N173 Pediatric Musculoskeletal Disorders | Q&A
With Explained Rationales | Brandnew!!!!!!!!!
Question
A nurse is assessing a child who has a musculoskeletal injury. Which of the following
findings would indicate a potential complication? (Select all that apply)
A) Increased pain in the affected limb
B) Coolness to the touch in the extremity
C) Capillary refill of less than 2 seconds
D) Pallor of the skin on the affected limb
E) Continuous movement of the fingers in the affected arm
Answer: A, B, D
Rationale: Increased pain can indicate complications such as compartment syndrome or
inadequate circulation. Coolness to the touch may suggest compromised blood flow and
should be further evaluated. Pallor of the skin indicates decreased blood flow, which is a
potential sign of vascular compromise. Capillary refill of less than 2 seconds is a normal
finding and does not indicate a complication; in fact, delayed capillary refill (greater than 2
seconds) would be concerning. Continuous movement of the fingers in the affected arm is
a normal finding and does not indicate a complication. Nurses must distinguish between
normal findings and warning signs of neurovascular compromise, including the classic
"five Ps": pain, pallor, paresthesia, paralysis, and pulselessness (or coolness). Early
recognition of these signs is critical to prevent permanent tissue damage.
Question
A child is being prepared for the placement of a fiberglass cast after a fracture. Which of
the following actions should the nurse take before applying the cast? (Select all that apply)
A) Explain to the child that the cast will feel heavy and tight
B) Ensure the skin is clean and dry before applying the cast
C) Apply lotion to the skin to prevent irritation
D) Monitor the child's vital signs prior to cast placement
E) Prepare the child for the noise of the cast cutter during removal
,Answer: A, B, E
Rationale: Explaining to the child that the cast will feel heavy and tight helps reduce
anxiety by preparing them for what to expect. Ensuring the skin is clean and dry helps
prevent skin irritation and infection under the cast. Preparing the child for the noise of the
cast cutter during removal is important because the sound can be frightening, and
anticipatory guidance reduces fear. Applying lotion is incorrect because lotion can cause
skin irritation and compromise the fit of the cast; the skin should be clean and dry.
Monitoring vital signs is important generally but is not a specific required action before cast
placement unless otherwise indicated. Nurses should provide developmentally
appropriate preparation for children undergoing cast application and removal.
Question
When providing care to a child in a cast, which nursing interventions are appropriate?
(Select all that apply)
A) Perform regular circulation checks
B) Encourage the child to keep the cast dry and clean
C) Teach the child to remove the cast if it feels uncomfortable
D) Elevate the casted extremity to reduce swelling
E) Monitor for signs of infection around the cast edges
Answer: A, B, D, E
Rationale: Performing regular circulation checks is essential to monitor for neurovascular
complications such as compartment syndrome. Encouraging the child to keep the cast dry
and clean helps prevent skin breakdown and infection. Elevating the casted extremity
reduces swelling and discomfort. Monitoring for signs of infection around the cast edges,
such as redness, warmth, drainage, or foul odor, is important for early detection and
treatment. Teaching the child to remove the cast is incorrect and dangerous; only a
healthcare provider should remove a cast, and improper removal can cause injury or loss
of alignment. Nurses play a key role in cast care education and complication surveillance.
Question
A 6-year-old child is immobilized in a cast following a fracture. Which complications should
the nurse monitor for? (Select all that apply)
,A) Constipation
B) Pressure ulcers
C) Deep vein thrombosis (DVT)
D) Osteoporosis
E) Respiratory complications
Answer: A, B, C
Rationale: Constipation can occur due to immobility and potential opioid use for pain
management. Pressure ulcers can develop from pressure from the cast, especially over
bony prominences. Deep vein thrombosis is a risk because immobility increases venous
stasis. Osteoporosis is a long-term consequence of prolonged immobility due to bone
demineralization, but it is not an immediate complication related to a short-term cast.
Respiratory complications such as atelectasis and pneumonia are associated with
prolonged immobility and bed rest, but they are less directly related to a casted extremity
compared with the other options. Nurses should monitor for signs of these complications
and implement preventive measures such as hydration, repositioning, and encouraging
movement of unaffected extremities.
Question
A nurse is caring for an infant diagnosed with congenital clubfoot. Which of the following
statements by the parents indicates a need for further teaching regarding the condition?
A) "We understand that our child may need to wear a brace for a significant period."
B) "We will ensure to keep the cast dry and clean."
