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Ch. 5: Sexually Transmitted Infections
| Page: 164 | ||
| 1. | The nurse is developing a plan of care for a client who is receiving aggressive drug therapy for treatment of HIV. The goal of this therapy is to: | |
| A) | Promote the progression of disease | |
| B) | Intervene in late-stage AIDS | |
| C) | Improve survival rates | |
| D) | Conduct additional drug research | |
| Ans: | C | |
| Response: | ||
| Aggressive antiretroviral therapy aims to reduce HIV morbidity and mortality, thereby improving survival rates. Drug therapy also aims to decrease the HIV viral load, restore the body’s ability to fight off infection, and improve the quality of life. Drug therapy does not promote the progression of the disease. It is started at the time of the first infection, not in late-stage AIDS. Treatment advances have been based on research, but drug therapy is not prescribed to conduct additional research. | ||
| Page: 164 | ||
| 2. | A woman who is HIV-positive is receiving HAART and is having difficulty with compliance. To promote adherence, which of the following areas would be most important to assess initially? | |
| A) | The woman’s beliefs and education | |
| B) | The woman’s financial situation and insurance | |
| C) | The woman’s activity level and nutrition | |
| D) | The woman’s family and living arrangements | |
| Ans: | A | |
| Response: | ||
| The most important area to assess initially would be the client’s beliefs and knowledge about the disease and its treatment. A common barrier is a lack of understanding about the link between drug resistance and nonadherence. Once this area is assessed, the nurse can assess for other barriers, such as finances and insurance, nutrition and activity level, and family issues, including living arrangements (for example, the woman may be afraid that her HIV status would be revealed if others see her taking medication). | ||
| Page: 162 | ||
| 3. | When developing a teaching plan for a community group about HIV infection, which group would the nurse identify as an emerging risk group for HIV infection? | |
| A) | Native Americans | |
| B) | Heterosexual women | |
| C) | New health care workers | |
| D) | Asian immigrants | |
| Ans: | B | |
| Response: | ||
| According to statistics, more than 90% of all HIV infections have resulted from heterosexual intercourse, making heterosexual women particularly vulnerable due to substantial mucosal exposure to seminal fluids. HIV disproportionately affects African-American and Hispanic women, but together they represent less than 25% of all U.S. women. New health care workers and Asian immigrants account for only a very small number of HIV-positive cases. | ||
| Page: 162 | ||
| 4. | After teaching a group of adolescents about HIV, the nurse asks them to identify the major means by which adolescents are exposed to the virus. The nurse determines that the teaching was successful when the group identifies which of the following? | |
| A) | Sexual intercourse | |
| B) | Sharing needles for IV drug use | |
| C) | Perinatal transmission | |
| D) | Blood transfusion | |
| Ans: | A | |
| Response: | ||
| Most HIV-infected adolescents are exposed to the virus through sexual intercourse, with recent data suggesting that the majority of HIV-infected adolescent males are infected through sex with men. Only a few adolescent males appear to be exposed through injection of drugs or heterosexual contact. Adolescent females are mostly exposed through heterosexual contact, with a small percentage exposed through injected drug use. Although perinatal transmission can occur, it is not the major means of transmission for adolescents. Exposure to the virus via blood transfusions had dropped significantly with the testing of blood and blood products. | ||
| Page: 123 | ||
| 5. | The nurse reviews the CD4 cell count of a client who is HIV-positive. A result less than which of the following would indicate to the nurse that the client has AIDS? | |
| A) | 1,000 cells/mm3 | |
| B) | 700 cells/mm3 | |
| C) | 450 cells/mm3 | |
| D) | 200 cells/mm3 | |
| Ans: | D | |
