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

Accepted Answer

Normal calcium is 8.5-11 mg/dL,and normal phosphorus is 3-4.5 mg/dL.Low values for both are seen in 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?"

Accepted Answer

The mother seems to have noticed thigh and buttock muscle wasting,which are signs of Legg-Calvé-Perthes disease.Other signs and symptoms include hip or knee soreness or stiffness,pain that increases with activity and decreases with rest,a painful limp,joint dysfunction,and limited ROM.Asking about a limp would be the most important question,as it is specific to this disease process.

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."

Accepted Answer

Parents should be instructed to take their child to a health-care provider if a cast appears loose,damaged,or soft.The other answers are not appropriate.

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."

Accepted Answer

Parents always need to observe for complications of casting,including neurovascular compromise.A child who is excessively fussy and whose toes are cool should be seen by a health-care provider to assess circulation and possibly modify or change the cast.The parent should be told to take the child to the nearest emergency department (ED).The other answers are inappropriate.If circulation is compromised,elevation and ice will make the problem worse.The parent should not be instructed to modify the cast.Although ibuprofen may manage the child's pain better than acetaminophen,the priority instruction is to send the parent to the ED.

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

Accepted Answer

Flat bones are located in the skull,scapulae,ribs,sternum,and clavicle.Long bones are found in the extremities,and include the fingers and toes.Short bones are located in the ankles and wrists.Irregular bones are the vertebrae,pelvis,and facial bones.

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

Accepted Answer

A spiral break is caused by a twisting force and shows a diagonal line that coils around the bone.An oblique break shows a diagonal line across the bone.A transverse break shows a line that crosses the shaft at a 90-degree angle.In a greenstick-type break,the bone is bent but not broken.

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

Accepted Answer

The major symptom of Osgood-Schlatter disease is pain below the kneecap that is aggravated by activity and relieved by rest.Symptoms resolve around the time skeletal growth ceases (about puberty).The child experiences pain when asked to squat or extend the knee against resistance.This is a good indicator of Osgood-Schlatter disease.

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

Accepted Answer

Alterations in musculoskeletal functioning may be related to a congenital defect such as muscular dystrophy,clubfoot,or osteogenesis imperfecta.Other musculoskeletal alterations may be related to an acquired defect such as Legg-Calvé-Perthes disease,slipped femoral capital epiphysis,Osgood-Schlatter disease,scoliosis,sprains,strains,fractures,osteomyelitis,juvenile arthritis,or tetanus.

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

Accepted Answer

The red marrow produces red and white blood cells and platelets.Yellow marrow produces fat cells.The growth plates and periosteum are not involved in producing different cells.

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

Accepted Answer

Osteonecrosis is a cardinal sign of Legg-Calvé-Perthes disease.This disorder is frequently treated with non-weight-bearing status and bracing or casting.The other treatment modalities are used to treat clubfoot.

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

Accepted Answer

Placing the child in the prone position on the floor makes it easier for feeding the child.Mobilizing a child in a wagon is a good modification for a stroller while the child is in the spica cast.Toddler car seats that do not have sides are also a good modification for a child in a spica cast.The parents will need to modify the bath by giving the child a sponge bath.

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

Accepted Answer

The skin under the brace worn to treat scoliosis needs to be assessed for breakdown,especially when the brace is new.An important diagnosis would be risk for impaired skin integrity.Seeing no skin breakdown under the brace indicates the outcomes have been met for this goal.Being able to explain the rationale for the bracing and participating in social activities also indicate that outcomes for appropriate diagnoses have been met,but these do not take priority over a possible injury to the child.The brace needs to be worn continuously for 23 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

Accepted Answer

Growth and development are dependent upon being able to interact with the environment.Any child with a musculoskeletal disorder is at risk for impaired growth and development.A priority outcome for any of these children is to maintain normal growth and development.Some children may need to adapt to changing activity restrictions.For some children,ambulation will be delayed or not possible.Staying current with education is important,but does not take priority over maintaining normal growth and development.

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."

Accepted Answer

Tendons are fibrous connective tissues that have very little blood supply.Therefore healing from a tendon injury takes time.This is the best response;there is no indication that the teen has an infection interfering with recovery,it is inaccurate and disheartening to tell a young person that tendons may never heal,and the nurse should not assume the patient is noncompliant 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

Accepted Answer

After spinal fusion,the patient must be logrolled to turn.Logrolling involves two nurses turning the patient as one single unit so that the spine is maintained in a straight line.The other actions are appropriate.

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

Accepted Answer

A type IV fracture must be reduced surgically.The nurse ensures that signed consent is on the chart.Fractures in a 10-year-old are not as commonly caused by child abuse as by bicycle crashes or sporting injuries,so unless other signs of maltreatment are noticed,this would not be a priority.Because the child is not having a closed reduction,explanation of this process is not needed.The child will also not be immobilized in traction for a prolonged period.

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.

Accepted Answer

In acute SFCE,range-of-motion exercises are not done to the affected extremity because they may cause further damage.The other interventions are appropriate for a child with this diagnosis.

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."

Accepted Answer

Although children are more prone to fractures than adults due to continued bone growth,because their bones are still growing,fractures heal quickly.Ligaments hold two or more bones or cartilages together.Bone is a dynamic tissue and continues to be developed and reabsorbed throughout life.

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.

Accepted Answer

All assessment findings signify positive adaptation to this disorder.However,because the child is on bedrest,the priority is to prevent complications of immobility including contractures or decreased ROM in joints.

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.

Accepted Answer

Recent research shows that clubfoot is genetic,so no prevention is possible.In utero positioning can possibly influence the disorder as well.Second-hand smoke exposure is not related.Folic acid is important for preventing neural tube disorders.

Quiz 29: Caring for the Child With a Musculoskeletal Condition

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 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 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 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?

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

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?

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

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 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?

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

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

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

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 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?