Pediatric Nursing - Chapter 20

Which factor(s) is/are associated with slipped capital femoral epiphysis (SCFE) (select all that apply) 1. Obesity 2. Female gender 3. African descent 4. Age of 5 - 10 years 5. Pubertal hormonal changes 6. Endocrine disorders

1, 5, 6 1. Obesity increases risk by stressing the epiphyseal plate 5. Most common during puberty hormone changes 6. Is associated with endocrine disorders.

The nurse is teaching a soccer team in the community about avoiding overuse injuries. What will the nurse include in the teaching? 1. There is no need to stretch or do warm-up exercises before the game. 2. The game rules are for the coaches. 3. The only time you can talk about pain is when the game is over. 4. The preparation before the game is important for the body to be stretched.

4. Starting out the game with warm-up exercises will help prevent overuse injuries.

A toddler is admitted to the hospital with a respiratory infection and a history of osteogenesis imperfecta. What safety precaution will the nurse use to prevent bone injury of the toddler? 1. Allow toddler to ambulate in the pediatric unit 2. Use noninvasive blood pressure measurements as needed 3. Monitor temperature with a tympanic thermometer 4. Encourage gentle holding of the toddler by staff

2. The healthcare team should forego taking blood pressure to avoid upper arm fractures.

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness 2. Use lotion or powder on the skin to prevent rubbing of straps 3. Remove the harness during diaper changes for ease of cleaning the 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.

The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis. The nurse would evaluate the teaching as successful when the parent is able to say that the disorder is caused by the: 1. Breakdown of osteoclasts in the joint space causing bone loss 2. Loss of cartilage in the joints 3. Build-up of calcium crystals in the joint spaces 4. Immune-stimulated inflammatory response in the joint.

4. JIA is caused by an immune response by the body on the joint spaces.

What is an appropriate nursing intervention for the school-age child diagnosed with juvenile idiopathic arthritis who is experiencing nausea with nonsteroidal anti-inflammatory medications? 1. Providing water with medications 2. Encouraging the child to participate in school activities 3. Minimizing pain by limiting activities 4. Encouraging the child to take medications with food

4. The nurse should encourage the child to take the medication with food to stop the nausea.

Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is. 1. It is a fracture located in the growth plate of the bone 2. Because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture 3. It is a fracture in which a complete break occurs in the bones, and small pieces of bone are broken off. 4. It is a fracture that does not go all the way through the bone.

4. It is a fracture that does not go all the way through the bone.

A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that: 1. This is a serious injury that could cause long-term growth issues 2. The fracture usually heals within 6 weeks without further complications 3. The child will never be able to play contact sports. 4. Fractures involving the growth plate require pain medication.

1. Fractures of the growth plate are serious, as they can disrupt the growth process.

A 9-year-old is in a Spica cast and complains of pain 1 hour after receiving IV 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.

The parents of a 3-week-old states that the infant was re-casted this morning for clubfoot and has been crying for the past hour. Which intervention 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.

Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply 1. Duck gait 2. Pain 3. Osteoarthritis in adulthood 4. Osteoporosis in adulthood 5. Increased flexibility of the hip join in adulthood.

1, 2, 3. 1. Due to abnormal hip joint function, the patients gait is stiff and waddling. 2. Due to abnormal femoral head placement, the patient may experience pain and decreased flexibility in adulthood. 3. Due to abnormal femoral head placement, the patient may experience osteoarthritis in the hip joint in adulthood.

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, 2, 3. 1. Myelomeningocele 2. Cerebral Palsy 3. Diastrophic dwarfism

A 6-year-old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which are early signs of compartment syndrome? (select all that apply) 1. Edema 2. Numbness 3. Sever pain 4. Weak Pulses 5. Anular rash

1, 2, 4

A 13-year-old just returned from surgery for scoliosis. Which nursing interventions are appropriate in the first 24 hours. (select all that apply) 1. Assess for pain 2. Logroll to change position 3. Get the teen to the bathroom 12-24 hours after surgery 4. Check the neurological status 5. Monitor blood pressure

1, 2, 4, 5

A 14-year-old with osteogenesis imperfecta is confined to a wheelchair. Which nursing interventions will promote normal development? (select all that apply) 1. Encourage participation in groups with teens who have disabilities or chronic illness. 2. Encourage decorating the wheelchair with stickers 3. Encourage transfer of primary care to an adult provider at age 18 years 4. Allow the teen to view the radiographs 5. Help the teen set realistic goals for the future 6. Discourage discussion of sexuality, as the child is not likely to date

1, 2, 4, 5

Which would the nurse teach a patient when NSAID's are prescribed for treating juvenile idiopathic arthritis? 1. Take with food 2. Take on an empty stomach 3. Blood levels are require for drug dosages 4. Good oral hygiene is needed.

