Muskculoskeletal disorders
A new pediatric orthopedic nurse is learning about the most common areas for a child to have a fracture. She knows all are common sites except the: 1. Tibia. 2. Radius. 3. Femur. 4. Clavicle.
. Femur.
A 2-year-old with Downs syndrome presents to the clinic with a chief complaint of unsteady walking. The physical therapist wants to use orthotics to help with ambulation. The main uses of assistive aids in neuromuscular conditions are: 1. To prevent deformity and improve function. 2. To stop mobility and use a stroller. 3. To cover their feet and keep them warm. 4. To relax muscles in a child with ligament laxity.
. To prevent deformity and improve function.
A 5-year-old boy presents to the emergency department with a history of a motor vehicle accident. He was restrained in the backseat, and the car was hit head on. He has a swollen and deformed left thigh. He is in extreme pain. He has frequent muscle spasms. X-rays reveal a midshaft femur fracture. As you prepare the child prior to surgery, you will assist with anticipatory guidance as well as show and discuss a spica cast. What information will be helpful to this young boy? 1. A hard cast from your waist to your toes will protect your leg so it can heal. 2. We can put a cast like yours on your bear. 3. The IV will give you medicine to make you sleep, wake up, and help with the pain. 4. All of the above.
1. A hard cast from your waist to your toes will protect your leg so it can heal. 2. We can put a cast like yours on your bear. 3. The IV will give you medicine to make you sleep, wake up, and help with the pain. 4. All of the above.
A 4-year-old female status post left supracondylar elbow pinning presents to the clinic with a chief complaint of increased swelling to the fingers, a change in color from pink to pale, numbness and tingling, and increased pain from 24 hours ago. Her fiberglass cast was applied immediately after surgery. The mother is concerned and anxious. With your knowledge about neurovascular status post surgery and fracture care, you are concerned about which of the following conditions? 1. Compartment syndrome 2. Refracture 3. Nothing. These are normal findings. 4. The mom is crazy and needs a dose of valium.
1. Compartment syndrome
A 21-one-year old basketball player comes to the emergency department with a swollen, ecchymotic, painful right ankle. He states he went up for a jump shot and twisted it. He reports pain over the medial malleolus. He cannot walk on it and was assisted off the court at the game. He reports that he has done this before, but it is different this time. He wants an air cast splint and crutches, but no x-rays. What statement indicates that this young athlete may not understand the difference between a fracture and a sprain?
1. I will be fine in 3 days. 2. I can play if you give me the splint. 3. I dont need x-rays today. Ive done this before. 4. All of the above.
General cast care considerations would include which of the following? 1. Keep cast clean and dry, monitor integrity of cast materials, and elevate the involved extremity for 24 to 48 hours as recommended. Monitor neurovascular status per doctors orders and shower as instructed. 2. Allow the cast to get wet and follow up in 4 to 6 weeks for cast removal. 3. Spray the cast with Febreze if a foul smell occurs. 4. All of the above
1. Keep cast clean and dry, monitor integrity of cast materials, and elevate the involved extremity for 24 to 48 hours as recommended. Monitor neurovascular status per doctors orders and shower as instructed.
An 11-year-old boy with a tibia shaft fracture presents for his first follow-up visit after an injury. He is placed into a non-weight bearing, long leg cast with instructions about cast care. Your knowledge about cast care reveals that you should include which of the following statements in your instructions? 1. Keep the cast clean and dry, do not insert objects into the cast, and call the doctor if the cast becomes loose, cracked, or ill fitting. 2. You may take a shower in the cast, just dont put weight on it. 3. Its okay to put coins down the cast. 4. Do not call the office for a foul smell or skin irritation.
1. Keep the cast clean and dry, do not insert objects into the cast, and call the doctor if the cast becomes loose, cracked, or ill fitting.
Allison has fractured her left tibia. The nurse should assess which of the following? Select all that apply. 1. Skin color distal to the fracture 2. Pain in the extremity 3. Pulses distal to the fracture 4. Paresthesia proximal to the fracture 5. Paralysis proximal to the fracture
1. Skin color distal to the fracture 2. Pain in the extremity 3. Pulses distal to the fracture
A 3-year-old male presents to the clinic, post-hospital discharge, for osteomyelitis. The mother states that he just stopped walking on his left leg for no reason, he had a high fever, and was in extreme pain. We went to the emergency room and laboratory tests and an MRI were done. He is on IV antibiotics, but I think we should stop the medicine now. He is much better. Your understanding of the care and treatment of osteomyelitis enables you to respond with which of the following? 1. Typically speaking, depending on the organism being treated, most patients with osteomyelitis are treated with 6 to 8 weeks of IV antibiotics minimum, followed by a course of oral antibiotics directed by the infection control team. 2. Sure, you can stop the antibiotics anytime. I am glad he is much better. 3. If you stop the antibiotics now, your child will die. 4. None of the above responses are correct.
1. Typically speaking, depending on the organism being treated, most patients with osteomyelitis are treated with 6 to 8 weeks of IV antibiotics minimum, followed by a course of oral antibiotics directed by the infection control team.
