Deck 34: The Child With Musculoskeletal or Articular Dysfunction

Question 1

Parents bring a 7-year-old child to the clinic for evaluation of an injured wrist after a bicycle accident.The parents and child are upset,and the child will not allow an examination of the injured arm.What priority nursing intervention should occur at this time?

A) Send the child to radiology so radiography can be performed.
B) Initiate an intravenous line and administer morphine for the pain.
C) Calmly ask the child to point to where the pain is worst and to wiggle fingers.
D) Have the parents hold the child so that the nurse can examine the arm thoroughly.

Answer 1

Calmly ask the child to point to where the pain is worst and to wiggle fingers.

Question 2

An 8-year-old child is hit by a motor vehicle in the school parking lot.The school nurse notes that the child is responding to verbal stimulation but is not moving his extremities when requested.What is the first action the nurse should take?

A) Wait for the child's parents to arrive.
B) Move the child out of the parking lot.
C) Have someone notify the emergency medical services (EMS) system.
D) Help the child stand to return to play.

Answer 2

Have someone notify the emergency medical services (EMS) system.

Question 3

The nurse is teaching parents the proper use of a hip-knee-ankle-foot orthosis (HKAFO)for their 4-year-old child.The parents demonstrate basic essential knowledge by making what statement?

A) "Alcohol will be used twice a day to clean the skin around the brace."
B) "Weekly visits to the orthotist are scheduled to check screws for tightness."
C) "Initially, a burning sensation is expected and the brace should remain in place."
D) "Condition of the skin in contact with the brace should be checked every 4 hours."

Answer 3

"Condition of the skin in contact with the brace should be checked every 4 hours."

Question 4

A 7-year-old child has just had a cast applied for a fractured arm with the wrist and elbow immobilized.What information should be included in the home care instructions?

A) No restrictions of activity are indicated.
B) Elevate casted arm when both upright and resting.
C) The shoulder should be kept as immobile as possible to avoid pain.
D) Swelling of the fingers is to be expected. Notify a health professional if it persists more than 48 hours.

Question 5

What finding is characteristic of fractures in children?

A) Fractures rarely occur at the growth plate site because it absorbs shock well.
B) Rapidity of healing is inversely related to the child's age.
C) Pliable bones of growing children are less porous than those of adults.
D) The periosteum of a child's bone is thinner, is weaker, and has less osteogenic potential compared to that of an adult.

Question 6

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

A) Removing adhesive traction straps daily to prevent skin breakdown
B) Assessing for tightness, weakness, or contractures in uninvolved joints and muscles
C) Providing active range of motion exercises to affected extremity three times a day
D) Keeping child prone to maintain good alignment

Question 7

The nurse is caring for an immobilized preschool child.What intervention is helpful during this period of immobilization?

A) Encourage wearing pajamas.
B) Let the child have few behavioral limitations.
C) Keep the child away from other immobilized children if possible.
D) Take the child for a "walk" by wagon outside the room.

Question 8

The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle.The emergency medical system (EMS)has been activated.The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding.What should the nurse do related to the tourniquet?

A) Loosen the tourniquet.
B) Leave the tourniquet in place.
C) Remove the tourniquet and apply direct pressure if bleeding is still present.
D) Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each time.

Question 9

A young girl has just injured her ankle at school.In addition to notifying 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.

Question 10

Immobilization causes what effect on metabolism?

A) Hypocalcemia
B) Decreased metabolic rate
C) Positive nitrogen balance
D) Increased levels of stress hormones

Question 11

A 14-year-old is admitted to the emergency department with a fracture of the right humerus epiphyseal plate through the joint surface.What information does the nurse know regarding this type of fracture?

A) It will create difficulty because the child is left handed.
B) It will heal slowly because this is the weakest part of the bone.
C) This type of fracture requires different management to prevent bone growth complications.
D) This type of fracture necessitates complete immobilization of the shoulder for 4 to 6 weeks.

Question 12

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

A) Soak in a bathtub.
B) Vigorously scrub the leg.
C) Carefully pick material off the leg.
D) Apply powder to absorb the material.

Question 13

The nurse is caring for a hospitalized adolescent whose femur was fractured 18 hours ago.The adolescent suddenly develops chest pain and dyspnea.The nurse should suspect what complication?

A) Sepsis
B) Osteomyelitis
C) Pulmonary embolism
D) Acute respiratory tract infection

Question 14

What measure is important in managing hypercalcemia in a child who is immobilized?

A) Provide adequate hydration.
B) Change position frequently.
C) Encourage a diet high in calcium.
D) Provide a diet high in calories for healing.

Question 15

A child with a hip spica cast is being prepared for discharge.Recognizing that caring for a child at home is complex,the nurse should include what instructions for the parents' discharge teaching?

