Chapter 27 Musculoskeletal Disorders
A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents? "Let's put you in touch with other families who have experienced this." "The infant only needs the harness for 12 weeks." "The harness does not hurt the infant." "Do not attempt to adjust the harness yourself."
"Let's put you in touch with other families who have experienced this."
The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment? Wearing this brace only during the night will not be so embarrassing." "I am so glad I can take this brace off for the school dance." "When I start feeling tired, I can just take my brace off for a few minutes." "At least when I take a shower I have a few minutes out of this brace."
"At least when I take a shower I have a few minutes out of this brace."
While assessing a preadolescent child, the nurse notes curvature of the child's spine. Which statement by the child's parent supports this observation? "I've wondered why my child won't let me in the room when changing clothes." "My child has such a hard time finding pants that fit right. They never seem to fit evenly over the hips." "My child has been taking ibuprofen daily for the last few weeks because of hip pain after walking so much at school." "My child has been reporting back pain for the last 2 or 3 months."
"My child has such a hard time finding pants that fit right. They never seem to fit evenly over the hips."
The mother of a 9-year-old boy brings the boy to the clinic for an evaluation because he has a fever. The history reveals a recent trauma to the knee. The nurse inspects the joint. Which of the following would lead the nurse to suspect osteomyelitis? Select all that apply. Pain on palpation Drainage from the area Coolness of the area Edema of the area Localized tenderness
Edema of the area Localized tenderness Pain on palpation
The nurse is caring for an extremely active 13-year-old adolescent who has recently been prescribed a back brace to treat scoliosis. Which intervention will be most critical to the success of treatment? Teach the parents about the disease and its treatment. Show the adolescent how the brace works and when to wear it. Ask for the adolescent's feelings about being in a brace. Emphasize and encourage compliance related to the use of a back brace.
Emphasize and encourage compliance related to the use of a back brace.
A child has just been received into the clinic, and the nurse is assigned to her care. The physician determines that the child has a broken left radius, and the arm is placed in a short cast. The nurse should give the mother which of the following instructions to care for the child's cast properly? Select all that apply. Use a padded hanger to scratch inside the cast if itching. Check to see whether the fingers are warm to the touch. Handle the cast only with the open palms as it dries. Report a foul odor around the cast. Check the child's hand function by moving the fingers and extending the thumb.
Handle the cast only with the open palms as it dries. Check the child's hand function by moving the fingers and extending the thumb. Check to see whether the fingers are warm to the touch. Report a foul odor around the cast.
The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be: "These will help the cast look more attractive so the child won't feel self-conscious." "These make a smooth edge on the cast so the skin is better protected." "We put these on so the child will not pull the padding from under the cast." "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry."
"These make a smooth edge on the cast so the skin is better protected."
The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns? "This is not your fault and we will help you with her care and treatment." "There are simple noninvasive treatment options." "Your daughter will likely wear a Pavlik harness." "Don't worry; this is a relatively common diagnosis."
"This is not your fault and we will help you with her care and treatment."
A 14-year-old male is brought to the emergency department by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. When describing this fracture to the child and his parents, the nurse would integrate knowledge of which of the following? The break occurs in a line that crosses the shaft at a 90-degree angle. There are three or more fracture fragments. There is a diagonal line across the bone. The bone is bent but not broken.
There are three or more fracture fragments. Explanation: In a comminuted fracture, there are three or more fracture fragments.
Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment? a young adolescent female a teenage male a school-age female a school-age male
a young adolescent female Explanation: Mild scoliosis occurs between the genders equally, but idiopathic scoliosis requiring treatment occurs 10 times more often in females than males. Usually, treatment is initiated during early adolescence, around age 11 to 14 years.
After teaching a group of nursing students about osteogenesis imperfecta (OI), the instructor determines that the teaching was successful when the group identifies which type as the most common? Type III Type II Type I Type IV
Type I Explanation: A classification system has been developed that identifies four main types of OI. Type I mid nondeforming is the most common and mildest form. Children with type I have bones that are predisposed to fractures. Other than spinal curvature, bone deformity is minimal. Type II perinatal lethal is the most severe type and is frequently lethal at or shortly after birth. Type III severely deforming and type IV moderately deforming are more serious than type I but not as lethal as type II.
The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which situation? A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating.
