San Jacinto College - RNSG 2201

Chapter 29: The Child with Musculoskeletal or Articular Dysfunction Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child’s immobilization status?

1. 1. Metabolic rate increases
   2. Increased joint mobility leading to contractures
   3. Bone calcium increases, releasing excess calcium into the body (hypercalcemia)
   4. Venous stasis leading to thrombi or emboli formation

2. The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status?

1. 1. Hypocalcemia
   2. Decreased metabolic rate
   3. Positive nitrogen balance

1. 4. Increased production of stress hormones

3. The nurse should monitor for which effect on the cardiovascular system when a child is immobilized?
   1. Venous stasis
   2. Increased vasopressor mechanism
   3. Normal distribution of blood volume
   4. Increased efficiency of orthostatic neurovascular reflexes

4. Which can result from the bone demineralization associated with immobility?
   1. Osteoporosis
   2. Urinary retention
   3. Pooling of blood
   4. Susceptibility to infection

5. A young girl has just injured her ankle at school. In addition to calling the child’s parents, what is the most appropriate immediate action by the school nurse?
   1. Apply ice.
   2. Observe for edema and discoloration.
   3. Encourage child to assume a position of comfort.
   4. Obtain parental permission for administration of acetaminophen or aspirin.

6. Which term is used to describe a type of fracture that does not produce a break in the skin?
   1. Simple

1. 2. Compound
   3. Complicated
   4. Comminuted

7. Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell off of a tree. When discussing this injury with her parents, the nurse should consider which statement?
   1. Healing is usually delayed in this type of fracture.
   2. Growth can be affected by this type of fracture.
   3. This is an unusual fracture site in young children.
   4. This type of fracture is inconsistent with a fall.

8. The nurse is conducting a staff in-service on casts. Which is an advantage to using a fiberglass cast instead of a plaster of Paris cast?
   1. Cheaper
   2. Dries rapidly
   3. Molds closely to body parts
   4. Smooth exterior

9. The nurse is conducting teaching to parents of a 7-year-old child who fractured an arm and is being discharged with a cast. Which instruction should be included in the teaching?
   1. Swelling of the fingers is to be expected for the next 48 hours.
   2. Immobilize the shoulder to decrease pain in the arm.
   3. Allow the affected limb to hang down for 1 hour each day.
   4. Elevate casted arm when resting and when sitting up.

10. The nurse uses the palms of the hands when handling a wet cast for which reason?
    1. To assess dryness of the cast
    2. To facilitate easy turning
    3. To keep the patient’s limb balanced
    4. To avoid indenting the cast

11. Which should cause a nurse to suspect that an infection has developed under a cast?
    1. Complaint of paresthesia
    2. Cold toes
    3. Increased respirations
    4. “Hot spots” felt on cast surface

12. A child is upset because when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which should the nurse suggest to remove this material?
    1. Soak in a bathtub.
    2. Vigorously scrub leg.
    3. Apply powder to absorb material.
    4. Carefully pick material off leg.

13. An adolescent with a fractured femur is in Russell’s traction. Surgical intervention to correct the fracture is scheduled for the morning. Nursing actions should include which action?
    1. Maintaining continuous tractioNnUuRnStIiNl G1ThBo.uCrObMefore the scheduled surgery
    2. Maintaining continuous traction and checking position of traction frequently
    3. Releasing traction every hour to perform skin care
    4. Releasing traction once every 8 hours to check circulation

14. Which is a type of skin traction with the legs in an extended position?
    1. Dunlop
    2. Bryant
    3. Russell
    4. Buck extension

15. Which type of traction uses skin traction on the lower leg and a padded sling under the knee?
    1. Dunlop
    2. Bryant
    3. Russell
    4. Buck extension

16. Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. Which action should the nurse take first?
    1. Notify the practitioner of the changes noted.
    2. Give the child medication to relieve the pain.
    3. Reposition the child and notify physician.
    4. Chart the observations and check the extremity again in 15 minutes.

17. Which is an appropriate nursing intervention when caring for a child in traction?
    1. Remove adhesive traction straps daily to prevent skin breakdown.
    2. Assess for tightness, weakness, or contractures in uninvolved joints and muscles.
    3. Provide active range-of-motion exercises to affected extremity three times a day.
    4. Keep the child in one position to maintain good alignment.

