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Chapter 30: Caring for the Child with a Musculoskeletal Condition
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____
1. The pediatric nurse explains to the student nurse that alterations in musculoskeletal functioning may
be related to a congenital defect or an acquired defect. The nurse gives the following as an example
of a congenital defect:
a. osteomyelitis.
b. juvenile arthritis.
c. muscular dystrophy.
d. Osgood-Schlatter disease.
____
2. The student nurse studying the anatomy of the musculoskeletal system understands that bones are
classified by their size and shape. The nurse learns that the pelvis is a(n):
a. flat bone.
b. long bone.
c. short bone.
d. irregular bone.
____
3. The pediatrician orders blood work for a patient with juvenile arthritis. The pediatric nurse knows
that a higher than normal white blood cell count (greater than 6000 to 17,000/microliter) indicates:
a. bacterial infection.
b. bleeding disorder.
c. parasitic condition.
d. inflammatory condition.
____
4. The nurse checks the C-reactive protein for a patient with a bacterial infection and finds it to be
elevated, indicating infection or septic arthritis. The nurse knows the normal value is:
a. greater than l.0 mg/dl.
b. less than l.0 mg/dl.
c. greater than 2.0 mg/dl.
d. less than 2.0 mg/dl.
____
5. A pediatric nurse is caring for a 1-year-old child in a spica cast. The nurse teaches the parents that
modifications need to be made for this child, including:
a. using a sitting position on the floor to feed the child.
b. using a wagon instead of a stroller to move the child.
c. using a car seat with sturdy sides to transport the child.
d. using a baby bath with shallow water to clean the child.
____
6. A 15-year-old boy is brought to the emergency room by his parents following an injury to his arm
that occurred during football practice. The x-ray shows a diagonal line that coils around the bone.
The pediatric nurse knows that this indicates a type of fracture known as:
a. spiral.
b. oblique.
c. transverse.
d. greenstick.
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____
7. A pediatrician asks a patient with a knee injury to squat. The pediatric nurse knows the pediatrician
is checking the patient for the signs of:
a. osteomyelitis.
b. juvenile arthritis.
c. muscular dystrophy.
d. Osgood-Schlatter disease.
____
8. A nurse explains to the parents of a 10-year-old patient with scoliosis that the most effective care for
their child is:
a. using an exercise regimen and bracing as complementary care.
b. using chiropractic therapy and exercises as complementary care.
c. using exercise and transcutaneous electrical stimulation as complementary care.
d. using transcutaneous electrical stimulation and NSAIDs as complementary care.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____
9. An 8-year-old girl has a third-degree sprain of the ankle. The pediatric nurse caring for the patient
knows that the criteria for this classification of sprain include: (Select all answers that apply.)
a. the ligament is stretched and the affected joint is stable.
b. the patient cannot bear weight or use the extremity.
c. there is severe pain over the joint making an exam difficult.
d. there is full range of motion and weight bearing.
____ 10. A pediatrician orders Russell traction for a 12-year-old patient with Legg-Calvé-Perthes disease. The
pediatric nurse caring for the patient ensures that the patient’s: (Select all answers that apply.)
a. hip is flexed and abducted.
b. lying in a supine position.
c. skin is inspected every 12 hours.
d. bony prominences are massaged.
____ 11. Following hip surgery, a patient is placed in a spica cast. The pediatric nurse knows a complication
of the cast, known as cast syndrome, can be prevented by the following nursing actions: (Select all
answers that apply.)
a. increasing fluid intake.
b. Keeping the same position.
c. Increasing fiber in the diet.
d. Cutting a window in the cast.
____ 12. The pediatric nurse teaches a patient that following a sprain to an extremity, it is important to take
the following measures: (Select all answers that apply.)
a. immediately perform range of motion exercises on the extremity.
b. apply heat to the extremity for first 48 hours at 15-minute intervals.
c. apply an ace wrap to apply pressure and reduce swelling of the joint.
d. elevate and move the affected joint to reduce swelling and stiffness.
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____ 13. The pediatric nurse caring for a patient with juvenile arthritis administers the following medications
recommended for this disease: (Select all answers that apply.)
a. leflunomide (Arava).
b. infliximab (Remicade).
c. acetaminophen (Tylenol).
d. methotrexate (Rheumatrex).
____ 14. The pediatric nurse explains to the parents of a child with kyphosis that it is caused by a congenital
or acquired condition. The nurse notes the following congenital causes of kyphosis as: (Select all
answers that apply.)
a. osteomyelitis.
b. rheumatoid arthritis.
c. ankylosing spondylitis.
d. osteogenesis imperfecta.
____ 15. The pediatric nurse discusses home care with the parents of a patient who is returning home
following a spinal fusion. Some of the recommended measures discussed by the nurse include:
(Select all answers that apply.)
a. allow the child to return to school about 4 to 6 weeks following surgery.
b. explain activity restrictions to the child and caregivers.
c. maintain a regular diet with added calcium, fiber, fluids, and vitamin C.
d. encourage ambulation when permitted, usually 2 to 3 weeks postoperatively.
Matching
The pediatric nurse understands the musculoskeletal disorders listed below. Match the disorders with
their descriptions.
a. Osteogenesis imperfecta
b. Kyphosis
c. Juvenile arthritis
d. Osgood-Schlatter disease
e. Scoliosis
f. Osteomyelitis
g. Tetanus
h. Legg-Calvé-Perthes disease
____ 16. An aseptic necrosis (necrosis occurring without infection) of the femoral head
____ 17. A painful prominence of the tibial tubercle
____ 18. Infection that occurs when bacteria lodge and multiply in the middle of the bone where circulation is
sluggish
____ 19. A nonpainful lateral curvature of the spine
____ 20. An autoimmune inflammatory process with unknown origin but is thought to be triggered by an
infection
____ 21. A nonpainful spinal curvature in the sagittal plane
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____ 22. Disease that occurs when an exotoxin, which is produced by an anaerobic, gram-positive bacillus,
forms spores
____ 23. Brittle bone disease
True/False
Indicate whether the statement is true or false.
____ 24. The pediatric nurse working on the orthopedic unit of the hospital knows that the purpose of petaling
a cast is to promote good hygiene by protecting the proximal edges of the long leg casts and the
perineal area of the spica casts from soiling.
____ 25. The nurse recognizes that the main principle of traction is to reduce dislocations and to immobilize
fractures in the child.
____ 26. The pediatric nurse knows that the most severe form of osteomyelitis and the most commonly
known form is talipes equinovarus.
Completion
Complete each statement.
27. The nurse explains to the parents of a patient in traction that skeletal traction is used for days or
weeks until the bone is ready for casting or _____________________ (surgery to place the bones in
their proper position.).
28. An orthopedic surgeon orders Crutchfield tongs for a patient. The pediatric nurse knows that
Crutchfield tongs are used in the treatment of _____________________ and
_____________________ fractures. The tongs are placed into the child’s _____________________.
29. The pediatric nurse performing the neurovascular assessment for a post-surgery patient knows that
capillary refill time can be assessed by applying brief pressure to the _____________________ and
noting how quickly pink color returns. Capillary refill time of less than _____________________
seconds is the norm.
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Chapter 30: Caring for the Child with a Musculoskeletal Condition
Answer Section
MULTIPLE CHOICE
1. ANS: C
Alterations in musculoskeletal functioning may be related to a congenital defect such as muscular
dystrophy, clubfoot, or osteogenesis imperfecta. Other musculoskeletal alterations may be related to
an acquired defect such as Legg-Calvé-Perthes disease, slipped femoral capital epiphysis,
Osgood-Schlatter disease, scoliosis, sprains, strains, fractures, osteomyelitis, juvenile arthritis, and
tetanus.
PTS: 1
DIF: Easy
REF: 964
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
2. ANS: D
Flat bones are located in the skull, scapulae, ribs, sternum, and clavicle. Long bones are found in the
extremities and include the fingers and toes. Most childhood disorders are located in the long bones.
Short bones are located in the ankle and wrist. Irregular bones are the vertebrae, pelvis, and facial
bones.
PTS: 1
DIF: Easy
REF: 964
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
3. ANS: A
High white blood cell count indicates a bacterial infection or septic arthritis. Low platelet level
indicates a bleeding disorder. Eosinophils indicate an allergic or parasitic condition. Basophils
indicate a chronic inflammatory condition.
PTS: 1
DIF: Moderate
REF: 965
OBJ: 3
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
4. ANS: B
C-reactive protein measures a protein in blood that is released when an infection is present: greater
than 0.9 indicates an infection or septic arthritis; less than 1.0 mg/dl is the normal value.
PTS: 1
DIF: Difficult
REF: 965
OBJ: 3
KEY: Cognitive Level: Analysis | Content Area: Peds/Maternity | Patient Needs: SECE/Management of Care
| Integrated Process: Clinical Problem Solving (Nursing Process)
5. ANS: B
Placing the child in the prone position on the floor makes it easier for feeding the child. Mobilizing a
child in a wagon is a good modification for a stroller while the child is in the spica cast. Toddler car
seats that do not have sides are also a good modification for a child in a spica cast. The parents will
need to modify the bath by giving the child a sponge bath.
PTS: 1
DIF: Moderate
REF: 966
OBJ: 5| 8
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Full file at https://thetestbank.eu/-Maternal-Child-Nursing-Care-Optimizing-Outcomes-for-Mothers-Children-and-Families-
Care | Integrated Process: Teaching/Learning
6. ANS: A
A spiral break is caused by a twisting force and shows a diagonal line that coils around the bone. An
oblique break shows a diagonal line across the bone. A transverse break shows a line that crosses the
shaft at a 90-degree angle. In a greenstick-type break the bone is bent but not broken.
PTS: 1
DIF: Easy
REF: 975
OBJ: 3
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
7. ANS: D
The major symptom of Osgood-Schlatter disease is pain below the kneecap that is aggravated by
activity and relieved by rest. Symptoms resolve around the time skeletal growth ceases (about
puberty). The child experiences pain when asked to squat or extend the knee against resistance. This
is a good indicator of Osgood-Schlatter disease.
PTS: 1
DIF: Easy
REF: 979
OBJ: 2
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
8. ANS: A
Thompson (2004)
revealed outcomes from exercises alone and chiropractic therapy are rarely therapeutic in managing
scoliosis. Transcutaneous electrical stimulation has also proved ineffective. Exercises are of benefit
when used in conjunction with bracing to maintain and strengthen the muscles of the back and
abdomen.
PTS: 1
DIF: Moderate
REF: 985
OBJ: 10
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
MULTIPLE RESPONSE
9. ANS: B, C
In a third-degree sprain the injury is severe, the ligament is completely torn, and the joint is unstable.
There is significant swelling and severe ecchymosis occurring within the first 30 minutes. There is
also severe pain over the joint, making examination difficult. The person cannot bear weight or
otherwise use the extremity.
PTS: 1
DIF: Moderate
REF: 977
OBJ: 2
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
10. ANS: A, B
Russell traction is a type of skin traction used to stabilize femur fractures until a callus forms or with
Legg-Calvé-Perthes disease. With this type of traction, the child lies supine with hip flexed,
abducted, and immobile. The nurse should perform skin care every 4 hours and should not massage
bony prominences.
PTS: 1
DIF: Moderate
REF: 968
OBJ: 5
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Full file at https://thetestbank.eu/-Maternal-Child-Nursing-Care-Optimizing-Outcomes-for-Mothers-Children-and-Families-
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
11. ANS: A, C, D
Cast syndrome can be prevented by three nursing interventions: frequent repositioning, increasing
fluids and fiber in the child’s diet, and cutting a “belly hole” or a window in the cast to allow for
abdominal expansion.
PTS: 1
DIF: Easy
REF: 966
OBJ: 5
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
12. ANS: C, D
The nurse should teach the RICE acronym: Rest the injured extremity to prevent further injury and
allow the ligament to heal; Ice for the first 48 hours, keep ice packs in place for 15-minute intervals
to decrease swelling; Compression, apply an ace wrap or some other method to apply pressure to the
affected joint to help reduce swelling of the joint; and Elevation and early motion of the affected
joint, elevation reduces swelling, early motion of the affected helps keep the full range of motion of
the joint.
PTS: 1
DIF: Moderate
REF: 978
OBJ: 5
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Teaching/Learning
13. ANS: A, B, D
The approved NSAIDs are ibuprofen (Children’s Advil), naproxen (Aleve), tolmetin (Tolectin), and
choline magnesium trisalicylate (Trilisate). Some of the more commonly used DMARDs are
methotrexate (Rheumatrex), cyclophosphamide (Cytoxan), sulfasalazine (Azulfidine), and
infliximab (Remicade). New drugs potentially available for use with juvenile arthritis are
leflunomide (Arava) and etanercept (Enbrel).
PTS: 1
DIF: Moderate
REF: 982
OBJ: 9
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: PHI/Pharmacological
and Parenteral Therapies | Integrated Process: Clinical Problem Solving (Nursing Process)
14. ANS: C, D
In children, kyphosis is caused by a congenital or acquired condition. Some congenital causes of
kyphosis are ankylosing spondylitis, metabolic disorders, osteogenesis imperfecta, spina bifida,
Paget disease, and Scheuermann disease, which causes juvenile or adolescent kyphosis because there
are wedge-shaped vertebrae in the thoracic region.
PTS: 1
DIF: Moderate
REF: 986
OBJ: 1
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Teaching/Learning
15. ANS: A, B, C
The child may return to school about 4 to 6 weeks after surgery. Explain activity restrictions to the
child and caregivers (no twisting or bending, no lifting of heavy objects, no contact or high-impact
sports for 2 years). A regular diet with added calcium, fiber, vitamin C, and fluids is maintained.
Ambulation is encouraged when it is permitted, usually about 5 days postoperatively.
PTS: 1
DIF: Moderate
REF: 987
OBJ: 8
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Teaching/Learning
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MATCHING
16. ANS: H
PTS: 1
DIF: Easy
REF: 973
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
NOT: Perinatal Nursing Terms and Definitions
17. ANS: D
PTS: 1
DIF: Easy
REF: 979
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
NOT: Perinatal Nursing Terms and Definitions
18. ANS: F
PTS: 1
DIF: Easy
REF: 979
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
NOT: Perinatal Nursing Terms and Definitions
19. ANS: E
PTS: 1
DIF: Easy
REF: 983
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
NOT: Perinatal Nursing Terms and Definitions
20. ANS: C
PTS: 1
DIF: Easy
REF: 980
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
NOT: Perinatal Nursing Terms and Definitions
21. ANS: B
PTS: 1
DIF: Easy
REF: 986
OBJ: 1
KEY: Cognitive Level: Knowledge
NOT: Perinatal Nursing Terms and Definitions
22. ANS: G
PTS: 1
DIF: Easy
REF: 987
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
NOT: Perinatal Nursing Terms and Definitions
23. ANS: A
PTS: 1
DIF: Easy
REF: 989
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
NOT: Perinatal Nursing Terms and Definitions
TRUE/FALSE
24. ANS: T
Hygiene is a major concern for a child in a spica cast or bilateral long leg casts with a bar. Protecting
the proximal edges of the long leg casts and the perineal area of the spica cast from soiling is a key
hygienic intervention that is achieved by petaling the cast.
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PTS: 1
DIF: Easy
REF: 966
OBJ: 5
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
25. ANS: T
During the application of traction, one body part is pulled in one direction (traction) against a
counter pull in the opposite direction (countertraction).
PTS: 1
DIF: Easy
REF: 968
OBJ: 5
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
26. ANS: F
The most severe form is clubfoot and the most commonly known form is talipes equinovarus.
PTS: 1
DIF: Easy
REF: 972
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Teaching/Learning
COMPLETION
27. ANS:
open reduction
Skeletal traction is used when the weight of the traction needs to be more than 5 pounds. In children,
skeletal traction is used for long periods and where greater strength of pull is needed than with skin
traction. Skeletal traction is used for days or weeks until the bone is ready for casting or open
reduction (surgery to place the bone back into a normal position).
PTS: 1
DIF: Moderate
REF: 969
OBJ: 1
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Teaching/Learning
28. ANS:
cervical; thoracic; skull
Crutchfield tongs are used in the treatment of cervical and thoracic fractures. The tongs are placed
into the child’s skull. The pull is along the axis of the spine. The traction usually hangs off the head
of the bed and the countertraction is the body.
PTS: 1
DIF: Easy
REF: 969
OBJ: 1
KEY: Cognitive Level: Knowledge | Content Area: Peds/Maternity | Patient Needs: SECE/Management of
Care | Integrated Process: Clinical Problem Solving (Nursing Process)
29. ANS:
nail bed; 3
Capillary refill time (CRT) is assessed by applying brief pressure to the nail bed and noting how
quickly pink color returns. CRT of less than 3 seconds is the norm. If CRT is greater than 3 seconds,
circulation is poor.
PTS: 1
DIF: Moderate
REF: 970
OBJ: 3
KEY: Cognitive Level: Application | Content Area: Peds/Maternity | Patient Needs: Health Promotion and
Maintenance | Integrated Process: Clinical Problem Solving (Nursing Process)