PEDS Quiz 11

A nurse is assessing a child after a fractured femur. Signs that compartment syndrome is occurring are: (Select all that apply.)

Pain not relieved by pain medication. Prolonged capillary-refill time with paresthesia.

A nurse is caring for a child hospitalized for osteomyelitis of the left lower extremity. Which of the following interventions should be included in the child's plan of care? (Select all that apply.)

Administer intravenous antibiotics Encourage increased fluid intake Assess the child for signs of infection

A nurse is caring for a child who has an arm cast. Which of the following is an early sign of altered neurovascular function?

Pain, dramatically out of proportion for the severity of injury.

Which situation should alert the school nurse that a child requires additional assessment for Legg-Calvé-Perthes disease?

A 7-year-old boy who is limping and states this his hip hurts

Genu vacuum (bowlegs)

A condition in which the knees stay wide apart when the child stands with the feet and ankles together. It is considered normal in children under 2 to 3 years of age.

The pediatric nurse is caring for a neonate with congenital clubfoot. The child has a cast to correct the defect. Before discharge, what should the nurse tell the parents?

A new cast is needed every week

Spiral

A twisting motion causes the fracture

Developmental dysplasia of the hip

Asymmetrical buttock creases, hip click or pop, hips with limited range of motion (hips can't fully spread).

The nurse in the newborn nursery is doing the admission assessment on a neonate. Developmental dysplasia of the hip (DDH) should be suspected when the nurse observes

Asymmetry of the gluteal and thigh fat folds

metatarsus adductus

Bones in the front half of the foot bend or turn in toward the body. Foot can be manually straightened out.

A child with developmental dysplasia of the hip has a spica cast applied. Which action(s) specific to the spica cast should be taken? (Select all that apply)

Check for cracks or breaks in the cast. Ensure the child's head is higher than his feet. Assess for circulation, movement, and sensation. Auscultate the bowel sounds. Check for swelling and tightness. Place a disposable diaper inside the edges of the rear part of the cast.

Scoliosis

C-shaped (one curve) or S-shaped curvature (two curves) in the spine.

The nurse is teaching family members how to care for their infant in a Pavlik harness to treat congenital developmental dysplasia of the hip. The nurse should include in the parental education to

Check at least two or three times a day for red areas under the straps

An infant has just returned from surgery for correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The toes on both feet are edematous, but there is color, sensitivity, and movement to them. The nurse should

Elevate the legs on pillows

Osteogenesis imperfecta

Extremely fragile bones

Transverse

Perpendicular to the long axis of bone.

A nurse is caring for a preschooler who has muscular dystrophy. For which of the following findings should the nurse assess? (Select all that apply.)

Muscular weakness in lower extremities Unsteady, wide-based or waddling gait Gower's sign

Which type of medication is most commonly used to treat juvenile arthritis?

Non-steroidal anti-inflammatory drugs (NSAIDS)

A nurse is caring for a preschooler who walks but has difficulty keeping up with peers. The nurse is assessing the preschooler for possible right developmental dysplasia of the hip (DDH). Which of the following assessments should the nurse use to assess for DDH?

Trendelenburg sign

A 14-year-old female will receive a Milwaukee brace to correct scoliosis with a 24 degree curve. Reviewing her discharge instructions, the nurse recognizes that the client has received adequate teaching when she says she will

Wear the brace all day and remove it only to bathe

Which of the following statements by the mother of a child with osteogenesis imperfecta demonstrates to the nurse understanding of safety measures needed to prevent injury?

"I will use wrinkle- free lift sheet to reposition her"

A nurse is educating a family about the type of fracture their 8-year-old son has experienced. Which of the following would be an accurate way to explain a closed fracture of the radius to the family?

"One of the bones in the arm broke completely, but did not penetrate the skin"

A nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica cast. The child's mother asks the nurse why a Pavlik harness is not being used. Which of the following responses by the nurse appropriately addresses the mother's question?

"The Pavlik harness is used for infants less than 6 months of age"

Which statement would reassure the nurse that the parents understand the teaching regarding their 4-year-old with genu valgum?

"This is a normal developmental issue that will improve as the child grows"

The nurse has completed discharge teaching for the family of a child diagnosed with Legg-Calve-Perthes disease. The nurse knows further teaching is needed about the condition if the family states,

"We're glad this will only take about six weeks to correct"

Which of the following interventions are appropriate in providing care for a child in skeletal traction?

Make sure the weights hang freely and do not touch the floor. Apply an antibiotic ointment around the pin, if ordered. After traction equipment is removed, provide skin care every four hours. Clean the pins with normal saline, when ordered.

Muscular dystrophy

Use of arms and hands in rising from a sitting to a standing position by "climbing up the thighs" in grasping and pulling on body parts from the knees to hips

A nurse is evaluating the pin sites of a child with an external fixator. The nurse is least concerned with

serous drainage

A child has been admitted to the hospital with osteomyelitis. Which statement should the nurse understand as correct for this medical diagnosis?

