Musc Skeletal

The nurse is preparing an adolescent girl for Harrington instrumentation to treat scoliosis. Which of the following should the nurse include? 1. Nasogastric intubation and urinary catheter may be required. 2. Ambulation will not be allowed for up to 3 months. 3. Surgery eliminates the need for casting and bracing. 4. Discomfort can be controlled with nonpharmacologic methods.

1. Nasogastric intubation and urinary catheter may be required.

Which of the following measures is important in managing hypercalcemia in a child who is immobilized? 1. Provide adequate hydration. 2. Change position frequently. 3. Encourage diet high in calcium. 4. Provide diet high in protein and calories.

1. Provide adequate hydration.

Immobilization causes which of the following effects on the cardiovascular system? 1. Venous stasis 2. Increased vasopressor mechanism 3. Normal distribution of blood volume 4. Increased efficiency of orthostatic neurovascular reflexes

1. Venous stasis

A child with juvenile rheumatoid arthritis is started on a nonsteroidal anti-inflammatory drug. Nursing considerations include: 1. monitor for abdominal pain and bloody stools. 2. monitor blood pressure. 3. administer between meals. 4. expect inflammation to be gone in 3 to 4 days.

1. monitor for abdominal pain and bloody stools.

An appropriate nursing intervention when caring for a child in traction would be which of the following? 1. Removing adhesive traction straps daily to prevent skin breakdown 2. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles 3. Providing active range-of-motion exercises to affected extremity three times a day 4. Keeping child prone to maintain good alignment

2. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles

A child who is paralyzed is placed on a tilt table to achieve an upright posture. This is to reduce which of the following effects of immobilization? 1. Impaired healing 2. Bone demineralization 3. Negative nitrogen balance 4. Altered distribution of blood volume

2. Bone demineralization

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following? 1. Healing is usually delayed in this type of fracture. Bone growth can be affected with this type of fracture. 2. Bone growth can be affected with this type of fracture. 3. This is an unusual fracture site in young children. 4. This type of fracture is inconsistent with a fall.

2. Bone growth can be affected with this type of fracture.

A youngster has just returned from surgery in a hip spica cast. The priority nursing intervention would be which of the following? 1. Elevate head of bed. 2. Check circulation. 3. Turn to right side. 4. Offer sips of water.

2. Check circulation.

Immobilization causes which of the following effects on metabolism? 1. Hypocalcemia 2. Decreased metabolic rate 3. Positive nitrogen balance 4. Increased production of stress hormones

2. Decreased metabolic rate

A young child has recently been fitted with knee, ankle, and foot orthosis (brace). Care of the skin should include which of the following? 1. Apply lotion or cream to soften skin. 2. If an open sore does not heal in 3 days, contact physician or orthotist. 3. If child experiences burning sensation under brace, place padding between skin and brace. 4. If small blister develops, apply rubbing alcohol and place padding between skin and brace.

2. If an open sore does not heal in 3 days, contact physician or orthotist.

Which of the following statements is true concerning osteogenesis imperfecta? 1. It is easily treated. 2. It is an inherited disorder. 3. Later-onset disease usually runs a more difficult course. 4. Braces and exercises are of no therapeutic value

2. It is an inherited disorder.

The nurse stops to assist an adolescent who has experienced severe trauma when hit by a motorcycle. The emergency medical system has been activated. The first person who provided assistance applied a tourniquet to the child's leg because of arterial bleeding. The nurse should do which of the following related to the tourniquet? 1. Loosen the tourniquet. 2. Leave the tourniquet in place. 3. Remove tourniquet and apply direct pressure if bleeding is still present. 4. Remove tourniquet every 5 minutes, leaving it off for 30 seconds each time.

2. Leave the tourniquet in place.

An adolescent is in traction. The purpose of the traction is to fatigue the muscle and reduce muscle spasm so that the bones can be realigned. Nursing actions should include which of the following? 1. Maintain continuous traction until muscle spasm ceases. 2. Maintain continuous traction to prevent muscle from contracting. 3. Release traction every hour to allow muscle to briefly regain its contractibility. 4. Release traction once every 8 hours to allow muscle to briefly regain its contractibility.

