RN FUNDAMENTALS 2022

HESI RN FUNDAMENTALS The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). Which of the following would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. a) Sensation b) Capillary refill c) Color d) Vital signs e) Pulse c)Color a)Sensation e)Pulse b)Capillary refill Explanation: A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment. The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which of the following forms of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? a) Internal fixation device b) Stockinette c) Spica cast d) External fixation device c)Spica cast Explanation: The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast. In caring for a child in traction, of the following interventions, which is the highest priority for the nurse? a) The nurse should clean the pin sites at least once every eight hours. b) The nurse should monitor for decreased circulation every four hours. c) The nurse should record accurate intake and output. d) The nurse should provide age-appropriate activities for the child. b)The nurse should monitor for decreased circulation every four hours. Explanation: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction. The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which of the following symptoms? a) Pallor b) Pain c) Paralysis d) Paresthesia d)Paresthesia Explanation: Paresthesia is diminished or absent sensation or numbness or tingling. Pallor is paleness of color and paralysis is the loss of function. The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection? a) Diminished pulse b) Delayed capillary refill c) Pallor of the fingers d) Drainage on the cast d)Drainage on the cast Explanation: Drainage on the cast could indicate an infection. Pale fingers would suggest impaired circulation. Delayed capillary refill would suggest impaired circulation. Diminished pulse would suggest impaired circulation. The type of fracture often seen in young children is a fracture in which there is not complete ossification of the bone and the bone bends and just partially breaks. This type of fracture is which of the following? a) Epiphyseal b) Spiral c) Complete d) Greenstick d)Greenstick Explanation: Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks. The nurse is working with a group of caregivers of school-age children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be which of the following? a) Incomplete b) Complete c) Spiral d) Greenstick b)Complete Explanation: If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Green stick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone. You assist with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and complains of being hot. Which nursing intervention would be indicated? a) Advise the child that this is to be expected. b) Observe the child for infection. c) Suggest removal of the cast to the orthopedist. d) Moisten the cast with cool water. a)Advise the child that thisis to be expected. Explanation: Plaster becomes hot as it sets. This effect is reduced with newer plastic casts. This is a normal expectation about which to educate the child before the application of the cast. If discomfort continues, notify the provider. Infection would not present in this way with a cast application. Never moisten a case. An infant appears floppy,sucks poorly, and has weak respiratory effort. She is diagnosed with congenital myasthenia gravis. In explaining this condition to the infant's mother, which of the following should she mention as the cause of the condition? a) An inherited disorder involving faulty neurotransmitter transmission or reception b) Infection of the bone by Streptococcus pyogenes c) Degeneration ofskeletal muscle fibers, possibly due to viral infection d) An autoimmune disorder involving the development of circulating antibodies against body cells a)An inherited disorder involving faulty neurotransmitter transmission or reception Explanation: With myasthenia gravis, there is interference in ACh processing, which leadsto symptoms of progressive muscle weakness or inability to contract. Congenital myasthenia appears to be an inherited disorder that results in faulty ACh transmission or reception. Dermatomyositis occurs from degeneration of skeletal muscle fibers. The cause of the disorder is unknown, although either a viral infection or an autoimmune basis is suspected. The cause of juvenile arthritis is unknown, although it is thought to be an autoimmune process in which a child develops circulating antibodies (immunoglobulins) against body cells. Osteomyelitis is infection of the bone by Streptococcus pyogenes. The nurse caring for a patient in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which of the following nursing interdisciplinary interventions are recommended to help prevent these adverse conditions? a) Encourage child to stifle cough and take shallow breathsto prevent ineffective breathing patterns. b) Give the patient large, frequent meals with decreased fiber and increased protein and Vitamin C. c) Encourage active and passive range-of-motion activitiesto prevent ineffective tissue perfusion. d) Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply. c)Encourage active and passive range-of-motion