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A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions?
- A. No restrictions of activity are indicated.
- B. Elevate casted arm when both upright and resting.
- C. The shoulder should be kept as immobile as possible to avoid pain.
- D. Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.
Correct Answer: B
Rationale: Elevating the casted arm during rest and in a sling when upright promotes venous return and reduces swelling. Strenuous activity is limited initially, shoulder movement is encouraged, and finger swelling requires immediate reporting to prevent neurovascular damage.
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Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time?
- A. Send the child to radiology so radiography can be performed.
- B. Initiate an intravenous line and administer morphine for the pain.
- C. Calmly ask the child to point to where the pain is worst and to wiggle fingers.
- D. Have the parents hold the child so that the nurse can examine the arm thoroughly.
Correct Answer: C
Rationale: Gaining the child?s trust by calmly assessing pain location and finger movement is the priority to evaluate neurovascular status without increasing distress. Radiography requires initial assessment, morphine is premature, and restraining the child escalates anxiety.
The nurse is teaching parents the proper use of a hip-knee-ankle-foot orthosis (HKAFO) for their 4-year-old child. The parents demonstrate basic essential knowledge by making what statement?
- A. Alcohol will be used twice a day to clean the skin around the brace.
- B. Weekly visits to the orthotist are scheduled to check screws for tightness.
- C. Initially, a burning sensation is expected and the brace should remain in place.
- D. Condition of the skin in contact with the brace should be checked every 4 hours.
Correct Answer: D
Rationale: Checking skin every 4 hours prevents breakdown from HKAFO contact points. Alcohol dries skin, parents can check screws, and burning requires brace removal and orthotist consultation, not tolerance.
An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested. What is the first action the nurse should take?
- A. Wait for the childs parents to arrive.
- B. Move the child out of the parking lot.
- C. Have someone notify the emergency medical services (EMS) system.
- D. Help the child stand to return to play.
Correct Answer: C
Rationale: Activating EMS is critical for a child unable to move extremities post-collision, indicating potential spinal cord injury requiring immediate hospital evaluation. Moving the child risks further injury, waiting for parents delays care, and standing is contraindicated.
What measure is important in managing hypercalcemia in a child who is immobilized?
- A. Provide adequate hydration.
- B. Change position frequently.
- C. Encourage a diet high in calcium.
- D. Provide a diet high in calories for healing.
Correct Answer: A
Rationale: Vigorous hydration (3000-4000 ml/day for adolescents) with diuretics helps manage hypercalcemia by promoting calcium excretion. Frequent position changes address skin and respiratory issues, calcium intake is restricted, and high-protein, not just high-calorie, diets aid healing.
What is an appropriate nursing intervention when caring for a child in traction?
- A. Removing adhesive traction straps daily to prevent skin breakdown
- B. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles
- C. Providing active range of motion exercises to affected extremity three times a day
- D. Keeping child prone to maintain good alignment
Correct Answer: B
Rationale: Assessing uninvolved joints for tightness, weakness, or contractures prevents complications from traction stress. Adhesive straps are rarely removed, exercises are for unaffected limbs, and prone positioning isn?t required; alignment is maintained with movement checks.