57: Musculoskeletal

London_4e_TB_Ch57.doc.docx

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Question Stem The nurse in the newborn nursery is doing the admission assessment on a neonate. Which assessment finding would lead the nurse to suspect unilateral congenital hip dysplasia?

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Answer Choice 1Lordosis

Rationale 1Lordosis does not occur with hip dysplasia.

Answer 1false

Choice 2Trendelenburg sign

Rationale 2Trendelenburg sign and telescoping of the affected limb are signs that present in an older child with congenital hip dysplasia.

Answer 2false

Choice 3Asymmetry of the gluteal and thigh fat folds

Rationale 3A sign of congenital hip dysplasia in the infant would be asymmetry of the gluteal and thigh fat folds.

Answer 3true

Choice 4Telescoping of the affected limb

Rationale 4Trendelenburg sign and telescoping of the affected limb are signs that present in an older child with congenital hip dysplasia.

Answer 4false

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Meta 4 Learning Outcome 1:57.1 Describe pediatric variations in the musculoskeletal system.

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Question Stem A school health nurse is screening for scoliosis. For what assessment findings would the nurse look?

Standard TextSelect all that apply.

Stimulus

Answer Choice 1Lordosis

Rationale 1Lordosis is not present with scoliosis.

Answer 1false

Choice 2Prominent scapula

Rationale 2The classic signs of scoliosis include uneven shoulders and hips, a one-sided rib hump, and prominent scapula.

Answer 2true

Choice 3Pain

Rationale 3Pain generally is not present with scoliosis unless it is severe.

Answer 3false

Choice 4A one-sided rib hump


Answer 4true

Choice 5Uneven shoulders and hips


Answer 5true

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Question Stem The nurse has completed parent education related to treatment for a child with congenital clubfoot. The nurse knows that parents need further teaching when they state:

Stimulus

Answer Choice 1"We're getting a special car seat to accommodate the casts."

Rationale 1Using a car seat is the law. Special car seats to accommodate the casts are available and should be utilized.

Answer 1false

Choice 2"We'll watch for any swelling of the feet while the casts are on."

Rationale 2Parents should be watching for swelling while the casts are on.

Answer 2false

Choice 3"We'll keep the casts dry."

Rationale 3Keeping the casts dry is important to prevent complications

Answer 3false

Choice 4"We're happy this is the only cast our baby will need."

Rationale 4Serial casting is the treatment of choice for congenital clubfoot. The cast is changed every one to two weeks until the corrected foot position is achieved.

Answer 4true

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Meta 4 Learning Outcome 1:57.2 Plan nursing care for children with structural deformities of the foot, hip, and spine.

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Question Stem A child must wear a brace for correction of scoliosis. Which nursing diagnosis takes priority at this time?

Stimulus

Answer Choice 1Impaired gas exchange, risk for

Rationale 1Risk for impaired gas exchange is a late effect of scoliosis and would not be the priority. If the patient is compliant with wearing the brace, the risk should be minimized.

Answer 1false

Choice 2Altered growth and development, risk for

Rationale 2The diagnosis of altered growth and development would not be the priority and should be corrected by the wearing of the brace.

Answer 2false

Choice 3Impaired skin integrity, risk for

Rationale 3The skin should be monitored for breakdown in any area where the brace might rub against the skin.

Answer 3true

Choice 4Impaired mobility, risk for

Rationale 4The diagnosis of impaired mobility would not be the priority and should be corrected if the patient is compliant with wearing the brace.

Answer 4false

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Meta 4 Learning Outcome 1:57.2 Plan nursing care for children with structural deformities of the foot, hip, and spine.

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Question Stem An adolescent has just returned from surgery after spinal fusion surgery. Which assessment finding would take priority at this time?

Stimulus

Answer Choice 1Sleeps when not bothered but arouses easily with stimuli

Rationale 1This is a normal response postanesthesia.

Answer 1false

Choice 2Impaired color, sensitivity, and movement to lower extremities

Rationale 2When the spinal column is manipulated, there is a risk for impaired color, sensitivity, and movement to lower extremities.

