MUSCULOSKELETAL PEDIATRIC SUCCESS 2ND EDITION

12. The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following? 1. Electromyelogram. 2. Nerve conduction velocity. 3. Muscle biopsy. 4. Creatine kinase level.

3 12. 1. The electromyelogram is part of the diagnostic workup, but muscle biopsy results classify muscle disorders. 2. Nerve conduction velocity is part of the diagnostic workup, but muscle biopsy results classify muscle disorders. 3. Muscle biopsy confirms the type of myopathy that the patient has. 4. Creatine kinase is in muscle tissue and is found in large amounts in muscular diseases. TEST-TAKING HINT: Muscle biopsy is the definitive test for myopathies.

14. Which should a nurse in the ED be prepared for in a child with a possible spinal cord injury? 1. Severe pain. 2. Elevated temperature. 3. Respiratory depression. 4. Increased intracranial pressure.

3 14. 1. Severe pain is unlikely, but the child may have pain at the injury site. 2. An elevated temperature is not common in a spinal cord injury. In fact, most trauma patients are hypothermic in spite of high ambient temperatures. 3. A spinal cord injury can occur at any level. The higher the level of the injury, the more likely the child is to have respiratory insufficiency or failure. The nurse should be prepared to support the child's respiratory system. 4. Spinal cord injury with an open or closed head injury does not cause an increase in intracranial pressure. TEST-TAKING HINT: The test taker must know the signs of a spinal cord injury.

22. The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which would be a priority nursing diagnosis before surgery? 1. Alteration in parent-infant bonding. 2. Altered growth and development. 3. Risk of infection. 4. Risk for weight loss.

2 22. 1. This is certainly a possibility, but in the pre-operative period risk of infection is the priority. 2. Altered growth and development may occur, but in the pre-operative period risk of infection is the priority. 3. A normal saline dressing is placed over the sac to prevent tearing, which would allow the cerebrospinal fluid to escape and microorganisms to enter and cause an infection. 4. It is normal in the first 2 weeks of life to lose up to 10% of birth weight. In fact, this infant may lose more weight because of surgery, but the priority is risk of infection. TEST-TAKING HINT: The pre-operative priority is risk of infection, especially when effort is necessary to keep a sterile saline dressing on the sac.

13. Why does spinal cord injury without radiographic abnormality sometimes occur in children? 1. Children can suffer momentary severe subluxation and trauma to the spinal cord. 2. The immature spinal column in children does not allow for quality films. 3. The hemorrhaging that occurs with injury obscures radiographic abnormalities. 4. Radiographic abnormalities are not evident because of incomplete ossification of the vertebrae.

1 13. 1. Spinal cord injury without radiographic abnormality results from the spinal cord sliding between the vertebrae and then sliding back into place without injury to the bony spine. It is thought to be the result of an immature spinal column that allows for reduction after momentary subluxation. 2. On x-ray the spinal cord and body structure appear normal. The edema of the cord and resulting ischemia can cause neurological dysfunction below the level of the injury. 3. Hemorrhaging that occurs with the injury does not obscure radiographic findings. 4. The vertebrae are adequately ossified for radiographic study to reveal abnormalities. TEST-TAKING HINT: The test taker must understand the physiology of spinal cord injuries in children.

17. Which symptoms will a child suffering from complete spinal cord injury experience? 1. Loss of motor and sensory function below the level of the injury. 2. Loss of interest in normal activities. 3. Extreme pain below the level of the injury. 4. Loss of some function, with sparing of function below the level of the injury.

1 17. 1. Children with complete spinal cord injury lose motor and sensory function below the level of the injury as a result of interruption of nerve pathways. 2. Although spinal cord-injured children may suffer depression, it is not correct to state that all of them lose interest in normal activities. 3. Pain is absent below the level of the injury because of loss of sensory function. 4. Sparing of function below the level of the injury occurs only when there is partial spinal cord injury. TEST-TAKING HINT: A spinal cord injury causes loss of motor and sensory function below the level of the injury.

21. Which priority item should be placed at the bedside of a newborn with myelomeningocele? 1. A bottle of normal saline. 2. A rectal thermometer. 3. Extra blankets. 4. A blood pressure cuff.

1 21. 1. Before the surgical closure of the sac, the infant is at risk for infection. A sterile dressing is placed over the sac to keep it moist and help prevent it from tearing. 2. The infant's temperature will be taken, but prevention of infection is the priority. 3. Prevention of infection is the priority. Once the temperature is taken, it can be determined if extra blankets are needed. 4. Blood pressure is difficult to monitor in the newborn period. Prevention of infection is the priority. TEST-TAKING HINT: The test taker should focus on the care and potential complications of an infant with spina bifida to answer the question correctly.

23. Which should the nurse include when teaching sexuality education to an adolescent with a spinal cord injury? 1. "You can enjoy a healthy sex life and most likely conceive children." 2. "You will never be able to conceive if you have no genital sensation." 3. "Development of secondary sex characteristics is delayed." 4. "A few females have regular menstrual periods after injury."

1 23. 1. The reproductive system continues to function properly after a spinal cord injury. Much sexual activity and response occurs in the brain as well. 2. Conception does not depend on sensation in the genitals. 3. Secondary sex characteristics develop normally. 4. Females may have irregular periods after the injury, but most return to their normal cycles. TEST-TAKING HINT: Spinal cord injuries have little effect on reproduction.

24. A child with a repaired myelomeningocele is in the clinic for a regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the nurse tell the parent? 1. Tethered cord is a post-surgical complication. 2. Tethered cord occurs during times of slow growth. 3. Release of the tethered cord will be necessary only once. 4. Offering laxatives and acetaminophen daily will help control these problems.