A) Turn every 8 hours.
B) Specially designed car restraints are necessary.
C) Diapers should be avoided to reduce soiling of the cast.
D) Use an abduction bar between the legs to aid in turning.

Question 16

What statement is correct regarding sports injuries during adolescence?

A) Conditioning does not help prevent many sports injuries.
B) The increase in strength and vigor during adolescence helps prevent injuries related to fatigue.
C) More injuries occur during organized athletic competition than during recreational sports participation.
D) Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

Question 17

What condition can result from the bone demineralization associated with immobility?

A) Osteoporosis
B) Pooling of blood
C) Urinary retention
D) Susceptibility to infection

Question 18

What is a physiologic effect of immobilization on children?

A) Metabolic rate increases.
B) Venous return improves because the child is in the supine position.
C) Circulatory stasis can lead to thrombus and embolus formation.
D) Bone calcium increases, releasing excess calcium into the body (hypercalcemia).

Question 19

The middle school nurse is speaking to parents about prevention of injuries as a goal of the physical education program.How should the goal be achieved?

A) Use of protective equipment at the family's discretion
B) Education of adults to recognize signs that indicate a risk for injury
C) Sports medicine program to help student athletes work through overuse injuries
D) Arrangements for multiple sports to use same athletic fields to accommodate more children

Question 20

The nurse uses the five Ps to assess ischemia in a child with a fracture.What finding is considered a late and ominous sign?

A) Petaling
B) Posturing
C) Paresthesia
D) Positioning

Question 21

What term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine?

A) Scoliosis
B) Lordosis
C) Kyphosis
D) Ankylosis

Question 22

What is a major goal for the therapeutic management of juvenile idiopathic arthritis (JIA)?

A) Control pain and preserve joint function.
B) Minimize use of joint and achieve cure.
C) Prevent skin breakdown and relieve symptoms.
D) Reduce joint discomfort and regain proper alignment.

Question 23

A preadolescent has been diagnosed with scoliosis.The planned therapy is the use of a thoracolumbosacral orthotic.The preadolescent asks how long she will have to wear the brace.What is the appropriate response by the nurse?

A) "For as long as you have been told."
B) "Most preadolescents use the brace for 6 months."
C) "Until your vertebral column has reached skeletal maturity."
D) "It will be necessary to wear the brace for the rest of your life."

Question 24

What statement is true concerning osteogenesis imperfecta (OI)?

A) It is easily treated.
B) It is an inherited disorder.
C) Braces and exercises are of no therapeutic value.
D) Later onset disease usually runs a more difficult course.

Question 25

What is the primary method of treating osteomyelitis?

A) Joint replacement
B) Bracing and casting
C) Intravenous antibiotic therapy
D) Long-term corticosteroid therapy

Question 26

An adolescent comes to the school nurse after experiencing shin splints during a track meet.What reassurance should the nurse offer?

A) Shin splints are expected in runners.
B) Ice, rest, and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve pain.
C) It is generally best to run around and "work the pain out."
D) Moist heat and acetaminophen are indicated for this type of injury.

Question 27

What is the recommended drink for athletes during practice and competition?

A) Sports drinks to replace carbohydrates
B) Cold water for gastrointestinal tract rapid absorption
C) Carbonated beverages to help with acid-base balance
D) Enhanced performance carbohydrate-electrolyte drinks

Question 28

What nursing intervention is most appropriate when caring for the child with osteomyelitis?

A) Encourage frequent ambulation.
B) Administer antibiotics with meals.
C) Move and turn the child carefully and gently to minimize pain.
D) Provide active range of motion exercises for the affected extremity.

Question 29

A 4-year-old child is placed in Buck extension traction for Legg-Calvé-Perthes disease.He is crying with pain as the nurse assesses the skin of his right foot and sees that it is pale with an absence of pulse.What should the nurse do first?

A) Reposition the child and notify the practitioner.
B) Notify the practitioner of the changes noted.
C) Give the child medication to relieve the pain.
D) Chart the observations and check the extremity again in 15 minutes.

Question 30

What needs to be included as essential teaching for adolescents with systemic lupus erythematosus (SLE)?

A) High calorie diet because of increased metabolic needs
B) Home schooling to decrease the risk of infections
C) Protection from sun and fluorescent lights to minimize rash
D) Intensive exercise regimen to build up muscle strength and endurance

Question 31

A 17-year-old patient is returning to the surgical unit after Luque instrumentation for scoliosis repair.In addition to the usual postoperative care,what additional intervention will be needed?

A) Position changes are made by log rolling.
B) Assistance is needed to use the bathroom.
C) The head of the bed is elevated to minimize spinal headache.
D) Passive range of motion is instituted to prevent neurologic injury.

Question 32

When does idiopathic scoliosis become most noticeable?