| Response: | ||
| When the CD4 T-cell count reaches 200 or less, the person has reached the stage of AIDS as per the CDC. A CD4 T-cell count between 450 and 1,200 is considered normal. | ||
| Page: 166 | ||
| 6. | When obtaining the health history from a client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)? | |
| A) | Hive-like rash for the past 2 days | |
| B) | Five different sexual partners | |
| C) | Weight gain of 5 lbs in one year | |
| D) | Clear vaginal discharge | |
| Ans: | B | |
| Response: | ||
| The number of sexual partners is a risk factor for the development of STIs. A rash could be related to numerous underlying conditions. A weight gain of 5 lbs in one year is not a factor increasing one’s risk for STIs. A change in the color of vaginal discharge such as yellow, milky, or curd-like, not clear, would suggest a STI. | ||
| Page: 143 | ||
| 7. | Assessment of a female client reveals a thick, white vaginal discharge. She also reports intense itching and dyspareunia. Based on these findings, the nurse would suspect that the client has: | |
| A) | Trichomoniasis | |
| B) | Bacterial vaginosis | |
| C) | Candidiasis | |
| D) | Genital herpes simplex | |
| Ans: | C | |
| Response: | ||
| A thick, white vaginal discharge accompanied by intense itching and dyspareunia suggest vulvovaginal candidiasis. Trichomoniasis is characterized by a heavy yellow, green, or gray frothy or bubbly discharge. Bacterial vaginosis is manifested by a thin, white homogenous vaginal discharge with a characteristic stale fish-like odor. Genital herpes simplex involves genital ulcers. | ||
| Page: 149 | ||
| 8. | A client with trichomoniasis is to receive metronidazole (Flagyl). The nurse instructs the client to avoid which of the following while taking this drug? | |
| A) | Alcohol | |
| B) | Nicotine | |
| C) | Chocolate | |
| D) | Caffeine | |
| Ans: | A | |
| Response: | ||
| The client should be instructed to avoid consuming alcohol when taking metronidazole because severe nausea and vomiting could occur. There is no need to avoid nicotine, chocolate, or caffeine when taking metronidazole. | ||
| Page: 153 | ||
| 9. | A woman gives birth to a healthy newborn. As part of the newborn’s care, the nurse instills erythromycin ophthalmic ointment as a preventive measure related to which STI? | |
| A) | Genital herpes | |
| B) | Hepatitis B | |
| C) | Syphilis | |
| D) | Gonorrhea | |
| Ans: | D | |
| Response: | ||
| To prevent gonococcal ophthalmia neonatorum, erythromycin or tetracycline ophthalmic ointment is instilled into the eyes of all newborns. This action is required by law in most states. The ointment is not used to prevent conditions related to genital herpes, hepatitis B, or syphilis. | ||
| Page: 151 | ||
| 10. | Which findings would the nurse expect to find in a client with bacterial vaginosis? | |
| A) | Vaginal pH of 3 | |
| B) | Fish-like odor of discharge | |
| C) | Yellowish-green discharge | |
| D) | Cervical bleeding on contact | |
| Ans: | B | |
| Response: | ||
| Manifestations of bacterial vaginosis include a thin, white homogenous vaginal discharge with a characteristic stale fish odor, vaginal pH greater than 4.5, and clue cells on wet-mount examination. A yellowish-green discharge with cervical bleeding on contact would be characteristic of trichomoniasis. | ||
| Page: 155 | ||
| 11. | A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through the: | |
| A) | Amniotic fluid | |
| B) | Placenta | |
| C) | Birth canal | |
| D) | Breast milk | |
| Ans: | B | |
| Response: | ||
| The syphilis spirochete can cross the placenta at any time during pregnancy. It is not transmitted via amniotic fluid, passage through the birth canal, or breast milk. | ||
| Page: 158 | ||
| 12. | The nurse encourages a female client with human papillomavirus (HPV) to receive continued follow-up care because she is at risk for: | |
| A) | Infertility | |
| B) | Dyspareunia | |
| C) | Cervical cancer | |
| D) | Dysmenorrhea | |
| Ans: | C | |
| Response: | ||
| Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer. Therefore, the client needs continued follow-up for Pap smears. HPV is not associated with an increased risk for infertility, dyspareunia, or dysmenorrhea. | ||
