Deck 56: The Child With Alterations in Musculoskeletal Function

Question 1

Which assessment finding for a toddler-age child in balanced Bryant traction for a fractured right femur would require immediate action by the nurse?
1) The child keeps trying to turn and lie on his belly.
2) The ropes are unequal in length.
3) The child's buttocks are resting on the bed.
4) The Ace bandage wrapping the legs is wrinkled.

Answer 1

3

Question 2

Which assessment finding would require an immediate nursing action when providing care to an adolescent who is postoperative for spinal fusion surgery?
1) Sleeps when not bothered but arouses easily with stimuli
2) Impaired color, sensitivity, and movement to lower extremities
3) Nausea relieved by antiemetics
4) Pain relieved by analgesics

Answer 2

2

Question 3

The father of a school-age child who requires hospital admission for intravenous antibiotics to treat osteomyelitis states, "I don't understand why normal antibiotics can't be used." Which should the nurse include in the response to the father?
1) The antibiotic of choice is not available in oral form.
2) Blood flow to bones is limited, and parenteral administration is necessary to get appropriate blood levels.
3) Because the child is older now, it is harder to get the child to cooperate with oral antibiotics.
4) Because 2 weeks of therapy is necessary, the intravenous route will produce fewer side effects.

Answer 3

2

Question 4

Which assessment data obtained by the nurse during the health history portion of the assessment process support the current diagnosis of Duchenne muscular dystrophy (MD) for an 18-month-old child?
1) Infant was postmature by almost 2 weeks.
2) The child seems very muscular.
3) The child walked early and without support at 10 months.
4) The child's older sister developed scoliosis in the fourth grade.

Question 5

Which clinical manifestations should the nurse expect when assessing a pediatric client who is diagnosed with congenital hip dysplasia (CHD)? Select all that apply.
1) Limited adduction of the affected hip
2) Asymmetry of thigh fat folds
3) Telescoping of the thigh
4) Muscle weakness
5) Atrophy of the muscles

Question 6

Which are appropriate interventions for the nurse to include in the plan of care for a child who is receiving traction? Select all that apply.
1) Monitoring breath sounds
2) Assessing neurovascular status every 2 hours
3) Repositioning every 2 to 3 hours
4) Using moleskin to protect the skin from rough edges
5) Encouraging the parents cuddle with their child

Question 7

Which action by the nurse is appropriate for a child who presents in the emergency department with an ankle injury?
1) Avoid compressing the area to allow tissue swelling as necessary.
2) Perform passive range-of-motion to the extremity.
3) Lower the extremity below the level of the heart.
4) Apply ice to the extremity.

Question 8

Which clinical manifestations should the nurse expect when assessing a pediatric client who is diagnosed with Legg-Calvé-Perthes disease? Select all that apply.
1) Limited abduction of the affected hip
2) Asymmetry of thigh fat folds
3) Telescoping of the thigh
4) Muscle weakness
5) Atrophy of the muscles

Question 9

Which should the nurse include in the neurovascular assessment for an infant following casting of the leg for talipes equinovarus?
1) Warmth
2) Capillary refill
3) Pedal pulse
4) Sensation
5) Movement of the toes

Question 10

Which is the priority nursing diagnosis for nurse to use when planning care for a school-age child who must wear a brace for correction of scoliosis?
1) Impaired Gas Exchange, Risk for
2) Altered Growth and Development, Risk for
3) Impaired Skin Integrity, Risk for
4) Impaired Mobility, Risk for

Question 11

Which finding, noted during the newborn admission assessment, would lead the nurse to suspect unilateral congenital hip dysplasia?
1) Lordosis
2) Trendelenburg sign
3) Asymmetry of the gluteal and thigh fat folds
4) Telescoping of the affected limb

Question 12

Which interventions should the nurse include in the plan of care for an adolescent client who is on complete bed rest after spinal fusion surgery secondary to scoliosis to prevent complications associated with immobility? Select all that apply.
1) Encouraging use of the spirometer every 2 hours while the child is awake
2) Log-rolling the client every 2 hours while awake
3) Increasing intake of milk to maintain bone calcium
4) Increasing fruit and grains in the diet
5) Limiting fluid intake to reduce the need to void

Question 13

A school nurse suspects that a child who fell at recess has a fractured arm. Which should the nurse consider when applying a splint to transport the child to the hospital?
1) The splint is applied firmly enough to prevent swelling.
2) The arm is fully extended in the splint.
3) The splint is fully padded to prevent skin damage.
4) The joints above and below the suspected fracture are immobilized by the splint.

Question 14

Which clinical data noted by the nurse during the shift assessment indicate the pediatric client may be experiencing compartment syndrome? Select all that apply.
1) Pink, warm extremity
2) Dorsalis pedis pulse present
3) Prolonged capillary refill time
4) Pain not relieved by pain medication
5) Paresthesia of the leg

Question 15

Which parental statement would cause the nurse to include further education related to the care required for a child who is diagnosed with congenital clubfoot?
1) "We're getting a special car seat to accommodate the casts."
2) "We'll watch for any swelling of the feet while the casts are on."
3) "We'll keep the casts dry."
4) "We're happy this is the only cast our baby will need."

Question 16

An infant returns to the unit following surgical correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The nurse notes that the toes on both feet are edematous, but there is color, sensitivity, and movement to them. Which action by the nurse is the priority?
1) Apply a warm, moist pack to the feet.
2) Elevate the legs on pillows.
3) Encourage movement of the toes.
4) Call the surgical provider to report the edema.

Question 17

The nurse is providing care to a child who is diagnosed with Legg-Calvé-Perthes disease. Which parental statement regarding the child's care required further teaching from the nurse?
1) "We're glad this will only take about 6 weeks to correct."
2) "We understand abduction of the affected leg is important."
3) "We know to watch for areas on the skin that the brace might rub."
4) "We understand swimming is a good sport for Legg-Calvé-Perthes."

Question 18

Which teaching topic is the priority for the nurse who is teaching the family of an infant diagnosed with osteogenesis imperfecta?
1) Cast care
2) Trunk and extremity support during everyday care
3) Postoperative spinal surgery care
4) Traction care

Question 19

Which clinical manifestations should the nurse monitor for when conducting a scoliosis screening for a school-age child? Select all that apply.
1) Lordosis
2) Prominent scapula
3) Pain
4) A one-sided rib hump
5) Uneven shoulders and hips

Question 20

Which should the nurse include in a teaching session for the parents of an infant who will be placed in a Pavlik harness for the treatment of congenital developmental dysplasia?
1) Apply lotion or powder to minimize skin irritation.
2) Check at least 2 or 3 times a day for red areas under the straps.
3) Put clothing over the harness for maximum effectiveness of the device.
4) Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper.

Question 21

Which injury prevention strategies should the nurse include in the plan of care for a pediatric client who is diagnosed with muscular dystrophy?
1) Develop a home fire evacuation plan.
2) Provide information regarding oxygen safety.
3) Recommend the use of portable generator.
4) Teach safe transfer methods.
5) Perform neurovascular checks every 2 hours.

Question 22

Which are appropriate interventions for the nurse to include in the plan of care for a child who is casted? Select all that apply.
1) Monitoring breath sounds
2) Assessing neurovascular status every 4 hours
3) Repositioning every 2 to 3 hours
4) Using moleskin to protect the skin from rough edges
5) Encouraging the parents cuddle with their child