Deck 29: Caring for the Child With a Musculoskeletal Condition

Question 1

The nurse is providing care to a pediatric patient admitted for a workup of bone deformity.The latest laboratory values indicate calcium at 6.6 mg/dL and phosphorus at 2.1 mg/dL.Which condition does the nurse correlate with these values?

A)Muscular dystrophy
B)Osgood-Schlatter disease
C)Rickets
D)Scoliosis

Answer 1

Rickets

Question 2

A mother brings her daughter to the clinic after noticing the child's new swimsuit fits baggily on one side of her bottom and the child's right thigh looks quite odd compared to the other one.Which assessment question would provide the nurse the most important information?

A)"Do her joints dislocate easily?"
B)"Does she fatigue easily?"
C)"Has your child been limping?"
D)"When did you see her in a swimsuit last?"

Answer 2

"Has your child been limping?"

Question 3

A parent calls the clinic to report that his child's cast seems to be looser than it was yesterday.Which instruction is most appropriate for the nurse to provide to the parent?

A)"Bring your child in so we can evaluate the cast."
B)"If the cast is loose,circulation won't be compromised."
C)"Pad the top of the cast with a small towel so it fits."
D)"This is not unusual;just keep your next appointment."

Answer 3

"Bring your child in so we can evaluate the cast."

Question 4

A parent calls the nursing call center stating that his child,who has a cast after surgical treatment of a clubfoot,is very fussy even after acetaminophen (Tylenol)administration and that the child's toes seem cool.What advice does the nurse give the parent?

A)"Elevate the affected extremity and apply ice for 20 minutes."
B)"Make four cuts to the top of the cast,each about 1 inch long."
C)"Take your child to the nearest emergency department now."
D)"Try giving your child a dose of ibuprofen (Pediaprofen)instead."

Question 5

The student nurse studying the anatomy of the musculoskeletal system understands that bones are classified by their size and shape.How does the student classify the pelvis?

A)Flat bone
B)Irregular bone
C)Long bone
D)Short bone

Question 6

A 15-year-old boy is brought to the emergency room by his parents following an injury to his arm that occurred during football practice.The x-ray shows a diagonal line that coils around the bone.Based on this x-ray,which type of fracture does the nurse prepare to teach the family about?

A)Greenstick
B)Oblique
C)Spiral
D)Transverse

Question 7

A pediatrician asks a patient with a knee injury to squat.Which disorder is this patient suspected of having?

A)Juvenile arthritis
B)Muscular dystrophy
C)Osgood-Schlatter disease
D)Osteomyelitis

Question 8

The pediatric nurse explains to the student nurse that alterations in musculoskeletal functioning may be related to a congenital defect or an acquired defect.Which disorder is an example of a congenital defect?

A)Juvenile arthritis
B)Muscular dystrophy
C)Osgood-Schlatter disease
D)Osteomyelitis

Question 9

The student nurse studying anatomy knows that red blood cells are produced where?

A)Growth plates
B)Periosteum
C)Red marrow
D)Yellow marrow

Question 10

A child who has been limping for several weeks is brought to the clinic and undergoes radiological studies.The results show osteonecrosis.Which information does the nurse plan to teach the parents about their child's condition?

A)Non-weight-bearing status and mobility limitations
B)Overcorrection with serial casting for 2-3 years
C)Surgical correction with the Z-plasty technique
D)Wearing and caring for a Browne splint

Question 11

A pediatric nurse is caring for a 1-year-old child who is in a spica cast.The nurse teaches the parents that modifications need to be made for this child.Which modification does the nurse teach?

A)Using a baby bath with shallow water to clean the child
B)Using a car seat with sturdy sides to transport the child
C)Using a sitting position on the floor to feed the child
D)Using a wagon instead of a stroller to move the child

Question 12

An adolescent patient is prescribed a brace to treat scoliosis.Which assessment finding by the nurse indicates that outcomes for a priority nursing diagnosis have been met by the patient?

A)Is able to explain the rationale for the bracing
B)No redness or breakdown seen under the brace
C)Participates in social activities with friends
D)Wears brace continuously for 20 hours each day

Question 13

A nurse working in an inpatient pediatric unit cares for many children with musculoskeletal impairments.Which outcome takes priority for these children?

A)Adapting to changing activity restrictions
B)Continuing their growth and development
C)Resuming ambulation as soon as possible
D)Staying current with schoolwork with tutors

Question 14

An adolescent expresses frustration over how long his football injury to a tendon is taking to heal.Which response by the nurse is the most appropriate?

