1. The nurse is providing care to a pediatric patient admitted for a work-up of bone
deformity. The latest laboratory values indicate calcium at 6.6 mg/dL and phosphorus at
2.1 mg/dL. Which condition does the nurse correlate with these values?
a. Muscular dystrophy
b. Osgood-Schlatter disease
c. Rickets
d. Scoliosis
ANS: C
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #2. Describe the pathophysiology, etiology, clinical manifestations, and
management of various musculoskeletal systems compared with adult
musculoskeletal systems.
Page: 741
Heading: Blood and Body Fluid Analysis for the Child with Musculoskeletal
Conditions
Integrated Processes: Nursing Process: Assessment
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Assessment; Critical Thinking; Nursing
Difficulty: Difficult
Feedback
A. Muscular dystrophy is a neuromuscular disorder that is not indicated by low
calcium and phosphorus levels.
B. Osgood-Schlatter disease is characterized by knee pain. It is a genetic condition
related to overuse and has no correlation to calcium and phosphorus levels.
C. Normal calcium is 8.5–11 mg/dL, and normal phosphorus is 3–4.5 mg/dL. Low
values for both indicate rickets.
D. Scoliosis is a spinal deformity diagnosed by radiography, not by laboratory
values.
2. A pediatric nurse is caring for a 1-year-old child who is in a spica cast. The nurse teaches
the parents that modifications need to be made for this child. Which modification does the
nurse teach?
a. Using a baby bath with shallow water to clean the child
b. Using a car seat with sturdy sides to transport the child
, c. Using a sitting position on the floor to feed the child
d. Using a wagon instead of a stroller to move the child
ANS: D
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #5. Develop teaching plans and discharge criteria for parents whose
children have various musculoskeletal conditions.
Page: 723
Heading: Modifications for a Child in a Hip Spica Cast
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity: Basic Care and Comfort
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing Roles
Difficulty: Moderate
Feedback
A. The parents will need to modify the bath by giving the child a sponge bath.
B. Toddler car seats that do not have sides are a good modification for a child in a
spica cast.
C. Placing the child in the prone position on the floor can make feeding the child
easier.
D. Mobilizing a child in a wagon is a good modification for a stroller while the
child is in the spica cast.
3. A new nurse is caring for a child after spinal fusion to correct scoliosis. Which action by
the new nurse causes the experienced nurse to intervene?
a. Assesses neurological status and vital signs every hour
b. Instructs patient to turn by pulling on side rails
c. Monitors chest tube for air leakage and drainage
d. Promotes use of the incentive spirometer each hour
ANS: B
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #3. Prioritize, design, implement, and evaluate developmentally
appropriate and holistic nursing interventions for the child with altered
musculoskeletal conditions.
Page: 744-745
Heading: Surgical Care
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing
Difficulty: Moderate
, Feedback
A. It is appropriate for the nurse to assess neurological status and vital signs every
hour.
B. After spinal fusion, the patient must be logrolled to turn. Logrolling involves
two nurses turning the patient as one single unit so that the spine is maintained
in a straight line. The patient should not be instructed to pull on the side rails to
turn.
C. It is appropriate for the nurse to monitor the chest tube for air leakage and
drainage.
D. It is appropriate for the nurse to promote use of the incentive spirometer each
hour.
4. A nurse working in an inpatient pediatric unit cares for many children with
musculoskeletal impairments. Which outcome takes priority for these children?
a. Adapting to changing activity restrictions
b. Continuing their growth and development
c. Resuming ambulation as soon as possible
d. Staying current with schoolwork with tutors
ANS: B
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #3. Prioritize, design, implement, and evaluate developmentally
appropriate and holistic nursing interventions for the child with altered
musculoskeletal conditions.
Page: 720
Heading: Growth and Development
Integrated Processes: Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing
Difficulty: Moderate
Feedback
A. Some children may need to adapt to changing activity restrictions, but the
priority outcome is maintaining normal growth and development.
