Deck 20: Musculoskeletal Disorders

Question 1

Identify one or more choices that best complete the statement or answer the question.
The family of an infant is present in the hospital when the diagnosis of osteogenesis imperfecta is given to the infant. The nurse is responsible for care of the infant and family. Which hospital care is appropriate? Select all that apply.

A)Avoid excessive force when monitoring blood pressure.
B)Consult a social worker for concerns of child abuse.
C)Teach the parents how to gently handle the infant.
D)Inform ancillary staff about handling precautions.
E)Prepare for the use of a riser cast for treatment.

Answer 1

Avoid excessive force when monitoring blood pressure.
Teach the parents how to gently handle the infant.
Inform ancillary staff about handling precautions.

Question 2

The nurse is providing care to a 7-year-old child who has been diagnosed with avascular necrosis. The patient's guardians ask the nurse what to expect due to this diagnosis. Which would be appropriate information to provide to the parents?

A)The child will be hospitalized and placed in traction.
B)The child will be treated by surgically placing a femoral screw.
C)The child will be placed in a Pavlik harness for several weeks.
D)The child will be given medication while on bedrest.

Answer 2

The child will be hospitalized and placed in traction.

Question 3

A school-aged child is refusing to use her right hand to write or type in the classroom. The child states that her wrist hurts. There is no apparent deformity, but the wrist is swollen. The child reports crashing her bike and landing on her hand 2 days prior. If fractured, which type of fracture does the child likely suffer from?

A)Greenstick fracture
B)Elbow fracture
C)Torus fracture
D)Toddler fracture

Answer 3

Torus fracture

Question 4

The nurse is caring for a 13-year-old patient diagnosed with adolescent idiopathic scoliosis. The curve in her back was treated by spinal fusion with rod insertion. Which is the priority nursing intervention in the postoperative period?

A)Promote adequate oral fluid intake.
B)Keep oxygen saturation within normal limits.
C)Ensure placement of indwelling urinary catheter.
D)Maintain a straight back, no bending.

Question 5

The nurse is preparing to complete assessments on children in a homeless shelter. Which assessment will assist the nurse to identify possible musculoskeletal conditions each child?

A)Eating and sleeping patterns
B)Height and weight growth patterns
C)Motor development patterns
D)Sensory development patterns

Question 6

An 11-year-old child who had been treated for a broken leg is having his cast removed. After removal, the child asks the nurse about playing basketball for his local league. Which should be included in the response to the child?

A)The child should avoid playing basketball for up to 4 weeks but can then resume playing.
B)The child can play basketball as soon as the stiffness in this leg subsides, which is typically within 3 to 5 days.
C)The child should avoid playing basketball until he has stopped growing due to risk of reinjury.
D)The child may play basketball immediately, but should stop if the extremity develops swelling and pain.

Question 7

The nurse is providing care to a preschool-aged child who has been placed in a hip Spica cast for treatment of a femur fracture. The child is given narcotic pain medication for the first 48 hours before being sent home. When providing discharge instructions to the child's parents, which is the most important?

A)Assist the child to find ways to play while in the cast.
B)Ensure the cast is not too tight around the abdomen.
C)Keep the cast clean by using absorbent pads when toileting.
D)Avoid giving the child sugary snacks while being treated.

Question 8

A 12-year-old girl is noted to walk with an uneven gait, and her shoulders appear uneven. The left shoulder sits lower than the right shoulder, and her waist appears to be tilted from side to side. Which condition is the girl most likely experiencing?

A)Internal femoral torsion
B)Hip dysplasia
C)Club foot
D)Scoliosis

Question 9

A 3-year-old, well-known to the nursing staff, is admitted to the hospital frequently for fracture treatment secondary to osteogenesis imperfecta. It is known by staff and parents that the child is fragile. The nurse develops a long-term care plan to review with the parents. Which is the priority intervention for this child's plan of care?

A)Observe the child's height and weight growth.
B)Monitor for bluish colored sclera development.
C)Teach methods to prevent falls and injury.
D)Inform parents about the OI foundation.

Question 10

A 4-year-old who had a broken arm is preparing to have the cast removed after 4 weeks. The child's parent states, "I had a cast on my arm a lot longer than that for it to heal. Are you sure the cast has been on long enough?" Which is the best response to the parent?