1 24. 1. Tethered cord is caused by scar tissue formation from the surgical repair of the myelomeningocele and may affect bowel, bladder, or lower extremity functioning. 2. Tethered cord occurs during growth spurts. 3. Often the release of the tether will again become necessary. 4. Laxatives and acetaminophen are temporary remedies, and they treat only the symptoms. TEST-TAKING HINT: Tethering is caused by scar tissue from any surgical intervention and may recur as the child grows.

3. The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. Which should the nurse tell them? 1. "Muscular dystrophies usually result in progressive weakness." 2. "The weakness that your child is having will probably not increase." 3. "Your child will be able to function normally and not need any special accommodations." 4. "The extent of weakness depends on doing daily physical therapy."

1 3. 1. Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder. 2. The weakness is progressive. 3. The child will require assistance, and the need for it will increase with time and age. 4. Daily therapy may be helpful in decreasing contractures, although it will not deter the disease progression. TEST-TAKING HINT: The test taker should know that muscular dystrophy is a progressive degenerative disorder.

30. A 3-month-old with spina bifida is admitted to the nurse's unit. Which gross motor skills should the nurse assess at this age? 1. Head control. 2. Pincer grasp. 3. Sitting alone. 4. Rolling over.

1 30. 1. A 3-month-old has good head control. 2. Pincer grasp occurs at about 9 months. 3. Sitting alone occurs at about 6 months. 4. Rolling over occurs at about 4 months. TEST-TAKING HINT: The test taker must know normal developmental milestones.

32. A school-aged child is admitted to the unit pre-operatively for bladder reconstruction. The child is latex-sensitive. Which intervention should the nurse implement? 1. Post a sign on the door and chart that the child is latex-allergic. 2. Use powder-free latex gloves when giving care. 3. Keep personal items such as stuffed animals in a plastic bag to avoid latex contamination. 4. Use a disposable plastic-covered blood pressure cuff that will stay in the child's room.

1 32. 1. Posting a sign on the door and charting that the child has a latex allergy is important so others will be aware of the allergy. 2. Do not use latex gloves with a child who has a latex allergy. 3. Keeping personal items in a plastic bag does not keep latex away from the child. 4. A plastic cover for the blood pressure cuff is proper to use but is not related to the latex allergy. TEST-TAKING HINT: The test taker must know which supplies have latex and about contact allergies.

37. The parent of a toddler newly diagnosed with cerebral palsy (CP) asks the nurse what caused it. The nurse should answer with which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.

1 37. 1. At least 80% of cases of CP result from unknown prenatal factors. 2. It used to be thought that CP resulted from perinatal factors, but current knowledge is that CP results more commonly from existing prenatal brain abnormalities. 3. It used to be thought that CP resulted from perinatal factors, but current knowledge is that CP results more commonly from existing prenatal brain abnormalities. 4. Frequently, the exact cause is not known. TEST-TAKING HINT: The test taker must know the latest information to answer this question correctly.

38. Which developmental milestone should the nurse be concerned about if a 10-month-old could not do it? 1. Crawl. 2. Cruise. 3. Walk. 4. Have a pincer grasp.

1 38. 1. Most infants are able to crawl unassisted by 8 months. 2. Infants learn to cruise (walk around holding onto furniture) at about 9 to 10 months. 3. Walking occurs on average at about 12 months. 4. Pincer grasp (thumb and forefinger) occurs at about 9 to 10 months. TEST-TAKING HINT: The test taker must know developmental milestones.

46. Parents bring their 2-month-old into the clinic with concerns that the baby seems "floppy." The parents say the baby seems to be working hard to breathe, eats very slowly, and seems to fatigue quickly. The nurse assesses intercostal retractions, although the baby is otherwise in no distress. They add there was a cousin whose baby had similar symptoms. The nurse would be most concerned with what possible complications? 1. Respiratory compromise. 2. Dehydration. 3. Need for emotional support for the family. 4. Feeding intolerance.

1 46. 1. This baby may have Werdnig-Hoffman disease, which is characterized by progressive generalized muscle weakness that eventually leads to respiratory failure. Respiratory compromise is the most important complication. 2. There is no history of being unable to ingest oral fluids; the baby is just a slow feeder. 3. This is important, but respiratory compromise is a priority in this situation. 4. There is no indication of feeding intolerance; the baby is just a slow feeder. TEST-TAKING HINT: Consider the ABCs in this situation: airway, breathing, and cardiac status. These are priorities when caring for clients.

47. The mother of a newborn relates that this is her first child, the baby seems to sleep a lot, and does not cry much. Which question would the nurse ask the mother? 1. "How many ounces of formula does your baby take at each feeding?" 2. "How many bowel movements does your baby have in a day?" 3. "How much sleep do you get every night?" 4. "How long does the baby stay awake at each feeding?"

1 47. 1. Babies can lose up to 10% of birth weight but should regain it by 2 weeks of age. Knowing how much the baby eats can help the nurse determine if the infant is receiving adequate nutrition. 2. The number of bowel movements will also indicate whether the infant receives enough formula. 3. If the infant does not awaken during the night, then the mother may sleep all night. Most 2-week-olds feed every 2 to 4 hours day and night. 4. How long the infant stays awake is not the most important information. Most infants sleep about 20 hours per day. TEST-TAKING HINT: The "red flags" in this question are that the baby sleeps a lot and does not cry much, both unusual behaviors. Follow-up questions need to be asked to determine if the infant is gaining weight as expected.

57. Which is the best advice to offer the parent of a 6-month-old with Werdnig-Hoffman disease on how to treat the infant's constipation? 1. Offer extra water every day. 2. Add corn syrup to two bottles a day. 3. Give the infant a glycerine suppository today. 4. Let the infant go 3 days without a stool before intervening.

1 57. 1. Constipation means hard stools and infrequent passage. Adding extra water to the diet helps make the stool softer in this age child. 2. It is not recommended to add corn syrup or honey to the bottle of a child younger than 12 months because of the danger of botulism. 3. It is not recommended to give an infant a glycerine suppository for hard infrequent stools; constipation should be managed with dietary changes. 4. Adding additional water daily is the easiest first step in handling constipation. TEST-TAKING HINT: The test taker must know how to treat constipation in an infant, which is different from treating it in a child.

