Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder

When teaching a group of parents about the skeletal development in children, what information will the nurse provide? Children's bones have a thin periosteum and limited blood supply. The growth plate is the area of growing tissue near the ends of flat bones. The infant's skeleton has undergone complete ossification by birth. A young child's bones commonly bend instead of break when an injury occurs.

A young child's bones commonly bend instead of break when an injury occurs. Explanation: The infant and a young child's bones are more flexible and more porous with a lower mineral count than adults. The structural differences of a young child's bone allow for greater shock absorption thus, bones will often bend rather than break when an injury occurs. Growth plates are growing tissue found near the ends of long bones. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply.

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client? Bracing Traction Surgery Exercise

Bracing Explanation: For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? Change position from side to side hourly. Cover the sac with a saline-moistened dressing. Keep the mass uncovered and dry. Prevent cold stress using an Isolette and blankets.

Cover the sac with a saline-moistened dressing. Explanation: Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors? Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Duchenne muscular dystrophy is diagnosed in boys who develop gait changes during the late school-age years. Duchenne muscular dystrophy is a nonprogressive disorder that severely affects muscle function through spinal cord atrophy. Duchenne muscular dystrophy is a progressive disease of muscles and nerves that affects males and females equally.

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Explanation: Duchenne muscular dystrophy is the most common of several muscular dystrophies and is a progressive, fatal disorder. It involves mainly skeletal muscles, but other muscles are affected over time. Onset occurs in early childhood. The disorder is X-linked recessive. An enzyme is lacking that is necessary for the maintenance of muscle cells. No structural abnormalities of the spinal cord or peripheral nerves are noted.

The nurse is conducting a physical examination of a child with a brachial plexus injury. Which finding would lead the nurse to be highly suspicious of Erb palsy? The child is unable to close one of his eyes. The involved extremity is adducted, prone, and internally rotated. The mouth is drawn to the noninvolved side. Asymmetry of the face occurs when the child is crying.

The involved extremity is adducted, prone, and internally rotated. Explanation: Erb palsy is an upper brachial plexus injury and the involved extremity usually presents as adducted, prone, and internally rotated. Inability to close one eye, facial asymmetry, or drawing of the mouth to the noninvolved side are associated with facial nerve palsy as a result of cranial nerve injuries.

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

The nurse should monitor for decreased circulation every 4 hours. Explanation: Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. Providing age-appropriate activities and monitoring intake and output are important interventions for any ill child but would not be the highest priority interventions for the child in traction.

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? toddlerhood adolescence preschool age school age

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

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child: has blue-looking nail beds on the toes. has a weak femoral pulse. feels increasing severe pain. cannot plantarflex his foot.

feels increasing severe pain. Explanation: Any reports of pain in a child with a new cast or immobilized extremity need to be explored and monitored closely for the possibility of compartment syndrome.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? peanuts alcohol gel cat dander latex

latex Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. prone left side lying supine semi-Fowler right side lying

prone right side lying left side lying Explanation: Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching? "The casted arm must be kept still." "Pale, cool, or blue skin coloration is to be expected." "We must avoid causing depressions in the cast." "We need be aware of odor or drainage from the cast."

"Pale, cool, or blue skin coloration is to be expected." Explanation: It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? muscle biopsy X-ray EEG assessment of ambulation

muscle biopsy Explanation: Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates? a normal spinal closure spina bifida with myelomeningocele spina bifida occulta spina bifida with meningocele

spina bifida occulta Explanation: Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arouse suspicion of its presence, or it may be overlooked entirely.

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

standing Explanation: 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.

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 instruction is 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 six weeks." "Ice will help reduce the inflammation." "NSAIDs can help with pain control and inflammation." "You will need to see a physical therapist for stretching and strengthening exercises."

"You and your coaches need to understand that you cannot play soccer for at least six weeks." Explanation: A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches.

The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? Ensure traction weights are hanging freely, not touching the bed or floor. Plan to add additional weights as the fracture heals, usually once per day. Remove traction weights once per shift for 30 minutes and then replace them. Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed.

Ensure traction weights are hanging freely, not touching the bed or floor. Explanation: Traction is used as a pulling force on an extremity or body part. For it to be effective, the weights need to hang freely at all times and the ropes need to remain in the pulley grooves. The weights are not replaced or removed during traction. The child can move all extremities except the affected one(s). The child remains in traction until healing occurs, a cast is applied, or surgical repair is performed.

