28-Neuromuscular PrepU
A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take? a. Explain that children can take their first steps as late as 18 months of age. b. Explain that the child could start walking any day. c. Ask the parent if the child has been ill recently. d. Refer the child to a developmental specialist for evaluation.
a
A 7-year-old child with cerebral palsy comes to the clinic for an evaluation. The child is prescribed medications to address muscle spasticity and seizures. When assessing the child's mouth, which condition would the nurse associate with the child's medication regimen? a. Gingival hyperplasia b. Enamel erosion c. Malocclusion d. Multiple dental caries
a
The nurse is assessing for bladder and bowel function in a newborn with spina bifida at the level of the lumbar spine. Which reflex test would the nurse use to assess this function? a. Anal wink b. Cremasteric c. Gag d. Achille's
a
In caring for the child with Guillain-Barré syndrome, the nurse will provide much supportive care while watching carefully for signs of deterioration in which body system? a. Urinary b. Integumentary c. Respiratory d. Cardiovascular
c
The nurse is conducting a health assessment of a 6-year-old girl with spina bifida. During the interview, the girl keeps interrupting and shouting to get her mother's attention. The mother instantly responds to every interruption and attempts to placate her with promises of a trip to the toy store. How should the nurse address the mother about the girl's apparent lack of discipline? a. "Does your daughter interrupt you like that on a regular basis?" b. "How do you feel when your daughter interrupts you?" c. "Are you embarrassed by your daughter's behavior?" d. "She is certainly demanding, isn't she?"
b
The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? a. absence of Moro reflex b. presence of symmetrical spontaneous movement c. presence of Moro reflex d. absence of tonic neck reflex
c
The nurse is assessing a 6-year-old child. The nurse instructs the child, "Let me see all of your pretty white teeth." Which cranial nerve is the nurse assessing? a. IV b. II c. VI d. VII
d
What reflex response will the nurse consider abnormal when assessing the 8-month-old infant? a. Plantar grasp b. Parachute c. Babinski d. Brisk deep tendon
d
A nurse is providing care to a child diagnosed with cerebral palsy who is experiencing painful muscle spasms. The health care provider has prescribed baclofen 40 mg/day PO in three divided doses. How many milligrams should the nurse administer in each dose? Record your answer using one decimal place.
13.3
A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? a. 9-month-old infant who can pull self up to a standing position b. 14-month-old toddler who walks with a parent's assistance c. 24-month-old toddler who engages in parallel play d. 3-year-old preschool-aged child who goes up stairs on hands and knees
d
The nurse has cared for a family of two boys with a progressive form of muscular dystrophy. The oldest boy died 3 years ago from complications of his condition at the age of 15. The younger boy is now 14. He tells the nurse, "I'm scared and depressed because I'm getting to be the same age as my brother was when he died. I don't know what to do." Which response by the nurse would be most appropriate? a. "You can't think about that. It is not good for your health" b. "Worrying is counterproductive. Focus on the positive" c. "You are doing well now, and you should take it a day at a time" d. "Let's look at your health and how it differs from your brother's"
d
The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? a. indications of hydrocephalus b. lordosis c. appearance of smaller than normal calf muscles d. Gowers sign
d
Which characteristic is true of cerebral palsy? a. It results in intellectual disability. b. It's reversible. c. It's progressive. d. It appears at birth or during the first 2 years of life.
d
The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: a. limb-girdle. b. Duchenne. c. facioscapulohumeral. d. myotonia.
b
The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? a. sodium b. creatine kinase c. bilirubin d. serum potassium
b
Through which mechanism is Duchenne muscular dystrophy acquired? a. virus b. environmental toxins c. heredity d. autoimmune factors
c
The nurse is reviewing the therapist's documentation in the medical record of an assigned client who has cerebral palsy. The therapist has noted the parents may be experiencing vulnerable child syndrome. Which observation of the family unit best supports this potential diagnosis? a. The child is schooled at home with a private tutor. b. The parents regularly attend a support group for parents of special needs children. c. The child has been diagnosed with pneumonia twice in the past year. d. The parents report they feel their child requires more therapy than the care team has indicated will be needed.
d
The parents of a 4-year-old child bring the child to the provider's office for an evaluation. The parents are concerned about the child's weakness and problems with stair climbing. The nurse assesses the child and documents the findings. Based on the findings, the nurse suspects Duchenne muscular dystrophy (DMD). When discussing the findings with the primary care provider, the nurse anticipates which laboratory test being prescribed to provide additional information? a. White blood cell count b. Prothrombin time (PT) c. Alkaline phosphatase d. Creatinine kinase (CK)
d
A child diagnosed with spinal muscular atrophy is experiencing problems with swallowing and reflux which has resulted in frequent episodes of aspiration. The primary care provider prescribes medication therapy to address this problem. The nurse would plan to teach the parents about which medication(s)? Select all that apply. a. Albuterol b. Prednisone c. Azithromycin d. Ranitidine e. Omeprazole
d, e
What methods can a nurse use to evaluate extremity function in an 18-month-old? Select all that apply. a. Observe the child in developmentally appropriate play. b. Look for symmetric motion in the arms and legs. c. Have the child push against resistance with both feet. d. Ask the child to squeeze the nurse's fingers simultaneously. e. Elicit from the parent a description of fine and gross motor activities.
