Quiz #2 Study Questions Flashcards

1
Q

So what do you need to assess (priority) when you have a fracture?

A

a. Pulses first
b. Then color, temperature

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2
Q

Checking for pulse, temp, color of extremity for possible complication → compartment
syndrome

A

a. If not treated appropriately → volkman contractur can occur

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3
Q

Cancer of the femur and long bones → ewing sarcoma a. Two types of treatment
i. Bone lengthening device in the bone
ii. Amputation

A

Occurs in the shots of long bones and of trunk bones. Treatment includes surgical biopsy, intensive radiation therapy to tumor site, and chemotherapy, but not amputation.

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4
Q

The nurse is caring for a patient with a left above the knee amputation. The patient is complaining of severe pain in the left leg and wants something for pain. What should the nurse do first?

  1. Notify the surgeon.
  2. Medicate the patient immediately.
  3. Advise the patient that several therapies are available for the treatment of this problem.
  4. Tell the patient that this is phantom limb pain and sometimes follows amputation.
A
  1. Tell the patient that this is phantom limb pain and sometimes follows amputation.

The nurse should first explain to the patient that this is phantom limb pain and sometimes follows amputation. The patient should be given pain medication afterwards. The surgeon should be notified if this is continuous. The patient should also be advised that there are several therapies available for the treatment of this problem.

Amputation nursing consideration dealing with phantom pain
a. Explain to patients that this phantom pain is expected and normal and that we will help them to find a coping mechanism with this new phantom pain

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5
Q

If someone has knock knee, how are they standing?

A

a. Their knees are attaching with their feet apart

Is also known as Genu Valgum

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6
Q

Scoliosis is usually found at what age

A

a. Adolescent

congenital- occurs in fetal development

infantile- occurs at birth to 3 years of age

juvenile- occur in children ages 3-10 years old

adolescent- occurs at 10 years of age or older

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7
Q

A nurse is planning care for an adolescent who has scoliosis and requires surgical intervention.

Which of the following behaviors by the adolescent should the nurse anticipate because it is the most common reaction?

A. Body image changes.
B. Loss of privacy.
C. Feelings of displacement.
D. Identity crisis.

A

A. Body image changes.

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8
Q

A client who has sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse’s first intervention?

a. Assess pedal pulses.
b. Apply oxygen by nasal cannula.
c. Increase the IV flow rate.
d. Document the finding.

A

a. Assess pedal pulses.

The symptoms represent early warning of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible.

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9
Q

A nurse is caring for a toddler who has a fractured right femur and is in Bryant’s traction. When monitoring to determine if the traction is appropriately assembled, the nurse expects to observe which of the following?
a. Skin straps maintaining the leg in an extended position
b. Weights attached to a pin that is inserted in the femur
c. A padded sling under the knee of the affected leg
d. The buttocks elevated slightly off the bed

A

d. The buttocks elevated slightly off the bed

rationale: The child’s hips are flexed at a 90° angle with the legs suspended by pulleys and weights. The weights must hang freely from the bed to maintain alignment

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10
Q

A child with developmental dysplasia of the hip has a spica cast applied. Which action(s) specific to the spica cast should be taken? (Select all that apply)
A. Check for cracks or breaks in the cast.
B. Ensure the child’s head is higher than his feet.
C. Assess for circulation, movement, and sensation.
D. Measure the blood pressure frequently.
E. Auscultate the bowel sounds.
F. Use the rod between the child’s legs to lift and turn the child.
G. Check for swelling and tightness.
H. Position with feet elevated above heart level.
I. Place a disposable diaper inside the edges of the rear part of the cast.

A

A. Check for cracks or breaks in the cast.
B. Ensure the child’s head is higher than his feet.
C. Assess for circulation, movement, and sensation.
E. Auscultate the bowel sounds.
G. Check for swelling and tightness.
I. Place a disposable diaper inside the edges of the rear part of the cast.

Patient with SPICA cast, what are the nurses interventions to assess?
a. Pulses, color, movement, any circulation of numbness or tingling

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11
Q

A nurse is providing teaching to a parent of a child who has a fracture of an epiphyseal plate. Which state should the nurse make?

A. “The blood supply to the bone is disrupted.”
B. “Normal bone growth can be affected”
C. “Bone Marrow can be lost though the fracture”
D. “the younger the child the longer the healing process will take”

A

b.“Normal bone growth can be affected.” RA fracture of the epiphyseal plate can affect growth in a child. Therefore, it needs to be detected and treated rapidly.

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12
Q

Goal for septic arthritis

A

a. Treat the underlying infection

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13
Q

An infant with developmental dysplasia of the hip is placed in a Pavlik harness. Which instructions should the nurse include in a teaching plan for the parents?

a-Apply lotion or powder to minimize skin irritation.
b-Put clothing over the harness for maximum effectiveness.
c-Check for red areas under the straps two to three times a day.
d-Use a thin absorbent disposable diaper over the harness.

