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Flashcards in Chapter 31 Deck (15):
1

What is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization?
a. Increased metabolism
b. Increased venous return
c. Increased cardiac output
d. Decreased exercise tolerance

Ans: D
Muscle disuse leads to tissue breakdown and loss of muscle mass or muscle atrophy. It may take weeks or months to recover.
Metabolism decreases during periods of immobility.
There is decreased venous return due to decreased muscle activity secondary to immobility.
There is decreased cardiac output secondary to immobility.

2

Which measure is important in managing hypercalcemia in a child who is immobilized?
a. Promote adequate hydration
b. Change position frequently
c. Encourage a diet high in calcium
d. Provide a diet high in protein and calories

Ans: A
Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia.
Changing the child's position frequently will help with managing skin integrity but will not affect calcium levels.
The calcium will not be incorporated into bone because of the lack of weight bearing. The child is at risk of developing hypercalcemia.
The child's metabolism is slower because of the immobilization. A diet with sufficient calories and nutrients for healing is important.

3

The nurse is caring for an immobilized preschool child. What is helpful during this period of immobilization?
a. Encourage the child to wear pajamas.
b. Let the child have few behavioral limitations.
c. Keep the child away from other immobilized children if possible.
d. Take the child for a "walk" by wagon outside the room.

Ans: D
It is important for children to have activities outside of the room if possible. This can give them opportunities to meet their normal growth and developmental needs.
The child should be encouraged to wear street clothes during the day.
Limit setting is necessary with all children.
There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed.

4

What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle?
a. Elevation increases the pain threshold.
b. Elevation increases metabolism in the tissues.
c. Elevation produces deep tissue vasodilation.
d. Elevation reduces edema formation.

Ans: D
Elevating the extremity uses gravity to facilitate venous return to reduce edema.
Elevation should have no significant effect on the pain threshold.
Elevation should not affect metabolism.
Venous return to the heart, not vasodilation, is facilitated by elevation.

5

What is characteristic of fractures in children?
a. Fractures rarely occur at the growth plate site because it absorbs shock well.
b. Rapidity of healing is inversely related to the child's age.
c. Pliable bones of growing children are less porous than those of adults.
d. The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared with that of the adult.

Ans: B
Fractures heal in less time in children than in adults. As the child ages, the healing time increases.
The cartilage epiphyseal plate is the weakest point of the long bone. Therefore, it is a frequent site of damage and fractures.
The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs.
Bone healing in children is rapid due to the thickened periosteum and generous blood supply.

6

The callus that develops at a fracture site is important because it provides
a. use of the injured part.
b. sufficient support for weight bearing.
c. means for adequate blood supply.
d. means for holding bone fragments together.

Ans: D
New bone cells are formed in large numbers and stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus.
Functional use cannot occur until the fracture site is stable.
Sufficient support for weight bearing cannot occur until the fracture site is stable.
The callus does not provide an adequate blood supply.

7

A 3-year-old has just returned from surgery in a hip spica cast. The priority nursing intervention is to
a. elevate the head of the bed.
b. offer sips of water.
c. check circulation, sensation, and motion of toes.
d. turn the child to the right side, then the left side every 4 hours.

Ans: C
The chief concern is that the extremity may continue to swell. The circulation, sensation, and motion of the toes must be assessed to ensure that the cast does not become a tourniquet and cause complications.
Elevating the head of the bed might help with comfort, but it is not a priority. The nurse must be observant to the risk of increased swelling in the extremities.
Offering sips of water is acceptable once assessment of the extremities has been completed.
The child's position should be changed every 2 hours. Positioning a child with a spica cast is important to prevent injury.

8

An adolescent has had a lower leg amputation secondary to a motorcycle accident and is complaining of pain in the missing extremity. The nurse should recognize that this is
a. indicative of narcotic addiction
b. indicative of the need for psychological counseling
c. abnormal and suggests nerve damage
d. normal and called phantom limb sensation

Ans: D
Phantom limb sensation is an expected experience because the nerve–brain connections are still present. They gradually fade. This should be discussed preoperatively with the child.
There is no indication of narcotic addiction by the adolescent complaining of pain in the amputated extremity.
Phantom limb pain is expected after an amputation; psychological counseling is not required for the adolescent experiencing it.
Phantom limb pain is expected after an amputation and is not suggestive of nerve damage.

