Question 1

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma.How should the nurse approach this patient?

Accepted Answer

Honesty is essential to gain the cooperation and trust of the child.The diagnosis of cancer should not be disguised with falsehoods.The adolescent should be prepared in advance for the surgery so that there is time for reflection about the diagnosis and subsequent treatment.This allows him to gain answers to his questions.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 before surgery of the need for chemotherapy and its adverse effects.

Question 2

When does idiopathic scoliosis become most noticeable?

Accepted Answer

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

Question 3

What effect does immobilization have on the cardiovascular system?

Accepted Answer

Because of the decreased muscle contraction,the physiological effects of immobilization include venous stasis.This can lead to pulmonary emboli or thrombi.A decreased vasopressor mechanism results in orthostatic hypotension,syncope,hypotension,decreased cerebral blood flow,and tachycardia.The distribution of blood volume is altered,with decreased cardiac workload and exercise tolerance.Immobilization causes a decreased efficiency in orthostatic neurovascular reflexes,with an inability to adapt readily to the upright position and pooling of blood in the extremities in the upright position.

Question 4

What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?

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 accentuation of the cervical or lumbar curvature beyond physiological limits.

Question 5

Why does a nurse use the palms of his hands when handling a wet cast?

Accepted Answer

Wet casts should be handled with the palms of the hands,not the fingers,to prevent the creation of pressure points.Assessing dryness,facilitating easy turning,or keeping the patient's limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.

Question 6

A young girl has just injured her ankle at school.In addition to calling the child's parents,what is the school nurse's most appropriate,immediate action?

Accepted Answer

Soft-tissue injuries should be iced immediately.In addition to ice,the extremity should be rested and elevated and have compression applied.Observing for edema and discolouration,encouraging the child to assume a comfortable position,and obtaining parental permission or administration of acetaminophen or aspirin are not immediate priorities.

Question 7

Osteosarcoma is the most common bone cancer in children.What is the most common primary tumour site?

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 of the tumours occur in the femur.After the femur,most of the remaining sites are the humerus,tibia,pelvis,jaw,and phalanges.

Question 8

A child is upset because,when the cast was removed from her leg,the skin surface was caked with desquamated skin and sebaceous secretions.What should the nurse suggest to remove this material?

Accepted Answer

Simply soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions.It may take several days to eliminate the accumulation completely.The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding.Oil or lotion,but not powder,may provide comfort for the child's skin.

Question 9

What effect does immobilization have on metabolism?

Accepted Answer

Immobilization causes a decreased metabolic rate with the slowing of all systems and decreased food intake,leads to hypercalcemia,and causes a negative nitrogen balance secondary to muscle atrophy.The production of stress hormones decreases,resulting in reduced physical and emotional coping capacity.

Question 10

What is one advantage of using a fibreglass cast instead of a plaster one?

Accepted Answer

A synthetic casting material dries within minutes compared to a plaster cast,which takes several hours to dry.Synthetic casts are more expensive,not less.Plaster casts mould closer to body parts.Synthetic casts have a rough exterior,which may scratch surfaces.

Question 11

What can result from the bone demineralization associated with immobility?

Accepted Answer

Bone demineralization leads to a negative calcium balance,osteoporosis,pathological fractures,extraosseous bone formation,and renal calculi.Urinary retention is secondary to the effect of immobilization on the urinary tract.The pooling of blood is a result of the cardiovascular effects of immobilization.Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

Question 12

A newborn is born with mild clubfeet.What should the nurse explain to the parents when they ask how this will be corrected?

Accepted Answer

Serial casting,the preferred treatment,is begun shortly after birth and before discharge from the nursery.Successive casts allow for gradual stretching of the 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.Surgical intervention is done only if serial casting is not successful.Children do not improve without intervention.

Question 13

Which type of traction uses skin traction on the lower leg and a padded sling under the knee?

Accepted Answer

Russell traction involves skin traction on the lower leg and a padded sling under the knee.The combination of longitudinal and perpendicular traction allows the lower extremity to be realigned and immobilizes the hips and knees in a flexed position.Dunlop traction is an upper extremity traction used for fractures of the humerus.Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip.Buck extension traction has the legs in an extended position and is used primarily for short-term immobilization,before surgery with dislocated hips,for correcting contractures,or for bone deformities such as Legg-Calvé-Perthes disease.

Question 14

What is the primary method for 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 corticosteroids are not indicated for infectious processes.

Question 15

What term is used to describe a fracture that does not produce a break in the skin?

Accepted Answer

If a fracture does not produce a break in the skin,it is called a simple or closed fracture.A compound or open fracture is one with an open wound through which the bone protrudes.A complicated fracture is one in which the bone fragments damage other organs or tissues.A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue;these are rare in children.

Question 16

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied to a fractured arm with the wrist and elbow immobilized.What instruction should the nurse include in the discharge information?

Accepted Answer

The injured extremity should be kept elevated while resting and in a sling when upright.This will increase venous return.Swelling of the fingers may indicate neurovascular damage and should be reported immediately,since permanent damage can occur within 6 to 8 hours.Joints above and below the cast on the affected extremity should be moved.The child should not engage in strenuous activity for the first few days.Rest with the extremity elevated is encouraged.

Question 17

Which is an appropriate nursing intervention when caring for a child in traction?

Accepted Answer

Traction places stress on the affected bone,joint,and muscles.The nurse must assess for tightness,weakness,or contractures developing in the uninvolved joints and muscles.The adhesive straps should be released or replaced only when absolutely necessary.Active,passive,or active with resistance exercises should be carried out for the unaffected extremity only.Movement is expected with children-each time the child moves,the nurse should check to ensure that proper alignment is maintained.

Question 18

Which should be included when the nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip?

Accepted Answer

Infants have a rapid growth pattern.The child needs to be assessed by the practitioner every week for possible adjustments.Lotions and powders should not be used with the harness.The harness should not be removed,except as directed by the practitioner.A thin,disposable diaper can be placed under the harness.

Question 19

What sentence is most descriptive of the therapeutic management of osteosarcoma?

Accepted Answer

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

Question 20

What causes a nurse to suspect that an infection has developed under a cast?

Accepted Answer

If hot spots are felt on the cast surface,they usually indicate infection beneath the area.This should be reported so a window can be made in the cast to observe the site.The five P's of ischemia from a vascular injury include pain,pallor,pulselessness,paresthesia,and paralysis.Paresthesia is an indication of vascular injury,not infection.Cold toes may be indicative of a cast that's too tight and need further evaluation.Increased respirations may indicate a respiratory infection or pulmonary emboli.This should be reported,and the child should be evaluated.

Quiz 53: Musculoskeletal or Articular Dysfunction