Nurse Is Performing a Screening for Scoliosis on a School-Age Child. Which of the Following Instructions Should the Nurse Provide

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Sample questions from Nurse Is Performing a Screening for Scoliosis on a School-Age Child. Which of the Following Instructions Should the Nurse Provide

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.During a school health screening, an 11-year-old stands with a level pelvis and shoulders that appear even. The nurse is preparing to perform the forward-bend portion of the scoliosis screen. Which instruction should the nurse give?

   • A.Stand on one foot and bend sideways toward the floor.
   • B.Stand with your feet together and knees straight, then bend forward at the waist and let your arms hang toward the floor.
   • C.Sit upright with your arms crossed, then lean forward without moving your hips.
   • D.Stand with your feet apart and knees bent, then twist your trunk as far as you can to each side.

   Rationale: The forward-bend screen is performed with feet together and knees straight while the child bends at the waist and allows the arms to hang freely; this helps the nurse compare rib and back contours. Twisting, sitting, and side bending do not provide the standard view and can obscure asymmetry. The exam takeaway is to give clear, neutral instructions and observe the back from behind during forward flexion.

2. 2.At a community health fair, a 12-year-old has a visible prominence on the right side of the back during forward bending. The child reports no pain and has no weakness or numbness. Which action should the nurse take next?

   • A.Document the screening finding and notify the parent or guardian that a follow-up evaluation is recommended.
   • B.Repeat the screen daily for 1 week before notifying the parent or guardian.
   • C.Refer the child directly for spinal surgery because the asymmetry is visible.
   • D.Tell the child that scoliosis is confirmed and that a brace will be needed.

   Rationale: A screening finding suggests possible asymmetry but does not diagnose scoliosis, so the nurse should document the finding and arrange communication for appropriate clinical follow-up. A brace or surgery cannot be determined from a screening exam, and delaying notification for repeated daily screening is not appropriate. The exam takeaway is to distinguish screening from diagnosis and coordinate timely follow-up without overstating the result.

3. 3.At an elementary school, a 10-year-old is scheduled for scoliosis screening in a multipurpose room where other students are waiting nearby. The child appears embarrassed and asks whether classmates will see the results. Which actions should the nurse take to protect the child's rights and support accurate screening? Select all that apply.

   • A.Share the finding only with personnel who need the information to coordinate follow-up.
   • B.Announce the screening result to the teacher so the teacher can arrange follow-up.
   • C.Move the screening to a private area where the child's back can be observed without an audience.
   • D.Follow school policy for obtaining required parent or guardian permission and the child's cooperation.
   • E.Explain the steps in age-appropriate language and invite the child to ask questions before beginning.
   • F.Tell the child that the screen will determine whether scoliosis is present.

   Rationale: A private setting, an age-appropriate explanation, required permission and cooperation, and limited sharing support dignity, informed participation, and confidentiality. Announcing results to the teacher breaches privacy unless the teacher has a legitimate need and disclosure is permitted under policy. A screening result identifies a finding that may need evaluation; it does not establish a diagnosis.

4. 4.In a school clinic, a 13-year-old refuses to remove a sweatshirt for a scoliosis screen and says, "Everyone will laugh at me." The screening is routine, and the child has no symptoms. Which response by the nurse is best?

   • A.Have the child remove the sweatshirt immediately because screening is required for all students.
   • B.Ask a classmate to reassure the child while the nurse completes the screen.
   • C.Explain the purpose and privacy measures, offer a gown, and ask whether the child is willing to proceed.
   • D.Record a positive screening result because the child did not cooperate.

   Answer and rationale are in the full material.

5. 5.At a school health office, a 9-year-old with a history of cerebral palsy is due for a scoliosis screen. The child uses a wheelchair and cannot stand or bend forward without assistance. Which action is most appropriate?

   • A.Have the child perform the forward bend while the nurse holds both arms overhead.
   • B.Mark the screen as negative because the child cannot complete the maneuver.
   • C.Ask the child to stand unsupported so the nurse can compare shoulder height.
   • D.Document that the standard screening maneuver could not be completed and coordinate an individualized clinical assessment.

   Answer and rationale are in the full material.