WONG ch.33
The nurse is caring for an immobilized preschool child. What intervention is helpful during this period of immobilization? a. Encourage wearing pajamas. b. Let the child have few behavioral limitations. c. Keep the child away from other immobilized children if possible. d. Take the child for a "walk" by wagon outside the room.
ANS:D Transporting the child outside of the room by stretcher, wheelchair, or wagon increases environmental stimuli and provides social contact. Street clothes are preferred for hospitalized children. This decreases the sense of illness and disability. The child needs appropriate limits for both adherence to the medical regimen and developmental concerns. It is not necessary to keep the child away from other immobilized children.
The nurse is teaching the girls' varsity sports teams about the "female athlete triad." What is essential information to include? a. They should take low to moderate calcium to avoid hypercalcemia. b. They have strong bones because of the athletic training. c. Low estrogen levels may lead to a deficit in bone mineral density. d. A diet high in carbohydrates accommodates increased training.
ANS:C Adolescent athletes with amenorrhea have a lower bone mineral density. Increased calcium (1500 mg) is recommended for amenorrheic athletes. The decreased estrogen in girls with the female athlete triad, coupled with potentially inadequate diet, leads to osteoporosis. Diets high in protein and calories are necessary to avoid potentially long-term consequences of intensive, prolonged exercise programs in pubertal girls.
What nursing intervention is most appropriate when caring for the child with osteomyelitis? a. Encourage frequent ambulation. b. Administer antibiotics with meals. c. Move and turn the child carefully and gently to minimize pain. d. Provide active range of motion exercises for the affected extremity.
ANS:C During the acute phase, any movement of the affected limb causes discomfort to the child. Careful positioning with the affected limb supported is necessary. Weight bearing is not permitted until healing is well under way to avoid pathologic fractures. Intravenous antibiotics are used initially. Food is not necessary with parenteral therapy. Active range of motion would be painful for the child.
A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal anti-inflammatory drug (NSAID). What nursing consideration should be included? a. Monitor heart rate. b. Administer NSAIDs between meals. c. Check for abdominal pain and bloody stools. d. Expect inflammation to be gone in 3 or 4 days.
ANS:C NSAIDs are the first-line drugs used in JIA. Potential side effects include gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI bleeding and elevated blood pressure. The heart rate is not affected by this drug class. NSAIDs should be given with meals to minimize gastrointestinal problems. The anti-inflammatory response usually takes 3 weeks before effectiveness can be evaluated.
The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign? a. Petaling b. Posturing c. Pulselessness d. Positioning
ANS:C Puslselessness is an ominous sign that requires immediate notification of the practitioner. Permanent muscle and tissue damage can occur within 6 hr. The other signs of ischemia that need to be reported are pain, pallor, pulselessness, and paralysis. Petaling is a method of placing protective or smooth edges on a cast. Posturing is not a sign of peripheral ischemia. Finding a position of comfort can be difficult with a fracture. It would not be an ominous sign unless pain was increasing or uncontrollable.
What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)? a. Elevate the child's legs. b. Place a foot cradle on the bed. c. Place a pillow under the child's knees. d. Assist the child to dorsiflex the feet and rotate the ankles.
ANS:D For a child who is immobilized, circulatory stasis and DVT development are prevented by instructing patients to change positions frequently, dorsiflex their feet and rotate the ankles, sit in a bedside chair periodically, or ambulate several times daily. Elevating the legs or placing a foot cradle on the bed will not prevent DVTs. A pillow under the knee would impair circulation, not improve it.
A newborn had a breech intrauterine presentation and has a family history of hip dysplasia. Which is the most reliable assessment to diagnose this infant with hip dysplasia? Hip abduction Detection of Galeazzi sign Barlow and Ortolani maneuvers Asymmetric thigh and gluteal folds
Barlow and Ortolani maneuvers A newborn with a breech intrauterine presentation and with a family history of hip dysplasia may develop developmental dysplasia of the hip (DDH). The Barlow and Ortolani maneuvers are most reliable from birth to 4 weeks of age. These maneuvers demonstrate the joint subluxation and its tendency to dislocate. After 10 weeks of age, the most sensitive test is limited hip abduction. Other signs of determining DDH are checking for Galeazzi sign, which is shortening of the thigh on the affected side, and asymmetric thigh and gluteal folds, but these are not the most reliable methods to check for DDH.
