ADN 420 Developmental and Mobility Exam 1

Which statement about cerebral palsy would be accurate?

"Cerebral palsy is a condition that doesn't get worse." By definition, cerebral palsy is a nonprogressive neuromuscular disorder. It can be mild or quite severe and is believed to be the result of a hypoxic event during pregnancy or the birth process and doesn't run in families.

The young child is experiencing muscle spasms and has been given lorazepam. Which statements by the child indicate that the child may be experiencing some common side effects? Select all that apply.

"I feel sort of dizzy." "I need to take a nap." This child has taken a benzodiazepine. Common side effects associated with this medication are dizziness and sedation. The skeletal muscle relaxes and the spasms will diminish. Nausea and upper gastrointestinal pain are not common side effects associated with this medication.

The mother of a 4-year-old reports using time-outs as a means for disciplining the child. Which statement by the mother would require the nurse to provide additional teaching?

"I usually have him in time-out for about 10 minutes." A time-out should be timed appropriately. The time-out should occur at the time the offense occurred, to ensure the child relates the offense (the behavioral problem) to the time-out period. Brief time-outs are more effective than very long ones, because a long time-out enables the child to redirect attention from calming down to being resentful. The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. A time-out should end as soon as the child is calm. Time-outs do not have to occur in the child's room; any location where the child is removed from activity and has an opportunity to become calm will do.

During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents?

"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here."

The nurse is discussing home safety with the parents of a 10-year-old client. Which statement by the client's parents most concerns the nurse?

"Our child swims alone before we get home from work."

A 15-year-old female adolescent tells the nurse she would like to get a tattoo. What response by the nurse is most appropriate?

"Tattoos are invasive and there is the potential for disease with their application."

The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns?

"This is not your fault and we will help you with her care and treatment." Because the mother is crying and experiencing the initial shock of the diagnosis, the nurse's primary concern is to support the mother and assure her that she is not to blame for the DDH. While education is important, the nurse should let the mother adjust to the diagnosis and assure her that the baby and her family will be supported now and throughout the treatment period.

A mother brings her child into the clinic for follow up after beginning treatment for attention deficit hyperactivity Disorder (ADHD). One of the outcomes was for the child to complete homework within a 1-hour time interval. The mother reports that it still takes 1 1/2 hours but that is dramatically reduced from the 3 hours or more before beginning treatment. What is the best response for the nurse to make to the child?

"You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?"

The child has been diagnosed with rickets. The child's mother is educated about the importance of providing the child with 10 micrograms (400 International Units) of an oral vitamin D supplement each day. The child's mother purchases over-the-counter vitamin D drops. The supplement is noted to contain 5 mcg of vitamin D in each 0.5 mL. How much of the supplement should the mother administer to the child each day? Record your answer using one decimal place.

1 (0.5 mL/5 mcg) x (10 mcg/1) = 1 mL

A young couple expecting their first child comes to the clinic concerned that their baby will be born with Down syndrome. The nurse informs the couple that the incidence of Down syndrome is highest in women older than what age?

35 years

Which clients may be experiencing an alteration in neurotrophin levels? Select all that apply.

A 55-year-old who is exhibiting clinical manifestations of early-onset Alzheimer disease A 44-year-old with a family history of Huntington disease who is exhibiting jerky, uncontrollable movements Neurotrophic or nerve growth factors are required to maintain the long-term survival of the postsynaptic cell and are secreted by axon terminals independent of action potentials. Alterations in neurotrophin levels have been implicated in neurodegenerative disorders such as Alzheimer disease and Huntington disease, as well as psychiatric disorders such as depression and substance abuse.

If the basal ganglia, part of the cerebral hemispheres, are damaged by diseases such as Parkinson disease and Huntington chorea, what clinical manifestation could result?

Abnormal movement patterns Parkinson disease, Huntington chorea, and some forms of cerebral palsy, among other dysfunctions involving the basal ganglia, result in a frequent or continuous release of abnormal postural or axial and proximal movement patterns. If damage to the basal ganglia is localized to one side, the movements occur on the opposite side of the body.

Several staff members are taking a break in the unit's conference room when one of them states, "I dread getting old and having to retire. I don't want to just sit on the porch in my rocking chair." The statement reflects which of the following?

