ch 29 adaptive quiz Flashcards
What type of fracture in children results when the porous bone is compressed? 1 Buckle fracture 2 Complete fracture 3 Greenstick fracture 4 Plastic deformation
A buckle fracture results when porous bone is compressed. In a complete fracture, the bone fragments are divided. In a greenstick fracture, the bone is angulated beyond the limits of bending. Plastic deformation occurs when the bone is bent but not broken.
For which finding should the nurse look when assessing a newborn for developmental dysplasia of the hip? 1 Lordosis 2 Ortolani sign 3 Trendelenburg sign 4 Telescoping of the affected limb
The Ortolani sign is indicative of developmental dysplasia of the hip in a newborn. In an older infant lordosis and telescoping of the affected limb are signs of developmental dysplasia of the hip. In the weight-bearing child the Trendelenburg sign with lordosis is a clinical manifestation of developmental dysplasia of the hip.
A child has just been fitted with a cast to heal a fracture of the arm. What findings does the nurse recognize as clinical signs of compartment syndrome? Select all that apply. 1 Pain 2 Pallor 3 Paresthesia 4 Pulselessness 5 Palpable pulses
Compartment syndrome is a serious complication that results from compression of nerves, blood vessels, and muscle inside a closed space. It can occur after a cast is applied. Clinical signs of compartment syndrome include pain, pallor, pulselessness, paresthesia, paralysis, and pressure.
A student nurse is caring for a patient with venous stasis in the leg. The student nurse advises the patient to rest in the same position, measures circumference of the extremities periodically, administers anticoagulant drugs as prescribed and assists the patient to perform active or passive exercises. Which intervention of the student nurse does the registered nurse correct?
1
Administering the anticoagulants as prescribed
Correct2
Advising the patient to rest in the same position
3
Measuring the circumference of extremities periodically
4
Assisting the patient to perform active or passive exercises
Venous stasis in the lower extremities can result in pulmonary emboli and thrombus formation. To reduce the risk of venous stasis, the nurse assists the patient with frequent position changes. Venous stasis causes blood coagulation; therefore, anticoagulants reduce the risk of blood clot formation in the patient. The nurse should measure the circumference of the lower extremities periodically, because an increase in circumference can worsen the condition if untreated. The nurse should elevate the lower extremities and assist the patient to perform active and passive exercises to reduce the risk for emboli.
Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
The nurse is caring for a child who has a loss of respiratory muscle strength and who is unable to cough. Which nursing intervention does the nurse perform to help the child clear the airway?
1
Ask the child to suppress the cough.
2
Restrict fluid intake for the child.
Correct3
Splint the chest while the child is coughing.
4
Administer antibiotic drugs to the child.
In case of respiratory muscle weakness, there is difficulty in coughing. The nurse should support the child’s chest by splinting with a pillow so that it is easier to cough. Coughing is a defense mechanism of the body that removes foreign irritants from the respiratory tract. Thus the nurse should encourage the child to cough. The child should be provided adequate fluids to prevent thickening of chest secretions. Antibiotic drugs should be administered only if the child shows signs and symptoms of infection.
What is the first-line of medications used to treat juvenile idiopathic arthritis? 1 Methotrexate 2 Corticosteroids 3 Biologic agents Correct4 Nonsteroidal antiinflammatory drugs
Nonsteroidal antiinflammatory drugs (NSAIDs) are the first line of medications used to treat juvenile rheumatoid arthritis. Methotrexate is the second-line medication when treatment with NSAIDs has failed. Neither corticosteroids nor biologic agents are the first line of medications used to treat juvenile rheumatoid arthritis.
A child who has been brought to the pediatrician’s office complains of thigh and groin pain. What is the priority nursing action in response to the child’s chief complaint?
Incorrect1
Assessing the child’s reflexes
Correct2
Performing a complete hip examination
3
Having the child perform tests of balance
4
Documenting the chief complaint in the chart
A complete hip examination is the priority nursing action when a child presents with thigh and groin pain. Assessing the child’s reflexes is not a priority nursing action when the child presents with thigh and groin pain. Having the child perform tests of balance is not a priority nursing action when the child presents with thigh and groin pain. Documenting the chief complaint in the chart is important but not a priority nursing action when the child presents with thigh and groin pain.
The nurse is caring for a child who has dependent edema. What interventions does the nurse perform to help reduce edema and prevent related complications? 1 Apply bandages to the lower limbs. Incorrect2 Elevate the lower limbs without knee flexion. Correct3 Reposition the patient every 2 hours. 4 Apply ice to the edematous area.
People with dependent edema are at high risk for development of pressure ulcers. In order to prevent ulcers, the nurse repositions the patient frequently. The nurse also ensures that there is no friction on the patient’s skin. Using bandages and elevating the lower limbs are useful in cases of reduced venous return or venous stasis but not in dependent edema. Applying ice only helps in causing blood flow to cease; it does not decrease dependent edema.
Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer.
