Chapter 50 The Child with a Musculoskeletal Alteration

Chapter 50  The Child with a Musculoskeletal Alteration

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. Which statement is accurate concerning a child’s musculoskeletal system and how it may be

different from an adult’s?
a. Growth occurs in children as a result of an increase in the number of muscle fibers.
b. Infants are at greater risk for fractures because their epiphyseal plates are not

fused.
c. Because soft tissues are resilient in children, dislocations and sprains are less

common than in adults.
d. Their bones have less blood flow.

ANS: C
Because soft tissues are resilient in children, dislocations and sprains are less common than in
adults. A child’s growth occurs because of an increase in size rather than an increase in the
number of the muscle fibers. Fractures in children younger than 1 year are unusual because a
large amount of force is necessary to fracture their bones. A child’s bones have greater blood
flow than an adult’s bones.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1208 | Pediatric Differences Box OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

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

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.

ANS: C
Fractures in infants warrant further investigation to rule out child abuse. Fractures in children
younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large
amount of force is necessary to fracture their bones. Safety practices are important to assess as
well, but the priority is checking for child abuse. Genetic factors are a rare cause of fractures.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 1208 | Pediatric Differences Box
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. Which nursing intervention is appropriate to assess for neurovascular competency in a child

who fell off the monkey bars at school and hurt his arm?
a. The degree of motion and ability to position the extremity
b. The length, diameter, and shape of the extremity
c. The amount of swelling noted in the extremity and pain intensity
d. The skin color, temperature, movement, sensation, and capillary refill of the

extremity

ANS: D

A neurovascular evaluation includes assessing skin color and temperature, ability to move the
affected extremity, degree of sensation experienced, and speed of capillary refill in the
extremity. The degree of motion in the affected extremity and ability to position the extremity
are incomplete assessments of neurovascular competency. The length, diameter, and shape of
the extremity are not assessment criteria in a neurovascular evaluation. Although the amount
of swelling is an important factor in assessing an extremity, it is not a criterion for a
neurovascular assessment.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1217 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

4. A mother whose 7-year-old child has been placed in a cast for a fractured right arm reports

that the child will not stop crying even after taking acetaminophen with codeine. The child
also will not straighten the fingers on the right arm. What advice by the nurse is best?
a. Take the child to the emergency department.
b. Put ice on the injury.
c. Avoid letting the child get so tired.
d. Wait another hour; if the child is still crying, call back.

ANS: A
Unrelieved pain and the child’s inability to extend his fingers are signs of compartment
syndrome, which requires immediate attention. Placing ice on the extremity is an
inappropriate action for the symptoms. Telling the mother not to let her child get tired is an
inappropriate response to a concern. A child who has signs and symptoms of compartment
syndrome should be seen immediately. Waiting an hour could compromise the recovery of the
child.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 1213 | p. 1216 | Parents Want to Know Box
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

5. A 4-year-old child with a long leg cast complains of “fire” in his cast. Which action by the

nurse is most appropriate?
a. Notify the provider on his or her next rounds.
b. Note the complaint in the nurse’s notes.
c. Notify the provider immediately.
d. Report the complaint to the next nurse on duty.

ANS: C
A burning sensation under the cast is an indication of tissue ischemia. It may be an early
indication of serious neurovascular compromise, such as compartment syndrome, that requires
immediate attention. The child’s symptom requires immediate attention. Notifying the
physician on the next rounds is inappropriate. Charting the complaint in the nurse’s notes is an
appropriate action but not the priority. The priority action is to contact the provider.
Communication across shifts is important to the continuing assessment of the child; however,
this symptom requires immediate evaluation, and the provider should be contacted.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 1216 | Parents Want to Know Box
OBJ: Integrated Process: Communication and Documentation

MSC: Client Needs: Physiologic Integrity