2. Maintain continuous traction to prevent muscle from contracting.

Which of the following is characteristic of fractures in children? 1. Fractures rarely occur at the growth plate site because it absorbs shock well. 2. Rapidity of healing is inversely related to the age of the child. 3. Pliable bones of growing children are less porous than those of the adult. 4. Periosteum of a child's bone is thinner, weaker, and has less osteogenic potential compared with the adult.

2. Rapidity of healing is inversely related to the age of the child.

The nurse at a summer camp recognizes the signs of heatstroke in an adolescent girl. Her temperature is 103°F. She is slightly confused but able to drink water. Nursing care while waiting for transport to the hospital should include which of the following? 1. Administer antipyretic. 2. Administer salt tablets. 3. Apply towels wet with cool water. 4. Sponge with solution of rubbing alcohol and water.

3. Apply towels wet with cool water.

Which of the following are considered major goals of the therapeutic management of juvenile arthritis? 1. Prevent joint discomfort; regain proper alignment 2. Prevent loss of joint function; achieve cure 3. Control pain; preserve joint function 4. Prevent skin breakdown; relieve symptoms

3. Control pain; preserve joint function

Which of the following terms is used when the force of stress on the ligament is so great as to displace the normal position of the opposing bone ends or the bone end to its socket? 1. Sprain 2. Fracture 3. Dislocation 4. Stress fracture

3. Dislocation

Which of the following is the first stage of bone healing when a fracture has occurred? 1. Ossification 2. Callus formation 3. Hematoma formation 4. Cellular proliferation

3. Hematoma formation

Which of the following is the primary method of treating osteomyelitis? 1. Joint replacement 2. Bracing and casting 3. Intravenous antibiotic therapy 4. Long-term corticosteroid therapy

3. Intravenous antibiotic therapy

An appropriate nursing intervention when caring for a child with a cast is which of the following? 1. Wait 24 hours after cast application to change the child's position. 2. Use fingers when handling cast to prevent trauma while cast is drying. 3. Make sure all cast edges are smooth and free of irritating projections. 4. Elevate cast extremity only after cast has completely dried.

3. Make sure all cast edges are smooth and free of irritating projections.

The nurse is caring for a child who recently became paralyzed. Which of the following clinical manifestations are suggestive of hypercalcemia? 1. Seizures 2. Agitation 3. Nausea, vomiting, lethargy 4. Sudden chest pain, dyspnea

3. Nausea, vomiting, lethargy

Which of the following results when ice is applied immediately following a soft-tissue injury, such as a sprained ankle? 1. Increases the pain threshold. 2. Increases metabolism in the tissues. 3. Produces a deep tissue vasodilation. 4. More histamine-like substances are released.

3. Produces a deep tissue vasodilation.

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 which of the following? 1. Sepsis 2. Osteomyelitis 3. Pulmonary embolism 4. Acute respiratory tract infection

3. Pulmonary embolism

The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse should consider which of the following in caring for this child who has experienced severe trauma? 1. The possibility of spinal cord injury should be ruled out before transporting child to the hospital. 2. Temperature maintenance is more difficult than in adults, because young children have a larger surface area related to body mass. 3. Rapid assessment should begin with ABC status: airway, breathing, consciousness. 4. Assessment should begin with area injured; assessment of other areas can wait.

3. Rapid assessment should begin with ABC status: airway, breathing, consciousness.

Which of the following types of traction uses skin traction on the lower leg and a padded sling under the knee? 1. Dunlop 2. Bryant 3. Russell 4. Buck extension

3. Russell

Which of the following is considered an acute injury? 1. Bursitis 2. Stress fracture 3. Sprains of joint ligaments 4. Plantar fascitis

3. Sprains of joint ligaments

An important nursing consideration when caring for a child with juvenile rheumatoid arthritis would be which of the following? 1. Apply ice packs to relieve acute swelling and pain. 2. Administer acetaminophen to reduce inflammation. 3. Teach child and family correct administration of medications. 4. Encourage range-of-motion exercises during periods of inflammation.

