Chapter 24: The Child with a Musculoskeletal Condition

The observation that may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs is: a. red, green, and yellow bruises on his body. b. bruises are dispersed on his head, arms, and legs. c. a broken arm last year, and the child being described as accident-prone. d. the mother is very anxious for her son to get medical attention.

ANS: A As bruises heal, they change color in stages. Different colors of bruises indicate that injuries have not all occurred at the same time. The nurse must consider whether the bruises match the caretaker's explanation of what happened.

On entering the room of a child in Buck's traction the nurse makes all of the following observations. The observation that requires nursing intervention is the: a. child's heels are placed firmly against the foot of the bed. b. head of bed is elevated 20 degrees. c. weights are hanging freely. d. ropes are on pulleys.

ANS: A Buck's traction is dependent on the child as a counterweight. The heels should be elevated above the level of the foot of the bed

The nurse who is checking for capillary refill on a child in Bryant's traction will record adequate perfusion if the toe regains color in _____ seconds. a. 3 b. 4 c. 5 d. 6

ANS: A Capillary refill in 3 seconds or less is determined to be indicative of adequate perfusion.

The nurse is providing instructions about how to treat a sprained ankle. The nurse will recognize the need for additional teaching when the mother states: a. "Apply warm compresses to the ankle for the first 24 hours." b. "Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off." c. "Wrap the ankle in an Ace bandage for support." d. "Keep the leg elevated when sitting."

ANS: A Heat is not a treatment for soft tissue injuries. The principles of managing soft tissue injuries are rest, ice, compression, and elevation

The nurse caring for a child in Bryant's traction knows that the risk of serious complications will be reduced by ensuring that: a. neurovascular checks are done frequently. b. bandages are wrapped tightly. c. the child is restrained from rolling over. d. the child's buttocks are resting on the bed.

ANS: A The nurse caring for a child in traction must be alert for Volkmann's ischemia, which occurs when circulation is obstructed.

A nurse assessing a preadolescent child for scoliosis would: a. ask the child to bend forward at the waist, and would observe the child's back for asymmetry. b. observe the gait while the child is walking forward heel to toe. c. have the child flex the knees and look for uneven knee height. d. look at the child's shoulders and hips while fully clothed.

ANS: A The nurse looks at the back as the child bends forward for general body alignment and asymmetry.

The interventions that would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis would be: a. wearing splints at night to prevent extension contractures. b. applying moist heat packs upon awakening. c. taking a warm tub bath the evening before. d. sleeping with two pillows under the head.

ANS: B Application of moist heat, with a compress or by tub bath upon awakening, will help to lessen stiffness.

A child hospitalized for treatment of osteomyelitis complains that he is tired of being sick and wants to know when the antibiotic protocol will end. The nurse responds that antibiotic therapy will probably last for: a. 2 weeks. b. 6 weeks. c. 2 months. d. 3 months.

ANS: B Because osteomyelitis is an infection in the bone, antibiotics are given intravenously for 4 to 6 weeks.

The nurse caring for a child in Buck's skin traction will keep the: a. child in high-Fowler's position. b. child pulled up in bed. c. child's heel on the bed surface. d. child's feet against the foot of the bed.

ANS: B Buck's traction is a type of skin traction that relies on the child's weight as counterbalance The child must be kept with head elevated no more than 20 degrees, pulled up in bed, and the feet should not touch the bed surface or the foot of the bed.

The nurse reviewing the characteristics of Ewing's sarcoma would point out that: a. amputation is the accepted treatment. b. the disease is sensitive to radiation and chemotherapy. c. metastasis is rare. d. the disease is more prevalent among toddlers and preschoolers.

ANS: B Ewing's sarcoma is sensitive to radiation therapy and chemotherapy. Amputation of the affected extremity is not recommended. This cancer occurs in school-age children and does metastasize.

A nurse assessing a preadolescent child for scoliosis would: a. ask the child to bend forward at the waist, and would observe the child's back for asymmetry. b. observe the gait while the child is walking forward heel to toe. c. have the child flex the knees and look for uneven knee height. d. look at the child's shoulders and hips while fully clothed.

ANS: B Functional scoliosis usually is caused by poor posture, and it is not a spinal disease.

The parent of a child with osteomyelitis asks why his child is in so much pain. The nurse's response will be based on the understanding that the pain of osteomyelitis is caused by: a. the pressure of inelastic bone. b. purulent drainage in the bone marrow. c. the cast applied on the extremity. d. circulatory congestion of the skin.

ANS: B Osteomyelitis is an infection of the bone. Inflammation produces an exudate that collects under the marrow and cortex of the bone. The vessels are compressed and thrombosis occurs, producing ischemia and pain

The nurse notes as an abnormal finding on a musculoskeletal assessment of a 4-year-old that the child: a. has inward-turned knees while standing. b. walks on the toes. c. appears to have flat feet. d. swings his arms when walking.

