Pediatric Success Orthopedic

The nurse is explaining rhabdomyosarcoma cancer to an adolescent. From which of the following muscles does the cancer arise? 1. Skeletal. 2. Cardiac. 3. Striated. 4. Connective.

1.2 mg. Change pounds to kilograms (2.2 lb = 1 kg: 65/2.2 = 29.5 kg). Then multiply kilograms by the dose of 0.04 mg/kg: 29.5 × 0.04 = 1.18 mg or round to 1.2 mg.

Which classification of osteogenesis imperfecta (OI) is lethal in utero and in infancy? 1. Type I. 2. Type II. 3. Type III. 4. Type IV.

2. Type II is lethal in utero and in infancy because of multiple fractures and deformities and underdeveloped lungs.

When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age group? 1. Infancy. 2. Toddlers. 3. School-aged children. 4. Adolescents.

4. Osteosarcoma is a common cancer of adolescents.

Which should be obtained to make a diagnosis of slipped capital femoral epiphysis (SCFE)? 1. A history of hip trauma. 2. A physical examination of hip, thigh, and knees. 3. A complete blood count. 4. A radiographic examination of the hip.

4. Radiographic examination is the only definitive diagnostic tool for SCFE. TEST-TAKING HINT: The most definitive tool in assessing a hip is radiographic examination.

Which is most important when teaching a parent about preventing osteomyelitis? 1. Parents can stop worrying about bone infection once their child reaches school age. 2. Parents need to clean open wounds thoroughly with soap and water. 3. Children will always get a fever if they have osteomyelitis. 4. Children should wear long pants when playing outside because their legs might get scratched.

2. Because bacteria from an open wound can lead to osteomyelitis, thorough cleaning with soap and water is the best prevention.

It is recommended that a child with metastatic rhabdomyosarcoma undergo a bone marrow transplant. Education regarding life-threatening side effects should include: 1. Diarrhea. 2. Fever. 3. Skin breakdown. 4. Tumor shrinkage.

2. Fever indicates infection that can be life threatening after a bone marrow transplant.

The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. Which is the nurse's best response? 1. "Direct inoculation of the bone from stepping barefoot on a sharp stick." 2. "An infection from a scratched mosquito bite carried the infection through the bloodstream to the bone." 3. "The blood supply to the bone was disrupted because of the child's diabetes." 4. "An infection of the upper respiratory tract."

2. Infection through the bloodstream is the most likely cause of osteomyelitis in a child.

A child with Ewing sarcoma is receiving chemotherapy and is experiencing severe nausea. The nurse has to administer Ativan at 0.04 mg/kg, and the child weighs 65 lb. What dose should the nurse administer?

2. Limb salvage requires the lengthening procedures to encourage the bone to continue to grow so the child will not have a short limb.

A child with Ewing sarcoma is undergoing a limb salvage procedure. Which statement indicates the parents understand the procedure? 1. "Our child will have a bone graft to save the limb." 2. "Our child will need follow-up lengthening procedures." 3. "Our child will need shorter shirt sleeves." 4. "Our child will not need chemotherapy."

2. Limb salvage requires the lengthening procedures to encourage the bone to continue to grow so the child will not have a short limb.

A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia? 1. "My child will be more at risk for diarrhea." 2. "My child will be more at risk for infection." 3. "My child's hair will fall out." 4. "My child will need to drink more."

2. Neutropenia makes a child more at risk for infection, because the immune system is compromised due to the chemotherapy.

Which is an important nursing intervention to teach about photosensitivity to the parents of a child with systemic lupus erythematosus (SLE)? 1. Regular clothing is appropriate for sun exposure. 2. Sunscreen application is necessary for protection. 3. Teenage patients cannot participate in outdoor sports. 4. Uncovered fluorescent lights offer no danger

2. Sunscreen helps reduce accelerated burning due to sensitivity.

A child is admitted to the pediatric unit with the diagnosis of systemic lupus erythematosus (SLE). On assessment, the nurse expects the child to have: 1. Leukemia. 2. Malar rash. 3. Weight gain. 4. Heart failure.

2. The "butterfly," or malar, rash is the most common manifestation of SLE

A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do first? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Tell the child to wait another hour for the medication to work.