The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what? a. "We'll keep the cast dry." b. "We're happy this is the only cast our baby will need." c. "We'll watch for any swelling of the foot while the cast is on." d. "We're getting a special car seat to accommodate the cast."
ANS:B The common approach to clubfoot management and treatment is the Ponseti method. Serial casting is begun shortly after birth. Weekly gentle manipulation and stretching of the foot along with placement of serial long-leg casts allow for gradual repositioning of the foot. The extremity or extremities are casted until maximum correction is achieved, usually within 6 to 10 weeks. If parents state that this is the only cast the infant will need, they need further teaching.
What is an appropriate nursing intervention when caring for a child in traction? a. Removing adhesive traction straps daily to prevent skin breakdown b. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles c. Providing active range of motion exercises to affected extremity three times a day d. Keeping child prone to maintain good alignment
ANS:B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.
A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.) a. Relieve itching with heat. b. Elevate the arm when resting. c. Observe the fingers for any evidence of discoloration. d. Do not allow the child to put anything inside the cast. e. Examine the skin at the cast edges for any breakdown.
ANS:B, C, D, E Cast care involves elevating the arm, observing the fingers for evidence of discoloration, not allowing the child to put anything inside the cast, and examining the skin at the edges of the cast for any breakdown. Ice, not heat, should be applied to relieve itching.
The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Erythema over joints b. Soft tissue contractures c. Swelling in multiple joints d. Morning stiffness of the joints e. Loss of motion in the affected joints
ANS:B, C, D, E Whether single or multiple joints are involved, stiffness, swelling, and loss of motion develop in the affected joints in JIA. The swelling results from soft tissue edema, joint effusion, and synovial thickening. The affected joints may be warm and tender to the touch, but it is not uncommon for pain not to be reported. The limited motion early in the disease is a result of muscle spasm and joint inflammation; later it is caused by ankylosis or soft tissue contracture. Morning stiffness of the joint(s) is characteristic and present on arising in the morning or after inactivity. Erythema is not typical, and a warm, painful, red joint is always suspect for infection.
The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hr ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication? a. Sepsis b. Osteomyelitis c. Pulmonary embolism d. Acute respiratory tract infection
ANS:C Fat emboli are of greatest concern in individuals with fractures of the long bones. Fat droplets from the marrow are transferred to the general circulation, where they are transported to the lung or brain. This type of embolism usually occurs within the second 12 hr after the injury. Sepsis would manifest with fever and lethargy. Osteomyelitis usually is seen with pain at the site of infection and fever. A child with an acute respiratory tract infection would have nasal congestion, not chest pain.
A child has just been fitted with a cast to heal a fracture of the arm. The nurse is vigilant for which early signs of compartment syndrome? Select all that apply. Pain Pallor Paralysis Paresthesia Pulselessness
Pain Pallor Paresthesia Pulselessness Compartment syndrome is a serious complication that results from compression of nerves, blood vessels, and muscle inside a closed space. It can occur after a cast is applied. Early clinical signs of compartment syndrome include pain, pallor, pulselessness, paresthesia, and pressure. If left untreated, paralysis and deformity may occur. Therefore paralysis is a late sign of compartment syndrome.
What is the most comprehensive therapeutic management for juvenile idiopathic arthritis? Pain control, physical and occupational therapy, splints, and ice packs Pain control, physical and occupational therapy, splints, and acetaminophen to reduce inflammation Pain control, physical and occupational therapy, splints, and nonsteroidal antiinflammatory drugs for inflammation Pain control, physical and occupational therapy, splints, and range-of-motion exercises during periods of inflammation
Pain control, physical and occupational therapy, splints, and nonsteroidal antiinflammatory drugs for inflammation Pain control, physical and occupational therapy, splints, and nonsteroidal antiinflammatory drugs for inflammation comprise the most comprehensive therapeutic management for juvenile idiopathic arthritis. Acetaminophen does not reduce inflammation, and warm, moist heat is better than ice for relieving stiffness and pain. Range-of-motion exercises should not be performed during periods of inflammation.