A)"I'll ask the doctor to check for a tendon infection."
B)"Often these injuries never fully heal and return to normal."
C)"Tendons have a poor blood supply,so healing is slow."
D)"You have to be more compliant with immobilization."

Question 15

A new nurse is caring for a child after spinal fusion to correct scoliosis.Which action by the new nurse causes the experienced nurse to intervene?

A)Assesses neurological status and vital signs every hour
B)Instructs patient to turn by pulling on side rails
C)Monitors chest tube for air leakage and drainage
D)Promotes use of the incentive spirometer each hour

Question 16

A 10-year-old child is in the emergency department with a type IV femur fracture.Which intervention takes priority?

A)Assessing the child for signs of maltreatment
B)Ensuring that signed consent for surgery is on the chart
C)Explaining the process of closed reduction with sedation
D)Preparing the child for prolonged immobility in traction

Question 17

A child has been hospitalized with an acute-grade IV slipped femoral capital epiphysis (SFCE)and is on bedrest awaiting surgical correction.A new nurse places the following interventions on the child's care plan.Which intervention leads the experienced nurse to intervene?

A)Consult child-life therapist for diversionary activities.
B)Perform range-of-motion exercises to both lower extremities.
C)Reinforce teaching on crutch-walking postoperatively.
D)Teach child and family about non-weight-bearing status.

Question 18

A nurse is conducting a sports fitness class for volunteer coaches.Which information provided by the nurse is the most appropriate?

A)"Fractures heal more quickly in children because the bones are still growing."
B)"Children are prone to fractures because their bones are weaker than adults' bones."
C)"Ligaments are bands of fibrous tissue that hold muscles to the bones."
D)"Once a child reaches adult height,bone development eventually stops."

Question 19

A child is being cared for at home with modified bed rest for Legg-Calvé-Perthes disease.Which assessment finding indicates to the home health-care nurse that outcomes for a priority diagnosis have been met?

A)The child maintains grades in school via tutoring.
B)The family identifies effective coping strategies.
C)Full range of motion is present in all joints.
D)The family identifies appropriate diversionary activities.

Question 20

A woman who wishes to become pregnant again consults with the nurse about preventing her child from being born with clubfoot.She has two other children,both treated for this disorder.Which information does the nurse provide about preventing clubfoot?

A)Avoid secondhand cigarette smoke while pregnant
B)Fetal positioning in utero cannot be controlled
C)Getting enough folic acid early in pregnancy is advisable.
D)The disorder is genetic so no prevention is available.

Question 21

The parents of a child recently diagnosed with Duchenne's muscular dystrophy want to know if their infant twin daughters should be tested for the disease too.Which response by the nurse is the most appropriate?

A)"No,Duchenne's muscular dystrophy is a sex-linked genetic disorder rarely affecting females."
B)"No,infants the age of your daughters are too young to undergo testing for Duchenne's muscular dystrophy."
C)"Yes,the earlier the diagnosis of any type of muscular dystrophy is made,the better the child's quality of life."
D)"Yes,females are equally likely to have Duchenne's muscular dystrophy as are boys."

Question 22

A student athlete has a serious anterior cruciate ligament (ACL)tear,and her knee is swollen with excess synovial fluid.Which procedure does the nurse prepare this athlete for?

A)Application of heat
B)Immediate surgery
C)Joint aspiration
D)Knee reduction

Question 23

A 4-year-old child is recovering from a modified Nuss procedure.Which is the priority intervention by the nurse?

A)Ambulating the child as soon as allowed
B)Encouraging food and fluids postoperatively
C)Monitoring vital signs and wound drainage
D)Playing with the child using pinwheels or bubbles

Question 24

A home health-care nurse is visiting a child with Duchenne's muscular dystrophy (MD).The child has a new cough,poor appetite,fatigue,and a reddened area on his coccyx from sitting in his wheelchair all day.What intervention by the nurse takes priority?

A)Assess the child for his favorite high-protein foods.
B)Develop a protocol for changing positions more often.
C)Encourage the family to allow the child plenty of rest.
D)Notify the health-care provider and request antibiotics.

Question 25

A nurse is caring for an 8-year-old child hospitalized 2 days after open reduction and internal fixation (ORIF)of a femur fracture sustained in a motor vehicle crash.The child is now in a long-leg cast. Which assessment finding prompts the nurse to notify the health-care provider?

