Neuro Ch 28 PrepU

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents?

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

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response?

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

The nurse is assessing the moro reflex of a 3-month-old infant. What action will the nurse perform?

Gently lift the infant off the bed by the arms, and let go when the shoulders are off the bed.

A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation?

Muscular wasting results in generalized immobility and difficulty feeding and breathing. (SMA type 1 is the most severe form of spinal muscle atrophy that results in muscle wasting, generalized immobility and difficulty feeding. This is an autosomal recessive genetic disorder that affects motor but not cognitive development. SMA type 1 has a rapid progression; these infants do not usually live past 2 years of age. Infants diagnosed with SMA type 1 will not sit unassisted and will not walk. Physical therapy is beneficial in strengthening some muscles, especially in those with the less severe SMA types 2, 3 or 4.)

The nurse is caring for a newborn with spina bifida and a myelomeningocele who was born approximately 1 hour ago. What action will the nurse anticipate in the plan of care for the child?

Prepare the infant for spinal surgery.

The nurse is caring for a child with spinal muscular atrophy being treated with azithromycin. What consideration will the nurse take into account in the plan of care while administering this medication?

Report diarrhea and abdominal cramping to the health care provider.

The nurse is assessing a 1-month-old infant's ability to feed during the neurologic assessment. What action will the nurse perform?

Stroke the infant's cheek.

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?

anal wink

Testing a child's hearing by observing a response to a whisper without a visual clue assesses

cranial nerve VIII, the acoustic nerve.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal?

creatine kinase

Through which mechanism is Duchenne muscular dystrophy acquired?

heredity

A 3-month-old infant is seen in the pediatric clinic. The infant's parent expresses concern that the child has developed cerebral palsy. The nurse assesses the infant. Which assessment finding indicates to the nurse that the parent's concern is valid?

hypertonia in the upper extremities

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation?

presence of Moro reflex (The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child.)

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele?

risk for infection

The nurse is caring for a school-age child diagnosed with Duchenne muscular dystrophy who is receiving glucocorticoid therapy. When teaching the parents about this therapy, the nurse would emphasize which aspect?

safety measures for injury prevention (Although annual cardiac exams, active and passive range-of-motion exercises, and assisted coughing techniques are important components of care for a child with Duchenne muscular dystrophy (DMD), safety measures for injury prevention would be critical for this child because of the use of glucocorticoids. This therapy has been shown to improve neuromuscular outcomes but it is also associated with adverse effects on bone health. Long-term use predisposes the child to osteoporosis. Coupled with the fact that children with DMD have progressively weakening muscles, the risk of osteoporosis is compounded. Both vertebral fractures and fractures of the long bones are common even in low-level trauma. Therefore, safety would be the priority.)

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first?

standing

The nurse is assessing the spine of an infant. Which finding requires further follow up by the nurse?

tuft of hair present on the lower back

The nurse is preparing to perform a neurologic assessment on a 2-year-old child at a well-child visit. How will the nurse begin the assessment?

while the child is in the caregiver's lap

____is the trigeminal nerve and is tested by having the child bite down and by evaluating the corneal reflex and also sensory response with a cotton wisp.

Nerve V

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?

Risk for impaired skin integrity

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?

"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved."

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?

3-year-old preschool-aged child who goes up stairs on hands and knees

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?

VII

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?

VII (The nurse is testing if cranial nerve VII was intact. The cranial nerve VII is the facial nerve and can be assessed by asking to see a child's teeth, having them smile, or lift an eyebrow. In infants facial symmetry would be assessed. Cranial nerve II is assessed by testing visual fields and visual acuity. Cranial nerve IV is tested by having the child move eyes downward and inward. Cranial nerve VI is assessed by checking for the ability of the eyes to move laterally.)

DMD (Duchenne Muscular Dystrophy)

a disease causing skeletal muscle degeneration, resulting in progressive muscle weakness and deterioration

A 10-year-old child is brought to the emergency department by the parents. Based on the documented findings above, the nurse suspects Guillain-Barré syndrome, which is later confirmed by diagnostic testing. When developing the child's plan of care, which treatment would the nurse anticipate as the priority?

administration of intravenous immune globulin (IVIG)

The nurse is assessing the coordination of a 2-year-old child at a well-child visit. For what will the nurse observe?

gait while walking (he nurse will observe the gait while walking for a 2-year-old child, because this is a developmentally appropriate approach to assessing the child's coordination based on the child's age. Attempts to touch the caregiver's face would be an appropriate part of the coordination assessment for an infant of about 2 months old. The heel-to-toe walking ability is appropriate for assessing coordination in a child of about 3 to 4 years, whereas walking on the heels and then only on the toes may be used to assess the coordination of school-age and older children.)

A sign of Duchenne muscular dystrophy is

growers sign

The nurse is providing education for the parents of a child with muscular dystrophy about nutrition. Which statement by the parent requires further follow up by the nurse?

