PEDS CH 27 ?'s

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching? a. "I should gently massage the skin under the straps once a day to stimulate circulation." b. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." c. "I should remove the harness several times a day to prevent contractures." d. "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."

ANS: A To prevent skin breakdown with an infant who has developmental dysplasia of the hip and is in a Pavlik harness, the parent should gently massage the skin under the straps once a day to stimulate circulation. The parent should not apply lotions or powder because this could irritate the skin. The parent should not remove the harness, except during a bath, and should place the diaper under the straps.

What statement is true concerning osteogenesis imperfecta (OI)? a. It is easily treated. b. It is an inherited disorder. c. Braces and exercises are of no therapeutic value. d. Later onset disease usually runs a more difficult course.

ANS: B OI is a heterogeneous, autosomal dominant disorder characterized by fractures and bone deformity. Treatment is primarily supportive. Several investigational therapies are being evaluated. The primary goal of therapy is rehabilitation. Lightweight braces and splints help support limbs, prevent fractures, and aid in ambulation. The disease is present at birth. Prognosis is affected by the type of OI.

The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session? a. "Bisphosphonate therapy is not beneficial for OI." b. "Physical therapy should be avoided as it may cause damage to bones." c. "Lift the infant by the buttocks, not the ankles, when changing diapers." d. "The infant should meet expected gross motor development without assistive devices."

ANS: C Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Bisphosphonate and physical therapy are beneficial for OI. Lightweight braces will be used when the child starts to ambulate.

What is the primary method of treating osteomyelitis? a. Joint replacement b. Bracing and casting c. Intravenous antibiotic therapy d. Long-term corticosteroid therapy

ANS: C Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus infection. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and long-term corticosteroid therapy are not indicated for infectious processes.

An adolescent patient is prescribed a brace to treat scoliosis. Which assessment finding by the nurse indicates that outcomes for a priority nursing diagnosis have been met by the patient? A. Is able to explain the rationale for the bracing B. No redness or breakdown seen under the brace C. Participates in social activities with friends D. Wears brace continuously for 20 hours each day

B. No redness or breakdown seen under the brace

Which would the nurse assess in a child diagnosed with osteomyelitis? Select all that apply a. unwillingness to move affected extremity b. severe pain c. fever d. previous closed fracture of an extremity e. redness and swelling at the site

a. unwillingness to move affected extremity b. severe pain c. fever e. redness and swelling at the site

Which interventions should the nurse include in the plan of care for an adolescent client who is on complete bed rest after spinal fusion surgery secondary to scoliosis to prevent complications associated with immobility? Select all that apply. 1. Encouraging use of the spirometer every 2 hours while the child is awake 2. Log-rolling the client every 2 hours while awake 3. Increasing intake of milk to maintain bone calcium 4. Increasing fruit and grains in the diet 5. Limiting fluid intake to reduce the need to void

1. Encouraging use of the spirometer every 2 hours while the child is awake 2. Log-rolling the client every 2 hours while awake 4. Increasing fruit and grains in the diet Respiratory complications are a common complication of immobility. Turning the client frequently will reduce pressure on bony prominences. Fruit and grains will provide extra fiber to reduce the risk of complication.

A teen has a scoliosis curve of 35°. What treatment option does the nurse prepare the child and family for? A. Bracing B. Continued screening C. Exercise therapy D. Surgical intervention

A. Bracing

A child has been hospitalized with suspected osteomyelitis. The child's white blood cell count (WBC) is 22,000/mm3 and his C-reactive protein is 15 mg/dL. Which conclusion by the nurse is appropriate based on these laboratory values? A. The child has an infection somewhere. B. The child has osteomyelitis. C. The child is immunocompromised. D. These tests are not related to the condition.