Answer 2true

Choice 3Nausea

Rationale 3Nausea in the postoperative period is not uncommon, but it is not the priority at this time.

Answer 3false

Choice 4Pain

Rationale 4Pain is a common finding in the postoperative period and should be addressed, but impaired color, sensitivity, and movement of the lower extremities is the priority at this time.

Answer 4false

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Meta 4 Learning Outcome 1:57.4 Partner with families to plan care for children with musculoskeletal conditions that are chronic or require long-term care.

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Question Stem The nurse has completed discharge teaching for the family of a child diagnosed with Legg-Calv-Perthes disease. The nurse knows further teaching is needed about the condition if the family states:

Stimulus

Answer Choice 1"We're glad this will only take about six weeks to correct."

Rationale 1The treatment for Legg-Calv-Perthes disease takes approximately two years.

Answer 1true

Choice 2"We understand abduction of the affected leg is important."

Rationale 2The leg should be kept in the abducted position to prevent damage to the head of the femur due to Legg-Calv-Perthes disease.

Answer 2false

Choice 3"We know to watch for areas on the skin that the brace might rub."

Rationale 3A brace is a component of the treatment of Legg-Calve-Perthes disease and is worn to prevent damage to the head of the femur, so skin irritation should be monitored.

Answer 3false

Choice 4"We understand swimming is a good sport for Legg-Calv-Perthes."

Rationale 4Swimming is a good activity to increase mobility in a child with Legg-Calv-Perthes disease.

Answer 4false

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Question Stem Which of the following would take priority when teaching the family how to care for an infant with osteogenesis imperfecta?

Stimulus

Answer Choice 1Teaching the family how to care for an infant in a cast

Rationale 1Traction, casts, and spinal surgery are not routinely done for osteogenesis imperfecta.

Answer 1false

Choice 2Teaching the family that the trunk and extremities should always be supported when moving this infant

Rationale 2With osteogenesis imperfecta, nursing care focuses on preventing fractures. Because the bones are fragile, the entire body must be supported when the child is moved.

Answer 2true

Choice 3Teaching the family how to care for an infant postop spinal surgery


Answer 3false

Choice 4Teaching the family how to care for an infant in traction


Answer 4false

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Question Stem An infant has just returned from surgery for correction of bilateral congenital clubfeet. The infant has bilateral long-leg casts. The toes on both feet are edematous, but there is color, sensitivity, and movement to them. What should the nurse do first?

Stimulus

Answer Choice 1Apply a warm, moist pack to the feet.

Rationale 1Warm, moist heat will increase swelling and the moisture may cause the cast to disintegrate.

Answer 1false

Choice 2Elevate the infants legs on pillows.

Rationale 2The infants legs should be elevated on a pillow for 24 hours to promote healing and help with venous return. This is the priority action.

Answer 2true

Choice 3Encourage movement of the toes.

Rationale 3An infant would not be able to follow directions to move the toes, and in this case it would not be as effective as would elevating the legs on pillows.

Answer 3false

Choice 4Call the physician to report the edema.

Rationale 4Some amount of swelling can be expected, so it would not be appropriate to notify the physician, especially if the color, sensitivity, and movement to the toes remained normal.

Answer 4false

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Meta 4 Learning Outcome 1:57.5 Prioritize nursing interventions to promote safely and developmental progression in children who require braces, casts, traction, and surgery.

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Question Stem The nurse is teaching a family how to care for their infant in a Pavlik harness to treat congenital developmental dysplasia of the hip. Which instruction is appropriate for the nurse to include in parental education in relation to the Pavlik harness?

Stimulus

Answer Choice 1Apply lotion or powder to minimize skin irritation.

Rationale 1Lotion or powder can contribute to skin breakdown and should not be used.

Answer 1false

Choice 2Check at least two or three times a day for red areas under the straps.

Rationale 2The skin underneath the straps of the brace should be checked two or three times a day for red areas, which might indicate skin breakdown.

Answer 2true

Choice 3Put clothing over the harness for maximum effectiveness of the device.

Rationale 3A light layer of clothing should be worn under the brace to assist in preventing skin breakdown, not over the brace.