activitiesto prevent ineffective tissue perfusion. Explanation: The nurse should turn the patient and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The patient should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The patient should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition. The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which of the following situations? a) A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating. b) A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. c) A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. d) A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. c)A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Explanation: Spiral fractures, which twist around the bone, are fre quently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks. The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. Of the following nursing interventions, which would be most important for the nurse to include in working with this child and the child's caregivers? a) The nurse should help the caregiversto understand and the child to effectively use the corrective devices. b) The nurse should support the caregivers in restricting activity during the treatment. c) The nurse should provide information when the child or caregiver requests it. d) The nurse should be a contact person when the child is hospitalized. a)The nurse should help the caregivers to understand and the child to effectively use the corrective devices. Explanation: Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability. Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step. a) True b) False False Explanation: If a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step, the head of the radius may escape the ligament surrounding it and become dislocated (nursemaid's elbow). Fracture of the femur is rare and is typically caused by an automobile accident, a fall from a considerable height, or child maltreatment. After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching? a) "She'll need to limit any activity that involves the wrist." b) "We'll apply a warm moist compress to the wrist for 20 minutes at a time." c) "We'll make sure she keeps her arm above heart level." d) "We can wrap the wrist in an elastic bandage to help reduce the swelling." b)"We'll apply a warm moist compress to the wrist for 20 minutes at a time." Explanation: Care for a sprain includes rest, ice, compression, and elevation. Cold therapy, not heat, is used for 20 to 30 minutes at a time, then removed for 1 hour and repeated for the first 24 to 48 hours. Compression via an elastic bandage, elevating above heart level, and limiting activity are appropriate measures. The nurse is teaching a group of peers regarding different types of fractures. Which of the following best describes an open fracture? a) A fracture in which the broken bone penetrates the skin. b) A fracture in which there is a single break in the bone without penetration of the skin. c) A fracture in which the fragments of the bone are separated. d) A fracture in which the fragments of the bone remain partially joined. a)A fracture in which the broken bone penetrates the skin. Explanation: The open fracture, also called a compound fracture, penetrates the skin. When the fragments of the bone are separated, the fracture is said to be complete. A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age? a) Adolescence b) School age c) Toddlerhood d) Preschool age a)Adolescence Explanation: Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence. In discussing the treatment for children with scoliosis, a group of pediatric nurses makes the following statements. Which statement is most accurate related to the treatment ofscoliosis? a) "Children treated for scoliosis by using braces have to wear the brace almost all the time." b) "Children with severe scoliosis are treated using electricalstimulation." c) "The only successful treatment for scoliosis is surgery within two weeks of the diagnosis." d) "The treatment for children with scoliosis usually lasts three to four months." a)"Children treated for scoliosis by using braces have to wear the brace almost all the time." Explanation: The Boston brace and the TLSO brace are made of plastic and are customized to fit the child for treatment ofscoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit. A nurse applies ice to a patient's leg to relieve the pain due to a soft tissue injury. Which of the following is a recommended guideline for use of cold therapy? a) Use cold therapy to increase blood flow in patients with impaired circulation. b) Apply gel packs for no longer than 30 minutes and monitor closely for tissue damage. c) Apply ice for the first 24 to 48 hours after injury to reduce edema. d) Apply the ice to the injury, never immerse the injured part in cold water. c)Apply ice for the first 24 to 48 hours after injury to reduce edema. Explanation: Application of ice is recommended for the first 24 to 48 hours after injury to reduce edema. Ice is usually applied as crushed ice in a bag, applied over a thin layer of cloth, or by immersing the injured part in cool water. Cold therapy is not recommended for persons with hypersensitivity