PEDS FOR SUCCESS: ORTHOPEDIC DISORDERS

Which is most important when teaching a parent about preventing osteomyelitis? 1. Parents can stop worrying about bone infection once their child reaches school age. 2. Parents need to clean open wounds thoroughly with soap and water. 3. Children will always get a fever if they have osteomyelitis. 4. Children should wear long pants when playing outside because their legs might get scratched.

2

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

2

A child is going to receive radiation for Ewing sarcoma. Which of the following is the best nursing intervention to prevent skin breakdown during therapy? 1. Advise the child to wear loose-fitting clothes to minimize irritation. 2. Advise the child to use emollients to prevent dry skin. 3. Apply cold packs nightly to reduce the warmth caused by the treatments. 4. Apply hydrocortisone to soothe itching from dry skin.

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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.

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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).

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The nurse is teaching the parent of a child diagnosed with systemic lupus erythe- matosus (SLE). The nurse evaluates the teaching as effective when the parent states: 1. "The cause is unknown." 2. "There is no genetic involvement." 3. "Drugs are not a trigger for the illness." 4. "Antibodies improve disease outcome."

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Which is the definition of talipes varus? 1. An inversion or bending inward of the foot. 2. An eversion or bending outward of the foot. 3. A high arch of the foot. 4. A low arch (flatfoot) of the foot.

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Which nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy? 1. Risk for fluid volume deficit. 2. Potential for chronic pain. 3. Risk for skin impairment. 4. Ineffective airway clearance.

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

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

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Which is an important nursing intervention to teach about photosensitivity to the parents of a child with systemic lupus erythematosus (SLE)? 1. Regular clothing is appropriate for sun exposure. 2. Sunscreen application is necessary for protection. 3. Teenage patients cannot participate in outdoor sports. 4. Uncovered fluorescent lights offer no danger.

2

A child with Ewing sarcoma is undergoing a limb salvage procedure. Which statement indicates the parents understand the procedure? 1. "Our child will have a bone graft to save the limb." 2. "Our child will need follow-up lengthening procedures." 3. "Our child will need shorter shirt sleeves." 4. "Our child will not need chemotherapy."

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A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia? 1. "My child will be more at risk for diarrhea." 2. "My child will be more at risk for infection." 3. "My child's hair will fall out." 4. "My child will need to drink more."

2

The parent of a child diagnosed with osteomyelitis asks how the child acquired the illness. Which 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

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

20. A 20-degree spinal curve that is non- progressive will not disfigure or interfere with normal functioning, so it is not treated with bracing or surgery.

36. When instructing a family about care of an 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 soap and water. 4. Return the brace to the orthopedic surgeon for cleaning.

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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 is the primary reason for surgical treatment? 1. Young age. 2. Drug allergies. 3. Nonresponse to intravenous antibiotics. 4. Physician preference.

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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.

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Select the number of inches lateral to the heel where a crutch should be placed. 1. 1to3. 2. 4to5. 3. 6to8. 4. 9 to 10.

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The nurse expects the blood culture report of an 8-year-old with septic arthritis to grow which causative organism? 1. Streptococcus pneumoniae. 2. Escherichia coli. 3. Staphylococcus aureus. 4. Neisseria gonorrhoeae.

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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 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.

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Which is most important to discuss with an adolescent who is going to have a leg amputation for osteosarcoma? 1. Pain. 2. Spirituality. 3. Body image. 4. Lack of coping.

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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.

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

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52. The nurse is teaching the parent of a child newly diagnosed with juvenile idiopathic arthritis (JIA). 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 joint spaces. 4. Immune-stimulated inflammatory response in the joint.

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Which is an important nursing intervention to monitor in a child with systemic lupus erythematosus (SLE) and renal involvement? 1. Monitor weight. 2. Check for uric salts in urine. 3. Watch for hypotension. 4. Check for protein in urine.

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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 bone, and small pieces of bone are broken off. 4. It is a fracture that does not go all the way through the bone.

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

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Which should the nurse stress to the parents of an infant in a Pavlik harness for treat- ment 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 lotions or powder on the 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.

