Child Health: Causes of Death, Obesity, Immunizations, and Communication, Exercises of Nursing

Download Child Health: Causes of Death, Obesity, Immunizations, and Communication and more Exercises Nursing in PDF only on Docsity! 1 MORBIDITY/MORTALITY STATISTICS: The clinic nurse is reviewing statistics on infant mortality for the United States versus other countries. Compared with other countries that have a population of at least 25 million, the nurse makes which determination? -The United States is ranked last among 27 countries. Which is the leading cause of death in infants younger than 1 year in the United States? -congenital anomalies What is the major cause of death for children older than 1 year in the United States? -Unintentional injuries In addition to injuries, what are the leading causes of death in adolescents ages 15 to 19 years? -Suicide and homicide The nurse is planning a teaching session to adolescents about deaths by unintentional injuries. Which should the nurse include in the session with regard to deaths caused by injuries? -more deaths occur in males What do mortality statistics describe? -the number of individuals who have died over a specific period The nurse should assess which age group for suicide ideation since suicide in which age group is the third leading cause of death? -late school age and adolescents Parents of a hospitalized toddler ask the nurse, what is meant by family-centered care? The nurse should respond with which statement? -Family-centered care recognizes that the family is the constant in a child’s life 1 The school nurse is evaluating the number of school-age children classified as obese. The nurse recognizes that the percentile of body mass index that classifies a child as obese is greater than which? -95th percentile The school nurse is explaining to older school children that obesity increases the risk for which disorders? (Select all that apply.) -hypertension, dyslipidemia, and altered glucose metabolism COMPLICATIONS OF JAUNDICE What is an infant with severe jaundice at risk for developing? -encephalopathy 1 The clinic nurse is reviewing the immunization guidelines for hepatitis B. Which are true of the guidelines for this vaccine? (Select all that apply.) -the hepatitis B vaccination series should be begun at birth -an unimmunized 10-year-old child should receive 3 doses administered 4 weeks apart The nurse is planning to administer immunizations to a 6-month-old infant. Which interventions should the nurse implement to minimize local reactions from the vaccines? (Select all that apply.) -select a needle length of 1 inch -inject the vaccine into the vastus lateralis The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.) -a child with asthma -a child with diabetes -a child with cancer receiving chemo What immunization should not be given to a child receiving chemotherapy for cancer? -MMR A parent of a hospitalized child on chemotherapy asks the nurse if a sibling of the hospitalized child should receive the varicella vaccination. The nurse should give which response? -the sibling can get a Varicella vaccination COMMUNICATION STYLE (only Q’s that were not totally common sense included) Which is considered a block to effective communication? -using clichs Which is the single most important factor to consider when communicating with children? -child’s developmental level 1 Because children younger than 5 years are egocentric, the nurse should do which when communicating with them? -focus communication on the child The nurse’s approach when introducing hospital equipment to a preschooler who seems afraid should be based on which principle? -child may think equipment is alive When the nurse interviews an adolescent, which is especially important? -allow an opportunity to express feelings The nurse understands that blocks to therapeutic communication include what? (Select all that apply.) -socializing -using clichs -defending a situation 1 RESPIRATORY DISTRESS IN INFANTS Which is a central factor responsible for respiratory distress syndrome in a newborn? -deficient surfactant production A preterm infant of 33 weeks of gestation is admitted to the neonatal intensive care unit. Approximately 2 hours after birth, the neonate begins having difficulty breathing, with grunting, tachypnea, and nasal flaring. What should the nurse recognize? -further evaluation is needed The nurse is caring for a preterm neonate who requires mechanical ventilation for treatment of respiratory distress syndrome. Because of the mechanical ventilation, the nurse should recognize an increased risk of what? -pneumothorax What are possible premature infant complications from oxygen therapy and mechanical ventilation? -bronchopulmonary dysplasia and retinopathy of prematurity A preterm infant with respiratory distress syndrome is receiving inhaled nitric oxide (NO). What is the reason for administering the inhaled nitric oxide? -to reduce pulmonary vasoconstriction and pulmonary hypertension The nurse is caring for a neonate with respiratory distress syndrome. The infant has an endotracheal tube. What should nursing considerations related to suctioning include? -suctioning should not be carried out routinely The health care provider has prescribed surfactant, beractant (Survanta), to be administered to an infant with respiratory distress syndrome (RDS). The