C HAPTER 27: A LTERATIONS IN
M USCULOSKELETAL F UNCTION
MULTIPLE CHOICE
1. What is the primary method of treating osteomyelitis?
a. Joint replacement
b. Bracing and casting
c. Intravenous antibiotic therapy
d. Long-term corticosteroid therapy
ANS: C
Osteomyelitis is an infection of the bone, most commonly caused by
Staphylococcus aureus infection. The treatment of choice is antibiotics. Joint
replacement, bracing and casting, and long-term corticosteroid therapy are not
indicated for infectious processes.
2. What nursing intervention is most appropriate when caring for the child with
osteomyelitis?
a. Encourage frequent ambulation.
b. Administer antibiotics with meals.
c. Move and turn the child carefully and gently to minimize pain.
d. Provide active range of motion exercises for the affected extremity.
ANS: C
, During the acute phase, any movement of the affected limb causes discomfort
to the child. Careful positioning with the affected limb supported is
necessary. Weight bearing is not permitted until healing is well under way to
avoid pathologic fractures. Intravenous antibiotics are used initially. Food is
not necessary with parenteral therapy. Active range of motion wo uld be
painful for the child.
3. What statement is true concerning osteogenesis imperfecta (OI)?
a. It is easily treated.
b. It is an inherited disorder.
c. Braces and exercises are of no therapeutic value.
d. Later onset disease usually runs a more difficult course.
ANS: B
OI is a heterogeneous, autosomal dominant disorder characterized by
fractures and bone deformity. Treatment is primarily supportive. Several
investigational therapies are being evaluated. The primary goal of therapy is
rehabilitation. Lightweight braces and splints help support limbs, prevent
fractures, and aid in ambulation. The disease is present at birth. Prognosis is
affected by the type of OI.
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity
4. What is a major goal for the therapeutic management of juvenile idiopathic
arthritis (JIA)?
a. Control pain and preserve joint function.
b. Minimize use of joint and achieve cure.
c. Prevent skin breakdown and relieve symptoms.
, d. Reduce joint discomfort and regain proper alignment.
ANS: A
The goals of therapy are to control pain, preserve joint range of motion and
function, minimize the effects of inflammation, and promote normal growth
and development. There is no cure for JIA at this time. Skin breakdown is not
an issue for most children with JIA. Symptom relief and reduction in
discomfort are important. When the joints are damaged, it is often
irreversible.
5. A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal
antiinflammatory drug (NSAID). What nursing consideration should be included?
a. Monitor heart rate.
b. Administer NSAIDs between meals.
c. Check for abdominal pain and bloody stools.
d. Expect inflammation to be gone in 3 or 4 days.
ANS: C
NSAIDs are the first-line drugs used in JIA. Potential side effects include
gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI
bleeding and elevated blood pressure. The heart rate is not affected by this
drug class. NSAIDs should be given with meals to minimize g astrointestinal
problems. The antiinflammatory response usually takes 3 weeks before
effectiveness can be evaluated.
6. What is an important nursing consideration when caring for a child with juvenile
idiopathic arthritis (JIA)?
a. Apply ice packs to relieve acute swelling and pain.
, b. Administer acetaminophen to reduce inflammation.
c. Teach the child and family correct administration of medications.
d. Encourage range of motion exercises during periods of inflammation.
ANS: C
The management of JIA is primarily pharmacologic. The family should be
instructed regarding administration of medications and the value of a regular
schedule of administration to maintain a satisfactory blood level in the body.
They need to know that nonsteroidal antiinflammatory drugs should no t be
given on an empty stomach and to be alert for signs of toxicity. Warm, moist
heat is best for relieving stiffness and pain. Acetaminophen does not have
antiinflammatory effects. Range of motion exercises should not be done
during periods of inflammation.
7. What needs to be included as essential teaching for adolescents with systemic
lupus erythematosus (SLE)?
a. High calorie diet because of increased metabolic needs
b. Home schooling to decrease the risk of infections
c. Protection from sun and fluorescent lights to minimize rash
d. Intensive exercise regimen to build up muscle strength and endurance
ANS: C
The photosensitive rash is a major concern for individuals with SLE.
