Deck 48: The Child With Musculoskeletal or Articular Dysfunction

Question 1

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized.Which instructions should be included in the teaching?

A) Swelling of the fingers is to be expected for the next 48 hours.
B) Immobilize the shoulder to decrease pain in the arm.
C) Allow the affected limb to hang down for 1 hour each day.
D) Elevate casted arm when resting and when sitting up.

Answer 1

Elevate casted arm when resting and when sitting up.

Question 2

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

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

Answer 2

Russell

Question 3

What is the initial method of treating osteomyelitis?

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

Answer 3

Intravenous antibiotic therapy

Question 4

The nurse uses the palms of the hands when handling a wet cast to achieve what outcome?

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

Question 5

What effect does immobilization have 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 6

What 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 7

Four year old,placed in Buck's extension traction for Legg-Calvé-Perthes disease,is crying with pain as the nurse assesses that the skin of the 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 the physician.
D) Chart the observations and check the extremity again in 15 minutes.

Question 8

Which condition can result from the bone demineralization associated with immobility?

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

Question 9

A young child has just injured an ankle at school.In addition to calling the child's parents,what is the most appropriate immediate action by the school nurse?

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

Question 10

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

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

Question 11

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

A) Answering questions with straightforward honesty.
B) Avoiding discussing the seriousness of the condition.
C) Explaining that, although the amputation is difficult, it will cure the cancer.
D) Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy.

Question 12

The nurse is caring for a 4-year-old child immobilized by a fractured hip.Which complication should the nurse monitor for?

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

Question 13

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 14

Which term 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 15

What is an appropriate nursing intervention when caring for a child in traction?

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 16

Which medication 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)

Question 17

When does idiopathic scoliosis become most noticeable?

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

Question 18

What is an advantage to using a fiberglass cast instead of a plaster cast?

A) Is less expensive
B) Dries rapidly
C) Molds closely to body parts
D) Has a smooth exterior

Question 19

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hips (DDH).What information should be included?

A) Apply lotion or powder to minimize skin irritation.
B) Remove the harness several times a day to prevent contractures.
C) Hip stabilization usually occurs within 12 weeks.
D) Place a diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

Question 20

A neonate is born with mild clubfeet.When the parents ask the nurse how this will be corrected,the nurse should base the explanation on what fact?

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 21

A school-age child is diagnosed with systemic lupus erythematosus (SLE).The nurse should plan to implement which interventions for this child? (Select all that apply.)

A) Instructions to avoid exposure to sunlight
B) Teaching about body changes associated with SLE
C) Preparation for home schooling
D) Restricted activity

Question 22

A nurse is conducting discharge teaching for parents of an infant diagnosed with osteogenesis imperfecta (OI).Further teaching is indicated if the parents make which statement?

A) "We will be very careful handling the baby."
B) "We will lift the baby by the buttocks when diapering."
C) "We're glad there is a cure for this disorder."
D) "We will schedule follow-up appointments as instructed."

Question 23

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease.Nursing considerations should include which action?

A) Encouraging normal activity for as long as is possible.
B) Explaining the cause of the disease to the child and family.
C) Preparing the child and family for long-term, permanent disabilities.
D) Teaching the family the care and management of the corrective appliance.

Question 24

The nurse is caring for an infant with developmental dysplasia of the hips (DDH).Which clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Positive Ortolani sign
B) Unequal gluteal folds
C) Negative Babinski's sign
D) Trendelenburg's sign
E) Telescoping of the affected limb
F) Lordosis

Question 25

What nursing consideration is especially important when caring for a child diagnosed with juvenile idiopathic arthritis (JIA)?

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

Question 26

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

A) Discolored teeth
B) Below-normal intelligence
C) Increased muscle tone
D) Above-average stature

Question 27

Which interaction 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) Arrangements for tutoring and schoolwork
C) Instructions for a high-fat, low-protein diet
D) Instructions for the parent to return the child to team sports immediately

Question 28

A 10 year old sustained a fracture in the epiphyseal plate of the right fibula when falling from a tree.When discussing this injury with the child's parents,the nurse should consider which statement?

A) Healing is usually delayed in this type of fracture.
B) Growth can be affected by 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 29

Which nursing intervention is appropriate to assess for neurovascular competency in a child suspected of experiencing compartment syndrome?

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 30

Discharge planning for the child diagnosed with juvenile arthritis includes the need for which intervention?

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 aspirin to decrease gastric irritation.
D) Immobilizing the painful joints, which are the results of the inflammatory process.

Question 31

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia.Which assessment findings indicate possible compartment syndrome? (Select all that apply.)

A) Palpable distal pulse
B) Capillary refill to extremity of <3 seconds
C) Severe pain not relieved by analgesics
D) Tingling of extremity
E) Inability to move extremity

Question 32

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.