Birth Defects Practice Questions

The mother of a neonate with clubfoot feels guilty because she believes she did something to cause the condition. the nurse should explain that the cause of clubfoot is 1. unknown 2. always hereditary 3. due to unrestricted movement in utero 4. caused by the position of the fetus in utero

1

Which can occur in untreated developmental dysplasia of the hip (DDH)? Select all that apply. 1. Duck gait. 2. Pain. 3. Osteoarthritis in adulthood. 4. Osteoporosis in adulthood. 5. Increased flexibility of the hip joint in adulthood.

1, 2, 3. 1. Due to abnormal hip joint function, the client's gait is stiff and waddling. 2. Due to abnormal femoral head placement, the client may experience pain and decreased flexibility in adulthood. 3. Due to abnormal femoral head placement, the client may experience osteoarthritis in the hip joint in adulthood. 4. There is no increased risk for osteoporosis. 5. There is no increased flexibility of the hip joint in adulthood. TEST-TAKING HINT: If the test taker knows that untreated DDH leads to decreased smooth movement of hip joint, then answer 5 can be eliminated.

The parent of an infant dx with clubfoot asks the nurse about the casting treatment regimen. The nurse determines that further instruction is not needed when the parent states 1. The cast will be changed in 6 weeks 2. The cast will be changed in 2 weeks 3. The cast will be changed when his child starts to walk 4. The cast will be changed when his child starts to crawl

2

The mother asks the nurse about using a car seat for her toddler who is in a hip spica cast. The nurse should tell the mother: 1."You can use a seat belt because of the spica cast." 2."You will need a specially designed car seat for your toddler." 3."You can still use the car seat you already have." 4."You'll need to get a special release from the police so that a car seat won't be needed.

2 The toddler in a hip spica cast needs a specially designed car seat. The one that the mother already has will not be appropriate because of the need for the car seat to accommodate the cast and abductor bar

The nurse is discharging a baby with clubfoot who has had a cast applied. The nurse should provide additional teaching to the parents if they state: 1."I should call if I see changes in the color of the toes under the cast." 2."I should use a pillow to elevate my child's foot as he sleeps." 3."My baby will need a series of casts to fix her foot." 4."Having a cast should not prevent me from holding my baby.

2. Elevating the extremity at different points during the day is helpful to prevent edema, but pillows should not be used in the crib because they increase the risk of sudden infant death syndrome (SIDS). A change in the color of the toes is a sign of impaired circulation and requires medical evaluation. Children typically need a series of 5 to 10 casts to correct the deformity. Infants with club feet still need frequent holding like any other newborn.

A child is allowed full activity following the repair of a clubfoot. Which activity would be most helpful for this child 1. Playing catch 2. Standing 3. Swimming 4. Walking

4

A baby was born 2 hours ago by Cesarean section. The newborn has a myelomeningocele with the sac intact and has been placed in an incubator. The nurse, when planning care for the baby, should focus on potential for: A. Disuse syndrome B. Infection C. Fluid volume deficit D. Decreased cardiac output

B A: Varying degrees of neurological involvement affecting the lower musculoskeletal system occur; however, this is not a life-threatening problem. B: There is potential for infection spreading into the CNS through the meningeal sac, which could be life threatening. C: Electrolyte imbalance is not a problem. D:Renal complications often occur, but cardiac complications would not occur from myelomeningocele

Appropriate nursing interventions for a newborn's myelomeningocele sac prior to surgery include using sterile technique and: A. Leaving the sac open to air B. Applying petrolatum to cover the sac C. Applying moist saline dressings D. Applying dry dressings

C A The sac should be kept moist. Leaving the sac open to air, especially in an incubator, has a drying effect. B: Prolonged use of ointments can cause breakdown of the tissue. C: The sac should be kept moist to maintain the integrity of the sac prior to surgery. D: A dry dressing may be irritating to the sac.

