Musculoskeletal Disorders Pediatric Nursing NCLEX Practice Exam

If you want to extend your learning about Pediatric Nursing, this 15-item NCLEX style examination will help you boost your knowledge about the musculoskeletal and neuromuscular disorders during infancy into childhood and adolescence.

EXAM TIP: If you’re a morning person, start studying early before taking a break at lunchtime. Or, if you’re more fruitful at night, take a larger break earlier on so you’re able to settle down come evening. Each individual is unique, so establish a study habit that works for you.

A lot of times people look at the negative side of what they feel they can’t do. I always look on the positive side of what I can do.
― Chuck Norris

Topics

Topics or concepts included in this exam are:

Guidelines

To make the most out of this quiz, follow the guidelines below:

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales (if any) are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.

Questions

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Pediatric Nursing: Musculoskeletal and Neuromuscular Disorders

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Pediatric Nursing: Musculoskeletal and Neuromuscular Disorders

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1. Mr. and Mrs. Andrews’ child was diagnosed with Duchenne’s muscular dystrophy; which of the following usually is the first indication of the condition?

A. Inability to suck in the newborn
B. Lateness in walking in the toddler
C. Difficulty running in the preschooler
D. Decreasing coordination in the school-age child

2. A spica cast was put on Baby Betty after an unfortunate incident to immobilize her hips and thighs; which of the following is the priority nursing action immediately after application?

A. Keep the cast dry and clean.
B. Cover the perineal area.
C. Elevate the cast.
D. Perform neurovascular checks.

3. Veronica is a 14-year-old girl who wears a brace for structural scoliosis; which of the following statements indicate effective use of the brace?

A. “I sure am glad that I only have to wear this awful thing at night.”
B. “I’m really glad that I can take this thing off whenever I get tired.”
C. “I wonder if I can take the brace off when I go to the homecoming dance.”
D. “I’ll look forward to taking this thing off to take my bath every day.”

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4. Which of the following is the most common permanent disability in childhood?

A. Scoliosis
B. Muscular dystrophy
C. Cerebral palsy
D. Developmental dysplasia of the hip (DDH)

5. Among toddlers and children up to age five, femur fractures usually result from a low energy fall. In most cases, the orthopedic surgeon realigns the fracture using fluoroscopy or x-ray imaging as a guide and immobilizes the leg in a type of cast called a spica cast. Approximately how many weeks does it take for a fractured femur to heal in a 3-year-old?

A. 2 weeks
B. 4 weeks
C. 8 weeks
D. 10 weeks

6. Nurse Cheryl is assessing Fred, a 14-year-old boy who had scoliosis; besides checking neurologic status directly after Harrington rod instrumentation and spinal fusion, she should be regarded with which of the following factors?

A. Comfort level
B. Dietary tolerance
C. Physical therapy needs
D. Understanding of the procedure

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7. When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following?

A. Rheumatoid arthritis
B. Permanent nerve damage
C. Osteomyelitis
D. Bone growth disruption

8. Mrs. Lodge’s child requires the use of Pavlik harness; which of the following would Nurse Betty do to best assess the mother‘s ability to care for her child?

A. Demonstrate to the mother how to remove and reapply the device.
B. Have the mother remove and reapply the harness before discharge.
C. Have the mother verbalize the purpose for using the device.
D. Request a home health care nurse visit after discharge.

9. Nurse Kevin is assessing a newborn for developmental dysplasia of the hip (DDH); he would expect to assess which of the following?

A. Characteristic limp
B. Ortolani’s sign
C. Symmetrical gluteal folds
D. Trendelenburg‘s signs

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10. Mrs. Cooper is concerned about her 4-month-old son’s unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy?

A. “He holds his left leg so stiff that I have a hard time putting on his diapers.”
B. “My baby won’t lift his head up and look at me; he’s so floppy.”
C. “My baby’s left hip tilts when I pull him to standing position.”
D. “I’m very worried because my baby has not rolled all the way over yet.”

11. You have learned that in babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. Which of the following is the most common form of DDH?