2. The nurse looks for the source of the pain by performing a neuromuscular assessment.

Why are chemotherapeutic agents such as methotrexate and cyclophosphamide sometimes used to treat juvenile idiopathic arthritis (JIA)? 1. Effective against cancer-like JIA. 2. Affect the immune system. 3. Are similar to NSAIDs. 4. Are absorbed into the synovial fluid.

2. These drugs affect the immune system to reduce its ability to attack itself, as in the case of JIA.

A spinal curve of less than _________ degrees that is non progressive does not require treatment for scoliosis.

20. A 20-degree spinal curve that is nonprogressive will not disfigure or interfere with normal functioning, so it is not treated with bracing or surgery

The parent of a 3-week-old states that 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? 1. Give pain medication. 2. Reposition the infant in the crib. 3. Check the neurocirculatory status of the foot. 4. Use a cool blow-dryer to blow into the cast to control itching.

3. Checking the neurocirculatory status of the foot is the highest priority.

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? 1. Pain from the brace. 2. Difficulty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.

3. Children this age are very conscious of their appearance and fitting in with their peers, so they might be very resistant to wearing a brace.

A 10-year-old with osteomyelitis has been on intravenous antibiotics for 48 hours. The child is allergic to amoxicillin. Vital signs are T 101.8°F (38.8°C), BP 100/60, P 96, R 24. Which is the primary reason for surgical treatment? 1. Young age. 2. Drug allergies. 3. Nonresponse to intravenous antibiotics. 4. Physician preference.

3. If a patient does not respond to an appropriate antibiotic within 48 hours, surgery may be indicated.

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone.

3. In DDH, asymmetrical thigh and gluteal folds are frequently present.

The nurse expects the blood culture report of an 8-year-old with septic arthritis to grow which causative organism? 1. Streptococcus pneumoniae. 2. Escherichia coli. 3. Staphylococcus aureus. 4. Neisseria gonorrhoeae.

3. S. aureus is a common organism found on the skin and is frequently the cause of septic arthritis.

A child is diagnosed with stage IV rhabdomyosarcoma, and the parent asks what that means. The nurse provides which of the following explanations? 1. The tumor is limited to the organ site. 2. There is regional disease from the organ involved. 3. There is distant metastatic disease. 4. The disease is limited to the lymph nodes.

3. Stage IV disease means there is distant metastatic disease.

Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis (JIA)? 1. Fat loss. 2. Adrenal stimulation. 3. Immune suppression. 4. Hypoglycemia.

3. Steroids cause immune suppression, which is the reason behind its use in JIA; it reduces the body's attack on itself.

The nurse is explaining rhabdomyosarcoma cancer to an adolescent. From which of the following muscles does the cancer arise? 1. Skeletal. 2. Cardiac. 3. Striated. 4. Connective.

3. Striated muscle is in many organs and sites of the body, thus leading to the multiple sites of the disease.

Select the number of inches lateral to the heel where a crutch should be placed. 1. 1 to 3. 2. 4 to 5. 3. 6 to 8. 4. 9 to 10.

3. This position provides the best protection for balance and stability.

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.

4. Checking under straps frequently is suggested to prevent skin breakdown.

Which would be the best nursing intervention for a child with phantom pain after an amputation? 1. Tell the child that the pain does not exist. 2. Request a PCA pump from the physician for pain management. 3. Encourage the child to rub the stump. 4. Provide Elavil to help with pain.

4. Elavil is a medication for nerve pain that is helpful in relieving phantom pain.

Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is? 1. It is a fracture located in the growth plate of the bone. 2. Because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture. 3. It is a fracture in which a complete break occurs in the bone, and small pieces of bone are broken off. 4. It is a fracture that does not go all the way through the bone.

4. It is a fracture that does not go all the way through the bone.

Which is an important nursing intervention to monitor in a child with systemic lupus erythematosus (SLE) and renal involvement? 1. Monitor weight. 2. Check for uric salts in urine. 3. Watch for hypotension. 4. Check for protein in urine

4. Protein in urine is a sign of renal impairment, even in nephrotic syndrome, in which the kidneys are losing protein.

The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: 1. Breakdown of osteoclasts in the joint space causing bone loss. 2. Loss of cartilage in the joints. 3. Build-up of calcium crystals in joint spaces. 4. Immune-stimulated inflammatory response in the joint.

4. JIA is caused by an immune response by the body on the joint spaces.

The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? 1. Immediately after diagnosis. 2. At age 4 to 6 months. 3. Prior to walking (age 9 to 12 months). 4. After walking is established (age 15 to 18 months).

1. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made.

The nurse on the pediatric floor is receiving a child with the possible diagnosis of septic arthritis of the elbow. Which would the nurse expect on assessment? Select all that apply. 1. Resistance to bending the elbow. 2. Nausea and vomiting. 3. Fever. 4. Bruising of the elbow. 5. Swelling of the elbow. 6. A history of nursemaid's elbow as a toddler.

1, 2, 3, 5. 1. Infection of the elbow joint can cause pain that leads to protecting the joint and resisting movement. 2. Infection of the elbow may cause generalized nausea and vomiting. 3. Infection of the elbow frequently causes fever. 4. There is no bruising with septic arthritis. 5. Septic arthritis can cause swelling of the joint. 6. There is no increased risk with a history of nursemaid elbow.

Which would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply. 1. Unwillingness to move affected extremity. 2. Severe pain. 3. Fever. 4. Previous closed fracture of an extremity. 5. Redness and swelling at the site.

1, 2, 3, 5. 1. Pain in an extremity leads to resistance to movement. 2. Pain is frequently severe in osteomyelitis. 3. Fever is present in the acute phase of the illness. 4. Osteomyelitis can sometimes be seen after a direct inoculation of an open fracture. There is no increased risk after a closed fracture. 5. Redness and swelling occur because of the infection.

Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply. 1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. 4. Osteoporosis in adulthood. 5. Increased flexibility of the hip joint in adulthood.

1, 2, 3. 1. Due to abnormal hip joint function, the patient's gait is stiff and waddling. 2. Due to abnormal femoral head placement, the patient may experience pain and decreased flexibility in adulthood. 3. Due to abnormal femoral head placement, the patient may experience osteoarthritis in the hip joint in adulthood.

The nurse tells the parent that other conditions can be associated with congenital clubfoot. Select all that apply. 1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol syndrome.

1, 2, 3. 1. There is an association between myelomeningocele and congenital clubfoot. 2. There is an association between some forms of cerebral palsy and congenital clubfoot. 3. There is an association between diastrophic dwarfism and congenital clubfoot.

A 14-year-old with osteogenesis imperfecta (OI) is confined to a wheelchair. Which nursing interventions will promote normal development? Select all that apply. 1. Encourage participation in groups with teens who have disabilities or chronic illness. 2. Encourage decorating the wheelchair with stickers. 3. Encourage transfer of primary care to an adult provider at age 18 years. 4. Allow the teen to view the radiographs. 5. Help the teen set realistic goals for the future. 6. Discourage discussion of sexuality, as the child is not likely to date.

1, 2, 4, 5.

Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? Select all that apply. 1. "Your child will need to wear a brace on the feet 23 hours a day for at least 2 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 3. "Your child will not be able to participate in sports that require a lot of running." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally." 6. "Most children treated for clubfeet require surgery at puberty."

1, 2, 4, 5. 1. After the final casting, bracing is required for 23 to 24 hours per day for 2 months. This decreases the likelihood of a recurrence. 2. Because clubfoot can recur, it is important to have regular follow-up with the orthopedic surgeon until age 18 years. 3. After treatment, most children are able to participate in any sport. 4. Even with proper bracing, there may be a recurrence. 5. Most children treated for clubfeet develop normally appearing and functioning feet. 6. Most children do not require surgery at puberty.

A 13-year-old just returned from surgery for scoliosis. Which nursing intervention(s) is/are appropriate in the first 24 hours? Select all that apply. 1. Assess for pain. 2. Logroll to change positions. 3. Get the teen to the bathroom 12 to 24 hours after surgery. 4. Check neurological status. 5. Monitor blood pressure.

1, 2, 4, 5. 1. General post-operative nursing interventions include assessing for pain. 2. Specific to scoliosis surgery, logrolling is the means of changing positions. 3. Patients may not be upright less than 24 hours post-operatively. 4. It is essential to check neurological status in a patient who just had scoliosis surgery. 5. General post-operative nursing interventions include assessing vital signs.

Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes which of the following? Select all that apply. 1. Assess pain. 2. Assess pulses. 3. Elevate extremity above the level of the heart. 4. Monitor capillary refill. 5. Provide pain medication as needed.

