ch54 Perry Test Bank

Perry: Maternal Child Nursing Care, 4th Edition
Chapter 54: Musculoskeletal or Articular Dysfunction

Test Bank
MULTIPLE CHOICE
a.
b.
c.
d.
1.
What effect does immobilization have on metabolism?
Hypocalcemia
Decreased metabolic rate
Positive nitrogen balance
Increased production of stress hormones
ANS: B
Immobilization causes a decreased metabolic rate with slowing of all systems and a
decreased food intake, leads to hypercalcemia, and causes a negative nitrogen balance
secondary to muscle atrophy. A decreased production of stress hormones occurs with
decreased physical and emotional coping capacity.
PTS: 1
DIF: Cognitive Level: Comprehension REF: 1677
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment
2.
What effect does immobilization have on the cardiovascular system? It
causes:
a.
Venous stasis.
b.
Increased vasopressor mechanism.
c.
Normal distribution of blood volume.
d.
Increased efficiency of orthostatic neurovascular reflexes.
ANS: A
Because of decreased muscle contraction, the physiologic effects of immobilization
include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased
vasopressor mechanism results in orthostatic hypotension, syncope, hypotension,
decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume
is found with decreased cardiac workload and exercise tolerance. Immobilization causes a
decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt
readily to the upright position and pooling of blood in the extremities in the upright
position.
PTS: 1
3.
ty?
a.
b.
What can result from the bone demineralization associated with immobili-
Osteoporosis
Urinary retention
c.
d.
Pooling of blood
Susceptibility to infection
ANS: A
Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic
fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary
to the effect of immobilization on the urinary tract. Pooling of blood is a result of the
cardiovascular effects of immobilization. Susceptibility to infection can result from the
effects of immobilization on the respiratory and renal systems.
PTS: 1
4.
A young girl has just injured her ankle at school. In addition to calling the
childs parents, the most appropriate, immediate action by the school nurse is to:
a.
Apply ice.
b.
Observe for edema and discoloration.
c.
Encourage child to assume a comfortable position.
d.
Obtain parental permission for administration of acetaminophen or aspirin.
ANS: A
Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be
rested, elevated, and have compression applied. Observing for edema and discoloration,
encouraging the child to assume a comfortable position, and obtaining parental permission or administration of acetaminophen or aspirin are not immediate priorities.
PTS: 1
DIF: Cognitive Level: Analysis
REF: 1681
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation
5.
Which term is used to describe a type of fracture that does not produce a
break in the skin?
a. Simple
c. Complicated
b. Compound
d. Comminuted
ANS: A
If a fracture does not produce a break in the skin, it is called a simple or closed fracture. A
compound or open fracture is one with an open wound through which the bone protrudes.
A complicated fracture is one in which the bone fragments damage other organs or
tissues. A comminuted fracture occurs when small fragments of bone are broken from the
fractured shaft and lie in the surrounding tissue. These are rare in children.
PTS:
DIF:
Cognitive Level: Comprehension
REF: 1682