nurse understands that the beractant will be administered by which route? -via the ET tube 1 -I should not add additional salt to any of my child’s meals What is an appropriate nursing intervention for a child with minimal change nephrotic syndrome (MCNS) who has scrotal edema? -elevate the scrotum with a rolled washcloth What do the clinical manifestations of minimal change nephrotic syndrome include? -massive proteinuria, hypoalbuminemia, and edema For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs? -diuresis occurs as urinary protein excretion diminishes 1 A nurse is evaluating the effectiveness of teaching regarding care of a child with minimal change nephrotic syndrome (MCNS) that is in remission after administration of prednisone. The nurse realizes further teaching is required if the parents state what? -we understand our child will not be able to attend school, so we will arrange for home schooling The nurse is preparing to admit a child to the hospital with a diagnosis of minimal change nephrotic syndrome. The nurse understands that the peak age at onset for this disease is what? -2 to 3 years What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply.) -no salt added at the table -restriction of foods high in sodium NURSING INTERVENTIONS FOR IV THERAPY The nurse is caring for a child receiving a continuous intravenous (IV) low-dose infusion of morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to do which first? -administer naloxone (Narcan) The nurse is planning pain control for a child. Which is the advantage of administering pain medication by the intravenous (IV) bolus route? -provides most rapid onset of effect, usually in about 5 minutes When caring for a child with an intravenous (IV) infusion, what is an appropriate nursing action? -check the insertion site frequently for signs of infiltration The nurse determines that a child’s intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action? -end the infusion and notify the practitioner 1 CYSTIC FIBROSIS Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF? -mechanical obstruction caused by increased viscosity of mucous gland secretions What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)? -Meconium ileus What tests aid in the diagnosis of cystic fibrosis (CF)? -sweat test, stool for fat, chest radiography 1 An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation? -contact precautions What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include? -rhinorrhea, wheezing, and fever The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child’s SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take? -notify the health care provider What interventions can the nurse teach parents to do to ease respiratory efforts for a child with a mild respiratory tract infection? (Select all that apply.) -cool mist -warm mist -steam vaporizer -run a shower of hot water to produce steam TONSILLECTOMY The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? -I can use an ice collar on my child for pain control along with analgesics A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action? -continue to assess for bleeding A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, My tummy hurts. The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the child’s pain? -Tylenol PR 1 A tonsillectomy or adenoidectomy is contraindicated in what conditions? (Select all that apply.) -cleft palate -blood dyscrasias -acute infection at the time of surgery When caring for a child after a tonsillectomy, what intervention should the nurse do? -watch for continuous swallowing 1 STREP A child has a streptococcal throat infection and is being treated with antibiotics. What should the nurse teach the parents to prevent infection of others? -the child can return to school after taking antibiotics for 24 hours The test that provides the most reliable evidence of recent streptococcal infection is which? -Antistreptolysin O test SKIN LESIONS Which is described as an elevated, circumscribed skin lesion that is less than 1 cm in diameter and filled with serous fluid? -vesicle Which of the following is a firm, palpable, circumscribed elevation of the skin less than 1 cm in diameter? -papule A flat, brown mole less than 1 cm in diameter would be called a: -macule SCABIES/PEDICULOSIS CAPITIS/CELLULITIS/IMPETIGO What often causes cellulitis? -streptococci or staphylococci Lymphangitis (streaking) is frequently seen in what? -cellulitis What is most important in the management of cellulitis? 1 -infection An adolescent girl is cooking on a gas stove when her bathrobe catches fire. Her father smothers the flames with a rug and calls an ambulance. She has sustained major burns over much of her body. Which of the following is important in her immediate care? -remove her burned clothing and jewelry A young child has sustained a minor burn to the foot. Which of the following is the best method to stop the burning process? -run under cool water A toddler sustains a minor burn on the hand from hot coffee. The first action in treating this burn is to: -hold burned area under cool running water 1 A high-protein diet for the child with major burns is ordered to: -avoid protein breakdown Fentanyl and midazolam (Versed) are given before debridement of a child's burn wounds. These drugs are important to: -provide pain relief Nitrous oxide