Test Instructions
Read the article. The test for this CE activity can only be taken online at http://www.nursingcenter.com/CE/AENJ. Tests can no longer be mailed or faxed.
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* Registration deadline is September 3, 2021.
Provider Accreditation
Lippincott Professional Development will award 1.0 contact hours for this continuing nursing education activity. This activity has been assigned 0 pharmacology credits.
Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.0 contact hours. LPD is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida CE Broker #50-1223.
The ANCC's accreditation status of Lippincott Professional Development refers only to its continuing nursing educational activities and does not imply Commission on Accreditation approval or endorsement of any commercial product.
Payment: The registration fee for this test is $12.95.
Disclosure Statement
The authors and planners have disclosed that they have no significant relationship with or financial interest in any commercial companies that pertain to this educational activity.
CE TEST QUESTIONS
General Purpose: To provide information about evidence-based diagnosis and treatment of radial head subluxation (RHS).
Learning Objectives/Outcomes: After completing this continuing education activity, you should be able to:
1. Describe the epidemiology, anatomy, and pathophysiology of RHS.
2. Illustrate the clinical presentation and diagnosis of RHS.
3. Explain the reduction techniques, complications, and discharge education for RHS.
1. Typically, RHS tends to result from
a. repetitive movement of the arm over a prolonged period.
b. overreaching with the arm.
c. pulling on an outstretched arm.
2. The most common pathophysiological mechanism causing nursemaid's elbow is
a. axial traction on a pronated forearm.
b. flexion of a supinated arm.
c. tendonitis of the elbow caused by infection.
3. RHS most commonly occurs in children aged
a. 1-4 months.
b. 1-4 years.
c. 4-6 years.
4. One theory supporting the increased incidence of RHS in the younger age group is that
a. the child is most likely to have an arm pulled by a parent.
b. children have a smaller shaft in relation to the radial head.
c. the annular ligament is absent in young children.
5. Which of the following statements accurately depicts epidemiological findings about RHS?
a. The right arm is more frequently involved.
b. Recurrence occurs in 25% of patients.
c. Most patients were found to be below the 75th percentile for weight.
6. Which anatomical structure helps keep the radius in place during forearm rotation?
a. the brachialis muscle.
b. the synovial bursa.
c. the annular ligament.
7. The annular ligament of children can have some laxity up until the age of
a. 6 years.
b. 8 years.
c. 10 years.
8. Until the age of 7 years, the radius in children
a. has a prominent head on a small neck.
b. lacks a head or neck.
c. is connected directly to the ulna.
9. When obtaining a history from a patient with possible RHS, keep in mind that it occurs due to
a. axial traction with the wrist pronated and the elbow extended.
b. pushing of the radial head through the radial collateral ligament.
c. the radial shaft becoming entrapped in the radiohumeral joint.
10. The most common initial parental complaint of children who present with RHS is
a. "they cry with excruciating pain upon every movement."
b. "they won't use their arm."
c. "the affected arm is shorter than the other one."
11. Whenever a child presents with an orthopedic injury, you should be sure to rule out possible
a. calcium deficiency.
b. bone cancer.
c. nonaccidental trauma.
12. When examining children with RHS,
a. typically, they are in distress and hold their arm in the supinated position.
b. examine using palpation of the entire extremity from the clavicle down.
c. observe the children when they bend and straighten their arm while standing.
13. With a history consistent with RHS, the diagnosis is typically made
a. following a radiograph of the arm.
b. clinically.
c. using computed axial tomography.
14. Consider ordering radiographs in your patient with symptoms of RHS in all of the following cases except
a. if initial reduction attempts are unsuccessful.
b. with some tenderness upon palpation of the radial head.
c. with the presence of swelling, ecchymosis, deformity, or severe pain with examination.
15. Before a closed reduction, analgesia to reduce procedural pain may include
a. ibuprofen upon patient arrival and before the procedure.
b. lidocaine gel to the affected area.
c. oral oxycodone before the procedure.
16. Regarding the closed reduction techniques used for RHS, the literature shows that
a. supination-flexion (SF) is the preferred reduction technique.
b. hyperpronation (HP) is less effective than SF.
c. HP is superior to SF in regard to first attempt success.
17. One hand holding the elbow applying firm pressure to the radial head and the other hand holding the distal forearm to rotate inward describes the
a. HP technique.
b. SF technique.
c. hyperextension technique.
18. Following reduction of RHS,
a. the child should continue analgesia and apply ice for 1-2 days.
b. immobilization with a sling is recommended for 1-3 days.
c. there is no need for analgesia or immobilization.