Deck 31: The Child With Musculoskeletal or Articular Dysfunction

Question 1

A child is upset because when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which of the following should the nurse suggest to remove this material?

A)Soak in a bathtub.
B)Vigorously scrub leg.
C)Apply powder to absorb material.
D)Carefully pick material off leg.

Answer 1

Soak in a bathtub.

Question 2

The nurse uses the palms of the hands when handling a wet cast to achieve which of the following?

A)Assess dryness of the cast.
B)Facilitate easy turning.
C)Keep the patient's limb balanced.
D)Prevent indenting the cast.

Answer 2

Prevent indenting the cast.

Question 3

A 7-year-old has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which of the following should be included in the home care instructions?

A)Swelling of the fingers is to be expected.Notify a health professional if it persists more than 48 hours.
B)The shoulder should be kept as immobile as possible to avoid pain.
C)No restrictions of activity are indicated.
D)Elevate casted arm when both upright and resting.

Answer 3

Elevate casted arm when both upright and resting.

Question 4

An appropriate nursing intervention when caring for a child in traction would be which of the following?

A)Remove adhesive traction straps daily to prevent skin breakdown.
B)Assess for tightness, weakness, or contractures in uninvolved joints and muscles.
C)Provide active range-of-motion exercises to affected extremity 3 times a day.
D)Keep child in one position to maintain good alignment.

Question 5

Which of the following would be the most appropriate play activity for a 3-year-old child in a spica cast, considering both safety and development?

A)Marbles
B)Game of checkers
C)Coloring with crayons
D)Playing with toy telephone

Question 6

A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate, immediate action by the school nurse is which of the following?

A)Apply ice.
B)Observe for edema and discoloration.
C)Encourage child to assume a position of comfort.
D)Obtain parental permission for administration of acetaminophen or aspirin.

Question 7

Which of the following terms is used to describe a type of fracture that does not produce a break in the skin?

A)Simple
B)Compound
C)Complicated
D)Comminuted

Question 8

Which of the following clinical manifestations of developmental dysplasia of the hip (previously called congenital hip dysplasia) would be seen in the newborn?

A)Positive Ortolani click
B)Trendelenburg sign
C)Telescoping of the affected limb
D)Lordosis

Question 9

A child has just returned to the orthopedic unit after being placed in a hip spica cast. The instructions to parents for home care should include which of the following?

A)Turn every 8 hours.
B)Diapers should be avoided to reduce soiling of the cast.
C)Use abduction bar between legs to aid in turning.
D)Specially designed car seats are indicated and required.

Question 10

Which of the following is a physiological effect of immobilization on children?

A)Metabolic rate increases.
B)Increased joint mobility can lead to contractures in a short time.
C)Bone calcium increases, releasing excess calcium into the body (hypercalcemia).
D)Venous stasis can lead to thrombi and/or emboli formation.

Question 11

Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first?

A)Notify the practitioner of the changes noted.
B)Give the child medication to relieve the pain.
C)Reposition the child and notify physician.
D)Chart the observations and check the extremity again in 15 minutes.

Question 12

Which of the following types of traction uses skin traction on the lower leg and a padded sling under the knee?

A)Dunlop
B)Bryant
C)Russell
D)Buck extension

Question 13

Which of the following is an advantage to using a fiberglass cast instead of a plaster of Paris cast?

A)Cheaper
B)Dries rapidly
C)Molds closely to body parts
D)Smooth exterior

Question 14

Which of the following is a type of skin traction with legs in an extended position?

A)Dunlop
B)Bryant
C)Russell
D)Buck extension

Question 15

Immobilization causes which of the following effects on the cardiovascular system?

A)Venous stasis
B)Increased vasopressor mechanism
C)Normal distribution of blood volume
D)Increased efficiency of orthostatic neurovascular reflexes

Question 16

Immobilization causes which of the following effects on metabolism?

A)Hypocalcemia
B)Decreased metabolic rate
C)Positive nitrogen balance
D)Increased production of stress hormones

Question 17

An adolescent is in traction. The purpose of the traction is to fatigue the muscle and reduce muscle spasm so that the bones can be realigned. Nursing actions should include which of the following?

A)Maintain continuous traction until muscle spasm ceases.
B)Maintain continuous traction to prevent muscle from contracting.
C)Release traction every hour to allow muscle to briefly regain its contractibility.
D)Release traction once every 8 hours to allow muscle to briefly regain its contractibility.

Question 18

Which of the following can result from the bone demineralization associated with immobility?

A)Osteoporosis
B)Urinary retention
C)Pooling of blood
D)Susceptibility to infection

Question 19

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following?

A)Healing is usually delayed in this type of fracture.
B)Bone growth can be affected with this type of fracture.
C)This is an unusual fracture site in young children.
D)This type of fracture is inconsistent with a fall.

Question 20

Which of the following would cause a nurse to suspect that an infection has developed under a cast?

A)Complaint of paresthesia
B)Cold toes
C)Increased respirations
D)"Hot spots" felt on cast surface

Question 21

The nurse is preparing an adolescent girl for an instrumentation procedure to treat scoliosis. Which of the following should the nurse include?

A)Nasogastric intubation and urinary catheter may be required.
B)Ambulation will not be allowed for up to 3 months.
C)Surgery eliminates the need for casting and bracing.
D)Discomfort can be controlled with nonpharmacologic methods.

Question 22

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. The nurse's approach should include which of the following?

A)Answer questions with straightforward honesty.
B)Avoid discussing the seriousness of the condition.
C)Explain that although the amputation is difficult, it will cure the cancer.
D)Assist adolescent to accept the amputation as better than a long course of chemotherapy.

Question 23

Which of the following is the primary method of treating osteomyelitis?

A)Joint replacement
B)Bracing and casting
C)Intravenous antibiotic therapy
D)Long-term corticosteroid therapy

Question 24

Osteosarcoma is the most common bone cancer in children. Where are most of the primary tumor sites?

A)Femur
B)Humerus
C)Pelvis
D)Tibia

Question 25

A 4-year-old is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following?

A)Encourage normal activity for as long as is possible.
B)Explain the cause of the disease to the child and family.
C)Prepare child and family for long-term, permanent disabilities.
D)Teach family the care and management of the corrective appliance.

Question 26

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which of the following should be included?

A)Apply lotion or powder to minimize skin irritation.
B)Remove harness several times a day to prevent contractures.
C)Necessity to return to clinic every 1 to 2 weeks.
D)Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

Question 27

When does idiopathic scoliosis become most noticeable?

A)Newborn period
B)When child starts to walk
C)During preadolescent growth spurt
D)Adolescence

Question 28

Which of the following terms is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?

A)Scoliosis
B)Ankylosis
C)Lordosis
D)Kyphosis

Question 29

An important nursing consideration when caring for a child with juvenile rheumatoid arthritis would be which of the following?

A)Apply ice packs to relieve stiffness and pain.
B)Administer acetaminophen to reduce inflammation.
C)Teach child and family correct administration of medications.
D)Encourage range-of-motion exercises during periods of inflammation.

Question 30

Which of the following is most descriptive of the therapeutic management of osteosarcoma?

A)Treatment usually consists of surgery and chemotherapy.
B)Amputation of affected extremity is rarely necessary.
C)Intensive irradiation is the primary treatment.
D)Bone marrow transplantation offers the best chance of long-term survival.

Question 31

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that:

A)Traction is tried first.
B)Surgical intervention is needed.
C)Frequent, serial casting is tried first.
D)Children outgrow this condition when they learn to walk.

Question 32

Which of the following medications is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)?

A)Aspirin
B)Corticosteroids
C)Cytotoxic drugs such as methotrexate
D)Nonsteroidal antiinflammatory drugs (NSAIDs)