PEDS Prep U Chapter 22: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

Correct response: "Pale, cool, or blue skin coloration is to be expected." Explanation: It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct.

The nurse caring for a child who has been put into a leg cast must be on alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child:

Correct response: feels increasing severe pain. Explanation: Any reports of pain in a child with a new cast or immobilized extremity need to be explored and monitored closely for the possibility of compartment syndrome.

The nurse cares for an infant with myelomeningocele before surgical intervention. What action will the nurse take?

Cover the sac with a saline-moistened dressing. Explanation: Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided

The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction?

Skin traction Explanation: Traction is used to provide immobilization to reduce or immobilize a fracture, align an injured extremity or allow the extremity to be restored to the normal length. The types of traction include skin, skeletal and suspension. The types of skin traction include Bryant, Russell, Buck, cervical and side arm 90-90. In these types of traction some type of tape, rubber, plastic or manufactured material is attached to the skin. A weight is attached via pulley which indirectly exerts pull on the musculoskeletal system. Dunlop is a form of skeletal traction. Balanced suspension uses a series of weights and pulleys to align the hip, femur or tibia

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching?

"My son's activity is too limited to stimulate his bowels." Explanation: The nurse needs to point out to the mother that even minimal activity increases peristalsis. Together they can come up with appropriate activities within the child's limits or restrictions to promote peristalsis. It is important to determine the usual pattern for passing stool so that the mother and nurse can determine the best program. Palpating the abdomen can reveal distention, suggesting constipation. Adequate fluid is necessary to stimulate peristalsis.

A young child with Duchenne muscular dystrophy is placed on both prednisone and calcium. Parents view these two medications as rather "common" and question their importance for the child. What explanation by the nurse will be most helpful to the parents?

"Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing." Explanation: Studies have shown that boys treated with prednisone have improved muscle strength and function. This is thought to be due to the protection that prednisone provides to muscle fibers. Calcium is needed to prevent osteoporosis, which is a side effect of prednisone that also occurs when weight bearing is limited. Respiratory infection is a risk in that those muscles weaken with progression of the disease, but reactive airway disease is not a particular risk. No peripheral nerve involvement is observed in Duchenne muscular dystrophy. Side effects of prednisone include weight gain and appetite stimulation, but these are not the reasons for the prednisone therapy. Calcium does augment dietary intake of the mineral and is important for tooth development, and it may play a role in prevention of muscle cramps, but these are not the main reasons for taking the calcium supplement.

A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?

Auscultation Explanation: The physical examination specific to fractures includes inspection, observation, and palpation. The nurse may assume that auscultation is not used; however, auscultation of the child's lungs may reveal adventitious sounds that are often present when respiratory muscle function is impaired

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?

"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?

Type II Explanation: According to the Salter-Harris classification, a type II fracture is partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis.

The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers which issues should be reported if they occur or are seen related to this child. Select all that apply. a) Any area on the cast that is warm to the touch b) A foul odor under the cast c) Any itching under or around the edges of the cast d) Drainage from under the cast e) Any pink color in the fingers or toes of casted extremity f) Looseness of the cast on the extremity

a) Any area on the cast that is warm to the touch b) A foul odor under the cast d) Drainage from under the cast f) Looseness of the cast on the extremity

The nurse is caring for a child with muscular dystrophy. Which prescription will the nurse question?

clozapine Explanation: Duchenne muscular dystrophy is the most common neuromuscular disorder of childhood, mostly affecting males. There is no cure, but treatments are available to slow progression and provide symptom management. Corticosteroids, such as prednisone, may be prescribed to protect muscle fibers from damage to the sarcolemma. Studies have shown males treated with prednisone have increased strength and function. Calcium supplements and vitamin D are prescribed to prevent osteoporosis. Antidepressants, not antipsychotics (such as clozapine), may be helpful when depression occurs related to the chronicity of the disease and/or as an effect of corticosteroid use

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition?

degeneration of muscle fibers Explanation: Degeneration of muscle fibers with progressive weakness and wasting best describes muscular dystrophy. Demyelination of myelin sheaths is a description of multiple sclerosis. Lesions within the brain cortex and the upper motor neurons suggest a neurologic, not a muscular, disease.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone

A young female has been prescribed corticosteroids for dermatomyositis. Which statements by her mother indicate the need for further education? Select all that apply. a) I give it to her first thing in the morning before breakfast." b) We are taking her to Disney in the summer." c) The physician said that when it's time for her to stop taking this medication, he will gradually start reducing her dose." d) She's got to take this medication to help with the calcium deposits that can form." e) She might recover completely from this condition."

a) "I give it to her first thing in the morning before breakfast." b) "We are taking her to Disney in the summer." Explanation: Corticosteroids should be given with food to minimize gastric upset. Corticosteroids can mask infection. This child should avoid large crowds to prevent exposure to infectious organisms. The other parent responses are correct regarding corticosteroids and dermatomyositis.

