Child Health - Musculoskeletal.txt

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bamaguh1988
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Child Health - Musculoskeletal.txt
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2015-01-08 17:12:34
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  1. A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 
    1. Administer an analgesic. 
    2. Release the skin traction. 
    3. Apply ice to the extremity. 
    4. Notify the health care provider (HCP).
    4. Notify the health care provider (HCP).
  2. A child is placed in skeletal traction for treatment of a fractured femur. The nurse develops a plan of care and includes which intervention? 
    1. Ensure that all ropes are outside the pulleys. 
    2. Ensure that the weights are resting lightly on the floor. 
    3. Restrict diversional and play activities until the child is out of traction. 
    4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied.
    4. Check the health care provider's (HCP's) prescriptions for the amount of weight to be applied.
  3. A 4-year-old child sustains a fall at home and after an x-ray examination, the child is determined to have a fractured arm and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a need for further instruction? 
    1. "The cast may feel warm as the cast dries." 
    2. "I can use lotion or powder around the cast edges to relieve itching." 
    3. "A small amount of white shoe polish can touch up a soiled white cast." 
    4. "If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast."
    2. "I can use lotion or powder around the cast edges to relieve itching."
  4. The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse should make which response? 
    1. "Avoid all exercise during painful periods." 
    2. "Range-of-motion exercises must be performed every day." 
    3. "Have the child perform simple isometric exercises during this time." 
    4. "Administer additional pain medication before performing range-of-motion exercises."
    3. "Have the child perform simple isometric exercises during this time."
  5. A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse should take which action? 
    1. Administer an antiemetic. 
    2. Increase the intravenous fluids. 
    3. Place the child in a Sims's position. 
    4. Notify the health care provider (HCP).
    4. Notify the health care provider (HCP).
  6. The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? 
    1. "I will encourage my child to perform prescribed exercises." 
    2. "I will have my child wear soft fabric clothing under the brace." 
    3. "I should apply lotion under the brace to prevent skin breakdown." 
    4. "I should avoid the use of powder because it will cake under the brace."
    3. "I should apply lotion under the brace to prevent skin breakdown."
  7. The nurse is assisting a health care provider (HCP) examining an infant with developmental dysplasia of the hip perform an Ortolani maneuver. The nurse understands that this maneuver is performed for which purpose? 
    1. To assess for hip instability 
    2. To assess for movement of the hips 
    3. To push the femoral head out of the acetabulum 
    4. To ensure that hyperextension and full range of motion exist
    1. To assess for hip instability
  8. A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition? 
    1. Limited range of motion in the affected hip 
    2. An apparent lengthened femur on the affected side 
    3. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed 
    4. Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table
    1. Limited range of motion in the affected hip
  9. Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? 
    1. "Treatment needs to be started as soon as possible." 
    2. "I realize my infant will require follow-up care until fully grown." 
    3. "I need to bring my infant back to the clinic in 1 month for a new cast." 
    4. "I need to come to the clinic every week with my infant for the casting."
    3. "I need to bring my infant back to the clinic in 1 month for a new cast."
  10. The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions should be included on the list? Select all that apply. 
    1. Use the fingertips to lift the cast while it is drying. 
    2. Keep small toys and sharp objects away from the cast. 
    3. Use a padded ruler or another padded object to scratch the skin under the cast if it itches. 
    4. Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold. 
    5. Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling. 
    6. Contact the health care provider (HCP) if the child complains of numbness or tingling in the extremity.
    • 2. Keep small toys and sharp objects away from the cast. 
    • 5. Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling. 
    • 6. Contact the health care provider (HCP) if the child complains of numbness or tingling in the extremity.
  11. The clinic nurse provides instructions to the parents of an infant with developmental dysplasia of the hip (DDH), regarding care of the Pavlik harness. Which instruction should the nurse include? 