A)A foul odor coming from the cast
B)Child eating only 20% of meals
C)Old dried drainage marked on the cast
D)Request for pain medicine every 4 hours

Question 26

A new nurse is placing an elastic wrap on a patient with an ankle sprain.Which action by this nurse causes an experienced nurse to intervene?

A)Exerts moderate pull on the wrap
B)Instructs the patient on wrapping the injury
C)Starts wrapping distal to the injury
D)Wraps in a proximal-to-distal fashion

Question 27

An infant hospitalized with multiple fractures has just been diagnosed with osteogenesis imperfecta.The nurse finds the parents crying.Which response by the nurse is the most appropriate?

A)"I know how you feel.I would be upset to find this out too."
B)"There is medicine that can allow her to live a normal life."
C)"Would you like me to help you with holding your baby?"
D)"You are actually lucky;many of these babies die at birth."

Question 28

A teen has a scoliosis curve of 35°.What treatment option does the nurse prepare the child and family for?

A)Bracing
B)Continued screening
C)Exercise therapy
D)Surgical intervention

Question 29

A child has just been diagnosed with juvenile arthritis (JA).The parents want to know what caused this to happen.Which statement by the nurse is the most appropriate?

A)"Genetic abnormalities are triggered by infection."
B)"It seems to be an autoimmune disease."
C)"Latent infections can recur and cause JA."
D)"No one really understands how JA occurs."

Question 30

A child in the intensive care unit with tetanus will be receiving a neuromuscular blocking agent.Which intervention takes priority for this child?

A)Monitor urinary catheter output hourly.
B)Provide stimulation from TV or radio.
C)Turn patient every 2 hours.
D)Provide ventilator care to prevent pneumonia.

Question 31

A child is 3 hours postoperative,having had an open reduction and internal fixation (ORIF)of a type IV tibial fracture,which is now also casted.Which action by the nurse takes priority?

A)Assess neurovascular status every hour.
B)Change IV pain medication to oral pills.
C)Provide an ice bag for 30 minutes every hour.
D)Teach parents about activity restrictions.

Question 32

A nurse is caring for a child who had an open reduction and internal fixation (ORIF)of a femur fracture 12 hours ago.The nurse finds the child pale and short of breath.What action by the nurse takes priority?

A)Assess oxygen saturation while a coworker calls the physician.
B)Assess and treat the child for pain or anxiety as needed.
C)Raise the head of the bed to a 45°angle and reassess.
D)Review the child's postoperative hemoglobin and hematocrit.

Question 33

The pediatric nurse is caring for a child recently diagnosed with transient synovitis of the hip.Which medication order is most appropriate for this child?

A)Acetaminophen (Tylenol)10-15 mg/kg every 4 hours
B)Ibuprofen (Motrin)30-50 mg/kg/day in 3-4 divided doses
C)Naproxen (Aleve)20-30 mg/kg/dose every 4 hours
D)Prednisone (Deltasone)0.1-2 mg/kg/day in 1-4 divided doses

Question 34

An 8-month-old child with congenital myotonic dystrophy has been hospitalized with a severe respiratory infection.Which action by the nurse is the most appropriate?

A)Determine if the family wants aggressive ventilatory support.
B)Discuss the option of lung transplantation with the family.
C)Hold a family meeting to discuss palliative care measures and code status.
D)Inform the family the child will be ventilator dependent as she gets older.

Question 35

A nurse is caring for a child with Duchenne's muscular dystrophy (MD).The child's creatinine kinase level has dropped by over half since it was last measured.What assessment finding correlates with these results?

A)Better respiratory functioning
B)Decreased muscle strength
C)Improved posture and walking
D)Stabilizing muscle strength

Question 36

A child has been hospitalized with suspected osteomyelitis.The child's white blood cell count (WBC)is 22,000/mm³ and his C-reactive protein is 15 mg/dL.Which conclusion by the nurse is appropriate based on these laboratory values?

A)The child has an infection somewhere.
B)The child has osteomyelitis.
C)The child is immunocompromised.
D)These tests are not related to the condition.

Question 37

A child in traction is having muscle spasms.Which medication does the nurse prepare to administer?

A)Acetaminophen (Tylenol)
B)Diazepam (Valium)
C)Morphine sulfate (Astromorph)
D)Oxycodone (Percocet)

Question 38

A child is going home with a distractor in place after surgery to repair syndactyly.Which discharge teaching is most important?

