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Peds Chapter 50: The Child with a Musculoskeletal Alteration
Terms in this set (37)
Which statement is accurate concerning a child's musculoskeletal system and how it may
be different from an adult's?
a. Growth occurs in children as a result of an increase in the number of muscle
b. Infants are at greater risk for fractures because their epiphyseal plates are not
c. Because soft tissues are resilient in children, dislocations and sprains are less
common than in adults.
d. Their bones have less blood flow.
A A child's growth occurs because of an increase in size rather than an increase in
the number of the muscle fibers.
B This is not a true statement. Fractures in children younger than 1 year are unusual
because a large amount of force is necessary to fracture their bones.
C Because soft tissues are resilient in children, dislocations and sprains are less
common than in adults. This is an accurate statement.
D A child's bones have greater blood flow than an adult's bones.
When infants are seen for fractures, which nursing intervention is a priority?
a. No intervention is necessary. It is not uncommon for infants to fracture bones.
b. Assess the family's safety practices. Fractures in infants usually result from falls.
c. Assess for child abuse. Fractures in infants are often nonaccidental.
d. Assess for genetic factors.
A Fractures in infancy are not common.
B Infants should be cared for in a safe environment and should not be falling.
C Fractures in infants warrant further investigation to rule out child abuse.
Fractures in children younger than 1 year are unusual because of the
cartilaginous quality of the skeleton; a large amount of force is necessary to
fracture their bones.
D Fractures in infancy are usually nonaccidental rather than related to a genetic
Which nursing intervention is appropriate to assess for neurovascular competency in a
child who fell off the monkey bars at school and hurt his arm?
a. The degree of motion and ability to position the extremity
b. The length, diameter, and shape of the extremity
c. The amount of swelling noted in the extremity and pain intensity
d. The skin color, temperature, movement, sensation, and capillary refill of the
A The degree of motion in the affected extremity and ability to position the
extremity are incomplete assessments of neurovascular competency.
B The length, diameter, and shape of the extremity are not assessment criteria in a
C Although the amount of swelling is an important factor in assessing an
extremity, it is not a criterion for a neurovascular assessment.
D A neurovascular evaluation includes assessing skin color and temperature, ability
to move the affected extremity, degree of sensation experienced, and speed of
capillary refill in the extremity.
A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports
that he will not stop crying even after taking acetaminophen with codeine. He also will not
straighten the fingers on his right arm. The nurse tells the mother to
a. Take him to the emergency department.
b. Put ice on the injury.
c. Avoid letting him get so tired.
d. Wait another hour; if he is still crying, call back.
A Unrelieved pain and the child's inability to extend his fingers are signs of
compartmental syndrome, which requires immediate attention.
B Placing ice on the extremity is an inappropriate action for the symptoms.
C This is an inappropriate response to give to a mother who is concerned about her
D A child who has signs and symptoms of compartmental syndrome should be seen
immediately. Waiting an hour could compromise the recovery of the child.
A 4-year-old child with a long leg cast complains of "fire" in his cast. The nurse should
a. Notify the physician on his next rounds.
b. Note the complaint in the nurse's notes.
c. Notify the physician immediately.
d. Report the complaint to the next nurse on duty.
A The child's symptom requires immediate attention. Notifying the physician on
the next rounds is inappropriate.
B Charting the complaint in the nurse's notes is an inappropriate action. Careful
notation of symptoms is important, but the priority action is to contact the
C A burning sensation under the cast is an indication of tissue ischemia. It may be
an early indication of serious neurovascular compromise, such as compartmental
syndrome, that requires immediate attention.
D Communication across shifts is important to the continuing assessment of the
child; however, this symptom requires immediate evaluation, and the physician
should be contacted.
When a child with a musculoskeletal injury on the foot is assessed, what is most indicative
of a fracture?
a. Increased swelling after the injury is iced
b. The presence of localized tenderness distal to the site
c. The presence of an elevated temperature for 24 hours
d. The inability of the child to bear weight
A Although edema is often present with a fracture, it would be unusual for swelling
to increase after application of ice, and this would not be most indicative of a
fracture. Swelling after icing does not identify the degree of the injury.
B Localized tenderness along with limited joint mobility may indicate serious
injury, but inability to bear weight on the extremity is a more reliable sign.
Tenderness is not a usual complaint distal to the affected site.
C Elevated temperature is associated with infection, but not a fracture.
