Chapter 24: The Child with a Musculoskeletal Condition

What will the nurse include when caring for a child in Buck's extension? a. Positioning the child with hips flexed 90 degrees at all times b. Keeping the weights in contact with the floor c. Checking for skin irritation from traction equipment d. Releasing the weights on a schedule

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

A 13-year-old girl is diagnosed with functional scoliosis. What does the nurse explain as the cause of this spinal curvature defect? a. Juvenile rheumatoid arthritis b. Poor posture c. Heredity d. Myelomeningocele

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

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

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

What nursing action will significantly decrease the risk of serious complications for a child in Bryant's traction? a. Neurovascular checks are done frequently. b. Bandages are wrapped tightly. c. The child is restrained from rolling over. d. The child's buttocks are resting on the bed.

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

The nurse explains that Bryant's traction is reserved for children who weigh less than _____ pounds.

ANS: 30 Bryant's traction is a skin traction used in the treatment of orthopedic disorders of young children who weigh less than 30 pounds. Greater weight would cause excessive counterbalance and injury to soft tissues.

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

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

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

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

On entering the room of a child in Buck traction, the nurse makes all of the following observations. Which observation requires a nursing intervention? a. Child's heels are placed firmly against the foot of the bed. b. Head of bed is elevated 20 degrees. c. Weights are hanging freely. d. Ropes are on pulleys.

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

The nurse is checking for capillary refill on a child in Bryant's traction. How long does it take for the toe to regain color if adequate perfusion is assessed? a. 3 seconds b. 4 seconds c. 5 seconds d. 6 seconds

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

What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis? a. Ask the child to bend forward at the waist and observe the child's back for asymmetry. b. Observe the gait while the child is walking forward heel to toe. c. Have the child flex the knees and look for uneven knee height. d. Look at the child's shoulders and hips while fully clothed.

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

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

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

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

ANS: A, C, D, E All options except high self-esteem are possible triggers for a parent to become abusive.

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

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

Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis? a. Wearing splints at night to prevent extension contractures b. Applying moist heat packs upon awakening c. Taking a warm tub bath the evening before d. Sleeping with two pillows under the head

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

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

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

What intervention will the nurse caring for a child in Buck skin traction implement? a. Position in high Fowler's position. b. Assist the child to be pulled up in bed. c. Keep child's heel on the bed surface. d. Maintain child's feet against the foot of the bed.

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

The nurse is reviewing the characteristics of Ewing's sarcoma. Which statement if made by the nurse indicates correct understanding of this disease? a. "Amputation is the accepted treatment." b. "The disease is sensitive to radiation and chemotherapy." c. "Metastasis is rare." d. "The disease is more prevalent among toddlers and preschoolers."

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

The parent of a child with osteomyelitis asks why his child is in so much pain. What will the nurse respond causes the pain experienced with osteomyelitis? a. "Pressure of inelastic bone" b. "Purulent drainage in the bone marrow" c. "The cast applied on the extremity" d. "Circulatory congestion of the skin"

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

What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4-year-old child? a. Has inward-turned knees while standing. b. Walks on the toes. c. Appears to have flat feet. d. Swings his arms when walking.

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

What instruction would the nurse provide to an adolescent who has been fitted with a Milwaukee brace? a. Wear the brace directly against the skin. b. Wear the brace over regular clothing. c. Wear the brace over a T-shirt 23 hours a day. d. Remove the brace before sleeping.

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

A pediatric nurse is assisting with the care of a child diagnosed with a fractured femur. What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse? a. Stress fracture b. Compound fracture c. Spiral fracture d. Greenstick fracture

ANS: C A spiral fracture of the femur is caused by a forceful twisting motion. When the history of an injury does not correlate with x-ray findings, child abuse should be

Approximately how old does the nurse assess a large green bruise on the thigh of a 4-year-old to be? a. 2 days b. 4 days c. 6 days d. 8 days

ANS: C Bruises heal in various stages that are indicated according to color; after 5 to 7 days bruise are green.

What characteristic manifestation does the nurse caring for a child with Duchenne's muscular dystrophy document? a. Ambulates by holding onto furniture b. Exhibits atrophy of the calf muscles c. Falls frequently and is clumsy d. Has delayed fine-motor development

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

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

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

A child is sent to the school nurse for assessment because she comes to school every day disheveled, unbathed, and hungry. The assessment does not indicate any bruises or marks on the body. What do these finding indicate? a. Sexual abuse b. Physical abuse c. Physical neglect d. Emotional abuse

ANS: C Physical neglect is the failure to provide for the basic physical needs of the child, including food, clothing, shelter, and basic cleanliness.

The nurse assessing a child with juvenile rheumatoid arthritis notes the child's right knee and ankle are swollen, warm, and tender. The child has a temperature of 38.8° C (102° F) and abdominal pain. What type of juvenile rheumatoid arthritis do these findings suggest? a. Psoriatic b. Enthesitis c. Systemic d. Acute febrile

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

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

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

Why does a child's fracture heal more rapidly than the adult's? a. A child's bones are less porous than adult bone. b. A child's bones are covered by a thicker periosteum. c. A child's bones are not affected by bone overgrowth. d. A child's bones have faster callus formation.

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

What finding would the nurse assessing the neurovascular status of a child in Russell traction report immediately? a. Skin that's warm to the touch b. Capillary refill less than 3 seconds c. Ability to wiggle toes d. Bluish coloration of skin

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

Which assessment performed by a nursing student performing a neurovascular check alerts the instructor that further education is necessary? a. Pulses b. Capillary refill c. Movement d. Pupils

ANS: D Neurovascular checks include assessment of pain, pulse, sensation, color, capillary refill, and movement. Pupils are assessed with a neurological check.

How does Russell traction provide adequate skin traction? a. Subluxates the tibia b. Does not interfere with range of motion c. Prevents the knee from flexing d. Supplies continuous pull in two directions

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