The parents of an infant born with clubfoot express feelings of guilt and anxiety about their child's condition. what is the nurses most appropriate intervention A. teach them about their child's condition B. introduce them to other parents whose children have the same condition C. ask if they would like to speak with the chaplain D. encourage discussion of their feelings

D

Which should the nurse include in the teaching plan for a child who had surgery to correct bilateral clubfeet and had the casts removed. select all that apply 1. Your child will need to wear a brace on the feet 23 hours a day for at least 2 months 2. Your child should see an orthopedic surgeon regularly until the age of 18 3. Your child will not be able to participate in sports that require a lot of running 4. Your child may have recurrence of clubfoot in a year or more 5. Most children treated for clubfeet develop feet that appear and function normally 6. Most children treated for clubfeet require surgery at puberty

1, 2, 4, 5. 1. After the final casting, bracing is required for 12 months. This decreases the likelihood of a recurrence. 2. Because clubfoot can recur, it is important to have regular follow-up with the orthopedic surgeon until age 18 years. 3. After treatment, most children are able to participate in any sport. 4. Even with proper bracing, there may be a recurrence. 5. Most children treated for clubfeet develop normally appearing and functioning feet. 6. Most children do not require surgery at puberty. TEST-TAKING HINT: If the test taker is aware that clubfoot can recur, providing instruction that includes long-term follow-up care will help in selecting answers

A 5-year-old has been diagnosed with pseudohypertrophic muscular dystrophy. Which nursing intervention(s) would be appropriate? Select all that apply. 1. Discuss with the parents the potential need for respiratory support. 2. Explain that this disease is easily treated with medication. 3. Suggest exercises that will limit the use of muscles and prevent fatigue. 4. Assist the parents in finding a nursing facility for future care. 5. Encourage the parents to contact the school to develop an IEP.

1, 3, 5. 1. Muscles become weaker, including those needed for respiration, and a decision will need to be made about whether respiratory support will be provided. 2. This is a progressive disease, which medications do not treat. 3. Physical therapy will be part of the treatment plan, but respiratory support is a priority. 4. The parents need to decide eventually if they will keep the child home or cared for in a nursing facility, but that is not an immediate concern. 5. Parents should be encouraged to allow the child to go to school and participate in activities as tolerated. TEST-TAKING HINT: Pseudohypertrophic muscular dystrophy is a progressive neuromuscular disease with no cure. Children can have a good quality of life if parents are guided in how to help their child.

When interacting with the mother of a child who has Duchenne's muscular dystrophy, the nurse observes behavior indicating that the mother may feel guilty about her child's condition. The nurse interprets this behavior as guilt stemming from which of the following? 1.The terminal nature of the disease. 2.The dependent behavior of the child. 3.The genetic mode of transmission. 4.The sudden onset of the disease.

3 The guilt that mothers of children with muscular dystrophy commonly experience usually results from the fact that the disease is genetic and the mother transmitted the defective gene. Although many children die from the disease, the disease is considered chronic and progressive. As the disease progresses, the child becomes more dependent. However, guilt typically stems from the knowledge that the mother transmitted the disease to her son rather than the dependency of the child. The disease onset is usually gradual, not sudden.

The mother of a child with Duchenne's muscular dystrophy asks about the chance that her next child will have the disease. The nurse responds based on the understanding of which of the following? 1.Sons have a 50% chance of being affected. 2.Daughters have a 1 in 4 chance of being carriers. 3.Each child has a 1 in 4 chance of developing the disease. 4.Each child has a 50% chance of being a carrier.

1 Duchenne's muscular dystrophy is an X-linked recessive disorder. The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50% chance of being carriers.

The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and its management. Which of the following statements by the mother indicates successful teaching? 1."My son will probably be unable to walk independently by the time he is 9 to 11 years old." 2."Muscle relaxants are effective for some children; I hope they can help my son." 3."When my son is a little older, he can have surgery to improve his ability to walk." 4."I need to help my son be as active as possible to prevent progression of the disease.

1 Muscular dystrophy is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9 to 11 years. There is no effective treatment for childhood muscular dystrophy. Although children who remain active are able to avoid wheelchair confinement for a longer period, activity does not prevent disease progression.

After the birth of an infant with clubfoot, the nursery nurse should do which when instructing the parents. select all that apply 1. Speak in simple language about the defect 2. Avoid the parents unless providing direct care so they can grieve privately 3. Keep the infants feet covered at all times 4. Present the infant as precious, emphasize well formed parts of the body 5. Tell the parents that defects could be much worse 6. Be prepared to answer questions multiple times

1, 4, 6. 1. The parents will likely be shocked immediately after the birth of the child. To facilitate their understanding, the nurse should speak in simple terms. 2. Avoiding the parents is not therapeutic. 3. The baby should be shown to the parents as are all newborns, without hiding the clubfoot. 4. The baby should be shown to the parents as are all newborns, emphasizing the well-formed parts of the body. 5. Negating the parents 'grieving is not therapeutic. 6. Information may need to be repeated as the family begins to absorb the information. TEST-TAKING HINT: The test taker can draw on therapeutic communication skills to choose correct answers.

