Price: Pediatric Nursing, 11 Edition: Chapter 17: Musculoskeletal Disorders Testbank Multiple Choice

Price: Pediatric Nursing, 11th Edition
Chapter 17: Musculoskeletal Disorders

Testbank
MULTIPLE CHOICE
1. The nurse understands that a difference in the childs skeletal system as compared to an
adults is:
a. The thick periosteum assists in repair of fractures
b. Growth is not affected by fractures
c. Bone overgrowth in healing fractures is uncommon
d. The childs bones are less porous than an adults bones
ANS: A
Thick, rich periosteum assists in rapid repair of a fracture in a child. Childrens fractures
can result in overgrowth. The childs bones are more porous and less dense than an
adults bones.
DIF: Cognitive Level: Comprehension REF: p. 318
OBJ: 2
TOP: Periosteum KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
2. The nurse writes out a schedule for the casting procedures to correct a clubfoot, which
would be:
a. At 5-day intervals for the first 4 weeks
b. At 1-week intervals for the first 6 weeks
c. At 10-day intervals for the first 8 weeks
d. At 2-week intervals for the first 10 weeks
ANS: B
The casting is repeated every week for the first 6 weeks and then at 1- to 2-week intervals
until a more anatomic position has been achieved.
OBJ: N/A
TOP: Casting for Clubfoot
KEY: Nursing Process Step:
Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
3. The nurse clarifies that the brace applied to help correct a clubfoot should be worn:
a. Only at night
b. 6 hours at a time
c. 8 hours on, and then 2 hours off
d. 23 hours per day
ANS: D
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Testbank
17-2
The brace that is applied in an attempt to correct a clubfoot is worn 23 hours per day for
an extended amount of time.
OBJ: N/A
TOP: Brace for Clubfoot
Implementation
4. The goal of clubfoot repair is to have a corrected foot by the time the child is:
a. 6 months of age
b. 9 months of age
c. 12 months of age
d. 18 months of age
ANS: C
The goal of clubfoot repair is to be completed by the time the child is 12 months of age
so the child can use normal shoes when learning to walk.
DIF: Cognitive Level: Comprehension
TOP: Clubfoot Correction
MSC: NCLEX: N/A
REF: p. 319
OBJ: N/A
KEY: Nursing Process Step: N/A
5. When the 8-month-old child who has had a plaster cast applied becomes fussy and
irritable, the mother asks how long it will take the cast to dry. The nurses response will
be based on the knowledge that plaster casts dry in about:
a. 2 hours
b. 10 hours
c. 18 hours
d. 24 hours
ANS: D
Plaster casts take 24 to 72 hours to dry.
DIF: Cognitive Level: Knowledge
REF: p. 319
OBJ: N/A
TOP: Plaster
KEY: Nursing Process Step: Implementation
6. When caring for a child with a broken leg who is in a wet plaster cast, the nurse should:
a. Cover the cast to keep from chilling the child
b. Rest the cast on the foot of the bed to relieve the weight
c. Handle the cast with the palms of the hands
d. Avoid moving the child until the cast is dry
ANS: C
The cast should be handled with the palms of the hands, not the fingers, to keep from
making indentations. For the same reason, the cast is not propped on a hard surface. The
child should be repositioned every 2 hours. The cast should not be covered as it will delay
drying.
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Testbank
17-3
DIF: Cognitive Level: Application

REF: p. 319
OBJ: N/A
TOP: Plaster Cast KEY: Nursing Process Step: Implementation
7. When the 8-year-old complains of the rough edges of the cast cutting her fingers, the
nurse should:
a. Tape adhesive over the fingers
b. Shake a small amount of powder into the cast
c. Soften the edge of the cast with warm oil and remold the cast
d. Apply adhesive petals around the edge of the cast
ANS: D
Petaling a cast with adhesive tape will reduce the discomfort of rough edges against the
patients skin.
OBJ: N/A
TOP: Petaling
8. When the child comes back from surgery after the correction of a clubfoot, the nurse
assesses a discolored area on the cast. The initial intervention of the nurse should be:
a. Make a note in the patient record
b. Notify the charge nurse
c. Circle the area and write the time
d. Elevate the limb
ANS: C
The initial intervention should be to circle the area and write the time on the cast in order
to evaluate if the area changes in size. After this initial intervention, the limb is elevated,
the charge nurse or physician is notified, and a note is made in the patient record.
REF: p. 318
OBJ: N/A
TOP: Cast Assessment
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Reduction of Risk
9. The nurse recognizes the Trendelenburg gait as a diagnostic sign of:
a. Legg-Calv-Perthes disease
b. Duchenne muscular dystrophy
c. Developmental dysplasia of the hip (DDH)
d. Scoliosis
ANS: C
The Trendelenburg gait is the diagnostic gait of a child with developmental dysplasia of
the hip (DDH).
TOP: Developmental Dysplasia of the Hip
OBJ: N/A
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Testbank
17-4

