Musculoskeletal - NCLEX-Style Questions

Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is? 1. It is a fracture located in the growth plate of the bone. 2. Because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture. 3. It is a fracture in which a complete break occurs in the bone, and small pieces of bone are broken off. 4. It is a fracture that does not go all the way through the bone.

4. It is a fracture that does not go all the way through the bone.

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take? 1. Administer an analgesic. 2. Release the skin traction. 3. Apply ice to the extremity. 4. Notify the health care provider (HCP).

4. Notify the health care provider (HCP).

A 9-year-old is in a spica cast and complains of pain 1 hour after receiving intravenous opioid analgesia. What should the nurse do first? 1. Give more pain medication. 2. Perform a neuromuscular assessment. 3. Call the surgeon for orders. 4. Change the child's position.

2. Perform a neuromuscular assessment.

Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed? Select all that apply. 1. "Your child will need to wear a brace on the feet 23 hours a day for 12 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 3. "Your child will not be able to participate in sports that require a lot of running." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally." 6. "Most children treated for clubfeet require surgery at puberty."

1. "Your child will need to wear a brace on the feet 23 hours a day for 12 months." 2. "Your child should see an orthopedic surgeon regularly until the age of 18 years." 4. "Your child may have a recurrence of clubfoot in a year or more." 5. "Most children treated for clubfeet develop feet that appear and function normally." Rationale: After the final casting, bracing is required for 12 months. This decreases the likelihood of a recurrence. Because clubfoot can recur, it is important to have regular follow-up with the orthopedic surgeon until age 18 years. Even with proper bracing, there may be a recurrence. Most children treated for clubfeet develop normally appearing and functioning feet.

A 13-year-old just returned from surgery for scoliosis. Which nursing intervention is appropriate in the first 24 hours? Select all that apply. 1. Assess for pain. 2. Logroll to change positions. 3. Get the teen to the bathroom 12 to 24 hours after surgery. 4. Check neurological status. 5. Monitor blood pressure.

1. Assess for pain. 2. Logroll to change positions. 4. Check neurological status. 5. Monitor blood pressure. Rationale: Patients may not be upright less than 24 hours postoperatively.

Which instruction should the nurse give the parents of an adolescent with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Continue upper body exercises to limit loss of muscle strength. 2. Do not turn the teen in bed when complaining of pain. 3. Provide homework, computer games, and other activities to decrease boredom. 4. Do most activities of daily living for the teen. 5. Expect expressions of anger and hostility. 6. Continue setting limits on behavior.

1. Continue upper body exercises to limit loss of muscle strength. 3. Provide homework, computer games, and other activities to decrease boredom. 5. Expect expressions of anger and hostility. 6. Continue setting limits on behavior. Rationale: Immobilization can lead to a decrease in muscle strength. Upper body exercises should be continued soon after surgery. It is important for this client to continue as many normal activities as possible. This should include schoolwork and leisure activities. Some expressions of anger and hostility are normal, because this adolescent is losing some independence with this immobility. Continuation of setting limits on behavior is important to keep as much normality as possible.

Which can occur in untreated developmental dysplasia of the hip (DDH)?Select all that apply. 1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. 4. Osteoporosis in adulthood. 5. Increased flexibility of the hip joint in adulthood.

1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. Rationale: Due to abnormal hip joint function, the client's gait is stiff and waddling. Due to abnormal femoral head placement, the client may experience pain and decreased flexibility in adulthood. Due to abnormal femoral head placement, the client may experience osteoarthritis in the hip joint in adulthood.

A 14-year-old with osteogenesis imperfecta (OI) is confined to a wheelchair. Which nursing interventions will promote normal development? Select all that apply. 1. Encourage participation in groups with teens who have disabilities or chronic illness. 2. Encourage decorating the wheelchair with stickers. 3. Encourage transfer of primary care to an adult provider at age 18 years. 4. Allow the teen to view the radiographs. 5. Help the teen set realistic goals for the future. 6. Discourage discussion of sexuality, because the child is not likely to date.