1, 2, 4, 5. 1. In a recent fracture, the nurse should assess pain and provide treatment. 2. Pain, pallor, and weak or absent pulses are all signs of compartment syndrome. 3. Elevating the extremity is important to decrease edema prior to the onset of compartment syndrome. However, once compartment syndrome is suspected, the extremity should be kept at the level of the heart to facilitate arterial and venous flow. 4. Weak or absent pulse is a sign of compartment syndrome, so monitoring capillary refill is important in assessment. 5. Pain, pallor, and weak or absent pulses are signs of compartment syndrome. Pain should be treated.

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/are an early sign(s) of compartment syndrome in this child? Select all that apply. 1. Edema. 2. Numbness. 3. Severe pain. 4. Weak pulse. 5. Anular rash.

1, 2, 4. 1. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 2. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 3. Edema, numbness or tingling, and pain are early signs of compartment syndrome. 4. A weak pulse is a late sign of compartment syndrome. 5. There is no rash with early compartment syndrome.

Select all that apply to the care of a child with a retroperitoneal rhabdomyosarcoma. 1. Acute pain. 2. Risk for impaired urinary elimination. 3. Impaired gas exchange. 4. Self-care deficit. 5. Risk for constipation.

1, 2, 5. 1. Pain occurs due to pressure on the organs in the lower abdomen. 2. A retroperitoneal tumor affects the organs of the lower abdomen, including the bowel and bladder. 3. A retroperitoneal tumor affects the organs of the lower abdomen, including the bowel and bladder. This tumor does not affect the lungs. 4. There is no indication the child cannot administer self-help. 5. Because this tumor is in the lower abdomen, it puts pressure on the bowel causing constipation.

One nursing diagnosis for juvenile idiopathic arthritis (JIA) is impaired physical mobility. Select all that apply. 1. Give pain medication prior to ambulation. 2. Assist with range-of-motion activities. 3. Encourage the child to eat a high-fat diet. 4. Provide oxygen as necessary. 5. Use nonpharmacological methods, such as heat.

1, 2, 5. 1. Providing pain medication prior to ambulation helps decrease pain during ambulation. 2. Children with JIA need to do rangeof- motion exercises to prevent joint stiffness. 3. A high-fat diet is not helpful for mobility. 4. Oxygen is usually not necessary with the diagnosis of JIA. 5. Using nonpharmacological methods such as heat helps with flexibility and pain.

The nurse caring for a child with osteomyelitis assesses poor appetite. Which intervention( s) is/are most appropriate for this child? Select all that apply. 1. Offer high-calorie liquids. 2. Offer favorite foods. 3. Do not worry about intake, as appetite loss is expected. 4. Suggest intravenous removal to encourage oral intake. 5. Decrease pain medication that might cause nausea. 6. Offer frequent small meals.

1, 2, 6. 1. High-calorie liquids are sometimes received better when the child has a poor appetite. 2. Offering favorite foods can sometimes tempt the child to eat, even with a poor appetite. 3. Although decreased appetite is expected, it is something that needs nursing intervention in order to promote healing. 4. An intravenous line is necessary for antibiotics, so it cannot be removed to encourage oral intake. 5. Although some pain medications cause nausea, their use is important. If patients are in pain, they are not likely to want to eat. 6. Small, frequent meals might increase daily caloric intake.

When planning a rehabilitative approach for a child with osteogenesis imperfecta (OI), the nurse should prevent which of the following? Select all that apply. 1. Positional contractures and deformities. 2. Bone infection. 3. Muscle weakness. 4. Osteoporosis. 5. Misalignment of lower extremity joints.

1, 3, 4, 5. 1. A long-term goal in caring for a child with OI is to prevent contractures and deformities. 2. There is no increased risk for bone infection in OI. 3. A long-term goal in caring for a child with OI is to prevent muscle weakness. 230 PEDIATRIC SUCCESS 4. A long-term goal in caring for a child with OI is to prevent osteoporosis. 5. A long-term goal in caring for a child with OI is to prevent misalignment of lower extremity joints.

Which instruction(s) should the nurse give the parents of an adolescent with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Continue upper body exercises to limit loss of muscle strength. 2. Do not turn the teen in bed when complaining of pain. 3. Provide homework, computer games, and other activities to decrease boredom. 4. Do most activities of daily living for the teen. 5. Expect expressions of anger and hostility. 6. Continue setting limits on behavior.