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 Explanation: Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis

The nurse is diligent to provide necessary care to each child. What major role do nurses help provide in the care of nearly all children with neuromuscular disorders?

coordinating care with specialists Explanation: Being part of a multidisciplinary team and coordinating the care the child usually needs from a variety of specialists is an essential and major role. The other nursing activities are important as well, but many children/families require individual interventions

A nurse is conducting a physical examination of a 5-year-old boy with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find?

pectus excavatum ("funnel chest") Explanation: Pectus excavatum ("funnel chest") develops in children with SMA type 1 and type 2 who exhibit paradoxical breathing. The chest becomes funnel shaped and the xiphoid process is retracted. Pseudohypertrophy of the calves is associated with Duchenne muscular dystrophy. Loss of strength in hip extension is associated with Duchenne muscular dystrophy. Loss of strength in ankle dorsiflexion is associated with Duchenne muscular dystrophy

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 Explanation: A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Decreased oral intake and an elevated temperature could indicate an infection. However, circulation is priority over infection in the client and would be most concerning for the nurse. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically.

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply. a) Calcium and vitamin D play important roles in bone growth and bone breakdown. b) Calcitonin plays a role in the remodeling of bone. c)Adipose cell formation happens in the red bone marrow. d) Periosteum is the outer covering of the bone. e) The diaphysis is the rounded end portion of the bone.

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

The nurse is conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common?

blue sclera Explanation: Blue sclera is not diagnostic of osteogenesis imperfecta, but it is a common finding. The foot drawn up and inward (talipes varus) and the sole of the foot facing backwards (talipes equinus) are associated with clubfoot (congenital talipes equinovarus). Dimpled skin and hair in the lumbar region are common findings with spina bifida occulta

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size?

constipation and bladder dysfunction Explanation: Symptoms of constipation and bladder dysfunction may result due to an increasing size of the lesion. Increasing ICP and head circumference would point to hydrocephalus. Leaking cerebrospinal fluid would indicate the sac is leaking.

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 Explanation: Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze

A pediatric client's parent calls the nurse and states, "My child fell off the bike. My child was wearing a helmet, but did scrape the knee and it is bleeding a lot. What should I do?" Which response by the nurse is best?

"You should apply pressure to the site and then bring your child in to be evaluated." Explanation: First, the nurse needs to address the client's bleeding by having the parent apply pressure to the site. Then, the child needs to be evaluated to determine if additional treatment is needed, such as stitches. Measures including rest, ice, compression, and elevation (RICE) will be further discussed with the parent and child after the bleeding is stopped and the wound has been evaluated. There is no indication the child needs immediate evaluation, nor is there indication the child cannot move other extremities or has an altered level of consciousness. Bleeding is priority for this client

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

Risk for impaired skin integrity Explanation: The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

The nurse is caring for a child diagnosed with osteomyelitis in the tibia. What prescription would the nurse question? Select all that apply. a) ambulating QID b) IV antibiotics for 3 days c) blood cultures prior to administration of antibiotics d) CT scan of the lower leg e) oral antibiotics for 4 weeks after completion of the IV antibiotics

a) ambulating QID b) IV antibiotics for 3 days Explanation: Diagnostic exams for osteomyelitis include blood cultures, white blood cell count, CT scans, and potentially an MRI. Medical therapy includes a limitation on weight-bearing on the affected part, bed rest, immobilization, IV antibiotics for up to 2 weeks, and then oral antibiotics for an additional 3 to 4 weeks.

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply. a) exaggerated deep tendon reflexes b) hemiplegia c) poor control of balance d) hypertonicity e) drooling f) dysarthria

a) exaggerated deep tendon reflexes b) hemiplegia c) poor control of balance d) hypertonicity Explanation: Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement; hypertonicity of the affected extremities; and hemiplegia, quadriplegia, or diplegia, based on the limbs affected. Drooling and dysarthria are associated with athetoid cerebral palsy.

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

back with hips up off the bed. Explanation: Bryant traction is used to reduce fractures or with developmental dysplasia of the hip (DDH) in children younger than 2 years of age. In this type of traction, both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed. The position of having the child on the back with the hips flat is describing Buck traction. The position where the hip is flexed on the injured side and the uninjured extended is 90-90 traction. There is no traction when the child would be on the stomach.

