Peds Exam 2-Chapter 48; Musculoskeletal or Articular Dysfunction

Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy? a. Instructions for a low-calorie diet b. Arrangements for tutoring and schoolwork c. Instructions for a high-fat, low-protein diet d. Instructions for the parent to return the child to team sports immediately

b. Arrangements for tutoring and schoolwork

The nurse is caring for a 12-year-old who is immobilized because of a broken femur. Which of the following is a major musculoskeletal consequence of immobilization the nurse should be aware of? a. Increased joint mobility will occur. b. Will see an increase in muscle size and strength. c. Circulatory stasis may develop. d. Muscle hypertrophy can occur.

b. Will see an increase in muscle size and strength.

A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI). Further teaching is indicated if the parents make which statement? a. "We will be very careful handling the baby." b. "We will lift the baby by the buttocks when diapering." c. "We're glad there is a cure for this disorder." d. "We will schedule follow-up appointments as instructed."

c. "We're glad there is a cure for this disorder."

Which of the following statements by the parents indicates a need for further teaching with regard to the treatment of congenital clubfoot? a. "We'll expose the cast to air to help it dry." b. "We'll watch for any swelling of the foot while the cast is on." c. "We're happy this is the only cast our baby will need." d. "Our baby may need surgery of their foot too."

c. "We're happy this is the only cast our baby will need."

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 family's 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. Assess for child abuse. Fractures in infants are often nonaccidental.

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. What should be included? a. Apply lotion or powder to minimize skin irritation. b. Remove the harness several times a day to prevent contractures. c. Return to the clinic every 1 to 2 weeks. d. Place a diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

c. Return to the clinic every 1 to 2 weeks.

Which type of traction uses skin traction on the lower leg and a padded sling under the knee? a. Dunlop b. Bryant's c. Russell d. Buck's extension

c. Russell

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia. Which assessment findings indicate possible compartment syndrome (Select all that apply)? a. Palpable distal pulse b. Capillary refill to extremity of <3 seconds c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

c. Severe pain not relieved by analgesics d. Tingling of extremity e. Inability to move extremity

An important nursing consideration when caring for a child with juvenile idiopathic arthritis (JIA) is to: a. Apply ice packs to relieve stiffness and pain. b. Administer acetaminophen to reduce inflammation. c. Teach child and family the correct administration of medications. d. Encourage range-of-motion exercises during periods of inflammation.

c. Teach child and family the correct administration of medications.

Which of the following is a type of skin traction with legs in an extended position? a. Dunlop b. Bryant c. Russell d. Buck extension

d. Buck extension

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

d. Children have thickened periosteum and more generous blood supply

A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should plan to implement which interventions for this child (Select all that apply)? a. Instructions to avoid exposure to sunlight b. Teaching about body changes associated with SLE c. Preparation for home schooling d. Restricted activity

a. Instructions to avoid exposure to sunlight b. Teaching about body changes associated with SLE

Which of the following nursing interventions is most appropriate when caring for the child with osteomyelitis during the acute phase? a. Move and turn the child carefully and gently to minimize discomfort. b. Administer po antibiotics with meals. c. Implement droplet precautions in children with osteomyelitis. d. Provide active range of motion exercises for the affected extremity.

a. Move and turn the child carefully and gently to minimize discomfort.

The nurse is preparing an adolescent with scoliosis for a Luque-rod segmental spinal instrumentation procedure. Which consideration should the nurse include? a. Nasogastric intubation and urinary catheter may be required. b. Ambulation will not be allowed for up to 3 months. c. Surgery eliminates the need for casting and bracing. d. Discomfort can be controlled with nonpharmacologic methods.

a. Nasogastric intubation and urinary catheter may be required.

A student athlete was injured during a soccer game. The school nurse observes significant swelling. The player states he thought he "heard a pop," and the pain is "pretty bad," and "my ankle feels like it is coming apart." Based on this description, the school nurse suspects what injury? a. Sprain b. Strain c. Dislocation d. Fracture

a. Sprain

What is most descriptive of the therapeutic management of osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of the affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.

a. Treatment usually consists of surgery and chemotherapy.

What effect does immobilization have on the cardiovascular system? a. Venous stasis b. Increased vasopressor mechanism c. Normal distribution of blood volume d. Increased efficiency of orthostatic neurovascular reflexes

a. Venous stasis

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which instructions should be included in the teaching? a. Swelling of the fingers is to be expected for the next 48 hours. b. Immobilize the shoulder to decrease pain in the arm. c. Allow the affected limb to hang down for 1 hour each day. d. Elevate casted arm when resting and when sitting up.

d. Elevate casted arm when resting and when sitting up.

