Quiz: Chapter 48, The Child With Musculoskeletal or Articular Dysfunction

After assessment of an infant the nurse informs the primary health care provider that the child has a positive Ortolani test. Which finding obtained from the test enables the nurse to reach this conclusion?

Decreased hip abduction

During an assessment, the nurse notes a butterfly rash on a client's nose and across the cheeks. The nurse also observes esophageal dysfunction and nephrotic syndrome in the client. The client reports occasional seizures, abdominal pain, headache, and nausea. Which medications should the nurse expect to be prescribed for the client? Select all that apply.

Methotrexate (MTX) Azathioprine (Imuran)

What is an appropriate nursing intervention when caring for the child with chronic osteomyelitis?

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

______________________include: (1) Manual traction—Applied to the body part by the hands placed distal to the fracture site. Manual traction may be provided during application of a cast but more commonly when a closed reduction is performed. (2) Skin traction—Applied directly to the skin surface and indirectly to the skeletal structures. The pulling mechanism is attached to the skin with adhesive material or an elastic bandage. Both types are applied over soft, foam-backed traction straps to distribute the traction pull. (3) Skeletal traction—Applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture.

Types of traction

The client with juvenile idiopathic _________________________ has joint deformities due to osteoporosis.

arthritis

The presence of a _____________________ on the nose and across the cheeks could indicate systemic lupus erythematosus, which is a chronic autoimmune disease of the connective tissues and blood vessels. The disease may be characterized by inflammation, seizures, esophageal dysfunction, abdominal pain, nausea, and headache. Methotrexate (MTX) and azathioprine (Imuran) are effective immunosuppressive drugs that can be prescribed for the treatment of systemic lupus erythematosus.

butterfly rash

Epistaxis is a sign of ____________________________. The client with rhabdomyosarcoma may have a bleeding nose due to the compression of blood vessels with the tumor

rhabdomyosarcoma

What is the healing time for a femoral shaft fracture in late childhood?

6 to 8 weeks

Healing time for a femoral shaft in adolescence is ____________ to ________________weeks.

8 to 12

Which instructions should the nurse provide the patient and the family about the management of systemic lupus erythematosus (SLE)? Select all that apply.

"Avoid exposure to sunlight." "Take prescribed antimalarial drugs on a regular basis." "Always carry medical identification indicating the disease and steroid dependence."

A home care nurse is caring for a 4-month-old infant with developmental dysplasia of the hip (DDH). The baby is in a Pavlik harness. The baby's mother tells the nurse, "I don't think my baby will be able to sleep while wearing the harness." What is an appropriate response by the nurse?

"It is important for the harness to be worn continuously."

The nurse is teaching the parent of a 12-month-old infant about assessing developmental dysplasia of the hip in babies. What instruction does the nurse give the parent to check the presence of a Trendelenburg sign?

"Make the infant stand on the affected leg."

Healing time for a femoral shaft in the neonatal period is ___________ to ______________ weeks.

2 to 3

Healing time for a femoral shaft in early childhood is only______________weeks.

4

A nursing student is helping to care for a client with lower extremity venous stasis. The student places three pillows under the client's legs and instructs the client to rest in only one position. The student measures the circumference of the client's extremities periodically and administers anticoagulants as prescribed. Which intervention of the student indicates the need for additional teaching?

Advising the client to rest in only one position

A nurse is caring for a young infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? Select all that apply.

Asymmetric thigh and gluteal folds Positive Ortolani and Barlow tests Shortening of limb on affected side

The nurse is caring for a client with systemic lupus erythematosus. Which clinical manifestations might the nurse find in the client? Select all that apply.

Atelectasis Abdominal crisis Thrombophlebitis

A child has just returned from surgery in a hip spica cast. What is the priority nursing intervention?

Check circulation.

Therapeutic management of the patient with systemic lupus erythematosus includes what?

