Deck 50: The Child with a Musculoskeletal Alteration

Question 1

A neonate is born with mild clubfeet.When the parents ask the nurse how this will be corrected,what response by the nurse is best?

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.

Answer 1

Frequent, serial casting is tried first.

Question 2

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

A) Wash the area with warm water and soap.
B) Vigorously scrub the leg.
C) Apply powder to absorb the material.
D) Carefully pick the material off the leg.

Answer 2

Wash the area with warm water and soap.

Question 3

A 6-year-old patient who has been placed in skeletal traction has pain,edema,and fever.The nurse should assess which of the following?

A) Neurologic status
B) Range of motion of all extremities
C) Warmth at site of pain
D) Blood pressure

Answer 3

Warmth at site of pain

Question 4

Discharge planning for the child with juvenile arthritis includes the need for

A) routine ophthalmologic examinations to assess for visual problems.
B) a low-calorie diet to decrease or control weight in the less mobile child.
C) avoiding the use of NSAIDs to decrease gastric irritation.
D) immobilizing the painful joints, which is the result of the inflammatory process.

Question 5

In caring for a child with an open fracture,the nurse should carefully assess for

A) infection.
B) osteoarthritis.
C) epiphyseal disruption.
D) periosteum thickening.

Question 6

When a child with a musculoskeletal injury on the foot is assessed,what is most indicative of a fracture?

A) Increased swelling after the injury is iced
B) The presence of localized tenderness distal to the site
C) The presence of an elevated temperature for 24 hours
D) The inability of the child to bear weight

Question 7

What is the major concern guiding treatment for the child with Legg-Calvé-Perthes disease?

A) Avoid permanent deformity.
B) Minimize pain.
C) Maintain normal activities.
D) Encourage new hobbies.

Question 8

Which factor is important to include in the teaching plan for parents of a child with Legg-Calvé-Perthes disease?

A) It is an acute illness lasting 1 to 2 weeks.
B) It affects primarily adolescents.
C) There is a disturbance in the blood supply to the femoral epiphysis.
D) It is caused by a virus.

Question 9

When assessing a child for an upper extremity fracture,the nurse should know that these fractures most often result from

A) automobile crashes.
B) falls.
C) physical abuse.
D) sports injuries.

Question 10

When infants are seen for fractures,which nursing intervention is a priority?

A) No intervention is necessary. It is not uncommon for infants to fracture bones.
B) Assess the family's safety practices. Fractures in infants usually result from falls.
C) Assess for child abuse. Fractures in infants are often nonaccidental.
D) Assess for genetic factors.

Question 11

Patient and parent education for the child who has a synthetic cast should include which of the following?

A) Applying a heating pad to the cast if the child has swelling in the affected extremity
B) Wrapping the outer surface of the cast with an Ace bandage
C) Splitting the cast if the child complains of numbness or pain
D) Covering the cast with plastic and waterproof tape to keep it dry while bathing or showering

Question 12

A child with osteomyelitis asks the nurse,"What is a 'sed' rate?" What is the best response for the nurse?

A) "It tells us how you are responding to the treatment."
B) "It tells us what type of antibiotic you need."
C) "It tells us whether we need to immobilize your extremity."
D) "It tells us how your nerves and muscles are doing."

Question 13

The nurse is assessing a 14-year-old who plays football and complains of knee pain when running and climbing stairs during football practice.The nurse should anticipate which action for this condition?

A) Bedrest with range-of-motion exercises
B) Prolonged IV antibiotics
C) Electromyography
D) NSAIDs or knee immobilizer

Question 14

Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's?

A) Growth occurs in children as a result of an increase in the number of muscle fibers.
B) Infants are at greater risk for fractures because their epiphyseal plates are not fused.
C) Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.
D) Their bones have less blood flow.

Question 15

During painful episodes of juvenile arthritis,a plan of care should include what nursing intervention?

A) A weight-control diet to decrease stress on the joints
B) Proper positioning of the affected joints to prevent musculoskeletal complications
C) Complete bed rest to decrease stress to joints
D) High-resistance exercises to maintain muscular tone in the affected joints

Question 16

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm?

A) The degree of motion and ability to position the extremity
B) The length, diameter, and shape of the extremity
C) The amount of swelling noted in the extremity and pain intensity
D) The skin color, temperature, movement, sensation, and capillary refill of the extremity

Question 17

A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports that the child will not stop crying even after taking acetaminophen with codeine.The child also will not straighten the fingers on the right arm.What advice by the nurse is best?

A) Take the child to the emergency department.
B) Put ice on the injury.
C) Avoid letting the child get so tired.
D) Wait another hour; if the child is still crying, call back.

Question 18

A 4-year-old child with a long leg cast complains of "fire" in his cast.Which action by the nurse is most appropriate?

A) Notify the provider on his or her next rounds.
B) Note the complaint in the nurse's notes.
C) Notify the provider immediately.
D) Report the complaint to the next nurse on duty.

