Musculoskeletal/Bone Cancer
A child with Ewing sarcoma is undergoing a limb salvage procedure. Which statement indicates the parents understand the procedure?
1. “Our child will have a bone graft to save the limb.”
2. “Our child will need follow-up lengthening procedures.”
3. “Our child will need shorter shirt sleeves.”
4. “Our child will not need chemotherapy
What is 2?
Limb salvage requires lengthening procedures to encourage the bone to continue to grow so the child will not have a short limb.
The nurse is teaching an adolescent about Ewing sarcoma and indicates which as a common site?
1. Shaft.
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 with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse’s best response.
1. “Give her some acetaminophen, and see if her symptoms improve. If they do not
improve, bring her to the pediatrician’s office.”
2. “It is common for girls to have these symptoms, especially prior to beginning
their menstrual cycle. Give her a few days, and see if she improves.”
3. “You are probably worried that she is having a problem with her shunt. This is very unlikely as it has been working well for 9 years.”
4. “You should immediately take her to the emergency room as these may be symptoms of a shunt malfunction.”
What is 4?
These are symptoms of a shunt malfunction and should be evaluated immediately.
Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. Which is the primary purpose of hydrotherapy?
a. Débride the wounds.
b. Increase peripheral blood flow.
c. Provide pain relief.
d. Destroy bacteria on the skin.
What is A?
With hydrotherapy, water is applied to help clean the skin and remove damaged tissues. Fentanyl and midazolam (Versed) are given before the débridement of a child's burn wounds to provide pain relief. A high protein diet such as peanut butter is recommended.
An 8-year-old with type 1 diabetes mellitus is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first?
1. Administer glucagon intramuscularly.
2. Offer the child 8 oz of milk.
3. Administer rapid-acting insulin lispro (Humalog).
4. Offer the child 8 oz of water or calorie-free liquid.
What is 2?
Milk is best to give for mild hypoglycemia, which would present with the symptoms described.
A child is going to receive radiation for Ewing sarcoma. Which of the following is the best nursing intervention to prevent skin breakdown during therapy?
1. Advise the child to wear loose-fitting clothes to minimize irritation.
2. Advise the child to use emollients to prevent dry skin.
3. Apply cold packs nightly to reduce the warmth caused by the treatments.
4. Apply hydrocortisone to soothe itching from dry skin.
What is 1?
Loose clothing helps reduce irritation on sensitive irradiated skin.
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
Which should be the priority nursing diagnosis for a 12-hour-old newborn with a myelomeningocele at L2?
1. Altered bowel elimination related to neurological deficits.
2. Potential for infection related to the physical defect.
3. Altered nutrition related to neurological deficit.
4. Disturbance in self-concept related to physical disability.
What is 2? Because this infant has not had a repair, the sac is exposed. It could rupture, allowing organisms to enter the cerebrospinal fluid, so this is the priority.
Which best describes a full-thickness (third-degree) burn?
a. Erythema and pain
b. Skin showing erythema followed by blister formation
c. Destruction of all layers of skin evident with extension into subcutaneous tissue
d. Destruction injury involving underlying structures such as muscle, fascia, and bone
What is C?
c. Destruction of all layers of skin evident with extension into subcutaneous tissue
A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do first?
1. Give more pain medication.
2. Perform a neuromuscular assessment.
3. Call the surgeon for orders.
4. Tell the child to wait another hour for the medication to work.
What is 2?
The nurse looks for the source of the pain by performing a neuromuscular assessment.
When teaching parents about osteosarcoma, the nurse knows instruction has been successful when a parent says that this type of cancer is common in which age group?
1. Infancy.
2. Toddlers.
3. School-aged children.
4. Adolescents.
What is 4?
Osteosarcoma is a common cancer of adolescents.
A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus?
1. Low-pitched cry and depressed fontanel.
2. Low-pitched cry and bulging fontanel.
3. Bulging fontanel and downwardly rotated eyes.
4. Depressed fontanel and upwardly rotated eyes.
What is 3?
An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. With sunset eyes, the sclera can be seen above the iris.
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.
Which assessment of an 18-month-old with burns on his feet would cause suspicion of child abuse?
1. Splash marks on his right lower leg.
2. Burns noted on right arm.
3. Symmetrical burns on both feet.
4. Burns mainly noted on the right foot.
What is 3?
Physical abuse has certain characteristics. Symmetrical burns on both feet indicate abuse.
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 osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia?
1. “My child will be more at risk for diarrhea.”
2. “My child will be more at risk for infection.”
3. “My child’s hair will fall out.”
4. “My child will need to drink more.”
What is 2?
Neutropenia makes a child more at risk for infection, because the immune system is compromised due to the chemotherapy.
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.
A child is admitted with extensive burns. The nurse notes that there are burns on the child's lips and singed nasal hairs. The nurse should suspect that the child has a(n):
a. chemical burn.
b. inhalation injury.
c. electrical burn.
d. hot-water scald.
What is B?
Inhalation injury.
The parent of a 3-week-old states that the infant was recasted 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 neurocirculatory status of the foot.
4. Use a cool blow-dryer to blow into the cast to control itching.
What is 3?
Checking the neurocirculatory status of the foot is the highest priority.
Which nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy?
1. Risk for fluid volume deficit.
2. Potential for chronic pain.
3. Risk for skin impairment.
4. Ineffective airway clearance.
What is 1?
Chemotherapy can cause nausea, vomiting, and possibly diarrhea, which contribute to fluid volume deficit.
Nursing care of a child with a fractured extremity in whom there is suspected compartment syndrome includes which of the following? Select all that apply.
1. Assess pain.
2. Assess pulses.
3. Elevate extremity above the level of the heart.
4. Monitor capillary refill.
5. Provide pain medication as needed
What is 1, 2, 4, 5?
1. In a recent fracture, the nurse should assess pain and provide treatment.
2. Pain, pallor, and weak or absent pulses are all signs of compartment syndrome.
4. Weak or absent pulse is a sign of compartment syndrome, so monitoring capillary refill is important in assessment.
5. Pain, pallor, and weak or absent pulses are signs of compartment syndrome. Pain should be treated.
Over the last week, an infant with a repaired myelomeningocele has had a high-pitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile.
Today length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following?
1. Tell the parent this is normal for an infant with a repaired myelomeningocele.
2. Tell the parent this might mean the baby has increased intracranial pressure.
3. Suspect the baby’s intracranial pressure is low because of a leak.
4. Refer the baby to the neurologist for follow-up care.
What is 2?
The increase in head size is one of the first signs of increased intracranial pressure; other signs include high-pitched cry and irritability.
A child with extensive burns requires débridement. The nurse should anticipate which priority goal related to this procedure?
a. Reduce pain.
b. Prevent bleeding.
c. Maintain airway.
d. Restore fluid balance
What is A?
Reduce pain. With debridement, the nurse should administer opioid pain medication at least 30 minutes before the procedure.