Musculoskeletal
An infant has been diagnosed with Hip Dysplasia (DDH) (Two part question)
A. What may be the first line of treatment to immobilize the hip joints?
B. What may be the second line of treatment to immobilize the hip joints?
What is:
A. a Pavlik Harness
B. a Hip Spica Cast
The nurse is teaching an adolescent about Ewing Sarcoma and indicates which as a common site?
1. Shaft of a long bone.
2. Growth plate.
3. Ball of the femur.
4. Bone marrow.
What is 1?
Ewing sarcoma is a bone tumor that affects the shafts of long bones.
A child has a fracture of the forearm and the parents are asking the nurse of signs of Compartment Syndrome.
(Name at least two).
What are:
Pain without relief
Tightness in the affected area (tight cast)
Numbness, tingling or weakness in the fingers or toes (depending on where the cast is)
Cool and pale extremities
A child is diagnosed with a GH (Growth Hormone) deficiency.
The parents ask what medication he might be put on and what are the side effects.
This is the med most likely used, how administered, and name at least 1 side effect.
What is Somatropin?
The synthetic med (given SQ).
Side effects are HA, joint pain
Increased blood glucose, pancreatitis
These are symptoms of Rubeola disease (Measles).
(Name two)
What are:
Mild to moderate fever
Conjunctivitis
Fatigue
Cough, runny nose
Tiny white spotted rash occurs after 3-4 days (spike in fever with rash).
A child is hospitalized for osteomyelitis. The parent asks what the priority nursing actions will be with her child.
(Identify at least 3).
What is: IV therapy including IV antibiotics, monitor VS and I & O, administer pain meds as needed and consult PT.
Which is most important to discuss with an adolescent who is going to have a leg amputation for Osteosarcoma?
1. Pain.
2. Spirituality.
3. Body image.
4. Lack of coping.
What is 3?
Body image is a developmental issue for adolescents and influences their acceptance of themselves and by peers.
Which should the nurse tell the parent of an infant with spina bifida?
1. “Bone growth will be more than that of babies who are not sick because your baby will be less active.”
2. “Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills.”
3. “Nutritional needs for your infant will be calculated based on activity level.”
4. “Fine motor skills will be delayed because of the disability.”
What is 2?
Children with decreased activity due to illness or trauma are helped by physical and occupational therapy. The varied activities stimulate the senses.
Describe the "Rule of 9's" in a pediatric nursing burn patient.
What is:
The assessment used to estimate the TBSA burned in a pediatric client.
18% for head & neck
14% for each leg
9% for each arm
The TBSA is used to understand the total fluid replacement (Parkland Formula needed).
What is at least one long term complication of Mumps?
What is:
Encephalitis, Meningitis, deafness
A child is diagnosed with Osteogenesis Imperfecta.
Name at least two signs/symptoms.
What are:
Bones that break easily, bowed legs,
short in stature, curved spine (scoliosis), brittle teeth, possible hearing loss.
A child is recently diagnosed with a Wilm's Tumor. What teaching points would be important?
(Name at least two).
What is:
Do not palpate the abdominal mass.
Wilm's Tumor usually occurs in the kidneys or abdomen (usually unilateral)
Wilm's Tumor Signs/Symptoms: Fatigue and Weight loss
These are the 5 P's in the Neurovascular checks.
What are:
P: Pain
P: Pallor
P: Pulses
P: Paresthesia
P: Paralysis
A 12-year-old with type 2 diabetes mellitus presents with a fever and a 2-day history of vomiting. The nurse observes that the child’s breath has a fruity odor and breathing is deep and rapid. Which should the nurse do first?
1. Offer the child 8 oz of clear non-caloric fluid.
2. Test the child’s urine for ketones.
3. Prepare the child for an IV infusion.
4. Offer the child 25 g of carbohydrates.
What is 3?
This patient needs fluid and electrolyte therapy to restore tissue perfusion prior to beginning IV insulin therapy. This child is most likely in DKA.
Next steps: IV regular insulin, K monitoring, and neuro checks.
What type of precautions would you do with Conjunctivitis?
What is:
Viral: Contact precautions
Bacterial: Standard
Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply.
1. Duck gait.
2. Pain.
3. Osteoarthritis in adulthood.
4. Osteoporosis in adulthood.
5. Increased flexibility of the hip joint in adulthood.
What is 1, 2, 3?
1. Due to abnormal hip joint function, the patient’s gait is stiff and waddling.
2. Due to abnormal femoral head placement,
the patient may experience pain and decreased flexibility in adulthood.
3. Due to abnormal femoral head placement,
the patient may experience osteoarthritis in the hip joint in adulthood.
A child with ALL is undergoing Chemotherapy and Radiation treatment. What are some common side effects of each?
(Name at least two for each).
What is:
Neutropenia makes a child more at risk for infection, because the immune system is compromised due to the chemotherapy.
What is: loss of appetite (N & V due to the chemo).
What is: Myelosuppression (bone-marrow suppression) due to the Chemo (resulting in anemia, neutropenia and thrombocytopenia)
Radiation: Skin issues or alopecia (can occur with both chemo and radiation)
A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that:
1. This is a serious injury that could cause long-term growth issues.
2. The fracture usually heals within 6 weeks without further complications.
3. The child will never be able to play contact sports.
4. Fractures involving the growth plate require pain medication.
What is 1?
Fractures of the growth plate are serious, as they can disrupt the growth process.
The school nurse is talking to a 14-year-old about managing type 1 diabetes mellitus. Which statement indicates the student’s understanding of the disease?
1. “It really does not matter what type of carbohydrate I eat as long as I take the right amount of insulin.”
2. “I should probably have a snack right after gym class.”
3. “I need to cut back on my carbohydrate intake and increase my lean protein intake.”
4. “Losing weight will probably help me decrease my need for insulin.”
What is 1?
A carbohydrate is a carbohydrate, and insulin dosing is based on blood sugar level and carbohydrates to be eaten.
These are nursing actions used for Contact Dermatitis for an infant.
(Name at least two)
What are:
Change diapers frequently
Cleanse diaper area with non-irritating cleanser or warm water
Use soft cloths free of alcohol & fragrances
Expose the affected area to air
The parent of a 3-week-old states that his infant was re-casted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first?
1. Give pain medication.
2. Reposition the infant in the crib.
3. Check the neurovascular status of the foot.
4. Use a cool blow-dryer to blow into the cast to control itching.
What is 3?
Checking the neurovascular status of the foot is the highest priority.
These are signs and symptoms of a Retinoblastoma.
(Name at least two).
What is:
A white glow in a child's pupil often seen in a flash photo, crossed eyes, eye pain, poor vision, and an enlarged bulging eye.
A child is diagnosed with Juvenile Arthritis.
A. What are at least two signs of this illness?
B. What are at least two risk factors?
What are:
A. Joint pain, joint tenderness, fever, rash, fatigue
B. Genetic link, exposure to second-hand smoke, females more at risk than males.
These are signs and symptoms of Grave's Disease in children.
(Name at least two).
What are:
A rapid & irregular heartbeat
Tremors
Weight loss
Bulging eyes
Increased appetite and increased BMs
These are risk factors for acne.
(Name at least two).
What are:
Genetic link
More common in males
Age: More common in teens
Some cosmetic products (lanolin etc)
Working in a fast food area exposed to cooking grease