A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests. Which test would the nurse identify as most important to be completed first?

creatine kinase Explanation: The sample for creatine kinase must be obtained before the electromyogram or muscle biopsy because those tests may lead to a release of creatine kinase and provide false results. Nerve conduction velocity tests could be done at any time.

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects?

folic acid supplementation Explanation: Strong evidence exists that folic acid supplementation by the mother before conception decreases the incidence of neural tube defects by 50%. Ultrasound screening at 16 to 18 weeks' gestation can help identify fetuses at risk, but this would not prevent neural tube defects. Screening of maternal serum alpha-fetoprotein levels can help identify fetuses at risk, but this would not prevent neural tube defects. Neural tube defects are not related to genetic dysfunction, so genetic testing would be of no value

A type of traction sometimes used in the treatment of the child with scoliosis is called:

halo traction. Explanation: When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction

A 3-month-old infant is seen in the pediatric clinic. The infant's parent expresses concern that the child has developed cerebral palsy. The nurse assesses the infant. Which assessment finding indicates to the nurse that the parent's concern is valid?

hypertonia in the upper extremities Explanation: Cerebral palsy manifests as hyper- or hypotonia, and cognitive and developmental delays. Gower sign is a manifestation of muscular dystrophy not cerebral palsy. A 3-month-old infant should be developmentally able to turn toward a voice or sound but is too young to sit without support.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?

muscle biopsy Explanation: Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor?

obesity Explanation: Obesity is a risk factor for the development of tibia vara. Tibia vara occurs most frequently in children who are early walkers. Limited or lack of exposure to sunlight may lead to rickets. Hormonal alterations during puberty may play a role in the development of slipped capital femoral epiphysis

Which diagnostic measure is most accurate in detecting neural tube defects?

significant level of alpha-fetoprotein present in amniotic fluid Explanation: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as:

spastic. Explanation: Spastic involves hypertonicity and permanent contractures on both extremities on one side. Athetoid (dyskinetic) involves abnormal involuntary movements affecting all four extremities and sometimes the face, neck, and tongue. Ataxic affects balance and depth perception. Spastic affects the lower extremities. Mixed is a combination of spastic, athetoid and ataxic

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

to continue with age-appropriate activities Explanation: The treatment for scoliosis is aimed at preventing progression of the curve and decreasing the impact on the pulmonary and cardiac function. Bracing is one way to do that. The brace should be worn for 23 hours per day. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. It is extremely important that the adolescent has compliance with the brace usage. The nurse can help by teaching the adolescent ways to help peers understand the need for the brace. Sex changes continue with or without bracing.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when incidents occur. Select all that apply. a) The boy experiences mild pain when wiggling his toes. b) The boy has had a fever of greater than 102 °F (38.9°C) for the last 36 hours. c) New drainage is seeping out from under the cast. d) The outside of the boy's cast got wet and had to be dried using a hair dryer. e) The boy's toes are light blue and very swollen.

b) The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. c) New drainage is seeping out from under the cast. e) The boy's toes are light blue and very swollen.

A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention?

a 4-year-old preschool-age child who consistently walks on tiptoes Explanation: At 4 years of age, a child should not consistently walk on tiptoes. This is a common manifestation of muscular dystrophy and requires intervention. At 2 months of age, an infant's movements are uncoordinated and it may take several attempts to touch objects the infant reaches for. Infants begin to walk between 9 and 18 months of age, and may begin by walking while holding a caregiver's hands. At 2 years of age, a toddler is able to walk up the steps one step at a time.

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental bowlegs (genu varum)?

A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray Explanation: Blount disease is retardation of growth of the epiphyseal line on the medial side of the proximal tibia (inside of the knee) that results in bowlegs (genu varum). Unlike the normal developmental aspect of genu varum, Blount disease is usually unilateral and is a serious disturbance in bone growth that requires treatment. In those with Blount disease, the medial aspect of the proximal tibia will show a sharp, beaklike appearance. The other answers all describe genu varum, not Blount disease

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

presence of Moro reflex Explanation: The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?

spina bifida occulta Explanation: Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arouse suspicion of its presence, or it may be overlooked entirely

The nurse is assessing an infant at a well-check visit. The infant's parent expresses worry about the infant's feet because they are so flat and wide. What is the most appropriate response by the nurse?

