Chapter 24: The Child With a Musculoskeletal Condition My Nursing Test Banks

Chapter 24: The Child With a Musculoskeletal Condition

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. 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:

a.

There are no long-term effects.

b.

The disease is self-limiting, resolving itself in a year.

c.

Degenerative arthritis may develop later in life.

d.

There is risk of osteogenic sarcoma in adulthood.

ANS: C

Marked distortion of the head of the femur may lead to an imperfect joint or to degenerative arthritis of the hip later in life.

DIF: Cognitive Level: Application REF: 560 OBJ: 9

TOP: Legg-Calv-Perthes Disease KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. The nurse caring for a child in Bucks skin traction will keep the:

a.

Child in high-Fowlers position

b.

Child pulled up in bed

c.

Childs heel on the bed surface

d.

Childs feet against the foot of the bed

ANS: B

Bucks traction is a type of skin traction that relies on the childs weight as counter-balance The child must be kept with head elevated no more than 20 degrees, pulled up in bed, and the feet should not touch the bed surface or the foot of the bed.

DIF: Cognitive Level: Analysis REF: 553 OBJ: 7

TOP: Bucks Traction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. When caring for a child in Bucks extension, the nurse would include:

a.

Positioning the child with hips flexed 90 at all times

b.

Keeping the weights in contact with the floor

c.

Checking for skin irritation from traction equipment

d.

Releasing the weights on a schedule

ANS: C

The skin exposed to frequent friction may break down.

DIF: Cognitive Level: Application REF: 553 OBJ: 7

TOP: Traction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. The nurse reviewing the characteristics of Ewings sarcoma would point out that with Ewings sarcoma:

a.

Amputation is the accepted treatment.

b.

The disease is sensitive to radiation and chemotherapy.

c.

Metastasis is rare.

d.

The disease is more prevalent in toddlers and preschoolers.

ANS: B

Ewings sarcoma is sensitive to radiation therapy and chemotherapy. Amputation of the affected extremity is not recommended. This cancer occurs in school-age children and does metastasize.

DIF: Cognitive Level: Comprehension: Physiological Adaptation

REF: 561 OBJ: N/A TOP: Ewings Sarcoma

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

5. The nurse caring for a child with Duchennes muscular dystrophy notes a characteristic manifestation, which is that the child:

a.

Ambulates by holding onto furniture

b.

Exhibits atrophy of the calf muscles

c.

Falls frequently and is clumsy

d.

Has delayed fine-motor development

ANS: C

Frequent falling and clumsiness are clinical manifestations of Duchennes muscular dystrophy.

DIF: Cognitive Level: Knowledge REF: 560 OBJ: 4

TOP: Duchennes Muscular Dystrophy KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. 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.

a.

Pauciarticular

b.

Polyarticular

c.

Systemic

d.

Acute febrile

ANS: A

The pauciarticular form of juvenile rheumatoid arthritis is limited to four joints or fewer.

DIF: Cognitive Level: Analysis REF: 562 OBJ: 8

TOP: Juvenile Rheumatoid Arthritis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. 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:

a.

Apply warm compresses to the ankle for the first 24 hours.

b.

Put an ice pack on the ankle, alternating 30 minutes on with 30 minutes off.

c.

Wrap the ankle in an Ace bandage for support.

d.

Keep the leg elevated when sitting.

ANS: A

Heat is not a treatment for soft tissue injuries. The principles of managing soft tissue injuries are rest, ice, compression, and elevation.

DIF: Cognitive Level: Analysis REF: 552 OBJ: 12

TOP: Soft Tissue Injury KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

8. The nurse explains that Russell traction is a type of skin traction that:

a.

Subluxates the tibia

b.

Does not interfere with range of motion

c.

Prevents the knee from flexing

d.

Supplies continuous pull in two directions

ANS: D

Russell traction is skin traction, similar to Bucks traction, with a sling positioned under the knee, which prevents subluxation of the tibia. Although the traction interferes with full ROM, the patient can change position without disrupting the continuous pull in two directions.

DIF: Cognitive Level: Application REF: 553 OBJ: 7

TOP: Russell Traction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. The nurse who is checking for capillary refill on a child in Bryants traction will record adequate perfusion if the toe regains color in _____ seconds

a.

3

b.

4

c.

