Pedi Ortho Neuromuscular MCQs

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be: A. Incomplete B. Complete C. Greenstick D. Spiral

B If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

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 familys 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 not common 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.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? A. sodium B. bilirubin C. serum potassium D. creatine kinase

D Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. (Signs of muscle breakdown)

In caring for a child in traction, which intervention is the highest priority for the nurse? A. The nurse should monitor for decreased circulation every 4 hours. B. The nurse should clean the pin sites at least once every 8 hours. C. The nurse should provide age-appropriate activities for the child. D. The nurse should record accurate intake and output.

A Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. The other interventions are appropriate, but not highest priority.

In caring for a child with a compound fracture, what should the nurse carefully assess for? A. Infection B. Osteoarthritis C. Epiphyseal disruption D. Periosteum thickening

A In a compound fracture, because the skin has been broken, the child is at risk for organisms to enter the wound. The incidence of osteoarthritis and the chance of epiphyseal disruption are not increased with compound fracture. Periosteum thickening is part of the healing process and is not a complication.

A group of students is reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age? A. adolescence B. toddlerhood C. school age D. preschool age

A Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? A. "Applying ice to the area will reduce the pain and swelling." B. "Apply ice to the injury for 60 minutes on and 60 minutes off." C. "Elevate the legs, and use bed rest for 24 hours." D. "Taking warm baths will help relax muscles and reduce pain."

A 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. The first line of treatment for these injuries is RICE (rest, ice, compression, elevation). Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. Cold causes vasoconstriction to reduce the pain and swelling. The legs should be elevated, but there is no timeline for how long this should occur. Warm baths would cause vasodilation, further increasing the pain and swelling.

A 9-month-old child is diagnosed with spastic cerebral palsy (CP).Which clinical manifestation should the nurse expect to assess in this patient? A. Hypertonia and rigidity B. Hemiplegia and hypotonia C. Repeated twitching movements D. Tremors and exaggerated posturing

A Spasticity is a form of hypertonia, or increased muscle tone. This results in stiff muslces and rigidity, which make movement difficult or even impossible.

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? A. "Itching is common. It's nothing to worry about." B. "Blowing cool air with a fan or hair dryer may relieve the feeling." C. "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." D. "A small amount of lotion or baby oil can be poured in the cast to moisturize the area."

B Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is: A. skin traction. B. skeletal traction. C. Russell traction. D. Buck extension traction.

B Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. 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 caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation? A. 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. B. 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. C. 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. D. 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.

B Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force.

The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information? A. "Has he achieved his developmental milestones on time?" B. "Would you please describe the weakness you are seeing in your son?" C. "Do you think he is simply fatigued?" D. "Has his pace of achieving milestones diminished?"

B The nurse needs to obtain a clear description of weakness. This open-ended question would most likely elicit specific examples of weakness and shed light on whether the boy is simply fatigued.

The nurse is caring for a 6-year-old client with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications? A. Adjust the weights as needed. B. Assess the popliteal region carefully for skin breakdown. C. Clean and massage his entire leg daily. D. Provide pin care as needed.

B The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care.

A 5 year old has a fracture of the right upper arm. The x-ray showed that one side of the bone is bent while the other is broken. This known as a __________ fracture? A. Spiral B. Greenstick C. Oblique D. Transverse

B This is a greenstick fracture. These types of fractures are more common in the pediatric population because their bones tend to be more flexible and the periosteum is stronger than an adult.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. A. The boy experiences mild pain when wiggling his toes. B. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. C. New drainage is seeping out from under the cast. D. The outside of the boy's cast got wet and had to be dried using a hair dryer. E. The boy's toes are light blue and very swollen.

B,C,E The parents should call the physician when the following things occur: The child has a temperature greater than 101.5° F (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? A. breathing B. sitting C. standing D. swallowing

C Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a client would have difficulty standing before having difficulty sitting. *Recall Gower's sign is a classical physical finding; patient needs to climb on their own thighs to stand up

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment? A. the presence of a waddling gait and difficulty climbing stairs B. a short heel cord caused by walking on the toes C. meeting motor milestones such as sitting, walking, and standing but at a later age than the average child D. when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

D A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs.