Chapter 44: Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder

The nurse is conducting a neuromuscular assessment on a toddler. What assessment technique(s) is important for the nurse to include in this assessment? Select all that apply.

Compare muscle strength and tone bilaterally. Observe for involuntary muscle contractions. Perform passive range-of-motion on all extremities.

The mother of a toddler with myelomeningocele is thinking about having another child. What is most important for the nurse to recommend to this mother? Educate on testing she should have during the new pregnancy. Advise continuing taking the dose of folic acid she had previously been prescribed. Schedule a preconception appointment with the health care provider. Discuss the need for genetic testing with the health care provider.

Schedule a preconception appointment with the health care provider.

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? a) Prevent cold stress using an Isolette and blankets b) Cover the sac with a saline-moistened dressing c) Change position from side to side hourly d) Keep the mass uncovered and dry

b) Cover the sac with a saline-moistened dressing

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? a) Folic acid to 0.4 mg/day b) Ascorbic acid to 4 mg/day c) Folic acid above 0.4 mg/day d) Ascorbic acid to 0.4 mg/day

c) Folic acid above 0.4 mg/day

The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child: cannot plantarflex his foot. has blue-looking nail beds on the toes. feels increasing severe pain. has a weak femoral pulse.

feels increasing severe pain.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected."

The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply.

Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand.

A nurse is providing care to a hospitalized child diagnosed with cerebral palsy. The nursing is preparing the family for discharge. What action by the nurse will most ensure the family's success after discharge?

Have the family meet with a case manager before discharge.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? Peanuts Cat dander Latex Alcohol gel

Latex

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

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.

The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. New drainage is seeping out from under the cast. The boy's toes are light blue and very swollen.

The nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which action would be most appropriate to help reduce friction resulting from this paralysis? a) Place a folded diaper in between the legs. b) Place synthetic sheepskin under the infant's chest. c) Place a pad beneath the diaper area and change frequently. d) Place the child on a special care mattress.

a) Place a folded diaper in between the legs.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant?

baclofen

The nurse is teaching the parents of a preschool-aged child with cerebral palsy about the upcoming surgery that is planned for the child to help control their spasticity. The nurse discusses that the surgeon will be inserting which item in their child during this procedure? botulinum toxin baclofen pump central venous catheter vagal nerve stimulator

baclofen pump

The nurse is assessing a child with spastic cerebral palsy. Which of the following would the nurse expect to assess? Select all that apply. a) Poor control of balance b) Hemiplegia c) Drooling d) Hypertonicity e) Exaggerated deep tendon reflexes f) Dysarthria

e)Exaggerated deep tendon reflexes b)Hemiplegia a)Poor control of balance d)Hypertonicity

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

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele? a) Impaired physical mobility b) Constipation c) Delayed growth and development d) Risk for infection

risk for infection

Which diagnostic measure is most accurate in detecting neural tube defects? amniocentesis for lecithin-sphingomyelin (L/S) ratio presence of high maternal levels of albumin after 12th week of gestation flat plate of the lower abdomen after the 23rd week of gestation significant level of alpha-fetoprotein present in amniotic fluid

significant level of alpha-fetoprotein present in amniotic fluid

Which type of spinal neural tube defect does the nurse recognize as common and usually benign? meningocele myelomeningocele spina bifida occulta spina bifida

spina bifida occulta

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?

"Blowing cool air with a fan or hair dryer may relieve the feeling."

A nurse is assisting the parents of a child who requires a Pavlik harness. The parents are apprehensive about how to care for their baby. The nurse should stress which teaching point? "The harness does not hurt the baby." "It is important that the harness be worn continuously." "The baby needs the harness only for 2 to 3 weeks." "Let me teach you how to make appropriate adjustments to the harness."

"It is important that the harness be worn continuously."

The nurse is caring for an 8-year-old child in traction. The client has been in an acute care setting for 2 weeks and will require an additional 10 days in the hospital. The client is showing signs of regression with thumb sucking and pleas for the now tattered baby blanket. What would be the most helpful intervention?

"Let's ask your parents to bring your friends for a visit."

A nurse is assisting the parents of an infant who requires a Pavlik harness. The parents are apprehensive about how to care for their infant and concerned about holding and playing with the infant. How can the nurse best assist the parents? "The infant only needs the harness for 12 weeks." "Do not attempt to adjust the harness yourself." "Let's put you in touch with other families who have experienced this." "The harness does not hurt the infant."

"Let's put you in touch with other families who have experienced this."

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? "It has been linked to maternal alcohol consumption during pregnancy." "It's a common complication of amniocentesis." "The cause is unknown and there are many environmental factors that may contribute to it." "Older age at conception is one of the major causes of the defect."

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

The nurse is conducting a wellness examination of a 6-month-old infant. The parent points out some dimpling and skin discoloration in the infant's lumbosacral area. Which is the nurse's best response? "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica." "Dimpling, skin discoloration, and abnormal patches of hair are often indicators of spina bifida occulta." "This could be an indicator of spina bifida; we need to evaluate this further."

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."

The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state: "We need to apply some petroleum jelly to her labia and the catheter before we attempt to insert it." "We need to insert the catheter about 6 inches so that we make sure the catheter is in the bladder." "When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty." "Before inserting the catheter, we need to wipe her labia with normal saline from back to front."

"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information?