to cold or with impaired circulation. Gel packs cool skin faster than an ice bag and should be applied for no more than 10 minutes. A 14-year-old girl is diagnosed as having scoliosis. When doing scoliosisscreening with her, an important observation would be to note a) the angle of the iliac crest when she bends forward. b) the angle of her lower chest when she sits down. c) her posterior spine when she bends forward. d) the posterior spine when she bends sideways. c)her posterior spine when she bends forward. Explanation: A lateral curvature of the spine (scoliosis) is best revealed when the child bends forward. Bending to the side would not provide an accurate assessment of the spine nor would assessing the iliac crest or the chest. A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care? a) Assisting the child with crutch walking b) Restricting fluid to encourage red cell production c) Keeping the child quiet while in skeletal traction d) Maintaining intravenous antibiotic therapy d)Maintaining intravenous antibiotic therapy Explanation: Osteomyelitis is a serious infection. It is treated vigorously with intravenous antibiotics. It would not require traction. The stem does not indicate the location of the infection, so the child may not need crutches. Fluid restriction does not help red blood cell production. The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. Which of the following would the nurse expect to administer if ordered? a) Alendronate b) Pamidronate c) Narcotic analgesics d) Diazepam Diazepam Explanation: Diazepam is an antianxiety drug that also hasthe effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Narcotic analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesisimperfecta. In understanding the function of the musculoskeletal system, the nurse recognizes that which of the following allows for movement of the body parts? a) Cartilage b) Ligaments c) Tendons d) Joints d)Joints Explanation: Bones are attached to each other by connecting links called joints, which allow for movement of the body parts. Skeletal muscles attach to the bones, with a moveable joint between them. Tendons and ligaments hold the muscles and bones together. Cartilage is a type of connective tissue consisting of cells implanted in a gel-like substance, which gradually calcifies and becomes bone. The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record? a) Low serum calcium levels b) Low alkaline phosphate levels c) High serum phosphate levels d) X-ray confirmation of adequate bone shape a)Low serum calcium levels Explanation: With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone. A nursing instructor is preparing a class presentation about tibia vara. Which of the following would the instructor include as a risk factor? a) Late walking b) Lack of sunlight exposure c) Hormonal alterations during puberty d) Obesity d)Obesity Explanation: Obesity is a risk factor for the development of tibia vara. Tibia vara occurs most frequently in children who are early walkers. Limited or lack of exposure to sunlight may lead to rickets. Hormonal alterations during puberty may play a role in the development of slipped capital femoral epiphysis. Structuralscoliosis is five times more common in girls than in boys. a) False b) True b)True A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. Which of the following are nursing interventions that should be implemented in this case? *(Select all that apply.) a) Instituting infection-control precautionsrelated to drainage tubes b) Instruction to the parents regarding the importance of the child maintaining bed rest c) Casting of the affected limb d) Instruction to the parents regarding how to care for an antibiotic IV line at home e) Administration of IV antibiotics at the hospital f) Instruction to the parentsregarding proper traction of the limb e)Administration of IV antibiotics at the hospital b)Instruction to the parents regarding how to care for an antibiotic IV line at home b)Instruction to the parents regarding the importance of the child maintaining bed rest a)Instituting infection-control precautions related to drainage tubes Explanation: Osteomyelitis is infection of the bone. Medical therapy includes limitation of weight bearing on the affected part, bed rest, immobilization, and a short administration of an IV antibiotic such as oxacillin (Bactocill), asindicated by the blood culture. Intravenous therapy is usually initiated in the hospital and then continued at home for as long as 2 weeks. When the child is discharged from the hospital, be certain to review with parents measures to care for the antibiotic intravenous line if this will be continued at home. Keep in mind young children are active, even if they are on bed rest so need age appropriate activities so they maintain rest, not activity. If a child had surgery and drainage tubes are in place, institute infection-control precautions, because the drain evacuates infected material. Neither casting nor traction is required for osteomyelitis. A neonatal nurse examines an infant and notes decreased hip motion that causes pain upon movement. This nurse suspects Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. a) True b) False