A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. Explanation: Spiral fractures, which twist around the bone, are frequently associated with child abuse and are caused by a wrenching force.
A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Apply ice to the injury for 60 minutes on and 60 minutes off." "Elevate the legs, and use bed rest for 24 hours." "Applying ice to the area will reduce the pain and swelling." "Taking warm baths will help relax muscles and reduce pain."
"Applying ice to the area will reduce the pain and swelling." Explanation: Shin splints are a form of an overuse syndrome. These syndromes occur when there is repeated force applied to connective tissue, causing it to break down. T
The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education? "Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future." "Since her fracture is in the central shaft of her leg, it may interfere with the growth of that leg." "My child is at risk for abnormal growth of the leg because the break is in the outer layer of the bone." "Injuries that happen at the end of the bone, the epiphysis, are at a greater risk for becoming infected."
"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future."
An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to prevent torticollis." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent herniation of a spinal disk, which is painful." "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."
"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."
The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention? "Would you like a coloring book?" "Do you want a book to read?" "You are too big to suck your thumb." "Let's ask your parents to bring your friends for a visit."
"Let's ask your parents to bring your friends for a visit."
An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image? "You should not worry about what everyone else is wearing. You look fine." "Kids can be cruel sometimes. Has anyone told you that you look different?" "Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." "Just hold your head up and be confident in how you look. Look for some after-school activities you can do wearing your brace."
"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it."
A 13-year-old adolescent is being treated for scoliosis with a brace. During the first follow-up appointment after the brace was initiated, which statement by the adolescent indicates the need for further instruction? "I leave my brace on for gym at school." "I check my brace daily to make sure there is no damage or change to it." "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." "I do exercises after school." "I wear a t-shirt under my brace."
"When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." Explanation: Scoliosis refers to the lateral curvature of the spine. There are differing types of the condition. Mild-to-moderate curvatures can be managed by a brace. The brace is worn daily for all activities other than bathing. Clients should remove the brace for only 1 hour each day. Exceeding this time with the brace off will impair the therapeutic effects of the bracing treatment.
The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which of the following instructions would be most important to emphasize to the boy and his parents? "You and your coaches need to understand that you cannot play soccer for at least 6 weeks." "You will need to see a physical therapist for stretching and strengthening exercises." "NSAIDS can help with pain control and inflammation." "Ice will help reduce the inflammation."
"You and your coaches need to understand that you cannot play soccer for at least 6 weeks."
The nurse is assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client? rest, elevation of the leg, treatment of pain with acetaminophen ice alternating with ankle and knee-strengthening exercises alternating applications of 15 to 30 minutes of heat and ice NSAIDs, ice, and limiting exercise
NSAIDs, ice, and limiting exercise
A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition? A 9-year-old boy who is sedentary A 15-year-old girl who dances ballet A 13-year-old boy who is on his school's cross-country team An 11-year-old girl who is obese
A 13-year-old boy who is on his school's cross-country team
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? Cartilage Ligaments Joints Tendons
Cartilage Explanation: During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.
The mother of a child who has sustained a fractured leg is worried how long her child will be unable to walk without crutches. The nurse would explain to the mother that the child should be walking independently soon due to what reason? Children's bones heal faster than adults. Children do not feel as much pain as adults. A child weighs less than an adult so the child can walk earlier. Children are less compliant and tend to quit using the crutches.
Children's bones heal faster than adults.
The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply. Monitor the color of the nail beds in the right hand. Document any signs of pain. Check capillary refill time in the both arms. Wear a protective gown when moving the child's arm. Wear sterile gloves when removing or touching the cast.
Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand.
The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed. Plan to add additional weights as the fracture heals, usually once per day. Ensure traction weights are hanging freely, not touching the bed or floor. Remove traction weights once per shift for 30 minutes and then replace them.
Ensure traction weights are hanging freely, not touching the bed or floor.
