Peds - Chapter 22: Nursing Care of the Child With a Neuromuscular Disorderr

What reflex response will the nurse consider abnormal when assessing the 8-month-old infant? a) Parachute b) Brisk deep tendon c) Babinski d) Plantar grasp

Brisk deep tendon By 8 months, the infant should have +2 or average deep tendon reflexes. The protective parachute reflex would have developed between 6 and 7 months. The plantar grasp will remain until about 9 months and the Babinski until 12 months.

After teaching a group of students about medications commonly used for neuromuscular disorders, the nursing instructor determines that the teaching was successful when the students identify which agent as a centrally acting skeletal muscle relaxant? a) Baclofen b) Botulin toxin c) Prednisone d) Lorazepam

Baclofen

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? a) Vagal nerve stimulator b) Baclofen pump c) Central venous catheter d) Botulinum toxin

Baclofen pump

A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? a) Increasing ICP b) Leaking cerebrospinal fluid c) Increasing head circumference d) Constipation and bladder dysfunction

Constipation and bladder dysfunction

Other than providing direct care to children, what is the major role of nurses in the care of nearly all children with neuromuscular disorders? a) Consoling parents b) Coordinating care by specialists c) Teaching children self-care d) Helping with specialized equipment

Coordinating care by specialists

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way? a) Change position from side to side hourly b) Cover the sac with a saline-moistened dressing c) Keep the mass uncovered and dry d) Prevent cold stress using an Isolette and blankets

Cover the sac with a saline-moistened dressing

A child is to undergo testing for suspected muscular dystrophy and is scheduled for the following tests. Which test would the nurse identify as most important to be completed first? a) Nerve conduction velocity b) Electromyogram c) Muscle biopsy d) Creatine kinase

Creatine kinase

The nurse is assessing a child with spina bifida occulta. During the assessment, the parents say, "It's going to be so difficult taking care of our child. He'll never be able to walk." The nurse identifies which nursing diagnosis as the priority? a) Risk for injury related to lack of muscle control b) Ineffective coping related to diagnosis of chronic condition c) Impaired physical mobility related to spinal cord defect d) Deficient knowledge related to diagnosis and condition

Deficient knowledge related to diagnosis and condition

The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should she use to best describe this condition? a) Degeneration of muscle fibers b) Upper motor neuron lesions c) Lesions of the brain cortex d) A demyelinating disease

Degeneration of muscle fibers

A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal? a) Development of gross motor movement b) Development of fine motor skills c) Promote optimal self-care ability d) Enhance feeding capabilities

Development of gross motor movement

Given knowledge of muscular dystrophy, the nurse would expect to see which form of this condition most commonly in children? a) Duchenne b) Limb-girdle c) Becker d) Myotonic

Duchenne

The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality? 1. Encourage follow-through with physical therapy exercises 2. Restrict the child to a special needs classroom 3. Encourage after school activities within the limites of the child's abilities 4. Ensure the school is aware of the child's capabilities

Encourage after school activities within the limites of the child's abilities

The nurse is teaching a health and wellness course to young women of childbearing age. Which vitamin will the nurse encourage all to take daily? a) Folic acid b) Niacin c) Ascorbic acid d) Calcium

Folic acid

The mother of a 3-year-old with a myelomeningocele is thinking about having another baby. The nurse should inform the woman that she should increase her intake of which acid? a) Folic acid above 0.4 mg/day b) Ascorbic acid to 4 mg/day c) Folic acid to 0.4 mg/day d) Ascorbic acid to 0.4 mg/day

Folic acid above 0.4 mg/day

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? a) Appearance of smaller than normal calf muscles b) Gowers sign c) Indications of hydrocephalus d) Lordosis

Gowers sign

Through which mechanism is Duchenne's muscular dystrophy acquired? a) Heredity b) Autoimmune factors c) Virus d) Environmental toxins

Heredity

Which characteristic is true of cerebral palsy? a) It's progressive. b) It's reversible. c) It results in mental retardation. d) It appears at birth or during the first 2 years of life.