An adolescent injured the knee at school and had a dislocation of the patella. Which is the priority intervention by the school nurse? Administer analgesics for pain. Advise surgical patellar reduction. Monitor for spontaneous reduction. Perform the patellar reduction manually.
Perform the patellar reduction manually. Patellar dislocation always happens laterally and is accompanied by acute pain and disability. The nurse should help bring the patella to its normal position by applying pressure. Analgesics are administered to provide relief from pain, but they do not repair the dislocation. For recurrent patellar dislocation, open surgery may be needed to repair the damage. Spontaneous reduction occurs in most cases. However, if the spontaneous dislocation does not occur immediately, the nurse should apply pressure to slide the patella back to its normal position.
An adolescent has heatstroke while vigorously exercising outside in the sun. Which is the priority intervention for this patient? Supplemental oxygen administration Cautious fluid and electrolyte replacement Antipyretic administration on an immediate basis Rapid cooling until core temperature reaches 102oF
Rapid cooling until core temperature reaches 102oF The adolescent's clothing should be removed and cool water should be applied. Rapid cooling is necessary until the core temperature reaches 102 oF. Careful monitoring of the temperature is the first priority. Supplemental oxygen administration and cautious fluid and electrolyte replacement are supportive care needed at the time of heatstroke management. Antipyretics should be avoided because antipyretics are metabolized by the liver, which is already not functioning well due to the heatstroke.
The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 40° C (104° F). She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include what intervention? a. Administer antipyretics. b. Administer salt tablets. c. Apply towels wet with cool water. d. Sponge with solution of rubbing alcohol and water.
ANS:C Heatstroke is a failure of normal thermoregulatory mechanisms. The onset is rapid with initial symptoms of headache, weakness, and disorientation. Immediate care is relocation to a cool environment, removal of clothing, and applying of cool water (wet towels or immersion). Antipyretics are not used because they are metabolized by the liver, which is already not functioning. Salt tablets are not indicated and may be harmful by increasing dehydration. Rubbing alcohol is not used.
A child is experiencing phantom limb pain after a total knee amputation. Which is the best measure to control the pain? Administer analgesics. Check for neuroma in the stump. Tell the child that the pain is unreal. Suggest exercises for muscle strengthening.
Administer analgesics. The child may experience phantom limb pain. It is real and should be treated with analgesics and other measures of pain management. If the limb pain increases with ambulation, it may indicate a neuroma at the free nerve endings in the stump and should be evaluated immediately. The parents and caregivers should always show their support to the child and always listen to the child; they should treat the phantom limb pain as a real pain. Phantom limb pain does not go away with muscle strengthening exercises; the sensation fades away gradually.
The patient has been diagnosed with systemic lupus erythematosus. The nurse anticipates the provider to order which therapy? A high-protein, low-salt diet Administration of corticosteroids to control inflammation Application of cold salts to suppress the inflammatory process A rigorous exercise regimen to build up muscle strength and endurance
Administration of corticosteroids to control inflammation Corticosteroid administration is the primary mode of therapy currently for systematic lupus erythematosus (SLE). The application of cold salts will not affect the inflammatory process associated with SLE. A balanced diet that does not exceed caloric expenditures is recommended. Exercise should be done in moderation.
The child presents to the school nurse's office after twisting an ankle in physical education class. Which is the nurse's first action? Observe for edema. Apply ice on the site. Elevate the extremity. Administer analgesics
Apply ice on the site. A child with a twisted ankle has suffered a soft tissue injury. The area should be iced immediately to reduce pain and to promote healing. With severe injury, the area is swollen. Instead of waiting to observe for edema, the nurse first should apply ice. Next, the nurse should apply an elastic wrap to provide compression and to keep the ice pack in place, and then elevate the extremity. Elevating the extremity helps reduce the edema formation in the injured area. Analgesics may be given afterwards to relieve the discomfort.
