Deck 34: Musculoskeletal Alterations

Question 1

What differences in the musculoskeletal system of children make their bones able to absorb more energy before breaking and to heal more quickly?

A) Adults do not take in as much calcium as children do, thus their bones are weaker.
B) Children's bones have more cartilage and a stronger periosteum.
C) The muscles and ligaments in adults are not as strong as those of children.
D) Children have a better diet and take in more vitamins and minerals than adults do.

Answer 1

Children's bones have more cartilage and a stronger periosteum.

Question 2

Which of the following can be caused by a fracture that disrupts or transects the epiphyseal growth plate of a child?

A) gigantism
B) dwarfism
C) increased risk of a fat emboli or bleeding into the tissues
D) limb length discrepancy or a halt in height attainment

Answer 2

limb length discrepancy or a halt in height attainment

Question 3

Where is fat stored in bones?

A) surrounding the epiphyseal growth plate
B) in the gray marrow of the medullary cavity
C) in the yellow marrow of the medullary cavity
D) in the metaphysis section of the bone

Answer 3

in the yellow marrow of the medullary cavity

Question 4

Where does hematopoiesis occur in bones?

A) in the red marrow of the medullary cavity of the bone
B) in the proximal epiphysis
C) in the gray marrow of the medullary cavity of the bone
D) in the distal epiphysis

Question 5

Growth hormone is produced in the:

A) posterior lobe of the pituitary
B) anterior lobe of the pituitary
C) thalamus
D) hypothalamus

Question 6

The school nurse working in the middle school or high school will find that most sports injuries in older children and adolescents affect:

A) long bones
B) soft tissues
C) the head
D) spinal cord

Question 7

A parent asks the nurse for advice in letting her child pursue an interest in sports. The parent asks which sports are the most dangerous. The nurse will advise this parent that most injuries in organized sports occur in which of the following sports?

A) ice hockey, wrestling, and football
B) swimming, horseshoes, and hiking
C) karate, gymnastics, and dance
D) tennis, handball, and racquetball

Question 8

Sports injuries are classified in which of the following ways?

A) major and minor
B) short-term and long-term
C) acute or overuse
D) temporary and chronic

Question 9

The school nurse is seeing students who have experienced sports injuries. The nurse will talk with the students about ways to prevent sports injuries and will advise them that a major way to prevent sports injuries is:

A) adequate conditioning, including warm-ups and cooldowns
B) to increase calcium, carbohydrates, and protein in the daily diet
C) weight lifting, sit-ups, and push-ups on a daily basis
D) relaxation exercises, deep breathing, and mind training

Question 10

The nurse gets a telephone call from a parent who wants to know what to do for her child who just twisted an ankle, which is beginning to swell and hurt. The nurse will advise the parent to do which of the following?

A) Have the child stay in bed until the swelling and pain subsides.
B) Elevate the leg and use an ice pack to the ankle, alternating 30 minutes on and 15 off.
C) Apply alternating heat and cold with 15 minutes of heat and 15 minutes of cold.
D) Apply an Ace bandage or wrap securely and fairly tight with tape for 24 to 48 hours.

Question 11

You are the school nurse assessing the neurovascular status of a child who had a sports injury. You check the skin color, capillary refill, skin temperature, and pulses of distal extremities. You report the capillary refill as within the normal range if it is less than:

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

Question 12

A parent brings a 3-year-old child to the clinic with a complaint of a painful elbow. The pediatrician orders an X-ray, which reveals the child has a dislocated elbow. The pediatrician or the office nurse will:

A) immediately call and report suspected child abuse
B) assess to see if this injury is related to rough play with other children
C) talk with the family about not forcibly lifting the child by the hand
D) question the parent to ascertain who might be abusing the child

Question 13

The nurse arrives for the shift report and finds out that one of his assigned clients has a compound or open fracture and is going to surgery sometime during the shift. The nurse knows that this type of fracture involves:

A) a bone that has broken, and the two sections of broken bone are not aligned
B) a broken bone that is protruding through the skin, causing an open wound
C) two or more types of fractures, thus compounding or making the situation worse
D) significant bleeding into the area surrounding the fracture

Question 14

A parent asks the nurse to explain what the pediatrician meant by greenstickfracture. The nurse will explain that a greenstick fracture is one in which the bone has:

A) snapped into two separate pieces
B) a break through the periosteum and bone on one side but the other side is intact and only bends
C) a fracture line at a right angle to the long axis of the bone and which is on the shaft of the bone
D) a fracture line slanting, or diagonal, across the bone

Question 15

Injuries of the growth plate can be classified with the Salter-Harris system. Which of the following classifications have the best prognosis?