| Page: 157 | ||
| 13. | A client is diagnosed with pelvic inflammatory disease (PID). When reviewing the client’s medical record, which of the following would the nurse expect to find? Select all that apply. | |
| A) | Oral temperature of 100.4 degrees F | |
| B) | Dysmenorrhea | |
| C) | Dysuria | |
| D) | Lower abdominal tenderness | |
| E) | Discomfort with cervical motion | |
| F) | Multiparity | |
| Ans: | B, C, D, E | |
| Response: | ||
| History and physical examination findings of PID include dysmenorrhea, dysuria, lower abdominal tenderness, and cervical motion tenderness. Typically the client has a fever above 101 degrees F and is nulliparous. | ||
| Page: 161 | ||
| 14. | Which instructions would the nurse include when teaching a woman with pediculosis pubis? | |
| A) | “Take the antibiotic until you feel better.” | |
| B) | “Wash your bed linens in bleach and cold water.” | |
| C) | “Your partner doesn’t need treatment at this time.” | |
| D) | “Remove the nits with a fine-toothed comb.” | |
| Ans: | D | |
| Response: | ||
| The nurse should instruct the client to remove the nits from the hair using a fine-toothed comb. Permethrin cream and lindane shampoo are used as treatment, not antibiotics. Bedding and clothing should be washed in hot water to decontaminate it. Sexual partners should be treated also, as well as family members who live in close contact with the infected person. | ||
| Page: 154 | ||
| 15. | A client with genital herpes simplex infection asks the nurse, “Will I ever be cured of this infection?” Which response by the nurse would be most appropriate? | |
| A) | “There is a new vaccine available that prevents the infection from returning.” | |
| B) | “All you need is a dose of penicillin and the infection will be gone.” | |
| C) | “There is no cure, but drug therapy helps to reduce symptoms and recurrences.” | |
| D) | “Once you have the infection, you develop an immunity to it.” | |
| Ans: | C | |
| Response: | ||
| Genital herpes is a life-long viral infection. No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. A vaccine is available for HPV infection but not genital herpes. Penicillin is used to treat syphilis. No immunity develops after a genital herpes infection. | ||
Ch. 31: Health Assessment of Children
| Page: 957 | ||
| 1. | The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond? | |
| A) | “Your daughter has acrocyanosis; this is causing her blue hands and feet.” | |
| B) | “Let’s watch her carefully to make sure she does not have a circulatory problem.” | |
| C) | “This is normal; her circulatory system will take a few days to adjust.” | |
| D) | “This a vaso-motor response caused by cooling or warming.” | |
| Ans: | C | |
| Response: | ||
| The nurse should tell the parents that this is normal and that the baby’s circulatory system is adjusting to extra-uterine life. Using the technical term “acrocyanosis” would most likely scare the parents. Telling the parents that the child may have a circulatory problem is inaccurate as this is a normal variation. Acrocyanosis and the mottling caused by cooling and warming are two different variations. | ||
| Page: 960 | ||
| 2. | A nurse is assessing the fontanels of a crying newborn and notes that the posterior fontanel pulsates and briefly bulges. What do these findings indicate? | |
| A) | Increased intracranial pressure | |
| B) | Overhydration | |
| C) | Dehydration | |
| D) | A normal finding | |
| Ans: | D | |
| Response: | ||
| It is common to see the fontanel pulsate or briefly bulge if a baby cries. Overhydration or increased cranial pressure would cause a persistent bulging. Dehydration would cause the fontanel to be sunken. | ||
| Page: 949 | ||
| 3. | The nurse is preparing to take a tympanic temperature reading of a 4-year-old. To get an accurate reading, what does the nurse need to do? | |
| A) | Pull the earlobe back and down. | |
| B) | Direct the infrared sensor at the tympanic membrane. | |
| C) | Pull the earlobe down and forward. | |
| D) | Remove any visible cerumen from inside the ear canal. | |
