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Chapter 50 The Child with a Musculoskeletal Alteration
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Chapter 50 The Child with a Musculoskeletal Alteration
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Chapter 50: The Child with a Musculoskeletal AlterationTest Bank
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
Feedback
A A child’s growth occurs because of an increase in size rather than an increase in
the number of the muscle fibers.
B This is not a true statement. Fractures in children younger than 1 year are
unusual because a large amount of force is necessary to fracture their bones.
C Because soft tissues are resilient in children, dislocations and sprains are less
common than in adults. This is an accurate statement.
D A child’s bones have greater blood flow than an adult’s bones.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1337
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
Feedback
A Fractures in infancy are not common.
B Infants should be cared for in a safe environment and should not be falling.
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.
D Fractures in infancy are usually nonaccidental rather than related to a genetic
factor.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1346
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
Feedback
A The degree of motion in the affected extremity and ability to position the
extremity are incomplete assessments of neurovascular competency.
B The length, diameter, and shape of the extremity are not assessment criteria in a
neurovascular evaluation.
C Although the amount of swelling is an important factor in assessing an
extremity, it is not a criterion for a neurovascular assessment.
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.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1349
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 he will not stop crying even after taking acetaminophen with codeine. He also will not
straighten the fingers on his right arm. The nurse tells the mother to
a. Take him to the emergency department.
b. Put ice on the injury.
c. Avoid letting him get so tired.
d. Wait another hour; if he is still crying, call back.
ANS: A
Feedback
A Unrelieved pain and the child’s inability to extend his fingers are signs of
compartmental syndrome, which requires immediate attention.
B Placing ice on the extremity is an inappropriate action for the symptoms.
C This is an inappropriate response to give to a mother who is concerned about her
child.
D A child who has signs and symptoms of compartmental syndrome should be
seen immediately. Waiting an hour could compromise the recovery of the child.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1346
OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity
5. A 4-year-old child with a long leg cast complains of “fire” in his cast. The nurse should
a. Notify the physician on his next rounds.
b. Note the complaint in the nurse’s notes.
c. Notify the physician immediately.
d. Report the complaint to the next nurse on duty.
, ANS: C
Feedback
A The child’s symptom requires immediate attention. Notifying the physician on
the next rounds is inappropriate.
B Charting the complaint in the nurse’s notes is an inappropriate action. Careful
notation of symptoms is important, but the priority action is to contact the
physician.
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 compartmental
syndrome, that requires immediate attention.
D Communication across shifts is important to the continuing assessment of the
child; however, this symptom requires immediate evaluation, and the physician
should be contacted.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1344
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
6. When a child with a musculoskeletal injury on the foot is assessed, what is most indicative of
a fracture?
a. Increased swelling after the injury is iced
b. The presence of localized tenderness distal to the site
c. The presence of an elevated temperature for 24 hours
d. The inability of the child to bear weight
ANS: D
Feedback
A Although edema is often present with a fracture, it would be unusual for swelling
to increase after application of ice, and this would not be most indicative of a
fracture. Swelling after icing does not identify the degree of the injury.
B Localized tenderness along with limited joint mobility may indicate serious
injury, but inability to bear weight on the extremity is a more reliable sign.
Tenderness is not a usual complaint distal to the affected site.
C Elevated temperature is associated with infection, but not a fracture.
D An inability to bear weight on the affected extremity is indicative of a more
serious injury. With a fracture, general manifestations include pain or tenderness
at the site, immobility or decreased range of motion, deformity of the extremity,
edema, and inability to bear weight.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1347
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
7. A child with osteomyelitis asks the nurse, “What is a ‘sed’ rate?” What is the best response
for the nurse?
a. “It tells us how you are responding to the treatment.”
b. “It tells us what type of antibiotic you need.”
c. “It tells us whether we need to immobilize your extremity.”
d. “It tells us how your nerves and muscles are doing.”
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