Musculoskeleltal

Question 1

A type of traction sometimes used in the treatment of the child with scoliosis is called which of the following?

            a) Dunlop's traction
            b) Bryant's traction
            c) Russell traction
            d) Halo traction

Answer 1

d) Halo traction

Rationale: When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction.

Question 2

The nurse performing a focused health history on a newborn asks the parents if there are any hereditary disorders affecting musculoskeletal function in the family history. These disorders include (select all answers that apply):

            a) Limb deformities
            b) Clubfoot
            c) Scoliosis
            d) Hip dysplasia
            e) Brachial plexus injury

Answer 2

b) Clubfoot
c) Scoliosis
d) Hip dysplasia

Rationale: The nurse should explore the family history for any hereditary disorders. The presence of scoliosis, clubfoot, hip or skeletal dysplasia, or neuromuscular disorders in family members may help in diagnosing genetically linked orthopedic disorders.

Question 3

The nurse is caring for an 8-month-old in Bryant traction for developmental dysplasia of the hip and is monitoring for complications. Which assessment finding would alert the nurse to a possible complication?

            a) Crusting at pin site
            b) A weak pedal pulse
            c) Mild fussiness
            d) Brisk capillary refill

Answer 3

b) A weak pedal pulse

Rationale: A diminished pedal pulse could be a sign of neurovascular compromise caused by pressure from the elastic bandages. Brisk capillary refill is a normal finding. Mild fussiness is to be expected and is nonspecific when an infant is immobilized and has both legs extended vertically. Bryant traction is a type of skin traction and does not use pins.

Question 4

A nurse is caring for a 10-year-old patient who is in skeletal traction following injuries sustained in a car accident. Which of the following accurately describes a recommended nursing measure for this type of traction

a) Assess traction weights daily & remove/add weight as necessary.
b) Use warm saline as a cleansing solution before and after pin care.
c) Perform pin-site care on a daily/weekly basis after the first 48-72 hours.
d) Make sure weights are touching the floor or top of bed at all times.

Answer 4

c) Perform pin-site care on a daily/weekly basis after the first 48-72 hours.

Rationale: At sites with mechanically stable bone–pin interfaces, pin-site care should be done on a daily or weekly basis (after the first 48 to 72 hours). The nurse should never remove or add traction weights without specific physician orders, or allow weights to touch the floor or drag on the bed parts; weights should hang free. A chlorhexidine 2 mg/mL solution may be the most effective cleansing solution for pin care.

Question 5

The nurse caring for a child with an external fixator knows that this device is used to (select all answers that apply):

         a) Provide support for weak limbs
            b) Treat complex, unstable fractures of both upper and lower extremities
            c) Lengthen bones
            d) Correct angular or rotational defects
            e) Manipulate a joint or muscle group to restore joint alignment
            f) Cause vasodilation & relieve inflammation from muscle stiffness/spasm

Answer 5

b) Treat complex, unstable fractures of both upper and lower extremities

c) Lengthen bones
d) Correct angular or rotational defects

Rationale: An external fixator is used to treat complex, unstable fractures of both upper and lower extremities since it can hold the bone fragments much more rigidly than a cast. An external fixator may also be used to lengthen bones or correct angular or rotational defects. The purpose of serial manipulation is to restore joint alignment or to maintain functional mobility of a joint. The purpose of a splint or brace is to immobilize a body part or to provide support for weak limbs. Heat is generally used to cause vasodilation and relieve inflammation from muscle stiffness or spasm.

Question 6

When helping parents plan care for a child with Legg-Calvé-Perthes disease, you would teach them that the usual therapy for children with this disorder is

            a) surgery with supporting rods.
            b) exercise to increase muscle strength of the knee joint.
            c) passive range-of-motion exercises TID.
            d) a nonweight-bearing period.

Answer 6

d) a nonweight-bearing period.

Rationale: Resting the affected femoral epiphysis aids healing.