Through which mechanism is Duchenne muscular dystrophy acquired? heredity environmental toxins autoimmune factors virus

heredity Explanation: Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

A pediatric client's parent calls the nurse and states, "My child fell off the bike. My child was wearing a helmet, but did scrape the knee and it is bleeding a lot. What should I do?" Which response by the nurse is best? "Apply ice packs to the site for 15 to 20 minutes, then elevate the extremity." "Tell me if your child can move all four extremities and knows his or her name and current location." "You should apply pressure to the site and then bring your child in to be evaluated." "You need to immediately bring your child to his primary health care provider's office."

"You should apply pressure to the site and then bring your child in to be evaluated." Explanation: First, the nurse needs to address the client's bleeding by having the parent apply pressure to the site. Then, the child needs to be evaluated to determine if additional treatment is needed, such as stitches. Measures including rest, ice, compression, and elevation (RICE) will be further discussed with the parent and child after the bleeding is stopped and the wound has been evaluated. There is no indication the child needs immediate evaluation, nor is there indication the child cannot move other extremities or has an altered level of consciousness. Bleeding is priority for this client.

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 do not feel as much pain as adults. Children's bones heal faster than 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. Explanation: Fractures in children heal faster, are generally less complicated, and occur for different reasons than fractures in adults. Thus, children rehabilitate faster than most adults. Children feel pain just like adults. Weight does not lessen the time required for crutches. Compliance is not an issue.

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. stomach with both legs extended. back with hips flat on the bed.

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 position of having the child on the back with the hips flat is describing Buck traction. The position where the hip is flexed on the injured side and the uninjured extended is 90-90 traction. There is no traction when the child would be on the stomach.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? lorazepam botulin toxin prednisone baclofen

baclofen Explanation: Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy.

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition? degeneration of muscle fibers upper motor neuron lesions a demyelinating disease lesions of the brain cortex

degeneration of muscle fibers Explanation: Degeneration of muscle fibers with progressive weakness and wasting best describes muscular dystrophy. Demyelination of myelin sheaths is a description of multiple sclerosis. Lesions within the brain cortex and the upper motor neurons suggest a neurologic, not a muscular, disease.

The nurse is obtaining a health history on a woman of childbearing age who wants to become pregnant. What information in her health history places her at high risk for having a child with a myelomeningocele? history of asthma; taking montelukast history of a seizure disorder; taking phenobarbital history of a previous abdominal surgery history of scoliosis

history of a seizure disorder; taking phenobarbital Explanation: Maternal consumption of certain drugs that antagonize folic acid, such as anticonvulsants (carbamazepine and phenobarbital), places her at high risk for having a child with neural tube defect such as a myelomeningocele. A history of taking montelukast, previous abdominal surgery, or a history of scoliosis do not pose a risk for having a child with a myelomeningocele.

Which of these strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy? long leg braces manual wheelchair walker motorized wheelchair

long leg braces Explanation: Long leg braces are functional assistive devices that provide increased independence and increased use of upper and lower body strength. Wheelchairs, both motorized and manual, provide less independence and less use of upper and lower body strength. Walkers are functional assistive devices that provide less independence than braces.

Which diagnostic measure is most accurate in detecting neural tube defects? significant level of alpha-fetoprotein present in amniotic fluid flat plate of the lower abdomen after the 23rd week of gestation amniocentesis for lecithin-sphingomyelin (L/S) ratio presence of high maternal levels of albumin after 12th week of gestation

significant level of alpha-fetoprotein present in amniotic fluid Explanation: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as: ataxic. athetoid or dyskinetic. mixed. spastic.

spastic. Explanation: Spastic involves hypertonicity and permanent contractures on both extremities on one side. Athetoid (dyskinetic) involves abnormal involuntary movements affecting all four extremities and sometimes the face, neck, and tongue. Ataxic affects balance and depth perception. Spastic affects the lower extremities. Mixed is a combination of spastic, athetoid and ataxic.

A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching? "The very first step is to apply water-based lubricant to the catheter." "We need to soak the catheter in a vinegar and water solution daily." "My son may someday learn how to do this for himself." "We must be careful to use latex-free catheters."

"The very first step is to apply water-based lubricant to the catheter." Explanation: It is very important to remind the parents that they must always wash hands very well with soap and water prior to catheterization to help prevent infection. The other statements are correct.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child? Using only a draw sheet to move the casted arm. Handling the cast with open palms when moving the arm. Encouraging the child to move the arm slowly up and down to help the cast dry. Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm.