a, b, e
The nurse is providing preoperative care for a newborn with myelomeningocele. Which action is the central nursing priority? a. maintain infant in prone position b. prevent rupture or leaking of cerebrospinal fluid c. keep lesion free from fecal matter or urine d. maintain infant's body temperature
b
The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply? a. "The contents of the sac you see only has fluid in it and should cause the child no problem." b. "It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." c. "Your child's defect involves only the nerves to the bladder and bowel and can be easily repaired." d. "The sac is a very small cyst and should resolve within the first year of life."
b
Which statement about cerebral palsy would be accurate? a. "Cerebral palsy is a condition that doesn't get worse." b. "Cerebral palsy is a condition that runs in families." c. "Cerebral palsy means there will be many disabilities." d. "Cerebral palsy occurs because of too much oxygen to the brain."
a
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? a. history of a seizure disorder; taking phenobarbital b. history of scoliosis c. history of asthma; taking montelukast d. history of a previous abdominal surgery
a
The pediatric nurse practitioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this? a. The boy rises from the floor by walking his hands up his legs. b. Severe lordosis is evident in the lumbar spine. c. The boy has a large tan skin lesion on his torso. d. The head is held tilted with limited side-to-side motion.
a
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
a
The parent of a child with cerebral palsy asks how therapeutic horseback riding might benefit his adolescent. What benefits would the nurse describe? Select all that apply. a. Flexibility, balance, and muscle strength tend to improve. b. Self-esteem and confidence usually get a boost. c. Appetite tends to be stimulated with riding. d. Sleep problems often resolve.
a, b
A newborn is diagnosed with spina bifida. What initial reactions might the nurse expect to observe in the parents of the newborn? Select all that apply. a. Denial b. Disbelief c. Acceptance d. Shock e. Elation
a, b, d
A nurse admits a 10-year-old with spina bifida who is confined to a wheelchair. When asking the parent and child questions, the parent appears disinterested and distant, allowing the child to answer all questions. What typical caregiver response is this parent displaying? a. Denial b. Rejection c. Overprotection d. Acceptance
b
A nurse has provided care to several children during their well-child visits. The nurse has assessed each child's neurologic status. Which assessment finding indicates a problem requiring intervention? a. a 10-month-old infant who is able to ambulate with assistance b. a 4-year-old preschool-age child who consistently walks on tiptoes c. a 2-month-old infant who reaches for a rattle several times before connecting with it d. a 2-year-old toddler who can walk up the steps one at a time
b
A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond? a. "There are many things that you can do like crafts, computers or art." b. "There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." c. "You need to remain as active as possible and have a positive attitude." d. "You have to go to a support group; it will be very helpful."
b
The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? a. EEG b. muscle biopsy c. X-ray d. assessment of ambulation
b
The nurse is caring for a child with a spinal cord injury and providing instruction to the parents on promoting skin integrity. Which response from the mother indicates a need for further teaching? a. "I must monitor skin affected by his adaptive equipment." b. "I need to monitor his skin at least twice a week." c. "He must change positions frequently." d. "We must avoid harsh cleaning products."
b
The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition? a. lesions of the brain cortex b. degeneration of muscle fibers c. a demyelinating disease d. upper motor neuron lesions
b
A nurse is caring for a 2-year-old girl with cerebral palsy. The child is having difficulty with proper nutrition and is not gaining adequate weight. How can the nurse elicit additional information to establish a diagnosis? a. "Does she like to feed herself or do you feed her?" b. "Does she have difficulty swallowing or chewing?" c. "Let's offer her a snack now and you can tell me about her diet on a typical day." d. "Let's see if she is dehydrated and we'll assess her respiratory system."
c
An 8-year-old girl with cerebral palsy heard about handicapped horseback riding and is begging to try it. Her mother is frightened of her falling and talks to the nurse. What is the most helpful nursing response? a. "Hippotherapy can build balance and muscle strength." b, "Let me give you a helpful website for horse stable information." c. "The horse stable has specially trained staff and employs physical therapists to work with the children to provide a specific and safe program." d. "Horseback riding often aids in developing self-esteem."
c
The nurse is conducting a wellness examination on a 12-year-old boy with cerebral palsy and starts discussing about transitioning into adult health care services. The boy is able to speak, but the mother does most of the talking. Which response by the nurse would be most appropriate? a. "Now that Tom is older, he might want to conduct these examinations without you." b. "You need to let Tom answer these questions." c. "Tom, what is important to you as you look to the future?" d. "Tom, have you thought about your future?"
c
