Chapter 38: Alterations of Musculoskeletal Function in Children My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 38: Alterations of Musculoskeletal Function in Children

Test Bank

MULTIPLE CHOICE

1. While performing an assessment of a 2-month-old, the nurse notes a positive Ortolani click. The nurse would suspect the child has:

a.

A hip fracture

b.

Hip dysplasia

c.

Osteogenesis imperfecta

d.

Osteomyelitis

ANS: B

Ortolani click is symptomatic of developmental dysplasia of the hip.

A hip fracture would be evident by shortening of the leg and external rotation.

Osteogenesis imperfecta is diagnosed by fractures.

Osteomyelitis is diagnosed by fever and infection.

REF: p. 1024

2. A 9-month-old male was diagnosed with osteogenesis imperfecta (OI) following recurrent fractures and findings of osteopenia. This disease is caused by:

a.

Uterine teratogens

b.

A genetic defect

c.

Malnutrition

d.

Trauma

ANS: B

OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen, the main component of bone and blood vessels.

OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen, the main component of bone and blood vessels. It is not due to teratogens.

OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen, the main component of bone and blood vessels. It is not due to malnutrition.

OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen, the main component of bone and blood vessels. It is not due to trauma, although trauma does result in fracture.

REF: p. 1025

3. A 9-month-old male was diagnosed with OI following recurrent fractures and findings of osteopenia. This disease is caused by errors in the synthesis of:

a.

Elastin

b.

Glycoproteins

c.

Collagen

d.

Calcium salts

ANS: C

OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen.

OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen, not elastin.

OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen, not glycoproteins.

OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen, not calcium salts.

REF: p. 1025

4. Children with OI suffer from frequent:

a.

Bone fractures

b.

Dislocations

c.

Bone infections

d.

Joint injuries

ANS: A

Children with OI suffer from bone fractures.

Children with OI suffer from bone fractures, not dislocations.

Children with OI suffer from bone fractures, not bone infections.

Children with OI suffer from bone fractures, not joint injuries.

REF: p. 1025

5. A 1-year-old female was diagnosed with OI. Which of the following is a complication in this patient?

a.

Congestive heart failure

b.

Liver failure

c.

Aortic aneurysm

d.

Pulmonary emboli

ANS: C

Because type I collagen also is the main component of blood vessels, vascular deformity, such as aortic aneurysm, can occur.

Aortic aneurysm, not congestive heart failure, could occur in this child.

Aortic aneurysm, not liver failure, could occur in this child.

Aortic aneurysm, not pulmonary emboli, could occur in this child.

REF: p. 1025

6. A 5-year-old female was diagnosed with seropositive juvenile rheumatoid arthritis (RA). The treatment option for this disease is termed:

a.

Supportive

b.

Curative

c.

Antibacterial

d.

Experimental

ANS: A

Treatment is supportive, not curative. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a mainstay, and methotrexate is also being used with success. The aims are to minimize inflammation and deformity.

Treatment is supportive, not curative.

Juvenile RA is not infectious, so treatment is not antibacterial.

Treatment may include experimental options, but the treatment remains supportive.

REF: p. 1027

7. LCP disease affects which of the following joints?

a.

Vertebral

b.

Shoulder

c.

Hip

d.

Knee

ANS: C

LCP affects the hip.

LCP affects the hip, not the vertebrae.

LCP affects the hip, not the shoulder.

LCP affects the hip, not the knee.

REF: p. 1029

8. Osgood-Schlatter disease causes inflammation of the:

a.

Shoulder joint

b.

Patellar tendon

c.

Elbow ligaments

d.

Hip cartilage

ANS: B

Osgood-Schlatter disease affects the patella.

Osgood-Schlatter affects the patella, not the shoulder.

Osgood-Schlatter affects the patella, not the elbow.

Osgood-Schlatter affects the patella, not the hip.

REF: p. 1029

9. Which of the following types of scoliosis accounts for the majority of the cases of scoliosis?

a.

Idiopathic

b.

Infectious

c.

Iatrogenic

d.

Secondary

ANS: A

Eighty percent of all scoliosis is idiopathic.

