Alterations in Musculoskeletal Function in Children

A school health nurse is screening for scoliosis. What assessment findings should the nurse look for? (Select all that apply.) A. Uneven shoulders and hips. B. A one-sided rib hump. C. Prominent scapula. D. Lordosis. E. Pain.

ABC

Which of the following nursing interventions are appropriate for a child with muscular dystrophy? (Select all that apply.) A. Suggest swimming as a good exercise for this child. B. Provide resources to the parents related to developmental norms for the child's age. C. Teach the family proper body mechanics. D. Immunize the child on the recommended schedule. E. Encourage the child to perform as much self-care as possible.

ACDE

The nurse is caring for a child in Bryant skin traction. Which nursing interventions ensure proper care of this client? Select all that apply. A. Inspect traction weights regularly to make sure they hang freely. Weights should not touch the floor, bed, or each other. B. Check pin sites and surrounding skin regularly for signs of infection. C. Make sure ropes are positioned properly in the pulley track, the pulleys move freely, and the pulleys hang freely. D. Adjust pulleys and weights to provide the proper pull and alignment on the affect part. E. Place the child in a prone position to maintain good alignment. F. Check the traction frequently to ensure that proper alignment is maintained. G. Check feet for color, pulses, warmth, and sensation, every 2 hours. H. Observe frequently for skin breakdown on both legs. I. Move the child as infrequently as possible to maintain traction.

ACFGH

A fracture to the epiphyseal plate of a child's left arm occurs. What complication may result? A. Early-onset osteoporosis B. Reduced future growth C. Stenosis D. Juvenile arthritis

B

A nurse is caring for a child who has an arm cast. Which of the following is an early sign of altered neurovascular function? A. Decreased capillary refill time. B. Pain, dramatically out of proportion for the severity of injury. C. Inability to detect a pulse distal to the cast. D. Inability to move distal extremity. E. The arm is cool to the touch (the same temperature as the local environment).

B

A nurse is caring for a preschooler who walks but has difficulty keeping up with peers. The nurse is assessing the preschooler for possible right developmental dysplasia of the hip (DDH). Which of the following assessments should the nurse use to assess for DDH? A. Barlow test B. Trendelenburg sign C. Manipulation of right foot and ankle D. Ortolani test

B

A nurse is evaluating the pin sites of a child with an external fixator. The nurse is least concerned with A. Redness and inflammation B. Serous drainage C. Pain at pin site D. Purulent drainage E. Pain and tenderness over the affected area of bone

B

An infant has just returned from surgery for correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The toes on both feet are edematous, but there is color, sensitivity, and movement to them. The nurse should A. Call the physician to report the edema. B. Elevate the legs on pillows. C. Apply a warm, moist pack to the feet. D. Encourage movement of toes.

B

The pediatric nurse is caring for a neonate with congenital clubfoot. The child has a cast to correct the defect. Before discharge, what should the nurse tell the parents? A. The cast will be removed in 6 weeks. B. A new cast is needed every week. C. A short leg cast is applied when the baby is ready to walk. D. The cast will be removed when the baby begins to crawl. E. A foot abduction brace is applied after the first week of casting.

B

A nurse is educating a family about the type of fracture their 8-year-old son has experienced. Which of the following would be an accurate way to explain a closed fracture of the radius to the family? A. "One in which a wound through the overlying soft tissues communicates with the site of the break." B. "One of the bones in the leg is broken incompletely, like a green twig." C. "One of the bones in the arm broke completely and penetrated the skin." D. "One of the bones in the arm broke completely, but did not penetrate the skin." E. "One of the bones in the leg is crushed and broken into little pieces."

D

An 8-year-old boy with Duchenne muscular dystrophy (DMD) is being seen in the clinic for a routine health visit. A high-priority nursing diagnosis for this patient is A. Risk for Falls Related to Breakdown of Muscles. B. Risk for Infection Related to Altered Immune System. C. Risk for Impaired Skin Integrity Related to Loss of Sensation. D. Risk for Corneal Injury Related to Eye Inflammation (Uveitis).

