Chapter 40 (PEDS)

The caregiver of a 2-year-old who has a polyurethane resin cast on her arm calls the clinic to report that her child is crying and says that the cast has sand in it. The caregiver states that she has had casts of her own and knows how badly they can itch. She says she always used a hanger to scratch but is worried that it will be too sharp for the child. Which of the following statements would be appropriate for the nurse to make to this caregiver? a) "You could give the child an extra dose of acetaminophen and see if that helps." b) "A plastic ruler is less likely than a hanger to cut the child's skin." c) "Nothing should be put into the cast. You can blow cool air into it with a hair dryer." d) "Since the child's cast is synthetic, she could soak it with cool water."

"Nothing should be put into the cast. You can blow cool air into it with a hair dryer."

The musculoskeletal system is made up of various types of bones. Most bone growth is completed by which of the following ages? a) 10 years of age b) 20 years of age c) 5 years of age d) 14 years of age

20 years of age

A child and mother come into the orthopedic clinic. The mother is concerned about her child who has recently been diagnosed with scoliosis. The mother asks about surgical treatment and if it will be necessary. The nurse bases her response on knowledge that surgery is implicated for curvatures greater than: a) 25 to 30 degrees. b) 25 degrees. c) 20 to 25 degrees. d) 40 degrees.

40 degrees.

A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they identify which of the following? a) The process of breaking down and forming new bone is decreased in children compared with adults. b) Callus production is slower but greater in amount in children than in adults. c) A fracture closer to the growth plate heals much slower than one in the metaphysis. d) A child's bones heal more quickly than those of an adult.

A child's bones heal more quickly than those of an adult.

The caregivers of a child with juvenile rheumatoid arthritis are asking the nurse about exercise for their child. The nurse explains to the caregivers that gentle daily exercise is needed to prevent which of the following from occurring? a) Scoliosis b) Kyphosis c) Ankylosis d) Lordosis

Ankylosis

The nurse is caring for a newborn diagnosed with congenital talipes equinovarus. Which of the following treatments would the nurse most likely expect for this newborn? a) Application of a cast b) Putting the child in Bryant's traction c) Placing the child in special shoes d) Doing passive range of motion

Application of a cast

The nurse is caring for a child with juvenile rheumatoid arthritis. Which of the following medications would the nurse most likely be administering to this child to manage the symptoms of this disorder? a) Aspirin b) Morphine c) Codeine d) Acetaminophen

Aspirin

The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications? a) Clean and massage his entire leg daily. b) Provide pin care as needed. c) Adjust the weights as needed. d) Assess the popliteal region carefully for skin breakdown.

Assess the popliteal region carefully for skin breakdown.

The caregiver of a child with a recent puncture wound on the arm calls the pediatrician's office reporting that after seeming well at bedtime last night, the child now has a temperature of 101 degrees Fahrenheit, pain at the site of the injury, and is unable to fully bend the elbow of the arm which had been injured. The nurse recommends the child be brought in to see the care provider. Which of the following would likely be ordered for this child? a) A muscle biopsy b) Blood work c) An x-ray d) A surgical consult

Blood work

A school-aged child has difficulty getting from a sitting position to a standing position and must brace the legs to rise. Which lab test would the nurse expect the provider to order? a) Erythrocyte sedimentation rate b) C-reactive protein c) Rheumatoid factor d) Creatine kinase

Creatine kinase

The nurse is discussing fractures seen in children with a group of caregivers. One of the caregivers states, "I have heard that if a bone breaks it can cause permanent damage and stop the growth of the bone." This statement is accurate if the break occurs in which of the following? a) Humerus b) Epiphyseal plate c) Joint d) Xiphoid process

Epiphyseal plate

A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? a) Growth plate b) Epiphysis c) Physis d) Metaphysis

Epiphysis

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which of the following symptoms might be an early warning signal that the child has developed compartment syndrome? The child a) Cannot plantarflex his foot b) Feels increasing severe pain c) Has a weak femoral pulse d) Has blue-looking nail beds on the toes

Feels increasing severe pain

The type of fracture often seen in young children is a fracture in which there is not complete ossification of the bone and the bone bends and just partially breaks. This type of fracture is which of the following? a) Epiphyseal b) Spiral c) Greenstick d) Complete

Greenstick

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in doing which of the following with this child? a) Handling the cast with open palms when moving the arm. b) Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm. c) Encouraging the child to move the arm slowly up and down to help the cast dry. d) Using only a draw sheet to move the casted arm.

Handling the cast with open palms when moving the arm.