"Your baby's feet are normal. The longitudinal arch will develop after your baby walks for several months." Explanation: An infant's foot is flatter and proportionately wider than an adult's foot. Feet change as a child grows, but this answer does not address the parent's concern. The nurse also should not tell caregivers or clients to not worry because this is not therapeutic. The longitudinal arch typically is not present until the infant has been walking for a few months. The nurse would not indicate the infant will have no arch as an adult because this is incorrect. There is no need to notify the primary health care provider because this is an expected finding

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant?

baclofen Explanation: Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy.

The nurse is providing preoperative care for a newborn with myelomeningocele. Which action is the central nursing priority?

prevent rupture or leaking of cerebrospinal fluid Explanation: The central nursing priority is to prevent rupture or leaking of cerebrospinal fluid. Keeping the infant in a prone position will help prevent pressure on the lesion. Keeping the lesion free from fecal matter or urine is important as well, but the priority is to prevent rupture or leakage. The nurse should consider the lesion first when maintaining the infant's body temperature

A parent brings a 12-month-old child diagnosed with congenital cerebral palsy to the clinic. The nurse completes an assessment. Which assessment finding requires immediate intervention by the nurse?

suspected failure to thrive Explanation: The finding that requires the nurse's immediate attention is the suspicion of failure to thrive (FTT). FTT refers to inadequate growth in infants and children. Children diagnosed with cerebral palsy (CP) often have difficulty maintaining adequate nutrition due to muscle spasticity and difficulty chewing and swallowing. The nurse who suspects FTT in a child with CP should refer the child to a dietitian and/or speech therapist. Parents should also be taught the most effective way to feed their child. Spastic movements are common findings in CP and in this case do not require immediate intervention by the nurse. Babbling speech may also be found in the infant diagnosed with CP. The infant should be referred to a speech therapist but in this case does not require immediate intervention. A 12-month-old child with CP may need assistance to sit related to muscle spasticity.

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?

risk for infection Explanation: All of these diagnoses are important for a child with a myelomeningocele. However, during the first 12 hours of life, the most life-threatening event would be an infection. The other diagnoses will be addressed as the child develops

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?

Assuming the usual feeding position will be difficult. Explanation: Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?

Deficient knowledge related to diagnosis and condition Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for health care professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping

The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries? Select all that apply. a) Encourage 1 to 2 days off per week of competitive athletics. b) Apply ice to the injured area to reduce inflammation. c) Avoid using NSAIDs for pain control. d) Immobilize the muscles that are involved. e) Have the coach monitor the treatment program for sports injuries. f) Perform appropriate stretching during a 20-to 30-minute warmup.

a)Encourage 1 to 2 days off per week of competitive athletics. b) Apply ice to the injured area to reduce inflammation. f) Perform appropriate stretching during a 20-to 30-minute warmup. Explanation: Conservative treatment methods for the child with an overuse injury include encouraging 1 to 2 days off per week of competitive athletics, performing appropriate stretching during a 20-to-30-minute warmup, and applying ice to the injured area to reduce inflammation and irritation. NSAIDs (ibuprofen) are used for inflammation and pain control. The physical therapist institutes a stretching and strengthening program for the appropriate muscle groups. Parents and coaches may not understand that the level of activity that causes overuse symptoms varies from child to child. Notes or telephone conversations from the physician or nurse to the child's coach can clarify any misconceptions about what is expected during the recovery and recuperative periods

The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply. a)Document any signs of pain. b)Check capillary refill time in both arms. Monitor the color of the nail beds in the right hand. c) Wear a protective gown when moving the child's arm. d) Wear sterile gloves when removing or touching the cast.

a)Document any signs of pain. b) Check capillary refill time in the both arms. c) Monitor the color of the nail beds in the right hand.

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction. Explanation: Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction

An infant was born with a severely deformed hand. He is now 6 months old. The nurse informs the parents that the orthopedic surgeon has recommended amputation of the hand and fitting of a prosthesis. The mother objects and tells the nurse that they would like to wait and see how the hand develops. Which of the following should the nurse say in response?

"With a deformity such as this, the hand is highly unlikely to improve." Explanation: Depending on the condition, in many children, there is a potential for better function if the malformed portion of an extremity is amputated before a prosthesis is fitted. This creates a difficult decision for parents because it is one they cannot undo later. They need assurance that hands with malformed fingers, for example, will not later grow to become normal and a well-fitted prosthesis will allow their child a more usual childhood (and adult life) than if the original disorder was left unchanged. It is not the nurse's place to insert her opinion about the matter.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent?

"Applying ice to the area will reduce the pain and swelling." Explanation: Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling

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." Explanation: Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast

The nurse is caring for a school-age child diagnosed with transient synovitis. What statement by a parent indicates a need for further education regarding this diagnosis?

