PEDIATRIC NURSING CERTIFICATION EXAMINATION:
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) &
PAVLIK HARNESS MANAGEMENT
Comprehensive 200-Question Mastery Assessment with Clinical
Rationales
MODULE 1: Core Pavlik Harness Instructions & Skin Integrity
(Questions 1 - 40)
Question 1: A nurse is caring for an infant who has developmental
dysplasia of the hip (DDH) and is placed in a Pavlik harness. Which
of the following instructions should the nurse provide to the parents
regarding daily skin care?
A. Apply baby powder or cornstarch under the harness straps to
absorb moisture and prevent friction.
B. Check beneath the straps and harness folds at least two to
three times daily for skin irritation, redness, or breakdown.
C. Remove the harness completely during bath time and massage
lotion into the skin creases daily.
D. Apply thin layers of petroleum jelly over the infant's entire lower
extremities before securing the harness.
Correct Answer: B | Rationale: Parents must inspect the infant's skin
beneath the harness straps and at skin folds (neck, axilla, groin,
popliteal) 2-3 times daily to detect early signs of friction, redness, or
breakdown. Baby powder and cornstarch are contraindicated because
they cake and foster bacterial/fungal growth. Lotions and petroleum
jelly can soften the skin and increase the risk of friction breakdown.
Unless specifically ordered by the orthopedic surgeon for supervised
, bathing, the harness should generally remain on, or removal protocols
must strictly follow physician guidelines.
Question 2: A mother asks the nurse what type of clothing her 3-
month-old infant should wear while wearing a Pavlik harness.
Which response by the nurse is most appropriate?
A. Dress the infant in heavy denim overalls to provide durable
padding against the metal buckles.
B. Place the infant in a wide-fitting cotton undershirt beneath the
chest strap and knee socks under the foot stirrups to protect the
skin.
C. Ensure the infant wears tight-fitting stretch pants over the harness
to keep the hips securely abducted.
D. Dress the infant in only a diaper with no upper body garments to
prevent overheating.
Correct Answer: B | Rationale: A soft cotton undershirt worn
beneath the chest strap and knee socks worn under the foot stirrups
provide a protective barrier between the harness straps and the infant's
delicate skin, preventing chafing and friction burns. Heavy denim or
tight clothing interferes with proper hip positioning and can cause
skin irritation. Diapers should be worn underneath the harness straps.
Question 3: When educating parents on diapering an infant in a
Pavlik harness, which technique should the nurse emphasize to
maintain hip reduction?
A. Remove the leg straps temporarily during diaper changes to allow
full leg extension.
B. Slide the diaper underneath the straps without removing the
harness or lifting the infant's legs by the ankles.
C. Lift the infant's legs high by the ankles to slide a thick, double-
layered disposable diaper underneath.
, D. Unbuckle the chest strap and place the infant prone during every
diaper change.
Correct Answer: B | Rationale: To maintain proper hip reduction
and prevent subluxation, diapers should be slipped underneath the
straps without removing the harness and without lifting the infant's
legs by the ankles (which can adduct or straighten the hips). Leg
straps must never be unbuckled by parents unless specifically
instructed by the orthopedic physician.
Question 4: A nurse is instructing the parents of an infant in a
Pavlik harness about bathing. Which of the following statements
indicates a correct understanding of the teaching?
A. "We will give our baby full tub baths every evening after
completely removing the harness."
B. "We will perform sponge baths while the harness remains in
place, keeping the skin dry and clean."
C. "We can submerge our baby in the bathtub as long as we dry the
leather straps thoroughly with a hair dryer."
D. "We will remove the chest and leg straps during bath time to let
our baby kick freely for 30 minutes."
Correct Answer: B | Rationale: Sponge baths are typically
performed while the Pavlik harness remains on the infant to maintain
continuous hip reduction, unless the orthopedic surgeon has explicitly
authorized supervised harness removal for bathing. Submerging the
harness or removing it without direct medical clearance risks hip
dislocation.
Question 5: Which of the following observations made during a
follow-up visit for an infant in a Pavlik harness requires immediate
nursing intervention?
, A. The infant is wearing a soft cotton undershirt underneath the chest
strap.
B. Redness is noted over bony prominences that blanches when
pressed and resolves within 15 minutes of repositioning.
C. A raw, weeping, excoriated area is present under the anterior
chest strap.
D. The foot stirrups are secured snugly with toes warm and pink with
brisk capillary refill.
Correct Answer: C | Rationale: A raw, weeping, excoriated area
indicates skin breakdown, which requires immediate medical
evaluation and adjustment of the harness or temporary
discontinuation under physician guidance. Non-blanching erythema
or open skin is a red flag. Transient blanching redness is common,
and warm toes with brisk capillary refill indicate adequate perfusion.
Question 6: A nurse is teaching parents about the rationale of the
Pavlik harness for developmental dysplasia of the hip. Which
explanation is most accurate?
A. "The harness stretches the femoral shaft downward to lengthen the
affected leg."
B. "The harness holds the infant's hips in flexion and abduction,
keeping the femoral head deep within the acetabulum to
stimulate normal socket development."
C. "The harness rigidly immobilizes both legs in full extension to
allow the hip ligaments to calcify."
D. "The harness uses gentle traction weights attached to the crib to
realign the hip joint."