58. Which should the nurse do for a 6-year-old living in a rural area who is missing school shots and who has sustained a puncture wound? 1. Administer DTaP vaccine 2. Start the child on an antibiotic. 3. Clean the wound with hydrogen peroxide. 4. Send the child to the emergency department.

1 58. 1. A child less than 7 years of age and not fully immunized who has a tetanusprone wound should receive DTaP vaccine to prevent tetanus. Tetanusprone wounds include puncture wounds and those contaminated with dirt, feces, or soil. 2. An antibiotic probably will be started, but administering DTaP vaccine is the priority. 3. Wounds are routinely cleansed with soap and water. Hydrogen peroxide does not clean better. 4. This child can be cared for in the clinic. TEST-TAKING HINT: The test taker must know about wound care and which wounds are considered contaminated.

6. A 5-year-old has been diagnosed with pseudohypertrophic muscular dystrophy. Which nursing intervention would be appropriate? 1. Discuss with the parents the potential need for respiratory support. 2. Explain that this disease is easily treated with medication. 3. Suggest exercises that will limit the use of muscles and prevent fatigue. 4. Assist the parents in finding a nursing facility for future care.

1 6. 1. Muscles become weaker, including those needed for respiration, and a decision will need to be made about whether respiratory support will be provided. 2. This is a progressive disease, which medications do not treat. 3. Physical therapy will be part of the treatment plan, but respiratory support is a priority. 4. The parents need to decide eventually if they will keep the child home or cared for in a nursing facility, but that is not an immediate concern. TEST-TAKING HINT: Pseudohypertrophic muscular dystrophy is a progressive neuromuscular disease with no cure.

8. Which will help a school-aged child with muscular dystrophy stay active longer? 1. Normal activities, such as swimming. 2. Using a treadmill every day. 3. Several periods of rest every day. 4. Using a wheelchair upon getting tired.

1 8. 1. Children who are active are usually able to postpone use of a wheelchair. It is important to keep using muscles for as long as possible, and aerobic activity is good for a child. 2. Use of a treadmill is not fun for children or adults, so keeping the child using the treadmill might be an issue. 3. Any child with a chronic disease should be kept as active as possible for as long as possible. 4. The goal is to keep the child as active as possible to postpone use of a wheelchair for as long as possible. TEST-TAKING HINT: Appropriate interventions for different kinds of chronically ill children can be similar, so think about what would be best for this child.

55. A child has a provisional diagnosis of myasthenia gravis. Which should the nurse expect in this child? Select all that apply. 1. Double vision. 2. Ptosis. 3. Fatigue. 4. Ascending paralysis. 5. Sensory disturbance.

1, 2, 3. 1. Symptoms in a child with myasthenia gravis include fatigue, double vision, ptosis, and difficulty swallowing and chewing. This is an autoimmune disease triggered by a viral or bacterial infection. Antibodies attack acetylcholine receptors and block their functioning. 2. Symptoms in a child with myasthenia gravis include fatigue, double vision, ptosis, and difficulty swallowing and chewing. 3. Symptoms in a child with myasthenia gravis include fatigue, double vision, ptosis, and difficulty swallowing and chewing. 4. Symptoms in a child with myasthenia gravis include fatigue, double vision, ptosis, and difficulty swallowing and chewing. 5. Symptoms in a child with myasthenia gravis include fatigue, double vision, ptosis, and difficulty swallowing and chewing. TEST-TAKING HINT: The test taker must know the correct symptoms of myasthenia gravis.

9. The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. Mother 2. Sister. 3. Brother. 4. Aunts and all female cousins. 5. Uncles and all male cousins.

1, 2, 4. 1. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. 2. Women carry the disease, and males are affected. All female relatives should be tested. 3. Women carry the disease, and males are affected. All female relatives should be tested. 4. Women carry the disease, and males are affected. All female relatives should be tested. 5. Women carry the disease, and males are affected. All female relatives should be tested. TEST-TAKING HINT: Knowing that Duchenne muscular dystrophy is inherited as an Xlinked trait excludes father, brother, uncle, and male cousins as carriers.

18. The nurse is planning care for a child with a T12 spinal cord injury. Which lifelong complications should the child and family know about? Select all that apply. 1. Skin integrity. 2. Incontinence. 3. Loss of large and small motor activity. 4. Loss of voice. 5. Flaccid paralysis.

1, 2. 1. Spinal cord-injury patients experience many issues due to loss of innervation below the level of the injury. Skin integrity and incontinence are issues because of immobility and loss of pain receptors below the level of the injury. 2. Skin integrity and incontinence are issues because of immobility and loss of pain receptors below the level of the injury. 3. Loss of motor activity is also a result of loss of innervation below the level of the injury. 4. Loss of voice is not a complication of T12 injury. 5. Flaccid paralysis occurs initially but changes to spasticity during the rehabilitation stage. TEST-TAKING HINT: The test taker must know the long-term effects of spinal cord injuries.

43. A child is admitted to the pediatric unit with spastic CP. Which would the nurse expect a child with spastic CP to demonstrate? Select all that apply. 1. Increased deep tendon reflexes. 2. Decreased muscle tone. 3. Scoliosis. 4. Contractures. 5. Scissoring. 6. Good control of posture. 7. Good fine motor skills.

1, 3, 4, 5. 43. 1. Children with spastic CP have increased deep tendon reflexes. 2. Children with spastic CP have increased muscle tone. 3. Children with spastic CP have scoliosis. 4. Children with spastic CP have contractures of the Achilles tendons, knees, and adductor muscles. 5. Children with spastic CP have scissoring when walking. 6. Children with spastic CP have poor control of posture. 7. Children with spastic CP have poor fine motor skills. TEST-TAKING HINT: The test taker must know the typical signs of CP.

