WONG ch.34
The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which? a. Take vital signs every hour. b. Place the infant in the prone position to minimize tension on the sac. c. Watch for signs that might indicate developing hydrocephalus. d. Apply a heat lamp to facilitate drying and toughening of the sac.
ANS:B The spinal sac is protected from damage until surgery is performed. Early surgical closure is recommended to prevent local trauma and infection. Monitoring vital signs and watching for signs that might indicate developing hydrocephalus are important interventions, but preventing trauma to the sac is a priority. The sac is kept moist until surgical intervention is done.
An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident. The parents keep asking the nurse, "How bad is it?" The nurse's response should be based on which knowledge? a. Families adjust better to life-threatening injuries when information is given over time. b. Immediate loss of function is indicative of the long-term consequences of the injury. c. Extent and severity of damage cannot be determined for several weeks or even months. d. Numerous diagnostic tests will be done immediately to determine extent and severity of damage.
ANS:C The extent and severity of damage cannot be determined initially. The immediate loss of function is caused by anatomic and impaired physiologic function, and improvement may not be evident for weeks or months. It is essential to provide information about the adolescent's status to the parents. Immediate treatment information should be provided. Long-term rehabilitation and prognosis can be addressed after the child is stabilized. During the immediate postinjury period, physiologic responses to the injury make an accurate assessment of damage difficult.
What functional ability should the nurse expect in a child with a spinal cord lesion at C7? a. Complete respiratory paralysis b. No voluntary function of upper extremities c. Inability to roll over or attain sitting position d. Almost complete independence within limitations of wheelchair
ANS:D Individuals who sustain injuries at the C7 level are able to achieve a significant level of independence. Some assistance is needed with transfers and lower extremity dressing. Patients are able to roll over in bed and to sit and eat independently. Patients with injuries at C3 or higher have complete respiratory paralysis. Those with injuries at C4 or higher do not have voluntary function of higher extremities. Injuries at C5 or higher prevent rolling over or sitting.
Which nursing information is appropriate for the parent of a 9-year-old girl with cerebral palsy (CP) wanting to promote socialization at school? After-school activities are not recommended for children with CP. Participation in after-school activities leads to lowered self-esteem in children with CP. Activities such as karate, basketball, and cheerleading are appropriate for children with CP. After-school activities often provide children with CP opportunities for socialization and recreation.
After-school activities often provide children with CP opportunities for socialization and recreation. After-school recreational outlets should be considered for the child who is unable to participate in athletic programs or other physically demanding activities. Activities such as karate, basketball, and cheerleading are not always appropriate for children with cerebral palsy (CP). Participation in after-school activities is not associated with lowered self-esteem in children with CP.
Which advantages are appropriate in the use of ankle-foot orthoses for a child with cerebral palsy? Have custom seats for dependent mobilization Are useful for independent mobility Are used to prevent deformity and increase energy efficiency of gait Provide sitting balance
Are used to prevent deformity and increase energy efficiency of gait Ankle-foot orthoses (or braces) are used to prevent deformity, increase the energy efficiency of gait, and control alignment. Ankle-foot orthoses do not have custom seats for dependent mobilization. They are supportive devices for the ankle or a part of the foot. Custom seats cannot be adjusted within this device. They also do not allow independent mobility or provide sitting balance. They control the ankle position and compensate for the muscle weakness.
Which drug is appropriate for the child with cerebral palsy and epilepsy? Baclofen Reserpine Levodopa Carbamazepine
Carbamazepine Seizures are common in patients with cerebral palsy. Patients experiencing frequent seizures are given antiepileptic drugs for effective illness management. Carbamazepine is the preferred drug for patients with seizures. Baclofen is used for pain management in patients for postoperative care. Reserpine is used to treat chorea and athetosis. Levodopa is used to treat muscular disorders like dystonia.
