Question 1

The nurse is conducting preoperative teaching to parents and their child about an external fixation device. What should the nurse include in the teaching session? (Select all that apply.)

Accepted Answer

The device is attached surgically by securing a series of external full or half rings to the bone with wires. Children and parents should be instructed in pin care, including observation for infection and loosening of pins. Partial weight bearing is allowed, and the child needs to learn to walk with crutches. Alterations in activity include modifications at school and in physical education. Full weight bearing is not allowed until the distraction is completed and bone consolidation has occurred.

Question 2

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a functional prosthetic device?

Accepted Answer

An infant should be fitted with a functional prosthetic leg when the infant is developmentally ready to pull to a standing position. When the infant begins limb exploration, a soft prosthesis can be used. The child should begin using the prosthesis as part of his or her normal development. This will match the infant's motor readiness.

Question 3

A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long?

Accepted Answer

The approximate healing times for a femoral shaft fracture are as follows: neonatal period, 2 to 3 weeks; early childhood, 4 weeks; later childhood, 6 to 8 weeks; and adolescence, 8 to 12 weeks.

Question 4

The nurse is assisting with application of a synthetic cast on a child with a fractured humerus. What are the advantages of a synthetic cast over a plaster of Paris cast? (Select all that apply.)

Accepted Answer

The advantages of synthetic casts over plaster of Paris casts are that they are less bulky, dry faster, permit regular clothes to be worn, and can be cleaned. Plaster of Paris casts mold readily to a body part, but synthetic casts do not mold easily to body parts.

Question 5

The school nurse recognizes that the adverse effects of performance-enhancing substances can include what? (Select all that apply.)

Accepted Answer

Mood changes have been observed as adverse effects of using performance-enhancing substances, including aggressiveness, changes in libido, depression, anxiety, and psychosis. Fluid retention, not dehydration, and hypertension, not hypotension, are adverse effects of performance-enhancing substances.

Question 6

The nurse is caring for a child immobilized because of Russel traction. What interventions should the nurse implement to prevent renal calculi? (Select all that apply.)

Accepted Answer

To prevent renal calculi in a child who is immobilized, a nurse should monitor output; ensure adequate fluids; and encourage cranberry juice, which acidifies urine. Apple juice and milk alkalize the urine, so they should not be encouraged.

Question 7

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain?

Accepted Answer

Serial casting is begun shortly after birth, before discharge from the nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

Question 8

The nurse is teaching a child with a cast about cast removal. What should the nurse teach the child about cast removal?

Accepted Answer

Cutting the cast to remove it or to relieve tightness is frequently a frightening experience for children. They fear the sound of the cast cutter and are terrified that their flesh, as well as the cast, will be cut. Because it works by vibration, a cast cutter cuts only the hard surface of the cast. The oscillating blade vibrates back and forth very rapidly and will not cut when placed lightly on the skin. Children have described it as producing a "tickly" sensation.

Question 9

The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI). What should the nurse include in the teaching session?

Accepted Answer

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. Bisphosphonate and physical therapy are beneficial for OI. Lightweight braces will be used when the child starts to ambulate.

Question 10

The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE). What clinical manifestations should the nurse expect to observe? (Select all that apply.)

Accepted Answer

Clinical manifestations of SLE include arthralgia, abdominal pain, and glomerulonephritis. Weight loss, not gain, and anemia, not polycythemia, are manifestations of SLE.

Question 11

In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE), what statements should the nurse include? (Select all that apply.)

Accepted Answer

Teaching for an adolescent with SLE should foster adaptation and self-advocacy and include using a moisturizer with an SPF of 30, avoiding pregnancy because it can produce a flare-up, and modifying recreational activities but continuing with daily exercise as an essential part of the treatment plan. The adolescent should continue to receive immunizations as scheduled, should expect to gain weight while on steroid therapy, and would not have a specialized diet.

Question 12

What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)?

Accepted Answer

For a child who is immobilized, circulatory stasis and DVT development are prevented by instructing patients to change positions frequently, dorsiflex their feet and rotate the ankles, sit in a bedside chair periodically, or ambulate several times daily. Elevating the legs or placing a foot cradle on the bed will not prevent DVTs. A pillow under the knee would impair circulation, not improve it.

Question 13

The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA). What clinical manifestations should the nurse expect to observe? (Select all that apply.)

Accepted Answer

Whether single or multiple joints are involved, stiffness, swelling, and loss of motion develop in the affected joints in JIA. The swelling results from soft tissue edema, joint effusion, and synovial thickening. The affected joints may be warm and tender to the touch, but it is not uncommon for pain not to be reported. The limited motion early in the disease is a result of muscle spasm and joint inflammation; later it is caused by ankylosis or soft tissue contracture. Morning stiffness of the joint(s) is characteristic and present on arising in the morning or after inactivity. Erythema is not typical, and a warm, painful, red joint is always suspect for infection.

Question 14

The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what?

Accepted Answer

The common approach to clubfoot management and treatment is the Ponseti method. Serial casting is begun shortly after birth. Weekly gentle manipulation and stretching of the foot along with placement of serial long-leg casts allow for gradual repositioning of the foot. The extremity or extremities are casted until maximum correction is achieved, usually within 6 to 10 weeks. If parents state that this is the only cast the infant will need, they need further teaching.

Question 15

The health care provider has prescribed cyclosporin (Sandimmune) 5 mg/kg/day PO divided twice daily for a child with juvenile arthritis. The child weighs 110 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer in a whole number.
_________

Accepted Answer

The answer of The health care provider has prescribed cyclosporin...

Question 16

The health care provider has prescribed sulfasalazine (Azulfidine) 5 mg/kg PO per dose twice a day for a child with juvenile arthritis. The child weighs 55 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.
________

Accepted Answer

The answer of The health care provider has prescribed sulfasalazine...

Question 17

A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take?

Accepted Answer

During the first few hours after a cast is applied, the chief concern is that the extremity may continue to swell to the extent that the cast becomes a tourniquet, shutting off circulation and producing neurovascular complications (compartment syndrome). One measure to reduce the likelihood of this problem is to elevate the body part and thereby increase venous return. The health care provider does not need to be notified because edema is expected and warm moist packs will not decrease the edema. The child should move the toes, but that will not help reduce the edema.

Question 18

After spinal fusion surgery the nurse should check for signs of what?

Accepted Answer

In addition to the usual postoperative assessments of wound, circulation, and vital signs, the neurologic status of the patient's extremities requires special attention. Prompt recognition of any neurologic impairment is imperative because delayed paralysis may develop that requires surgical intervention.

Question 19

A child has had a short-arm synthetic cast applied. What should the nurse teach to the child and parents about cast care? (Select all that apply.)

Accepted Answer

Cast care involves elevating the arm, observing the fingers for evidence of discoloration, not allowing the child to put anything inside the cast, and examining the skin at the edges of the cast for any breakdown. Ice, not heat, should be applied to relieve itching.

Question 20

The health care provider has prescribed azathioprine (Imuran) 1 mg/kg/day PO for a child with juvenile arthritis. The child weighs 77 lb. The nurse is preparing to administer the daily dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.
_______

Accepted Answer

The answer of The health care provider has prescribed azathioprine...

Quiz 34: The Child with Musculoskeletal or Articular Dysfunction