MSC: NCLEX: Physiological Integrity: Physiological Adaptation
10. The nurse explains that the desired outcome of the treatments to correct developmental
dysplasia of the hip is:
a. Stimulate ossification of the head of the femur
b. Deepen the acetabulum
c. Surgically rebuild the acetabulum
d. Prevent the femur from pressing into the acetabulum
ANS: B
Deepening the acetabulum by pressing the head of the femur into it will deepen the joint
and allow the head of the femur to be stabilized. This is accomplished by the use of a
pillow splint or a Pavlik harness.
DIF:
TOP:
KEY:
MSC:
Cognitive Level: Comprehension REF: p. 320

OBJ: N/A
Developmental Dysplasia of the Hip
Nursing Process Step: Implementation
NCLEX: Physiological Integrity: Physiological Adaptation
11. The nurse giving tips to parents of a child in the Pavlik harness would suggest that to
prevent chafing they should:
a. Use powder in the diaper area
b. Dress the baby in a T-shirt and long socks
c. Take the harness off every 2 hours
d. Use lanolin-based ointment on the legs
ANS: B
The use of a T-shirt and long socks will help relieve chafing as the baby will be in the
harness full-time except for diaper changes.
OBJ: 3
TOP: Pavlik Harness
Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of
Disease
12. The nurse recognizes that a child with cerebral palsy who has jerky movements and
scissoring of the legs has the type of cerebral palsy classified as:
a. Mixed
b. Athetoid
c. Spastic
d. Dyskinetic
ANS: C
Jerky movements and scissoring of the legs are characteristic of spastic cerebral palsy.
DIF:
Cognitive Level: Comprehension
REF: p. 323
OBJ: N/A
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Testbank
17-5
TOP: Spastic Type of Cerebral Palsy

13. The nurse caring for a child with Duchenne muscular dystrophy notes a characteristic
manifestation, which is that the child:
a. Ambulates by holding onto furniture
b. Exhibits atrophy of the calf muscles
c. Falls frequently and is clumsy
d. Has delayed fine-motor development
ANS: C
The child with Duchenne muscular dystrophy is clumsy and falls frequently because of
pseudohypertrophy of the calves and contractures of the ankles and hips.
OBJ: 4
TOP: Duchenne Muscular Dystrophy
14. The nurse is aware that an activity that will help delay muscle atrophy for a child with
Duchenne muscular dystrophy is:
a. Progressive weight lifting
b. Riding a seesaw
c. Swimming
d. Working on a trampoline
ANS: C
Swimming is helpful to promote range of motion and delay muscle atrophy.
OBJ: 4
TOP: Duchenne Muscular Dystrophy
KEY: Nursing Process Step: Planning
15. The nurse is concerned about the fracture across the epiphyseal plate of a 9-year-old child
because such a fracture could:
a. Interfere with bone growth
b. Progress into osteomyelitis
c. Cause a mis-union of the bone ends
d. Lead to a long recovery period
ANS: A
Fractures that disturb the epiphyseal plate can affect bone growth.
OBJ: 6
TOP: Pediatric Fractures
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Testbank
17-6
16. A 17-year-old whose legs were crushed in a motorcycle accident has come to the
emergency department. While waiting for x-rays, the patient begins to sweat and have
labored breathing. The nurse suspects that the patient has had:
a. An anxiety attack
b. The onset of shock
c. A fat embolism
d. An aspiration of blood
ANS: C
A fat embolism occurs as fat escapes from the bone marrow. The signs of an embolism
are labored respirations and a possible change in level of consciousness. This condition
should be reported immediately.
DIF: Cognitive Level: Analysis
REF: p. 325
OBJ: 6
TOP: Fat Embolism
17. The nurse explains that Russell traction is a type of skin traction that:
a. Subluxates the tibia
b. Does not interfere with range of motion
c. Prevents the knee from flexing
d. Supplies continuous pull in two directions
ANS: D
Russell traction is skin traction (similar to Bucks traction) with a sling positioned under
the knee, which prevents subluxation of the tibia. Although the traction interferes with
full range of motion, the patient can change position without disrupting the continuous
pull in two directions.
REF: p. 327
OBJ: 6
TOP: Russell Traction
Implementation
18. The nurse assesses that a 5-year-old who is in Russell traction is holding his left elbow
with the right hand and seems to be in pain. The child will not use the left arm to reach
for a toy or a glass of juice. Based on these assessments, the nurse suspects the child has
suffered:
a. Muscle spasms
b. A pulled muscle
c. A dislocated elbow
d. Osteomyelitis
ANS: C
Dislocated elbows in children who are in traction are not uncommon. The injury occurs
when the child uses a twisting motion of the lower arm and hand, which dislocates the
radial head.
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Testbank
17-7