Which nursing approach is appropriate when discussing family participation during hospitalization with the parents of a child with cerebral palsy who is having corrective surgery? Assigning the parents specific times to visit their child in the hospital Telling the parents to room-in and take part in all aspects of the child's care Scheduling nursing care when the parents are out of the child's hospital room Discussing the parents' desire to participate in the care of the child
Discussing the parents' desire to participate in the care of the child The most family-centered approach to promoting parent participation in the care of the child with cerebral palsy is to discuss the parents' desire to participate in the care of their child as a means of discovering the right level of involvement for the family. Assigning the parents specific times to visit their child in the hospital, telling the parents to room-in and take part in all aspects of the child's care, and scheduling nursing care when the parents are out of the child's hospital room are not the most therapeutic responses that the nurse could give the family.
Which condition is appropriate for the child with impaired motor activity, reduced range of abduction movement in the upper limb, and normal muscle strength in the lower limb? Duchenne muscular dystrophy Congenital muscular dystrophy Kugelberg-Welander muscular disease Landouzy-Dejerine muscular dystrophy
Landouzy-Dejerine muscular dystrophy
Which treatment is appropriate to ease spasticity in a child with cerebral palsy? Exercise Diuretic medication Anticonvulsant medication Implanted medication pump
Implanted medication pump Implantation of a pump to deliver medication into the intrathecal space can help ease spasticity in a child with cerebral palsy. Exercises, though beneficial, will not be enough to ease the spasticity found in a child with cerebral palsy. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. Diuretics do not help ease spasticity.
Which nursing action is appropriate when caring for the child with a myelomeningocele in the preoperative stage? Applying a heat lamp to facilitate drying and toughening of the sac Placing the child on one side to decrease pressure on the spinal cord Keeping the skin clean and dry to prevent irritation from diarrheal stools Measuring the head circumference and examining the fontanels for signs of developing hydrocephalus
Measuring the head circumference and examining the fontanels for signs of developing hydrocephalus Obstructive hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of the head circumference will aid in early detection of associated increased intracranial pressure. Before surgery the child is kept in a prone position to decrease tension on the sac and reduce the risk of trauma or sac tearing. The sac must be kept moist. Sterile, moist, nonadherent dressings are placed over the sac as prescribed by the health care provider. Most infants do not have diarrheal stools. The sac area, though, should be kept clean and dry and out of contact with urine and stools.
Which clinical manifestation is found in a child with spastic cerebral palsy? Hypotonicity Wide-based gait Dystonic movements Positive Babinski sign
Positive Babinski sign The Babinski sign, primitive reflexes, ankle clonus, exaggerated stretch reflexes, and contractures are clinical manifestations in children with spastic cerebral palsy. Hypertonicity, rather than hypotonicity, is present. A wide-based gait is found in ataxic cerebral palsy. Dystonic movements are more common in dyskinetic cerebral palsy.
Which nursing intervention is appropriate for the child with spina bifida that has developed a latex allergy as a result of numerous bladder catheterizations and surgeries? Recommend allergy testing Provide a latex-free environment Use only powder-free latex gloves Limit the use of latex products as much as possible
Provide a latex-free environment The most important nursing intervention is to provide a latex-free environment. From birth on, limitation of exposure to latex is essential in an attempt to minimize sensitization. Latex-free catheters for self-catheterization are available. Allergy testing may expose the child to the allergen and therefore is not recommended. The gloves contain latex and will contribute to sensitization. No latex products should be used with children who have latex allergies. Latex products should be avoided at all times.
Which intervention is appropriate when ensuring adequate nutrition of the preterm infant with cerebral palsy? Provide feedings by mouth. Provide enteral feedings. Provide parenteral feedings. Provide gastrostomy feedings.
Provide gastrostomy feedings.
Which nursing recommendation is appropriate for the 6-year-old child who was born with a myelomeningocele, has a neurogenic bladder, and whose parents have been performing clean intermittent catheterization? Teaching the child to perform self-catheterization Teaching the child the appropriate bladder control Continuing to have the parents do the catheterization Encouraging the family to consider urinary diversion
Teaching the child to perform self-catheterization At 6 years of age this child should have the dexterity to perform intermittent catheterization. This will give the child more control and mastery over the disability. Bladder control cannot be taught in a child with a neurogenic bladder. A urinary diversion is not necessary for a neurogenic bladder.
