Pillitteri: Maternal and Child Health Nursing, 5 Edition

Pillitteri: Maternal and Child Health Nursing, 5th Edition
Chapter 51: Nursing Care of the Child With a Musculoskeletal Disorder
1. A 2-year-old is diagnosed with osteomyelitis. Which of the following would you anticipate as
a primary nursing intervention to include in the child's plan of care?
A) Maintaining intravenous antibiotic therapy.
B) Keeping the child quiet while in skeletal traction.
C) Restricting fluid to encourage red cell production.
D) Assisting the child with crutch walking.
Ans: A
Client Needs: D-2: Nursing process
Cognitive Level: Application
Difficulty: Moderate
Objective: 5
Feedback: Osteomyelitis is a serious infection. It is treated vigorously with intravenous
antibiotics.
2. A 7-year-old is seen with pauciarticular juvenile arthritis. She notices extreme pain when she
wakes in the morning. The best advice you can give her parents would be to
A) have her take 325 mg of aspirin immediately on arising.
B) encourage her to take a warm bath each morning before school.
C) have her do isotonic exercises until the pain is gone.
D) encourage her to remain in bed until the pain is gone.
Ans: B
Difficulty: Difficult
Objective: 5
Feedback: Taking aspirin on an empty stomach could lead to gastric irritation; warmth is
soothing to arthritic joints.
3. The physician of a child with juvenile arthritis asks you to telephone the school to arrange a
new activity program for her. A change you would anticipate arranging for her is to
A) be excused from all extracurricular activities.
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B) begin school earlier in the day than other children.
C) be excused from all swimming classes.
D) modify her physical program.
Ans: D
Objective: 5
Feedback: Children with arthritis should be encouraged to maintain as near normal a school
program as possible to maintain self-esteem. Some activities may need to be modified because of
pain or joint contractures.
4. A child with pauciarticular juvenile arthritis is scheduled for an eye examination every 3
months. The examination is important because
A) iridocyclitis may occur as a basic symptom of her disease.
B) the eye globe does not continue to grow with juvenile arthritis.
C) continuous drug therapy causes corneal opacity.
D) eye infection may develop easily with juvenile rheumatoid arthritis.
Ans: A
Objective: 1
Feedback: Inflammation or iridocyclitis can occur as part of the basic involvement of juvenile
rheumatoid arthritis.
5. You are caring for a child with a broken wrist that has just been placed in a cast. You would
elevate the arm to
A) promote healing.
B) prevent edema.
C) discourage infection.
D) ensure proper bone alignment.
Ans: B
Objective: 5
Feedback: Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling
from the injury.
6. You assist with the application of a full body plaster cast to a child. The child immediately
becomes diaphoretic and complains of being hot. Which nursing intervention would be
indicated?
A) Observe the child for infection.
B) Suggest removal of the cast to the orthopedist.
C) Moisten the cast with cool water.
D) Advise the child that this is to be expected.
Ans: D
Objective: 6
Feedback: Plaster becomes hot as it sets. This effect is reduced with newer plastic casts.
7. A 14-year-old girl is diagnosed as having scoliosis. When doing scoliosis screening with her,
an important observation would be to note
A) her posterior spine when she bends forward.
B) the angle of the iliac crest when she bends forward.
C) the posterior spine when she bends sideways.
D) the angle of her lower chest when she sits down.
Ans: A
Client Needs: B-2: Nursing process
Difficulty: Easy
Objective: 2
Feedback: A lateral curvature of the spine (scoliosis) is best revealed when the child bends
forward.
8. A girl with scoliosis is prescribed a body brace. The purpose of the brace is to
A) improve spinal alignment.
B) correct spinal curvature.
C) prevent herniation of a spinal disk.
D) prevent torticollis.
Ans: A
Objective: 1
Feedback: Body bracing helps to hold the spine in alignment and prevent further curvature.
9. While an adolescent wears a body brace for scoliosis, you would teach her
A) to continue with age-appropriate activities.
B) to stand absolutely still whenever she is out of the brace.
C) to wear the brace a maximum of 20 hours each day.
D) that secondary sex changes will stop until the brace is removed.
Ans: A
Client Needs: B-2: Teaching/learning
Objective: 6
Feedback: Wearing a body brace should not interfere with normal activities, which are necessary
to maintain adolescent self-esteem.
10. An adolescent girl has spinal instrumentation surgery at 16 years of age. Immediately after
this procedure, you would teach her to
A) sit up immediately afterward, although this may hurt.
B) always sleep prone.
C) wait to be logrolled before turning from one side to the other.
D) plan on 6 months of hospitalization.
Ans: C
Client Needs: D-3: Teaching/learning
Objective: 5
Feedback: Spinal instrumentation means rods are placed beside the spine, and the vertebrae are
fused. Logrolling is necessary to prevent injury until the fusion is complete.
11. The most important assessment of neurovascular status to make after spinal surgical
instrumentation would be to
A) check the nailbeds of the fingers for capillary refill.
B) determine the presence of brachial pulses.
C) assess the legs for warmth.
D) ask if the child has pain.
Ans: C
Objective: 2
Feedback: The edema that accompanies spinal instrumentation surgery can impair circulation to