Ageism The staff member's statement reflects ageism, attitudes based on stereotypes that reinforce negative images of older people. Gerontology is the scientific study of the aging process. Geriatrics is the practice that focuses on the physiology, pathology, diagnosis, and management of disorders and diseases of older adults. Chronological aging refers to the passage of time as one gets older.

Patient should be cautioned to avoid which when taking skeletal muscle relaxants?

Alcohol Patients should be cautioned to avoid alcohol while taking these muscle relaxants; if this combination cannot be avoided, they should take extreme precautions.

When caring for a child newly diagnosed with special needs, which nursing action is priority?

Answering the caregiver's questions Answering questions and providing education to the caregivers is priority to prevent unrealistic expectations of the child and the health care system. Accurate, kind explanations given promptly help to promote a more positive environment for all involved. The nurse will supplement education on the diagnosis as needed as this should have already been discussed with the primary health care provider who made the diagnosis. The nurse will also provide any resource material the family needs. Respite care may be needed once the caregivers feel fatigue.

Erikson's Developmental Stages Early Childhood (1-3 yrs)

Autonomy vs Shame

Parents of a preschooler with cerebral palsy ask the nurse what the surgeon plans to implant in their child's body to control spasticity. What is the nurse's answer?

Baclofen pump A baclofen pump can be placed surgically to deliver continuous medication intrathecally. Baclofen can also be taken orally. Botulinum toxin is injected by a practitioner into specified muscle groups to reduce spasticity. A central venous catheter places medication directly into rapidly moving blood and would not be used. A vagal nerve stimulator is used to control seizures.

Erikson's Developmental Stages Infancy (0-1 yr)

Basic trust vs. Mistrust

Which components of the nervous system make up the central nervous system?

Brain and spinal cord The brain and the spinal column make up the central nervous system. The peripheral nervous system lies outside of these two structures.

Which behavior by a 3 year-old child does not validate Erikson's developmental task for preschoolers?

Compares his soccer abilities with his peers.

The nurse is playing a game with a toddler in the hospital room. What is the most important benefit of this nurse-client interaction?

Developing a trusting relationship with the nurse

Which adverse effects would a nurse most likely assess in a client who is receiving a centrally acting skeletal muscle relaxant? (Select all that apply.)

Drowsiness Insomnia Dry mouth Constipation Urinary frequency Hypotension

When caring for a client taking dantrolene, for what adverse effects should the nurse monitor the client? Select all that apply.

Drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary frequency Adverse effects of dantrolene do not include bradycardia or urinary retention.

The clinic nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa (Sinemet) for 7 years. What common side effects of Sinemet would the nurse assess this patient for?

Dyskinesia Within 5 to 10 years of taking levodopa, most patients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome, characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.

Which activities would the client with a T4 spinal cord injury be able to perform independently? Select all that apply.

Eating Breathing Transferring to a wheelchair Writing Eating, breathing, transferring to a wheelchair, and writing are functional abilities for those with a T4 injury. Ambulation can be performed independently by a client with an injury at T11-S5 injury.

The nurse is planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis?

Ensuring adequate calcium and vitamin D intake

The mother of a child with special needs states, "I should have stopped drinking soda when I was pregnant. Maybe if I had, everything would be OK." What is the nurse's interpretation of this remark?

Feelings of guilt are being expressed.

An adolescent is being observed for attention deficit hyperactivity disorder (ADHD). Which circumstance would demonstrate evidence to support this diagnosis?

Forgets to turn in homework, does not follow directions, cannot stay in assigned seat in class, and is always talking excessively and inappropriately.

Erikson's Developmental Stages Adulthood (26-64 yrs)

Generatively vs stagnation

In a spinal cord injury, neurogenic shock develops due to loss of the autonomic nervous system functioning below the level of the lesion. Which of the following indicators of neurogenic shock would the nurse expect to find? Select all that apply.

Hypotension Venous pooling Tachypnea Hypothermia The vital organs are affected in a spinal cord injury, causing the blood pressure and heart rate to decrease. This loss of sympathetic innervation causes a variety of other clinical manifestations, including a decrease in cardiac output, venous pooling in the extremities, and peripheral vasodilation resulting in mild hypotension, bradycardia, and warm skin. In addition, the patient does not perspire on the paralyzed portions of the body because sympathetic activity is blocked; therefore, close observation is required for early detection of an abrupt onset of fever.

Erikson's Developmental Stages Adolescence (12-19 yrs)

Identity vs Confusion

When the nurse observes physical indicators of illness in the older population, that nurse should be aware of which of the following principles?

Indicators that are useful and reliable in younger populations cannot be relied on as indications of potential life-threatening problems in older adults. Physical indicators of illness that are useful and reliable in young and middle-aged people cannot be relied on for the diagnosis of potential life-threatening problems in older adults. A potentially life-threatening problem in an older person is more serious than it would be in a middle-aged person because the older adult does not have the physical resources of the middle-aged person. Physical indicators of serious health care problems in a young or middle-aged population do not indicate disease states that are considered "mild" in the elderly population. It is true that middle-aged people do not react to disease states the same as a younger population, but this option does not answer the question.

Erikson's Developmental Stages School Age (6-12 yrs)

Industry vs Inferiority

A mother brings her 2-year-old child to the pediatrician's office, voicing concerns about her toddler's growth over the last year. According to the child's records, the toddler has gained 6 pounds (2.7 kg ) and grown 2.5 in (6.25 cm) since his last visit a year ago. How should the nurse respond to this mother's concerns?

Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about.

Erikson's Developmental Stages Play age (3-6 yrs)

Initiative vs Guilt

Erikson's Developmental Stages Old Age (65-death)

Integrity vs despair

Erikson's Developmental Stages Early Adulthood (20-25 yrs)

Intimacy vs Isolation

Which characteristic is true of cerebral palsy?

It appears at birth or during the first 2 years of life. Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are intellectually disabled, many have normal intelligence.

The health care provider is performing a spinal tap on a client with suspected infection. The provider would perform the procedure at:

L3 or L4 A pocket of CSF, the dural cisterna spinalis, extends from approximately L2 to S2. Because this area contains an abundant supply of CSF and the spinal cord does not extend this far, the area often is used for sampling the CSF. A procedure called a spinal tap, or puncture, can be done by inserting a special needle into the dural sac at L3 or L4. The spinal roots, which are covered with pia mater, are in little danger of trauma from the needle used for this purpose.

A client with a spinal cord injury has experienced contractures and destructive changes in the joints of the lower extremities. The nurse determines which of the following is the most likely cause?

Loss of proprioception and reflex control of the muscles -The tendons and ligaments of the joint capsule are sensitive to position and movement, particularly stretching and twisting. These structures are supplied by the large sensory nerve fibers that form proprioceptor endings. Loss of proprioception and reflex control of muscular support lead to destructive changes in the joint.

Since catecholamines can be degraded by enzymes, which medication category—usually prescribed to treat a Parkinson disease client—can increase the levels of neurotransmitters by decreasing their enzymatic degradation?

Monoamine oxidase (MAO) inhibitor Catecholamines also can be degraded by enzymes, such as catechol-O-methyltransferase (COMT) in the synaptic space or monoamine oxidase (MAO) in the nerve terminals. COMT inhibitors and MAO inhibitors are used in the treatments of various conditions, such as Parkinson disease, major depression, and anxiety. The other medications listed do not perform this function.

A 60-year-old woman has been recently diagnosed with multiple sclerosis, a disease in which the oligodendrocytes of the client's central nervous system (CNS) are progressively destroyed. Which physiologic process within the neurologic system is most likely to be affected by this disease process?

Nerve conduction The oligodendrocytes form the myelin in the central nervous system (CNS). As with peripheral myelinated fibers, the covering of axons in the CNS increases the velocity of nerve conduction. Oxygen metabolism and synthesis of CSF and neurotransmitters are not directly affected.

Which stimulus is known to trigger an episode of autonomic dysreflexia in the client who has suffered a spinal cord injury?

Placing a blanket over the client An object on the skin or skin pressure may precipitate autonomic dysreflexia. In general, constipation or fecal impaction triggers autonomic dysreflexia. When the client is observed to be demonstrating signs of autonomic dysreflexia, the nurse immediately places the client in a sitting position to lower blood pressure. The most common cause of autonomic dysreflexia is a distended bladder.

The nurse is performing range-of-motion exercises on a client's arm. The nurse starts by lifting the arm forward to above the head of the client. Which action would the nurse perform next?