Correct Answer: B | Rationale: The Pavlik harness is a dynamic
orthosis that positions the infant's hips in flexion and abduction (the
'frog' or 'jockey' position). This maintains the femoral head in the
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) &
PAVLIK HARNESS MANAGEMENT
Comprehensive 200-Question Mastery Assessment with Clinical
Rationales
MODULE 1: Core Pavlik Harness Instructions & Skin Integrity
(Questions 1 - 40)
Question 1: A nurse is caring for an infant who has developmental
dysplasia of the hip (DDH) and is placed in a Pavlik harness. Which
of the following instructions should the nurse provide to the parents
regarding daily skin care?
A. Apply baby powder or cornstarch under the harness straps to
absorb moisture and prevent friction.
B. Check beneath the straps and harness folds at least two to
three times daily for skin irritation, redness, or breakdown.
C. Remove the harness completely during bath time and massage
lotion into the skin creases daily.
D. Apply thin layers of petroleum jelly over the infant's entire lower
extremities before securing the harness.
Correct Answer: B | Rationale: Parents must inspect the infant's skin
beneath the harness straps and at skin folds (neck, axilla, groin,
popliteal) 2-3 times daily to detect early signs of friction, redness, or
breakdown. Baby powder and cornstarch are contraindicated because
they cake and foster bacterial/fungal growth. Lotions and petroleum
jelly can soften the skin and increase the risk of friction breakdown.
Unless specifically ordered by the orthopedic surgeon for supervised
, bathing, the harness should generally remain on, or removal protocols
must strictly follow physician guidelines.
Question 2: A mother asks the nurse what type of clothing her 3-
month-old infant should wear while wearing a Pavlik harness.
Which response by the nurse is most appropriate?
A. Dress the infant in heavy denim overalls to provide durable
padding against the metal buckles.
B. Place the infant in a wide-fitting cotton undershirt beneath the
chest strap and knee socks under the foot stirrups to protect the
skin.
C. Ensure the infant wears tight-fitting stretch pants over the harness
to keep the hips securely abducted.
D. Dress the infant in only a diaper with no upper body garments to
prevent overheating.
Correct Answer: B | Rationale: A soft cotton undershirt worn
beneath the chest strap and knee socks worn under the foot stirrups
provide a protective barrier between the harness straps and the infant's
delicate skin, preventing chafing and friction burns. Heavy denim or
tight clothing interferes with proper hip positioning and can cause
skin irritation. Diapers should be worn underneath the harness straps.
Question 3: When educating parents on diapering an infant in a
Pavlik harness, which technique should the nurse emphasize to
maintain hip reduction?
A. Remove the leg straps temporarily during diaper changes to allow
full leg extension.
B. Slide the diaper underneath the straps without removing the
harness or lifting the infant's legs by the ankles.
C. Lift the infant's legs high by the ankles to slide a thick, double-
layered disposable diaper underneath.
, D. Unbuckle the chest strap and place the infant prone during every
diaper change.
Correct Answer: B | Rationale: To maintain proper hip reduction
and prevent subluxation, diapers should be slipped underneath the
straps without removing the harness and without lifting the infant's
legs by the ankles (which can adduct or straighten the hips). Leg
straps must never be unbuckled by parents unless specifically
instructed by the orthopedic physician.
Question 4: A nurse is instructing the parents of an infant in a
Pavlik harness about bathing. Which of the following statements
indicates a correct understanding of the teaching?
A. "We will give our baby full tub baths every evening after
completely removing the harness."
B. "We will perform sponge baths while the harness remains in
place, keeping the skin dry and clean."
C. "We can submerge our baby in the bathtub as long as we dry the
leather straps thoroughly with a hair dryer."
D. "We will remove the chest and leg straps during bath time to let
our baby kick freely for 30 minutes."
Correct Answer: B | Rationale: Sponge baths are typically
performed while the Pavlik harness remains on the infant to maintain
continuous hip reduction, unless the orthopedic surgeon has explicitly
authorized supervised harness removal for bathing. Submerging the
harness or removing it without direct medical clearance risks hip
dislocation.
Question 5: Which of the following observations made during a
follow-up visit for an infant in a Pavlik harness requires immediate
nursing intervention?
, A. The infant is wearing a soft cotton undershirt underneath the chest
strap.
B. Redness is noted over bony prominences that blanches when
pressed and resolves within 15 minutes of repositioning.
C. A raw, weeping, excoriated area is present under the anterior
chest strap.
D. The foot stirrups are secured snugly with toes warm and pink with
brisk capillary refill.
Correct Answer: C | Rationale: A raw, weeping, excoriated area
indicates skin breakdown, which requires immediate medical
evaluation and adjustment of the harness or temporary
discontinuation under physician guidance. Non-blanching erythema
or open skin is a red flag. Transient blanching redness is common,
and warm toes with brisk capillary refill indicate adequate perfusion.
Question 6: A nurse is teaching parents about the rationale of the
Pavlik harness for developmental dysplasia of the hip. Which
explanation is most accurate?
A. "The harness stretches the femoral shaft downward to lengthen the
affected leg."
B. "The harness holds the infant's hips in flexion and abduction,
keeping the femoral head deep within the acetabulum to
stimulate normal socket development."
C. "The harness rigidly immobilizes both legs in full extension to
allow the hip ligaments to calcify."
D. "The harness uses gentle traction weights attached to the crib to
realign the hip joint."
Correct Answer: B | Rationale: The Pavlik harness is a dynamic
orthosis that positions the infant's hips in flexion and abduction (the
'frog' or 'jockey' position). This maintains the femoral head in the
