MUSCOLOSKELETAL

Question 1

A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should the nurse take?
A/ Administer an analgesic.
B/ Release the skin traction.
C/ Apply ice to the extremity.
D/ Notify the health care provider (HCP).

Answer 1

D/ Notify the health care provider (HCP).

An absent pulse to an extremity of the affected limb after a bone fracture could mean that the child is developing or experiencing compartment syndrome. This is an emergency situation, and the HCP should be notified immediately. Administering analgesics would not improve circulation. The skin traction should not be released without an HCP’s prescription. Applying ice to an extremity with absent perfusion is incorrect. Ice may be prescribed when perfusion is adequate to decrease swelling.

Question 2

The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse should make which response?
A/ “Avoid all exercise during painful periods.”
B/ “Range-of-motion exercises must be performed every day.”
C/ “Have the child perform simple isometric exercises during this time.”
D/ “Administer additional pain medication before performing range-of-motion exercises.”

Answer 2

C/ “Have the child perform simple isometric exercises during this time.”

Juvenile idiopathic arthritis is an autoimmune inflammatory disease affecting the joints and other tissues, such as articular cartilage. During painful episodes of juvenile idiopathic arthritis, hot or cold packs and splinting and positioning the affected joint in a neutral position help reduce the pain. Although resting the extremity is appropriate, beginning simple isometric or tensing exercises as soon as the child is able is important. These exercises do not involve joint movement.

Question 3

A 1-month-old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip. On assessment, the nurse understands that which finding should be noted in this condition?
A/ Limited range of motion in the affected hip
B/ An apparent lengthened femur on the affected side
C/ Asymmetrical adduction of the affected hip when the infant is placed supine with the knees
and hips flexed
D/ Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended
against the examining table

Answer 3

A/ Limited range of motion in the affected hip

In developmental dysplasia of the hip, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical and restricted abduction of the affected hip, when the child is placed supine with the knees and hips flexed, would be an assessment finding in developmental dysplasia of the hip in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.