A)Clean around the pin sites twice a day with soap and water.
B)Don't pull the pins;they will gradually fall out on their own.
C)Perform range-of-motion exercises to the affected fingers daily.
D)Turn the screw with the Allen wrench twice a day for a week.

Question 39

The parents of a 3-year old cannot understand how their child has developed osteoporosis,stating "We didn't think children could get this disease." Which assessment by the nurse is most important?

A)Attainment of developmental milestones
B)Dietary intake of calcium
C)Height and weight
D)Labor and birth history

Question 40

A 5-year-old child is hospitalized with osteomyelitis and will be going home in the next few days on intravenous (IV)antibiotics.Which action by the nurse is the most appropriate?

A)Ensure that a valid permit for a PICC line is on the chart.
B)Locate a pharmacy that will supply the IV medications.
C)Research the patient's insurance for home infusion coverage.
D)Teach the child about a PICC line using a doll.

Question 41

A pediatrician orders Russell traction for a 12-year-old patient with Legg-Calvé-Perthes disease.Which interventions are appropriate for the nurse to include in the care plan for this patient? (Select all that apply.)

A)Bony areas are massaged frequently.
B)Child is lying in a supine position.
C)Hip is flexed and abducted.
D)Skin is inspected every 12 hours.
E)The child uses a trapeze to move.

Question 42

The pediatric nurse discusses home care with the parents of a patient who is returning home following a spinal fusion.Which teaching points will the nurse include in the discharge teaching for this patient? (Select all that apply.)

A)Allow the child to return to school about 4 to 6 weeks following surgery.
B)Encourage ambulation when permitted,usually 2 to 3 weeks postoperatively.
C)Explain activity restrictions such as no twisting,bending,or lifting.
D)Maintain a regular diet with added calcium,fiber,fluids,and vitamin
E) Participation in contact sports such as football needs to be delayed for 1 year.

Question 43

An 8-year-old girl has a third-degree sprain of the ankle.Based on this diagnosis,which teaching points will the nurse include in the teaching plan for this patient and family? (Select all that apply.)

A)The ligament is only stretched and the affected joint is stable.
B)The patient cannot bear weight or use the extremity.
C)There is severe pain over the joint,making an exam difficult.
D)There is full range of motion and weight bearing.
E)Sprains and strains are unusual in a child this age.

Question 44

A nurse is caring for a patient in Crutchfield tongs.Which assessment finding requires immediate notification to the health-care provider?

A)Altered mental status
B)Crusted drainage at pin sites
C)Irritability and pain
D)WBCs of 98,000/mm3

Question 45

A nurse is teaching part of a babysitting class to teenagers.Which information about fractures does the nurse include in the lesson? (Select all that apply.)

A)Approximately 10% to 15% of childhood injuries are fractures.
B)Bicycle crashes account for many fractures .
C)Girls rarely have stress fractures from sports.
D)New bone growth is complete in 6 weeks.
E)Some fractures can interrupt normal growth.

Question 46

The nurse is providing care to a pediatric patient who has orders for Crutchfield tongs.Which diagnosis does the nurse anticipate prior to reviewing the patient's medical record?

A)Dislocated hip
B)Femur fracture
C)Osteopenia
D)Spinal fracture

Question 47

A child's family history includes muscular dystrophy (MD).What diagnostic testing does the nurse prepare the child and family for? (Select all that apply.)

A)Blood urea nitrogen
B)Creatinine kinase
C)Electromyelogram
D)Muscle biopsy
E)Ultrasound

Question 48

The nurse is caring for a child diagnosed with clubfoot.Which assessment findings does the nurse anticipate in the affected extremity? (Select all that apply.)

A)Adducted forefoot
B)Dorsiflexion
C)Everted heel
D)Plantar flexion
E)Rigidity

Question 49

The nurse is providing care to a pediatric patient who suffered an ankle sprain.Which interventions are appropriate to include in the patient's plan of care? (Select all that apply.)

A)Apply an Ace wrap to apply pressure and reduce swelling of the joint.
B)Apply heat to the extremity for the first 48 hours at 15-minute intervals.
C)Elevate and move the affected joint to reduce swelling and stiffness.
D)Immediately perform range-of-motion exercises on the extremity.
E)Place ice on the injury for 15 minutes at a time for the first 1 to 2 days.

Question 50

A young teen has been diagnosed with Osgood-Schlatter disease.Which information does the nurse teach the patient and family regarding this diagnosis? (Select all that apply.)

