Chapter 26: The Child with a Musculoskeletal Alteration My Nursing Test Banks

Chapter 26: The Child with a Musculoskeletal Alteration

Test Bank

MULTIPLE CHOICE

1. Which is an accurate statement concerning a childs musculoskeletal system and how it may be different from adults?

a.

Growth occurs in children as a result of an increase in the number of muscle fibers.

b.

Infants are at greater risk for fractures because their epiphyseal plates are not fused.

c.

Because soft tissues are resilient in children, dislocations and sprains are less common than in adults.

d.

Their bones have less blood flow.

ANS: C

Because soft tissues are resilient in children, dislocations and sprains are less common than in adults. A childs growth occurs because of an increase in size rather than an increase in the number of the muscle fibers. Fractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. A childs bones have greater blood flow than an adults bones.

DIF: Cognitive Level: Comprehension REF: p. 663

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

2. When infants are seen for fractures, which nursing intervention is a priority?

a.

No intervention is necessary. It is not uncommon for infants to fracture bones.

b.

Assess the familys safety practices. Fractures in infants usually result from falls.

c.

Assess for child abuse. Fractures in infants are often nonaccidental.

d.

Assess for genetic factors.

ANS: C

Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are not common because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. Infants should be cared for in a safe environment and should not be falling. Fractures in infancy are usually nonaccidental rather than related to a genetic factor.

DIF: Cognitive Level: Application REF: p. 671

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

3. Which nursing assessment is appropriate for determining neurovascular competency?

a.

Degree of motion and ability to position the extremity

b.

Length, diameter, and shape of the extremity

c.

Amount of swelling noted in the extremity and pain intensity

d.

Skin color, temperature, movement, sensation, and capillary refill of the extremity

ANS: D

A neurovascular evaluation includes assessing skin color and temperature, ability to move the affected extremity, degree of sensation experienced, and speed of capillary refill in the extremity. The degree of motion in the affected extremity and the ability to position the extremity are incomplete assessments of neurovascular competency. The length, diameter, and shape of the extremity are not assessment criteria in a neurovascular evaluation. Although the amount of swelling is an important factor in assessing an extremity, it is not a criterion for a neurovascular assessment.

DIF: Cognitive Level: Application REF: p. 669

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

4. 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?

a.

Take him to the emergency department.

b.

Put ice on the injury.

c.

Avoid letting him get so tired.

d.

Wait another hour. If he is still crying, call back.

ANS: A

Unrelieved pain and the childs inability to extend his fingers are signs of compartmental syndrome, which requires immediate attention. Placing ice on the extremity is an inappropriate action for the presenting symptoms. It is inappropriate for the nurse to tell the mother who is concerned about her child to avoid letting him get so tired. A child who has signs and symptoms of compartmental syndrome should be seen immediately. Waiting an hour could compromise the recovery of the child.

DIF: Cognitive Level: Analysis REF: p. 669

OBJ: Nursing Process Step: Intervention MSC: Health Promotion and Maintenance

5. A 4-year-old child with a long leg cast complains of fire in his cast. The nurse should:

a.

notify the physician on his next rounds.

b.

chart the complaint in the nurses notes.

c.

notify the physician immediately.

d.

report the complaint to the next nurse on duty.

ANS: C

A burning sensation under the cast is an indication of tissue ischemia. It may be an early indication of serious neurovascular compromise, such as compartment syndrome, that requires immediate attention. The childs presenting symptom requires immediate attention. Notifying the physician on the next rounds is inappropriate. Charting the complaint in the nurses notes is an inappropriate action. Careful notation of symptoms is important, but the priority action is to contact the physician. Communication across shifts is important to the continuing assessment of the child; however, this symptom requires immediate evaluation, and the physician should be contacted.

DIF: Cognitive Level: Analysis REF: p. 669

OBJ: Nursing Process Step: Intervention MSC: Physiological Integrity

6. Which statement is most correct with regard to childhood musculoskeletal injuries?

a.

After the injury is iced, the swelling decreases, indicating the injury is not severe.

b.

The presence of localized tenderness indicates a more serious injury.

c.

