COMPREHENSIVE NURSING CERTIFICATION & EXAM
REVIEW:
SCOLIOSIS, SPINAL FUSION, AND PEDIATRIC ORTHOPEDIC
CARE
200 Clinical Practice Questions, Diagnostic Evaluation, Pre/Post-
Operative Management, and Detailed Rationales
Question 1: [Diagnostic Procedures & Cobb Angle - Q1] Which
diagnostic tool is primarily used to evaluate spinal rotation and
trunk asymmetry during initial screening?
Scoliometer
Stethoscope
Spirometer
Goniometer
Correct Answer: Scoliometer
Rationale: A scoliometer measures trunk rotation during the Adams
forward bend test, helping determine referral thresholds.
Question 2: [Diagnostic Procedures & Cobb Angle - Q2] What is the
primary purpose of obtaining lateral bending radiographs in the
evaluation of adolescent idiopathic scoliosis?
To measure bone mineral density
To assess curve flexibility and correctability
To evaluate pulmonary function
To rule out infection
, Correct Answer: To assess curve flexibility and correctability
Rationale: Bending films show how flexible or rigid the spinal curve
is, assisting the surgeon in planning instrumentation levels.
Question 3: [Diagnostic Procedures & Cobb Angle - Q3] A nurse
notes that a client's Cobb angle progressed by 8 degrees over 6
months. What clinical interpretation should the nurse make?
The curve is stable and requires observation only.
Rapid curve progression is occurring, requiring immediate orthopedic
re-evaluation.
The bracing regimen was 100% successful.
The client has developed spontaneous resolution.
Correct Answer: Rapid curve progression is occurring, requiring
immediate orthopedic re-evaluation.
Rationale: Progression of >5 degrees over 6 months indicates an
active, rapidly worsening curve in a growing adolescent.
Question 4: [Diagnostic Procedures & Cobb Angle - Q4] When
reviewing a spinal X-ray report for scoliosis, the nurse understands
that the apex of the curve refers to:
The topmost vertebra of the entire spine
The vertebra most tilted and furthest displaced from the midline
The lowest lumbar vertebra
The sacral promontory
, Correct Answer: The vertebra most tilted and furthest displaced
from the midline
Rationale: The apex is the vertebra in the curve with the maximum
rotation and deviation from the central vertical axis.
Question 5: [Diagnostic Procedures & Cobb Angle - Q5] Which
member of the interprofessional healthcare team is primarily
responsible for calculating the Cobb angle on spinal radiographs?
Registered Nurse (RN)
Orthopedic Surgeon / Radiologist
Physical Therapist
Child Life Specialist
Correct Answer: Orthopedic Surgeon / Radiologist
Rationale: The Cobb angle is measured by drawing perpendicular
lines from the endplates of the most tilted vertebrae at the top and
bottom of the curve.
Question 6: [Preoperative Nursing Care & Education - Q6] A nurse
is teaching an adolescent about autologous blood donation prior to
spinal fusion surgery. What is the primary rationale for this
practice?
To prevent allergic transfusion reactions and reduce the risk of
transmitted infections
To accelerate post-op bone healing
To eliminate the need for IV access during surgery
, To decrease postoperative pain
Correct Answer: To prevent allergic transfusion reactions and
reduce the risk of transmitted infections
Rationale: Spinal fusion can involve significant intraoperative blood
loss. Autologous donation (or preoperative acute normovolemic
hemodilution/cell saver) minimizes allogeneic transfusion risks.
Question 7: [Preoperative Nursing Care & Education - Q7] An
adolescent scheduled for spinal fusion expresses intense anxiety
about postoperative pain. Which nursing intervention is most
therapeutic?
Telling the client not to worry because pain meds are very strong
Explaining the use of Patient-Controlled Analgesia (PCA) and
developing a pain management plan
Discouraging discussion about pain to reduce anxiety
Informing the client that they will be unconscious for the first week
Correct Answer: Explaining the use of Patient-Controlled
Analgesia (PCA) and developing a pain management plan
Rationale: Preoperative education regarding PCA pumps empowers
the adolescent, establishes realistic expectations, and decreases
anxiety.
Question 8: [Preoperative Nursing Care & Education - Q8] A nurse
is teaching a client and family about logrolling techniques before
spinal fusion surgery. Why is logrolling necessary postoperatively?
