Peds musculoskeletal Study Guide Ed11 & Ed10

a

10. Which of the following is a complication of immobility that is easily prevented with appropriate nursing intervention? a. Disuse atrophy b. Diarrhea c. Hypocalcemia d. Pain

c

11. Which of the following is not included in the teaching plan of a child with a brace or prosthesis? a. Frequent assessment of all areas in contact with the brace for signs of skin irritation b. Assessment of the stump area before application of the prosthesis c. Removal of the prosthesis limited to bedtime unless skin breakage occurs d. Use of protective clothing under the brace

b

13. Continuous pressure on the radial nerve may result in: a. footdrop. b. wristdrop.

d

16. Bone healing is characteristically more rapid in children than in adults because: a. children have less constant muscle contraction associated with the fracture. b. children's fractures are less severe than adult fractures. c. children have an active growth plate that helps speed repair with less likelihood of deformity. d. children have thickened periosteum and a more generous blood supply.

b

17. The method of fracture reduction is not determined by: a. the child's age. b. the manner in which the fracture occurred. c. the degree of displacement. d. the amount of edema.

b

19. Emergency treatment for the child with a fracture includes: a. moving the child to allow removal of clothing from the area of injury. b. immobilization of the limb, usually including joints above and below the injury site. c. pushing the protruding bone under the skin. d. keeping the area of injury in a dependent position.

b

2. The nurse is suspicious of child abuse (nonaccidental injury) when: i. there is a delay in seeking medical assistance for the injury. ii. the parent's history of the injury is not congruent with the actual injury. iii. x-ray studies demonstrate previous fractures in different stages of healing. iv. the child is crying and fearful of separation from the parent. a. i, ii, iii, and iv b. i, ii, and iii c. ii and iii d. ii, iii, and iv

d

21. An appropriate nursing intervention for the care of a child with an extremity in a new cast is to: a. keep the cast covered with a sheet. b. use the fingertips when handling the cast to prevent pressure areas. c. use heated fans or dryers to circulate air and speed the cast-drying process. d. turn the child at least every 2 hours to help dry the cast evenly.

c

25. To reduce anxiety in the child undergoing cast removal, which of the following nursing interventions would the nurse expect to be least effective? a. Demonstrate how the cast saw works before beginning the procedure. b. Describe cast saw as feeling "tickly" and warm. c. Explain that it will take only a few minutes. d. Continue to reassure that all is going well and that the child's behavior is accepted during the removal process.

c

26. Julie, age 10, has just returned from surgery for repair of an open fracture; she has a dressing and elastic bandage wrap on her leg from upper thigh to midcalf. The nurse immediately notifies the physician if assessment findings include which of the following? a. Appearance of blood-stained area the size of a dime on the dressing b. 2+ pedal pulse c. Inability to move the toes d. Report of pain level of 4/10 on Wong-Baker Faces Pain Rating Scale

b

28. The nurse is caring for 7-year-old Charles after application of skeletal traction. Which of the following is contraindicated? a. Clean pin sites per hospital policy. b. Release the traction when repositioning Charles in bed. c. Inspect pin sites for bleeding or infection. d. Assess for alterations in neurovascular status.

b

29. The nurse is assessing Carol, age 8 years, for complications related to her recent fracture and the application of a fiberglass cast to her forearm and elbow. Carol is crying with pain, the nurse is unable to locate pulses in the affected extremity, and there is lack of sensitivity to the area as well as some edema. Which of the following would the nurse suspect as most likely to be occurring? a. Normal occurrence for the first few hours after application of traction b. Volkmann contracture c. Nerve compression syndrome d. Epiphyseal damage

b

3. A nurse discovers 5-year-old Jimmy, a neighbor, lying in the street next to his bicycle. The nurse sends another witness to activate the emergency medical services (EMS) while the nurse begins a primary assessment of Jimmy. Which of the following best describes the primary assessment and its correct sequence? a. Body inspection, level of consciousness, head-to-toe survey, and airway patency b. Level of consciousness, airway patency, respiratory effectiveness, circulatory status c. Open airway, head-to-toe assessment for injuries, and chest compressions d. Weight estimation, symptom analysis, blood pressure measurement

a

30. Johnny, a 12-year-old with fracture of the femur, has developed sudden chest pain and shortness of breath. The astute nurse suspects: a. pulmonary embolism. b. compartment syndrome. c. myocardial infarction. d. pneumonia.