Answer 3false

Choice 4Place a diaper over the harness, preferably using a thin, superabsorbent, disposable diaper.

Rationale 4The diaper should be placed under the brace, along with a light layer of clothing.

Answer 4false

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Question Stem A child has experienced a sprain of the right ankle. The school nurse should:

Stimulus

Answer Choice 1Leave the ankle open to the air and avoid compressing the area to allow tissue swelling as necessary.

Rationale 1For the first 24 hours for a sprain, rest, ice, compression, and elevation (RICE) should be followed. Therefore, the nurse should apply a compression bandage to the extremity.

Answer 1false

Choice 2Perform passive range-of-motion to the extremity.

Rationale 2For the first 24 hours for a sprain, rest, ice, compression, and elevation (RICE) should be followed. Therefore, the nurse should rest the extremity rather than perform range-of-motion.

Answer 2false

Choice 3Lower the extremity below the level of the heart.

Rationale 3For the first 24 hours for a sprain, rest, ice, compression, and elevation (RICE) should be followed. Therefore, the nurse should elevate the extremity.

Answer 3false

Choice 4Apply ice to the extremity.

Rationale 4For the first 24 hours for a sprain, rest, ice, compression, and elevation (RICE) should be followed. Therefore, the nurse should apply ice to the extremity.

Answer 4true

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Question Stem A nurse is assessing a child after an open reduction of a fractured femur. Which signs indicate that compartment syndrome could be occurring?


Stimulus

Answer Choice 1Pink, warm extremity

Rationale 1Pink, warm extremity is a normal finding post-fracture reduction.

Answer 1false

Choice 2Dorsalis pedis pulse present

Rationale 2A present dorsalis pedis pulse would be a normal finding post-fracture reduction.

Answer 2false

Choice 3Prolonged capillary refill time

Rationale 3A prolonged capillary refill time is a sign of compartment syndrome.

Answer 3true

Choice 4Pain not relieved by pain medication

Rationale 4A prolonged capillary refill time with loss of paresthesia and pain not relieved by medication are signs of compartment syndrome.

Answer 4true

Choice 5Paresthesia of the leg

Rationale 5Paresthesia is tingling and numbness of the affected extremity and is a sign of compartment syndrome.

Answer 5true

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Meta 4 Learning Outcome 1:57.6 Develop a nursing care plan for fractures, including teaching for injury prevention and nursing implementations for the child who has sustained a fracture.

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Question Stem A six-year-old boy is admitted to the hospital with a diagnosis of osteomyelitis of the left femur. The plan of care includes a two-week round of intravenous antibiotics. The father questions why the child must be hospitalized and why the child cannot receive oral antibiotics. The nurse explains:

Stimulus

Answer Choice 1The antibiotic of choice is not available in oral form.

Rationale 1Most antibiotics are available in multiple forms.

Answer 1false

Choice 2Blood flow to bones is limited, and parenteral administration is necessary to get appropriate blood levels.

Rationale 2This is accurate information.

Answer 2true

Choice 3Because the child is older now, it is harder to get the child to cooperate with oral antibiotics.

Rationale 3The older child can understand the reason for antibiotics and cooperate.

Answer 3false

Choice 4Because two weeks of therapy is necessary, the intravenous route will produce fewer side effects.

Rationale 4Both oral and intravenous antibiotics may have side effects.

Answer 4false

Choice 5

Rationale 5

Answer 5

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Meta 4 Learning Outcome 1:57.3 Recognize signs and symptoms of infectious musculoskeletal disorders and refer for appropriate care.

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Question Stem A two-year-old child is placed in balanced Bryants traction for a fractured right femur. Which finding by the nurse should be reported to the surgeon?

Stimulus

Answer Choice 1The child keeps trying to turn and lay on his belly.

Rationale 1This child needs a jacket restraint to maintain appropriate positioning if someone cannot stay with him. It does not require notifying the surgeon.

Answer 1false

Choice 2The ropes are unequal in length.

Rationale 2In balanced traction, the ropes and pulleys determine the traction and the length of the rope is unimportant.

Answer 2false

Choice 3The childs buttocks are resting on the bed.