A 6 year old boy who comes to the clinic has been limping on and off for several months. The limping lasts several hours to several days and stops hurting once he sits down. He is an active soccer player and loves to run around. Physical examination demonstrates limited internal rotation. X ray examination reveals avascular necrosis of the femoral head. Therefore you know the diagnosis is: a) Ewing sarcoma b) Legg-calve Perthes syndrome c) developmental dysplasia of the hip d) osteosarcoma

Legg-calve Perthes syndrome

A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care? a) Maintaining intravenous antibiotic therapy b) Restricting fluid to encourage red cell production c) Assisting the child with crutch walking d) Keeping the child quiet while in skeletal traction

Maintaining intravenous antibiotic therapy

An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? a) Elevating the arm b) Giving additional pain medication as ordered c) Applying ice d) Notifying the doctor immediately

Notifying the doctor immediately

A nursing student tells the staff nurse on the pediatric orthopedic unit that she has heard of a musculoskeletal disorder in which there is an infection of the bone. Which of the following disorders does this statement describe? a) Juvenile rheumatoid arthritis b) Muscular dystrophy c) Osteomyelitis d) Osteosarcoma

Osteomyelitis

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which of the following symptoms? a) Pallor b) Paresthesia c) Pain d) Paralysis

Paresthesia

A nurse is caring for a 10-year-old patient who is in skeletal traction following injuries sustained in a car accident. Which of the following accurately describes a recommended nursing measure for this type of traction? a) Assess the traction weights daily and remove or add weight as necessary. b) Make sure the weights are touching the floor or top of bed at all times. c) Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours. d) Use warm saline as a cleansing solution before and after pin care.

Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours.

The school nurse is doing a presentation to a group of caregivers of children diagnosed with scoliosis. One of the caregivers asks the nurse about structural scoliosis. The nurse explains that which of the following is involved with the diagnosis of structural scoliosis? a) Poor posture b) Muscle spasm caused by trauma c) Rotated and malformed vertebrae d) Unequal leg length

Rotated and malformed vertebrae

A group of nursing students are reviewing information about the type of skin and skeletal traction. The students demonstrate understanding of this information when they identify which of the following as a type of skeletal traction? a) Side arm 90-90 traction b) Russell traction c) Buck traction d) Bryant traction

Side arm 90-90 traction

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is which of the following? a) Russell traction b) Skeletal traction c) Skin traction d) Buck extension traction

Skeletal traction

The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which of the following type of traction? a) Balanced suspension traction b) Dunlop's traction c) Skin traction d) Skeletal traction

Skin traction

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which of the following forms of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? a) Internal fixation device b) Spica cast c) Stockinette d) External fixation device

Spica cast

An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? a) Plastic deformity b) Spiral fracture c) Greenstick fracture d) Buckle fracture

Spiral fracture

The nurse is working with an 6-year-old boy who recently was diagnosed with Legg-Calvé-Perthes disease The mother of the boy tells the nurse that she understands that exercise is important to help preserve muscle and joint function and asks the nurse for recommendations on types of exercise that would be appropriate. Which of the following should the nurse recommend? a) Soccer b) Hiking c) Jumping jacks d) Swimming

Swimming

In caring for a child in traction, of the following interventions, which is the highest priority for the nurse? a) The nurse should provide age-appropriate activities for the child. b) The nurse should clean the pin sites at least once every eight hours. c) The nurse should monitor for decreased circulation every four hours. d) The nurse should record accurate intake and output.

The nurse should monitor for decreased circulation every four hours.

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be which of the following? a) "These will help the cast look more attractive so the child won't feel self conscious." b) "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry." c) "We put these on so the child will not pull the padding from under the cast." d) "These make a smooth edge on the cast so the skin is better protected."

These make a smooth edge on the cast so the skin is better protected."

The nurse is caring for a child who has had a cast applied to treat a fracture of the fibula. To monitor the pulse of the child's involved extremity the nurse will monitor which of the following? a) Radial pulse b) Brachial pulse c) Tibial pulse d) Apical pulse

Tibial pulse

When helping parents plan care for a child with Legg-Calvé-Perthes disease, you would teach them that the usual therapy for children with this disorder is a) a nonweight-bearing period. b) surgery with supporting rods. c) passive range-of-motion exercises TID. d) exercise to increase muscle strength of the knee joint.

a nonweight-bearing period.

An infant is placed in Bryant's traction. For Bryant's traction to be effective, the infant must be positioned on the a) back with hips up off the bed. b) stomach with both legs extended. c) back with the injured hip flexed and the uninjured one extended. d) back with hips flat on the bed.

back with hips up off the bed

The immature bones of infants and children differ from adult bones; a) because immature bones have a weaker, less resistant periosteum b) because adult bones bend and do not break c) because the bones continue to grow and have open epiphyseal growth plates d) because they repair less raoidly

because the bones continue to grow and have open epiphyseal growth plates

A 14-year-old girl is diagnosed as having scoliosis. When doing scoliosis screening with her, an important observation would be to note a) her posterior spine when she bends forward. b) the angle of the iliac crest when she bends forward. c) the angle of her lower chest when she sits down. d) the posterior spine when she bends sideways.

her posterior spine when she bends forward.

You are caring for a child with a broken wrist that has just been placed in a cast. You would elevate the arm to a) prevent edema. b) promote healing. c) ensure proper bone alignment. d) discourage infection.

prevent edema.