Question 19

A nurse is teaching parents the difference between pediatric fractures and adult fractures.Which observation is true about pediatric fractures?

A) They seldom are complete breaks.
B) They are often open fractures.
C) They are often at the epiphyseal plate.
D) They are often the result of decreased mobility of the bones.

Question 20

Which instruction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy?

A) Instructions for a low-calorie diet
B) Arrange for tutoring and school work
C) Instructions for a high-fiber diet
D) Instructions to return the child to school as soon as possible

Question 21

What is the most appropriate intervention for an adolescent with a mild scoliosis?

A) Long-term monitoring
B) Surgical intervention
C) Bracing
D) No follow-up

Question 22

A nurse knows that which exercise is best for a child with juvenile arthritis?

A) Jogging
B) Tennis
C) Gymnastics
D) Swimming

Question 23

A boy who has fractured his forearm is unable to extend his fingers.The nurse knows that this

A) is normal following this type of injury.
B) may indicate compartment syndrome.
C) may indicate fat embolism.
D) may indicate damage to the epiphyseal plate.

Question 24

Which term 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 25

A nurse is assessing cranial nerve VII.How does the nurse perform this assessment?

A) Ask the child to smile or "show your teeth."
B) Have the child shrug shoulders against resistance.
C) Tell the child to squeeze your hands hard.
D) Instruct the child to stick out the tongue.

Question 26

A child is in skeletal traction.Which interventions should the nurse implement to prevent complications of immobility? (Select all that apply.)

A) Reposition the child every 2 hours.
B) Avoid use of an egg-crate or sheepskin mattress.
C) Limit fluid intake.
D) Administer stool softeners as prescribed.
E) Encourage coughing and deep breathing.

Question 27

Which statement by the mother of an adolescent being discharged after spinal fusion for severe scoliosis indicates the need for further teaching?

A) "I am glad we chose surgery. Now it is all over and done."
B) "I'll see you in a month; we'll be back fairly regularly."
C) "I have to pick up some more T-shirts on the way home."
D) "Those exercises the physical therapist showed us were not too hard."

Question 28

Juvenile arthritis should be suspected in a child who exhibits

A) frequent fractures.
B) joint swelling and pain lasting longer than 6 weeks.
C) increased joint mobility.
D) lurching and abnormal gait with limited abduction.

Question 29

When providing education for the parents of a child with Duchenne muscular dystrophy,the nurse plans to include

A) testing all female children for the disease.
B) testing the father for the presence of the trait on the Y chromosome.
C) genetic counseling for all female children.
D) testing the parents to determine the carrier.

Question 30

A child has a cast applied to the left forearm.Which interventions should the nurse include in the home care instructions for the parents? (Select all that apply.)

A) Keep small toys away from the cast.
B) Use a padded ruler to scratch the skin under the cast if it itches.
C) Assess the cast daily for unusual odors.
D) Elevate the extremity on pillows for the first 24 to 48 hours.
E) Numbness and tingling in the extremity are expected.

Question 31

Which factor should the nurse include when teaching a parent about the care of a newborn in a Pavlik harness for hip dysplasia?

A) The harness may be removed with every diaper change.
B) The harness maintains the hips in flexion, abduction, and external rotation.
C) The harness is only the first step of treatment.
D) The harness is worn for 2 weeks.

Question 32

A priority nursing intervention when caring for a child in a Pavlik harness is

A) skin care.
B) bowel function.
C) feeding patterns.
D) respiratory function.

Question 33

A nurse is preparing to administer naproxen to a toddler weighing 29 pounds.The pharmacy delivers a bottle containing 125 mg/5 mL.Based on knowledge of the safe dose,how much liquid does the nurse prepare to administer? Display your solve using a whole number.______ mL

Question 34

The nurse knows that treatment of Osgood-Schlatter disease includes

A) limitation of knee bending or kneeling.
B) increasing range of motion (ROM) of the knee.
C) encouraging flexion of the hip.
D) limitation of adduction of the hip.

Question 35

What actions should the nurse perform while caring for a school-age child who sprained his ankle playing football? (Select all that apply.)

A) Turn the child every 1 to 2 hours.
B) Assist with range-of-motion exercises every 2 hours.
C) Apply ice to the affected ankle.
D) Wrap the ankle with an ACE bandage.
E) Elevate the affected extremity.

Question 36

During a well-child visit,the nurse identifies that an 18-month-old infant is bowlegged.What action by the nurse is most appropriate?

A) Assess the infant's diet history.
B) Document the finding in the chart.
C) Facilitate a referral to an orthopedist.
D) Perform further assessment of the musculoskeletal system.

Question 37

When assessing the child with osteogenesis imperfecta,the nurse should expect to observe

A) discolored teeth.
B) below-normal intelligence.
C) increased muscle tone.
D) above-average stature.