Which drug is appropriate to administer to a child with severe tetanus who fails to respond to generally used muscle relaxants? Midazolam Vecuronium Magnesium sulfate Dantrolene sodium
Vecuronium Vecuronium, a potent neuromuscular blocking agent, should be administered to a patient with severe tetanus who is not responding to usual muscle relaxants. Midazolam, magnesium sulfate, and dantrolene sodium are the usual muscle relaxants used in the management of tetanus.
Which statement is appropriate when explaining the diagnosis of dystonic cerebral palsy (CP) to the parents of a 2-month-old infant that is showing slow, twisting movements of the trunk and abnormal posture? "The child has CP, in which upper motor neuron muscular weakness occurs." "The child has CP, in which altered skeletal muscle performance occurs." "Your child shows disintegration of movements of the upper extremities." "Your child has CP, in which combination of spastic and dyskinetic CP symptoms occur."
"The child has CP, in which upper motor neuron muscular weakness occurs." There are different types of CP. The dystonic CP is a condition in which involuntary muscle contractures and abnormal posture occurs in the child. This spastic CP represents an upper motor neuron muscular weakness. Athetoid and dystonic CP are nonspastic CP. Therefore the nurse should not describe the condition as one in which altered skeletal muscle performance occurs. Disintegration of movements of the upper extremities is noticed during ataxic CP. In such condition the common symptoms are wide-based gait and rapid, repetitive movement. Again, the child does not have mixed CP. In mixed CP, symptoms of spastic and dyskinetic CP are observed.
The nurse is preparing to admit a 2-year-old child with spina bifida occulta. What clinical manifestations of spina bifida occulta should the nurse expect to observe? (Select all that apply.) a. Dark tufts of hair b. Skin depression or dimple c. Port-wine angiomatous nevi d. Soft, subcutaneous lipomas e. Bladder and sphincter paralysis
ANS:A, B, C, D Clinical manifestations of spina bifida occulta include dark tufts of hair; skin depression or dimple; port-wine angiomatous nevi; and soft, subcutaneous lipomas. Bladder and sphincter paralysis are present with spina bifida cystica but not occulta.
A feeding technique the nurse can teach to parents of a child with cerebral palsy to improve use of the lips and the tongue to facilitate speech is which? a. Feeding pureed foods b. Placing food on the tongue c. Placing food at the side of the tongue d. Placing food directly into the mouth with a spoon
ANS:C Feeding techniques such as forcing the child to use the lips and tongue in eating facilitate speech. An example of this technique is placing food at the side of the tongue, first one side and then the other, and making the child use the lips to take food from a spoon rather than placing it directly on the tongue. Feeding pureed foods would not encourage use of the lips and tongue.
A 12-year-old child with Guillain-Barré syndrome (GBS) is admitted to the pediatric intensive care unit. She tells you that yesterday her legs were weak and that this morning she was unable to walk. After the nurse determines the current level of paralysis, which should the next priority assessment be? a. Swallowing ability b. Parental involvement c. Level of consciousness d. Antecedent viral infections
ANS:A Assessment of swallowing is essential. Both pharyngeal involvement and respiratory function are usually involved at the same time. The child may require ventilatory support. The inability to swallow also contributes to aspiration pneumonia. Parental involvement is important after the physiologic assessment is complete. The child is answering questions and describing the onset of the illness, which demonstrates she is alert and oriented. Information regarding antecedent viral infections can be obtained after the child is assessed and stabilized.
The clinic nurse is assessing infant reflexes. What assessment indicates a persistence of primitive reflexes? a. Tonic neck reflex at 8 months of age b. Palmar grasp at 4 months of age c. Plantar grasp at 9 months of age d. Rooting reflex at 3 months of age
ANS:A Persistence of primitive reflexes is one of the earliest clues to CP (e.g., obligatory tonic neck reflex at any age or nonobligatory persistence beyond 6 months of age and the persistence or even hyperactivity of the Moro, plantar, and palmar grasp reflexes). The palmar grasp disappears by 6 months, the plantar grasp disappears by 12 months, and the rooting reflex disappears at 4 months, so these are normal findings.