A) In the newborn period
B) When the child starts to walk
C) During the preadolescent growth spurt
D) During adolescence

Question 33

A student athlete was injured during a basketball game.The nurse observes significant swelling.The player states he thought he "heard a pop," that the pain is "pretty bad," and that the ankle feels "as if it is coming apart." Based on this description,the nurse suspects what injury?

A) Sprain
B) Fracture
C) Dislocation
D) Stress fracture

Question 34

What is an important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA)?

A) Apply ice packs to relieve acute swelling and pain.
B) Administer acetaminophen to reduce inflammation.
C) Teach the child and family correct administration of medications.
D) Encourage range of motion exercises during periods of inflammation.

Question 35

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness.What statement by the parent would indicate a correct understanding of the teaching?

A) "I should gently massage the skin under the straps once a day to stimulate circulation."
B) "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation."
C) "I should remove the harness several times a day to prevent contractures."
D) "I will place the diaper over the harness, preferably using a superabsorbent disposable diaper that is relatively thin."

Question 36

Parents are considering treatment options for their 5-year-old child with Legg-Calvé-Perthes disease.Both surgical and conservative therapies are appropriate.They are able to verbalize the differences between the therapies when they make what statement?

A) "All therapies require extended periods of bed rest."
B) "Conservative therapy will be required until puberty."
C) "Our child cannot attend school during the treatment phase."
D) "Surgical correction requires a 3- to 4-month recovery period."

Question 37

The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl.Her temperature is 40° C (104° F).She is slightly confused but able to drink water.Nursing care while waiting for transport to the hospital should include what intervention?

A) Administer antipyretics.
B) Administer salt tablets.
C) Apply towels wet with cool water.
D) Sponge with solution of rubbing alcohol and water.

Question 38

A child with juvenile idiopathic arthritis (JIA)is started on a nonsteroidal antiinflammatory drug (NSAID).What nursing consideration should be included?

A) Monitor heart rate.
B) Administer NSAIDs between meals.
C) Check for abdominal pain and bloody stools.
D) Expect inflammation to be gone in 3 or 4 days.

Question 39

The nurse is teaching the parent of a 4-year-old child with a cast on the arm about care at home.What statement by the parent indicates a correct understanding of the teaching?

A) "I should have the affected limb hang in a dependent position."
B) "I will use an ice pack to relieve the itching."
C) "I should avoid keeping the injured arm elevated."
D) "I will expect the fingers to be swollen for the next 3 days."

Question 40

The nurse is teaching the girls' varsity sports teams about the "female athlete triad." What is essential information to include?

A) They should take low to moderate calcium to avoid hypercalcemia.
B) They have strong bones because of the athletic training.
C) Pregnancy can occur in the absence of menstruation.
D) A diet high in carbohydrates accommodates increased training.

Question 41

The nurse is teaching infant care to parents with an infant who has been diagnosed with osteogenesis imperfecta (OI).What should the nurse include in the teaching session?

A) "Bisphosphonate therapy is not beneficial for OI."
B) "Physical therapy should be avoided as it may cause damage to bones."
C) "Lift the infant by the buttocks, not the ankles, when changing diapers."
D) "The infant should meet expected gross motor development without assistive devices."

Question 42

The health care provider has prescribed sulfasalazine (Azulfidine)5 mg/kg PO per dose twice a day for a child with juvenile arthritis.The child weighs 55 lb.The nurse is preparing to administer the 0900 dose.Calculate the dose the nurse should administer in milligrams.Record your answer below in a whole number.
________

Question 43

The nurse is conducting preoperative teaching to parents and their child about an external fixation device.What should the nurse include in the teaching session?

A) Pin care
B) Crutch walking
C) Modifications in activity
D) Observing pin sites for infection
E) Full weight bearing will be allowed after 24 hours

Question 44

A 3-year-old child has a femoral shaft fracture.The nurse recognizes that the approximate healing time for this child is how long?

A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks

Question 45

In teaching a 16-year-old adolescent who was recently diagnosed with systemic lupus erythematosus (SLE),what statements should the nurse include?

A) "You should use a moisturizer with a sun protection factor (SPF) of 30."
B) "You should avoid pregnancy because this can cause a flare-up."
C) "You should not receive any immunizations in the future."
D) "You may need to be on a low-protein, high-carbohydrate diet."
E) "You should expect to lose weight while taking steroids."
F) "You may need to modify your daily recreational activities."

Question 46

The nurse is caring for a 14-year-old child with systemic lupus erythematous (SLE).What clinical manifestations should the nurse expect to observe?