It appears at birth or during the first 2 years of life.

Which of the following strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy? a) Manual wheelchair b) Walker c) Motorized wheelchair d) Long leg braces

Long leg braces

What is the priority nursing intervention for the child recently admitted with Guillian-Barre syndrome? 1. Perform range of motion exercises 2. Take temperature every 4 hours 3. Monitor respiratory status closely 4. Assess skin frequently

Monitor respiratory status closely

When a child is suspected of having muscular dystrophy, a nurse should expect which muscles to be affected first? a) Muscles of respiration b) Muscles of the foot c) Muscles of the hip d) Muscles of the hand

Muscles of the hip

A nurse is conducting a physical examination of a 5-year-old boy with spinal muscular atrophy (SMA) type 2. What assessment findings would the nurse expect to find? a) Pectus excavatum b) Pseudohypertrophy of the calves c) Loss of strength in hip extension d) Loss of strength in ankle dorsiflexion

Pectus excavatum Pectus excavatum develops in children with SMA type 1 and type 2 who exhibit paradoxical breathing. The chest becomes funnel shaped and the xiphoid process is retracted. Pseudohypertrophy of the calves , Loss of strength in hip extension, Loss of strength in ankle dorsiflexion is associated with Duchenne muscular dystrophy.

What will be the nurse's next action after noting dimpling and a tuft of hair located in the lumbosacral area of the preschool child during examination? a) Inspect for precocious hair growth in the genital and underarm areas b) Record and refer the finding for follow-up to the pediatrician c) Move on to other assessments without calling attention to the difference d) Snip the tuft of hair off close to the skin for hygienic reasons

Record and refer the finding for follow-up to the pediatrician

Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? a) Risk for impaired skin integrity b) Disorganized infant behavior c) Peripheral neurovascular dysfunction d) Risk for activity intolerance

Risk for impaired skin integrity

Which diagnostic measure is most accurate in detecting neural tube defects? a) Flat plate of the lower abdomen after the 23rd week of gestation b) Significant level of alpha-fetoprotein present in amniotic fluid c) Presence of high maternal levels of albumin after 12th week of gestation d) Amniocentesis for lecithin-sphingomyelin (L/S) ratio

Significant level of alpha-fetoprotein present in amniotic fluid

Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? a) Standing b) Sitting c) Breathing d) Swallowing

Standing Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a client would have difficulty standing before having difficulty sitting.

The nurse is caring for a 10-year-old girl with myasthenia gravis. The nurse suspects myasthenic crisis based on which of the following? a) Bradycardia b) Tachycardia c) Sweating d) Increased salivation

Tachycardia

The nurse is caring for a child recently fitted with braces on both legs due to cerebral palsy (CP). What would the nurse emphasize in the discharge teaching? a) "If the brace is painful, feel free to take it off." b) "Check the skin that is covered by the braces for redness and breakdown." c) "Please try and follow the therapist's on and off schedule." d) "It is very important to comply with the use of this brace."

"Check the skin that is covered by the braces for redness and breakdown."

The nurse is caring for a newborn with facial nerve palsy from birth trauma. The mother is very upset and concerned about the child's prognosis. Which response by the nurse would be most appropriate? a) "This is the most common facial nerve palsy." b) "Was this from pressure resulting from forceps?" c) "In most cases treatment is not necessary, only observation." d) "Have you seen any signs of improvement?"

"In most cases treatment is not necessary, only observation."

The nurse is caring for a 6-year-old boy with myelomeningocele. The nurse is teaching the mother how to promote appropriate bowel elimination and avoid constipation. Which response from the mother indicates a need for further teaching? a) "I can palpate his abdomen to assess for constipation" b) "My son's activity is too limited to stimulate his bowels." c) "He must have an adequate amount of fluid." d) "I need to figure out his usual pattern for passing stool."

"My son's activity is too limited to stimulate his bowels."

