Question 1

A clinic nurse is conducting a staff in-service for other clinic staff regarding the signs and symptoms of a rhabdomyosarcoma tumor.Which should be included in the teaching session (Select all that apply)?
A)Bone fractures
B)Abdominal mass
C)Sore throat and ear pain
D)Headache
E)Ecchymosis of conjunctiva

Accepted Answer

The initial signs and symptoms of rhabdomyosarcoma tumors are related to the site of the tumor and compression of adjacent organs.Some tumor locations,such as the orbit,manifest early in the course of the illness.Other tumors,such as those of the retroperitoneal area,only produce symptoms when they are relatively large and compress adjacent organs.Unfortunately,many of the signs and symptoms attributable to rhabdomyosarcoma are vague and frequently suggest a common childhood illness,such as "earache" or "runny nose." An abdominal mass,sore throat and ear pain,and ecchymosis of conjunctiva are signs of a rhabdomyosarcoma tumor.Bone fractures would be seen in osteosarcoma and a headache is a sign of a brain tumor.

Question 2

Discharge planning for the child with juvenile arthritis includes the need for:
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 result of the inflammatory process.

Accepted Answer

The systemic effects of juvenile arthritis can result in visual problems,making routine eye examinations important.Children with juvenile arthritis do not have problems with increased weight and often are anorexic and in need of high-calorie diets.Children with arthritis are often treated with aspirin.Children with arthritis are able to immobilize their own joints.Range-of-motion exercises are important for maintaining joint flexibility and preventing restricted movement in the affected joints.

Question 3

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

Accepted Answer

Key issues for a child with SLE include therapy compliance; body-image problems associated with rash,hair loss,and steroid therapy; school attendance; vocational activities; social relationships; sexual activity; and pregnancy.Specific instructions for avoiding exposure to the sun and ultraviolet B light,such as using sunscreens,wearing sun-resistant clothing,and altering outdoor activities,must be provided with great sensitivity to ensure compliance while minimizing the associated feeling of being different from peers.The child should continue school attendance in order to gain interaction with peers and activity should not be restricted,but promoted.

Question 4

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.

Accepted Answer

Fractures in infants warrant further investigation to rule out child abuse.Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones.Infants should be cared for in a safe environment and should not be falling.Fractures in infancy are usually nonaccidental rather than related to a genetic factor.

Question 5

When assessing the child with osteogenesis imperfecta,the nurse should expect to observe:
A)Discolored teeth.
B)Below-normal intelligence.
C)Increased muscle tone.
D)Above-average stature.

Accepted Answer

Children with osteogenesis imperfecta have incomplete development of bones,teeth,ligaments,and sclerae.Teeth are discolored because of abnormal enamel.Despite their appearance,children with osteogenesis imperfecta have normal or above-normal intelligence.The child with osteogenesis imperfecta has weak muscles and decreased muscle tone.Because of compression fractures of the spine,the child appears short.

Question 6

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

Accepted Answer

Indications of compartment syndrome are severe pain not relieved by analgesics,tingling of extremity,and inability to move extremity.A palpable distal pulse and capillary refill to the extremity of <3 seconds are expected findings.

Question 7

The nurse is caring for an infant with developmental dysplasia of the hip.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

Accepted Answer

A positive Ortolani sign and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months.Negative Babinski's sign,Trendelenburg's sign,telescoping of the affected limb,and lordosis are not clinical manifestations of developmental dysplasia of the hip.

Question 8

Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's?
A)Growth occurs in children as a result of an increase in the number of muscle fibers.
B)Infants are at greater risk for fractures because their epiphyseal plates are not fused.
C)Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.
D)Children's bones have less blood flow.

Accepted Answer

Because soft tissues are resilient in children,dislocations and sprains are less common than in adults.A child's growth occurs because of an increase in size rather than an increase in the number of the muscle fibers.Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones.A child's bones have greater blood flow than an adult's bones.

Question 9

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure.Which consideration should the nurse include?
A)Nasogastric intubation and urinary catheter may be required.
B)Ambulation will not be allowed for up to 3 months.
C)Surgery eliminates the need for casting and bracing.
D)Discomfort can be controlled with nonpharmacologic methods.