C) "This condition will be completely corrected with the first set of casts."
D) "We will need to follow up regularly to monitor for any recurrence."
Answer: C
Rationale: The statement that the condition will be completely corrected with the first set
of casts indicates a need for further teaching. While casting and bracing are effective,
multiple interventions may be needed over time, and complete correction may not occur
with the first set of casts. The Ponseti method, for example, involves serial casting over
several weeks, often followed by Achilles tenotomy and prolonged bracing. Ongoing follow-
up is essential due to the risk of recurrence. The other statements demonstrate appropriate
understanding: bracing is often required for a significant period, casts must be kept dry and
clean, and regular follow-up is necessary. Nurses should correct misconceptions and
reinforce the long-term nature of clubfoot management.
, Question
Which nursing intervention is most important for a child with congenital clubfoot in a cast?
A) Monitor for signs of infection at the cast site
B) Encourage the child to engage in physical activities
C) Educate the family about dietary needs
D) Apply lotion to the skin under the cast
Answer: A
Rationale: Monitoring for signs of infection at the cast site is the most important nursing
intervention for a child with congenital clubfoot in a cast. The cast can trap moisture and
lead to skin breakdown or infection, and early detection is critical. Encouraging physical
activities is not appropriate while the child is in a cast, as it could compromise the
correction. Educating the family about dietary needs is important for general health but is
not the most important intervention specific to cast care. Applying lotion under the cast is
contraindicated because it can cause skin irritation and infection. Nurses should teach
families to monitor for signs of infection, including fever, redness, swelling, drainage, and
foul odor, and to report them promptly.
Question
Select all that apply: Which of the following are key components of management for a child
with congenital clubfoot?
A) Serial casting
B) Surgical release of the Achilles tendon
C) Passive stretching at home
D) Immediate corrective surgery without casting
E) Long-term follow-up appointments
Answer: A, B, C, E
Rationale: Serial casting is a primary non-surgical management technique, typically using
the Ponseti method, which involves weekly cast changes to gradually correct the deformity.
Surgical management, including Achilles tendon release (tenotomy), is often required,
especially when the equinus deformity persists. Passive stretching at home is essential for
associated conditions like metatarsus adductus and helps maintain correction. Long-term
follow-up is necessary to monitor for recurrence, which can occur even after successful
With Explained Rationales | Brandnew!!!!!!!!!
Question
A nurse is assessing a child who has a musculoskeletal injury. Which of the following
findings would indicate a potential complication? (Select all that apply)
A) Increased pain in the affected limb
B) Coolness to the touch in the extremity
C) Capillary refill of less than 2 seconds
D) Pallor of the skin on the affected limb
E) Continuous movement of the fingers in the affected arm
Answer: A, B, D
Rationale: Increased pain can indicate complications such as compartment syndrome or
inadequate circulation. Coolness to the touch may suggest compromised blood flow and
should be further evaluated. Pallor of the skin indicates decreased blood flow, which is a
potential sign of vascular compromise. Capillary refill of less than 2 seconds is a normal
finding and does not indicate a complication; in fact, delayed capillary refill (greater than 2
seconds) would be concerning. Continuous movement of the fingers in the affected arm is
a normal finding and does not indicate a complication. Nurses must distinguish between
normal findings and warning signs of neurovascular compromise, including the classic
"five Ps": pain, pallor, paresthesia, paralysis, and pulselessness (or coolness). Early
recognition of these signs is critical to prevent permanent tissue damage.
Question
A child is being prepared for the placement of a fiberglass cast after a fracture. Which of
the following actions should the nurse take before applying the cast? (Select all that apply)
A) Explain to the child that the cast will feel heavy and tight
B) Ensure the skin is clean and dry before applying the cast
C) Apply lotion to the skin to prevent irritation
D) Monitor the child's vital signs prior to cast placement
E) Prepare the child for the noise of the cast cutter during removal
,Answer: A, B, E
Rationale: Explaining to the child that the cast will feel heavy and tight helps reduce
anxiety by preparing them for what to expect. Ensuring the skin is clean and dry helps
prevent skin irritation and infection under the cast. Preparing the child for the noise of the
cast cutter during removal is important because the sound can be frightening, and
anticipatory guidance reduces fear. Applying lotion is incorrect because lotion can cause
skin irritation and compromise the fit of the cast; the skin should be clean and dry.
Monitoring vital signs is important generally but is not a specific required action before cast
placement unless otherwise indicated. Nurses should provide developmentally
appropriate preparation for children undergoing cast application and removal.