An appropriate nursing intervention for the care of a child with an extremity in a new hip spica plaster cast is: a. Keeping the cast covered with a sheet. b. Using the fingertips when handling the cast to prevent pressure areas. c. Using heated fans or dryers to circulate air and speed the cast-drying process. d. Expose the plaster cast to air until dry.

d. Expose the plaster cast to air until dry.

The nurse uses the palms of the hands when handling a wet cast to: a. Assess dryness of the cast. c. Keep the patient's limb balanced. b. Facilitate easy turning. d. Avoid indenting the cast.

d. Avoid indenting the cast.

The goal that is most appropriate for the child with juvenile arthritis is for the child to be able to exhibit signs of: a. Adequate joint motion and function. b. Improved skin integrity. c. Weight loss and improved nutritional status. d. Adequate respiratory function.

a. Adequate joint motion and function.

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. The nurse's approach should include: a. Answering questions with straightforward honesty. b. Avoiding discussing the seriousness of the condition. c. Explaining that, although the amputation is difficult, it will cure the cancer. d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy.

a. Answering questions with straightforward honesty.

A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate immediate action by the school nurse is to: a. Apply ice. b. Observe for edema and discoloration. c. Encourage child to assume a comfortable position. d. Obtain parental permission for administration of acetaminophen or aspirin.

a. Apply ice.

The nurse is creating a plan of care for a child with a leg cast secondary to a tibia fracture. Which of the following interventions would be appropriate to decrease the risk for ineffective peripheral tissue perfusion related to pressure from cast? Select all that apply. a. Assess foot and toes every 4 hours and as necessary for skin temperature and presence of pedal pulses. b. Keep leg elevated by a pillow day 1 or as directed by the healthcare provider. c. Remind the parents not to allow the child to put anything in the cast. d. Assess capillary refill of toes every 4 hours and as necessary. e. Educate the child's parents on use of good body mechanics when repositioning the child. f. Observe the affected extremity (fingers or toes) for any edema or discoloration every 4 hours and as necessary.

a. Assess foot and toes every 4 hours and as necessary for skin temperature and presence of pedal pulses. b. Keep leg elevated by a pillow day 1 or as directed by the healthcare provider. d. Assess capillary refill of toes every 4 hours and as necessary. f. Observe the affected extremity (fingers or toes) for any edema or discoloration every 4 hours and as necessary.

When assessing the child with osteogenesis imperfecta, the nurse should expect to observe: a. Discolored teeth. b. Below-normal intelligence. c. Increased muscle tone. d. Above-average stature.

a. Discolored teeth.

Osteosarcoma is the most common bone cancer in children. Where are most of the primary tumor sites? a. Femur b. Humerus c. Pelvis d. Tibia

a. Femur

Four-year-old David is placed in Buck's extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first?a. Notify the practitioner of the changes noted. b. Give the child medication to relieve the pain. c. Reposition the child and notify the physician. d. Chart the observations and check the extremity again in 15 minutes

a. Notify the practitioner of the changes noted.

Which condition can result from the bone demineralization associated with immobility? a. Osteoporosis b. Urinary retention c. Pooling of blood d. Susceptibility to infection

a. Osteoporosis

The nurse is caring for a child with newly applied cast and is assessing for compartment syndrome. Which of the following is considered a late sign of ischemia? a. Pallor b. Paresthesia c. Pain d. Petaling

a. Pallor

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe (Select all that apply)? a. Positive Ortolani sign b. Unequal gluteal folds c. Negative Babinski's sign d. Trendelenburg's sign e. Telescoping of the affected limb f. Lordosis

a. Positive Ortolani sign b. Unequal gluteal folds

Nursing implementation directed toward nonsurgical management in an adolescent with scoliosis primarily includes: a. Promoting self-esteem and positive body image. b. Promoting immobilization of the legs. c. Promoting adequate nutrition. d. Preventing infection.

a. Promoting self-esteem and positive body image.

Discharge planning for the child with juvenile arthritis includes the need for: a. Routine ophthalmologic examinations to assess for visual problems. b. A low-calorie diet to decrease or control weight in the less mobile child. c. Avoiding the use of aspirin to decrease gastric irritation. d. Immobilizing the painful joints, which are the result of the inflammatory process.

a. Routine ophthalmologic examinations to assess for visual problems.