Handling the cast with open palms when moving the arm. Explanation: A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process.

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective? Gently massage the child's back to stimulate circulation. Assess neurovascular status on the affected extremity once every shift. 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. Explanation: It is important to be vigilant in inspecting the child's skin for rashes, redness, and irritation to uncover areas where pressure injuries are likely to develop. Applying lotion, gentle massage, and keeping the skin dry and clean are part of the routine skincare regimen. However, performing these interventions without first performing a skin assessment can cause the nurse to miss important signs that can potentially result in more injury to the child. Neurovascular assessment should be performed frequently as prescribed by the health care provider or at least every 4 hours to evaluate skin integrity and venous circulation.

The nurse is observing a child walk down stairs using a swing-through gait. What action by the child is correct? The child tries to walk without the crutches. The child places the crutches on the lower step before placing the good foot down between the crutches. Both crutches are placed on the lower step, and then the good foot is placed on the step below the crutches. One crutch is placed on the lower step, and then the good foot is placed next to the crutch.

The child places the crutches on the lower step before placing the good foot down between the crutches. Explanation: To walk downstairs using a swing-through gait, the child places the crutches on the lower step, and then the good foot is placed on the step between the crutches. Both crutches should be moved at the same time. The good foot should not be placed on a lower step than the crutches when going down stairs.

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? "Blowing cool air with a fan or hair dryer may relieve the feeling." "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." "Itching is common. It's nothing to worry about." "A small amount of lotion or baby oil can be poured in the cast to moisturize the area."

"Blowing cool air with a fan or hair dryer may relieve the feeling." Explanation: 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 nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? lordosis indications of hydrocephalus appearance of smaller than normal calf muscles Gowers sign

Gowers sign Explanation: A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

A type of traction sometimes used in the treatment of the child with scoliosis is called: Dunlop traction. Bryant traction. Russell traction. halo traction.

halo traction. Explanation: When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction.

A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor? obesity late walking hormonal alterations during puberty lack of sunlight exposure

obesity Explanation: Obesity is a risk factor for the development of tibia vara. Tibia vara occurs most frequently in children who are early walkers. Limited or lack of exposure to sunlight may lead to rickets. Hormonal alterations during puberty may play a role in the development of slipped capital femoral epiphysis.

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? "Let's ask your parents to bring your friends for a visit." "Do you want a book to read?" "You are too big to suck your thumb." "Would you like a coloring book?"

"Let's ask your parents to bring your friends for a visit." Explanation: After 2 weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the child's parent or supervised by the child-life specialist would help the client adapt to the immobilized state. Telling the client that he or she is too big to suck the thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as the child has likely grown tired of books and coloring after 2 weeks.

A parent is angry about the adolescent's diagnosis of osteosarcoma. The parent is telling the adolescent that if he hadn't played football last year and broken his leg, this would not have happened. What is the nurse's best response to the parent's statement? "When your adolescent broke the leg last year, it may have weakened the bone, allowing cancer to start there." "Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." "Cancer in the bone can result from old injuries so it probably was not caused from getting hurt last year, but an earlier injury." "Does bone cancer run in your family? Maybe your adolescent inherited it through genes."

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Explanation: Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma.

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response? "Older age at conception is one of the major causes of the defect." "The cause is unknown and there are many environmental factors that may contribute to it." "It has been linked to maternal alcohol consumption during pregnancy." "It's a common complication of amniocentesis."

"The cause is unknown and there are many environmental factors that may contribute to it." Explanation: There is no one known cause of spina bifida, but scientists believe that it's linked to hereditary and environmental factors. Neural tube defects, including spina bifida, have been strongly linked to low dietary intake of folic acid. Maternal age doesn't have an impact on spina bifida. An amniocentesis is performed to help diagnose spina bifida in utero but doesn't cause the disorder. Maternal alcohol intake during pregnancy has been linked to intellectual disability, craniofacial defects, and cardiac abnormalities, but not spina bifida.