The nurse at the high school is providing education to the athletes participating in fall sports practices. In the education, the nurse should include: (Select all that apply.) 1. Warm-up exercises before playing any sport. 2. Cool down exercises are only needed if long distance running has occurred. 3. Telling the coaches if you are hurt or have a possible injury. 4. Anticipating that the body will be able to have a high exercise level within one week of practice staring. 5. Instructions on hydration.
1. Warm-up exercises before playing any sport. 3. Telling the coaches if you are hurt or have a possible injury. 5. Instructions on hydration.
mother brings into the emergency department a frail-looking infant with blue sclera and arm and leg deformities. The mom said she was changing her diaper and heard a snap. She put her shirt on and she heard another snap. She says that the baby has been crying, but eating a little. Mom reports a clavicle fracture in the delivery room, but the doctors told her it was nothing and would heal fine. The nurse notes a small lump on her right clavicle. It is not painful to the touch. The infants left forearm and right femur appear swollen and deformed. Based on your clinical knowledge of birth defects, your best answer to the mother would be:
1. We will call the doctor to do a skeletal survey. 2. We will call the Child Protective Services team to rule out abuse. 3. We will call Genetics to see if any genetic birth defects run in your family. 4. All of the above.
39. The most common age for femur fractures related to falls are children between the ages of: 1. 12 to 24 months. 2. 36 months to 4 years. 3. 5 to 6 years old. 4. 15 to 17 years old.
12 to 24 months.
The school nurse is screening children for scoliosis. Identify the age range that is most at risk for developing the disease. 1. 12 year olds 2. 2 year olds 3. 5 year olds 4. 18 year olds
12 year olds
If a child is diagnosed with Juvenile Idiopathic Arthritis (JIA), which of the following statements is true? 1. Usually, a child outgrows the disorder. 2. NSAIDs are the treatment of choice. 3. The child should not participate in sports. 4. All of the children of these parents will have the disorder.
2. NSAIDs are the treatment of choice.
A nurse is assessing a child after an open reduction of a fractured femur. Signs that compartment syndrome could be occurring would be
2. Pain not relieved by pain medication. 4. Prolonged capillary-refill time with paresthesia.
.The nurse is working with a client who is in cervical traction. How much should the head of the bed be elevated?
20-30 degrees
You are the school nurse assessing the neurovascular status of a child who had a sports injury. You check the skin color, capillary refill, skin temperature, and pulses of distal extremities. You report the capillary refill as within the normal range if it is less than:
3 seconds
A 7-year-old is having on and off knee, ankle, wrist, and hip pain. The family history is positive for rheumatoid arthritis. No injury has taken place, and the child has occasional swelling of joints. Pain resolves with rest, ice, and NSAIDs. The primary care physician ran labs with positive rheumatoid factor ANA and ESR. This child is a soccer player and a violinist. Your differential diagnosis would be: 1. Juvenile Idiopathic Arthritis (JIA), septic arthritis, osteomyelitis, and fracture. 2. Juvenile Idiopathic Arthritis (JIA), toxic synovitis, osteomyelitis, and Developmental Dislocated Hips (DDH). 3. Juvenile Idiopathic Arthritis (JIA), chronic inflammatory arthritis, chronic osteomyelitis, and Developmental Dislocated Hips (DDH). 4. Juvenile Idiopathic Arthritis (JIA) only.
4. Juvenile Idiopathic Arthritis (JIA) only.
Ella, an 18 month old, is brought to the clinic because the mother states that her daughter has not been putting weight on her left leg for most of the day. The doctor says that the tibia is broken after reading an X-ray. The nurse is asked to finish the discharge teaching for Ella. The nurse knows that she must discuss all of the following except: 1. Care for the cast. 2. Care for the skin. 3. Discuss signs and symptoms if the cast is too tight or there is an increase in swelling. 4. Schedule only one follow appointment in six weeks.
4. Schedule only one follow appointment in six weeks.
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. The nurse responds that antibiotic therapy will probably last for:
6 weeks
A 6 month old is brought to the ER by her babysitter. The babysitter explains that the child has been irritable all morning and will not bear weight on her right leg since she was dropped off at 8 a.m. The babysitter has attempted to contact the mother, but has not been able to reach her. After the examination, the child is diagnosed with spiral femur fracture. The nurse will need to contact Social Services because: 1. Any time a child enters the ER, Social Services needs to be contacted. 2. The mother did not bring the child in, and the babysitter does not have medical power of attorney, so a social worker will determine the needs of the child. 3. A femur fracture is abnormal unless trauma or abuse has occurred. Social Services will help to rule out child abuse. 4. The social worker will be of no help until the mother asks for services.
A femur fracture is abnormal unless trauma or abuse has occurred. Social Services will help to rule out child abuse.
Which intervention is part of the discharge plan for a child with osteomyelitis?
A referral to a home healthcare agency
Which of the following is the leading therapy for lateral tibial torsion? 1. A tibial osteotomy 2. A femur osteotomy 3. Tibial decorticate positioning 4. Range of motion exercises
A tibial osteotomy
The nurse explains to the parents of a child with developmental hip dysplasia that the application of a Pavlik harness is necessary. In what position will the harness hold the childs femurs?
