CHAPTER 34: MUSCULOSKELETAL ALTERATIONS My Nursing Test Banks

CHAPTER 34: MUSCULOSKELETAL ALTERATIONS

MULTIPLE CHOICE

1.What differences in the musculoskeletal system of children make their bones able to absorb more energy before breaking and to heal more quickly?

a.

Adults do not take in as much calcium as children do, thus their bones are weaker.

b.

Childrens bones have more cartilage and a stronger periosteum.

c.

The muscles and ligaments in adults are not as strong as those of children.

d.

Children have a better diet and take in more vitamins and minerals than adults do.

ANS: B

Feedback

A

Incorrect. Calcium intake is not the most significant factor in predicting the risk for breaking a bone in the pediatric client.

B

Correct. The bones of children contain a large amount of cartilage, which makes them more porous and more flexible. This allows them to bend and buckle rather than break.

C

Incorrect. Muscle and ligament strength is not the most significant factor in predicting the risk for breaking a bone in the pediatric client.

D

Incorrect. Diet is not the most significant factor in predicting the risk for breaking a bone in the pediatric client.

PTS:1REF:p. 1294 Musculoskeletal Alterations

OBJ: Cognitive Level: Application

2.Which of the following can be caused by a fracture that disrupts or transects the epiphyseal growth plate of a child?

a.

gigantism

b.

dwarfism

c.

increased risk of a fat emboli or bleeding into the tissues

d.

limb length discrepancy or a halt in height attainment

ANS: D

Feedback

A

Incorrect. A fracture that disrupts or transects the epiphyseal growth plate of a child is not associated with gigantism.

B

Incorrect. A fracture that disrupts or transects the epiphyseal growth plate of a child is not associated with dwarfism.

C

Incorrect. A fracture that disrupts or transects the epiphyseal growth plate of a child is not associated with increased risk for fat emboli or bleeding into the tissues.

D

Correct. Because children have an epiphyseal plate at the end of the long bones, a fracture that disrupts or transects this plate may interfere with the growth of the bone and lead to limb length discrepancies or a halt in height attainment.

PTS:1REF:p. 1294 Musculoskeletal Alterations

OBJ: Cognitive Level: Application

3.Where is fat stored in bones?

a.

surrounding the epiphyseal growth plate

b.

in the gray marrow of the medullary cavity

c.

in the yellow marrow of the medullary cavity

d.

in the metaphysis section of the bone

ANS: C

Feedback

A

Incorrect. Fat is not stored in the epiphyseal growth plate.

B

Incorrect. Fat is not stored in gray matter of the medullary cavity.

C

Correct. Fat is stored in the yellow marrow of the medullary cavity in the bones.

D

Incorrect. Fat is not stored in the metaphysis section of the bone.

PTS:1REF:p. 1294 Musculoskeletal Alterations

OBJ: Cognitive Level: Comprehension

4.Where does hematopoiesis occur in bones?

a.

in the red marrow of the medullary cavity of the bone

b.

in the proximal epiphysis

c.

in the gray marrow of the medullary cavity of the bone

d.

in the distal epiphysis

ANS: A

Feedback

A

Correct. Hematopoiesis occurs in the red marrow of the medullary cavity of the bone

B

Incorrect. Hematopoiesis does not occur in the proximal epiphysis.

C

Incorrect. Hematopoiesis does not occur in the gray matter of the medullary cavity.

D

Incorrect. Hematopoiesis does not occur in the distal epiphysis.

PTS:1REF:p. 1294 Musculoskeletal Alterations

OBJ: Cognitive Level: Comprehension

5.Growth hormone is produced in the:

a.

posterior lobe of the pituitary

c.

thalamus

b.

anterior lobe of the pituitary

d.

hypothalamus

ANS: B

Feedback

A

Incorrect. Growth hormone is not produced in the posterior lobe of the pituitary.

B

Correct. Growth hormone is produced in the anterior lobe of the pituitary.