The nurse knows that teaching was successful when a parent states which of the following are early signs of muscular dystrophy? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity

2 1. Muscles become enlarged from fatty infiltration, so they are not stronger. 2. Difficulty climbing stairs, running, and riding a bicycle are frequently the first symptoms of Duchenne muscular dystrophy. 3. High fevers and tiredness are not early signs of muscular dystrophy but could be later signs as complications become more common. 4. Respiratory infections and obesity are major complications as the disease progresses. TEST-TAKING HINT: Early symptoms have to do with decreased ability to perform normal development tasks involving muscle strength.

When developing the plan of care for a child with early Duchenne's muscular dystrophy, which of the following nursing goals is the priority? 1.Encouraging early wheelchair use. 2.Fostering social interactions. 3.Maintaining function of unaffected muscles. 4.Preventing circulatory impairment.

3 The primary nursing goal is to maintain function in unaffected muscles for as long as possible. There is no effective treatment for childhood muscular dystrophy. Children who remain active are able to forestall being confined in wheelchair. Remaining active also minimizes the risk for social isolation. Preventing rather than encouraging wheelchair use by maintaining function for as long as possible is an appropriate nursing goal. Children with muscular dystrophy become socially isolated as their condition deteriorates and they can no longer keep up with friends. Maintaining function helps prevent social isolation. Circulatory impairment is not associated with muscular dystrophy

The nurse is caring for a school-age child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

4 1. This diagnosis would relate to the family and not to the child. 2. This diagnosis would relate to the family and not to the child. 3. The child does not have pain with the muscular dystrophy process. 4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength. TEST-TAKING HINT: Knowing that the child has decreased strength helps to answer the question.

To maintain proper alignment of the hips and lower extremities in a baby with a myelomeningocele, the nurse should position the baby with the: A. Hips abducted and feet in a neutral position B. Hips adducted and feet flexed C. Hips subluxed and feet extended D. Hips adducted and feet in a natural position

A A: This position maintains proper alignment of the hips and lower extremities. B, C, D This position will pull the hips out of alignment.

Prior to surgery for a myelomeningocele, the nurse would place the baby in which of the following positions? A. Prone B. Right side C. Left side D. Dorsal

A A: This position minimizes the tension on the sac and reduces the potential for trauma to the area. B, C: A side-lying position puts pressure on the sac with potential for leaks or breaks. D: This would cause trauma to the sac and cause it to leak or break.

The nurse is teaching about congenital clubfoot in infants. the nurse evaluates the teaching as successful when the parent states that clubfoot is best treated when 1. Immediately after dx 2. At age 4-6 months 3. Prior to waling (9-12 months) 4. After walking is established (15-18 months)

1 1. The best outcomes for clubfoot are seen if casting begins as soon as the diagnosis is made, usually at birth. 2. Although casting helps if started in the newborn period, the delay of even 4 to 6 months postpones the positive outcome. 3. Infants of 9 months are already pulling up to stand and taking steps. Clubfoot puts weight on surfaces of the feet that are not meant for weight-bearing. 4. Clubfoot does not allow for normal gait, and the delay will decrease the likelihood of a successful outcome. TEST-TAKING HINT: The general principle of early treatment of orthopedic problems should lead to the correct answer.

The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following is most appropriate? 1.Fitting the diaper under the straps. 2.Leaving the harness off while the infant sleeps. 3.Checking for skin redness under straps every other day. 4.Putting powder on the skin under the straps every day.

1 The Pavlik harness is worn over a diaper. Knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided because they can cake and irritate the skin.

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. Which should the nurse tell them? Select all that apply. 1. "Muscular dystrophies usually result in progressive weakness." 2. "The weakness that your child is having will probably not increase." 3. "Your child will be able to function normally and not need any special accommodations." 4. "The extent of weakness depends on doing daily physical therapy." 5. "Your child may have pain in his legs with muscle weakness."

