N220 Exam 2 - Olol Musculoskeletal Alterations Made Up Questions

Front 1

A baby's femoral head and acetabulum are improperly aligned. The nurse knows this is called?

Back 1

Developmental Dysplasia

Front 2

The nurse knows that the patient with Developmental Dysplasia will show what clinical signs?

Back 2

1. hip instability
2. dislocation
3. subluxation (partial dislocation)
4. acetabular dysplasia (abnormal cellular or structural development)

Front 3

The nurse heard that a baby was born with developmental dysplasia. She assumes the child is a female because? She assumes that the left hip will be the one affected because?

Back 3

it affects girls 4 xs more then boys

the left hip is affected 2 x more than right due to the intrauterine position

Front 4

The nurse explains to a mother of a girl with Developmental Dysplasia that this happened intrauterio during what time period?

Back 4

12-18 wks gestation when lower limbs rotate and muscles develop

Front 5

The mother of a developmental dysplasia affected baby ask what could have caused this? The nurse knows?

Back 5

1. breech position
2. fetal size
3. genetics 20-50x more common in 1st degree relatives

Front 6

The nurse knows that a child with developmental dysplasia of the hip will have these manisfestations?

Back 6

1. limited abduction of the hip
2. asymmetry of the gluteal and thigh fat folds
3. telescoping or pistoning of the thigh
4. walks with limp from femoral head telescoping into pelvis

Front 7

The neonatal nurse realizes that the new born has developmental dysplasia when she sees what sign?

Back 7

Allis Sign- 1 knee is lower than the other when knees are flexed

Front 8

The nurse sees the peds doctor perform a diagnosis manuever to the new born in which the infant is placed on its back and the knees are moved together until they touch, then downward pressure is put on 1 femur at a time to see if the hips slip out of the joints or dislocate?

Back 8

Ortolani-Barlow maneuver

Front 9

The nurse explains to a parent that the treatment for developmental dysplasia is?

Back 9

<3 mths- Pavlik harness
>3 mths- skin traction Bryants
>18 mths - surgery and casting/bracing
early detection enables majority to attain normal hip function

Front 10

The nurse explains that the trmt for Dev. Dysplasia in a <3 mth old, called Pavlik harness is?

Back 10

dynamic splint that ensures hip flexion and abduction but does not allow hip extension or adduction

Front 11

The nurse explains that the trmt for Dev. Dysplasia in a >3 mth old, called Skin traction Bryants is?

Back 11

relocates femoral head into acetbulum while gently stretching the restrictive soft tissue

Front 12

Nursing Management for Developmental Dysplasia is?

Back 12

-

Front 13

An infant is diagnosed with congenital hip dislocation. On assessment the nurse expects to note:

Back 13

Ortolani's sign
also: asymmetrical thigh and gluteal folds, limited hip abduction, femoral shortening and Trendelenburg's sign

Front 14

A 14 mth old weighing 26lbs is admitted for traction to treat congenital hip disclocation. When preparing the client's room, the nurse anticipates using which traction system?

Back 14

Byrant's traction for younger than 2 who weight less than 30lbs.

Front 15

An infant is having his 2-mth checkup. The MD tells the parents she is assessing the baby for Ortolani's sign. The nurse explains that the presence of this sign indicates dislocation of what joint?

Back 15

Hip - The examiner can hear and feel a click if present

Front 16

A 1-mth old infant is seen in a clinic and is diagnosed with unilateral hip dysplasia. A nurse assesses the infant, knowing that what finding will be noted?

Back 16

limited range of motion in the affected hip -
For a child out of the infant stage, asymmetric abduction could be used to diagnose

Front 17

A nurse is assisting a physician during the exam of an infant with hip dysplasia. The MD performs an Ortolani manuever. The nurse is aware that this manuever is performed to?

Back 17

reduce the dislocated femoral head back into the acetabulum will hear a click on entry or exit of femerol head

Front 18

A nurse is assisting a physician during the exam of an infant with hip dysplasia. The MD performs a Barlow manuever. The nurse is aware that this manuever is performed to?

Back 18

The MD pushes the unstable head of the femor out of the acetabulum

Front 19

A clinic nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. What does the nurse include in the instructions?

Back 19

The harness should be worn for 16-23 hrs a day and should be removed only to check the skin and for bathing. Does not need to be removed for diaper changing or feedings

Front 20

When assessing a child suspected of having developmental dysplasia of the hip, the nurse would expect that an assessment of the child's orthopedic status would reveal?