A)"Children's bones heal faster than adults, so they don't need to wear a cast as long as an adult."
B)"Children's bones are different, but the cast should be on about as long as yours was."
C)"You're right. The cast hasn't been on nearly as long as an adult. I'll recheck with the health-care provider."
D)"We don't worry about children's bones as much; they will remodel well on their own."

Question 11

The mother of a 6-week-old patient calls the physician's office and reports her infant is irritable, running a fever, holds his hip in an "unusual" position, and was recently given antibiotics for an ear infection. Which response by the nurse is most appropriate?

A)"Administer acetaminophen every 4 hours for the fever and call back if he still has a fever in 24 hours."
B)"This can easily be managed at home and will most likely resolve on its own."
C)"The antibiotics need more time to work. Finish the antibiotics prescribed and call back if the symptoms continue."
D)"You need to take him to the walk-in clinic or emergency room for evaluation."

Question 12

A teenaged patient arrives in the emergency department where the physician diagnoses a dislocated shoulder. It is the patient's first dislocation. Which should the nurse prepare for treatment of the dislocation?

A)Make sedative medication available.
B)Prepare a minimally invasive surgery room.
C)Anticipate a physical therapist consultation.
D)Get portable radiology equipment.

Question 13

The nurse is providing care for a 14-year-old patient who is within the first 24 hours postoperative for scoliosis treatment. Which intervention, if performed, would demonstrate appropriate care measures?

A)Removing the indwelling urinary catheter immediately upon arrival to the care unit
B)Repositioning the patient every 2 to 4 hours while in bed during the recovery period
C)Encouraging the patient to walk postoperatively once daily during pain-free periods
D)Monitoring oxygen levels and bowel sounds once daily until patient is discharged to home

Question 14

Identify one or more choices that best complete the statement or answer the question.
A 14-year-old student reports to the school nurse that he has a persistent pain and soreness in his legs. The student is part of the football team. There is no evidence of injury to the student. Which information should the nurse provide to the student? Select all that apply.

A)Continue to practice despite tiredness and pain.
B)Do stretching exercises before playing or being active.
C)Ask the coach to sit out of practice for a week.
D)Ensure shoes and equipment fit properly and are stable.
E)Learn proper body mechanics for the activities.

Question 15

The nurse is caring for a child who reports he has pain in his ankle after "twisting" it during play. Which would be the most appropriate follow-up assessment to this report?

A)Color and temperature of the skin around the ankle
B)The patient's gait and range-of-motion of all extremities
C)Swelling and deformity of the ankle joint
D)Palpation of the joints proximal to the ankle

Question 16

The mother of a 3-month-old returns for a visit with the physician who is caring for the infant's hip dysplasia. However, the nurse notes that upon arrival, the infant is not wearing the prescribed Pavlick harness. The mother indicates she thought the infant was uncomfortable so she removed it. Which is the best response by the nurse?

A)Inform the mother how to check for capillary refill in the toes.
B)Assess the infant for trauma or swelling to the lower extremities.
C)Report the findings to the physician before entering the examination room.
D)Ask the mother to demonstrate how to place the Pavlick harness.

Question 17

A 2-year-old child is being evaluated for a musculoskeletal disorder. The child's laboratory results indicate hypophosphatemia, a normal erythrocyte sedimentation rate, and negative rheumatoid factor. Which disorder is the child likely experiencing?

A)Juvenile arthritis
B)Genu varum (bowlegs)
C)Septic arthritis
D)Avascular necrosis

Question 18

The child is visiting the clinic for a pre-sports-participation physical. Which should be included as part of the patient education to prevent musculoskeletal injury during participation?

A)Manage any pain with acetaminophen
B)Consume extra fluids during warm weather
C)Perform stretching exercises before play
D)Seek emergency treatment for injuries

Question 19

A child is being treated with a hip Spica cast and preparing to be discharged home. Which statement by the parents demonstrates effective education and readiness to care for the child?

A)"We will turn our daughter every day and watch for skin irritation."
B)"Placing the absorbent part of the diaper toward the skin is best."
C)"We will let our daughter chose her own snacks to help her be happy."
D)"If our daughter is in pain, we will use only oxycodone to treat pain."

Question 20

The nurse is caring for a child in the emergency department. The child's arm is abnormally positioned, and the child is holding the arm near that area and is crying with pain. The child's parents explain that the child fell off the bicycle when riding on the streets of this subdivision. Which is the priority care to provide to the child?

A)Apply ice to the painful area.
B)Elevate the child's arm.
C)Encourage the child to rest.
D)Protect the child from more injury.