"Becoming overweight is not a concern; I should encourage high-calorie foods whenever possible." (The statement, "Becoming overweight is not a concern; I should encourage high-calorie foods whenever possible," is inaccurate and requires further follow up by the nurse. Although malnutrition and weight loss are of concern, inactivity and glucocorticoid use make the child with muscular dystrophy prone to obesity. The statements, "Long-term use of glucocorticoids may increase hunger," "Swallowing and nutrient absorption may become impaired," and "A feeding tube may be required later in my child's care," are accurate with regard to nutrition and muscular dystrophy and do not require further follow up by the nurse.)

Which statement about cerebral palsy would be accurate?

"Cerebral palsy is a condition that doesn't get worse."

The nurse is conducting a presentation for a group of parents of adolescents at a local high school about spinal cord injury. One of the parents asks, "What is the most common cause of this type of injury?" Which response by the nurse would be most appropriate?

"Motor vehicle accidents cause over 50% of these injuries."

The nurse is providing education for the parent of a 4-year-old child who exhibits gross motor delay, difficulty navigating stairs, clumsiness, and a positive Gower sign. Molecular genetic testing for the child is pending. Which statement by the parent requires further follow up by the nurse?

"My child has Gower sign, and soon physical therapy should be started for Duchenne muscular dystrophy."

The nurse is caring for an infant with spina bifida and an open lesion at T4. The infant begins to exhibit signs of respiratory insufficiency and requires intubation. What action(s) will the nurse include in the plan of care? Select all that apply.

-Assess for anal wink reflex. -Keep the infant in a side-lying position during suctioning, drying, and assessment until intubation is performed. -Make accommodations to prevent pressure on the lesion while infant is supine after intubation. -Monitor urinary output.

What methods can a nurse use to evaluate extremity function in an 18-month-old? Select all that apply.

-Observe the child in developmentally appropriate play. -Elicit from the parent a description of fine and gross motor activities. -Look for symmetric motion in the arms and legs.

The nurse is caring for a 7-year-old child with cerebral palsy. What intervention(s) will the nurse perform to support adequate nutrition for the child? Select all that apply.

-Offer high-calorie foods when the child is most hungry. -Facilitate the opportunity to eat with family or friends. -Offer choices when possible. -Place child in upright position while feeding.

The nurse is assessing the moro (startle) reflex of a 2-month-old infant. Place the steps in the order in which the nurse will proceed. Use all options.

-Place the infant in the supine position. -Gently lift the infant off the surface by the arms. -Continue lifting until the shoulders are off the bed but the majority of the head is still on the bed. -Let go of the arms. -Observe for the arms flaring outward and abducting.

The nurse is caring for a 3-year-old child with muscular dystrophy who has a respiratory infection and is on mechanical ventilation. What intervention(s) will the nurse take to maintain effective ventilation for the child? Select all that apply.

-Provide frequent suctioning as needed. -Perform frequent mouth care. -Secure tubing and airway devices.

The nurse is assessing an infant with spina bifida for hydrocephalus. Which finding(s) requires further follow up by the nurse? Select all that apply.

-widening sutures on the head -sunset eyes -vomiting

___ is the oculomotor nerve and is testing by evaluating pupil reactivity and the six cardinal positions of gaze.

Cranial nerve III

___is the trochlear and is tested by having the child move the eyes downward and inward.

Cranial nerve IV

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?

Gowers sign

The nurse is assessing the vestibulocochlear nerve function of an infant. How will the nurse proceed with the assessment?

Observe the infant's ability to startle to loud noises.

The nurse is conducting a physical examination of a 10-year-old child. The nurse whispers the child's name from behind the child so that the child does not see the nurse's lips moving. Which cranial nerve is the nurse assessing?

VIII (8)

The nurse is conducting a physical examination of a 10-year-old child. The nurse whispers the child's name from behind the child so that the child does not see the nurse's lips moving. Which cranial nerve is the nurse assessing?

VIII 8 (Testing a child's hearing by observing a response to a whisper without a visual clue assesses cranial nerve VIII, the acoustic nerve. Nerve V is the trigeminal nerve and is tested by having the child bite down and by evaluating the corneal reflex and also sensory response with a cotton wisp. Cranial nerve IV is the trochlear and is tested by having the child move the eyes downward and inward. Cranial nerve III is the oculomotor nerve and is testing by evaluating pupil reactivity and the six cardinal positions of gaze.)

The nurse is reviewing the history of a 3-year-old child diagnosed with cerebral palsy as an infant. Which factor from the child's health history would the nurse identify as placing this child at risk for this condition?

birth at 26 weeks' gestation

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?

creatinine kinase (CK) (In light of the child's assessment findings, the nurse would anticipate the need for a creatinine kinase (CK) level. An elevated creatinine kinase (CK) level further raises the suspicion for DMD and should prompt a referral to a genetic specialist. A normal CK level all but eliminates the possibility for DMD, and alternative diagnoses should be investigated. White blood cell count, prothrombin time, or alkaline phosphatase would be inappropriate and shed no further light on the child's possible diagnosis.)

The nurse is caring for a 1-year-old child who was diagnosed with cerebral palsy during a well-child examination after a series of screening and diagnostic testing. What will the nurse plan to include in the child's care?

facilitating referral to a developmental health care provider

The nurse is teaching the parents of a child with cerebral palsy about side effects that may occur as a result of anticonvulsant therapy. What will the nurse include in the teaching?

gingival hyperplasia