10. The nurse knows that teaching was successful when a parent states which of the following are early signs of muscular dystrophy? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity.

2 10. 1. Muscles become enlarged from fatty infiltration, so they are not stronger. 2. Difficulty climbing stairs, running, and riding a bicycle are frequently the first symptoms of Duchenne muscular dystrophy. 3. High fevers and tiredness are not early signs of muscular dystrophy but could be later signs as complications become more common. 4. Respiratory infections and obesity are major complications as the disease progresses. TEST-TAKING HINT: Early symptoms have to do with decreased ability to perform normal developmental tasks involving muscle strength.

15. The nurse evaluates the teaching as successful when a parent states that which of the following can cause autonomic dysreflexia? 1. Exposure to cold temperatures. 2. Distended bowel or bladder. 3. Bradycardia. 4. Headache.

2 15. 1. Exposure to cold temperatures does not trigger an episode of autonomic dysreflexia. 2. Autonomic dysreflexia results from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc due to stimulation of the sympathetic nervous system. It is a response that typically results from stimulation of sensory receptors such as a full bladder or bowel. 3. Symptoms of autonomic dysreflexia are bradycardia, headache, and potentially life-threatening hypertension. 4. Symptoms of autonomic dysreflexia are bradycardia, headache, and potentially life-threatening hypertension. TEST-TAKING HINT: The test taker must know what triggers autonomic dysreflexia and what the symptoms are.

16. When assessing the neurological status of an 8-month-old, the nurse should check for which of the following? 1. Clarity of speech. 2. Interaction with staff. 3. Vision test. 4. Romberg test.

2 16. 1. The infant is preverbal, so assessing clarity of speech is not age-appropriate or developmentally appropriate. 2. Assessment for alteration in developmentally expected behaviors, such as stranger anxiety, is helpful. Interaction with staff is not to be expected due to stranger anxiety. 3. Vision testing is not the priority assessment. 4. An 8-month-old infant is not tested with the Romberg test. TEST-TAKING HINT: The test taker must know what is appropriate infant development.

19. After spinal cord surgery, an adolescent suddenly complains of a severe headache. Which should be the nurse's first action? 1. Check the blood pressure. 2. Check for a full bladder. 3. Ask if pain is present somewhere else. 4. Ask if other symptoms are present.

2 19. 1. The autonomic nervous system responds with arteriolar vasospasm, which results in an uncontrolled increase in blood pressure. The parasympathetic nervous system (vagus nerve) sends a stimulus to the heart resulting in bradycardia and vasodilation. 2. The sympathetic nervous system responds to a full bladder or bowel resulting from an uncontrolled, paroxysmal, continuous lower motor neuron reflex arc. This response is usually from stimulation of sensory receptors (e.g., distended bladder or bowel). Because the efferent pulse cannot pass through the spinal cord, the vagus nerve is not "turned off," and profound symptomatic bradycardia may occur. 3. Pain is not usually felt below the level of the injury, and pain elsewhere does not cause a severe headache. 4. In autonomic dysreflexia, the patient does not experience other symptoms. TEST-TAKING HINT: Autonomic dysreflexia is usually caused by a full bladder or bowel.

2. The nurse is performing an admission assessment on a 9-year-old who has just been diagnosed with systemic lupus erythematosus. Which assessment findings should the nurse expect? 1. Headaches and nausea. 2. Fever, malaise, and weight loss. 3. A papular rash covering the trunk and face. 4. Abdominal pain and dysuria.

2 2. 1. Neuropsychiatric symptoms include difficulty concentrating in school and emotional instability. 2. Fever, malaise, and weight loss are common presenting signs. 3. A rash is common, but with lupus it is usually a "butterfly" rash across the bridge of the nose. Maculopapular rashes are common but are usually on sun-exposed areas. 4. Lupus nephritis requires urine output monitoring and is usually asymptomatic. TEST-TAKING HINT: The test taker must know the presenting signs and symptoms of systemic lupus erythematosus.

20. An adolescent with a T4 spinal cord injury suddenly becomes dangerously hypertensive and bradycardic. Which intervention is appropriate? 1. Call the neurosurgeon immediately, as this sounds like sudden intracranial hypertension. 2. Check to be certain that the patient's bladder is not distended. 3. Administer Hyperstat to treat the blood pressure. 4. Administer atropine for bradycardia.

2 20. 1. Sudden hypertension and bradycardia are symptoms of autonomic dysreflexia. 2. Check to be certain that the bladder is not distended, which would trigger autonomic dysreflexia. 3. The first intervention is to assess the bladder for fullness before administering any medication. 4. The first intervention is to assess the bladder for fullness before administering any medication. TEST-TAKING HINT: The test taker must know which symptoms are suggestive of autonomic dysreflexia.

26. Which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? 1. Weigh diapers for 24-hour urine output. 2. Measure head circumference. 3. Offer clear fluids. 4. Assess for infection.

2 26. 1. Weighing diapers for 24-hour urine output totals is important, but it is not the first thing to do following surgery. 2. Hydrocephalus occurs in about 90% of infants with myelomeningocele, so measuring the head circumference daily and watching for an increase are important. Accumulation of cerebrospinal fluid can occur after closure of the sac. 3. Clear fluids are offered after the infant is fully awake and there is no vomiting. 4. Assessing for infection is important, but infection is not usually seen in the initial post-operative period. TEST-TAKING HINT: The dynamics of the cerebrospinal fluid change after closure of the sac.

27. Which should be the priority nursing diagnosis for a 12-hour-old newborn with a myelomeningocele at L2? 1. Altered bowel elimination related to neurological deficits. 2. Potential for infection related to the physical defect. 3. Altered nutrition related to neurological deficit. 4. Disturbance in self-concept related to physical disability.