The nurse is caring for an adolescent with Sever disease (calcaneal apophysitis). What treatment would be prescribed for this disorder? Select all that apply. heel stretching exercises after the pain has subsided acetaminophen administration immobilization with a cast for 4 to 6 weeks addition of a lift or cup to the heel of the shoe of the affected size application of ice before and after athletic events

application of ice before and after athletic events addition of a lift or cup to the heel of the shoe of the affected size heel stretching exercises after the pain has subsided Explanation: Sever disease (calcaneal apophysitis) is an overuse injury common in overweight children between ages 8 and 15 years. Treatment includes adding a lift or cup to the heal of the shoe, ice application before and after sporting events, NSAIDs such as ibuprofen, and once the pain has subsided, heel stretching exercises. Acetaminophen does not have anti-inflammatory properties and would not be indicated for this disorder. Immobilization and/or casting is not required.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record? low serum calcium levels low alkaline phosphate levels high serum phosphate levels x-ray confirmation of adequate bone shape

low serum calcium levels Explanation: With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? presence of symmetrical spontaneous movement absence of Moro reflex presence of Moro reflex absence of tonic neck reflex

presence of Moro reflex Explanation: The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child.

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

Assess the popliteal region carefully for skin breakdown. Explanation: 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.

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? Ineffective coping related to diagnosis of chronic condition Impaired physical mobility related to spinal cord defect Risk for injury related to lack of muscle control Deficient knowledge related to diagnosis and condition

Deficient knowledge related to diagnosis and condition Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for health care professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.

The nurse is conducting a neuromuscular assessment on a toddler. What assessment technique(s) is important for the nurse to include in this assessment? Select all that apply. Compare muscle strength and tone bilaterally. Assess the hips for extension and abduction. Perform passive range-of-motion on all extremities. Observe for involuntary muscle contractions. Observe the stepping reflex.

Compare muscle strength and tone bilaterally. Observe for involuntary muscle contractions. Perform passive range-of-motion on all extremities. Explanation: Musculoskeletal development continues as the newborn grows. The newborn has all the ligaments, muscles, tendons and cartilage present at birth and they are functional, but the newborn does not have control over them. This comes with growth and age. It is important for the nurse to complete a musculoskeletal assessment at each clinic visit in the physical assessment. Thus, for this toddler, muscle strength and tone should be compared bilaterally. Strength is assessed by the toddler's ability to move muscles against gravity. This is done by the toddler pushing the feet against the nurse's hands or by grasp. The nurse will observe for involuntary muscle contractions. Involuntary contractions could indicate spasticity. Range-of-motion should be done to determine if a joint position is fixed. When assessing the hips, they should be flexed, abducted and externally rotated. The stepping reflex is seen when the infant is held upright and moves the legs as is stepping or walking. This reflex should be gone by about 2 months.

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? "Elevate the legs, and use bed rest for 24 hours." "Applying ice to the area will reduce the pain and swelling." "Apply ice to the injury for 60 minutes on and 60 minutes off." "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. 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. As part of RICE, 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 parent brings the infant to the clinic for a well-child visit. During the assessment the nurse notes that the infant has an area of dark pigmentation with a tuft of hair on the sacrum. Which action should the nurse take? Ask the parent if the child has sustained an injury. Document the finding as a congenital dermal melanocytosis (slate gray nevus). Have the health care provider assess the finding. Ask the parent how long the tuft of hair has been there.

Have the health care provider assess the finding. Explanation: The dark pigmentation and tuft of hair on the sacrum suggests that the infant has spina bifida occulta, which will require follow up with diagnostic testing to confirm the diagnosis (ultrasound and/or magnetic resonance imaging). A congenital dermal melanocytosis (slate gray nevus, previously known as Mongolian spot) is a dark pigmented area commonly found on darker skinned infants on the sacrum, buttocks and sometimes the scapula. The tuft of hair is what leads to the suspicion of spina bifida occulta. There is no indication to ask the parent how long the tuft of hair has been there or if the infant sustained an injury.

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

creatine kinase Explanation: Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

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? "Has he achieved his developmental milestones on time?" "Has his pace of achieving milestones diminished?" "Would you please describe the weakness you are seeing in your son?" "Do you think he is simply fatigued?"

"Would you please describe the weakness you are seeing in your son?" Explanation: 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 other questions would most likely elicit a yes or no answer rather than any specific details about his weakness or development.

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? sway back kyphosis lordosis 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 nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition? A 13-year-old boy who is on his school's cross-country team A 15-year-old girl who dances ballet An 11-year-old girl who is obese A 9-year-old boy who is sedentary

A 13-year-old boy who is on his school's cross-country team Explanation: Osgood-Schlatter disease is the thickening and enlargement of the tibial tuberosity resulting from microtrauma, probably caused from overuse. It occurs more often in boys than girls and at preadolescence or early adolescence, probably because of rapid growth at these times.