1, 5. 1. Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder. 2. The weakness is progressive. 3. The child will require assistance, and the need for it will increase with time and age. 4. Daily therapy may be helpful in decreasing contractures, although it will not deter the disease progression. 5. The child may have pain due to loss of strength and muscle wasting. TEST-TAKING HINT: The test taker should know that muscular dystrophy is a progressive degenerative disorder.

The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following? 1. Electromyelogram. 2. Nerve conduction velocity. 3. Muscle biopsy. 4. Creatine kinase level.

3 1. The electromyelogram is part of the diagnostic workup, but muscle biopsy results classify muscle disorders. 2. Nerve conduction velocity is part of the diagnostic workup, but muscle biopsy results classify muscle disorders. 3. Muscle biopsy confirms the type of myopathy that the patient has. 4. Creatine kinase is in muscle tissue and is found in large amounts in muscular diseases. TEST-TAKING HINT: Muscle biopsy is the definitive test for myopathies

When teaching the family of an older infant who has had a spica cast applied for developmental dysplasia of the hip, which information should the nurse include when describing the abduction stabilizer bar? 1.It can be adjusted to a position of comfort. 2.It is used to lift the child. 3.It adds strength to the cast. 4.It is necessary to turn the child.

3 The abduction bar is incorporated into the cast to increase the cast's strength and maintain the legs in alignment. The bar cannot be removed or adjusted, unless the cast is removed and a new cast is applied. The bar should never be used to lift or turn the client, because doing so may weaken the cast.

The parents of a neonate born with congenital clubfoot express feelings of helplessness and guilt, and are exhibiting anxiety about how the neonate will be treated. Which of the following actions by the nurse would be most appropriate initially? 1.Ask them to share these concerns with the primary care provider. 2.Arrange a meeting with other parents whose infants have had successful clubfoot treatment. 3.Discuss the problem with the parents and the current feelings that they are experiencing. 4.Suggest that they make an appointment to talk things over with a counselor.

3. When an infant is born with an unexpected anomaly, parents are faced with questions, uncertainties, and possible disappointments. They may feel inadequate, helpless, and anxious. The nurse can help the parents initially by assessing their concerns and providing appropriate information to help them clarify or resolve the immediate problems. Referring the parents to the primary health care provider is not necessary at this time. The nurse can assist the parents by listening to their concerns. Having them talk with other parents would be helpful a little bit later, once the nurse assesses their concerns and discusses the problem and the parents' current feelings. If the parents continue to have difficulties expressing and working through their feelings, referral to a counselor would be appropriate.

The nurse is assessing the infant shown in the figure. On observing the client from this angle, the nurse should document that this infant has which of the following? 1.Ortolani's "click." 2.Limited abduction. 3.Galeazzi's sign. 4.Asymmetric gluteal folds.

4 This infant with congenital hip dysplasia has asymmetric gluteal folds. The Ortolani "click" occurs when the nurse feels the femur sliding into the acetabulum with a "click." Limited abduction may be observed during an attempt to abduct the infant's thighs. Galeazzi's sign reveals femoral foreshortening and is observed by flexing the thighs.

Which foods would be best for a child with Duchenne muscular dystrophy? Select all that apply. 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain. 5. Thickened liquids and smaller portions that are cut up.

4, 5. 1. As the child with muscular dystrophy becomes less active, diet becomes more important. Attention should be paid to quality and quantity of food, so the child does not gain too much weight. 2. Good-quality foods are important as the child continues to grow. 3. Extra protein will not help the child recover from this disease. 4. As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation. 5. As the child loses muscle control, the need for thickened liquids and small, well-cut-up solids becomes essential. TEST-TAKING HINT: Nutrition is important for every child; as the child becomes less ambulatory, weight concerns arise.

The nurse discusses with a client a prenatal test to screen for spinal anomalies done between 16 and 20 weeks' gestation, which is called the: A. Enzyme-linked immunosorbent assay (ELISA) B. VDRL C. BHCG D. alpha-Fetoprotein (AFP)

D A: ELISA is used for HIV screening. B: VDRL is used for syphilis screening. C: BHCG is used to determine pregnancy, especially ectopic pregnancy. D: Elevated levels of AFP in amniotic fluid or maternal serum have been found to reflect open neural tube defects.