A) I and II
B) III and IV
C) V
D) VI

Question 16

The school nurse assessing a child who has fallen off the swings at school is looking for signs and symptoms of a fracture. The nurse suspects that the bone is fractured, because the child is complaining of pain and tenderness of the lower arm, there is some swelling of the lower arm, and there is decreased range of motion and crepitus. Which of the following best describes crepitus?

A) bleeding into the skin over the affected bone
B) paresthesia when the affected bone is moved in active or passive movement
C) bone overlap felt as a bump or raised elevation of the bone
D) a grating sound heard on movement of the ends of a broken bone

Question 17

The nurse is doing discharge planning with the family of an African-American child who is going home after open reduction of a fracture. Which of the following is important for the nurse to ask the caregivers before telling them about the best foods to serve the child to facilitate healing?

A) "How much does your child typically eat at a meal?"
B) "What foods does your child like?"
C) "Is your child lactose intolerant?"
D) "Do you cook at home or eat out most of the time?"

Question 18

The school nurse asks a child who has returned to school after an open reduction of a fracture to describe what she has eaten in the past 24 hours in order to see if the family is following the instructions regarding foods that will assist in bone healing. Which of the following reports by the child would indicate that the child and her family are following discharge instructions?

A) "fish sandwich, potato chips, and soda"
B) "chicken breast, French fried potatoes, and tea"
C) "cheeseburger, broccoli, peaches, and milk"
D) "tuna fish sandwich, cookies, and lemonade"

Question 19

Which of the following explains why synthetic casts are not recommended for young children or serious fractures?

A) They are not as colorful as the plaster casts.
B) People cannot sign them like they do the plaster casts.
C) They do not mold as well as plaster casts.
D) Plaster casts allow the person more mobility.

Question 20

The nurse is assigned to a child who is in Buck's extension traction. When the nurse does the initial assessment and looks at the traction setup, the nurse will make certain that the:

A) ropes and pulleys are hanging freely and not touching the bed or floor
B) counterweights are all resting solidly on the floor
C) open wounds are bandaged if skin traction is being used and applied over wounds
D) child is lying as close to the foot of the bed as possible

Question 21

The nurse is working with a small child who is in Bryant's traction. During the initial assessment of the shift, the nurse will make certain that:

A) the child is in Sims' position
B) only one leg is suspended
C) the child's buttocks are off the bed
D) the legs are flexed slightly less than 180 degrees

Question 22

The nurse is working with a client who is in cervical traction. How much should the head of the bed be elevated?

A) 20-30 degrees
B) 45-60 degrees
C) 70-90 degrees
D) 95-120 degrees

Question 23

The nurse is working with a child who is experiencing a complication of fractures known as compartment syndrome. Which of the following signs and symptoms is this child most likely to have?

A) headache, dizziness, blurred vision, and sensitivity to the sun
B) nausea, vomiting, and diarrhea for 2 weeks
C) a shifting of fluid and electrolytes into the intracellular space
D) paresthesia, severe pain, and severe swelling of the digits below the affected compartment

Question 24

A parent of a child experiencing compartment syndrome asks the nurse to explain what this means. Which of the following is the nurse's best response?

A) "This is a serious condition involving increased pressure in sheaths of inelastic fascia leading to massive impairment of circulation."
B) "In this condition, the blood has shifted from the circulation to the interstitial spaces, creating a dramatic change in blood pressure."
C) "The child is sorting out all experiences into either good or bad and cannot see gray areas."
D) "A lot of the blood from the stomach and large muscles has gone to the area of injury to help in healing."

Question 25

Which of the following treatments is used for compartment syndrome?

A) immediately administer at least one unit of whole blood
B) place the client in the Trendelenburg position and call a code
C) split the cast if one is present or do a fasciotomy to relieve pressure
D) use a blanket or device to lower the temperature

Question 26

Which of the following is an early sign of compartment syndrome?

A) a red streak in the forearm
B) loss of sensation in the involved body part(s)
C) swelling of one side of the body
D) sudden inability of the medications to relieve pain

Question 27

The nurse is assigned to care for a child who is scheduled to have a plaster cast applied after reduction of a fracture of the radius. The nurse will prepare the child for cast application by explaining that:

A) "You will immediately begin to itch a lot, but don't scratch."
B) "The cast will be warm, and it will take a day or two to dry completely."
C) "The physician will be using a lot of strange tools to apply the cast."
D) "There is no need to be afraid."

