NCELX-PN MUSCULOSKELETAL PEDIATRICS

The mother of a child with juvenile idiopathic arthritis calls the nurse because the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if the child should perform range-of-motion (ROM) exercises at this time. The nurse should make which response to the mother?

"Have the child perform simple isometric exercises during this time."

The nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement, if made by one of the parents, indicates an understanding of the use of the harness?

"I can remove the harness to bathe my infant."

The nurse provides information to the parent of a 2-week-old infant who was diagnosed with clubfoot at the time of birth. Which statement by the parent indicates the need for further teaching regarding this disorder?

"I need to bring my child back to the clinic in 1 month for a new cast."

The nurse reinforces home care instructions to the parents of a child with a brace for scoliosis. Which statement by a parent indicates a need for further teaching?

"I understand that my child needs to wear this brace for 12 hours a day."

When reinforcing instructions to the caregiver of a child about cast care, the nurse anticipates the need for further teaching when the caregiver makes which statement?

"I will allow my child to put cotton balls inside the cast to relieve pressure."

The nurse is reinforcing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates the need for further teaching?

"I will apply lotion under the brace to prevent skin breakdown."

A child is brought to the emergency department, and a fracture of the left lower arm is suspected. The mother states that the child was rollerblading and attempted to break a fall with an outstretched arm. The child receives diagnostic x-rays, from which it has been determined that a fracture is present. A plaster of Paris cast is applied to the arm, and the nurse reinforces instructions to the mother regarding cast care at home. Which instructions should the nurse provide to the mother?

"The cast needs to be kept dry because when wet it will begin to disintegrate."

The nurse is reinforcing instructions to the parents of an infant with clubfoot about the care of a plaster cast. Which statement should the nurse include in the instructions? Select all that apply.

"The foot should be kept elevated for the first 24 to 48 hours." "Reposition the infant every 2 to 4 hours until cast is thoroughly dried." "The edges of the cast can be 'petaled' with small pieces of moleskin or adhesive tape."

The nurse is reinforcing instructions to the mother of a child with juvenile idiopathic arthritis regarding measures to take if a painful exacerbation of the disease occurs. Which statement by the mother indicates the need for further teaching?

"The full range-of-motion (ROM) exercises must be performed every day, even during the exacerbations."

The nurse has reinforced prior teaching of a school-age child who was given a brace to wear for the treatment of scoliosis. The child needs further teaching if which statement is made?

"This brace will correct my curve."

The mother of a child with Marfan syndrome asks the nurse what can be done at home to help her child. Which are the best responses by the nurse? Select all that apply.

"You may need to consider surgery in the future." "You will need to make regular pediatric appointments for your child." "You will need to make regular eye examination appointments for your child." "You will need to have your child take cardiac medication(s) to decrease stress on the aorta." "You will need to let the dentist know that antibiotics should be given before any procedure."

The nurse is assigned to care for a child with a compound (open) fracture of the arm that occurred as a result of a fall. The nurse plans care knowing that this type of fracture involves which specific characteristic?

A greater risk of infection than a simple fracture

The nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse monitors for the most serious complication associated with this type of traction by checking for which?

An elevated temperature

An adolescent is seen in the emergency department following an athletic injury, and it is suspected that the child sprained an ankle. X-rays are taken, and a fracture has been ruled out. The nurse reinforces instructions to the adolescent regarding home care for treatment of the sprain and provides the adolescent with which information?

Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 hours.

An infant is seen in a clinic and is diagnosed with unilateral hip dysplasia. Which finding is associated with this condition?

Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

The mother of a 5-year-old child brings the child to the emergency department and tells the nurse that the child fell. A fracture is suspected and an x-ray is taken. The results indicate that the child has a comminuted fracture of the right humerus. The mother asks the nurse to describe this type of fracture, and the nurse draws a picture for the mother. Which picture identifies this type of fracture? Refer to figure.

B

A child is to be admitted to the orthopedic unit following a Harrington rod insertion for the treatment of scoliosis. The nurse is assisting in preparing a plan of care for the child. The nurse plans to monitor which priority item in the immediate postoperative period?