The nurse is teaching the family of an infant with cerebral palsy how to administer a diazepam (Valium) pill by gastrostomy tube. What should the nurse include in the teaching session? a. The pill should be crushed and mixed with a small amount of water. b. The pill should be crushed and mixed with the infant's formula. c. After administering the medication, flush the tube with air. d. Before administering the medication, check the placement of the tube.
ANS:A Pills may be crushed and mixed with small amounts of water but not other liquids, such as formula or elixir medications, because these may act together to form a sludge that can interfere with gastrostomy tube function. When crushed pills or tablets are administered, flush the feeding tube with more water after instilling the dissolved pill in water. The tube should not be flushed with air, and placement does not need to be checked because it is directly into the stomach.
An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department. She has completed the tetanus immunization series, receiving the last tetanus toxoid booster 8 years ago. What care is necessary for therapeutic management of this adolescent to prevent tetanus? a. Tetanus toxoid booster is needed because of the type of injury. b. Human tetanus immunoglobulin is indicated for immediate prophylaxis. c. Concurrent administration of both tetanus immunoglobulin and tetanus antitoxin is needed. d. No additional tetanus prophylaxis is indicated. The tetanus toxoid booster is protective for 10 years.
ANS:A Protective levels of antibody are maintained for at least 10 years. Children with serious "tetanus-prone" wounds, including contaminated, crush, puncture, or burn wounds, should receive a tetanus toxoid booster prophylactically as soon as possible. This adolescent has circulating antibodies. The immunoglobulin is not indicated.
The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate? a. Prone with the head turned to the side b. On the side c. Supine in an infant carrier d. Supine, with defect supported with rolled blankets
ANS:A The prone position with the head turned to the side for feeding is the optimum position for the infant. It protects the spinal sac and allows the infant to be fed without trauma. The side-lying position is avoided preoperatively. It can place tension on the sac and affect hip dysplasia if present. The infant should not be placed in a supine position.
The nurse is preparing to admit a 7-year-old child with ataxic cerebral palsy. What clinical manifestations of ataxic cerebral palsy should the nurse expect to observe? (Select all that apply.) a. Wide-based gait b. Rapid, repetitive movements performed poorly c. Slow, twisting movements of the trunk or extremities d. Hypertonicity with poor control of posture, balance, and coordinated motion e. Disintegration of movements of the upper extremities when the child reaches for objects
ANS:A, B, E Clinical manifestations of ataxic cerebral palsy include a wide-based gait; rapid, repetitive movements performed poorly; and disintegration of movements of the upper extremities when the child reaches for objects. Slow, twisting movements of the trunk are seen with dyskinetic cerebral palsy, and hypertonicity with poor control of posture, balance, and coordinated motion are seen with spastic cerebral palsy.
The nurse is preparing to admit a 5-year-old child with a lower motor neuron syndrome. What clinical manifestations of a lower motor neuron syndrome should the nurse expect to observe? (Select all that apply.) a. Loss of hair b. Babinski reflex present c. Skin and tissue changes d. Marked atrophy of atonic muscle e. Hyperreflexia with tendon reflexes exaggerated
ANS:A, C, D Clinical manifestations of a lower motor neuron syndrome include loss of hair, skin and tissue changes, and marked atrophy of atonic muscle. Babinski reflex present and hyperreflexia with tendon reflexes exaggerated are manifestations of an upper motor neuron syndrome.
A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention? a. Recommend allergy testing. b. Provide a latex-free environment. c. Use only powder-free latex gloves. d. Limit use of latex products as much as possible.
ANS:B A latex-free environment is the goal. This includes eliminating the use of latex gloves and other medical devices containing latex. Allergy testing would provide information about whether the allergy has developed. It will not reduce the chances of developing the allergy. Although powder-free latex gloves are less allergenic, latex should not be used. Limiting the use of latex products is one component of providing a latex-free environment, but latex products should not be used.
The nurse is preparing a staff education in-service session for a group of new graduate nurses who will be working in a long-term care facility for children; many of the children have cerebral palsy (CP). What statement should the nurse include in the training? a. Children with dyskinetic CP have a wide-based gait and repetitive movements. b. Children with spastic pyramidal CP have a positive Babinski sign and ankle clonus. c. Children with hemiplegia CP have mouth muscles and one lower limb affected. d. Children with ataxic CP have involvement of pharyngeal and oral muscles with dysarthria.