1. Encourage participation in groups with teens who have disabilities or chronic illness. 2. Encourage decorating the wheelchair with stickers. 4. Allow the teen to view the radiographs. 5. Help the teen set realistic goals for the future. Rationale: It is not necessarily appropriate to transfer health care at age 18 years. If the teen is with a provider who has known the client and family most of the teen's life, it might be best to remain with that provider for several more years.

The nurse is teaching about congenital clubfoot in infants. The nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when? 1. Immediately after diagnosis. 2. At age 4 to 6 months. 3. Prior to walking (age 9 to 12 months). 4. After walking is established (age 15 to 18 months).

1. Immediately after diagnosis. Rationale: The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made, usually at birth.

The nurse tells the parent that other conditions can be associated with congenital clubfoot. Select all that apply. 1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism. 4. Breech position in utero. 5. Prematurity. 6. Fetal alcohol spectrum disorder.

1. Myelomeningocele. 2. Cerebral palsy. 3. Diastrophic dwarfism.

Which factor is associated with slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. Obesity. 2. Female gender. 3. Family history of SCFE. 4. Age of 5 to 9 years. 5. Pubertal hormonal changes. 6. Endocrine disorders.

1. Obesity. 3. Family history of SCFE. 5. Pubertal hormonal changes. 6. Endocrine disorders. Rationale: Obesity increases the risk of SCFE by stressing the epiphyseal plate. SCFE is most common during pubertal hormonal changes. SCFE is associated with endocrine disorders such as hyperthyroidism.

When planning a rehabilitative approach for a child with osteogenesis imperfecta (OI), the nurse should prevent which of the following? Select all that apply. 1. Positional contractures and deformities. 2. Bone infection. 3. Muscle weakness. 4. Osteoporosis. 5. Misalignment of lower extremity joints.

1. Positional contractures and deformities. 3. Muscle weakness. 4. Osteoporosis. 5. Misalignment of lower extremity joints. Rationale: There is no increased risk of bone infection in OI

After the birth of an infant with clubfoot, the nursery nurse should do which of the following when instructing the parents? Select all that apply. 1. Speak in simple language about the defect. 2. Avoid the parents unless providing direct care so that they can grieve privately. 3. Keep the infant's feet covered at all times. 4. Present the infant as precious; emphasize the well-formed parts of the body. 5. Tell the parent that defects could be much worse. 6. Be prepared to answer questions multiple times.

1. Speak in simple language about the defect. 4. Present the infant as precious; emphasize the well-formed parts of the body. 6. Be prepared to answer questions multiple times.

A nurse is caring for a 5-year-old who has a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that: 1. This is a serious injury that could cause long-term growth issues. 2. The fracture usually heals within 6 weeks without further complications. 3. The child will never be able to play contact sports. 4. Fractures involving the growth plate require pain medication.

1. This is a serious injury that could cause long-term growth issues.

When counseling the parents of a child with osteogenesis imperfecta (OI), the nurse should include which of the following? Select all that apply. 1. Discourage future children because the condition is inherited. 2. Provide education about the child's physical limitations. 3. Give the parents a letter signed by the primary care provider explaining OI. 4. Provide information on contacting the Osteogenesis Imperfecta Foundation. 5. Encourage the parents to treat the child like their other children. 6. Encourage use of calcium to decrease risk of fractures.

2. Provide education about the child's physical limitations. 3. Give the parents a letter signed by the primary care provider explaining OI. 4. Provide information on contacting the Osteogenesis Imperfecta Foundation. Rationale: Genetic counseling should be provided as part of long-term care so that the parents can make an informed decision about future children. The nurse should provide education about the child's physical limitations so that physical therapy and appropriate activity can be encouraged. OI is frequently confused with child abuse. Carrying a letter stating that the child has OI and what that condition looks like can ease the stressors of an emergency department visit. The Osteogenesis Imperfecta Foundation is an organization that can provide information and support for a family with a child with the condition. Children with OI must be treated with careful handling and cannot be allowed to participate in all activities that unaffected siblings are allowed. There is no support for the use of additional calcium to decrease fractures.

A spinal curve of less than __________ degrees that is nonprogressive does not require treatment for scoliosis.

