Chapter 51: Nursing Care of a Family When a Child Has a Musculoskeletal Disorder

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note? A. The posterior spine when bending forward B. The angle of the iliac crest when bending forward C. The posterior spine when bending sideways D. The angle of the lower chest when sitting down

A

A child with pauciarticular juvenile idiopathic arthritis is scheduled for an eye examination every 6months. When stressing the importance of the visit, which instruction is most accurate? A. Uveitis is possible, leading to severe blindness. B. The eye globe does not continue to grow, impacting sight. C. Continuous drug therapy causes corneal opacity. D. Eye infection may develop easily due to medication administration.

A

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide? A. to continue with age-appropriate activities B. to stand absolutely still when not wearing the brace C. to wear the brace a maximum of 20 hours each day D. that secondary sex changes will stop until the brace is removed

A

The nurse is caring for a child who has just received a cast for a broken wrist. The parents ask, "Why do we need to keep the arm up on a pillow?" Which response by the nurse is appropriate? A. "Keeping the arm raised helps to lessen the swelling." B. "Using a pillow helps to promote healing." C. "There is less chance of infection when the arm is kept elevated." D. "Positioning the arm like upward helps to make sure the bones stay aligned."

A

The nurse is instructing the mother of a school-age child with a leg cast about cast care at home. What should the nurse include in this teaching? Select all that apply. A. Cover the cast with a plastic bag to bathe. B. Remind the mother that nothing is to be put down the cast. C. Recommend using magic markers for autographs. D. Use the cool setting on a hair dryer to ease itchy skin. E. Encourage usual activities but restrict strenuous actions.

A,B,D,E

A preadolescent girl with scoliosis is prescribed a body brace. What should the nurse teach the child about the purpose of the brace? A. prevents torticollis B. improves spinal stability C. corrects existing spinal curvature D. prevents herniation of a spinal disk

B

A toddler is diagnosed with osteomyelitis. What should the nurse anticipate as a priority intervention when planning this child's care? A. assisting the child with crutch walking B. maintaining intravenous antibiotic therapy C. keeping the child quiet while in skeletal traction D. restricting fluid to encourage red cell production

B

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to: A. promote healing. B. prevent edema. C. discourage infection. D. ensure proper bone alignment.

B

An adolescent girl has spinal instrumentation surgery at 16 years of age. Immediately after this procedure, the nurse would teach her to: A. sit up, although this may hurt. B. always sleep prone. C. wait to be log-rolled before turning from one side to the other. D. plan on 6 months of hospitalization.

C

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the: A. back with hips flat on the bed. B. stomach with both legs extended. C. back with the injured hip flexed and the uninjured one extended. D. back with hips up off the bed.

D

The nurse is evaluating a school-age child's ability to crutch walk so that no weight is placed on an injured leg. Which walking technique indicates that teaching has been effective? A. walking gait B. two-point gait C. single-crutch support gait D. three-point swing-through gait

D

The nurse receives a report from the admission department that a child with a slipped capital femoral epiphysis is in route to the care area. The nurse would likely have received which description of the child to plan care? A. tall, thin female B. preadolescent female C. active school-age male D. obese preadolescent male

D

The nurse is caring for a school-age child newly diagnosed with juvenile idiopathic arthritis. Which diagnosis would be a priority for this client? A. Knowledge deficit related to care needs B. Risk for inefficient peripheral tissue perfusion C. Ineffective coping related to physical limitations D. Imbalanced nutrition: less than body requirements

A

The nurse is concerned that a preschool-age child is demonstrating signs of Duchenne muscular dystrophy. What did the nurse assess in this child? A. Gower sign B. facial weakness C. inability to whistle D. inadequate use of respiratory muscles

A

The nurse is preparing an educational session for adolescents to best ensure a lifelong healthy musculoskeletal system. Which teaching will be beneficial to the most attendees? A. importance of daily exercise B. need for early diagnosis of painful joints C. need for at least 8 hours of sleep each night D. adequate intake of calcium in dietary or supplement form

A

The nurse is caring for a school-age child recovering from an open reduction for a fractured femur. Which assessment findings indicate that the child is developing an infection? Select all that apply. A. lethargy B. increased pulse rate C. reduced pulse in the ankle D. cyanosis of the casted foot E. increased body temperature

A,B,E

A 7-year-old is seen with pauciarticular juvenile idiopathic arthritis. She notices extreme pain when she wakes in the morning. The best advice the nurse can give her parents would be to: A. have her take 325 mg of aspirin immediately on arising. B. encourage her to take a warm bath each morning before school. C. have her do isotonic exercises until the pain is gone. D. encourage her to remain in bed until the pain is gone.

B

The nurse is planning teaching for the parents of a child with Legg-Calvé- Perthes disease. On what should the nurse emphasize when conducting this teaching? A. Surgery is needed with supporting rods. B. The child will have a non-weight-bearing period. C. The child will need passive range-of-motion exercises three times a day. D. The child will need to exercise to increase muscle strength of the knee joint.

B

The nurse meets a child with a slipped capital femoral epiphysis. In what type of child does this usually occur? A. Tall, thin girls B. Obese adolescent boys C. Preadolescent girls D. Active school-age children

B

The nurse is caring for a child diagnosed with scoliosis. What actions by the child would indicate a need for intervention by the nurse? Select all that apply. A. placement of the brace over a t-shirt B. removal of the brace at bedtime C. Reports of, "I feel taller with the brace on." D. Loosening of the straps on the brace prior to bedtime. E. removal of the brace while playing a soccer game

B,D

The most important assessment of neurovascular status to make after spinal surgical instrumentation is: A. check the nail beds of the fingers for capillary refill. B. determine the presence of brachial pulses. C. assess the legs for warmth. D. ask if the child has pain.

C

When assisting parents in a home care plan for a child with Legg-Calvé-Perthes disease (LCPD), the nurse would teach the parents that which is anticipated? A. Surgery with supporting rods B. Passive range-of-motion exercises 3x per day C. A non-weight-bearing period initially occurs. D. Exercise to increase muscle strength of the knee joint

C

During a visit, the parents of a school-age child diagnosed with pauciarticular juvenile idiopathic arthritis tell the nurse, "There are times when the joint pain is really severe, Is there anything that might help?" Which response by the nurse would be appropriate? A. "Have your child lie still for about 1/2 hour when the pain gets bad." B. "Let me show you how to do sotonic exercises until the pain is gone." C. "Give your child a dose of aspirin on an empty stomach immediately when the pain occurs." D. "Apply a warm moist compress or heating pad to the area for 20 minutes."

D

Fractures in children are always potentially serious injuries. Which child with a fracture would you observe most closely for complication? A. one who has a green stick radial injury B. one who has an ulnar fracture C. one who has a fractured patella D. one who has an elbow fracture

D

The nurse assists with the application of a full-body plaster cast to a child. The child immediately becomes diaphoretic and reports feeling hot. Which nursing intervention would be indicated? A. Observe the child for infection. B. Suggest removal of the cast to the orthopedist. C. Moisten the cast with cool water. D. Advise the child that this is to be expected.

D

The physician of a child with juvenile idiopathic arthritis asks the nurse to telephone the school to arrange a new activity program for her. A change the nurse would anticipate arranging for the child is to: A. be excused from all extracurricular activities. B. begin school earlier in the day than other children. C. be excused from all swimming classes. D. modify her physical exercise program.

D