Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder Y ER GH VJIV

Spica cast

Rigid mold that encircles one or both arms or legs and the chest or trunk A hip spica cast is a sort of orthopedic cast used to immobilize the hip or thigh. It is used to facilitate healing of injured hip joints or of fractured femurs. A hip spica includes the trunk of the body and one or both legs

The nurse is assessing a young boy who has been brought to the health care provider for mobility and balance issues by his parents. Which findings are positively associated with the presence of Duchenne muscular dystrophy? Select all that apply. 1 Serum creatine kinase levels are elevated. 2 An electromyogram demonstrates the problem is within the nerves, not the muscles. 3 A muscle biopsy shows an absence of dystrophin. 4 The child is unable to rise easily into a standing position when placed on the floor. 5 Genetic testing indicates the presence of a gene associated with spinal muscular atrophy.

Significant muscle wasting is associated with this diagnosis. 1 Creatine kinase levels increase with muscle wasting. 3 A muscle biopsy will show an absence of dystrophin. 4 Gowers sign will be positive. NOT 2 An electromyogram will indicate the problem is with the muscles, not the nerves. 5 Genetic testing will reveal the presence of the gene associated with Duchenne muscular dystrophy

Stockinette

Stockinettes are used as a general-purpose protective skin covering, knitted from 100% unbleached cotton. Stockinettes are an inexpensive and convenient form of covering and protection for the skin and are also suitable for use under cast materials

Limb Girdle Dystrophy

Weakness, wasting of shoulder and pelvic girdles first

Bone buckle

Compression injury; the bone buckles rather than breaks

External fixation device

An external fixation device may be used to keep fractured bones stabilized and in alignment. The device can be adjusted externally to ensure the bones remain in an optimal position during the healing process. This device is commonly used in children and when the skin over the fracture has been damaged

Gowers sign

Difficulty rising to standing position; has to walk up legs using hands; occurs in Muscular dystrophy

Duchenne

Duchenne is the most severe form of muscular dystrophy

Greenstick fracture

Bending and incomplete break of a bone; most often seen in children

Myelomeningocele

(Spina bifida) A congenital defect in which the neural tube fails to close while the fetus is developing (the spinal cords is exposed through a skin defect)

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as: 1 significant bending without actual breaking. 2 bone buckling due to compression. 3 incomplete fracture. 4 bone that breaks into two pieces

1 A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. NOT 2 A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. 3 An incomplete fracture of the bone is a greenstick fracture. 4 A complete fracture is one in which the bone breaks into two pieces

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? 1 Gowers sign 2 appearance of smaller than normal calf muscles 3 indications of hydrocephalus 4 lordosis

1 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. NOT 3 Signs of hydrocephalus are not typically associated with DMD. 4 Kyphosis and scoliosis occur more frequently than lordosis. 2 A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

In caring for a child in traction, which intervention is the highest priority for the nurse? 1 The nurse should monitor for decreased circulation every 4 hours. 2 The nurse should clean the pin sites at least once every 8 hours. 3 The nurse should provide age-appropriate activities for the child. 4 The nurse should record accurate intake and output.

1 Any child in traction must be carefully monitored to detect any signs of decreased circulation or neurovascular complications. NOT 2 Cleaning pin sites is appropriate for a child in skeletal traction to reduce the risk of infection. 3.4. 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

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? 1 Duchenne muscular dystrophy 2 Facioscapulohumeral muscular dystrophy 3 Congenital myotonic dystrophy 4 Juvenile arthritis

1 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. NOT 2 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. 3 Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. 4 The symptoms of juvenile arthritis are primarily stiff and painful joints

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note? 1 The posterior spine when bending forward 2 The angle of the iliac crest when bending forward 3 The posterior spine when bending sideways 4 The angle of the lower chest when sitting down

1 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. NOT 2 The height of the iliac crest, not the angle, is measured on both sides and the difference is noted. 3 Bending to the side would not provide an accurate assessment of the spine because the curvature cannot be seen from the side. 4 The lower chest angle would not be an accurate assessment as it would be more associated with the ribs as opposed to the spine

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered? 1 diazepam 2 opioid analgesics 3 alendronate 4 pamidronate

1 Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. NOT 2 Opioid analgesics are used for pain relief. 3 Alendronate increases bone mineral density for children with osteogenesis imperfecta. 4 Pamidronate increases bone mineral density for children with osteogenesis imperfecta

How would the nurse best describe Gowers sign to the parents of a child with muscular dystrophy? 1 a transfer technique 2 a waddling-type gait 3 the pelvis position during gait 4 muscle twitching present during a quick stretch

1 Gowers sign is a description of a transfer technique present during some phases of muscular dystrophy. The child turns on the side or abdomen, extends the knees, and pushes on the torso to an upright position by walking his hands up the legs. NOT 2.3. The child's gait is unrelated to the presence of Gowers sign. 4 Muscle twitching present after a quick stretch is described as clonus

The nurse is caring for a preschooler with a greenstick fracture. Which statement by a parent indicates an understanding of this type of fracture? 1 "My child may need the arm broken completely prior to putting a cast on it." 2 "This type of fracture only occurs in the leg." 3 "Crepitus (crackling) can be felt over this type of fracture." 4 "I shouldn't have picked my child up by the arm. This fracture wouldn't have happened."