The nurse is caring for a child with urinary retention and bladder infection. The child has not passed urine for the last 4 to 5 hours. What intervention does the nurse perform first to relieve the child of urinary retention? Administer diuretics as prescribed. Catheterize the child immediately. Stimulate the bladder using warm water. Keep fluid intake to a minimum.
Stimulate the bladder using warm water. Urinary retention can be relieved by pouring warm water on the genital organs. This helps to stimulate the bladder for contraction and voiding. Diuretics are helpful in increasing urinary output, but they do not relieve urinary retention. They can worsen the retention by increasing the formation of urine. Catheterization is done only in severe urinary retention. The patient is encouraged to take adequate fluids, and fluid intake is not restricted.
Which effect does immobilization have on the cardiovascular system? Lessened need for oxygen No specific primary effect Negative nitrogen balance Venous stasis and dependent edema
Venous stasis and dependent edema Immobilization physically affects the cardiovascular system by causing venous stasis and dependent edema. Decreased need for oxygen is how immobilization affects the respiratory system, not the cardiovascular system. Immobilization has very specific effects on the cardiovascular system. Negative nitrogen balance is how immobilization affects metabolism, not the cardiovascular system.
The nurse is educating a group of people about the first aid to be given in cases of fractures. A person questions how to splint a leg fracture when there is no ready-made splint available. Which statement by the nurse is most appropriate? "You need not splint the leg." "Just bandage the affected limb." "Use a smaller splint if available." "Use the patient's other leg as a splint.
"Use the patient's other leg as a splint." A splint offers support and rest to the injured body part. If a ready-made splint is not available, the patient's other leg can be used as a splint to support the injured part. A splint should cover the joint above and below the fracture. Using a smaller splint or bandaging the limb may be insufficient to immobilize the fractured leg. Splinting the leg is very important, because movement in the fractured limb may further worsen the fracture.
The nurse is caring for a child with poor gastrointestinal tract muscle tone who complains of constipation. Which suggestion of the nurse helps the child in relieving constipation? "You should eat a high-fat diet." "You should eat a high-fiber diet." "You should eat a high-vitamin diet." "You should eat a high-protein diet."
"You should eat a high-fiber diet." The patient has constipation due to decreased gastrointestinal muscle strength and muscle tone. High-fiber diets increase the bulk of feces and help to relieve constipation. High-fat, high-protein, or high-vitamin diets do not aid in relieving constipation, because they do not affect gastrointestinal motility.
A child who has been in a cast for a long period of time is brought to the hospital for its removal. Which is the most appropriate teaching by the nurse at the time of cast removal? The cast cutter may cut the skin a little bit. The cutting may produce heat, and it may burn the skin. After cast removal, a rigorous scrubbing of the skin is necessary. A prolonged period of casting may result in decreased muscle mass.
A prolonged period of casting may result in decreased muscle mass. Decreased muscle mass is noted if the cast is in place for a lengthy period of time. Exercise and routine activities will help in gradual return of function and appearance if there was no other trauma beforehand. The cast cutter works by vibration and cuts only the hard part of the cast; it does not cut the skin. There may be heat generation while cutting the cast, but it will not burn the skin. After the cast is removed, the underlying skin is covered with desquamated skin and sebaceous secretions. It should be removed by a simple soak in a bathtub; vigorous scrubbing may cause excoriation and bleeding.
Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease. Both surgical and conservative therapies are appropriate. They are able to verbalize the differences between the therapies when they make what statement? a. "All therapies require extended periods of bed rest." b. "Conservative therapy will be required until puberty." c. "Our child cannot attend school during the treatment phase." d. "If conservative measures are unsuccessful, surgical reconstruction may be necessary."