| Ans: | B | |
| Response: | ||
| The accuracy of tympanic temperature reading is dependent upon appropriate technique. The nurse needs to be sure to direct the infrared sensor at the tympanic membrane. Since the child is over the age of 3, the earlobe does not need to be pulled back and down. The nurse would not remove earwax from inside the ear canal. | ||
| Page: 950 | ||
| 4. | The nurse is assessing the heart rate of a healthy 13-month-old child. The nurse knows to auscultate which of the following sites to obtain an accurate assessment? | |
| A) | Radial pulse | |
| B) | Brachial pulse | |
| C) | Apical pulse at the third or fourth intercostal space | |
| D) | Apical pulse at the fourth or fifth interspace at the midclavicular line | |
| Ans: | C | |
| Response: | ||
| For children younger than 2 years of age, the nurse should auscultate the apical pulse with the stethoscope at the point of maximum intensity just above and outside of the left nipple at the third or fourth intercostal space. The radial pulse is difficult to palpate accurately on children less than 2 years of age because the blood vessels lie so close to the skin surface and are easily obliterated. The brachial pulse is not the best point of auscultation. The point of maximum intensity (PMI) is heard best at the fourth or fifth intercostal space at the midclavicular line beginning around 7 years of age. | ||
| Page: 960 | ||
| 5. | The nurse is assessing the neck of an 8-year-old child with Down syndrome. Which of the following findings would the nurse expect during the examination? | |
| A) | Webbing | |
| B) | Excessive neck skin | |
| C) | Lax neck skin | |
| D) | Shortened neck | |
| Ans: | C | |
| Response: | ||
| Lax neck skin may occur with Down syndrome. Webbing or excessive neck skin folds may be associated with Turner syndrome. A shortened neck is expected in a child under age 4. | ||
| Page: 959 | ||
| 6. | The nurse is conducting a routine health assessment of a 3-month-old boy and notices a flat occiput. The nurse provides teaching and emphasizes the importance of “tummy time.” Which of the following responses by the mother indicates a need for further teaching? | |
| A) | “He must be positioned on his tummy as much as possible.” | |
| B) | “I need to watch him during his tummy time.” | |
| C) | “I need to change his head position while he is in an upright chair.” | |
| D) | “His head has flattened due to the pressure of his head position.” | |
| Ans: | A | |
| Response: | ||
| The nurse needs to emphasize that “tummy time” should occur only when the child is observed and awake; the baby should still sleep on his back. The other statements are correct. | ||
| Page: 953 | ||
| 7. | The nurse is measuring the blood pressure of a 12-year-old boy with an oscillometric device. The boy’s reading is greater than the 90th percentile for gender and height. What is the appropriate nursing action? | |
| A) | Repeat the reading with the oscillometric device. | |
| B) | Repeat the blood pressure reading using auscultation. | |
| C) | Measure the blood pressure in all four extremities. | |
| D) | Measure the blood pressure with a Doppler. | |
| Ans: | B | |
| Response: | ||
| The nurse should repeat the reading using auscultation. The nurse should not use the Doppler ultrasound method in this circumstance. The nurse would measure the blood pressure in all four extremities in a child presenting with cardiac complaints. | ||
| Page: 959 | ||
| 8. | The nurse is inspecting the fingernails of an 18-month-old girl. Which of the following findings indicates chronic hypoxemia? | |
| A) | Nails that curve inward | |
| B) | Clubbing of the nails | |
| C) | Nails that curve outward | |
| D) | Dry, brittle nails | |
| Ans: | B | |
| Response: | ||
| Clubbing of the nails indicates chronic hypoxemia, related to either respiratory or cardiac disease. Nails that curve inward or outward may be hereditary or linked with injury, infection, or iron deficiency anemia. Dry, brittle nails may indicate a nutritional deficiency. | ||
| Page: 951 | ||
