Musculoskeletal Practice Questions

Which of the following describes the technique the nurse would use to screen the school age child fro scoliosis? a. Have the child stand firmly on both feet and bend forward at the hips with the trunk exposed b. Listen for a clicking sounds as the child abducts the hips c. Have the child run the heel of one foot down the shin of the other while standing d. Have the child shrug the shoulders as the nurse applies mild pressure to the shoulders

ANS: A In a child with scoliosis, the spine fails to straighten when the child stands firmly on both feets and bends forward

A child is upset because when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which should the nurse suggest to remove this material? a. Soak in a bathtub. b. Vigorously scrub leg. c. Apply powder to absorb material. d. Carefully pick material off leg.

ANS: A Simple soaking in the bathtub is usually sufficient for the removal of the desquamated skin and sebaceous secretions. It may take several days to eliminate the accumulation completely. The parents and child should be advised not to scrub the leg vigorously or forcibly remove this material because it may cause excoriation and bleeding. Oil or lotion, but not powder, may provide comfort for the child.

Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. Which action should the nurse take first? a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify physician. d. Chart the observations and check the extremity again in 15 minutes.

ANS: A The absence of a pulse and change in color of the foot must be reported immediately for evaluation by the practitioner. Pain medication should be given after the practitioner is notified. Legg-Calvé-Perthes disease is an emergency condition; immediate reporting is indicated. The findings should be documented with ongoing assessment.

Which is an appropriate nursing intervention when caring for a child in traction? a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity three times a day. d. Keep the child in one position to maintain good alignment.

ANS: B Traction places stress on the affected bone, joint, and muscles. The nurse must assess for tightness, weakness, or contractures developing in the uninvolved joints and muscles. The adhesive straps should be released or replaced only when absolutely necessary. Active, passive, or active with resistance exercises should be carried out for the unaffected extremity only. Movement is expected with children. Each time the child moves, the nurse should check to ensure that proper alignment is maintained.

Andy is a 6 year old with a fractured arm. The nurse helps apply a cast in the office. Which of the following is most important to remember while helping with the application of the cast and caring for it afterwards? a. Using only the fingertips while holding the cast b. Petal the rough edges of the cast by applying tape from the outside to the inside of the cast c. Assess the child's ability to wiggle the fingers d. Encourage the use of powder to absorb any odors and help with itching

ANS: C It is most essential to assess the child's ability to wiggle his fingers to neurovascular status. The cast should be handled with the palms of the hands not fingertiops to avoid pressure areas. The cast should be petalled from the inside to the outside to avoid skin irritation. Powders shoudl be avoided as it can absorb perspiration and lead to bacterial infections.

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome? (Select all that apply.) a. Palpable distal pulse b. Capillary refill to extremity less than 3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

ANS: C, D, E Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the extremity less than 3 seconds are expected findings.

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal antiinflammatory drugs (NSAIDs)

ANS: D NSAIDs are the first drugs used in JIA. Naproxen, ibuprofen, and tolmetin are approved for use in children. Aspirin, once the drug of choice, has been replaced by the NSAIDs because they have fewer side effects and easier administration schedules. Corticosteroids are used for life-threatening complications, incapacitating arthritis, and uveitis. Methotrexate is a second-line therapy for JIA.

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

ANS: D The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight bearing, which helps reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset.

A three month old with developmental dysplasia of the hip is to be placed in a Pavlik harness. The parents appear apprehensive and ask the purpose of the harness. The nurse's best response would be? a. "The Pavlik harness will help enlarge the hip socket by keeping the legs in an abducted position" b. "The Pavlik harness will help reduce the hip socket by keeping the legs in an abducted position" c. "The Pavlik harness will help enlarge the hip socket by keeping the legs in an adducted position" d. "The Pavlik harness will help reduce the hip socket by keeping the legs in an adducted position"

A. "The Pavlik harness will help enlarge the hip socket by keeping the legs in an abducted position"

Which can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

ANS: A Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

he nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing "phantom limb pain." Which prescribed medication is appropriate to administer to relieve phantom limb pain? a. Amitriptyline (Elavil) b. Hydrocodone (Vicodin) c. Oxycodone (OxyContin) d. Alprazolam (Xanax)

ANS: A Amitriptyline (Elavil) has been used successfully to decrease phantom limb pain. Opioids such as Vicodin or OxyContin would not be prescribed for this pain. A benzodiazepine such as Xanax would not be prescribed for this type of pain.