A. The child has an infection somewhere.

During the initial assessment of a child admitted to the pediatric unit with osteomyelitis of the left tibia, when assessing the area over the tibia, which is an expected finding? a. diffuse tenderness b. decreased pain c. increased warmth d. localized edema

c. increased warmth

Which are appropriate interventions for the nurse to include in the plan of care for a child who is receiving traction? Select all that apply. 1. Monitoring breath sounds 2. Assessing neurovascular status every 2 hours 3. Repositioning every 2 to 3 hours 4. Using moleskin to protect the skin from rough edges 5. Encouraging the parents cuddle with their child

1. Monitoring breath sounds 2. Assessing neurovascular status every 2 hours 5. Encouraging the parents cuddle with their child

The father of a school-age child who requires hospital admission for intravenous antibiotics to treat osteomyelitis states, "I don't understand why normal antibiotics can't be used." Which should the nurse include in the response to the father? 1. The antibiotic of choice is not available in oral form. 2. Blood flow to bones is limited, and parenteral administration is necessary to get appropriate blood levels. 3. Because the child is older now, it is harder to get the child to cooperate with oral antibiotics. 4. Because 2 weeks of therapy is necessary, the intravenous route will produce fewer side effects.

2 This is accurate information.

Which should the nurse include in a teaching session for the parents of an infant who will be placed in a Pavlik harness for the treatment of congenital developmental dysplasia? 1. Apply lotion or powder to minimize skin irritation. 2. Check at least 2 or 3 times a day for red areas under the straps. 3. Put clothing over the harness for maximum effectiveness of the device. 4. Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper.

2 The skin underneath the straps of the brace should be checked 2 or 3 times a day for red areas, which might indicate skin breakdown.

Which clinical manifestations should the nurse expect when assessing a pediatric client who is diagnosed with congenital hip dysplasia (CHD)? Select all that apply. 1. Limited adduction of the affected hip 2. Asymmetry of thigh fat folds 3. Telescoping of the thigh 4. Muscle weakness 5. Atrophy of the muscles

2 3 Asymmetry of the thigh fat folds is a clinical manifestation associated with CHD. Telescoping of the thigh is a clinical manifestation associated with CHD.

Which clinical manifestations should the nurse monitor for when conducting a scoliosis screening for a school-age child? Select all that apply. 1. Lordosis 2. Prominent scapula 3. Pain 4. A one-sided rib hump 5. Uneven shoulders and hips

2 4 5 The classic signs of scoliosis include uneven shoulders and hips, a one-sided rib hump, and prominent scapula. The classic signs of scoliosis include uneven shoulders and hips, a one-sided rib hump, and prominent scapula. The classic signs of scoliosis include uneven shoulders and hips, a one-sided rib hump, and prominent scapula.

Which teaching topic is the priority for the nurse who is teaching the family of an infant diagnosed with osteogenesis imperfecta? 1. Cast care 2. Trunk and extremity support during everyday care 3. Postoperative spinal surgery care 4. Traction care

2. With osteogenesis imperfecta, nursing care focuses on preventing fractures. Because the bones are fragile, the entire body must be supported when the child is moved.

Which is the priority nursing diagnosis for nurse to use when planning care for a school-age child who must wear a brace for correction of scoliosis? 1. Impaired Gas Exchange, Risk for 2. Altered Growth and Development, Risk for 3. Impaired Skin Integrity, Risk for 4. Impaired Mobility, Risk for

3

Which finding, noted during the newborn admission assessment, would lead the nurse to suspect unilateral congenital hip dysplasia? 1. Lordosis 2. Trendelenburg sign 3. Asymmetry of the gluteal and thigh fat folds 4. Telescoping of the affected limb

3 Explanation: A sign of congenital hip dysplasia in the infant would be asymmetry of the gluteal and thigh fat folds. Trendelenburg sign and telescoping of the affected limb are signs that present in an older child with congenital hip dysplasia.

Which clinical data noted by the nurse during the shift assessment indicate the pediatric client may be experiencing compartment syndrome? Select all that apply. 1. Pink, warm extremity 2. Dorsalis pedis pulse present 3. Prolonged capillary refill time 4. Pain not relieved by pain medication 5. Paresthesia of the leg

3, 4, 5 A prolonged capillary refill time is a sign of compartment syndrome. A prolonged capillary refill time with loss of paresthesia and pain not relieved by medication are signs of compartment syndrome. Paresthesia is tingling and numbness of the affected extremity and is a sign of compartment syndrome.