ANS:B CP has a variety of clinical classifications. Spastic pyramidal CP includes manifestations such as a positive Babinski sign and ankle clonus; ataxic CP has a wide-based gait and repetitive movements; hemiplegia CP is characterized by motor dysfunction on one side of the body with upper extremity more affected than lower limbs; and dyskinetic CP involves the pharyngeal and oral muscles, causing drooling and dysarthria.
The nurse should suspect a child has cerebral palsy (CP) if the parent says what? a. "My 6-month-old baby is rolling from back to prone now." b. "My 4-month-old doesn't lift his head when on his tummy." c. "My 8-month-old can sit without support." d. "My 10-month-old is not walking."
ANS:B Delayed gross motor development is a universal manifestation of CP. The child shows a delay in all motor accomplishments, and the discrepancy between motor ability and expected achievement tends to increase with successive developmental milestones as growth advances. The infant who does not lift his head when on the tummy is showing a gross motor delay, as that is seen at 0 to 3 months. The other statements are within normal growth and development expectations.
A child, age 3 years, has cerebral palsy (CP) and is hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. What is the most appropriate nursing action related to feeding this child? a. Bottle or tube feed him a specialized formula until he gains sufficient weight. b. Stabilize his jaw with caregiver's hand (either from a front or side position) to facilitate swallowing. c. Place him in a well-supported, semi-reclining position. d. Place him in a sitting position with his neck hyperextended to make use of gravity flow.
ANS:B Jaw control is compromised in many children with CP. More normal control is achieved if the feeder stabilizes the oral mechanisms from the front or side of the face. Bottle or tube feeding will not improve feeding without jaw support. The semi-reclining position and hyperextended neck position increase the chances of aspiration.
The nurse is preparing to admit a 7-year-old child with an upper motor neuron syndrome. What clinical manifestations of an upper motor neuron syndrome should the nurse expect to observe? (Select all that apply.) a. No flexor spasms b. Babinski reflex present c. No wasting of muscle mass d. Marked atrophy of atonic muscle e. Hyperreflexia with tendon reflexes exaggerated
ANS:B, C, E Clinical manifestations of an upper motor neuron syndrome include Babinski reflex present, no wasting of muscle mass, and hyperreflexia with tendon reflexes exaggerated. No flexor spasms and marked atrophy of atonic muscle are manifestations of a lower motor neuron syndrome.
he nurse is preparing to admit a 5-year-old with spina bifida cystica that was below the second lumbar vertebra. What clinical manifestations of spina bifida cystica below the second lumbar vertebra should the nurse expect to observe? (Select all that apply.) a. No motor impairment b. Lack of bowel control c. Soft, subcutaneous lipomas d. Flaccid, partial paralysis of lower extremities e. Overflow incontinence with constant dribbling of uri
ANS:B, D, E The clinical manifestations of spina bifida cystica below the second lumbar vertebra include lack of bowel control, flaccid, partial paralysis of lower extremities, and overflow incontinence with constant dribbling of urine. No motor impairment occurs with spina bifida cystica that was below the third lumbar vertebra, and soft, subcutaneous lipomas occur with spina bifida occulta.
The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment. The nurse's response should be based on which knowledge? a. Affected children have some degree of cognitive impairment. b. Around 20% of affected children have normal intelligence. c. About 30% to 50% of affected children have significant cognitive impairments. d. Cognitive impairment is expected if motor and sensory deficits are severe.
ANS:C Children with CP have a wide range of intelligence, and 30% to 50% have significant cognitive impairments. A large percentage of children with CP do not have mental impairment. Many individuals who have severely limiting physical impairment have the least amount of intellectual compromise.
During a well-child visit, the mother tells the nurse that her 4-month-old infant is constipated, is less active than usual, and has a weak-sounding cry. The nurse suspects botulism and questions the mother about the child's diet. What factor should support this diagnosis? a. Breastfeeding b. Commercial formula c. Infant cereal with honey d. Improperly sterilized bottles
ANS:C Ingestion of honey is a risk factor for infant botulism in the United States. Honey should not be given to children younger than the age of 1 year. Botulism is not found with the use of commercial infant cereals. Although there is a slight increase in botulism in breastfed infants when compared with formula-fed infants, there is not sufficient evidence to support formula feeding as prevention. Thoroughly cleaning bottles used for formula feeding is sufficient for botulism prevention. Inadequate sterilization of home-canned foods can contribute to botulism.