Eighty percent of all scoliosis is idiopathic, not infectious.

Eighty percent of all scoliosis is idiopathic, not iatrogenic.

Eighty percent of all scoliosis is idiopathic, not secondary.

REF: p. 1029

10. A 3-year-old male presents with developmental delay. Testing reveals that the child has muscular dystrophy. Treatment will include:

a.

Aspirin

b.

Antivirals

c.

Steroids

d.

Chemotherapy

ANS: C

Treatment with steroids can prolong the ability to walk by several years and improves life expectancy.

Treatment with steroids, not aspirin, can prolong the ability to walk by several years and improves life expectancy.

Treatment with steroids, not antivirals, can prolong the ability to walk by several years and improves life expectancy.

Treatment with steroids, not chemotherapy, can prolong the ability to walk by several years and improves life expectancy.

REF: p. 1031

11. The treatment of Osgood-Schlatter disease includes:

a.

Steroids

b.

Restriction from physical activity

c.

High doses of aspirin

d.

Knee replacement

ANS: B

The primary treatment of Osgood-Schlatter disease includes restriction from physical activity.

The primary treatment of Osgood-Schlatter disease includes restriction from physical activity, not steroids.

The primary treatment of Osgood-Schlatter disease includes restriction from physical activity, not high doses of aspirin.

The primary treatment of Osgood-Schlatter disease includes restriction from physical activity, not knee replacement.

REF: p. 1029

12. Duchenne muscular dystrophy (DMD) has a(n) _____ inheritance pattern.

a.

Autosomal recessive

b.

X-linked recessive

c.

Y-linked dominant

d.

Autosomal dominant

ANS: B

DMD is X-linked, occurring only in boys.

DMD is X-linked, not autosomal recessive.

DMD is X-linked, not Y-linked.

DMD is X-linked, not autosomal dominant.

REF: p. 1030

13. The onset of DMD most often occurs at:

a.

3 to 6 months of age

b.

Preschool years

c.

School age

d.

The onset of puberty

ANS: C

Boys with DMD will present in the preschool years with muscle weakness, difficulty walking, and large calves.

Boys with DMD will present in the preschool years, not as early as 3 to 6 months.

Boys with DMD will present in the preschool years, not as late as school age.

Boys with DMD will present in the preschool years with muscle weakness, not at puberty.

REF: p. 1030

14. A 22-year-old female has a brother with DMD and wants to know if her children will inherit it. A fairly accurate test to identify female carriers of the disease is measurement of serum levels of:

a.

Dystrophin

b.

Myoglobin

c.

Creatine kinase (CK)

d.

Troponin

1

ANS: C

Diagnosis is confirmed by measuring the blood CK level, which is sometimes 100 times the normal level, with confirmation by genetic testing for mutations in the dystrophin gene.

Diagnosis is confirmed by measuring the blood CK level, which is sometimes 100 times the normal level, with confirmation by genetic testing for mutations in the dystrophin gene.

Diagnosis is confirmed by measuring the blood CK level, which is sometimes 100 times the normal level, with confirmation by genetic testing for mutations in the dystrophin gene.

Diagnosis is confirmed by measuring the blood CK level, which is sometimes 100 times the normal level, with confirmation by genetic testing for mutations in the dystrophin gene.

REF: p. 1031

15. A 13-year-old female presents with pain at night, cough, and dyspnea. Testing reveals a metastasizing malignant bone tumor. The most likely type of tumor is:

a.

Nonossifying fibroma

b.

Chondrosarcoma

c.

Ewing sarcoma

d.

Osteosarcoma

ANS: D

With osteosarcoma, the most common presenting complaint is pain. Night pain, awakening a child from sleep, is a particularly foreboding sign. There may be swelling, warmth, and redness caused by the vascularity of the tumor. Symptoms also may include cough, dyspnea, and chest pain if lung metastasis is present.

a

With osteosarcoma, not nonossifying fibroma, the most common presenting complaint is pain. Night pain, awakening a child from sleep, is a particularly foreboding sign. There may be swelling, warmth, and redness caused by the vascularity of the tumor. Symptoms also may include cough, dyspnea, and chest pain if lung metastasis is present.