The nurse is assessing a group of early adolescents for scoliosis. One of the teenagers asks the nurse what will be done. The nurse explains that which of the following will be included in the assessment? Select all that apply. Examination of the hips for symmetry Examination of the shoulder blades for symmetry Examination of the shoulders for symmetry Examination of leg length Examination of the spine for curvature
Examination of the shoulder blades for symmetry Examination of the hips for symmetry Examination of the shoulders for symmetry Examination of the spine for curvature
The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? Situational low self-esteem related to the use of a walker Impaired physical mobility related to a cast on the leg Pain related to chronic inflammation of the lower leg Deficient diversional activities related to a need for imposed activity restriction for 6 weeks
Impaired physical mobility related to a cast on the leg
The nurse is preparing the adolescent with a left lower extremity cast for cast removal. What action(s) will the nurse take? Select all that apply. Advise that the extremity may be smaller than before the cast was placed. Inform the adolescent that the cast removal device is loud. State that lotion may be used to rehydrate the skin. Use the term "cast saw" as a developmentally appropriate descriptor of the cast removal device. Teach that the skin under the cast may be dry in appearance.
Inform the adolescent that the cast removal device is loud. State that lotion may be used to rehydrate the skin. Advise that the extremity may be smaller than before the cast was placed.
A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective? Assess neurovascular status on the affected extremity once every shift. Gently massage the child's back to stimulate circulation. Keep the child's skin distal to the traction clean and dry. Inspect the child's skin for rashes, redness, irritation, or pressure injuries.
Inspect the child's skin for rashes, redness, irritation, or pressure injuries.
The nurse is assessing a school-aged child at the emergency department. The child is limping and reports pain in the hip, groin, and knee. The symptoms worsened gradually over time. The health care provider has prescribed radiologic studies to assess for slipped capital femoral epiphysis (SCFE). What action will the nurse perform first? Prepare the child and family for surgery. Suggest developmentally appropriate activities that can be done while on bed rest. Instruct the parents and child to take weight off the affected leg. Provide the child with crutches.
Instruct the parents and child to take weight off the affected leg
The nurse meets a child with a slipped capital femoral epiphysis. In what type of child does this usually occur? Tall, thin girls Obese adolescent boys Preadolescent girls Active school-age children
Obese adolescent boys
The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. Which of the following would the nurse do next? Make sure the skin and linens are clean and dry. Apply lotion to his foot and avoid friction to the area. Turn the child regularly. Reposition the child's foot on a pressure-reducing device.
Reposition the child's foot on a pressure-reducing device.
The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? External fixation device Internal fixation device Stockinette Spica cast
Spica cast Explanation: The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open.
A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis? Staphylococcus aureus Streptococcus group B Mycobacterium Haemophilus influenzae
Staphylococcus aureus Explanation: Staphylococcus aureus is the most common cause of osteomyelitis; therefore, the nurse would expect the antibiotics to cover that bacteria
The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? The nurse should support the caregivers in restricting activity during the treatment. The nurse should provide information when the child or caregiver requests it. The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. The nurse should be a contact person when the child is hospitalized.
The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.
A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note? The posterior spine when bending sideways The angle of the lower chest when sitting down The angle of the iliac crest when bending forward The posterior spine when bending forward
The posterior spine when bending forward
A 14-year-old male is brought to the ER by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. Which of the following best describes this type of fracture? There is a diagonal line across the bone. The bone is bent, but not broken. A line crosses the shaft at a 90º angle. There are three or more fracture fragments.
There are three or more fracture fragments. Explanation: In a comminuted fracture there are three or more fracture fragments. With a transverse fracture, a line crosses the shaft at a 90º angle. In an oblique fracture, there is a diagonal line across the bone. With a greenstick fracture, the bone is bent, but not broken.
A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected? loss of strength in ankle dorsiflexion lordosis kyphosis Trendelenburg gait
Trendelenburg gait
The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse? temperature 100.2°F (37.9°C) mild fussiness decreased oral intake a weak pedal pulse
a weak pedal pulse Explanation: A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages
The nurse is screening a child for scoliosis and documents the findings as shown in the chart note above. Which finding(s) requires further follow up by the nurse? Select all that apply. alignment of the head dietary calcium shoulder bag use how the clothing hangs on the body unevenness of the shoulders
alignment of the head how the clothing hangs on the body unevenness of the shoulders
An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the: back with hips up off the bed. back with the injured hip flexed and the uninjured one extended. back with hips flat on the bed. stomach with both legs extended.
back with hips up off the bed. Explanation: Bryant traction is used to reduce fractures or with developmental dysplasia of the hip (DDH) in children younger than 2 years of age. In this type of traction, both legs are extended vertically with the child's weight serving as the counterbalance. For there to be traction, the infant's hips must be off the bed.