Corticosteroids to control inflammation

The nurse is assessing a child with juvenile idiopathic arthritis who is receiving methotrexate (MXT). The nurse finds that the child has persistent inflammation. Which drug does the nurse expect to be prescribed for the child?

Etanercept (Enbrel)

A 15-year-old patient underwent surgery to have the right foot amputated. The amputation was done to remove a cancerous growth. What is an appropriate postoperative nursing intervention to promote psychological adjustment and mobility?

Help the patient adjust to the temporary prosthesis.

Which statement is true concerning osteogenesis imperfecta?

It is an inherited disorder.

A 2-month-old infant has been diagnosed with developmental dysplasia of the hip. The health care provider has prescribed immediate treatment for the baby using a Pavlik harness. What is the rationale behind this urgency?

It is easier to get the hip into a more abducted position.

_________________________ is a self-limiting disorder affecting children, which is associated with aseptic necrosis of the femoral head. By reviewing radiographs, the nurse can observe the bones and determine the stage of the disease. During the fourth radiographic stage of the disorder, the nurse would observe gradual reformation of the femur head and a spherical shape. The second stage of the disorder is associated with the resorption and revascularization of capital bone, which gives it a mottled appearance. The third phase is associated with the formation of new bone. During the first stage of the disorder, aseptic necrosis of the capital femoral epiphysis with degenerative changes takes place and flattens the upper surface of the femoral head.

Legg-Calvé-Perthes disease

The nurse is caring for a client with a slipped capital femoral epiphysis. Which clinical manifestations does the nurse observe in the client? Select all that apply.

Loss of abduction Limp on affected side Shortening of lower extremity

The callus that develops at the fracture site is important because it provides what?

Means for holding bone fragments together

The nurse is caring for a child experiencing disuse atrophy of the left arm. What is the most effective nursing intervention that can be implemented to decrease muscle catabolism?

Performing range-of-motion exercises

Which assessment findings support the nurse's conclusion that a 2-week-old neonate has hip dysplasia? Select all that apply.

Positive Barlow test Positive Ortolani test Positive Galeazzi sign

Which measure is important in managing hypercalcemia in a child who is immobilized?

Promoting adequate hydration

The nurse is preparing a care plan for a patient who has a large bilateral hip spica cast. Which interventions should the nurse include in the care plan to prevent physiologic complications in the patient? Select all that apply.

Providing a high-calorie, high-protein diet Encouraging the patient to sit upright whenever possible Advising the patient to rest on a pressure-reduction mattress

What is characteristic of fractures in children compared to adults?

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

An adolescent who had a lower leg amputated after a motorcycle accident complains of pain in the missing extremity. What is the nurse's most appropriate action?

Reassure the patient that it is normal and is called phantom limb sensation.

The nurse manager on the orthopedic unit is preparing an in-service about types of traction at the next staff meeting. What information should the nurse manager include in the presentation? Select all that apply.

Skin traction can be applied using a pulling mechanism attached with adhesive material Pins are commonly used with skeletal traction..

____________________________ is a chronic autoimmune disease. Due to the immunogenic reactions, the client with systemic lupus erythematosus may develop atelectasis, abdominal crisis, and thrombophlebitis..

Systemic lupus erythematosus

The nurse is caring for an immobilized preschool child. During this period of immobilization, what is the nurse's best action?

Take the child outside of the room by wagon.

What orthopedic finding suggests the presence of developmental dysplasia of the hip (DDH)?

The affected limb shorter than the other

A 4-month-old infant has been diagnosed with developmental dysplasia of the hip (DDH). What appropriate intervention will follow the diagnosis?

The baby will be set up to be fitted with a Pavlik harness.

Which finding would the nurse observe during the fourth radiographic stage of Legg-Calvé-Perthes disease?

The reformation of a spherical femoral head

The primary health care provider diagnoses a client with slipped capital femoral epiphysis and instructs the nurse to prepare the client for surgery immediately. What is the rationale for this instruction?

To prevent avascular necrosis