Antibiotic therapy should continue for 3-6 weeks

A school nurse is evaluating a child who hurt her leg in gym class. The nurse believes it is a muscle strain, but is still going to refer her to her pediatric nurse practitioner. Which instruction should the child follow until she is seen by the PNP?

Apply ice for 15 minutes at a time

A child has experienced a sprain of the right ankle. The school nurse should

Apply ice to the extremity

A nurse is caring for a child who has just received a cast. Which of the following considerations is important in providing care for this child?

Assess the casted extremity every 15-30 minutes the first two hours after cast application.

Which of the following nursing interventions is most effective in relieving joint stiffness and muscle spasm in a 10-year-old girl with juvenile arthritis?

Assist her with heat application and ROM exercises

Compartment syndrome

Fasciotomy to relieve pressure on nerves and blood vessels

A child has just returned from surgery after spinal-fusion surgery. The nurse should check for signs of

Impaired color, sensitivity, and movement to lower extremities

The nurse is caring for a child in Bryant skin traction. Which nursing interventions ensure proper care of this client?

Inspect traction weights regularly to make sure they hang freely. Weights should not touch the floor, bed, or each other. Make sure ropes are positioned properly in the pulley track, the pulleys move freely, and the pulleys hang freely. Check the traction frequently to ensure that proper alignment is maintained. Check feet for color, pulses, warmth, and sensation, every 2 hours. Observe frequently for skin breakdown on both legs

Oblique

Instead of a right angle, the bone has broken at an angle to the long axis of the bone.

Juvenile idiopathic arthritis

Long-term (chronic) disease resulting in joint pain and swelling. May also have red eyes and eye pain (uveitis).

Legg-Calve-Perthes disease

Occurs when the ball of the thighbone in the hip does not get enough blood, causing the bone to die

Slipped Capital Femoral Epiphysis (SCFE)

Occurs when the femoral head displaces from the femoral neck, most often during the adolescent growth spurt. Happens more in boys than girls

Greenstick

Only one cortex of the bone has a fracture. In other words, cracks in only one side of the cortex.

A nurse notes blue sclerae during a newborn assessment. The infant should be checked for

Osteogenesis imperfecta

A nurse performs triage in a pediatric orthopedic clinic. Which of the following should the nurse recognize as a symptom of slipped capital femoral epiphysis (SCFE)?

Pain in the hip of a preadolescent child

A fracture to the epiphyseal plate of a child's left arm occurs. What complication may result?

Reduced future growth

Cervical Traction

Skin or skeletal fraction. Stabilizes a spinal fracture or muscle spasm.

Which of the following nursing interventions are appropriate for a child with muscular dystrophy? (Select all that apply.)

Suggest swimming as a good exercise for this child Teach the family proper body mechanics Immunize the child on the recommended schedule Encourage the child to perform as much self-care as possible

Care for an infant with osteogenesis imperfecta should include

Support of the trunk and extremities when moving

Congenital talipes equinovarus (clubfoot)

The foot turns inward and downward. Cannot be manually straightened out.

A school health nurse is screening for scoliosis. What assessment findings should the nurse look for? (Select all that apply.)

Uneven shoulders and hips A one-sided rib hump Prominent scapula

Dunlop Traction

Skin or skeletal traction. Two lines of pull on the arm. Fracture of the humerus (long bone in upper arm) or elbow fracture.

A child must wear a brace for correction of scoliosis. The nursing diagnosis that should be included in this child's plan of care is

Risk for Impaired Skin Integrity

An 8-year-old boy with Duchenne muscular dystrophy (DMD) is being seen in the clinic for a routine health visit. A high-priority nursing diagnosis for this patient is

Risk for falls related to breakdown of muscles

The school nurse is performing musculoskeletal screening examinations for students in the fifth grade class. The nurse notes that a student's shoulders are at different heights—one shoulder blade is more prominent than the other. The student also has a raised, prominent hip and an uneven waist. These findings may indicate:

Scoliosis

90-90 Degree Traction

Skeletal traction. Used on femur if skin traction isn't suitable. 90-degree flexion of both hip and knee; lower extremity in a boot cast. Weights are suspended by a pin through the lower portion of the thighbone. Fracture of femur (thighbone).

Bryant Traction

Skin traction. Both lower extremities flexed 90° at hips (even if only one extremity is affected). Keep the buttocks slightly elevated off the bed. Used in children younger than 3 years old to stabilize hips or to reduce femur fractures (developmental hip dysplasia, fractured femur, after bladder exstrophy repair). Traction may be followed by application of a hip-spica cast.

Russell's Traction

Skin traction. Two lines of pull on lower extremity, perpendicular and longitudinal. Fracture of hip or femur (thigh bone).

Buck Traction

Skin traction. Used to TEMPORARILY immobilize a fractured leg or injured knee. Also used to correct lower extremity contractures or deformities.

A nurse is caring for a school-age child who has juvenile idiopathic arthritis. Which of the following are appropriate home care instructions? (Select all that apply.)

Sleep on a firm mattress Take frequent rest periods throughout the day Perform ROM exercises when inflammation as subsided