5

d.

6

ANS: A

Capillary refill in 3 seconds or less is determined to be indicative of adequate perfusion.

DIF: Cognitive Level: Analysis REF: 556 OBJ: 2

TOP: Fracture KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. 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:

a.

The pressure of inelastic bone

b.

Purulent drainage in the bone marrow

c.

The cast applied on the extremity

d.

Circulatory congestion of the skin

ANS: B

Osteomyelitis is an infection of the bone. Inflammation produces an exudate that collects under the marrow and cortex of the bone. The vessels are compressed and thrombosis occurs, producing ischemia and pain.

DIF: Cognitive Level: Analysis REF: 556 OBJ: N/A

TOP: Osteomyelitis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. 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:

a.

2 weeks

b.

6 weeks

c.

2 months

d.

3 months

ANS: B

Because osteomyelitis is an infection in the bone, antibiotics are given intravenously for 4 to 6 weeks.

DIF: Cognitive Level: Application REF: 556 OBJ: 11

TOP: Osteomyelitis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. The nurse, assessing the neurovascular status of a child in Russell traction, should report immediately the finding of:

a.

Skin warm to the touch

b.

Capillary refill less than 3 seconds

c.

Ability to wiggle toes

d.

Bluish coloration of skin

ANS: D

Cyanosis or pallor noted in an extremity is an indication of circulatory impairment.

DIF: Cognitive Level: Application REF: 556 OBJ: 11

TOP: Neurovascular Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. When a 13-year-old girl is diagnosed with functional scoliosis, the nurse would explain the spinal curvature defect is usually caused by:

a.

Juvenile rheumatoid arthritis

b.

Poor posture

c.

Heredity

d.

Myelomeningocele

ANS: B

Functional scoliosis usually is caused by poor posture, and it is not a spinal disease.

DIF: Cognitive Level: Application REF: 563 OBJ: 14

TOP: Scoliosis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. A nurse assessing a preadolescent child for scoliosis would:

a.

Ask the child to bend forward at the waist, and would observe the childs back for asymmetry

b.

Observe the gait while the child is walking forward heel to toe

c.

Have the child flex the knees and look for uneven knee height

d.

Look at the childs shoulders and hips while fully clothed

ANS: A

The nurse looks at the back, as the child bends forward, for general body alignment and asymmetry.

DIF: Cognitive Level: Application REF: 563 OBJ: 14

TOP: Scoliosis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. The nurse caring for a child in Bryants traction knows that the risk of serious complications will be reduced by ensuring that:

a.

Neurovascular checks are done frequently

b.

Ace bandages are wrapped tightly

c.

The baby is restrained from rolling over

d.

The childs buttocks are resting on the bed

ANS: A

The nurse caring for a child in traction must be alert for Volkmanns ischemia, which occurs when circulation is obstructed.

DIF: Cognitive Level: Analysis REF: 562 OBJ: N/A

TOP: Traction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. The interventions that would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis would be:

a.

Wearing splints at night to prevent extension contractures

b.

Applying moist heat packs upon awakening

c.

Taking a warm tub bath the evening before

d.

Sleeping with two pillows under the head

ANS: B

Application of moist heat, with a compress or by tub bath upon awakening, will help to lessen stiffness.

DIF: Cognitive Level: Application REF: 562 OBJ: 8

TOP: Juvenile Rheumatoid Arthritis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. The nurse providing instructions to an adolescent who has been fitted with a Milwaukee brace would teach the patient to:

a.

Wear the brace directly against the skin.

b.

Wear the brace over regular clothing.

c.

Wear the brace over a T-shirt 23 hours a day.

d.

Remove the brace before sleeping.

ANS: C

A Milwaukee brace is worn approximately 23 hours a day over a T-shirt that protects the skin.

DIF: Cognitive Level: Application REF: 563 OBJ: 14

TOP: Scoliosis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. 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:

a.

The child has red, green, and yellow bruises on his body.

b.

The childs bruises are dispersed on his head, arms, and legs.

c.

The child had a broken arm last year and is described as accident prone.

d.

The childs mother is very anxious for her son to get medical attention.

ANS: A

As bruises heal, they change color in stages. Different colors of bruises indicate that injuries have not all occurred at the same time. The nurse must consider whether the bruises match the caretakers explanation of what happened.