Question 7

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which of the following symptoms?

            a) Paresthesia
            b) Paralysis
            c) Pallor
            d) Pain

Answer 7

a) Paresthesia

Rationale: Paresthesia is diminished or absent sensation or numbness or tingling. Pallor is paleness of color and paralysis is the loss of function.

Question 8

The emergency department nurse is caring for a 3-year-old girl with an arm injury. The mother is very upset because she believes she broke her daughter’s arm. “I was lifting her by her hands and felt a pop in her wrist. She instantly started screaming.” The child is now guarding and refusing to move her arm. Which response by the nurse would be most appropriate?

         a) "You probably dislocated her radial head when you lifted her."
            b) "The popping noise was the ligament surrounding the radial head becoming entrapped."
            c) "Her arm isn't broken. This injury is common and easily fixed with no complications."
            d) "This is most likely nursemaid's elbow; you will have to be more careful in the future."

Answer 8

c) “Her arm isn’t broken. This injury is common and easily fixed with no complications.”

Rationale: The nurse should quickly reassure the mother that this is a common occurrence, seen every day in the emergency department, and is easily fixed and resolves with no complications. Although a popping noise indicates entrapment of the ligament, this response does not address the mother’s concerns. Although the radial head most likely dislocated, this response does not address the mother’s concern. Although this condition is called nursemaid’s elbow, telling the mother she has to be more careful only serves to put blame on the mother and does not address her concerns.

Question 9

The nurse is caring for an 8-year-old girl in traction. She has been in an acute care setting for two weeks and will require an additional 10 days in the hospital. She is showing signs of regression with thumb sucking and pleas for her tattered baby blanket. Which of the following would be the most helpful intervention?

            a) "Let's ask your mom to bring your friends for a visit."
            b) "Do you want a book to read?"
            c) "Would you like a coloring book?"
            d) "You are too big to suck your thumb."

Answer 9

a) “Let’s ask your mom to bring your friends for a visit.”

After two weeks in traction, a child can become easily bored and regress in social and personal skills. A visit from friends arranged by the girl’s mother or supervised by the child-life specialist would help her adapt to her immobilized state. Telling the girl she is too big to suck her thumb is unhelpful. Suggesting a book or coloring book would be unhelpful at this point, as she has likely grown tired of books and coloring after two weeks.

Question 10

A nurse is performing a physical examination of a child with a suspected fracture. Which assessment technique would the nurse be least likely to use?

            a) Palpation
            b) Observation
            c) Auscultation
            d) Inspection

Answer 10

c) Auscultation

The physical examination specific to fractures includes inspection, observation, and palpation. Auscultation is not used.

Question 11

The nurse is talking with the caregiver of a 13-year-old diagnosed with scoliosis. The child has come to the clinic to be fitted with a brace to begin her treatment. The child appears upset and angry and states, “I hate this brace; I hate it already.” In an effort to support this child, which of the following statements would be the most appropriate for the nurse to make to this child’s caregiver?

a) “Children her age often withdraw during stressful times; let her have some time alone to think about the situation and to get used to the brace.
b) “Remind your child that her spine needs to be corrected in order to keep her whole musculoskeletal system healthy for a long, long time.
c) “If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good.”
d) “Take your daughter to an oncology floor for a few minutes so she can see children who are much sicker than she is.”

Answer 11

c) “If you can afford it, let your daughter choose an article or two of clothing that she can wear with the brace that will help her feel that she looks good.”

Help the child select clothing that blends with current styles but is loose enough to hide the brace. Self-image and the need to be like others are very important at this age. Wearing a brace creates a distinct change in body image, especially in the older child or adolescent, at a time when body consciousness is at an all-time high. The need to wear the brace and deal with the limitations it involves may cause anger; the change in body image can cause a grief reaction. Handling these feelings successfully requires understanding support from the nurse, family, and peers. It is important for the child to have an opportunity to talk about his or her feelings.

Question 12

The nurse is caring for a child with Osteomyelitis who has a leg wound. The highest priority nursing intervention for this child would be for the nurse to do which of the following?

            a) The nurse should minimize the movement of the leg.
            b) The nurse should encourage the child to avoid weight bearing.
            c) The nurse should monitor nutritional intake.
            d) The nurse should follow transmission-based precautions.