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? a) "Older age at conception is one of the major causes of the defect." b) "It has been linked to maternal alcohol consumption during pregnancy." c) "It's a common complication of amniocentesis." d) "The cause is unknown and there are many environmental factors that may contribute to it."

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

A nurse is teaching the parents of a boy with a neurogenic bladder about clean intermittent catheterization. Which response indicates a need for further teaching? a) "We must be careful to use latex-free catheters." b) "My son may someday learn how to do this for himself." c) "We need to soak the catheter in a vinegar and water solution daily." d) "The very first step is to apply water-based lubricant to the catheter."

"The very first step is to apply water-based lubricant to the catheter."

The nurse is conducting a wellness examination of a 6-month-old child. The mother points out some dimpling and skin discoloration in the child's lumbosacral area. How should the nurse respond? a) "This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look." b) "This is often an indicator of spina bifida occulta as opposed to spina bifida cystica." c) "This could be an indicator of spina bifida; we need to evaluate this further." d) "Dimpling, skin discoloration, and abnormal patches of hair are often indicators of spina bifida occulta."

"This can be considered a normal variant with no indication of a problem; however, the doctor will want to take a closer look."

How would the nurse best describe Gowers' sign to the parents of a child with muscular dystrophy? a) Muscle twitching present during a quick stretch b) The pelvis position during gait c) A transfer technique d) A waddling-type gait

A transfer technique Gowers' sign: uses hands to walk up the body into standing position because lack of hip/thigh muscle

The nurse will prepare the 17-year-old with myasthenia gravis for which surgical procedure to treat the disorder? a) Thyroidectomy b) Cholecystectomy c) Splenectomy d) Thymectomy

Thymectomy

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair? a) Antitip device b) Wheelchair belt c) Extended breaks d) Headrest support

Wheelchair belt

The nurse is caring for a 2-year-old boy with cerebral palsy (CP). The medical record indicates "hypertonicity and permanent contractures affecting both extremities on one side." Based on these findings, the nurse identifies this type of CP as: a) mixed. b) athetoid or dyskinetic. c) ataxic. d) spastic.

spastic

The young girl has been prescribed corticosteroids for dermatomyositis. Which statements by her mother indicates the need for further education? Select all that apply. a) "She's got to take this medication to help with the calcium deposits that can form." b) "We are taking her to Disney in the summer." c) "She might recover completely from this condition." d) "The physician said when it's time for her to stop taking this medication; he will gradually start reducing her dose." e) "I give it to her first thing in the morning before breakfast."

• "I give it to her first thing in the morning before breakfast." • "We are taking her to Disney in the summer."

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply. a) Hemiplegia b) Dysarthria c) Hypertonicity d) Drooling e) Poor control of balance f) Exaggerated deep tendon reflexes

• Exaggerated deep tendon reflexes • Hemiplegia • Poor control of balance • Hypertonicity

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply. a) Supine b) Prone c) Left side lying d) Right side lying e) Semi-Fowler

• Prone • Left side lying • Right side lying

The nurse learns that the child has been admitted with clinical manifestations associated with cholinergic crisis. Which of the following findings is associated with this condition? Select all that apply. a) The child's apical heart rate is 52 beats per minute b) The child is drooling excessively c) The child exhibits diaphoresis d) The child is complaining that his muscles are very weak e) The child's blood pressure is 172/94

• The child exhibits diaphoresis • The child's apical heart rate is 52 beats per minute • The child is complaining that his muscles are very weak • The child is drooling excessively

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors? a) Duchenne muscular dystrophy is a progressive disease of muscles and nerves that affects males and females equally. b) Duchenne muscular dystrophy is diagnosed in boys who develop gait changes during the late school-age years. c) Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. d) Duchenne muscular dystrophy is a nonprogressive disorder that severely affects muscle function through spinal cord atrophy.

Duchenne muscular dystrophy causes progressive muscular weakness that ends in death.

