Question 1

The nurse in the newborn nursery is doing the admission assessment on a neonate.Which area in the accompanying picture is an abnormal finding indicating that the neonate might have congenital hip dysplasia?

Accepted Answer

A

Question 2

A 12-year-old boy with Duchenne muscular dystrophy is being seen in the clinic for a routine health visit.An appropriate nursing diagnosis for this client would be:

Accepted Answer

Duchenne muscular dystrophy is a degenerative muscular disorder that eventually leads to the loss of mobility and the ability to ambulate. The hypertrophy of muscles is an early sign of the disease's progression, and thus, a risk for impaired mobility is an appropriate nursing diagnosis.

Question 3

A child has just returned from spinal fusion surgery.The nurse should check for signs of:

Accepted Answer

Spinal fusion surgery involves fixation of the vertebrae to promote spinal stability, and is often used to treat scoliosis. After surgery, the nurse should monitor for signs of impaired function or mobility in the lower extremities, such as impaired sensation or movement, which can indicate nerve damage or compression. Signs of increased intracranial pressure or impaired pupillary response are not typically associated with spinal fusion surgery, and seizure activity is a possibility but not a common occurrence.

Question 4

The nurse is caring for a child in Bryant's skin traction.An appropriate nursing intervention for this child would be to:

Accepted Answer

Checking the traction frequently is an appropriate nursing intervention for a child in Bryant's skin traction as it ensures that proper alignment is being maintained. Removing the adhesive traction straps daily for this type of traction can cause disruption to the alignment, so it is not an appropriate intervention. Placing the child prone may not be necessary, as long as the child is maintaining proper alignment. Moving the child as infrequently as possible may also disrupt the alignment and is not necessarily the best option.

Question 5

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

Accepted Answer

Applying ice to the sprained ankle will help to reduce pain, swelling, and inflammation. Warm, moist packs can actually increase swelling and should not be used in the acute phase of an injury. Performing passive range-of-motion could potentially make the injury worse and should not be done until after the acute phase has passed. Elevating the extremity above the level of the heart can also help to reduce swelling but is not as effective as applying ice.

Question 6

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 appear edematous,but there is color,sensitivity,and movement to them.The nurse should:

Accepted Answer

Elevating the legs on pillows can help reduce edema by promoting venous return and decreasing swelling.

Question 7

Care for an infant with osteogenesis imperfecta should include:

Accepted Answer

Infants with osteogenesis imperfecta have a high risk of fractures when moving, so supporting their trunk and extremities is essential to prevent fractures. Traction care, cast care, and postop spinal surgery care would only be necessary in certain situations and not necessarily for all infants with osteogenesis imperfecta.

Question 8

A child has been admitted to the hospital with osteomyelitis.The nurse would expect to administer which intravenous antibiotic for this child?

Accepted Answer

Osteomyelitis is a bone infection that requires treatment with intravenous antibiotics. Vancomycin and clindamycin are commonly used antibiotics for treating osteomyelitis due to their ability to cover a wide range of bacteria, including those that are commonly involved in this type of infection such as Staphylococcus aureus. Ampicillin or penicillin would not be effective as they do not cover these bacteria. Gentamicin or tobramycin may be used in combination with another antibiotic for osteomyelitis treatment, but they are not always the first-line choice. Rifampin may be used in combination with another antibiotic, but it is not used as a single therapy for osteomyelitis.

Question 9

A nurse notes a blue sclera during a newborn assessment.The infant should be checked for:

Accepted Answer

Blue sclera can be a characteristic sign of osteogenesis imperfecta, a genetic disorder that causes brittle bones and other connective tissue problems. The other options are not typically associated with blue sclera.

Question 10

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

Accepted Answer

The nurse would look for uneven shoulders and hips, a one-sided rib hump, and prominent scapula as these are all common physical signs of scoliosis. Lordosis and pain are not specific to scoliosis and may indicate other conditions.

Question 11

The nurse is teaching a family how to care for an infant in a Pavlik harness to treat congenital developmental dysplasia of the hip.The nurse will include in the parental education instructions to:

Accepted Answer

The nurse should instruct the family to check for red areas under the straps to prevent skin irritation or breakdown, which is a common concern with the use of a Pavlik harness.

Question 12

A child must wear a brace for correction of scoliosis.The nursing diagnosis that should be included in this child's plan of care is:

Accepted Answer

Wearing a brace can lead to skin irritation or breakdown due to constant pressure and friction, making "Risk for impaired skin integrity" a relevant nursing diagnosis.

Question 13

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 is a condition in which the blood supply to the head of the femur is temporarily disrupted, leading to bone death and collapse. Treatment may involve a period of bracing and/or casting, but the process of "re-ossification" and healing can take up to two years or longer. Six weeks is not an accurate timeline for this condition.

Question 14

A nurse is assessing a child after an open reduction of a fractured femur.A sign that compartment syndrome could be occurring would be:

Accepted Answer

Prolonged capillary refill time with loss of paresthesia is indicative of reduced blood flow and nerve damage, which are characteristic symptoms of compartment syndrome. A pink, warm extremity, pain relief with medication, and the presence of a dorsalis pedis pulse are not definitive indicators of compartment syndrome.

Question 15

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

While it is certainly possible that a child may only need one cast, it is not always the case with treatment for congential clubfoot. This statement indicates a lack of awareness of potential outcomes and the need for further education.

Quiz 58: The Child With Alterations in Musculoskeletal Function