Chapter 24: The Child with a Musculoskeletal Condition Nursing School Test Banks

Chapter 24: The Child with a Musculoskeletal Condition

MULTIPLE CHOICE

1. What would the nurse include in planning teaching to parents of a child with Legg-Calv-Perthes disease about the long-term effects of this disease?
a. There are no long-term effects.
b. The disease is self-limited and requires no long-term treatment.
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: Comprehension REF: Page 568 OBJ: 11
TOP: Legg-Calv-Perthes Disease KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. What intervention will the nurse caring for a child in Bucks skin traction implement?
a. Position in high Fowlers position.
b. Assist the child to be pulled up in bed.
c. Keep childs heel on the bed surface.
d. Maintain 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 counterbalance. The child must be kept with head elevated no more than 20 degrees and pulled up in bed, and the feet should not touch the bed surface or the foot of the bed.

DIF: Cognitive Level: Application REF: Page 560 OBJ: 6
TOP: Bucks Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. What will the nurse include when caring for a child in Bucks extension?
a. Positioning the child with hips flexed 90 degrees 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: Page 563, Nursing Tip
OBJ: 6 TOP: Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. The nurse is reviewing the characteristics of Ewings sarcoma. Which statement if made by the nurse indicates correct understanding of this disease?
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 among 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 REF: Page 569 OBJ: N/A
TOP: Ewings Sarcoma KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

5. What characteristic manifestation does the nurse caring for a child with Duchennes muscular dystrophy document?
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: Page 567 OBJ: 10
TOP: Duchennes Muscular Dystrophy KEY: Nursing Process Step: Data Collection
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. The child has a temperature of 38.8 C (102 F) and abdominal pain. What type of juvenile rheumatoid arthritis do these findings suggest?
a. Psoriatic
b. Enthesitis
c. Systemic
d. Acute febrile
ANS: C
The systemic form of juvenile rheumatoid arthritis is associated with an elevated temperature, erythrocyte sedimentation rate (ESR), and C-reactive protein; abdominal pain; and a macular rash.

DIF: Cognitive Level: Application REF: Page 569 OBJ: 12
TOP: Juvenile Rheumatoid Arthritis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching?
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: Application REF: Page 559, Memory Jogger
OBJ: 4 TOP: Soft Tissue Injury
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

8. How does Russell traction provide adequate skin traction?
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, 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: Comprehension REF: Page 560 OBJ: 6
TOP: Russell Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. The nurse is checking for capillary refill on a child in Bryants traction. How long does it take for the toe to regain color if adequate perfusion is assessed?
a. 3 seconds
b. 4 seconds
c. 5 seconds
d. 6 seconds
ANS: A
Capillary refill in 3 seconds or less is determined to be indicative of adequate perfusion.

DIF: Cognitive Level: Comprehension REF: Page 563, Skill 24-1
OBJ: 8 TOP: Fracture KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. The parent of a child with osteomyelitis asks why his child is in so much pain. What will the nurse respond causes the pain experienced with osteomyelitis?
a. 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: Comprehension REF: Page 566-567
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. How long will the nurse indicate that antibiotic therapy will probably last?
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: Page 566-567
OBJ: 1 TOP: Osteomyelitis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. What finding would the nurse assessing the neurovascular status of a child in Russell traction report immediately?
a. Skin thats 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: Page 563, Safety Alert
OBJ: 7 | 8 TOP: Neurovascular Assessment
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. A 13-year-old girl is diagnosed with functional scoliosis. What does the nurse explain as the cause of this spinal curvature defect?
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: Comprehension REF: Page 570-571
OBJ: 13 TOP: Scoliosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. What intervention is appropriate for a nurse assessing a preadolescent child for scoliosis?
a. Ask the child to bend forward at the waist and 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: Page 570-571
OBJ: 13 TOP: Scoliosis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. What nursing action will significantly decrease the risk of serious complications for a child in Bryants traction?
a. Neurovascular checks are done frequently.
b. Bandages are wrapped tightly.
c. The child 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: Application REF: Page 562 OBJ: 7
TOP: Traction: Volkmanns Ischemia KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. Which intervention would be helpful in relieving morning discomfort associated with juvenile rheumatoid arthritis?
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: Page 569 OBJ: 12
TOP: Juvenile Rheumatoid Arthritis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. What instruction would the nurse provide to an adolescent who has been fitted with a Milwaukee brace?
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, which protects the skin.