With osteosarcoma, not chondrosarcoma, the most common presenting complaint is pain. Night pain, awakening a child from sleep, is a particularly foreboding sign. There may be swelling, warmth, and redness caused by the vascularity of the tumor. Symptoms also may include cough, dyspnea, and chest pain if lung metastasis is present.

With osteosarcoma, not Ewing sarcoma, the most common presenting complaint is pain. Night pain, awakening a child from sleep, is a particularly foreboding sign. There may be swelling, warmth, and redness caused by the vascularity of the tumor. Symptoms also may include cough, dyspnea, and chest pain if lung metastasis is present.

REF: p. 1033

16. In reviewing the history of the patient with osteosarcoma, the nurse might also expect the patient to have:

a.

Rhabdomyosarcoma

b.

Ewing sarcoma

c.

Fibroma

d.

Retinoblastoma

ANS: D

In children with osteosarcoma, there has been a link to individuals with retinoblastoma (a hereditary eye tumor).

In children with osteosarcoma, there has been a link to individuals with retinoblastoma (a hereditary eye tumor), not rhabdomyosarcoma.

In children with osteosarcoma, there has been a link to individuals with retinoblastoma (a hereditary eye tumor), not Ewing sarcoma.

In children with osteosarcoma, there has been a link to individuals with retinoblastoma (a hereditary eye tumor), not fibromas.

REF: p. 1033

17. A 16-year-old male was recently diagnosed with osteosarcoma. The tumor is most likely present in the _____ of long bones.

a.

Epiphyses

b.

Metaphyses

c.

Marrow

d.

Osteocytes

ANS: B

Osteosarcoma is most likely present in the metaphyses of long bones.

Osteosarcoma occurs mainly in the metaphyses of long bones near sites of active physical growth, not in the epiphyses.

Osteosarcoma occurs mainly in the metaphyses of long bones near sites of active physical growth, not in the marrow.

Osteosarcoma occurs mainly in the metaphyses of long bones near sites of active physical growth, not in osteocytes.

REF: p. 1033

18. Ewing sarcoma originates from:

a.

Osteoblasts

b.

Epithelial cells

c.

The spleen

d.

The bone marrow

ANS: D

Ewing sarcoma originates from the bone marrow.

Ewing sarcoma originates from the bone marrow, not osteoblasts.

Ewing sarcoma originates from the bone marrow, not epithelial cells.

Ewing sarcoma originates from the bone marrow, not the spleen.

REF: p. 1034

19. A major predictor of poor prognosis for Ewing sarcoma is:

a.

Age of onset

b.

Size of tumor

c.

Presence of metastasis

d.

Gender of child

ANS: C

Metastasis at diagnosis is another poor prognostic indicator, with 5-year survival rate dropping to under 40%.

Metastasis is the major indicator of poor prognosis, not age of onset.

Metastasis is the major indicator of poor prognosis, not size of tumor.

Metastasis is the major indicator of poor prognosis, not gender.

REF: p. 1034

MULTIPLE RESPONSE

1. A 6-year-old male presents with fever, pain, swelling, and warmth. Tests reveal osteomyelitis In addition to the clinical symptoms, the nurse would expect elevations in which lab tests? (Select all that apply.)

a.

C-reactive protein

b.

White blood cell count

c.

Red cell count

d.

Erythrocyte sedimentation rate (ESR)

e.

Liver enzymes

ANS: A, B, D

Children often will present with fever, elevated white blood cell count (50% to 70%), elevated C-reactive protein (98%), and elevated ESR (90%).

REF: p. 1026

COMPLETION

1. Polyarthritis is a type of juvenile arthritis in which more than _____ joints are affected

ANS:

three

3

REF: p. 1027

2. Incidence of Legg-Calv-Perthes (LCP) disease peaks at age______.

ANS:

6

six

LCP disease is a common osteochondrosis usually occurring in children between the ages of 3 and 10 years, with a peak incidence at 6 years.

REF: p. 1027

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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