The more swelling there is, the less severe the injury is.

d.

The less willing the child is to bear weight, the more serious the injury is.

ANS: D

An inability to bear weight on the affected extremity is indicative of a more serious injury. With a fracture, general manifestations include pain or tenderness at the site, immobility or decreased range of motion, deformity of the extremity, edema, and inability to bear weight. A decrease in swelling after icing does not identify the degree of the injury. Localized tenderness along with limited joint mobility may indicate serious injury, but an inability to bear weight on the extremity is a more reliable sign. The degree of swelling does not indicate how serious the injury is.

DIF: Cognitive Level: Comprehension REF: p. 674

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

7. A child with osteomyelitis asks the nurse, What is a sed rate? What is the best response for the nurse?

a.

It tells us how you are responding to the treatment.

b.

It tells us what type of antibiotic you need.

c.

It tells us whether we need to immobilize your extremity.

d.

It tells us how your nerves and muscles are doing.

ANS: A

The erythrocyte sedimentation rate (ESR) indicates the presence of inflammation and infectious process and is one of the best indicators of the childs response to treatment. Although the ESR indirectly identifies whether an antibiotic is needed, the organism involved dictates the type of antibiotic and the length of treatment. The ESR does not direct whether the extremity will be immobilized and will not evaluate neuromuscular status.

DIF: Cognitive Level: Application REF: pp. 676-677

OBJ: Nursing Process Step: Intervention MSC: Physiological Integrity

8. Which intervention is part of the discharge plan for a child with osteomyelitis?

a.

Instructions for a low-calorie diet

b.

A referral to a home healthcare agency

c.

Instructions for a high-fat, low-protein diet

d.

Instructions for the parent to return the child to team sports immediately

ANS: B

Because the child with osteomyelitis often requires intravenous antibiotics at home, a home healthcare referral is appropriate. The child with osteomyelitis is on a high-calorie, high-protein diet. The child with osteomyelitis may need time for the bone to heal before returning to full activities.

DIF: Cognitive Level: Application REF: p. 677

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

9. During a 14-year-old adolescents physical examination, the nurse identifies that he plays soccer and football and is complaining of knee pain when he rises from a squatting position. The nurse should suspect:

a.

Legg-Calv-Perthes disease.

b.

osteomyelitis.

c.

Duchenne muscular dystrophy.

d.

Osgood-Schlatter disease.

ANS: D

Knee pain and tenderness aggravated by activity that requires kneeling, running, climbing stairs, and rising from a squatting position are highly significant for Osgood-Schlatter disease. The etiology is believed to be related to repetitive stress from sports-related activities combined with overuse of immature muscles and tendons. Pain on activity that decreases with rest is indicative of Legg-Calv-Perthes disease. Preexisting pain, favoring the affected limb, erythema, and tenderness are associated with osteomyelitis. Duchenne muscular dystrophy presents with progressive generalized weakness and muscle wasting.

DIF: Cognitive Level: Analysis REF: p. 684

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

10. The nurse caring for a child with Osgood-Schlatter disease should evaluate the childs:

a.

knowledge of activity restrictions.

b.

understanding of traction.

c.

acceptance of life-long limitations.

d.

knowledge of skin care.

ANS: A

The major component of treatment for Osgood-Schlatter disease is activity restriction for 6 weeks or more. Traction is not used for Osgood-Schlatter disease. This is a self-limiting disorder, not a life-long disorder. The problem usually disappears once growth stops. Although activity is restricted, the degree of restriction should not result in skin care problems.

DIF: Cognitive Level: Application REF: p. 684

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

11. Which factor is important to include in the teaching plan for parents of a child with Legg-Calv-Perthes disease?

a.

It is a chronic disease with long-term sequelae.

b.

It affects children in the toddler stage.

c.

There is a disturbance in the blood supply to the femoral epiphysis.

d.

It is caused by a virus.

ANS: C

Legg-Calv-Perthes disease is a self-limiting disease that affects the blood supply to the femoral epiphysis. The most serious problem associated with it is the risk of permanent deformity. Legg-Calv-Perthes disease is not a chronic disease. The disease process usually lasts between 1 and 2 years and is a disorder of growth. It is seen in children between 2 and 12 years of age. Most cases occur between 4 and 9 years of age. The etiology is unknown.