A

The nurse has completed discharge teaching for the family of a child diagnosed with Legg-Calve-Perthes disease. The nurse knows further teaching is needed about the condition if the family states, A. "We're glad this will only take about six weeks to correct." B. "We understand swimming is a good sport for Legg-Calve-Perthes." C. "We know to watch for areas on the skin the brace may rub." D. "We understand that abduction of the affected leg is important."

A

The nurse in the newborn nursery is doing the admission assessment on a neonate. Developmental dysplasia of the hip (DDH) should be suspected when the nurse observes A. Asymmetry of the gluteal and thigh fat folds. B. Trendelenburg sign. C. Telescoping of the affected limb. D. Lordosis.

A

Which statement would reassure the nurse that the parents understand the teaching regarding their 4-year-old with genu valgum? A. "This is a normal developmental issue that will improve as the child grows." B. "Casting will be needed to correct the deformity." C. "This deformity is a manifestation of arthritis and osteoporosis." D. "This deformity was caused by a vitamin D deficiency."

A

Which of the following interventions are appropriate in providing care for a child in skeletal traction? (Select all that apply). A. Make sure the weights hang freely and do not touch the floor. B. Apply an antibiotic ointment around the pin, if ordered. C. Rotate pins every hour while traction is in place. D. After traction equipment is removed, provide skin care every four hours. E. Clean the pins with normal saline, when ordered. F. Adjust the pulleys and weights as needed.

ABDE

A nurse is caring for a school-age child who has juvenile idiopathic arthritis. Which of the following are appropriate home care instructions? (Select all that apply.) A. Sleep on a firm mattress. B. Use cold compresses for joint pain. C. Take ibuprofen (Motrin) on an empty stomach. D. Take frequent rest periods throughout the day. E. Perform range-of-motion exercises when inflammation has subsided.

ADE

Which of the following statements by the mother of a child with osteogenesis imperfecta demonstrates to the nurse understanding of safety measures needed to prevent injury? A. "I will use my hands to gently turn her in the bed." B. "I will use a wrinkle-free lift sheet to reposition her." C. "I will pad her floor with plenty of soft throw rugs." D. "I will confine clutter to just one section of her bedroom floor." E. "I will gently spank her when she misbehaves."

B

Which situation should alert the school nurse that a child requires additional assessment for Legg-Calvé-Perthes disease? A. A 7-year-old girl complaining of a muscle spasm in her calf B. A 7-year-old boy who is limping and states that his hip hurts C. A 10-year-old boy with a fever and complaints of knee pain D. A 16-year-old girl with swollen knees and ankles who is limping

B

Which type of medication is most commonly used to treat juvenile arthritis? A. Glucocorticoids (prednisone) B. Non-steroidal ant-inflammatory drugs (NSAIDs) C. Disease-modifying antirheumatic drugs (DMARDs) D. Biologic response modifiers (immunomodulators)

B

A school nurse is evaluating a child who hurt her leg in gym class. The nurse believes it is a muscle strain, but is still going to refer her to her pediatric nurse practitioner. Which instruction should the child follow until she is seen by the PNP? A. Increase motion to the extremity quickly to increase circulation. B. Try to walk on it, even if she experiences pain. C. Go back to gym class and participate. D. Apply ice for 15 minutes at a time.

D

The school nurse is performing musculoskeletal screening examinations for students in the fifth grade class. The nurse notes that a student's shoulders are at different heights—one shoulder blade is more prominent than the other. The student also has a raised, prominent hip and an uneven waist. These findings may indicate: A. Torticollis. B. Kyphosis. C. Lordosis. D. Scoliosis.

D

Which of the following nursing interventions is most effective in relieving joint stiffness and muscle spasm in a 10-year-old girl with juvenile arthritis? A. Provide support to flexed joints with pillows and pads. B. Position her on her abdomen several times a day. C. Massage the inflamed joints with creams and oils. D. Assist her with heat application and ROM exercises.

