Nokea
What will the nurse respond causes the pain experienced with osteomyelitis?
- A. Pressure of inelastic bone'
- B. Purulent drainage in the bone marrow'
- C. The cast applied on the extremity'
- D. Circulatory congestion of the skin'
Correct Answer: B
Rationale: Purulent drainage in the bone marrow causes inflammation, vessel compression, and ischemia, leading to pain in osteomyelitis.
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What statement by the mother does the nurse recognize as indicative of a need for additional teaching?
- A. Apply warm compresses to the ankle for the first 24 hours.'
- B. Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off.'
- C. Wrap the ankle in an Ace bandage for support.'
- D. Keep the leg elevated when sitting.'
Correct Answer: A
Rationale: Warm compresses are incorrect for sprained ankle treatment; rest, ice, compression, and elevation are the appropriate interventions.
Which observation is most likely to cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs?
- A. Red, green, and yellow bruises on his body.
- B. Bruises are dispersed on his head, arms, and legs.
- C. A broken arm last year, and the child being described as accident-prone.
- D. The mother is very anxious for her son to get medical attention.
Correct Answer: A
Rationale: Multiple bruise colors indicate injuries at different healing stages, suggesting possible abuse rather than a single incident.
What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse?
- A. Stress fracture
- B. Compound fracture
- C. Spiral fracture
- D. Greenstick fracture
Correct Answer: C
Rationale: Spiral fractures, caused by twisting motions, may suggest abuse if the injury history does not match the findings.
What does the nurse explain as the cause of this spinal curvature defect?
- A. Juvenile rheumatoid arthritis
- B. Poor posture
- C. Heredity
- D. Myelomeningocele
Correct Answer: B
Rationale: Functional scoliosis is typically caused by poor posture and is not a structural spinal disease.
What intervention will the nurse caring for a child in Buck skin traction implement?
- A. Position in high Fowler's position.
- B. Assist the child to be pulled up in bed.
- C. Keep child's heel on the bed surface.
- D. Maintain child's feet against the foot of the bed.
Correct Answer: B
Rationale: Assisting the child to be pulled up in bed maintains proper alignment in Buck traction, using the child's weight as counterbalance.