Answer 12

d) The nurse should follow transmission-based precautions.

All of these interventions are done for the child with Osteomyelitis who has a wound, but the highest priority would be to follow transmission-based precautions to prevent the spread of infection, especially if the wound is open and draining.

Question 13

The nurse is presenting an in-service to a group of peers on the topic of traction. The nurse asks the group to give examples of types of skin traction. The following types were named by the nurses. Which of the following is an example of a type of skeletal traction?

            a) Balanced suspension traction
            b) Russell traction
            c) Buck extension traction
            d) Bryant's traction

Answer 13

a) Balanced suspension traction

Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Examples of skeletal traction are 90-degree traction and balanced suspension traction. Dunlop’s traction, sometimes used for fractures of the humerus or the elbow, can be either skin or skeletal traction. It is skeletal traction if a pin is inserted into the bone to immobilize the extremity.
Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant’s traction, Buck extension traction, and Russell traction.

Question 14

The nurse is caring for a child admitted with Legg-Calvé-Perthes disease. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis?

            a) Poor posture and malformed vertebrae
            b) Inflammation of the joints
            c) Difficulty standing and walking
            d) Pain in the groin and a limp

Answer 14

d) Pain in the groin and a limp

Symptoms first noticed in Legg-Calvé-Perthes disease are pain in the hip or groin and a limp accompanied by muscle spasms and limitation of motion.

Question 15

You meet a child with a slipped femoral epiphysis. In what type of child does this usually occur?

            a) Preadolescent girls
            b) Obese adolescent boys
            c) Active school-aged children
            d) Tall, thin girls

Answer 15

b) Obese adolescent boys

A slipped epiphyseal femur injury most typically occurs in overweight preadolescent or adolescent boys. Stress increases the risk. A thin child would not have an increased risk, and the age range is past preadolescent and school age.

Question 16

A girl with scoliosis is prescribed a body brace. The purpose of the brace is to

            a) prevent herniation of a spinal disk.
            b) correct spinal curvature.
            c) prevent torticollis.
            d) improve spinal alignment.

Answer 16

d) improve spinal alignment.

Body bracing helps to hold the spine in alignment and prevent further curvature. The brace will not correct the problem. Herniation and torticollis are not associated with scoliosis.

Question 17

Maria is a 9-month-old whose babysitter brings her to the ER. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. How should the nurse respond to this situation?

a) Evaluate the child for an underlying musculoskeletal disorder.
b) Arrange for the parents to come in for an evaluation for possible physical abuse.
c) Ask the babysitter to advocate for the child and report the incident to the authorities.
d) Call social services to find the parents and evaluate them for child abuse.

Answer 17

b) Arrange for the parents to come in for an evaluation for possible physical abuse.

A child younger than age 1 who presents with a fracture should be evaluated for possible physical abuse. The parents should be contacted first, and the family should undergo an evaluation for possible physical abuse since femoral fractures in nonambulating infants, particularly spiral fractures, are believed to be highly specific for inflicted injury. If physical abuse is not found, the infant should be evaluated for an underlying musculoskeletal disorder.

Question 18

The nurse is caring for an active 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and complains of shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely which of the following?

            a) Epiphysiolysis of the distal radius
            b) Osgood-Schlatter disease
            c) Sever's disease
            d) Epiphysiolysis of the proximal humerus

Answer 18

d) Epiphysiolysis of the proximal humerus

Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

Question 19

The nurse is assessing a 10-year-old girl recently fitted with a cast on her wrist. Which assessment finding would alert the nurse to a possible infection?

            a) Pallor of the fingers
            b) Drainage on the cast
            c) Delayed capillary refill
            d) Diminished pulse

Answer 19

b) Drainage on the cast

Drainage on the cast could indicate an infection. Pale fingers would suggest impaired circulation. Delayed capillary refill would suggest impaired circulation. Diminished pulse would suggest impaired circulation.

