A nurse is providing discharge instructions to a parent and his school-age child who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include?

Choice A: Torticollis is not a disorder that causes lateral curvature of the spine, but rather a condition that causes tilting or twisting of the neck due to contraction or spasm of the sternocleidomastoid muscle. Torticollis can cause pain, stiffness, or limited range of motion in the neck. Torticollis can be congenital or acquired due to injury, infection, or posture.

Choice B: Lordosis is not a disorder that causes lateral curvature of the spine, but rather a condition that causes excessive inward curvature of the lower spine. Lordosis can cause back pain, stiffness, or difficulty in movement. Lordosis can be congenital or acquired due to obesity, pregnancy, osteoporosis, or spondylolisthesis.

Choice C: Kyphosis is not a disorder that causes lateral curvature of the spine, but rather a condition that causes excessive outward curvature of the upper spine. Kyphosis can cause a hunchback appearance, back pain, stiffness, or breathing problems. Kyphosis can be congenital or acquired due to aging, osteoporosis, arthritis, or spinal injury.

Choice D: Scoliosis is a disorder that causes lateral curvature of the spine in one or more places. Scoliosis can cause uneven shoulders or hips, back pain, fatigue, or breathing problems. Scoliosis can be congenital or idiopathic (unknown cause). Scoliosis can be diagnosed by physical examination and X-ray and treated by braces or surgery depending on the severity and progression of the curve.

Choice A: Urinary incontinence is a condition of involuntary loss of urine control, which can be caused by various factors, such as nerve damage, bladder dysfunction, or medication side effects. It is not always caused by neuroblastoma, which is a type of cancer that arises from immature nerve cells.

Choice B: Blood-fed is not a term that describes a neuroblastoma. Neuroblastoma is a type of cancer that arises from immature nerve cells, which can form tumors in various parts of the body, such as the adrenal glands, abdomen, chest, or spine.

Choice C: Tiny is not a term that describes a neuroblastoma. Neuroblastoma can vary in size and shape depending on the location and stage of the tumor. Some neuroblastomas can be very large and cause compression of nearby organs or structures.

Choice D: Unfortunately, much of the time, by the time a diagnosis has been made, metastasis has already occurred. This statement describes a neuroblastoma accurately. Neuroblastoma is a type of cancer that arises from immature nerve cells, which can spread rapidly to other parts of the body, such as the bones, liver, lymph nodes, or skin.
Metastasis is the process of cancer cells breaking away from the original tumor and forming new tumors elsewhere. Neuroblastoma often has no specific symptoms until it has metastasized, making it difficult to diagnose early and treat effectively.