REF: p. 329
OBJ: N/A
TOP: Dislocated Elbow
Disease.
19. The nurse caring for a child in traction with a broken leg should add to the plan of care an
intervention to prevent constipation, such as:
a. Offering different fluids during the day
b. Encouraging the intake of milk products
c. Avoiding fruits
d. Limiting foods high in fiber
ANS: A
Offering fluids frequently, providing fluids at the bedside, and encouraging foods high in
fiber will help prevent constipation.
REF: p. 329
OBJ: 5
TOP: Prevention of Constipation
Implementation
20. In discussing the long-term effects of Legg-Calv-Perthes disease, the nurse would
include the information that:
a. There are no long-term effects
b. The disease is likely to recur
c. Deformity of the femoral head may result in arthritis
d. There is a risk of osteogenic sarcoma in adulthood
ANS: C
Deformity of the femoral head can cause problems such as arthritis in later life.
REF: p. 329
OBJ: 7
TOP: Legg-Calv-Perthes disease
Implementation
21. When a 3-year-old girl is diagnosed with neuromuscular scoliosis, the nurse explains that
the spinal curvature defect is usually caused by:
a. Juvenile rheumatoid arthritis
b. Poor posture
c. Heredity
d. Myelomeningocele
ANS: D
Neuromuscular scoliosis is the result of a disease such as cerebral palsy or spina bifida.
REF: p. 332
OBJ: N/A
TOP: Scoliosis
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Testbank
17-8

22. A nurse assessing a preadolescent child for scoliosis would:
a. Ask the child to bend forward at the waist, and then observe the childs back for
asymmetry
b. Observe the gait while the child is walking forward heel to toe
c. Have the child flex the knees and look for uneven knee height
d. Look at the childs shoulders and hips while fully clothed
ANS: A
The nurse looks at the back, as the child bends forward, for general body alignment and
asymmetry.
REF: p. 333
OBJ: N/A
TOP: Scoliosis
Disease
23. The nurse providing instructions to an adolescent who has been fitted with a Milwaukee
brace would suggest:
a. Wearing the brace directly against the skin
b. Wearing the brace over regular clothing
c. Wearing the brace over a T-shirt 23 hours per day
d. Removing the brace before sleeping
ANS: C
A Milwaukee brace is worn approximately 23 hours per day over a T-shirt that protects
the skin. Some experts believe the same therapeutic outcome will occur with only 16
hours of wear per day.
OBJ: 8
TOP: Milwaukee Brace
Implementation
COMPLETION
1. The nurse informs the parents of a child with a clubfoot that the ___________ method is
the current method of manipulation.
ANS:
Ponseti
The Ponseti method is the current method employed for manipulation of a clubfoot. The
foot is gently manipulated into better alignment and then casted. These steps are repeated
until the foot is straightened.
DIF:
Cognitive Level: Knowledge
REF: p. 319
OBJ: N/A
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Testbank
17-9
TOP: Manipulation
Implementation
2. The nurse is aware that in the condition of developmental dysplasia of the hip (DDH), the
deformity is caused when the head of the femur does not seat itself in the __________.
ANS:
Acetabulum
The head of the femur in a child with DDH is displaced from the shallow acetabulum.
DIF:
TOP:
KEY:
MSC:

