Question 1

A child in the intensive care unit with tetanus will be receiving a neuromuscular blocking agent.Which intervention takes priority for this child?

Accepted Answer

The child receiving a neuromuscular blocking agent is completely paralyzed and needs ventilator support.Proper care is important to prevent pneumonia.Monitoring urinary output and turning the patient are important,but do not take priority over breathing.The child needs a quiet environment free of excess stimulation.

Question 2

A home health-care nurse is visiting a child with Duchenne's muscular dystrophy (MD).The child has a new cough,poor appetite,fatigue,and a reddened area on his coccyx from sitting in his wheelchair all day.What intervention by the nurse takes priority?

Accepted Answer

All actions are appropriate; however,children with MD usually die of respiratory infections,so aggressive treatment at the first sign of a respiratory infection is warranted.The nurse should notify the health-care provider and request antibiotics.

Question 3

A child has just been diagnosed with juvenile arthritis (JA).The parents want to know what caused this to happen.Which statement by the nurse is the most appropriate?

Accepted Answer

JA is an autoimmune,inflammatory process often thought to be triggered by an infection.The etiology is not genetic,caused by latent infections,or completely unknown.

Question 4

A new nurse is placing an elastic wrap on a patient with an ankle sprain.Which action by this nurse causes an experienced nurse to intervene?

Accepted Answer

When using an elastic wrap,start wrapping distal to the injury,work up over the injury,and end the wrapping proximal to the injury.The other actions are correct.

Question 5

A child is 3 hours postoperative,having had an open reduction and internal fixation (ORIF)of a type IV tibial fracture,which is now also casted.Which action by the nurse takes priority?

Accepted Answer

After surgery and/or casting,it is vital to assess neurovascular status,which is usually done with postoperative vital signs.Excessive swelling can disrupt circulation to the extremity,so the nurse assesses the child's neurovascular status frequently.Applying ice is also a good intervention,but not for more than 15 minutes at a time.When the child is tolerating oral foods and fluids,the nurse can switch to pain pills from IV narcotics.Teaching is important,but not as important as preventing injury from complications.

Question 6

A teen has a scoliosis curve of 35°.What treatment option does the nurse prepare the child and family for?

Accepted Answer

A curve of 35°is considered mild scoliosis.Bracing is the treatment of choice at this point.Continued screening is inappropriate,as the child has scoliosis.Research has shown that exercise alone does not improve outcomes.Surgical intervention is reserved for more serious cases.

Question 7

A student athlete has a serious anterior cruciate ligament (ACL)tear,and her knee is swollen with excess synovial fluid.Which procedure does the nurse prepare this athlete for?

Accepted Answer

The health-care provider will remove excess synovial fluid via aspiration.Heat is not used for the first 24 hours.Immediate surgery may or may not be warranted.A knee reduction is performed for a dislocated knee.

Question 8

The parents of a child recently diagnosed with Duchenne's muscular dystrophy want to know if their infant twin daughters should be tested for the disease too.Which response by the nurse is the most appropriate?

Accepted Answer

Duchenne's muscular dystrophy is a sex-linked recessive disease that usually only affects males.Females with Turner's syndrome,in which the child only inherits one X chromosome from the mother,can be affected,but females are usually carriers. The infant twin daughters do not need to be tested.

Question 9

A nurse is caring for a child with Duchenne's muscular dystrophy (MD).The child's creatinine kinase level has dropped by over half since it was last measured.What assessment finding correlates with these results?

Accepted Answer

Early in MD creatinine kinase levels are elevated.As muscle wasting occurs and muscle bulk diminishes,creatinine kinase levels will drop.A finding of decreased muscle strength correlates with the laboratory results.

Question 10

A nurse is caring for an 8-year-old child hospitalized 2 days after open reduction and internal fixation (ORIF)of a femur fracture sustained in a motor vehicle crash.The child is now in a long-leg cast. Which assessment finding prompts the nurse to notify the health-care provider?

Accepted Answer

A foul odor coming from the cast may indicate an infection at the surgical site or at the fracture site.The nurse should notify the health-care provider.Loss of appetite may be from several causes: fatigue,stress,side effect of medications,dislike of hospital food,loss of industry (child is in Erikson's stage of industry vs.inferiority),trying to regain some control,pain,or fear of pain.The nurse needs to assess this situation further to determine the cause of this issue.Old drainage would not be worrisome; if the drainage continues to increase,the nurse should notify the health-care provider.At 2 days since surgery,wanting pain medication every 4 hours is not unreasonable.

Question 11

A child is going home with a distractor in place after surgery to repair syndactyly.Which discharge teaching is most important?

Accepted Answer

The distractor uses pins placed in the bone fragments that extend through the skin.The parents need to care for the pins using soap and water to clean around the exit sites.The pins need to be removed surgically; they will not fall out on their own.Because the bones are pinned,range of motion is not possible.The Allen wrench is used to turn the screw on the distractor twice a week.

Question 12

A nurse is caring for a child who had an open reduction and internal fixation (ORIF)of a femur fracture 12 hours ago.The nurse finds the child pale and short of breath.What action by the nurse takes priority?

Accepted Answer

This child appears to be experiencing a complication of fracture,which may include shock,fat embolism,deep vein thrombosis,pulmonary embolism,and infection.Shortness of breath should alert the nurse to a respiratory complication as a first priority.The nurse should have a coworker call the physician while obtaining other assessment data,including oxygen saturation,vital signs,and a respiratory assessment.Although it is possible that a postoperative hemoglobin and hematocrit are low enough that the child is experiencing shock,the priority steps in assessing and intervening are airway,breathing,and circulation (ABCs),so breathing comes before circulation.The child may have pain or anxiety,but these are not the priority.Raising the head of the bed may or may not be helpful,but the nurse first needs to assess oxygen saturation.

