Question 1

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

Accepted Answer

If a fracture does not produce a break in the skin, it is called a simple, or closed, fracture. A compound, or open, fracture is one with an open wound through which the bone protrudes. A complicated fracture is one in which the bone fragments damage other organs or tissues. A comminuted fracture occurs when small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue. These are rare in children.

Question 2

Which is a type of skin traction with the legs in an extended position?
A) Dunlop
B) Bryant
C) Russell
D) Buck extension

Accepted Answer

Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position.

Question 3

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

Accepted Answer

Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

Question 4

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 5

A child is upset because when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which should the nurse suggest to remove this material?
A) Soak in a bathtub.
B) Vigorously scrub leg.
C) Apply powder to absorb material.
D) Carefully pick material off leg.

Accepted Answer

Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

Question 6

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. Which action should the nurse take first?
A) Notify the practitioner of the changes noted.
B) Give the child medication to relieve the pain.
C) Reposition the child and notify physician.
D) Chart the observations and check the extremity again in 15 minutes.

Accepted Answer

The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication should be given after the practitioner is notified. Legg-Calvé-Perthes disease is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.

Question 7

Which can result from the bone demineralization associated with immobility?
A) Osteoporosis
B) Urinary retention
C) Pooling of blood
D) Susceptibility to infection

Accepted Answer

Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

Question 8

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 9

The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status?
A) Hypocalcemia
B) Decreased metabolic rate
C) Positive nitrogen balance
D) Increased production of stress hormones

Accepted Answer

Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

Question 10

A young girl has just injured her 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 position of comfort.
D) Obtain parental permission for administration of acetaminophen or aspirin.

Accepted Answer

Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a position of comfort, and obtaining parental permission for administration of acetaminophen or aspirin are not immediate priorities. The application of ice can reduce the severity of the injury.

Question 11

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included?
A) Apply lotion or powder to minimize skin irritation.
B) Remove harness several times a day to prevent contractures.
C) Return to clinic every 1 to 2 weeks.
D) Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

Accepted Answer

Infants have a rapid growth pattern. The child needs to be assessed by the practitioner every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness.

Question 12

Which should 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

Accepted Answer

If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site. The five Ps of ischemia from a vascular injury are pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may be indicative of a respiratory tract infection or pulmonary emboli. This should be reported, and child should be evaluated.

Question 13

A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation?
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.

Accepted Answer

Serial casting is begun shortly after birth before discharge from nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy. Serial casting is the preferred treatment. Surgical intervention is done only if serial casting is not successful. Children do not improve without intervention.

Question 14

The nurse should monitor for which effect on the cardiovascular system when a child is immobilized?
A) Venous stasis
B) Increased vasopressor mechanism
C) Normal distribution of blood volume
D) Increased efficiency of orthostatic neurovascular reflexes

Accepted Answer

The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.

Question 15

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

Accepted Answer

Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryant traction is skin traction with the legs flexed at a 90-degree angle at the hip. Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.

Question 16

The nurse is conducting a staff in-service on casts. Which is an advantage to using a fiberglass cast instead of a plaster of Paris cast?
A) Cheaper
B) Dries rapidly
C) Molds closely to body parts
D) Smooth exterior

Accepted Answer

A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive and have a rough exterior, which may scratch surfaces. Plaster casts mold closer to body parts.

Question 17

The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which 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.

Accepted Answer

The injured extremity should be kept elevated while resting and in a sling when upright. This will increase venous return. Swelling of the fingers may indicate neurovascular damage and should be reported immediately. Permanent damage can occur within 6 to 8 hours. Joints above and below the cast on the affected extremity should be moved. The affected limb should not hang down for any length of time.

Question 18

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child's immobilization status?
A) Metabolic rate increases
B) Increased joint mobility leading to contractures
C) Bone calcium increases, releasing excess calcium into the body (hypercalcemia)
D) Venous stasis leading to thrombi or emboli formation

Accepted Answer

The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. Loss of joint mobility leads to contractures. Bone demineralization with osteoporosis and hypercalcemia occur with immobilization.

Question 19

An adolescent with a fractured femur is in Russell's traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action?
A) Maintaining continuous traction until 1 hour before the scheduled surgery
B) Maintaining continuous traction and checking position of traction frequently
C) Releasing traction every hour to perform skin care
D) Releasing traction once every 8 hours to check circulation

Accepted Answer

When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle's normal contracting ability to again cause malpositioning of the bone ends. Continuous traction must be maintained to keep the bone ends in satisfactory realignment. Releasing at any time, either 1 hour before surgery, once every hour for skin care, or once every 8 hours would not keep the fracture in satisfactory alignment.

Question 20

The nurse uses the palms of the hands when handling a wet cast for which reason?
A) To assess dryness of the cast
B) To facilitate easy turning
C) To keep the patient's limb balanced
D) To avoid indenting the cast

Accepted Answer

Wet casts should be handled by the palms of the hands, not the fingers, to avoid creating pressure points. Assessing dryness, facilitating easy turning, and keeping the patient's limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast.

Quiz 29: The Child with Musculoskeletal or Articular Dysfunction

Which term is used to describe a type of fracture that does not produce a break in the skin?

Which is a type of skin traction with the legs in an extended position?

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

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

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

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. Which action should the nurse take first?

Which can result from the bone demineralization associated with immobility?

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?

The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status?

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

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

Which should cause a nurse to suspect that an infection has developed under a cast?

A neonate is born with bilateral mild talipes equinovarus (clubfoot) . When the parents ask the nurse how this will be corrected, the nurse should give which explanation?

The nurse should monitor for which effect on the cardiovascular system when a child is immobilized?

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

The nurse is conducting a staff in-service on casts. Which is an advantage to using a fiberglass cast instead of a plaster of Paris cast?

The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching?

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child's immobilization status?

An adolescent with a fractured femur is in Russell's traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action?

The nurse uses the palms of the hands when handling a wet cast for which reason?