DIF: Cognitive Level: Application REF: p. 688

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

12. The major concern guiding treatment for the child with Legg-Calv-Perthes disease is to:

a.

avoid permanent deformity.

b.

minimize pain.

c.

maintain normal activities.

d.

encourage new hobbies.

ANS: A

The major concern related to Legg-Calv-Perthes disease is to prevent an arthritic process resulting from the flattening of the femoral head of the femur when it protrudes outside the acetabulum. The pain associated with Legg-Calv-Perthes disease decreases with increased rest, making activity restriction an important factor for these children. The priority concern for treatment is to prevent deformity through decreased activity. Selected hobbies that do not require physical activity are encouraged.

DIF: Cognitive Level: Comprehension REF: p. 689

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

13. What is a realistic outcome for the child with osteogenesis imperfecta?

a.

The child will have a decreased number of fractures.

b.

The child will demonstrate normal growth patterns.

c.

The child will participate in contact sports.

d.

The child will have no fractures after infancy.

ANS: A

The biochemical defect associated with osteogenesis imperfecta causes a defect in the synthesis of collagen. The abnormal collagen results in incomplete bone development, placing the child at high risk for fracturing bones. Receiving safety education and wearing protective apparatus can decrease the number of fractures. Because of incomplete bone formation, children with osteogenesis imperfecta do not have normal growth patterns. The high risk of fractures and the abnormal growth patterns do not allow for active participation in contact sports. Osteogenesis imperfecta is a life-long disease process.

DIF: Cognitive Level: Comprehension REF: p. 693

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

14. Discharge planning for the child with juvenile arthritis includes the need for:

a.

routine ophthalmological examinations to assess for visual problems.

b.

a low-calorie diet to decrease or control weight in the less mobile child.

c.

avoiding the use of aspirin to decrease gastric irritation.

d.

immobilizing the painful joints, which is the result of the inflammatory process.

ANS: A

The systemic effects of juvenile arthritis can result in visual problems, making routine eye examinations important. Children with juvenile arthritis do not have problems with increased weight and often are anorexic and in need of high-calorie diets. They are often treated with aspirin. Children with arthritis can immobilize their own joints. Range-of-motion exercises are important for maintaining joint flexibility and preventing restricted movement in the affected joints.

DIF: Cognitive Level: Application REF: p. 697

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

15. During painful episodes of juvenile arthritis, a plan of care should include which nursing intervention?

a.

A weight-control diet to decrease stress on the joints

b.

Proper positioning of the affected joints to prevent musculoskeletal complications

c.

Complete bed rest to decrease stress to joints

d.

High-resistance exercises to maintain muscular tone in the affected joints

ANS: B

Proper positioning is important to support and protect affected joints. Isometric exercises and passive range-of-motion exercises will prevent contractures and deformities. Children in pain often are anorexic and need high-calorie foods. Children with juvenile arthritis need a combination of rest and exercise and need to avoid high-resistance exercises. They also benefit from low-resistance exercises such as swimming.

DIF: Cognitive Level: Application REF: p. 697

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

16. When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from:

a.

automobile accidents.

b.

falls.

c.

physical abuse.

d.

sports injuries.

ANS: B

The major cause of childrens fractures is falls. Because of the protection reflexes, the outstretched arm often receives the full force of the fall. Automobile accidents, physical abuse, and sports injuries may result in fractures to any bone.

DIF: Cognitive Level: Comprehension REF: p. 671

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

17. In caring for a child with a compound fracture, what should the nurse carefully assess for?

a.

Infection

b.

Osteoarthritis

c.

Epiphyseal disruption

d.

Periosteum thickening

ANS: A

Because the skin has been broken, the child is at risk for organisms to enter the wound. The incidence of osteoarthritis and the chance of epiphyseal disruption are not increased with compound fracture. Periosteum thickening is part of the healing process and is not a complication.

DIF: Cognitive Level: Comprehension REF: p. 674

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

18. A nurse is teaching parents the difference between pediatric fractures and adult fractures. Which observation is true about pediatric fractures?

a.