1. NSAID's can cause gastric bleeding with long term use; food helps reduce exposure to stomach lining.

The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? 1. Immediately after diagnosis 2. At age 4 to 6 months 3. Prior to walking (age 9 to 12 months) 4. After walking is established (age 15 to 18 months)

1. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made.

A child fell and injured a knee during a baseball game. The parents ask what the best inexpensive diagnostic test that can be used to visualize the knee is. How should the nurse respond? 1. Radiograph 2. Arthrography 3. Ultra sound 4. Computerized tomography scan

2. An arthrography will provide visualization of the knee joint.

The nurse understands that a diagnosis of osteogenesis imperfecta is detectable in utero by ultrasound. What ultrasound finding would identify a suspected osteogenesis imperfecta? 1. Growth plate deformities 2. Identification of bowing of the long bones 3. Fractured clavicle 4. Painful lower extremities

2. The ultrasound will identify the bowing of the long bones in utero for a suspicion of osteogenesis imperfecta.

Why are chemotherapeutic agents such as methotrexate and cyclophosphamide sometimes used to treat juvenile idiopathic arthritis? 1. Effective against cancer-like JIA 2. Affect the immune system 3. Are similar to NSAID's 4. Are absorbed into the synovial fluid.

2. These drugs affect the immune system to reduce its ability to attack itself.

Which classification of osteogenesis imperfecta is lethal in utero and in infancy? 1. Type I 2. Type II 3. Type III 4. Type IV

2. Type II is lethal in utero and in infancy because of multiple fractures and deformities and underdeveloped lungs.

A spinal curve of less than ___________________ degrees that is non-progressive does not require treatment for scoliosis.

20 degrees A 20 degree spinal curve that is non-progressive will not disfigure or interfere with normal functioning.

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 long? 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 fitting in with peers. They might be very resistant to wearing a brace.

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? 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.

A child is diagnosed with juvenile idiopathic arthritis. What does the nurse recognize as the most common reason to seek medical care? 1. Anorexia 2. Limping in the early morning 3. On and off joint pain in several different joints 4. Low- grade fever

3. On and off joint pain in several different joints is the most common reason for children to seek medical care with juvenile idiopathic arthritis

Which would the nurse teach an adolescent is a complication of corticosteroids used in the treatment of juvenile idiopathic arthritis? 1. Fat loss 2. Adrenal stimulation 3. Immune suppression 4. Hypoglycemia

3. Steroids cause immune suppression, which is the reason it is used in JIA; it reduces the body's attack on itself.

The nurse is admitting a child in the emergency department (ED). The child is wearing a harness. What is the musculoskeletal abnormality? 1. Clavicle fracture 2. Femur fracture 3. Clubfoot 4. Hip dysplasia

4. A Pavlik harness is used to correct hip dysplasia.

Which should be obtained to make a diagnosis of slipped capital femoral epiphysis? 1. A history of hip trauma 2. A physical examination of hip, thigh, knees 3. A complete blood count 4. A radiographic examination of the hip

4. Radiographic examination is the only definitive diagnostic tool for SCFE

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, 2, 4, 5

Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? (select all that apply) 1. "Your child will need to wear a brace on the feet 23 hours a day for at least 2 months" 2. Your child should see an orthopedic surgeon regularly until the age of 18 years" 3. "Your child will not be able to participate in sports that require a lot of running" 4. " Your child may have a recurrence of clubfoot in a year or more" 5. " Most children treated for clubfeet develop feet that appear and function normally" 6. "Most children treated for clubfeet require surgery at puberty"

1, 2, 4, 5

One nursing diagnosis for juvenile idiopathic arthritis is impaired physical mobility. (select all that apply) 1. Give pain medication prior to ambulation 2. Assist with range-of-motion activities 3. Encourage the child to eat a high-fat diet 4. Provide oxygen as necessary 5. Use non-pharmacological methods, such as heat.