C

Incorrect. Growth hormone is not produced in the thalamus.

D

Incorrect. Growth hormone is not produced in the hypothalamus.

PTS:1REF:p. 1295 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

6.The school nurse working in the middle school or high school will find that most sports injuries in older children and adolescents affect:

a.

long bones

c.

the head

b.

soft tissues

d.

spinal cord

ANS: B

Feedback

A

Incorrect. In this age group, sports injuries are not as common in long bones.

B

Correct. In the middle school or high school student, most sports injuries affect the soft tissues. Soft-tissue injuries include sprains, strains, and contusions.

C

Incorrect. In this age group, sports injuries are not as common in the head.

D

Incorrect. In this age group, sports injuries are not as common in the spinal cord.

PTS:1REF:p. 1295 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

7.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?

a.

ice hockey, wrestling, and football

c.

karate, gymnastics, and dance

b.

swimming, horseshoes, and hiking

d.

tennis, handball, and racquetball

ANS: A

Feedback

A

Correct. Ice hockey, wrestling, and football are among the sports considered to be the most likely to result in injury.

B

Incorrect. Swimming, horseshoes, and hiking are not associated with the same potential for injury. However, it is essential to advise parents of all potential injuries associated with both contact and noncontact sports.

C

Incorrect. Karate, gymnastics, and dance are not associated with the same potential for injury. However, it is essential to advise parents of all potential injuries associated with both contact and noncontact sports.

D

Incorrect. Tennis, handball, and racquetball are not associated with the same potential for injury. However, it is essential to advise parents of all potential injuries associated with both contact and noncontact sports.

PTS:1REF:p. 1295 Anatomy and Physiology

OBJ: Cognitive Level: Application

8.Sports injuries are classified in which of the following ways?

a.

major and minor

c.

acute or overuse

b.

short-term and long-term

d.

temporary and chronic

ANS: C

Feedback

A

Incorrect. Sports injuries are not classified as major and minor.

B

Incorrect. Sports injuries are not classified as short-term and long-term.

C

Correct. Sports injuries are typically classified as being acute or overuse. Overuse injuries occur when a child continually uses a muscle, muscle group, joint, ligament, or tendon.

D

Incorrect. Sports injuries are not classified as temporary and chronic.

PTS:1REF:p. 1297 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

9.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:

a.

adequate conditioning, including warm-ups and cooldowns

b.

to increase calcium, carbohydrates, and protein in the daily diet

c.

weight lifting, sit-ups, and push-ups on a daily basis

d.

relaxation exercises, deep breathing, and mind training

ANS: A

Feedback

A

Correct. A major way to prevent sports injuries is adequate conditioning, including warm-ups and cooldowns. Inadequate conditioning is a major factor in injuries as muscles are tighter and susceptible to injury without warm-up periods. Conditioning before beginning in intensive sports season is critical.

B

Incorrect. A major way to prevent sports injuries is not to increase calcium, carbohydrates, and protein in the daily diet

C

Incorrect. A major way to prevent sports injuries is not weight lifting, sit-ups, and push-ups on a daily basis.

D

Incorrect. A major way to prevent sports injuries is not relaxation exercises, deep breathing, and mind training.

PTS:1REF:p. 1297 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

10.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?

a.

Have the child stay in bed until the swelling and pain subsides.

b.

Elevate the leg and use an ice pack to the ankle, alternating 30 minutes on and 15 off.

c.

Apply alternating heat and cold with 15 minutes of heat and 15 minutes of cold.

d.

Apply an Ace bandage or wrap securely and fairly tight with tape for 24 to 48 hours.

ANS: B

Feedback

A

Incorrect. Elevation of the injured part and application of ice will reduce swelling. Rest or staying off the injury for several hours to several days is also important; however, elevation and ice are more critical.

B

Correct. During the first 24 to 48 hours following a soft tissue injury of the ankle a parent should elevate the leg and use an ice pack to the ankle, alternating 30 minutes on and 15 off.