Which term is used to describe a type of fracture that does not produce a break in the skin? a. Simple b. Compound c. Complicated d. Comminuted

a. Simple

A child is upset because, when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. What should the nurse suggest to remove this material? a. Soak in a bathtub. c. Apply powder to absorb material. b. Vigorously scrub the leg. d. Carefully pick material off of the leg.

a. Soak in a bathtub.

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip (DDH) about preventing skin breakdown under the Pavlik harness. Which statement by the parent would indicate a correct understanding of the teaching? a. "I will apply a lotion for sensitive skin under the straps after my baby has been given a bath to prevent skin irritation." b. "I should gently massage the skin under the straps once or twice a day to stimulate circulation." c. "I should remove the harness a few times throughout the day and provide passive ROM to all extremities." d. "I will place a diaper over the harness for added hip support."

b. "I should gently massage the skin under the straps once or twice a day to stimulate circulation."

A clinic nurse is conducting a staff in-service for other clinic staff regarding the signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session (Select all that apply)? a. Bone fractures b. Abdominal mass c. Sore throat and ear pain d. Headache e. Ecchymosis of conjunctiva

b. Abdominal mass c. Sore throat and ear pain e. Ecchymosis of conjunctiva

An appropriate nursing intervention when caring for a child in traction is to: a. Remove adhesive traction straps daily to prevent skin breakdown. b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles. c. Provide active range-of-motion exercises to affected extremity 3 times a day. d. Keep child in one position to maintain good alignment.

b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles.

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complications should the nurse monitor? a. Hypocalcemia b. Decreased metabolic rate c. Positive nitrogen balance d. Increased production of stress hormones

b. Decreased metabolic rate

An advantage to using a fiberglass cast instead of a plaster cast is that a fiberglass cast: a. Is less expensive. b. Dries rapidly c. Molds closely to body parts. d. Has a smooth exterior.

b. Dries rapidly

When caring for a 7-year-old child with a suspected fracture which of the following would be an appropriate intervention to implement? a. Apply heat to the injured area. b. Elevate the injured limb if possible. c. Palpate the affected limb. d. Immobilize the limb including the joint below the fracture site.

b. Elevate the injured limb if possible.

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement? a. Healing is usually delayed in this type of fracture. b. Growth can be affected by this type of fracture. c. This is an unusual fracture site in young children. d. This type of fracture is inconsistent with a fall.

b. Growth can be affected by this type of fracture.

An adolescent is in traction. The purpose of the traction is to fatigue the muscle and reduce muscle spasm so that the bones can be realigned. Nursing actions should include which of the following? a. Maintain continuous traction until muscle spasm ceases. b. Maintain continuous traction to prevent muscle from contracting. c. Release traction every hour to allow muscle to briefly regain its contractibility. d. Release traction once every 8 hours to allow muscle to briefly regain its contractibility.

b. Maintain continuous traction to prevent muscle from contracting.

What is the most common management of the newborn with hip dysplasia? a. Hip spica cast b. Pavlik harness c. Buck extension traction d. Denise-Brown splint

b. Pavlik harness

A preadolescent has been diagnosed with scoliosis. The planned therapy is to use a thoracolumbosacral orthotic (TSLO brace). The patient asks how long they will have to wear the brace. The nurse's best response is: a. Typically between 6 and 12 months. b. Until your growth is complete. c. Up until the spinal fusion surgery occurs. d. The length of time will be reassessed at age 25.

b. Until your growth is complete.

The nurse is teaching general infant care to parents of an infant diagnosed with osteogenesis imperfecta (OI). Which of the following would be most important to include in the teaching session? a. "Vitamin D therapy is beneficial for OI." b. "Physical therapy should be avoided as it may cause damage to bones." c. "Lift the infant by the buttocks, not the ankles, when changing diapers." d. "Braces have not been found to be helpful with ambulation."

c. "Lift the infant by the buttocks, not the ankles, when changing diapers."

Which statement is accurate concerning a child's musculoskeletal system and how it may be different from an adult's? a. Growth occurs in children as a result of an increase in the number of muscle fibers. b. Infants are at greater risk for fractures because their epiphyseal plates are not fused. c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. d. Children's bones have less blood flow.

c. Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.

A 3-year-old child is admitted to the hospital with osteomyelitis of the right femur. The nurse would expect to start an IV and begin empiric antibiotic therapy after blood is drawn for which lab test? a. Hemoglobin and hematocrit b. White blood cell count c. Culture d. C-reactive protein (CRP)

c. Culture

When does idiopathic scoliosis become most noticeable? a. Newborn period b. When child starts to walk c. During preadolescent growth spurt d. Adolescence

c. During preadolescent growth spurt

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that: a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.

c. Frequent, serial casting is tried first.