A nurse is preparing a presentation for a health fair focusing on prevention of congenital neuromuscular disorders. What would the nurse emphasize as most important in preventing neural tube defects? a) Ultrasound screening at 16 weeks' gestation b) Folic acid supplementation c) Maternal serum α-fetoprotein levels screening d) Genetic testing for gene identification

Folic acid supplementation

A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history? 1. Age that the child learned to walk. 2. Parents' expectation of the child's development 3. Functional status related to eating and mobility 4. Birth history to identify cause of cerebral palsy

Functional status related to eating and mobility

The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high-risk for having a child with a myelomeningocele? a) History of a previous abdominal surgery. b) History of asthma taking montelukast. c) History of scoliosis. d) History of a seizure disorder and taking phenobarbital.

History of a seizure disorder and taking phenobarbital.

A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention? 1. Apply supplemental oxygen 2. Notify the respiratory therapist 3. Monitor pulse oximentry 4. Position for adequate airway clearance

Position for adequate airway clearance

Question: The young child has been diagnosed with Guillain-Barré syndrome and it is progressing in a classic manner. Rank the following sequence of events in the order that they typically occur. 1 The child states that it is difficult to move his legs. 2 The child reports numbness and tingling in his toes. 3 The child states that it is difficult to move his arms. 4 The child is having difficulty producing facial expressions.

The child reports numbness and tingling in his toes. The child states that it is difficult to move his legs. The child states that it is difficult to move his arms. The child is having difficulty producing facial expressions.

A 5-year-old girl, diagnosed with myelomeningocele, is admitted to the hospital for a corrective surgical procedure. Choose four questions below that the nurse shouls ask when obtaining the health history that would assist in planning the child's care? 1. What is the child's current mobility status? 2. Is there a family hx of myelomeningocele? 3. What is the child's genitorurinary and bowel function and regimen? 4. Does this child have a hx of hydrocephalus with presence of shunt? 5. Does she have kown latex sensitivity? 6. Were there any complications during the pregnancy or birth of this child? 7. Did the mother take prenatal folic acid supplementation?

What is the child's current mobility status? What is the child's genitorurinary and bowel function and regimen? Does this child have a hx of hydrocephalus with presence of shunt? Does she have kown latex sensitivity? (These questions will help develop a plan of care for the girl)

The child has a meningocele and a neurogenic bladder. Which of the following topics should the nurse include in the teaching plan when educating the child and the child's caregivers? Select all that apply. a) Signs and symptoms of a urinary tract infection b) Different types of surgeries used to treat this condition c) The importance of antibiotic use to prevent urinary tract infections from occurring d) How and when to perform clean intermittent urinary catheterization e) How and when to administer oxybutynin chloride

• How and when to administer oxybutynin chloride • How and when to perform clean intermittent urinary catheterization • Signs and symptoms of a urinary tract infection • Different types of surgeries used to treat this condition

A nurse is developing a teaching plan for the parents of a child with myasthenia gravis. Which of the following would the nurse include? Select all... a) How to administer anticholinergic drugs b) Signs and symptoms of infection c) Ways to increase the temperature of the child's environment d) Establishment of plans for rest periods e) Stress management techniques

• How to administer anticholinergic drugs • Establishment of plans for rest periods • Signs and symptoms of infection • Stress management techniques

The nurse is caring for an 8-month-old boy presenting with poor feeding, listlessness, and a weak cry. What assessment finding would lead the nurse to suspect a diagnosis of botulism? a) Diminished gag reflex b) Floppy extremities c) Drooping eyelids d) Inadequate sucking

Diminished gag reflex

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? a) Inspection of the cystic sac on the child's back for leakage b) Auscultation for bowel sounds c) Listening for a shrill cry d) Careful supine positioning

Inspection of the cystic sac on the child's back for leakage

The nurse is caring for an infant with a myelomeningocele who has paralysis of the lower extremities. Which action would be most appropriate to help reduce friction resulting from this paralysis? a) Place the child on a special care mattress. b) Place a pad beneath the diaper area and change frequently. c) Place a folded diaper in between the legs. d) Place synthetic sheepskin under the infant's chest.