The nurse caring for a child with muscular dystrophy observes the child using the Gower maneuver while trying to: a) walk b) sit c) bend over d) stand

stand

The nurse is reinforcing teaching with the caregivers of a child who has had a cast on the arm removed after the cast has been in place for six weeks. The caregiver makes the following statements. Which statement indicates an understanding of the teaching? a) "I usually let him take a tub bath, but we will keep him out of warm water for a couple of days." b) "He loves to play outside now that the weather is nice; I will have to remind him to use sunscreen." c) "We will be careful to not let him put his little sister's baby oil on his arm for a few weeks." d) "As soon as we get home I will scrub his arm really well to remove the loose skin."

"He loves to play outside now that the weather is nice; I will have to remind him to use sunscreen."

The nurse is providing education related to use of brace that the orthopedic surgeon has ordered as treatment of idiopathic scoliosis in an adolescent girl. Which statements by the teen best initiates an understanding of appropriate use of the brace? a) " I can take my brace off only for special occasions" b) " I do not need to wear my brace at night while I am sleeping" c) "I can take my brace off for only 1 hour per day for showering" d) " It is most important for me to wear my brace during the day while I am upright"

"I can take my brace off for only 1 hour per day for showering"

The nurse is caring for a child diagnosed three months ago with juvenile rheumatoid arthritis (JRA). The caregiver reports that the child has recently complained of little pain and is not currently taking aspirin or NSAIDs. The caregiver also tells the nurse that just to be on the safe side, she is continuing to keep the child from doing physical exercise. The mother states, "I think we have beaten this disease." In working with this child and the caregiver, which of the following statements would be best for the nurse to say? a) "That is not what is best. The medications aren't for pain; she needs to take aspirin every few days." b) "Let's review some of the instructions. She does need to take an anti-inflammatory every day." c) "It sounds as though things are going well. Be sure to restart the medication as soon as there is any flare up of pain." d) "I'm glad you're feeling optimistic. She should exercise now but give her aspirin before she does."

"Let's review some of the instructions. She does need to take an anti-inflammatory every day."

The nurse is teaching a group of peers regarding different types of fractures seen in children. Which of the following best describes a comnplete fracture? a) A fracture in which the the bone buckles rather than breaks. b) A fracture in which the bone bends without breaking. c) A fracture in which the bone breaks into two pieces. d) An incomplete fracture of the bone.

A fracture in which the bone bends without breaking.

The nurse is caring for a child admitted with juvenile rheumatoid arthritis. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Pain in the groin and a limp b) Inflammation of the joints c) Poor posture and malformed vertebrae d) Difficulty standing and walking

Inflammation of the joints

The nurse is developing a teaching plan for a child who is to have his cast removed. Which of the following would the nurse most likely include? a) Applying petroleum jelly to the dry skin b) Rubbing the skin vigorously to remove the dead skin c) Soaking the area in warm water every day d) Washing the skin with dilute peroxide and water

Soaking the area in warm water every day

An 8-year-old boy with a fractured forearm is to have a fiberglass cast applied. Which of the following would the nurse include when teaching the child about the cast? a) The cast will take a day or two to dry completely. b) The child will need to keep his arm down at his side for 48 hours. c) The child initially may experience a very warm feeling inside the cast. d) The edges will be covered with a soft material to prevent irritation.

The child initially may experience a very warm feeling inside the cast.

The nurse is caring for a child in a type of traction in which weights are being used. Which of the following is true regarding the weights? a) The weights can be removed and the child encouraged to move around in bed several times a day. b) The weights should be removed once a shift and then replaced. c) The weights must be hanging freely, not touching the bed or floor. d) Additional weights will be added as the fracture is healing, usually once a day.

The weights must be hanging freely, not touching the bed or floor.

A newborn is scheduled for casting to correct a talipes disorder. You would advise her parents that the cast will extend a) to the waist. b) above the knee. c) to the hip. d) to the calf.

above the knee.

In planning teaching to parents of a child with Legg-Calvé-Perthes disease about the long-term effects of this disease, the nurse would include that: a) degenerative arthritis may develop later in life. b) there is risk of osteogenic sarcoma in adulthood. c) the disease is self-limited and requires no long-term treatment. d) there are no long-term effects.

degenerative arthritis may develop later in life.

A girl with scoliosis is prescribed a body brace. The purpose of the brace is to a) prevent herniation of a spinal disk. b) correct spinal curvature. c) prevent torticollis. d) improve spinal alignment.

improve spinal alignment.

The nurse explains that Russell traction is a type of skin traction that: a) prevents the knee from flexing. b) supplies continuous pull in two directions. c) does not interfere with range of motion. d) subluxates the tibia.

supplies continuous pull in two directions.

Choice Multiple question - Select all answer choices that apply. The nurse is caring for a child after an accident in which the child fractured his arm. A cast has been applied to the child's right arm. Which of the following actions should the nurse implement? Select all that apply. a) Wear a protective gown when moving the child's arm. b) Document any signs of pain. c) Monitor the color of the nail beds in the right hand. d) Check radial pulse in the both arms. e) Wear sterile gloves when removing or touching the cast.

• Document any signs of pain. • Check radial pulse in the both arms. • Monitor the color of the nail beds in the right hand.