Accepted Answer

Luque-rod segmental spinal instrumentation is a surgical procedure.Nasogastric intubation and urinary catheterization may be required.Ambulation is allowed as soon as possible.Depending on the instrumentation used,most patients walk by the second or third postoperative day.Casting and bracing are required postoperatively.The child usually has considerable pain for the first few days after surgery.Intravenous opioids should be administered on a regular basis.

Question 10

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm?
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.

Accepted Answer

A neurovascular evaluation includes assessing skin color and temperature,ability to move the affected extremity,degree of sensation experienced,and speed of capillary refill in the extremity.The degree of motion in the affected extremity and ability to position the extremity are incomplete assessments of neurovascular competency.The length,diameter,and shape of the extremity are not assessment criteria in a neurovascular evaluation.Although the amount of swelling is an important factor in assessing an extremity,it is not a criterion for a neurovascular assessment.

Question 11

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

Accepted Answer

The family needs to learn the purpose,function,application,and care of the corrective device and the importance of compliance to achieve the desired outcome.The initial therapy is rest and non-weight bearing,which helps reduce inflammation and restore motion.Legg-Calvé-Perthes is a disease with an unknown etiology.A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head.The disease is self-limiting,but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset.

Question 12

A nurse is conducting discharge teaching for parents of an infant 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."

Accepted Answer

The treatment for OI is primarily supportive.Although patients and families are optimistic about new research advances,there is no cure.The use of bisphosphonate therapy with IV pamidronate to promote increased bone density and prevent fractures has become standard therapy for many children with OI; however,long bones are weakened by prolonged treatment.Infants and children with this disorder require careful handling to prevent fractures.They must be supported when they are being turned,positioned,moved,and held.Even changing a diaper may cause a fracture in severely affected infants.These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows.Follow-up appointments for treatment with bisphosphonate can be expected.

Question 13

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

Accepted Answer

Promoting optimal growth and development in the school-age child is important.It is important to continue schoolwork and arrange for tutoring if indicated.The child with osteomyelitis should be on a high-calorie,high-protein diet.The child with osteomyelitis may need time for the bone to heal before returning to full activities.

Question 14

Kristin,age 10 years,sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree.When discussing this injury with her 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.

Accepted Answer

Detection of epiphyseal injuries is sometimes difficult,but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected.Healing of epiphyseal injuries is usually prompt.The epiphysis is the weakest point of the long bones.This is a frequent site of damage during trauma.

Question 15

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)

Accepted Answer

NSAIDs are the first drugs used in JIA.Naproxen,ibuprofen,and tolmetin are approved for use in children.Aspirin,once the drug of choice,has been replaced by the NSAIDs because they have fewer side effects and easier administration schedules.Corticosteroids are used for life-threatening complications,incapacitating arthritis,and uveitis.Methotrexate is a second-line therapy for JIA.

Question 16

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 straight forward 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.

Accepted Answer

Honesty is essential to gain the cooperation and trust of the child.The diagnosis of cancer should not be disguised with falsehoods.The adolescent should be prepared in advance for the surgery so that there is time for reflection about the diagnosis and subsequent treatment.This allows questions to be answered.To accept the need for radical surgery,the child must be aware of the lack of alternatives for treatment.Amputation is necessary,but it will not guarantee a cure.Chemotherapy is an integral part of the therapy with surgery.The child should be informed of the need for chemotherapy and its side effects before surgery.

Question 17

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.

Accepted Answer

The management of JIA is primarily pharmacologic.The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body.They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity.Warm,moist heat is best for relieving stiffness and pain.Acetaminophen does not have antiinflammatory effects.Range-of-motion exercises should not be done during periods of inflammation.

Quiz 48: Musculoskeletal or Articular Dysfunction

A clinic nurse is conducting a staff in-service for other clinic staff regarding the signs and symptoms of a rhabdomyosarcoma tumor.Which should be included in the teaching session (Select all that apply) ?

Discharge planning for the child with juvenile arthritis includes the need for:

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) ?

When infants are seen for fractures,which nursing intervention is a priority?

When assessing the child with osteogenesis imperfecta,the nurse should expect to observe:

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) ?

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

Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's?

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure.Which consideration should the nurse include?

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm?

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

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

Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy?

Kristin,age 10 years,sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree.When discussing this injury with her parents,the nurse should consider which statement?

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA) ?

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

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