Pediatric disorders of the orthopedic system

Question 1

The nurse practitioner is educating a group of students on Legg-Calvé-Perthes disease. Conclude which statement is accurate.

Athletic adolescents are at a higher risk for acquiring Legg-Calvé-Perthes disease.

Legg-Calvé-Perthes disease may be bilateral.

Legg-Calvé-Perthes disease is more common in females.

Legg-Calvé-Perthes disease is caused by overuse of the extremity.

Answer 1

Legg-Calvé-Perthes disease may be bilateral.

Question 2

The nurse practitioner is educating a group of students on treatment plans for patients presenting with scoliosis. Propose an accurate statement.

Observation is recommended for curvatures less than 30 degrees.

Treatment should be initiated in patients with a curvature of 5 degrees.

Surgical intervention is recommended in curves greater than 45 degrees.

Bracing is not necessary when the child is at school.

Answer 2

Surgical intervention is recommended in curves greater than 45 degrees.

Question 3

Recommend a management measure or treatment for a patient with Legg-Calvé-Perthes disease.

Relief of weight bearing

Moderate impact exercises for strength building

Surgery for children under the age of 6 years

Muscle relaxants for pain control and comfort

Answer 3

Relief of weight bearing

Question 4

Establish an accurate statement for educating a group of nursing students on orthopedic disorders and Osgood–Schlatter disease.

For optimal results, physical therapy should be initiated on diagnosis.

Surgical management is reserved for patients who fail to respond to conservative measures.

The patient typically denies a history of physical trauma.

A magnetic resonance imaging (MRI) scan is recommended for diagnosis of Osgood–Schlatter disease.

Answer 4

Surgical management is reserved for patients who fail to respond to conservative measures.

Question 5

The nurse practitioner is educating a group of students on tenosynovitis. Propose a recommended treatment and prevention option.

Consider surgery if symptomatic for greater than 30 days

Application of heat or cold

Treat with steroidal cream for inflammation

Topical antibiotics

Answer 5

Application of heat or cold

Question 6

A.J. presents to the clinic at for a routine examination. The nurse practitioner suspects A.J. has Osgood–Schlatter disease. Determine what Osgood–Schlatter disease is commonly associated with.

Decreased range of motion of the extremity

Swelling at the tibial tubercle

Pain that radiates down the extremity

Recent lower extremity fracture

Answer 6

Swelling at the tibial tubercle

Question 7

Management of scoliosis depends on the severity of the curve as well as the age of the child. Predict which would require surgical intervention.

Thoracic curve greater than 25 degrees in a child who has closed epiphyseal plates

Skeletally immature patients with curves with Cobb angle greater than or equal to 50 degrees

Thoracic curve greater than 25 degrees in a child who is still growing

Curves of 15 degrees in a child who is still growing

Answer 7

Skeletally immature patients with curves with Cobb angle greater than or equal to 50 degrees

Question 8

A 5-year-old presents to the clinic with complaints of hip pain. The nurse practitioner diagnoses the patient with synovitis. Conclude which statement regarding synovitis is accurate.

Normal range of motion present on examination.

Treatment is aggressive to prevent septic arthritis.

This disorder must be distinguished from septic arthritis.

Discomfort typically lasts 30 days.

Answer 8

This disorder must be distinguished from septic arthritis.

Question 9

Propose a treatment goal for a patient presenting with Legg-Calvé-Perthes disease.

Initiating surgical correction in children aged 6 and younger

Prevention of degenerative arthritis

Encouraging hydration, exercise, and stretching

Prevention of further worsening of the curvature

Answer 9

Prevention of degenerative arthritis

Question 10

The nurse practitioner is evaluating a patient presenting with scoliosis. Predict a physical finding of scoliosis.

Severe back pain

Chest pain and tenderness on palpation

Asymmetry of scapula

Arms that are symmetric in length

Answer 10

Asymmetry of scapula

Question 11

Predict the patient at a higher risk for developing Legg-Calvé-Perthes disease.