ANS:D Surgical correction involves additional risks of anesthesia, infection, and possibly blood transfusion. The recovery period is only 3 to 4 months rather than the 2 to 4 years of conservative therapies. The use of non-weight-bearing appliances and surgical intervention does not require prolonged bed rest. Conservative therapy is indicated for 2 to 4 years. The child is encouraged to attend school and engage in activities that can be adapted to therapeutic appliances.
An infant is brought to the clinic for a well-child visit. The nurse notices that the infant is tightly swaddled in blankets, as she was during an earlier visit. The nurse teaches correct swaddling of the infant, with the hips placed in slight flexion and abduction during swaddling. What complication is the nurse trying to prevent? Hip dysplasia Pressure sore Limb fracture Muscle contracture
Hip dysplasia There is evidence that tight swaddling makes an infant prone to hip dysplasia. The nurse is primarily trying to prevent developmental dysplasia of the hip. A tight wrap for a longer period of time may result in a pressure sore. If the wrapping is too tight, it may result in soft tissue injury. Limb fracture may happen if there is any trauma involved. A contracture of hip adductor and flexor muscles is a sign of developmental dysplasia of the hip.
What is the most widely used therapy to treat the 1-week-old infant who has developmental dysplasia of the hip (DDH)? Traction Pavlik harness Surgical closed reduction Proximal femoral osteotomy
Pavlik harness The Pavlik harness is most widely used to manage DDH in a newborn. When adduction contracture is present at 6 to 10 weeks of age, other devices such as skin traction can be used to manage DDH. In 6 to 24 months of age, if DDH is detected, it is treated with surgical closed reduction and then application of spica cast. In an older child, proximal femoral osteotomy is performed to manage DDH.
What is the most comprehensive way to treat an overuse syndrome? Activity and acetaminophen Rest and nonsteroidal antiinflammatory drugs Activity and nonsteroidal antiinflammatory drugs Rest, physical therapy, and nonsteroidal antiinflammatory drugs (NSAIDs)
Rest, physical therapy, and nonsteroidal antiinflammatory drugs (NSAIDs) Rest, physical therapy, and NSAIDs are the recommended way to treat an overuse syndrome. Rest and NSAIDs are appropriate, but not comprehensive. Activity and acetaminophen are not recommended for the therapeutic management of overuse syndrome.
The nurse is caring for a child who has a decreased metabolic rate. What food item does the nurse include in the child's diet? Butter Bananas Soybeans Strawberries
Soybeans Children with a decreased metabolic rate should consume a high-protein, high-fiber diet. Soybeans and other legumes are excellent sources of proteins and should be included in the child's diet. Butter is a high-fat food item and is not recommended. Bananas and strawberries are rich sources of vitamins, potassium, and other nutrients but are not very good sources of proteins.
The nurse is caring for a child who has a loss of respiratory muscle strength and who is unable to cough. Which nursing intervention does the nurse perform to help promote airway clearance? Ask the child to suppress the cough. Restrict fluid intake for the child. Splint the chest while the child is coughing. Administer antibiotic drugs to the child.
Splint the chest while the child is coughing. In case of respiratory muscle weakness, there is difficulty in coughing. The nurse should support the child's chest by splinting with a pillow so that it is easier to cough. Coughing is a defense mechanism of the body that removes foreign irritants from the respiratory tract. Thus the nurse should encourage the child to cough. The child should be provided adequate fluids to prevent thickening of chest secretions. Antibiotic drugs should be administered only if the child shows signs and symptoms of infection.
A student athlete was injured during a basketball game. The nurse observes significant swelling. The player states he thought he "heard a pop," that the pain is "pretty bad," and that the ankle feels "as if it is coming apart." Based on this description, the nurse suspects what injury? a. Sprain b. Fracture c. Dislocation d. Stress fracture
ANS:A Sprains account for approximately 75% of all ankle injuries in children. A sprain results when the trauma is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched. Joint laxity is the most valid indicator of the severity of a sprain. A fracture involves the cross-section of the bone. Dislocations occur when the force of stress on the ligaments disrupts the normal positioning of the bone ends. Stress fractures result from repeated muscular contraction and are seen most often in sports involving repetitive weight bearing such as running, gymnastics, and basketball.
