ONC Pediatric/Congenital/Neuromuscular
Conditions/Operative Orthopedics Practice Exam
A surgical nurse is reviewing types of orthopaedic hardware
... [Show More] with a nursing student. Which of the following screws should the nurse identify as using a guide wire for both drilling and screw insertion while maintaining proper bone position?
a. Cancellous screw
b. Cannulated screw
c. Compression screw
d. Cortical screw - CORRECT ANSWER b. Cannulated screw
Rationale: A cannulated screw is the only one in this list with a hole that allows the screw to be inserted over a guide wire.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 111
A surgical nurse is preparing a patient for shoulder surgery. The nurse should identify which of the following as the appropriate position for this patient during the procedure?
a. Prone
b. Beach chair
c. Lithotomy
d. Jackknife - CORRECT ANSWER b. Beach chair
Rationale: Beach chair and lateral are the two positions commonly used for shoulder surgery. Prone is for back surgery, lithotomy for obstetric/gynecologic procedures, and jackknife for rectal surgeries.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, pp. 45, 163
A surgical nurse is reviewing risk factors for surgical site infection (SSI) with orienting nurses. Which of the following should the nurse identify as a predisposing factor for SSI?
a. Dose of cefazolin (Ancef®) 15 minutes before skin incision
b. Total surgery time less than 2 hours
c. Patient history of type 2 diabetes controlled by diet
d. Patient fracture requiring external fixation - CORRECT ANSWER d. Patient fracture requiring external fixation
Rationale: A fracture that requires external fixation can increase a patient's risk for developing SSI. All the other options assist in reducing the chance of developing an SSI.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, pp. 75-76
A surgical nurse is preparing for an orthopaedic procedure that will involve grafting. Which of the following graft materials should the nurse identify as harvested from one individual and implanted into another individual of the same species?
a. Allograft
b. Autograft
c. Xerograft
d. Xenograft - CORRECT ANSWER a. Allograft
Rationale: Allograft is harvested from one person and implanted into another person. Autograft comes from the same person, and xenograft is from a different species. Xerograft does not exist.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 92
A surgical nurse is circulating during performance of cemented total hip arthroplasty. Which of the following should the nurse identify as the most frequently occurring patient reaction to the use of polymethylmethacrylate (PMMA) cement during this procedure?
a. Hemorrhage
b. Hematoma
c. Transitory increase in pain
d. Transitory decrease in blood pressure - CORRECT ANSWER d. Transitory decrease in blood pressure
Rationale: A transitory decrease in blood pressure is the most common patient reaction to use of PMMA cement. Other options occur infrequently. In particular, the transitory increase in pain may result from heat released during cement polymerization; however, it is not common.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 23
To avoid brachial plexus injury during upper extremity surgery, the surgical nurse should position the patient's arm in which of the following?
a. Abduction of arm at less than 90 degrees
b. Adduction of arm at more than 90 degrees
c. Palms facing downward when arm is out on arm board
d. Palms facing upward when arm tucked at side - CORRECT ANSWER a. Abduction of arm at less than 90 degrees
Rationale: Upper extremity neuropathies arise from injury to the brachial plexus. To prevent injury to the brachial plexus, the surgical team must ensure the arm board is level with the OR bed. When an arm is placed on the arm board, it must not extend beyond a 90-degree angle to the body.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 127
The surgical nurse is preparing a patient for correction of a scoliotic deformity. The nurse should know the __________ approach is used to perform this procedure.
a. Lateral
b. Anterior
c. Posterior
d. Thoracic - CORRECT ANSWER c. Posterior
Rationale: The classical surgical approach is posterior. Other positions are not indicated for deformity correction.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 452
As part of the orientation of a new nurse to the OR, the surgical nurse is reviewing the correct sequence of events for insertion of screws during internal fixation. The surgical nurse should correctly identify which of the following?
a. Drill, measure, screw, tap
b. Measure, drill, tap, screw
c. Drill, measure, tap, screw
d. Measure, tap, drill, screw - CORRECT ANSWER c. Drill, measure, tap, screw\
Rationale: A gliding hole is drilled and the size of the drill bit corresponds to the appropriately sized screw. A bone tap is inserted to push the screw past the far cortex, and then the final twisting of the screw buries the head so it is better seated in the far cortex and so the head does not protrude.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 111
A patient is scheduled for open rotator cuff repair. The surgical nurse should know this procedure would be performing using which of the following surgical approaches?