Question 28

The nurse working with a child with a new cast will use which of the following techniques to work with the cast?

A) Handle the cast gently with the palms of the hand.
B) Use sterile gloved hands when touching the cast.
C) Do not touch the cast for at least 24 hours.
D) Wrap the cast with a towel before touching it.

Question 29

The nurse observes a child with a cast using a pencil to reach inside the cast to scratch an area that the child has been saying is itchy. The child explains that the pencil won't quite reach the place that itches. Which of the following is the nurse's best intervention?

A) Find the child a longer pencil, and make certain the child is using the eraser end.
B) Give the child a longer pencil, and make sure it is new and has no point.
C) Provide the child with a long feather.
D) Use a hair dryer to blow air into the cast.

Question 30

The nurse is working with a child who is in a spica hip cast. Which of the following interventions on the part of the nurse would be best to help protect the cast from urine and stool and protect the skin?

A) Use a protective barrier cream or lotion, or petroleum jelly applied liberally to the skin.
B) Petal the cast around the edges, especially in the area of the groin and perineum.
C) Use a fracture bedpan with a plastic sheet placed under it.
D) Place a small plastic sheet just inside the cast edges, and drape it over the outside.

Question 31

The nurse is working with a child who is hospitalized and in traction. The parents of this child share with the nurse that the child is very angry with them at times. They share that they are hurt and frustrated by this anger because they are staying with the child and doing all they can to make the experience less traumatic. Which of the following is the nurse's best response?

A) "Go on, tell me more about how you are feeling right now."
B) "Let me have a talk with your child and if I am not successful, we can get the psychologist to talk with the child about this anger."
C) "Your child is displacing anger about being immobilized on you because you are safe targets, safer than the physicians and nurses."
D) "Do you have any ideas why your child is so angry at you?"

Question 32

The nurse encourages the caregivers of a child immobilized in traction to have friends and extended family visit the child. The major rationale for this action on the part of the nurse is directed to which of the following goals?

A) decreasing the child's focus on pain
B) building a support system for the child and caregivers
C) reducing boredom
D) preventing social isolation and deprivation

Question 33

The nurse assesses a child's neurovascular status. The child has a long leg cast for a fracture of the humerus. The nurse finds that there is a slight decreased sensation in the foot and toes of the casted leg as compared to the baseline assessment data. The nurse realizes that this is indicative of which of the following conditions?

A) a normal condition because sensation will increase and decrease slightly and not be exactly stable
B) pain that competes for recognition with sensation in the pain gateway theory
C) neurovascular compromise and an indication of the need for further assessment
D) probable interrater reliability error calling for establishment of a new baseline

Question 34

The nurse is assessing a child who has a fractured bone that has been pinned. There is caked blood and some purulent drainage in the pin area. Which of the following would be the best action for the nurse to take?

A) Clean the pin area with hydrogen peroxide solution.
B) Clean the area with soap and water.
C) Use hospital policy and, if not available, use alcohol on sterile 4 ´ 4's to clean the pin.
D) Report findings, and obtain a physician's order for pin-cleaning procedure.

Question 35

Which of the following statements best defines osteomyelitis?

A) any bone and muscle inflammation that is usually caused by a viral nonspecific organism
B) an infection of a muscle group associated with a given bone
C) an infection of an entire bone caused by a microorganism, which is usually bacterial but may be viral or fungal
D) a necrotic, infectious, inflammatory process, which left untreated will progress to gangrene

Question 36

Which of the following physician's orders would the nurse anticipate in cases of osteomyelitis to minimize pain and decrease the speed of infection by lymph channels?

A) ice packs to the affected limb
B) heat to the affected limb
C) splinting of the limb
D) intravenous pain medication

Question 37

The nurse is going over discharge instructions with the caregivers of a child who has osteomyelitis and is going home on oral medications. Which of the following discharge instructions is the most important for the nurse to give the caregivers?

A) how to assess for hearing loss
B) entertainment ideas
C) the importance of a tutor
D) restriction of visitors

Question 38

A pediatric client is diagnosed with an incomplete or partial dislocation of the articular surfaces of the joints. When the parents ask the nurse what this condition is called, the nurse accurately responds that it is referred to as ____________________.