Abduction
A mother with a child with Juvenile Idiopathic Arthritis calls the clinic nurse because the child is having a pain exacerbation. The mother asks the nurse if the child can continue with her range of motion exercises at the time. The appropriate nursing response is: 1. Range of motion exercises should be done every day. 2. Have the child do isometric exercises during this time. 3. Administer additional pain medication before doing the exercises. 4. Avoid exercises during this time.
Administer additional pain medication before doing the exercises.
John, a 12-year-old with a fracture of the femur, has developed chest pain and shortness of breath. The nurse suspects a pulmonary embolism. The priority nursing action is to: 1. Elevate the affected extremity. 2. Administer oxygen. 3. Administer pain medication. 4. Start an IV infusion of heparin.
Administer oxygen.
A new pediatric nurse asks why the pediatric floor has had an increase in the number of femur fractures during the month of July. A veteran staff nurse knows that: 1. An increase in femur fractures is common in summer months because of the outdoor activities children participate in. 2. An increase in femur fractures is common after school gets out because children are not watched as closely. 3. This increase is abnormal. Usually the increase is seen in the winter months with sledding accidents. 4. This increase is abnormal because most children do not receive femur fractures.
An increase in femur fractures is common in summer months because of the outdoor activities children participate in.
The nurse is providing instructions about how to treat a sprained ankle. The nurse will recognize the need for additional teaching when the mother states:
Apply warm compresses to the ankle for the first 24 hours.
Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy?
Arrange for tutoring and school work
When infants are seen for fractures, which nursing intervention is a priority?
Assess for child abuse. Fractures in infants are often nonaccidental.
When teaching care for a child immobilized in a spica cast, which is the most appropriate intervention?
Assessment for a sluggish capillary refill
The nurse in the newborn nursery is doing the admission assessment on a neonate. Congenital hip dysplasia will be suspected when the nurse observes
Asymmetry of the gluteal and thigh fat folds.
Which is an accurate statement concerning a childs musculoskeletal system and how it may be different from adults?
Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.
The nurse understands a difference in the childs skeletal system as compared to an adults is:
Bone growth is not affected by fractures.
During fetal development, several factors can affect the outcome of bone development. All of the following influence the development except: 1. Fifths disease. 2. Exposure to cat feces. 3. Caffeine consumption. 4. Contaminated water.
Caffeine consumption.
The development of the musculoskeletal system occurs during fetal development. Originally, bones begin as: 1. Cartilage. 2. Osteoclasts. 3. Osteoblasts. 4. Tendons.
Cartilage.
The nurse is teaching family members how to care for their infant in a Pavlik harness to treat congenital developmental dysplasia of the hip. The nurse will include in the parental education to
Check at least two or three times a day for red areas under the straps.
When caring for a child in Bucks extension, the nurse would include:
Checking for skin irritation from traction equipment
The nurse caring for a child in Bucks skin traction will keep the:
Child pulled up in bed
What differences in the musculoskeletal system of children make their bones able to absorb more energy before breaking and to heal more quickly?
Childrens bones have more cartilage and a stronger periosteum.
Patient and parent education for the child who has a synthetic cast should include which information?
Cover the cast with plastic and waterproof tape to keep it dry while bathing or showering.
In planning teaching to parents of a child with Legg-Calv-Perthes disease about the long-term effects of this disease, the nurse would include that:
Degenerative arthritis may develop later in life.
When assessing the child with osteogenesis imperfecta, the nurse should expect to make which observation?
Discolored teeth
A neonate is brought to the nursery three hours after birth for an assessment. The child was diagnosed with a unilateral club foot in utero. During the nursing assessment, a priority will be assessing: 1. The size of the quadricep muscles in comparison to the calf muscles. 2. Dorsiflexion and plantar flexion of the affected foot. 3. Family history. 4. Vital signs.
Dorsiflexion and plantar flexion of the affected foot.
A child has been admitted to the emergency room after sliding into third base with his right leg during a baseball game. An X-ray has confirmed a broken right tibia. The child complains of severe pain in his right leg. Upon assessment, the nurse would anticipate seeing: 1. Ecchymosis of the left leg. 2. Ecchymosis to the right leg. 3. A bone puncturing the skin. 4. All of the above would be possible due to this injury.
Ecchymosis to the right leg.
The nurse gets a telephone call from a parent who wants to know what to do for her child who just twisted an ankle, which is beginning to swell and hurt. The nurse will advise the parent to do which of the following?
Elevate the leg and use an ice pack to the ankle, alternating 30 minutes on and 15 off.
An infant has just returned from surgery for correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The toes on both feet are edematous, but there is color, sensitivity, and movement to them. The nurse should
Elevate the legs on pillows.
Lucy is performing an assessment on a child who has been admitted with osteomyelitis of the hip. Lucy knows that while doing the assessment, the patient may exhibit: 1. No signs of pain. 2. Erythema and edema to the hip. 3. Normal vital signs. 4. A good appetite.
Erythema and edema to the hip.
