Price: Pediatric Nursing, 11th Edition

17-2Testbank

Copyright 2012, 2008, 2005, 2001, 1997, 1992, 1987, 1981, 1976, 1970, 1965 by Saunders, an imprint of Elsevier Inc.Copyright 2012, 2008, 2005, 2001, 1997, 1992, 1987, 1981, 1976, 1970, 1965 by Saunders, an imprint of Elsevier Inc.Price: Pediatric Nursing, 11th Edition

Chapter 17: Musculoskeletal Disorders

Testbank

MULTIPLE CHOICE

1.The nurse understands that a difference in the childs skeletal system as compared to an adults is:a.The thick periosteum assists in repair of fracturesb.Growth is not affected by fracturesc.Bone overgrowth in healing fractures is uncommond.The childs bones are less porous than an adults bones

ANS:AThick, rich periosteum assists in rapid repair of a fracture in a child. Childrens fractures can result in overgrowth. The childs bones are more porous and less dense than an adults bones.

DIF:Cognitive Level: ComprehensionREF:p. 318OBJ:2TOP:PeriosteumKEY:Nursing Process Step: ImplementationMSC:NCLEX: Health Promotion and Maintenance: Growth and Development

2.The nurse writes out a schedule for the casting procedures to correct a clubfoot, which would be:a.At 5-day intervals for the first 4 weeksb.At 1-week intervals for the first 6 weeksc.At 10-day intervals for the first 8 weeksd.At 2-week intervals for the first 10 weeks

ANS:BThe casting is repeated every week for the first 6 weeks and then at 1- to 2-week intervals until a more anatomic position has been achieved.

DIF:Cognitive Level: ComprehensionREF:p. 319OBJ:N/ATOP:Casting for ClubfootKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Basic Care and Comfort

3.The nurse clarifies that the brace applied to help correct a clubfoot should be worn:a.Only at nightb.6 hours at a timec.8 hours on, and then 2 hours offd.23 hours per day

ANS:DThe brace that is applied in an attempt to correct a clubfoot is worn 23 hours per day for an extended amount of time.

DIF:Cognitive Level: ComprehensionREF:p. 319OBJ:N/ATOP:Brace for ClubfootKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Basic Care and Comfort

4.The goal of clubfoot repair is to have a corrected foot by the time the child is:a.6 months of ageb.9 months of agec.12 months of aged.18 months of age

ANS:CThe goal of clubfoot repair is to be completed by the time the child is 12 months of age so the child can use normal shoes when learning to walk.

DIF:Cognitive Level: ComprehensionREF:p. 319OBJ:N/ATOP:Clubfoot CorrectionKEY:Nursing Process Step: N/AMSC:NCLEX: N/A

5.When the 8-month-old child who has had a plaster cast applied becomes fussy and irritable, the mother asks how long it will take the cast to dry. The nurses response will be based on the knowledge that plaster casts dry in about:a.2 hoursb.10 hoursc.18 hoursd.24 hours

ANS:DPlaster casts take 24 to 72 hours to dry.

DIF:Cognitive Level: KnowledgeREF:p. 319OBJ:N/ATOP:PlasterKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Basic Care and Comfort

6.When caring for a child with a broken leg who is in a wet plaster cast, the nurse should:a.Cover the cast to keep from chilling the childb.Rest the cast on the foot of the bed to relieve the weightc.Handle the cast with the palms of the handsd.Avoid moving the child until the cast is dry

ANS:CThe cast should be handled with the palms of the hands, not the fingers, to keep from making indentations. For the same reason, the cast is not propped on a hard surface. The child should be repositioned every 2 hours. The cast should not be covered as it will delay drying.

DIF:Cognitive Level: ApplicationREF:p. 319OBJ:N/ATOP:Plaster CastKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Basic Care and Comfort

7.When the 8-year-old complains of the rough edges of the cast cutting her fingers, the nurse should:a.Tape adhesive over the fingersb.Shake a small amount of powder into the castc.Soften the edge of the cast with warm oil and remold the castd.Apply adhesive petals around the edge of the cast

ANS:DPetaling a cast with adhesive tape will reduce the discomfort of rough edges against the patients skin.

DIF:Cognitive Level: ComprehensionREF:p. 318OBJ:N/ATOP:PetalingKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Basic Care and Comfort

8.When the child comes back from surgery after the correction of a clubfoot, the nurse assesses a discolored area on the cast. The initial intervention of the nurse should be:a.Make a note in the patient recordb.Notify the charge nursec.Circle the area and write the timed.Elevate the limb

ANS:CThe initial intervention should be to circle the area and write the time on the cast in order to evaluate if the area changes in size. After this initial intervention, the limb is elevated, the charge nurse or physician is notified, and a note is made in the patient record.