D An inability to bear weight on the affected extremity is indicative of a more
serious injury. With a fracture, general manifestations include pain or tenderness
at the site, immobility or decreased range of motion, deformity of the extremity,
edema, and inability to bear weight
A child with osteomyelitis asks the nurse, "What is a 'sed' rate?" What is the best response
for the nurse?
a. "It tells us how you are responding to the treatment."
b. "It tells us what type of antibiotic you need."
c. "It tells us whether we need to immobilize your extremity."
d. "It tells us how your nerves and muscles are doing."
A The erythrocyte sedimentation rate (ESR) indicates the presence of inflammation
and infectious process and is one of the best indicators of the child's response to
B Although the ESR indirectly identifies whether an antibiotic is needed, the
organism involved dictates the type of antibiotic and the length of treatment.
C The ESR does not direct whether the extremity will be immobilized.
D An ESR rate will not evaluate neuromuscular status.
Which interaction is part of the discharge plan for a school-age child with osteomyelitis
who is receiving home antibiotic therapy?
a. Instructions for a low-calorie diet
b. Arrange for tutoring and school work
c. Instructions for a high-fat, low-protein diet
d. Instructions for the parent to return the child to team sports immediately
A The child with osteomyelitis is on a high-calorie, high-protein diet.
B Promoting optimal growth and development in the school-age child is important.
It is important to continue school work and arrange for tutoring if indicated.
C The child with osteomyelitis is on a high-calorie, high-protein diet.
D The child with osteomyelitis may need time for the bone to heal before returning
to full activities.
During a 14-year-old's physical examination, the nurse identifies that he plays soccer and
football and is complaining of knee pain when he rises from a squatting position, and
difficulty with weight bearing. The nurse should suspect
a. Legg-Calvé-Perthes disease
c. Duchenne muscular dystrophy
d. Osgood-Schlatter disease
A Pain on activity that decreases with rest is indicative of Legg-Calvé-Perthes
B Preexisting pain, favoring the affected limb, erythema, and tenderness are
associated with osteomyelitis.
C Duchenne muscular dystrophy causes progressive generalized weakness and
D Knee pain and tenderness aggravated by activity that requires kneeling, running,
climbing stairs, and rising from a squatting position is highly significant for
Osgood-Schlatter disease. The cause is believed to be related to repetitive stress
from sports-related activities combined with overuse of immature muscles and
A child is upset because, when the cast is removed from her leg, the skin surface is caked
with desquamated skin and sebaceous secretions. What should the nurse suggest to remove
a. Wash the area with warm water and soap.
b. Vigorously scrub leg.
c. Apply powder to absorb material.
d. Carefully pick material off leg.
A Simple soaking in the bathtub is usually sufficient for the removal of the
desquamated skin and sebaceous secretions.
B The parents and child should be advised not to scrub the leg vigorously or
forcibly remove this material because it may cause excoriation and bleeding.
C Oil or lotion, but not powder, may provide comfort for the child.
D The parents and child should be advised not to scrub the leg vigorously or
forcibly remove this material because it may cause excoriation and bleeding.
Which factor is important to include in the teaching plan for parents of a child with
a. It is an acute illness lasting 1 to 2 weeks.
b. It affects primarily adolescents.
c. There is a disturbance in the blood supply to the femoral epiphysis.
d. It is caused by a virus.
A The disease process usually lasts between 1 and 2 years and is a disorder of
B Legg-Calvé-Perthes disease is seen in children between 2 and 12 years of age.
Most cases occur between 4 and 9 years of age.
C Legg-Calvé-Perthes disease is a self-limiting disease that affects the blood
supply to the femoral epiphysis. The most serious problem associated is the risk
of permanent deformity.
D The etiology is unknown.
What is the major concern guiding treatment for the child with Legg-Calvé-Perthes
a. Avoid permanent deformity.
b. Minimize pain.
c. Maintain normal activities.
d. Encourage new hobbies.
A The major concern related to Legg-Calvé-Perthes disease is to prevent an
arthritic process resulting from the flattening of the femoral head of the femur
when it protrudes outside the acetabulum.
B The pain associated with Legg-Calvé-Perthes disease decreases with increased
rest, making activity restriction an important factor for these children. The
priority concern for treatment is to prevent deformity.
C In Legg-Calvé-Perthes disease, the major concern is to prevent deformity
through decreased activity.
D Prevention of deformity is the major concern for children with
Legg-Calvé-Perthes disease, and rest is a mandatory treatment. Selected hobbies
that do not require physical activity are encouraged.
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be
corrected, the nurse should explain that
a. Traction is tried first.
b. Surgical intervention is needed.
c. Frequent, serial casting is tried first.
d. Children outgrow this condition when they learn to walk.
A Serial casting is the preferred treatment.
B Surgical intervention is done only if serial casting is not successful.