A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. What nursing intervention is a priority for this child? a. Minimizing environmental stimuli b. Administering immunoglobulin c. Monitoring and maintaining systemic blood pressure d. Discussing long-term care issues with the family
ANS:C Spinal cord injury patients are physiologically labile, and close monitoring is required. They may be unstable for the first few weeks after the injury. Increased blood pressure may be an indication of autonomic dysreflexia. It is not necessary to minimize environmental stimuli for this type of injury. Spinal cord injury is not an infectious process. Immunoglobulin is not indicated. Discussing long-term care issues with the family is inappropriate. The family is focusing on the recovery of their child. It will not be known until the rehabilitation period how much function the child may recover.
An 8-year-old girl with moderate cerebral palsy (CP) recently began joining a regular classroom for part of the day. Her mother asks the school nurse about joining the after-school Girl Scout troop. The nurse's response should be based on which knowledge? a. Most activities such as Girl Scouts cannot be adapted for children with CP. b. After-school activities usually result in extreme fatigue for children with CP. c. Trying to participate in activities such as Girl Scouts leads to lowered self-esteem in children with CP. d. Recreational activities often provide children with CP with opportunities for socialization and recreation.
ANS:D After-school and recreational activities serve to stimulate children's interest and curiosity. They help the children adjust to their disability, improve their functional ability, and build self-esteem. Increasing numbers of programs are adapted for children with physical limitations. Almost all activities can be adapted. The child should participate to her level of energy. Self-esteem increases as a result of the positive feedback the child receives from participation.
An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome [GBS]). When explaining this disease process to the parents, what should the nurse consider? a. Paralysis is progressive with little hope for recovery. b. Disease is inherited as an autosomal, sex-linked, recessive gene. c. Disease results from an apparently toxic reaction to certain medications. d. Muscle strength slowly returns, and most children recover.
ANS:D Recovery usually begins within 2 to 3 weeks, and most patients regain full muscle strength. The paralysis is progressive with proximal muscle weakness occurring before distal weakness. The recovery of muscle strength occurs in the reverse order of onset of paralysis. Most individuals regain full muscle strength. Better outcomes are associated with younger ages. GBS is an immune-mediated disease often associated with a number of viral or bacterial infections or the administration of vaccines.
When a child develops latex allergy, which food may also cause an allergic reaction? a. Yeast b. Wheat c. Peanuts d. Bananas
ANS:D There are cross-reactions between allergies to latex and to a number of foods such as bananas, avocados, kiwi, and chestnuts. Although yeast, wheat, and peanuts are potential allergens, currently they are not known to cross-react with latex allergy.
A woman who is 6 weeks pregnant tells the nurse that she is worried that, even though she is taking folic acid supplements, the baby might have spina bifida because of a family history. The nurse's response should be based on what? a. Prenatal detection is not possible yet. b. There is no genetic basis for the defect. c. Chromosome studies done on amniotic fluid can diagnose the defect prenatally. d. Open neural tube defects (NTDs) result in elevated concentrations of alpha-fetoprotein in amniotic fluid.
ANS:D Ultrasound scanning and measurement of alpha-fetoprotein may indicate the presence of anencephaly or myelomeningocele. The optimum time for performing this analyzing is between 16 and 18 weeks. Prenatal diagnosis is possible through amniocentesis. A multifactorial origin is suspected, including drugs, radiation, maternal malnutrition, chemicals, and possibly a genetic mutation. Chromosome abnormalities are not present in NTDs.