    1. The harness should be worn 6 hours a day. 
    2. The infant should not be moved when out of the harness. 
    3. The harness should be removed to check the skin and for bathing. 
    4. The harness must be removed for diaper changes and feeding.
    3. The harness should be removed to check the skin and for bathing.
  12. A child is brought to the hospital emergency department for an injury to the lower right arm that occurred in a fall off a bicycle. On assessment the nurse notes that the skin at the site of the injury is intact. A fracture is suspected, and a radiograph is taken. The nurse can see on the radiograph viewer that the fracture of the bone is across the entire bone shaft with some possible displacement. What type of fracture should the nurse determine that this child has? 
    1. Simple fracture 
    2. Greenstick fracture 
    3. Compound fracture 
    4. Comminuted fracture
    1. Simple fracture
  13. A neighborhood nurse is attending a soccer game at a local middle school. One of the students falls off the bleachers and sustains an injury to the left arm. The nurse quickly attends to the child and suspects that the child's arm may be broken. Which nursing action would be the priority before transferring the child to the hospital emergency department? 
    1. Immobilize the arm. 
    2. Ask for the name of the child's pediatrician or family health care provider so that he or she can be contacted. 
    3. Have someone call the radiology department of the local hospital to let staff know that the child will be arriving. 
    4. Tell the child that the arm probably is fractured but not to worry because permanent damage to the arm will not occur.
    1. Immobilize the arm.
  14. A child sustains a fall at home and is brought to the hospital emergency department by the child's mother. After a radiographic examination, the child is determined to have a fractured arm, and a plaster cast is applied. The nurse provides instructions to the mother regarding neurocirculatory assessment and function. Which statement by the mother indicates a need for further instruction? 
    1. "I'll need to check her skin twice a day at the cast edges." 
    2. "If her hand gets real cool and pale, I can apply the heating pad to it." 
    3. "For the first couple of days, I should try to keep her hand higher than her heart most of the time, using pillows." 
    4. "If she seems way too fussy and her arm is painful even after I've given her the pain medication, it might be a problem, and I should call you for help to decide on what is happening."
    2. "If her hand gets real cool and pale, I can apply the heating pad to it."
  15. A child who sustained a fractured ankle has a short leg cast applied, and the nurse provides home care instructions to the mother. The mother returns to the emergency department 16 hours later because the child is complaining of severe pain. The nurse notes that the child's toes are cool, pale, and puffy and that the child is agitated and crying loudly. The mother states, "I gave her the pain medication you sent with us just like you told us, and I have kept her foot up on two pillows since we left, except when she gets up to go to the bathroom. I don't understand why she hurts so much. Do something!" What is the most likely clinical situation that occurred? 
    1. Compartment syndrome 
    2. Inadequate pain medication 
    3. Skin breakdown around the cast edges 
    4. Noncompliance with home care instructions
    1. Compartment syndrome
  16. A child must wear a brace for correction of scoliosis. The nurse develops a plan of care knowing the child is at risk for which problem? 
    1. Inability to ambulate 
    2. Breaks in skin integrity 
    3. Decreased oxygenation 
    4. Delayed growth and development
    2. Breaks in skin integrity
  17. The pediatric nurse educator provides a teaching session to the nursing staff regarding juvenile idiopathic arthritis (JIA). Which statement by a nursing staff member indicates a need for further education? 
    1. "A complication of JIA is iridocyclitis." 
    2. "JIA most often occurs before the age of 16." 
    3. "JIA is twice as likely to occur in boys than in girls." 
    4. "Clinical manifestations of JIA include morning stiffness and painful, stiff, swollen joints."
    3. "JIA is twice as likely to occur in boys than in girls."
  18. The nurse in the pediatric unit is preparing for the admission of a child with a dislocated hip. The child will be placed in Buck's extension traction preoperatively for short-term immobilization. The nurse prepares to place the child in which type of traction setup?

    1. A 
    2. B 
    3. C 
    4. D
    1. A
  19. The mother of a 5-year-old child brings the child to the hospital emergency department and tells the nurse that the child fell. A fracture is suspected, and a radiograph is taken. The results indicate that the child has a comminuted fracture. The mother asks the nurse to describe this type of fracture, and the nurse draws a picture for the mother. Which picture identifies this type of fracture?