The primary health care provider has prescribed intravenous (IV) antibiotic therapy for a child with acute osteomyelitis. After assessment, the nurse finds that the child is not responding to the therapy. Which follow-up treatment strategy does the nurse expect the primary health care provider to prescribe? Correct1 Surgery 2 Chemotherapy Incorrect3 Probiotic therapy 4 Oral antibiotic therapy
Acute osteomyelitis is infection in the bone caused by a blood-borne bacterium. Therefore, intravenous (IV) antibiotic therapy is prescribed to the child. Surgery is indicated if there is no response to oral or IV antibiotic therapy. Chemotherapy is not indicated in the treatment of osteomyelitis. Probiotic therapy is not indicated in the treatment of osteomyelitis, but it is used to prevent antibiotic-associated diarrhea. Oral antibiotic therapy is not of use; because oral therapy is initiated before IV therapy, the child will not respond to the oral antibiotic therapy.
A 5-year-old child fractured the left elbow while playing with friends. The health care provider has prescribed regular cast changes and bed rest. What should the nurse educate the parents about cast care?
Correct1
Apply lotion to the skin after cast removal.
Incorrect2
Scrub away residual material on the skin.
3
Immerse the cast briefly in a tub bath.
4
Cover the damp cast edges with adhesive.
After the cast is removed, the skin surface will be caked with desquamated skin and sebaceous secretions. Application of mineral oil or lotion may remove the particles and provide comfort. The parents and child should be instructed not to pull or forcibly remove this material with vigorous scrubbing because it may cause excoriation and bleeding. The skin under the cast may become macerated from inadequate drying after water immersion. Adhesive will not adhere to a damp cast even if the cast is composed of fiberglass; it takes about a half-hour for it to dry.
What nursing interventions should be considered for a child who is immobilized? Select all that apply. Correct1 Antiembolism stockings Correct2 Correct body alignment Correct3 Passive range-of-motion activities 4 Supine posture whenever possible Incorrect5 Play activities involving the involved extremity
Nursing interventions for the child who is immobilized include the use of antiembolism stockings, correct body alignment, and passive range-of-motion activities. The child should be placed in an upright, rather than supine, position when possible. Play activities should be planned to use the child’s uninvolved extremity rather than the involved extremity.
The nurse, assessing a child who has a cast, suspects infection on noting which finding? 1 Cold toes Incorrect2 Quickened respiration 3 Complaint of paresthesia Correct4 Feeling "hot spots" on the cast's surface
Hot spots felt on a cast’s surface usually indicate infection beneath the area. This should be reported so a window can be made in the cast through which to observe the site. Cold toes may indicate a too-tight cast and the need for further evaluation. Increased respiratory rate may indicate a respiratory infection or pulmonary embolus. This finding should be reported, and the child should be evaluated. The “five Ps” of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection.
The nurse is caring for a child with osteosarcoma who recently underwent amputation of the lower right leg. The child is complaining of severe pain and itching in his right foot. What is the best response by the nurse?
1
Giving the child a mild opioid
2
Explaining to the child that he is just angry about losing his foot
Correct3
Letting the child know that the sensations are real, not imagined
4
Letting the child know that these sensations are a drug-induced hallucination
Letting the child know that the sensations are real, not imagined, is the best response by the nurse. Phantom limb pain, in which the patient experiences tingling, itching, and pain in the amputated limb, can develop after amputation. Giving the child a mild opioid is not the most effective way to reduce the pain. Amitriptyline (Elavil) is the drug of choice for phantom limb pain. Severe pain and itching in the amputated extremity is not a manifestation of anger over losing the foot or a drug-induced hallucination.
What is the most comprehensive therapeutic management for juvenile idiopathic arthritis?
1
Pain control, physical and occupational therapy, splints, and ice packs
2
Pain control, physical and occupational therapy, splints, and acetaminophen to reduce inflammation
Correct3
Pain control, physical and occupational therapy, splints, and nonsteroidal antiinflammatory drugs for inflammation
4
Pain control, physical and occupational therapy, splints, and range-of-motion exercises during periods of inflammation
Pain control, physical and occupational therapy, splints, and nonsteroidal antiinflammatory drugs for inflammation is the most comprehensive therapeutic management for juvenile idiopathic arthritis. Acetaminophen does not reduce inflammation, and warm, moist heat is better than ice for relieving stiffness and pain. Range-of-motion exercises should not be performed during periods of inflammation.
The nurse is educating a group of people about the first aid to be given in cases of fractures. A person questions how to splint a leg fracture when there is no ready-made splint available. Which statement of the nurse appropriately answers the question asked? 1 "Use a smaller splint if available." 2 "Just bandage the affected limb." Correct3 "Use the patient's other leg as a splint." 4 "You need not splint the leg."
A splint offers support and rest to the injured body part. If a ready-made splint is not available, the patient’s other leg can be used as a splint to support the injured part. A splint should cover the joint above and below the fracture. Using a smaller splint or bandaging the limb may be insufficient to immobilize the fractured leg. Splinting the leg is very important, as movement in the fractured limb may further worsen the fracture.