DIF:Cognitive Level: ApplicationREF:p. 318OBJ:N/ATOP:Cast AssessmentKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity: Reduction of Risk

9.The nurse recognizes the Trendelenburg gait as a diagnostic sign of:a.Legg-Calv-Perthes diseaseb.Duchenne muscular dystrophyc.Developmental dysplasia of the hip (DDH)d.Scoliosis

ANS:CThe Trendelenburg gait is the diagnostic gait of a child with developmental dysplasia of the hip (DDH).

DIF:Cognitive Level: ComprehensionREF:p. 320OBJ:N/ATOP:Developmental Dysplasia of the HipKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity: Physiological Adaptation

10.The nurse explains that the desired outcome of the treatments to correct developmental dysplasia of the hip is:a.Stimulate ossification of the head of the femurb.Deepen the acetabulumc.Surgically rebuild the acetabulumd.Prevent the femur from pressing into the acetabulum

ANS:BDeepening the acetabulum by pressing the head of the femur into it will deepen the joint and allow the head of the femur to be stabilized. This is accomplished by the use of a pillow splint or a Pavlik harness.

DIF:Cognitive Level: ComprehensionREF:p. 320OBJ:N/ATOP:Developmental Dysplasia of the HipKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Physiological Adaptation

11.The nurse giving tips to parents of a child in the Pavlik harness would suggest that to prevent chafing they should:a.Use powder in the diaper areab.Dress the baby in a T-shirt and long socksc.Take the harness off every 2 hoursd.Use lanolin-based ointment on the legs

ANS:BThe use of a T-shirt and long socks will help relieve chafing as the baby will be in the harness full-time except for diaper changes.

DIF:Cognitive Level: ComprehensionREF:p. 321OBJ:3TOP:Pavlik HarnessKEY:Nursing Process Step: ImplementationMSC:NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12.The nurse recognizes that a child with cerebral palsy who has jerky movements and scissoring of the legs has the type of cerebral palsy classified as:a.Mixedb.Athetoidc.Spasticd.Dyskinetic

ANS:CJerky movements and scissoring of the legs are characteristic of spastic cerebral palsy.

DIF:Cognitive Level: ComprehensionREF:p. 323OBJ:N/ATOP:Spastic Type of Cerebral PalsyKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity: Physiological Adaptation

13.The nurse caring for a child with Duchenne muscular dystrophy notes a characteristic manifestation, which is that the child:a.Ambulates by holding onto furnitureb.Exhibits atrophy of the calf musclesc.Falls frequently and is clumsyd.Has delayed fine-motor development

ANS:CThe child with Duchenne muscular dystrophy is clumsy and falls frequently because of pseudohypertrophy of the calves and contractures of the ankles and hips.

DIF:Cognitive Level: ComprehensionREF:p. 324OBJ:4TOP:Duchenne Muscular DystrophyKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity: Physiological Adaptation

14.The nurse is aware that an activity that will help delay muscle atrophy for a child with Duchenne muscular dystrophy is:a.Progressive weight liftingb.Riding a seesawc.Swimmingd.Working on a trampoline

ANS:CSwimming is helpful to promote range of motion and delay muscle atrophy.

DIF:Cognitive Level: ComprehensionREF:p. 325OBJ:4TOP:Duchenne Muscular DystrophyKEY:Nursing Process Step: PlanningMSC:NCLEX: Physiological Integrity: Physiological Adaptation

15.The nurse is concerned about the fracture across the epiphyseal plate of a 9-year-old child because such a fracture could:a.Interfere with bone growthb.Progress into osteomyelitisc.Cause a mis-union of the bone endsd.Lead to a long recovery period

ANS:AFractures that disturb the epiphyseal plate can affect bone growth.

DIF:Cognitive Level: ComprehensionREF:p. 325OBJ:6TOP:Pediatric FracturesKEY:Nursing Process Step: PlanningMSC:NCLEX: Health Promotion and Maintenance: Growth and Development

16.A 17-year-old whose legs were crushed in a motorcycle accident has come to the emergency department. While waiting for x-rays, the patient begins to sweat and have labored breathing. The nurse suspects that the patient has had:a.An anxiety attackb.The onset of shockc.A fat embolismd.An aspiration of blood

ANS:CA fat embolism occurs as fat escapes from the bone marrow. The signs of an embolism are labored respirations and a possible change in level of consciousness. This condition should be reported immediately.