A new nurse is caring for a child after spinal fusion to correct scoliosis. Which action by the new nurse causes the experienced nurse to intervene? A. Assesses neurological status and vital signs every hour B. Instructs patient to turn by pulling on side rails C. Monitors chest tube for air leakage and drainage D. Promotes use of the incentive spirometer each hour

B. Instructs patient to turn by pulling on side rails

Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes with of the following? Select all that apply a. assess pain b. assess pulses c. elevate extremity above the level of the heart d. monitor capillary refill e. provide pain medication as needed

a. assess pain b. assess pulses d. monitor capillary refill e. provide pain medication as needed

Johnny, a 12 year old with fracture of the femur, has developed sudden chest pain and shortness of breath. The nurse suspects a. pulmonary embolism b. compartment syndrome c. myocardial infarction d. pneumonia

b. compartment syndrome

An infant hospitalized with multiple fractures has just been diagnosed with osteogenesis imperfecta. The nurse finds the parents crying. Which response by the nurse is the most appropriate? A. "I know how you feel. I would be upset to find this out too." B. "There is medicine that can allow her to live a normal life." C. "Would you like me to help you with holding your baby?" D. "You are actually lucky many of these babies die at birth."

C. "Would you like me to help you with holding your baby?"

A 6 year old involved in a bicycle crash has a spleen injury and a right tibia/fibula fracture that has been casted. Which is an early sign of compartment syndrome in this child? Select all that apply a. edema b. numbness c. severe pain d. weak pulse e. anular rash

a. edema c. severe pain

Which assessment finding would require an immediate nursing action when providing care to an adolescent who is postoperative for spinal fusion surgery? 1. Sleeps when not bothered but arouses easily with stimuli 2. Impaired color, sensitivity, and movement to lower extremities 3. Nausea relieved by antiemetics 4. Pain relieved by analgesics

2. Impaired color, sensitivity, and movement to lower extremities When the spinal column is manipulated, there is a risk for impaired color, sensitivity, and movement to lower extremities.

The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system (EMS) has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. What should the nurse do related to the tourniquet? a. Loosen the tourniquet. b. Leave the tourniquet in place. c. Remove the tourniquet and apply direct pressure if bleeding is still present. d. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.

ANS: B A tourniquet is applied only as a last resort, and then it is left in place and not loosened until definitive treatment is available. After the tourniquet is applied, skin and tissue necrosis occur below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation. This can induce systemic, deadly tourniquet shock.

A preadolescent has been diagnosed with scoliosis. The planned therapy is the use of a thoracolumbosacral orthotic. The preadolescent asks how long she will have to wear the brace. What is the appropriate response by the nurse? a. "For as long as you have been told." b. "Most preadolescents use the brace for 6 months." c. "Until your vertebral column has reached skeletal maturity." d. "It will be necessary to wear the brace for the rest of your life."

ANS: C Bracing can halt or slow the progress of most curvatures. They must be used continuously until the child reaches skeletal maturity. Telling the child "for as long as you have been told" does not answer the child's question and does not promote involvement in care. Six months is unrealistic because skeletal maturity is not reached until adolescence. When skeletal growth is complete, bracing is no longer effective.

When does idiopathic scoliosis become most noticeable? a. In the newborn period b. When the child starts to walk c. During the preadolescent growth spurt d. During adolescence

ANS: C Idiopathic scoliosis is most noticeable during the preadolescent growth spurt. It is seldom apparent before age 10 years.

The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse would consider what in caring for this child who has experienced severe trauma? a. Rapid assessment should begin with ABC status: airway, breathing, and circulation. b. Assessment should begin with the area injured; assessment of other areas can wait. c. The possibility of spinal cord injury should be ruled out before transporting the child to the hospital. d. Temperature maintenance is more difficult than in adults because young children have a larger surface area related to body mass.

a. Rapid assessment should begin with ABC status: airway, breathing, and circulation.