They seldom are complete breaks.

b.

They are often compound fractures.

c.

They are often at the epiphyseal plate.

d.

They are often the result of decreased mobility of the bones.

ANS: A

Pediatric fractures seldom are complete breaks. Rather, childrens bones tend to bend or buckle. Compound fractures are no more common than simple fractures in children. Epiphyseal plate fractures are no more common than any other type of fracture. Increased mobility of the bones prevents children from having complete fractures.

DIF: Cognitive Level: Application REF: p. 671

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

19. Patient and parent education for the child who has a synthetic cast should include which information?

a.

Apply a heating pad to the cast if the child has swelling in the affected extremity.

b.

Wrap the outer surface of the cast with an Ace bandage.

c.

Split the cast if the child complains of numbness or pain.

d.

Cover the cast with plastic and waterproof tape to keep it dry while bathing or showering.

ANS: D

Damp skin is more susceptible to breakdown. The cast should be kept clean and dry. To prevent swelling, elevate the extremity and apply bagged ice to the casted area. Wrapping the outer surface with an Ace bandage is not indicated. If the child complains of numbness or pain, he should return immediately to the clinic or emergency department for an evaluation of neurovascular status.

DIF: Cognitive Level: Application REF: p. 672

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

20. 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?

a.

Meningitis

b.

Crepitus

c.

Osteomyelitis

d.

Osteochondrosis

ANS: C

The most serious complication of skeletal traction is osteomyelitis. Clinical manifestations include complaints of localized pain, swelling, warmth, tenderness, or unusual odor. An elevated temperature may accompany the symptoms. The symptoms of meningitis include headache, photophobia, fever, nausea, and vomiting. Crepitus is the sandy or gravelly feeling noted when a broken bone is palpated. Osteochondrosis is a disorder of the epiphyses involving an interruption of the blood supply.

DIF: Cognitive Level: Comprehension REF: p. 676

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

21. A child who has fractured his forearm is unable to extend his fingers. The nurse knows that this:

a.

is normal following this type of injury.

b.

may indicate compartmental syndrome.

c.

may indicate fat embolism.

d.

may indicate damage to the epiphyseal plate.

ANS: B

Swelling causes pressure to rise within the immobilizing device leading to compartmental syndrome. Signs include severe pain, often unrelieved by analgesics, and neurovascular impairment. It is not uncommon in the forearm, so the inability to extend the fingers may indicate compartmental syndrome. It is not normal that the child is unable to extend his fingers; this indicates neurovascular compromise of some type. Paresthesia or numbness or loss of feeling can indicate a neurovascular compromise and can result in paralysis. Fat embolism causes respiratory distress with hypoxia and respiratory acidosis. Paresthesia is not related to damage to the epiphyseal plate.

DIF: Cognitive Level: Comprehension REF: p. 669

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

22. When teaching care for a child immobilized in a spica cast, which is the most appropriate intervention?

a.

Application of talcum powder to the skin twice daily

b.

Fluid restriction to prevent loose stools or diarrhea

c.

Assessment for a sluggish capillary refill

d.

Instructing that insertion of small objects into the cast for itching or discomfort is helpful

ANS: C

Capillary refill that is sluggish is indicative of impaired neurovascular function. The nurse should avoid applying talcum powder because it may become sticky or cake on the skin and cause irritation. The child needs appropriate fluid intake to prevent constipation or stool impaction. This is especially important because activity is limited. The nurse should instruct caregivers that nothing should be put inside the cast. Keeping food, small toys, and sharp objects away from the cast will be important.

DIF: Cognitive Level: Application REF: p. 669

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

23. When assessing the child with osteogenesis imperfecta, the nurse should expect to make which observation?

a.

Discolored teeth

b.

Below-normal intelligence

c.

Increased muscle tone

d.

Above-average stature

ANS: A

Children with osteogenesis imperfecta have incomplete development of bones, teeth, ligaments, and sclerae. Teeth are discolored because of abnormal enamel. Despite their appearance, the child with osteogenesis imperfecta has normal or above-normal intelligence. The child with osteogenesis imperfecta has weak muscles and decreased muscle tone. Because of compression fractures of the spine, the child appears short.