is being administered to a child with extensive burn injuries. The purpose of this drug is to: -provide anesthesia Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the primary purpose of hydrotherapy? -debride the wounds What is a systemic response to severe burns in a child? -abrupt drop in CO What sign is one of the first to indicate overwhelming sepsis in a child with burn injuries? -disorientation What finding is the most reliable guide to the adequacy of fluid replacement for a small child with burns? -urinary output of 1-2 ml/kg of body weight/hour What is the nursing action related to the applying of biologic or synthetic skin coverings for a child with partial-thickness burns of both legs? -observe wounds for signs of infection What is an effective strategy to reduce the stress of burn dressing procedures? -involve the child and give choices 1 What consideration is important for the nurse when changing dressings and applying topical medication to a child’s abdomen and leg burns? -wash hands and forearms before and after dressing change What is a strategy used to minimize scarring with burn injury in a child? -limitation of period without pressure to areas of scarring Prevention of burn injury is important anticipatory guidance. In the infant and toddler period, which mode is the most common cause of burn? -hot liquids in the kitchen 1 What cardiovascular defect results in obstruction to blood flow? -aortic stenosis FLUID IMBALANCES Nurses should be alert for increased fluid requirements in which circumstance? -fever What factor predisposes an infant to fluid imbalances? -immature kidney functioning Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms? -dry, sticky mucous membranes What laboratory finding should the nurse expect in a child with an excess of water? -decreased hematocrit What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)? -neuromuscular irritability What type of dehydration occurs when the electrolyte deficit exceeds the water deficit? -hypotonic dehydration What amount of fluid loss occurs with moderate dehydration? -50 to 90 ml/kg Physiologically, the child compensates for fluid volume losses by which mechanism? -fluid shift from interstitial space to intravascular space Ongoing fluid losses can overwhelm the child’s ability to compensate, resulting in shock. What early clinical sign precedes shock? 1 -tachycardia The presence of which pair of factors is a good predictor of a fluid deficit of at least 5% in an infant? -dry mucous membranes and generally ill appearance The nurse suspects fluid overload in an infant receiving intravenous fluids. What clinical manifestation is suggestive of water intoxication? -irritability and seizures In what condition should the nurse be alert for altered fluid requirements in children? (Select all that apply.) -oliguric renal failure -increased ICP -mechanical ventilation 1 What clinical manifestations should be observed in a 2-year-old child with hypotonic dehydration? (Select all that apply.) -slightly moist mucous membranes -absent tears -very rapid pulse The nurse is caring for a child with hypokalemia. The nurse evaluates the child for which signs and symptoms of hypokalemia? (Select all that apply.) -hypotension -muscle weakness -cardiac arrhythmias The nurse is caring for a child with hypercalcemia. The nurse evaluates the child for which signs and symptoms of hypercalcemia? (Select all that apply.) -anorexia -constipation -muscle hypotonicity The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and symptoms of hypernatremia? (Select all that apply.) -lethargy -oliguria -dry, sticky mucus CLEFT PALATE The parents of an infant with a cleft palate ask the nurse, What follow-up care will our infant need after the repair? Which is an accurate response by the nurse? -your infant will need follow-up w/ audiologists and orthodontists The nurse is caring for a child after a cleft palate repair who is on a clear liquid diet. Which feeding device should the nurse use to deliver the clear liquid diet? 1 A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed any meconium stools. What disease should the nurse suspect? -Hirschsprung disease A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include? -assessing bowel function The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time? -30 min before breakfast 1 The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include? (Select all that apply.) -hold the infant in prone position after feeding -prescribed Cimetidine should be given 30 min before feedings The nurse is preparing to admit a 3-year-old child with intussusception. What clinical manifestations should the nurse expect to observe? (Select all that apply.) -passage of red, currant jellylike stools -tender, distended abdomen -sudden acute abdominal pain The nurse is teaching parents of a child with gastroesophageal reflux (GER) disease foods that can exacerbate acid reflux. What foods should be included in the teaching session? (Select all that apply.) -citrus -spicy foods -peppermint The nurse is preparing to admit a 2-month-old child with hypertrophic pyloric stenosis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) -weight loss -projectile vomiting -the infant is hungry after vomiting The nurse is preparing to admit a 6-month-old child with gastroesophageal reflux disease. What clinical