Chapter 29: Caring for the Child With a Musculoskeletal Condition Nursing School Test Banks

Chapter 29: Caring for the Child With a Musculoskeletal Condition

MULTIPLE CHOICE

1. The pediatric nurse explains to the student nurse that alterations in musculoskeletal functioning may be related to a congenital defect or an acquired defect. Which disorder is an example of a congenital defect?
A. Juvenile arthritis
B. Muscular dystrophy
C. Osgood-Schlatter disease
D. Osteomyelitis
ANS: B
Alterations in musculoskeletal functioning may be related to a congenital defect such as muscular dystrophy, clubfoot, or osteogenesis imperfecta. Other musculoskeletal alterations may be related to an acquired defect such as Legg-Calv-Perthes disease, slipped femoral capital epiphysis, Osgood-Schlatter disease, scoliosis, sprains, strains, fractures, osteomyelitis, juvenile arthritis, or tetanus.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. The student nurse studying the anatomy of the musculoskeletal system understands that bones are classified by their size and shape. How does the student classify the pelvis?
A. Flat bone
B. Irregular bone
C. Long bone
D. Short bone
ANS: B
Flat bones are located in the skull, scapulae, ribs, sternum, and clavicle. Long bones are found in the extremities, and include the fingers and toes. Short bones are located in the ankles and wrists. Irregular bones are the vertebrae, pelvis, and facial bones.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

3. An adolescent patient is prescribed a brace to treat scoliosis. Which assessment finding by the nurse indicates that outcomes for a priority nursing diagnosis have been met by the patient?
A. Is able to explain the rationale for the bracing
B. No redness or breakdown seen under the brace
C. Participates in social activities with friends
D. Wears brace continuously for 20 hours each day
ANS: B
The skin under the brace worn to treat scoliosis needs to be assessed for breakdown, especially when the brace is new. An important diagnosis would be risk for impaired skin integrity. Seeing no skin breakdown under the brace indicates the outcomes have been met for this goal. Being able to explain the rationale for the bracing and participating in social activities also indicate that outcomes for appropriate diagnoses have been met, but these do not take priority over a possible injury to the child. The brace needs to be worn continuously for 23 hours each day.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate

PTS: 1

4. The nurse is providing care to a pediatric patient admitted for a workup of bone deformity. The latest laboratory values indicate calcium at 6.6 mg/dL and phosphorus at 2.1 mg/dL. Which condition does the nurse correlate with these values?
A. Muscular dystrophy
B. Osgood-Schlatter disease
C. Rickets
D. Scoliosis
ANS: C
Normal calcium is 8.511 mg/dL, and normal phosphorus is 34.5 mg/dL. Low values for both are seen in rickets.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

5. A pediatric nurse is caring for a 1-year-old child who is in a spica cast. The nurse teaches the parents that modifications need to be made for this child. Which modification does the nurse teach?
A. Using a baby bath with shallow water to clean the child
B. Using a car seat with sturdy sides to transport the child
C. Using a sitting position on the floor to feed the child
D. Using a wagon instead of a stroller to move the child
ANS: D
Placing the child in the prone position on the floor makes it easier for feeding the child. Mobilizing a child in a wagon is a good modification for a stroller while the child is in the spica cast. Toddler car seats that do not have sides are also a good modification for a child in a spica cast. The parents will need to modify the bath by giving the child a sponge bath.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

6. A 15-year-old boy is brought to the emergency room by his parents following an injury to his arm that occurred during football practice. The x-ray shows a diagonal line that coils around the bone. Based on this x-ray, which type of fracture does the nurse prepare to teach the family about?
A. Greenstick
B. Oblique
C. Spiral
D. Transverse
ANS: C
A spiral break is caused by a twisting force and shows a diagonal line that coils around the bone. An oblique break shows a diagonal line across the bone. A transverse break shows a line that crosses the shaft at a 90-degree angle. In a greenstick-type break, the bone is bent but not broken.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

7. A pediatrician asks a patient with a knee injury to squat. Which disorder is this patient suspected of having?
A. Juvenile arthritis
B. Muscular dystrophy
C. Osgood-Schlatter disease
D. Osteomyelitis
ANS: C
The major symptom of Osgood-Schlatter disease is pain below the kneecap that is aggravated by activity and relieved by rest. Symptoms resolve around the time skeletal growth ceases (about puberty). The child experiences pain when asked to squat or extend the knee against resistance. This is a good indicator of Osgood-Schlatter disease.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