Place a folded diaper in between the legs.

The nurse is providing presurgical care for a newborn with myelomeningocele. Which action is the central nursing priority? a) Maintain infant in prone position b) Maintain infant's body temperature c) Keep lesion free from fecal matter or urine d) Prevent rupture or leaking of cerebrospinal fluid

Prevent rupture or leaking of cerebrospinal fluid

The nurse is caring for a 7-year-old with Guillain-Barré syndrome (GBS). Which of the following would be the most effective intervention to monitor for respiratory deterioration? a) Ineffective cough b) Diminished breath sounds c) Serial measurement of tidal volume d) Pulse oximetry

Serial measurement of tidal volume

The nurse is caring for 2-year-old with myelomeningocele. When teaching about care related to neurogenic bladder, what response by the parent would indicate that additional teaching is required? 1. "Routine catheterization will decrease the risk of infection from urine staying in the bladder." 2. "I know it will be important for me to catheterize my child for the rest of his life." 3. "I will make sure that I always use latex-free catheters." 4. "I will wash the catheter with warm soapy water after each use."

"I know it will be important for me to catheterize my child for the rest of his life."

A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? a) "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life." b) "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." c) "It has little influence on the intellectual and perceptual abilities of the child." d) "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."

"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately."

A nurse is caring for a 2-year-old girl with cerebral palsy. The child is having difficulty with proper nutrition and is not gaining adequate weight. How can the nurse elicit additional information to establish a diagnosis? a) "Does she have difficulty swallowing or chewing?" b) "Let's see if she is dehydrated and we'll assess her respiratory system." c) "Let's offer her a snack now and you can tell me about her diet on a typical day." d) "Does she like to feed herself or do you feed her?"

"Let's offer her a snack now and you can tell me about her diet on a typical day."

A young child with Duchenne muscular dystrophy is placed on both prednisone and calcium. Parents view these two medications as rather "common" and question their importance for the child. What explanation by the nurse will be most helpful to the parents? a) "Prednisone will help protect his vulnerable respiratory tract from developing reactive airway disease. Calcium is needed to guard against muscle cramping." b) "Prednisone will stimulate weight gain and appetite. Calcium is needed to ensure adequate supplies for the development of permanent teeth." c) "Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing." d) "Prednisone will protect against nerve inflammation in his hips and legs. Calcium is necessary should dietary intake be insufficient to meet growth needs."

"Prednisone helps to keep muscle fibers strong and delays progression of the disease. Calcium protects against osteoporosis caused by both prednisone and lack of weight bearing."

A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond? a) "You need to remain as active as possible and have a positive attitude." b) "There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." c) "You have to go to a support group; it will be very helpful." d) "There are many things that you can do like crafts, computers or art."

"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group."

The nurse is teaching the parents of a female child with a myelomeningocele how to perform clean intermittent catheterization. The nurse determines that the teaching was effective when the parents return demonstrate the procedure and state: a) "Before inserting the catheter, we need to wipe her labia with normal saline from back to front." b) "We need to insert the catheter about 6 inches so that we make sure the catheter is in the bladder." c) "We need to apply some petroleum jelly to her labia and the catheter before we attempt to insert it." d) "When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

"When the urine stops flowing, we should press on the lower belly to ensure the bladder is empty."

A teenager has been admitted to the hospital with respiratory complications related to Duchenne muscular dystrophy. How can the nurse best provide support for the parents, who are the caretakers of this adolescent? a) Assume responsibility for the teen's daily care while accepting input from parents and the teen b) Provide accommodations for both parents to room-in with their teen c) Teach the parents how to add chest physical therapy to the care they provide d) Encourage the parents to assist their child with his activities of daily living while hospitalized

Assume responsibility for the teen's daily care while accepting input from parents and the teen

Why will it be necessary for the nurse to be very supportive of parents' attempts to feed the infant with recently repaired myelomeningocele? a) The infant will have a poor sucking reflex. b) Pain will interfere with the feeding process. c) Assuming the usual feeding position will be difficult. d) Nausea and vomiting often follow repair of the cystic mass.