When assessing an adolescent for scoliosis, what should the nurse ask the client to do? a. bend forward at the waist with arms hanging freely b. lie flat on the floor and extend the legs straight from the trunk c. sit in a chair while lifting the feet and legs to a right angle with the trunk d. stand against a wall while pressing the length of the back against the wall

a. bend forward at the waist with arms hanging freely

To meet the developmental needs of an 8 year old child who is confined to home with osteomyelitis, what goal should the nurse include in the care plan? a. encourage the child to communicate with school mates b. encourage the parents to stay with the child c. allow siblings to visit freely throughout the day d. talk to the child about his interests twice daily

a. encourage the child to communicate with school mates

The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which care is most appropriate? a. fit the diaper under the straps b. leave the harness off while the infant sleeps c. check for skin redness under straps every other day d. put powder on the skin under the straps every day

a. fit the diaper under the straps

When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply a. pain medication is contrainidicated so that symptoms are not masked b. blood cultures will be obtained c. pus will be aspirated from the subperiosteum d. an intravenous line with antibiotics will be started e. surgery will be necessary

b. blood cultures will be obtained c. pus will be aspirated from the subperiosteum d. an intravenous line with antibiotics will be started

The care plan for the child during the acute phase of osteomyelitis always includes a. performing wound irrigations b. ensuring administration of antibiotics c. isolating the child d. incorporating passive ROM exercises for the affected area

b. ensuring administration of antibiotics

Which is important when teaching a parent about preventing osteomyelitis? a. parents can stop worrying about bone infection once their child reaches school age b. parents need to clean open wounds thoroughly with soap and water c. children will always get a fever if they have osteomyelitis d. children should wear long pants when playing outside because their legs might get scratched

b. parents need to clean open wounds thoroughly with soap and water

A nurse is completing preoperative teaching with an adolescent client who is scheduled to receive spinal instrumentation for scoliosis. Which of the following information should the nurse include in the teaching? a. "you will go home the same day of surgery" b. "you will have minimal pain" c. "you will need to receive blood" d. "you will not be able to eat until the day after surgery

c. "you will need to receive blood"

Which would the nurse expect to assess on a 3 week old infant with developmental dysplasia of the hip? Select all that apply a. excessive hip abduction b. femoral lengthening of an affected leg c. asymmetry of gluteal and thigh folds d. pain when lying prone e. positive Ortolani test

c. asymmetry of gluteal and thigh folds e. positive Ortolani test

When teaching the family of an older infant who has a spica cast applied for developmental dysplasia of the hip, which information should the nurse include when describing the abduction stabilizer bar? a. it can be adjusted to a position of comfort b. it is used to lift the child c. it adds strength to the cast d. it is necessary to turn the child

c. it adds strength to the cast

infant in the newborn nursery is diagnosed with developmental dysplasia of the hip, and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include a. return to the orthopedist's office in 2 weeks to remove the hip spica cast b. the infant's bilateral foot cats should be elevated on pillows as much as possible c. remove the Pavlik harness once a day for no more than 2 hours and inspect skin d. remove the Pavlik harness while the infant is awake to allow "tummy time"

c. remove the Pavlik harness once a day for no more than 2 hours and inspect skin

A nurse is caring for a toddler who has hip dysplasia and has been placed in a hip spica cast. The child's guardian asks the nurse why a Pavlik harness is not being used. Which of the following responses should the nurse make? a. "The Pavlik harness is used for children with scoliosis, not hip dysplasia" b. "The Pavlic harness is used for school-age children" c. "The Pavlic harness cannot be used for your child because her condition is too severe" d. "The Pavlic harness is used for infants less than 6 months of age

d. "The Pavlic harness is used for infants less than 6 months of age

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 distension. On the basis of these findings, the nurse should take which action? a. administer an antiemetic b. increase the intravenous fluids c. place the child in a Sim's position d. notify the health care provider

d. notify the health care provider

The primary diagnostic tool used in the developmental dyplasia of the hip in a newborn is a. a radiograph b. an ultrasound c. MRI d. the Barlow and Ortolani maneuvers

d. the Barlow and Ortolani maneuvers

A 5-year-old child is hospitalized with osteomyelitis and will be going home in the next few days on intravenous (IV) antibiotics. Which action by the nurse is the most appropriate? A. Ensure that a valid permit for a PICC line is on the chart.' B. Locate a pharmacy that will supply the IV medications. C. Research the patient's insurance for home infusion coverage. D. Teach the child about a PICC line using a doll.

A. Ensure that a valid permit for a PICC line is on the chart.'

What nursing intervention is most appropriate when caring for the child with osteomyelitis? a. Encourage frequent ambulation. b. Administer antibiotics with meals. c. Move and turn the child carefully and gently to minimize pain. d. Provide active range of motion exercises for the affected extremity.