The nurse is preparing an adolescent with scoliosis for a spinal surgical instrumentation placement procedure. Which consideration should the nurse include? a. A chest tube and urinary catheter may be required. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

ANS: A Surgical spinal instrumentation is a surgical procedure. A chest tube and urinary catheterization may be required. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients walk by the second or third postoperative day. Casting and bracing are required postoperatively. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.

The nurse is conducting a staff in-service on casts. Which is an advantage to using a fiberglass cast instead of a plaster of Paris cast? a. Cheaper b. Dries rapidly c. Molds closely to body parts d. Smooth exterior

ANS: B A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive and have a rough exterior, which may scratch surfaces. Plaster casts mold closer to body parts.

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb f. Lordosis

ANS: A, B A positive Ortolani test and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Unequal gluteal folds, negative Babinski sign, and Trendelenburg sign are signs that appear in older infants and children. Telescoping of the affected limb and lordosis are not clinical manifestations of developmental dysplasia of the hip.

The nurse is preparing to teach a health maintenance class on bones. While reviewing the material, the nurse questions which of the following statements? a. Most fractures in a 4 year old will heal in 4 weeks b. Injuries that damage the epiphyseal plate will result in bone infection c. Clavicular fractures are one of the most common fractures in children d. Toddlers with fractures tend to heal faster than adolescents with fractures

ANS: B Injuries to the epiphyseal plate can result in bone growth abnormalities not infection. In children under 10 bone fractures take approximately 1 week per year of age to heal. Clavicular fractures are one of the most common fractures in children.

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

ANS: B Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.

An infant is diagnosed with developmental dysplasia of the hip. On assessment, the nurse expects to note: a. Symmetrical thigh and gluteal folds b. Ortolani sign c. Increased hip abduction d. Femoral lengthening on the affected side

ANS: B Ortolani sign is a clicking sound that occurs when the healthcare provider manually abducts through a frog-legged position causing the affectedhip to slide out of the acetabulum. The child with developmental dysplasia of the hip would have asymmetrical thigh and gluteal folds as well as shortening of the affected leg due to telescoping.

An adolescent with a fractured femur is in Russell's traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action? a. Maintaining continuous traction until 1 hour before the scheduled surgery b. Maintaining continuous traction and checking position of traction frequently c. Releasing traction every hour to perform skin care d. Releasing traction once every 8 hours to check circulation

ANS: B When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle's normal contracting ability to again cause malpositioning of the bone ends. Continuous traction must be maintained to keep the bone ends in satisfactory realignment. Releasing at any time, either 1 hour before surgery, once every hour for skin care, or once every 8 hours would not keep the fracture in satisfactory alignment.

A 13 year old diagnosed with juvenile idiopathic arthritis (JIA) describes feeling left out at school and wants to join an acivity. Which of the following is the nurse's best response? a. "You may want to try soccer as it includes lots of running to build endurance" b. "Football is a good sport as it will help you run and stretch" c. "Swimming is a good way to exercise and stretch" d. "Have you thought about being a team helper. You could still be involved but not get hurt"

ANS: C Swimming is an excellent way for a child to exercise with low risk of contact injuries. Many children with JIA are discouraged from contact sports as it may lead to an injury causing joint inflammation.

The nurse is caring for a school-age child diagnosed with juvenile idiopathic arthritis (JIA). Which intervention should be a priority? a. Apply ice packs to relieve stiffness 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.

ANS: C The management of JIA is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that NSAIDs should not be given on an empty stomach and to be alert for signs of toxicity. Warm moist heat is best for relieving stiffness and pain. Acetaminophen does not have antiinflammatory effects. Range-of-motion exercises should not be done during periods of inflammation.

A 3 year old has just returned from surgery in a hip spica cast. The priority nursing intervention is to a. Elevate the head of the bed b. Offer sips of water c. Check, circulation, sensation, and motion of toes d. Turn the child to the right side, then the left side every 4 hours

C. check, circulation, sensation, and motion of toes

What is a secondary effect when a child experiences decreased muscle strength, tone and endurance from immobilization? a. Increased metabolism b. Increased venous return c. Increased cardiac output d. Decreased exercise tolerance

D. decreased exercise tolerance