Question 20

A 9-year old child is scheduled for a computed tomography with contrast medium. Which of the following would be most important for the nurse to assess?

            a) Allergies
            b) Pain
            c) White blood cell count
            d) Swelling

Answer 20

a) Allergies

Assessing for allergies would be the priority because a contrast medium is being used. Pain is an important assessment but is unrelated to the test scheduled. Swelling is an important assessment finding, but this is unrelated to the test scheduled. Although a white blood cell count is important for determining an infection, it is unrelated to the test scheduled.

Question 21

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. Which of the following would the nurse expect to administer if ordered?

a) Diazepam
b) Narcotic analgesics
c) Pamidronate
d) Alendronate

Answer 21

a) Diazepam

Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Narcotic analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta

Question 22

The nurse is reinforcing teaching with the caregivers of a child who has had a cast on the arm removed after the cast has been in place for six weeks. The caregiver makes the following statements. Which statement indicates an understanding of the teaching?

a) “As soon as we get home I will scrub his arm really well to remove the loose skin.”
b) “I usually let him take a tub bath, but we will keep him out of warm water for a couple of days.”

c ) “He loves to play outside now that the weather is nice; I will have to remind him to use sunscreen.”

d) “We will be careful to not let him put his little sister’s baby oil on his arm for a few weeks.”

Answer 22

c ) “He loves to play outside now that the weather is nice; I will have to remind him to use sunscreen.”

casted area should be soaked in warm water to help remove the crusty layer of accumulated skin. Application of oil or lotion may prove comforting. Family caregivers and the child must be cautioned against scrubbing or scraping this area because the tender layer of new skin underneath the crust may bleed.

Question 23

A nurse is applying a cast to a 12-year-old boy with a simple fracture of the radius in the arm. Which of the following is most important for the nurse to do when she has finished applying the cast?

a) X-ray the cast to make sure the bones are aligned properly
b) Assess the fingers for warmth, pain, and function
c) Cut a window in the cast over the wrist
d) Apply a tube of stockinette over the cast

Answer 23

b) Assess the fingers for warmth, pain, and function

Assess fingers or toes carefully for warmth, pain, and function after application of a cast to be certain a compartment syndrome is not developing. Before a cast is applied, not after, a tube of stockinette is stretched over the area, and soft cotton padding is placed over bony prominences. A “window” may be placed in a cast for an open fracture or if an infection is suspected—not to prevent an infection—so that the area can be observed; however, a window is not indicated in this case. The x-ray should be performed before casting, to diagnose the fracture, not afterward.

Question 24

Structural scoliosis is five times more common in girls than boys.

True or False?

Answer 24

True

Question 25

The nurse caring for a patient in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which of the following nursing interdisciplinary interventions are recommended to help prevent these adverse conditions?

a) Give the patient large, frequent meals with decreased fiber and increased protein and Vitamin C.
b) Check for a normal capillary refill of 3 to 5 seconds on a daily basis to ensure there in adequate arterial supply.
c) Encourage child to stifle cough and take shallow breaths to prevent ineffective breathing patterns.
d) Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.

Answer 25

d) Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion.

The nurse should turn the patient and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The patient should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The patient should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

Question 26

A nursing student tells the staff nurse on the pediatric orthopedic unit that she has heard of a musculoskeletal disorder in which there is an infection of the bone. Which of the following disorders does this statement describe?

a) Osteosarcoma
b) Juvenile rheumatoid arthritis
c) Osteomyelitis
d) Muscular dystrophy

Answer 26

c) Osteomyelitis

Osteomyelitis is an infection of the bone usually caused by Staphylococcus aureus. Acute osteomyelitis is twice as common in boys and results from a primary infection.