A

c-Check for red areas under the straps two to three times a day.

Child with developmental dysplasia of the hip, will wear a pavlik harness at home, what can you teach about home care?
a. can only take off 1hr max a day for showering
Need to be kept on for 23 hours/day

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14
Q

a nurse is caring for a 10 month old infant who is in a cast for developmental dysplasia of the hip (DDH). which of the following strategies should the nurse implement to promote the infant’s growth and development

a. The colorful latex balloons to the side of the crib
b. Provide a small electronic toy
c. Change the infant’s diaper as soon as soiling occurs
d. Allow infant to stand in the crib

A

d. Allow infant to stand in the crib

** If patient is in a cast for hip dysplasia, what can you educate the child to do to help with their growth and development?
a. Stand in their crib**

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15
Q

During your assessment of a patient with croup (laryngotrachealbronchitis), which of the following is most likely to be seen?

A

Barking seal cough

The manifestations of croup are a harsh cough described as barking or brassy, hoarseness, inspiratory stridor, low-grade fever, increased respiratory rate, and respiratory distress that may develop slowly or quickly.

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16
Q

What would be the treatment for a child with croup with barking cough?

a. Humidified air via tent or mask
b. Cool mist to decrease stridor
c. NPO (do not feed them)
d. Racemic epinephrine to decrease edema and mucus build up
e. Have intubation equipment avail at bedside
f. Allow parents to hold the child to comfort them

A
17
Q

2 year in respiratory distress, what signs can you assess to check for improvements?
A. Listen to lungs and breathing are clear
B. Listen for decrease of the cough
C. Decrease of nasal flaring
D. Decrease of retraction
E. Oxygen sats going up
F. HR below 140

A
18
Q

A 3 year old arrives to the ER. The child has a temperature of 102.4 F, respiratory rate of 45, and is agitated. The child is diagnosed with epiglottitis. You note the child is sitting up, positioned forward with chin in the air and the tongue is protruding with the mouth open. Which nursing intervention below is NOT appropriate for this patient?
A. Assist the patient in a supine position.
B. Keep the child on the parent’s lap during treatments.
C. Keep the child nothing by mouth.
D. Avoid taking a temperature on the patient orally.

A

A. Assist the patient in a supine position.

Allow the child to be in a position that allows them to breathe and be comfortable. The child is in the tripod position, which is a common finding with epiglottis. Placing the child in the supine position is contraindicated because it impedes respiratory effort.

What is the position that a patient with epiglotitis should assume?
A. Tripod upright position

19
Q

What do you see when assessing someone suspecting of pneumonia?

A

A. Crackles in the lung bilaterall
B. Dehydrated due to lack of intake → BUN and sodium slightly elevated

20
Q

What do you see with a patient admitted with RSV?

A

a. Secretions with retractions
b. Pretty sleepy
c. Respiratory rate will be elevated

21
Q

A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect?

a. Sweat chloride test, stool for fat, chest radiograph films
b. Stool test for fat, gastric contents for hydrochloride, chest radiograph films
c. Sweat chloride test, bronchoscopy, duodenal fluid analysis
d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

A

a. Sweat chloride test, stool for fat, chest radiograph films

A sweat chloride test result greater than 60 mEq/L is diagnostic of CF.

Cystic fibrosis, what is the diagnostic test done for them
a. Diagnostic test? → Sweat chloride test
b. Treatment? → nebulizer with albuterol prior to chest physiotherapy

22
Q

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to:

a. not administer pancreatic enzymes if child is receiving antibiotics.
b. decrease dose of pancreatic enzymes if child is having frequent, bulky stools.
c. administer pancreatic enzymes between meals if at all possible.
d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

A

d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

How do you know if the discharge teaching for CF has been affective in relation to medication administration?
a. They understand that they can sprinkle the pancreatic enzymes with snacks and meals
b. Why? → CF patients can not digest the fat in their foods

23
Q

The nurse is caring for a school-aged child with cystic fibrosis. Which pathophysiologic factor has the greatest impact on the child’s health status and is of priority in the care plan?
1. Extremely thick mucus causes obstructed airways.
2. There is acute inflammation of the lung parenchyma.
3. Endocrine glands secrete increased levels of hormones.
4. Increased irritability of the airways results in obstruction.

A
  1. Extremely thick mucus causes obstructed airways.

How would you decribe the secretions for a CF patient? a. Thick

a respiratory disorder that results from inheriting a mutated gene. It is characterized by mucus glands that secrete an increase in the quantity of thick, tenacious mucus, which leads to mechanical obstruction of organs

24
Q

How do you know, after performing tracheal suctioning on a patient, that it has been
Effective?