2 27. 1. Infants with myelomeningocele have altered bowel elimination as a result of their defect, but this is not the priority. 2. Because this infant has not had a repair, the sac is exposed. It could rupture, allowing organisms to enter the cerebrospinal fluid, so this is the priority. 3. These infants usually eat normally. 4. The infant is too young to have a selfconcept disturbance yet. TEST-TAKING HINT: Before surgery, the myelomeningocele is exposed, so risk of infection is much higher.

28. Over the last week, an infant with a repaired myelomeningocele has had a highpitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile. Today length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following? 1. Tell the parent this is normal for an infant with a repaired myelomeningocele. 2. Tell the parent this might mean the baby has increased intracranial pressure. 3. Suspect the baby's intracranial pressure is low because of a leak. 4. Refer the baby to the neurologist for follow-up care.

2 28. 1. The fact that the head circumference has changed so much might indicate increased intracranial pressure. 2. The increase in head size is one of the first signs of increased intracranial pressure; other signs include highpitched cry and irritability. 3. The increase in head size is one of the first signs of increased intracranial pressure; other signs include high-pitched cry and irritability. 4. This infant should be referred to the neurosurgeon, not the neurologist, and a CT scan should be obtained to determine the cause of the increase. TEST-TAKING HINT: The test taker should know how fast an infant's head size changes.

29. Which should the nurse tell the parent of an infant with spina bifida? 1. "Bone growth will be more than that of babies who are not sick because your baby will be less active." 2. "Physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills." 3. "Nutritional needs for your infant will be calculated based on activity level." 4. "Fine motor skills will be delayed because of the disability."

2 29. 1. Bone growth is related to weight bearing as well as to secretion of the growth hormone. Decreased activity usually results in less bone growth. 2. Children with decreased activity due to illness or trauma are helped by physical and occupational therapy. The varied activities stimulate the senses. 3. This is partially true. Nutritional needs in children are also calculated based on growth needs. 4. Many children with myelomeningocele have low-level defects, usually in the lumbar area, which do not affect upper body fine motor skills. TEST-TAKING HINT: The test taker should know normal growth patterns.

42. The nurse is doing a follow-up assessment of a 9-month-old. The infant rolls both ways, sits with some support, pushes food out of the mouth, and pushes away when held. The parent asks about the infant's development. The nurse responds by saying which of the following? 1. "Your child is developing normally." 2. "Your child needs to see the primary care provider." 3. "You need to help your child learn to sit unassisted." 4. "Push the food back when your child pushes food out."

2 42. 1. A 9-month-old should be able to sit alone, crawl, pull up, not push food out of the mouth (tongue thrust), and push away when held when wanting to get down. This child is not developing normally and must see the primary care provider. 2. A 9-month-old should be able to sit alone, crawl, pull up, not push food out of the mouth (tongue thrust), and push away when held when wanting to get down. This child is not developing normally and must see the primary care provider. 3. The mother will need help to teach the child how to sit alone. 4. Pushing food back into the mouth may be one strategy, but this is clearly abnormal in a 9-month-old. TEST-TAKING HINT: The test taker must know normal developmental milestones. Rolling occurs at about 4 months, sitting alone occurs at 6 months, and pushing food out of the mouth decreases by 4 months when the tongue thrust reflex wanes.

44. A 3-year-old child with CP is admitted for dehydration following an episode of diarrhea. The nurse's assessment follows: awake, pale, thin child lying in bed, multiple contractures, drooling, coughing spells noted when parent feeds. T 97.8°F (36.5°C), P 75, R 25, weight 7.2 kg, no diarrheal stool for 48 hours. Which nursing diagnosis is most important? 1. Potential for skin breakdown: lying in one position. 2. Alteration in nutrition: less than body requirements. 3. Potential for impaired social support: mother sole caretaker. 4. Alteration in elimination: diarrhea.

2 44. 1.This child is definitely at risk for skin breakdown, but alteration in nutrition is the priority. The child weighs 15 pounds, which is normal for a 4-month-old. The child is severely underweight. The mother needs help to manage the coughing spells while the child is being fed. 2. This is the priority nursing diagnosis for this severely underweight child. Weight is average for a 4-month-old. The coughing episodes while feeding may indicate aspiration. The parent needs help to learn how to feed so less coughing occurs. 3. The parent needs support in caring for this child, but alteration in nutrition is the priority. The child weighs 15 pounds, which is normal for a 4-month-old. The child is severely underweight. The parent needs help to manage the coughing spells while the child is being fed. 4. The child has not had a diarrheal stool for 48 hours, so the assumption is safe that the illness is over. The child weighs 15 pounds, which is normal for a 4-month-old. The child is severely underweight. The parentneeds help to manage the coughing spells while the child is being fed. TEST-TAKING HINT: The test taker should convert the weight in kilograms to pounds to have a better understanding of it. Knowing what a 3-year-old should weigh helps with answering this question.

49. The parents of a toddler diagnosed with Werdnig-Hoffmann disease ask the nurse what they can feed their child that would be quality food. Which would be good choices for the nurse to recommend? 1. A hot dog and chips. 2. Chicken and broccoli. 3. A banana and almonds. 4. A milkshake and a hamburger.

2 49. 1. Hot dogs and chips are too high in sodium and fat. 2. Chicken is a good source of protein, and broccoli is a good choice for naturally occurring vitamins. 3. A banana is a food toddlers usually like. A child under 5 years should not eat nuts, because they are a choking hazard for a child who does not chew food well. 4. A milkshake has a high amount of fat, as does a hamburger. TEST-TAKING HINT: The test taker must know good-quality foods that should be offered to children.

50. The parent of a child diagnosed with Werdnig-Hoffmann disease notes times of not being able to hear the child breathing. Which should the nurse do first? 1. Check pulse oximetry on the child. 2. Count the child's respirations. 3. Listen to the child's lung sounds. 4. Ask the parent if the child coughs at night.