Rationale 3In order to provide adequate counter-traction, the buttocks should be slightly elevated off the bed. The surgeon should be notified.

Answer 3true

Choice 4The ace bandage wrapping the legs is wrinkled.

Rationale 4This is not a significant finding.

Answer 4false

Choice 5

Rationale 5

Answer 5

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Question Stem When assigned to the patient on complete bed rest for spinal fusion secondary to scoliosis, the nurse will want to intervene to prevent common complications of immobility. Nursing interventions will include:


Stimulus

Answer Choice 1Encouraging use of the spirometer every two hours while the child is awake.

Rationale 1Respiratory complications are a common complication of immobility.

Answer 1true

Choice 2Log-rolling the patient every two hours while awake.

Rationale 2Turning the patient frequently will reduce pressure on bony prominences.

Answer 2true

Choice 3Increasing intake of milk to maintain bone calcium.

Rationale 3Calcium will be pulled from the bones due to immobility. Adding additional calcium in the form of milk will increase the risk of kidney stones.

Answer 3false

Choice 4Increasing fruit and grains in the diet.

Rationale 4Fruit and grains will provide extra fiber to reduce the risk of complication.

Answer 4true

Choice 5Limiting fluid intake to reduce the need to void.

Rationale 5Fluid intake should be increased to flush the kidneys.

Answer 5false

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Question Stem While at recess, a child falls and hurts his arm. The school nurse is called and suspects a fractured arm. The nurse will apply a splint before transporting the child to the hospital. The nurse will ensure that:

Stimulus

Answer Choice 1The splint is applied firmly enough to prevent swelling.

Rationale 1The purpose of the splint is not to prevent swelling.

Answer 1false

Choice 2The arm is fully extended in the splint.

Rationale 2The nurse will not want to manipulate the arm, so the nurse will splint the arm in the position it is found.

Answer 2false

Choice 3The splint is fully padded to prevent skin damage.

Rationale 3The splint does not need to be padded.

Answer 3false

Choice 4The joints above and below the suspected fracture are immobilized.

Rationale 4This is the important concept in splintingimmobilizing the joint above and below the fracture to prevent movement of the bones.

Answer 4true

Choice 5

Rationale 5

Answer 5

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Question Stem An 18-month-old child is admitted to the hospital unit for weakness of the lower extremities. Duchenne muscular dystrophy is suspected. Which assessment finding on the admission history and physical is indicative of this disorder?

Stimulus

Answer Choice 1Infant was post-mature by almost two weeks.

Rationale 1Post-maturity is not related to Duchenne muscular dystrophy.

Answer 1false

Choice 2The child seems very muscular.

Rationale 2Duchenne muscular dystrophy is also called pseudohypertrophic due to the enlarged appearance of the muscle. The pathophysiology is infiltration of the muscle fibers with fatty tissue.

Answer 2true

Choice 3The child walked early and without support at 10 months.

Rationale 3This finding is not indicative of Duchenne muscular dystrophy.

Answer 3false

Choice 4The childs older sister developed scoliosis in the fourth grade.

Rationale 4The older sisters scoliosis is not related to MD. Duchenne MD is sex-linked recessive and affects only boys.

Answer 4false

Choice 5

Rationale 5

Answer 5

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Question Stem An infant returns to the unit following casting of the leg for talipes equinovarus. Standing orders include monitoring the neurovascular status. In addition to color, for what will the nurse monitor the infants foot?


Stimulus

Answer Choice 1Warmth

Rationale 1The temperature of the foot of the casted leg should be compared to the temperature of the other foot.

Answer 1true

Choice 2Capillary refill

Rationale 2This indicates blood return to the tissues and is an important finding.

Answer 2true

Choice 3Pedal pulse

Rationale 3The pedal pulse cannot be reached in the casted foot.

Answer 3false

Choice 4Sensation

Rationale 4Nerve function is evaluated by touching the toes and noting the childs response.

Answer 4true

Choice 5Movement of the toes

Rationale 5The child is encouraged to wiggle the toes. If the patient is an infant, tickling will cause the child to respond with movement.

Answer 5true

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57: Musculoskeletal