8. A new nurse is caring for a child after spinal fusion to correct scoliosis. Which action by the new nurse causes the experienced nurse to intervene?
A. Assesses neurological status and vital signs every hour
B. Instructs patient to turn by pulling on side rails
C. Monitors chest tube for air leakage and drainage
D. Promotes use of the incentive spirometer each hour
ANS: B
After spinal fusion, the patient must be logrolled to turn. Logrolling involves two nurses turning the patient as one single unit so that the spine is maintained in a straight line. The other actions are appropriate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

9. An adolescent expresses frustration over how long his football injury to a tendon is taking to heal. Which response by the nurse is the most appropriate?
A. Ill ask the doctor to check for a tendon infection.
B. Often these injuries never fully heal and return to normal.
C. Tendons have a poor blood supply, so healing is slow.
D. You have to be more compliant with immobilization.
ANS: C
Tendons are fibrous connective tissues that have very little blood supply. Therefore healing from a tendon injury takes time. This is the best response; there is no indication that the teen has an infection interfering with recovery, it is inaccurate and disheartening to tell a young person that tendons may never heal, and the nurse should not assume the patient is noncompliant with immobilization.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

10. A nurse is conducting a sports fitness class for volunteer coaches. Which information provided by the nurse is the most appropriate?
A. Fractures heal more quickly in children because the bones are still growing.
B. Children are prone to fractures because their bones are weaker than adults bones.
C. Ligaments are bands of fibrous tissue that hold muscles to the bones.
D. Once a child reaches adult height, bone development eventually stops.
ANS: A
Although children are more prone to fractures than adults due to continued bone growth, because their bones are still growing, fractures heal quickly. Ligaments hold two or more bones or cartilages together. Bone is a dynamic tissue and continues to be developed and reabsorbed throughout life.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

11. The student nurse studying anatomy knows that red blood cells are produced where?
A. Growth plates
B. Periosteum
C. Red marrow
D. Yellow marrow
ANS: C
The red marrow produces red and white blood cells and platelets. Yellow marrow produces fat cells. The growth plates and periosteum are not involved in producing different cells.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

12. A nurse working in an inpatient pediatric unit cares for many children with musculoskeletal impairments. Which outcome takes priority for these children?
A. Adapting to changing activity restrictions
B. Continuing their growth and development
C. Resuming ambulation as soon as possible
D. Staying current with schoolwork with tutors
ANS: B
Growth and development are dependent upon being able to interact with the environment. Any child with a musculoskeletal disorder is at risk for impaired growth and development. A priority outcome for any of these children is to maintain normal growth and development. Some children may need to adapt to changing activity restrictions. For some children, ambulation will be delayed or not possible. Staying current with education is important, but does not take priority over maintaining normal growth and development.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

13. A woman who wishes to become pregnant again consults with the nurse about preventing her child from being born with clubfoot. She has two other children, both treated for this disorder. Which information does the nurse provide about preventing clubfoot?
A. Avoid secondhand cigarette smoke while pregnant
B. Fetal positioning in utero cannot be controlled
C. Getting enough folic acid early in pregnancy is advisable.
D. The disorder is genetic so no prevention is available.
ANS: D
Recent research shows that clubfoot is genetic, so no prevention is possible. In utero positioning can possibly influence the disorder as well. Second-hand smoke exposure is not related. Folic acid is important for preventing neural tube disorders.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

14. A parent calls the clinic to report that his childs cast seems to be looser than it was yesterday. Which instruction is most appropriate for the nurse to provide to the parent?
A. Bring your child in so we can evaluate the cast.
B. If the cast is loose, circulation wont be compromised.
C. Pad the top of the cast with a small towel so it fits.
D. This is not unusual; just keep your next appointment.
ANS: A
Parents should be instructed to take their child to a health-care provider if a cast appears loose, damaged, or soft. The other answers are not appropriate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