REVIEW:
SCOLIOSIS, SPINAL FUSION, AND PEDIATRIC ORTHOPEDIC
CARE
200 Clinical Practice Questions, Diagnostic Evaluation, Pre/Post-
Operative Management, and Detailed Rationales
Question 1: [Diagnostic Procedures & Cobb Angle - Q1] Which
diagnostic tool is primarily used to evaluate spinal rotation and
trunk asymmetry during initial screening?
Scoliometer
Stethoscope
Spirometer
Goniometer
Correct Answer: Scoliometer
Rationale: A scoliometer measures trunk rotation during the Adams
forward bend test, helping determine referral thresholds.
Question 2: [Diagnostic Procedures & Cobb Angle - Q2] What is the
primary purpose of obtaining lateral bending radiographs in the
evaluation of adolescent idiopathic scoliosis?
To measure bone mineral density
To assess curve flexibility and correctability
To evaluate pulmonary function
To rule out infection
, Correct Answer: To assess curve flexibility and correctability
Rationale: Bending films show how flexible or rigid the spinal curve
is, assisting the surgeon in planning instrumentation levels.
Question 3: [Diagnostic Procedures & Cobb Angle - Q3] A nurse
notes that a client's Cobb angle progressed by 8 degrees over 6
months. What clinical interpretation should the nurse make?
The curve is stable and requires observation only.
Rapid curve progression is occurring, requiring immediate orthopedic
re-evaluation.
The bracing regimen was 100% successful.
The client has developed spontaneous resolution.
Correct Answer: Rapid curve progression is occurring, requiring
immediate orthopedic re-evaluation.
Rationale: Progression of >5 degrees over 6 months indicates an
active, rapidly worsening curve in a growing adolescent.
Question 4: [Diagnostic Procedures & Cobb Angle - Q4] When
reviewing a spinal X-ray report for scoliosis, the nurse understands
that the apex of the curve refers to:
The topmost vertebra of the entire spine
The vertebra most tilted and furthest displaced from the midline
The lowest lumbar vertebra
The sacral promontory
, Correct Answer: The vertebra most tilted and furthest displaced
from the midline
Rationale: The apex is the vertebra in the curve with the maximum
rotation and deviation from the central vertical axis.
Question 5: [Diagnostic Procedures & Cobb Angle - Q5] Which
member of the interprofessional healthcare team is primarily
responsible for calculating the Cobb angle on spinal radiographs?
Registered Nurse (RN)
Orthopedic Surgeon / Radiologist
Physical Therapist
Child Life Specialist
Correct Answer: Orthopedic Surgeon / Radiologist
Rationale: The Cobb angle is measured by drawing perpendicular
lines from the endplates of the most tilted vertebrae at the top and
bottom of the curve.
Question 6: [Preoperative Nursing Care & Education - Q6] A nurse
is teaching an adolescent about autologous blood donation prior to
spinal fusion surgery. What is the primary rationale for this
practice?
To prevent allergic transfusion reactions and reduce the risk of
transmitted infections
To accelerate post-op bone healing
To eliminate the need for IV access during surgery
, To decrease postoperative pain
Correct Answer: To prevent allergic transfusion reactions and
reduce the risk of transmitted infections
Rationale: Spinal fusion can involve significant intraoperative blood
loss. Autologous donation (or preoperative acute normovolemic
hemodilution/cell saver) minimizes allogeneic transfusion risks.
Question 7: [Preoperative Nursing Care & Education - Q7] An
adolescent scheduled for spinal fusion expresses intense anxiety
about postoperative pain. Which nursing intervention is most
therapeutic?
Telling the client not to worry because pain meds are very strong
Explaining the use of Patient-Controlled Analgesia (PCA) and
developing a pain management plan
Discouraging discussion about pain to reduce anxiety
Informing the client that they will be unconscious for the first week
Correct Answer: Explaining the use of Patient-Controlled
Analgesia (PCA) and developing a pain management plan
Rationale: Preoperative education regarding PCA pumps empowers
the adolescent, establishes realistic expectations, and decreases
anxiety.
Question 8: [Preoperative Nursing Care & Education - Q8] A nurse
is teaching a client and family about logrolling techniques before
spinal fusion surgery. Why is logrolling necessary postoperatively?