a)True Explanation: Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 1,200 live births, with some hereditary factors influencing incidence. You are caring for a child with a broken wrist that hasjust been placed in a cast. You would elevate the arm to a) promote healing. b) prevent edema. c) ensure proper bone alignment. d) discourage infection. b)prevent edema. Explanation: Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing nor discourage infection. The cast will maintain proper bone alignment. The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. Which of the following should be the first intervention? a) Make sure the skin and linens are clean and dry. b) Gently massage his foot and heel each shift. c) Apply lotion to hisfoot and avoid friction to the area. d) Reposition the child's foot on a pressure-reducing device. d)Reposition the child's foot on a pressure-reducing device. Explanation: The nurse'sfirst action is to remove continuous pressure from this area. The other actions can help decrease potential for skin breakdown, but the pressure must be relieved first. The nurse is caring for a child with osteomyelitis. Which of the following is true regarding this diagnosis? Select all that apply. a) As abscess forms, ruptures and spreadsinfection in the metaphysis of the bone b) Corticosteroids are the treatment of choice c) Transmission-based precautions are followed in most cases d) Caused by Staphylococcus aureus e) Lab findings show a leukocyte count of 1,000 to 2,000 cells d)Caused by Staphylococcus aureus c)Transmission-based precautions are followed in most cases a)As abscess forms, ruptures and spreadsinfection in the metaphysis of the bone Explanation: Osteomyelitis is caused by Staphylococcus aureus. The bacteria enter the bloodstream and are carried to the metaphysis, the growing portion of the bone, where an abscess forms, ruptures, and spreads the infection along the bone under the periosteum. Transmission-based precautions may be required if a wound is open and draining. While an adolescent wears a body brace for scoliosis, you would teach her a) to wear the brace a maximum of 20 hours each day. b) thatsecondary sex changes will stop until the brace is removed. c) to continue with age-appropriate activities. d) to stand absolutely still whenever she is out of the brace. c)to continue with age-appropriate activities. Explanation: Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. Sex changes continue with or without bracing; the provider will determine the length of time for wearing the brace each day. The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client? a) Congenital myotonic dystrophy b) Duchenne muscular dystrophy c) Facioscapulohumeral muscular dystrophy d) Juvenile arthritis b)Duchenne muscular dystrophy Explanation: By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy beginsin utero and typically leadsto death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints. The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which of the following instructions is most important to emphasize to the boy and his parents? a) "Ice will help reduce the inflammation." b) "NSAIDs can help with pain control and inflammation." c) "You will need to see a physical therapist for stretching and strengthening exercises." d) "You and your coaches need to understand that you cannot play soccer for at leastsix weeks." d)"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches. A type of traction sometimes used in the treatment of the child with scoliosis is called which of the following? a) Bryant'straction b) Dunlop's traction c) Halo traction d) Russell traction c)Halo traction Explanation: When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction. The nurse is caring for an 8-year-old girl in traction. She has been in an acute care setting for two weeks and will require an additional 10 days in the hospital. She is showing signs of regression with thumb sucking and pleas for her tattered baby blanket. Which of the following would be the most helpful intervention? a) "Would you like a coloring book?" b) "Let's ask your mom to bring your friends for a visit." c) "You are too big to suck your thumb." d) "Do you want a book to read?" b)"Let's ask your mom to bring your friends for a visit." Explanation: After two weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the girl's mother or supervised by the child-life specialist would help her adapt to her immobilized state. Telling the girl she is too big to suck her thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as she has likely grown tired of books and coloring after two weeks. A nursing student tells the staff nurse on the pediatric orthopedic unit that she has heard of a musculoskeletal disorder in which there is an infection of the bone. Which of the following disorders does this statement describe? a) Osteosarcoma b) Osteomyelitis c) Muscular dystrophy d) Juvenile rheumatoid arthritis b)Osteomyelitis Explanation: Osteomyelitis is an infection of the bone usually caused by Staphylococcus aureus. Acute osteomyelitis is twice as common in boys and results from a primary infection. The nurse is caring for an active 11-year-old presenting with tenderness