Cerebral Palsy

The client has just undergone CT scanning with a contrast medium. Which statement by the client demonstrates an understanding of postprocedure care? A) "I should drink extra fluid for the remainder of the day" B) "I should not take any medication for at least 4 hours" C) "I should eat lightly for the remainder of the day" D) "I should rest quietly for the remainder of the day"

A

A client with a seizure disorder is being admitted to the hospital. Which should the nurse plan to implement for this client? SATA A) Pad the bed's side rails B) Place an airway at the bedside C) Place oxygen equipment at the bedside D) Place suction equipment at the bedside E) Tape a padded tongue blade to the wall at the head of the bed

A B C D

The nurse is obtaining a health history from the parents of a child with cerebral palsy (CP). Which question should the nurse use to determine whether the child's brain insult happened after birth? A)"Was the mother older than 40 years when the child was born?" B)"Were there any accidents before age 3?" C)"Was the child born prematurely?" D)"Was the child born subsequent to the fourth child?"

B)"Were there any accidents before age 3?" Asking about maternal age at birth, prematurity, and birth order all assess possible prenatal causes of CP. Asking about accidents before age 3 can help determine whether the child's brain insult happened after birth.

The nurse observes the UAP positioning the client with ICP. Which position would require intervention by the nurse? A) head midline B) Head turned to the side C) Neck in neutral position D) Head of the bed elevated 30-45 degrees

B

The nurse is reviewing the postoperative prescription for an infant with hydrocephalus, who came back from surgery with a ventriculoperitoneal shunt. Which of the primary health care providers prescriptions does the nurse question? A) position the infant on the inoperative side B) Keep the head of the bed elevated at 45 degrees C) monitor for signs of infection and check the dressing for drainage D) observe for irritability, a high shill cry, lethargy, and poor feeding.

B) Keep the head of the bed elevated at 45 degrees Postoperative management for infants with hydrocephalus who have undergone ventriculoperitoneal shunt should be flat in a bed to avoid the rapid reduction of intracranial fluid

The nurse is evaluating care provided to a 9-year-old patient with cerebral palsy (CP). Which patient outcome should indicate to the nurse that the patient has achieved a developmental milestone? A) The patient is able to feed themselves. B) The patient has joined the Girl Scouts. C) The patient's parents administer medications appropriately. D) The patient returns for follow-up doctor's appointments as scheduled.

B) The patient has joined the Girl Scouts. Joining age-appropriate group activities indicates that the patient is achieving an age-related developmental milestone. The patient should be able to self-feed by this age. Following a prescribed medication regimen and having routine medical evaluations does not measure the success of nursing care.

The parents of a 7-year-old patient with cerebral palsy (CP) ask for strategies to help with mealtime for their child. Which statement should the nurse provide? A)"Provide a liquid diet only." B)"Provide soft foods with the use of large, padded utensils." C)"Continue feeding your child for nutrition purposes." D)"Provide foods that require chewing to prevent aspiration."

B)"Provide soft foods with the use of large, padded utensils." Problems with swallowing, sucking, chewing, and movements in the mouth and jaw also cause nutritional challenges. Give the child soft foods in small amounts. Utensils with large, padded handles may be easier for the child to use. Liquids only can be an aspiration risk, as well as possibly not provide adequate nutrition. The child should always be encouraged to function independently.

A term newborn who contracted an infection in utero may have spastic cerebral palsy (CP) caused by a brain insult from the infection. Which area of the brain should the nurse explain was affected when talking to the patient's parents? A)Basal ganglia B)Multiple areas C)Cerebellum D)Cerebral cortex

D)Cerebral cortex Spastic CP is generally attributable to a brain insult in the cerebral cortex. Ataxic CP is generally attributable to a brain insult in the cerebellum. Mixed CP is generally attributable to multiple injury sites. Dyskinetic CP is generally attributable to a brain insult in the basal ganglia.

The client is admitted to the hospital for observation with a probable minor head injury after an automobile crash. The nurse expects the cervical collar will remain in place until which time? A)The client is taken for spinal x-rays B) The family comes to visit after surgery C) The nurse needs to provide physical care D) The primary health care provider reviews the x-ray results

D

The nurse provides homecare instructions to the parent of a child with attention deficit hyperactivity disorder regarding behavioral therapy intervention. Which statement by the parent indicates a need for further teaching. A) "I hear that the side effects of the medication that my child will be on can cause overeating" B) "I know that consistent medication and regular follow-up visits are a part of the plan for my child" C) "I know I need to maintain a consistent home environment because my child is easily distracted" D) "I understand that I will need to learn some behavioral modification techniques to help my child's impulsivity"

A) "I hear that the side effects of the medication that my child will be on can cause overeating" The treatment plan for children with attention deficit hyperactivity disorder includes simulant medications that may have the adverse effect of appetite suppression and weight loss, not overeating.