A. Acetabular dysplasia
B. Dislocation
C. Preluxation
D. Subluxation

12. Incomplete development of teeth, bones, and ligaments is the result of:

A. Congenital hip dysplasia
B. Duchenne’s muscular dystrophy
C. Osteogenesis imperfecta
D. Osteomyelitis

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13. Reggie is a teenager suffering from osteomyelitis; the nurse would expect which of the following symptoms? Select all that apply.

A. Fever
B. Irritability
C. Pallor
D. Tenderness
E. Swelling

14. Match the traction methods to their corresponding descriptions:

1. Buck’s traction
2. Russell’s traction
3. Bryant’s traction

A. legs in an extended position
B. leg extended, knee flexed
C. hips flexed 90degrees, both legs

A. 1C, 2B, 3A
B. 1B, 2A, 3C
C. 1A, 2B, 3C
D. 1A, 2C, 3B

15. Neurovascular assessment for a fracture patient includes: Select all that apply.

A. Prosthesis
B. Polyps
C. Pain
D. Pallor
E. Pulselessness
F. Paresthesia
G. Paralysis
H. Poikilothermia

Answers and Rationale

1. Answer: C. Difficulty running in the preschooler

  • Option C: Usually, sign and symptoms of Duchenne’s muscular dystrophy are not noticed until ages 3 to 5 years. Typically weakness starts with the pelvic girdle, evidenced as difficulty running in the preschooler. Duchenne’s muscular dystrophy usually is not diagnosed in the infant or toddler period.
  • Option A: Sucking is not the first sign of Duchenne’s muscular dystrophy.
  • Option B: Sign and symptoms of muscular dystrophy are not noticed until ages 3 to 5 years.

2.  Answer: D. Perform neurovascular checks.

  • Option D: Neurovascular assessment is always a priority in the assessment of a freshly applied cast to ensure adequate circulation and neurologic function and prevent complications or injury.
  • Options A, B, and C: Keeping the cast dry and clean, covering the perineal area to prevent wetness and soiling, and elevating the cast to prevent or minimize edema are all important, but these are not the priority immediately after a cast applied.

3. Answer: D. “I’ll look forward to taking this thing off to take my bath every day.”

  • Option D: The brace should be dropped for simply 1 hour of every 24-hour period for hygiene and skin care.
  • Option A: Wearing the brace at night would be true only following radiologic studies indicate the spine has bone marrow maturity and the adolescent has been weaned from off whenever 1 to 2 years.
  • Option B: Taking the brace off whenever tired indicates poor understanding of the brace.
  • Option C: Although physical appearance and social activities with peers are significant, the brace should not be excluded during these times.

4. Answer: C. Cerebral palsy

  • Option C: Cerebral palsy is the most common permanent disability of childhood. Cerebral palsy is a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy.
  • Options A and D: Scoliosis and DDH should not cause permanent disability.
  • Option B: Muscular dystrophy is a group of disorders that cause progressive degeneration and weakness of skeletal muscles.

5. Answer: B. 4 weeks

  • Option B: The approximate healing time for a fractured femur during childhood is 4 weeks.

6. Answer: A. Comfort level

  • Option A: Instrumentation and spinal fusion cause considerable pain. Therefore, the adolescent needs vigorous pain management, which involves assessment, administration of pain medication, and evaluation of the response. In the immediate postoperative period, the child is conscious of sensation and surroundings.
  • Option B: Typically, shortly after surgery, the adolescent will not be taking anything by mouth.
  • Option C: Physical therapy is not an urgent postoperative goal at this time. However, it may be appropriate later on in the postoperative period.
  • Option D: Assessment and understanding of the procedure is a preoperative nursing responsibility.

7. Answer: D. Bone growth disruption

  • Option D: The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in limb shortening.
  • Option A: Rheumatoid arthritis is a collagen disease with an autoimmune component, with no relationship to fractures.
  • Options B and C: Nerve damage and osteomyelitis may occur with any fracture, but growth disruption is a primary concern at the epiphyseal plate.