a. Anteromedial
b. Anterosuperior
c. Lateral
d. Posterior - CORRECT ANSWER b. Anterosuperior
Rationale: Anterosuperior rotator cuff tears usually have a biceps tendon disorder. An open repair is needed to perform a biceps tenodesis which has been shown to provide better outcomes with better pain relief and shoulder function.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 165
The surgical nurse is assisting in internal fixation of a mid-shaft femoral fracture. The nurse should identify which of the following intramedullary nails as least stable?
a. Reamed medullary nail
b. Unreamed medullary nail
c. Unreamed hollow medullary nail
d. Flexible medullary nail - CORRECT ANSWER a. Reamed medullary nail
Rationale: Reaming will cause the nail to enter into the canal eccentrically, which may lead to the distal fracture fragment being either too medial or too lateral.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 116
A surgeon asks for a periosteal elevator to visualize a fractured bone. The nurse should identify which of the following instruments for this purpose?
a. Babcock
b. Meyerding
c. Verbrugge
d. Cobb - CORRECT ANSWER d. Cobb
Rationale: The Cobb is a chisel-like instrument that is designed to lift, or elevate, the periosteum from the bone. A Babcock is a grasping instrument made to grasp soft tissue or bowel. A Meyerding is a type of retractor used in spine surgeries, and a Verbrugge is a bone-holding forcep.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 59
Which of the following should demonstrate the surgical nurse's understanding of tourniquet safety during performance of a total knee arthroplasty?
a. The surgeon should be notified of tourniquet time at 120 minutes.
b. The tourniquet is inflated with limb in dependent position.
c. The tourniquet is inflated to 300-350 mm Hg.
d. The surgeon should not need to exsanguinate the lower limb. - CORRECT ANSWER c. The tourniquet is inflated to 300-350 mm Hg.
Rationale: The tourniquet is inflated to 300-350 mm Hg for use on the thigh. The surgeon needs to be notified at regular, established intervals of the duration of the tourniquet time; general agreement indicates the tourniquet should not be inflated longer than 90 minutes for a lower extremity procedure. The limb must be elevated and exsanguinated for this procedure.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 130
In assisting with a lower extremity surgery, the surgical nurse should be aware that which of the following nerves can be compressed during surgery because of its superficial position at the lateral aspect of the fibular head?
a. Pudendal
b. Peroneal
c. Tibial
d. Sural - CORRECT ANSWER b. Peroneal
Rationale: The common peroneal nerve arises from the sciatic nerve; it travels around the fibular neck and laterally around the fibular head. Most peroneal nerve injuries come from compression in this prominent region of the lateral ankle.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 128
The surgical nurse is preparing a patient to receive a Bier block before a procedure. The nurse should recognize this type of anesthesia as most appropriate for which of the following?
a. Plantar fascia release
b. Hammer toe release
c. Bunionectomy
d. Carpal tunnel release - CORRECT ANSWER d. Carpal tunnel release
Rationale: The Bier block is used primarily for upper extremity surgery. This includes procedures such as carpal tunnel release and Depuytren contracture release.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 125
The parents of a child with cerebral palsy tell the nurse their son appears to have chronic pain secondary to muscle spasms. Which of the following interventions should the nurse recognize as the best initial intervention for managing the child's pain?
a. Administer oral muscle relaxants
b. Administer oral opioids
c. Immobilize the affected extremity
d. Reduce changes in position - CORRECT ANSWER a. Administer oral muscle relaxants
Rationale: The source of pain is from the muscle spasms and contractions. Opioids often are not effective for this type of pain. Immobilization or reduced changes in position may not prevent muscular irritation and spasms.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 278
Parents bring their 2-year-old child with cerebral palsy (CP) to the pediatrician's office for follow up. Identified symptoms include poor muscle tone of all extremities and inability to sit upright, as well as uncontrolled movements throughout the body. The nurse should recognize these symptoms as consistent with which type of CP?
a. Ataxic
b. Athetoid
c. Spastic
d. Mixed - CORRECT ANSWER b. Athetoid
Rationale: Athetoid CP (also known as dyskinetic or dystonic CP) is marked by motor restlessness and postural instability. The involuntary, uncontrollable movements are not typical of the other types of CP.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 273
The doctor has documented problems with reciprocal motion in the medical record of a child with Duchenne's muscular dystrophy. When the child's mother asks about this descriptor, the nurse should indicate lack of reciprocal motion reflects the child's
a. difficulty running or climbing stairs.
b. proximal muscle weakness.
c. frequent tripping and falling.
d. inability to perform fine motor activities. - CORRECT ANSWER a. difficulty running or climbing stairs.