The caregiver of a child with a recent puncture wound on the arm calls the pediatrician's office reporting that after seeming well at bedtime last night, the child now has a temperature of 101℉ (38.3℃), pain at the site of the injury, and is unable to fully bend the elbow of the arm which had been injured. The nurse recommends the child be brought in to see the health care provider. What would likely be ordered for this child? blood work an x-ray a muscle biopsy a surgical consult
blood work Explanation: In osteomyelitis, diagnosis is based on laboratory findings of leukocytosis (15,000 to 25,000 cells or more), an increased ESR, and positive blood culture
The nurse is conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common? blue sclera The sole of the foot faces backwards. dimpled skin, hair in lumbar region The foot is drawn up and inward.
blue sclera
The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding? lordosis kyphosis sway back idiopathic scoliosis
idiopathic scoliosis Explanation: Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.
A toddler is diagnosed with osteomyelitis. What should the nurse anticipate as a priority intervention when planning this child's care? maintaining intravenous antibiotic therapy assisting the child with crutch walking keeping the child quiet while in skeletal traction restricting fluid to encourage red cell production
maintaining intravenous antibiotic therapy Explanation: For osteomyelitis, medical therapy includes administration of intravenous antibiotics, which is usually initiated in the hospital and then continued at home for as long as 2 weeks; an intermittent infusion device or peripherally inserted central catheter may be used. After this, the child will be prescribed an oral antibiotic for 3 to 4 more weeks
The nurse is preparing to administer pamidronate to a child with osteogenesis imperfecta. What intervention(s) will the nurse perform during the child's care? Select all that apply. monitoring the IV site during infusion monitoring urinary output administering by IV every 1 to 2 months monitoring complete blood count (CBC) assessing for fever and myalgia
monitoring the IV site during infusion monitoring urinary output
Fractures in children are always potentially serious injuries. Which child with a fracture would you observe most closely for complication? one who has an elbow fracture one who has a greenstick radial injury one who has a fractured patella one who has an ulnar fracture
one who has an elbow fracture Explanation: Elbow injuries are particularly dangerous because edema can interfere with blood vessels and nerves that pass beside the join
The nurse is assessing a 7-year-old child with right Legg-Calvé-Perthes (LCP) disease, and documents the findings shown in the chart note above. Which finding(s) is consistent with LCP disease? Select all that apply. clothes draping unevenly pain in the leg right leg shorter than left leg limited hip mobility slouched posture
pain in the leg right leg shorter than left leg limited hip mobility
The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom? pain paralysis paresthesia pallor
paresthesia Explanation: Paresthesia is diminished or absent sensation or numbness or tingling.
A child is in Buck traction to correct a hip problem. When caring for this child, it is most important for the nurse to implement which intervention? provide diversionary activities administer antispasmodics every 4 hours keep the affected leg on a pillow remove the boot every 8 hours
remove the boot every 8 hours Explanation: Buck traction is a skin traction used to treat hip and knee problems. The traction is applied in a straight line with the extremity in a boot and weights attached that hang freely off the end of the bed. It is imperative the boot be removed every 8 hours for skin assessment. Due to the weight applied to the boot, skin integrity can easily become impaired.
The nurse is providing discharge teaching for a 12-year-old child undergoing bracing following surgical correction of scoliosis. The child expresses concern about body image. What will the nurse include in the teaching? Select all that apply when to resume full activities increase in height when bracing is finished size of scar importance of correcting cardiopulmonary compromise lack of curve when bracing is completed
size of scar lack of curve when bracing is completed increase in height when bracing is finished
The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is: skeletal traction. Russell traction. skin traction. Buck extension traction.
skeletal traction.
A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion? decreased erythrocyte sedimentation rate swelling and point tenderness increased range of motion coolness of the affected site
swelling and point tenderness Explanation: Findings associated with osteomyelitis include swelling, point tenderness, warmth over the site, decreased range of motion, and an elevated sedimentation rate.
Question 9 of 10 The nurse is performing a neurovascular assessment on a child in 90-90 skeletal traction. What will the nurse include in the assessment? Select all that apply. ability to sit up in bed tactile sensation ability to wiggle fingers and toes skin color capillary refill
tactile sensation ability to wiggle fingers and toes capillary refill skin color