Question 1

The nurse is caring for a school-age child diagnosed with juvenile idiopathic arthritis (JIA).Which intervention should be a priority?

Accepted Answer

The management of JIA is primarily pharmacologic.The family should be instructed regarding administration of medications and the value of regular schedule of administration to maintain a satisfactory blood level in the body.They need to know that NSAIDs should not be given on an empty stomach and to be alert for signs of toxicity.Warm moist heat is best for relieving stiffness and pain.Acetaminophen does not have antiinflammatory effects.Range-of-motion exercises should not be done during periods of inflammation.

Question 2

The nurse is taking care of an adolescent with osteosarcoma.The parents ask the nurse about treatment.The nurse should make which accurate response about treatment for osteosarcoma?

Accepted Answer

The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy.Intensive irradiation and bone marrow transplantation are usually not part of the therapeutic management.

Question 3

An adolescent with juvenile idiopathic arthritis (JIA)is prescribed abatacept (Orencia).Which should the nurse teach the adolescent regarding this medication? (Select all that apply.)

Accepted Answer

Abatacept reduces inflammation by inhibiting T cells and is given intravenously every 4 weeks.Possible side effects of biologics include an increased infection risk.Because of the infection risk,children should be evaluated for tuberculosis exposure before starting these medications.Live vaccines should be avoided while taking these agents.

Question 4

A school-age child is diagnosed with systemic lupus erythematosus (SLE).The nurse should plan to implement which interventions for this child? (Select all that apply.)

Accepted Answer

Key issues for a child with SLE include therapy compliance; body-image problems associated with rash,hair loss,and steroid therapy; school attendance; vocational activities; social relationships; sexual activity; and pregnancy.Specific instructions for avoiding exposure to the sun and UVB light,such as using sunscreens,wearing sun-resistant clothing,and altering outdoor activities,must be provided with great sensitivity to ensure compliance while minimizing the associated feeling of being different from peers.The child should continue school attendance in order to gain interaction with peers and activity should not be restricted,but promoted.

Question 5

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia.Which assessment findings indicate possible compartment syndrome? (Select all that apply.)

Accepted Answer

Indications of compartment syndrome are severe pain not relieved by analgesics,tingling of extremity,and inability to move extremity.A palpable distal pulse and capillary refill to the extremity less than 3 seconds are expected findings.

Question 6

The nurse is taking care of an adolescent diagnosed with kyphosis.Which describes this condition?

Accepted Answer

Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine.Scoliosis is a complex spinal deformity usually involving lateral curvature,spinal rotation causing rib asymmetry,and thoracic hypokyphosis.Ankylosis is the immobility of a joint.Lordosis is an exaggerated concave lumbar curvature of the spine.

Question 7

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure.Which consideration should the nurse include?

Accepted Answer

Luque-rod segmental spinal instrumentation is a surgical procedure.Nasogastric intubation and urinary catheterization may be required.Ambulation is allowed as soon as possible.Depending on the instrumentation used,most patients walk by the second or third postoperative day.Casting and bracing are required postoperatively.The child usually has considerable pain for the first few days after surgery.Intravenous opioids should be administered on a regular basis.

Question 8

A school nurse is conducting a staff in-service to other school nurses on idiopathic scoliosis.During which period of child development does idiopathic scoliosis become most noticeable?

Accepted Answer

Idiopathic scoliosis is most noticeable during the preadolescent growth spurt.Idiopathic scoliosis is seldom apparent before age 10 years.Diagnosis usually occurs during the preadolescent growth spurt.

Question 9

A clinic nurse is conducting a staff in-service for other clinic nurses about signs and symptoms of a rhabdomyosarcoma tumor.Which should be included in the teaching session? (Select all that apply.)

Accepted Answer

The initial signs and symptoms of rhabdomyosarcoma tumors are related to the site of the tumor and compression of adjacent organs.Some tumor locations,such as the orbit,manifest early in the course of the illness.Other tumors,such as those of the retroperitoneal area,only produce symptoms when they are relatively large and compress adjacent organs.Unfortunately,many of the signs and symptoms attributable to rhabdomyosarcoma are vague and frequently suggest a common childhood illness,such as "earache" or "runny nose." An abdominal mass,sore throat and ear pain,and ecchymosis of conjunctiva are signs of a rhabdomyosarcoma tumor.Bone fractures would be seen in osteosarcoma and a headache is a sign of a brain tumor.

Question 10

A nurse is conducting a staff in-service on childhood cancers.Which is the primary site of osteosarcoma?