The nurse caring for a child with Duchennes muscular dystrophy notes a characteristic manifestation, which is that the child:
Falls frequently and is clumsy
When offering treatment options for a minor fracture (buckle fracture) care to a child, especially an athlete that wants to continue playing, what are the best recommendations for immobilization? 1. Do not immobilize the fracture. 2. Removable splint 3. Fiberglass cast 4. Ace bandage
Fiberglass cast
A 1-year-old toddler presents to the outpatient clinic with the parents concerned about their child being pigeon-toed. The grandparents state a positive family history of clubfoot. The family is sure its clubfoot, and that the child is going to be deformed and disabled now. Upon physical examination, the child would have which of the following characteristics? 1. Fixed deformity in equinus, tight heel cords, inability to place foot flat on the ground, or walking on supinated feet 2. Tight hamstrings and walking on tiptoes 3. Forefoot abduction and heel in neutral alignment 4. Inward rotated tibia shafts
Fixed deformity in equinus, tight heel cords, inability to place foot flat on the ground, or walking on supinated feet
Janice, an adult orthopedic nurse, has been asked to float to the pediatric orthopedic floor for the next two weeks. It is important for Janice to remember that children have more complicated issues with fractures because: 1. Fractures can occur along an immature growth plate. 2. Children have a lower pain tolerance. 3. Children do not understand how to use crutches, and it takes more time to do discharge teaching. 4. A childs bone takes many more weeks to heal than an adult.
Fractures can occur along an immature growth plate.
A child with Duchenne muscular dystrophy rises from the floor by walking up the thighs with the hands. How should the nurse record this observation?
Gowers sign
The nurse working with a child with a new cast will use which of the following techniques to work with the cast?
Handle the cast gently with the palms of the hand.
Injuries of the growth plate can be classified with the Salter-Harris system. Which of the following classifications have the best prognosis?
I and II
Which statement made by the parent of a 6-month-old infant undergoing serial casting for treatment of clubfoot indicates the parent is correctly following the treatment plan?
I monitor the temperature of his foot often to make sure that the cast still fits.
A nurse in the pediatric orthopedic clinic is giving discharge teaching to the parents of a child with scoliosis on how to use a brace. Which statement by the parent would indicate the need for further education? 1. I will encourage my child to practice the physical therapy exercises. 2. I will have my child wear soft clothing under her brace to prevent skin breakdown. 3. I should apply lotion under the brace to help prevent skin breakdown. 4. I should not use powder under the brace because it can cause a buildup and be irritating.
I should apply lotion under the brace to help prevent skin breakdown.
. The teaching plan for the child with structural disorders of the bones and joints, such as developmental dysphasia of the hip, should include which instruction?
Importance of follow-up until the child reaches skeletal maturity
A mother with a 12-month-old male African American child is in the clinic to discuss his bowed legs. She states that the childs father and grandfather both have it, and it was never treated. She doesnt want him to look funny. With your knowledge of infantile Blounts disease, you know that which of the following is true? 1. Infants that are early walkers are more prone to infantile Blounts disease. 2. Typically, hereditary factors are involved. 3. Long-leg, cumbersome braces are well tolerated. 4. Blounts disease should not be treated until after age 4.
Infants that are early walkers are more prone to infantile Blounts disease.
A student nurse is performing a musculoskeletal assessment on a 2 year old. When doing the assessment, it is important for the student nurse to start with: 1. Palpating the bony prominences of the body. 2. Participating in a range of motion exercises. 3. Participating in weight-bearing exercises. 4. Inspecting the body visually.
Inspecting the body visually.
The nurse is doing discharge planning with the family of an African-American child who is going home after open reduction of a fracture. Which of the following is important for the nurse to ask the caregivers before telling them about the best foods to serve the child to facilitate healing?
Is your child lactose intolerant?
A child with osteomyelitis asks the nurse, What is a sed rate? What is the best response for the nurse?
It tells us how you are responding to the treatment.
Juvenile arthritis should be suspected in a child who exhibits
Joint swelling and pain lasting longer than 6 weeks
A 1-year-old toddler presents to the outpatient clinic with parents concerned about pigeon-toes. The grandparents state a positive family history of clubfoot. The family is sure its clubfoot, and that the child is going to be deformed and disabled now. What is the likely diagnosis? 1. Metatarsus Adductus 2. Tibial Torsion 3. Femoral Anteversion 4. Blounts Disease
Metatarsus Adductus
A school nurse is assessing children for scoliosis. The nurse knows that a major curve is: 1. 15 to 25 degrees. 2. 10 to 14 degrees. 3. More than 25 degrees. 4. Less than 5 degrees.
More than 25 degrees.
A child has been diagnosed with toxic synovitis. The mother asks the nurse about the signs and symptoms she should be aware of because she does not want any of her other children to have the same diagnosis. The nurse discusses the disease process with the mother. She knows that the mother understands the teaching when she states: 1. My other children are at high risk for the next 7 to 14 days. 2. My other children are not at risk because this is usually caused by an allergy or minor trauma. 3. My other children are not at risk because they are older than 10. 4. This disease is very rare, and my other children are healthy, so there is little risk for them.
My other children are not at risk because this is usually caused by an allergy or minor trauma.
The nurse has been asked to aid in diagnostic testing for transient monoarticular synovitis. The nurse prepares the supplies for the procedure because she knows that the child will: 1. Need to have X-rays performed. 2. Need to have blood drawn for an ESR. 3. Need to be sedated for a spinal tap. 4. Need to have a cardiac monitor during the procedure.
Need to have blood drawn for an ESR.
