Mrs. Cooper is concerned about her 4-month-old son’s unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy?
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Solution
“My baby won’t lift his head up and look at me; he’s so floppy.”
Option B: Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to 90-degree angle by age 4 months with only a partial head lag by age 2 months.
Option A: Although rigidity and tenseness are possible signs cerebral palsy, a limitation in one leg suggests DDH.
Option C: Tilting of the hip is an indication of developmental dysplasia of the hip (DDH).
Option D: Rolling completely over usually does not occur until the infant is age 6 months.
Nurse Kevin is assessing a newborn for developmental dysplasia of the hip (DDH); he would expect to assess which of the following?
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Solution
Ortolani’s sign
Option B: Ortolani’s sign is felt and heard when newborn‘s or neonate’s hip is flexed and abducted.
Option A: A characteristic limp would be noted in the ambulatory child.
Option C: Asymmetrical gluteal folds would be noted in DDH.
Option D: Trendelenburg‘s sign is noted in the weight-bearing child when the child stands on the affected hip and the pelvis tilts downward on the normal side instead of upward.
Mrs. Lodge’s child requires the use of Pavlik harness; which of the following would Nurse Betty do to best assess the mother’s ability to care for her child?
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Solution
Have the mother remove and reapply the harness before discharge.
Option B: Having the mother remove and reapply the harness before discharge allows the nurse to directly observe the mother’s method and comfort level. It also provides time for reinstruction if needed.
Option A: Although the nurse’s demonstration is a good teaching method, it does not permit evaluation of the mother’s routine.
Option C: Verbalization is significant to allow the nurse to assess the mother’s understanding, but it does not allow evaluation of the mother’s psychomotor skills.
Option D: Requesting a home visit is further means of evaluation but does not provide instant feedback.
When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following?
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Solution
Bone growth disruption
Option D: The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in limb shortening.
Option A: Rheumatoid arthritis is a collagen disease with an autoimmune component, with no relationship to fractures.
Options B and C: Nerve damage and osteomyelitis may occur with any fracture, but growth disruption is a primary concern at the epiphyseal plate.
Nurse Cheryl is assessing Fred, a 14-year-old boy who had scoliosis; besides checking neurologic status directly after Harrington rod instrumentation and spinal fusion, she should be regarded with which of the following factors?
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Solution
Comfort level
Option A: Instrumentation and spinal fusion cause considerable pain. Therefore, the adolescent needs vigorous pain management, which involves assessment, administration of pain medication, and evaluation of the response. In the immediate postoperative period, the child is conscious of sensation and surroundings.
Option B: Typically, shortly after surgery, the adolescent will not be taking anything by mouth.
Option C: Physical therapy is not an urgent postoperative goal at this time. However, it may be appropriate later on in the postoperative period.
Option D: Assessment and understanding of the procedure is a preoperative nursing responsibility.
Among toddlers and children up to age five, femur fractures usually result from a low energy fall. In most cases, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide and immobilizes the leg in a type of cast called a spica cast. Approximately how many weeks does it take for a fractured femur to heal in a 3-year-old?
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Solution
4 weeks
Option B: The approximate healing time for a fractured femur during childhood is 4 weeks.
Which of the following is the most common permanent disability in childhood?
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Solution
Cerebral palsy
Option C: Cerebral palsy is the most common permanent disability of childhood. Cerebral palsy is a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy.
Options A and D: Scoliosis and DDH should not cause permanent disability.
Option B: Muscular dystrophy is a group of disorders that cause progressive degeneration and weakness of skeletal muscles.
Veronica is a 14-year-old girl who wears a brace for structural scoliosis; which of the following statements indicate effective use of the brace?
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Solution
“I’ll look forward to taking this thing off to take my bath every day.”
Option D: The brace should be dropped for simply 1 hour of every 24-hour period for hygiene and skin care.
Option A: Wearing the brace at night would be true only following radiologic studies indicate the spine has bone marrow maturity and the adolescent has been weaned from off whenever 1 to 2 years.
Option B: Taking the brace off whenever tired indicates poor understanding of the brace.
Option C: Although physical appearance and social activities with peers are significant, the brace should not be excluded during these times.
A spica cast was put on Baby Betty after an unfortunate incident to immobilize her hips and thighs; which of the following is the priority nursing action immediately after application?
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Solution
Perform neurovascular checks.
Option D: Neurovascular assessment is always a priority in the assessment of a freshly applied cast to ensure adequate circulation and neurologic function and prevent complications or injury.
Options A, B, and C: Keeping the cast dry and clean, covering the perineal area to prevent wetness and soiling, and elevating the cast to prevent or minimize edema are all important, but these are not the priority immediately after a cast applied.
Mr. and Mrs. Andrews’ child was diagnosed with Duchenne’s muscular dystrophy; which of the following usually is the first indication of the condition?
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Solution
Difficulty running in the preschooler
Option C: Usually, sign and symptoms of Duchenne’s muscular dystrophy are not noticed until ages 3 to 5 years. Typically weakness starts with the pelvic girdle, evidenced as difficulty running in the preschooler. Duchenne’s muscular dystrophy usually is not diagnosed in the infant or toddler period.
Option A: Sucking is not the first sign of Duchenne’s muscular dystrophy.
Option B: Sign and symptoms of muscular dystrophy are not noticed until ages 3 to 5 years.