"I will get the prescription for the antibiotics filled as soon as we leave the office today." Explanation: Transient synovitis is an inflammatory disease, not an infection; therefore, antibiotics are not needed. NSAIDs such as ibuprofen and limited activity are prescribed. Surgical intervention is not needed. Ibuprofen can cause GI distress, so it should be administered with food to help reduce this distress.

The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education?

"I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain." Explanation: Children with JA should be encouraged to attend school, even if it is a shortened day because this increases activity. Using an elevated toilet seat may help decrease pain in the knees. A daily exercise program should be completed, and incorporating exercises into a game or dance can make them more enjoyable for the child. Warm baths can help can help reduce pain and increase movement in the involved joints.

The nurse is talking with the caregiver of a 13-year-old diagnosed with scoliosis. The child has come to the clinic to be fitted with a brace to begin her treatment. The child appears upset and angry and states, "I hate this brace; I hate it already." In an effort to support this child, which statement would be the most appropriate for the nurse to make to this child's caregiver?

"If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good." Explanation: Help the child select clothing that blends with current styles but is loose enough to hide the brace. Self-image and the need to be like others are very important at this age. Wearing a brace creates a distinct change in body image, especially in the older child or adolescent, at a time when body consciousness is at an all-time high. The need to wear the brace and deal with the limitations it involves may cause anger; the change in body image can cause a grief reaction. Handling these feelings successfully requires understanding support from the nurse, family, and peers. It is important for the child to have an opportunity to talk about his or her feelings.

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?

"In most cases treatment is not necessary, only observation." Explanation: The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." Explanation: A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year.

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." Explanation: It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

The nurse is reinforcing teaching with the caregivers of a child who has been placed in an external fixation device for the treatment of an orthopedic condition. Which statement made by the caregivers indicates an understanding of the external fixation device?

"It will be hard, but we know our child will be in this device for a long time." Explanation: External fixation devices are sometimes left in place for as long as 1 year. The pin sites are left open to the air and should be inspected and cleansed every 8 hours. The child and caregiver should be able to recognize the signs of infection at the pin sites. The appearance of the pins puncturing the skin and the unusual appearance of the device can be upsetting to the child.

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention?

"Let's ask your parents to bring your friends for a visit." Explanation: After 2 weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the child's parent or supervised by the child-life specialist would help the client adapt to the immobilized state. Telling the client that he or she is too big to suck the thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as the child has likely grown tired of books and coloring after 2 weeks

A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents?

"Let's put you in touch with other families who have experienced this." Explanation: A Pavlik harness is used to reduce and stabilize the hip by preventing hip extension and adduction and maintaining the hip in flexion and abduction. It can be very daunting for parents to care for their child in this device. There are many helpful pointers and suggestions that are available from other parents and orthopedic organizations. Referring the parents to other families who have experienced a Pavlik harness will provide assurance and likely increase compliance with the regimen. The other responses are factual but do not address the parent's concerns.

The nurse is caring for a preschooler with a greenstick fracture. Which statement by a parent indicates an understanding of this type of fracture?

"My child may need the arm broken completely prior to putting a cast on it." Explanation: Greenstick fractures are incomplete fractures. They commonly occur in young children. Sometimes greenstick fractures are broken completely before casting to prevent the bone from resuming its "bent" position in the cast. This fracture does not always occur in the leg. Crepitus (crackling) typically occurs over a clavicle fracture. A dislocation of the radial head is the typical injury that occurs when a child is picked up by one arm.

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." Explanation: Throw rugs, small footstools, and toys need to be cleared out of paths at home so the crutches do not slip. Children should not rest their axilla on the crutch pads when standing; this can cause damage to the brachial nerve plexus. When the child is walking, crutches need to be approximately 6 inches (15 cm) to the side of the foot to maintain a wide, balanced base for support. It is okay to utilize a backpack to carry books and supplies because the client's hands will not be free due to the crutches.

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?

"The cause is unknown and there are many environmental factors that may contribute to it." Explanation: There is no one known cause of spina bifida, but scientists believe that it's linked to hereditary and environmental factors. Neural tube defects, including spina bifida, have been strongly linked to low dietary intake of folic acid. Maternal age doesn't have an impact on spina bifida. An amniocentesis is performed to help diagnose spina bifida in utero but doesn't cause the disorder. Maternal alcohol intake during pregnancy has been linked to intellectual disability, craniofacial defects, and cardiac abnormalities, but not spina bifida

A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching?

