Page 1143 - Saunders Comprehensive Review For NCLEX-RN

Box 39-3

Medications Used in Juvenile Idiopathic Arthritis

Corticosteroid injections: Prescribed when only a few joints are involved.
Usually do not have any significant side effects.
Oral corticosteroids: May be prescribed but only for as short a time and at the
lowest dose possible. Long-term use is associated with side effects such as
weight gain, poor growth, osteoporosis, cataracts, avascular necrosis,
hypertension, and risk of infection.
Disease modifying antirheumatic drugs: Known as DMARDs are prescribed as
a second-line treatment when many joints are involved or the child does not
respond to corticosteroid joint injections. Biologics may also be prescribed,
and these include antitumor necrosis factor agents. All of these medications
cause side effects that need to be discussed with the child and/or parents.
Reference
American College of Rheumatology (2017), https://www.rheumatology.org/I-
Am-A/Patient-Caregiver/Diseases-Conditions/Juvenile-Arthritis

Practice Questions

393. A child has a right femur fracture caused by a motor vehicle crash and is
placed in skin traction temporarily until surgery can be performed. During
assessment, the nurse notes that the dorsalis pedis pulse is absent on the
right foot. Which action should the nurse take?
1. Administer an analgesic.
2. Release the skin traction.
3. Apply ice to the extremity.
4. Notify the primary health care provider (PHCP).
394. A child is placed in skeletal traction for treatment of a fractured femur. The
nurse creates a plan of care and should include which intervention?
1. Ensure that all ropes are outside the pulleys.
2. Ensure that the weights are resting lightly on the floor.
3. Restrict diversional and play activities until the child is out of
traction.
4. Check the primary health care provider’s (PHCP’s) prescriptions
for the amount of weight to be applied.
395. A 4-year-old child sustains a fall at home. After an x-ray examination, the
child is determined to have a fractured arm and a plaster cast is applied. The
nurse provides instructions to the parents regarding care for the child’s cast.
Which statement by the parents indicates a need for further instruction?
1. “The cast may feel warm as the cast dries.”
2. “I can use lotion or powder around the cast edges to relieve
itching.”
3. “A small amount of white shoe polish can touch up a soiled white
cast.”
4. “If the cast becomes wet, a blow drier set on the cool setting may

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