| 9. | The nurse is assessing the heart rate of a healthy school-age child. The nurse expects that the child’s heart rate will be in which of the following ranges? | |
| A) | 120 to 160 bpm | |
| B) | 80 to 130 bpm | |
| C) | 75 to 120 bpm | |
| D) | 80 to 150 bpm | |
| Ans: | C | |
| Response: | ||
| The normal range for a healthy school-age child would be 75 to 120 bpm. The ranges for a healthy infant would be 80 to 150, a healthy newborn would be 120 to 160, and a healthy preschooler would be 80 to 130. | ||
| Page: 951 | ||
| 10. | The nurse is using pulse oximetry to measure oxygen saturation in a 3-year-old girl. The nurse understands that falsely high readings may be associated with which situation or condition? | |
| A) | A non-secure connection | |
| B) | Cold extremities | |
| C) | Hypovolemia | |
| D) | Anemia | |
| Ans: | D | |
| Response: | ||
| Falsely high readings may be associated with anemia. Falsely low readings may be associated with cold extremities, hypovolemia, and a non-secure connection. | ||
| Page: 945 | ||
| 11. | Which of the following would be least effective in gaining the cooperation of a toddler during a physical examination? | |
| A) | Tell the child that another child the same age wasn’t afraid. | |
| B) | Allow the child to touch and hold the equipment when possible. | |
| C) | Permit the child to sit on the parent’s lap during the examination. | |
| D) | Offer immediate praise for holding still or doing what was asked. | |
| Ans: | A | |
| Response: | ||
| Toddlers are egocentric, and telling the toddler how well another child behaved or cooperated probably will not help gain this child’s cooperation. Allowing the child to touch and hold the equipment, permitting the child to sit on the parent’s lap during the exam, and offering praise immediately for cooperating would foster cooperation. | ||
| Page: 949 | ||
| 12. | A mother brings her 3-1/2-year-old daughter to the emergency department because the child has been vomiting and having diarrhea for the past 36 hours. When assessing this child’s temperature, which method would be least appropriate? | |
| A) | Oral | |
| B) | Tympanic | |
| C) | Rectal | |
| D) | Axillary | |
| Ans: | C | |
| Response: | ||
| Obtaining the child’s temperature via the rectal route would be least appropriate because the child has diarrhea, and insertion of the thermometer might traumatize the rectal mucosa. Additionally, the rectal route is highly invasive and a child of this age fears body invasion. Using the oral route might be problematic due to the child’s age and inability to cooperate, especially in light of the child’s vomiting. However, it would not be as dangerous as obtaining a rectal temperature. The tympanic or axillary method would be the most appropriate method. | ||
| Page: 956 | ||
| 13. | Assessment reveals that a child weighs 73 lbs and is 4 ft 1 in tall. The nurse calculates this child’s body mass index as: | |
| A) | 19.1 | |
| B) | 20.7 | |
| C) | 21.4 | |
| D) | 24.5 | |
| Ans: | C | |
| Response: | ||
| Body mass index is determined by dividing the child’s weight (in pounds) by the child’s height (in inches) squared and then multiplying this figure by 703. Thus, 73 lbs divided by (49 inches ´ 49 inches) equals 0.0304 multiplied by 703 equals 21.37 or 21.4. | ||
| Page: 950 | ||
| 14. | The nurse is preparing to assess the pulse of an 18-month-old. Which pulse would be most difficult for the nurse to palpate? | |
| A) | Radial | |
| B) | Brachial | |
| C) | Pedal | |
| D) | Femoral | |
| Ans: | A | |
| Response: | ||
| In a child less than 2 years of age, the radial pulse is very difficult to palpate, whereas the pedal, brachial, and femoral pulses are usually easily palpated. | ||
| Page: 969 | ||
| 15. | While auscultating the heart of a 5-year-old child, the nurse notes a murmur that is soft and quiet and heard each time the heart is auscultated. The nurse documents this finding as which of the following? | |
| A) | Grade 1 | |
| B) | Grade 2 | |
| C) | Grade 3 | |
| D) | Grade 4 | |
| Ans: | B | |
| Response: | ||