1 Greenstick fractures are incomplete fractures. They commonly occur in young children. Sometimes greenstick fractures are broken completely before casting to prevent the bone from resuming its "bent" position in the cast. NOT 2 This fracture does not always occur in the leg. 3 Crepitus (crackling) typically occurs over a clavicle fracture. 4 A dislocation of the radial head is the typical injury that occurs when a child is picked up by one arm

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? 1 Impaired physical mobility related to a cast on the leg 2 Deficient diversional activities related to a need for 3 imposed activity restriction for 6 weeks 3 Situational low self-esteem related to the use of a walker 4 Pain related to chronic inflammation of the lower leg

1 Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? 1 "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." 2 "It is important to correct spinal curvature before it gets too bad, causing you problems." 3 "It is important to prevent herniation of a spinal disk, which is painful." 4 "It is important to prevent torticollis"

1 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. NOT 2 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. 4 Torticollis is tightened neck muscles causing the head to tilt downward. 3 A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine

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? 1 adolescence 2 school age 3 preschool age 4 toddlerhood

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

A 14-year-old girl with a fractured leg is receiving instructions from the nurse on how to use crutches. Which intervention should the nurse implement to help prevent nerve palsy in the client? 1 Teach the client not to rest with the crutch pad pressing on the axilla. 2 Assess the tips of the crutches to be certain the rubber tip is intact. 3 Be certain the child is walking with the crutches about 6 inches to the side of the foot. 4 Caution parents to clear articles such as throw rugs out of paths at home

1 Pressure of a crutch against the axilla could lead to compression and damage of the brachial nerve plexus crossing the axilla, resulting in permanent nerve palsy. Teach children not to rest with the crutch pad pressing on the axilla but always to support their weight at the hand grip. NOT 2 Always assess the tips of crutches to be certain the rubber tip is intact and not worn through as the tip prevents the crutch from slipping. 3 Be certain the child is walking with the crutches placed about 6 inches to the side of the foot. This distance furnishes a wide, balanced base for support. 4 Caution parents to clear articles such as throw rugs, small footstools or toys out of paths at home, to avoid tripping the child.

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg? 1 Check the infant's toes for coldness or blueness. 2 Change the infant's diapers frequently. 3 Perform passive foot exercises. 4 Apply Denis Browne splints to the infant each night.

1 Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. NOT 2.3.4. The other answers are other interventions pertaining to caring for a child with clubfoot but are not associated specifically with ensuring good circulation

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent? 1 "Applying ice to the area will reduce the pain and swelling." 2 "Apply ice to the injury for 60 minutes on and 60 minutes off." 3 "Elevate the legs, and use bed rest for 24 hours." 4 "Taking warm baths will help relax muscles and reduce pain."

1 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). NOT 2 Cold should be applied for 20 to 30 minutes and then removed for 60 minutes. This process is repeated until the area is numb. 3 As part of RICE, the legs should be elevated, but there is no timeline for how long this should occur. 4 Warm baths would cause vasodilation, further increasing the pain and swelling. Cold causes vasoconstriction to reduce the pain and swelling.

The nurse is doing an examination on an infant with a diagnosis of developmental dysplasia of the hip (DDH). Which finding would be an indication of this diagnosis? 1 Gluteal fold higher on one side than the other 2 Sac protruding on the lower back 3 Respiratory rate of 30 breaths per minute 4 Head circumference of 18 inches (46 cm)

1 Signs that indicate DDH include asymmetry of the gluteal skin folds (higher on the affected side), limited abduction of the affected hip, and shortening of the femur

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: 1 Duchenne. 2 facioscapulohumeral. 3 limb-girdle. 4 myotonia.

