Chapter 29: The Child with Musculoskeletal or Articular Dysfunction

Chapter 29: The Child with Musculoskeletal or Articular Dysfunction

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complication should the nurse monitor related to the child’s immobilization status?

a.	Metabolic rate increases
b.	Increased joint mobility leading to contractures
c.	Bone calcium increases, releasing excess calcium into the body (hypercalcemia)
d.	Venous stasis leading to thrombi or emboli formation

 

 

ANS:  D

The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. The metabolic rate decreases with immobilization. Loss of joint mobility leads to contractures. Bone demineralization with osteoporosis and hypercalcemia occur with immobilization.

 

DIF:    Cognitive Level: Apply                   REF:   p. 944

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

2. The nurse is caring for a preschool child immobilized by a spica cast. Which effect on metabolism should the nurse monitor on this child related to the immobilized status?

a.	Hypocalcemia
b.	Decreased metabolic rate
c.	Positive nitrogen balance
d.	Increased production of stress hormones

 

 

ANS:  B

Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake. Immobilization leads to hypercalcemia and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with decreased physical and emotional coping capacity.

 

DIF:    Cognitive Level: Understand            REF:   p. 944

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

3. The nurse should monitor for which effect on the cardiovascular system when a child is immobilized?

a.	Venous stasis
b.	Increased vasopressor mechanism
c.	Normal distribution of blood volume
d.	Increased efficiency of orthostatic neurovascular reflexes

 

 

ANS:  A

The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.

 

DIF:    Cognitive Level: Understand            REF:   p. 944

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

4. Which can result from the bone demineralization associated with immobility?

a.	Osteoporosis
b.	Urinary retention
c.	Pooling of blood
d.	Susceptibility to infection

 

 

ANS:  A

Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory and renal systems.

 

DIF:    Cognitive Level: Understand            REF:   p. 944

TOP:   Integrated Process: Nursing Process: Assessment

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

 

5. A young girl has just injured her ankle at school. In addition to calling the child’s parents, what is the most appropriate immediate action by the school nurse?

a.	Apply ice.
b.	Observe for edema and discoloration.
c.	Encourage child to assume a position of comfort.
d.	Obtain parental permission for administration of acetaminophen or aspirin.

 

 

ANS:  A

Soft-tissue injuries should be iced immediately. In addition to ice, the extremity should be rested, be elevated, and have compression applied. Observing for edema and discoloration, encouraging the child to assume a position of comfort, and obtaining parental permission for administration of acetaminophen or aspirin are not immediate priorities. The application of ice can reduce the severity of the injury.

 

DIF:    Cognitive Level: Apply                   REF:   p. 947

TOP:   Integrated Process: Nursing Process: Implementation

MSC:  Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential