Chapter 50: The Child with a Musculoskeletal Alteration

Which statement by the mother of an adolescent being discharged after spinal fusion for severe scoliosis indicates the need for further teaching? a. "I am glad we chose surgery. Now it is all over and done." b. "I'll see you in a month; we'll be back fairly regularly." c. "I have to pick up some more T-shirts on the way home." d. "Those exercises the physical therapist showed us were not too hard."

A

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. Wash the area with warm water and soap. b. Vigorously scrub leg. c. Apply powder to absorb material. d. Carefully pick material off leg.

A

A child with osteomyelitis asks the nurse, "What is a 'sed' rate?" What is the best response for the nurse? a. "It tells us how you are responding to the treatment." b. "It tells us what type of antibiotic you need." c. "It tells us whether we need to immobilize your extremity." d. "It tells us how your nerves and muscles are doing."

A

A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports that he will not stop crying even after taking acetaminophen with codeine. He also will not straighten the fingers on his right arm. The nurse tells the mother to a. Take him to the emergency department. b. Put ice on the injury. c. Avoid letting him get so tired. d. Wait another hour; if he is still crying, call back.

A

A nurse is teaching parents the difference between pediatric fractures and adult fractures. Which observation is true about pediatric fractures? a. They seldom are complete breaks. b. They are often compound fractures. c. They are often at the epiphyseal plate. d. They are often the result of decreased mobility of the bones

A

A priority nursing intervention when caring for a child in a Pavlik harness is a. Skin care b. Bowel function c. Feeding patterns d. Respiratory function

A

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 is the result of the inflammatory process

A

In caring for a child with a compound fracture, the nurse should carefully assess for a. Infection b. Osteoarthritis c. Epiphyseal disruption d. Periosteum thickening

A

The nurse knows that treatment of Osgood-Schlatter disease includes a. Limitation of knee bending or kneeling b. Increasing range of motion (ROM) of the knee c. Encouraging flexion of the hip d. Limitation of adduction of the hip

A

Tissue ischemia and nerve damage are serious complications that may result from immobilization in a cast or from traction. The five Ps of vascular impairment can be used as a guide when assessing for neurovascular problems. List the five Ps. A. pain, pallor, pulselessness, paresthesia, paralysis B. pain, pink, pulse, pallor, pin C. pain, paresthesia, paralysis, pink, paranoia

A

True or False A frequent parental concern is children's leg length inequality. Asymptomatic leg length inequality is relatively common in children. A. True B. False

A

What is the major concern guiding treatment for the child with Legg-Calvé-Perthes disease? a. Avoid permanent deformity. b. Minimize pain. c. Maintain normal activities. d. Encourage new hobbies.

A

What is the most appropriate intervention for an adolescent with a mild scoliosis? a. Long-term monitoring b. Surgical intervention c. Bracing d. No follow-up

A

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

Which interventions should the nurse include in the home care instructions for the parents of a child who has a cast applied to the left forearm? Select all that apply. a. Keep small toys away from the cast. b. Use a padded ruler to scratch the skin under the cast if it itches. c. Daily assess the cast for unusual odors. d. Elevate the extremity on pillows for the first 24 to 48 hours. e. Numbness and tingling in the extremity is expected.

A,C,D

Which interventions should the nurse implement to prevent complications of immobility for a child in skeletal traction? Select all that apply. a. Reposition the child every 2 hours. b. Avoid use of an egg-crate or sheepskin mattress. c. Limit fluid intake. d. Administer stool softeners as prescribed. e. Encourage coughing and deep breathing.

A,D,E

Which factor should the nurse include when teaching a parent about the care of a newborn in a Pavlik harness for hip dysplasia? a. The harness may be removed with every diaper change. b. The harness is used to maintain the infant's hips in flexion and abduction and external rotation. c. The harness is only the first step of treatment. d. The harness is worn for 2 weeks.

B

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. Arrange for tutoring and school work c. Instructions for a high-fat, low-protein diet d. Instructions for the parent to return the child to team sports immediately

B

A boy who has fractured his forearm is unable to extend his fingers. The nurse knows that this a. Is normal following this type of injury b. May indicate compartmental syndrome c. May indicate fat embolism d. May indicate damage to the epiphyseal plate

B

During a well-child visit, the nurse identifies that an 18-month-old infant is bowlegged. She is aware that this assessment is a. Common in children with nutritional deficiencies b. Common in infants and toddlers c. A serious condition needing further evaluation d. An indication of neurologic impairment

B

During painful episodes of juvenile arthritis, a plan of care should include what nursing intervention? a. A weight-control diet to decrease stress on the joints b. Proper positioning of the affected joints to prevent musculoskeletal complications c. Complete bed rest to decrease stress to joints d. High-resistance exercises to maintain muscular tone in the affected joints

B

Juvenile arthritis should be suspected in a child who exhibits a. Frequent fractures b. Joint swelling and pain lasting longer than 6 weeks c. Increased joint mobility d. Lurching and abnormal gait, limited abduction

B

When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from a. Automobile accidents b. Falls c. Physical abuse d. Sports injuries

B

A 4-year-old child with a long leg cast complains of "fire" in his cast. The nurse should a. Notify the physician on his next rounds. b. Note the complaint in the nurse's notes. c. Notify the physician immediately. d. Report the complaint to the next nurse on duty.

C

A 6-year-old patient who has been placed in skeletal traction has pain, edema, and fever. The nurse should suspect a. Meningitis b. Crepitus c. Osteomyelitis d. Osteochondrosis

C

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

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

When providing education for the parents of a child with Duchenne muscular dystrophy, the nurse plans to include a. Testing all female children for the disease b. Testing the father for the presence of the trait on the Y chromosome c. Genetic counseling for all female children d. Testing the parents to determine the carrier

C

Which factor is important to include in the teaching plan for parents of a child with Legg-Calvé-Perthes disease? a. It is an acute illness lasting 1 to 2 weeks. b. It affects primarily adolescents. c. There is a disturbance in the blood supply to the femoral epiphysis. d. It is caused by a virus.

C

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. Their bones have less blood flow.

C

What actions should the nurse perform while caring for a school-age child who sprained his ankle playing football? Select all that apply. a. Turn the child every 1 to 2 hours. b. Assist with range-of-motion exercises every 2 hours. c. Apply ice to the affected ankle. d. Wrap the ankle with an Ace bandage. e. Elevate the affected extremity.

C,D,E

A nurse knows that which exercise is best for a child with juvenile arthritis? a. Jogging b. Tennis c. Gymnastics d. Swimming in a heated pool

D

During a 14-year-old's physical examination, the nurse identifies that he plays soccer and football and is complaining of knee pain when he rises from a squatting position, and difficulty with weight bearing. The nurse should suspect a. Legg-Calvé-Perthes disease b. Osteomyelitis c. Duchenne muscular dystrophy d. Osgood-Schlatter disease

D

Patient and parent education for the child who has a synthetic cast should include a. Applying a heating pad to the cast if the child has swelling in the affected extremity b. Wrapping the outer surface of the cast with an Ace bandage c. Splitting the cast if the child complains of numbness or pain d. Covering the cast with plastic and waterproof tape to keep it dry while bathing or showering

D

When a child with a musculoskeletal injury on the foot is assessed, what is most indicative of a fracture? a. Increased swelling after the injury is iced b. The presence of localized tenderness distal to the site c. The presence of an elevated temperature for 24 hours d. The inability of the child to bear weight

D

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

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