15. A parent calls the nursing call center stating that his child, who has a cast after surgical treatment of a clubfoot, is very fussy even after acetaminophen (Tylenol) administration and that the childs toes seem cool. What advice does the nurse give the parent?
A. Elevate the affected extremity and apply ice for 20 minutes.
B. Make four cuts to the top of the cast, each about 1 inch long.
C. Take your child to the nearest emergency department now.
D. Try giving your child a dose of ibuprofen (Pediaprofen) instead.
ANS: C
Parents always need to observe for complications of casting, including neurovascular compromise. A child who is excessively fussy and whose toes are cool should be seen by a health-care provider to assess circulation and possibly modify or change the cast. The parent should be told to take the child to the nearest emergency department (ED). The other answers are inappropriate. If circulation is compromised, elevation and ice will make the problem worse. The parent should not be instructed to modify the cast. Although ibuprofen may manage the childs pain better than acetaminophen, the priority instruction is to send the parent to the ED.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

16. A mother brings her daughter to the clinic after noticing the childs new swimsuit fits baggily on one side of her bottom and the childs right thigh looks quite odd compared to the other one. Which assessment question would provide the nurse the most important information?
A. Do her joints dislocate easily?
B. Does she fatigue easily?
C. Has your child been limping?
D. When did you see her in a swimsuit last?
ANS: C
The mother seems to have noticed thigh and buttock muscle wasting, which are signs of Legg-Calv-Perthes disease. Other signs and symptoms include hip or knee soreness or stiffness, pain that increases with activity and decreases with rest, a painful limp, joint dysfunction, and limited ROM. Asking about a limp would be the most important question, as it is specific to this disease process.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

17. A child who has been limping for several weeks is brought to the clinic and undergoes radiological studies. The results show osteonecrosis. Which information does the nurse plan to teach the parents about their childs condition?
A. Non-weight-bearing status and mobility limitations
B. Overcorrection with serial casting for 23 years
C. Surgical correction with the Z-plasty technique
D. Wearing and caring for a Browne splint
ANS: A
Osteonecrosis is a cardinal sign of Legg-Calv-Perthes disease. This disorder is frequently treated with non-weight-bearing status and bracing or casting. The other treatment modalities are used to treat clubfoot.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

18. A child is being cared for at home with modified bed rest for Legg-Calv-Perthes disease. Which assessment finding indicates to the home health-care nurse that outcomes for a priority diagnosis have been met?
A. The child maintains grades in school via tutoring.
B. The family identifies effective coping strategies.
C. Full range of motion is present in all joints.
D. The family identifies appropriate diversionary activities.
ANS: C
All assessment findings signify positive adaptation to this disorder. However, because the child is on bedrest, the priority is to prevent complications of immobility including contractures or decreased ROM in joints.

Cognitive Level: Evaluation/Evaluating
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Evaluation
Difficulty: Moderate

PTS: 1

19. A child has been hospitalized with an acute-grade IV slipped femoral capital epiphysis (SFCE) and is on bedrest awaiting surgical correction. A new nurse places the following interventions on the childs care plan. Which intervention leads the experienced nurse to intervene?
A. Consult child-life therapist for diversionary activities.
B. Perform range-of-motion exercises to both lower extremities.
C. Reinforce teaching on crutch-walking postoperatively.
D. Teach child and family about non-weight-bearing status.
ANS: B
In acute SFCE, range-of-motion exercises are not done to the affected extremity because they may cause further damage. The other interventions are appropriate for a child with this diagnosis.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

20. A 10-year-old child is in the emergency department with a type IV femur fracture. Which intervention takes priority?
A. Assessing the child for signs of maltreatment
B. Ensuring that signed consent for surgery is on the chart
C. Explaining the process of closed reduction with sedation
D. Preparing the child for prolonged immobility in traction
ANS: B
A type IV fracture must be reduced surgically. The nurse ensures that signed consent is on the chart. Fractures in a 10-year-old are not as commonly caused by child abuse as by bicycle crashes or sporting injuries, so unless other signs of maltreatment are noticed, this would not be a priority. Because the child is not having a closed reduction, explanation of this process is not needed. The child will also not be immobilized in traction for a prolonged period.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