D

Match the following fractures to the accurate descriptions. Each item is used only once. 1. Perpendicular to the long axis of bone. 2. Only one cortex of the bone has a fracture. In other words, cracks in only one side of the cortex. 3. Instead of a right angle, the bone has broken at an angle to the long axis of the bone. 4. A twisting motion causes the fracture. A. Greenstick B. Transverse C. Oblique D. Spiral

1 - B 2 - A 3 - C 4 - D

Match the following types of traction to the accurate description. Each item is used only once. 1. Skin traction. Used to TEMPORARILY immobilize a fractured leg or injured knee. Also used to correct lower extremity contractures or deformities. 2. Skin traction. Both lower extremities flexed 90° at hips (even if only one extremity is affected). Keep the buttocks slightly elevated off the bed. Used in children younger than 3 years old to stabilize hips or to reduce femur fractures (developmental hip dysplasia, fractured femur, after bladder exstrophy repair). Traction may be followed by application of a hip-spica cast. 3. Skin traction. Two lines of pull on lower extremity, perpendicular and longitudinal. Fracture of hip or femur (thigh bone). 4. Skin or skeletal traction. Two lines of pull on the arm. Fracture of the humerus (long bone in upper arm) or elbow fracture. 5. Skeletal traction. Used on femur if skin traction isn't suitable. 90degree flexion of both hip and knee; lower extremity in a boot cast. Weights are suspended by a pin through the lower portion of the thighbone. Fracture of femur (thighbone). 6. Skin or skeletal fraction. Stabilizes a spinal fracture or muscle spasm. A. Buck Traction B. Bryant Traction C. Russell's Traction D. Dunlop Traction E. 90-90 Degree Traction F. Cervical Traction

1 - A 2 - B 3 - C 4 - D 5 - E 6 - F

A 14-year-old female will receive a Milwaukee brace to correct scoliosis with a 24 degree curve. Reviewing her discharge instructions, the nurse recognizes that the client has received adequate teaching when she says she will A. Wear the brace all day and remove it only to bathe. B. Put the brace on a minimum of one hour, three times per day. C. Wear the brace after school and at night. D. Take off the brace if her skin gets sore or starts to break down.

A

A child has experienced a sprain of the right ankle. The school nurse should A. Apply ice to the extremity. B. Apply a warm, moist pack to the extremity. C. Perform passive range of motion to the extremity. D. Lower the extremity to below the level of the heart.

A

A child must wear a brace for correction of scoliosis. The nursing diagnosis that should be included in this child's plan of care is A. Risk for Impaired Skin Integrity. B. Risk for Delayed Development. C. Risk for Activity Intolerance. D. Risk for Decreased Cardiac Output. E. Risk for Disuse Syndrome.

A

Care for an infant with osteogenesis imperfecta should include A. Support of the trunk and extremities when moving. B. Traction care. C. Cast care. D. Postop spinal-surgery care.

A

A child with developmental dysplasia of the hip has a spica cast applied. Which action(s) specific to the spica cast should be taken? (Select all that apply) A. Check for cracks or breaks in the cast. B. Ensure the child's head is higher than his feet. C. Assess for circulation, movement, and sensation. D. Measure the blood pressure frequently. E. Auscultate the bowel sounds. F. Use the rod between the child's legs to lift and turn the child. G. Check for swelling and tightness. H. Position with feet elevated above heart level. I. Place a disposable diaper inside the edges of the rear part of the cast.

ABCEGI

A nurse is caring for a child hospitalized for osteomyelitis of the left lower extremity. Which of the following interventions should be included in the child's plan of care? (Select all that apply.) A. Avoid administration of opioid analgesics for pain. B. Administer intravenous antibiotics. C. Encourage increased fluid intake. D. Assess for rising ESR levels, which indicate healing. E. Assess the child for signs of infection. F. Ambulate three times daily, to prevent blood clots.

BCE

A nurse is assessing a child after a fractured femur. Signs that compartment syndrome is occurring are: (Select all that apply.) A. Pink, warm extremity. B. Pain not relieved by pain medication. C. Dorsalis pedis pulse present. D. Prolonged capillary-refill time with paresthesia.

BD

A nurse is caring for a child who has just received a cast. Which of the following considerations is important in providing care for this child? A. Apply powder to the inside edges of the cast to help decrease moisture. B. When handling the cast in the first 24 hours, use fingertips only. C. Assess the casted extremity every 15-30 minutes the first two hours after cast application. D. Give the child a blunt object to help with the itching under the cast. E. To decrease irritation, put lotion on the skin.

