effect will occur in approximately 8 weeks b. within 24 hours, the child will have anti-inflammatory relief c. the nurse should be called before giving the child any OTC medications d. if a dose is forgotten or missed, that dose is not made up
d
What would cause a nurse to suspect that an infection has developed under a cast? a. Cold toes b. Increased respirations c. Complaint of paresthesia d. "Hot spots" felt on the cast surface
b c d
When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply a. pain medication is contrainidicated so that symptoms are not masked b. blood cultures will be obtained c. pus will be aspirated from the subperiosteum d. an intravenous line with antibiotics will be started e. surgery will be necessary
b c d
When counseling the parents of a child with osteogenesis imperfecta, the nurse should include which of the following? Select all that apply a. discourage future children because the condition is inherited b. provide education about the child's physical limitations c. give the parents a letter signed by the primary care provider explaining OI d. provide information on contacting the osteogenesis imperfecta foundation e. encourage the parents to treat the child like their older children f. encourage use of calcium to decrease risk of fractures
b
When developing the teaching plan for parents using the Pavlik harness with their child, what should be the nurse's initial step? a. assess the parents' current coping strategies b. determine the parents' knowledge about the device c. provide the parents with written instructions d. give the parents a list of community resources
c
When planning home care for the child with Legg-Calve-Perthes disease, what should be the primary focus for family teaching? a. need for intake of protein-rich foods b. gentle stretching exercises for both legs c. management of the corrective appliance d. relaxation techniques for pain control
c
When teaching the family of an older infant who has a spica cast applied for developmental dysplasia of the hip, which information should the nurse include when describing the abduction stabilizer bar? a. it can be adjusted to a position of comfort b. it is used to lift the child c. it adds strength to the cast d. it is necessary to turn the child
d
Which is an important nursing intervention to monitor in a child with systemic lupus erythematosus and renal involvement? a. monitor weight b. check for uric salts in urine c. watch for hypotension d. check for protein in urine
b
Which is an important nursing intervention to teach about photosensitivity to the parents of a child with systemic lupus erythematosus? a. regular clothing is appropriate for sun exposure b. sunscreen application is necessary for protection c. teenage patients cannot participate in outdoor sports d. uncovered fluorescent lights offer no damage
b
Which is important when teaching a parent about preventing osteomyelitis? a. parents can stop worrying about bone infection once their child reaches school age b. parents need to clean open wounds thoroughly with soap and water c. children will always get a fever if they have osteomyelitis d. children should wear long pants when playing outside because their legs might get scratched
d
Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is? a. it is a fracture located in the growth plate of the bone b. because children's bones are not fully developed, any fracture in a young child is a greenstick fracture c. it is a fracture in which a complete break occurs in a bone, and small pieces of bone are broken off d. it is a fracture that does not go all the way through the bone
c
Which of the following is not included in the teaching plan of a child with a 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