A

a. Listen to lung sound for clearness

25
Q

Pertussis

A

(WHOOPING COUGH)

-A highly contagious acute upper respiratory infection caused by the bacterium Bordetella pertussis.
-The nurse should identify that a dry, hacking cough is a manifestation of pertussis. This disease usually begins with indications of an upper respiratory tract infection, which includes a dry, hacking cough that is sometimes more severe at night.
-The nurse should initiate droplet precautions for a child who has pertussis. Pertussis is transmitted through contact with infected large-droplet nuclei that are suspended in the air when the child coughs, sneezes, or talks.

What is another word for pertussis?
a. Wooping cough

26
Q

A life-threatening episode of airway obstruction that is often unresponsive to common treatment.

A

Status asthmaticus

What moves asthma to become status asmaticus?
a. Status asmaticus is not responsive to treatment

27
Q

A nurse is providing teaching to the parents of a child who has streptococcal pharyngitis about ways to prevent disease transmission. Which of the following responses by the parents indicates an understanding of the teaching?

a. “We’ll continue to encourage him to drink lots of fluids.”
b. “We’ll take his temperature every 4 hrs.”
c. “We’ll give him Tylenol for the pain.”
d. We’ll discard his toothbrush and buy another.”

A

d. We’ll discard his toothbrush and buy another.”

How would you advise a family to prevent the transmit of strep pharyngitis? a. Buy a new toothbrush
i. so that the child does not reinfect themselves

28
Q

Compare between viral nasopharyngeal infection, epiglottitis, and croup

A
29
Q

What category of pediatric patients are considered under treated for pain?

A

a. Cognitively and neurologically impaired children

30
Q

What is true about nonpharmacologic strategies for pain management?

A

They may reduce pain perception.

When doing nonpharmalogical pain management, how does this affect pain management?
a. Helps reduce the perception of pain
i. Repsitioning, distractions, getting them to do something else

31
Q

What type of pain scale can you give to a 1 year old who has gone to surgery?

A

a. FLACC SCALE
i. Face
ii. Crying
iii. Activity
iv. Leg movements
v. Consolability

32
Q

A nurse is assessing an 18-month-old infant who is postoperative. Which of the following pain scales should the nurse use?
A. FACES
B. CRIES
C. FLACC
D. PIPP

A

C. FLACC

Rationale: The nurse should use the FLACC pain scale to monitor the infant for pain. The FLACC scale monitors facial expression, leg movement, activity, cry, and consolability in children 2 months to 7 years of age.

How can you assess an infants pain level?
a. Monitor for increase body movement

33
Q

Which indicates understanding of teaching to parents w/ a 1 yo who requires a Pavlik harness to tx hip dysplasia?
a) “I should remove the harness at night to allow my infant to stretch her legs”
b) “I will need to adjust the straps of the harness once each week”
c) “I should apply baby powder to my infant’s skin BID”
d) “I will place my infant’s diaper under the harness straps”

A

d) “I will place my infant’s diaper under the harness straps”

34
Q

A 2-day-old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip, and treatment is started by the orthopedist. The nurse assists the parents by provid- ing home care instructions that include:

a. Return to the orthopedist’s office in 2 weeks to remove the hip spica cast
b. The infant’s bilateral foot casts should be elevated on pillows as much as possible
c. Remove the Pavlik harness once a day for no more than 2 hours and inspect skin
d. Remove the Pavlik harness while the infant is awake to allow “tummy time”

A

c. Remove the Pavlik harness once a day for no more than 2 hours and inspect skin

35
Q

A patient required an above-the-knee amputation for a crush injury to the lower-left leg. Twenty-four hours postoperatively, the patient is complaining that his left foot is itching and asks why this is happening. What would be the best response by the nurse?

  1. “The itching occurs because you are experiencing phantom limb pain.”
  2. “You should talk with your doctor about this because this is abnormal.”
  3. “You are having this sensation because the nerve endings are still intact in the left foot.”
  4. “You are experiencing phantom limb sensation, which is a completely normal response after amputation.”
A
  1. “You are experiencing phantom limb sensation, which is a completely normal response after amputation.”

Patients experience sensations such as tingling, numbness, itching, and warmth/cold as if the limb is still present. These sensations are caused by stimulation along the nerve pathway in which the sensory endings were in the amputated part. The nerve endings are no longer intact, because the limb has been amputated. Just mentioning that the patient has phantom limb pain and that’s what is causing the itching is not a complete enough answer. The patient must be assured that it is completely normal. Phantom limb sensation is an expected occurrence with amputations and is not considered an abnormal finding.