MSK PREP-U

A parent calls the clinic nurse to say the child has shin splints after playing soccer. What instructions should the nurse provide this parent?

"Applying ice to the area will reduce the pain and swelling."

The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education?

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

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals?

"It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms."

The nurse is reviewing the plan of care with the parents of a 1-year-old child undergoing the Ponseti method for the treatment of clubfoot. What statement will the nurse include in the teaching?

"This method involves a cast being applied several times."

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?

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

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage

The nurse is caring for an extremely active 13-year-old adolescent who has recently been prescribed a back brace to treat scoliosis. Which intervention will be most critical to the success of treatment?

Emphasize and encourage compliance related to the use of a back brace.

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?

Impaired physical mobility related to a cast on the leg

The nurse is assessing a school-aged child at the emergency department. The child is limping and reports pain in the hip, groin, and knee. The symptoms worsened gradually over time. The health care provider has prescribed radiologic studies to assess for slipped capital femoral epiphysis (SCFE). What action will the nurse perform first?

Instruct the parents and child to take weight off the affected leg.

The type of traction in which tape, rubber, or plastic materials are used to indirectly exert pull on a fractured bone is which type of traction?

Skin traction

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?

Spica cast

A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis?

Staphylococcus aureus

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?

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

A nurse is conducting a physical examination on an 11-year-old boy with Legg-Calvé-Perthes disease. Which assessment finding would be expected?

Trendelenburg gait

Which client would be the most likely person to be diagnosed with idiopathic scoliosis that requires treatment?

a young adolescent female

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

skeletal traction.

The nurse is performing a neurovascular assessment on a child in 90-90 skeletal traction. What will the nurse include in the assessment? Select all that apply.

tactile sensation ability to wiggle fingers and toes capillary refill skin color

An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?

to continue with age-appropriate activities

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be:

"These make a smooth edge on the cast so the skin is better protected."

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?

"You and your coaches need to understand that you cannot play soccer for at least six weeks."

A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition?

A 13-year-old boy who is on his school's cross-country team

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?

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.

The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child? Select all that apply.

Any area on the cast that is warm to the touch A foul odor under the cast Drainage from under the cast Looseness of the cast on the extremity

Maria is a 9-month-old whose babysitter brings her to the emergency department. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. Which of the following would be most appropriate for the nurse to do?

Arrange for the parents to come in for an evaluation for possible physical abuse.

The client is a 9-month-old whose babysitter brings her to the ER. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. How should the nurse respond to this situation?

Arrange for the parents to come in for an evaluation for possible physical abuse.

The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child?

Handling the cast with open palms when moving the arm.

A child is in traction and is at risk for impaired skin integrity. Which intervention is most effective?

Inspect the child's skin for rashes, redness, irritation, or pressure injuries.

The nurse is caring for a child who is approximately 6 hours postoperative for surgical correction of scoliosis. What will the nurse include in the plan of care?

Logroll the child periodically with arms crossed.

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?

Notify the health care provider of the findings immediately.

The child is recovering from multiple leg fractures in Buck extension traction and reports pain out of proportion to the injury. The child's parent reports that the pain is unrelieved by the opioid treatment. Which action will the nurse perform first?

Notify the health care provider.

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention?

Reposition the child's foot on a pressure-reducing device.

The nurse is caring for a child with a newly placed plaster cast who is postoperative from surgery for Blount disease. What will the nurse include in the plan of care?

Teach the child and parents to cover the cast while bathing.

The nurse is assessing for tissue ischemia in a child with a cast who is postoperative for surgery to correct Blount disease. Which finding requires further follow up by the nurse?

The foot is pale in color with a capillary refill of 4 seconds.

A 14-year-old adolescent is suspected of having scoliosis. When doing scoliosis screening, what observation would be important for the nurse to note?

The posterior spine when bending forward

A 14-year-old male is brought to the emergency department by his parents with a suspected fracture of the arm sustained while playing soccer. An x-ray shows a comminuted fracture. When describing this fracture to the child and his parents, the nurse would integrate knowledge of which of the following?

There are three or more fracture fragments.

A nurse is performing a physical assessment of the musculoskeletal system of 5-year-old Manuel. Which of the following is a recommended assessment technique appropriate for this client?

assess Manuel while he sits in his parent's lap.

The nurse is planning care for a 14-year-old client whose x-ray shows a comminuted fracture with the need for external appliance stabilization. Which nursing action is most important?

assessing the color and movement of the hand and fingers

An infant is placed in Bryant traction. For Bryant traction to be effective, the infant must be positioned on the:

back with hips up off the bed.

The nurse is assessing a newborn following a cesarean birth necessitated by a breech presentation. The nurse knows that this presentation places the newborn at increased risk for:

developmental dysplasia of the hip (DDH).

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child:

feels increasing severe pain.

The nurse is caring for a child with osteomyelitis who has a leg wound. The highest priority nursing intervention for this child would be for the nurse to:

follow transmission-based precautions.

Legg-Calvé-Perthes disease (LCPD) is more likely to be seen in which group?

white boys

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?

"Blowing cool air with a fan or hair dryer may relieve the feeling."

The nurse has completed client education with the parents of a child with a femur fracture. Which statement by a parent indicates successful education?

"Breaks that happen between the rounded end and the central shaft of the bone can cause growth issues in the future."

The nurse is caring for a child who has just received a cast for a broken wrist. The parents ask, "Why do we need to keep the arm up on a pillow?" Which response by the nurse is appropriate?

"Keeping the arm raised helps to lessen the swelling."

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention?

"Let's ask your parents to bring your friends for a visit."

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby and concerned about holding and playing with him. Which response by the nurse would be most appropriate?

"Let's put you in touch with other families who have experienced this."

A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents?

"Let's put you in touch with other families who have experienced this."

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. Which of the following would the nurse do next?

Reposition the child's foot on a pressure-reducing device.

The mother of a 9-year-old boy brings the boy to the clinic for an evaluation because he has a fever. The history reveals a recent trauma to the knee. The nurse inspects the joint. Which of the following would lead the nurse to suspect osteomyelitis? Select all that apply.

edema of the area localized tenderness pain on palpation

While the nurse is providing discharge education to the parents of an 18-month-old child, the parents express concern that their child has a musculoskeletal disorder because the child has bowed legs. How should the nurse respond?

"Bowed legs are normal at this age and typically straighten on their own."

In caring for a child being treated for scoliosis, the highest priority goal is which of the following?

The child will remain free of injury.

A nurse is assessing a child with suspected osteomyelitis. Which finding would help support this suspicion?

swelling and point tenderness

After teaching a group of nursing students about osteogenesis imperfecta (OI), the instructor determines that the teaching was successful when the group identifies which type as the most common?

type I

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom?

paresthesia