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A nurse cares for an infant with osteogenesis imperfecta (OI). Which
interventions are appropriate? Select all that apply.
a. Support the trunk and extremities together when lifting.
b. Use an automated blood pressure cuff for accuracy.
c. Lift the infant by the buttocks rather than the ankles during diaper
changes.
d. Encourage swimming and low-impact play within safe limits.
e. Keep the child immobilized for long periods to prevent fractures.
f. Recognize that fractures in various stages of healing can mimic
child abuse.
A, C, D, F
Rationale: In OI, handle gently and support the whole body; use a
MANUAL cuff (automated cuffs over-pressurize fragile arms, so B is
wrong); lift by the buttocks, not the ankles. Promote weight-
bearing/low-impact activity because prolonged immobilization (E)
worsens osteopenia. Multiple healing fractures can mimic non-
accidental trauma.
,A nurse teaches about pediatric fractures and growth plate
(epiphyseal) injuries. Which statements are accurate? Select all that
apply.
a. Children's bones are softer and more flexible than adults'.
b. About 30% of pediatric fractures involve the growth plate.
c. Growth plate injuries can disrupt future bone growth.
d. Children heal fractures more slowly than adults.
e. Growth plate injuries are classified using the Salter-Harris system.
f. Early X-rays always clearly reveal growth plate injuries.
A, B, C, E
Rationale: Pediatric bones are soft and flexible; ~30% of fractures
are epiphyseal and can cause limb-length discrepancy or angular
deformity. They are classified by the Salter-Harris system. Children
heal FASTER than adults (D), and growth plate injuries may NOT
show on early X-rays (F).
,A nurse performs the Barlow and Ortolani maneuvers on a
newborn. Which finding does the nurse document as a POSITIVE
sign of hip instability or dislocation?
a. A soft, high-pitched click as the hip is moved.
b. A palpable "clunk" as the femoral head moves in or out of the
acetabulum.
c. Symmetric gluteal and thigh skin folds.
d. Equal knee heights when the hips and knees are flexed.
B - a palpable "clunk."
Rationale: The positive Barlow/Ortolani finding is a palpable "clunk,"
not a click. A is the trap - a soft, high-pitched click is a benign,
common finding and is NOT considered positive; the answer is the
"clunk." The clunk is the femoral head actually sliding out of (Barlow)
or back into (Ortolani) the acetabulum, and it is the finding that
suggests hip instability or dislocation and requires further
evaluation. C (symmetric skin folds) and D (equal knee heights) are
normal/negative findings. Remember: click is benign, clunk is the
positive sign.
, A nurse teaches the parents of a child with a new fiberglass cast.
Which statements indicate correct understanding? Select all that
apply.
a. "I will lift the wet cast with my palms, not my fingertips."
b. "I can put powder or lotion inside the cast to relieve itching."
c. "I will elevate the casted limb above heart level for the first day or
two."
d. "I will call the provider for a foul odor or drainage stains on the
cast."
e. "I can use cool air, such as a hair dryer on the cool setting, for
itching."
f. "I will report increased swelling, numbness, or increasing pain."
A, C, D, E, F
Rationale: Lift a wet cast with palms (not fingertips), elevate above
heart level initially, and use cool air for itching. Report infection
signs (foul odor, drainage) and neurovascular changes (swelling,
numbness, increasing pain). NOTHING goes inside the cast - no
powder or lotion (B).