Question 1

A pediatrician orders Russell traction for a 12-year-old patient with Legg-Calvé-Perthes disease.Which interventions are appropriate for the nurse to include in the care plan for this patient? (Select all that apply.)

Accepted Answer

Russell traction is a type of skin traction used to stabilize femur fractures until a callus forms or to correct bone deformities or contractures,as in Legg-Calvé-Perthes disease.With this type of traction,the child lies supine with hip flexed,abducted,and immobile.The child can help with repositioning using a trapeze above the bed.The nurse should assess the skin more often than every 12 hours and should not massage bony prominences.

Question 2

The pediatric nurse discusses home care with the parents of a patient who is returning home following a spinal fusion.Which teaching points will the nurse include in the discharge teaching for this patient? (Select all that apply.)

Accepted Answer

The child may return to school about 4 to 6 weeks after surgery.Explain activity restrictions to the child and caregivers (no twisting or bending,no lifting of heavy objects,no contact or high-impact sports for 2 years).A regular diet with added calcium,fiber,vitamin C,and fluids is maintained.Ambulation is encouraged when it is permitted,usually about 5 days postoperatively.Participation in contact sports is not allowed for 2 years.

Question 3

An 8-year-old girl has a third-degree sprain of the ankle.Based on this diagnosis,which teaching points will the nurse include in the teaching plan for this patient and family? (Select all that apply.)

Accepted Answer

Sprains are less common in younger children than are fractures.In a third-degree sprain the injury is severe,the ligament is completely torn,and the joint is unstable.There is significant swelling and severe ecchymoses occurring within the first 30 minutes.There is also severe pain over the joint,making examination difficult.The person cannot bear weight or otherwise use the extremity.

Question 4

A nurse is caring for a patient in Crutchfield tongs.Which assessment finding requires immediate notification to the health-care provider?

Accepted Answer

Crutchfield tongs are inserted into the skull.Any alteration in mental status could signify a serious complication,such as infection or intracranial bleeding (both are rare but possible).The nurse would not need to report crusted drainage,irritability and pain,or a normal white blood cell count.

Question 5

A nurse is teaching part of a babysitting class to teenagers.Which information about fractures does the nurse include in the lesson? (Select all that apply.)

Accepted Answer

Fractures are common,accounting for about 10% to 15% of childhood injuries,and often occur due to motor vehicle crashes,bicycle crashes,falls,and sporting injuries.Depending on where the fracture is,it has the potential to disrupt or halt growth in the bone.Girls are being seen with stress fractures more frequently.New bone growth takes up to 12 weeks to occur.

Question 6

The nurse is providing care to a pediatric patient who has orders for Crutchfield tongs.Which diagnosis does the nurse anticipate prior to reviewing the patient's medical record?

Accepted Answer

Crutchfield tongs are used to treat cervical or thoracic fractures.

Question 7

A child's family history includes muscular dystrophy (MD).What diagnostic testing does the nurse prepare the child and family for? (Select all that apply.)

Accepted Answer

Common diagnostic tests for MD include creatinine kinase,electromyelogram,and muscle biopsy.Blood urea nitrogen and ultrasound are not used.

Question 8

The nurse is caring for a child diagnosed with clubfoot.Which assessment findings does the nurse anticipate in the affected extremity? (Select all that apply.)

Accepted Answer

Signs of clubfoot include plantar flexion,inverted heel,adducted forefoot,and rigidity to the point that the foot cannot be manipulated into a neutral position.

Question 9

The nurse is providing care to a pediatric patient who suffered an ankle sprain.Which interventions are appropriate to include in the patient's plan of care? (Select all that apply.)

Accepted Answer

The nurse should teach the RICE acronym: Rest the injured extremity to prevent further injury and allow the ligament to heal;ice for the first 48 hours,keeping ice packs in place for 15-minute intervals to decrease swelling;compression with an Ace wrap or some other method to apply pressure to the affected joint to help reduce swelling of the joint;and elevation and early motion of the affected joint (elevation reduces swelling;early motion of the affected joint helps maintain full range of motion).

Question 10

A young teen has been diagnosed with Osgood-Schlatter disease.Which information does the nurse teach the patient and family regarding this diagnosis? (Select all that apply.)

Accepted Answer

The nurse should teach that activity can be resumed when symptoms (pain)are gone.Icing the knee after activity is beneficial,as is wearing an elastic wrap or neoprene sleeve over the knee.Nonsteroidal anti-inflammatory medications such as ibuprofen are best for pain management.Bedrest and surgery are usually not required.

