Level 1
Which finding is considered abnormal in neuromuscular assessment of a child?
A. Purposeful movement in a toddler
B. Hypertonia
C. Brisk reflexes at birth
D. Full range of motion in an infant
Correct answer: B
Rationale:Your notes list hypertonia, hypotonia, and sluggish deep tendon reflexes as abnormal findings. Brisk reflexes at birth can be normal early on.
Which intervention is most important for a sprain in the first 48 hours?
A. Heat and massage
B. RICE
C. Bedrest for 2 weeks only
D. Immediate weight-bearing
Correct answer: B
Rationale:The key treatment for sprains and strains is RICE: rest, ice, compression, and elevation.
Which imaging test is used to identify a fracture or bone abnormality?
A. Muscle biopsy
B. Radiograph
C. CBC
D. Nerve conduction test
Correct answer: B
Rationale:Radiographs (x-rays) are used to identify fractures and bone abnormalities.
A 7-year-old child had a cast placed for a forearm fracture 3 hours ago. The child now reports severe pain that is not relieved by medication. The fingers are pale and cool. What is the nurse’s priority interpretation?
A. Normal cast discomfort
B. Compartment syndrome
C. Expected swelling only
D. Anxiety related to hospitalization
Correct answer: B
Rationale:Severe unrelenting pain, pallor, and coolness are classic findings of compartment syndrome, which requires immediate action. The cast may need to be removed.
A school-age child is being evaluated for muscular dystrophy. The provider orders a test that reflects muscle damage. Which test should the nurse expect?
A. ESR
B. Creatine kinase
C. Blood culture
D. PT/INR
Correct answer: B
Rationale:Creatine kinase is used because it reflects muscle damage and helps evaluate muscular dystrophy.
Why are infant bones more likely to bend rather than break?
A. They are fully ossified
B. They contain less cartilage
C. They are not completely ossified and are more flexible
D. They have closed growth plates
Correct answer: C
Rationale:Infant skeletons are not completely ossified, have more cartilage, and are more flexible than adult bones.
How should ice be applied for an acute musculoskeletal injury?
A. 60 minutes on, 20 minutes off
B. 20 to 30 minutes on, then remove for 1 hour
C. Continuously for 24 hours
D. Only once per day
Correct answer: B
Rationale:Your notes state cold therapy should be applied for 20 to 30 minutes, removed for 1 hour, then reapplied.
Which lab is most associated with diagnosing muscular dystrophy?
A. BNP
B. Creatine kinase
C. Potassium
D. Ferritin
Correct answer: B
Rationale:Creatine kinase reflects muscle damage and is used in diagnosing muscular dystrophy.
A child is in skeletal cervical traction after injury. Which nursing action is most important to maintain effective traction?
A. Allow the weights to rest on the bed
B. Remove the weights during meals
C. Ensure the weights hang freely and ropes stay in the pulley grooves
D. Elevate the foot of the bed without an order
Correct answer: C
Rationale:Traction must remain constant and even. The weights should hang freely, and ropes must stay in the pulley grooves.
A boy with Duchenne muscular dystrophy has increasing difficulty climbing stairs and uses his hands to push himself upright from the floor. Which finding does the nurse recognize?
A. Positive Ortolani sign
B. Gower’s sign
C. Tinel’s sign
D. Kernig’s sign
Correct answer: B
Rationale:Your notes specifically identify Gower’s sign as associated with Duchenne muscular dystrophy.
Which area is most vulnerable to injury and can affect future bone growth?
A. Diaphysis
B. Growth plate
C. Tendon insertion
D. Periosteum only
Correct answer: B
Rationale:The growth plate is structurally weak, open until near puberty, and injury there can affect future growth and cause deformity or shortening.
After cast placement, which teaching is correct?
A. The limb should be kept dependent for 48 hours
B. A very warm feeling inside the cast is expected at first
C. The cast must be scrubbed when drying
D. Petroleum jelly should be applied under the cast
Correct answer: B
Rationale:A warm feeling is expected while the cast dries. The limb should also be elevated for 48 hours to reduce swelling.
Which condition is the most severe neural tube defect?
A. Spina bifida occulta
B. Meningocele
C. Myelomeningocele
D. Torticollis
Correct answer: C
Rationale:Myelomeningocele is the most severe neural tube defect and may cause paralysis and bowel/bladder incontinence below the lesion.
A 3-month-old infant with DDH is prescribed a Pavlik harness. Which parent statement shows correct understanding?