Back 20

an apparent shortening of one leg Operative word is "Child"

Front 21

An 18 mth old child is admitted with a diagnosis of developmental dysplasia of the left hip. During the assessment the nurse should elicit the Tredelenburg sign by positioning the toddler:

Back 21

Standing

When standing and bearing weight, the pelvis tilts downward instead of upward, indicating a positive Trendelenburg's sign

Front 22

6 wks after birth, an infant is diagnosed with developmental dysplasia of the hip. The nurse is aware that corrective measures will be instituted immediately because?

Back 22

The infants hip joint is still cartilaginous, and molding of the acetabulum is possible

Front 23

A 2 yr old has a hip spica cast applied for developmental dysplasia of the hip. The mother asks the nurse how to keep the cast clean. The nurse's best response would be

Back 23

Place plastic wrap around the perineal edges

Front 24

3 days following the applicaton of a spica cast, a child has a temp fo 101.4 F. Suspecting an infection, the nurse should first assess the child for?

Back 24

2. a foul smell coming from the cast

Front 25

The nurse knows that a child diagnosed with Muscular Dystropy has a life expectancy of?

Back 25

early 20's

Front 26

signs and symptoms of Developmental dysplasia at different ages

Back 26

The signs of developmental dysplasia of the hip (DDH) vary depending on whether one or both hips are affected.

A newborn or infant with DDH may have:

No obvious signs of a defect.
Extra folds of skin on the inside of the thigh(s). However, a newborn without this condition also may have these extra folds.
Less mobility or flexibility in the movement of the hip joint(s).
One leg that is shorter than the other.
Other physical deformities, especially of the feet.
In rare cases, DDH develops in the first few weeks or months after birth and signs may not be seen until your child starts to walk. Then your child may:

Stand with one hip raised higher than the other because one leg is shorter than the other. The shorter leg is on the affected side.
Walk on the toes of one foot with the heel up off the floor, attempting to make up for the difference in leg length.
Walk with a limp (or a waddling gait if both hips are affected).
Stand with a greater-than-normal inward curve (lordosis) of the lower back (lumbar area) if both hips are affected.

Front 27

A young girl is diagnosed with Muscular Dystrophy. The nurse knows?

Back 27

this is a mistake because only males have this disease

Front 28

The nurse reads up on Muscular Dystrophy and find out that there are two kinds. what are they?

Back 28

Duchenne (pseudohypertrophic)

Becker

Front 29

A child is diagnosed with a mild form of Muscular Dystrophy. The nurse knows this is called?

Back 29

Becker- mild form with a gene mutation similar to Duchenne form

Front 30

The nurse knows that a child with Duchenne's muscular Dystrophy will have this etiology?

Back 30

1.gene in xp21.2 region of chromosome
2.enlargement of muscles as a result of infiltration with fatty tissue
3. cascade of cellular events leading to necrosis in muscle fibers and replacment by connective tissue and fat

Front 31

The nurse knows the signs of Muscular Dy. is?

Back 31

1. muscle weakness that begins in lower extremeties
2. enlarged calf muscles (myo replaced by fat)
3. by middle teens not able to walk
4. condition cont.l to rise causing scoliosis, other muscle conditions, cardiomyopathy, resp. difficulty

Front 32

The nurse must run lab test to aid in diagnosing M.D. she knows she will be asked to run?

Back 32

1. Serum enzyme assay
2. muscle biopsy- measure dystrophin
3. Serum creatine kinase (CK) elevated early

Front 33

The nurse knows that the treatment for M.D is?

Back 33

no treatment
Prednisone and deflazacort may preserve muscle function for a period
just treat the symptoms

Front 34

Nursing management of M.D. is?

Back 34

perform/teach ROM

Encourage independence

Respiratory care - deep breathing/cough

genetic counseling

assist family to cope (fatal dx)

monitor meds

refer to MD associa.

Front 35

When assessing a child with M.D. the nurse expects what findings?

Back 35

waddling gait

Front 36

question

Back 36

answer

Front 37

question

Back 37

answer

Front 38

question

Back 38

answer

Front 39

question

Back 39

answer

Front 40

question

Back 40

answer

Front 41

A child presents at the clinic with his midfoot facing down, hindfoot turns inward and the forefoot curls toward the heel. The nurse recognizes this as?

Back 41

Clubfoot Talipes Equinovarus

Front 42

The nurse expects to see what other signs in the diagnosis of clubfoot besides the shape and distortion of the foot?

