neuromuscular

The nurse is conducting a health assessment of a 6-year-old girl with spina bifida. During the interview, the girl keeps interrupting and shouting to get her mother's attention. The mother instantly responds to every interruption and attempts to placate her with promises of a trip to the toy store. How should the nurse address the mother about the girl's apparent lack of discipline?

"How do you feel when your daughter interrupts you?"

The nurse is caring for a child with a spinal cord injury and providing instruction to the parents on promoting skin integrity. Which response from the mother indicates a need for further teaching?

"I need to monitor his skin at least twice a week."

The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply?

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved."

The nurse is caring for a 6-year-old Native American boy who has recently been diagnosed with a progressive neuromuscular disease. The parent's grief has been exacerbated due to the suspicion and distrust of many in their family and community. Numerous family members believe that the boy's condition is a curse. As a result, the family is being shunned by several members of their family. The parents ask for the nurse's help in educating their relatives. Which response by the nurse would be most appropriate?

"Let's meet with one of your spiritual advisers and develop a solution"

The nurse is conducting a presentation for a group of parents of adolescents at a local high school about spinal cord injury. One of the parents asks, "What is the most common cause of this type of injury?" Which response by the nurse would be most appropriate?

"Motor vehicle accidents cause over 50% of these injuries."

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?

"The cause is unknown and there are many environmental factors that may contribute to it."

An 8-year-old girl with cerebral palsy heard about handicapped horseback riding and is begging to try it. Her mother is frightened of her falling and talks to the nurse. What is the most helpful nursing response?

"The horse stable has specially trained staff and employs physical therapists to work with the children to provide a specific and safe program."

The nurse is conducting a wellness examination on a 12-year-old boy with cerebral palsy and starts discussing about transitioning into adult health care services. The boy is able to speak, but the mother does most of the talking. Which response by the nurse would be most appropriate?

"Tom, what is important to you as you look to the future?"

The nurse is caring for a 2-year-old girl with spina bifida. The mother confides that she is depressed and feels that she has somehow contributed to her daughter's condition. Her guilt is compounded by her mother-in-law's accusations that the mother's poor nutrition during pregnancy caused the spina bifida. What should the nurse tell the mother?

"Your feelings are normal, and it is important to talk about this"

A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.

13.3

A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene?

3-year-old preschool-aged child who goes up stairs on hands and knees

A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention?

A 4-year-old preschool-age child who consistently walks on tip toes

A teenager has been admitted to the hospital with respiratory complications related to Duchenne muscular dystrophy. How can the nurse best provide support for the parents, who are the caretakers of this adolescent?

Assume responsibility for the teen's daily care while accepting input from parents and the teen

A newborn is diagnosed with spina bifida. What initial reactions might the nurse expect to observe in the parents of the newborn? Select all that apply.

Disbelief Denial Shock

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors?

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take?

Explain that children can take their first steps as late as 18 months of age.

Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing?

Head lag when pulled from supine to sitting

A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?

Muscular wasting results in generalized immobility and difficulty feeding and breathing.

The nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which actions would be most appropriate to help reduce friction resulting from this paralysis? Select all that apply.

Place a folded diaper in between the legs. Place the child on a special care mattress. Place synthetic sheepskin under the infant's chest

The nurse is caring for a school-age child diagnosed with Duchenne muscular dystrophy who is receiving glucocorticoid therapy. When teaching the parents about this therapy, the nurse would emphasize which aspect?

Safety measures for injury prevention

Which type of spinal neural tube defect does the nurse recognize as common and usually benign?

Spina bifida occulta

The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this?

The boy rises from the floor by walking his hands up his legs.

The nurse is reviewing the therapist's documentation in the medical record of an assigned client who has cerebral palsy. The therapist has noted the parents may be experiencing vulnerable child syndrome. Which observation of the family unit best supports this potential diagnosis?

The parents report they feel their child requires more therapy than the care team has indicated will be needed.

The nurse is assessing a 6-year-old child. The nurse instructs the child, "Let me see all of your pretty white teeth." Which cranial nerve is the nurse assessing?

VII

Why does the nurse suspect cerebral palsy in the 8-month-old just assessed?

When startled, a strong Moro reflex is noted.

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size?

constipation and bladder dysfunction

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

creatine kinase

A 7-year-old child with cerebral palsy comes to the clinic for an evaluation. The child is prescribed medications to address muscle spasticity and seizures. When assessing the child's mouth, which condition would the nurse associate with the child's medication regimen?

gingival hyperplasia

Which characteristic is true of cerebral palsy?

it appears at birth or during the first 2 years of life

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?

muscle biopsy

A nurse is providing care to a pediatric client hospitalized with a diagnosis of Duchenne muscular dystrophy (DMD). The nurse is reviewing the above laboratory results. Which laboratory result will have the greatest impact on the client's condition?

potassium

A nurse admits a 10-year-old with spina bifida who is confined to a wheelchair. When asking the parent and child questions, the parent appears disinterested and distant, allowing the child to answer all questions. What typical caregiver response is this parent displaying?

rejection

In caring for the child with Guillain-Barré syndrome, the nurse will provide much supportive care while watching carefully for signs of deterioration in which body system?

respiratory

The nurse is caring for a newborn who was born with spina bifida with myelomeningocele of the thoracic spine. The nurse would prioritize assessment of which area?

respiratory status

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

risk for impaired skin integrity

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?

risk for infection

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?

standing

The nurse is caring for a 10-year-old girl with myasthenia gravis. The nurse suspects myasthenic crisis based on which of the following?

tachycardia

The nurse is caring for the family with a 9-year-old child with cerebral palsy. Which intervention will best improve communication between the nurse and the family?

using reflective listening techniques

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair?

wheelchair belt

A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond?

"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group."

A 4-month-old infant is brought to the clinic for a well-baby check. The nurse conducts a developmental assessment of the infant's reflexes and documents the findings. On reviewing the documentation, the nurse would notify the primary care provider about which finding?

rooting

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

Presence of Moro reflex

The parents of a 4-year-old child bring the child to the provider's office for an evaluation. The parents are concerned about the child's weakness and problems with stair climbing. The nurse assesses the child and documents the findings. Based on the findings, the nurse suspects Duchenne muscular dystrophy (DMD). When discussing the findings with the primary care provider, the nurse anticipates which laboratory test being prescribed to provide additional information?

creatinine kinase

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should she use to best describe this condition?

degeneration of muscle fibers

A multidisciplinary team meeting is being called by the nurse to identify methods to reduce spasticity in a school-age child with cerebral palsy. Input from which discipline will not be needed at this gathering?

dietary

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?

gowers sign

Through which mechanism is Duchenne muscular dystrophy acquired?

hereditary