| A grade 2 murmur is soft and quiet and is heard each time the chest is auscultated. A grade 1 murmur is barely audible and is heard at some times and not at other times. A grade 3 murmur is audible with intermediate intensity. A grade 4 murmur is audible and accompanied by a palpable thrill. | ||
Ch. 44: Nursing Care of the Child with a Musculoskeletal Disorder
| Page: 1466 | ||
| 1. | An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department (ED) and her arm placed in a cast. At 11 p.m. her mother brought her back to the ED due to unrelenting pain that has not been relieved by the prescribed narcotics. Which of the following would the nurse do first? | |
| A) | Notify the doctor immediately. | |
| B) | Apply ice. | |
| C) | Elevate the arm. | |
| D) | Give additional pain medication as ordered. | |
| Ans: | A | |
| Response: | ||
| The nurse should notify the doctor immediately because the girl’s symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation. | ||
| Page: 1484 | ||
| 2. | The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a “jock” like himself could have this condition and is afraid it will affect his spot on the water polo team. Which response by the nurse would best address the boy’s concerns? | |
| A) | “If you wear your brace properly, you may not need surgery.” | |
| B) | “The good news is that you have very minimal curvature of your spine.” | |
| C) | “Let’s talk to another patient with scoliosis who is winning for his swim team.” | |
| D) | “Let’s talk to the doctor about your treatment options.” | |
| Ans: | C | |
| Response: | ||
| Because this boy is concerned about limiting his participation in water polo and perceives scoliosis as a disease for “non-jocks,” putting the child in contact with someone with the same problem would be helpful. The suggestions about wearing the brace and talking to the doctor could be helpful by engaging his input in the treatment. However, these suggestions, as well as reminding him that his curvature is minimal, do not address his specific concerns. | ||
| Page: 1477 | ||
| 3. | The nurse is caring for an infant with torticollis and is providing instructions to the parents about how to help their daughter. Which statement by the parents indicates a need for further teaching? | |
| A) | “We must encourage our daughter to turn her head both ways.” | |
| B) | “Flatness on one side of the head is a common side effect.” | |
| C) | “We must use firm pressure when stretching every other day.” | |
| D) | “We need to hold each stretch for 10 to 30 seconds each time.” | |
| Ans: | C | |
| Response: | ||
| The nurse needs to remind the parents that the stretching exercises should be done several times a day. The stretching is applied with gentle pressure, not firm, and should be done every day for multiple sessions. Each stretch should be held for 10 to 30 seconds. Changing the child’s head position is important to prevent flattening, which can be a common side effect of this condition. | ||
| Page: 1477 | ||
| 4. | The nurse is caring for a 14-month-old boy with rickets who was recently adopted from overseas. His condition was likely a result of a diet very low in milk products. After teaching the parents about treatment, which response indicates a need for further teaching? | |
| A) | “We must give him calcium and phosphorus with his food every morning.” | |
| B) | “He must take vitamin D as prescribed and spend some time in the sunlight.” | |
| C) | “He must take calcium at breakfast and phosphorus at bedtime.” | |
| D) | “We should encourage him to have fish, dairy products, and liver if he will eat it.” | |
| Ans: | A | |
| Response: | ||
| The nurse should emphasize that the calcium and phosphorus supplements should be administered at different times to promote proper absorption of both of these supplements. Vitamin D and sunlight and intake of fish, dairy products, and liver are important aspects of the treatment plan for rickets. | ||
| Page: 1479 | ||
| 5. | The nurse is caring for a 13-year-old boy in traction prior to surgery for slipped capital femoral epiphysis. He has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. He is complaining that he feels isolated and is resisting further treatment. Which intervention would be most helpful? | |