The school nurse has been called to the playground for an emergency. When she arrives, she notes that a young girl is laying on the ground, holding her arm with a bone fragment protruding from her skin. What is the priority assessment at this time? 1. Neurovascular check 2. Elevation of the extremity 3. Providing ice 4. Pain management
Neurovascular check
An 8 year old has a left femur fracture due to a motor vehicle accident and is placed in skin traction until surgery in the morning. During the nurses assessment, she notices that the dorsalis pedis pulse is absent. What is the priority for the nurse to do next? 1. Notify the doctor immediately. 2. Give the ordered pain medication. 3. Release the skin traction. 4. Apply ice and elevate the foot.
Notify the doctor immediately.
A child comes to the nurses office at school during recess and states that she was swinging on the monkey bars when she felt a pop in her shoulder. The nurse should: 1. Notify the parents to have the child taken to the doctor. 2. Tell the girl to go back to the playground because this is normal. 3. Encourage the girl to do range of motion exercises to make her arm feel better. 4. Get ice for her shoulder and send her to class after recess.
Notify the parents to have the child taken to the doctor.
A 14 year old has been diagnosed with Blounts disease. The nurse knows that the greatest risk factor for this disease process is: 1. Juvenile Idiopathic Arthritis. 2. Obesity. 3. Diabetes. 4. Asthma.
Obesity.
A 6-year-old patient in skeletal traction for a femur fracture has pain and edema of the thigh and is febrile. The nurse should suspect which condition?
Osteomyelitis
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. The nursing diagnosis that takes highest priority for this child is:
Pain resulting from tissue trauma
The nurse assessing a child with juvenile rheumatoid arthritis notes the childs right knee and ankle are swollen, warm, and tender. This finding is suggestive of the _____ type of juvenile rheumatoid arthritis.
Pauciarticular
The nurse is working with a child who is in a spica hip cast. Which of the following interventions on the part of the nurse would be best to help protect the cast from urine and stool and protect the skin?
Petal the cast around the edges, especially in the area of the groin and perineum.
During painful episodes of juvenile arthritis, a plan of care should include what nursing intervention?
Proper positioning of the affected joints to prevent musculoskeletal complications
A 13-year-old boy, who has played baseball for three years, comes in complaining of left elbow pain and swelling. He is a pitcher. He plays baseball all year. X-rays reveal medial epicondyle irritation. There is no avulsion fracture. Based on these findings, you explain to the child that he can:
Protect, rest, ice, compress, and elevate the injury as well as stop baseball for three weeks.
The parent of a child with osteomyelitis asks why his child is in so much pain. The nurses response will be based on the understanding that the pain of osteomyelitis is caused by:
Purulent drainage in the bone marrow
A 10-year-old female gymnast fell off the balance beam, landing on her forearm. She has swelling, pain, and deformity. What diagnostic test would be the most helpful for the physician? 1. Rheumatoid laboratory tests 2. Radiographs of her forearm 3. MRI 4. CT Scan
Radiographs of her forearm
A 2-week-old infant with Developmental Dislocated Hips (DDH) is currently being treated in a Pavlick harness. The mom calls and is concerned that the child is not kicking like before and seems to be in pain. She has a history of colic. Although the harness seemed to fit well in clinic last week, you are concerned. Therefore, the proper statement to the mother would be: 1. Try some Tylenol and call her pediatrician. 2. Remove the harness and we will see you in clinic ASAP. 3. Go to the nearest emergency department to have the child seen. 4. Remove the harness and call for an appointment in three months.
Remove the harness and we will see you in clinic ASAP.
The nurse is assessing a child who has a fractured bone that has been pinned. There is caked blood and some purulent drainage in the pin area. Which of the following would be the best action for the nurse to take?
Report findings, and obtain a physicians order for pin-cleaning procedure.
A 12-year-old boy with Duchennes muscular dystrophy is being seen in the clinic for a routine health visit. An appropriate nursing diagnosis for this patient would be
Risk for Impaired Mobility Related to Hypertrophy of Muscles.
A child must wear a brace for correction of scoliosis. The nursing diagnosis that should be included in this childs plan of care is
Risk for Impaired Skin Integrity.
If an immature child presents to the clinic with point tenderness over the distal physis of the wrist or ankle, but negative fracture by X-ray report or observation of films, your knowledge of the Salter-Harris fracture classification would identify which of the following fractures? 1. Salter Harris I 2. Salter Harris II 3. Salter Harris III 4. Salter Harris IV
Salter Harris I
The Ponseti technique for the treatment of clubfoot consists of: 1. Wrapping the foot with ace wraps for 12 hours a day. 2. Serial casting of the foot beginning at the age of 2. 3. Serial castings beginning within the first week of life. 4. Letting the child adapt to the foot, and then treat later in life if the family/child choose to do so.
Serial castings beginning within the first week of life.
A 16-year-old soccer player comes into the ER with left knee effusion and extreme pain. The child claims that while kicking the ball away from an opponent, she felt a pop and fell to the ground. She had to be assisted off the field. She is in the playoffs and wants to play again. X-rays are normal, but as the nurse, you know which of the following about sports injuries?
She will need crutches and a knee immobilizer as well as to rest, ice, compress, and elevate the injury.