b

31. The priority nursing action for Johnny (in question 30) is to: a. elevate the affected extremity. b. administer oxygen. c. administer pain medication. d. start an intravenous (IV) infusion of heparin.

d

33. Which of the following statements about "nursemaid's elbow" is correct? a. This most common partial dislocation of the radial head of the elbow is usually found in children ages 1 to 4 years. b. This condition is caused by a sudden pull at the wrist while the arm is fully extended and the forearm is pronated. c. The longer the dislocation is present, the longer it takes the child to recover mobility after treatment. d. All of the above statements are correct.

a

34. Immediate treatment of sprains and strains includes: a. rest and cold application. b. disregarding the pain and "working out" the sprain or strain. c. rest, elevation, and pain medication. d. compression of the area and heat application.

c

36. Ben, a 15-year-old high school student, is at a track event. He has been running multiple events. He was feeling unwell before the event and had been vomiting. Now he is complaining of thirst, headache, fatigue, dizziness, and nausea. He seems to be somewhat disoriented and is sweating. Ben's temperature is normal. Which of the following is the most likely to describe Ben's condition? a. Heat cramps b. Dehydration c. Heat exhaustion d. Heatstroke

b

37. Which of the following statements made to the athlete by the nurse is correct? a. It is more important to replace sodium and chloride than water. b. Recommended dietary energy intake for adolescents involved in sports is 50% of caloric intake from carbohydrates. c. Iron replacement is necessary only for the female athlete. d. Energy for prolonged exercise is best obtained from high-carbohydrate foods eaten 2 hours before the event.

b

38. Sixteen-year-old Ben has been brought to the school nurse's office for heatstroke. He has a temperature of 40° C (104° F) and is awake but disoriented. Which of the following is contraindicated? a. Immediate removal of clothing and application of cool water to the skin b. Administration of antipyretics c. Use of fans directed at Ben d. Activation of EMS for transport to hospital

a

39. Zac, a 16-year-old football star at the local high school, is at the school nurse practitioner's office for acne that is not clearing with the over-the-counter medications. During the physical examination, the nurse notes that Zac has achieved a marked increase in muscle and strength in a very short time. Which of the following would the nurse suspect caused these changes? a. Use of an ergogenic aid, anabolic steroids b. More frequent and more strenuous workouts in the gym c. Increased protein and vitamins in the diet d. Use of methylphenidate (Ritalin) or phenmetrazine (Preludin)

a

40. Commotio cordis: a. occurs after a blunt, nonpenetrating blow to the chest, which produces ventricular fibrillation. b. rarely causes death. c. occurs almost exclusively in athletes with hypertrophic cardiomyopathy. d. occurs in athletes who have a history of sudden death in a relative under the age of 50 years.

a

42. The condition recognized in the infant with limited neck motion, in which the neck is flexed and turned to the affected side as a result of shortening of the sternocleidomastoid muscle, is: a. torticollis. b. brachial plexus palsy. c. lordosis. d. kyphosis.

d

43. Bob, age 7 years, is diagnosed with Legg-Calvé-Perthes disease. Which of the following manifestations is not consistent with this diagnosis? a. Intermittent appearance of a limp on the affected side b. Hip soreness, ache, or stiffness that can be constant or intermittent c. Pain and limp most evident on arising and at the end of a long day of activities d. Specific history of injury to the area

a

44. Slipped capital femoral epiphysis is suspected when: a. an adolescent or preadolescent begins to limp and complains of continuous or intermittent pain in the hip. b. an examination reveals no restriction on internal rotation or adduction but restriction on external rotation. c. referred pain goes into the sacral and lumbar areas. d. all of the above occur.

d

45. The primary diagnostic tool used in developmental dysplasia of the hip (DDH) in a newborn is: a. a radiograph. b. an ultrasound. c. magnetic resonance imaging. d. the Barlow and Ortolani maneuvers.

c

46. The recommended treatment for DDH in an infant 2 months old is: a. surgical fixation. b. hip spica cast. c. Pavlik harness. d. hip abduction orthosis.

