peds ch 24

A teenager who had a cast applied after a tibia fracture complains that his pain medication is not working and his pain is still 9 or 10. The nurse notices some edema of the toes and a capillary refills of 6 seconds. The priority action of the nurse would be:

1. call the health care provider immediately

A "neurovascular check" for tissue perfusion includes which of the following observations(select all that apply)

1. pulse 2. color and capillary refill 3. movement and sensation

A type of fracture to young children that may be indicative of child abuse is:

2. spiral fracture of the femur

Yellow bruise is approximately:

3. 7 to 10 days

32. The nurse explains that Bryants traction is reserved for children who weigh less than _____ pounds.

30

An abnormal S shape curvature of the spine seen in school age children is:

4. scoliosis

When a child is referred to a health care provider after scoliosis screening, the plan is to defer treatment and watch the child. The nurse determines that the child's curvature must be less than:

B. 20 degrees

Which type of traction would the nurse expect to be used for a 20-month-old child who has a fractured femur?

B. Bryant's

What would be the priority nursing intervention when a nurse is caring for a child wearing an Ace bandage for a sprained ankle?

B. Perform a neurovascular assessment.

The treatment of osteomyelitis includes the use of:

B. antibiotics

A 3-year-old is being removed from the home of an abusive parent. The child is crying and a coworker wonders if thsi could be a sin that the child was not abused. The nurse understands that the child:

B. will mourn the loss of family, even if there was abuse

Which statement by a mother might indicate future problems related to the care of a newborn infant?

C. "The baby cries all the time. She doesn't seem to like me. I didn't think it would be like this. Sometimes I think she is just trying to irritate me.

The mother of an infant born with congenital torticollis tells the nurse she is concerned that her child will always have limited neck motion. What is the best nursing response to the mother's concern?

C. "The conditon will most likely resolve by age 2-6 months."

Which is an expected assessment finding in a child with suspected scoliosis?

C. Asymmetry of the shoulders

One of the most common causes of death in a child with muscular dystrophy is:

C. Cardiac Failure

Which is a priority nursing diagnosis for an adolescent treated for osteosarcoma?

C. Disturbed body image

The nurse completed a nerovascular check on a child in Russell's traction for a fractured femur. Which finding should be reported to the charge nurse?

C. Toes feel tingly

The nurse is aware that a fracture involving the epiphyseal plate in a long bone can result in:

C. impaired bone growth

The development of uveitis is an autoimmune complication of:

C. juvenile rheumatoid arthritis

The nurse is reinforcing the health care provider's explanation of treatment for Legg-Calve-Perthes disease. What information would the nurse review with parents?

D. Ambulation-abduction casts or braces

Which disease is usually inherited as a sex-linked disorder?

D. Duchenne's muscular dystrophy

A toddler has been walking independently for 1 month. Observation of the toddler's gait reveals the child's feet are wide apart and the gait is unsteady. How would the nurse interpret this finding?

D. This is a normal gait for a child in the toddler age group

An appropriate nursing action when caring for a child in Bryant's traction is to:

D. position the child's legs as right angles to the body

34. The child with Duchennes muscular dystrophy must push on his legs and walk up the leg in order to rise to a standing position. The nurse recognizes this characteristic behavior as _______________ maneuver.

Gowers

37. _______________________is a condition in which neck motion is limited and the cervical spine is rotated because of shortening of the sternocleidomastoid muscle.

Torticollis

9. The nurse is checking for capillary refill on a child in Bryants traction. How long does it take for the toe to regain color if adequate perfusion is assessed?

a. 3 seconds

7. The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching?

a. Apply warm compresses to the ankle for the first 24 hours.

14. What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis?

a. Ask the child to bend forward at the waist and observe the childs back for asymmetry.

28. What factor(s) may trigger abuse in a parent? (Select all that apply.)

a. Being abused as a child c. Substance abuse d. Overwhelming responsibility e. Knowledge deficit relative to child care

22. On entering the room of a child in Bucks traction, the nurse makes all of the following observations. Which observation requires a nursing intervention?

a. Childs heels are placed firmly against the foot of the bed.

