Musculoskeletal- Family questions

Sports injuries are commonly associated with: a. Improper training b. Higher frequency in females c. Scoliosis d. Low socioeconomic status

A

A nurse is assessing a child who has Legg‑Calve‑Perthes disease. Which of the following findings should the nurse expect? (Select all that apply.) A. Longer affected leg B. Hip stiffness C. Intense pain D. Limited ROM E. Limp with walking

B, D, E A child who has Legg‑Calve‑Perthes exhibits hip stiffness, limited ROM and a limp due to the necrosis of the femoral head.

The nurse is providing instructions about how to treat a sprained ankle. The nurse will recognize the need for additional teaching when the mother states: a. "Apply warm compresses to the ankle for the first 24 hours." b. "Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off." c. "Wrap the ankle in an Ace bandage for support." d. "Keep the leg elevated when sitting."

ANS: A Heat is not a treatment for soft tissue injuries. The principles of managing soft tissue injuries are rest, ice, compression, and elevation

The nurse demonstrates which similarities among all traction devices? Select all that apply. a. Pull the limb into extension b. Decrease muscle spasm c. Reduce pain d. Align two bone fragments e. Immobilize the limb

ANS: A, B, D, E Tractions are designed to immobilize and pull limbs into extension. Traction can also align broken bones and decrease muscle spasm. Although some traction devices may relieve pain, many may actually cause pain.

The interventions that would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis would be: a. wearing splints at night to prevent extension contractures. b. applying moist heat packs upon awakening. c. taking a warm tub bath the evening before. d. sleeping with two pillows under the head.

ANS: B Application of moist heat, with a compress or by tub bath upon awakening, will help to lessen stiffness.

The nurse notes as an abnormal finding on a musculoskeletal assessment of a 4-year-old that the child: a. has inward-turned knees while standing. b. walks on the toes. c. appears to have flat feet. d. swings his arms when walking.

ANS: B Toe walking after 3 years of age may indicate a muscle problem

The nurse providing instructions to an adolescent who has been fitted with a Milwaukee brace would teach the patient to: a. wear the brace directly against the skin. b. wear the brace over regular clothing. c. wear the brace over a T-shirt 23 hours a day. d. remove the brace before sleeping.

ANS: C A Milwaukee brace is worn approximately 23 hours a day over a T-shirt, which protects the skin

The nurse caring for a child with Duchenne's muscular dystrophy notes a characteristic manifestation, which is that the child: a. ambulates by holding onto furniture. b. exhibits atrophy of the calf muscles. c. falls frequently and is clumsy. d. has delayed fine-motor development.

ANS: C Frequent falling and clumsiness are clinical manifestations of Duchenne's muscular dystrophy.

The nurse performing a neurovascular check on a limb in traction would report and document which finding(s) as indicative of altered circulation? Select all that apply. a. Pulse is equal to uncasted limb. b. Patient is aware of touch and warm and cold application. c. Limb is cool to the touch. d. Capillary refill is 5 seconds. e. Distal limb can flex and extend.

ANS: C, D The limb should be warm, and capillary refill should be less than 3 seconds

The nurse explains that the child's fracture heals more rapidly than the adult's because the child's bones: a. are less porous than adult bone. b. are covered by a thicker periosteum. c. are not affected by bone overgrowth. d. have faster callus formation.

ANS: D Callus forms more rapidly in the child than the adult

A school nurse suspects that a child who fell at recess has a fractured arm. Which should the nurse consider when applying a splint to transport the child to the hospital? 1. The splint is applied firmly enough to prevent swelling. 2. The arm is fully extended in the splint. 3. The splint is fully padded to prevent skin damage. 4. The joints above and below the suspected fracture are immobilized by the splint.

Answer: 4 Explanation: 1. The purpose of the splint is not to prevent swelling. 2. The nurse will not want to manipulate the arm, so the nurse will splint the arm in the position it is found. 3. The splint does not need to be padded. 4. This is the important concept in splinting—immobilizing the joint above and below the fracture to prevent movement of the bones.

Most children with Duchenne muscular dystrophy become wheel-chair dependent by what age? a. 7 to 9 years of age b. 10 to 12 years of age c. 14 to 16 years of age d. Highly variable depending on response to treatment

B

What is the cause of structural scoliosis?. a. Poor posture b. Vertebral rotation c. Poor calcium absorption d. Intrauterine trauma

B

Which of the following diagnoses is associated with contracture of one of the sternocleidomastoid muscles? a. Lordosis b. Torticollis c. Scoliosis d. Kyphosis

B

What assessments would you make of a 3 year old with a diagnosis of Duchenne's muscular dystrophy? A. lethargy, pallor, and a low hemoglobin B. uses his hands to push himself off the floor from a sitting position C. mild mental retardation or cognitive delay D. seizure activity

B. uses his hands to push himself off the floor from a sitting position

Initial treatment of a sprain includes which of the following? a. Rest, ice, compression, elevation, and NSAIDs b. Heat, ROM exercise, compression, elevation, and NSAIDs c. Rest, heat, compression, elevation, and NSAIDs d. Rest, ice, ibuprofen, compression, and NSAIDs

A

Signs and symptoms associated with Duchenne muscular dystrophy are: a. History of delayed developmental milestones b. Visual-motor disturbance, calf hypertrophy c. Delayed motor development, positive Ortolani maneuver d. History of "clumsiness," visual-moto disturbance

A

Systemic-onset JIA is most commonly associated with: a. High, daily intermittent spiking fevers and rash b. Single joint involvement c. Positive RF factor d. Painless joint involvement

A

In Legg-Calvé-Perthes disease, which of the following signs and symptoms are seen? a. Insidious onset of limp with knee and groin pain b. Sudden onset of limp and pain in lateral hip c. Fever and insidious onset of limp d. Afebrile and sudden onset of limp

A.