A newborn baby is diagnosed with a myelomeningocele. The nurse measures his head circumference daily to assess for the development of what complication? A. Hydrocele B. Hordeolum C. Hypsarrhythmia D. Hydrocephalus

D A: This is fluid in the tunica vaginalis testes and is not associated with myelomeningocele. B: This is a stye and not a complication of myelomeningocele. C: This occurs in infantile spasms and is not a complication of myelomeningocele. D: There is greater production than absorption of cerebrospinal fluid in the ventricular system, which is a complication associated with myelomeningocele.

When developing the teaching plan for parents using the Pavlik harness with their child, what should be the nurse's initial step? 1.Assessing the parents' current coping strategies. 2.Determining the parents' knowledge about the device. 3.Providing the parents with written instructions. 4.Giving the parents a list of community resources

2 Assessing the learner's knowledge level is the initial step in any teaching plan to promote the maximum amount of learning. This assessment also provides the nurse with a starting point for teaching. Assessing coping strategies can provide important information to the development of the teaching plan but is not the initial step. Giving parents written instructions or a list of community resources is appropriate once the parents' knowledge level has been determined and teaching has begun.

The parent of a 3w week old states that the infant was recasted this morning for clubfoot and has been crying for the past hour. which intervention should the nurse suggest the parent do first 1. Give pain medication 2. Reposition the infant in the crib 3. Check the neurocirculatory status of the foot 4. Use a cool blow dryer to blow into the cast to control itching

3 1. The cause of the crying needs to be determined prior to administering pain medication. 2. Although this is a good choice, it is not the first intervention 3. Checking the neurocirculatory status of the foot is the highest priority. 4. Although this is a good choice for cast discomfort, it is not the first choice. TEST-TAKING HINT: The test taker should prioritize nursing interventions and know that safety needs are paramount

Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.

4 1. Socks should be put on under the straps to prevent rubbing of the skin. The harness is stable if fitted correctly. 2. Lotions and powders tend to cake and irritate under the straps. Their use is not recommended. 3. The harness is not to be removed except in specific conditions and after instruction on removal and refitting. Diapering is easily done with the harness in place. 4. Checking under straps frequently is suggested to prevent skin breakdown. TEST-TAKING HINT: The test taker can eliminate answer 1 because the question is about skin redness and irritation, not harness fi t.

The nurse observes as a child with Duchenne's muscular dystrophy attempts to rise from a sitting position on the floor. After attaining a kneeling position, the child "walks" his hands up his legs to stand. The nurse documents this as which of the following? 1.Galeazzi's sign. 2.Goodell's sign. 3.Goodenough's sign. 4.Gower's sign

4 With Gower's sign, the child walks the hands up the legs in an attempt to stand, a common approach used by children with Duchenne's muscular dystrophy when rising from a sitting to a standing position. Galeazzi's sign refers to the shortening of the affected limb in congenital hip dislocation. Goodell's sign refers to the softening of the cervix, considered a sign of probable pregnancy. Goodenough's sign refers to a test of mental age.

The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. Mother. 2. Sister. 3. Brother. 4. Aunts and all female cousins. 5. Uncles and all male cousins.

1, 2, 4. 1. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. 2. The X chromosome carries the disease, and males are affected. The sister should have genetic testing to determine whether she carries the gene and identify her risks for having male offspring with the disease. 3. Because the disease is carried on the X chromosome, only females need to be genetically tested. Women carry the disease, and males are affected. All female relatives should be tested unless they are symptomatic. 4. The X chromosome carries the disease and males are affected. All female relatives should be tested. 5. The X chromosome carries the disease and males are affected. All female relatives should be tested. TEST-TAKING HINT: Knowing that Duchenne muscular dystrophy is inherited as an X-linked trait excludes fathers, brothers, uncles, and male cousins as carriers

Which will help a school-age child with muscular dystrophy stay active longer? Select all that apply. 1. Normal activities, such as swimming. 2. Using a treadmill every day. 3. Several periods of rest every day. 4. Using a wheelchair upon getting tired. 5. Sleeping as late as needed

1, 3, 4. 1. Swimming is an excellent exercise that uses many muscles and helps build strength. Children who are active are usually able to postpone use of a wheelchair. It is important to keep using muscles for as long as possible, and aerobic activity is good for a child. 2. Use of a treadmill is not fun for children or adults, so keeping the child using the treadmill might be an issue. 3. Any child with a chronic disease should be kept as active as possible for as long as possible; short rest periods built into the day are helpful in maintaining stamina. 4. Children with neuromuscular diseases oftentimes will use a wheelchair to conserve energy and increase mobility. The wheelchair acts as the child's means of getting to where they want to go as independently as possible. 5. The child should be on a regular daily schedule including the same bedtime and getting up time. Rest times should be provided during the day. TEST-TAKING HINT: Appropriate interventions for different kinds of chronically ill children can be similar, so think about what would be best for this child.