Capillary refill, sensation, and motion in all extremities

The nurse is assisting in preparing a plan of care for a child who will be returning from surgery following the application of a hip spica cast. Which would be the priority action in the plan of care for this child on return from the procedure?

Check circulation in the feet.

The nurse is monitoring a child with a cast on the forearm for signs of compartment syndrome. The nurse understands that which data collection technique is unlikely to provide information about this complication?

Checking the child's ability to perform range of motion to the shoulder area of the affected extremity

The nurse is checking the capillary refill of a child with a cast applied to the left arm. The nurse compresses the nail bed of a finger, and it returns to its original color in 2 seconds. Which action should be taken by the nurse?

Document the findings.

The nurse is assigned to care for a child with a spica cast. Which action should be avoided when caring for the child?

Using pillows to elevate the head and shoulders

A nursing student is asked to discuss juvenile idiopathic arthritis (JIA) at a clinical conference scheduled for the end of the clinical day. Which statement by the nursing student indicates the need for further research of this disorder?

"This disease is twice as likely to occur in boys as in girls."

A child with a fractured femur is placed in Buck's skin traction, and the nurse is planning care for the client. Which information about this type of traction is correct?

Is a type of skin traction that pulls the hip and leg into extension

The nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which finding should the nurse expect to note documented in the infant's record regarding this condition?

Hip joint laxity

The nurse is collecting data from a child suspected of having juvenile idiopathic arthritis (JIA). Which findings should the nurse expect to note if JIA were present? Select all that apply.

Malaise, fatigue, and lethargy Painful, stiff, and swollen joints Limited range of motion of the joints History of late afternoon temperature, with temperature spiking up to 105° F

A child with cerebral palsy (CP) is working to achieve maximum potential for locomotion, self-care, and socialization in school. To meet these goals, which action should the nurse take when working with the child?

Place the child on a wheeled scooter board.

The nurse is caring for a pediatric client in skin traction. To prevent skin breakdown, which nursing intervention for this child is best?

Stimulate circulation with gentle massage over pressure areas.

A 13-year-old child is diagnosed with osteogenic sarcoma of the femur. Following a course of chemotherapy, it is decided that leg amputation is necessary. Following the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which statement made by the nurse will best assist in alleviating the child's fear?

"This aching and cramping are normal and temporary and will subside."

The nurse assists to create a nursing care plan for the child with an arm cast and should include which interventions in the plan? Select all that apply.

Instruct parents to keep the cast clean and dry. Monitor the extremity for circulatory impairment. Instruct the child not to stick objects down the cast. Notify the registered nurse (RN) immediately if circulatory impairment occurs.

The nurse is assigned to care for a child who is in skeletal traction. The nurse needs to avoid which action when caring for the child?

Placing the bed linens on the traction ropes

The nurse is providing information to the family of a child about a synthetic cast that has been applied to the child for the treatment of a clubfoot. Which information should the nurse provide to the mother?

The synthetic cast allows for greater mobility than a plaster cast.

A 4-year-old child sustains a fall at home and is brought to the emergency department by the mother. Following x-ray examination, it has been determined that the child has a fractured arm, and a plaster cast is applied. The nurse reinforces instructions to the mother regarding cast care for the child. Which statement by the mother indicates a need for further teaching?

"The cast will feel warm when it is dried."

The nurse reinforces instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which instruction provided by the nurse is accurate?

The harness needs to be removed to check the skin and for bathing.

The nurse is performing a neurovascular check on a hospitalized child who had a cast applied to the lower leg. The child complains of tingling in the toes distal to the fracture site. Which action should the nurse take?

Notify the registered nurse (RN).

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 distention. On the basis of these findings, the nurse should take which action?

Notify the registered nurse.

The nurse is assisting a primary health care provider (PHCP) during an examination of an infant with hip dysplasia. The PHCP performs the Ortolani maneuver. Which data should the nurse expect to note during the examination?

The dislocated femoral head pops back into the acetabulum