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. Wear a protective gown when moving the child's arm. Wear sterile gloves when removing or touching the cast. Check capillary refill time in the both arms.

Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand. Explanation: The most important function for the nurse in caring for a child in a cast is frequent neurovascular checks. The nurse should monitor for increased pain and edema, a pale or blue color to the extremities, skin coolness, numbness or tingling, poor capillary refill, and decreased pulse strength. Increased pain, especially unrelieved with pain medications, can indicate serious complications such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary as the cast is not sterile.

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." Explanation: It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

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? "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." "I leave my brace on for gym at school." "I wear a t-shirt under my brace." "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." 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. During the time the brace is off, hygiene activities such as bathing should be done. It is important to check the brace for any damage daily to prevent injury. For comfort, a lightweight t-shirt may be worn under the brace.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele? There is a bony defect that occurs without soft-tissue involvement. There is no protrusion of the spinal cord, only soft-tissue inflammation occurs. There is protrusion of the spinal cord and meninges, with nerve roots embedded. The spinal meninges protrude through the bony defect and form a cystic sac.

The spinal meninges protrude through the bony defect and form a cystic sac. Explanation: When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client? Duchenne muscular dystrophy Juvenile arthritis Facioscapulohumeral muscular dystrophy Congenital myotonic dystrophy

Duchenne muscular dystrophy Explanation: By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

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. The outside of the boy's cast got wet and had to be dried using a hair dryer. The boy experiences mild pain when wiggling his toes. New drainage is seeping out from under the cast. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. The boy's toes are light blue and very swollen.

The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. New drainage is seeping out from under the cast. The boy's toes are light blue and very swollen. Explanation: 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.

The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be: Sever disease (calcaneal apophysitis). epiphysiolysis of the proximal humerus. Osgood-Schlatter disease. epiphysiolysis of the distal radius.

epiphysiolysis of the proximal humerus. Explanation: Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease (calcaneal apophysitis) causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

The client 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? Ask the babysitter to advocate for the child and report the incident to the authorities. Evaluate the child for a seizure disorder, as that is probably why the infant is injured. Evaluate the infant for an underlying musculoskeletal disorder. Arrange for the parents to come in for an evaluation for possible physical abuse.

Arrange for the parents to come in for an evaluation for possible physical abuse. Explanation: Any type of fracture can be the result of child abuse (child mistreatment), 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 child abuse (child mistreatment). 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.

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. Have the coach monitor the treatment program for sports injuries. Encourage 1 to 2 days off per week of competitive athletics. Immobilize the muscles that are involved. Perform appropriate stretching during a 20-to 30-minute warmup. Avoid using NSAIDs for pain control. Apply ice to the injured area to reduce inflammation.

Encourage 1 to 2 days off per week of competitive athletics. Apply ice to the injured area to reduce inflammation. Perform appropriate stretching during a 20-to 30-minute warmup. Explanation: 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.

A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment? Quietly observe the child at play while interviewing the parent. Review the child's health history to determine if the child is on track developmentally. Get down to the child's level and interact with the child. Ask the parent to describe the child's development.

Quietly observe the child at play while interviewing the parent. Explanation: The best way to assess a young child's neuromuscular system is to observe the child from a distance. Observing the child at play will allow the nurse to assess the child's gross and fine motor skills, as well as cognitive abilities. Asking the parent to describe the child's motor development may be appropriate in some cases such as the ability to feed. Getting down to the child's level may help assess the child's social development but observing the child play at a distance is best to assess a child's fine and gross motor development. Reviewing the child's history will give the nurse a sense of the child's past developmental level but will not give information about the child's current status.

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 forward The angle of the iliac crest when bending forward The posterior spine when bending sideways The angle of the lower chest when sitting down

The posterior spine when bending forward Explanation: Diagnosis of scoliosis is best made with inspection and observation. When inspecting the back with the child in a standing position, the nurse should note asymmetries such as shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. A lateral curvature of the spine is best revealed when the child bends forward. The child should bend forward with the arms hanging freely. The curve and asymmetry of the back can be observed. The height of the iliac crest, not the angle, is measured on both sides and the difference is noted. Bending to the side would not provide an accurate assessment of the spine because the curvature cannot be seen from the side. The lower chest angle would not be an accurate assessment as it would be more associated with the ribs as opposed to the spine.