After teaching the parents of an infant with clubfoot requiring application of a plaster cast how to care for the cast, which of the following statements would indicate that the parents have understood the teaching? 1."If the cast becomes soiled, we'll clean it with soap and water." 2."We'll elevate the leg with the cast on pillows, so the leg is above heart level." 3."We will check the color and temperature of the toes of the casted leg frequently." 4."The petals on the edge of the cast can be removed after the first 24 hours.

3 A cast that is too tight can cause a tourniquet effect, compromising the neurovascular integrity of the extremity. Manifestations of neurovascular impairment include pain, edema, pulselessness, coolness, altered sensation, and inability to move the distal exposed extremity. The toes of the casted extremity should be assessed frequently to evaluate for changes in neurovascular integrity. Wetting a plaster cast with water and soap softens the plaster, which may alter the cast's effectiveness. There is no reason to elevate the casted extremities when a child with clubfoot is being treated with nonsurgical measures. The legs would be elevated if swelling were present. Petals, which are applied to cover the rough edges of the cast, are to be left in place to minimize the risk for skin irritation from the cast edges.

A nurse is making an initial visit to a family with a 3-year-old child with early Duchenne's muscular dystrophy. Which of the following findings is expected when assessing this child? 1.Contractures of the large joints. 2.Enlarged calf muscles. 3.Difficulty riding a tricycle. 4.Small, weak muscles.

3 Usually the first clinical manifestations of Duchenne's muscular dystrophy include difficulty with typical age-appropriate physical activities such as running, riding a bicycle, and climbing stairs. Contractures of the large joints typically occur much later in the disease process. Occasionally enlarged calves may be noted, but they are not typical findings in a child with Duchenne's muscular dystrophy. Muscular atrophy and development of small, weak muscles are later signs.

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? Select all that apply. 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone. 5. Positive Ortolani test

3, 5. 1. In DDH, a newborn can have excessive hip adduction. 2. In DDH, an appearance of femoral shortening is frequently present on the affected side. 3. In DDH, asymmetrical thigh and gluteal folds are frequently present. 4. Infants do not experience pain from this condition. 5. The Ortolani maneuver moves a disclocated hip back into the socket with a distinct clunk. TEST-TAKING HINT: If the test taker knows that DDH decreases smooth movement of the femoral head, then answers 1 and 2 can be eliminated because they indicate increased movement of the femur.

The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include: Select all that apply. 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech. 5. Increasing difficulty swallowing and shallow breathing.

3, 5. 1. These symptoms are common with Down syndrome. 2. Duchenne muscular dystrophy does not produce these symptoms. 3. The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems. 4. These symptoms are evidence of a possible head injury. 5. The muscles of a child with MD tend to show increasing weakness and atrophy over time. The children are at risk for swallowing, aspiration, and pneumonia. TEST-TAKING HINT: The test taker should be able to identify signs and symptoms attributable to the loss of muscle function.

A 16-month-old child is seen in the clinic for a checkup for the first time. The nurse notices that the toddler limps when walking. Which of the following would be appropriate to use when assessing this toddler for developmental dysplasia of the hip? 1.Ortolani's maneuver. 2.Barlow's maneuver. 3.Adam's position. 4.Trendelenburg's sign.

4. In a toddler, weight bearing causes the pelvis to tilt downward on the unaffected side instead of upward as it would normally. This is Trendelenburg's sign, and it indicates developmental dysplasia of the hip. Ortolani's maneuver is used during the neonatal period to assess developmental dysplasia of the hip in infants. With the infant quiet, relaxed, and lying on the back, the hips and knees are flexed at right angles. The knees are moved to abduction and pressure is exerted. If the femoral head moves forward, then it is dislocated. Barlow's maneuver is used to assess developmental dysplasia of the hip in infants. As the femur is moved into or out of the acetabulum, a "clunk" is heard, indicating dislocation. Adam's position is used to evaluate for structural scoliosis. The child bends forward with feet together and arms hanging freely or with palms together.