The nurse is caring for a child with cerebral palsy. Which intervention should the nurse use to support this patient's nutritional status? A) Provide small amounts of food at a time B) Use utensils with small, padded, adaptive handles C) Restrict fluid intake D) Provide adequate protein

A) Provide small amounts of food at a time Small amounts of food should be given to a child with CP because of problems with chewing and swallowing. Utensils with large, not small, padded, adaptive handles should be provided. There is no need to restrict this child's fluid. All nutrients are important for this patient.

The mother of an 18-month-old child is concerned about the child not meeting developmental milestones and wants the child tested for cerebral palsy. Which diagnostic approach should the nurse explain to this mother? A) CT scan B) Urinalysis C) Laboratory test for certain proteins D) Observation of symptoms and ruling out other disorders

D) Observation of symptoms and ruling out other disorders There is no specific diagnostic test for CP. Diagnosis is usually made by observation of symptoms and ruling out other causes of manifestations. CT scan may be used to identify other organic brain diseases that may be causing certain symptoms but is not used to specifically diagnose CP. Laboratory testing for proteins and results of urinalysis are not helpful in diagnosing CP.

Which conditions most frequently shorten the life of adults with cerebral palsy (CP)? A)Arthritis and contractures B)Muscle atrophy and brain tumors C)Incontinence and skin breakdown D)Respiratory disorders and seizures

D)Respiratory disorders and seizures Respiratory disorders and seizures can shorten the life of adults with CP. Incontinence and skin breakdown can lead to infection and complications, but these are not as life-limiting as respiratory and seizure disorders. Muscle atrophy can lead to complications, and brain tumors are not necessarily prone to occur in those with CP. Arthritis and contractures can lead to further mobility but are not directly life limiting.

A child has a basilar skull fracture. Which primary health care provider's prescription should the nurse question? A) restrict fluid intake B) Insert an indwelling urinary catheter C) Keep an IV line patent D) suction via the nasotracheal route as needed

D Nasotracheal suctioning is contraindicated in a child with a basilar skull fracture. Because of the locations of the injury, the suction catheter may be induced into the brain.

A pregnant patient is scheduled for an ultrasound to attempt to diagnose the possibility of cerebral palsy (CP). Which statement should the nurse use to explain to the patient how this test is used to identify the possibility of CP? A)"An ultrasound can detect abnormalities of the brain that can increase the likelihood of the presence of CP." B)"An ultrasound can detect specific deformities and developmental disorders that are associated with CP." C)"An ultrasound can determine the position of the fetus in the uterus, which can identify any possible abnormality leading to CP." D)"An ultrasound can positively detect CP by measuring the size of the brain."

A)"An ultrasound can detect abnormalities of the brain that can increase the likelihood of the presence of CP." Neonatal brain abnormalities, such as intraventricular hemorrhage, can contribute to the development of CP. An ultrasound can help detect these abnormalities prior to birth. An ultrasound can detect birth defects and abnormalities, but these are not necessarily associated with CP. Fetal position is not associated with CP, although malpositioned infants, such as breech presentation, can increase risk of difficult delivery and brain injury. CP is not identified by the size of the brain.

The nurse is reviewing multiple cases of patients diagnosed with cerebral palsy (CP). Which patient would benefit most from enhanced mobility? A)A 15-year-old patient who uses a manual wheelchair at school. B)A 17-year-old patient who works at a grocery store as a bagger. C)A 55-year-old patient who lives in a group home and uses a walker. D)A 13-year-old patient who uses a wheelchair and has a private nurse at home.

A)A 15-year-old patient who uses a manual wheelchair at school. A high school student who uses a manual wheelchair would most likely benefit most from adaptive and assistive technology, such as a motorized wheelchair, to promote mobility. The patient working as a bagger is quite independent, as is the patient who can ambulate and use a walker. The patient who uses a wheelchair may benefit from increased mobility, but having a private nurse increases the likelihood that the patient is assisted with mobility.

A 9-month-old child is diagnosed with spastic cerebral palsy (CP). Which clinical manifestation should the nurse expect to assess in this patient? A) Hypertonia and rigidity B) Hemiplegia and hypotonia C) Bizarre twitching movements D) Tremors and exaggerated posturing

A)Hypertonia and rigidity Hypertonia in infancy and muscle rigidity are seen in spastic cerebral palsy. Hypotonia is seen in dyskinetic CP caused by an extrapyramidal injury. Tremors and exaggerated posturing are seen in dyskinetic CP. Bizarre twitching movements are seen in dyskinetic CP caused by an extrapyramidal, basal ganglia injury.