"The very first step is to apply water-based lubricant to the catheter." Explanation: It is very important to remind the parents that they must always wash hands very well with soap and water prior to catheterization to help prevent infection. The other statements are correct

The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse?

"We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." Explanation: When a parent describes a child as always falling over the feet or awkward, the nurse needs to assess for toeing-in or metatarsus adductus. One way to assess for this is to have the child stand on a copier and make a print of the feet. It will show any inward turning of the feet. For most instances, it resolves without therapy. If it persists past 1 year, passive stretching exercises may be prescribed. It is not a severe bone disorder and typically does not need surgical intervention.

After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching?

"We'll apply a warm moist compress to the wrist for 20 minutes at a time." Explanation: Care for a sprain includes rest, ice, compression, and elevation. Cold therapy, not heat, is used for 20 to 30 minutes at a time, then removed for 1 hour and repeated for the first 24 to 48 hours. Compression via an elastic bandage, elevating above heart level, and limiting activity are appropriate measures.

A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction?

"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Explanation: Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily for all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort, a lightweight t-shirt may be worn under the brace.

The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state:

"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty." Explanation: When the urine stops flowing, the parents should press on the lower abdomen or have the child lean forward to tense the abdominals to ensure that no more urine is in the bladder. For a female, the catheter is inserted about 2 to 3 inches. For a male, the catheter is inserted about 4 to 6 inches. Before the catheter is inserted, the labia is cleaned with a washcloth or disposable wipe from front to back. A generous amount of water-soluble lubricant, not petroleum jelly, is applied to the catheter. There is no need to apply the lubricant to the labia.

A nurse in the pediatrician's office is providing teaching to a parent of a 24-month-old child who has been diagnosed with muscular dystrophy (MD). Drag words from the choices below to fill in each blank in the following sentence. The nurse educates the parent regarding their child's risk for developing___________________ and________________________

-respiratory infections -cardiomyopathy

The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much supplement should the mother administer to the child each day? Record your answer using one decimal place.

1 Explanation: The supplement has 5 mcg of vitamin D in each 0.5 ml. The child is supposed to receive 10 mcg each day of supplemental vitamin D.Desired/Have x Quantity = dose 10 mcg/5 mcg x 0.5 ml = 1.0 mL Ratio/proportion: 0.5 mL/5 micrograms = x/10 micrograms = 1.0 ml

A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.

13.3 Explanation: The nurse will divide the number of doses per day into the total amount prescribed for each day. 40 mg ÷ 3 doses = 13.3 mg/dose

A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition?

A 13-year-old boy who is on his school's cross-country team Explanation: Osgood-Schlatter disease is the thickening and enlargement of the tibial tuberosity resulting from microtrauma, probably caused from overuse. It occurs more often in boys than girls and at preadolescence or early adolescence, probably because of rapid growth at these times

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Explanation: Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

When assisting parents in a home care plan for a child with Legg-Calvé-Perthes disease (LCPD), the nurse would teach the parents that which is anticipated?

A non-weight-bearing period initially occurs. Explanation: Resting the affected femoral epiphysis aids healing

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated?

Advise the child that this is to be expected. Explanation: Plaster becomes hot as it sets. Even with fiberglass casts, there will be a warm feeling inside the cast when it is drying. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, the nurse should notify the health care provider. Infection would not present in this way with a cast application. A cast should not be moistened. If it does become wet, the cast should be dried with a hair dryer. There are some newer types of casts which can get wet but the nurse should know this before applying any moisture.

The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?

Assess the popliteal region carefully for skin breakdown. Explanation: The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care

A teenager has been admitted to the hospital with respiratory complications related to Duchenne muscular dystrophy. How can the nurse best provide support for the parents, who are the caretakers of this adolescent?

Assume responsibility for the teen's daily care while accepting input from parents and the teen. Explanation: The parents have probably been caring daily for their son for longer than 10 years while his condition has deteriorated and his care has become more complex. They may use this hospitalization as an opportunity to be relieved briefly of some of this responsibility (respite). Chest PT and rooming-in are important but do not address the need for respite.

The nurse is caring for an 8 year old in skeletal traction for a fractured femur. Which type of traction would be communicated in the shift hand-off?