B. Growth and development are dependent upon being able to interact with the
environment. Any child with a musculoskeletal disorder is at risk for impaired
growth and development. A priority outcome for any of these children is to
maintain normal growth and development.
C. For some children, ambulation will be delayed or not possible.
D. Staying current with education is important but does not take priority over
maintaining normal growth and development.
5. A woman who wishes to become pregnant again consults with the nurse about preventing
, her child from being born with clubfoot. She has two other children, both treated for this
disorder. Which information does the nurse provide about preventing clubfoot?
a. Avoid secondhand cigarette smoke while pregnant
b. Sleep on your left side as much as possible.
c. Getting enough folic acid early in pregnancy is advisable.
d. The disorder is genetic, so no prevention is available.
ANS: D
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #3. Prioritize, design, implement, and evaluate developmentally
appropriate and holistic nursing interventions for the child with altered
musculoskeletal conditions.
Page: 727-728
Heading: Clubfoot>Prevention
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing Roles
Difficulty: Moderate
Feedback
A. Secondhand smoke exposure is not related to clubfoot.
B. Sleeping on the left side promotes circulation but has no effect on clubfoot.
C. Folic acid is important for preventing neural tube disorders but has no effect on
clubfoot.
D. Recent research shows that clubfoot is genetic, so no prevention is possible.
6. A parent calls the clinic to report that his child’s cast seems to be looser than it was
yesterday. Which instruction is most appropriate for the nurse to provide to the parent?
a. “Bring your child in so we can evaluate the cast.”
b. “You can try wetting it and wrapping it tighter.”
c. “Pad the top of the cast with a small towel so it fits.”
d. “This is not unusual; just keep your next appointment.”
ANS: A
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #3. Prioritize, design, implement, and evaluate developmentally
appropriate and holistic nursing interventions for the child with altered
musculoskeletal conditions.
Page: 728
Heading: Patient Education> The Child with Clubfoot Wearing a Cast
Integrated Processes: Communication and Documentation
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Application [Applying]
deformity. The latest laboratory values indicate calcium at 6.6 mg/dL and phosphorus at
2.1 mg/dL. Which condition does the nurse correlate with these values?
a. Muscular dystrophy
b. Osgood-Schlatter disease
c. Rickets
d. Scoliosis
ANS: C
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #2. Describe the pathophysiology, etiology, clinical manifestations, and
management of various musculoskeletal systems compared with adult
musculoskeletal systems.
Page: 741
Heading: Blood and Body Fluid Analysis for the Child with Musculoskeletal
Conditions
Integrated Processes: Nursing Process: Assessment
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Assessment; Critical Thinking; Nursing
Difficulty: Difficult
Feedback
A. Muscular dystrophy is a neuromuscular disorder that is not indicated by low
calcium and phosphorus levels.
B. Osgood-Schlatter disease is characterized by knee pain. It is a genetic condition
related to overuse and has no correlation to calcium and phosphorus levels.
C. Normal calcium is 8.5–11 mg/dL, and normal phosphorus is 3–4.5 mg/dL. Low
values for both indicate rickets.
D. Scoliosis is a spinal deformity diagnosed by radiography, not by laboratory
values.
2. A pediatric nurse is caring for a 1-year-old child who is in a spica cast. The nurse teaches
the parents that modifications need to be made for this child. Which modification does the
nurse teach?
a. Using a baby bath with shallow water to clean the child
b. Using a car seat with sturdy sides to transport the child
, c. Using a sitting position on the floor to feed the child
d. Using a wagon instead of a stroller to move the child
ANS: D
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #5. Develop teaching plans and discharge criteria for parents whose
children have various musculoskeletal conditions.
Page: 723
Heading: Modifications for a Child in a Hip Spica Cast
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity: Basic Care and Comfort
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing Roles
Difficulty: Moderate
Feedback
A. The parents will need to modify the bath by giving the child a sponge bath.
B. Toddler car seats that do not have sides are a good modification for a child in a
spica cast.