A 6-year-old patient with cerebral palsy (CP) is being fed by their mother. The nurse notices that the patient is reaching for the spoon and attempting to self-feed. Which is the most appropriate intervention? A)Providing large, padded utensils and encouraging self-feeding B)Encouraging the mother to keep trying, because it is not likely that the child will be able to self-feed C)Assisting the mother by holding the child's hands to prevent food from spilling D)Discussing possible tube feeding with the healthcare provider

A)Providing large, padded utensils and encouraging self-feeding Specially designed utensils and encouraging self-feeding promote independence and can improve coordination. Large, padded utensils are easy to grasp and should be provided to promote self-feeding. Restraining a child who is attempting to self-feed is not appropriate and should never be done. The mother should keep trying but with the correct utensils. Tube feeding is not usually indicated if the child is able to eat.

The nurse is reviewing the care of a patient with cerebral palsy (CP) with a new nurse. Which medication should the nurse emphasize would be effective in minimizing gastrointestinal side effects of CP? A)Ranitidine B)Baclofen C)Dantrolene D)Botulinum toxin

A)Ranitidine Ranitidine or cimetidine are used to minimize gastrointestinal side effects. Medications used to control spasms include skeletal muscle relaxants, baclofen, and benzodiazepines. Botulinum toxin has been used to decrease spasticity.

A 3-year-old patient with cerebral palsy (CP) has begun having seizures. Which recommendation should the nurse make to enhance this patient's safety? A)Wear a helmet. B)Use specialized safety belts when seated. C)Ensure adequate lighting in walkways D)Apply leg braces.

A)Wear a helmet. A child with CP who has seizures is at risk for a head injury from falling or trauma to the head during a seizure. A helmet would protect the child's head. Keeping hallways adequately lit is more appropriate as a precaution for older children. Seat belts are not needed every time the patient sits. Braces may be effective in preventing contractures but are not beneficial in preventing injury in children who have seizures.

The parents of a 3-year-old child with cerebral palsy (CP) do not wish to begin any physical therapy or use braces or positioning devices until the child is older. Which response should the nurse make to the parents? A)"You shouldn't wait because that could make the condition much worse." B)"The earlier the intervention is started, the better the long-term result to optimize independence." C)"You may want to wait until walking occurs." D)"It's up to you. It really doesn't matter when therapy is started."

B)"The earlier the intervention is started, the better the long-term result to optimize independence."

The nurse is conducting an in-service about cerebral palsy (CP). Which lifespan considerations should the nurse include? A)Premature aging is uncommon in CP. B)Comorbidities often shorten the lifespan of those with CP. C)Most patients with CP are severely disabled and dependent. D)Bowel and bladder incontinence is uncommon in CP.

B)Comorbidities often shorten the lifespan of those with CP. Seizures and respiratory disorders are examples of comorbidities that shorten the lifespan of patients with CP. Premature aging is often seen in patients with CP due to the continual state of stress on the body. Many children with CP grow up to lead full, independent lives and have families. Those with CP are prone to bowel and bladder incontinence, which can hinder their quality of life.

A 7-year-old girl with dyskinetic cerebral palsy (CP) uses either a stroller or wheelchair for mobility since birth. Which assessment should the nurse consider the priority? A)Height and weight B)Skin integrity and body alignment C)Swallowing difficulty D)Nutrition status and bowel function

B)Skin integrity and body alignment Skin integrity and good body alignment are essential for a child with CP who is in a wheelchair. Pillows, towels, and bolsters may be needed for positioning or to take pressure off reddened areas of skin. Height and weight must be assessed for every child, as should nutrition status and bowel habits. Assessment for swallowing difficulty is used to detect clinical manifestations that may indicate that a child has CP.

Which laboratory result would verify the diagnosis of bacterial meningitis? A) clear cerebrospinal fluid with high protein and low glucose levels B) cloudy cerebrospinal fluid with low protein and low glucose levels C) cloudy cerebrospinal fluid with high protein and low glucose levels D) decreased pressure with cloudy cerebrospinal fluid with a high protein level

C A diagnosis of meningitis is made by testing the cerebrospinal fluid obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include increased pressure, cloudy cerebrospinal fluid, a high protein level, and a low glucose level.