ANS: C During the acute phase, any movement of the affected limb causes discomfort to the child. Careful positioning with the affected limb supported is necessary. Weight bearing is not permitted until healing is well under way to avoid pathologic fractures. Intravenous antibiotics are used initially. Food is not necessary with parenteral therapy. Active range of motion would be painful for the child.

After spinal fusion surgery the nurse should check for signs of what? a. Seizure activity b. Increased intracranial pressure c. Impaired color, sensitivity, and movement to the lower extremities d. Impaired pupillary response during neurologic checks

ANS: C In addition to the usual postoperative assessments of wound, circulation, and vital signs, the neurologic status of the patient's extremities requires special attention. Prompt recognition of any neurologic impairment is imperative because delayed paralysis may develop that requires surgical intervention.

The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign? a. Petaling b. Posturing c. Paresthesia d. Positioning

ANS: C Paresthesia distal to the injury or cast is an ominous sign that requires immediate notification of the practitioner. Permanent muscle and tissue damage can occur within 6 hours. The other signs of ischemia that need to be reported are pain, pallor, pulselessness, and paralysis. Petaling is a method of placing protective or smooth edges on a cast. Posturing is not a sign of peripheral ischemia. Finding a position of comfort can be difficult with a fracture. It would not be an ominous sign unless pain was increasing or uncontrollable.

An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take? a. Wait for the child's parents to arrive. b. Move the child out of the parking lot. c. Have someone notify the emergency medical services (EMS) system. d. Help the child stand to return to play.

ANS: C The child was involved in a motor vehicle collision and at this time is not able to move his extremities. The child needs immediate attention at a hospital for assessment of the possibility of a spinal cord injury. Because the child cannot move his extremities, the child should not be moved until his cervical and vertebral spines are stabilized. The EMS team can appropriately stabilize the spinal column for transport. Although it is important to notify the parents, the EMS system should be activated and transport arranged for serious injuries. The only indication to move the child is to prevent further trauma.

Diagnostic evaluation is important for early recognition of scoliosis. Which of the following is the correct procedure for the school nurse conducting this examination? a. view the child, who is standing and walking fully clothed, to look for uneven hanging of clothing b. view all children form the left and right side to look mainly for asymmetry of the hip height c. completely undress all children before the examination d. view the child, who is wearing underpants, from behind when the child bends forward at the hips

d. view the child, who is wearing underpants, from behind when the child bends forward at the hips

Nursing considerations for the patient diagnosed with osteogenesis imperfecta include a. preventing fractures by holding onto the child's ankles when changing diapers b. providing nonjudgmental support while parents may be dealing with accusations of child abuse c. providing guidelines to the parents in avoiding all exercise and sports for the child d. educating parents that the use of braces and splints can increase the rate of fracture

b. providing nonjudgmental support while parents may be dealing with accusations of child abuse

A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair. In addition to the usual postoperative care, what additional intervention will be needed? a. Position changes are made by log rolling. b. Assistance is needed to use the bathroom. c. The head of the bed is elevated to minimize spinal headache. d. Passive range of motion is instituted to prevent neurologic injury.

ANS: A After scoliosis repair using a Luque procedure, the adolescent is turned by log rolling to prevent damage to the fusion and instrumentation. The patient is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. A urinary catheter is placed. The head of the bed is not elevated until the second postoperative day. Range of motion exercises are begun on the second postoperative day.

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? a. limited range of motion in the affected hip b. an apparent lengthened femur on the affected side c. asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed d. symmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

a. limited range of motion in the affected hip

When planning a rehabilitation approach for a child with osteogenesis imperfecta, the nurse should prevent which of the following? Select all that apply a. positional contractures and deformities b. bone infection c. muscle weakness d. osteoporosis e. misalignment of lower extremity joints

a. positional contractures and deformities c. muscle weakness d. osteoporosis e. misalignment of lower extremity joints

Nursing care directed toward nonsurgical management of a teenager with scoliosis primarily includes a. promoting self-esteem and positive body image b. preventing immobility c. promoting adequate nutrition d. preventing infection

a. promoting self-esteem and positive body image