Balanced suspension traction Explanation: Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Examples of skeletal traction are 90-degree traction and balanced suspension traction. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck's extension traction, and Russell traction

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 Explanation: By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Explanation: Duchenne muscular dystrophy is the most common of several muscular dystrophies and is a progressive, fatal disorder. It involves mainly skeletal muscles, but other muscles are affected over time. Onset occurs in early childhood. The disorder is X-linked recessive. An enzyme is lacking that is necessary for the maintenance of muscle cells. No structural abnormalities of the spinal cord or peripheral nerves are noted

The nurse is caring for an extremely active 13-year-old adolescent who has recently been prescribed a back brace to treat scoliosis. Which intervention will be most critical to the success of treatment?

Emphasize and encourage compliance related to the use of a back brace. Explanation: Encouraging and emphasizing compliance with the treatment regimen will ultimately be most critical. The brace is intended to prevent the progression of the curve and must be worn 23 hours per day. Compliance with this is sometimes difficult with adolescents because peer pressure is very important as well as the need to be like all their friends. Educating the parents about scoliosis, showing the adolescent how to use the brace, and listening to the adolescent's concerns are also important. But in the end, the most important factor is that the adolescent wears the brace according to the treatment plan.

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. Explanation: The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing?

Head lag when pulled from supine to sitting Explanation: Head lag in the child requires referral. By 4 to 5 months, the infant should be able to maintain the head in a neutral position. The other assessment findings are normal for age, indicating no need for referral

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 Explanation: Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

A nurse is caring for an infant with spinal muscle atrophy (SMA) type 1. What will the nurse include in the plan of care for the infant?

Instruct the parents on performing the technique of chest percussion. Explanation: Spinal muscle atrophy (SMA) type 1 is also known as Werdnig-Hoffmann disease and infantile SMA. It is the most severe of the three types. This disease is autosomal recessive and affects the ability of spinal nerves to communicate with muscle, eventually leading to atrophy. Type 1 progresses rapidly to early childhood death, usually from respiratory complications. Chest percussion assists in decreasing pulmonary complications. Mobility would be encouraged through the use of therapy, range-of-motion, and orthotics. The child's diet would be age-appropriate and balanced to prevent dehydration and impaired growth. Carbohydrate balance is not specific to this disease. Intravascular hemorrhages are a concern for a child diagnosed with cerebral palsy

Which characteristic is true of cerebral palsy?

It appears at birth or during the first 2 years of life. Explanation: Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are intellectually disabled, many have normal intelligence

A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?

Muscular wasting results in generalized immobility and difficulty feeding and breathing. Explanation: SMA type 1 is the most severe form of spinal muscle atrophy that results in muscle wasting, generalized immobility and difficulty feeding. This is an autosomal recessive genetic disorder that affects motor but not cognitive development. SMA type 1 has a rapid progression; these infants do not usually live past 2 years of age. Infants diagnosed with SMA type 1 will not sit unassisted and will not walk. Physical therapy is beneficial in strengthening some muscles, especially in those with the less severe SMA types 2, 3 or 4

The nurse meets a child with a slipped capital femoral epiphysis. In what type of child does this usually occur?

Obese adolescent boys Explanation: A slipped capital epiphyseal femur injury occurs when the femoral head dislocates from the neck and the shaft of the femur at the level of the epiphyseal plate. The epiphysis slips downward and backward. This occurs in boys aged 9 to 16 years who are sedentary and overweight. It is thought that with a teenage growth spurt the femoral head weakens and is less resistant to stressors. Hormones are also thought to play a role. This problem is generally not seen in girls or children who are active

A nurse is caring for a 10-year-old who is in skeletal traction following injuries sustained in a car accident. Which statement accurately describes a recommended nursing measure for this type of traction?

Perform pin-site care on a daily or weekly basis after the first 48 to 72 hours. Explanation: At sites with mechanically stable bone-pin interfaces, pin-site care should be done on a daily or weekly basis (after the first 48 to 72 hours). The nurse should never remove or add traction weights without specific physician orders, or allow weights to touch the floor or drag on the bed parts; weights should hang free. A chlorhexidine 2 mg/ml solution may be the most effective cleansing solution for pin care

A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment?

Quietly observe the child at play while interviewing the parent. Explanation: The best way to assess a young child's neuromuscular system is to observe the child from a distance. Observing the child at play will allow the nurse to assess the child's gross and fine motor skills, as well as cognitive abilities. Asking the parent to describe the child's motor development may be appropriate in some cases such as the ability to feed. Getting down to the child's level may help assess the child's social development but observing the child play at a distance is best to assess a child's fine and gross motor development. Reviewing the child's history will give the nurse a sense of the child's past developmental level but will not give information about the child's current status.

The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this?