6.
An advantage to using a fiberglass cast instead of a plaster cast is that a
fiberglass cast:
a. Is less expensive.
c. Molds closely to body parts.
b. Dries rapidly.
d. Has a smooth exterior.
ANS: B
A synthetic casting material dries in 5 to 30 minutes as compared with a plaster cast,
which takes 10 to 72 hours to dry. Synthetic casts are more expensive. Plaster casts mold
closer to body parts. Synthetic casts have a rough exterior, which may scratch surfaces.
PTS: 1
DIF: Cognitive Level: Application
REF: 1684
7.
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. What instruction
should be included in the teaching?
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.
ANS: D
The injured extremity should be kept elevated while resting and in a sling when upright.
This will increase venous return. Swelling of the fingers may indicate neurovascular
damage and should be reported immediately. Permanent damage can occur within 6 to 8
hours. Joints above and below the cast on the affected extremity should be moved. The
child should not engage in strenuous activity for the first few days. Rest with elevation of
the extremity is encouraged.
PTS: 1
REF: 1685
a.
b.
8.
The nurse uses the palms of the hands when handling a wet cast to:
Assess dryness of the cast.
c. Keep the patients limb balanced.
Facilitate easy turning.
d. Avoid indenting the cast.
ANS: D
Wet casts should be handled by the palms of the hands, not the fingers, to prevent
creating pressure points. Assessing dryness, facilitating easy turning, or keeping the
patients limb balanced are not reasons for using the palms of the hand rather than the
fingers when handling a wet cast.
PTS: 1
9.
What would cause a nurse to suspect that an infection has developed under
a cast?
a. Complaint of paresthesia
c. Increased respirations
b. Cold toes
d. Hot spots felt on cast surface
ANS: D
If hot spots are felt on the cast surface, they usually indicate infection beneath the area.
This should be reported so a window can be made in the cast to observe the sight. The
five Ps of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia,
and paralysis. Paresthesia is an indication of vascular injury, not infection. Cold toes may
be indicative of too tight a cast and need further evaluation. Increased respirations may
indicate a respiratory infection, or pulmonary emboli. This should be reported, and the
child should be evaluated.
PTS: 1
REF: 1685
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis
10.
A child is upset because, when the cast is removed from her leg, the skin
surface is caked with desquamated skin and sebaceous secretions. What should the nurse
suggest to remove this material?
a. Soak in a bathtub
c. Apply powder to absorb material
b. Vigorously scrub the leg
d. Carefully pick material off of the leg
ANS: A
Simple soaking in the bathtub is usually sufficient for the removal of the desquamated
skin and sebaceous secretions. It may take several days to eliminate the accumulation
completely. The parents and child should be advised not to scrub the leg vigorously or
forcibly remove this material because it may cause excoriation and bleeding. Oil or
lotion, but not powder, may provide comfort for the child.
PTS: 1
REF: 1686
11.
Which type of traction uses skin traction on the lower leg and a padded
sling under the knee?
a. Dunlop
c. Russell
b. Bryant
d. Buck extension
ANS: C
Russell traction uses skin traction on the lower leg and a padded sling under the knee.
The combination of longitudinal and perpendicular traction allows realignment of the
lower extremity and immobilizes the hips and knees in a flexed position. Dunlop traction
is an upper extremity traction used for fractures of the humerus. Bryant traction is skin
traction with the legs flexed at a 90-degree angle at the hip. Buck extension traction is a
type of skin traction with the legs in an extended position. It is used primarily for shortterm immobilization, before surgery with dislocated hips, for correcting contractures, or
for bone deformities such as Legg-Calv-Perthes disease.
PTS: 1
12.
Four-year-old David is placed in Buck extension traction for Legg-CalvPerthes disease. He is crying with pain as the nurse assesses that the skin of his right foot
is pale with an absence of pulse. What should the nurse do first?
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
ANS: A
The absence of a pulse and change in color of the foot must be reported immediately for
evaluation by the practitioner. Pain medication should be given after the practitioner is
notified. This is an emergency condition; immediate reporting is indicated. The findings
should be documented with ongoing assessment.
PTS: 1
REF: 1689
13.
to:
a.
b.
c.
d.
An appropriate nursing intervention when caring for a child in traction is
Remove adhesive traction straps daily to prevent skin breakdown.

Assess for tightness, weakness, or contractures in uninvolved joints and muscles.
Provide active range-of-motion exercises to affected extremity three times a day.
Keep child in one position to maintain good alignment.
ANS: B
Traction places stress on the affected bone, joint, and muscles. The nurse must assess for
tightness, weakness, or contractures developing in the uninvolved joints and muscles. The
adhesive straps should be released/replaced only when absolutely necessary. Active,
passive, or active with resistance exercises should be carried out for the unaffected
extremity only. Movement is expected with children. Each time the child moves the nurse
should check to ensure that proper alignment is maintained.
PTS:
DIF:
Cognitive Level: Application
REF: 1689