    1. A 
    2. B 
    3. C 
    4. D
    2. B
  20. An infant is brought to the child care clinic for a follow-up visit. The nurse notes that the infant is wearing this apparatus. The nurse documents that the infant is wearing which device?

    1. A back brace for the treatment of scoliosis 
    2. Bilateral foot braces for the treatment of clubfoot 
    3. A shoulder brace for the treatment of shoulder dystocia 
    4. A Pavlik harness for the treatment of congenital hip dislocation
    4. A Pavlik harness for the treatment of congenital hip dislocation
  21. A child with cerebral palsy (CP) is in a management program to achieve maximum potential for locomotion, self-care, and socialization in school. The nurse works with the child to meet these goals by performing which action? 
    1. Placing the child on a wheeled scooter board 
    2. Removing ankle-foot orthoses and braces once the child arrives at school 
    3. Keeping the child in a special education classroom with other children with similar disabilities 
    4. Placing the child in the supine position with a 30-degree elevation of the head of the bed to facilitate feeding
    1. Placing the child on a wheeled scooter board
  22. A nurse has reinforced teaching for a school-age child who was given a brace to wear for the treatment of scoliosis. The nurse determines that the child needs further teaching if the child makes which statement? 
    1. "This brace will correct my curve." 
    2. "I will wear my brace under my clothes." 
    3. "I may not need surgery if I wear my brace." 
    4. "I will do back exercises at least five times a week."
    1. "This brace will correct my curve."
  23. A 9-year-old child fractures the left tibia while using a skateboard. The nurse would be most concerned with the client's risk of future uneven leg length if the fracture was in which area of this long bone? 
    1. Epiphysis 
    2. Diaphysis 
    3. Metaphysis 
    4. Epiphyseal line
    4. Epiphyseal line
  24. A child has just returned from surgery and has a hip spica cast. What is the nurse's priority action for this client? 
    1. Elevate the head of the bed. 
    2. Assess the circulatory status. 
    3. Abduct the hips using pillows. 
    4. Turn the child onto the right side.
    2. Assess the circulatory status.
  25. Russell's traction is prescribed for a child with a lower leg fracture. The mother of the child asks the nurse about the purpose of the traction. The nurse explains to the mother that which is the primary action of this type of traction? 
    1. Relieve the child's pain. 
    2. Reduce or realigns a fracture site. 
    3. Provide a form of restraint for the child. 
    4. Keep the child from moving around in bed.
    2. Reduce or realigns a fracture site.
  26. A child with developmental dysplasia of the hip (DDH) is placed in a Pavlik harness. The nurse is aware that with this type of device the child's legs are immobilized in what position? 
    1. Prone 
    2. Abduction 
    3. Adduction 
    4. Extension
    2. Abduction
  27. The nurse is reviewing the health care record of an infant suspected of having unilateral hip dysplasia. Which assessment finding should the nurse expect to note documented in the infant's record regarding this condition? 
    1. Full range of motion in the affected hip 
    2. An apparent short femur on the unaffected side 
    3. Asymmetrical adduction of the affected hip when placed supine, with the knees and hips flexed 
    4. Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table
    4. Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table
  28. A nurse is implementing a teaching plan for a 4-month-old child who has been diagnosed with developmental dysplasia of the hip (DDH). The child will be placed in the Pavlik harness. Which statement by the family indicates that they understand the care of their child while placed in the Pavlik harness? 
    1. "I know that the harness must be worn continuously." 
    2. "I will bring my child back to the orthopedic office in a month or two so the straps can be checked." 
    3. "I realize that I will also need to put two diapers on my child so that the harness will stay dry and does not get soiled." 
    4. "I will watch for any redness or skin irritation where the straps are applied and call the health care provider for red areas."
    4. "I will watch for any redness or skin irritation where the straps are applied and call the health care provider for red areas."
  29. A nurse is caring for a child who fractured the ulna bone and had a cast applied 24 hours ago. The child tells the nurse that the arm feels like it is falling asleep. Which nursing action is most appropriate? 