The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching? a. "I should gently massage the skin under the straps once a day to stimulate circulation." b. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." c. "I should remove the harness several times a day to prevent contractures." d. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."
ANS:A To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.
The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.) a. Less bulky. b. Drying time is faster. c. Molds readily to body part. d. Permits regular clothing to be worn. e. Can be cleaned with small amount of soap and water.
ANS:A, B, D, E The advantages of synthetic casts over plaster of Paris casts are that they are less bulky, dry faster, permit regular clothes to be worn, and can be cleaned. Plaster of Paris casts mold readily to a body part, but synthetic casts do not mold easily to body parts.
The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Arthralgia b. Weight gain c. Polycythemia d. Abdominal pain e. Glomerulonephritis
ANS:A, D, E Clinical manifestations of SLE include arthralgia, abdominal pain, and glomerulonephritis. Weight loss, not gain, and anemia, not polycythemia, are manifestations of SLE.
The school nurse recognizes that the adverse effects of performance-enhancing substances can include what? (Select all that apply.) a. Depression b. Dehydration c. Hypotension d. Aggressiveness e. Changes in libido
ANS:A, D, E Mood changes have been observed as adverse effects of using performance-enhancing substances, including aggressiveness, changes in libido, depression, anxiety, and psychosis. Fluid retention, not dehydration, and hypertension, not hypotension, are adverse effects of performance-enhancing substances.
The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. What should the nurse do related to the tourniquet? a. Loosen the tourniquet. b. Leave the tourniquet in place. c. Remove the tourniquet and apply direct pressure if bleeding is still present. d. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.
ANS:B A tourniquet is applied only as a last resort, and then it is left in place and not loosened until definitive treatment is available. After the tourniquet is applied, skin and tissue necrosis occur below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation. This can induce systemic, deadly tourniquet shock.
An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device? a. As soon as possible after birth. b. When the infant is developmentally ready to stand up. c. At about ages 12 to 15 months, when most children are walking. d. At about 4 years, when the healthy limb is not growing so rapidly.
ANS:B An infant should be fitted with a functional prosthetic leg when the infant is developmentally ready to pull to a standing position. When the infant begins limb exploration, a soft prosthesis can be used. The child should begin using the prosthesis as part of his or her normal development. This will match the infant's motor readiness.
A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take? a. Call the health care provider to report the edema. b. Elevate the foot and leg on pillows. c. Apply a warm moist pack to the foot. d. Encourage movement of toes.
ANS:B During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell to the extent that the cast becomes a tourniquet, shutting off circulation and producing neurovascular complications (compartment syndrome). One measure to reduce the likelihood of this problem is to elevate the body part and thereby increase venous return. The health care provider does not need to be notified because edema is expected and warm moist packs will not decrease the edema. The child should move the toes, but that will not help reduce the edema.
An adolescent comes to the school nurse after experiencing shin splints during a track meet. What reassurance should the nurse offer? a. Shin splints are expected in runners. b. Ice, rest, and nonsteroidal anti-inflammatory drugs (NSAIDs) usually relieve pain. c. It is generally best to run around and "work the pain out." d. Moist heat and acetaminophen are indicated for this type of injury.
ANS:B Shin splints result when the ligaments tear away from the tibial shaft and cause pain. Actions that have an anti-inflammatory effect are indicated for shin splints. Ice, rest, and NSAIDs are the usual treatment. Shin splints are rarely serious, but they are not expected, and preventive measures are taken. Rest is important to heal the shin splints. Continuing to place stress on the tibia can lead to further damage.
The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home. What statement by the parent indicates a correct understanding of the teaching? a. "I should have the affected limb hang in a dependent position." b. "I will use an ice pack to relieve the itching." c. "I should avoid keeping the injured arm elevated." d. "I will expect the fingers to be swollen for the next 3 days."
