Exam (elaborations)
Chapter 29. The Child with Musculoskeletal or Articular Dysfunction
- Course
- Pediatric nursing
- Institution
- Baylor College Of Medicine
Chapter 29. The Child with Musculoskeletal or Articular Dysfunction
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Chapter 29. The Child with Musculoskeletal or Articular DysfunctionMULTIPLE CHOICE
1. An 8-year-old child is hit by a motor vehicle in the school parking lot. The school nurse
notes that the child is responding to verbal stimulation but is not moving his extremities when
requested. What is the first action the nurse should take?
a. Wait for the childs parents to arrive.
b. Move the child out of the parking lot.
c. Have someone notify the emergency medical services (EMS) system.
d. Help the child stand to return to play.
ANS: C
The child was involved in a motor vehicle collision and at this time is not able to move his
extremities. The child needs immediate attention at a hospital for assessment of the possibility of
a spinal cord injury. Because the child cannot move his extremities, the child should not be
moved until his cervical and vertebral spines are stabilized. The EMS team can appropriately
stabilize the spinal column for transport. Although it is important to notify the parents, the EMS
system should be activated and transport arranged for serious injuries. The only indication to
move the child is to prevent further trauma.
DIF: Cognitive Level: Analyzing REF: dl. 1545
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
,2. The nurse stops to assist an adolescent who has experienced severe trauma when hit by a
motorcycle. The emergency medical system (EMS) has been activated. The first person who
provided assistance applied a tourniquet to the childs leg because of arterial bleeding. What
should the nurse do related to the tourniquet?
a. Loosen the tourniquet.
b. Leave the tourniquet in place.
c. Remove the tourniquet and apply direct pressure if bleeding is still present.
d. Remove the tourniquet every 5 minutes, leaving it off for 30 seconds each
time. ANS: B
A tourniquet is applied only as a last resort, and then it is left in place and not loosened until
definitive treatment is available. After the tourniquet is applied, skin and tissue necrosis occur
below the site. Loosening or removing the tourniquet allows toxins from the tissue necrosis to be
released into the circulation. This can induce systemic, deadly tourniquet shock.
DIF: Cognitive Level: Analyzing REF: dl. 1545
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
3. What is a physiologic effect of immobilization on children?
a. Metabolic rate increases.
, b. Venous return improves because the child is in the supine position.
c. Circulatory stasis can lead to thrombus and embolus formation.
d. Bone calcium increases, releasing excess calcium into the body
(hypercalcemia). ANS: C
The physiologic effects of immobilization, as a result of decreased muscle contraction, include
venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with
immobilization. With the loss of muscle contraction, there is a decreased venous return to the
heart. Calcium leaves the bone during immobilization, leading to bone demineralization and
increasing the calcium ion concentration in the blood.
DIF: Cognitive Level: Understanding REF: dl. 1549
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
4. What condition can result from the bone demineralization associated with immobility?
a. Osteoporosis
b. Pooling of blood
c. Urinary retention
d. Susceptibility to
infection ANS: A
Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures,
extraosseous bone formation, and renal calculi. Pooling of blood is a result of the cardiovascular
effects of immobilization. Urinary retention is secondary to the effect of immobilization on the
urinary tract. Susceptibility to infection can result from the effects of immobilization on the
respiratory and renal systems.
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