The nurse instructs a mother of a child who has seizures regarding seizure precautions. Which statement by the mother indicates a need for further teaching? A) "I will make my child wear a medical identification alert bracelet" B) "I know that my child will need to have a companion when swimming" C) "I will need to give antiseizure medications when my child has a seizure" D) "I will have my child wear a bike helmet when riding a bike or skateboarding"

C Antiseizure medications are given on a routine basis to prevent seizure, they are not rescue medications given at the time of a seizure.

The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. During data collection about the child, the nurse expects to note which characteristic of this type of posturing? A) Flaccid paralysis of all extremities B) Adduction of the arms at the shoulder C) Rigid extension and pronation of the arms and legs D)Abnormal flexation of the upper extremities and extension and adduction of the lower extremities

C) Rigid extension and pronation of the arms and legs Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs.

The parent of a child with cerebral palsy (CP) ask the nurse, "What is the purpose of these braces?" Which response by the nurse is correct? A)"Braces will help promote flexibility." B)"Braces will help strengthen muscles." C)"Braces help with mobility and provide stabilization." D)"Braces will protect your child from broken bones."

C)"Braces help with mobility and provide stabilization." Braces for a patient with CP serve the purpose of providing stability and, in turn, promoting mobility. Braces do not provide protection; it is still possible for a patient to break a bone while wearing braces. Therapeutic massage, not braces, helps strengthen muscles and promote flexibility.

The nurse is giving an overview of cerebral palsy (CP) to a group of new nurses. Which statement should the nurse include in the teaching? A)"CP is a progressive disease that is inherited." B)"CP is identified during the prenatal period." C)"Not all patients with CP have an intellectual disability." D)"The pathogenesis of CP is the same in most cases."

C)"Not all patients with CP have an intellectual disability." CP may or may not include an intellectual disability. CP is not progressive and not inherited; however, genetic mutations have been found recently in some patients with CP. Some cases of CP occur after birth and not during the prenatal period, and the pathogenesis varies from patient to patient. Pathogens, toxins, trauma, hypoxia, and genetic mutations can all lead to CP.

A family caregiver asks why a 40-year-old patient with cerebral palsy (CP) developed hypertension at such a young age. Which response should the nurse make? A)"There may be a family history of hypertension that you did not know about." B)"People with CP are at increased risk of developing hypertension and other cardiovascular problems due to immobility." C)"The effects of constant stress on the body caused by CP leads to the development of conditions earlier in life." D)"You may want to reduce salt and fat in his diet. He obviously has not been eating a healthy diet."

C)"The effects of constant stress on the body caused by CP leads to the development of conditions earlier in life." Conditions such as hypertension and atherosclerotic heart disease occur frequently at an early age in those with CP as a result of the constant stress on the body leading to premature aging. A family history may or may not be relevant in the presence of CP. Immobility can lead to numerous health problems but not specifically hypertension. An unhealthy diet may contribute somewhat to the early development of hypertension, but it is more likely due to stress on the body as a result of CP.

During a routine exam, the nurse notices that a 2-year-old child shows signs of inadequate coordination and muscle stiffness. Which developmental disorder should the nurse suspect in this patient? A)Autism spectrum disorder B)Failure to thrive C)Cerebral palsy D)Attention-deficit/hyperactivity disorder

C)Cerebral palsy The patient may have the developmental disorder of cerebral palsy, which is characterized by inadequate balance and coordination (ataxia), uncontrolled movements (dyskinesia), and muscle stiffness (spasticity). The patient's symptoms are not associated with failure to thrive, autism spectrum disorder, and attention-deficit/hyperactivity disorder.

The parents of a 5-year-old patient with mixed cerebral palsy (CP) ask why a baclofen pump is scheduled to be surgically implanted in the child. Which explanation should the nurse give about the purpose of this medication pump? A)It increases ankle range of motion. B)It allows flat-footed walking C)It controls muscle spasms. D)It prevents infections.

C)It controls muscle spasms. Implantation of a baclofen pump allows continuous delivery of the drug baclofen, which improves muscle spasms. The surgical treatment of Achilles tendon lengthening is used to increase ankle range of motion and to allow the child to walk flat-footed. Intrathecal pump implantation actually increases the risk of infection and must be carefully monitored. Baclofen is not being provided to the patient to prevent infections.

A 22-year-old patient with cerebral palsy (CP) is experiencing chronic pain. Which reason should the nurse identify that explains the most common cause of chronic pain in adults with this health problem? A)Brain lesions B)Skin breakdown C)Muscle contractions D)Skeletal deformities

C)Muscle contractions Muscle contractions place the body in a continuous state of stress. The pain that results from this increases with age. Skin breakdown may occur in those who have urinary or bowel incontinence, but this is not the most common cause of pain. Skeletal deformities can result in positional discomfort but are not the leading cause of pain. Brain lesions are not a common cause of pain in those with CP.

