Musculoskeletal Disorders (Exam 3)
When helping parents plan care for a child with Legg-Calvé-Perthes disease, the nurse would teach the parents that the usual therapy for children with this disorder is: a) exercise to increase muscle strength of the knee joint. b) a nonweight-bearing period. c) surgery with supporting rods. d) passive range-of-motion exercises TID.
b) a nonweight-bearing period. Resting the affected femoral epiphysis aids healing.
The nurse is conducting a physical examination of a newborn with suspected osteogenesis imperfecta. Which finding is common? a) Foot is drawn up and inward b) Dimpled skin, hair in lumbar region c) Sole of foot faces backwards d) Blue sclera
d) Blue sclera Blue sclera is not diagnostic of osteogenesis imperfecta, but it is a common finding. Foot drawn up and inward (talipes varus) and sole of foot facing backwards (talipes equinus) are associated with clubfoot. Dimpled skin and hair in the lumbar region are common findings with spina bifida occulta.
An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care? a) Provide range of motion to the unaffected extremity b) Keeping the buttocks slightly elevated c) Wrapping the bandages from the ankle to the knee d) Removing the traction boot every 8 hours
b) Keeping the buttocks slightly elevated With Bryant traction, the buttocks should be slightly elevated and clear of the bed. The bandages are wrapped from the ankles to midthigh in Bryant traction. The legs are wrapped from the ankle to knee. A traction boot is not used with Bryant traction. This action would be appropriate for Buck traction. With Bryant traction, both legs are extended vertically, so range of motion would not be appropriate.
The nurse is caring for a child with osteomyelitis. Which of the following is true regarding this diagnosis? Select all that apply. a) Lab findings show a leukocyte count of 1,000 to 2,000 cells b) Transmission-based precautions are followed in most cases c) Corticosteroids are the treatment of choice d) As abscess forms, ruptures and spreads infection in the metaphysis of the bone e) Caused by Staphylococcus aureus
b) Transmission-based precautions are followed in most cases d) As abscess forms, ruptures and spreads infection in the metaphysis of the bone e) Caused by Staphylococcus aureus Osteomyelitis is caused by Staphylococcus aureus. The bacteria enter the bloodstream and are carried to the metaphysis, the growing portion of the bone, where an abscess forms, ruptures, and spreads the infection along the bone under the periosteum. Transmission-based precautions may be required if a wound is open and draining.
A 14-year-old boy was diagnosed with a closed fracture of the ulna at approximately 9 a.m. The fracture was reduced in the emergency room and his arm placed in a cast. At 6 p.m. his mother has brought him back to the emergency room due to unrelenting pain that has not been relieved by his prescribed narcotics. What should the nurse do first? a) Give additional pain medication as ordered. b) Assess the neurovascular status of the arm. c) Alert the doctor immediately and apply ice. d) Elevate the arm above the level of the heart.
c) Alert the doctor immediately and apply ice. The nurse should notify the doctor immediately because the boy's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible
A nurse applies ice to a client's leg to relieve the pain due to a soft tissue injury. What is a recommended guideline for use of cold therapy? a) Apply the ice to the injury for 60 minutes on and 60 minutes off. b) Apply gel packs for no longer than 30 minutes and monitor closely for tissue damage. c) Apply ice for the first 24 to 48 hours after injury to reduce pain and edema. d) Use cold therapy to increase blood flow in clients with impaired circulation.
c) Apply ice for the first 24 to 48 hours after injury to reduce pain and edema. Application of ice is recommended for the first 24 to 48 hours after injury to reduce pain and edema. It should be applied for 20 to 30 minutes, then removed for 1 hour, and then applied for 20 to 30 minutes again. Ice is usually applied as crushed ice in a bag or a commercial cold pack applied over a thin layer of cloth or apply cold compresses. Cold therapy is not recommended for persons with hypersensitivity to cold or with impaired circulation. Gel packs cool skin faster than an ice bag and should be applied for no more than 10 minutes.