1, 2, 5

When planning a rehabilitative approach for a child with osteogenesis imperfecta, the nurse should prevent which of the following? (Select all that apply) 1. Positional contractures and deformities 2. Bone infection 3. Muscle weakness 4. Osteoporosis 5. Misalignment of lower extremity joints.

1, 3, 4, 5 1. Positional contractures and deformities 3. Muscle weakness 4. Osteoporosis 5. Misalignment of lower extremity joints

Which instructions should the nurse give the parents of an adolescent with slipped capital femoral epiphysis (select all that apply) 1. Continue upper body exercises to limit loss of muscle strength 2. Do not turn the teen in bed when complaining of pain 3. Provide homework, computer games, and other activities to decrease boredom 4. Do most activities of daily living for the teen. 5. Expect expressions of anger and hostility 6. Continue setting limits on behavior.

1, 3, 5, 6 1. Upper body exercise should be continued after surgery 3. Its important for the patient to continue as many normal activities as possible including school work and leisure activity 5. Normal to have anger/hostility since they are losing independence. 6. Set limits is important to maintain normalcy

After the birth of an infant with clubfoot, the nursery nurse should do which when instructing the parents? (select all that apply) 1. Speak in simple language about the defect 2. Avoid the parents unless providing direct care so they can grieve privately 3. Keep the infants feet covered at all times 4. Present the infant as precious; emphasize the well-formed parts of the body 5. Tell the parents that defects could be much worse. 6. Be prepared to answer questions multiple times

1, 4, 6

A child falls and fractures a clavicle. What statement indicates that further teaching is needed? 1. "My son can no longer play football." 2. "My son will pain until it heals." 3. "It is important to wear a sling for 4 weeks until healing occurs." 4. "My son may have a bump that will smooth out."

1. A child with a clavicle fracture is advised to avoid contact sports for 6 weeks.

When counseling the parents of a child with osteogenesis imperfecta, the nurse should include which of the following? (Select all that apply) 1. Discourage future children because the condition is inherited 2. Provide education about the child's physical limitations. 3. Give the parents a letter signed by the PCP explaining osteogenesis imperfecta 4. Provide information on contacting the osteogenesis imperfecta foundation 5. Encourage the parents to treat the child like their other children 6. Encourage the use of calcium to decrease the risk of fractures.

2, 3, 4 2. So that PT and appropriate activity can be encouraged. 3. OI is frequently confused with child abuse, a signed letter can ease the stress of an ER visit. 4. This organization can provide info and support for family of a child with this condition.

Which should be included in teaching a family about post-surgical care for a slipped capital femoral epiphysis? (select all that apply) 1. The patient will receive help with weight-bearing ambulation 24-48 hours after surgery 2. Monitoring of pain medication to prevent drug dependence 3. Instruction on pin site care 4. Offering low-calorie meals to encourage weight loss 5. Correct use of crutches by the patient 6. Outpatient physical therapy for 6 - 8 weeks

3, 5 3. The parents will be assessing pin sites for infection and stability upon discharge. 5. Instruction on crutch usage will be given prior to discharge. Crutch walking will not be done during early post-op stage.

Select the number of inches lateral to the heel where a crutch should be placed. 1. 1 to 3 inches 2. 4 to 5 inches 3. 6 to 8 inches 4. 9 to 10 inches

3. 6 to 8 inches provides the best protection for balance and stability.

A nurse is examining an infant with left-sided curved scoliosis. The mother asks the nurse what diagnostic study will be used to determine severity of the scoliosis. What diagnostic study does the nurse anticipate will be ordered for the infant? 1. Spinal X-ray 2. Ultrasound 3. Magnetic resonance imaging 4. Bone biopsy

3. A magnetic resonance image will determine severity of the scoliosis.

When instructing a family about care of orthosis, the nurse should emphasize which of the following? 1. Clean the brace with diluted bleach 2. Dry the brace over a heater or in the sun 3. Clean the brace weekly with mild sap and water 4. Return the brace to the orthopedic surgeon for cleaning

3. An orthosis should be cleaned weekly with mild soap and water.