1, 3, 5, 6. 1. Immobilization can lead to a decrease in muscle strength. Upper body exercises should be continued soon after surgery. 2. Although turning the patient in bed after surgery may be painful, it is essential that parents and the patient know that it is necessary to prevent skin ulcerations and promote healing. 3. It is important for this patient to continue as many normal activities as possible. This should include schoolwork and leisure activities. 4. To promote independence that is essential for a teenager, this patient should be encouraged to continue activities of daily living. 5. Some expressions of anger and hostility are normal, as this adolescent is losing some independence with this immobility. 6. Continuation of setting limits on behavior is important to keep as much normalcy as possible.

After the birth of an infant with clubfoot, the nursery nurse should do which when instructing the parents? Select all that apply. 1. Speak in simple language about the defect. 2. Avoid the parents unless providing direct care so they can grieve privately. 3. Keep the infant's feet covered at all times. 4. Present the infant as precious; emphasize the well-formed parts of the body. 5. Tell the parent that defects could be much worse. 6. Be prepared to answer questions multiple times.

1, 4, 6. 1. The parents will likely be shocked immediately after the birth of the child. To facilitate their understanding, the nurse should speak in simple terms. 2. Avoiding the parents is not therapeutic. 3. The baby should be shown to the parents as are all newborns, without hiding the clubfoot. 4. The baby should be shown to the parents as are all newborns, emphasizing the well-formed parts of the body. 5. Negating the parents' grieving is not therapeutic. 6. Information may need to be repeated as the family begins to absorb the information.

Which factor(s) is/are associated with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Obesity. 2. Female gender. 3. African descent. 4. Age of 5 to 10 years. 5. Pubertal hormonal changes. 6. Endocrine disorders.

1, 5, 6. 1. Obesity increases the risk of SCFE by stressing the epiphyseal plate. 2. SCFE is more common in males. 3. SCFE is more common in whites. 4. SCFE is most common from the ages of 10 to 16 years. 5. SCFE is most common during pubertal hormonal changes. 6. SCFE is associated with endocrine disorders.

Which nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy? 1. Risk for fluid volume deficit. 2. Potential for chronic pain. 3. Risk for skin impairment. 4. Ineffective airway clearance

1. Chemotherapy can cause nausea, vomiting, and possibly diarrhea, which contribute to fluid volume deficit.

The nurse is teaching an adolescent about Ewing sarcoma and indicates which as a common site? 1. Shaft. 2. Growth plate. 3. Ball of the femur. 4. Bone marrow.

1. Ewing sarcoma is a bone tumor that affects the shafts of long bones.

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: 1. This is a serious injury that could cause long-term growth issues. 2. The fracture usually heals within 6 weeks without further complications. 3. The child will never be able to play contact sports. 4. Fractures involving the growth plate require pain medication.

1. Fractures of the growth plate are serious, as they can disrupt the growth process.

A child is going to receive radiation for Ewing sarcoma. Which of the following is the best nursing intervention to prevent skin breakdown during therapy? 1. Advise the child to wear loose-fitting clothes to minimize irritation. 2. Advise the child to use emollients to prevent dry skin. 3. Apply cold packs nightly to reduce the warmth caused by the treatments. 4. Apply hydrocortisone to soothe itching from dry skin.

1. Loose clothing helps reduce irritation on the sensitive irradiated skin.

Which would the nurse teach a patient when NSAIDs are prescribed for treating juvenile idiopathic arthritis (JIA)? 1. Take with food. 2. Take on an empty stomach. 3. Blood levels are required for drug dosages. 4. Good oral hygiene is needed.

1. NSAIDs can cause gastric bleeding with long-term use; food helps to reduce the exposure of the drug on the stomach lining.

The nurse is teaching the parent of a child diagnosed with systemic lupus erythematosus (SLE). The nurse evaluates the teaching as effective when the parent states: 1. "The cause is unknown." 2. "There is no genetic involvement." 3. "Drugs are not a trigger for the illness." 4. "Antibodies improve disease outcome."

1. SLE is a complex disease; there are many triggers, but how the disease develops is not known

Which is the definition of talipes varus? 1. An inversion or bending inward of the foot. 2. An eversion or bending outward of the foot. 3. A high arch of the foot. 4. A low arch (flatfoot) of the foot.