Question 13

The parents of a 3-year old cannot understand how their child has developed osteoporosis,stating "We didn't think children could get this disease." Which assessment by the nurse is most important?

Accepted Answer

Very-low-birth-weight and premature infants are at risk for developing osteoporosis because bone mass is acquired during the last weeks of pregnancy.If this child were born prematurely,that could explain the osteoporosis.Attaining milestones and height and weight are not the priority (height loss is possible with multiple fractures in older children).Although teens can develop osteoporosis from dietary deficiency of calcium and vitamin D,it is highly unlikely that a 3-year-old would have osteoporosis from this situation.

Question 14

A 4-year-old child is recovering from a modified Nuss procedure.Which is the priority intervention by the nurse?

Accepted Answer

The modified Nuss procedure is an open chest reconstruction for severe cases of pectus excavatum.Preventing pneumonia is a critical nursing action.Because this child is too young to use an incentive spirometer,"playing" with him or her using bubbles,pinwheels,or paper triangles the child can blow across the table accomplishes pulmonary hygiene.The other activities are important postoperative nursing interventions,but are not specific to this operation.

Question 15

An 8-month-old child with congenital myotonic dystrophy has been hospitalized with a severe respiratory infection.Which action by the nurse is the most appropriate?

Accepted Answer

Congenital myotonic dystrophy usually causes death before the age of 1 year due to the inability to maintain respirations.In this situation,the nurse should have a meeting with the family to explore a broad range of therapeutic options,including palliative care measures and code status.Just inquiring about ventilatory support is too narrow a focus.Lung transplantation is not a treatment for this disorder.Children with this disease die at a young age,and so they do not grow up dependent on ventilators.

Question 16

A child has been hospitalized with suspected osteomyelitis.The child's white blood cell count (WBC)is 22,000/mm³ and his C-reactive protein is 15 mg/dL.Which conclusion by the nurse is appropriate based on these laboratory values?

Accepted Answer

Elevations in WBCs and C-reactive protein indicate an infection is present,but are not specific for any one kind of infection.

Question 17

A 5-year-old child is hospitalized with osteomyelitis and will be going home in the next few days on intravenous (IV)antibiotics.Which action by the nurse is the most appropriate?

Accepted Answer

A child going home on IV antibiotics will need a PICC line inserted for home infusion therapy.The nurse should ensure that a consent for this procedure is on the chart.Researching pharmacies and infusion companies can be done by the social worker.Teaching the child with a doll is appropriate,but does not take priority over legal responsibilities.

Question 18

An infant hospitalized with multiple fractures has just been diagnosed with osteogenesis imperfecta.The nurse finds the parents crying.Which response by the nurse is the most appropriate?

Accepted Answer

Causing more injury to their child is a common concern among parents of children with osteogenesis imperfecta.The nurse needs to show them how to hold,change,feed,and play with their babies.In this situation,the caring nurse offers to help the parents learn to hold their baby and offers support.The nurse should never assume to know how someone else is feeling.Medications will not help this child lead a normal life.Stating that the parents are lucky is belittling their feelings.

Question 19

A child in traction is having muscle spasms.Which medication does the nurse prepare to administer?

Accepted Answer

Diazepam is a muscle relaxant and is used to treat muscle spasms.The other medications are for pain.

Question 20

The pediatric nurse is caring for a child recently diagnosed with transient synovitis of the hip.Which medication order is most appropriate for this child?

Accepted Answer

This disorder is treated with NSAIDs.Acetaminophen is not an NSAID,although the dose listed is a safe dose.Prednisone is also not an NSAID,although the dose listed is a safe dose. Ibuprofen and Naproxen are both NSAIDs.The dose of ibuprofen is correct; the safe dose for naproxen is 10-15 mg/kg/dose every 12 hours.

Quiz 29: Caring for the Child With a Musculoskeletal Condition

A child in the intensive care unit with tetanus will be receiving a neuromuscular blocking agent.Which intervention takes priority for this child?

A home health-care nurse is visiting a child with Duchenne's muscular dystrophy (MD) .The child has a new cough,poor appetite,fatigue,and a reddened area on his coccyx from sitting in his wheelchair all day.What intervention by the nurse takes priority?

A child has just been diagnosed with juvenile arthritis (JA) .The parents want to know what caused this to happen.Which statement by the nurse is the most appropriate?

A new nurse is placing an elastic wrap on a patient with an ankle sprain.Which action by this nurse causes an experienced nurse to intervene?

A child is 3 hours postoperative,having had an open reduction and internal fixation (ORIF) of a type IV tibial fracture,which is now also casted.Which action by the nurse takes priority?

A teen has a scoliosis curve of 35°.What treatment option does the nurse prepare the child and family for?

A student athlete has a serious anterior cruciate ligament (ACL) tear,and her knee is swollen with excess synovial fluid.Which procedure does the nurse prepare this athlete for?

The parents of a child recently diagnosed with Duchenne's muscular dystrophy want to know if their infant twin daughters should be tested for the disease too.Which response by the nurse is the most appropriate?

A nurse is caring for a child with Duchenne's muscular dystrophy (MD) .The child's creatinine kinase level has dropped by over half since it was last measured.What assessment finding correlates with these results?

A nurse is caring for an 8-year-old child hospitalized 2 days after open reduction and internal fixation (ORIF) of a femur fracture sustained in a motor vehicle crash.The child is now in a long-leg cast. Which assessment finding prompts the nurse to notify the health-care provider?