Question 1

A child is upset because when the cast is removed from her leg, the skin surface is caked with desquamated skin and sebaceous secretions. Which of the following should the nurse suggest to remove this material?

Accepted Answer

Soaking in a bathtub is the most gentle and effective method to soften and remove desquamated skin and sebaceous secretions after cast removal. It avoids potential skin damage that could be caused by vigorous scrubbing, application of powder, or picking at the material.

Question 2

The nurse uses the palms of the hands when handling a wet cast to achieve which of the following?

Accepted Answer

Using the palms of the hands to handle a wet cast helps distribute pressure evenly, preventing indentations in the soft material of the cast as it dries.

Question 3

A 7-year-old has just had a cast applied for a fractured arm with the wrist and elbow immobilized. Which of the following should be included in the home care instructions?

Accepted Answer

Elevating the casted arm helps reduce swelling and pain by promoting venous return, which is crucial in the initial period after cast application. Keeping the limb elevated can also decrease the risk of complications such as compartment syndrome. Choices A, B, and C are incorrect because swelling persisting more than 48 hours could indicate complications, the shoulder should not be kept immobile as it is important to maintain range of motion in unaffected joints, and activity restrictions are usually indicated to prevent further injury or displacement of the fracture.

Question 4

An appropriate nursing intervention when caring for a child in traction would be which of the following?

Accepted Answer

Traction is used to align and stabilize a specific area of the body, such as after a fracture. It's important to monitor the child for potential complications in areas not directly affected by the traction. Assessing for tightness, weakness, or contractures in uninvolved joints and muscles helps ensure that other parts of the body remain healthy and functional, preventing secondary complications. Choices A, C, and D could actually harm the patient or counteract the purpose of the traction.

Question 5

Which of the following would be the most appropriate play activity for a 3-year-old child in a spica cast, considering both safety and development?

Accepted Answer

The answer of Which of the following would be the...

Question 6

A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate, immediate action by the school nurse is which of the following?

Accepted Answer

Applying ice is the most appropriate immediate action to reduce swelling and pain in the injured area.

Question 7

Which of the following terms is used to describe a type of fracture that does not produce a break in the skin?

Accepted Answer

A simple fracture, also known as a closed fracture, is one where the bone breaks but there is no puncture or open wound in the skin.

Question 8

Which of the following clinical manifestations of developmental dysplasia of the hip (previously called congenital hip dysplasia) would be seen in the newborn?

Accepted Answer

The Ortolani test is a maneuver used specifically in newborns to detect hip instability or dislocation, characteristic of developmental dysplasia of the hip. A positive Ortolani sign (a "click" felt or heard when the dislocated hip is reduced into the acetabulum) indicates the presence of this condition. Other options like the Trendelenburg sign, telescoping of the affected limb, and lordosis are not clinical manifestations typically observed in newborns with developmental dysplasia of the hip.

Question 9

A child has just returned to the orthopedic unit after being placed in a hip spica cast. The instructions to parents for home care should include which of the following?

Accepted Answer

Specially designed car seats are required for children in a hip spica cast due to the cast's size and shape, which can prevent fitting into standard car seats safely. This ensures the child's safety during transportation.

Question 10

Which of the following is a physiological effect of immobilization on children?

Accepted Answer

Immobilization in children can lead to venous stasis, which increases the risk of thrombus and embolus formation due to reduced blood flow and pooling in the veins.

Question 11

Four-year-old David is placed in Buck extension traction for Legg-Calvé-Perthes 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?

Accepted Answer

The absence of pulse and pallor in the foot indicate compromised circulation, which is a medical emergency. The first action should be to notify the practitioner immediately to address the potential loss of blood flow to the extremity.

Question 12

Which of the following types of traction uses skin traction on the lower leg and a padded sling under the knee?

Accepted Answer

Russell traction involves the use of skin traction on the lower leg and a padded sling under the knee to provide more effective alignment and pain relief.

Question 13

Which of the following is an advantage to using a fiberglass cast instead of a plaster of Paris cast?

Accepted Answer

Fiberglass casts dry more rapidly than plaster of Paris casts, allowing for quicker mobilization and less inconvenience for the patient.

Question 14

Which of the following is a type of skin traction with legs in an extended position?

Accepted Answer

Buck extension traction is a type of skin traction used for fractures, where the legs are kept in an extended position. It is commonly applied to the lower limb for conditions such as hip and knee problems.

Question 15

Immobilization causes which of the following effects on the cardiovascular system?

Accepted Answer

Immobilization can lead to venous stasis due to reduced muscle contractions that normally help in venous return, potentially increasing the risk of blood clots.

Question 16

Immobilization causes which of the following effects on metabolism?

Accepted Answer

Immobilization leads to a decreased metabolic rate due to reduced physical activity and muscle atrophy.

Question 17

An adolescent is in traction. The purpose of the traction is to fatigue the muscle and reduce muscle spasm so that the bones can be realigned. Nursing actions should include which of the following?

Accepted Answer

Continuous traction is necessary to prevent muscle contraction and maintain alignment for healing.

Question 18

Which of the following can result from the bone demineralization associated with immobility?

Accepted Answer

Osteoporosis can result from bone demineralization, which often occurs due to immobility, as bones lose density and strength when not subjected to regular physical activity or weight-bearing exercises.

Question 19

Kristin, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following?

Accepted Answer

Bone growth can be affected with this type of fracture because the epiphyseal plate (growth plate) is involved, which is crucial for the longitudinal growth of bones in children.

Question 20

Which of the following would cause a nurse to suspect that an infection has developed under a cast?

Accepted Answer

"Hot spots" on the surface of a cast can indicate an underlying infection due to increased warmth from inflammation, making it a sign for nurses to investigate further.

Quiz 31: The Child With Musculoskeletal or Articular Dysfunction