OBJ: N/A
Nursing Process Step: Planning
3. When the pediatrician abducts the childs femur, the nurse hears an audible click, which
is the diagnostic sign called______________.
ANS:
Ortolanis sign
Ortolanis sign is the audible click heard when the femur is snapped back into the
acetabulum.
OBJ: 1
TOP: Ortolanis Sign
4. The child with Duchenne muscular dystrophy must push on his or her legs and walk up
the leg in order to rise to a standing position. The nurse recognizes this characteristic
behavior as the __________ maneuver.
ANS:
Gower
The Gower maneuver is a characteristic method of rising from the floor by walking up
the legs to push the upper body erect.
TOP: Gower Maneuver
MSC: NCLEX: N/A
REF: p. 324
OBJ: 4
5. The child with cerebral palsy who exhibits slow writhing movements that increase during
periods of emotional stress is showing the characteristics of __________ cerebral palsy.
ANS:
Athetoid
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Testbank
17-10
The athetoid or dyskinetic type of cerebral palsy exhibits slow writhing movements that
increase during periods of emotional stress.
TOP: Athetoid Cerebral Palsy
MSC: NCLEX: N/A
REF: p. 325
OBJ: N/A
6. The five Ps of compartment syndrome are: (1)_____(2)_____(3)_____(4)_____(5)_____

ANS:
Pain, pallor, pulselessness, paresthesia, and paralysis
Compartment syndrome can occur as a result of pressure on tissues resulting from edema
or swelling. This pressure compromises the circulation and results in pain, pallor,
pulselessness, paresthesia, and paralysis distal to the swelling. This is a medical
emergency.
TOP: Compartment Syndrome
MSC: NCLEX: N/A
REF: p. 329
OBJ: 6
MULTIPLE RESPONSE
1. The nurse is aware that the musculoskeletal system of the child is composed of: (Select
all that apply.)
a. Major blood vessels
b. Bones
c. Joints
d. Muscle
e. Cartilage
ANS: B, C, D, E
The musculoskeletal system is composed of bones, joints, muscle, and cartilage.
REF: p. 318
OBJ: 2
TOP: Musculoskeletal System
2. The nurse reassures a worried parent that the childs fracture will heal quickly because
the rich periosteum provides: (Select all that apply.)
a. Blood vessels
b. Calcium
c. Nerve fibers
d. Lymphatic vessels
e. Fat cells
ANS: A, C, D
The periosteum contains blood vessels, nerve fibers, and lymphatic vessels.
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Testbank
17-11

REF: p. 318
OBJ: 2
TOP: Periosteum KEY: Nursing Process Step: Implementation
3. The nurse is glad to see that the 3-month-old is going to be casted with a synthetic cast
because synthetic casts: (Select all that apply.)
a. Dry quicker
b. Do not cause circulatory problems
c. Are lighter
d. Allow for greater mobility
e. Can be modified and reused
ANS: A, C, D
Synthetic casts made of fiberglass or polyurethane dry in less than 30 minutes and are
lighter and allow for more mobility.
OBJ: N/A
TOP: Synthetic Casts
4. Signs and symptoms that would indicate that a leg cast has interfered with the circulation
of a limb would be: (Select all that apply.)
a. Pallor
b. Pain
c. Weak pulse
d. Warmth in toes
e. Paralysis
ANS: A, B, C, E
Pallor, pain, weakness or lack of pulse, burning, coldness, paralysis, and numbness are all
indicators of an embarrassed circulation. Warm toes indicate adequate circulation. The
cast may need to be slit or removed entirely.
REF: p. 319
OBJ: N/A
TOP: Circulatory Checks
Disease
5. The nurse in a well-child clinic would suspect a child to have developmental dysplasia of
the hip (DDH) when diagnostic characteristics are assessed such as: (Select all that
apply.)
a. A narrow pelvis
b. Asymmetrical gluteal folds
c. The foot on the affected side turns out
d. When legs are flexed, one knee is lower than the other
e. The foot on the affected side is cooler
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Testbank
17-12
ANS: B, D
Indications of DDH that are characteristic are asymmetric gluteal folds on the affected
side, and when the legs are flexed the knee on the affected side is lower than the other.
DIF:
TOP:
KEY:
MSC:
Cognitive Level: Application