20 degrees Rationale: A 20-degree spinal curve that is nonprogressive will not disfigure or interfere with normal functioning, so it is not treated with bracing or surgery.

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? Select all that apply. 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone. 5. Positive Ortolani test.

3. Asymmetry of gluteal and thigh folds. 5. Positive Ortolani test. Rationale: In DDH, a newborn can have excessive hip adduction. In DDH, an appearance of femoral shortening is frequently present on the affected side. In DDH, asymmetrical thigh and gluteal folds are frequently present. Infants do not experience pain from this condition. The Ortolani maneuver moves a disclocated hip back into the socket with a distinct clunk.

The parent of a 3-week-old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. Which intervention should the nurse suggest the parent do first? 1. Give pain medication. 2. Reposition the infant in the crib. 3. Check the neurocirculatory status of the foot. 4. Use a cool blow-dryer to blow into the cast to control itching.

3. Check the neurocirculatory status of the foot.

Which should be included in teaching a family about postsurgical care for slipped capital femoral epiphysis (SCFE)? Select all that apply. 1. The client will receive help with weight-bearing ambulation 24 to 48 hours after surgery. 2. Monitoring of pain medication to prevent drug dependence. 3. Instruction on pin site care. 4. Offering low-calorie meals to encourage weight loss. 5. Correct use of crutches by the client. 6. Exercises to strengthen hip and leg muscles.

3. Instruction on pin site care. 5. Correct use of crutches by the client. 6. Exercises to strengthen hip and leg muscles. Rationale: The parents will be assessing pin sites for infection and stability upon discharge. Instructions on care should be demonstrated for and then by the parents. Instruction on crutch usage will be given prior to discharge. Crutch walking will not be done during the early postoperative stage. The physical therapist will give the client exercises to strengthen the hip and leg muscles.

A 12-year-old diagnosed with scoliosis is to wear a brace for 23 hours a day. What is the most likely reason the child will not wear it for that long? 1. Pain from the brace. 2. Difficulty in putting the brace on. 3. Self-consciousness about appearance. 4. Not understanding what the brace is for.

3. Self-consciousness about appearance.

Which should be obtained to make a diagnosis of slipped capital femoral epiphysis (SCFE)? 1. A history of hip trauma. 2. A physical examination of hip, thigh, and knees. 3. A complete blood count. 4. A radiographic examination of the hip.

4. A radiographic examination of the hip. Rationale: Radiographic examination is the only definitive diagnostic tool for SCFE.

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.

4. Check under the straps at least two to three times daily for red areas. Rationale: Checking under straps frequently is suggested to prevent skin breakdown. Socks should be put on under the straps to prevent rubbing of the skin. The harness is stable if fitted correctly. Lotions and powders tend to cake and irritate under the straps. Their use is not recommended. The harness is not to be removed except in specific conditions and after instruction on removal and refitting. Diapering is easily done with the harness in place.

The nurse caring for an adolescent client newly diagnosed with scoliosis who is ordered to wear a brace. Which action should the nurse take first? A) Auscultate lung and heart sounds B) Obtain a physical therapy consultation C) Measure the client's shoulder levels and the heights of their anterior and posterior superior iliac spines. D) Refer the client to a community support group

A) Auscultate lung and heart sounds Rationale: Auscultate lung and heart sounds Since scoliosis can cause cardiopulmonary compromise, the nurse should begin by assessing the client's vital signs and auscultating lung and heart sounds, taking note of any signs or symptoms of cardiopulmonary compromises, such as dyspnea, chest pain, blue-tinged extremities, increased blood pressure, or increased pulse.

The nurse is caring for an adolescent client in the emergency department who sustained an ankle fracture while playing basketball. Which intervention(s) should be implemented for this client? Select all that apply. A) Elevate the ankle B) Assess capillary refill on bilateral toes C) Apply topical lidocaine to the ankle D) Immobilize the ankle E) Apply an ice pack to the ankle

A) Elevate the ankle B) Assess capillary refill on bilateral toes D) Immobilize the ankle E) Apply an ice pack to the ankle Rationale: Nursing interventions for clients diagnosed with a fracture include immobilization of the injured area, application of ice, and elevation of the extremity to reduce swelling. Neurovascular status of clients diagnosed with a fracture should be monitored frequently to ensure that there is adequate blood flow to the affected limb.

