LP3 Chapter 12 Orthopedic disorders

62. A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which of the following are early signs of compartment syndrome in this child? Select all that apply. 1. Edema. 2. Numbness. 3. Severe pain. 4. Weak pulse. 5. Anular rash

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. 4. A weak pulse is a late sign of compartment syndrome. TEST-TAKING HINT: The test taker can eliminate answers 3 and 5 because severe pain and rash are not signs of early compartment syndrome.

29. A 13-year-old just returned from surgery for scoliosis. What nursing interventions 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. General postoperative nursing interventions include assessing for pain. 2. Specific to scoliosis surgery, logrolling is the means of changing positions. 4. It is essential to check neurological status in a patient who just had scoliosis surgery. 5. General postoperative nursing interventions include assessing vital signs. TEST-TAKING HINT: The test taker can use general postoperative care principles to lead to several correct answers

63. 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. 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. 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. TEST-TAKING HINT: The test taker can eliminate answer 3 because it is important to keep the affected extremity at heart level to help arterial and venous blood flow.

13. Which of the following 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. Following a closed fracture of an extremity. 5. Redness and swelling at the site.

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. 5. Redness and swelling occur because of the infection. TEST-TAKING HINT: The test taker can rule out answer 4 if it is understood that a closed fracture does not increase the risk of bone infection

6. 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. 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. TEST-TAKING HINT: The test taker could look at other congenital deformities to gain a clue to an association to clubfoot.

14. The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. What 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. TEST-TAKING HINT: The age of the patient is important in choosing the most likely cause of the disease.

30. 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. TEST-TAKING HINT: The surgeon should be called only after an assessment of the patient is done. The test taker can rule out answer 3.

18. 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 of the following interventions 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. TEST-TAKING HINT: The test taker should prioritize nursing interventions and know that safety needs are paramount.

27. 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 duration? 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 of fitting in with their peers, so they might be very resistant to wearing a brace. TEST-TAKING HINT: The test taker must understand the development of children.

15. 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 of the following 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. This is the correct answer. TEST-TAKING HINT: Answer 4 should be eliminated because patient treatment should be based on evidence-based practice

1. The nurse is assessing a 2-week-old for signs of DDH. The nurse should expect the infant to have which of the following? 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. TEST-TAKING HINT: If the test taker knows that DDH decreases smooth movement of the femoral head, then answers 1 and 2 can be eliminated because they indicate increased movement of the femur.

2. An infant is in a Pavlik harness for treatment of DDH. While instructing the parents on preventing skin breakdown, the nurse should stress which of the following? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on 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. TEST-TAKING HINT: The test taker can eliminate answer 1 because the question is about skin breakdown, not harness fit.