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Which would be the best nursing intervention for a child with phantom pain after an amputation? 1. Tell the child that the pain does not exist. 2. Request a PCA pump from the physician for pain management. 3. Encourage the child to rub the stump. 4. Provide Elavil to help with pain.

4

Which parts of the body should the nurse assess on a child in a spica cast? List the relevant label(s) from the following figure.

The nurse needs to assess areas under the cast for drainage through the cast and assess neurocirculatory status of the feet.

When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age group? 1. Infancy. 2. Toddlers. 3. School-aged children. 4. Adolescents.

4

A 13-year-old just returned from surgery for scoliosis. Which nursing intervention(s) is/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.

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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.

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42. The nurse is teaching an adolescent about Ewing sarcoma and indicates which as a common site? 1. Shaft. 2. Growth plate. 3. Ball of the femur. 4. Bone marrow.

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A child is admitted to the pediatric unit with the diagnosis of systemic lupus erythe- matosus (SLE). On assessment, the nurse expects the child to have: 1. Leukemia. 2. Malar rash. 3. Weight gain. 4. Heart failure.

2

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/are an early sign(s) of compartment syndrome in this child? Select all that apply. 1. Edema. 2. Numbness. 3. Severe pain. 4. Weak pulse. 5. Anular rash.

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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.

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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 joint in adulthood.

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The nurse on the pediatric floor is receiving a child with the possible diagnosis of septic arthritis of the elbow. Which would the nurse expect on assessment? Select all that apply. 1. Resistance to bending the elbow. 2. Nausea and vomiting. 3. Fever. 4. Bruising of the elbow. 5. Swelling of the elbow. 6. A history of nursemaid's elbow as a toddler.

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Which 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. Previous closed fracture of an extremity. 5. Redness and swelling at the site.

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A 14-year-old with osteogenesis imperfecta (OI) 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.

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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.

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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."

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One nursing diagnosis for juvenile idiopathic arthritis (JIA) 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 nonpharmacological methods, such as heat.

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The nurse caring for a child with osteomyelitis assesses poor appetite. Which inter- vention(s) is/are most appropriate for this child? Select all that apply. 1. Offer high-calorie liquids. 2. Offer favorite foods. 3. Do not worry about intake, as appetite loss is expected. 4. Suggest intravenous removal to encourage oral intake. 5. Decrease pain medication that might cause nausea. 6. Offer frequent small meals.

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When planning a rehabilitative approach for a child with osteogenesis imperfecta (OI), 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.

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Which instruction(s) should the nurse give the parents of an adolescent with slipped capital femoral epiphysis (SCFE)? 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.

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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 infant's feet covered at all times. 4. Present the infant as precious; emphasize the well-formed parts of the body. 5. Tell the parent that defects could be much worse. 6. Be prepared to answer questions multiple times.

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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 to 10 years. 5. Pubertal hormonal changes. 6. Endocrine disorders.

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Because estrogen is a possible trigger for a systemic lupus erythematosus (SLE) flare, advice for a teenager who may become sexually active includes which of the follow- ing? Select all that apply. 1. Use Ortho Tri-Cyclen. 2. Use Depo-Provera. 3. Practice abstinence. 4. Use condoms. 5. Use Ortho Evra.

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When a child is suspected of having osteomyelitis, the nurse can prepare the family to expect which of the following? Select all that apply. 1. Pain medication is contraindicated so that symptoms are not masked. 2. Blood cultures will be obtained. 3. Pus will be aspirated from the subperiosteum. 4. An intravenous line with antibiotics will be started. 5. Surgery will be necessary.

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When counseling the parents of a child with osteogenesis imperfecta (OI), 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 primary care provider explaining OI. 4. Provide information on contacting the Osteogenesis Imperfecta Foundation. 5. Encourage the parents to treat the child like their other children. 6. Encourage use of calcium to decrease risk of fractures.

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Which should be included in teaching a family about post-surgical care for slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. The patient will receive help with weight-bearing ambulation 24 to 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 to 8 weeks.

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Where should the top of the crutch bar be in relation to the axilla?

The crutch bar should not put pressure on nerves in the axilla.