Deck 24: The Child With a Musculoskeletal Condition

Question 1

What nursing action will significantly decrease the risk of serious complications for a child in Bryant's traction?

A) Neurovascular checks are done frequently.
B) Bandages are wrapped tightly.
C) The child is restrained from rolling over.
D) The child's buttocks are resting on the bed.

Answer 1

Neurovascular checks are done frequently.

Question 2

A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end.How long will the nurse indicate that antibiotic therapy will probably last?

A) 2 weeks
B) 6 weeks
C) 2 months
D) 3 months

Answer 2

6 weeks

Question 3

Which observation is most likely to cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs?

A) Red,green,and yellow bruises on his body.
B) Bruises are dispersed on his head,arms,and legs.
C) A broken arm last year,and the child being described as accident-prone.
D) The mother is very anxious for her son to get medical attention.

Answer 3

Red,green,and yellow bruises on his body.

Question 4

The nurse is reviewing the characteristics of Ewing's sarcoma.Which statement if made by the nurse indicates correct understanding of this disease?

A) "Amputation is the accepted treatment."
B) "The disease is sensitive to radiation and chemotherapy."
C) "Metastasis is rare."
D) "The disease is more prevalent among toddlers and preschoolers."

Question 5

A 6-year-old sustained a fractured femur and was put in Russell traction 2 days ago.She screams in pain when she raises herself onto the bedpan.Which nursing diagnosis takes highest priority for this child?

A) Pain resulting from tissue trauma
B) High risk for impaired skin integrity resulting from immobility
C) Altered growth and development related to separation from family
D) Altered urinary elimination related to immobility and traction

Question 6

What will the nurse include when caring for a child in Buck's extension?

A) Positioning the child with hips flexed 90 degrees at all times
B) Keeping the weights in contact with the floor
C) Checking for skin irritation from traction equipment
D) Releasing the weights on a schedule

Question 7

The nurse is checking for capillary refill on a child in Bryant's traction.How long does it take for the toe to regain color if adequate perfusion is assessed?

A) 3 seconds
B) 4 seconds
C) 5 seconds
D) 6 seconds

Question 8

The parent of a child with osteomyelitis asks why his child is in so much pain.What will the nurse respond causes the pain experienced with osteomyelitis?

A) "Pressure of inelastic bone"
B) "Purulent drainage in the bone marrow"
C) "The cast applied on the extremity"
D) "Circulatory congestion of the skin"

Question 9

Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis?

A) Wearing splints at night to prevent extension contractures
B) Applying moist heat packs upon awakening
C) Taking a warm tub bath the evening before
D) Sleeping with two pillows under the head

Question 10

How does Russell traction provide adequate skin traction?

A) Subluxates the tibia
B) Does not interfere with range of motion
C) Prevents the knee from flexing
D) Supplies continuous pull in two directions

Question 11

What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4-year-old child?

A) Has inward-turned knees while standing.
B) Walks on the toes.
C) Appears to have flat feet.
D) Swings his arms when walking.

Question 12

A 13-year-old girl is diagnosed with functional scoliosis.What does the nurse explain as the cause of this spinal curvature defect?

A) Juvenile rheumatoid arthritis
B) Poor posture
C) Heredity
D) Myelomeningocele

Question 13

The nurse is providing instructions about how to treat a sprained ankle.What statement by the mother does the nurse recognize as indicative of a need for additional teaching?

A) "Apply warm compresses to the ankle for the first 24 hours."
B) "Put an ice pack on the ankle,alternating 30 minutes on with 30 minutes off."
C) "Wrap the ankle in an Ace bandage for support."
D) "Keep the leg elevated when sitting."

Question 14

The nurse assessing a child with juvenile rheumatoid arthritis notes the child's right knee and ankle are swollen,warm,and tender.The child has a temperature of 38.8° C (102° F)and abdominal pain.What type of juvenile rheumatoid arthritis do these findings suggest?

A) Psoriatic
B) Enthesitis
C) Systemic
D) Acute febrile

Question 15

What finding would the nurse assessing the neurovascular status of a child in Russell traction report immediately?