2 50. 1. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds, and then check pulse oximetry. 2. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds, and then check pulse oximetry. 3. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds, and then check pulse oximetry. 4. The first intervention is to check the respiratory rate of the child to see if it is abnormal, then listen to the lung sounds, and then check pulse oximetry. Asking if the child coughs at night would be helpful information as well. TEST-TAKING HINT: The test taker would first count respirations to determine if the rate is normal for a child that age. Auscultation comes next, then pulse oximetry if needed.

56. The nurse judges teaching as successful when the parent of a child with myasthenia gravis states which of the following? 1. "My child should play on the school's basketball team." 2. "My child should meditate every day." 3. "My child should be allowed to do what other kids do." 4. "My child should be watched carefully for signs of illness."

2 56. 1. Children with myasthenia gravis should not play strenuous sports. They should learn strategies to decrease stress. 2. Meditation is a good strategy to learn to decrease stress. 3. Children with myasthenia gravis can do many things other children do. They should be advised not to play strenuous sports, however, and they should learn how to control stress. 4. Children are watched for signs of illness because of the exacerbation of signs of myasthenia gravis. TEST-TAKING HINT: The test taker must know the physiology of the illness.

61. Causes of autonomic dysreflexia include which of the following? Select all that apply. 1. Decrease in blood pressure. 2. Abdominal distention. 3. Bladder distention. 4. Diarrhea. 5. Tight clothing. 6. Hypothermia.

2, 3, 5. 61. A decrease in blood pressure does not contribute to autonomic dysreflexia. Increased blood pressure usually occurs with autonomic dysreflexia. 2. Autonomic dysreflexia may be caused by abdominal pressure from a fecal impaction. 3. An overdistended bladder is usually the precipitating factor causing an increase in abdominal pressure. 4. Fecal impaction and constipation, not diarrhea, can be causes of autonomic dysreflexia. 5. Tight clothing can increase pressure to the central core of the body. 6. Hyperthermia does not cause autonomic dysreflexia. TEST-TAKING HINT: Autonomic dysreflexia most often occurs due to an irritating stimulus within the body below the level of spinal cord injury.

25. Which should be included in the plan of care for a newborn with a myelomeningocele who will have a surgical repair tomorrow? 1. Offer formula every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours.

3 25. 1. A newborn may want formula every 2 to 4 hours but frequently is too sleepy to eat on a schedule. 2. The infant should not be positioned on the back before surgery because of the potential to rupture the sac. 3. Priority care for an infant with a myelomeningocele is to protect the sac. A wet dressing keeps it moist with less chance of tearing. 4. Infants with myelomeningocele do not have pain because of lack of nerve innervations below the level of the defect. TEST-TAKING HINT: Realizing the defect is on the back eliminates answer 2. Knowing newborns are sleepy and do not eat on a schedule eliminates answer 1.

34. A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus? 1. Low-pitched cry and depressed fontanel. 2. Low-pitched cry and bulging fontanel. 3. Bulging fontanel and downwardly rotated eyes. 4. Depressed fontanel and upwardly rotated eyes.

3 34. 1. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. 2. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. 3. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. With sunset eyes the sclera can be seen above the iris. 4. An alteration in the circulation of the cerebrospinal fluid causes hydrocephalus. The anterior fontanel bulges because of an increase in cerebrospinal fluid, and an increase in intracranial pressure causes a high-pitched cry in infants and downward deviation of the eyes, also called sunset eyes. TEST-TAKING HINT: The test taker must know the difference in clinical signs of hydrocephalus in infants and older children. Infants' heads expand, whereas older children's skulls are fixed. The anterior fontanel closes between 12 and 18 months.

4. The nurse should tell the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy that some of the progressive complications include: 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, and dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech.

3 4. 1. These symptoms are common with Down syndrome. 2. Duchenne muscular dystrophy does not produce these symptoms. 3. The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems. 4. These symptoms are evidence of a possible head injury. TEST-TAKING HINT: The test taker should be able to identify signs and symptoms attributable to the loss of muscle function.

40. The parent of a young child with CP brings the child to the clinic for a checkup. Which parent's statement indicates an understanding of the child's long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I'm the one who knows the most about my child and can do the most for my child."

3 40. 1. The parent has an unrealistic picture of the child's future. The parent must help the child achieve as much independence as possible in order to achieve full potential. 2. The child probably will never catch up to other children. That is part of the disorder, so the parent's role is to help the child achieve as much independence as possible. 3. This statement indicates that the parent understands the long-term needs of the child. 4. Parents do know the most about their children, but doing the most for the child is not the best way to manage the child's development. The child must become as independent as possible. TEST-TAKING HINT: The test taker must understand the goals for children with chronic illnesses or disorders. One goal is to ensure that the child be diagnosed as early as possible so that interventions can be started. Another is to help the child realize as much potential as possible.

41. A child with spastic CP had an intrathecal dose of baclofen in the early afternoon. What is the expected result 31 /2 hours post dose that suggests the child would benefit from a baclofen pump? 1. The ability to self-feed. 2. The ability to walk with little assistance. 3. Decreased spasticity. 4. Increased spasticity.

3 41. 1. The expected benefit from intrathecal bac - lofen is less spasticity, which allows the child to have more muscle control. This leads to more fine motor control and ambulation. The onset of action is 30 minutes, and it peaks in 6 hours. 2. The expected benefit from intrathecal bac - lofen is less spasticity, which allows the child to have more muscle control. This leads to more fine motor control and ambulation. The onset of action is 30 minutes, and it peaks in 6 hours. 3. If baclofen were going to work for this child, one could tell because spasticity would be decreased. 4. Baclofen should decrease, not increase, spasticity. TEST-TAKING HINT: The test taker must know the purpose of baclofen.

45. The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which is the nurse's best response? 1. "Children with CP have some amount of mental retardation." 2. "Approximately 20% of children with CP have normal intelligence." 3. "Many children with CP have normal intelligence." 4. "Mental retardation is expected if motor and sensory deficits are severe."

