Chpt. 46 Peds. Musculoskeletal Disorders

A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition? 1. Limited range of motion in the affected hip 2. An apparent lengthened femur on the affected side 3. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 4. Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table.

1. Limited range of motion in the affected hip rationale: In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical and restricted abduction of the affected hip, when the child is placed supine with the knees and hips flexed, would be an assessment finding in developmental dysplasia of the hip in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.

The nurse is assisting a HCP examining an infant with developmental dysplasia of the hip perform an Ortolani maneuver. The nurse understands that this maneuver is performed for which purpose? 1. To assess for hip instability 2. To assess for movement of the hips 3. To push the femoral head out of the acetabulum 4. To ensure that hyperextension and full range of motion exist

1. To assess for hip instability

A 4-year-old child sustains a fall at home and after an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the patents indicates a need for further instruction? 1. "The cast may feel warm as the cast dries." 2. "I can use lotion or powder around the cast edges to relieve itching." 3. "A small amount of white shoe polish can touch up a soiled white cast." 4. "If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast."

2. "I can use lotion or powder around the cast edges to relieve itching."

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? Select all that apply 1. Use the finginertips to lift the castwhile it is drying 2. Keep small toys and sharp objects away from the cast 3. use a padded ruler or another padded object to scratch the skin under the cast if it itches 4. Place a heating pad on the lower end of the cast and over the giners if the giners feel cold 5. Elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling 6. Contact the HCP if the child complains of numbness or tingling in the extremity

2. Keep small toys and sharp objects away from the cast 5. Elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling 6. Contact the HCP if the child complains of numbness or tingling in the extremity

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse should make which response? 1. "Avoid all exercise during painful periods." 2. "Range-of-motion exercises must be performed every day." 3. "Have the child perform simple isometric exercises during this time." 4. "Administer additional pain medication before performing range-of-motion exercises."

3. "Have the child perform simple isometric exercises during this time." Rationale: Juvenile idiopathic arthritis is an autoimmune inflammatory disease affecting the joints and other tissues, such as articular cartilage. During painful episodes of juvenile idiopathic arthritis, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Although resting the extremity is appropriate, beginning simple isometric or tensing exercises do not involve joint movement.

Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statemnet by the parents indicates a need for further teaching regarding this disorder? 1. "Treatment needs to be started as soon as possible." 2. "I realize my infant will require follow-up care until fully grown." 3. "I need to bring my infant back to the clinic in 1 month for a new cast." 4. "I need to come to the clinic every week with my infant for the casting."

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

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 1. "I will encourage my child to perform prescribed exercises." 2. "I will have my child wear soft fabric clothing under the brace." 3. "I should apply lotion under the brace to prevent skin breakdown." 4. "I should avoid the use of powder because it will cake under the brace."

3. "I should apply lotion under the brace to prevent skin brakdown

A client is placed in skeletal traction for treatment of a fractured femur. The nurse develops a pan of care and includes which intervention? 1. Ensure that all roes are outside the pulleys 2. Ensure that the weights are resting lightly on the floor 3. Restrict diversional and play activities until the child is out of traction 4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied

4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 1. Administer an antiemetic 2. Increase the IV fluids 3. Place the child in a Sims's position 4. Notify the health care provider (HCP)

4. Notify the HCP

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic 2. Release the skin traction 3. Apply ice to the extremity 4. Notify the health care provider (HCP)

4. Notify the health care provider