Page 1147 - Saunders Comprehensive Review For NCLEX-RN

Test-Taking Strategy: Focus on the subject, exercise during an acute exacerbation
of the disease. Eliminate options 1 and 2 because of the closed-ended words “all”
and “must,” and option 4 because of the word additional.
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pediatrics: Musculoskeletal
Health Problem: Pediatric-Specific: Juvenile Idiopathic Arthritis
Priority Concepts: Mobility; Pain
Reference: McKinney et al. (2018), pp. 1237-1238.

397. Answer: 4

Rationale: Scoliosis is a three-dimensional spinal deformity that usually involves
lateral curvature, spinal rotation resulting in rib asymmetry, and hypokyphosis of
the thorax. A complication after surgical treatment of scoliosis is superior mesenteric
artery syndrome. This disorder is caused by mechanical changes in the position of
the child’s abdominal contents, resulting from lengthening of the child’s body. The
disorder results in a syndrome of emesis and abdominal distention similar to that
which occurs with intestinal obstruction or paralytic ileus. Postoperative vomiting in
children with body casts or children who have undergone spinal fusion warrants
attention because of the possibility of superior mesenteric artery syndrome. Options
1, 2, and 3 are incorrect.
Test-Taking Strategy: Focus on the subject, complications after surgical treatment
for scoliosis. Eliminate option 2 first because it should not be implemented unless
prescribed by the PHCP. Eliminate option 3 next because this child requires
logrolling, and Sims’ position may cause injury after surgery. From the remaining
options, note the assessment signs and symptoms in the question. These should alert
you that notification of the PHCP is necessary.
Level of Cognitive Ability: Synthesizing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Pediatrics: Musculoskeletal
Health Problem: Pediatric-Specific: Scoliosis
Priority Concepts: Clinical Judgment; Collaboration
Reference: Hockenberry, Wilson, Rodgers (2017), p. 970.

398. Answer: 3

Rationale: A brace may be prescribed to treat scoliosis. Braces are not curative but
may slow the progression of the curvature to allow skeletal growth and maturity.
The use of lotions or powders under a brace should be avoided because they can
become sticky and cake under the brace, causing irritation. Options 1, 2, and 4 are
appropriate interventions in the care of a child with a brace.
Test-Taking Strategy: Note the strategic words, need for further instruction. These
words indicate a negative event query and ask you to select an option that is an
incorrect statement. Careful reading of the options will assist in directing you to the

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