Wong's Nursing Care of Infants and Children 9th Edition by Marilyn J. Hockenberry, David Wilson
Wong's Nursing Care of Infants and Children 9th Edition by Marilyn J. Hockenberry, David Wilson
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Chapter 39: The Child with Musculoskeletal or Articular Dysfunction
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
MULTIPLE CHOICE
| a. | wait for the child’s 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. |
ANS: C
The child was involved in a motor vehicle collision and at this time is not able to move his extremities. The child needs immediate attention at a hospital for assessment of the possibility of a spinal cord injury. Since the child cannot move the extremities, the child should not be moved until the cervical and vertebral spines are stabilized. The EMS team can appropriately stabilize the spinal column for transport. Although it is important to notify the parents, the EMS system should be activated and transport arranged for serious injuries. The only indication to move the child is to prevent further trauma.
DIF: Cognitive Level: Analysis REF: p. 1622
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
| a. | Loosen the tourniquet. |
| b. | Leave the tourniquet in place. |
| c. | Remove the tourniquet and apply direct pressure if bleeding is still present. |
| d. | Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time. |
ANS: B
A tourniquet is applied only as a last resort, and then it is left in place and not loosened until definitive treatment is available. Once the tourniquet is applied, skin and tissue necrosis occur below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be released into the circulation. This can induce systemic, deadly tourniquet shock.
DIF: Cognitive Level: Analysis REF: p. 1622
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
| a. | Metabolic rate increases. |
| b. | Venous return improves, since child is in supine position. |
| c. | Circulatory stasis can lead to thrombus and embolus formation. |
| d. | Bone calcium increases, releasing excess calcium into the body (hypercalcemia). |
ANS: C
The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. With the loss of muscle contraction, there is a decreased venous return to the heart. Calcium leaves the bone during immobilization, leading to bone demineralization and increasing the calcium ion concentration in the blood.
DIF: Cognitive Level: Comprehension REF: p. 1625
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
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