C

Incorrect. The nurse will not advise the parent to apply alternating heat and cold with 15 minutes of heat and 15 minutes of cold.

D

Incorrect. If an Ace bandage or wrap is used, it should not be wrapped too tightly as this may impair neurovascular status. Ice and elevation take priority over wrapping the ankle.

PTS:1REF:p. 1299 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

11.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:

a.

6 seconds

c.

4 seconds

b.

5 seconds

d.

3 seconds

ANS: D

Feedback

A

Incorrect. Capillary refill is not within the normal range if it is less than 6 seconds.

B

Incorrect. Capillary refill is not within the normal range if it is less than 5 seconds.

C

Incorrect. Capillary refill is not within the normal range if it is less than 4 seconds.

D

Correct. Capillary refill is within the normal range if it is less than 3 seconds.

PTS:1REF:p. 1299 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

12.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:

a.

immediately call and report suspected child abuse

b.

assess to see if this injury is related to rough play with other children

c.

talk with the family about not forcibly lifting the child by the hand

d.

question the parent to ascertain who might be abusing the child

ANS: C

Feedback

A

Incorrect. A dislocated elbow is not typically caused by child abuse. Child abuse can cause fractures of the sternum, ribs, skull, nose, facial features, femur (in children less than 1 year of age); and spiral fractures.

B

Incorrect. A dislocated elbow is usually not related to rough play with other children.

C

Correct. Dislocation of the elbow results when a childs hand is suddenly jerked by an adult to prevent a fall or when a child is forcibly lifted by the hand. Therefore, The pediatrician or the office nurse will talk with the family about not forcibly lifting the child by the hand.

D

Incorrect. A dislocated elbow is not typically caused by child abuse; therefore, this response is inappropriate.

PTS:1REF:p. 1299 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

13.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.

a bone that has broken, and the two sections of broken bone are not aligned

b.

a broken bone that is protruding through the skin, causing an open wound

c.

two or more types of fractures, thus compounding or making the situation worse

d.

significant bleeding into the area surrounding the fracture

ANS: B

Feedback

A

Incorrect. A compound or open fracture is not a bone that has broken, and the two sections of broken bone are not aligned.

B

Correct. A compound or open fracture is a broken bone that is protruding through the skin, causing an open wound.

C

Incorrect. A compound or open fracture is not two or more types of fractures, thus compounding or making the situation worse.

D

Incorrect. A compound or open fracture is not significant bleeding into the area surrounding the fracture.

PTS:1REF:p. 1301 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

14.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.

snapped into two separate pieces

b.

a break through the periosteum and bone on one side but the other side is intact and only bends

c.

a fracture line at a right angle to the long axis of the bone and which is on the shaft of the bone

d.

a fracture line slanting, or diagonal, across the bone

ANS: B

Feedback

A

Incorrect. A greenstick fracture is not one in which the bone has snapped into two separate pieces. This is a description of a complete fracture.

B

Correct. 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.

C

Incorrect. A greenstick fracture is not one in which there is a fracture line at a right angle to the long axis of the bone and which is on the shaft of the bone. This is the definition of a transverse fracture.

D

Incorrect. A greenstick fracture is not one in which the bone has a fracture line slanting, or diagonal, across the bone. This is a description of an oblique fracture.

PTS:1REF:p. 1301 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

15.Injuries of the growth plate can be classified with the Salter-Harris system. Which of the following classifications have the best prognosis?

a.

I and II

c.

V

b.

III and IV

d.

VI

ANS: A

Feedback

A

Correct. Injuries of the growth plate can be classified with the Salter-Harris system. Salter I and II have the best prognosis for normal growth.

B

Incorrect. Salter III and IV do not have the best prognosis for normal growth.

C

Incorrect. Salter V does not have the best prognosis for normal growth.

D

Incorrect. The Salter-Harris classification system includes I through V. There is not a VI.