manifestations should the nurse expect to observe? (Select all that apply.) -spitting up -failure to thrive -excessive crying -respiratory problems ACUTE APPENDICITIS 1 What clinical manifestation should be the most suggestive of acute appendicitis? -colicky, cramping, abdominal pain around the umbilicus When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? -sudden relief from pain The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? -allow the child to assume a position of comfort The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) -fever 1 A pregnant woman asks about prenatal diagnosis of hydrocephalus. The nurse’s response should be based on which knowledge? -it can be diagnosed w/ fetal ultrasonography A child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What is a common reason for elective revision of this shunt? -growth of the child since the initial shunting A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What sign or symptom does the child have that indicates a revision is necessary? -alteration in LOC NORMAL INFANT REFLEXES The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. How should the nurse interpret these findings? -neurologic health The nurse is checking reflexes on a 7-month-old infant. When the infant is suspended in a horizontal prone position, the head is raised, and the legs and spine are extended. Which reflex is this? -Landau GUILLAIN-BARRE An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barr syndrome [GBS]). When explaining this disease process to the parents, what should the nurse consider? -muscle strength slowly returns, and most children recover A 12-year-old child with Guillain-Barr syndrome (GBS) is admitted to the pediatric intensive care unit. She tells you that yesterday her legs were weak and that this morning she was unable to walk. After the nurse determines the current level of paralysis, which should the next priority assessment be? -swallowing ability 1 SEIZURES What is the initial clinical manifestation of generalized seizures? -loss of consciousness What type of seizure may be difficult to detect? -absence What is important to incorporate in the plan of care for a child who is experiencing a seizure? -describe and record the seizure activity observed 1 A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. How should the nurse respond? -a step-wise approach will be used to reduce the dosage gradually After a tonic-clonic seizure, what symptoms should the nurse expect the child to experience? -lethargy and confusion What is the antiepileptic medication that requires monitoring of vitamin D and folic acid? -Phenobarbital A child has been admitted with status epilepticus. An emergency medication has been ordered. What medication should the nurse expect to be prescribed? -Lorazepam The nurse is preparing to admit a 7-year-old child with complex partial seizures. What clinical features of complex partial seizures should the nurse recognize? (Select all that apply.) -mental disorientation -there is frequently a postictal state -there is usually an impaired consciousness The nurse is preparing to admit a 10-year-old child with absence seizures. What clinical features of absence seizures should the nurse recognize? (Select all that apply.) -there is no aura -there is a brief LOC -there is an occasional clonic movement The nurse is teaching the parents of a child with a seizure disorder about the triggers that can cause a seizure. What should the nurse include in the teaching session? (Select all that apply.) -emotional stress -flickering lights -hyperventilation 1 A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? -give an antiemetic before chemo A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try? -relax any eating pressures The nurse is caring for a child receiving chemotherapy for leukemia. The child’s granulocyte count is 600/mm3 and platelet count is 45,000/mm3. What oral care should the nurse recommend for this child? -daily toothbrushing and flossing 1 What description identifies the pathophysiology of leukemia? -unrestricted proliferation of immature WBC’s A child with leukemia is receiving intrathecal chemotherapy to prevent which condition? -CNS damage A parent tells the nurse that 80% of children with the same type of leukemia as his sons have a 5- year survival. He believes that because another child on the same protocol as his son has just died, his son now has a better chance of success. What is the best response by the nurse? -each child has an 80% likelihood of 5-year survival The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL). The parent states, my child has a low platelet count, and we are being discharged this afternoon. What do I need to do at home? What statement is most appropriate for the nurse to make? -your child should avoid contact sports or activities that could cause bleeding What are favorable prognostic criteria for acute lymphoblastic leukemia? (Select all that apply.) -CALLA positive -early preB cell -2 to 10 years of age ANEMIA What physiologic defect is responsible for causing anemia? -decreased oxygen-carrying capacity of blood A child with severe anemia requires a unit of red blood cells (RBCs). The nurse explains to the child that the transfusion is necessary for which reason? -increase her energy so she will not be so tired What explanation provides