Deck 24: The Child With a Musculoskeletal Condition

Question 1

The nurse, assessing the neurovascular status of a child in Russell traction, should report immediately the finding of:

A) Skin warm to the touch
B) Capillary refill less than 30 seconds
C) Ability to wiggle toes
D) Bluish coloration of skin

Answer 1

Bluish coloration of skin

Question 2

The nurse notes as an abnormal finding on a musculoskeletal assessment of a 4-year-old that the child:

A) Has inward-turned knees while standing
B) Walks on his toes
C) Appears to have flat feet
D) Swings his arms when walking

Answer 2

Walks on his toes

Question 3

When a 13-year-old girl is diagnosed with functional scoliosis, the nurse would explain the spinal curvature defect is usually caused by:

A) Juvenile rheumatoid arthritis
B) Poor posture
C) Heredity
D) Myelomeningocele

Answer 3

Poor posture

Question 4

In planning teaching to parents of a child with Legg-Calvé-Perthes disease about the long-term effects of this disease, the nurse would include that:

A) There are no long-term effects.
B) The disease is self-limiting, resolving itself in a year.
C) Degenerative arthritis may develop later in life.
D) There is risk of osteogenic sarcoma in adulthood.

Question 5

The nurse providing instructions to an adolescent who has been fitted with a Milwaukee brace would teach the patient to:

A) Wear the brace directly against the skin.
B) Wear the brace over regular clothing.
C) Wear the brace over a T-shirt 23 hours a day.
D) Remove the brace before sleeping.

Question 6

The nurse reviewing the characteristics of Ewing's sarcoma would point out that with Ewing's sarcoma:

A) Amputation is the accepted treatment.
B) The disease is sensitive to radiation and chemotherapy.
C) Metastasis is rare.
D) The disease is more prevalent in toddlers and preschoolers.

Question 7

The interventions that would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis would be:

A) Wearing splints at night to prevent extension contractures
B) Applying moist heat packs upon awakening
C) Taking a warm tub bath the evening before
D) Sleeping with two pillows under the head

Question 8

The nurse who is checking for capillary refill on a child in Bryant's traction will record adequate perfusion if the toe regains color in _____ seconds

A) 3
B) 4
C) 5
D) 6

Question 9

The nurse caring for a child in Bryant's traction knows that the risk of serious complications will be reduced by ensuring that:

A) Neurovascular checks are done frequently
B) Ace bandages are wrapped tightly
C) The baby is restrained from rolling over
D) The child's buttocks are resting on the bed

Question 10

The parent of a child with osteomyelitis asks why his child is in so much pain. The nurse's response will be based on the understanding that the pain of osteomyelitis is caused by:

A) The pressure of inelastic bone
B) Purulent drainage in the bone marrow
C) The cast applied on the extremity
D) Circulatory congestion of the skin

Question 11

The nurse explains that Russell traction is a type of skin traction that:

A) Subluxates the tibia
B) Does not interfere with range of motion
C) Prevents the knee from flexing
D) Supplies continuous pull in two directions

Question 12

The nurse caring for a child in Buck's skin traction will keep the:

A) Child in high-Fowler's position
B) Child pulled up in bed
C) Child's heel on the bed surface
D) Child's feet against the foot of the bed

Question 13

A 6-year-old sustained a fractured femur and was put in Russell traction 2 days ago. She screams in pain when she raises herself onto the bedpan. The nursing diagnosis that takes highest priority for this child is:

A) Pain resulting from tissue trauma
B) High risk for impaired skin integrity resulting from immobility
C) Altered growth and development related to separation from family
D) Altered urinary elimination related to immobility and traction

Question 14

The nurse assessing a child with juvenile rheumatoid arthritis notes the child's right knee and ankle are swollen, warm, and tender. This finding is suggestive of the _____ type of juvenile rheumatoid arthritis.

A) Pauciarticular
B) Polyarticular
C) Systemic
D) Acute febrile

Question 15

A nurse assessing a preadolescent child for scoliosis would:

A) Ask the child to bend forward at the waist, and would observe the child's back for asymmetry
B) Observe the gait while the child is walking forward heel to toe
C) Have the child flex the knees and look for uneven knee height
D) Look at the child's shoulders and hips while fully clothed

Question 16

The nurse is providing instructions about how to treat a sprained ankle. The nurse will recognize the need for additional teaching when the mother states:

A) "Apply warm compresses to the ankle for the first 24 hours."
B) "Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off."
C) "Wrap the ankle in an Ace bandage for support."
D) "Keep the leg elevated when sitting."

Question 17

The nurse caring for a child with Duchenne's muscular dystrophy notes a characteristic manifestation, which is that the child:

A) Ambulates by holding onto furniture
B) Exhibits atrophy of the calf muscles
C) Falls frequently and is clumsy
D) Has delayed fine-motor development

Question 18

A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. The nurse responds that antibiotic therapy will probably last for:

A) 2 weeks
B) 6 weeks
C) 2 months
D) 3 months

Question 19

The observation that may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs is:

A) The child has red, green, and yellow bruises on his body.
B) The child's bruises are dispersed on his head, arms, and legs.
C) The child had a broken arm last year and is described as accident prone.
D) The child's mother is very anxious for her son to get medical attention.

Question 20

When caring for a child in Buck's extension, the nurse would include:

A) Positioning the child with hips flexed 90° at all times
B) Keeping the weights in contact with the floor
C) Checking for skin irritation from traction equipment
D) Releasing the weights on a schedule

Question 21

The child with Duchenne's muscular dystrophy must push on his legs and "walk up the leg" in order to rise to a standing position. The nurse recognizes this characteristic behavior as ____________________ maneuver.

Question 22

The nurse understands a difference in the child's skeletal system as compared to an adult's is:

A) The child's bone is less porous than adult bone.
B) Bone growth is not affected by fractures.
C) Bone overgrowth in healing fractures is uncommon.
D) Callus formation in healing fractures occurs more rapidly.

Question 23

The nurse recognizes the signs of ____________________ syndrome in a child in a "90-90" traction when the toes are pale and edematous and have a very slow capillary refill.

Question 24

The nurse performing a neurovascular check on a limb in traction will assess: Select all that apply.

A) Pulse quality
B) Degree of sensation
C) Color quality
D) Capillary refill
E) Degree of movement
F) None of the above

Question 25

The nurse explains that Bryant's traction is reserved for children who weigh less than ____________________ pounds.

Question 26

The nurse reminds the adolescent boy with Ewing's sarcoma that he is prohibited from vigorous weight-bearing during treatment with radiation to reduce the risk of a ____________________ fracture.

Question 27

The nurse demonstrates how all traction devices: Select all that apply.

A) Pull the limb into extension
B) Decrease muscle spasm
C) Reduce pain
D) Align two bone fragments
E) Immobilize the limb