The boy rises from the floor by walking his hands up his legs. Explanation: Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand. The other options do not describe Gowers' sign, although lordosis is often a manifestation of Duchenne muscular dystrophy

The nurse is observing a child walk downstairs using a swing-through gait. What action by the child is correct?

The child places the crutches on the lower step before placing the good foot down between the crutches. Explanation: To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs

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. Explanation: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction

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 Explanation: Diagnosis of scoliosis is best made with inspection and observation. When inspecting the back with the child in a standing position, the nurse should note asymmetries such as shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. A lateral curvature of the spine is best revealed when the child bends forward. The child should bend forward with the arms hanging freely. The curve and asymmetry of the back can be observed. The height of the iliac crest, not the angle, is measured on both sides and the difference is noted. Bending to the side would not provide an accurate assessment of the spine because the curvature cannot be seen from the side. The lower chest angle would not be an accurate assessment as it would be more associated with the ribs as opposed to the spine.

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected?

Trendelenburg gait Explanation: The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. a) Color b) Sensation c) Pulse d) Capillary refill e) Vital signs

a) Color b) Sensation c) Pulse d) Capillary refill Explanation: A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment

The nurse is caring for a child requiring a cast. The mother asks why the doctor is recommending a fiberglass cast when it is more expensive. What information should the nurse share with the mother? Select all that apply a) Fiberglass casts are lighter in weight than plaster casts." b) They can be waterproof when a special liner is used." c) Kids like them because they come in different colors." d) Fiberglass casts are typically used when the casts need to be changed often." e) Casts made out of fiberglass take longer to dry."

a) Fiberglass casts are lighter in weight than plaster casts." b) They can be waterproof when a special liner is used." c) Kids like them because they come in different colors."

What methods can a nurse use to evaluate extremity function in an 18-month-old? Select all that apply. a) Ask the child to squeeze the nurse's fingers simultaneously. b) Observe the child in developmentally appropriate play. c) Elicit from the parent a description of fine and gross motor activities. d) Have the child push against resistance with both feet. e) Look for symmetric motion in the arms and legs.

b) Observe the child in developmentally appropriate play. c) Elicit from the parent a description of fine and gross motor activities. e)Look for symmetric motion in the arms and legs.

The nurse is teaching the parents of a preschool-age child with cerebral palsy about the upcoming surgery that is planned for the child to help control their spasticity. The nurse tells the parents that the surgeon will be inserting which item in their child during this procedure?

baclofen pump Explanation: A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practitioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal?

development of gross motor movement Explanation: Physical therapy focuses on assisting in the development of gross motor movements, such as walking and positioning, and helps the child develop independent movement. Occupational therapy assists in the development of fine motor skills and fashioning orthotics and splints. Occupational therapy assists the child in performing optimal self-care ability by working on skills such as activities of daily living. Speech therapy assists with feeding techniques for the child who has swallowing problems

A nurse is conducting a physical examination of an infant with suspected metatarsus adductus. Type II metatarsus adductus is indicated when the forefoot is:

flexible passively past neutral, but only to midline actively. Explanation: In type II metatarsus adductus, the forefoot is flexible passively past neutral, but only to midline actively. The forefoot is flexible past neutral actively and passively in type I. The forefoot is rigid, does not correct to midline even with passive stretching in type III. An inverted forefoot turned slightly upward is indicative of clubfoot (congenital talipes equinovarus).

Muscular dystrophy is a result of which cause?

gene mutation Explanation: Muscular dystrophy is a result of a gene mutation. It isn't from a chromosome aberration or environmental factors. It's genetic and there is a known origin of the disease.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?

latex Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group

Which of these strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy?

long leg braces Explanation: Long leg braces are functional assistive devices that provide increased independence and increased use of upper and lower body strength. Wheelchairs, both motorized and manual, provide less independence and less use of upper and lower body strength. Walkers are functional assistive devices that provide less independence than braces.

The child diagnosed with muscular dystrophy often exhibits a forward curvature of the lumbar spine. What is this spinal condition called?

lordosis Explanation: Lordosis, a forward or inner curvature of the lumbar spine or swayback, is seen by school age in the child with muscular dystrophy. Kyphosis is also referred to as hunchback and demonstrates an outward curvature of the upper spine. Scoliosis is a sideways curvature of the spine. Synovitis is the inflammation of the synovial membrane, which can result in pain when moving an affected joint.

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking. Explanation: A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as:

syndactyly. Explanation: Syndactyly refers to webbing of the fingers and toes. Polydactyly refers to the presence of extra digits on the hand or foot. Metatarsus adductus is a medial deviation of the forefoot. Pectus carinatum is a protuberance of the chest wall.