the rationale for why iron-deficiency anemia is common during infancy? -cow’s milk is a poor source of iron 1 What statement best describes iron deficiency anemia in infants? -clinical manifestations are related to a reduction in the amount of oxygen available to tissues A school-age child is admitted in vasoocclusive sickle cell crisis (pain episode). The child’s care should include which therapeutic interventions? -hydration and pain management In which condition are all the formed elements of the blood simultaneously depressed? -aplastic anemia For children who do not have a matched sibling bone marrow donor, the therapeutic management of aplastic anemia includes what intervention? -immunosuppressive therapy 1 In a child with sickle cell anemia (SCA), adequate hydration is essential to minimize sickling and delay the vasoocclusion and hypoxiaischemia cycle. What information should the nurse share with parents in a teaching plan? -check for moist mucous membranes A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of a headache and is having unilateral hemiplegia. What action should the nurse implement? -notify the health care provider What pain medication is contraindicated in children with sickle cell disease (SCD)? -Meperidine (Demerol) A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan? -heat to the affected area HEMOPHILIA What statement is descriptive of most cases of hemophilia? -X-linked recessive inherited disorder in which a blood clotting factor is deficient The nurse is teaching the family of a child, age 8 years, with moderate hemophilia about home care. What should the nurse tell the family to do to minimize joint injury? -provide IV infusion of factor VIII concentrates PRECOCIOUS PUBERTY Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner? -PPP may be viewed as a variation in sexual development A child will start treatment for central precocious puberty. What synthetic hormone will be injected? -luteinizing hormone releasing hormone 1 DIABETES What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency? -type 1 What statement is characteristic of type 1 diabetes mellitus? -peak age incidence is 10-15 years What clinical manifestation is considered a cardinal sign of diabetes mellitus? -frequent urination 1 The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic? -additional snacks are needed before exercise A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention? -milk and peanut butter on bread What clinical manifestation occurs with hypoglycemia? -weakness and dizziness A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program? -essential info is presented initially The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption? -abdomen The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse’s response should be based on which knowledge? -it is suitable for up to 3 days if stored in the fridge A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed? -additional snacks are needed to compensate for increased activity To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence? -need to be perfect and similar to peers 1 HIP DYSPLASIA/CLUB FEET A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, what should the nurse explain? -frequent, serial casting is tried first The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what? -we’re happy this is the only cast our baby will need The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. What statement by the parent would indicate a correct understanding of the teaching? 1 -I should gently massage the skin under the straps once a day to stimulate circulation BONE FRACTURE What finding is characteristic of fractures in children? -rapidity of healing is inversely related to the child’s age A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface. What information does the nurse know regarding this type of fracture? -this type of fracture requires different management to prevent bone growth complications Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident. The parents and child are upset, and the child will not allow an examination of the injured arm. What priority nursing intervention should occur at this time? -calmly ask the child to point to where the pain is the worst and to wiggle fingers A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized. What information should be included in the home care instructions? -elevate casted arm when both upright and resting The nurse uses the five Ps to assess ischemia in a child with a fracture. What finding is considered a late and ominous sign? -paresthesia A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What technique should the nurse suggest to remove this material? -soak in a bathtub The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago. The adolescent suddenly develops chest pain and dyspnea. The nurse should suspect what complication? -PE 1 A child has just returned from surgery for repair of a fractured femur. The child has a long-leg cast on. The toes on the leg with the cast are edematous, but they have color, sensitivity, and movement. What action should the nurse take? -elevate the foot and leg on pillows A 3-year-old child has a femoral shaft fracture. The nurse recognizes that the approximate healing time for this child is how long? -4 weeks SCOLI OSIS When does idiopathic scoliosis become most noticeable?