in the shoulder. He isthe pitcher for his baseball team and complains ofshoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely which of the following? a) Sever's disease b) Epiphysiolysis of the distal radius c) Epiphysiolysis of the proximal humerus d) Osgood-Schlatter disease c)Epiphysiolysis of the proximal humerus Explanation: Epiphysiolysis of the proximal humerusis an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts. In understanding the development of the musculoskeletal system, the nurse recognizes that which of the following is implanted in a gel-like substance during fetal life? a) Ligaments b) Tendons c) Joints d) Cartilage d)Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cellsimplanted in a gel-like substance, gradually calcifies and becomes bone. The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in doing which of the following with this child? a) Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm. b) Encouraging the child to move the arm slowly up and down to help the cast dry. c) Using only a draw sheet to move the casted arm. d) Handling the cast with open palms when moving the arm. d)Handling the cast with open palms when moving the arm. Explanation: A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process. An infant with a femur fracture is placed in Bryant traction. Which of the following would the nurse include in the infant's plan of care? a) Keeping the buttocksslightly elevated b) Removing the traction boot every 8 hours c) Provide range of motion to the unaffected extremity d) Wrapping the bandages from the ankle to the knee a)Keeping the buttocksslightly elevated Explanation: With Bryant traction, the buttocks should be slightly elevated and clear of the bed. The bandages are wrapped from the ankles to midthigh in Bryant traction. The legs are wrapped from the ankle to knee. A traction boot is not used with Bryant traction. This action would be appropriate for Buck traction. With Bryant traction, both legs are extended vertically, so range of motion would not be appropriate. A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as which of the following? a) Bone that breaks into two pieces b) Incomplete fracture c) Bone buckling due to compression d) Significant bending without actual breaking d)Significant bending without actual breaking Explanation: A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces. The nurse is caring for a 6-year-old boy with Russell traction applied to hisleft leg. Which intervention would be most appropriate to prevent complications? a) Assessthe popliteal region carefully for skin breakdown. b) Provide pin care as needed. c) Adjust the weights as needed. d) Clean and massage his entire leg daily. a)Assessthe popliteal region carefully forskin breakdown. Explanation: The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care. A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as which of the following? a) Pectus carinatum b) Metatarsus adductus c) Syndactyly d) Polydactyly c)Syndactyly Explanation: Syndactyly refers to webbing of the fingers and toes. Polydactyly refersto the presence of extra digits on the hand or foot. Metatarsus adductus is a medial deviation of the forefoot. Pectus carinatum is a protuberance of the chest wall. The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which SalterHarris classification? a) Type II b) Type V c) Type I d) Type IV a)Type II Explanation: According to the Salter-Harris classification, a type II fracture is partially through the physis extending into the metaphysis. A type I fracture is through the physis, widening it. A type IV fracture is through the metaphysis, physis, and epiphysis. A type V fracture is a crushing injury to the physis. The child diagnosed with muscular dystrophy often exhibits a forward curvature of the lumbarspine. This description is accurate regarding which of the following? a) Kyphosis b) Scoliosis c) Synovitis d) Lordosis d)Lordosis Explanation: Lordosis, a forward curvature of the lumbar spine orswayback, is seen by school age in the child with muscular dystrophy. A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse be least likely to use? a) Observation b) Palpation c) Inspection d) Auscultation d)Auscultation Explanation: The physical examination specific to fracturesincludesinspection, observation, and palpation. Auscultation is not used. When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. These variations include: a) Rapid bone and muscle growth in adolescentsincrease their agility, thereby decreasing the incidence of injuries. b) The young child hasrigid soft tissue, so dislocations and sprains are common occurrences. c) During adolescence, muscle growth is influenced by increased production of androgenic hormones. d) The infant's muscles account for 45% of total body weight as opposed to 25% of adult body weight. c)During adolescence, muscle growth is influenced by increased production of androgenic hormones. Explanation: During adolescence, muscle growth is influenced by hormonal changes, primarily the increased production of androgenic hormones. The infant's muscles account for only 25% of total body weight, whereas they account for 40% to 45% in an adult. The young child