A 1-month-old infant is seen in a clinic and diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding would be noted in this condition? A) Limited range of motion in the affected hip B) An apparent lengthened femur on the affected side. C) Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed D) Symmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

A) Limited range of motion in the affected hip

Which measure is important in managing hypercalcemia in a child who is immobilized? A) Promote adequate hydration. B) Change position frequently. C) Encourage eating a diet high in calcium. D) Provide a diet that is high in protein and calories.

A) Promote adequate hydration. Rationale: Hydration is extremely important to help remove the excess calcium from the body. This can help prevent hypercalcemia.

Which is a characteristic of fractures in children? A) Rapidity of healing is inversely related to the age of the child. B) Fractures rarely occur at the growth plate site because it absorbs shock well. C) Pliable bones of growing children are less porous than those of the adult, thus slower to heal. D) The periosteum of a child's bone is thinner, weaker, and has less osteogenic potential compared with that of the adult.

A) Rapidity of healing is inversely related to the age of the child. Rationale: Fractures heal in children in less time than they do in adults. As the child ages, the healing time increases.

The nurse is caring for an adolescent client newly diagnosed with scoliosis with a spinal curvature of 35 degrees. Which treatment should the nurse review with the client and their guardian? A) Thoracic lumbar-sacral orthosis B) Stapling C) Physical therapy D) Body tethering

A) Thoracic lumbar-sacral orthosis Rationale: Curvatures that range from 25 to 40 degrees are treated with thoracic, lumbar-sacral orthosis, which is a bracing where a stiff torso armor is worn to slow the progression of the abnormal curvature

A *youngster* has just returned from surgery in a hip spica cast. The priority nursing intervention is to: A) check lower extremity circulation. B) elevate the head of the bed. C) turn the child to the right side. D) offer sips of water.

A) check lower extremity circulation. Rationale: The chief concern is that the extremity may continue to swell. This must be assessed to ensure that the cast does not become a tourniquet. Think about compartment syndrome.

A 4-year-old child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm, and a plaster cast is applied. The nurse provides instructions to the parents regarding care for the child's cast. Which statement by the parents indicates a *need for further instruction*? A) "The cast may feel warm as the cast dries B) "I can use lotion or powder around the cast edges to relieve itching C) "A small amount of white shoe polish can touch up a spoiled white cast D) If the cast becomes wet, a blow-dryer set on the cool setting may be used to dry the cast.

B) "I can use lotion or powder around the cast edges to relieve itching

Which statement is true concerning osteogenesis imperfecta? A) It is easily treated. B) It is an inherited disorder. C) Later onset disease usually runs a more difficult course. D) Braces and exercises are of no therapeutic value.

B) It is an inherited disorder.

The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm. Which instructions would be included on the list? Select all that apply A) Use the fingertips to lift the cast while it is drying B) keep small toys and sharp objects away from the cast C) Use a padded ruler or another padded object to scratch the skin under the cast if it itches D) Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold E) Elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling F) Contact the primary health care provider (PHCP) if the child complains of numbness or tingling in the extremity

B) keep small toys and sharp objects away from the cast E) Elevate the extremity on pillows for the first 24-48 hours after casting to prevent swelling F) Contact the primary health care provider (PHCP) if the child complains of numbness or tingling in the extremity

The nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a *need for further instructions*? A) "I will encourage my child to perform prescribed exercises." B) "I will have my child wear soft fabric clothing underneath the brace." C) "I need to apply lotion under the brace to prevent skin breakdown." D) "I need to avoid the use of power because it will cake under the brace."

C) "I need to apply lotion under the brace to prevent skin breakdown."

Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicated a *need for further teaching* regarding this disorder? A) "Treatment needs to be started as soon as possible." B) "I realize my infant will require follow-up care until fully grown." C) "I need to bring my infant back to the clinic in 1 month for a new cast." D) "I need to come to the clinic every week with my infant for the casting."

C) "I need to bring my infant back to the clinic in 1 month for a new cast."

