prep u neuromuscular/musculoskeletal
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."
A nurse is caring for an 11-year-old with an Ilizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction?
"Cleansing by showering should be sufficient."
The nurse is caring for a child admitted with possible Legg-Calvé-Perthes disease. Which assessment question should the nurse ask the child's caregivers to help support this diagnosis?
"Does she/he report pain in the groin that results in a limp?"
The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate?
"In most cases treatment is not necessary, only observation."
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 caring for a 6-year-old boy with a fractured ulna. He is fearful about the casting process and is resisting treatment. How should the nurse respond?
"Look over there at the neon fish in our aquarium."
A mother is angry about her son's diagnosis of osteosarcoma. She is telling him that if he had not played football last year and broken his leg, this would not have happened. What is the nurse's best response to the mother's statement?
"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."
While caring for a child who will be undergoing an electromyography, the nurse explains the procedure to the child's mother. Which statement by the mother would indicate a need for further education?
"Small electrical shocks will be given using the needles they put in the muscle."
The 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?
"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."
The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond?
"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."
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."
The nurse is assessing an infant at a well-check visit. The infant's mother states that she is worried about her child's feet because they are so flat and wide. What the appropriate response by the nurse?
"Your child's feet are normal for an infant. A child's longitudinal arch will not develop until the child is walking for several months."
A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention?
A 4-year-old preschool-age child who consistently walks on tip toes
A 3-year-old demonstrates lateral bowing of the tibia. Which signs would indicate that the boy's condition is Blount disease rather than the more typical developmental genu varum?
A sharp, beaklike appearance to the medial aspect of the proximal tibia on x-ray
Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele?
Assuming the usual feeding position will be difficult.
Other than providing direct care to children, what is the major role of nurses in the care of nearly all children with neuromuscular disorders?
Coordinating care by specialists
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?
Diazepam
The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid?
Folic acid above 0.4 mg/day
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?
Gower's sign
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
The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high risk for having a child with a myelomeningocele?
History of a seizure disorder and taking phenobarbital
The nurse is caring for a child diagnosed with osteomyelitis in the tibia. What prescription would the nurse question? Select all that apply
IV antibiotics for 3 days ambulating QID
An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant?
Inspection of the cystic sac on the child's back for leakage
The nurse is providing teaching about the disease to a client newly diagnosed with juvenile idiopathic arthritis (JIA) and his family. Which facts are accurate and should be shared with this family? Select all that apply.
JIA can affect any number of joints. The client will need to take several medications, including NSAIDS. Administer NSAIDS with food to decrease the incidence of gastric irritation.
The nurse is providing presurgical care for a newborn with myelomeningocele. Which action is the central nursing priority?
Prevent rupture or leaking of cerebrospinal fluid
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?
Record and refer the finding for follow-up to the pediatrician
Which diagnostic measure is most accurate in detecting neural tube defects?
Significant level of alpha-fetoprotein present in amniotic fluid
The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.
The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. New drainage is seeping out from under the cast. The boy's toes are light blue and very swollen
The pediatric nurse practioner (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?
The boy rises from the floor by walking his hands up his legs
In caring for a child in traction, which intervention is the highest priority for the nurse?
The nurse should monitor for decreased circulation every 4 hours.
A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse assume would not be used?
auscultation
After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant?
baclofen
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?
duchenne muscular dystrophy
The nurse is caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:
epiphysiolysis of the proximal humerus.
Through which mechanism is Duchenne muscular dystrophy acquired?
heredity
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?
idiopathic scoliosis
Which of these strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy?
long leg braces
The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?
muscle biopsy
The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?
presence of moro reflex
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.
right side lying, prone, left side lying
Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?
risk for impaired skin integrity
Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?
risk for infection
The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:
skeletal traction
Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?
standing
A nurse is assessing a newborn and observes webbing of the fingers and toes. The nurse documents this finding as
syndactyly
An adolescent wears a body brace for scoliosis. Which client education should the nurse provide?
to continue with age-appropriate activities
The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?
unhooking a weight while providing pin care
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?
wheelchair belt
The emergency department nurse is caring for a 3-year-old girl with an arm injury. The mother is very upset because she believes she broke her daughter's arm. "I was lifting her by her hands and felt a pop in her wrist. She instantly started screaming." The child is now guarding and refusing to move her arm. Which response by the nurse would be most appropriate?
"Her arm isn't broken. This injury is common and easily fixed with no complications."
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 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 caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?
Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.
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 nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?
creatinine kinase
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."
The nurse is caring for a 3-year-old boy with a fracture of the humerus. His chart indicates "fracture is partially through the physis extending into the metaphysis." The nurse identifies this as which Salter-Harris classification?
Type II
The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way?
cover the sac with a saline-moistened dressing
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
The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority?
Deficient knowledge related to diagnosis and condition
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?
Low serum calcium levels
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?
Teach the client not to rest with the crutch pad pressing on the axilla
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?
This medication will cure my child of this disorder
A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?
pale, cool, or blue skin coloration is to be expected
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:
significant bending without actual breaking.
In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?
cartilage
A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. What nursing interventions should be implemented? Select all that apply.
Administration of IV antibiotics at the hospital Instruct the parents on how to care for an IV line at home Instruct the parents regarding the importance of maintaining bed rest Institute infection-control precautions related to drainage tubes
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 more protected
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
color, sensation, pulse, capillary refill