Accepted Answer

Osteosarcoma is the most frequently encountered malignant bone cancer in children.The peak incidence is between ages 10 and 25 years.More than half occur in the femur.After the femur,most of the remaining sites are the humerus,tibia,pelvis,jaw,and phalanges.

Question 11

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)?

Accepted Answer

NSAIDs are the first drugs used in JIA.Naproxen,ibuprofen,and tolmetin are approved for use in children.Aspirin,once the drug of choice,has been replaced by the NSAIDs because they have fewer side effects and easier administration schedules.Corticosteroids are used for life-threatening complications,incapacitating arthritis,and uveitis.Methotrexate is a second-line therapy for JIA.

Question 12

An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days.The nurse's approach should include which action?

Accepted Answer

Honesty is essential to gain the child's cooperation and trust.The diagnosis of cancer should not be disguised with falsehoods.The adolescent should be prepared for the surgery so he or she has time to reflect on the diagnosis and subsequent treatment.This allows questions to be answered.To accept the need for radical surgery,the child must be aware of the lack of alternatives for treatment.Amputation is necessary,but it will not guarantee a cure.Chemotherapy is an integral part of the therapy with surgery.The child should be informed of the need for chemotherapy and its side effects before surgery.

Question 13

The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy.The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing "phantom limb pain." Which prescribed medication is appropriate to administer to relieve phantom limb pain?

Accepted Answer

Amitriptyline (Elavil)has been used successfully to decrease phantom limb pain.Opioids such as Vicodin or OxyContin would not be prescribed for this pain.A benzodiazepine,Xanax,would not be prescribed for this type of pain.

Question 14

The nurse is taking care of a 10-year-old child who has osteomyelitis.Which treatment plan is considered the primary method of treating osteomyelitis?

Accepted Answer

Osteomyelitis is an infection of the bone,most commonly caused by Staphylococcus aureus.The treatment of choice is antibiotics.Joint replacement,bracing and casting,and long-term corticosteroid therapy are not indicated for infectious processes.

Question 15

The nurse is caring for a 12-year-old child with a left leg below the knee amputation (BKA).The child had the surgery 1 week ago.Which intervention should the nurse plan to implement for this child?

Accepted Answer

Use of the overhead bed trapeze should be encouraged to begin to build up the arm muscles necessary for walking with crutches.Stump elevation may be used during the first 24 hours,but after this time,the extremity should not be left in this position because contractures in the proximal joint will develop and seriously hamper ambulation.Ice would not be an appropriate intervention and would decrease circulation to the stump.Stump shaping is done postoperatively with special elastic bandaging using a figure-eight bandage,which applies pressure in a cone-shaped fashion.This technique decreases stump edema,controls hemorrhage,and aids in developing desired contours so the child will bear weight on the posterior aspect of the skin flap rather than on the end of the stump.This wrap should not be replaced with a gauze dressing.

Question 16

A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI).Further teaching is indicated if the parents make which statement?

Accepted Answer

The treatment for OI is primarily supportive.Although patients and families are optimistic about new research advances,there is no cure.The use of bisphosphonate therapy with IV pamidronate to promote increased bone density and prevent fractures has become standard therapy for many children with OI; however,long bones are weakened by prolonged treatment.Infants and children with this disorder require careful handling to prevent fractures.They must be supported when they are being turned,positioned,moved,and held.Even changing a diaper may cause a fracture in severely affected infants.These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows.Follow-up appointments for treatment with bisphosphonate can be expected.

Question 17

The nurse is caring for an infant with developmental dysplasia of the hip.Which clinical manifestations should the nurse expect to observe? (Select all that apply.)

Accepted Answer

A positive Ortolani test and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months.Unequal gluteal folds,negative Babinski sign,and Trendelenburg sign are signs that appear in older infants and children.Telescoping of the affected limb and lordosis are not clinical manifestations of developmental dysplasia of the hip.

Quiz 31: The Child with Musculoskeletal or Articular Dysfunction

The nurse is caring for a school-age child diagnosed with juvenile idiopathic arthritis (JIA) .Which intervention should be a priority?

The nurse is taking care of an adolescent with osteosarcoma.The parents ask the nurse about treatment.The nurse should make which accurate response about treatment for osteosarcoma?

An adolescent with juvenile idiopathic arthritis (JIA) is prescribed abatacept (Orencia) .Which should the nurse teach the adolescent regarding this medication? (Select all that apply.)

A school-age child is diagnosed with systemic lupus erythematosus (SLE) .The nurse should plan to implement which interventions for this child? (Select all that apply.)