The nurse is assisting a primary health care provider (PHCP) in the examination of a 3-week-old infant with developmental dysplasia of the hip. What test or sign would the nurse expect the PHCP to assess? A) Babinski's sign B) Moro reflex C) Ortolani's maneuver D) Palmar-plantar grasp

C) Ortolani's maneuver

A nurse is caring for an immobilized preschool child. Which would be helpful during this period of immobilization? A) Encourage the child to wear pajamas. B) Let the child have few behavioral limitations. C) Take the child for a "walk" by wagon outside the room. D) Keep the child away from other immobilized children if possible.

C) Take the child for a "walk" by wagon outside the room. Rationale: It is important for children to have activities outside of the room if possible. This increases environmental stimuli and provides social contact with others.

The nurse suspects a 12-year-old client has scoliosis based on history and physical assessment. Which testing should the nurse prepare the client for to confirm the diagnosis of this condition? A) Forward bend test B) Magnetic resonance imaging (MRI) C) X-ray D) Computed tomography (CT) scan

C) X-ray Rationale: Screening for scoliosis is commonly performed during adolescence. Screening tests include visual inspection of the spine and back and palpation to check for abnormal curvatures. A diagnosis of scoliosis consists of the client's history and physical assessment. A scoliometer, a small instrument placed over the spine while the client is bending forward at the waist to measure the extent of the spinal rotation, might be used. This will then help determine whether or not a client requires further evaluation with an X-ray. The amount of spinal curvature is measured by the Cobb angle, which is determined by measuring between two lines drawn perpendicular to the upper border of the uppermost vertebrae and the lower edge of the lowest vertebrae involved in the curvature. Finally, a computed tomography (CT) scan and magnetic resonance imaging (MRI) might be needed for the preoperative assessment of clients who require surgical intervention.

An adolescent who has had a lower leg amputated after a motorcycle accident complains of pain in the missing extremity. The nurse recognizes that this complaint is: A) indicative of narcotic addiction. B) unexpected and suggests nerve damage. C) expected and called "phantom limb sensation." D) indicative of the need for psychological counseling.

C) expected and called "phantom limb sensation."

An infant is born with one lower limb deficiency. The optimum time for the child to be fitted with a prosthetic device is: A) as soon as possible after birth. B) about age 12 to 15 months, when most children are walking. C) when the infant begins sitting up and can maintain balance. D) about 4 years of age, when the healthy limb is not growing so rapidly.

C) when the infant begins sitting up and can maintain balance. Rationale: When the infant begins sitting up and can maintain balance is the most optimum time for the child to be fitted with a prosthetic device. The child is ready to stand, and the prosthetic device will be integrated into capabilities.

A child is placed on skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and would include which intervention. A) Ensure that all ropes are outside the pulleys B) Ensure that the weights are resting lightly on the floor C) Restrict diversional and play activities until the child is out of traction D) Check the primary health care provider's prescriptions for the amount of weight to be applied.

D) Check the primary health care provider's prescriptions for the amount of weight to be applied.

Which is a secondary effect when a child has 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 Rationale: Muscle disuse leads to tissue breakdown and loss of muscle mass. It may take weeks or months to recover.

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse notes abdominal distention. On the basis of these findings, the nurse would take which action? A) Administer an antiemetic B) Increase the IV fluids C) Place the child in a left lateral position D) Notify the primary health care provider

D) Notify the primary health care provider

The callus that develops at the fracture site is important because it provides: A) functional use of the injured part. B) means for adequate blood supply. C) sufficient support for weight bearing. D) means for holding bone fragments together.

D) means for holding bone fragments together. Rationale: New bone cells are formed in large numbers and are stimulated to maximum activity. They are found at the site of the injury. In time, calcium salts are absorbed to form the callus.

The rationale for elevating an extremity after a soft tissue injury such as a sprained ankle is that it: A) increases metabolism in the tissues. B) produces a deep tissue vasodilation. C) increases the pain threshold. D) reduces edema formation.

D) reduces edema formation. Rationale: Elevating the extremity uses gravity to facilitate venous return to reduce edema.