PTS:1REF:p. 1302 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

16.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.

bleeding into the skin over the affected bone

b.

paresthesia when the affected bone is moved in active or passive movement

c.

bone overlap felt as a bump or raised elevation of the bone

d.

a grating sound heard on movement of the ends of a broken bone

ANS: D

Feedback

A

Incorrect. Crepitus is not described as bleeding into the skin over the affected bone.

B

Incorrect. Crepitus is not described as paresthesia when the affected bone is moved in active or passive movement.

C

Incorrect. Crepitus is not described as bone overlap felt as a bump or raised elevation of the bone.

D

Correct. Crepitus is described as a grating sound heard on movement of the ends of a broken bone. It is often a sign of a fractured bone.

PTS:1REF:p. 1302 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

17.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?

a.

How much does your child typically eat at a meal?

b.

What foods does your child like?

c.

Is your child lactose intolerant?

d.

Do you cook at home or eat out most of the time?

ANS: C

Feedback

A

Incorrect. It is not important for the nurse to ask the caregivers about how much their child typically eats at a meal.

B

Incorrect. It is not a priority for the nurse to ask the caregivers what foods their child likes. Asking about lactose intolerance is a major priority first. Then it is helpful to know the likes and dislikes of the child.

C

Correct. The need for calcium is increased when a child sustains a fracture, and the major source of this mineral is dairy products. Many African-Americans have lactose intolerance in which they are unable to digest lactose found in dairy products. With ingestion of these foods they experience abdominal bloating, diarrhea and excessive flatus. It is important for the nurse to ask the caregivers of this child if the individual is lactose intolerant before telling them about the best foods to serve the child to facilitate healing. If the child is lactose intolerant, he or she may need to obtain calcium from other foods such as green leafy vegetables, soy milk, or take the lactase enzyme replacement before consuming dairy products.

D

Incorrect. It is not important for the nurse to ask the caregivers whether they cook at home or eat out most of the time.

PTS:1REF:p. 1304 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

18.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?

a.

fish sandwich, potato chips, and soda

b.

chicken breast, French fried potatoes, and tea

c.

cheeseburger, broccoli, peaches, and milk

d.

tuna fish sandwich, cookies, and lemonade

ANS: C

Feedback

A

Incorrect. These foods are low in calcium; therefore, this would indicate that she and her family are not following discharge instructions.

B

Incorrect. These foods are low in calcium; therefore, this would indicate that she and her family are not following discharge instructions.

C

Correct. The child needs an increase in calcium to assist in bone healing. If the child reports eating a cheeseburger, broccoli, peaches, and milk, it would indicate that she and her family are following discharge instructions.

D

Incorrect. These foods are low in calcium; therefore, this would indicate that she and her family are not following discharge instructions.

PTS:1REF:p. 1328 Growth-Related Disorders

OBJ: Cognitive Level: Application

19.Which of the following explains why synthetic casts are not recommended for young children or serious fractures?

a.

They are not as colorful as the plaster casts.

b.

People cannot sign them like they do the plaster casts.

c.

They do not mold as well as plaster casts.

d.

Plaster casts allow the person more mobility.

ANS: C

Feedback

A

Incorrect. Synthetic casts are available in colors; therefore, this is an incorrect explanation for why they are not recommended for young children or serious fractures.

B

Incorrect. People can sign a synthetic casts with a permanent marker; therefore, this is an incorrect explanation for why they are not recommended for young children or serious fractures.

C

Correct. Synthetic casts are not recommended for young children or serious fractures because they do not mold to the body as well as plaster casts.

D

Incorrect. Synthetic casts are not recommended for young children or serious fractures because plaster casts allow the person more mobility.

PTS:1REF:p. 1304 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

20.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:

a.

ropes and pulleys are hanging freely and not touching the bed or floor

b.

counterweights are all resting solidly on the floor

c.

open wounds are bandaged if skin traction is being used and applied over wounds

d.

child is lying as close to the foot of the bed as possible

ANS: A

Feedback

A

Correct. It is important for the ropes and pulleys to hang freely and not touch the bed or floor for Bucks extension traction to be effective.

