Neuromuscular Disorder peds

The nurse is caring for 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? 1. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." 2. "I know it will be important for me to catheterize my child for the rest of his life." 3. "I will make sure that I always use latex-free catheters." 4. "I will wash the catheter with warm soapy water after each use."

"I know it will be important for me to catheterize my child for the rest of his life."

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? a) "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life." b) "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." c) "It has little influence on the intellectual and perceptual abilities of the child." d) "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."

"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."

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

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

A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching? a) "We must be careful to use latex-free catheters." b) "My son may someday learn how to do this for himself." c) "We need to soak the catheter in a vinegar and water solution daily." d) "The very first step is to apply water-based lubricant to the catheter."

"The very first step is to apply water-based lubricant to the catheter."

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

"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 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? a) "Has he achieved his developmental milestones on time?" b) "Has his pace of achieving milestones diminished?" c) "Do you think he is simply fatigued?" d) "Would you please describe the weakness you are seeing in your son?"

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

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

Assuming the usual feeding position will be difficult.

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

Cover the sac with a saline-moistened dressing

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? a) Risk for injury related to lack of muscle control b) Ineffective coping related to diagnosis of chronic condition c) Impaired physical mobility related to spinal cord defect d) Deficient knowledge related to diagnosis and condition

Deficient knowledge related to diagnosis and condition

The nurse is teaching a health and wellness course to young women of childbearing age. Which vitamin will the nurse encourage all to take daily? a) Folic acid b) Niacin c) Ascorbic acid d) Calcium

Folic acid

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 above 0.4 mg/day b) Ascorbic acid to 4 mg/day c) Folic acid to 0.4 mg/day d) Ascorbic acid to 0.4 mg/day

Folic acid above 0.4 mg/day

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects? a) Ultrasound screening at 16 weeks' gestation b) Folic acid supplementation c) Maternal serum α-fetoprotein levels screening d) Genetic testing for gene identification

Folic acid supplementation

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

History of a seizure disorder and taking phenobarbital.

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

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

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 the child on a special care mattress. b) Place a pad beneath the diaper area and change frequently. c) Place a folded diaper in between the legs. d) Place synthetic sheepskin under the infant's chest.

Place a folded diaper in between the legs.

The nurse is providing presurgical care for a newborn with myelomeningocele. Which action is the central nursing priority? a) Maintain infant in prone position b) Maintain infant's body temperature c) Keep lesion free from fecal matter or urine d) Prevent rupture or leaking of cerebrospinal fluid

Prevent rupture or leaking of cerebrospinal fluid

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? a) Inspect for precocious hair growth in the genital and underarm areas b) Record and refer the finding for follow-up to the pediatrician c) Move on to other assessments without calling attention to the difference d) Snip the tuft of hair off close to the skin for hygienic reasons

Record and refer the finding for follow-up to the pediatrician

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? a) Risk for impaired skin integrity b) Disorganized infant behavior c) Peripheral neurovascular dysfunction d) Risk for activity intolerance

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? a) Impaired physical mobility b) Delayed growth and development c) Risk for infection d) Constipation

Risk for infection

Which diagnostic measure is most accurate in detecting neural tube defects? a) Flat plate of the lower abdomen after the 23rd week of gestation b) Significant level of alpha-fetoprotein present in amniotic fluid c) Presence of high maternal levels of albumin after 12th week of gestation d) Amniocentesis for lecithin-sphingomyelin (L/S) ratio

Significant level of alpha-fetoprotein present in amniotic 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. a) Supine b) Prone c) Left side lying d) Right side lying e) Semi-Fowler

• Prone • Left side lying • Right side lying

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

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

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: a) "Before inserting the catheter, we need to wipe her labia with normal saline from back to front." b) "We need to insert the catheter about 6 inches so that we make sure the catheter is in the bladder." c) "We need to apply some petroleum jelly to her labia and the catheter before we attempt to insert it." d) "When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

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

A 5-year-old girl, diagnosed with myelomeningocele, is admitted to the hospital for a corrective surgical procedure. Choose four questions below that the nurse shouls ask when obtaining the health history that would assist in planning the child's care? 1. What is the child's current mobility status? 2. Is there a family hx of myelomeningocele? 3. What is the child's genitorurinary and bowel function and regimen? 4. Does this child have a hx of hydrocephalus with presence of shunt? 5. Does she have kown latex sensitivity? 6. Were there any complications during the pregnancy or birth of this child? 7. Did the mother take prenatal folic acid supplementation?

What is the child's current mobility status? What is the child's genitorurinary and bowel function and regimen? Does this child have a hx of hydrocephalus with presence of shunt? Does she have kown latex sensitivity? (These questions will help develop a plan of care for the girl)

The child has a meningocele and a neurogenic bladder. Which of the following topics should the nurse include in the teaching plan when educating the child and the child's caregivers? Select all that apply. a) Signs and symptoms of a urinary tract infection b) Different types of surgeries used to treat this condition c) The importance of antibiotic use to prevent urinary tract infections from occurring d) How and when to perform clean intermittent urinary catheterization e) How and when to administer oxybutynin chloride

• How and when to administer oxybutynin chloride • How and when to perform clean intermittent urinary catheterization • Signs and symptoms of a urinary tract infection • Different types of surgeries used to treat this condition

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? a) "I can palpate his abdomen to assess for constipation" b) "My son's activity is too limited to stimulate his bowels." c) "He must have an adequate amount of fluid." d) "I need to figure out his usual pattern for passing stool."

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

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? a) Increasing ICP b) Leaking cerebrospinal fluid c) Increasing head circumference d) Constipation and bladder dysfunction

Constipation and bladder dysfunction

Which characteristic is true of cerebral palsy? a) It's progressive. b) It's reversible. c) It results in mental retardation. d) It appears at birth or during the first 2 years of life.

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

Which type of spinal neural tube defect does the nurse recognize as common and usually benign? a) Meningocele b) Spina bifida c) Spina bifida occulta d) Myelomeningocele

Spina bifida occulta