C Serial casting is begun shortly after birth before discharge from the nursery.
Successive casts allow for gradual stretching of skin and tight structures on the
medial side of the foot. Manipulation and casting of the leg are repeated
frequently (every week) to accommodate the rapid growth of early infancy.
D Children do not improve without intervention.
Discharge planning for the child with juvenile arthritis includes the need for
a. Routine ophthalmologic examinations to assess for visual problems
b. A low-calorie diet to decrease or control weight in the less mobile child
c. Avoiding the use of aspirin to decrease gastric irritation
d. Immobilizing the painful joints, which is the result of the inflammatory process
A The systemic effects of juvenile arthritis can result in visual problems, making
routine eye examinations important.
B Children with juvenile arthritis do not have problems with increased weight and
often are anorexic and in need of high-calorie diets.
C Children with arthritis are often treated with aspirin.
D Children with arthritis can immobilize their own joints. Range-of-motion
exercises are important for maintaining joint flexibility and preventing restricted
movement in the affected joints.
During painful episodes of juvenile arthritis, a plan of care should include what nursing
a. A weight-control diet to decrease stress on the joints
b. Proper positioning of the affected joints to prevent musculoskeletal complications
c. Complete bed rest to decrease stress to joints
d. High-resistance exercises to maintain muscular tone in the affected joints
A Children in pain often are anorexic and need high-calorie foods.
B Proper positioning is important to support and protect affected joints. Isometric
exercises and passive range-of-motion exercises will prevent contractures and
C Children with juvenile arthritis need a combination of rest and exercise.
D Children with juvenile arthritis need to avoid high-resistance exercises and they
benefit from low-resistance exercises, such as swimming.
When assessing a child for an upper extremity fracture, the nurse should know that these
fractures most often result from
a. Automobile accidents
c. Physical abuse
d. Sports injuries
A Automobile accidents result in fractures to any bones. Frequently, the femur is
B The major cause of children's fractures is falls. Because of the protection
reflexes, the outstretched arm often receives the full force of the fall.
C Physical abuse may result in fractures to any bone.
D Sports injuries may result in fractures to any bone.
In caring for a child with a compound fracture, the nurse should carefully assess for
c. Epiphyseal disruption
d. Periosteum thickening
A Because the skin has been broken, the child is at risk for organisms to enter the
B The incidence of osteoarthritis does not increase with a compound fracture.
C The chance of epiphyseal disruption is not increased with compound fracture.
D Periosteum thickening is part of the healing process and not a complication.
A nurse is teaching parents the difference between pediatric fractures and adult fractures.
Which observation is true about pediatric fractures?
a. They seldom are complete breaks.
b. They are often compound fractures.
c. They are often at the epiphyseal plate.
d. They are often the result of decreased mobility of the bones
A Pediatric fractures seldom are complete breaks. Rather, children's bones tend to
bend or buckle.
B Compound fractures are no more common than simple fractures in children.
C Epiphyseal plate fractures are no more common than any other type of fracture.
D Increased mobility of the bones prevents children from having complete
Patient and parent education for the child who has a synthetic cast should include
a. Applying a heating pad to the cast if the child has swelling in the affected
b. Wrapping the outer surface of the cast with an Ace bandage
c. Splitting the cast if the child complains of numbness or pain
d. Covering the cast with plastic and waterproof tape to keep it dry while bathing or
A To prevent swelling, elevate the extremity and apply bagged ice to the casted
B Wrapping the outer surface with an Ace bandage is not indicated.
C If the child complains of numbness or pain, the child should return immediately
to the clinic or emergency department for an evaluation of neurovascular status.
D Damp skin is more susceptible to breakdown. Cast should be kept clean and dry.
A 6-year-old patient who has been placed in skeletal traction has pain, edema, and fever.
The nurse should suspect
A The symptoms of meningitis include headache, photophobia, fever, nausea, and
B Crepitus is the "sandy" or "gravelly" feeling noted when a broken bone is
C The most serious complication of skeletal traction is osteomyelitis. Clinical
manifestations include complaints of localized pain, swelling, warmth,
tenderness, or unusual odor. An elevated temperature may accompany the
D Osteochondrosis is a disorder of the epiphyses involving an interruption of the
A boy who has fractured his forearm is unable to extend his fingers. The nurse knows that
a. Is normal following this type of injury
b. May indicate compartmental syndrome
c. May indicate fat embolism
d. May indicate damage to the epiphyseal plate
A This is not normal and indicates neurovascular compromise of some type.
Paresthesia or numbness or loss of feeling can indicate a serious problem and
can result in paralysis.