Question 11

The pediatric nurse explains to the parents of a child with kyphosis that it is caused by a congenital or acquired condition.Which conditions are considered congenital causes of kyphosis? (Select all that apply.)

Accepted Answer

In children,kyphosis is caused by a congenital or acquired condition.Some congenital causes of kyphosis are ankylosing spondylitis,metabolic disorders,osteogenesis imperfecta,spina bifida,Paget disease,and Scheuermann disease,which causes juvenile or adolescent kyphosis,in which the vertebrae in the thoracic region are wedge-shaped.

Question 12

A parent asks about the process of bone growth.When explaining bone development to the parent,which substances does the nurse include in the teaching session as being necessary? (Select all that apply.)

Accepted Answer

Bone growth depends on several substances,including calcium,calcitonin,parathyroid hormone,vitamin D,and other minerals and enzymes.Estrogen and thyroid hormones are not required.

Question 13

A student nurse is caring for a patient in skin traction.What action by the student causes the registered nurse to intervene?

Accepted Answer

The child should be positioned directly in line with the traction.The other interventions are correct.

Question 14

A nurse is teaching parents about caring for their child in a cast.Which information does the nurse provide? (Select all that apply.)

Accepted Answer

The nurse teaches parents how to care for a child in a cast,including moving the joints above and below the cast regularly,elevating the extremity above the heart as much as possible,keeping the child from putting objects down the cast (including toy parts),providing nutrition that encourages bone healing,and providing range of motion.

Question 15

A nurse completes the Pediatric Fall Risk Assessment on a patient who scores a 9.Which intervention by the nurse is most important to include on the care plan?

Accepted Answer

A pediatric fall risk score of 0 to 7 demonstrates low risk for falls,whereas a score of 8 to 17 indicates a high risk for falls.Because this child demonstrates a high risk for falls he or she should have assistance with transfers and walking.

Question 16

A 10-year-old child has had a sunken chest since birth,but has recently been noted to have activity intolerance when playing.Which diagnostic testing does the nurse teach the child and parents about? (Select all that apply.)

Accepted Answer

This child has signs and symptoms of pectus excavatum,which manifests with a sunken chest.If the cardiac or respiratory systems are involved,the child will show exercise intolerance (changes in vital signs,changes on ECG,complaints of chest pain or shortness of breath with activity).Common diagnostic measures for this disorder include chest x-ray,chromosomal analysis or enzyme studies,ECG and/or echocardiogram,pulmonary function studies,and a stress test.Ultrasound is not used.

Question 17

An 8-year-old child is being treated for suspected tetanus.Which medications are appropriate for this child? (Select all that apply.)

Accepted Answer

Penicillin G and erythromycin are appropriate choices for this child.Older children can take tetracycline once they have all their adult teeth.Ceftriaxone and clindamycin are not used.

Question 18

Following hip surgery,a patient is placed in a spica cast.What nursing interventions are appropriate for this patient? (Select all that apply.)

Accepted Answer

Cast syndrome can be prevented by three nursing interventions: frequent repositioning,increasing fluids and fiber in the child's diet,and cutting a "belly hole" or a window in the cast to allow for abdominal expansion.The other two interventions do not help prevent cast syndrome.

Question 19

A nurse is teaching parents how to care for their child who is undergoing serial casting for clubfoot.Which information does the nurse provide? (Select all that apply.)

Accepted Answer

Parents need to be taught how to properly care for their child's cast.The cast is left open to air for drying,so there are no special techniques needed.Specifically,the parents should not use a hair dryer,as this may cause burns.The parents should also be taught about managing the child's pain,as stretching the muscles and ligaments will be painful.They also need instruction on performing neurovascular checks and when to call the physician.Serial casting is not a surgical procedure,so wound care instructions are not needed.

Question 20

The pediatric nurse is caring for a patient with juvenile arthritis.The health-care provider tells the nurse the patient will be started on disease-modifying antirheumatic drugs (DMARDs).Which drugs does the nurse anticipate administering? (Select all that apply.)

Accepted Answer

DMARDs include methotrexate (Rheumatrex),cyclophosphamide (Cytoxan),sulfasalazine (Azulfidine),and infliximab (Remicade).Acetaminophen (Tylenol)has no anti-inflammatory effect and is not used to treat juvenile arthritis.Leflunomide is an immunosuppressant.

Quiz 29: Caring for the Child With a Musculoskeletal Condition