The most important assessment of neurovascular status to make after spinal surgical instrumentation would be to a) determine the presence of brachial pulses. b) check the nailbeds of the fingers for capillary refill. c) ask if the child has pain. d) assess the legs for warmth.
d) assess the legs for warmth. The edema that accompanies spinal instrumentation surgery can impair circulation to lower extremities. The lower extremities are affected and need to be assessed over the nail beds of the fingers; brachial pulse is in the arm. Most all children will have pain after surgery
A nurse is providing instructions to the parents of a 3-month-old with developmental dysplasia of the hip who is being treated with a Pavlik harness. Which statements by the parents demonstrate understanding of the instructions? Select all that apply. a) "We need to call the doctor if she is not able to actively kick her legs." b) "We need to adjust the straps so that they are snug but not too tight." c) "We should change her diaper without taking her out of the harness." d) "We need to send the harness to the dry cleaners to have it cleaned." e) "We need to check the area behind her knees for redness and irritation."
a) "We need to call the doctor if she is not able to actively kick her legs." c) "We should change her diaper without taking her out of the harness." e) "We need to check the area behind her knees for redness and irritation." Instructions related to use of a Pavlik harness include changing the child's diaper while in the harness; checking the areas behind the knees and diaper area for redness, irritation, or breakdown; and calling the doctor if the child is unable to actively kick her legs. The straps are not to be adjusted without checking with the physician or nurse practitioner first. The harness can be washed with mild detergent by hand and air dried. A hair dryer can be used to dry the harness but only if the air fluffing setting is used.
When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all that apply. a) African American ethnicity b) Excessive activity c) Obesity d) History of cystic fibrosis e) Age younger than 8 years
a) African American ethnicity c) Obesity Risk factors associated with slipped capital femoral epiphysis include age between 9 and 16 years, African American race, sedentary lifestyle, and being overweight or obese. A history of cystic fibrosis may contribute to rickets.
The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child? Select all that apply. a) Any area on the cast that is warm to the touch b) Drainage from under the cast c) Any pink color in the fingers or toes of casted extremity d) A foul odor under the cast e) Any itching under or around the edges of the cast f) Looseness of the cast on the extremity
a) Any area on the cast that is warm to the touch b) Drainage from under the cast d) A foul odor under the cast f) Looseness of the cast on the extremity In addition to the five Ps, any foul odor or drainage on or under the cast, "hot spots" on the cast (areas warm to the touch), looseness or tightness, or any elevation of temperature must be noted, documented, and reported. Family caregivers should be instructed to watch carefully for these same danger signals. Itching is common and does not need to be reported. Pink coloration of fingers and toes would be normal and not a concern.
The nurse is assessing an 11-year-old girl with scoliosis. What would the nurse expect to find? Select all that apply. a) Pronounced one-sided hump on bending over b) Asymmetric shoulder elevation c) Complaints of severe back pain d) Even curve at the waistline e) Hyperactive reflexes f) Diminished motor function
a) Pronounced one-sided hump on bending over b) Asymmetric shoulder elevation Assessment findings associated with scoliosis include asymmetric shoulder elevation, uneven curve at the waistline, rib hump on one side, and a pronounced hump on one side when bending over. Typically, only mild back discomfort is found and balance, motor strength, sensation, and reflexes are normal.
A nurse is caring for a 6-year-old boy with a fractured ulna. He is fearful about the casting process and is resisting treatment. How should the nurse respond? a) "Will you please take this medicine for pain?" b) "Look over there at the neon fish in our aquarium." c) "The application of the cast will not hurt." d) "Would you like to pick out your favorite color cast?"
b) "Look over there at the neon fish in our aquarium." The best response for a 6-year-old is to use distraction throughout the cast application. He is resisting the application of the cast, so the best approach at this point is distraction. Telling him that application will not hurt is not helpful; nor is asking the child whether he wants pain medication. It is helpful to enlist the cooperation of the child by showing the child cast materials before beginning the procedure; but if he is resisting treatment, distraction would be the best approach.