21. A nurse is caring for a child who had an open reduction and internal fixation (ORIF) of a femur fracture 12 hours ago. The nurse finds the child pale and short of breath. What action by the nurse takes priority?
A. Assess oxygen saturation while a coworker calls the physician.
B. Assess and treat the child for pain or anxiety as needed.
C. Raise the head of the bed to a 45angle and reassess.
D. Review the childs postoperative hemoglobin and hematocrit.
ANS: A
This child appears to be experiencing a complication of fracture, which may include shock, fat embolism, deep vein thrombosis, pulmonary embolism, and infection. Shortness of breath should alert the nurse to a respiratory complication as a first priority. The nurse should have a coworker call the physician while obtaining other assessment data, including oxygen saturation, vital signs, and a respiratory assessment. Although it is possible that a postoperative hemoglobin and hematocrit are low enough that the child is experiencing shock, the priority steps in assessing and intervening are airway, breathing, and circulation (ABCs), so breathing comes before circulation. The child may have pain or anxiety, but these are not the priority. Raising the head of the bed may or may not be helpful, but the nurse first needs to assess oxygen saturation.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

22. A child is 3 hours postoperative, having had an open reduction and internal fixation (ORIF) of a type IV tibial fracture, which is now also casted. Which action by the nurse takes priority?
A. Assess neurovascular status every hour.
B. Change IV pain medication to oral pills.
C. Provide an ice bag for 30 minutes every hour.
D. Teach parents about activity restrictions.
ANS: A
After surgery and/or casting, it is vital to assess neurovascular status, which is usually done with postoperative vital signs. Excessive swelling can disrupt circulation to the extremity, so the nurse assesses the childs neurovascular status frequently. Applying ice is also a good intervention, but not for more than 15 minutes at a time. When the child is tolerating oral foods and fluids, the nurse can switch to pain pills from IV narcotics. Teaching is important, but not as important as preventing injury from complications.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

23. A nurse is caring for an 8-year-old child hospitalized 2 days after open reduction and internal fixation (ORIF) of a femur fracture sustained in a motor vehicle crash. The child is now in a long-leg cast. Which assessment finding prompts the nurse to notify the health-care provider?
A. A foul odor coming from the cast
B. Child eating only 20% of meals
C. Old dried drainage marked on the cast
D. Request for pain medicine every 4 hours
ANS: A
A foul odor coming from the cast may indicate an infection at the surgical site or at the fracture site. The nurse should notify the health-care provider. Loss of appetite may be from several causes: fatigue, stress, side effect of medications, dislike of hospital food, loss of industry (child is in Eriksons stage of industry vs. inferiority), trying to regain some control, pain, or fear of pain. The nurse needs to assess this situation further to determine the cause of this issue. Old drainage would not be worrisome; if the drainage continues to increase, the nurse should notify the health-care provider. At 2 days since surgery, wanting pain medication every 4 hours is not unreasonable.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

24. A child in traction is having muscle spasms. Which medication does the nurse prepare to administer?
A. Acetaminophen (Tylenol)
B. Diazepam (Valium)
C. Morphine sulfate (Astromorph)
D. Oxycodone (Percocet)
ANS: B
Diazepam is a muscle relaxant and is used to treat muscle spasms. The other medications are for pain.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Easy

PTS: 1

25. A 4-year-old child is recovering from a modified Nuss procedure. Which is the priority intervention by the nurse?
A. Ambulating the child as soon as allowed
B. Encouraging food and fluids postoperatively
C. Monitoring vital signs and wound drainage
D. Playing with the child using pinwheels or bubbles
ANS: D
The modified Nuss procedure is an open chest reconstruction for severe cases of pectus excavatum. Preventing pneumonia is a critical nursing action. Because this child is too young to use an incentive spirometer, playing with him or her using bubbles, pinwheels, or paper triangles the child can blow across the table accomplishes pulmonary hygiene. The other activities are important postoperative nursing interventions, but are not specific to this operation.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

26. A child is going home with a distractor in place after surgery to repair syndactyly. Which discharge teaching is most important?
A. Clean around the pin sites twice a day with soap and water.
B. Dont pull the pins; they will gradually fall out on their own.
C. Perform range-of-motion exercises to the affected fingers daily.
D. Turn the screw with the Allen wrench twice a day for a week.
ANS: A
The distractor uses pins placed in the bone fragments that extend through the skin. The parents need to care for the pins using soap and water to clean around the exit sites. The pins need to be removed surgically; they will not fall out on their own. Because the bones are pinned, range of motion is not possible. The Allen wrench is used to turn the screw on the distractor twice a week.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