1 Studies have shown that Duchenne is the most severe form of muscular dystrophy. Myotonia isn't a form of the disease; it's a symptom

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? 1 low serum calcium levels 2 low alkaline phosphate levels 3 high serum phosphate levels 4 x-ray confirmation of adequate bone shape

1 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

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. 1 prone 2 right side lying 3 left side lying 4 semi-Fowler 5 supine

1.2.3. Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. 1 Color 2 Sensation 3 Pulse 4 Capillary refill 5 Vital signs

1.2.3.4 A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. NOT 5 Vital signs are not a component of a neurovascular assessment

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? 1 alcohol gel 2 latex 3 peanuts 4 cat dander

2 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. NOT 1.3.4. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

The nurse is teaching a health and wellness course to young women of childbearing age. Which vitamin will the nurse encourage all to take daily? 1 Ascorbic acid 2 Folic acid 3 Niacin 4 Calcium

2 It is recommended that all women of childbearing age ingest 0.4 mg of folic acid daily. NOT 1.3.4. Ascorbic acid is vitamin C, niacin is a B vitamin, and calcium is a mineral, not a vitamin

Through which mechanism is Duchenne muscular dystrophy acquired? 1 virus 2 heredity 3 autoimmune factors 4 environmental toxins

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

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? 1 bilirubin 2 creatine kinase 3 serum potassium 4 sodium

2 Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. NOT 1 Bilirubin is a by-product of liver function. 3.4. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation? 1 A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs. 2 A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate. 3 A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard. 4 A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating.

2 Spiral fractures, which twist around the bone, are frequently associated with child abuse (child mistreatment) and are caused by a wrenching force. NOT 3 When a broken bone penetrates the skin, the fracture is called compound, or open. 1 A simple, or closed, fracture is a single break in the bone without penetration of the skin. 4 In a greenstick fracture, the bone bends and often just partially breaks

The nurse is assessing a newborn and suspects developmental dysplasia of the hip (DDH). For which sign is the nurse prioritizing in this potential diagnosis? 1 Symmetry of the gluteal skin folds 2 Limited abduction of the affected hip 3 Lengthening of the femur 4 Bilateral adduction of the legs

2 The infant with DDH usually has limited abduction of the affected hip. The infant has asymmetry of the gluteal skin folds and shortening of the femur. Adduction is not a concern.

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. 1 Document any signs of pain. 2 Check capillary refill time in the both arms. 3 Monitor the color of the nail beds in the right hand. 4 Wear a protective gown when moving the child's arm. 5 Wear sterile gloves when removing or touching the cast.

2.3.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. 1 Increased pain, especially unrelieved with pain medications, can indicate serious complications such as compartment syndrome. NOT 4.5. Wearing a gown or sterile gloves is unnecessary as the cast is not sterile

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? 1 "This medication will help to increase bone mineral density." 2 "My child's risk for fractures will hopefully be decreased as by taking this medication." 3 "This medication will cure my child of this disorder." 4 "This medication doesn't prevent fractures from happening."

3 Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? 1 Snip the tuft of hair off close to the skin for hygienic reasons. 2 Move on to other assessments without calling attention to the difference. 3 Record and refer the finding for follow-up to the pediatrician. 4 Inspect for precocious hair growth in the genital and underarm areas.

3 Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. MRI is often the diagnostic tool used. NOT 1 No hygienic concerns need prevail. 4 These findings do not suggest development of precocious puberty or any other hormonal problem. 2 The dimpling and hair tuft must be clearly explained to the parents.

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? 1 kyphosis 2 lordosis 3 idiopathic scoliosis 4 sway back

3 Idiopathic scoliosis is an S-shaped curvature of the spine. NOT 1 Kyphosis is an outward curvature of the cervical spine. 2 Lordosis is an inward curving of the lumbar spine. 4 Sway back is another term used for lordosis

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? 1 Keep the mass uncovered and dry. 2 Prevent cold stress using an Isolette and blankets. 3 Cover the sac with a saline-moistened dressing. 4 Change position from side to side hourly

3 Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. NOT 2 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. 4 Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided

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? 1 "I check my brace daily to make sure there is no damage or change to it." 2 "I leave my brace on for gym at school." 3 "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed." 4 "I wear a t-shirt under my brace." 5 "I do exercises after school."

3 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 nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education? 1 "Because our child has scoliosis, treatment will include halo traction." 2 "The treatment for our child's scoliosis is anticipated to last between 3 to 4 months." 3 "Because our child is being treated by using braces, the braces will have to be worn almost all the time." 4 "The most successful treatment for scoliosis is surgery before reaching adult age."