ANS: B Toe walking after 3 years of age may indicate a muscle problem

The nurse providing instructions to an adolescent who has been fitted with a Milwaukee brace would teach the patient to: a. wear the brace directly against the skin. b. wear the brace over regular clothing. c. wear the brace over a T-shirt 23 hours a day. d. remove the brace before sleeping.

ANS: C A Milwaukee brace is worn approximately 23 hours a day over a T-shirt, which protects the skin

The nurse caring for a child with Duchenne's muscular dystrophy notes a characteristic manifestation, which is that the child: a. ambulates by holding onto furniture. b. exhibits atrophy of the calf muscles. c. falls frequently and is clumsy. d. has delayed fine-motor development.

ANS: C Frequent falling and clumsiness are clinical manifestations of Duchenne's muscular dystrophy.

In planning teaching to parents of a child with Legg-Calvé-Perthes disease about the long-term effects of this disease, the nurse would include that: a. there are no long-term effects. b. the disease is self-limited and requires no long-term treatment. c. degenerative arthritis may develop later in life. d. there is risk of osteogenic sarcoma in adulthood.

ANS: C Marked distortion of the head of the femur may lead to an imperfect joint or to degenerative arthritis of the hip later in life.

When caring for a child in Buck's extension, the nurse would include: a. positioning the child with hips flexed 90 degrees at all times. b. keeping the weights in contact with the floor. c. checking for skin irritation from traction equipment. d. releasing the weights on a schedule.

ANS: C The skin exposed to frequent friction may break down

The nurse assessing a child with juvenile rheumatoid arthritis notes the child's right knee and ankle are swollen, warm, and tender and with a temperature of 38.8 C (102 F) and abdominal pain. These findings suggest that this child has the ___________ type of juvenile rheumatoid arthritis. a. psoriatic b. enthesitis c. systemic d. acute febrile

ANS: C The systemic form of juvenile rheumatoid arthritis is associated with an elevated temperature, erythrocyte sedimentation rate (ESR), and C-reactive protein; abdominal pain; and a macular rash.

The nurse explains that Russell traction is a type of skin traction that: a. subluxates the tibia. b. does not interfere with range of motion. c. prevents the knee from flexing. d. supplies continuous pull in two directions

ANS: D Russell traction is skin traction, similar to Buck's, with a sling positioned under the knee, which prevents subluxation of the tibia. Although the traction interferes with full ROM, the patient can change position without disrupting the continuous pull in two directions

A 6-year-old sustained a fractured femur and was put in Russell traction 2 days ago. She screams in pain when she raises herself onto the bedpan. The nursing diagnosis that takes highest priority for this child is: a. pain resulting from tissue trauma. b. high risk for impaired skin integrity resulting from immobility. c. altered growth and development related to separation from family. d. altered urinary elimination related to immobility and traction.

ANS: A Although all of these nursing diagnoses are relevant to the child in traction, pain resulting from muscle spasm and tissue trauma is the highest priority.

The nurse considers what factor(s) that may trigger abuse in a parent? Select all that apply. a. Being abused as a child b. Low self-esteem c. Substance abuse d. Overwhelming responsibility e. Knowledge deficit relative to child care

ANS: A, B, C, D, E All options are possible triggers for a parent to become abusive.

The nurse demonstrates which similarities among all traction devices? Select all that apply. a. Pull the limb into extension b. Decrease muscle spasm c. Reduce pain d. Align two bone fragments e. Immobilize the limb

ANS: A, B, D, E Tractions are designed to immobilize and pull limbs into extension. Traction can also align broken bones and decrease muscle spasm. Although some traction devices may relieve pain, many may actually cause pain.

How does the pediatric skeletal system differ from that of the adult? Select all that apply. a. Lower mineral content b. More ossification c. Open epiphyses d. Less porosity e. Greater strength

ANS: A, C, E The child's skeletal system has less mineral content, greater porosity, open epiphyses, greater bone strength, and a thicker periosteum

The nurse assesses a large green bruise on the thigh of a 4-year-old to be approximately ____ days old. a. 2 b. 4 c. 6 d. 8

ANS: C

The nurse performing a neurovascular check on a limb in traction would report and document which finding(s) as indicative of altered circulation? Select all that apply. a. Pulse is equal to uncasted limb. b. Patient is aware of touch and warm and cold application. c. Limb is cool to the touch. d. Capillary refill is 5 seconds. e. Distal limb can flex and extend.

ANS: C, D The limb should be warm, and capillary refill should be less than 3 seconds

The nurse explains that the child's fracture heals more rapidly than the adult's because the child's bones: a. are less porous than adult bone. b. are covered by a thicker periosteum. c. are not affected by bone overgrowth. d. have faster callus formation.

ANS: D Callus forms more rapidly in the child than the adult

The nurse, assessing the neurovascular status of a child in Russell traction should report immediately the finding of: a. skin that's warm to the touch. b. capillary refill less than 3 seconds. c. ability to wiggle toes. d. bluish coloration of skin.

ANS: D Cyanosis or pallor noted in an extremity is an indication of circulatory impairment.