A nurse is caring for a school-age child who has a fracture to the right femur.
Which of the following findings is the nurse's priority?
Capillary refill less than 2 seconds.
Tingling in the right foot.
Respiratory rate 24/min.
2+ right pedal pulse.
The Correct Answer is B
Choice A rationale
Capillary refill less than 2 seconds is a normal finding and suggests adequate perfusion. It is not indicative of a priority concern in this context.
Choice B rationale
Tingling in the right foot can indicate nerve damage or compromised circulation, which is critical to address in a patient with a fracture. This symptom could suggest complications like compartment syndrome, requiring immediate medical attention.
Choice C rationale
Respiratory rate of 24/min is slightly elevated but not directly related to the fracture's immediate complications. It requires monitoring but is not the priority.
Choice D rationale
A 2+ right pedal pulse indicates a normal pulse and adequate circulation in the foot. While important, it does not represent an immediate concern in this context.
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Correct Answer is D
Explanation
Choice A rationale
Boys are generally screened for scoliosis at a later age than girls due to different growth patterns and timelines in puberty. Girls typically go through growth spurts earlier, which can reveal scoliosis sooner.
Choice B rationale
Scoliosis is not associated with childhood trauma. It's primarily idiopathic, meaning its cause is unknown, though genetics and growth factors are considered.
Choice C rationale
Children with scoliosis often do not report back pain. The condition is usually detected through physical exams or screenings rather than symptoms like pain.
Choice D rationale
The Adam's forward bend test is a common method for screening scoliosis, which involves the child bending forward at the waist with arms hanging down. This position highlights any abnormal curvature of the spine.
Correct Answer is C
Explanation
Choice A rationale
Walks with one hand held typically occurs around 12 months as infants gain balance and coordination for upright movement.
Choice B rationale
Sits unsupported usually happens around 6 months when infants' core muscles are strong enough to hold their torso upright.
Choice C rationale
Turning pages in a book is a fine motor skill that develops around 12 months as hand-eye coordination improves.
Choice D rationale
Rolling from front to back typically occurs around 6 months as infants develop stronger neck and upper body muscles.