27. A new nurse is placing an elastic wrap on a patient with an ankle sprain. Which action by this nurse causes an experienced nurse to intervene?
A. Exerts moderate pull on the wrap
B. Instructs the patient on wrapping the injury
C. Starts wrapping distal to the injury
D. Wraps in a proximal-to-distal fashion
ANS: D
When using an elastic wrap, start wrapping distal to the injury, work up over the injury, and end the wrapping proximal to the injury. The other actions are correct.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

28. A student athlete has a serious anterior cruciate ligament (ACL) tear, and her knee is swollen with excess synovial fluid. Which procedure does the nurse prepare this athlete for?
A. Application of heat
B. Immediate surgery
C. Joint aspiration
D. Knee reduction
ANS: C
The health-care provider will remove excess synovial fluid via aspiration. Heat is not used for the first 24 hours. Immediate surgery may or may not be warranted. A knee reduction is performed for a dislocated knee.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

29. A child has been hospitalized with suspected osteomyelitis. The childs white blood cell count (WBC) is 22,000/mm3 and his C-reactive protein is 15 mg/dL. Which conclusion by the nurse is appropriate based on these laboratory values?
A. The child has an infection somewhere.
B. The child has osteomyelitis.
C. The child is immunocompromised.
D. These tests are not related to the condition.
ANS: A
Elevations in WBCs and C-reactive protein indicate an infection is present, but are not specific for any one kind of infection.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

30. A 5-year-old child is hospitalized with osteomyelitis and will be going home in the next few days on intravenous (IV) antibiotics. Which action by the nurse is the most appropriate?
A. Ensure that a valid permit for a PICC line is on the chart.
B. Locate a pharmacy that will supply the IV medications.
C. Research the patients insurance for home infusion coverage.
D. Teach the child about a PICC line using a doll.
ANS: A
A child going home on IV antibiotics will need a PICC line inserted for home infusion therapy. The nurse should ensure that a consent for this procedure is on the chart. Researching pharmacies and infusion companies can be done by the social worker. Teaching the child with a doll is appropriate, but does not take priority over legal responsibilities.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

31. A child has just been diagnosed with juvenile arthritis (JA). The parents want to know what caused this to happen. Which statement by the nurse is the most appropriate?
A. Genetic abnormalities are triggered by infection.
B. It seems to be an autoimmune disease.
C. Latent infections can recur and cause JA.
D. No one really understands how JA occurs.
ANS: B
JA is an autoimmune, inflammatory process often thought to be triggered by an infection. The etiology is not genetic, caused by latent infections, or completely unknown.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

32. The pediatric nurse is caring for a child recently diagnosed with transient synovitis of the hip. Which medication order is most appropriate for this child?
A. Acetaminophen (Tylenol) 1015 mg/kg every 4 hours
B. Ibuprofen (Motrin) 3050 mg/kg/day in 34 divided doses
C. Naproxen (Aleve) 2030 mg/kg/dose every 4 hours
D. Prednisone (Deltasone) 0.12 mg/kg/day in 14 divided doses
ANS: B
This disorder is treated with NSAIDs. Acetaminophen is not an NSAID, although the dose listed is a safe dose. Prednisone is also not an NSAID, although the dose listed is a safe dose. Ibuprofen and Naproxen are both NSAIDs. The dose of ibuprofen is correct; the safe dose for naproxen is 1015 mg/kg/dose every 12 hours.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

33. The parents of a child recently diagnosed with Duchennes muscular dystrophy want to know if their infant twin daughters should be tested for the disease too. Which response by the nurse is the most appropriate?
A. No, Duchennes muscular dystrophy is a sex-linked genetic disorder rarely affecting females.
B. No, infants the age of your daughters are too young to undergo testing for Duchennes muscular dystrophy.
C. Yes, the earlier the diagnosis of any type of muscular dystrophy is made, the better the childs quality of life.
D. Yes, females are equally likely to have Duchennes muscular dystrophy as are boys.
ANS: A
Duchennes muscular dystrophy is a sex-linked recessive disease that usually only affects males. Females with Turners syndrome, in which the child only inherits one X chromosome from the mother, can be affected, but females are usually carriers. The infant twin daughters do not need to be tested.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

