Chapter 51 Musculoskeletal Peds

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

A. "Because our child is being treated by using braces, the braces will have to be worn almost all the time."

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? A. "Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." B. "Cancer in the bone can result from old injuries so it probably was not caused from getting hurt last year, but an earlier injury." C. "When your adolescent broke the leg last year, it may have weakened the bone, allowing cancer to start there." D. "Does bone cancer run in your family? Maybe your adolescent inherited it through genes."

A. "Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."

The nurse caring for a child diagnosed with juvenile idiopathic arthritis (JIA) should provide medication education to the caregivers for which first-choice medication to manage the child's pain and joint inflammation? A. Naproxen B. Codeine C. Aspirin D. Acetaminophen

A. Naproxen

An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image? A. "Just hold your head up and be confident in how you look. Look for some after-school activities you can do wearing your brace." B. "Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it." C. "You should not worry about what everyone else is wearing. You look fine." D. "Kids can be cruel sometimes. Has anyone told you that you look different?"

B. "Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it."

The nurse is caring for a child admitted with juvenile idiopathic arthritis (JIA). Which clinical manifestation would likely have been noted in the child with this diagnosis? A. difficulty standing and walking B. inflammation of the joints C. poor posture and malformed vertebrae D. pain in the groin and a limp

B. inflammation of the joints

The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education? A. "I'm glad my mom saved her elevated toilet seat she used when she had her knee replacement surgery." B. "My child loves to dance so we can add exercises into a dance routine." "C. I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain." D. "I will encourage my child to take a warm bath before school every morning."

C. I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain."

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse? A. Administer prescribed pain medication. B. Apply ice bags to the child's foot and ankle. C. Notify the health care provider of the findings immediately. D. Reposition the leg on pillows so that it is above the level of the child's heart.

C. Notify the health care provider of the findings immediately.

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? A. "This medication doesn't prevent fractures from happening." B. "My child's risk for fractures will hopefully be decreased as by taking this medication." C. "This medication will help to increase bone mineral density." D. "This medication will cure my child of this disorder."

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

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

D. "When I get home from school, I look forward to taking off my brace for a few hours before I go to bed."

A school-age child with pauciarticular juvenile idiopathic arthritis has extreme pain upon waking in the morning. Which intervention should the nurse suggest the parents try to help the child with the pain? A. Encourage bed rest until the pain is gone. B. Perform isotonic exercises until the pain is gone. C. Provide 325 mg of aspirin immediately on arising. D. Encourage a warm bath each morning before school.

D. Encourage a warm bath each morning before school.

In caring for a child being treated for scoliosis, the highest priority goal is which of the following? A. The child will verbalize acceptance of the treatment. B. The child's skin integrity will be maintained. C. The child will participate in age-appropriate activities. D. The child will remain free of injury.

D. The child will remain free of injury.

he nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse? A. "The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be." B. "The newer braces only have to be worn while the child is asleep and don't have to be worn at school." C. "Braces have been replaced with surgical intervention. Your child will only wear a brace for a few weeks after the surgery." D. "Unfortunately, bracing is the only option for treating this disorder. I'm sure your child will get used to it after a few weeks."

A. "The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

A child with pauciarticular juvenile idiopathic arthritis is scheduled for an eye examination every 3 months. When stressing the importance of the visit, which instruction is most accurate? A. Iridocyclitis may occur as a basic symptom of the disease. B. Eye infection may develop easily due to medication administration. C. Continuous drug therapy causes corneal opacity. D. The eye globe does not continue to grow, impacting sight.

A. Iridocyclitis may occur as a basic symptom of the disease.

The nurse is educating the parents of a child newly diagnosed with avascular necrosis of the femoral head. The nurse would be correct in including which information in the teaching plan? Select all that apply. A. The diagnosis involves imaging studies of the femoral head and hip joint to provide confirmation. B. A limp and swelling at the groin/hip area is often the first symptom noted by parents. C. Treatment involves administration of strong antibiotics via a port or PICC line. D. This disorder is most common in school-aged females who are gymnasts or play other sports. E. This condition is self-limiting, usually within 4 to 8 weeks.

A. The diagnosis involves imaging studies of the femoral head and hip joint to provide confirmation. B. A limp and swelling at the groin/hip area is often the first symptom noted by parents.

The nurse is assessing a group of early adolescents for scoliosis. One of the teenagers asks the nurse what will be done. The nurse explains that which of the following will be included in the assessment? Select all that apply. A. examination of leg length B. examination of the spine for curvature C. examination of the hips for symmetry D. examination of the shoulder blades for symmetry E. examination of the shoulders for symmetry

B. examination of the spine for curvature C. examination of the hips for symmetry D. examination of the shoulder blades for symmetry E. examination of the shoulders for symmetry

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? A. Jumping jacks B. Soccer C. Swimming D. Brisk walking

C. Swimming

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? A. The nurse should be a contact person when the child is hospitalized. B. The nurse should provide information when the child or caregiver requests it. C. The nurse should help the caregivers to understand and help the child to effectively use the corrective devices. D. The nurse should support the caregivers in restricting activity during the treatment.

C. The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

Legg-Calvé-Perthes disease (LCPD) is more likely to be seen in which group? A. Hispanic girls B. Black boys C. white boys D. Asian girls

C. white boys

The nurse is caring for a child diagnosed 3 months ago with juvenile idiopathic arthritis (JIA). The caregiver states that the child has recently reported little pain and is not currently taking aspirin or NSAIDs. The caregiver also tells the nurse that just to be on the safe side, she is continuing to keep the child from doing physical exercise. The mother states, "I think we have beaten this disease." In working with this child and the caregiver, which statement would be best for the nurse to make? A. "I'm glad you're feeling optimistic. She should exercise now but give her aspirin before she does." B. "Let's review some of the instructions. She does need to take an anti-inflammatory every day." C. "It sounds as though things are going well. Be sure to restart the medication as soon as there is any flare-up of pain." D. "That is not what is best. The medications aren't for pain; she needs to take aspirin every few days."

B. "Let's review some of the instructions. She does need to take an anti-inflammatory every day."

When assisting parents in a home care plan for a child with Legg-Calvé-Perthes disease (LCPD), the nurse would teach the parents that which is anticipated? A. Passive range-of-motion exercises 3x per day B. A non-weight-bearing period initially occurs. C. Exercise to increase muscle strength of the knee joint D. Surgery with supporting rods

B. A non-weight-bearing period initially occurs.

The child diagnosed with muscular dystrophy uses a method of rising from the floor which is referred to as which of the following? A. Legg-Calvé-Perthes B. Gowers sign C. Boston brace D. Milwaukee brace

B. Gowers sign

The nurse meets a child with a slipped capital femoral epiphysis. In what type of child does this usually occur? A. Tall, thin girls B. Obese adolescent boys C. Active school-age children D. Preadolescent girls

B. Obese adolescent boys

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? A. meeting motor milestones such as sitting, walking, and standing but at a later age than the average child B. the presence of a waddling gait and difficulty climbing stairs C. when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand D. a short heel cord caused by walking on the toes

C. when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment? A. "When I start feeling tired, I can just take my brace off for a few minutes." B. "I am so glad I can take this brace off for the school dance." C."At least when I take a shower I have a few minutes out of this brace." D. Wearing this brace only during the night will not be so embarrassing

C."At least when I take a shower I have a few minutes out of this brace."