C. Placing the child in the prone position on the floor can make feeding the child
easier.
D. Mobilizing a child in a wagon is a good modification for a stroller while the
child is in the spica cast.
3. A new nurse is caring for a child after spinal fusion to correct scoliosis. Which action by
the new nurse causes the experienced nurse to intervene?
a. Assesses neurological status and vital signs every hour
b. Instructs patient to turn by pulling on side rails
c. Monitors chest tube for air leakage and drainage
d. Promotes use of the incentive spirometer each hour
ANS: B
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #3. Prioritize, design, implement, and evaluate developmentally
appropriate and holistic nursing interventions for the child with altered
musculoskeletal conditions.
Page: 744-745
Heading: Surgical Care
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing
Difficulty: Moderate
, Feedback
A. It is appropriate for the nurse to assess neurological status and vital signs every
hour.
B. After spinal fusion, the patient must be logrolled to turn. Logrolling involves
two nurses turning the patient as one single unit so that the spine is maintained
in a straight line. The patient should not be instructed to pull on the side rails to
turn.
C. It is appropriate for the nurse to monitor the chest tube for air leakage and
drainage.
D. It is appropriate for the nurse to promote use of the incentive spirometer each
hour.
4. A nurse working in an inpatient pediatric unit cares for many children with
musculoskeletal impairments. Which outcome takes priority for these children?
a. Adapting to changing activity restrictions
b. Continuing their growth and development
c. Resuming ambulation as soon as possible
d. Staying current with schoolwork with tutors
ANS: B
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #3. Prioritize, design, implement, and evaluate developmentally
appropriate and holistic nursing interventions for the child with altered
musculoskeletal conditions.
Page: 720
Heading: Growth and Development
Integrated Processes: Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing
Difficulty: Moderate
Feedback
A. Some children may need to adapt to changing activity restrictions, but the
priority outcome is maintaining normal growth and development.
B. Growth and development are dependent upon being able to interact with the
environment. Any child with a musculoskeletal disorder is at risk for impaired
growth and development. A priority outcome for any of these children is to
maintain normal growth and development.
C. For some children, ambulation will be delayed or not possible.
D. Staying current with education is important but does not take priority over
maintaining normal growth and development.
5. A woman who wishes to become pregnant again consults with the nurse about preventing
, her child from being born with clubfoot. She has two other children, both treated for this
disorder. Which information does the nurse provide about preventing clubfoot?
a. Avoid secondhand cigarette smoke while pregnant
b. Sleep on your left side as much as possible.
c. Getting enough folic acid early in pregnancy is advisable.
d. The disorder is genetic, so no prevention is available.
ANS: D
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #3. Prioritize, design, implement, and evaluate developmentally
appropriate and holistic nursing interventions for the child with altered
musculoskeletal conditions.
Page: 727-728
Heading: Clubfoot>Prevention
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing Roles
Difficulty: Moderate
Feedback
A. Secondhand smoke exposure is not related to clubfoot.
B. Sleeping on the left side promotes circulation but has no effect on clubfoot.
C. Folic acid is important for preventing neural tube disorders but has no effect on
clubfoot.
D. Recent research shows that clubfoot is genetic, so no prevention is possible.
6. A parent calls the clinic to report that his child’s cast seems to be looser than it was
yesterday. Which instruction is most appropriate for the nurse to provide to the parent?
a. “Bring your child in so we can evaluate the cast.”
b. “You can try wetting it and wrapping it tighter.”
c. “Pad the top of the cast with a small towel so it fits.”
d. “This is not unusual; just keep your next appointment.”
ANS: A
Chapter: Chapter 21 Caring for the Child With a Musculoskeletal Condition
Objective: #3. Prioritize, design, implement, and evaluate developmentally
appropriate and holistic nursing interventions for the child with altered
musculoskeletal conditions.
Page: 728
Heading: Patient Education> The Child with Clubfoot Wearing a Cast
Integrated Processes: Communication and Documentation
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Application [Applying]
