Deck 54: Musculoskeletal or Articular Dysfunction

Question 1

Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his 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

Answer 1

Notify the practitioner of the changes noted

Question 2

What is most descriptive of the therapeutic management of osteosarcoma?

A)Treatment usually consists of surgery and chemotherapy.
B)Amputation of affected extremity is rarely necessary.
C)Intensive irradiation is the primary treatment.
D)Bone marrow transplantation offers the best chance of long-term survival.

Answer 2

Treatment usually consists of surgery and chemotherapy.

Question 3

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. What instruction 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 3

Elevate casted arm when resting and when sitting up.

Question 4

An advantage to using a fiberglass cast instead of a plaster cast is that a fiberglass cast:

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

Question 5

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

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

Question 6

Osteosarcoma is the most common bone cancer in children. Where are most of the primary tumor sites?

A)Femur.
B)Humerus.
C)Pelvis.
D)Tibia.

Question 7

What effect does immobilization have on metabolism?

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

Question 8

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

A)Apply lotion or powder to minimize skin irritation.
B)Remove the harness several times a day to prevent contractures.
C)Return to the clinic every 1 to 2 weeks.
D)Place a diaper over harness,preferably using a superabsorbent disposable diaper that is relatively thin.

Question 9

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 10

An appropriate nursing intervention when caring for a child in traction is to:

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 three times a day.
D)Keep child in one position to maintain good alignment.

Question 11

When does idiopathic scoliosis become most noticeable?

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

Question 12

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected,the nurse should explain that:

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 13

What effect does immobilization have on the cardiovascular system? It causes:

A)Venous stasis.
B)Increased vasopressor mechanism.
C)Normal distribution of blood volume.
D)Increased efficiency of orthostatic neurovascular reflexes.

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

The nurse uses the palms of the hands when handling a wet cast to:

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

Question 16

What can result from the bone demineralization associated with immobility?

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

Question 17

The primary method of treating osteomyelitis is:

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

Question 18

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 19

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

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 20

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

Question 21

An important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA) is to:

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 22

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

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 23

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 24

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? Choose all that apply.

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