a

47. Osteomyelitis resulting from a bloodborne bacterium that could have developed from an infected lesion is termed: a. acute hematogenous osteomyelitis. b. exogenous osteomyelitis. c. subacute osteomyelitis. d. chronic osteomyelitis.

b

48. The care plan for the child during the acute phase of osteomyelitis always includes: a. performing wound irrigations. b. ensuring administration of antibiotics. c. isolating the child. d. incorporating passive range-of-motion exercises for the affected area.

d

49. Which of the following statements about septic arthritis is true? a. The most common causative agent in children under 2 years of age is Haemophilus influenzae. b. Knees, hips, ankles, hands, and feet are the joints most commonly affected. c. Early radiographic findings show soft tissue swelling and erosions of the bone. d. IV antibiotic use is based on Gram stain and clinical presentation.

a

5. Major consequences of immobility in the pediatric patient include which of the following? a. Bone demineralization leading to osteoporosis b. Orthostatic hypertension c. Dependent edema in the lower extremities d. Increase in the metabolic rate

b

50. Nursing considerations for the patient diagnosed with osteogenesis imperfecta include: a. preventing fractures by holding on to the child's ankles when changing diapers. b. providing nonjudgmental support while parents may be dealing with accusations of child abuse. c. advising parents to limit touching or handling the child in order to prevent fractures. d. educating parents that the use of braces and splints can increase the rate of fracture.

d

51. In addition to the prevention of fractures, the nursing care of a child with osteogenesis imperfecta should include: a. oral and dental care. b. meticulous skin care. c. care related to the effects of drug treatment. d. all of the above.

d

52. Diagnostic evaluation is important for early recognition of scoliosis. Which of the following is the correct procedure for the school nurse conducting this examination? a. View the child, who is standing and walking fully clothed, to look for uneven hanging of clothing. b. View all children from the left and right side to look mainly for asymmetry of the hip height. c. Completely undress all children before the examination. d. View the child, who is wearing underpants/shorts, from behind when the child bends forward at the waist.

b

54. Marilyn, age 12 years, has been diagnosed with scoliosis and placed in a thoracolumbosacral orthotic (TLSO) brace. Which of the following information provided by the nurse to Marilyn is correct? a. "The brace will cure your curvature." b. "The brace is an underarm brace made of plastic that will be molded and shaped to your body to prevent worsening of the curvature." c. "The brace includes a neck ring to extend the neck." d. "The brace will only be worn in bed, since it prevents walking because of the severity of the trunk bend."

a

55. Nursing care directed toward nonsurgical management in a teenager with scoliosis primarily includes: a. promoting self-esteem and positive body image. b. preventing immobility. c. promoting adequate nutrition. d. preventing infection.

a

56. Which of the following goals of therapy is most appropriate for the child with juvenile idiopathic arthritis? a. Child will exhibit signs of reduced joint inflammation and adequate joint function. b. Child will exhibit no signs of impaired skin integrity due to rash. c. Child will exhibit normal weight and nutritional status. d. Child will exhibit no alteration in respiratory patterns or respiratory tract infection.

a. Diet: Eat a well-balanced diet without exceeding caloric expenditure and maintain appropriate weight on corticosteroids. A low-salt diet may be required if the patient becomes nephritic or hypertensive. A low-fat diet is indicated in children with dyslipidemia. Maximizing peak bone mass in adolescent SLE is essential with a diet rich in calcium and vitamin D. b. Sun exposure: Avoid excessive exposure; use sunscreen (with a sun protection factor of at least 30), hat, and protective clothing; schedule outdoor activities in morning and evening. c. Birth control medications: Pregnancy is a potential trigger for disease flare; because estrogen can trigger disease flare, low-dose estrogen or progesterone-only contraceptives are preferred. Some SLE medications (mycophenolate and methotrexate) are also associated with birth defects.

57. What should the nurse teach the patient and family of the child diagnosed with systemic lupus erythematosus (SLE) regarding each of the following topics? a. Diet b. Sun exposure c. Birth control medication

a

8. Nursing interventions aimed at preventing problems associated with immobility include which of the following? a. Encouraging self-care b. Restricting fluids with strict intake and output c. Limiting active range-of-motion exercises to once per day d. Decreasing sensory stimulation to allow adequate rest