DIF: Cognitive Level: Application REF: Page 570 OBJ: 13
TOP: Scoliosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. Which observation may cause the nurse to consider the possibility of child abuse when a mother says that her young child fell down the basement stairs?
a. Red, green, and yellow bruises on his body
b. Bruises are dispersed on his head, arms, and legs
c. A broken arm last year, and the child being described as accident-prone
d. The 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: Page 575, Safety Alert
OBJ: 15 TOP: Child Abuse KEY: Nursing Process Step: Data Collection
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. Which nursing diagnosis takes highest priority for this child?
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: Page 565, NCP 24-1
OBJ: 7 TOP: The Child with a Fracture in Traction
KEY: Nursing Process Step: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. What would the nurse consider an abnormal finding on a musculoskeletal assessment of a 4-year-old child?
a. Has inward-turned knees while standing
b. Walks on the 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: Page 557 OBJ: 3
TOP: Assessment of the Musculoskeletal System
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

21. Why does a childs fracture heal more rapidly than the adults?
a. A childs bones are less porous than adult bone.
b. A childs bones are covered by a thicker periosteum.
c. A childs bones are not affected by bone overgrowth.
d. A childs bones have faster callus formation.
ANS: D
Callus forms more rapidly in the child than the adult.

DIF: Cognitive Level: Knowledge REF: Page 560 OBJ: 2
TOP: Differences Between the Child and Adult
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. On entering the room of a child in Bucks traction, the nurse makes all of the following observations. Which observation requires a nursing intervention?
a. Childs heels are placed firmly against the foot of the bed.
b. Head of bed is elevated 20 degrees.
c. Weights are hanging freely.
d. Ropes are on pulleys.
ANS: A
Bucks traction is dependent on the child as a counterweight. The heels should be elevated above the level of the foot of the bed.

DIF: Cognitive Level: Application REF: Page 560 OBJ: 7
TOP: Bucks Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

23. Approximately how old does the nurse assess a large green bruise on the thigh of a 4-year-old to be?
a. 2 days
b. 4 days
c. 6 days
d. 8 days
ANS: C
Bruises heal in various stages that are indicated according to color; after 5 to 7 days bruise are green.

DIF: Cognitive Level: Comprehension REF: Page 575, Safety Alert
OBJ: 15 TOP: Child Abuse KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. A pediatric nurse is assisting with the care of a child diagnosed with a fractured femur. What type of fracture would be the most likely to alert the nurse to the possibility of physical abuse?
a. Stress fracture
b. Compound fracture
c. Spiral fracture
d. Greenstick fracture
ANS: C
A spiral fracture of the femur is caused by a forceful twisting motion. When the history of an injury does not correlate with x-ray findings, child abuse should be suspected because spiral fractures can be the result of manual twisting of the extremity.

DIF: Cognitive Level: Comprehension REF: Page 560 OBJ: 5
TOP: Fractures/Child Abuse KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. Which nursing diagnosis would be a priority when preparing a plan of care for a child in a leg cast?
a. Risk for altered peripheral tissue perfusion
b. Risk for altered urine elimination
c. Knowledge deficit
d. Risk for infection
ANS: A
Casting can lead to compromised tissue perfusion caused by increased pressure from edema or swelling pressing on the tissues. Neurovascular checks are an assessment priority.

DIF: Cognitive Level: Application REF: Page 562-563
OBJ: 9 TOP: Casting KEY: Nursing Process Step: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

26. A child is sent to the school nurse for assessment because she comes to school every day disheveled, unbathed, and hungry. The assessment does not indicate any bruises or marks on the body. What do these finding indicate?
a. Sexual abuse
b. Physical abuse
c. Physical neglect
d. Emotional abuse
ANS: C
Physical neglect is the failure to provide for the basic physical needs of the child, including food, clothing, shelter, and basic cleanliness.

