Musculoskeletal or Articular Dysfunction

Therapeutic management of the patient with systemic lupus erythematosus includes: o cold salts to suppress the inflammatory process. o a high-protein, low-salt diet. o an exercise regimen to build up muscle strength and endurance. o corticosteroids to control inflammation.

o corticosteroids to control inflammation. This will not affect the inflammatory process. A balanced diet without exceeding caloric expenditures is recommended. Exercise should be done in moderation. Currently this is the primary mode of therapy.

Which of the following can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

A (Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi.)

When assessing the child with osteogenesis imperfecta, the nurse should expect to observe: a. Discolored teeth. b. Below-normal intelligence. c. Increased muscle tone. d. Above-average stature.

A (Children with osteogenesis imperfecta have incomplete development of bones, teeth, ligaments, and sclerae. Teeth are discolored because of abnormal enamel. Despite their appearance, children with osteogenesis imperfecta have normal or above-normal intelligence. The child with osteogenesis imperfecta has weak muscles and decreased muscle tone. Because of compression fractures of the spine, the child appears short.)

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe (Select all that apply)? a. Positive Ortolani sign b. Unequal gluteal folds c. Negative Babinski's sign d. Trendelenburg's sign e. Telescoping of the affected limb f. Lordosis

A, B (A positive Ortolani sign and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Negative Babinski's sign, Trendelenburg's sign, telescoping of the affected limb, and lordosis are not clinical manifestations of developmental dysplasia of the hip.)

An advantage to using a fiberglass cast instead of a plaster cast is that a fiberglass cast: a. Is less expensive. b. Dries rapidly. c. Molds closely to body parts. d. Has a smooth exterior.

B (A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast, which takes 10 to 72 hours to dry. Synthetic casts are more expensive. Plaster casts mold closer to body parts. Synthetic casts have a rough exterior, which may scratch surfaces.)

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 a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. Osteogenesis imperfecta is an inherited disorder. The type of disease determines the course it will take. Lightweight braces and splints can help support limbs and fractures.)

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

B (The device will not be useful until the child is developmentally ready to use the leg. This 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 his or her capabilities.This may be too late. The device should be provided when the child is showing readiness to stand. This is too late.)

An adolescent is in traction. The purpose of the traction is to fatigue the muscle and reduce muscle spasm so that the bones can be realigned. Nursing actions should include which of the following? a. Maintain continuous traction until muscle spasm ceases. b. Maintain continuous traction to prevent muscle from contracting. c. Release traction every hour to allow muscle to briefly regain its contractibility. d. Release traction once every 8 hours to allow muscle to briefly regain its contractibility.

B (When the muscles are stretched, muscle spasm ceases and permits realignment of the bone ends. The continued maintenance of traction is important during this phase because releasing the traction allows the muscle's normal contracting ability to again cause of malpositioning of the bone ends.)

The nurse manager on the orthopedic unit is preparing an in-service about types of traction at the next staff meeting. The nurse manager should include which information in the presentation? (Select all that apply.) A. Skeletal traction is most likely used when closed reduction is performed. B. Skin traction can be applied using a pulling mechanism attached with adhesive material. C. Soft, foam-backed traction straps are used to distribute manual traction pull. D. Pins are commonly used with skeletal traction. E. Manual traction involves using wires or tongs inserted through the diameter of the bone distal to the fracture.

B, D (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. 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. 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.)

Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's? a. Growth occurs in children as a result of an increase in the number of muscle fibers. b. Infants are at greater risk for fractures because their epiphyseal plates are not fused. c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. d. Children's bones have less blood flow.

C (Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. A child's growth occurs because of an increase in size rather than an increase in the number of the muscle fibers. Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. A child's bones have greater blood flow than an adult's bones.)

When infants are seen for fractures, which nursing intervention is a priority? a. No intervention is necessary. It is not uncommon for infants to fracture bones. b. Assess the family's safety practices. Fractures in infants usually result from falls. c. Assess for child abuse. Fractures in infants are often nonaccidental. d. Assess for genetic factors.

C (Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. Infants should be cared for in a safe environment and should not be falling. Fractures in infancy are usually nonaccidental rather than related to a genetic factor.)

Which of the following types of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop b. Bryant c. Russell d. Buck extension

C (Russell traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position.)

A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI). Further teaching is indicated if the parents make which statement? a. "We will be very careful handling the baby." b. "We will lift the baby by the buttocks when diapering." c. "We're glad there is a cure for this disorder." d. "We will schedule follow-up appointments as instructed."

C (The treatment for OI is primarily supportive. Although patients and families are optimistic about new research advances, there is no cure. The use of bisphosphonate therapy with IV pamidronate to promote increased bone density and prevent fractures has become standard therapy for many children with OI; however, long bones are weakened by prolonged treatment. Infants and children with this disorder require careful handling to prevent fractures. They must be supported when they are being turned, positioned, moved, and held. Even changing a diaper may cause a fracture in severely affected infants. These children should never be held by the ankles when being diapered but should be gently lifted by the buttocks or supported with pillows. Follow-up appointments for treatment with bisphosphonate can be expected.)