DIF:Cognitive Level: AnalysisREF:p. 325OBJ:6TOP:Fat EmbolismKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity: Physiological Adaptation

17.The nurse explains that Russell traction is a type of skin traction that:a.Subluxates the tibiab.Does not interfere with range of motionc.Prevents the knee from flexingd.Supplies continuous pull in two directions

ANS:DRussell traction is skin traction (similar to Bucks traction) with a sling positioned under the knee, which prevents subluxation of the tibia. Although the traction interferes with full range of motion, the patient can change position without disrupting the continuous pull in two directions.

DIF:Cognitive Level: ApplicationREF:p. 327OBJ:6TOP:Russell TractionKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Physiological Adaptation

18.The nurse assesses that a 5-year-old who is in Russell traction is holding his left elbow with the right hand and seems to be in pain. The child will not use the left arm to reach for a toy or a glass of juice. Based on these assessments, the nurse suspects the child has suffered:a.Muscle spasmsb.A pulled musclec.A dislocated elbowd.Osteomyelitis

ANS:CDislocated elbows in children who are in traction are not uncommon. The injury occurs when the child uses a twisting motion of the lower arm and hand, which dislocates the radial head.

DIF:Cognitive Level: ApplicationREF:p. 329OBJ:N/ATOP:Dislocated ElbowKEY:Nursing Process Step: AssessmentMSC:NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease.

19.The nurse caring for a child in traction with a broken leg should add to the plan of care an intervention to prevent constipation, such as:a.Offering different fluids during the dayb.Encouraging the intake of milk productsc.Avoiding fruitsd.Limiting foods high in fiber

ANS:AOffering fluids frequently, providing fluids at the bedside, and encouraging foods high in fiber will help prevent constipation.

DIF:Cognitive Level: ApplicationREF:p. 329OBJ:5TOP:Prevention of ConstipationKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Basic Care and Comfort

20.In discussing the long-term effects of Legg-Calv-Perthes disease, the nurse would include the information that:a.There are no long-term effectsb.The disease is likely to recurc.Deformity of the femoral head may result in arthritisd.There is a risk of osteogenic sarcoma in adulthood

ANS:CDeformity of the femoral head can cause problems such as arthritis in later life.

DIF:Cognitive Level: ApplicationREF:p. 329OBJ:7TOP:Legg-Calv-Perthes diseaseKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Reduction of Risk

21.When a 3-year-old girl is diagnosed with neuromuscular scoliosis, the nurse explains that the spinal curvature defect is usually caused by:a.Juvenile rheumatoid arthritisb.Poor posturec.Heredityd.Myelomeningocele

ANS:DNeuromuscular scoliosis is the result of a disease such as cerebral palsy or spina bifida.

DIF:Cognitive Level: KnowledgeREF:p. 332OBJ:N/ATOP:ScoliosisKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Physiological Adaptation

22.A nurse assessing a preadolescent child for scoliosis would:a.Ask the child to bend forward at the waist, and then observe the childs back for asymmetryb.Observe the gait while the child is walking forward heel to toec.Have the child flex the knees and look for uneven knee heightd.Look at the childs shoulders and hips while fully clothed

ANS:AThe nurse looks at the back, as the child bends forward, for general body alignment and asymmetry.

DIF:Cognitive Level: ApplicationREF:p. 333OBJ:N/ATOP:ScoliosisKEY:Nursing Process Step: AssessmentMSC:NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

23.The nurse providing instructions to an adolescent who has been fitted with a Milwaukee brace would suggest:a.Wearing the brace directly against the skinb.Wearing the brace over regular clothingc.Wearing the brace over a T-shirt 23 hours per dayd.Removing the brace before sleeping

ANS:CA Milwaukee brace is worn approximately 23 hours per day over a T-shirt that protects the skin. Some experts believe the same therapeutic outcome will occur with only 16 hours of wear per day.

DIF:Cognitive Level: ComprehensionREF:p. 334OBJ:8TOP:Milwaukee BraceKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Reduction of Risk

COMPLETION

1.The nurse informs the parents of a child with a clubfoot that the ___________ method is the current method of manipulation.

ANS:Ponseti The Ponseti method is the current method employed for manipulation of a clubfoot. The foot is gently manipulated into better alignment and then casted. These steps are repeated until the foot is straightened.