Question 27

A nurse is working with a 12-year-old girl with osteomyelitis who is recovering from surgery. Which of the following are nursing interventions that should be implemented in this case? *(Select all that apply.)

a) Instruction to the parents regarding how to care for an antibiotic IV line at home
b) Administration of IV antibiotics at the hospital
c) Instruction to the parents regarding proper traction of the limb
d) Instituting infection-control precautions related to drainage tubes
e) Casting of the affected limb
f) Instruction to the parents regarding the importance of the child maintaining bed rest

Answer 27

a) Instruction to the parents regarding how to care for an antibiotic IV line at home
b) Administration of IV antibiotics at the hospital
d) Instituting infection-control precautions related to drainage tube
f) Instruction to the parents regarding the importance of the child maintaining bed rest

Osteomyelitis is infection of the bone. Medical therapy includes limitation of weight bearing on the affected part, bed rest, immobilization, and a short administration of an IV antibiotic such as oxacillin (Bactocill), as indicated by the blood culture. Intravenous therapy is usually initiated in the hospital and then continued at home for as long as 2 weeks. When the child is discharged from the hospital, be certain to review with parents measures to care for the antibiotic intravenous line if this will be continued at home. Keep in mind young children are active, even if they are on bed rest so need age appropriate activities so they maintain rest, not activity. If a child had surgery and drainage tubes are in place, institute infection-control precautions, because the drain evacuates infected material. Neither casting nor traction is required for osteomyelitis

Question 28

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child’s medical record?

a) High serum phosphate levels
b) Low alkaline phosphate levels
c) Low serum calcium levels
d) X-ray confirmation of adequate bone shape

Answer 28

c) Low serum calcium levels

With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

Question 29

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which of the following forms of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?

a) Spica cast
b) External fixation device
c) Internal fixation device
d) Stockinette

Answer 29

a) Spica cast

The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

Question 30

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse in which of the following situations?

a) A 6-year-old with a greenstick fracture of the wrist, which the caregiver reports as having been caused when the child fell while ice-skating.
b) A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate.
c) A 10-year-old with a simple fracture of the femur, which the caregiver reports as having been caused when the child fell down a set of stairs.
d) A 9-year-old with a compound fracture of the tibia, which the caregiver reports as having been caused when the child attempted a flip on a skateboard.

Answer 30

b) A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate.

Spiral fractures, which twist around the bone, are fre quently associated with child abuse and are caused by a wrenching force. When a broken bone penetrates the skin, the fracture is called compound, or open. A simple, or closed, fracture is a single break in the bone without penetration of the skin. In a greenstick fracture, the bone bends and often just partially breaks.

Question 31

The type of fracture often seen in young children is a fracture in which there is not complete ossification of the bone and the bone bends and just partially breaks. This type of fracture is which of the following?

a) Epiphyseal
b) Greenstick
c) Complete
d) Spiral

Answer 31

b) Greenstick

Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. The bone bends and often just partially breaks.

Question 32

The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). Which of the following would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

a) Sensation
b) Vital signs
c) Pulse
d) Color
e) Capillary refill

Answer 32

a) Sensation
c) Pulse
d) Color
e) Capillary refill

A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

Question 33

The nurse is caring for an extremely active 13-year-old girl who has recently been prescribed a back brace to treat scoliosis. Which of the following interventions will be most critical to the success of her treatment?

a) Asking for, and listening to, the child’s feelings about the treatment
b) Teaching the parents about the disease and its treatment
c) Showing the girl how the brace works and when to wear it
d) Ensuring treatment compliance due to mobility limitations

Answer 33

d) Ensuring treatment compliance due to mobility limitations

Ensuring compliance with the treatment regime will ultimately be most critical. Educating the parents about scoliosis, showing the girl how to use the brace, and listening to the child’s concerns are also important. But in the end, the most important factor is that the child wears the brace according to the treatment plan.

Question 34

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be which of the following?

a) “In case the child has an accident and misses the bedpan, these can be changed to keep the area dry.”
b) “These make a smooth edge on the cast so the skin is better protected.”

c ) “These will help the cast look more attractive so the child won’t feel self conscious.”

d) “We put these on so the child will not pull the padding from under the cast.”

Answer 34

b) “These make a smooth edge on the cast so the skin is better protected.”

f the cast has no protective edge, it should be petaled with adhesive tape strips. These help keep the skin protected from the rough edge of the cast. If the cast is near the genital area, plastic should be taped around the edge to prevent wetting and soiling of the cast; petaling the cast does not provide protection to keep the cast dry.

Question 35

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby and concerned about holding and playing with him. How can the nurse best assist the parents?

a) “Let’s put you in touch with other families who have experienced this.”
b) “Do not attempt to adjust the harness yourself.”
c) “The harness does not hurt the baby.”
d) “The baby only needs the harness for 12 weeks.”

Answer 35

a) “Let’s put you in touch with other families who have experienced this.”

There are many helpful pointers and suggestions that are available from other parents and orthopedic organizations. Referring the parents to other families who have experienced a Pavlik harness will provide assurance and likely increase compliance with the regimen. The other responses are factual but do not address the parent’s concerns.

Question 36

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which of the following symptoms might be an early warning signal that the child has developed compartment syndrome? The child

a) Has blue-looking nail beds on the toes
b) Cannot plantarflex his foot
c) Feels increasing severe pain
d) Has a weak femoral pulse

Answer 36

c) Feels increasing severe pain

Any complaint of pain in a child with a new cast or immobilized extremity needs to be explored and monitored closely for the possibility of compartment syndrome.

Question 37

In discussing the treatment for children with scoliosis, a group of pediatric nurses makes the following statements. Which statement is most accurate related to the treatment of scoliosis?

a) “The only successful treatment for scoliosis is surgery within two weeks of the diagnosis.”
b) “The treatment for children with scoliosis usually lasts three to four months.”

c ) “Children with severe scoliosis are treated using electrical stimulation.”

d) “Children treated for scoliosis by using braces have to wear the brace almost all the time.”

Answer 37

d) “Children treated for scoliosis by using braces have to wear the brace almost all the time.”

The Boston brace and the TLSO brace are made of plastic and are customized to fit the child for treatment of scoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit.

Question 38

After teaching the parents of a 6-year-old child about caring for a sprained wrist, which statement by the parents indicates the need for additional teaching?

a) “We’ll make sure she keeps her arm above heart level.”
b) “We can wrap the wrist in an elastic bandage to help reduce the swelling.”
c) “She’ll need to limit any activity that involves the wrist.”
d) “We’ll apply a warm moist compress to the wrist for 20 minutes at a time.”

Answer 38

d) “We’ll apply a warm moist compress to the wrist for 20 minutes at a time.”

Care for a sprain includes rest, ice, compression, and elevation. Cold therapy, not heat, is used for 20 to 30 minutes at a time, then removed for 1 hour and repeated for the first 24 to 48 hours. Compression via an elastic bandage, elevating above heart level, and limiting activity are appropriate measures.

Question 39

The nurse is caring for a 6-year-old boy with Russell traction applied to his left leg. Which intervention would be most appropriate to prevent complications?

a) Adjust the weights as needed.
b) Provide pin care as needed.
c) Assess the popliteal region carefully for skin breakdown.
d) Clean and massage his entire leg daily.

Answer 39

c) Assess the popliteal region carefully for skin breakdown.

The nurse would assess the popliteal region carefully for skin breakdown from the sling. The nurse would adjust the weights only per physician orders. Cleaning and massaging the skin is unrelated to care of the child with Russell traction. Russell traction is a form of skin traction, so there is no pin care.

Question 40

An infant with a femur fracture is placed in Bryant traction. Which of the following would the nurse include in the infant’s plan of care?

a) Removing the traction boot every 8 hours
b) Provide range of motion to the unaffected extremity
c) Wrapping the bandages from the ankle to the knee
d) Keeping the buttocks slightly elevated

Answer 40

d) Keeping the buttocks slightly elevated

With Bryant traction, the buttocks should be slightly elevated and clear of the bed. The bandages are wrapped from the ankles to midthigh in Bryant traction. The legs are wrapped from the ankle to knee. A traction boot is not used with Bryant traction. This action would be appropriate for Buck traction. With Bryant traction, both legs are extended vertically, so range of motion would not be appropriate.