DIF: Cognitive Level: Comprehension REF: p. 693

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

24. When teaching the parents of a child with osteogenesis imperfecta about nutrition, the nurse should emphasize a diet that is:

a.

high in protein.

b.

high in calories.

c.

low in fiber.

d.

high in calcium.

ANS: D

Foods high in calcium, and calcium supplements if necessary, should be included in the diet. Nutritional guidelines should support healthy growth and development. Protein intake should be based on the childs age-appropriate dietary needs. The diet should not be high in calories. Excessive weight gain can place undue stress on the musculoskeletal system. High-fiber foods should be included in the diet.

DIF: Cognitive Level: Application REF: p. 693

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

25. A nurse understands that which type of exercise would be best for a child with juvenile arthritis?

a.

Jogging

b.

Tennis

c.

Gymnastics

d.

Swimming in a heated pool

ANS: D

The warmth of the water, coupled with mild resistance, makes swimming the perfect medium for strengthening and range-of-motion exercises while protecting the joints. Jogging jars the hip, knee, and ankle joints and can cause joint damage. Tennis also jars the joints and can cause joint damage. Gymnastics does not protect the joints from injury.

DIF: Cognitive Level: Application REF: p. 696

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

26. Juvenile arthritis should be suspected in a child who exhibits which symptom?

a.

Frequent fractures

b.

Joint swelling and pain lasting longer than 6 weeks

c.

Increased joint mobility

d.

Lurching and abnormal gait, limited abduction

ANS: B

Intermittent joint pain lasting longer than 6 weeks is indicative of juvenile arthritis. Frequent fractures are indicative of osteogenesis imperfecta. Increased joint mobility is indicative of osteogenesis imperfecta. Lurching to the affected side causing an abnormal gait and limited abduction are associated with the developmental dysplasia of the hip (DDH).

DIF: Cognitive Level: Comprehension REF: p. 695

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

27. When providing education for the parents of a child with Duchenne muscular dystrophy, the nurse plans to include:

a.

testing all female children for the disease.

b.

testing the father for the presence of the trait on the Y chromosome.

c.

genetic counseling for all female relatives.

d.

testing the parents to determine the carrier.

ANS: C

Duchenne muscular dystrophy is a recessive sex-linked disease carried on the X chromosome so only males are affected with the disease. Because Duchenne muscular dystrophy is a recessive X-linked disorder, females can only be carriers and do not have the disease. The disease is an X-linked recessive disorder and would not be found on the Y chromosome. The disease is a recessive X-linked disease and is always carried by the mother.

DIF: Cognitive Level: Application REF: p. 692

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

28. The nurse knows that treatment of Osgood-Schlatter disease includes which intervention?

a.

Limitation of knee bending or kneeling

b.

Increasing range of motion (ROM) of the knee

c.

Encouraging flexion of the hip

d.

Limitation of adduction of the hip

ANS: A

Limitation of knee bending or kneeling provides pain control and allows the knees to heal. Increasing ROM of the knee increases pain and exacerbates the disease. Encouraging flexion of the hip will have no effect on the process affecting the knees. Limitation of hip adduction will not help the child with Osgood-Schlatter disease.

DIF: Cognitive Level: Application REF: p. 684

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

29. What is the most appropriate intervention for an adolescent with a mild scoliosis?

a.

Long-term monitoring

b.

Surgical intervention

c.

Bracing

d.

No follow-up

ANS: A

The child with mild scoliosis requires long-term follow-up to determine whether the curve will progress or remain stable. Surgical intervention is not needed for mild scoliosis. Mild scoliosis is not braced if it is stable. Follow-up to monitor the curve is important until skeletal maturity has occurred.

DIF: Cognitive Level: Application REF: p. 679

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

30. Which statement made by the mother of an adolescent being discharged after spinal fusion for severe scoliosis indicates the need for further teaching?

a.

I am glad we chose surgery. Now it is all over and done.

b.

Ill see you in a month; well be back fairly regularly.

c.

