Musculoskeletal function

Question 1

Which finding, noted during the newborn admission assessment, would lead the nurse to
suspect unilateral congenital hip dysplasia?
1. Lordosis
2. Trendelenburg sign
3. Asymmetry of the gluteal and thigh fat folds
4. Telescoping of the affected limb

Answer 1

3. Asymmetry of the gluteal and thigh fat folds
   Explanation:
4. Lordosis does not occur with hip dysplasia.
5. Trendelenburg sign and telescoping of the affected limb are signs that present in
   an older child with congenital hip dysplasia.
6. A sign of congenital hip dysplasia in the infant would be asymmetry of the gluteal and
   thigh fat folds.
7. Trendelenburg sign and telescoping of the affected limb are signs that present in an
   older child with congenital hip dysplasia.

Question 2

Which clinical manifestations should the nurse monitor for when conducting a scoliosis
screening for a school-age child? Select all that apply.
1. Lordosis
2. Prominent scapula
3. Pain
4. A one-sided rib hump
5. Uneven shoulders and hips

Answer 2

2. Prominent scapula
3. A one-sided rib hump
4. Uneven shoulders and hips

Question 3

Which parental statement would cause the nurse to include further education related to the
care required for a child who is diagnosed with congenital clubfoot?
1. “We’re getting a special car seat to accommodate the casts.”
2. “We’ll watch for any swelling of the feet while the casts are on.”
3. “We’ll keep the casts dry.”
4. “We’re happy this is the only cast our baby will need.”

Answer 3

4. “We’re happy this is the only cast our baby will need.”
   Explanation:
5. Using a car seat is the law. Special car seats to accommodate the casts are available and
   should be utilized.
6. Parents should be watching for swelling while the casts are on.
7. Keeping the casts dry is important to prevent complications.
8. Serial casting is the treatment of choice for congenital clubfoot. The cast is changed
   every 1 to 2 weeks until the corrected foot position is achieved.

Question 4

Which is the priority nursing diagnosis for nurse to use when planning care for a school-age
child who must wear a brace for correction of scoliosis?
1. Impaired Gas Exchange, Risk for
2. Altered Growth and Development, Risk for
3. Impaired Skin Integrity, Risk for
4. Impaired Mobility, Risk for

Answer 4

3. Impaired skin integrity, risk for

Question 5

Which assessment finding would require an immediate nursing action when providing care
to an adolescent who is postoperative for spinal fusion surgery?
1. Sleeps when not bothered but arouses easily with stimuli
2. Impaired color, sensitivity, and movement to lower extremities
3. Nausea relieved by antiemetics
4. Pain relieved by analgesics

Answer 5

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

Question 6

The nurse is providing care to a child who is diagnosed with Legg-Calvé-Perthes disease.
Which parental statement regarding the child’s care required further teaching from the
nurse?
1. “We’re glad this will only take about 6 weeks to correct.”
2. “We understand abduction of the affected leg is important.”
3. “We know to watch for areas on the skin that the brace might rub.”
4. “We understand swimming is a good sport for Legg-Calvé-Perthes.”

Answer 6

1. “We’re glad this will only take about 6 weeks to correct.”
   Explanation:
2. The treatment for Legg-Calvé-Perthes disease takes approximately 2 years.
3. The leg should be kept in the abducted position to prevent damage to the head of the
   femur due to Legg-Calvé-Perthes disease.
4. A brace is a component of the treatment of Legg-Calvé-Perthes disease and is worn to
   prevent damage to the head of the femur, so skin irritation should be monitored.
5. Swimming is a good activity to increase mobility in a child with Legg-Calvé-Perthes
   disease.

Question 7

Which teaching topic is the priority for the nurse who is teaching the family of an infant
diagnosed with osteogenesis imperfecta?
1. Cast care
2. Trunk and extremity support during everyday care
3. Postoperative spinal surgery care
4. Traction care

Answer 7

2. Trunk and extremity support during everyday care.
3. Traction, casts, and spinal surgery are not routinely done for osteogenesis imperfecta.
4. With osteogenesis imperfecta, nursing care focuses on preventing fractures. Because the
   bones are fragile, the entire body must be supported when the child is moved.
5. Traction, casts, and spinal surgery are not routinely done for osteogenesis imperfecta.
6. Traction, casts, and spinal surgery are not routinely done for osteogenesis imperfecta.

Question 8

An infant returns to the unit following surgical correction of bilateral congenital clubfeet.
The infant has bilateral long-leg casts. The nurse notes that the toes on both feet are
edematous, but there is color, sensitivity, and movement to them. Which action by the nurse
is the priority?
1. Apply a warm, moist pack to the feet.
2. Elevate the legs on pillows.
3. Encourage movement of the toes.
4. Call the surgical provider to report the edema.

Answer 8

2. Elevate the legs on pillows
   Explanation:
3. Warm, moist heat will increase swelling and the moisture may cause the cast to
   disintegrate.
4. The infant’s legs should be elevated on a pillow for 24 hours to promote healing and
   help with venous return. This is the priority action.
5. An 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.
6. Some 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.

Question 9

Which should the nurse include in a teaching session for the parents of an infant who will
be placed in a Pavlik harness for the treatment of congenital developmental dysplasia?
1. Apply lotion or powder to minimize skin irritation.
2. Check at least 2 or 3 times a day for red areas under the straps.
3. Put clothing over the harness for maximum effectiveness of the device.
4. Place a diaper over the harness, preferably using a thin, superabsorbent, disposable
diaper.

Answer 9

2. Check at least 2 or 3 times a day for red areas under the straps.
   Explanation:
3. Lotion or powder can contribute to skin breakdown and should not be used.
4. The skin underneath the straps of the brace should be checked 2 or 3 times a day for red
   areas, which might indicate skin breakdown.
5. A light layer of clothing should be worn under the brace to assist in preventing skin
   breakdown, not over the brace.
6. The diaper should be placed under the brace, along with a light layer of clothing.

Question 10

Which action by the nurse is appropriate for a child who presents in the emergency
department with an ankle injury?
1. Avoid compressing the area to allow tissue swelling as necessary.
2. Perform passive range-of-motion to the extremity.
3. Lower the extremity below the level of the heart.
4. Apply ice to the extremity.

Answer 10

4. Apply ice to the extremity

Question 11

Which clinical data noted by the nurse during the shift assessment indicate the pediatric
client may be experiencing compartment syndrome? Select all that apply.
1. Pink, warm extremity
2. Dorsalis pedis pulse present
3. Prolonged capillary refill time
4. Pain not relieved by pain medication
5. Paresthesia of the leg

Answer 11

3. Prolonged capillary refill time
4. Pain not relieved by pain medication
5. Paresthesia of the leg

Question 12

The father of a school-age child who requires hospital admission for intravenous antibiotics
to treat osteomyelitis states, “I don’t understand why normal antibiotics can’t be used.”
Which should the nurse include in the response to the father?
1. The antibiotic of choice is not available in oral form.
2. Blood flow to bones is limited, and parenteral administration is necessary to get
appropriate blood levels.
3. Because the child is older now, it is harder to get the child to cooperate with oral
antibiotics.
4. Because 2 weeks of therapy is necessary, the intravenous route will produce fewer side
effects.

Answer 12

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

Question 13

Which assessment finding for a toddler-age child in balanced Bryant traction for a fractured
right femur would require immediate action by the nurse?
1. The child keeps trying to turn and lie on his belly.
2. The ropes are unequal in length.
3. The child’s buttocks are resting on the bed.
4. The Ace bandage wrapping the legs is wrinkled.

Answer 13

3. The child’s buttocks are resting on the bed.
   Explanation:
4. This child needs a jacket restraint to maintain appropriate positioning if someone cannot
   stay with him. It does not require notifying the surgeon.
5. In balanced traction, the ropes and pulleys determine the traction and the length of the
   rope is unimportant.
6. In order to provide adequate counter-traction, the buttocks should be slightly elevated
   off the bed. The surgeon should be notified.
7. This is not a significant finding.

Question 14

Which interventions should the nurse include in the plan of care for an adolescent client
who is on complete bed rest after spinal fusion surgery secondary to scoliosis to prevent
complications associated with immobility? Select all that apply.
1. Encouraging use of the spirometer every 2 hours while the child is awake
2. Log-rolling the client every 2 hours while awake
3. Increasing intake of milk to maintain bone calcium
4. Increasing fruit and grains in the diet
5. Limiting fluid intake to reduce the need to void

Answer 14

1. Encouraging use of the spirometer q2 hours while the child is awake.
2. Log-rolling the client q2 while awake
3. Increasing fruit and grains in the diet.

Question 15

A school nurse suspects that a child who fell at recess has a fractured arm. Which should the
nurse consider when applying a splint to transport the child to the hospital?
1. The splint is applied firmly enough to prevent swelling.
2. The arm is fully extended in the splint.
3. The splint is fully padded to prevent skin damage.
4. The joints above and below the suspected fracture are immobilized by the splint.

Answer 15

4. the joints above and below the suspected fracture are immobilized by the splint.

Question 16

Which assessment data obtained by the nurse during the health history portion of the
assessment process support the current diagnosis of Duchenne muscular dystrophy (MD)
for an 18-month-old child?
1. Infant was postmature by almost 2 weeks.
2. The child seems very muscular.
3. The child walked early and without support at 10 months.
4. The child’s older sister developed scoliosis in the fourth grade.

Answer 16

2. The child seems very muscular
   Explanation:
3. Postmaturity is not related to Duchenne MD.
4. Duchenne MD is also called pseudohypertrophic due to the enlarged appearance of the
   muscle. The pathophysiology is infiltration of the muscle fibers with fatty tissue.
5. This finding is not indicative of Duchenne MD.
6. The older sister’s scoliosis is not related to MD. Duchenne MD is sex-linked recessive
   and affects only boys.

Question 17

Which should the nurse include in the neurovascular assessment for an infant following
casting of the leg for talipes equinovarus?
1. Warmth
2. Capillary refill
3. Pedal pulse
4. Sensation
5. Movement of the toes

Answer 17

1. Warmth
2. Capillary refill
3. Sensation
4. Movement of the toes

Question 18

18) Which clinical manifestations should the nurse expect when assessing a pediatric client who
is diagnosed with congenital hip dysplasia (CHD)? Select all that apply.
1. Limited adduction of the affected hip
2. Asymmetry of thigh fat folds
3. Telescoping of the thigh
4. Muscle weakness
5. Atrophy of the muscles

Answer 18

2. Asymmetry of thigh fat folds
3. Telescoping of the thigh.
   Explanation:
4. The nurse would anticipate limited abduction, not adduction, of the affected hip for a
   child diagnosed with CHD.
5. Asymmetry of the thigh fat folds is a clinical manifestation associated with CHD.
6. Telescoping of the thigh is a clinical manifestation associated with CHD.
7. Muscle weakness is not an expected clinical manifestation associated with CHD.
8. Atrophy of the muscles is not an expected clinical manifestation associated with CHD.

Question 19

Which clinical manifestations should the nurse expect when assessing a pediatric client who
is diagnosed with Legg-Calvé-Perthes disease? Select all that apply.
1. Limited abduction of the affected hip
2. Asymmetry of thigh fat folds
3. Telescoping of the thigh
4. Muscle weakness
5. Atrophy of the muscles

Answer 19

4. Muscle weakness
5. Atrophy of the muscles
   Explanation:
6. Limited abduction of the affected hip is a clinical manifestation associated with clinical
   hip dysplasia, not Legg-Calvé-Perthes disease.
7. Asymmetry of the thigh fat folds is a clinical manifestation associated with clinical hip
   dysplasia, not Legg-Calvé-Perthes disease.
8. Telescoping of the thigh is a clinical manifestation associated with clinical hip
   dysplasia, not Legg-Calvé-Perthes disease.
9. Muscle weakness is an expected clinical manifestation associated with Legg-Calvé-
   Perthes disease.
10. Atrophy of the muscles is not an expected clinical manifestation associated with Legg-
    Calvé-Perthes disease.

Question 20

Which are appropriate interventions for the nurse to include in the plan of care for a child
who is receiving traction? Select all that apply.
1. Monitoring breath sounds
2. Assessing neurovascular status every 2 hours
3. Repositioning every 2 to 3 hours
4. Using moleskin to protect the skin from rough edges
5. Encouraging the parents cuddle with their child

Answer 20

1. Monitoring breath sounds.
2. Assessing neurovascular status q2 hours
3. Encouraging the parents cuddle with their child.

Question 21

Which are appropriate interventions for the nurse to include in the plan of care for a child
who is casted? Select all that apply.
1. Monitoring breath sounds
2. Assessing neurovascular status every 4 hours
3. Repositioning every 2 to 3 hours
4. Using moleskin to protect the skin from rough edges
5. Encouraging the parents cuddle with their child

Answer 21

1. Monitoring breath sounds
2. Repositioning Q2-3 hours
3. Using moleskin to protect the skin from rough edges
4. Encouraging the parents to cuddle with their child