When providing care for a child in balanced suspension skeletal traction using a Thomas splint and Pearson attachment to the right femur, which intervention is most important for the nurse to implement?

Change position every 2 hours.

Monitor peripheral pulses and sensation in the right leg.

Cleanse pin sites as prescribed.

Assess skin for redness and signs of tissue breakdown.

Answer and Explanation

The Correct Answer is B

When caring for a child in balanced suspension skeletal traction, the most important intervention for the nurse to implement is monitoring peripheral pulses and sensation in the aﬀected leg to detect any compromise in circulation or nerve function. This is crucial because the traction places tension on the bones, which can result in nerve or vascular damage.

Changing positions every 2 hours is important to prevent pressure injuries, but it is not the most critical intervention.

Cleansing pin sites and assessing skin for redness and signs of tissue breakdown are also important, but they are not as urgent as monitoring peripheral pulses and sensation.

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Correct Answer is A

Explanation

Flaring of the nares is a sign of increased respiratory eﬀort, which is a manifestation of acute respiratory distress. This finding occurs when the child is attempting to draw in more air to meet the increased demand for oxygen.

Bilateral bronchial breath sounds can indicate consolidation or a bronchial obstruction, but they are not specific to acute respiratory distress.

Diaphragmatic respirations are a normal finding and may occur in response to respiratory distress, but they do not necessarily indicate acute respiratory distress.

A resting respiratory rate of 35 breaths/min is within the normal range for a 1-year-old child and does not necessarily indicate acute respiratory distress.

A. Pale urine. B. Increased ﬂuid intake. C. New onset bedwetting. D. Voiding every 4 hours.

Correct Answer is C

Explanation

To determine a possible urinary tract infection in a preschool-aged child who presents with ﬂank pain, dysuria, and low-grade fever, the nurse should gather additional information from the parent about new onset bedwetting. New onset bedwetting can be a sign of a urinary tract infection in children. The other options (A, B, and D) are not directly related to determining a possible urinary tract infection in this situation.

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When providing care for a child in balanced suspension skeletal traction using a Thomas splint and Pearson attachment to the right femur, which intervention is most important for the nurse to implement?

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Naxlex Comprehensive Predictor Exams

A 1-year-old child with respiratory syncytial virus (RSV) has been admitted to the pediatric unit. The nurse observes that the child has a fever, rhinorrhea, frequent coughing, and sneezing. Which additional finding should alert the nurse that the child is in acute respiratory distress?

Correct Answer is A

Explanation

The nurse is assessing a preschool-aged child who presents with ﬂank pain, dysuria, and low-grade fever. To determine a possible urinary tract infection, which additional information should the nurse gather from the parent?

Correct Answer is C

Explanation

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The nurse is providing teaching to a school-age child with left femoral osteomyelitis and the child's parent prior to discharge. Which instruction should the nurse provide related to the initial phase of treatment?

When providing care for a child in balanced suspension skeletal traction using a Thomas splint and Pearson attachment to the right femur, which intervention is most important for the nurse to implement?

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