A 12-year-old female is seen in the clinic for a chief complaint of in-toeing and being teased at school for the last six months. She had been seen as a toddler who W sat, and the doctor told her parents that she would outgrow this. However, she is still in-toeing a lot. The mom is concerned that she will grow up and not be able to wear high heels or walk down the stairs without tripping and falling. Your knowledge about femoral anteversion leads you to state which of the following? 1. She will outgrow this by the time she is 20 years old. 2. She will not outgrow this now. It usually resolves by the time children are 8 or 9 years of age, so only surgery will correct this now. 3. She will never be able to play running sports. 4. She should try gymnastics since she is so flexible.
She will not outgrow this now. It usually resolves by the time children are 8 or 9 years of age, so only surgery will correct this now.
Which nursing intervention is a priority when caring for a child in a Pavlik harness?
Skin care
Which nursing assessment is appropriate for determining neurovascular competency?
Skin color, temperature, movement, sensation, and capillary refill of the extremity
A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports he will not stop crying even after taking Tylenol with codeine. He also will not straighten the fingers on his right arm. The nurse tells the mother to do which?
Take him to the emergency department.
A pediatric patient has been brought to the emergency room because of hip pain, erythema, and edema, with a high heart rate and low-grade fever. The child will not bear weight on his left side. The diagnosis is osteomyelitis of the hip. The parents ask the nurse how the medical team plans to keep an IV in their child for at least three weeks for antibiotics. The nurse knows that: 1. The best solution will be for a PICC line to be placed in the child so that he/she does not need as many IV starts. 2. The IV sites will last up to 72 hours before needing changed, so this should not cause much pain for the child. 3. The childs arm will be immobilized so that an IV stays in. 4. The child will receive the antibiotics via injection if the IV site cannot be maintained.
The best solution will be for a PICC line to be placed in the child so that he/she does not need as many IV starts
The nurse is assigned to care for a child who is scheduled to have a plaster cast applied after reduction of a fracture of the radius. The nurse will prepare the child for cast application by explaining that:
The cast will be warm, and it will take a day or two to dry completely.
The observation that may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs is:
The child has red, green, and yellow bruises on his body.
What is a realistic outcome for the child with osteogenesis imperfecta?
The child will have a decreased number of fractures.
Which factor should the nurse include when teaching a parent about the care of a child in a Pavlik harness for hip dysplasia?
The harness is used to maintain the infants hips in flexion and abduction and external rotation.
A nurse is assisting the doctor with the examination of a 2 week old with developmental dysplasia of the hip. The doctor has ordered a Pavlik harness for the childs hips. The nurse knows that the teaching for the parent should include that: 1. The harness should be worn 24 hours a day. 2. The harness should only be removed for bathing. 3. The harness needs to be removed when feeding the infant. 4. The infant should remain immobile when in the harness.
The harness should only be removed for bathing.
Which statement is most correct with regard to childhood musculoskeletal injuries?
The less willing the child is to bear weight, the more serious the injury is.
Which factor is important to include in the teaching plan for parents of a child with Legg-Calv-Perthes disease?
There is a disturbance in the blood supply to the femoral epiphysis.
Which of the following explains why synthetic casts are not recommended for young children or serious fractures?
They do not mold as well as plaster casts.
. A nurse is teaching parents the difference between pediatric fractures and adult fractures. Which observation is true about pediatric fractures?
They seldom are complete breaks.
A parent of a child experiencing compartment syndrome asks the nurse to explain what this means. Which of the following is the nurses best response?
This is a serious condition involving increased pressure in sheaths of inelastic fascia leading to massive impairment of circulation.
A 2-year-old male presents to clinic with his caregiver stating that he slipped and fell running on the hardwood floor with the dog. He cried immediately and refused to bear weight on his left side. X-rays were taken in the emergency room of his hip, knee, and ankle. The report was negative. The caregiver states that he is still uncomfortable and is not walking on it. Laboratory tests were done and came back negative for elevated ESR, CRP, and CBC. Upon physical examination, he has pain and immediately withdraws his leg on palpation of his anterior tibia shaft. He says ouchie and no hurt my leg. Your knowledge and the exam would lead you to diagnose the child with which of the following conditions? 1. Juvenile Idiopathic Arthritis 2. Toddlers Fracture 3. Hip Dysplasia 4. Sprained ankle
Toddlers Fracture
A family has received the diagnosis of Osteogenesis Imperfecta for their 2-month-old daughter. The parents are asking several questions to the nurse. The nurse knows the child is a Type 1 classification because of all but one of the following characteristics. 1. Blue sclera 2. Normal dentition of teeth 3. Type 1 is responsible for two-thirds of all OI diagnosis. 4. Type 1 classification will be lethal within a few weeks.
Type 1 classification will be lethal within a few weeks.
.The nurse observes a child with a cast using a pencil to reach inside the cast to scratch an area that the child has been saying is itchy. The child explains that the pencil wont quite reach the place that itches. Which of the following is the nurses best intervention?
Use a hair dryer to blow air into the cast.
The nurse notes as an abnormal finding on a musculoskeletal assessment of a 4-year-old that the child:
Walks on his toes
Discharge teaching is being sent home with a girl who had a right radial fracture and has a cast. The nurse is teaching the family about PRICE. The nurse knows that the family understands the teaching when the mother states: 1. We will make sure to rest the arm, apply ice, and keep it elevated. The important part is to keep the cast for protection. 2. We will be able to let her return to her normal activities when we get home. 3. We will get some pencils so she can put them down the cast to scratch her skin. We should also have her elevate her arm at least two times a day with ice. 4. We will allow her friends to write on the cast with a permanent marker.