REF: p. 320
OBJ: N/A
Nursing Process Step: Assessment
6. The nurse instructing parents in the care of a child in a body spica cast would include the
information to: (Select all that apply.)
a. Use firm pillows in curvatures of the cast for support
b. Elevate the childs head and shoulders with pillows
c. Tuck a disposable diaper under the buttocks to prevent soiling the cast
d. Use a bib to keep food from falling into the cast
e. Relieve itching by blowing warm air from a hair dryer into the cast
ANS: A, C, D
Pillows should be used under curvatures of the cast; the head and shoulders should not be
elevated on pillows as it may cause respiratory difficulty. A disposable diaper tucked into
the buttock opening of the cast can prevent soiling the cast with feces. A bib will keep
food from entering the cast. Cool air is helpful with itching.
REF: p. 321
OBJ: 5
TOP: Spica Cast
7. The nurse is aware that some causes of cerebral palsy include: (Select all that apply.)
a. Perinatal cerebral hemorrhage
b. Prolonged labor
c. Maternal use of tobacco
d. Maternal exposure to rubella
e. Sexually transmitted diseases in the mother
ANS: A, B, D
Hemorrhage, prolonged labor, and exposure to infectious diseases such as rubella are
recognized causes of cerebral palsy.
OBJ: N/A
TOP: Cerebral Palsy
8. The nurse explains to the parents of a child with Duchenne muscular dystrophy that
treatment for this horrible disease is centered on: (Select all that apply.)
a. Progressive strengthening exercises
b. Passive exercises to prevent contractures
c. Surgery for joint contractures
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Testbank
17-13
d. Aggressive programs for weight control

e. Bracing for limb stability
ANS: B, C, D, E
Progressive strengthening exercises are not part of the treatment plan for Duchenne
muscular dystrophy.
DIF:
TOP:
KEY:
MSC:

OBJ: 4
Treatment for Duchenne Muscular Dystrophy
Nursing Process Step: Implementation
NCLEX: Physiological Integrity: Basic Care and Comfort
9. The school nurse is called to the schoolyard where there is a child on the ground with an
obvious simple fracture of the tibia. The nurse should: (Select all that apply.)
a. Call for assistance to carry the child into the building
b. Immobilize the limb with rolled newspapers or magazines
c. Apply ice cubes directly to the swelling
d. Call EMS
e. Immobilize the joints at the knee and ankle
ANS: B, D, E
The limb should be immobilized by a splint made of anything handy, and the joints above
and below the suspected fracture should be immobilized as well. Ice should be collected
in a cloth, but not put directly to the skin. Call EMS.
REF: p. 325
OBJ: 6
TOP: Skeletal
10. The nurse reviews the general rules for maintaining adequate tractions, which include:
(Select all that apply.)
a. Ropes to weights in the grooves of the pulleys
b. The child should be kept in anatomic alignment
c. Ace bandages should be wrapped tightly
d. Weights should hang free
e. Traction can be removed to facilitate care
ANS: A, B, D
Ropes should be in the pulleys, the child should be kept in alignment, the weights should
hang free, and the traction should be continuous. The bandages should not be wrapped
tightly, to prevent obstruction of circulation, and the traction should not be interrupted.
REF: p. 329
OBJ: 6
TOP: Traction
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Price: Pediatric Nursing, 11th Edition

Chapter 17: Musculoskeletal Disorders

DIF: Cognitive Level: Application

KEY: Nursing Process Step: Assessment

Cognitive Level: Comprehension REF: p. 320

Cognitive Level: Comprehension

TOP: Spastic Type of Cerebral Palsy

DIF: Cognitive Level: Application

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

Cognitive Level: Knowledge

Cognitive Level: Comprehension REF: p. 318

6. The five Ps of compartment syndrome are: (1)___(2)_(3)_(4)_(5)___

DIF: Cognitive Level: Knowledge

Cognitive Level: Application

d. Aggressive programs for weight control

Cognitive Level: Comprehension REF: p. 325

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