Return the arm to the starting position at the side of the body. The nurse would return the joint to a neutral position (i.e., its normal position of alignment) when finishing each exercise.

A nurse is educating the parents of an infant about possible health problems during infancy. Which of the following health problems during infancy is most serious?

SIDS

Which is a strategy for lowering risk for osteoporosis?

Smoking cessation Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.

The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse?

Speak with the parents about the unusual increased number of respiratory infections In the school-age child the respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. Because the child is absent excessively for respiratory infections the nurse should speak with the parents to aid in determining if there is an underlying cause, or suggest the child visits the pediatrician to discuss the issue.

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?

Staphylococcus aureus causes over 50% of bone infections. Other organisms include Proteus vulgaris and Pseudomonas aeruginosa, as well as E. coli.

When considering the moral development of a 7-year-old child, which actions are most consistent with the anticipated state of development?

The child focuses on being a good girl or boy. The 7- to 10-year-old usually follows rules out of a sense of being a "good" person. He or she wants to be a good person to parents, friends, and teachers and to himself or herself. The adult is viewed as being right. This is stage 3: interpersonal conformity (good child, bad child), according to Kohlberg. Younger children focus on their actions on avoiding punishment and base actions on what is best for them. Older children will give consideration to how their personal actions will impact others.

An orthopedic nurse is caring for a client who is postoperative day 1 following foot surgery. What nursing intervention should be included in the client's subsequent care?

The foot should be elevated in order to prevent edema. Pain experienced by clients who undergo foot surgery is related to inflammation and edema. To control the anticipated edema, the foot should be elevated on several pillows when the client is sitting or lying. Regular dressing changes are performed and the wound should be kept dry. Hydrogen peroxide is not used to cleanse surgical wounds.

The nurse is liaising with the physical therapist and occupational therapist to create an activity management plan for a patient who has multiple sclerosis. What principle should be integrated into guidelines for exercise and activity that the team will provide to this patient in anticipation of discharge?

The patient should perform frequent physical activity but avoid becoming fatigued.

The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?

The teen is uncertain and frequently unable to make decisions.

The nurse is caring for an 8-month-old infant in Bryant traction for developmental dysplasia of the hip (DDH) and is monitoring for complications. Which assessment finding most concerns the nurse?

a weak pedal pulse

A nurse is assessing pain in a client who has a spinal cord injury. The client states that even a light touch to the legs will illicit severe pain. The client is describing which type of pain?

allodynia Allodynia is a type of neurogenic pain whereby clients experience pain in response to a normally painless stimulus. Hyperalgesia is a type of neurogenic pain whereby clients experience an increased response to a painful stimulus. Nociceptive pain is detected by specialized sensory nerves located throughout the soft tissues and is not neurogenic. Idiopathic pain has no apparent underlying cause and is not neurogenic.

The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that the child has:

attention deficit hyperactive disorder (ADHD).

A client with multiple sclerosis (MS) is frustrated by tremors associated with the disease. How should the nurse explain why these tremors occur? Due to the demyelination of neurons that occurs in MS:

communication being sent through neurons is slowed. Myelin acts as an insulator that allows for rapid conduction of nerve impulses; therefore, the client with MS will have these impulses slowed, not quickened. Because the pattern of demyelination is sporadic, the signals arrive in a disorganized way. There are still some signals being sent, and this condition is not limited to neurons in the basal ganglia (although these can be involved).

The nurse is assessing the client for muscle mass, tone, and strength and determines that there is increased tone that interferes with movement. How does the nurse document this finding?

spasticity. Adequate skeletal muscle mass, tone, and strength are prerequisites to appropriate body movement and work performance. Spasticity, or hypertonicity, is defined as increased tone that interferes with movement. Spasticity is caused by neurologic impairments, and is often described as a stiffness, tightness, or pulling of the muscle. Hypertrophy refers to increased muscle mass resulting from exercise or training. Atrophy describes muscle mass that is decreased through disuse or neurologic impairment. Flaccidity, or hypotonicity, results from disuse or neurologic impairments, and is described as a weakness of paralysis.

The nurse is assessing the developmental level of children in a pediatric clinic. The nurse would be most concerned about which client?

the 24-month-old child who is unable to walk unassisted At 15 months of age, most toddlers can walk unassisted; there would be concern for a 24-month-old child who could not.