A) Skin that's warm to the touch
B) Capillary refill less than 3 seconds
C) Ability to wiggle toes
D) Bluish coloration of skin

Question 16

What instruction would the nurse provide to an adolescent who has been fitted with a Milwaukee brace?

A) Wear the brace directly against the skin.
B) Wear the brace over regular clothing.
C) Wear the brace over a T-shirt 23 hours a day.
D) Remove the brace before sleeping.

Question 17

What characteristic manifestation does the nurse caring for a child with Duchenne's muscular dystrophy document?

A) Ambulates by holding onto furniture
B) Exhibits atrophy of the calf muscles
C) Falls frequently and is clumsy
D) Has delayed fine-motor development

Question 18

What intervention will the nurse caring for a child in Buck skin traction implement?

A) Position in high Fowler's position.
B) Assist the child to be pulled up in bed.
C) Keep child's heel on the bed surface.
D) Maintain child's feet against the foot of the bed.

Question 19

What would the nurse include in planning teaching to parents of a child with Legg-Calvé-Perthes disease about the long-term effects of this disease?

A) There are no long-term effects.
B) The disease is self-limited and requires no long-term treatment.
C) Degenerative arthritis may develop later in life.
D) There is risk of osteogenic sarcoma in adulthood.

Question 20

What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis?

A) Ask the child to bend forward at the waist and observe the child's back for asymmetry.
B) Observe the gait while the child is walking forward heel to toe.
C) Have the child flex the knees and look for uneven knee height.
D) Look at the child's shoulders and hips while fully clothed.

Question 21

A pediatric nurse is assisting with the care of a child diagnosed with a fractured femur.What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse?

A) Stress fracture
B) Compound fracture
C) Spiral fracture
D) Greenstick fracture

Question 22

On entering the room of a child in Buck traction,the nurse makes all of the following observations.Which observation requires a nursing intervention?

A) Child's heels are placed firmly against the foot of the bed.
B) Head of bed is elevated 20 degrees.
C) Weights are hanging freely.
D) Ropes are on pulleys.

Question 23

Why does a child's fracture heal more rapidly than the adult's?

A) A child's bones are less porous than adult bone.
B) A child's bones are covered by a thicker periosteum.
C) A child's bones are not affected by bone overgrowth.
D) A child's bones have faster callus formation.

Question 24

Which assessment performed by a nursing student performing a neurovascular check alerts the instructor that further education is necessary?

A) Pulses
B) Capillary refill
C) Movement
D) Pupils

Question 25

How does the pediatric skeletal system differ from that of the adult? (Select all that apply. )

A) Lower mineral content
B) More ossification
C) Open epiphyses
D) Less porosity
E) Greater strength

Question 26

What factor(s)may trigger abuse in a parent? (Select all that apply. )

A) Being abused as a child
B) High self-esteem
C) Substance abuse
D) Overwhelming responsibility
E) Knowledge deficit relative to child care

Question 27

The nurse demonstrates which similarities among all traction devices? (Select all that apply. )

A) Pull the limb into extension.
B) Decrease muscle spasm.
C) Reduce pain.
D) Align two bone fragments.
E) Immobilize the limb.

Question 28

The nurse explains that Bryant's traction is reserved for children who weigh less than _____ pounds.

Question 29

The nurse performing a neurovascular check on a limb in traction would report and document which finding(s)as indicative of altered circulation? (Select all that apply. )

A) Pulse is equal to uncasted limb.
B) Patient is aware of touch and warm and cold application.
C) Limb is cool to the touch.
D) Capillary refill is 5 seconds.
E) Distal limb can flex and extend.

Question 30

A child is sent to the school nurse for assessment because she comes to school every day disheveled,unbathed,and hungry.The assessment does not indicate any bruises or marks on the body.What do these finding indicate?

A) Sexual abuse
B) Physical abuse
C) Physical neglect
D) Emotional abuse

Question 31

Approximately how old does the nurse assess a large green bruise on the thigh of a 4-year-old to be?

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