The primary method of treating osteomyelitis is: a. Joint replacement. b. Bracing and casting. c. Intravenous antibiotic therapy. d. Long-term corticosteroid therapy

c. Intravenous antibiotic therapy.

A 17-year-old female patient is returning to the pediatric intensive care unit after Luque instrumentation (rods) were placed for scoliosis repair. In addition to the usual immediate postoperative care, what additional intervention will be needed? a. Active range of motion to all extremities to decrease risk of neurological injury. b. Two-person assist to the bathroom. c. Logrolling for position changes. d. Elevating the head of the bed to 30-45 degrees to assist with lung deflation.

c. Logrolling for position changes.

What would cause a nurse to suspect that an infection has developed under a cast? a. Complaint of paresthesia c. Increased respirations b. Cold toes d. "Hot spots" felt on cast surface

d. "Hot spots" felt on cast surface

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta (OI) about the use of bisphosphonates for this condition. What statement by the parents indicate a need for further education? a. "This medication will help to increase bone mineral density." b. "My child's risk for fractures will hopefully be decreased as by taking this medication." c. "This drug is commonly used to treat osteogenesis imperfecta." d. "This medication will cure my child of this disorder."

d. "This medication will cure my child of this disorder."

Diagnostic evaluation is important for early recognition of scoliosis. Which of the following is the correct procedure to exam a child for scoliosis. a. Standing and walking fully clothed to look for uneven hanging of clothing. b. From the front to evaluate bone maturity. c. From the left and right side while the child is completely undressed. d. From behind while the child is bending forward and is wearing shorts or undergarments.

d. From behind while the child is bending forward and is wearing shorts or undergarments.

Which term is used to describe an abnormally increased convex angulation in the curvature of the thoracic spine? a. Scoliosis b. Ankylosis c. Lordosis d. Kyphosis

d. Kyphosis

A child with juvenile idiopathic arthritis (JIA) has been started on a nonsteroidal anti-inflammatory drug (NSAID). Which of the following nursing considerations should be included in parental education? a. Take an apical heart rate before giving the medication. b. Administering the medication between meals. c. Expect the joint inflammation to be gone in 3-4 days. d. Monitor for abdominal discomfort and bloody stools.

d. Monitor for abdominal discomfort and bloody stools.

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)? a. Aspirin b. Corticosteroids c. Cytotoxic drugs such as methotrexate d. Nonsteroidal anti inflammatory drugs (NSAIDs)

d. Nonsteroidal anti inflammatory drugs (NSAIDs)

Which of the following is the most common dislocation seen in children? a. Elbow dislocation b. Knee dislocation c. Shoulder dislocation d. Phalanges dislocation

d. Phalanges dislocation

A nurse is providing care to an adolescent client diagnosed with a fractured humerus and long arm cast in place. The nurse has completed their assessment. Which assessment finding requires the nurse to contact the health care provider? a. Pain rating of 3 out of 10. b. Mild itching under the cast. c. Capillary refill less than 2 seconds. d. Shiny digits

d. Shiny digits

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action? a. Encouraging normal activity for as long as is possible b. Explaining the cause of the disease to the child and family c. Preparing the child and family for long-term, permanent disabilities d. Teaching the family the care and management of the corrective appliance

d. Teaching the family the care and management of the corrective appliance

Which nursing intervention is appropriate to assess for neurovascular competency in a child who fell off the monkey bars at school and hurt his arm? a. The degree of motion and ability to position the extremity. b. The length, diameter, and shape of the extremity. c. The amount of swelling noted in the extremity and pain intensity. d. The skin color, temperature, movement, sensation, and capillary refill of the extremity.

d. The skin color, temperature, movement, sensation, and capillary refill of the extremity.

The nurse is caring for a 7-year-old with a possible diagnosis of Legg-Calvé-Perthes disease. Which of the following would be an appropriate intervention when planning care for this child? a. Strict bed rest and no activities. b. Prepare the child for surgical intervention most likely within the first 24 hours of admission. c. Promoting hemodynamic stabilization. d. Use of physical therapy or range-of-motion exercises to help restore hip motion

d. Use of physical therapy or range-of-motion exercises to help restore hip motion

Which of the following is a physiologic effect of immobilization on children? a. Metabolic rate increases. b. Increased joint mobility can lead to contractures in a short time. c. Bone calcium increases, releasing excess calcium into the body (hypercalcemia). d. Venous stasis can lead to thrombi or emboli formation.

d. Venous stasis can lead to thrombi or emboli formation.