I have to pick up some more T-shirts on the way home.

d.

Those exercises the physical therapist showed us were not too hard.

ANS: A

Spinal fusion requires long-term follow-up to assess the stability of the spinal correction. It is not over and done at this point. Showing knowledge of follow-ups, clothing, and exercises indicates the mothers understanding and does not require further teaching.

DIF: Cognitive Level: Analysis REF: p. 682

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

31. Which factor should the nurse include when teaching a parent about the care of a child in a Pavlik harness for hip dysplasia?

a.

The harness may be removed with every diaper change.

b.

The harness is used to maintain the infants hips in flexion and abduction and external rotation.

c.

The harness is only the first step of treatment.

d.

The harness is worn for only 2 weeks.

ANS: B

The harness is used to maintain the infants hips in flexion and external rotation to allow the hips (femoral head and acetabulum) to mold and grow normally. The harness must be worn for 23 hours per day and should be removed only according to the physicians recommendation. Hips that remain unstable become progressively more deformed as maturity takes place. With early diagnosis and treatment, the Pavlik harness is often the only treatment necessary. The length of treatment is determined by radiographic documentation of the maturity of the hips.

DIF: Cognitive Level: Application REF: p. 687

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

32. Which nursing intervention is a priority when caring for a child in a Pavlik harness?

a.

Skin care

b.

Bowel function

c.

Feeding patterns

d.

Respiratory function

ANS: A

The child in a Pavlik harness needs special attention to skin care because the infants skin is sensitive and the harness may cause irritation. The harness should not affect normal bowel function, feeding patterns, or normal respiratory function in the infant.

DIF: Cognitive Level: Application REF: p. 687

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

33. When instructing parents about the care of an infant in a cast for a clubfoot, the nurse should include:

a.

reassurance that clubfoot usually resolves spontaneously.

b.

instructions on washing the cast daily to keep it clean.

c.

the importance of analogous blood donations for impending surgery.

d.

notifying the physician of any vascular problems, such as toe swelling.

ANS: D

Toe swelling may be a sign of neurovascular compromise and the need for the cast to be readjusted. The physician should be notified immediately. Clubfoot does not resolve spontaneously. A clubfoot can recur and long-term follow-up is indicated. Casts are never washed. Parents should be instructed to keep the cast dry. Analogous blood donations are not a consideration for the child with a clubfoot.

DIF: Cognitive Level: Comprehension REF: p. 691

OBJ: Nursing Process Step: Intervention MSC: Health Promotion and Maintenance

34. 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 in children between the ages of 2 and 7 years.

b.

a common variation until 1 year after walking begins.

c.

a serious condition needing further evaluation.

d.

an indication of neurological impairment.

ANS: B

Bow legs are a common occurrence in children until approximately 1 year after the child begins walking. They tend to correct as the child grows. Bow legs are not a common finding in children older than 30 months. Bow legs may need intervention but do not generally indicate serious abnormalities. Bow legs do not generally indicate a neurological impairment.

DIF: Cognitive Level: Comprehension REF: p. 683

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

35. 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?

a.

I am careful to leave him in his bed with his leg elevated as much as possible.

b.

I monitor the temperature of his foot often to make sure that the cast still fits.

c.

Its okay that hes not trying to roll over; hell catch up later.

d.

Its okay if the cast gets wet during baths because it will be changed often.

ANS: B

The temperature of the foot should be monitored often to assess for neurovascular compromise. The child should be allowed to have developmental stimulation to achieve as normal a growth and development as possible. The child should be trying to roll over by this age; if the child is not, this indicates the need for further evaluation. The cast should be kept dry although it is being changed often.

DIF: Cognitive Level: Application REF: p. 691

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

36. 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?

a.

Importance of limiting physical activity to decrease the chance of injury

b.

Need for long-term hospitalization to ensure adequate treatment

c.

Importance of follow-up until the child reaches skeletal maturity

d.

Importance of avoiding child-resistant devices, as these can exacerbate the condition

ANS: C

Because recurrence is common, long-term follow-up is necessary until skeletal maturity is reached. Physical activity will not necessarily reduce injury

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