34. An 8-month-old child with congenital myotonic dystrophy has been hospitalized with a severe respiratory infection. Which action by the nurse is the most appropriate?
A. Determine if the family wants aggressive ventilatory support.
B. Discuss the option of lung transplantation with the family.
C. Hold a family meeting to discuss palliative care measures and code status.
D. Inform the family the child will be ventilator dependent as she gets older.
ANS: C
Congenital myotonic dystrophy usually causes death before the age of 1 year due to the inability to maintain respirations. In this situation, the nurse should have a meeting with the family to explore a broad range of therapeutic options, including palliative care measures and code status. Just inquiring about ventilatory support is too narrow a focus. Lung transplantation is not a treatment for this disorder. Children with this disease die at a young age, and so they do not grow up dependent on ventilators.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Difficult

PTS: 1

35. A nurse is caring for a child with Duchennes muscular dystrophy (MD). The childs creatinine kinase level has dropped by over half since it was last measured. What assessment finding correlates with these results?
A. Better respiratory functioning
B. Decreased muscle strength
C. Improved posture and walking
D. Stabilizing muscle strength
ANS: B
Early in MD creatinine kinase levels are elevated. As muscle wasting occurs and muscle bulk diminishes, creatinine kinase levels will drop. A finding of decreased muscle strength correlates with the laboratory results.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

36. A home health-care nurse is visiting a child with Duchennes muscular dystrophy (MD). The child has a new cough, poor appetite, fatigue, and a reddened area on his coccyx from sitting in his wheelchair all day. What intervention by the nurse takes priority?
A. Assess the child for his favorite high-protein foods.
B. Develop a protocol for changing positions more often.
C. Encourage the family to allow the child plenty of rest.
D. Notify the health-care provider and request antibiotics.
ANS: D
All actions are appropriate; however, children with MD usually die of respiratory infections, so aggressive treatment at the first sign of a respiratory infection is warranted. The nurse should notify the health-care provider and request antibiotics.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

37. A teen has a scoliosis curve of 35. What treatment option does the nurse prepare the child and family for?
A. Bracing
B. Continued screening
C. Exercise therapy
D. Surgical intervention
ANS: A
A curve of 35is considered mild scoliosis. Bracing is the treatment of choice at this point. Continued screening is inappropriate, as the child has scoliosis. Research has shown that exercise alone does not improve outcomes. Surgical intervention is reserved for more serious cases.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

38. A child in the intensive care unit with tetanus will be receiving a neuromuscular blocking agent. Which intervention takes priority for this child?
A. Monitor urinary catheter output hourly.
B. Provide stimulation from TV or radio.
C. Turn patient every 2 hours.
D. Provide ventilator care to prevent pneumonia.
ANS: D
The child receiving a neuromuscular blocking agent is completely paralyzed and needs ventilator support. Proper care is important to prevent pneumonia. Monitoring urinary output and turning the patient are important, but do not take priority over breathing. The child needs a quiet environment free of excess stimulation.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

39. An infant hospitalized with multiple fractures has just been diagnosed with osteogenesis imperfecta. The nurse finds the parents crying. Which response by the nurse is the most appropriate?
A. I know how you feel. I would be upset to find this out too.
B. There is medicine that can allow her to live a normal life.
C. Would you like me to help you with holding your baby?
D. You are actually lucky; many of these babies die at birth.
ANS: C
Causing more injury to their child is a common concern among parents of children with osteogenesis imperfecta. The nurse needs to show them how to hold, change, feed, and play with their babies. In this situation, the caring nurse offers to help the parents learn to hold their baby and offers support. The nurse should never assume to know how someone else is feeling. Medications will not help this child lead a normal life. Stating that the parents are lucky is belittling their feelings.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Moderate