A)Activity level is determined by pain.
B)Apply ice to the knee after activity.
C)Modified bedrest for 1 week is needed.
D)Surgical correction is usually required.
E)Use ibuprofen (Motrin)for pain.

Question 51

The pediatric nurse explains to the parents of a child with kyphosis that it is caused by a congenital or acquired condition.Which conditions are considered congenital causes of kyphosis? (Select all that apply.)

A)Ankylosing spondylitis
B)Chronic poor posture
C)Osteogenesis imperfecta
D)Osteomyelitis
E)Rheumatoid arthritis

Question 52

A parent asks about the process of bone growth.When explaining bone development to the parent,which substances does the nurse include in the teaching session as being necessary? (Select all that apply.)

A)Calcitonin
B)Calcium
C)Estrogen
D)Thyroid hormones
E)Vitamin D

Question 53

A student nurse is caring for a patient in skin traction.What action by the student causes the registered nurse to intervene?

A)Assesses neurovascular status every 2-4 hours
B)Ensures correct weights are hanging freely
C)Positions child perpendicular to the traction
D)Removes traction to assess the skin every 4 hours

Question 54

A nurse is teaching parents about caring for their child in a cast.Which information does the nurse provide? (Select all that apply.)

A)Be sure the child does not move joints above and below the cast.
B)Elevate the extremity above the heart as much as possible.
C)Keep the child from playing with toys that have very small parts.
D)Provide snacks high in calcium and vitamin D or provide supplements.
E)Reinforce active or passive range of motion to unaffected joints.

Question 55

A nurse completes the Pediatric Fall Risk Assessment on a patient who scores a 9.Which intervention by the nurse is most important to include on the care plan?

A)Allow independent ambulation around the unit.
B)Maintain forced bedrest with restraints if necessary.
C)Provide assistance with transfers and ambulation.
D)Use two individuals at all times for mobility.

Question 56

A 10-year-old child has had a sunken chest since birth,but has recently been noted to have activity intolerance when playing.Which diagnostic testing does the nurse teach the child and parents about? (Select all that apply.)

A)Chest x-ray
B)Chromosome analysis
C)ECG and echocardiogram
D)Pulmonary function studies
E)Ultrasound of the chest

Question 57

An 8-year-old child is being treated for suspected tetanus.Which medications are appropriate for this child? (Select all that apply.)

A)Ceftriaxone (Rocephin)
B)Clindamycin (Cleocin)
C)Erythromycin (Erythrocin)
D)Penicillin G (Pfizerpen)
E)Tetracycline (Sumycin)

Question 58

Following hip surgery,a patient is placed in a spica cast.What nursing interventions are appropriate for this patient? (Select all that apply.)

A)Cutting a window in the cast
B)Icing the area over the incision
C)Increasing fiber in the diet
D)Increasing fluid intake
E)Maintaining the same position

Question 59

A nurse is teaching parents how to care for their child who is undergoing serial casting for clubfoot.Which information does the nurse provide? (Select all that apply.)

A)Cast care
B)Cast drying techniques
C)Neurovascular assessment
D)Pain management
E)Wound care

Question 60

The pediatric nurse is caring for a patient with juvenile arthritis.The health-care provider tells the nurse the patient will be started on disease-modifying antirheumatic drugs (DMARDs).Which drugs does the nurse anticipate administering? (Select all that apply.)

A)Acetaminophen (Tylenol)
B)Indomethacin (Indocin)
C)Infliximab (Remicade)
D)Leflunomide (Arava)
E)Methotrexate (Rheumatrex)

Question 61

A nurse is completing a Pediatric Fall Risk Assessment on a child.The child has had no falls in the last 3 months,had surgery to repair a femur fracture on admission,is learning to use crutches,has a saline lock,is oriented to own ability,and is on narcotics.This child's fall risk score is ____________________.

Question 62

A child just had a long-leg cast placed after an open reduction and fixation of a femur fracture.What interventions are appropriate for the nurse to include in the child's plan of care? (Select all that apply.)

A)Assess the 4 Ps every hour,with vital signs.
B)Elevate the leg and apply ice for short periods.
C)Ensure that the proximal edge of the cast stays clean.
D)Handle the cast carefully when wet to prevent dents.
E)Use a hand-held dryer to help the cast dry faster.

Question 63

A nurse is caring for a patient with juvenile arthritis during an exacerbation.The child weighs 95 lb (43 kg).The physician orders sulfasalazine (Azulfidine)to be given in two divided doses per day.The safe dose range for a single dose of this drug for this child is ____________________ mg per dose.