"Would you please describe the weakness you are seeing in your son?"

The nurse is caring for a group of children on the pediatric unit. The nurse should collect further data and explore the possibility of child abuse (child mistreatment) in which situation?

A 7-year-old with a spiral fracture of the humerus, which the caregiver reports as having been caused when the child was hit by a bat swung by a Little League teammate.

The nurse is reinforcing discharge teaching with the caregivers of a child who is going home after a cast has been applied. The nurse explains to the caregivers that which issues should be reported if they occur or are seen related to this child? Select all that apply.

Any area on the cast that is warm to the touch A foul odor under the cast Drainage from under the cast Looseness of the cast on the extremity

The client is a 9-month-old whose babysitter brings her to the ER. An x-ray shows a spiral fracture of the femur. The babysitter tells the nurse that she found the infant in this condition when she showed up to watch her an hour ago. How should the nurse respond to this situation?

Arrange for the parents to come in for an evaluation for possible physical abuse.

Which characteristic is true of cerebral palsy? It results in intellectual disability. It's progressive. It appears at birth or during the first 2 years of life. It's reversible.

It appears at birth or during the first 2 years of life.

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom?

Paresthesia

A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment? Quietly observe the child at play while interviewing the parent. Review the child's health history to determine if the child is on track developmentally. Get down to the child's level and interact with the child. Ask the parent to describe the child's development.

Quietly observe the child at play while interviewing the parent.

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open?

Spica cast

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). Which of the following would the nurse emphasize in the discharge teaching? a) "It is very important to comply with the use of this brace." b) "If the brace is painful, feel free to take it off." c) "Check the skin that is covered by the braces for redness and breakdown." d) "Please try and follow the therapist's on and off schedule."

c) "Check the skin that is covered by the braces for redness and breakdown."

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? a) Careful supine positioning b) Listening for a shrill cry c) Inspection of the cystic sac on the child's back for leakage d) Auscultation for bowel sounds

c) Inspection of the cystic sac on the child's back for leakage

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal? development of fine motor skills development of gross motor movement promote optimal self-care ability enhance feeding capabilities

development of gross motor movement

The nurse is obtaining a health history on a woman of childbearing age who wants to become pregnant. What information in her health history places her at high risk for having a child with a myelomeningocele? history of a seizure disorder; taking phenobarbital history of asthma; taking montelukast history of a previous abdominal surgery history of scoliosis

history of a seizure disorder; taking phenobarbital

A 3-month-old infant is seen in the pediatric clinic. The infant's parent expresses concern that the child has developed cerebral palsy. The nurse assesses the infant. Which assessment finding indicates to the nurse that the parent's concern is valid? exhibits Gower sign unable to sit without support turns head toward sounds hypertonia in the upper extremities

hypertonia in the upper extremities

A nursery nurse is providing care to a newborn diagnosed with an open neural tube disorder. What is the nurse's initial priority in providing care to the newborn? injury prevention infection control nutritional support fluid maintenance

injury prevention

The nurse is providing preoperative care for a newborn with myelomeningocele. Which action is the central nursing priority? keep lesion free from fecal matter or urine maintain infant's body temperature maintain infant in prone position prevent rupture or leaking of cerebrospinal fluid

prevent rupture or leaking of cerebrospinal fluid

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply.

prone right side lying left side lying

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as: athetoid or dyskinetic. mixed. ataxic. spastic.

spastic

A parent brings a 12-month-old child diagnosed with congenital cerebral palsy to the clinic. The nurse completes an assessment. Which assessment finding requires immediate intervention by the nurse? suspected failure to thrive spastic movements of the extremities sits with assistance babbling speech

suspected failure to thrive

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching? "I can palpate his abdomen to assess for constipation." "He must have an adequate amount of fluid." "My son's activity is too limited to stimulate his bowels." "I need to figure out his usual pattern for passing stool."

"My son's activity is too limited to stimulate his bowels."

A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg? Change the infant's diapers frequently. Apply Denis Browne splints to the infant each night. Perform passive foot exercises. Check the infant's toes for coldness or blueness.

Check the infant's toes for coldness or blueness.

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? Ineffective coping related to diagnosis of chronic condition Risk for injury related to lack of muscle control Deficient knowledge related to diagnosis and condition Impaired physical mobility related to spinal cord defect

Deficient knowledge related to diagnosis and condition

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele? There is protrusion of the spinal cord and meninges, with nerve roots embedded. The spinal meninges protrude through the bony defect and form a cystic sac. There is no protrusion of the spinal cord, only soft-tissue inflammation occurs. There is a bony defect that occurs without soft-tissue involvement.

The spinal meninges protrude through the bony defect and form a cystic sac.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates? a normal spinal closure spina bifida occulta spina bifida with myelomeningocele spina bifida with meningocele

spina bifida occulta

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? a) Pain will interfere with the feeding process. b) Nausea and vomiting often follow repair of the cystic mass. c) Assuming the usual feeding position will be difficult. d) The infant will have a poor sucking reflex.

Assuming the usual feeding position will be difficult.

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents? a) "Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection." b) "Your child dribbles urine because the bladder either is overactive, pushing urine out, or is not active enough, becoming overfilled and causing urine to leak." c) "While your child is young, urine leaking from the bladder will not be a problem because diapering is expected." d) "Your child cannot properly control holding urine or emptying the bladder. "

"Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection."