Question 1

Which type of traction uses skin traction on the lower leg and a padded sling under the knee?

Accepted Answer

A)   Dunlop
B)   Bryant's
C)   Russell
D)   Buck's extension C

Question 2

The nurse is caring for a 4-year-old child immobilized by a fractured hip.Which complication should the nurse monitor for?

Accepted Answer

A)   Hypocalcemia
B)   Decreased metabolic rate
C)   Positive nitrogen balance
D)   Increased production of stress hormones B

Question 3

The nurse is caring for an infant with developmental dysplasia of the hips (DDH).Which clinical manifestations should the nurse expect to observe? (Select all that apply.)

Accepted Answer

A)   Positive Ortolani sign
B)   Unequal gluteal folds
C)   Negative Babinski's sign
D)   Trendelenburg's sign
E)   Telescoping of the affected limb F)  Lordosis A,B

Question 4

A neonate is born with mild clubfeet.When the parents ask the nurse how this will be corrected,the nurse should base the explanation on what fact?

Accepted Answer

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.

Question 5

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease.Nursing considerations should include which action?

Accepted Answer

A)   Encouraging normal activity for as long as is possible.
B)   Explaining the cause of the disease to the child and family.
C)   Preparing the child and family for long-term, permanent disabilities.
D)   Teaching the family the care and management of the corrective appliance.

Question 6

The nurse is teaching the parents of a 7-year-old child who has just had a cast applied for a fractured arm with the wrist and elbow immobilized.Which instructions should be included in the teaching?

Accepted Answer

A)   Swelling of the fingers is to be expected for the next 48 hours.
B)   Immobilize the shoulder to decrease pain in the arm.
C)   Allow the affected limb to hang down for 1 hour each day.
D)   Elevate casted arm when resting and when sitting up.

Question 7

What is an advantage to using a fiberglass cast instead of a plaster cast?

Accepted Answer

A)   Is less expensive
B)   Dries rapidly
C)   Molds closely to body parts
D)   Has a smooth exterior

Question 8

Four year old,placed in Buck's extension traction for Legg-Calvé-Perthes disease,is crying with pain as the nurse assesses that the skin of the right foot is pale with an absence of pulse.What should the nurse do first?

Accepted Answer

A)   Notify the practitioner of the changes noted.
B)   Give the child medication to relieve the pain.
C)   Reposition the child and notify the physician.
D)   Chart the observations and check the extremity again in 15 minutes.

Question 9

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia.Which assessment findings indicate possible compartment syndrome? (Select all that apply.)

Accepted Answer

A)   Palpable distal pulse
B)   Capillary refill to extremity of 
C)   Severe pain not relieved by analgesics
D)   Tingling of extremity
E)   Inability to move extremity

Question 10

The nurse uses the palms of the hands when handling a wet cast to achieve what outcome?

Accepted Answer

A)   Assess dryness of the cast
B)   Facilitate easy turning
C)   Keep the patient's limb balanced
D)   Avoid indenting the cast

Question 11

A child is upset because,when the leg cast is removed,the skin surface is caked with desquamated skin and sebaceous secretions.What should the nurse suggest to remove this material?

Accepted Answer

A)   Soak in a bathtub
B)   Vigorously scrub the leg
C)   Apply powder to absorb material
D)   Carefully pick material off of the leg

Question 12

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic arthritis (JIA)?

Accepted Answer

A)   Aspirin
B)   Corticosteroids
C)   Cytotoxic drugs such as methotrexate
D)   Nonsteroidal antiinflammatory drugs (NSAIDs)

Question 13

What would cause a nurse to suspect that an infection has developed under a cast?

Accepted Answer

A)   Complaint of paresthesia
B)   Cold toes
C)   Increased respirations
D)   "Hot spots" felt on cast surface

Question 14

When infants are seen for fractures,which nursing intervention is a priority?

Accepted Answer

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.

Question 15

What is the initial method of treating osteomyelitis?

Accepted Answer

A)   Joint replacement
B)   Bracing and casting
C)   Intravenous antibiotic therapy
D)   Long-term corticosteroid therapy

Question 16

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma.The nurse's approach should include what intervention?

Accepted Answer

A)   Answering questions with straightforward honesty.
B)   Avoiding discussing the seriousness of the condition.
C)   Explaining that, although the amputation is difficult, it will cure the cancer.
D)   Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy.

Question 17

What nursing consideration is especially important when caring for a child diagnosed with juvenile idiopathic arthritis (JIA)?

Accepted Answer

A)   Apply ice packs to relieve stiffness and pain.
B)   Administer acetaminophen to reduce inflammation.
C)   Teach child and family the correct administration of medications.
D)   Encourage range-of-motion exercises during periods of inflammation.

Question 18

What is an appropriate nursing intervention when caring for a child in traction?

Accepted Answer

A)   Remove adhesive traction straps daily to prevent skin breakdown.
B)   Assess for tightness, weakness, or contractures in uninvolved joints and muscles.
C)   Provide active range-of-motion exercises to affected extremity 3 times a day.
D)   Keep child in one position to maintain good alignment.

Question 19

Which term is used to describe a type of fracture that does not produce a break in the skin?

Accepted Answer

A)   Simple
B)   Compound
C)   Complicated
D)   Comminuted

Question 20

Which condition can result from the bone demineralization associated with immobility?

Accepted Answer

A)   Osteoporosis
B)   Urinary retention
C)   Pooling of blood
D)   Susceptibility to infection

Exam 48: The Child With Musculoskeletal or Articular Dysfunction