PTS: 1

40. The parents of a 3-year old cannot understand how their child has developed osteoporosis, stating We didnt think children could get this disease. Which assessment by the nurse is most important?
A. Attainment of developmental milestones
B. Dietary intake of calcium
C. Height and weight
D. Labor and birth history
ANS: D
Very-low-birth-weight and premature infants are at risk for developing osteoporosis because bone mass is acquired during the last weeks of pregnancy. If this child were born prematurely, that could explain the osteoporosis. Attaining milestones and height and weight are not the priority (height loss is possible with multiple fractures in older children). Although teens can develop osteoporosis from dietary deficiency of calcium and vitamin D, it is highly unlikely that a 3-year-old would have osteoporosis from this situation.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

41. A student nurse is caring for a patient in skin traction. What action by the student causes the registered nurse to intervene?
A. Assesses neurovascular status every 24 hours
B. Ensures correct weights are hanging freely
C. Positions child perpendicular to the traction
D. Removes traction to assess the skin every 4 hours
ANS: C
The child should be positioned directly in line with the traction. The other interventions are correct.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

42. 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 patients medical record?
A. Dislocated hip
B. Femur fracture
C. Osteopenia
D. Spinal fracture
ANS: D
Crutchfield tongs are used to treat cervical or thoracic fractures.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

43. A nurse is caring for a patient in Crutchfield tongs. Which assessment finding requires immediate notification to the health-care provider?
A. Altered mental status
B. Crusted drainage at pin sites
C. Irritability and pain
D. WBCs of 98,000/mm3
ANS: A
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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

44. 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?
A. Allow independent ambulation around the unit.
B. Maintain forced bedrest with restraints if necessary.
C. Provide assistance with transfers and ambulation.
D. Use two individuals at all times for mobility.
ANS: C
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.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

MULTIPLE RESPONSE

1. 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.)
A. Calcitonin
B. Calcium
C. Estrogen
D. Thyroid hormones
E. Vitamin D
ANS: A, B, E
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.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. 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.)
A. Adducted forefoot
B. Dorsiflexion
C. Everted heel
D. Plantar flexion
E. Rigidity
ANS: A, D, E
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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

3. 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.)
A. Cast care
B. Cast drying techniques
C. Neurovascular assessment
D. Pain management
E. Wound care
ANS: A, C, D
Parents need to be taught how to properly care for their childs 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 childs 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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

4. 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.)
A. Approximately 10% to 15% of childhood injuries are fractures.
B. Bicycle crashes account for many fractures .
C. Girls rarely have stress fractures from sports.
D. New bone growth is complete in 6 weeks.
E. Some fractures can interrupt normal growth.
ANS: A, B, E
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.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

5. A nurse is teaching parents about caring for their child in a cast. Which information does the nurse provide? (Select all that apply.)
A. Be sure the child does not move joints above and below the cast.
B. Elevate the extremity above the heart as much as possible.
C. Keep the child from playing with toys that have very small parts.
D. Provide snacks high in calcium and vitamin D or provide supplements.
E. Reinforce active or passive range of motion to unaffected joints.
ANS: B, C, D, E
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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

6. 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.)
A. Chest x-ray
B. Chromosome analysis
C. ECG and echocardiogram
D. Pulmonary function studies
E. Ultrasound of the chest
ANS: A, B, C, D
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.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

7. 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.)
A. The ligament is only stretched and the affected joint is stable.
B. The patient cannot bear weight or use the extremity.
C. There is severe pain over the joint, making an exam difficult.
D. There is full range of motion and weight bearing.
E. Sprains and strains are unusual in a child this age.
ANS: B, C, E
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.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

8. A pediatrician orders Russell traction for a 12-year-old patient with Legg-Calv-Perthes disease. Which interventions are appropriate for the nurse to include in the care plan for this patient? (Select all that apply.)
A. Bony areas are massaged frequently.
B. Child is lying in a supine position.
C. Hip is flexed and abducted.
D. Skin is inspected every 12 hours.
E. The child uses a trapeze to move.
ANS: B, C, E
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-Calv-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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

9. Following hip surgery, a patient is placed in a spica cast. What nursing interventions are appropriate for this patient? (Select all that apply.)
A. Cutting a window in the cast
B. Icing the area over the incision
C. Increasing fiber in the diet
D. Increasing fluid intake
E. Maintaining the same position
ANS: A, C, D
Cast syndrome can be prevented by three nursing interventions: frequent repositioning, increasing fluids and fiber in the childs 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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Implementation
Difficulty: Easy

