Peds Chapter 40: PrepU

A child and mother come into the orthopedic clinic. The mother is concerned about her child who has recently been diagnosed with scoliosis. The mother asks about surgical treatment and if it will be necessary. The nurse bases her response on knowledge that surgery is implicated for curvatures greater than:

40 degrees.

The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse?

A weak pedal pulse

A 14-year-old boy was diagnosed with a closed fracture of the ulna at approximately 9 a.m. The fracture was reduced in the emergency department and his arm placed in a cast. At 6 p.m. his mother has brought him back to the emergency department due to unrelenting pain that has not been relieved by his prescribed narcotics. Which of the following would the nurse do next?

Alert the primary health care provider immediately and apply ice.

The most important assessment of neurovascular status to make after spinal surgical instrumentation is:

Assess the legs for warmth.

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client?

Bracing

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply.

Calcium and vitamin D play important roles in bone growth and bone breakdown. Calcitonin plays a role in remodeling of bone. Periosteum is the outer covering of the bone.

A school-age child has difficulty getting from a sitting position to a standing position and must brace the legs to rise. Which lab test would the nurse expect the provider to order?

Creatinine phosphokinase

The nurse caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.

The nurse is assessing a group of early adolescents for scoliosis. One of the teenagers asks the nurse what will be done. The nurse explains that which of the following will be included in the assessment? Select all that apply.

Examination of the shoulder blades for symmetry Examination of the hips for symmetry Examination of the shoulders for symmetry Examination of the spine for curvature

The nurse is concerned that a preschool-age child is demonstrating signs of Duchenne muscular dystrophy. What did the nurse assess in this child?

Gower sign

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick

A nurse assesses a client who is complaining of calf pain, has a temperature of 101°F (38.3°C) and reports that his leg is very sore. X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and his erythrocyte sedimentation rate is elevated. What problem do these symptoms suggest?

Osteomyelitis

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to:

Prevent edema.

A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis?

Staphylococcus aureus

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours.

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note?

The posterior spine when bending forward

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

Unhooking a weight while providing pin care

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment?

When on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?

"Blowing cool air with a fan or hair dryer may relieve the feeling."

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."

A nurse is performing crutch training for an adolescent who has a fractured tibia. What statement by the adolescent indicates successful teaching?

"My mom is going to have to pick up all of her throw rugs so I don't slip on them."

A parent is angry about the adolescent's diagnosis of osteosarcoma. The parent is telling the adolescent that if he hadn't played football last year and broken his leg, this would not have happened. What is the nurse's best response to the parent's statement?

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

At an obstetric visit 28 weeks into her pregnancy, an expectant mother tells the nurse that her friend's newborn has a soft spot on his head. She is concerned that something is wrong with this baby and is worried the same thing could happen to her child. The best explanation the nurse could offer this expectant mother regarding the bones in the skull would be which statement?

"The softer spot and unclosed sutures in the skull allow the bones to move as they need to so that the baby's head can move through the narrow birth canal."

The nurse caring for a 13-year-old female with late onset type II pauciarticular juvenile idiopathic arthritis explains to the parents the prognosis for their child's condition. Which of the following statements best describes this prognosis?

"This disease responds well to therapy; your daughter will most likely not experience crippling disease."

The nurse is creating a care plan for a child with a leg cast. What interventions would be appropriate for the nursing diagnosis of Risk for ineffective peripheral tissue perfusion related to pressure from cast? Select all that apply.

Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. Keep leg elevated by a pillow at all times. Assess capillary refill of toes every 4 hours.

The pediatric nurse is providing care to a child with a brace. The nurse understands the importance of a properly fitted device that is used correctly while maintaining skin integrity. Which of the following would the nurse implement to achieve these goals? Select all that apply.

Daily baths or skin care with thorough drying minimizes skin irritation A brace can be removed for bathing, sleeping, or exercise

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?

Idiopathic scoliosis

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?

Impaired physical mobility related to a cast on the leg

The nurse is caring for a number of children with bone fractures who are being treated with casts, traction, or external fixation. Which of the following would be most important for the nurse to address when caring for a child with an external fixation device?

Preventing further injury Maintaining skin integrity Assessing neurovascular status Completing daily pin care

The nurse is evaluating a school-age child's ability to crutch walk so that no weight is placed on an injured leg. Which walking technique indicates that teaching has been effective?

Three-point swing-through gait

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?

To continue with age-appropriate activities

While examining a 4-year-old child, the nurse notes a decrease in hip motion that causes pain upon movement. The nurse interprets this finding as indicating Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity.

True