A) Arthralgia
B) Weight gain
C) Polycythemia
D) Abdominal pain
E) Glomerulonephritis

Question 47

The health care provider has prescribed cyclosporin (Sandimmune)5 mg/kg/day PO divided twice daily for a child with juvenile arthritis.The child weighs 110 lb.The nurse is preparing to administer the 0900 dose.Calculate the dose the nurse should administer in milligrams.Record your answer in a whole number.
_________

Question 48

A child has just returned from surgery for repair of a fractured femur.The child has a long-leg cast on.The toes on the leg with the cast are edematous,but they have color,sensitivity,and movement.What action should the nurse take?

A) Call the health care provider to report the edema.
B) Elevate the foot and leg on pillows.
C) Apply a warm moist pack to the foot.
D) Encourage movement of toes.

Question 49

The nurse is caring for a child immobilized because of Russel traction.What interventions should the nurse implement to prevent renal calculi?

A) Monitor output.
B) Encourage the patient to drink apple juice.
C) Encourage milk intake.
D) Ensure adequate fluids.
E) Encourage the patient to drink cranberry juice.

Question 50

What should the nurse plan for an immobilized child in cervical traction to prevent deep vein thrombosis (DVT)?

A) Elevate the child's legs.
B) Place a foot cradle on the bed.
C) Place a pillow under the child's knees.
D) Assist the child to dorsiflex the feet and rotate the ankles.

Question 51

A neonate is born with mild clubfeet.When the parents ask the nurse how this will be corrected,what should the nurse explain?

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.

Question 52

The health care provider has prescribed azathioprine (Imuran)1 mg/kg/day PO for a child with juvenile arthritis.The child weighs 77 lb.The nurse is preparing to administer the daily dose.Calculate the dose the nurse should administer in milligrams.Record your answer below in a whole number.
_______

Question 53

The nurse is assisting with application of a synthetic cast on a child with a fractured humerus.What are the advantages of a synthetic cast over a plaster of Paris cast?

A) Less bulky
B) Drying time is faster
C) Molds readily to body part
D) Permits regular clothing to be worn
E) Can be cleaned with small amount of soap and water

Question 54

The nurse knows that parents need further teaching with regard to the treatment of congenital clubfoot when they state what?

A) "We'll keep the cast dry."
B) "We're happy this is the only cast our baby will need."
C) "We'll watch for any swelling of the foot while the cast is on."
D) "We're getting a special car seat to accommodate the cast."

Question 55

After spinal fusion surgery the nurse should check for signs of what?

A) Seizure activity
B) Increased intracranial pressure
C) Impaired color, sensitivity, and movement to the lower extremities
D) Impaired pupillary response during neurologic checks

Question 56

The nurse is caring for a 14-year-old child with juvenile idiopathic arthritis (JIA).What clinical manifestations should the nurse expect to observe?

A) Erythema over joints
B) Soft tissue contractures
C) Swelling in multiple joints
D) Morning stiffness of the joints
E) Loss of motion in the affected joints

Question 57

The nurse is teaching a child with a cast about cast removal.What should the nurse teach the child about cast removal?

A) "The cast cutter will be a quiet machine."
B) "You will feel cold as the cast is removed."
C) "You will feel a tickly sensation as the cast is removed."
D) "The cast cutter cuts through the cast like a circular saw."

Question 58

The school nurse recognizes that the adverse effects of performance-enhancing substances can include what?

A) Depression
B) Dehydration
C) Hypotension
D) Aggressiveness
E) Changes in libido

Question 59

A child has had a short-arm synthetic cast applied.What should the nurse teach to the child and parents about cast care?

A) Relieve itching with heat.
B) Elevate the arm when resting.
C) Observe the fingers for any evidence of discoloration.
D) Do not allow the child to put anything inside the cast.
E) Examine the skin at the cast edges for any breakdown.

Question 60

An infant is born with one lower limb deficiency.When is the optimum time for the child to be fitted with a functional prosthetic device?

A) As soon as possible after birth
B) When the infant is developmentally ready to stand up
C) At about ages 12 to 15 months, when most children are walking
D) At about 4 years, when the healthy limb is not growing so rapidly

Question 61

Match the type of fracture to its definition.
Crosswise at right angles to the long axis of the bone

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

Question 62

The health care provider has prescribed hydroxychloroquine (Plaquenil)5 mg/kg/day PO divided bid for a child with systemic lupus erythematosus.The child weighs 66 lb.The nurse is preparing to administer the 0900 dose.Calculate the dose the nurse should administer in milligrams.Record your answer below in a whole number.
_________

Question 63

Match the type of fracture to its definition.
Slanting but straight between a horizontal and a perpendicular direction

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

Question 64

Match the type of fracture to its definition.
Small fragments of bone are broken from the fractured shaft and lie in the surrounding tissue

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

Question 65

Match the type of fracture to its definition.
Slanting and circular,twisting around the bone shaft

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