Adolescents who spend time outdoors need to use sunscreens with a high SPF,
hats, and clothing. Uncovered fluorescent lights can also cause a
photosensitivity reaction. The diet should be sufficient in calories and
nutrients for growth and development. The use of steroids can cause increased
hunger, resulting in weight gain. This can present a dditional emotional issues
M USCULOSKELETAL F UNCTION
MULTIPLE CHOICE
1. What is the primary method of treating osteomyelitis?
a. Joint replacement
b. Bracing and casting
c. Intravenous antibiotic therapy
d. Long-term corticosteroid therapy
ANS: C
Osteomyelitis is an infection of the bone, most commonly caused by
Staphylococcus aureus infection. The treatment of choice is antibiotics. Joint
replacement, bracing and casting, and long-term corticosteroid therapy are not
indicated for infectious processes.
2. What nursing intervention is most appropriate when caring for the child with
osteomyelitis?
a. Encourage frequent ambulation.
b. Administer antibiotics with meals.
c. Move and turn the child carefully and gently to minimize pain.
d. Provide active range of motion exercises for the affected extremity.
ANS: C
, During the acute phase, any movement of the affected limb causes discomfort
to the child. Careful positioning with the affected limb supported is
necessary. Weight bearing is not permitted until healing is well under way to
avoid pathologic fractures. Intravenous antibiotics are used initially. Food is
not necessary with parenteral therapy. Active range of motion wo uld be
painful for the child.
3. What statement is true concerning osteogenesis imperfecta (OI)?
a. It is easily treated.
b. It is an inherited disorder.
c. Braces and exercises are of no therapeutic value.
d. Later onset disease usually runs a more difficult course.
ANS: B
OI is a heterogeneous, autosomal dominant disorder characterized by
fractures and bone deformity. Treatment is primarily supportive. Several
investigational therapies are being evaluated. The primary goal of therapy is
rehabilitation. Lightweight braces and splints help support limbs, prevent
fractures, and aid in ambulation. The disease is present at birth. Prognosis is
affected by the type of OI.
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity
4. What is a major goal for the therapeutic management of juvenile idiopathic
arthritis (JIA)?
a. Control pain and preserve joint function.
b. Minimize use of joint and achieve cure.
c. Prevent skin breakdown and relieve symptoms.
, d. Reduce joint discomfort and regain proper alignment.
ANS: A
The goals of therapy are to control pain, preserve joint range of motion and
function, minimize the effects of inflammation, and promote normal growth
and development. There is no cure for JIA at this time. Skin breakdown is not
an issue for most children with JIA. Symptom relief and reduction in
discomfort are important. When the joints are damaged, it is often
irreversible.
5. A child with juvenile idiopathic arthritis (JIA) is started on a nonsteroidal
antiinflammatory drug (NSAID). What nursing consideration should be included?
a. Monitor heart rate.
b. Administer NSAIDs between meals.
c. Check for abdominal pain and bloody stools.
d. Expect inflammation to be gone in 3 or 4 days.
ANS: C
NSAIDs are the first-line drugs used in JIA. Potential side effects include
gastrointestinal (GI), renal, and hepatic side effects. The child is at risk for GI
bleeding and elevated blood pressure. The heart rate is not affected by this
drug class. NSAIDs should be given with meals to minimize g astrointestinal
problems. The antiinflammatory response usually takes 3 weeks before
effectiveness can be evaluated.
6. What is an important nursing consideration when caring for a child with juvenile
idiopathic arthritis (JIA)?
a. Apply ice packs to relieve acute swelling and pain.
, b. Administer acetaminophen to reduce inflammation.
c. Teach the child and family correct administration of medications.
d. Encourage range of motion exercises during periods of inflammation.
ANS: C
The management of JIA is primarily pharmacologic. The family should be
instructed regarding administration of medications and the value of a regular
schedule of administration to maintain a satisfactory blood level in the body.
They need to know that nonsteroidal antiinflammatory drugs should no t be
given on an empty stomach and to be alert for signs of toxicity. Warm, moist
heat is best for relieving stiffness and pain. Acetaminophen does not have
antiinflammatory effects. Range of motion exercises should not be done
during periods of inflammation.
7. What needs to be included as essential teaching for adolescents with systemic
lupus erythematosus (SLE)?
a. High calorie diet because of increased metabolic needs
b. Home schooling to decrease the risk of infections
c. Protection from sun and fluorescent lights to minimize rash
d. Intensive exercise regimen to build up muscle strength and endurance
ANS: C
The photosensitive rash is a major concern for individuals with SLE.
Adolescents who spend time outdoors need to use sunscreens with a high SPF,
hats, and clothing. Uncovered fluorescent lights can also cause a
photosensitivity reaction. The diet should be sufficient in calories and
nutrients for growth and development. The use of steroids can cause increased
hunger, resulting in weight gain. This can present a dditional emotional issues