1. Talipes varus is an inversion of the foot.

When counseling the parents of a child with osteogenesis imperfecta (OI), the nurse should include which of the following? Select all that apply. 1. Discourage future children because the condition is inherited. 2. Provide education about the child's physical limitations. 3. Give the parents a letter signed by the primary care provider explaining OI. 4. Provide information on contacting the Osteogenesis Imperfecta Foundation. 5. Encourage the parents to treat the child like their other children. 6. Encourage use of calcium to decrease risk of fractures.

2, 3, 4. 1. Genetic counseling should be provided as part of long-term care so that the parents can make an informed decision about future children. 2. The nurse should provide education about the child's physical limitations so that physical therapy and appropriate activity can be encouraged. 3. OI is frequently confused with child abuse. Carrying a letter stating that the child has OI and what that condition looks like can ease the stressors of an emergency department visit. 4. The Osteogenesis Imperfecta Foundation is an organization that can provide information and support for a family with a child with the condition. 5. Children with OI must be treated with careful handling and cannot be allowed to participate in all activities that unaffected siblings are allowed. 6. There is no support for the use of additional calcium to decrease fractures.

When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply. 1. Pain medication is contraindicated so that symptoms are not masked. 2. Blood cultures will be obtained. 3. Pus will be aspirated from the subperiosteum. 4. An intravenous line with antibiotics will be started. 5. Surgery will be necessary.

2, 3, 4. 1. Medication will be given regularly to help with the pain. 2. Blood cultures will be obtained. 3. Pus will be aspirated from the subperiosteum. 4. Antibiotics will be given via an intravenous line. 5. Surgery is indicated only when medication fails.

Because estrogen is a possible trigger for a systemic lupus erythematosus (SLE) flare, advice for a teenager who may become sexually active includes which of the following? Select all that apply. 1. Use Ortho Tri-Cyclen. 2. Use Depo-Provera. 3. Practice abstinence. 4. Use condoms. 5. Use Ortho Evra.

2, 3, 4. 1. Ortho Tri-Cyclen contains estrogen; therefore, it is contraindicated. 2. Depo-Provera is progesterone, the only contraceptive that is approved for use in sexually active women with SLE. 3. Abstinence is always recommended to prevent pregnancy. 4. Condoms are always recommended. 5. Ortho Evra ("the patch") contains estrogen and is therefore not recommended.

Which is most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? 1. Pain. 2. Spirituality. 3. Body image. 4. Lack of coping.

3. Body image is a developmental issue for adolescents and influences their acceptance of themselves and by peers.

Which should be included in teaching a family about post-surgical care for slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. The patient will receive help with weight-bearing ambulation 24 to 48 hours after surgery. 2. Monitoring of pain medication to prevent drug dependence. 3. Instruction on pin site care. 4. Offering low-calorie meals to encourage weight loss. 5. Correct use of crutches by the patient. 6. Outpatient physical therapy for 6 to 8 weeks.

3, 5. 1. Ambulation is to be non-weight bearing with crutches until range of motion is painless. This is usually 4 to 8 weeks. 2. Pain medication is to be administered regularly during hospitalization to provide comfort to the patient and encourage cooperation with daily activities and ambulation. Drug dependence for the post-operative patient is not a significant concern. 3. The parents will be assessing pin sites for infection and stability upon discharge. Instructions on care should be demonstrated for and then by the parents. 4. Although obesity is often a factor in SCFE, the patient requires adequate caloric intake for healing and recovery post-operatively. Obesity issues can be addressed after surgical recovery. 5. Instruction on crutch usage will be given prior to discharge. Crutch walking will not be done during the early post-operative stage.

The nurse evaluates teaching as successful when the parent explains that an excisional biopsy is done for which reason? 1. To find metastatic disease. 2. To remove all metastatic disease. 3. To confirm the type of metastatic disease. 4. To treat metastatic disease.

3. A biopsy confirms the histology of the tumor.

When instructing a family about care of an orthosis, the nurse should emphasize which of the following? 1. Clean the brace with diluted bleach. 2. Dry the brace over a heater or in the sun. 3. Clean the brace weekly with mild soap and water. 4. Return the brace to the orthopedic surgeon for cleaning.

3. An orthosis should be cleaned weekly with mild soap and water.

Which parts of the body should the nurse assess on a child in a spica cast? List the relevant label(s) from the following figure.

C, D. The nurse needs to assess areas under the cast for drainage through the cast and assess neurocirculatory status of the feet.

Where should the top of the crutch bar be in relation to the axilla?

The crutch bar should not put pressure on nerves in the axilla.