The client has clear fluid leaking from the nose after a basilar skull fracture. The nurse determines that this is cerebrospinal fluid is the fluid meets which criteria? A) Is grossly bloody in appearance and has a pH of 6 B) Clumps together on the dressing and has a pH of 7 C) is clear in appearance and tests negative for glucose D) Separates into concentric rings and tests positive for glucose

D

The client recovering from a head injury is arousable and participating in care. The nurse determines that the client understands measures to prevent elevations in ICP if the nurse observes the client doing which activity? A) blowing the nose B) Isometric exercises C) Coughing vigoriously D) Exhaling during repositioning

D

The nurse is caring for a client with ICP. Which change in vital signs would occur if ICP is rising? A) increasing temperature, increasing pulse, increasing respirations, decreasing BP B) Decreasing temperature, decreasing pulse, increasing respirations, decreasing BP C) Decreasing temperature, increasing pulse, decreasing respirations, increasing BP D) Increasing temperature, decreasing pulse, decreasing respirations, increasing BP

D

The parent of a child recently diagnosed with cerebral palsy ask the nurse about the disorder. The nurse bases the response on the understanding that cerebral palsy is which type of condition? A) an infectious disease of the CNS B) An inflammation of the brain as a result of a viral illness C) a congenital condition that results in moderate to severe retardation D) A chronic disability characterized by impaired muscle movement and posture

D Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system

The nurse reinforces instructions to the parent of a child with meningococcal meningitis. Which statement by the patent indicates a need for further teaching? A) "I can give my child acetaminophen for fever" B) "I will watch for any hearing loss that may occur" C) "I know that I will need to watch for any rash that my child may develop" D) "I will need to get my other children the pneumococcal vaccine, but not the baby yet, he is only 3 months old"

D Pneumococcal conjugate vaccine is recommended for all children beginning at age 2 months

A child is diagnosed with Reye's syndrome. The Nurse assists with developing a nursing care plan for the child and should include which intervention in this plan? A) Assess hearing loss B) Monitor urine output C) Change body position every 2 hours D) Provide a quiet atmosphere with dimmed lighting

D) Provide a quiet atmosphere with dimmed lighting Reyes syndrome is an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver. Decreasing the stimuli in the environment by providing a quiet and dimmed area would decrease the stress on the cerebral tissue and neuron responses.

A 9-year-old patient with cerebral palsy (CP) is being evaluated for a procedure that will assist with improving ambulation. For which procedure should the nurse prepare teaching? A)Joint stabilization B)Hamstring release C)Selective dorsal rhizotomy D)Achilles tendon lengthening

D)Achilles tendon lengthening Achilles tendon lengthening is most frequently done to improve ambulation that is impaired due to contractures of the tendon. This can assist with the ability to walk flat-footed, which can allow or improve ambulation. Selective dorsal rhizotomy is done to reduce spasticity. Hamstring lengthening will improve contractures and joint deformity. Joint stabilization can help provide support to joints that are damaged due to contractures or arthritis.

The nurse is discussing surgery treatment options with the parents of a child with cerebral palsy (CP). Which surgical intervention should the nurse review for applicability prior to discussing with the parents? A)Releasing the hamstrings B)Dorsal rhizotomy C)Surgically implanted intrathecal pump D)Achilles tendon shortening

D)Achilles tendon shortening Achilles tendon lengthening, not shortening, is a surgical intervention that is used to treat CP. Other surgical treatments include surgical implantation of an intrathecal pump, releasing the hamstrings, and dorsal rhizotomy.

The nurse is caring for newborns in the neonatal intensive care unit. Which infant should the nurse expect to be referred for further testing for cerebral palsy (CP)? A)Infant born at full term to a mother who had no prenatal care, with a difficult delivery and Apgar scores of 9 and 10 B)Infant born at full term, with decreased reflexes and requiring supplemental oxygen C)Infant born to a mother with gestational diabetes, weighing 10 lb, and having low Apgar scores at birth D)Infant born at 30 weeks of gestation, with a difficult, prolonged delivery and infection present in the amniotic fluid at birth

D)Infant born at 30 weeks of gestation, with a difficult, prolonged delivery and infection present in the amniotic fluid at birth Preterm delivery is the greatest risk factor for developing CP. Birth complications and exposure to infection also increases risk. Gestational diabetes and increased birth weight are not risk factors for cerebral palsy. Any infant who requires supplemental oxygen should be monitored for complications, but this is not specific to CP. Lack of prenatal care and a difficult delivery are risk factors, but the Apgar scores and full-term delivery are not.