B Swelling causes pressure to rise within the immobilizing device leading to
compartmental syndrome. Signs include severe pain, often unrelieved by
analgesics, and neurovascular impairment. It is not uncommon in the forearm, so
the inability to extend the fingers may indicate compartmental syndrome.
C The inability to extend the fingers often indicates neurovascular compromise. Fat
embolism causes respiratory distress with hypoxia and respiratory acidosis.
D This is not related to damage to the epiphyseal plate.
Which term is used to describe an abnormally increased convex angulation in the curvature
of the thoracic spine?
A Scoliosis is a complex spinal deformity usually involving lateral curvature,
spinal rotation causing rib asymmetry, and thoracic hypokyphosis.
B Ankylosis is the immobility of a joint.
C Lordosis is an accentuation of the cervical or lumbar curvature beyond
D Kyphosis is an abnormally increased convex angulation in the curve of the
When assessing the child with osteogenesis imperfecta, the nurse should expect to observe
a. Discolored teeth
b. Below-normal intelligence
c. Increased muscle tone
d. Above-average stature
A Children with osteogenesis imperfecta have incomplete development of bones,
teeth, ligaments, and sclerae. Teeth are discolored because of abnormal enamel.
B Despite their appearance, children with osteogenesis imperfecta have normal or
C The child with osteogenesis imperfecta has weak muscles and decreased muscle
D Because of compression fractures of the spine, the child appears short.
A nurse knows that which exercise is best for a child with juvenile arthritis?
d. Swimming in a heated pool
A Jogging jars the hip, knee, and ankle joints and can cause joint damage.
B Tennis also jars the joints and can cause joint damage.
C Gymnastics does not protect the joints from injury.
D The warmth of the water, coupled with mild resistance, makes swimming the
perfect medium for strengthening and range-of-motion exercises while
protecting the joints.
Juvenile arthritis should be suspected in a child who exhibits
a. Frequent fractures
b. Joint swelling and pain lasting longer than 6 weeks
c. Increased joint mobility
d. Lurching and abnormal gait, limited abduction
A Frequent fractures are indicative of osteogenesis imperfecta.
B Intermittent joint pain lasting longer than 6 weeks is indicative of juvenile
C Increased joint mobility is indicative of osteogenesis imperfecta.
D Lurching to the affected side causing an abnormal gait and limited abduction are
associated with developmental dysplasia of the hip (DDH).
PTS: 1 DIF: Cognitive Level: Comprehension REF:
When providing education for the parents of a child with Duchenne muscular dystrophy,
the nurse plans to include
a. Testing all female children for the disease
b. Testing the father for the presence of the trait on the Y chromosome
c. Genetic counseling for all female children
d. Testing the parents to determine the carrier
A Because it is a recessive X-linked disorder, females can only be carriers and do
not have the disease.
B The disease is an X-linked recessive disorder and would not be found on the Y
C Duchenne muscular dystrophy is a recessive sex-linked disease carried on the X
chromosome, so only males are affected with the disease.
D The disease is a recessive X-linked disease and is always carried by the mother.
The nurse knows that treatment of Osgood-Schlatter disease includes
a. Limitation of knee bending or kneeling
b. Increasing range of motion (ROM) of the knee
c. Encouraging flexion of the hip
d. Limitation of adduction of the hip
A Limitation of knee bending or kneeling provides pain control and allows the
knees to heal.
B Increasing ROM of the knee increases pain and exacerbates the disease.
C Encouraging flexion of the hip will have no effect on the process affecting the
D Limitation of hip adduction will not help the child with Osgood-Schlatter
What is the most appropriate intervention for an adolescent with a mild scoliosis?
a. Long-term monitoring
b. Surgical intervention
d. No follow-up
A The child with mild scoliosis requires long-term follow-up to determine whether
the curve will progress or remain stable.
B Surgical intervention is not needed for mild scoliosis.
C Mild scoliosis is not braced if it is stable.
D Follow-up to monitor the curve is important until skeletal maturity has occurred.
Which statement by the mother of an adolescent being discharged after spinal fusion for
severe scoliosis indicates the need for further teaching?
a. "I am glad we chose surgery. Now it is all over and done."
b. "I'll see you in a month; we'll be back fairly regularly."
c. "I have to pick up some more T-shirts on the way home."
d. "Those exercises the physical therapist showed us were not too hard."
A Spinal fusion requires long-term follow-up to assess the stability of the spinal
B This statement indicates the mother's understanding of the need for long-term
C T-shirts are needed to protect the skin under the orthoplasty jacket, which is
worn after fusion.
D This statement indicates the mother received instructions and understands that
continued interventions are needed.