| A) | “I know it is boring, but you must remain immobile for 2 more weeks.” | |
| B) | “If there are no complications, you only have 2 more weeks here.” | |
| C) | “Let’s develop a list of books, movies, games, and friends you would like to have visit.” | |
| D) | “If you resist your treatment, your condition will only get worse.” | |
| Ans: | C | |
| Response: | ||
| After 2 weeks in traction, a teenager can become bored and isolated from his usual peer interaction. The most helpful intervention would to engage the help of the child to develop a list of books, games, movies, and other activities that he would enjoy. The nurse should also encourage a visits and phone calls from friends. Telling him that he must remain immobile, stressing “only 2 weeks more,” and telling him that he’ll get worse if he resists do not offer solutions or elicit the input from the boy. | ||
| Page: 1463 | ||
| 6. | A nurse is caring for a 10-year-old girl following joint fluid aspiration. The nurse would expect to carry out which of the following immediately after the procedure? | |
| A) | Transporting the aspirated fluid to the lab within 30 minutes | |
| B) | Encouraging the child to drink fluids after the procedure | |
| C) | Applying a pressure dressing to the site | |
| D) | Applying a warm moist compress to the site | |
| Ans: | C | |
| Response: | ||
| Following joint fluid aspiration, the nurse should apply a pressure dressing to prevent hematoma formation or fluid recollection and should use cold therapy to decrease swelling. Transporting the specimen to the lab is a priority for the erythrocyte sedimentation rate and blood culture. Encouraging fluids is a priority intervention for tests performed with contrast medium. Application of heat therapy is contraindicated. | ||
| Page: 1476 | ||
| 7. | The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. The parents are upset by their toddler’s limited mobility. Which response by the nurse would be most appropriate? | |
| A) | “If you are noncompliant, your daughter could develop severe bowing of her legs.” | |
| B) | “It’s important to use the brace or your daughter may need surgery.” | |
| C) | “You are doing a great job. Let’s put our heads together on how to keep her busy.” | |
| D) | “You’ll need to accept this, since treatment may be required for several years.” | |
| Ans: | C | |
| Response: | ||
| The nurse should support the parents by encouraging and praising their compliance with bracing. It is also important to work with the parents to help develop age-appropriate diversions to promote normal growth and development. Telling the parents that they must be compliant or their daughter could develop severe bowing does not teach them and does not offer solutions. Telling the parents that they must simply accept this and that the treatment could take years is likely to upset them and does not teach them. | ||
| Page: 1474 | ||
| 8. | The nurse is conducting a physical examination of a child with suspected developmental dysplasia of the hip. Which finding would help confirm this diagnosis? | |
| A) | Abduction occurs to 75 degrees and adduction to within 30 degrees (with stable pelvis). | |
| B) | A distinct “clunk” is heard with Barlow and Ortolani maneuvers. | |
| C) | Knee height is equal. | |
| D) | The thigh and gluteal folds are symmetrical. | |
| Ans: | B | |
| Response: | ||
| A distinct clunk while performing Barlow and Ortolani maneuvers is caused as the femoral head dislocates or reduces back in to the acetabulum. Abduction to 75 degrees and adduction within 30 degrees, symmetrical thigh and gluteal folds, and equal knee height are normal findings. | ||
| Page: 1473 | ||
| 9. | 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? | |
| A) | “I need to avoid pushing or pulling on an arm or leg.” | |
| B) | “I must carefully lift the baby from under the armpits.” | |
| C) | “I should not bend an arm or leg into an awkward position.” | |
| D) | “We must avoid lifting the legs by the ankles when changing diapers.” | |
| Ans: | B | |
| Response: | ||