We will make sure to rest the arm, apply ice, and keep it elevated. The important part is to keep the cast for protection.
Kali has prepared the discharge teaching for a 3 year old after a repair to the Achilles tendon due to clubfoot. Kali knows that the parents understand the teaching when they say which of the following statements: 1. We will need to make sure to keep the regime set out for us, otherwise her feet could go back to the same position. 2. We will need to watch to make sure she is walking on her tiptoes. 3. It will be important for us to use the angle-foot orthotics as prescribed. 4. We will want her to walk on the lateral border of her shoes.
We will want her to walk on the lateral border of her shoes.
The nurse providing instructions to an adolescent who has been fitted with a Milwaukee brace would teach the patient to:
Wear the brace over a T-shirt 23 hours a day.
A newborn has talipes and is wearing casts. How often should the casts be changed?
Weekly
The nurse has completed discharge teaching for the family of a child diagnosed with Legg-Calve-Perthes disease. The nurse knows further teaching is needed about the condition if the family states,
Were glad this will only take about six weeks to correct. Rationale 2: The treatment generally takes approximately two years. Swimming is a good activity to increase mobility. A brace may be worn, so skin irritation should be monitored. The leg should be kept in the abducted position.
The nurse has completed parent education related to treatment for a child with congenital clubfoot. The nurse knows that parents need further teaching when they state,
Were happy this is the only cast our baby will need.
The nurse is working with a child who is hospitalized and in traction. The parents of this child share with the nurse that the child is very angry with them at times. They share that they are hurt and frustrated by this anger because they are staying with the child and doing all they can to make the experience less traumatic. Which of the following is the nurses best response?
Your child is displacing anger about being immobilized on you because you are safe targets, safer than the physicians and nurses.
A parent asks the nurse to explain what the pediatrician meant by greenstickfracture. The nurse will explain that a greenstick fracture is one in which the bone has:
a break through the periosteum and bone on one side but the other side is intact and only bends
The nurse arrives for the shift report and finds out that one of his assigned clients has a compound or open fracture and is going to surgery sometime during the shift. The nurse knows that this type of fracture involves:
a broken bone that is protruding through the skin, causing an open wound
During a well-child visit, the nurse identifies that an 18-month-old infant is bow legged. The nurse is aware that this assessment is:
a common variation until 1 year after walking begins.
The school nurse assessing a child who has fallen off the swings at school is looking for signs and symptoms of a fracture. The nurse suspects that the bone is fractured, because the child is complaining of pain and tenderness of the lower arm, there is some swelling of the lower arm, and there is decreased range of motion and crepitus. Which of the following best describes crepitus?
a grating sound heard on movement of the ends of a broken bone
The nurse demonstrates how all traction devices: Select all that apply.
a. Pull the limb into extension b. Decrease muscle spasm d. Align two bone fragments e. Immobilize the limb
The nurse performing a neurovascular check on a limb in traction will assess: Select all that apply.
a. Pulse quality b. Degree of sensation c. Color quality d. Capillary refill e. Degree of movement
.Sports injuries are classified in which of the following ways?
acute or overuse
.The school nurse is seeing students who have experienced sports injuries. The nurse will talk with the students about ways to prevent sports injuries and will advise them that a major way to prevent sports injuries is:
adequate conditioning, including warm-ups and cooldowns
A 14-year-old male hockey player presents to the clinic with a right clavicle fracture. The mother reports that he doesnt want to keep still and wear the splint. Your response should be: 1. We can try a sling/swathe or a figure 8 splint. Splints are mostly for comfort. 2. It takes about 2 to 3 weeks for the bones to become sticky, then the pain decreases. He should avoid contact sports for about 6 to 8 weeks. 3. Diversion activities are good to try, like movies or video games. 4. All of the above are correct.
all of the above
A 15-year-old basketball player presents to the clinic with a history of colliding with another player at yesterdays game. He was planted, and his right knee went out after the collision. He has pain and swelling to his knee. He is using crutches and an ace wrap. His mother is concerned and thinks he wont play basketball again. The emergency department told the mother that the x-rays were normal. What other treatment modalities may assist this young athlete? 1. Protect, rest, ice, compression, and elevation (PRICE) 2. A knee Immobilizer 3. Non-steroidal, anti-inflammatory drugs (NSAIDs) 4. All of the above
all of the above
A 5-year-old female falls off the swings at the school playground. Her elbow is swollen and painful. She is seen in the ER and goes to the OR for a supracondylar elbow pinning. The parents are upset and think she will not be able to do gymnastics again. You respond: 1. This is a common type of fracture for this age group. The children recover really well and often have no long-term side effects to the treatment. 2. She will be casted for three weeks, and then the pins will be removed. She should work on range of motion exercises after the cast is removed. She can do gymnastics again in about 4 to 6 weeks. 3. Her doctor will evaluate her progress with X-rays and let you know when she is ready for activities. 4. All the above
all of the above
Keyanna, a 7-year-old girl, has been placed in a leg spica case because of injuries she sustained in a motor vehicle accident. The nurse has created a plan of care for Keyanna while she is an inpatient on the pediatric floor. The plan of care should address: 1. Neurovascular checks. 2. Checking to make sure two fingers can be inserted along the abdomen of the cast to make sure that it is not too tight. 3. Constipation prevention. 4. All of the above should be in the plan of care.