ANS:B Teaching the parent to use an ice pack to relieve the itching is an important aspect when planning discharge for a child with a cast. The affected limb should not be allowed to hang in a dependent position for more than 30 minutes. The affected arm should be kept elevated as much as possible. If there is swelling or redness of the fingers, the parent should notify the health care provider.
The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session? a. "Bisphosphonate therapy is not beneficial for OI." b. "Physical therapy should be avoided as it may cause damage to bones." c. "Lift the infant by the buttocks, not the ankles, when changing diapers." d. "The infant should meet expected gross motor development without assistive devices."
ANS:C Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Bisphosphonate and physical therapy are beneficial for OI. Lightweight braces will be used when the child starts to ambulate.
The nurse is teaching parents the proper use of a hip-knee-ankle-foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement? a. "Alcohol will be used twice a day to clean the skin around the brace." b. "Weekly visits to the orthotist are scheduled to check screws for tightness." c. "Initially, a burning sensation is expected and the brace should remain in place." d. "Condition of the skin in contact with the brace should be checked every 4 hr."
ANS:D This type of brace has several contact points with the child's skin. To minimize the risk of skin breakdown and facilitate use of the brace, vigilant skin monitoring is necessary. Alcohol should not be used on the skin. It is drying. Parents are capable of checking and tightening the screws when necessary. If a burning sensation occurs, the brace should be removed. If several complaints of burning occur, the orthotist should be contacted.
A 3-year-old has just returned from surgery in a hip spica cast. Which is the priority nursing intervention? Offering sips of water Elevating the head of the bed Checking circulation, sensation, and motion of toes Turning the child to the right side and then the left side every 4 hours
Checking circulation, sensation, and motion of toes The chief concern is that the extremity may continue to swell. The circulation, sensation, and motion of the toes must be assessed to ensure that the cast does not become a tourniquet and cause complications. Elevating the head of the bed might help with comfort, but it is not a priority. The nurse must be alert to the risk of increased swelling in the extremities. Offering sips of water is acceptable once assessment of the extremities has been completed. The child's position should be changed every 2 hours. Correct positioning of a child with a spica cast is important to prevent injury.
What is the goal of treatment for a newborn with clubfoot? Correction of the deformity with a single cast worn for a year and followup observation Surgical correction of the deformity and maintenance of the correction until normal muscle balance is regained Correction of the deformity, maintenance of the correction until normal muscle balance is regained, and followup observation Correction of the deformity with casting for 3 to 8 weeks and maintenance of the correction until normal muscle balance is regained
Correction of the deformity, maintenance of the correction until normal muscle balance is regained, and followup observation The goal of treatment for clubfoot is to achieve a painless, plantigrade, and stable foot by correcting the deformity; maintenance of the correction until normal muscle balance is regained; and followup observation. Serial casts, rather than a single cast worn for a year, are the typical treatment protocol. Surgical correction is rarely required. Casting lasts 6 to 10 weeks for maximal correction, rather than 3 to 8 weeks.
Which is the best corrective measure to treat a child who has a shorter lower limb that causes asymmetrical weight bearing? Crutches Manual traction Prosthetic device Ilizarov external fixator
Ilizarov external fixator An Ilizarov external fixator is the common external fixation device used to lengthen bones. The child should be put on the device as soon as the child starts bearing weight. While on the external fixation device, partial weight bearing is allowed. The child should learn to use crutches to support walking. Manual traction is used to realign a bone. It does not promote bone growth. A prosthetic device is used in a limb deficiency.
What is the similarity seen between sprains and strains? In general, both sprains and strains occur rapidly. In both cases, joint or ligamentous laxity is common. In both cases, the area is painful to the touch and is swollen. In general, both happen at the level of the musculotendinous unit.
In both cases, the area is painful to the touch and is swollen. Sprains and strains share some common features. The area is painful to the touch and is swollen in both cases. Sprains occur rapidly, resulting from a severe trauma. In general, strains happen over time. In case of a severe injury, strains may develop rapidly. Strains do not involve ligaments. Joint laxity is not common in strains but is in sprains. Strains involve the muscles and tendons. Sprains happen at the level of muscles and ligaments.