B

Incorrect. There are no counterweights with Bucks extension traction.

C

Incorrect. Bucks extension traction is a type of skin traction. Skin traction should not be used if the child has a skin infection or breakdown, open wounds, or extensive tissue damage.

D

Incorrect. The nurses initial assessment would not be to make certain the child is lying as close to the foot of the bed as possible.

PTS:1REF:p. 1306 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

21.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:

a.

the child is in Sims position

b.

only one leg is suspended

c.

the childs buttocks are off the bed

d.

the legs are flexed slightly less than 180 degrees

ANS: C

Feedback

A

Incorrect. The child in Bryants traction is in a supine position with both legs flexed at 90 degrees.

B

Incorrect. Both legs are always suspended in this type of traction, even if just one is broken.

C

Correct. During the initial assessment of the shift, the nurse will make certain that the childs buttocks are off the bed.

D

Incorrect. The child in Bryants traction has both legs flexed at 90 degrees, not slightly less than 180 degrees.

PTS:1REF:p. 1306 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

22.The nurse is working with a client who is in cervical traction. How much should the head of the bed be elevated?

a.

20-30 degrees

c.

70-90 degrees

b.

45-60 degrees

d.

95-120 degrees

ANS: A

Feedback

A

Correct. A child in cervical traction should have the head of the bed elevated 20-30 degrees to maintain alignment.

B

Incorrect. A child in cervical traction should have the head of the bed elevated 20-30 degrees, not 45-60 degrees, to maintain alignment.

C

Incorrect. A child in cervical traction should have the head of the bed elevated 20-30 degrees, not 70-90 degrees, to maintain alignment.

D

Incorrect. A child in cervical traction should have the head of the bed elevated 20-30 degrees, not 95-120 degrees, to maintain alignment.

PTS:1REF:p. 1307 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

23.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?

a.

headache, dizziness, blurred vision, and sensitivity to the sun

b.

nausea, vomiting, and diarrhea for 2 weeks

c.

a shifting of fluid and electrolytes into the intracellular space

d.

paresthesia, severe pain, and severe swelling of the digits below the affected compartment

ANS: D

Feedback

A

Incorrect. Headache, dizziness, blurred vision, and sensitivity to the sun are not the signs and symptoms of compartment syndrome.

B

Incorrect. Nausea, vomiting, and diarrhea for 2 weeks are not the signs and symptoms of compartment syndrome.

C

Incorrect. A shifting of fluid and electrolytes into the intracellular space are not the signs and symptoms of compartment syndrome.

D

Correct. The signs and symptoms of compartment syndrome include paresthesia, severe pain, and severe swelling of the digits below the affected compartment.

PTS:1REF:p. 1308 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

24.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?

a.

This is a serious condition involving increased pressure in sheaths of inelastic fascia leading to massive impairment of circulation.

b.

In this condition, the blood has shifted from the circulation to the interstitial spaces, creating a dramatic change in blood pressure.

c.

The child is sorting out all experiences into either good or bad and cannot see gray areas.

d.

A lot of the blood from the stomach and large muscles has gone to the area of injury to help in healing.

ANS: A

Feedback

A

Correct. Compartment syndrome is a serious condition involving increased pressure in sheaths of inelastic fascia that support and partition muscles, blood vessels, and nerves. This increased pressure leads to massive impairment of circulation to the muscle encased in that compartment. If not treated immediately, this can lead to muscle death and permanent disability to the extremity.

B

Incorrect. This is not a correct explanation of compartment syndrome.

C

Incorrect. This is not a correct explanation of compartment syndrome.

D

Incorrect. This is not a correct explanation of compartment syndrome.