18. The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which should be included?
    1. Apply lotion or powder to minimize skin irritation.
    2. Remove harness several times a day to prevent contractures.
    3. Return to clinic every 1 to 2 weeks.
    4. Place diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

19. A neonate is born with bilateral mild talipes equinovarus (clubfoot). When the parents ask the nurse how this will be corrected, the nurse should give which explanation?
    1. Traction is tried first.
    2. Surgical intervention is needed.
    3. Frequent, serial casting is tried first.
    4. Children outgrow this condition when they learn to walk.

20. A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations should include which action?
    1. Encouraging normal activity for as long as is possible
    2. Explaining the cause of the disease to the child and family
    3. Preparing the child and family for long-term, permanent disabilities
    4. Teaching the family the care and management of the corrective appliance

21. The nurse is taking care of an adolescent diagnosed with kyphosis. Which describes this condition?
    1. Lateral curvature of the spine
    2. Immobility of the shoulder joint
    3. Exaggerated concave lumbar curvature of the spine
    4. Increased convex angulation in the curve of the thoracic spine

22. A school nurse is conducting a staff in-service to other school nurses on idiopathic scoliosis. During which period of child development does idiopathic scoliosis become most noticeable?

1. 1. Newborn period
   2. When child starts to walk
   3. Preadolescent growth spurt
   4. Adolescence

23. The nurse is preparing an adolescent with scoliosis for a spinal surgical instrumentation placement procedure. Which consideration should the nurse include?
    1. A chest tube and urinary catheter may be required.
    2. Ambulation will not be allowed for up to 3 months.
    3. Surgery eliminates the need for casting and bracing.
    4. Discomfort can be controlled with nonpharmacologic methods.

24. Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)?
    1. Aspirin
    2. Corticosteroids
    3. Cytotoxic drugs such as methotrexate
    4. Nonsteroidal antiinflammatory drugs (NSAIDs)

25. The nurse is caring for a school-age child diagnosed with juvenile idiopathic arthritis (JIA). Which intervention should be a priority?
    1. Apply ice packs to relieve stiffness and pain.
    2. Administer acetaminophen to reduce inflammation.
    3. Teach the child and family correct administration of medications.
    4. Encourage range-of-motion exercises during periods of inflammation.

26. The nurse is caring for a 12-year-old child with a left leg below-the-knee amputation (BKA). The child had the surgery 1 week ago. Which intervention should the nurse plan to implement for this child?
    1. Elevate the left stump on a pillow.
    2. Place an ice pack on the stump.
    3. Encourage the child to use an overhead bed trapeze when repositioning.
    4. Replace the ace wrap covering the  stump with a gauze dressing.

27. A nurse is conducting discharge teaching for parents of an infant with osteogenesis imperfecta (OI). Further teaching is indicated if the parents make which statement?
    1. “We will be very careful handling the baby.”
    2. “We will lift the baby by the buttocks when diapering.”
    3. “We’re glad there is a cure for this disorder.”
    4. “We will schedule follow-up appointments as instructed.”

28. The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing “phantom limb pain.” Which prescribed medication is appropriate to administer to relieve phantom limb pain?
    1. Amitriptyline (Elavil)
    2. Hydrocodone (Vicodin)
    3. Oxycodone (OxyContin)
    4. Alprazolam (Xanax)

MULTIPLE RESPONSE

1. The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply.)
   1. Positive Ortolani click
   2. Unequal gluteal folds
   3. Negative Babinski sign
   4. Trendelenburg sign
   5. Telescoping of the affected limb
   6. Lordosis

2. An adolescent with juvenile idiopathic arthritis (JIA) is prescribed abatacept (Orencia). Which should the nurse teach the adolescent regarding this medication? (Select all that apply.)
   1. Avoid receiving live immunizations while taking the medication.
   2. Before beginning this medication, a tuberculin screening test will be done.
   3. You will be getting a twice-a-day dose of this medication.
   4. This medication is taken orally.

3. A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should plan to implement which interventions for this child? (Select all that apply.)
   1. Instructions to avoid exposure to sunlight
   2. Teaching about body changes associated with SLE
   3. Preparation for home schooling
   4. Restricted activity