8. Answer: B. Have the mother remove and reapply the harness before discharge.

  • Option B: Having the mother remove and reapply the harness before discharge allows the nurse to directly observe the mother’s method and comfort level. It also provides time for reinstruction if needed.
  • Option A: Although the nurse’s demonstration is a good teaching method, it does not permit evaluation of the mother’s routine.
  • Option C: Verbalization is significant to allow the nurse to assess the mother’s understanding, but it does not allow evaluation of the mother’s psychomotor skills.
  • Option D: Requesting a home visit is further means of evaluation but does not provide instant feedback.

9. Answer: B. Ortolani’s sign

  • Option B: Ortolani’s sign is felt and heard when newborn’s or neonate’s hip is flexed and abducted.
  • Option A: A characteristic limp would be noted in the ambulatory child.
  • Option C: Asymmetrical gluteal folds would be noted in DDH.
  • Option D: Trendelenburg’s sign is noted in the weight-bearing child when the child stands on the affected hip and the pelvis tilts downward on the normal side instead of upward.

10. Answer: B. “My baby won’t lift his head up and look at me; he’s so floppy.”

  • Option B: Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to 90-degree angle by age 4 months with only a partial head lag by age 2 months.
  • Option A: Although rigidity and tenseness are possible signs cerebral palsy, a limitation in one leg suggests DDH.
  • Option C: Tilting of the hip is an indication of developmental dysplasia of the hip (DDH).
  • Option D: Rolling completely over usually does not occur until the infant is age 6 months.

11. Answer: D. Subluxation

  • Option D: DDH is a group of congenital abnormalities of the hip joints, which includes subluxation, dislocation, and preluxation. Of the types of congenital hip abnormalities, subluxation is the most common.
  • Options A and C: Preluxation, also known as acetabular dysplasia, is the mildest form.
  • Option B: Dislocation is complete displacement of the femoral head out of the acetabulum.

12. Answer: C. Osteogenesis imperfecta

  • Option C: Osteogenesis imperfecta (OI), also known as brittle bone disease, is a group of genetic disorders that principally affect the bones. It results in bones that break quickly. The severity may be mild to severe. Other symptoms may include problems with the teeth, loose joints, a blue tinge to the whites of the eye, short height, hearing loss, and breathing problems.
  • Option A: Congenital hip dislocation (CHD) occurs when a child is born with an unstable hip. It is caused by abnormal formation of the hip joint during the early stages of fetal development. CHD is also known as Developmental Dysplasia of the Hip (DDH).
  • Option B: Duchenne muscular dystrophy (DMD) is a genetic condition marked by progressive weakening of voluntary muscles. DMD worsens more rapidly than other types of muscular dystrophy.
  • Option D: A bone infection, also called osteomyelitis, can result when bacteria or fungi penetrate a bone. In children, bone infections usually occur in the long bones of the arms and legs. In adults, they usually appear in the hips, spine, and feet.

13. Answer: A, B, D, and E

  • Options A, B, D, and E: The symptoms for acute and chronic osteomyelitis are very similar and include fever, irritability, fatigue, nausea, tenderness, redness (not pallor in option C), and warmth in the area of the infection, swelling around the affected bone, and lost range of motion.

14. Answer: C. 1A, 2B, 3C

  • Buck’s traction is a type of skin traction with the legs in an extended position. It is used primarily for short-term immobilization, preoperatively with dislocated hips, for correcting contractures, or for bone deformities such as Legg-Calvé-Perthes disease.
  • Russell’s traction uses skin traction on the lower leg and a padded sling under the knee. The combination of longitudinal and perpendicular traction allows realignment of the lower extremity and immobilizes the hips and knees in a flexed position.
  • Bryant’s traction is skin traction with the legs flexed at a 90-degree angle at the hip.

15. Answer: C, D, E, F, G, and H

  • Options C, D, E, F, G, and H: When damage occurs to a muscle or muscle group within the fascial compartment, the resulting swelling and bleeding can create an increased pressure that, if left untreated, can choke off circulation, eventually leading to localized cellular hypoxia and death. The six P’s of compartment syndrome for warning signs to watch for are Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia.

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