A 9 year old child is in the hospital in skin traction after sustaining a simple fracture of the femur. Which of the following assessments should the nurse make during rounds with the child's orthopedist? The nurse should assess the: (Select all that apply) A. child's level of pain B. child's bowel sounds C. capillary refill of the child's toes D. skin under the bandage for signs of skin breakdown E. wound for signs of redness, edema, ecchymosis, drainage and approximation

A. child's level of pain B. child's bowel sounds C. capillary refill of the child's toes D. skin under the bandage for signs of skin breakdown

A nurse is caring for a school age child who has juvenille idiopathic arthritis. Which of the following are appropriate home care instructions. (Select all that apply) A. sleep on a firm mattress B. use cold compress for joint pain C. take ibuprofen (Motrin) on an empty stomach D. take frequent rest periods throughout the dayE. perform range of motion exercises

A. sleep on a firm mattress D. take frequent rest periods throughout the day E. perform range of motion exercises

A 6-year-old sustained a fractured femur and was put in Russell traction 2 days ago. She screams in pain when she raises herself onto the bedpan. The nursing diagnosis that takes highest priority for this child is: a. pain resulting from tissue trauma. b. high risk for impaired skin integrity resulting from immobility. c. altered growth and development related to separation from family. d. altered urinary elimination related to immobility and traction.

ANS: A Although all of these nursing diagnoses are relevant to the child in traction, pain resulting from muscle spasm and tissue trauma is the highest priority. The nurse

The observation that may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs is: a. red, green, and yellow bruises on his body. b. bruises are dispersed on his head, arms, and legs. c. a broken arm last year, and the child being described as accident-prone. d. the mother is very anxious for her son to get medical attention.

ANS: A As bruises heal, they change color in stages. Different colors of bruises indicate that injuries have not all occurred at the same time. The nurse must consider whether the bruises match the caretaker's explanation of what happened.

Which statement is true regarding the pain experienced with Legg-Calvé-Perthes disease? a. Pain experienced with Legg-Calvé-Perthes disease in the elbows and upper and lower arms is aggravated by activity and relieved by rest. b. Pain experienced with Legg-Calvé-Perthes disease in the knees, inner thighs, and groin is described as a continuous ache and relieved by antiinflammatory drugs. c. Pain experienced with Legg-Calvé-Perthes disease in the knees, inner thighs, and groin is aggravated by activity and relieved by rest. d. Pain experienced with Legg-Calvé-Perthes disease in the elbows and upper and lower arms is described as a continuous ache and relieved by antiinflammatory drugs.

C. Pain experienced with Legg-Calvé-Perthes disease in the knees, inner thighs, and groin is aggravated by activity and relieved by rest.

An 8 year old child has been diagnosed with Legg-Calve-Perthes disease. Which of the following information statements should the nurse include in the patient teaching regarding the illness? A. "You will have to stay home from school and lean from a tutor until you get better" B. "The infection in your bone will be treated with a special medication that you will receive through your vein" C. "You will use crutches and be allowed to walk only on your healthy leg until your bones are all better" D. "The cast must stay on your ankle and calf for a few weeks until they are fully healed."

C. "You will use crutches and be allowed to walk only on your healthy leg until your bones are all better"

A 6-year-old child presents with a limp and knee pain. The PNP finds limited passive internal rotation and abduction of the hip joint on physical examination. The most likely diagnosis is: a. Slipped capital femoral epiphysis b. Osgood-Schlatter disease c. Transient synovitis of the hip d. Legg-Calvé-Perthes disease

D

Which of the following statements is not true of slipped capital femoral epiphysis? a. Thought to be precipitated by hormone changes during puberty b. Unilateral involvement is more common than bilatera c. More common among males and African- Americans d. Thought to be caused by repetitive stresses in young athletes prior to growth spurt

D

Which of the following statements is true regarding slipped capital femoral epiphysis? a. More common in females b. Generally occurs following severe sudden trauma c. Incidence more common in athletes d. The goal of treatment is to stabilize or improve the position of the femoral head

D

A nurse is caring for a child who is suspected of having Legg‑Calve‑Perthes disease. The nurse should prepare the child for which of the following diagnostic procedures? A. Bone biopsy B. Genetic testing C. MRI D. Radiographs

D. A child who has Legg‑Calve‑Perthes exhibits necrosis of the femoral head and can be diagnosed by radiographs of the hip and pelvis.