DIF:Cognitive Level: KnowledgeREF:p. 319OBJ:N/ATOP:ManipulationKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Basic Care and Comfort

2.The nurse is aware that in the condition of developmental dysplasia of the hip (DDH), the deformity is caused when the head of the femur does not seat itself in the __________.

ANS:Acetabulum The head of the femur in a child with DDH is displaced from the shallow acetabulum.

DIF:Cognitive Level: ComprehensionREF:p. 318OBJ:N/ATOP:Developmental Dysplasia of the HipKEY:Nursing Process Step: PlanningMSC:NCLEX: Physiological Integrity: Physiological Adaptation

3.When the pediatrician abducts the childs femur, the nurse hears an audible click, which is the diagnostic sign called______________.

ANS:Ortolanis sign Ortolanis sign is the audible click heard when the femur is snapped back into the acetabulum.

DIF:Cognitive Level: ComprehensionREF:p. 320OBJ:1TOP:Ortolanis SignKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity: Physiological Adaptation

4.The child with Duchenne muscular dystrophy must push on his or her legs and walk up the leg in order to rise to a standing position. The nurse recognizes this characteristic behavior as the __________ maneuver.

ANS:Gower The Gower maneuver is a characteristic method of rising from the floor by walking up the legs to push the upper body erect.

DIF:Cognitive Level: ComprehensionREF:p. 324OBJ:4TOP:Gower ManeuverKEY:Nursing Process Step: N/AMSC:NCLEX: N/A

5.The child with cerebral palsy who exhibits slow writhing movements that increase during periods of emotional stress is showing the characteristics of __________ cerebral palsy.

ANS:Athetoid The athetoid or dyskinetic type of cerebral palsy exhibits slow writhing movements that increase during periods of emotional stress.

DIF:Cognitive Level: KnowledgeREF:p. 325OBJ:N/ATOP:Athetoid Cerebral PalsyKEY:Nursing Process Step: N/AMSC:NCLEX: N/A

6.The five Ps of compartment syndrome are: (1)_____(2)_____(3)_____(4)_____(5)_____

ANS:Pain, pallor, pulselessness, paresthesia, and paralysis Compartment syndrome can occur as a result of pressure on tissues resulting from edema or swelling. This pressure compromises the circulation and results in pain, pallor, pulselessness, paresthesia, and paralysis distal to the swelling. This is a medical emergency.

DIF:Cognitive Level: ComprehensionREF:p. 329OBJ:6TOP:Compartment SyndromeKEY:Nursing Process Step: N/AMSC:NCLEX: N/A

MULTIPLE RESPONSE

1.The nurse is aware that the musculoskeletal system of the child is composed of: (Select all that apply.)a.Major blood vesselsb.Bonesc.Jointsd.Musclee.Cartilage

ANS:B, C, D, EThe musculoskeletal system is composed of bones, joints, muscle, and cartilage.

DIF:Cognitive Level: KnowledgeREF:p. 318OBJ:2TOP:Musculoskeletal SystemKEY:Nursing Process Step: PlanningMSC:NCLEX: Health Promotion and Maintenance: Growth and Development

2.The nurse reassures a worried parent that the childs fracture will heal quickly because the rich periosteum provides: (Select all that apply.)a.Blood vesselsb.Calciumc.Nerve fibersd.Lymphatic vesselse.Fat cells

ANS:A, C, DThe periosteum contains blood vessels, nerve fibers, and lymphatic vessels.

DIF:Cognitive Level: KnowledgeREF:p. 318OBJ:2TOP:PeriosteumKEY:Nursing Process Step: ImplementationMSC:NCLEX: Health Promotion and Maintenance: Growth and Development

3.The nurse is glad to see that the 3-month-old is going to be casted with a synthetic cast because synthetic casts: (Select all that apply.)a.Dry quickerb.Do not cause circulatory problemsc.Are lighterd.Allow for greater mobilitye.Can be modified and reused

ANS:A, C, DSynthetic casts made of fiberglass or polyurethane dry in less than 30 minutes and are lighter and allow for more mobility.

DIF:Cognitive Level: ComprehensionREF:p. 319OBJ:N/ATOP:Synthetic CastsKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity: Physiological Adaptation

4.Signs and symptoms that would indicate that a leg cast has interfered with the circulation of a limb would be: (Select all that apply.)a.Pallorb.Painc.Weak pulsed.Warmth in toese.Paralysis

ANS:A, B, C, EPallor, pain, weakness or lack of pulse, burning, coldness, paralysis, and numbness are all indicators of an embarrassed circulation. Warm toes indicate adequate circulation. The cast may need to be slit or removed entirely.