A 15-year-old female who is recovering from an ankle sprain

A 2-year-old female who was born breech

A 10-year-old male

A 2-month-old premature infant

Answer 11

A 10-year-old male

Question 12

Propose a risk factor for a patient presenting with scoliosis.

8-year-old male with back pain

A sibling with scoliosis

A female with a family history of diabetes

An 18-year-old male

Answer 12

A sibling with scoliosis

Question 13

Recommend an activity for a patient presenting with femoral anteversion.

Reading

Patients must wear orthotics when exercising

Exercise is not recommended in children with femoral anteversion

Skating

Answer 13

Skating

Question 14

The nurse practitioner is evaluating a toddler in the clinic for genu varum. Determine a physical finding usually associated with patients presenting with genu varum.

Tenderness over the medial malleolus

Extreme pain with ambulation

Decreased internal rotation of the leg

Lower legs angled medially

Answer 14

Lower legs angled medially

Question 15

Establish a characteristic of a child presenting with femoral anteversion.

The child’s toes or kneecaps turn outward as he or she walks.

It is common in children presenting with multiple fractures.

The child has increased internal rotation and decreased external rotation at the hip.

It is typically detected when the child is 8–10 years old.

Answer 15

The child has increased internal rotation and decreased external rotation at the hip.

Question 16

The nurse practitioner is evaluating a pediatric patient for tibial torsion. Predict which is accurate regarding the risk and incidence in pediatrics.

Exercise is mandatory for the tibial torsion to resolve.

Patients with tibial torsion have a higher risk for arthritis.

Males and females are affected equally.

Tibial torsion is more common in females.

Answer 16

Males and females are affected equally.

Question 17

When treating a patient for pes planus, conclude what the nurse practitioner identifies as accurate.

Rigid orthotics are helpful in patients with functional flat feet.

Surgery is commonly indicated for patients with rigid pes planus.

Nonsteroidal anti-inflammatory medications can relieve swelling and pain.

Patients with functional flat feet must be referred to an orthopedic surgeon.

Answer 17

Patients with functional flat feet must be referred to an orthopedic surgeon.

Question 18

The nurse practitioner is evaluating a 5-year-old female for femoral anteversion. Recommend an effective diagnostic maneuver and examination technique for femoral anteversion.

McBurney’s test

Patient history of “egg beaters” or “windmill” pattern during running

Galeazzi test

Laboratory studies

Answer 18

Patient history of “egg beaters” or “windmill” pattern during running

Question 19

The nurse practitioner is concerned about a patient presenting with tibial torsion. Propose an accurate statement regarding tibial torsion.

Tibial torsion almost always improves without treatment.

Bracing and special shoes are recommended.

In tibial torsion, the child’s thighbone (femur) turns inward.

Tibial torsion occurs if the child’s lower leg (tibia) twists outward.

Answer 19

Tibial torsion almost always improves without treatment.

Question 20

The nurse practitioner is educating a group of students on orthopedic disorders. Decide which is a type of flexible pes planus.

Flexible pes planus Types I, II, and III

Physiological flat foot

Rigid pes planus

Calcaneovalgus flat foot

Answer 20

Flexible pes planus Types I, II, and III

Question 21

The nurse practitioner is reviewing risk factors for patients with orthopedic disorders. Propose a common risk factor for femoral anteversion.

Genetic inheritance

Prematurity

Frequently associated with child abuse

Higher incidence in males

Answer 21

Genetic inheritance

Question 22

When educating a group of students on genu varum, conclude which the nurse practitioner identifies as accurate.

Treatment is rarely indicated in physiologic genu varum.

Genu varum typically delays the toddler’s ability to walk.

Genu varum typically resolves by age 8.

It is a common knee disorder in which the apex of the deformity angles towards the midline.

Answer 22

Treatment is rarely indicated in physiologic genu varum.

Question 23

Recommend an activity for a patient presenting with femoral anteversion.

Exercise is recommended after casting

Exercise is not recommended in children with femoral anteversion

Patients must wear orthotics when exercising

Walking

Answer 23

Walking

Question 24

When treating a patient for pes planus, conclude what the nurse practitioner identifies as accurate.