Question
When providing care to a child in a cast, which nursing interventions are appropriate?
(Select all that apply)
A) Perform regular circulation checks
B) Encourage the child to keep the cast dry and clean
C) Teach the child to remove the cast if it feels uncomfortable
D) Elevate the casted extremity to reduce swelling
E) Monitor for signs of infection around the cast edges
Answer: A, B, D, E
Rationale: Performing regular circulation checks is essential to monitor for neurovascular
complications such as compartment syndrome. Encouraging the child to keep the cast dry
and clean helps prevent skin breakdown and infection. Elevating the casted extremity
reduces swelling and discomfort. Monitoring for signs of infection around the cast edges,
such as redness, warmth, drainage, or foul odor, is important for early detection and
treatment. Teaching the child to remove the cast is incorrect and dangerous; only a
healthcare provider should remove a cast, and improper removal can cause injury or loss
of alignment. Nurses play a key role in cast care education and complication surveillance.
Question
A 6-year-old child is immobilized in a cast following a fracture. Which complications should
the nurse monitor for? (Select all that apply)
,A) Constipation
B) Pressure ulcers
C) Deep vein thrombosis (DVT)
D) Osteoporosis
E) Respiratory complications
Answer: A, B, C
Rationale: Constipation can occur due to immobility and potential opioid use for pain
management. Pressure ulcers can develop from pressure from the cast, especially over
bony prominences. Deep vein thrombosis is a risk because immobility increases venous
stasis. Osteoporosis is a long-term consequence of prolonged immobility due to bone
demineralization, but it is not an immediate complication related to a short-term cast.
Respiratory complications such as atelectasis and pneumonia are associated with
prolonged immobility and bed rest, but they are less directly related to a casted extremity
compared with the other options. Nurses should monitor for signs of these complications
and implement preventive measures such as hydration, repositioning, and encouraging
movement of unaffected extremities.
Question
A nurse is caring for an infant diagnosed with congenital clubfoot. Which of the following
statements by the parents indicates a need for further teaching regarding the condition?
A) "We understand that our child may need to wear a brace for a significant period."
B) "We will ensure to keep the cast dry and clean."
C) "This condition will be completely corrected with the first set of casts."
D) "We will need to follow up regularly to monitor for any recurrence."
Answer: C
Rationale: The statement that the condition will be completely corrected with the first set
of casts indicates a need for further teaching. While casting and bracing are effective,
multiple interventions may be needed over time, and complete correction may not occur
with the first set of casts. The Ponseti method, for example, involves serial casting over
several weeks, often followed by Achilles tenotomy and prolonged bracing. Ongoing follow-
up is essential due to the risk of recurrence. The other statements demonstrate appropriate
understanding: bracing is often required for a significant period, casts must be kept dry and
clean, and regular follow-up is necessary. Nurses should correct misconceptions and
reinforce the long-term nature of clubfoot management.
, Question
Which nursing intervention is most important for a child with congenital clubfoot in a cast?
A) Monitor for signs of infection at the cast site
B) Encourage the child to engage in physical activities
C) Educate the family about dietary needs
D) Apply lotion to the skin under the cast
Answer: A
Rationale: Monitoring for signs of infection at the cast site is the most important nursing
intervention for a child with congenital clubfoot in a cast. The cast can trap moisture and
lead to skin breakdown or infection, and early detection is critical. Encouraging physical
activities is not appropriate while the child is in a cast, as it could compromise the
correction. Educating the family about dietary needs is important for general health but is
not the most important intervention specific to cast care. Applying lotion under the cast is
contraindicated because it can cause skin irritation and infection. Nurses should teach
families to monitor for signs of infection, including fever, redness, swelling, drainage, and
foul odor, and to report them promptly.
Question
Select all that apply: Which of the following are key components of management for a child
with congenital clubfoot?
A) Serial casting
B) Surgical release of the Achilles tendon
C) Passive stretching at home
D) Immediate corrective surgery without casting
E) Long-term follow-up appointments
Answer: A, B, C, E
Rationale: Serial casting is a primary non-surgical management technique, typically using
the Ponseti method, which involves weekly cast changes to gradually correct the deformity.
Surgical management, including Achilles tendon release (tenotomy), is often required,
especially when the equinus deformity persists. Passive stretching at home is essential for
associated conditions like metatarsus adductus and helps maintain correction. Long-term
follow-up is necessary to monitor for recurrence, which can occur even after successful