9

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a prosthetic device?
a. As soon as possible after birth
b. When the infant is developmentally ready to stand up
c. At about age 12 to 15 months, when most children are walking
d. At about 4 years, when the healthy limb is not growing so rapidly

Ans: B
The optimum time for the child to be fitted with a prosthetic device is when he or she is developmentally ready to stand up. The prosthetic device will be integrated into the child’s capabilities.
Fitting the infant for a prosthesis as soon as possible after birth will not be useful, because the child is not ready to use the leg.
Waiting until age 12 to 15 months to fit the child for a prosthesis may be too late. The fitting should be provided when the child is showing readiness to stand.
Waiting until age 4 years to fit the child for a prosthesis may be too late. The fitting should be provided when the child is showing readiness to stand.

10

Which statement is true concerning osteogenesis imperfecta (OI)?
a. OI is easily treated.
b. OI is an inherited disorder.
c. With a later onset, the disease usually runs a more difficult course.
d. Braces and exercises are of no therapeutic value.

Ans: B
OI is an autosomal dominant inherited disorder.
OI is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture.
OI has a predictable course that is determined by the pathophysiologic processes, not the time of onset.
Lightweight braces and splints can help support limbs and fractures.

11

What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis?
a. Provide active range-of-motion exercises of the affected extremity.
b. Administer pain medication with meals.
c. Encourage frequent ambulation.
d. Move and turn the child carefully and gently to minimize pain.

Ans: D
Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently.
Active range-of-motion exercises are contraindicated until pain has subsided.
Pain medication should be administered as needed.
Ambulation is contraindicated until pain has subsided.

12

Which statement is the most descriptive of rhabdomyosarcoma?
a. The most common sites are the head and neck.
b. It is a common hereditary neoplasm of childhood.
c. It is the most common bone tumor of childhood.
d. It is a benign tumor and unusual in children.

Ans: A
Although striated muscle fibers from which this tumor arises can be found anywhere in the body, the most common sites are the head and neck.
Rhabdomyosarcoma is not known to be hereditary.
Rhabdomyosarcoma arises from skeletal muscle tissue, not bone.
Rhabdomyosarcoma is highly malignant.

13

What are considered major goals of the therapeutic management of juvenile rheumatoid arthritis (JRA)?
a. Prevent joint discomfort; regain proper alignment.
b. Prevent loss of joint function; achieve cure.
c. Prevent physical deformity; preserve joint function.
d. Prevent skin breakdown; relieve symptoms.

Ans: C
The goals of treatment for JRA include the prevention of physical deformity, the preservation of joint function, and the control of pain.
Once the joint is damaged from the physiologic processes of JRA, it may not be possible to regain proper alignment.
Children with JRA may be cured of the disease.
Skin breakdown is usually not an issue in JRA.

14

Therapeutic management of the patient with systemic lupus erythematosus (SLE) includes
a. application of cold salts to suppress the inflammatory process.
b. a high-protein, low-salt diet.
c. a rigorous exercise regimen to build up muscle strength and endurance.
d. administration of corticosteroids to control inflammation.

Ans: D
Corticosteroid administration is the primary mode of therapy currently for SLE.
The application of cold salts will not affect the inflammatory process associated with SLE.
A balanced diet without exceeding caloric expenditures is recommended.
Exercise should be done in moderation.

15

A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Based on the nurse’s knowledge of DDH, which clinical manifestation should the nurse expect to observe? (Select all that apply.)
a. Lordosis
b. Negative Babinski sign
c. Asymmetric thigh and gluteal folds
d. Positive Ortolani and Barlow tests
e. Shortening of limb on affected side

Ans: C, D, E