PTS: 1

10. The nurse is providing care to a pediatric patient who suffered an ankle sprain. Which interventions are appropriate to include in the patients plan of care? (Select all that apply.)
A. Apply an Ace wrap to apply pressure and reduce swelling of the joint.
B. Apply heat to the extremity for the first 48 hours at 15-minute intervals.
C. Elevate and move the affected joint to reduce swelling and stiffness.
D. Immediately perform range-of-motion exercises on the extremity.
E. Place ice on the injury for 15 minutes at a time for the first 1 to 2 days.
ANS: A, C, E
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).

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

11. 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.)
A. Acetaminophen (Tylenol)
B. Indomethacin (Indocin)
C. Infliximab (Remicade)
D. Leflunomide (Arava)
E. Methotrexate (Rheumatrex)
ANS: C, E
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.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

12. 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.)
A. Ankylosing spondylitis
B. Chronic poor posture
C. Osteogenesis imperfecta
D. Osteomyelitis
E. Rheumatoid arthritis
ANS: A, C
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.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

13. 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.)
A. Allow the child to return to school about 4 to 6 weeks following surgery.
B. Encourage ambulation when permitted, usually 2 to 3 weeks postoperatively.
C. Explain activity restrictions such as no twisting, bending, or lifting.
D. Maintain a regular diet with added calcium, fiber, fluids, and vitamin C.
E. Participation in contact sports such as football needs to be delayed for 1 year.
ANS: A, C, D
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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

14. 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.)
A. Activity level is determined by pain.
B. Apply ice to the knee after activity.
C. Modified bedrest for 1 week is needed.
D. Surgical correction is usually required.
E. Use ibuprofen (Motrin) for pain.
ANS: A, B, E
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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

15. A childs family history includes muscular dystrophy (MD). What diagnostic testing does the nurse prepare the child and family for? (Select all that apply.)
A. Blood urea nitrogen
B. Creatinine kinase
C. Electromyelogram
D. Muscle biopsy
E. Ultrasound
ANS: B, C, D
Common diagnostic tests for MD include creatinine kinase, electromyelogram, and muscle biopsy. Blood urea nitrogen and ultrasound are not used.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

16. An 8-year-old child is being treated for suspected tetanus. Which medications are appropriate for this child? (Select all that apply.)
A. Ceftriaxone (Rocephin)
B. Clindamycin (Cleocin)
C. Erythromycin (Erythrocin)
D. Penicillin G (Pfizerpen)
E. Tetracycline (Sumycin)
ANS: C, D
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.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

17. A child just had a long-leg cast placed after an open reduction and fixation of a femur fracture. What interventions are appropriate for the nurse to include in the childs plan of care? (Select all that apply.)
A. Assess the 4 Ps every hour, with vital signs.
B. Elevate the leg and apply ice for short periods.
C. Ensure that the proximal edge of the cast stays clean.
D. Handle the cast carefully when wet to prevent dents.
E. Use a hand-held dryer to help the cast dry faster.
ANS: B, C, D
Appropriate interventions for the child with a cast include assessing the 5 Ps along with vital signs, elevating and icing the leg, keeping the proximal edges clean as part of hygiene, handling the cast carefully when wet to prevent denting, and allowing the cast to air dry.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

COMPLETION

1. A nurse is caring for a patient with juvenile arthritis during an exacerbation. The child weighs 95 lb (43 kg). The physician orders sulfasalazine (Azulfidine) to be given in two divided doses per day. The safe dose range for a single dose of this drug for this child is ____________________ mg per dose.

ANS:
6451,075
The safe dose range for this drug is 3050 mg/kg/day in two divided doses. If this drug is just being initiated, the dose begins at to the expected maintenance dose.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

2. A nurse is completing a Pediatric Fall Risk Assessment on a child. The child has had no falls in the last 3 months, had surgery to repair a femur fracture on admission, is learning to use crutches, has a saline lock, is oriented to own ability, and is on narcotics. This childs fall risk score is ____________________.

ANS:
12

The child gets 3 points each for surgery, crutches, saline lock, and narcotics.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

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