3 45. 1. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is severely affected when that may not be true. 2. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is severely affected when that may not be true. 3. Many children with CP have normal intelligence. 4. Children with CP have a range of intellectual abilities, from being profoundly retarded to having a high intelligence quotient. Many have normal intelligence. If a child has severe speech problems, some may assume that the child's intelligence is severely affected when that may not be true. TEST-TAKING HINT: Children with CP have a wide range of intellectual abilities.

48. The mother of an infant diagnosed with Werdnig-Hoffmann disease asks the nurse what she could have done during her pregnancy to prevent this. The nurse explains that the cause of Werdnig-Hoffmann is which of the following? 1. Unknown. 2. Restricted movement in utero. 3. Inherited as an autosomal-recessive trait. 4. Inherited as an autosomal-dominant trait.

3 48. 1. Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait. 2. Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait. 3. Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait. 4. Werdnig-Hoffmann disease is inherited as an autosomal-recessive trait. TEST-TAKING HINT: The test taker needs to know how infants get this progressive disease.

51. A child presents with a history of having had an upper respiratory tract infection 2 weeks ago; complains of symmetrical lower extremity weakness, back pain, muscle tenderness; and has absent deep tendon reflexes in the lower extremities. Which is important regarding this condition? 1. The disease process is probably bacterial. 2. The recent upper respiratory infection is not important information. 3. This may be an acute inflammatory demyelinating neuropathy. 4. CN involvement is rare.

3 51. 1. The disease etiology is frequently viral. 2. Frequently a child has had recent viral infection prior to developing neurological symptoms. 3. This child probably has GBS, which is an acute inflammatory demyelinating neuropathy. 4. CNs are frequently involved. TEST-TAKING HINT: Having a prior upper respiratory infection usually means this condition is not caused by bacteria, which eliminates answers 1 and 2. That leaves the choice between answers 3 and 4.

52. A child with GBS has had lots of oral fluids but has not urinated for 8 hours. Which is the nurse's first action? 1. Check the child's serum blood-urea-nitrogen level. 2. Check the child's complete blood count. 3. Catheterize the child in and out. 4. Run water in the bathroom to stimulate urination.

3 52. 1. Children with GBS frequently have urinary retention, so catheterization is necessary. Complications of GBS are usually respiratory and swallowing difficulties. Checking the serum blood urea nitrogen is a good thing to do, but not having voided in 10 hours is quite a lengthy time for a child. 2. The complete blood count does not provide helpful information about urinary retention. 3. The child must be in-and-out catheterized to avoid the possibility of developing a urinary tract infection from urine left in the bladder for too long. 4. Running water in the bathroom is a strategy used frequently to encourage patients to void. It takes time for it to work, however, and sometimes it does not have the intended results. TEST-TAKING HINT: Urinary retention occurs with GBS, and catheterization is necessary in a child who has had lots of fluids but not voided in 8 hours.

53. The nurse is planning care for a child who was recently admitted with GBS. Which is a priority nursing diagnosis? 1. Risk for constipation related to immobility. 2. Chronic sorrow related to presence of chronic disability. 3. Impaired skin integrity related to infectious disease process. 4. Activity intolerance related to ineffective cardiac muscle function.

3 53. 1. The goal is to prevent complications related to immobility. Efforts include maintaining skin integrity, maintaining respiratory function, and preventing contractures. Constipation is a concern but not the primary one. 2. Most children recover completely, so there is no chronic sorrow. 3. The goal is to prevent complications related to immobility. Efforts include maintaining skin integrity, maintaining respiratory function, and preventing contractures. 4. GBS is a disease affecting the peripheral nervous system, not the cardiac muscle. TEST-TAKING HINT: The test taker must have a basic understanding of GBS and know that it affects the peripheral nervous system.

59. Which should the nurse expect in a 2-week-old with a brachial plexus injury? Select all that apply. 1. History of a normal vaginal delivery. 2. Small infant. 3. Absent Moro reflex on one side. 4. No sensory loss. 5. Associated clavicle fracture.

3, 4, 5. 1. A brachial plexus injury in an infant (resulting from tearing or stretching of a nerve) usually occurs with large babies and breech delivery. 2. A brachial plexus injury in an infant (resulting from tearing or stretching of a nerve) usually occurs with large babies and breech delivery. 3. The infant will have an absent Moro reflex on one side and no sensory loss. 4. The infant will have an absent Moro reflex on one side and no sensory loss. 5. The injury may be associated with a fractured clavicle. TEST-TAKING HINT: The test taker must know what a brachial plexus is and how an injury would affect it.

1.An adolescent presents with sudden-onset unilateral facial weakness with drooping of one side of the mouth. The teen is unable to close the eye on the affected side, but has no other symptoms and otherwise feels well. The nurse could summarize the condition by which of the following? 1. The prognosis is poor. 2. This may be a stroke. 3. It is a fifth CN palsy. 4. This is paralysis of the facial nerve.

4 1. Paralysis of the facial nerve (CN VII) generally resolves within 2 to 4 weeks and has a good prognosis. Treatment is supportive. 2. It would be very unusual for a healthy adolescent to have a stroke. One would also expect other symptoms. 3. CN V (the trigeminal nerve) innervates the muscles of mastication. 4. This patient has Bell's palsy, which is an idiopathic mononeuritis of CN VII (the facial nerve) that innervates the face and muscles of expression. TEST-TAKING HINT: The test taker must know CNs and their actions.

11. The nurse is caring for a school-aged child with Duchenne muscular dystrophy in the elementary school. Which would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

4 11. 1. This diagnosis would relate to the family and not to the child. 2. This diagnosis would relate to the family and not to the child. 3. The child does not have pain with the muscular dystrophy process. 4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength. TEST-TAKING HINT: Knowing that the child has decreased strength helps to answer the question.