3 The Boston or the thoracolumbosacral orthosis (TLSO) brace is made of plastic and is customized to fit the child for treatment of scoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit. NOT 1 Halo traction may be used to treat clients with severe scoliosis, but not all clients. 2 Children will be reassessed every 4 to 6 months to determine the prognosis for continuing brace therapy and potentially refitting. Bracing may be indicated for months or years. 4 Surgery may be indicated, depending on the severity and complications resulting from the scoliosis; however, surgery is not the best option for all clients

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? 1 Internal fixation device 2 External fixation device 3 Spica cast 4 Stockinette

3 The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast

The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment? 1 the presence of a waddling gait and difficulty climbing stairs 2 a short heel cord caused by walking on the toes 3 meeting motor milestones such as sitting, walking, and standing but at a later age than the average child 4 when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

4 A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. NOT 1.2.3. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

The nurse is caring for a child with muscular dystrophy. Which prescription will the nurse question? 1 calcium supplement 2 vitamin D 3 prednisone 4 clozapine

4 Duchenne muscular dystrophy is the most common neuromuscular disorder of childhood, mostly affecting males. There is no cure, but treatments are available to slow progression and provide symptom management. NOT 3 Corticosteroids, such as prednisone, may be prescribed to protect muscle fibers from damage to the sarcolemma. Studies have shown males treated with prednisone have increased strength and function. 1.2. Calcium supplements and vitamin D are prescribed to prevent osteoporosis. Antidepressants, not antipsychotics (such as clozapine), may be helpful when depression occurs related to the chronicity of the disease and/or as an effect of corticosteroid use

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? 1 Tendons 2 Ligaments 3 Joints 4 Cartilage

4 During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone

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? 1 Traction 2 Exercise 3 Surgery 4 Bracing

4 For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. NOT 1.3. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. 2 Exercise may be implemented for very mild curvatures to strengthen the back muscles

The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this? 1 The boy has a large tan skin lesion on his torso. 2 Severe lordosis is evident in the lumbar spine. 3 The head is held tilted with limited side-to-side motion. 4 The boy rises from the floor by walking his hands up his legs.

4 Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand. NOT 1.2.3. The other options do not describe Gowers' sign, although lordosis is often a manifestation of Duchenne muscular dystrophy.

The nurse is working with a 6-year-old child recently diagnosed with Legg-Calvé-Perthes disease. The child's parents tells the nurse they understand exercise is important for their child but are not sure which activities are appropriate. Which activity will the nurse recommend for this client? 1 Jumping jacks 2 Soccer 3 Brisk walking 4 Swimming

4 Legg-Calvé-Perthes disease occurs when blood supply to the femoral head of the hip joint is temporarily interrupted and the bone begins to die. The child with Legg-Calvé-Perthes disease will experience limited range of motion in the hip. Thus, swimming and tricycle or bicycle riding are excellent exercises because they provide smooth joint action and will help to reduce joint destruction. NOT 1.2.3. In contrast, activities that place excessive strain on joints, such as running, jumping, prolonged walking, and kicking, should be avoided

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? 1 The nurse should provide information when the child or caregiver requests it. 2 The nurse should be a contact person when the child is hospitalized. 3 The nurse should support the caregivers in restricting activity during the treatment. 4 The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

4 Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease (LCPD). What is the most important nursing intervention for the nurse to include in working with this child and his caregivers? 1 The nurse should provide information when the child or caregiver requests it. 2 The nurse should be a contact person when the child is hospitalized. 3 The nurse should support the caregivers in restricting activity during the treatment. 4 The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

4 Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? 1 Peripheral neurovascular dysfunction 2 Disorganized infant behavior 3 Risk for activity intolerance 4 Risk for impaired skin integrity

4 The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. NOT 1 The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. 2.3. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair? 1 antitip device 2 extended breaks 3 headrest support 4 wheelchair belt

4 This client has poor trunk control; a belt will prevent him from falling out of the wheelchair. NOT 1.2.3. Antitip devices, head rest supports, and extended breaks are all important options but aren't the most important options in this situation

Osteogenesis Imperfecta (OI)

A hereditary disease resulting in the formation of brittle bones that fracture easily. There is faulty synthesis of collagen, the main structural protein in connective tissue.

Pin sites

A source of infection; monitor for signs of infection; cleanse and dress the sites as prescribed

Internal fixation device

A surgical procedure that stabilizes and joins the ends of fractured (broken) bones by mechanical devices such as metal plates, pins, rods, wires or screws

Facioscapulohumeral Dystrophy

Facial muscles weaken first, then shoulders and upper arms

Bracing for scoliosis

For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing

Myotonic Dystrophy

Generalized weakness, wasting of face, feet, hands, and neck first Delayed relaxation of muscles after contraction

Myotonia

Inability to relax voluntary muscle after vigorous effort

When examining a newborn for developmental dysplasia of the hip (DDH), which motion would the newborn's hip be unable to accomplish? 1 abduction 2 adduction 3 rotation 4 extension

Infants with shallow acetabulums are unable to abduct their hips.

serum creatine kinase (CK)

Measurement of the enzyme creatine kinase in serum. This enzyme normally is present in skeletal and cardiac muscle. Increased levels occur in muscular dystrophy, polymyositis, and with traumatic injuries.

DDH

developmental dysplasia of the hip