Rationale: Running or climbing stairs requires the child to use one limb, then the other (reciprocal motion) ; this is frequently difficult for a child with Duchenne's muscular dystrophy. Frequent falling or tripping can occur, but the child will describe this as the feet "being swept away" from under the child, a phenomenon not involving reciprocal movement. Proximal weakness and inability to perform fine motor activities are unrelated to this symptom.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 283-284
The nurse is caring for an infant born with myelomeningocele at the sacral level. What motor/sensory function should the nurse expect in this infant?
a. No motion in legs
b. Weak knee flexion
c. Mild weakness of ankles and toes
d. Sensation in the anterior thigh - CORRECT ANSWER c. Mild weakness of ankles and toes
Rationale: Mild weakness of the ankles and toes is associated with effects on the sacral level. Thoracic effects include no motion in the legs. Mid to lower lumbar effects (L3-L5) include weak knee flexion and sensation to below the knee.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 296
Parents bring their child with Duchenne's muscular dystrophy into the clinic for regular follow up. The nurse should know that the child's abnormal gait is due to muscle weakness in the
a. ankle
b. thighs.
c. tibialis anterior.
d. hip girdle. - CORRECT ANSWER d. hip girdle.
Rationale: In a child who is ambulatory, observation of walking will reveal an abnormal gait due to weakness of the hip girdle muscles.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 284, table 11.4
A patient newly diagnosed with multiple sclerosis is discussing lifestyle changes with the nurse. Which of the following statements by the patient should indicate to the nurse that more education is needed?
a. "I should go to bed and get up at the same time every day."
b. "I should limit my intake of Omega-3 fatty acids to avoid exacerbations."
c. "Exercise in water may help me move in ways I cannot move on land."
d. "I might experience worsening of symptoms in humid weather." - CORRECT ANSWER b. "I should limit my intake of Omega-3 fatty acids to avoid exacerbations."
Rationale: There is some evidence that a diet low in saturated fats and supplemented by Ometa-3 (from fatty fishes, cod-liver oil, or flaxseed oil) and Omega-6 (fatty acids from sunflower or safflower seed oil and possibly evening primrose oil) may have some benefit for people with MS; thus there is no reason to limit intake of Omega-3 fatty acids. As part of good sleep hygiene, experts recommend patients with MS go to bed and get up at the same time every day (and no more than 1 hour later on weekends). Water exercise may be especially beneficial to people with MS. Persons with MS can experience a temporary worsening of symptoms in hot, humid weather.
Reference: National Multiple Sclerosis Society. (n.d.). The Omega-3 Factor. Retrieved from https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Diet-Nutrition/Omega-3
A patient's husband brings her to the clinic for evaluation. He tells the nurse he is afraid his wife has Parkinson's disease. Which of the following, if described by the patient's husband, should the nurse recognize as suggestive of Parkinson's disease?
a. Use of a loud voice
b. Diarrhea
c. Narcolepsy
d. Angry facial expression - CORRECT ANSWER d. Angry facial expression
Rationale: Facial masking is often described as a serious, depressed, or mad look on the face; although it can also be caused by some medications, it is common in patients with PD. A patient with suspected PD may experience constipation and trouble sleeping, and speak in a low or hoarse voice.
Reference: Parkinson's Foundation. (n.d.). 10 Early Signs of Parkinson's Disease. Retrieved from https://www.parkinson.org/understanding-parkinsons/10-early-warning-signs
A child recently diagnosed with juvenile myasthenia gravis is prescribed pyridostigmine (Mestinon®). In discussing possible medication side effects with the child's parents, the nurse should include which of the following?
a. Headache
b. Weight gain
c. Diarrhea
d. Mood changes - CORRECT ANSWER c. Diarrhea
Rationale: Pryidostigmine tends to be a well-tolerated oral medication. However, it can have side effects such as abdominal cramps, diarrhea and, in very rare instances, worsening weakness. Mood changes and weight gain are likely to be associated with use of corticosteroids, while headache may result from treatment with intravenous immunoglobulin (IV Ig).
Reference: Myasthenia Gravis Foundation of America. (n.d.). For Parents. Retrieved from https://myasthenia.org/Living-Your-Best-Life-With-MG/For-Parents
A patient comes to the office with complaints of unaccustomed fatigue, new muscle weakness, joint pain, and increased difficulty tolerating cold temperatures. As part of his history, the nurse learns the patient migrated from Nigeria last year. Which of the following conditions should the nurse suspect is affecting this patient?
a. Multiple sclerosis
b. Muscular dystrophy
c. Post-polio syndrome
d. Parkinson's disease - CORRECT ANSWER c. Post-polio syndrome
Rationale: There are long-term physical consequences to having had poliomyelitis. New symptoms recognized by the medical community that may relate to prior polio include unaccustomed fatigue - either rapid muscle tiring or feeling of total body exhaustion; new weakness in muscles, both those originally affected and those seemingly unaffected; pain in muscles and/or joints; sleeping problems; breathing or swallowing problems; and/or decreased ability to tolerate cold temperatures. In addition, only Afghanistan, Pakistan, and Nigeria have never stopped transmission of polio.
Reference: Post-Polio Health International. (n.d.). Remember Polio? Retrieved from http://www.post-polio.org/edu/pabout.html
Additional source: World Health Organization. (2018). Does Polio Still Exist? Is It Curable? Retrieved from https://www.who.int/features/qa/07/en/
A 12-year-old boy is being seen for routine follow up after previous diagnosis with Becker muscular dystrophy. The nurse is discussing disease management with the boy's mother. Which of the following statements by the mother should the nurse recognize as indicating a need for additional education?
a. "I will apply his orthotics at night to keep the Achilles tendons stretched."
b. "I will provide a high-protein, low-carbohydrate diet for muscle development."
c. "I will tell the anesthesiologist that he has MD to avoid complications."
d. "I will take my son for a cardiac evaluation before starting exercise." - CORRECT ANSWER b. "I will provide a high-protein, low-carbohydrate diet for muscle development."
Rationale: A combination of immobility and weak abdominal muscles can lead to severe constipation, so the diet should be high in fluid and fiber, with fresh fruits and vegetables dominant. Orthotics can support the ankle and foot, or extend over the knee. They can be applied at night to keep feet from pointing downward and keep the Achilles tendons stretched. Because people with MD may have adverse reactions to some types of anesthesia, it's important to let the surgical team know the patient has MD. Because of the risk of cardiac involvement in MD, the affected child should have a cardiac evaluation before starting exercise.
Reference: Muscular Dystrophy Association. (n.d.). Becker Muscular Dystrophy: Medical Management. Retrieved from https://www.mda.org/disease/becker-muscular-dystrophy/medical-management
In reviewing the child's medical record, the nurse notes hemiplegia is the specific diagnosis for a child with cerebral palsy. Which of the following should the nurse expect to identify in this patient?
a. Ambulation in normal time
b. Tongue thrusting
c. Hearing loss
d. Minimally affected speech - CORRECT ANSWER a. Ambulation in normal time
Rationale: The child with hemiplegia is able to ambulate within normal time. Minimally affected speech is typical of a child with spastic diplegia. Options b and c are associated with dyskinetic cerebral palsy.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 274, table 11.2
A nurse is presenting information about Parkinson's disease for staff in a long-term care center. The nurse should identify a lack of which of the following as the cause of most symptoms of PD?
a. Dopamine
b. Serotonin
c. Acetylcholine
d. Glutamate - CORRECT ANSWER a. Dopamine
Rationale: Most symptoms of PD are caused by a lack of dopamine in the brain. Many drugs used for treatment of PD either try to replenish dopamine or mimic its effects.
Reference: Parkinson's Foundation. (n.d.). Prescription Medications. Retrieved from https://www.parkinson.org/Understanding-Parkinsons/Treatment/Prescription-Medications
A patient with multiple sclerosis tells the nurse she has read that MS can affect her cognitive abilities. The nurse should suggest activities such as board games and handiwork to enhance the patient's cognitive
a. dissonance.
b. distortion.
c. load.
d. reserve. - CORRECT ANSWER d. reserve.
Rationale: The concept of cognitive reserve helps to explain why individuals with the same degree of brain changes due to aging or a neurological disease like MS may have very different cognitive function. Research has shown a lifetime of intellectual enrichment from education as well as stimulating work and leisure activities helps to lessen or slow the impact of disease- or aging-related changes in the brain.
Reference: National Multiple Sclerosis Society. (n.d.). Cognitive Health. Retrieved from https://www.nationalmssociety.org/Living-Well-With-MS/Cognitive-Health
The nurse's care of a patient with early amyotrophic lateral sclerosis (ALS) would be guided by the knowledge that which of the following can occur as a result of the disease?
a. Hearing loss
b. Urinary urgency
c. Visual disturbances
d. Episodic diarrhea - CORRECT ANSWER b. Urinary urgency
Rationale: The patient with ALS can experience urinary urgency and will need bathroom assistance. Hearing and vision generally remain normal. The patient may experience abdominal bloating and constipation.
Reference: Muscular Dystrophy Association. (n.d.). Amyotrophic Lateral Sclerosis: Signs and Symptoms. Retrieved from https://www.mda.org/disease/amyotrophic-lateral-sclerosis/signs-and-symptoms
The treatment of a child's femoral shaft fracture involves application of a hip spica cast. The nurse should instruct the caregivers to monitor for which of the following?
a. Heel pressure
b. Cast slippage
c. Cast softening
d. Skin breakdown - CORRECT ANSWER d. Skin breakdown
Rationale: Skin breakdown is a significant risk with application of a spica cast.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 296
The nurse is reviewing pediatric orthopaedic problems with a class of nursing students. Which of the following should the nurse identify as the site of the most common upper extremity fracture in children?
a. Clavicle
b. Humerus
c. Scapula
d. Ulna - CORRECT ANSWER a. Clavicle
Rationale: Clavicle (collarbone) fractures are extremely common in children.
Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 28
When discussing the occurrence of slipped capital femoral epiphysis (SCFE) with the parents of a child newly diagnosed with the disorder, the nurse should explain that SCFE
a. is more common in girls than boys.
b. often occurs suddenly related to sports injury.
c. is more common in toddlers and pre-schoolers.
d. occurs commonly in adolescents and pre-adolescents. - CORRECT ANSWER d. occurs commonly in adolescents and pre-adolescents.
Rationale: SCFE is the most common disorder of the hip in adolescents. Age range for boys is 10-17 years, with a peak incidence at ages 13-14. Age range for girls is 8-15 years, with a peak incidence at age 11. It occurs two to three times more often in boys than in girls. This condition most likely occurs after a failed stress fracture experienced earlier in life.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 313-314
The nurse regularly sees a child with oligoarthritis. In addition to care from a rheumatologist, the nurse should ensure the child's parents understand the need to follow up regularly with which specialist?
a. Cardiologist
b. Neurologist
c. Ophthalmologist
d. Dermatologist - CORRECT ANSWER c. Ophthalmologist
Rationale: Eye involvement is a common occurrence in children with oligoarthritis, a form of juvenile idiopathic arthritis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 336
In an attempt to treat Legg-Calve-Perthes disease, the surgeon plans to place the affected child in an abduction orthosis. The nurse should confirm with the child's parents that the purpose of this treatment is to
a. limit weight bearing.
b. maintain the femoral head in internal rotation.
c. reposition the femoral head in the acetabulum.
d. release the adductor muscles. - CORRECT ANSWER b. maintain the femoral head in internal rotation.
Rationale: An abduction orthosis will maintain the femoral head in an abducted, internally rotated position. Weight bearing is allowed in the orthosis. Surgery, rather than an orthosis, would be needed to reposition the femoral head (varus osteotomy of the femur) or release the adductors.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 290
In discussing developmental dysplasia of the hip (DDH) with the caregivers of an affected child, the nurse should identify which of the following as a potential complication of this disorder?
a. Growth disturbance of the distal femur
b. Avascular necrosis of the distal femur
c. Valgus deformity of the ipsilateral knee
d. Varus deformity of the ipsilateral knee - CORRECT ANSWER c. Valgus deformity of the ipsilateral knee
Rationale: DDH has been found to have a higher incidence of medial compartment narrowing of the knee which results in a valgus deformity.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 281
The nurse is caring for a 12 year old with slipped capital femoral epiphysis (SCFE). Parents ask about activity restrictions after surgery. The nurse should tell the parents that after surgery the child will be
a. able to walk with no assistive device immediately.
b. in a long-leg brace for a month.
c. using crutches for ambulation initially.
d. able to play soccer in several weeks. - CORRECT ANSWER c. using crutches for ambulation initially.
Rationale: A long-leg brace is not necessary, but activities such as unassisted weight bearing and soccer are not appropriate for the immediate recovery phase.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 316
The nurse is counseling the parents of a child who has been diagnosed with osteogenesis imperfecta. As they discuss ways to help the child attain independent mobility, the nurse should recommend which of the following?
a. Thick casting for stability
b. Gentle daily exercise to extremities
c. Early participation in organized sports
d. Avoidance of early weight bearing - CORRECT ANSWER b. Gentle daily exercise to extremities
Rationale: Limiting weight bearing and casting will not aid in strong bone formation. Gentle exercises will keep the extremities functional and are unlikely to lead to fractures.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 307
The nurse provides information for the parent of a 10 year old with Blount's disease (tibia vara). Which of the following should the nurse include in the discussion of conservative management of this disorder?
a. Restrict participation in usual activities.
b. Follow-up x-rays are needed every 6 months.
c. A brace may be worn during the day and removed at night.
d. Manage the child's weight because obesity is a factor. - CORRECT ANSWER d. Manage the child's weight because obesity is a factor.
Rationale: Participation in normal activities should not be discouraged for the child with BD. Follow-up x-rays should be done every 3 months, and the brace is to be worn full time. Inactivity can lead to weight gain, and obesity can be a factor in development of BD.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 270-271
The nurse is providing a class on childhood injuries for the staff at a local daycare center. Which of the following should the nurse identify as the joint most commonly affected by dislocation in children ages 2-5?
a. Hip
b. Knee
c. Ankle
d. Elbow - CORRECT ANSWER d. Elbow
Rationale: Dislocation of the elbow often results from swinging activities that have the weight of the child pulling on the arm and elbow joint.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 517-518
A newborn diagnosed with clubfoot is scheduled to begin surgical treatment. Which of the following should the nurse stress with the parents?
a. Performance of cast care
b. Application of Bryant's traction
c. Application of orthotics
d. Careful handling of the infant - CORRECT ANSWER a. Performance of cast care
Rationale: Because clubfoot treatment typically involves frequent cast applications, nursing interventions should focus on teaching patients cast care and signs of skin issues. Bryant's traction is sometimes used for treatment of developmental dysplasia of the hip. Orthotics may be used in treatment of myelomeningocele. Careful handling is particularly stressed for the child with osteogenesis imperfecta.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 280
A mother is troubled by the deformity in her infant's right foot and questions the treatment plan after diagnosis of metatarsus adductus. The nurse should explain likely treatment with
a. passive hamstring stretching.
b. serial casting.
c. external fixation.
d. tendon release. - CORRECT ANSWER b. serial casting.
Rationale: Metatarsus adductus is managed by serial casting or bracing. The deformity yields more quickly when the cast is extended above the flexed knee, and the infant is also less likely to kick it off. Hamstring stretching is part of treatment for Osgood-Schlatter disease. Tendon release may be considered for painful contractures in a patient with muscular dystrophy.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 294
Developmental dysplasia of the hip (DDH) is suspected in an ambulatory 20-month-old child. If described by the child's mother, which of the following should the nurse associate with likely DDH?
a. Scissoring of the legs
b. Leg kicking in unison
c. Toe walking
d. Foot stiffness - CORRECT ANSWER c. Toe walking
Rationale: In an ambulatory child, toe walking, limping, or pain may be apparent and suggests DDH. Options a and b are associated with cerebral palsy, and option d may be noted in clubfoot.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 281
A 3 month old has been placed in a Pavlik harness. In response to the parent's question about the length of time for this treatment, the nurse should indicate which of the following?
a. 2-4 weeks
b. 6-12 weeks
c. 4-6 months
d. 8-12 months - CORRECT ANSWER b. 6-12 weeks
Rationale: This infant is being treated for developmental dysplasia of the hip. The Pavlik harness should be worn full-time by the infant for 6-12 weeks after achieving hip stability.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 282
A 12-year-old boy has been diagnosed with Osgood-Schlatter disease. In answering the parents' questions about the cause of this condition, the nurse should identify which of the following?