Back 42

1. muscle,s tendons and bones are involved
2. foot is small with shortened Achilles tendon
3. affects boys 2x more than girls

Front 43

What is the cause of Clubfoot?

Back 43

unknown

Front 44

The nurse expects that the child dx with clubfoot will be treated how?

Back 44

1. serial casting ASAP after birth
2. foot manipulated to achieve max correction of the varus deformity, then the equinus

Front 45

The nurse instructs the parent to care for the cast. What does she tell her?

Back 45

cast changed every 1-2 wks, cont for 8-12 wks

Front 46

After the clubfoot is corrected, what does the further treatment entail?

Back 46

after correction- splint with crossbar btw shoes- toes pointing outward

Front 47

With regard to M.D., what does the word "Equinus" refer to?

Back 47

midfoot is directed downward

Front 48

With regard to M.D., what does the word "Varus" refer to?

Back 48

Hindfoot turns inward

Front 49

With regard to M.D., what does the word "adduction" refer to?

Back 49

forefoot curls toward the heel and turns upward in partial supination

Front 50

Nursing management of clubfoot

Back 50

-

Front 51

The nurse is caring for a neonate with congenital clubfoot. The child has a cast to correct the defect. B4 discharge, what should the nurse tell the parents?

Back 51

A new cast is needed every 1-2 wks b/c of the rapid growth of the neonate

Front 52

ques

Back 52

ans

Front 53

ques

Back 53

ans

Front 54

ques

Back 54

ans

Front 55

ques

Back 55

ans

Front 56

The nurse knows that scoliosis is

Back 56

lateral or C-shaped curvature of the spine assoc. with rotational deformity of upper spine and ribs >10%

Front 57

The nurse knows that the cause of scoliosis is?

Back 57

idopathic - occures in girls during growth spurt btw 10-13 yr old
or early onset- b4 10 - 15% of cases

Front 58

The nurse knows the etiology of the idopathic type of scoliosis is?

Back 58

curves laterally with vertebral rotaion. Curve is right thoracic and left lumbar deformity. Ribs on concave side forced closer- ribs on convex side separate causing narrowing of thoracic cage and formation of rib hump. Disc spaces narrowed on concave and spread on convex

Front 59

Other etiologies of scoliosis are?

Back 59

congenital- myelomeningocele, CP, or M.D.

Acquired- injury to spinal cord or after chemo/radiation

Front 60

A 10 yr old girl presents to the clinic with truncal symmetry. The nurse knows this is? and may be a manisfestation of?

Back 60

Trunical symmetry is uneven shoulders and hips

1 sided rib hump

prominent scapula

A manifestation of Scoliosis

Front 61

The nurse knows that a child that is dx with Scoliosis was diagnosed with?

Back 61

1. observation
2. xrays, MRI, CT

Front 62

The nurse knows the trmt for scoliosis is?

Back 62

depends on degree and progression of curvature

mild- 10-20 exercises to improve posture

moderate - 20-40-- brace 23 hrs/day

severe- >40 spinal fusion with instrumentation

Front 63

A school nurse is screening children for scoliosis. She knows that the screening from the front view will show negative if?

Back 63

1. the head is midline
2. the shoulders are the same height
3. there is the same amt. of space btw arms and body

Front 64

A school nurse is screening children for scoliosis. She knows that the screening from the back view will show negative if?

Back 64

1. the head is midline
2. shoulders same hgt
3. scapula eually prominaent & at same height
4. spine straight
5. hips same height

Front 65

A school nurse is screening children for scoliosis. She suspects a student may have a mild form. To further assess the student the nurse has her?

Back 65

hold her hands together and bend toward floor,
negative is:
flank humps even
spine straight
marked roundness when viewed from side

Front 66

A nursing student is assisting a school nurse in performing scoliosis screening on the childrin in the school. the school
nuse questions the student nurse about the disorder and determines that the student understands the problem when the student states
that scoliosis is characterized by?

Back 66

abnormal lateral curvature of the spine
most common place of occurrence is the
right thoracid area, which produces a resultant
rib prominence.

Front 67

A nurse is caring for a child after spinal fusion for the trmt of scoliosis. The child complains of abdominal discomfort and begins to have episodes of vomiting. On further assessment, the nurse
notes abdominal distention. Which actions would be most appropriate?

Back 67

Notify the physician - a complication after surgical trmt of scoliosis is superior mesenteric artery
syndrome. caused by mechanical changes in the posion of the child's abd contents, resulting from lengthening
of the child's body.