Question 1

An infant has just returned from surgery for correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The toes on both feet are edematous, but there is color, sensitivity, and movement to them. What should the nurse do first?

Accepted Answer

Elevating the infant's legs on pillows will promote circulation and reduce edema. Applying a warm, moist pack could lead to increased swelling, and encouraging movement of the toes may be painful for the infant. Calling the physician to report the edema may be necessary, but not the first action needed.

Question 2

The nurse has completed parent education related to treatment for a child with congenital clubfoot. The nurse knows that parents need further teaching when they state:

Accepted Answer

Congenital clubfoot requires a series of casts and sometimes bracing over a period of several months to correct. Therefore, it is unlikely that only one cast will be needed. The parents need further education on the treatment process.

Question 3

An adolescent has just returned from surgery after spinal fusion surgery. Which assessment finding would take priority at this time?

Accepted Answer

Impaired color, sensitivity, and movement to lower extremities could indicate nerve damage or circulation problems, which would require immediate medical attention to prevent further complications. Sleep, nausea, and pain are common side effects after surgery and can be managed with medication and close monitoring.

Question 4

A child has experienced a sprain of the right ankle. The school nurse should:

Accepted Answer

Applying ice to the sprained ankle will help reduce inflammation and swelling. It is recommended to apply ice for 20 minutes at a time and repeat every few hours for the first 24-48 hours after the injury.

Question 5

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat congenital developmental dysplasia of the hip. Which instruction is appropriate for the nurse to include in parental education in relation to the Pavlik harness?

Accepted Answer

Parents should check for red areas under the straps to prevent skin irritation and ensure proper fit.

Question 6

An infant returns to the unit following casting of the leg for talipes equinovarus. Standing orders include monitoring the neurovascular status. In addition to color, for what will the nurse monitor the infant's foot?

Accepted Answer

The answer of An infant returns to the unit following...

Question 7

A six-year-old boy is admitted to the hospital with a diagnosis of osteomyelitis of the left femur. The plan of care includes a two-week round of intravenous antibiotics. The father questions why the child must be hospitalized and why the child cannot receive oral antibiotics. The nurse explains:

Accepted Answer

Blood flow to bones is limited, and parenteral administration is necessary to get appropriate blood levels.

Question 8

An 18-month-old child is admitted to the hospital unit for weakness of the lower extremities. Duchenne muscular dystrophy is suspected. Which assessment finding on the admission history and physical is indicative of this disorder?

Accepted Answer

Duchenne muscular dystrophy often presents with pseudohypertrophy of the calf muscles, making the child appear very muscular, especially in the early stages of the disease. This is due to fibrofatty infiltration of muscle tissue, not an actual increase in muscle strength.

Question 9

The nurse has completed discharge teaching for the family of a child diagnosed with Legg-Calvé-Perthes disease. The nurse knows further teaching is needed about the condition if the family states:

Accepted Answer

Legg-Calvé-Perthes disease can take 6 months to 2 years to fully heal, not 6 weeks. This statement indicates the family may not have fully understood the severity of the disease and the necessary treatment duration.

Question 10

While at recess, a child falls and hurts his arm. The school nurse is called and suspects a fractured arm. The nurse will apply a splint before transporting the child to the hospital. The nurse will ensure that:

Accepted Answer

The joints above and below the suspected fracture must be immobilized to prevent movement that could worsen the fracture. Option A is incorrect because the splint should not be applied firmly enough to prevent swelling as this can cause additional pressure and pain. Option B is incorrect because the arm should not be fully extended, as this could cause unnecessary stress on the affected area. Option C is incorrect because while the splint should be padded, it does not need to be fully padded to prevent skin damage.

Question 11

A nurse is assessing a child after an open reduction of a fractured femur. Which signs indicate that compartment syndrome could be occurring?

Accepted Answer

Compartment syndrome is a serious condition that occurs when there's increased pressure within the muscles, potentially leading to muscle and nerve damage as well as problems with blood flow. Signs of compartment syndrome include prolonged capillary refill time (indicating poor blood flow), pain that is not relieved by medication (due to the pressure and lack of adequate blood supply to the affected tissues), and paresthesia of the leg (a sensation of tingling, tickling, prickling, pricking, or burning of a person's skin with no apparent long-term physical effect, indicating nerve involvement).

Question 12

A school health nurse is screening for scoliosis. For what assessment findings would the nurse look?

Accepted Answer

Scoliosis is characterized by an abnormal lateral curvature of the spine, often identified through a prominent scapula, a one-sided rib hump, and uneven shoulders and hips during physical examination.

Question 13

Which of the following would take priority when teaching the family how to care for an infant with osteogenesis imperfecta?

Accepted Answer

Supporting the trunk and extremities is essential for infants with osteogenesis imperfecta, as their bones are more prone to fractures. While the other options may also be relevant in certain situations, caring for an infant with osteogenesis imperfecta involves constant attention to supporting the body to prevent fractures.

Question 14

A child must wear a brace for correction of scoliosis. Which nursing diagnosis takes priority at this time?

Accepted Answer

Wearing a brace for scoliosis can lead to pressure points and restricted movement, increasing the risk for impaired skin integrity due to potential skin breakdown and irritation.

Question 15

The nurse in the newborn nursery is doing the admission assessment on a neonate. Which assessment finding would lead the nurse to suspect unilateral congenital hip dysplasia?

Accepted Answer

Asymmetry of the gluteal and thigh fat folds is a classic sign of unilateral congenital hip dysplasia. Lordosis is an exaggerated anterior curvature of the lumbar spine that is not specific to hip dysplasia. Trendelenburg sign is typically associated with weakness of the hip abductor muscles and is not specific to hip dysplasia. Telescoping of the affected limb is a sign of developmental dysplasia of the hip (DDH), which can be associated with hip dysplasia, but it is not specific to unilateral congenital hip dysplasia.

Question 16

A two-year-old child is placed in balanced Bryant's traction for a fractured right femur. Which finding by the nurse should be reported to the surgeon?

Accepted Answer

In balanced Bryant's traction, it is essential that the child's buttocks do not rest on the bed to ensure proper traction and alignment of the fractured femur. If the child's buttocks are resting on the bed, it indicates that the traction is not applied correctly, which could impede healing or cause further injury.

Question 17

When assigned to the patient on complete bed rest for spinal fusion secondary to scoliosis, the nurse will want to intervene to prevent common complications of immobility. Nursing interventions will include:

Accepted Answer

A) Using a spirometer every two hours while awake helps prevent respiratory complications like pneumonia by encouraging deep breathing and keeping the airways clear.B) Log-rolling the patient every two hours helps prevent pressure ulcers and maintains spinal alignment after surgery, which is crucial for recovery from spinal fusion.D) Increasing fruits and grains in the diet helps prevent constipation, a common issue due to reduced mobility and the use of pain medications that can slow the bowel.

Quiz 57: The Child With Alterations in Musculoskeletal Function