lower extremities.
12. Fractures in children are always potentially serious injuries. Which child with a fracture
would you observe most closely for complication?
A) One who has a greenstick radial injury.
B) One who has an ulnar fracture.
C) One who has a fractured patella.
D) One who has an elbow fracture.
Ans: D
Objective: 2
Feedback: Elbow injuries are particularly dangerous because edema can interfere with blood
vessels and nerves that pass beside the joint.
13. You meet a child with a slipped femoral epiphysis. In what type of child does this usually
occur?
A) Tall, thin girls.
B) Obese adolescent boys.
C) Preadolescent girls.
D) Active school-age children.
Ans: B
Cognitive Level: Comprehension
Difficulty: Easy
Objective: 2
Feedback: A slipped epiphyseal femur injury most typically occurs in overweight preadolescent
or adolescent boys.
14. When helping parents plan care for a child with Legg-Calvé-Perthes disease, you would
teach them that the usual therapy for children with this disorder is
A) surgery with supporting rods.
B) passive range-of-motion exercises TID.
C) a non–weight-bearing period.
D) exercise to increase muscle strength of the knee joint.
Ans: C
Objective: 4
Feedback: Resting the affected femoral epiphysis aids healing.
15. An infant is placed in Bryant's traction. For Bryant's traction to be effective, the infant must
be positioned
A) on the back with hips flat on the bed.
B) on the stomach with both legs extended.
C) on the back with the injured hip flexed and the uninjured one extended.
D) on the back with hips up off the bed.
Ans: D
Objective: 7
Feedback: For there to be traction, the infant's hips must be off the bed.
16. A 9-year-old with myasthenia gravis is treated with neostigmine. To ensure the child's safety,
you would ensure that which of the following drugs is readily available?
A) Edrophonium (Tensilon).
B) Prednisone.
C) Atropine.
D) Allopurinol.
Ans: C
Objective: 5
Feedback: Atropine is the antidote for neostigmine (an anticholinesterase agent).
17. As a school nurse, which activity warrants the most careful observation for a child with
myasthenia gravis?
A) Walking between classrooms.
B) Eating lunch.
C) Taking a test.
D) Walking down the front steps.
Ans: B
Objective: 2
Feedback: Children with myasthenia gravis may develop weakened muscle control during
eating, leading to aspiration if not observed closely.
18. A child with muscular dystrophy is seen in your clinic. A common form of this can be
detected in children by the presence of a positive Gowers' sign. This is
A) weakened deep tendon reflexes.
B) inability to rise from the floor without pressing the hands against ankles, knees, and thighs.
C) inability to keep the eyelids open for more than 30 seconds.
D) exaggerated spinal reflexes.
Ans: B
Cognitive Level: Knowledge
Difficulty: Easy
Objective: 2
Feedback: Gowers' sign, or the inability to rise from the floor except using the hands to “walk
up” the body, is diagnostic of muscular dystrophy.
19. A neighbor of a child with muscular dystrophy is concerned that she may contract his illness.
You would explain to her that
A) the mode of transmission of muscular dystrophy is unknown.
B) the virus of muscular dystrophy has an unpredictable incubation period.
C) muscular dystrophy is inherited, so it is not contagious.
D) muscular dystrophy occurs predominantly in males.
Ans: C
Client Needs: B-2: Teaching/learning
Objective: 1
Feedback: Muscular dystrophy is inherited. The most common type is inherited as a sex-linked
recessive trait (pseudohypertrophic muscular dystrophy).
20. The mother of a child with muscular dystrophy asks you what type of diet her son will need
to follow. You would advise her that
A) there is no special diet necessary for her son.
B) a high-protein, high-carbohydrate diet may be helpful.
C) extra creatinine should be added to his diet daily.
D) a moderate-calorie diet will help him remain ambulatory longer.
Ans: D
Client Needs: D-1: Teaching/learning
Objective: 4
Feedback: Preventing a child from gaining excess weight can allow him to be ambulatory
longer. Because of lack of activity, it is easy to gain weight.
21. A 7-year-old with a fractured femur is in skeletal traction. Which nutrient should the nurse
encourage in his diet during this time?
A) Vitamin D
B) Calcium
C) Protein
D) Carbohydrates
Ans: C
Cognitive Level: Analysis
Objective: 6
Feedback: Protein helps with overall healing in the body. The addition of extra calcium is not
recommended if the child is on bed rest because of the potential for development of renal calculi.
22. A 6-year-old child has just spent 10 days in skeletal traction for a fractured femur. When
doing preoperative teaching before the cast application, a priority that the nurse should focus on
with the parents and child is:
A) The child will need physical therapy for crutch training postoperatively.
B) The child will be able to have a walking cast applied after 2 weeks.
C) The child will have the cast on for at least 3 to 4 weeks.
D) The child will be able to have the cast removed after 12 weeks.
Ans: C
Client Needs: D-1: Teaching
Objective: 6
Feedback: Once callus formation begins, a cast is applied. The younger child will have a more
rapid healing process than the older child. Use of crutches or walking casts are not appropriate
with a fractured femur in a young child.
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Pillitteri: Maternal and Child Health Nursing, 5th Edition

Chapter 51: Nursing Care of the Child With a Musculoskeletal Disorder

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