31. How does the pediatric skeletal system differ from that of the adult? (Select all that apply.)

a. Lower mineral content c. Open epiphyses e. Greater strength

15. What nursing action will significantly decrease the risk of serious complications for a child in Bryants traction?

a. Neurovascular checks are done frequently.

19. A 6-year-old sustained a fractured femur and was put in Russell traction 2 days ago. She screams in pain when she raises herself onto the bedpan. Which nursing diagnosis takes highest priority for this child?

a. Pain resulting from tissue trauma

29. The nurse demonstrates which similarities among all traction devices? (Select all that apply.)

a. Pull the limb into extension b. Decrease muscle spasm d. Align two bone fragments e. Immobilize the limb

18. Which observation may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs?

a. Red, green, and yellow bruises on his body

25. Which nursing diagnosis would be a priority when preparing a plan of care for a child in a leg cast?

a. Risk for altered peripheral tissue perfusion

11. A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. How long will the nurse indicate that antibiotic therapy will probably last?

b. 6 weeks

16. Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis?

b. Applying moist heat packs upon awakening

2. What intervention will the nurse caring for a child in Bucks skin traction implement?

b. Assist the child to be pulled up in bed.

13. A 13-year-old girl is diagnosed with functional scoliosis. What does the nurse explain as the cause of this spinal curvature defect?

b. Poor posture

10. The parent of a child with osteomyelitis asks why his child is in so much pain. What will the nurse respond causes the pain experienced with osteomyelitis?

b. Purulent drainage in the bone marrow

4. The nurse is reviewing the characteristics of Ewings sarcoma. Which statement if made by the nurse indicates correct understanding of this disease?

b. The disease is sensitive to radiation and chemotherapy.

20. What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4-year-old child?

b. Walks on the toes

23. Approximately how old does the nurse assess a large green bruise on the thigh of a 4-year-old to be?

c. 6 days

3. What will the nurse include when caring for a child in Bucks extension?

c. Checking for skin irritation from traction equipment

1. What would the nurse include in planning teaching to parents of a child with Legg-Calv-Perthes disease about the long-term effects of this disease?

c. Degenerative arthritis may develop later in life.

5. What characteristic manifestation does the nurse caring for a child with Duchennes muscular dystrophy document?

c. Falls frequently and is clumsy

30. The nurse performing a neurovascular check on a limb in traction would report and document which finding(s) as indicative of altered circulation? (Select all that apply.)

c. Limb is cool to the touch. d. Capillary refill is 5 seconds.

26. A child is sent to the school nurse for assessment because she comes to school every day disheveled, unbathed, and hungry. The assessment does not indicate any bruises or marks on the body. What do these finding indicate?

c. Physical neglect

24. A pediatric nurse is assisting with the care of a child diagnosed with a fractured femur. What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse?

c. Spiral fracture

6. The nurse assessing a child with juvenile rheumatoid arthritis notes the childs right knee and ankle are swollen, warm, and tender. The child has a temperature of 38.8 C (102 F) and abdominal pain. What type of juvenile rheumatoid arthritis do these findings suggest?

c. Systemic

17. What instruction would the nurse provide to an adolescent who has been fitted with a Milwaukee brace?

c. Wear the brace over a T-shirt 23 hours a day.

36. A nurse assessing welts on the body of a 2-year-old Vietnamese child should consider the skin lesions might be the result of the cultural practice of __________.

coining

35. The nurse recognizes the signs of ____________________ syndrome in a child in 90-90 traction when the toes are pale and edematous and have a very slow capillary refill.

compartment

21. Why does a childs fracture heal more rapidly than the adults?

d. A childs bones have faster callus formation.

12. What finding would the nurse assessing the neurovascular status of a child in Russell traction report immediately?

d. Bluish coloration of skin

27. Which assessment performed by a nursing student performing a neurovascular check alerts the instructor that further education is necessary?

d. Pupils

8. How does Russell traction provide adequate skin traction?

d. Supplies continuous pull in two directions

33. The nurse reminds the adolescent boy with Ewings sarcoma that he is prohibited from vigorous weight-bearing activities during treatment with radiation to reduce the risk of a(n) _______________ fracture.

pathological