A well-constructed, cushioned shoe with a supported heel counter is recommended for functional flat feet.

The use of hard-soled shoes helps to prevent pes planus.

Rigid orthotics are helpful in patients with functional flat feet.

Nonsteroidal anti-inflammatory medications can relieve swelling and pain.

Answer 24

A well-constructed, cushioned shoe with a supported heel counter is recommended for functional flat feet.

Question 25

The nurse practitioner is educating a group of students on genu varum versus genu valgum in pediatric patients. Establish an accurate statement.

Treatment is not typically indicated in genu varum or genu valgum.

Genu valgum is the stretching of a ligament binding the joint.

Genu varum is more frequent in females and associated with ligament laxity.

Genu varum typically requires surgery.

Answer 25

Treatment is not typically indicated in genu varum or genu valgum.

Question 26

The nurse practitioner is concerned about a patient presenting with tibial torsion. Propose an accurate statement regarding tibial torsion.

Bracing and special shoes are recommended.

In tibial torsion, the child’s thighbone (femur) turns inward.

External tibial torsion is a normal rotational variant.

Tibial torsion occurs if the child’s lower leg (tibia) twists outward.

Answer 26

External tibial torsion is a normal rotational variant.

Question 27

The nurse practitioner is evaluating a patient for tibial torsion. Determine a characteristic commonly associated with tibial torsion.

In-toeing is the most visible symptom of internal tibial torsion.

Tibial torsion causes the feet to be turned outward and the knees to be angled midline.

Tibial torsion involves the laxity of the soft tissues of the foot, resulting in in-toeing.

Tibial torsion is an exaggerated bending outward of the legs from the knees down.

Answer 27

In-toeing is the most visible symptom of internal tibial torsion.

Question 28

The nurse practitioner is evaluating a toddler in the clinic for genu varum. Recommend the most important initial management for a toddler presenting with genu varum.

Bracing

Refer for surgery

Family education

Prepare family for traction

Answer 28

Family education

Question 29

When evaluating a child for lower extremity disorders, the nurse practitioner may need to refer for appropriate follow up and treatment. Predict which child needs an orthopedic referral.

A-5-year-old presenting with ligament laxity and knock-knee

A 3-year-old whose feet point inward when standing or walking

A 5-year-old with increased femoral anteversion with complaints of extreme hip and knee pain

A 4-year-old presenting with medial femoral torsion

Answer 29

A 5-year-old with increased femoral anteversion with complaints of extreme hip and knee pain

Question 30

The nurse practitioner is discussing treatment options for a child who presents with genu valgum. Propose a statement that is accurate.

Radiographs are not indicated in patients with genu valgum.

It is because of twisting or rotation of the body around a fixed foot.

Genu valgum is typically considered normal until about 8 years of age.

Genu valgum is when there is a twist in the bone.

Answer 30

Genu valgum is typically considered normal until about 8 years of age.

Question 31

The nurse practitioner is educating a group of students on sprains versus strains in pediatric patients. Predict the statement that is accurate.

Muscle strains are not common in younger children.

A strain is the stretching of a ligament binding the joint.

A sprain is the stretching or tearing of a ligament binding the joint.

Grade 1 sprains may require surgery.

Answer 31

A sprain is the stretching or tearing of a ligament binding the joint.

Question 32

Child abuse should be suspected in all children presenting with a fracture. Determine which is accurate when evaluating a child with suspected child abuse.

Suspected cases of abuse must be appropriately referred.

Child abuse is uncommon in children presenting with multiple fractures.

The suspected child abuse should be referred after confronting the parent.

A repeat radiograph is recommended every 5 days.

Answer 32

Suspected cases of abuse must be appropriately referred.

Question 33

Question 5
J. B. was recently diagnosed with developmental hip dysplasia (DDH). The mother is questioning the treatment plan and prognosis. Predict what is associated with a better long-term outcome for patients diagnosed with DDH.