C

A nurse notes blue sclerae during a newborn assessment. The infant should be checked for A. Anemia. B. Juvenile idiopathic arthritis. C. Osteogenesis imperfecta. D. Muscular dystrophy. E. Hypoxia of tissue. F. Elevated bilirubin.

C

The nurse is teaching family members how to care for their infant in a Pavlik harness to treat congenital developmental dysplasia of the hip. The nurse should include in the parental education to A. Apply lotion or powder to minimize skin irritation. B. Put clothing over the harness for maximum effectiveness of the device. C. Check at least two or three times a day for red areas under the straps. D. Place a diaper over the harness, preferably using a thin superabsorbent disposable diaper.

C

A nurse is caring for a preschooler who has muscular dystrophy. For which of the following findings should the nurse assess? (Select all that apply.) A. Purposeless, involuntary, abnormal movements B. Spinal defect and sac-like protrusion C. Muscular weakness in lower extremities D. Unsteady, wide-based or waddling gait E. Upward slant to the eyes F. Gower's sign

CDF

A child has just returned from surgery after spinal-fusion surgery. The nurse should check for signs of A. Increased intracranial pressure. B. Seizure activity. C. Impaired pupillary response during neurological checks. D. Impaired color, sensitivity, and movement to lower extremities.

D

A child has been admitted to the hospital with osteomyelitis. Which statement should the nurse understand as correct for this medical diagnosis? A. Cultures should be done immediately after the first dose of antibiotic infuses. B. Antibiotics are ineffective against this virus. C. Penicillin is the antibiotic of choice. D. Antibiotic therapy should continue for 3-6 weeks.

D

A nurse is caring for a toddler who is diagnosed with hip dysplasia and has been placed in a hip spica cast. The child's mother asks the nurse why a Pavlik harness is not being used. Which of the following responses by the nurse appropriately addresses the mother's question? A. "The Pavlik harness is used for children with scoliosis, not hip dysplasia." B. "The Pavlik harness is used for school-age children." C. "The Pavlik harness cannot be used for your child because her condition is too severe." D. "The Pavlik harness is used for infants less than 6 months of age."

D

A nurse performs triage in a pediatric orthopedic clinic. Which of the following should the nurse recognize as a symptom of slipped capital femoral epiphysis (SCFE)? A. Intense knee pain while at rest. B. Presence of a limp in a younger school-age child. C. Painful external rotation of the affected leg. D. Pain in the hip of a preadolescent child.

D

Match the descriptor with the condition. Each term is used only once. 1. Use of arms and hands in rising from a sitting to a standing position by "climbing up the thighs" in grasping and pulling on body parts from the knees to hips. 2. C-shaped (one curve) or S-shaped curvature (two curves) in the spine. 3. Fasciotomy to relieve pressure on nerves and blood vessels 4. Asymmetrical buttock creases, hip click or pop, hips with limited range of motion (hips can't fully spread). 5. Bones in the front half of the foot bend or turn in toward the body. Foot can be manually straightened out. 6. The foot turns inward and downward. Cannot be manually straightened out. 7. Extremely fragile bones 8. Long-term (chronic) disease resulting in joint pain and swelling. May also have red eyes and eye pain (uveitis). 9. A condition in which the knees stay wide apart when the child stands with the feet and ankles together. It is considered normal in children under 2 to 3 years of age. 10. Occurs when the ball of the thighbone in the hip does not get enough blood, causing the bone to die. 11. EOccurs when the femoral head displaces from the femoral neck, most often during the adolescent growth spurt. Happens more in boys than girls. A. Osteogenesis imperfecta B. Developmental dysplasia of the hip C. Scoliosis D. Congenital talipes equinovarus (clubfoot) E. Juvenile idiopathic arthritis F. Muscular dystrophy G. Slipped Capital Femoral Epiphysis (SCFE) H. Legg-Calve-Perthes disease I. Compartment syndrome J. Genu varum (bowlegs) K. Metatarsus adductus

1 - F 2 - C 3 - I 4 - B 5 - K 6 - D 7- A 8 - E 9 - J 10 - H 11 - G