PTS:1REF:p. 1308 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

25.Which of the following treatments is used for compartment syndrome?

a.

immediately administer at least one unit of whole blood

b.

place the client in the Trendelenburg position and call a code

c.

split the cast if one is present or do a fasciotomy to relieve pressure

d.

use a blanket or device to lower the temperature

ANS: C

Feedback

A

Incorrect. This is not an appropriate treatment for compartment syndrome.

B

Incorrect. This is not an appropriate treatment for compartment syndrome.

C

Correct. Treatment for compartment syndrome involves immediate relief of the pressure by splitting the cast if one is present or performing a surgical intervention called a fasciotomy. In this surgical procedure an incision is made along the outside of the compartment, thus relieving the pressure and allowing for adequate perfusion.

D

Incorrect. This is not an appropriate treatment for compartment syndrome.

PTS:1REF:p. 1309 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

26.Which of the following is an early sign of compartment syndrome?

a.

a red streak in the forearm

b.

loss of sensation in the involved body part(s)

c.

swelling of one side of the body

d.

sudden inability of the medications to relieve pain

ANS: D

Feedback

A

Incorrect. An early sign of compartment syndrome is not a red streak in the forearm.

B

Incorrect. An early sign of compartment syndrome is not loss of sensation in the involved body part(s). However, numbness in the digits below the affected compartment is a sign of compartment syndrome.

C

Incorrect. An early sign of compartment syndrome is not swelling of one side of the body; however, swelling is noted in the digits below the affected compartment.

D

Correct. An early sign of compartment syndrome is severe, unrelenting pain distal to the injury that is unrelieved by pain medications.

PTS:1REF:p. 1309 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

27.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:

a.

You will immediately begin to itch a lot, but dont scratch.

b.

The cast will be warm, and it will take a day or two to dry completely.

c.

The physician will be using a lot of strange tools to apply the cast.

d.

There is no need to be afraid.

ANS: B

Feedback

A

Incorrect. Itching may occur but not immediately.

B

Correct. 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. A chemical reaction between the casting material and the water will cause a feeling of warmth.

C

Incorrect. The physician does not use a lot of strange tools to apply the cast. The only equipment needed includes a tubular gauze (stockinette), cotton padding material, and water.

D

Incorrect. This is not an appropriate statement because the child probably is afraid, simply because of fear of the unknown.

PTS:1REF:p. 1304 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

28.The nurse working with a child with a new cast will use which of the following techniques to work with the cast?

a.

Handle the cast gently with the palms of the hand.

b.

Use sterile gloved hands when touching the cast.

c.

Do not touch the cast for at least 24 hours.

d.

Wrap the cast with a towel before touching it.

ANS: A

Feedback

A

Correct. The nurse working with a child with a new cast will handle the cast gently with the palms of the hand to prevent dents.

B

Incorrect. It is not necessary to use sterile gloved hands when touching the cast.

C

Incorrect. It will take from 24 to 48 hours for a plaster cast to dry. However, it can be touched gently with the palms of the hand in order to elevate it on a pillow above the level of the heart to reduce swelling and improve circulation.

D

Incorrect. A new cast does not need to be wrapped with a towel before touching it.

PTS:1REF:p. 1305 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

29.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?

a.

Find the child a longer pencil, and make certain the child is using the eraser end.

b.

Give the child a longer pencil, and make sure it is new and has no point.

c.

Provide the child with a long feather.

d.

Use a hair dryer to blow air into the cast.

ANS: D

Feedback

A

Incorrect. The child should not be allowed to push small or sharp objects, like a pencil, under the cast, as these may injury the skin.

B

Incorrect. The child should not be allowed to push small or sharp objects, like a pencil, under the cast, as these may injury the skin.

C

Incorrect. The child should not be allowed to push small or sharp objects, like a pencil, under the cast, as these may injury the skin.

D

Correct. To relieve itching the nurses best intervention is to use a hair dryer set on a cool setting to blow air into the cast.

PTS:1REF:p. 1305 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

30.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?

a.