DIF: Cognitive Level: Analysis REF: 568 OBJ: 6

TOP: Child Abuse KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

19. 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:

a.

Pain resulting from tissue trauma

b.

High risk for impaired skin integrity resulting from immobility

c.

Altered growth and development related to separation from family

d.

Altered urinary elimination related to immobility and traction

ANS: A

Although all of these nursing diagnoses are relevant to the child in traction, pain resulting from muscle spasm and tissue trauma is the highest priority.

DIF: Cognitive Level: Analysis REF: 558 OBJ: 10

TOP: The Child With a Fracture in Traction

KEY: Nursing Process Step: Nursing Diagnosis

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. The nurse notes as an abnormal finding on a musculoskeletal assessment of a 4-year-old that the child:

a.

Has inward-turned knees while standing

b.

Walks on his toes

c.

Appears to have flat feet

d.

Swings his arms when walking

ANS: B

Toe walking after 3 years of age may indicate a muscle problem.

DIF: Cognitive Level: Analysis REF: 550 OBJ: 2

TOP: Assessment of the Musculoskeletal System

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

21. The nurse understands a difference in the childs skeletal system as compared to an adults is:

a.

The childs bone is less porous than adult bone.

b.

Bone growth is not affected by fractures.

c.

Bone overgrowth in healing fractures is uncommon.

d.

Callus formation in healing fractures occurs more rapidly.

ANS: B

Callus forms more rapidly in the child than the adult.

DIF: Cognitive Level: Knowledge REF: 551 OBJ: 3

TOP: Differences Between the Child and Adult

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

1. The nurse demonstrates how all traction devices:

Select all that apply.

a.

Pull the limb into extension

b.

Decrease muscle spasm

c.

Reduce pain

d.

Align two bone fragments

e.

Immobilize the limb

ANS: A, B, D, E

Tractions are designed to immobilize and pull limbs into extension. Traction can also align broken bones and decrease muscle spasm. Although some tractions may relieve pain, many tractions may actually cause pain.

DIF: Cognitive Level: Analysis REF: 561 OBJ: 10

TOP: Traction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. 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

ANS: A, B, C, D, E

All options listed are integral components of the neurovascular assessment that is done to ensure adequate perfusion to a limb in traction.

DIF: Cognitive Level: Application REF: 556 OBJ: 11

TOP: Neurovascular Assessment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

COMPLETION

1. The nurse explains that Bryants traction is reserved for children who weigh less than ____________________ pounds.

ANS: 40

DIF: Cognitive Level: Knowledge REF: 553 OBJ: 10

TOP: Bryants Traction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

NOT: Rationale: Bryants traction is a skin traction used in the treatment of orthopedic disorders of young children who weigh less than 40 pounds. Greater weight would cause excessive counterbalance and injury to soft tissues.

2. The nurse reminds the adolescent boy with Ewings sarcoma that he is prohibited from vigorous weight-bearing during treatment with radiation to reduce the risk of a ____________________ fracture.

ANS: pathological

DIF: Cognitive Level: Application REF: 561 OBJ: 3

TOP: Ewings Sarcoma KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

NOT: Rationale: The bone has lost its integrity because of the cancer and the following radiation. Excessive or vigorous weight bearing can cause a pathological fracture of the compromised bone.

3. The child with Duchennes muscular dystrophy must push on his legs and walk up the leg in order to rise to a standing position. The nurse recognizes this characteristic behavior as ____________________ maneuver.

ANS: Gowers

DIF: Cognitive Level: Application REF: 560 OBJ: 4

TOP: Duchennes Muscular Dystrophy KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

NOT: Rationale: Gowers maneuver is a unique way of rising from the floor by walking up the leg in order to get the upper body erect.

4. The nurse recognizes the signs of ____________________ syndrome in a child in a 90-90 traction when the toes are pale and edematous and have a very slow capillary refill.

ANS: compartment

DIF: Cognitive Level: Application REF: 556 OBJ: 10

TOP: Compartment Syndrome KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

NOT: Rationale: When a limb is in traction or has been cast, the caregiver must check for adequate perfusion of the limb. Compartment syndrome occurs when the attendant edema from the injury or the traction compromises the circulation. This is an emergency and must be corrected before permanent damage can occur.

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