The school nurse is observing a gym class. The nurse is most concerned about the risk for injury in which children? In children given extra fluids on a hot day In children who are physically fit but over tired In children who take the appropriate safety precautions In children who are not physically prepared for the activity
In children who are not physically prepared for the activity Children who are not physically prepared for a particular sporting activity are more likely to sustain a serious injury than are those who are prepared for the activity. Children who are physically fit but tired are not more likely to suffer a serious sports injury than children who are not physically prepared. The administration of extra fluids on hot days is not associated with an increased risk of serious sports injuries. Appropriate safety precautions do not increase a child's risk of sustaining a serious sports injury.
Which finding does the nurse look for when assessing a newborn for developmental dysplasia of the hip? Lordosis Ortolani sign Trendelenburg sign Telescoping of the affected limb
Ortolani sign The Ortolani sign is indicative of developmental dysplasia of the hip in a newborn. In an older infant lordosis and telescoping of the affected limb are signs of developmental dysplasia of the hip. In the weight-bearing child the Trendelenburg sign with lordosis is a clinical manifestation of developmental dysplasia of the hip.
A 6-year-old patient has presented to the emergency department with fractures on 5 different occasions. The nurse prepares to assist in the screening for which condition? Skeletal limb deficiency Osteogenesis imperfecta Legg-Calvé-Perthes disease Slipped capital femoral epiphysis
Osteogenesis imperfecta Children with multiple fractures should be screened for osteogenesis imperfecta. Skeletal limb deficiency is manifested by a loss of functional capacity, not multiple fractures. Legg-Calvé-Perthes disease is aseptic necrosis of the femoral head and not associated with multiple fractures. Slipped capital femoral epiphysis is the spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction and is not associated with multiple fractures.
The nurse is caring for a child who is immobilized following a motor vehicle accident and multiple fractures. As a result, the child has decreased chest expansion and reduced tidal volume. What is the appropriate intervention to aid respiration in this child? Position the child in supine position. Position the child in standing position. Position the child in semi-Fowler position. Position the child in Trendelenberg position
Position the child in semi-Fowler position Prolonged immobilization can increase the risk of respiratory complications such as decreased chest expansion and reduced tidal volume. The child should be positioned well to promote adequate chest expansion. Semi-Fowler position allows lung expansion and aids in respiration. Standing allows for better respiratory status and chest expansion. In this situation, it would be difficult for the child to stand, because the child is immobilized for a long time and may not be able to bear weight. The supine and Trendelenberg positions do not allow maximum lung expansion.
The nurse is caring for an immobilized preschool child. Which action is most helpful during this period of immobilization? Encouraging the child to wear pajamas Letting the child have few behavioral limitations Taking the child for a "walk" by wagon outside the room Keeping the child away from other immobilized children if possible
Taking the child for a "walk" by wagon outside the room It is important for children to have activities outside the room if possible. This gives them opportunities to meet their normal growth and developmental needs. The child should be encouraged to wear street clothes during the day. Limit-setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.
The nurse is caring for a child who has decreased muscle strength and muscle tone. Which is the most appropriate nursing intervention to ensure sufficient venous return? Immobilize the child. Limit the hours of sleep. Use compression stockings. Ensure sufficient fluid intake
Use compression stockings. In the presence of decreased muscle strength and tone, the venous return to the heart is also reduced. This stagnation of the venous blood can lead to the formation of thromboembolism, especially in the lower limbs. The best intervention in this condition is the use of compression, or antiembolism, stockings. The nurse encourages the child to move to improve the venous return. Immobilizing the child aggravates the condition and increases the risk of thrombus formation. The hours of sleeping are not related to thrombus formation as long as there is sufficient movement of the limb during the daytime. Adequate fluid intake is essential for the maintenance of normal health but is not directly related to thrombus formation.