Which factor should the nurse include when teaching a parent about the care of a newborn
in a Pavlik harness for hip dysplasia?
a. The harness may be removed with every diaper change.
b. The harness is used to maintain the infant's hips in flexion and abduction and
c. The harness is only the first step of treatment.
d. The harness is worn for 2 weeks.
A The harness must be worn for 23 hours per day and should be removed only
according to the physician's recommendation. Hips that remain unstable become
progressively more deformed as maturity takes place.
B The harness is used to maintain the infant's hips in flexion and external rotation
to allow the hips (femoral head and acetabulum) to mold and grow normally.
C With early diagnosis and treatment, the Pavlik harness is often the only treatment
D The length of treatment is determined by radiographic documentation of the
maturity of the hips.
A priority nursing intervention when caring for a child in a Pavlik harness is
a. Skin care
b. Bowel function
c. Feeding patterns
d. Respiratory function
A The child in a Pavlik harness needs special attention to skin care because the
infant's skin is sensitive and the harness may cause irritation.
B The harness should not affect normal bowel function in the infant.
C Families are typically instructed on techniques for holding and feeding. The
harness should not affect feeding patterns in the infant.
D The harness should not affect normal respiratory function in the infant
During a well-child visit, the nurse identifies that an 18-month-old infant is bowlegged.
She is aware that this assessment is
a. Common in children with nutritional deficiencies
b. Common in infants and toddlers
c. A serious condition needing further evaluation
d. An indication of neurologic impairment
A Bowlegs are not usually associated with nutritional deficiencies.
B Bowlegs are common in infants and toddlers.
C Bowlegs may need intervention but do not generally indicate serious
D Bowlegs do not generally indicate a neurologic impairment.
Which interventions should the nurse include in the home care instructions for the parents
of a child who has a cast applied to the left forearm? Select all that apply.
a. Keep small toys away from the cast.
b. Use a padded ruler to scratch the skin under the cast if it itches.
c. Daily assess the cast for unusual odors.
d. Elevate the extremity on pillows for the first 24 to 48 hours.
e. Numbness and tingling in the extremity is expected.
ANS: A, C, D
Correct Small toys should be kept away from the cast because they can become
lodged inside the cast. The cast should be inspected daily for any unusual
odors, which can indicate infection. The extremity should be elevated for
the first 24 to 48 hours to decrease edema.
Incorrect Nothing should be placed inside the cast. If numbness or tingling is
experienced, the physician should be notified.
Which interventions should the nurse implement to prevent complications of immobility
for a child in skeletal traction? Select all that apply.
a. Reposition the child every 2 hours.
b. Avoid use of an egg-crate or sheepskin mattress.
c. Limit fluid intake.
d. Administer stool softeners as prescribed.
e. Encourage coughing and deep breathing.
ANS: A, D, E
Correct Complications of immobility can affect the skin, the gastrointestinal
system, and the respiratory system. The child should be repositioned every
2 hours to prevent skin breakdown. Stool softeners should be administered
to avoid constipation and the child should cough and deep breathe to
maintain respiratory function.
Incorrect Egg-crate or sheep skin mattresses can be useful in preventing skin
breakdown, and fluids should be increased to prevent constipation, not
What actions should the nurse perform while caring for a school-age child who sprained
his ankle playing football? Select all that apply.
a. Turn the child every 1 to 2 hours.
b. Assist with range-of-motion exercises every 2 hours.
c. Apply ice to the affected ankle.
d. Wrap the ankle with an Ace bandage.
e. Elevate the affected extremity.
ANS: C, D, E
Correct The child with a soft tissue injury in the first 6 to 12 hours is treated by
controlling the swelling and reducing muscle damage. The acronym
"RICE" summarizes the care needed: rest, ice, compression, and elevation.
Incorrect During the acute phase of the injury, the child is not moved frequently and
range-of-motion exercises would not be done. The child with a soft tissue
injury in the first 6 to 12 hours is treated by controlling the swelling and
reducing muscle damage.
Tissue ischemia and nerve damage are serious complications that may result from
immobilization in a cast or from traction. The five Ps of vascular impairment can be used
as a guide when assessing for neurovascular problems. List the five Ps.
pain, pallor, pulselessness, paresthesia, paralysis
Prompt referral to a physician and intervention is crucial if neurovascular impairment is to
A frequent parental concern is children's leg length inequality. Asymptomatic leg length
inequality is relatively common in children. Is this statement true or false?
This statement is correct. Causes may be congenital or acquired. Treatment ranges from no
intervention to extensive reconstruction or prosthetic fitting.
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