| The nurse needs to emphasize that the mother must not lift a baby or young child with osteogenesis imperfecta from under the armpits, as this may cause harm. Pushing or pulling, bending an arm or leg into an awkward position, and lifting legs by the ankles when changing diapers should be avoided. | ||
| Page: 1466 | ||
| 10. | 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? | |
| A) | Applying petroleum jelly to the dry skin | |
| B) | Rubbing the skin vigorously to remove the dead skin | |
| C) | Soaking the area in warm water every day | |
| D) | Washing the skin with dilute peroxide and water | |
| Ans: | C | |
| Response: | ||
| After a cast is removed, the child and family should be instructed to soak the area in warm water every day to help soften and remove the dry flaky skin. Moisturizing lotion, not petroleum jelly, should be applied to the skin. Vigorous rubbing would traumatize the skin and should be avoided. Warm soapy water, not dilute peroxide and water, should be used to wash the area. | ||
| Page: 1454 | ||
| 11. | When teaching a group of students about the skeletal development in children, which of the following would the instructor include? | |
| A) | The growth plate is made up of the epiphysis. | |
| B) | A young child’s bones commonly bend instead of break with an injury. | |
| C) | The infant’s skeleton has undergone complete ossification by birth. | |
| D) | Children’s bones have a thin periosteum and limited blood supply. | |
| Ans: | B | |
| Response: | ||
| A young child’s bones are more flexible and more porous with a lower mineral count than adults. Thus, bones will often bend rather than break when an injury occurs. The growth plate is composed of the epiphysis and physis. The infant’s skeleton is not fully ossified at birth. Children’s bones have a thick periosteum and abundant blood supply. | ||
| Page: 1480 | ||
| 12. | Which of the following would lead the nurse to suspect osteomyelitis in a child? | |
| A) | Swelling and point tenderness | |
| B) | Decreased erythrocyte sedimentation rate | |
| C) | Coolness of the affected site | |
| D) | Increased range of motion | |
| Ans: | A | |
| Response: | ||
| Finding associated with osteomyelitis include swelling, point tenderness, warmth over the site, decreased range of motion, and an elevated sedimentation rate. | ||
| Page: 1489 | ||
| 13. | The school nurse is presenting a class to a group of students about common overuse disorders. Which of the following would the school nurse include? | |
| A) | Dislocated radial head | |
| B) | Transient synovitis of the hip | |
| C) | Osgood-Schlatter disease | |
| D) | Scoliosis | |
| Ans: | C | |
| Response: | ||
| Overuse syndromes refer to a group of disorders that result from repeated force applied to normal tissue. An example is Osgood-Schlatter disease. Dislocated radial head, transient synovitis of the hip, and scoliosis are not considered overuse syndromes. | ||
| Page: 1487 | ||
| 14. | Which of the following would be the most reliable indicator of a fracture in a child? | |
| A) | Lack of spontaneous movement | |
| B) | Point tenderness | |
| C) | Bruising | |
| D) | Inability to bear weight | |
| Ans: | B | |
| Response: | ||
| Point tenderness is one of the most reliable indicators of a fracture in a child. Neglect of an extremity, inability to bear weight, bruising, erythema, and pain may be present, but these findings can also suggest other conditions. | ||
| Page: 1480 | ||
| 15. | Which of the following would the nurse be least likely to find in a 6-year-old with septic arthritis of the hip? | |
| A) | Moderate to severe pain of the affected hip | |
| B) | Previous otitis media infection | |
| C) | Refusal to straighten the affected extremity | |
| D) | Full range of motion of the hip | |
| Ans: | D | |
| Response: | ||
| The child with septic arthritis of the hip typically has limited range of motion, maintaining the joint in flexion and not allowing the leg to be straightened. Moderate to severe pain is usually noted and there is a history of a previous infection, such as a respiratory infection or otitis media. | ||
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