The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries? Select all that apply. a) Immobilize the muscles that are involved. b) Encourage 1 to 2 days off per week of competitive athletics. c) Perform appropriate stretching during a 20-to 30-minute warmup. d) Avoid using NSAIDs for pain control. e) Have the coach monitor the treatment program for sports injuries. f) Apply ice to the injured area to reduce inflammation.
b) Encourage 1 to 2 days off per week of competitive athletics. c) Perform appropriate stretching during a 20-to 30-minute warmup. f) Apply ice to the injured area to reduce inflammation. Conservative treatment methods for the child with an overuse injury include encouraging 1 to 2 days off per week of competitive athletics, performing appropriate stretching during a 20-to 30-minute warmup, and applying ice to the injured area to reduce the inflammation and irritation. NSAIDs (ibuprofen) are used for inflammation and pain control. The physical therapist institutes a stretching and strengthening program for the appropriate muscle groups. Parents and coaches may not understand that the level of activity that causes overuse symptoms varies from child to child. Notes or telephone conversations from the physician or nurse to the child's coach can clarify any misconceptions about what is expected during the recovery and recuperative periods.
The nurse is presenting an in-service to a group of peers on the topic of traction. The nurse asks the group to give examples of types of skin traction. The following types were named by the nurses. Which is an example of a type of skeletal traction? a) Bryant traction b) Russell traction c) Balanced suspension traction d) Buck extension traction
c) Balanced suspension traction Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Examples of skeletal traction are 90-degree traction and balanced suspension traction. Dunlop traction, sometimes used for fractures of the humerus or the elbow, can be either skin or skeletal traction. It is skeletal traction if a pin is inserted into the bone to immobilize the extremity. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction.
The nurse is talking with the caregiver of a 13-year-old diagnosed with scoliosis. The child has come to the clinic to be fitted with a brace to begin her treatment. The child appears upset and angry and states, "I hate this brace; I hate it already." In an effort to support this child, which statement would be the most appropriate for the nurse to make to this child's caregiver? a) "Remind your child that her spine needs to be corrected in order to keep her whole musculoskeletal system healthy for a long, long time." b) "Take your daughter to an oncology floor for a few minutes so she can see children who are much sicker than she is." c) "Children her age often withdraw during stressful times; let her have some time alone to think about the situation and to get used to the brace." d) "If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good."
d) "If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good." Help the child select clothing that blends with current styles but is loose enough to hide the brace. Self-image and the need to be like others are very important at this age. Wearing a brace creates a distinct change in body image, especially in the older child or adolescent, at a time when body consciousness is at an all-time high. The need to wear the brace and deal with the limitations it involves may cause anger; the change in body image can cause a grief reaction. Handling these feelings successfully requires understanding support from the nurse, family, and peers. It is important for the child to have an opportunity to talk about his or her feelings.
Maria is a 9-month-old whose babysitter brings her to the ER. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. How should the nurse respond to this situation? a) Evaluate the child for a seizure disorder as that is probably why he is injured. b) Evaluate the child for an underlying musculoskeletal disorder. c) Ask the babysitter to advocate for the child and report the incident to the authorities. d) Arrange for the parents to come in for an evaluation for possible physical abuse.
d) Arrange for the parents to come in for an evaluation for possible physical abuse. Any type of fracture can be the result of child abuse but spiral femur fractures, rib fractures, and humerus fractures, particularly in the child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of abuse. The parents should be contacted first, and the family should undergo an evaluation for possible physical abuse since femoral fractures in nonambulating infants, particularly spiral fractures, are believed to be highly specific for inflicted injury. If physical abuse is not found, the infant should be evaluated for an underlying musculoskeletal disorder and not a seizure disorder.