Chapter 27 Alterations in Musculoskeletal Function

A school-age child is hospitalized with a fractured left femur. The child is in balanced skeletal traction and is in pain. Orders read "Morphine 2.5 mg IV q 3 hours for severe pain." How many mL of morphine would the nurse administer if the medication on hand is morphine 8 mg/1 mL? Record your answer using two decimal places.

0.31

The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place

1

A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental genu varum? A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray B. The medial surfaces of the knees are more than 2 in apart C. The malleoli are touching D. The condition is bilateral

A. A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray

A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented? Select all that apply. A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes E. Cast care of the affected limb F. Instruction to the parents regarding proper traction of the limb

A. Administration of IV antibiotics at the hospital B. Instruct the parents on how to care for an IV line at home C. Instruct the parents regarding the importance of maintaining bed rest D. Institute infection-control precautions related to drainage tubes

The nurse is caring for a child diagnosed with a sprain of the lower extremity. Which health care prescription(s) would the nurse clarify with the provider before implementing? Select all that apply. A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation C. Avoid bearing weight on the affected extremity for 3 to 4 days D. Compress the site using an elastic bandage to wrap the area E. Assure the parents understand when to return and to call or follow-up with concerns

A. Apply a heating pad four times daily for 20 minutes per application B. Offer aspirin (ASA) three times daily orally to the child for pain and inflammation

The nurse is creating a care plan for a child with a leg cast. What interventions would be appropriate for the nursing diagnosis of Risk for ineffective peripheral tissue perfusion related to pressure from cast? Select all that apply. A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. C. Remind the parents to not allow the child to put anything in the cast. D. Assess capillary refill of toes every 4 hours. E. Educate the child's parents on use of good body mechanics when repositioning the child.

A. Assess foot and toes every 4 hours for color, warmth, and presence of pedal pulses. B. Keep leg elevated by a pillow at all times. D. Assess capillary refill of toes every 4 hours.

The student nurse is preparing a presentation on bones and bone growth. What information should the student include? Select all that apply. A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. C. Adipose cell formation happens in the red bone marrow. D. Periosteum is the outer covering of the bone. E. The diaphysis is the rounded end portion of the bone.

A. Calcium and vitamin D play important roles in bone growth and bone breakdown. B. Calcitonin plays a role in remodeling of bone. D. Periosteum is the outer covering of the bone.

The nurse is conducting a routine physical examination of a newborn to screen for developmental DDH. The nurse correctly assesses the infant by placing the infant: A. In a prone position, noting asymmetry of the thigh or gluteal folds. B. With both legs extended and observes the hip and knee joint relationship. C. With both legs extended and observes the feet. D. In a supine position with both legs extended and observes the tibia/fibula.

A. In a prone position, noting asymmetry of the thigh or gluteal folds.

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. Lethargy B. Increased pulse rate E. Increased body temperature

The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What the appropriate response by the nurse? A. "You don't need to worry about your child's feet. They will change as your child grows." B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months." C. "Flat feet are normal in infants. Their longitudinal arch doesn't appear until they are 3 to 5 years old." D. "When your child starts walking, encourage walking on the heels. This will help to develop the arch more so your child doesn't have a problem with flat feet as an adult."

B. "Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months."

When performing physical assessments of children with musculoskeletal disorders, the nurse distinguishes normal variations in children's muscles versus adult muscles. Which of the following would be most important for the nurse to keep in mind? A. The infant's muscles account for 45% of total body weight as opposed to 25% of adult body weight. B. During adolescence, muscle growth is influenced by increased production of androgenic hormones. C. The young child has rigid soft tissue, so dislocations and sprains are common occurrences. D. Rapid bone and muscle growth in adolescents increase their agility, thereby decreasing the incidence of injuries.

B. During adolescence, muscle growth is influenced by increased production of androgenic hormones.

A school-age child with a supracondylar fracture of the humerus has been placed in a partial cast with the elbow region wrapped with an elastic bandage. What should the nurse explain to the parents and child regarding the reason for this type of casting approach? A. Encourages healing B. Ensures edema does not press on the nerves C. Keeps the bones of the forearm in alignment D. Provides additional stability until the bone heals

B. Ensures edema does not press on the nerves

Which nursing intervention is the priority for the immobilized child in an acute care setting? A. Ambulate the child up and down the hall twice a day. B. Offer age-appropriate toys and diversional activities. C. Take the child to the playroom at least once a day. D. Encourage active and passive range of motion exercises once a day.

B. Offer age-appropriate toys and diversional activities.

The child has been diagnosed with slipped capital femoral epiphysis. Which of the following characteristics about the patient is risk factor associated with the development of this condition? Select all that apply. A. The child is noted to be underweight by the nurse. B. The child is 13 years old. C. The child is African American. D. The child's parents state that the child has recently experienced a "growth spurt." E. The child is mal

B. The child is 13 years old. C. The child is African American. D. The child's parents state that the child has recently experienced a "growth spurt." E. The child is mal

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? A. "This medication will help to increase bone mineral density." B. "My child's risk for fractures will hopefully be decreased as by taking this medication." C. "This medication will cure my child of this disorder." D. "This medication doesn't prevent fractures from happening."

C. "This medication will cure my child of this disorder."

The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? A. "At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better." B. "Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon." C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet." D. "Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own."

C. "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet."

A 3-year-old child is admitted to the hospital with osteomyelitis of the right femur. The nurse would expect to start an IV and antibiotic after blood is drawn for which lab test? A. Hemoglobin and hematocrit B. White blood cell count C. Culture D. Platelets

C. Culture

In the emergency room, the nurse is assessing a toddler who is currently being treated for a radius fracture and has a history of multiple fractures. The assessment reveals short stature, blue sclera, and no bruising or swelling at the fracture site. The nurse suspects: A. Child abuse. B. Attention deficit/hyperactivity disorder. C. Osteogenesis imperfecta. D. Lack of parental supervision.

C. Osteogenesis imperfecta.

A nurse assesses a client who is complaining of calf pain, has a temperature of 101°F (38.3°C) and reports that his leg is very sore. X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and his erythrocyte sedimentation rate is elevated. What problem do these symptoms suggest? A. Muscular dystrophy B. Legg-Calves-Perth disease C. Osteomyelitis D. Compartment syndrome

C. Osteomyelitis

The nurse receives a report from the admission department that a child with a slipped femoral epiphysis is en route to the care area. For which type of child should the nurse begin to plan care? A. Tall, thin female B. Preadolescent female C. Active school-age male D. Obese preadolescent male

D. Obese preadolescent male