a. Autosomal-dominant gene defect
b. Repeated pathologic fractures
c. Fibrous alterations in muscles
d. Rapid pre-pubertal growth - CORRECT ANSWER d. Rapid pre-pubertal growth
Rationale: Rapid growth and increased physical activity predispose the early adolescent to the development of Osgood-Schlatter disease. An autosomal-dominant gene defect is the cause of most cases of osteogenesis imperfecta. Repeated bouts of infarction and subsequent pathologic fractures account for the development of Legg-Calve-Perthes disease. Fibrous, fatty alterations in the muscles are associated with arthrogryposis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 302
The mother of a child with juvenile idiopathic arthritis is discussing strategies for the child's success in school with the nurse. Which of the following statements by the mother should indicate to the nurse that additional teaching is needed?
a. "I will buy high-quality running shoes to decrease my child's ankle pain."
b. "I will work with my child's teacher to ensure enough travel time between classes."
c. "I will get a large backpack so my child can carry books between school and home."
d. "I will allow my child to use the home computer to complete long reports." - CORRECT ANSWER c. "I will get a large backpack so my child can carry books between school and home."
Rationale: A child with JIA should have two sets of books so he or she does not have to carry them between school and home. Other options represent good support strategies by the mother.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 339
A 12-year-old child has been diagnosed with a scoliotic curve of 15 degrees. The nurse should confirm which of the following with the child's parents as part of the plan of care for this patient?
a. Observe regularly for progression.
b. Fabricate a brace for nighttime use.
c. Add counterweights to halo traction.
d. Schedule posterior spinal fusion. - CORRECT ANSWER a. Observe regularly for progression.
Rationale: Most curves less than 15-20 degrees are observed for progression at 6-month intervals during peak growth and annually otherwise; they are unlikely to progress further. Other options are appropriate for greater curves.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 451
The nurse is providing a class on signs of physical abuse for the staff at a local daycare center. Which of the following should the nurse identify as most likely to receive fractures of the hands or feet as a result of physical abuse?
a. 8 year old
b. 6 year old
c. 4 year old
d. 2 year old - CORRECT ANSWER d. 2 year old
Rationale: Fractures of the hands or feet in infants and young toddlers commonly result from physical abuse.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 311, Table 11.9
Parents bring their 6-year-old child to the clinic for evaluation of pain localized to the groin and the medial aspect of the thigh. They tell the nurse the child's pain has continued for several months and has been aggravated by activity. The nurse observes the child has an antalgic limp. Which of the following should the nurse expect as the diagnosis?
a. Blount's disease
b. Legg-Calve-Perthes disease
c. Achondroplasia
d. Neurofibromatosis - CORRECT ANSWER b. Legg-Calve-Perthes disease
Rationale: A child with Legg-Calve-Perthes disease may present with mild pain localized to the groin or medial aspect of the thigh or knee. The child often has had pain and a limp for several months before being seen by a healthcare provider. Blount's disease involves a pathologic bowing of the legs; it is considered a growth disorder involving the proximal tibial growth plate. Achondroplasia is also a disorder of the growth and remodeling of bone and cartilage. The identified symptoms are not typical of neurofibromatosis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 289
The nurse is discussing bracing with the parents of a child with scoliosis. The nurse should tell the parents that a new brace needs to be fabricated for a growing child every
a. 2-4 months
b. 6 months
c. 10 months
d. 12-18 months - CORRECT ANSWER d. 12-18 months
Rationale: As the child grows, a new brace needs to be fabricated every 12-18 months.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 451
When bracing is prescribed for a child with Blount's disease, the child's caregivers ask the nurse the purpose of this treatment. Which of the following should the nurse identify?
a. Provide medial stability for the knee joint
b. Internally rotate the leg
c. Relieve stress on the medial tibial metaphysis
d. Counteract lateral compressive forces - CORRECT ANSWER c. Relieve stress on the medial tibial metaphysis
Rationale: Bracing is an option to relieve excessive stress on the medial tibial metaphysis, to provide lateral stability to the knee joint, and to externally rotate the leg. A locked brace counteracts the pathologic medial compressive forces, allowing resumption of normal growth and correction of deformity.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 271
A child with suspected Osgood-Schlatter disease complains of pain when bicycling. Which of the following sites for the child's pain should the nurse identify as supporting this diagnosis?
a. Lateral malleolus
b. Tibial tubercle
c. Greater trochanter
d. Achilles tendon - CORRECT ANSWER b. Tibial tubercle
Rationale: Patients with Osgood-Schlatter disease commonly complain of pain over the tibial tubercle, which increases with activities such as running or bicycle riding. Pain in the other sites is not consistent with Osgood-Schlatter disease.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 302 [Show Less]