Surgery if harnessing is not successful

Double or triple diapers to maintain the child’s hip stability

Forced reduction or abduction for infants

Using the Pavlik harness for the first year of life

Answer 33

Surgery if harnessing is not successful

Question 34

amantha is a 10-year-old female who presents to the clinic for discomfort after stepping onto an uneven surface and twisting her ankle. Determine what an evaluation of patients presenting with possible sprains must include.

Anterior drawer test

Hydration status and urinary output

Joint stability

Test for Murphy’s sign

Answer 34

oint stability

Question 35

Question 1
The nurse practitioner is providing anticipatory guidance to the parents of a 2-year-old. Propose a common cause of subluxation of elbow.

Inflammation of the shoulder joint

Twisting or rotating the body around a fixed foot

A child being pulled by the hand

Falling on an outstretched arm with the wrist dorsiflexed

Answer 35

A child being pulled by the hand

Question 36

In a newborn, predict when a diagnosis of hip dislocation or developmental hip dysplasia (DDH) is suspected.

Flaccidity of the left leg following the extension of both legs

Wide hip abduction is symmetric

The femoral head is within the acetabulum but can be maneuvered and completely dislocated

Tonic neck reflex in which the left leg is flexed

Answer 36

Rest

Question 37

Question 9
Plain radiographs are warranted when a patient presents with atypical findings of a possible ankle sprain. Propose an atypical finding of a possible ankle sprain.

Full range of motion and mild discomfort with ambulation

Intermittent mild tenderness

Tenderness over the lateral malleolus

Stretching and tenderness of the tendon

Answer 37

Tenderness over the lateral malleolus

Question 38

An 11-year-old presents to the clinic with complaints of a deformity of her back that started a few months ago. Determine which is consistent with a diagnosis of scoliosis.

Severe back pain

A history of hip pain and limping

15-degree lateral curvature of the spine

Inflammation of the sheath of the spine

Answer 38

15-degree lateral curvature of the spine

Question 39

The nurse practitioner is educating a group of students on patients presenting with Osgood–Schlatter disease. Establish appropriate treatment for a patient presenting with Osgood–Schlatter disease.

A brace for immobilization

Rest of extremity

Serial casting

Antibiotic therapy

Answer 39

Rest of extremity

Question 40

When evaluating a patient for tenosynovitis, establish what the nurse practitioner recognizes that tenosynovitis in adolescents is commonly associated with.

More common in females

Extremity strain

More common in obese males

Upper extremity and shoulders

Answer 40

Extremity strain

Question 41

The nurse practitioner is completing a well examination on a pediatric patient. Conclude which patient needs an orthopedic referral.

A febrile 5-year-old who presents with a limp, hip pain, and limited range of motion

A patient who complains of knee pain that is localized to the tibial tubercle

A patient with a 2-day history of mild back discomfort

A patient presenting with a 1-day history of limping

Answer 41

febrile 5-year-old who presents with a limp, hip pain, and limited range of motion

Question 42

Establish an accurate statement for educating a group of nursing students on orthopedic disorders and Osgood–Schlatter disease.

Complete avoidance of sports activity is recommended.

A magnetic resonance imaging (MRI) scan is recommended for diagnosis of Osgood–Schlatter disease.

Surgical management is reserved for patients who fail to respond to conservative measures.

The patient typically denies a history of physical trau

Answer 42

Surgical management is reserved for patients who fail to respond to conservative measures.

Question 43

Question 6
The nurse practitioner is evaluating a patient presenting with scoliosis. Predict a physical finding of scoliosis.

Shortness of breath and decreased range of motion

Severe back pain

Arms that are symmetric in length

Rib asymmetry

Answer 43

Rib asymmetry

Question 44

The nurse practitioner is educating a group of students on Legg-Calvé-Perthes disease. Conclude which statement is accurate.

Legg-Calvé-Perthes disease appears in conjunction with synovitis.

Legg-Calvé-Perthes disease is caused by overuse of the extremity.

Legg-Calvé-Perthes disease is more common in females.

The etiology of Legg-Calvé-Perthes disease is undefined.

Answer 44

The etiology of Legg-Calvé-Perthes disease is undefined.