A nurse is caring for an 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.) A. Lordosis B. Negative Babinski sign C. Asymmetric thigh and gluteal folds D. Positive Ortolani and Barlow tests E. Shortening of limb on affected side

C, D, E (Asymmetric thigh and gluteal folds are a clinical manifestation of DDH and seen from birth to 2 months old. Positive Ortolani and Barlow tests are clinical manifestations of DDH. Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation. Barlow test is the adducting to feel if the femoral head slips out of the socket posterolaterally. Shortening of limb on affected side is another clinical manifestation of DDH. Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH. A negative Babinski sign is not a clinical manifestation of DDH. It is a neurologic reflex.)

Which of the following is a type of skin traction with legs in an extended position? a. Dunlop b. Bryant c. Russell d. Buck extension

D (Buck extension traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.)

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

D (Functional use cannot occur until the fracture site is stable. Functional use cannot occur until the fracture site is stable. The callus does not provide an adequate blood supply. 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.)

What would cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia c. Increased respirations b. Cold toes d. "Hot spots" felt on cast surface

D (If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so a window can be made in the cast to observe the site. The "five Ps" of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may be indicative of too tight a cast and need further evaluation. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and the child should be evaluated.)

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

D (The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome. The initial therapy is rest and non-weight bearing, which helps reduce inflammation and restore motion. Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient therapy and the child's age at onset)

A 4 year old is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following? a. Encourage normal activity for as long as is possible. b. Explain the cause of the disease to the child and family. c. Prepare child and family for long-term, permanent disabilities. d. Teach family the care and management of the corrective appliance.

D (The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome.)

A nurse is caring for an 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.) o Lordosis o Negative Babinski sign o Asymmetric thigh and gluteal folds o Positive Ortolani and Barlow tests o Shortening of limb on affected side

o Asymmetric thigh and gluteal folds o Positive Ortolani and Barlow tests o Shortening of limb on affected side Asymmetric thigh and gluteal folds are a clinical manifestation of DDH and seen from birth to 2 months old. Positive Ortolani and Barlow tests are clinical manifestations of DDH. Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation. Barlow test is the adducting to feel if the femoral head slips out of the socket posterolaterally. Shortening of limb on affected side is another clinical manifestation of DDH. Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH. A negative Babinski sign is not a clinical manifestation of DDH. It is a neurologic reflex.

What is most descriptive of rhabdomyosarcoma? o Most common sites are head and neck o Common hereditary neoplasm of childhood o Most common bone tumor of childhood o Benign tumor; not commonly found in children

o Most common sites are head and neck Although striated muscle fibers from which this tumor arises can be found anywhere in the body, the most common sites are the head and neck. It is not known to be hereditary. It arises from skeletal muscle tissue, not bone. It is highly malignant.

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

o Rapidity of healing is inversely related to the age of the child. The cartilage epiphyseal plate is the weakest point of the long bone. Therefore, it is a frequent site of damage. Fractures heal in children in less time than they do in adults. As the child ages, the healing time increases. The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs. Bone healing in children is rapid because of the thickened periosteum and generous blood supply.

The nurse manager on the orthopedic unit is preparing an in-service about types of traction at the next staff meeting. The nurse manager should include which information in the presentation? (Select all that apply.) o Skeletal traction is most likely used when closed reduction is performed. o Skin traction can be applied using a pulling mechanism attached with adhesive material. o Soft, foam-backed traction straps are used to distribute manual traction pull. o Pins are commonly used with skeletal traction. o Manual traction involves using wires or tongs inserted through the diameter of the bone distal to the fracture.

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

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

o means for holding bone fragments together. Functional use cannot occur until the fracture site is stable. Functional use cannot occur until the fracture site is stable. The callus does not provide an adequate blood supply. 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.

An appropriate nursing intervention when caring for the child with chronic osteomyelitis is to: o provide active range-of-motion exercises for the affected extremity. o administer antibiotics with meals. o encourage frequent ambulation. o move and turn the child carefully and gently to minimize pain.

o move and turn the child carefully and gently to minimize pain. Active range of motion is contraindicated until pain has subsided. Pain medication should be administered as needed. Ambulation is contraindicated until pain has subsided. Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently.

Major goals of the therapeutic management of juvenile rheumatoid arthritis are to: o prevent joint discomfort and regain proper alignment. o prevent loss of joint function and achieve cure. o prevent physical deformity and preserve joint function. o prevent skin breakdown and relieve symptoms.

o prevent physical deformity and preserve joint function. Once the joint is damaged, it may not be possible to regain proper alignment. It may not be possible to achieve a cure. These are the goals of treatment. A third goal is to control pain. Skin breakdown is usually not an issue in juvenile rheumatoid arthritis.