A. “I should remove it most of the day so the baby can stretch.”
B. “I will check behind the knees and diaper area for skin breakdown.”
C. “My baby should not move the legs while wearing it.”
D. “I should tighten it if the baby seems uncomfortable.”
Correct answer: B
Rationale:With a Pavlik harness, parents should monitor for skin breakdown, keep it on as prescribed, change diapers while in the harness, and the infant should still be able to kick the legs.
A child with Duchenne muscular dystrophy is admitted with increased respiratory effort and crackles. Which nursing intervention is most appropriate?
A. Keep the child flat in bed
B. Position upright and encourage coughing and deep breathing
C. Restrict all activity and fluids
D. Remove orthotics permanently
Correct answer: B
Rationale:Duchenne management includes upright positioning, deep breathing exercises, and coughing to support chest expansion and airway clearance.
Which assessment finding is the most reliable indicator of a fracture in a child?
A. General irritability
B. Mild warmth
C. Point tenderness
D. Temporary redness
Correct answer: C
Rationale:Your notes specifically state that point tenderness is the most reliable sign of fracture.
Which instruction is correct after cast removal?
A. Rub the skin vigorously to remove flakes
B. Use petroleum jelly daily
C. Soak in warm soapy water and apply moisturizing lotion
D. Scrape off dry skin with a towel
Correct answer: C
Rationale:After cast removal, the child should soak in warm soapy water, use moisturizing lotion, and avoid vigorous rubbing or petroleum jelly.
Which finding is most associated with developmental dysplasia of the hip?
A. Rib hump
B. Distinct clunk with Barlow or Ortolani maneuver
C. Barking cough
D. Positive Babinski reflex
Correct answer: B
Rationale:A distinct clunk with Barlow or Ortolani is concerning for DDH, while a high-pitched click is considered benign.
A 15-year-old obese adolescent presents with sudden hip pain and inability to bear weight after basketball practice. Which condition should the nurse suspect first?
A. Developmental dysplasia of the hip
B. Slipped capital femoral epiphysis
C. Tibia vara
D. Torticollis
Correct answer: B
Rationale:This presentation is classic for slipped capital femoral epiphysis, especially in an obese adolescent with sudden hip pain and inability to bear weight.
A preterm child with cerebral palsy has hypertonicity, exaggerated deep tendon reflexes, and permanent contractures. Which type of CP is most likely?
A. Athetoid
B. Ataxic
C. Spastic
D. Mixed
Correct answer: C
Rationale:Spastic cerebral palsy is the most common type and is characterized by hypertonicity, contractures, and exaggerated reflexes.
A fracture in which age group should raise the highest suspicion for possible child abuse?
A. Adolescent athlete
B. School-age child with a wrist fracture
C. Infant with a fracture
D. Preschooler with a sprain
Correct answer: C
Rationale:Fractures in infants are highly unusual and should raise suspicion for abuse, especially spiral femur, rib, or humerus fractures in children younger than 2 years.
What is the correct fit for crutches?
A. Top of crutch directly in the axilla
B. Top of crutch level with shoulder
C. Top of crutch 2 to 3 finger widths below the axilla
D. Hand grips at knee level
Correct answer: C
Rationale:The crutch top should be 2 to 3 finger widths below the axilla to prevent nerve palsy.
Which child is at highest risk for slipped capital femoral epiphysis?
A. Thin 4-year-old with clubfoot
B. Obese 13-year-old with sudden hip pain and inability to bear weight
C. Newborn with torticollis
D. Toddler with a mild sprain
Correct answer: B
Rationale:SCFE is most associated with obesity, ages 9 to 16, growth spurts, and sudden inability to bear weight.
A toddler is brought in with a spiral femur fracture. The caregiver reports the child “rolled off the couch.” What should the nurse do first?
A. Accept the explanation and prepare discharge papers
B. Recognize this injury pattern as concerning for abuse and follow reporting protocol
C. Encourage the caregiver not to worry
D. Focus only on pain medication and avoid further questions
Correct answer: B
Rationale:A spiral femur fracture in a very young child is concerning for nonaccidental trauma and should be investigated according to protocol.
An adolescent is screened at school for scoliosis. The nurse notes asymmetric shoulders and then asks the student to bend forward. Which finding would most support scoliosis?
A. A pronounced rib hump on one side
B. Pain only in the wrists
C. Equal waistline curves
D. Symmetric scapulae
Correct answer: A
Rationale:During scoliosis screening, a rib hump on one side with forward bending is a key abnormal finding. Large curves may later require bracing or surgery depending on severity.