31. A 15-year-old with spina bifida is seen in the clinic for a well-child checkup. The teen uses leg braces and crutches to ambulate. Which nursing diagnosis takes priority? 1. Potential for infection. 2. Alteration in mobility. 3. Alteration in elimination. 4. Potential body image disturbance.

4 31. 1. This is certainly a possibility, especially as the teen uses braces and can have some skin irritation. 2. This is a nursing diagnosis to attend to now, because the teen uses braces and crutches. 3. Because the teen is ambulatory, the teen probably has a lower-level defect, but even lower-level defects have some type of elimination issues. 4. As an adolescent on crutches and wearing braces, the teen would have the issue of body image disturbance, which must be addressed. This is a priority. TEST-TAKING HINT: The test taker must know normal development.

33. Which should the nurse prepare the parents of an infant for following surgical repair and closure of a myelomeningocele shortly after birth? The infant will: 1. Not need any long-term management and should be considered cured. 2. Not be at risk for urinary tract infections or movement problems. 3. Have continual drainage of cerebrospinal fluid, needing frequent dressing changes. 4. Need lifelong management of urinary, orthopedic, and neurological problems.

4 33. 1. Children with myelomeningocele have ongoing, lifelong, complex health-care needs. 2. Children with myelomeningocele may have frequent urinary tract infections and mobility concerns. 3. The surgical closure prevents the leakage of cerebrospinal fluid; dressing changes are necessary only during the post-operative period. 4. Although immediate surgical repair decreases infection, morbidity, and mortality rates, these children will require lifelong management of neurological, orthopedic, and elimination problems. TEST-TAKING HINT: The test taker can eliminate answer 1 due to the complexity of myelomeningocele.

35. The nurse is developing a plan of care for a child recently diagnosed with cerebral palsy (CP). Which should be the nurse's priority goal? 1. Ensure the ingestion of sufficient calories for growth. 2. Decrease intracranial pressure. 3. Teach appropriate parenting strategies for a special-needs child. 4. Ensure that the child reaches full potential.

4 35. 1. Adequate calories are an appropriate goal, but the priority for a special-needs child is that the child develop to full potential. 2. Children with CP do not have increased intracranial pressure. 3. Teaching appropriate parenting strategies for a special-needs child is important and is done so the child can reach full potential. 4. The priority for all children is to develop to their full potential. TEST-TAKING HINT: All of these are important goals, but determining the priority goal for a special-needs child is the key.

36. The nurse evaluates teaching of parents of a child newly diagnosed with cerebral palsy (CP) as successful when the parents state that CP is which of the following? 1. Inability to speak and uncontrolled drooling. 2. Involuntary movements of lower extremities only. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon reflexes.

4 36. 1. Children may also have pseudobulbar involvement, which creates swallowing difficulties and recurrent aspiration. 2. Abnormal involuntary movements usually involve the face, neck, trunk, and extremities. 3. Abnormal involuntary movements usually involve the face, neck, trunk, and extremities. 4. The primary disorder is of muscle tone, but there may be other neurological disorders such as seizures, vision disturbances, and impaired intelligence. Spastic CP is the most common type and is characterized by a generalized increase in muscle tone, increased deep tendon reflexes, and rigidity of the limbs on both flexion and extension. TEST-TAKING HINT: The test taker must know the definition of CP.

39. The parent of an infant asks the nurse what to watch for to determine if the infant has CP. Which is the nurse's best response? 1. "If the infant cannot sit up without support before 8 months." 2. "If the infant demonstrates tongue thrust before 4 months." 3. "If the infant has poor head control after 2 months." 4. "If the infant has clenched fists after 3 months."

4 39. 1. Children with CP frequently have developmental delays, including not being able to sit alone by 8 months. Sitting alone usually occurs by 6 months, so 8 months would be the outer limit of normal development and cause for concern. 2. Tongue thrust is common in infants younger than 6 months, but if it goes on after 6 months it is of concern. 3. Good head control is normally attained by 3 months. 4. Clenched fists after 3 months of age may be a sign of CP. TEST-TAKING HINT: The test taker must know normal developmental milestones to identify those that are abnormal.

5. Which can elicit the Gower sign? Have the patient: 1. Close the eyes and touch the nose with alternating index fingers. 2. Hop on one foot and then the other. 3. Bend from the waist to touch the toes. 4. Walk like a duck and rise from a squatting position.

4 5. 1. This is the Romberg sign, which measures balance. 2. This test measures balance and coordination. 3. This test measures flexibility. 4. Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from a squatting position due to the lack of muscle strength. TEST-TAKING HINT: By eliminating cerebellar activities, the test taker would know that the Gower sign assists in measuring leg strength.

54. Which should the nurse expect as an intervention in a child in the recovery phase of GBS? 1. Assess for respiratory compromise. 2. Assess for swallowing difficulties. 3. Evaluate neuropsychological functioning. 4. Begin an active physical therapy program.

4 54. 1. Assessing for respiratory compromise is critical in the acute phase of the disease process. Beginning active physical therapy is important for helping muscle recovery and preventing contractures. 2. Assessing for swallowing difficulties is critical in the acute phase of the disease process. Beginning active physical therapy is important for helping muscle recovery and preventing contractures. 3. GBS does not affect cognitive functioning. 4. Beginning active physical therapy is important for helping muscle recovery and preventing contractures. TEST-TAKING HINT: The test taker must know the normal progress of the disease. A hint is provided by the word recovery in the question.

7. Which foods would be best for a child with Duchenne muscular dystrophy? 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain.

4 7. 1. As the child with muscular dystrophy becomes less active, diet becomes more important. Attention should be paid to quality and quantity of food, so the child does not gain too much weight. 2. Good-quality foods are important as the child continues to grow. 3. Extra protein will not help the child recover from this disease. 4. As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation. TEST-TAKING HINT: Nutrition is important for every child; as the child becomes less ambulatory, weight concerns arise.