DIF:Cognitive Level: ApplicationREF:p. 319OBJ:N/ATOP:Circulatory ChecksKEY:Nursing Process Step: AssessmentMSC:NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5.The nurse in a well-child clinic would suspect a child to have developmental dysplasia of the hip (DDH) when diagnostic characteristics are assessed such as: (Select all that apply.)a.A narrow pelvisb.Asymmetrical gluteal foldsc.The foot on the affected side turns outd.When legs are flexed, one knee is lower than the othere.The foot on the affected side is cooler

ANS:B, DIndications of DDH that are characteristic are asymmetric gluteal folds on the affected side, and when the legs are flexed the knee on the affected side is lower than the other.

DIF:Cognitive Level: ApplicationREF:p. 320OBJ:N/ATOP:Developmental Dysplasia of the HipKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity: Physiological Adaptation

6.The nurse instructing parents in the care of a child in a body spica cast would include the information to: (Select all that apply.)a.Use firm pillows in curvatures of the cast for supportb.Elevate the childs head and shoulders with pillowsc.Tuck a disposable diaper under the buttocks to prevent soiling the castd.Use a bib to keep food from falling into the caste.Relieve itching by blowing warm air from a hair dryer into the cast

ANS:A, C, DPillows should be used under curvatures of the cast; the head and shoulders should not be elevated on pillows as it may cause respiratory difficulty. A disposable diaper tucked into the buttock opening of the cast can prevent soiling the cast with feces. A bib will keep food from entering the cast. Cool air is helpful with itching.

DIF:Cognitive Level: ApplicationREF:p. 321OBJ:5TOP:Spica CastKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Physiological Adaptation

7.The nurse is aware that some causes of cerebral palsy include: (Select all that apply.)a.Perinatal cerebral hemorrhageb.Prolonged laborc.Maternal use of tobaccod.Maternal exposure to rubellae.Sexually transmitted diseases in the mother

ANS:A, B, DHemorrhage, prolonged labor, and exposure to infectious diseases such as rubella are recognized causes of cerebral palsy.

DIF:Cognitive Level: ComprehensionREF:p. 322OBJ:N/ATOP:Cerebral PalsyKEY:Nursing Process Step: PlanningMSC:NCLEX: Physiological Integrity: Physiological Adaptation

8.The nurse explains to the parents of a child with Duchenne muscular dystrophy that treatment for this horrible disease is centered on: (Select all that apply.)a.Progressive strengthening exercisesb.Passive exercises to prevent contracturesc.Surgery for joint contracturesd.Aggressive programs for weight controle.Bracing for limb stability

ANS:B, C, D, EProgressive strengthening exercises are not part of the treatment plan for Duchenne muscular dystrophy.

DIF:Cognitive Level: ComprehensionREF:p. 325OBJ:4TOP:Treatment for Duchenne Muscular DystrophyKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Basic Care and Comfort

9.The school nurse is called to the schoolyard where there is a child on the ground with an obvious simple fracture of the tibia. The nurse should: (Select all that apply.)a.Call for assistance to carry the child into the buildingb.Immobilize the limb with rolled newspapers or magazinesc.Apply ice cubes directly to the swellingd.Call EMSe.Immobilize the joints at the knee and ankle

ANS:B, D, EThe limb should be immobilized by a splint made of anything handy, and the joints above and below the suspected fracture should be immobilized as well. Ice should be collected in a cloth, but not put directly to the skin. Call EMS.

DIF:Cognitive Level: ApplicationREF:p. 325OBJ:6TOP:SkeletalKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological Integrity: Reduction of Risk

10.The nurse reviews the general rules for maintaining adequate tractions, which include: (Select all that apply.)a.Ropes to weights in the grooves of the pulleysb.The child should be kept in anatomic alignmentc.Ace bandages should be wrapped tightlyd.Weights should hang freee.Traction can be removed to facilitate care

ANS:A, B, DRopes should be in the pulleys, the child should be kept in alignment, the weights should hang free, and the traction should be continuous. The bandages should not be wrapped tightly, to prevent obstruction of circulation, and the traction should not be interrupted.

DIF:Cognitive Level: ApplicationREF:p. 329OBJ:6TOP:TractionKEY:Nursing Process Step: PlanningMSC:NCLEX: Physiological Integrity: Basic Care and Comfort