Which contraindication is appropriate when administering succinylcholine in a child with myasthenia gravis (MG)? Causes apnea Induces paralysis Potentiates the symptoms Precipitates fatal cardiac arrhythmias
Induces paralysis The nurse would avoid administering succinylcholine in a child with MG because the drug is a neuromuscular-blocking agent that may induce paralysis, which can last for weeks. Intrathecal baclofen would be avoided in tetanus patients because it may cause apnea and would only be used in the intensive care setting. Aminoglycoside antibiotics such as gentamicin are avoided in MG patients because antibiotics potentiate the symptoms. Edrophonium would be avoided in infants and children with MG who are younger than 2 years old, because the drug may precipitate fatal cardiac arrhythmias.
How do lower motor neuron lesions affect the muscular function differently than upper motor neuron lesions? Interrupting the reflex arc Increasing deep tendon reflexes Producing abnormal superficial reflexes Producing weakness associated with spasticity
Interrupting the reflex arc Lower motor neuron lesions interrupt the reflex arc and cause weakness and atrophy of skeletal muscles. Deep tendon reflexes are diminished or absent in lower motor neuron lesions, whereas in upper motor neuron lesions, deep tendon reflexes are increased. Upper motor neuron lesions produce abnormal superficial reflexes and weakness associated with spasticity.
Which drug is appropriate to administer for the effective management of muscular dystrophy? Baclofen Prednisone Vecuronium Divalproex/valproic acid
Prednisone Muscular dystrophies are chronic genetic disorders most common in children. To date, no specific medication has been established to treat the disorders. Prednisone is the suggested corticosteroid medication for managing the ill effects of muscular dystrophy. Several clinical trials have proven that the use of corticosteroids improves muscle strength and performance in children with muscular dystrophy. Baclofen is used to treat muscular spasms. Vecuronium is a neuromuscular blocking agent used to treat seizures caused by tetanus infection. Valproic acid/divalproex is used to treat epilepsy-related disorders of cerebral palsy.
Which most common cause is appropriate for the diagnosis of cerebral palsy (CP)? Birth asphyxia Cerebral trauma Neonatal diseases Prenatal brain abnormalities
Prenatal brain abnormalities The most common currently identifiable cause of CP is existing brain abnormalities during the prenatal period. Birth asphyxia had previously been considered a factor in the development of CP. Neonatal diseases have previously been considered factors in the development of CP. Cerebral trauma has previously been considered a factor in the development of CP.
Which major goal of therapy is appropriate for children with cerebral palsy (CP)? Curing the underlying defect causing the disorder Reversing degenerative processes that have occurred Preventing spread to individuals in close contact with the children Recognizing the disorder early and promoting optimal development
Recognizing the disorder early and promoting optimal development Because cerebral palsy (CP) is currently a permanent disorder, the goal of therapy is the promotion of optimal development. This is done through early recognition and commencement of therapy. It is difficult to reverse the degenerative processes associated with CP. The underlying defect(s) associated with the development of CP cannot be cured. CP is not contagious.
Which statement is appropriate when describing bowel function in children born with a myelomeningocele? Incontinence cannot be prevented. Enemas and laxatives are contraindicated. Some degree of fecal continence can usually be achieved. A colostomy is usually required by the time the child reaches adolescence.
Some degree of fecal continence can usually be achieved. With diet modification and regular toilet habits (bowel training) to prevent constipation and impaction, some degree of fecal continence can be achieved. Although a lengthy process, continence can be achieved with modification of diet, use of stool softeners, enemas, or a combination thereof. Enemas and stool softeners are part of the strategy to achieve continence. Laxatives should be used only as a last resort. A colostomy is not indicated for the child with myelomeningocele.
Which nursing action is appropriate when educating parents on how to promote mobilization in the infant with cerebral palsy? Using wheeled go-carts Ankle-foot orthoses Strollers with custom seats Power-operated wheelchairs
Strollers with custom seats Normalization and the ability to care for oneself are the primary goals of therapy for patients with cerebral palsy. The strategy used for infants is the use of strollers with customized seats. Because infants have poorly developed motor activity, making use of strollers promotes dependent mobilization as a part of illness management. Wheeled go-carts are used to promote mobilization in toddlers, preschoolers, and school-age children. Ankle-foot orthoses are used to prevent deformity of the limbs in older children with cerebral palsy. They are generally not worn by infants. Power-operated wheelchairs are mostly used for adolescents to promote independent mobility.