3. Teach child and family correct administration of medications

An adolescent comes to the school nurse after experiencing shin splints during a track meet. The nurse should offer reassurance that: 1. shin splints are not serious injuries. 2. it is generally best to walk around and "work the pain out." 3. ice, rest, and nonsteroidal anti-inflammatory drugs usually relieve pain. 4. heat, rest, and nonsteroidal anti-inflammatory drugs usually relieve pain.

3. ice, rest, and nonsteroidal anti-inflammatory drugs usually relieve pain.

Which of the following would cause a nurse to suspect that an infection has developed under a cast? 1. Complaint of paresthesia 2. Cold toes 3. Increased respirations 4. "Hot spots" felt on cast surface

4. "Hot spots" felt on cast surface

Which of the following statements is correct regarding sports injuries during adolescence? 1. The increase in strength and vigor during adolescence helps to prevent injuries related to fatigue. 2. Rapidly growing bones, muscles, joints, and tendons offer some protection from unusual strain. 3. More injuries occur during organized athletic competition than during recreational sports participation. 4. Adolescents may not possess insight and judgment to recognize when a sports injury is beyond their capabilities.

4. Adolescents may not possess insight and judgment to recognize when a sports injury is beyond their capabilities.

Which of the following is a physiologic effect of immobilization on children? 1. Metabolic rate increases. 2. Increased joint mobility can lead to contractures in a short time. 3. Bone calcium increases, releasing excess calcium into the body (hypercalcemia). 4. Circulatory stasis and hypercoagulability of the blood can lead to thrombus and embolus formation.

4. Circulatory stasis and hypercoagulability of the blood can lead to thrombus and embolus formation.

Therapeutic management of the patient with systemic lupus erythematosus includes which of the following? 1. Cold salts to suppress the inflammatory process 2. A high-protein, low-salt diet 3. An exercise regimen to build up muscle strength and endurance 4. Corticosteroids to control inflammation

4. Corticosteroids to control inflammation

Which of the following terms is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? 1. Scoliosis 2. Ankylosis 3. Lordosis 4. Kyphosis

4. Kyphosis

The provisional callus that develops at the fracture site is important because it provides which of the following? 1. Functional use of injured part 2. Sufficient support for weight bearing 3. Means for adequate blood supply 4. Means for holding bone fragments together

4. Means for holding bone fragments together

An appropriate nursing intervention when caring for the child with osteomyelitis is which of the following? 1. Provide active range-of-motion exercises of affected extremity. 2. Administer antibiotics with meals. 3. Encourage frequent ambulation. 4. Move and turn child carefully and gently to minimize pain .

4. Move and turn child carefully and gently to minimize pain

Which of the following would be the most appropriate play activity for a 3-year-old girl in a spica cast, considering both safety and development? 1. Marbles 2. Game of checkers 3. Coloring with crayons 4. Playing with toy telephone

4. Playing with toy telephone

The nurse uses the palms of the hands when handling a wet cast to achieve which of the following? 1. Assess dryness of cast. 2. Facilitate easy turning. 3. Keep the patient's limb balanced. 4. Prevent indenting the cast.

4. Prevent indenting the cast.

Scoliosis is which of the following? 1. Aseptic necrosis of the vertebrae 2. Abnormally increased convex angulation in the curvature of the thoracic spine 3. Abnormally exaggerated concave lumbar curvature 4. Spinal deformity involving lateral curvature, rotation, and thoracic hypokyphosis

4. Spinal deformity involving lateral curvature, rotation, and thoracic hypokyphosis

The nurse is caring for an immobilized preschool child. Which of the following is helpful during this period of immobilization? 1. Encourage wearing pajamas. 2. Let child have few behavioral limitations. 3. Keep child away from other immobilized children if possible. 4. Take child for a "walk" by wagon outside the room.

4. Take child for a "walk" by wagon outside the room.

A 4-year-old is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following? 1. Encourage normal activity for as long as is possible. 2. Explain the cause of the disease to the child and family. 3. Prepare child and family for long-term, permanent disabilities. 4. Teach family the care and management of the corrective appliance.

4. Teach family the care and management of the corrective appliance.