Peds Musculoskeletal & Trauma

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands the need for this treatment is based on which of the following?

• PaCO2 levels decrease, causing vasoconstriction.

• Drainage of cerebrospinal fluid occurs.

• Activity is controlled via a stimulator.

• Hyperexcitability of the nerves is reduced.

The nurse is providing care to a child with a long-leg hip spica cast. Which of the following would be a priority nursing diagnosis?

• Risk for impaired skin integrity due to cast and location

• Deficient knowledge related to cast care

• Risk for delayed development related to immobility

• Self-care deficit related to immobility

Which of the following would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure?

• Bradycardia

• Cheyne-Stokes respirations

• Fixed, dilated pupils

• Projectile vomiting

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. Which of the following would the nurse not include in the child's discharge instructions? Select all that apply.

• “Expect his headache to get worse initially and then disappear.”

• “Wake him every 2 hours to check his movement and responses.”

• “Call your medical provider if he vomits more than 4 times.”

• “Any watery fluid draining from his ears is normal.”

• “Stay with the child for the first 24 hours & closely watch for days after”

The nurse is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the mother indicates a need for further teaching?

• “I need to avoid pushing or pulling on an arm or leg.”

• “I must carefully lift the baby from under the armpits.”

• “I should not bend an arm or leg into an awkward position.”

• “We must avoid lifting the legs by the ankles to change diapers.”

The nurse is developing a teaching plan for a child who is to have his cast removed. Which of the following would the nurse most likely include?

• Applying petroleum jelly to the dry skin

• Rubbing the skin vigorously to remove the dead skin

• Soaking the area in warm water every day

• Washing the skin with dilute peroxide and water

A 15-year-old boy complains of sudden pain at the hip that is referred to the groin. You notice his hip drops when lifting the opposite leg & he is borderline obese. He is unable to bear much weight on the side of the affected hip & has decreased ROM with external rotation. After the patient’s diagnosis is confirmed with an X-ray, what possibilities should the nurse expect to happen next? Select all that apply.

• Bed rest will be enforced with activity restriction

• No passive range of motion will be permitted

• Surgery will be performed with the possibility of traction use

• Prolonged immobility may occur, isolating the adolescent

• Surgery will be performed & no weight bearing will be allowed 1 week

The nurse is assessing an 11-year-old girl with scoliosis. Which of the following would the nurse expect to find? Select all answers that apply.

• Complaints of severe back pain

• Asymmetric shoulder elevation

• Even curve at the waistline

• Pronounced one-sided hump on bending over

• Diminished motor function

A 3-year-old was brought to the emergency department by her mother, who states, “I think she broke her arm.” The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which of the following signs could signal child abuse? Select all that apply.

• Spiral, humeral, or rib fracture on X-ray

• Child cries and wants to go home

• Child laughs during physical exam

• Child clings to the nurse during examination

• Child does not cry with physical exam

When trying to manage aggressive or impulsive behaviors in children or adolescents, what is the best nursing intervention?

• Train the child to be assertive

• Provide consistency and limit setting

• Allow the child to negotiate the rules

• Encourage the child to express feelings