all of the above
Which of the following statements best defines osteomyelitis?
an infection of an entire bone caused by a microorganism, which is usually bacterial but may be viral or fungal
Growth hormone is produced in the:
anterior lobe of the pituitary
A child has experienced a sprain of the right ankle. The school nurse should
apply ice to the extremity
The major concern guiding treatment for the child with Legg-Calv-Perthes disease is to:
avoid permanent deformity.
The school nurse asks a child who has returned to school after an open reduction of a fracture to describe what she has eaten in the past 24 hours in order to see if the family is following the instructions regarding foods that will assist in bone healing. Which of the following reports by the child would indicate that the child and her family are following discharge instructions?
cheeseburger, broccoli, peaches, and milk
The nurse explains that Russell traction is a type of skin traction that:
d. Supplies continuous pull in two directions
. When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from:
falls
When providing education for the parents of a child with Duchenne muscular dystrophy, the nurse plans to include:
genetic counseling for all female relatives.
The nurse is going over discharge instructions with the caregivers of a child who has osteomyelitis and is going home on oral medications. Which of the following discharge instructions is the most important for the nurse to give the caregivers?
how to assess for hearing loss
A parent asks the nurse for advice in letting her child pursue an interest in sports. The parent asks which sports are the most dangerous. The nurse will advise this parent that most injuries in organized sports occur in which of the following sports?
ice hockey, wrestling, and football
A 7-year-old boy has been diagnosed with Legg Calve Perthes disease. The femoral head is noted to be in the necrosis state. During this phase, the nurse knows that the child will be: 1. In pain. 2. Asymptomatic. 3. Limping. 4. Unable to bear any weight on the leg.
in pain
Where does hematopoiesis occur in bones?
in the red marrow of the medullary cavity of the bone
Where is fat stored in bones?
in the yellow marrow of the medullary cavity
In caring for a child with a compound fracture, what should the nurse carefully assess for?
infection
Which of the following can be caused by a fracture that disrupts or transects the epiphyseal growth plate of a child?
limb length discrepancy or a halt in height attainment
A child who has fractured his forearm is unable to extend his fingers. The nurse knows that this:
may indicate compartmental syndrome.
The nurse assesses a childs neurovascular status. The child has a long leg cast for a fracture of the humerus. The nurse finds that there is a slight decreased sensation in the foot and toes of the casted leg as compared to the baseline assessment data. The nurse realizes that this is indicative of which of the following conditions?
neurovascular compromise and an indication of the need for further assessment
A 4-year-old child with a long leg cast complains of fire in his cast. The nurse should:
notify the physician immediately.
When instructing parents about the care of an infant in a cast for a clubfoot, the nurse should include:
notifying the physician of any vascular problems, such as toe swelling.
The nurse is working with a child who is experiencing a complication of fractures known as compartment syndrome. Which of the following signs and symptoms is this child most likely to have?
paresthesia, severe pain, and severe swelling of the digits below the affected compartment
A 9-year-old patient is complaining of skin irritation from the edges of a cast that was applied the previous day. The nurse should take which of the following actions? 1. Petal the cast edges with adhesive tape. 2. Massage the skin at the rim of the cast. 3. File the edges until smooth. 4. Apply more casting material to make the edges softer.
petal the cast edges with adhesive tape.
The nurse encourages the caregivers of a child immobilized in traction to have friends and extended family visit the child. The major rationale for this action on the part of the nurse is directed to which of the following goals?
preventing social isolation and deprivation
The nurse is assigned to a child who is in Bucks extension traction. When the nurse does the initial assessment and looks at the traction setup, the nurse will make certain that the:
ropes and pulleys are hanging freely and not touching the bed or floor
Discharge planning for the child with juvenile arthritis includes the need for:
routine ophthalmological examinations to assess for visual problems.
.The school nurse working in the middle school or high school will find that most sports injuries in older children and adolescents affect:
soft tissues
Which of the following physicians orders would the nurse anticipate in cases of osteomyelitis to minimize pain and decrease the speed of infection by lymph channels?
splinting of the limb
Which of the following treatments is used for compartment syndrome?
split the cast if one is present or do a fasciotomy to relieve pressure
A pediatric client is diagnosed with an incomplete or partial dislocation of the articular surfaces of the joints. When the parents ask the nurse what this condition is called, the nurse accurately responds that it is referred to as ____________________.
subluxation
Which of the following is an early sign of compartment syndrome?
sudden inability of the medications to relieve pain
A parent brings a 3-year-old child to the clinic with a complaint of a painful elbow. The pediatrician orders an X-ray, which reveals the child has a dislocated elbow. The pediatrician or the office nurse will:
talk with the family about not forcibly lifting the child by the hand
.The nurse is working with a small child who is in Bryants traction. During the initial assessment of the shift, the nurse will make certain that:
the childs buttocks are off the bed