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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.
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The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program. How should the goal be achieved?
- A. Use of protective equipment at the familys discretion
- B. Education of adults to recognize signs that indicate a risk for injury
- C. Sports medicine program to help student athletes work through overuse injuries
- D. Arrangements for multiple sports to use same athletic fields to accommodate more children
Correct Answer: B
Rationale: Educating adults to recognize fatigue, dehydration, and injury risk signs prevents sports injuries. Protective equipment is mandatory, working through overuse injuries is harmful, and shared fields increase distraction and injury risk.
A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material?
- A. Soak in a bathtub.
- B. Vigorously scrub the leg.
- C. Carefully pick material off the leg.
- D. Apply powder to absorb the material.
Correct Answer: A
Rationale: Soaking in a bathtub gently removes desquamated skin and secretions over days, avoiding skin damage. Scrubbing or picking risks excoriation, and powder is ineffective; oil or lotion may help comfort, not removal.
The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication?
- A. Sepsis
- B. Osteomyelitis
- C. Pulmonary embolism
- D. Acute respiratory tract infection
Correct Answer: C
Rationale: Pulmonary embolism, often from fat emboli in long bone fractures, is likely within 12-24 hours post-injury, presenting with chest pain and dyspnea. Sepsis and osteomyelitis involve fever, and respiratory infections typically cause nasal congestion, not acute chest pain.
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 finding is characteristic of fractures in children?
- A. Fractures rarely occur at the growth plate site because it absorbs shock well.
- B. Rapidity of healing is inversely related to the childs age.
- C. Pliable bones of growing children are less porous than those of adults.
- D. The periosteum of a childs bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.
Correct Answer: B
Rationale: Fractures in children heal faster in younger individuals due to robust periosteum and bone pliability. Growth plates are prone to fractures, children?s bones are more porous and pliable, and their periosteum is thicker with greater osteogenic potential than adults?.