Chapter 20: Musculoskeletal Disorders

Chapter 20: Musculoskeletal Disorders

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A mother brings into the emergency department a frail-looking infant with blue sclera and arm and leg deformities. The mom said she was changing her diaper and heard a “snap.” She put her shirt on and she heard another “snap.” She says that the baby has been crying, but eating a little. Mom reports a clavicle fracture in the delivery room, but the doctors told her it was nothing and would heal fine. The nurse notes a small lump on her right clavicle. It is not painful to the touch. The infants’ left forearm and right femur appear swollen and deformed. Based on your clinical knowledge of birth defects, your best answer to the mother would be:
2. “We will call the doctor to do a skeletal survey.”
3. “We will call the Child Protective Services team to rule out abuse.”
4. “We will call Genetics to see if any genetic birth defects run in your family.”
5. All of the above.

 

ANS: 4

	Feedback
1.	Often, children with osteogenesis imperfect (OI) are misdiagnosed; therefore, all children should undergo steps to rule out abuse, then proceed with genetic counseling, testing to verify a genetic disorder. The blue sclera and fractures without severe trauma are signs of OI.
2.	Often, children with osteogenesis imperfect (OI) are misdiagnosed; therefore, all children should undergo steps to rule out abuse.
3.	Often, children with osteogenesis imperfect (OI) are misdiagnosed; therefore, all children should undergo steps to rule out abuse, then proceed with genetic counseling, testing to verify a genetic disorder.
4.	All of the responses are correct. Often, children with osteogenesis imperfect (OI) are misdiagnosed; therefore, all children should undergo steps to rule out abuse, then proceed with genetic counseling, testing to verify a genetic disorder. The blue sclera and fractures without severe trauma are signs of OI.

KEY: Content Area: Musculoskeletal | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 20 | Type: Multiple Choice

 

 

 

2. A 13-year-old boy, who has played baseball for three years, comes in complaining of left elbow pain and swelling. He is a pitcher. He plays baseball all year. X-rays reveal medial epicondyle irritation. There is no avulsion fracture. Based on these findings, you explain to the child that he can:
3. Swim. It’s a safer sport.
4. Resume baseball gradually with pain-free motion.
5. Change positions in baseball for the season.
6. Protect, rest, ice, compress, and elevate the injury as well as stop baseball for three weeks.

 

ANS: 4

	Feedback
1.	The repetitive motion of swimming can cause the same irritation.
2.	Sports injuries are common in adolescents, especially overuse injuries. Open growth plates are locations for overuse injuries. Little Leaguer’s elbow is characterized by pain, swelling, and repetitive motions.
3.	The child may not have an interest in other positions. A modification to his pitching may need to be made.
4.	Sports injuries are common in adolescents, especially overuse injuries. Open growth plates are locations for overuse injuries. Little Leaguer’s elbow is characterized by pain, swelling, and repetitive motions.

KEY: Content Area: Safety and Injury | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Comprehension | REF: CHAPTER 20 | Type: Multiple Choice

 

 

 

3. A 16-year-old soccer player comes into the ER with left knee effusion and extreme pain. The child claims that while kicking the ball away from an opponent, she felt a “pop” and fell to the ground. She had to be assisted off the field. She is in the playoffs and wants to play again. X-rays are normal, but as the nurse, you know which of the following about sports injuries?
4. X-rays can help classify fractures, but cannot classify tissue, tendons, and ligaments.
5. She probably has an ACL tear based on the symptoms of swelling, pain, inability to bear weight, and hearing a “pop” before she went down.
6. She will need an MRI.
7. She will need crutches and a knee immobilizer as well as to rest, ice, compress, and elevate the injury.

 

ANS: 4

	Feedback
1.	The X-ray can see some damage to the ligaments and swollen areas.
2.	The “pop” does not classify the injury.
3.	A CT scan would help identify the injured area.
4.	Care of acute sports-related injuries include PRICE: protect from further injury, rest, ice, compression, and elevation to relieve pain.

KEY: Content Area: Musculoskeletal | Integrated Processes: Physiological Integrity | Client Need: Nursing Process | Cognitive Level: Analysis | REF: CHAPTER 20 | Type: Multiple Choice

 

 

 

4. A 21-one-year old basketball player comes to the emergency department with a swollen, ecchymotic, painful right ankle. He states he went up for a jump shot and twisted it. He reports pain over the medial malleolus. He cannot walk on it and was assisted off the court at the game. He reports that he has done this before, but it is different this time. He wants an air cast splint and crutches, but no x-rays. What statement indicates that this young athlete may not understand the difference between a fracture and a sprain?
5. “I will be fine in 3 days.”
6. “I can play if you give me the splint.”
7. “I don’t need x-rays today. I’ve done this before.”
8. All of the above.

 

ANS: 4

	Feedback
1.	Sprains, strains, and fractures can all have the same symptoms of pain, swelling, inability to bear weight, and ecchymosis that may last a few days.
2.	An x-ray will assist with fracture detection at this time.
3.	An x-ray will assist with fracture detection.
4.	Sprains, strains, and fractures can all have the same symptoms of pain, swelling, inability to bear weight, and ecchymosis. An x-ray will assist with fracture detection.

KEY: Content Area: Musculoskeletal | Integrated Processes: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Analysis | REF: CHAPTER 20 | Type: Multiple Choice

 

 

 

5. A 5-year-old boy presents to the emergency department with a history of a motor vehicle accident. He was restrained in the backseat, and the car was hit head on. He has a swollen and deformed left thigh. He is in extreme pain. He has frequent muscle spasms. X-rays reveal a midshaft femur fracture. As you prepare the child prior to surgery, you will assist with anticipatory guidance as well as show and discuss a spica cast. What information will be helpful to this young boy?
6. A hard cast from your waist to your toes will protect your leg so it can heal.
7. We can put a cast like yours on your bear.
8. The IV will give you medicine to make you sleep, wake up, and help with the pain.
9. All of the above.

 

ANS: 4

	Feedback
1.	Clear explanations in easy to understand language for this age group will help this child cope with new and uncomfortable experiences. Using hands-on demonstrations and familiar play things assist with decreasing anxiety about the unknown.
2.	Placing a cast on a stuffed animal may help decrease the anxiety of the patient.
3.	Using hands-on demonstrations and familiar play things assist with decreasing anxiety about the unknown.
4.	Clear explanations in easy to understand language for this age group will help this child cope with new and uncomfortable experiences. Using hands-on demonstrations and familiar play things assist with decreasing anxiety about the unknown.

KEY: Content Area: Musculoskeletal | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity | Cognitive Level: Application | REF: CHAPTER 20 | Type: Multiple Choice