Use a protective barrier cream or lotion, or petroleum jelly applied liberally to the skin.

b.

Petal the cast around the edges, especially in the area of the groin and perineum.

c.

Use a fracture bedpan with a plastic sheet placed under it.

d.

Place a small plastic sheet just inside the cast edges, and drape it over the outside.

ANS: B

Feedback

A

Incorrect. Using a protective barrier cream or lotion, or petroleum jelly applied liberally to the skin is not the best way to help protect the cast from urine and stool and protect the skin.

B

Correct. Petaling the cast around the edges, especially in the area of the groin and perineum, is the best way to help protect the cast from urine and stool and protect the skin.

C

Incorrect. Using a fracture bedpan with a plastic sheet placed under it is not the best way to help protect the cast from urine and stool and protect the skin.

D

Incorrect. Placing a small plastic sheet just inside the cast edges, and draping it over the outside is not the best way to help protect the cast from urine and stool and protect the skin.

PTS:1REF:p. 1305 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

31.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?

a.

Go on, tell me more about how you are feeling right now.

b.

Let me have a talk with your child and if I am not successful, we can get the psychologist to talk with the child about this anger.

c.

Your child is displacing anger about being immobilized on you because you are safe targets, safer than the physicians and nurses.

d.

Do you have any ideas why your child is so angry at you?

ANS: C

Feedback

A

Incorrect. This response encourages the parents to further express their feelings but does not explain the rationale for the childs behavior.

B

Incorrect. Immobility deprives the child of a natural outlet for feelings. This childs behavior is a normal response to being immobilized and does not require intervention of a psychologist.

C

Correct. Children who are immobilized may exhibit a variety of psychological responses. The child may become angry, uncooperative, or engage in aggressive behaviors (especially toward the caregivers). It is important for the nurse to reassure caregivers that they should not take it personally. The child is displacing anger on them because they are safe targets, safer than the physicians and nurses.

D

Incorrect. This is not a helpful response because the parents are asking the nurse for an explanation of the childs anger.

PTS:1REF:p. 1309 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

32.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?

a.

decreasing the childs focus on pain

b.

building a support system for the child and caregivers

c.

reducing boredom

d.

preventing social isolation and deprivation

ANS: D

Feedback

A

Incorrect. The rationale for the nurses action is not to decrease the childs focus on pain. Musculoskeletal pain is one of the most severe types of pain, and should be managed with appropriate pain medications.

B

Incorrect. The rationale for the nurses action is not to build a support system for the child and caregivers.

C

Incorrect. The primary rationale for the nurses action is not to reduce boredom, yet boredom is a problem for the child who is immobilized.

D

Correct. Children who are confined in a hospital room and whose mobility is restricted often experience sensory deprivation and social isolation. Encouraging the caregivers of a child immobilized in traction to have friends and extended family visit helps prevent these problems.

PTS:1REF:p. 1310 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

33.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?

a.

a normal condition because sensation will increase and decrease slightly and not be exactly stable

b.

pain that competes for recognition with sensation in the pain gateway theory

c.

neurovascular compromise and an indication of the need for further assessment

d.

probable interrater reliability error calling for establishment of a new baseline

ANS: C

Feedback

A

Incorrect. A slight decreased sensation in the foot and toes of the casted leg as compared to the baseline assessment data is not a normal condition.

B

Incorrect. A slight decreased sensation in the foot and toes of the casted leg as compared to the baseline assessment data is not indicative of pain that competes for recognition with sensation in the pain gateway theory.

C

Correct. A slight decreased sensation in the foot and toes of the casted leg as compared to the baseline assessment data is indicative of neurovascular compromise and an indication of the need for further assessment.

D

Incorrect. A slight decreased sensation in the foot and toes of the casted leg as compared to the baseline assessment data is not indicative of probable interrater reliability error calling for establishment of a new baseline.

PTS:1REF:p. 1310 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

34.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?

a.

Clean the pin area with hydrogen peroxide solution.

b.