DIF: Cognitive Level: Comprehension REF: Page 573 OBJ: 14
TOP: Child Abuse Triggers KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

27. Which assessment performed by a nursing student performing a neurovascular check alerts the instructor that further education is necessary?
a. Pulses
b. Capillary refill
c. Movement
d. Pupils
ANS: D
Neurovascular checks include assessment of pain, pulse, sensation, color, capillary refill, and movement. Pupils are assessed with a neurological check.

DIF: Cognitive Level: Comprehension REF: Page 563 OBJ: 8
TOP: Neurovascular Assessment KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

28. What factor(s) may trigger abuse in a parent? (Select all that apply.)
a. Being abused as a child
b. High self-esteem
c. Substance abuse
d. Overwhelming responsibility
e. Knowledge deficit relative to child care
ANS: A, C, D, E
All options except high self-esteem are possible triggers for a parent to become abusive.

DIF: Cognitive Level: Comprehension REF: Page 573, Health Promotion box
OBJ: 15 TOP: Child Abuse Triggers
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

29. The nurse demonstrates which similarities among 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 traction devices may relieve pain, many may actually cause pain.

DIF: Cognitive Level: Comprehension REF: Page 560-561
OBJ: 7 TOP: Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

30. The nurse performing a neurovascular check on a limb in traction would report and document which finding(s) as indicative of altered circulation? (Select all that apply.)
a. Pulse is equal to uncasted limb.
b. Patient is aware of touch and warm and cold application.
c. Limb is cool to the touch.
d. Capillary refill is 5 seconds.
e. Distal limb can flex and extend.
ANS: C, D
The limb should be warm, and capillary refill should be less than 3 seconds.

DIF: Cognitive Level: Comprehension REF: Page 563, Skill 24-1
OBJ: 8 TOP: Neurovascular Assessment
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

31. How does the pediatric skeletal system differ from that of the adult? (Select all that apply.)
a. Lower mineral content
b. More ossification
c. Open epiphyses
d. Less porosity
e. Greater strength
ANS: A, C, E
The childs skeletal system has less mineral content, greater porosity, open epiphyses, greater bone strength, and a thicker periosteum.

DIF: Cognitive Level: Comprehension REF: Page 556-557
OBJ: 2 TOP: Skeletal Differences KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

COMPLETION

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

ANS:
30

Bryants traction is a skin traction used in the treatment of orthopedic disorders of young children who weigh less than 30 pounds. Greater weight would cause excessive counterbalance and injury to soft tissues.

DIF: Cognitive Level: Knowledge REF: Page 560 OBJ: 7
TOP: Bryants Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

33. The nurse reminds the adolescent boy with Ewings sarcoma that he is prohibited from vigorous weight-bearing activities during treatment with radiation to reduce the risk of a(n) _______________ fracture.

ANS:
pathological

The bone has lost its integrity because of the cancer and radiation. Excessive or vigorous weight bearing can cause a pathological fracture of the compromised bone.

DIF: Cognitive Level: Application REF: Page 569 OBJ: 2
TOP: Ewings Sarcoma KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

34. 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

Gowers maneuver is a unique way of rising from the floor by walking up the leg in order to get the upper body erect.

DIF: Cognitive Level: Knowledge REF: Page 567 OBJ: 10
TOP: Duchennes Muscular Dystrophy KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

ANS:
compartment

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.

DIF: Cognitive Level: Comprehension REF: Page 563 OBJ: 7
TOP: Compartment Syndrome KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

36. A nurse assessing welts on the body of a 2-year-old Vietnamese child should consider the skin lesions might be the result of the cultural practice of __________.

ANS:
coining

Some Vietnamese place heated coins on the body to cure disease. This practice leaves welts that are sometimes mistaken for child abuse.

DIF: Cognitive Level: Comprehension REF: Page 575 OBJ: 16
TOP: Cultural Practices: Coining KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

37. _______________________is a condition in which neck motion is limited and the cervical spine is rotated because of shortening of the sternocleidomastoid muscle.

ANS:
Torticollis

Torticollis (tortus, twisted, and collium, neck) is a condition in which neck motion is limited and the cervical spine is rotated because of shortening of the sternocleidomastoid muscle. It can be either congenital or acquired and can also be either acute or chronic.

DIF: Cognitive Level: Knowledge REF: Page 569 OBJ: 1
TOP: Torticollis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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