    1. Encourage the child to keep the arm elevated. 
    2. Report the findings to the health care provider. 
    3. Document the findings, and reassess the arm 4 hours. 
    4. Tell the child that this is normal while the cast is drying.
    2. Report the findings to the health care provider.
  30. An adolescent is seen in the emergency department for a suspected sprain of the ankle. X-rays have been obtained, and a fracture has been ruled out. Which instruction should the nurse provide to the adolescent regarding home care for treatment of the sprain? 
    1. Elevate the extremity, and maintain strict bed rest for a period of 7 days. 
    2. Immobilize the extremity, and maintain the extremity in a dependent position. 
    3. Apply heat to the injured area every 4 hours for the first 48 hours, and then begin to apply ice. 
    4. Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 to 48 hours.
    4. Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 to 48 hours.
  31. The nurse is reinforcing instructions to the mother of a child who has a plaster cast applied to the left arm. Which statement by the mother indicates a need for further teaching? 
    1. "I will have to use a heat lamp to help the cast dry." 
    2. "I need to cover the cast with plastic during bathes or showers." 
    3. "I should call the health care provider if the cast feels warm or hot or has an unusual smell or odor." 
    4. "I will keep small toys and sharp objects away from the cast and be sure that my child does not put anything inside the cast."
    1. "I will have to use a heat lamp to help the cast dry.
  32. The nurse is assisting a health care provider (HCP) during the examination of an infant with developmental hip dysplasia. The health care provider performs the Ortolani maneuver. The nurse determines that the infant exhibits a positive response to this maneuver if which finding is noted? 
    1. A shrill cry from the infant 
    2. Asymmetry of the affected hip 
    3. Reduced range of motion in the right and left hip 
    4. A palpable click during abduction of the affected hip
    4. A palpable click during abduction of the affected hip
  33. A nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which statement by one of the parents indicates an understanding of the use of the harness? 
    1. "I can remove the harness to bathe my infant." 
    2. "I need to remove the harness to feed my infant." 
    3. "I need to remove the harness to change the diaper." 
    4. "My infant needs to remain in the harness at all times."
    1. "I can remove the harness to bathe my infant."
  34. A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates a need for further teaching? 
    1. "I cannot place powder under the brace." 
    2. "I need to place a soft shirt on my child under the brace." 
    3. "I need to be sure to apply lotion on the skin under the brace." 
    4. "I need to encourage my child to perform prescribed exercises."
    3. "I need to be sure to apply lotion on the skin under the brace."
  35. The nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse should monitor for which sign of a serious complication associated with this type of traction? 
    1. Lack of appetite 
    2. Elevated temperature 
    3. Decrease in the urinary output 
    4. Increase in the blood pressure
    2. Elevated temperature
  36. A child is brought to the emergency department, and diagnostic x-rays of the child reveal that a fracture is present. The mother states that the child was rollerblading and attempted to break a fall with an outstretched arm. A plaster of Paris cast is applied to the arm. Which instructions should the nurse provide the mother? Select all that apply. 
    1. The cast will mold to the body part. 
    2. The cast should be dry in about 6 hours. 
    3. Keep the cast elevated for the first day on pillows. 
    4. Make sure that the child can frequently wiggle the fingers. 
    5. The cast is water-resistant, so the child is able to take a bath or a shower. 
    6. The cast needs to be kept dry, because when wet it will begin to disintegrate.
    • 1. The cast will mold to the body part.
    • 3. Keep the cast elevated for the first day on pillows. 
    • 4. Make sure that the child can frequently wiggle the fingers.  
    • 6. The cast needs to be kept dry, because when wet it will begin to disintegrate.
  37. The clinic nurse is assessing a child suspected of having juvenile rheumatoid arthritis (JRA). Which assessment findings should the nurse expect to note in a child who has been diagnosed with JRA? Select all that apply. 
    1. Hematuria 
    2. Morning stiffness 
    3. Painful, stiff, and swollen joints 
    4. Limited range of motion of the joints 
    5. Stiffness that develops later in the day 
    6. History of late afternoon temperature, with temperature spiking up to 105° F
    • 2. Morning stiffness 
    • 3. Painful, stiff, and swollen joints 
    • 4. Limited range of motion of the joints 
    • 6. History of late afternoon temperature, with temperature spiking up to 105° F

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