Clean the area with soap and water.

c.

Use hospital policy and, if not available, use alcohol on sterile 4 4s to clean the pin.

d.

Report findings, and obtain a physicians order for pin-cleaning procedure.

ANS: D

Feedback

A

Incorrect. Hydrogen peroxide solution is not an effective cleaning agent for the pin area for adults. Further studies need to be conducted to determine the best cleaning agent for children. Therefore, this would not be the best action for the nurse to take. The nurses findings indicate an infection and should be reported first.

B

Incorrect. There is insufficient evidence on which to recommend any single method of pin care. The nurses findings indicate an infection and should be reported first.

C

Incorrect. There is insufficient evidence on which to recommend any single method of pin care. The nurses findings indicate an infection and should be reported first.

D

Correct. The best action for the nurse to take after finding caked blood and some purulent drainage in the pin area is to report the findings, and obtain a physicians order for pin-cleaning procedure. Purulent drainage, redness, swelling, elevated temperature, odor, and complaints of pain are signs of infection.

PTS:1REF:p. 1312 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

35.Which of the following statements best defines osteomyelitis?

a.

any bone and muscle inflammation that is usually caused by a viral nonspecific organism

b.

an infection of a muscle group associated with a given bone

c.

an infection of an entire bone caused by a microorganism, which is usually bacterial but may be viral or fungal

d.

a necrotic, infectious, inflammatory process, which left untreated will progress to gangrene

ANS: C

Feedback

A

Incorrect. Any bone and muscle inflammation that is usually caused by a viral nonspecific organism does not best define osteomyelitis.

B

Incorrect. An infection of a muscle group associated with a given bone does not best define osteomyelitis.

C

Correct. Osteomyelitis is an infection of an entire bone caused by a microorganism, which is usually bacterial but may be viral or fungal.

D

Incorrect. A necrotic, infectious, inflammatory process, which left untreated will progress to gangrene does not best define osteomyelitis.

PTS:1REF:p. 1312 Musculoskeletal Injuries

OBJ: Cognitive Level: Comprehension

36.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?

a.

ice packs to the affected limb

c.

splinting of the limb

b.

heat to the affected limb

d.

intravenous pain medication

ANS: C

Feedback

A

Incorrect. The nurse would not anticipate applying ice packs to the affected limb.

B

Incorrect. The nurse would not anticipate applying heat to the affected limb.

C

Correct. Splinting of the limb minimizes pain and decreases the spread of infection to the lymph channels. The splint should be removed periodically to allow movement and to prevent stiffening and muscle atrophy.

D

Incorrect. Intravenous pain medication would relieve the pain associated with osteomyelitis but would not decrease the speed of infection by lymph channels.

PTS:1REF:p. 1314 Infectious Disorders

OBJ: Cognitive Level: Application

37.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?

a.

how to assess for hearing loss

c.

the importance of a tutor

b.

entertainment ideas

d.

restriction of visitors

ANS: A

Feedback

A

Correct. Since many of the antibiotics used in treating osteomyelitis have adverse audiologic side effects, caregivers need to be taught how to assess for hearing loss and to report this to the health care provider.

B

Incorrect. If the childs mobility is still limited, entertainment ideas may be discussed with the caregivers, but they are not the most important instruction.

C

Incorrect. The importance of a tutor may be appropriate to discus with the caregivers, especially if the child has been absent from school for a long period of time. However, it is not the most important discharge instruction.

D

Incorrect. Restriction of visitors is not necessary since osteomyelitis is not a contagious disorder, and the infection has subsided by the time of discharge.

PTS:1REF:p. 1314 Infectious Disorders

OBJ: Cognitive Level: Comprehension

COMPLETION

1.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 ____________________.

ANS:

subluxation

Subluxation is an incomplete or partial dislocation of the articular surfaces of a joint.

PTS:1REF:p. 1299 Musculoskeletal Injuries

OBJ: Cognitive Level: Application

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