14.
The nurse is teaching a family how to care for their infant in a Pavlik
harness to treat developmental dysplasia of the hip. What should be included?
a.
Apply lotion or powder to minimize skin irritation.
b.
Remove the harness several times a day to prevent contractures.
c.
Return to the clinic every 1 to 2 weeks.
d.
Place a diaper over harness, preferably using a superabsorbent disposable diaper
that is relatively thin.
ANS: C
Infants have a rapid growth pattern. The child needs to be assessed by the practitioner
every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used
with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness.
PTS: 1
15.
A neonate is born with mild clubfeet. When the parents ask the nurse how
this will be corrected, the nurse should explain that:
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.
ANS: C
Serial casting, the preferred treatment, is begun shortly after birth before discharge from
nursery. Successive casts allows for gradual stretching of skin and tight structures on the
medial side of the foot. Manipulation and casting of the leg are repeated frequently (every
week) to accommodate the rapid growth of early infancy. Surgical intervention is done
only if serial casting is not successful. Children do not improve without intervention.
PTS: 1
16.
Which term is used to describe an abnormally increased convex angulation
in the curvature of the thoracic spine?
a. Scoliosis
c. Lordosis
b. Ankylosis
d. Kyphosis
ANS: D
Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine.
Scoliosis is a complex spinal deformity usually involving lateral curvature, spinal rotation
causing rib asymmetry, and thoracic hypokyphosis. Ankylosis is the immobility of a joint.
Lordosis is an accentuation of the cervical or lumbar curvature beyond physiologic limits.
PTS: 1
a.
b.
17.
When does idiopathic scoliosis become most noticeable?
Newborn period
c. During preadolescent growth spurt
When child starts to walk
d. Adolescence
ANS: C
Idiopathic scoliosis is most noticeable during the preadolescent growth spurt and is
seldom apparent before age 10 years.
PTS: 1
a.
b.
18.
The primary method of treating osteomyelitis is:
Joint replacement.
c. Intravenous antibiotic therapy.
Bracing and casting.
d. Long-term corticosteroid therapy.
ANS: C
Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus
aureus. The treatment of choice is antibiotics. Joint replacement, bracing and casting, and
long-term corticosteroids are not indicated for infectious processes.
PTS: 1
19.
Osteosarcoma is the most common bone cancer in children. Where are
most of the primary tumor sites?
a. Femur.
c. Pelvis.
b. Humerus.
d. Tibia.
ANS: A
Osteosarcoma is the most frequently encountered malignant bone cancer in children. The
peak incidence is between ages 10 and 25 years. More than half occur in the femur. After
the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges.
PTS: 1
a.
20.
What is most descriptive of the therapeutic management of osteosarcoma?
Treatment usually consists of surgery and chemotherapy.
b.
c.
d.
Amputation of affected extremity is rarely necessary.

Intensive irradiation is the primary treatment.
Bone marrow transplantation offers the best chance of long-term survival.
ANS: A
The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy.
Amputation is frequently required. Intensive radiation and bone marrow transplantation
are usually not part of the therapeutic management.
PTS: 1
21.
An adolescent is scheduled for a leg amputation in 2 days for treatment of
osteosarcoma. The nurses approach should include:
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.
ANS: A
Honesty is essential to gain the cooperation and trust of the child. The diagnosis of cancer
should not be disguised with falsehoods. The adolescent should be prepared in advance
for the surgery so that there is time for reflection about the diagnosis and subsequent
treatment. This allows questions to be answered. To accept the need for radical surgery,
the child must be aware of the lack of alternatives for treatment. Amputation is necessary,
but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with
surgery. The child should be informed of the need for chemotherapy and its side effects
before surgery.
PTS: 1
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation
REF: 1706
22.
Which medication is usually tried first when a child is diagnosed with
juvenile idiopathic arthritis (JIA)?
a.
Aspirin
b.
Corticosteroids
c.
Cytotoxic drugs such as methotrexate
d.
Nonsteroidal antiinflammatory drugs (NSAIDs)
ANS: D
NSAIDs are the first drugs used in JIA. Naproxen, ibuprofen, and tolmetin are approved
for use in children. Aspirin, once the drug of choice, has been replaced by the NSAIDs
because they have fewer side effects and easier administration schedules. Corticosteroids
are used for life-threatening complications, incapacitating arthritis, and uveitis.
Methotrexate is a second-line therapy for JIA.
PTS: 1
23.
An important nursing consideration when caring for a child with juvenile
idiopathic arthritis (JIA) is to:
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.
ANS: C
The management of JIA is primarily pharmacologic. The family should be instructed
regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that
nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be
alert for signs of toxicity. Warm, moist heat is best for relieving stiffness and pain.
Acetaminophen does not have antiinflammatory affects. Range-of-motion exercises
should not be done during periods of inflammation.
PTS: 1
REF: 1709
MULTIPLE RESPONSE
1.
The nurse is caring for an infant with developmental dysplasia of the hip.
Which clinical manifestations should the nurse expect to observe? Choose all that apply.
a.
Positive Ortolani click
b.
Unequal gluteal folds
c.
Negative Babinski sign
d.
Trendelenburg sign
e.
Telescoping of the affected limb
f.
Lordosis
ANS: A, B
A positive Ortolani test and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Negative Babinski sign,
Trendelenburg sign, telescoping of the affected limb, and lordosis are not clinical
manifestations of developmental dysplasia of the hip.
PTS: 1
REF: 1692

ch54 Perry Test Bank

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ch54 Perry Test Bank

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Perry: Maternal Child Nursing Care, 4th Edition

Chapter 54: Musculoskeletal or Articular Dysfunction

What effect does immobilization have on the cardiovascular system? It

Cognitive Level: Comprehension

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

An appropriate nursing intervention when caring for a child in traction is

Remove adhesive traction straps daily to prevent skin breakdown.

Cognitive Level: Application

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation

Amputation of affected extremity is rarely necessary.

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