Musculoskeletal Prep U
In caring for a child in traction, which intervention is the highest priority for the nurse?
The nurse should monitor for decreased circulation every 4 hours.
A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as a primary nursing intervention to include in the child's plan of care? a. maintaining intravenous antibiotic therapy b. assisting the child with crutch walking c. keeping the child quiet while in skeletal traction d. restricting fluid to encourage red cell production
a
A nurse is conducting an in-service program for a group of pediatric nurses about pediatric rehabilitation and habilitation. When describing the differences between pediatric and adult services, which of the following would the nurse identify as the primary difference? a. Adults have reached a level of physical and mental maturity. b. Adult rehabilitation focuses on attaining skills previously unknown. c. Children have strong experiential bases on which to build. d. Children most often need rehabilitation due to an injury.
a
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? a. Cartilage b. Joints c. Tendons d. Ligaments
a
The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? a. The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. b. The nurse should support the caregivers in restricting activity during the treatment. c. The nurse should provide information when the child or caregiver requests it. d. The nurse should be a contact person when the child is hospitalized.
a
The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom? a. pallor b. pain c. paralysis d. paresthesia
d
The school nurse is doing a presentation to a group of caregivers of children diagnosed with scoliosis. One of the caregivers asks the nurse about structural scoliosis. Which condition is involved with the diagnosis of structural scoliosis? a. poor posture b. muscle spasm caused by trauma c. unequal leg length d. rotated and malformed vertebrae
d
A nurse is performing a physical assessment of the musculoskeletal system of Manuel, a 31/2-year-old. Which assessment technique would be most appropriate for this child? a. Assess Manuel while he sits in his parent's lap. b. Palpate the arms from the shoulders to the fingers. c. Assess range of motion (ROM) of his head to check for torticollis. d. Assess Manuel's hips for any dislocations.
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
In understanding the function of the musculoskeletal system, the nurse recognizes that which of the following allows for movement of the body parts? a. joints b. tendons c. cartilage d. ligaments
a
The pediatric nurse caring for orthopedic patients knows that priorities for care of a child with a splint or brace focus on ensuring that the device is fitted and used correctly and on maintaining skin integrity. Which of the following nursing interventions help to achieve this goal? Select all answers that apply. a. Daily baths or skin care with thorough drying minimizes skin irritation. b. The Pavlik harness must be worn at all times for 4 to 6 weeks. c. A brace or splint can be removed for bathing, sleeping, or exercise. d. Wearing polyester clothing under the device can minimize skin irritation. e. A wrist or knee splint used during acute arthritic phases or after injury can be removed during periods of inactivity. f. Milwaukee or Boston braces must be worn between 8 and 12 hours per day.
a, b, c, e
A nurse is caring for a 6-year-old child with a fractured ulna. The child is fearful about the casting process and is resisting treatment. How should the nurse respond? a. "The application of the cast will not hurt." b. "Would you like to pick out your favorite color cast?" c. "The cast will stop the bone from breaking into several pieces." d. "Look over there at the neon fish in our aquarium."
d
The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding? a. sway back b. lordosis c. kyphosis d. idiopathic scoliosis
d
The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be: a. "These make a smooth edge on the cast so the skin is better protected." b. "These will help the cast look more attractive so the child won't feel self-conscious." c. "We put these on so the child will not pull the padding from under the cast." d. "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry."
a
The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents? a. "You and your coaches need to understand that you cannot play soccer for at least six weeks." b. "Ice will help reduce the inflammation." c. "You will need to see a physical therapist for stretching and strengthening exercises." d. "NSAIDs can help with pain control and inflammation."
a
Maria is a 9-month-old whose babysitter brings her to the emergency department. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. Which of the following would be most appropriate for the nurse to do? a. Evaluate the child for an underlying musculoskeletal disorder. b. Arrange for the parents to come in for an evaluation for possible physical abuse. c. Call social services to find the parents and evaluate them for child abuse. d. Ask the babysitter to advocate for the child and report the incident to the authorities.
b
The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention? a. Apply lotion to his foot and avoid friction to the area. b. Gently massage his foot and heel each shift. c. Reposition the child's foot on a pressure-reducing device. d. Make sure the skin and linens are clean and dry.
c
The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is: a. skin traction. b. Russell traction. c. skeletal traction. d. Buck extension traction.
c
The nurse is assessing a newborn following a caesarian section birth necessitated by a breech presentation. The nurse knows that this presentation places the newborn at increased risk for: a. Genu valgum. b. Clubfoot. c. Osteogenesis imperfecta. d. Developmental dysplasia of the hip.
d
The nurse is caring for a child with osteomyelitis who has a leg wound. The highest priority nursing intervention for this child would be for the nurse to: a. monitor nutritional intake. b. encourage the child to avoid weight bearing. c. minimize the movement of the leg. d. follow transmission-based precautions.
d
The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? a. Internal fixation device b. External fixation device c. Stockinette d. Spica cast
d
An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? a. "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." b. "It is important to correct spinal curvature before it gets too bad, causing you problems." c. "It is important to prevent herniation of a spinal disk, which is painful." d. "It is important to prevent torticollis."
a
A nurse caring for a child wearing a brace to correct scoliosis provides patient and family teaching for home care of the brace. Which of the following would the nurse most likely include in the teaching plan? Select all that apply. a. "Be sure to avoid sitting in one position for long periods of time." b. "Loosen the brace during meals if necessary." c. "Take a shower instead of a bath to stimulate the skin." d. "Wear a 100% cotton T-shirt under the brace to absorb moisture." e. "Gradually decrease wearing time so the skin can develop tolerance." f. "Schedule wearing the brace during waking hours for best therapeutic results."
a, b, d
The nurse is preparing an education program for parents of a child diagnosed with Legg-Calvé-Perthes disease (LCPD) disorder. What information does the nurse need to include? Select all that apply. a. This disorder has four stages that last over several years. b. The second stage can last up to 2 years and includes breakdown or fragmentation of the bone in the head of the femur. c. The initial stage symptoms include a limp and guarding of the hip while moving. d. If left untreated, the femur head will deform, which can lead to chronic pain. e. In children over 6, surgical placement of a containment device over the head of the femur is the typical treatment.
a, c, d
The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. a. The boy's toes are light blue and very swollen. b. The boy experiences mild pain when wiggling his toes. c. New drainage is seeping out from under the cast. d. The outside of the boy's cast got wet and had to be dried using a hair dryer. e. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours.
a, c, e
A 14-year-old male is brought to the emergency department by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. When describing this fracture to the child and his parents, the nurse would integrate knowledge of which of the following? a. The bone is bent but not broken. b. There are three or more fracture fragments. c. The break occurs in a line that crosses the shaft at a 90-degree angle. d. There is a diagonal line across the bone.
b
A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis? a. Haemophilus influenzae b. Staphylococcus aureus c. Streptococcus group B d. Mycobacterium
b
An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the: a. back with the injured hip flexed and the uninjured one extended. b. back with hips up off the bed. c. back with hips flat on the bed. d. stomach with both legs extended.
b
The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation? a. A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. b. A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. c. A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. d. A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating.
b
The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse? a. "The newer braces only have to be worn while the child is asleep and don't have to be worn at school." b. "The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." c. "Braces have been replaced with surgical intervention. Your child will only wear a brace for a few weeks after the surgery." d. "Unfortunately, bracing is the only option for treating this disorder. I'm sure your child will get used to it after a few weeks."
b
The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction? a. Dunlop traction b. Balanced suspension traction c. Skeletal traction d. Skin traction
d