hasresilient soft tissue, so dislocations and sprains are unusual occurrences. Rapid bone and muscle growth may contribute to the appearance of "clumsy" and awkward motions of the adolescent who is trying to adjust to new body dimensions. An infant is placed in Bryant's traction. For Bryant'straction to be effective, the infant must be positioned on the a) back with hips up off the bed. b) stomach with both legs extended. c) back with the injured hip flexed and the uninjured one extended. d) back with hips flat on the bed. a)back with hips up off the bed. Correct Explanation: For there to be traction, the infant's hips must be off the bed. On the stomach or hips on the bed are not the correct positions for this patient. A 14-year-old boy was diagnosed with a closed fracture of the ulna at approximately 9 a.m. The fracture was reduced in the emergency room and his arm placed in a cast. At 6 p.m. his mother has brought him back to the emergency room due to unrelenting pain that has not been relieved by his prescribed narcotics. What should the nurse do first? a) Assess the neurovascular status of the arm. b) Elevate the arm above the level of the heart. c) Alert the doctor immediately and apply ice. d) Give additional pain medication as ordered. c)Alert the doctor immediately and apply ice. Explanation: The nurse should notify the doctor immediately because the boy's symptoms are the classic sign of compartmentsyndrome. Immediate treatment isrequired to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which of the following symptoms might be an early warning signal that the child has developed compartment syndrome? The child a) Has a weak femoral pulse b) Feelsincreasing severe pain c) Cannot plantarflex hisfoot d) Has blue-looking nail beds on the toes b)Feelsincreasing severe pain Explanation: Any complaint of pain in a child with a new cast or immobilized extremity needs to be explored and monitored closely for the possibility of compartment syndrome. A girl with scoliosis is prescribed a body brace. The purpose of the brace is to a) improve spinal alignment. b) preventtorticollis. c) prevent herniation of a spinal disk. d) correct spinal curvature. a)improve spinal alignment. Explanation: Body bracing helps to hold the spine in alignment and prevent further curvature. The brace will not correct the problem. Herniation and torticollis are not associated with scoliosis. The nurse is caring for a child in a type of traction in which weights are being used. Which of the following is true regarding the weights? a) The weights should be removed once a shift and then replaced. b) Additional weights will be added as the fracture is healing, usually once a day. c) The weights must be hanging freely, not touching the bed or floor. d) The weights can be removed and the child encouraged to move around in bed several times a day. c)The weights must be hanging freely, not touching the bed or floor. Explanation: When a child is in traction the weights must be hanging freely, not touching the bed or floor. The nurse is caring for a child admitted with Legg-Calvé-Perthes disease. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Poor posture and malformed vertebrae b) Difficulty standing and walking c) Inflammation of the joints d) Pain in the groin and a limp d)Pain in the groin and a limp Explanation: Symptoms first noticed in Legg-Calvé-Perthes disease are pain in the hip or groin and a limp accompanied by muscle spasms and limitation of motion. A nurse is setting up an electric heating pad for a 6-year-old boy requiring heat therapy. Which of the following would be the most appropriate way to engage the child during use of the heating pad? a) "Here are some crayons and paper." b) "Look at how the dial glows." c) "Do not unplug the heating pad." d) "Let's see what is on TV." a)"Here are some crayons and paper." Explanation: It is best to distract the child with an age-appropriate activity. Do not make a show of the set-up process by pointing out the glowing dial or how the device turns on and off. A child might be tempted to turn the heating pad on and off or unplug it, even after being instructed not to. Television is a passive activity and often overused as a distraction for children. You meet a child with a slipped femoral epiphysis. In what type of child does this usually occur? a) Obese adolescent boys b) Active school-aged children c) Tall, thin girls d) Preadolescent girls a)Obese adolescent boys Explanation: A slipped epiphyseal femur injury most typically occursin overweight preadolescent or adolescent boys. Stress increases the risk. A thin child would not have an increased risk, and the age range is past preadolescent and school age. A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected? a) Lordosis b) Loss ofstrength in ankle dorsiflexion c) Kyphosis d) Trendelenburg gait d)Trendelenburg gait Explanation: The nurse would expect to note a Trendelenburg gait due to pain. Lordosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Kyphosis is an excessive curvature of the spine and is not associated with Legg-Calvé-Perthes disease. Loss of strength in ankle dorsiflexion is associated with some neuromuscular disorders but not this condition.