Assuming the usual feeding position will be difficult.

The nurse is taking a health history of a 6-year-old girl with suspected dermatomyositis. During the physical examination, which of the following would help confirm the nurse's suspicions? a) Tenting of skin b) Ptosis or altered eye movements c) Red-purple rash on upper eyelids, knuckles, elbows, and knees d) Delayed capillary refill

Red-purple rash on upper eyelids, knuckles, elbows, and knees

The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information? a) "Has he achieved his developmental milestones on time?" b) "Has his pace of achieving milestones diminished?" c) "Do you think he is simply fatigued?" d) "Would you please describe the weakness you are seeing in your son?"

"Would you please describe the weakness you are seeing in your son?"

Muscular dystrophy is a result of which cause? a) Chromosomal aberration b) Genetic and environmental factors c) Gene mutation d) Unknown nongenetic origin

Gene mutation

The nurse is caring for a 5-year-old child with Guillain-BarrÉ syndrome. Which of the following would be the best way to assess the level of paralysis? a) Monitor for ataxia b) Observe for symmetrical flaccid weakness c) Gentle tickling d) Inquire about sensory disturbances

Gentle tickling

Which condition would alert the nurse that a child may be suffering from muscular dystrophy? a) Hyperactive lower extremity reflexes b) Hypertonia of extremities c) Increased lumbar lordosis d) Upper extremity spasticity

Increased lumbar lordosis

The nurse is assessing a young boy who has been brought to the physician for mobility and balance issues by his parents. Which findings are positively associated with the presence of Duchenne muscular dystrophy? Select all that apply. a) An electromyogram demonstrates the problem is within the nerves, not the muscles. b) The child is unable to rise easily into a standing position when placed on the floor. c) Serum creatine kinase levels are elevated. d) Genetic testing indicates the presence of a gene associated with spinal muscular atrophy. e) A muscle biopsy shows an absence of dystrophin.

• Serum creatine kinase levels are elevated. • An electromyogram demonstrates the problem is within the nerves, not the muscles. • The child is unable to rise easily into a standing position when placed on the floor.

The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents? a) "Your child cannot properly control holding urine or emptying the bladder. " b) "While your child is young, urine leaking from the bladder will not be a problem because diapering is expected." c) "Your child dribbles urine because the bladder either is overactive, pushing urine out, or is not active enough, becoming overfilled and causing urine to leak." d) "Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection."

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

A multidisciplinary team meeting is being called by the nurse to identify methods to reduce spasticity in a school-age child with cerebral palsy. Input from which discipline will not be needed at this gathering? a) Pharmacy b) Dietary c) Surgery d) Orthotics

Dietary

The nurse is conducting a physical examination of a 9-month-old infant with a suspected neuromuscular disorder. Which finding would warrant further evaluation? a) Presence of symmetrical spontaneous movement b) Absence of Moro reflex c) Presence of Moro reflex d) Absence of tonic neck reflex

Presence of Moro reflex

Which nursing diagnosis is most relevant in the first 12 hours of life for a neonate born with a myelomeningocele? a) Impaired physical mobility b) Delayed growth and development c) Risk for infection d) Constipation

Risk for infection

Which type of spinal neural tube defect does the nurse recognize as common and usually benign? a) Meningocele b) Spina bifida c) Spina bifida occulta d) Myelomeningocele

Spina bifida occulta

Why does the nurse suspect cerebral palsy in the 8-month-old just assessed? a) When startled, a strong Moro reflex is noted. b) The child sits independently with a straight back. c) The child does not crawl. d) The baby drools almost constantly.

When startled, a strong Moro reflex is noted.

The nurse is assessing a young boy who has been brought to the physician for mobility and balance issues by his parents. Which findings are positively associated with the presence of Duchenne muscular dystrophy? Select all that apply. a) Genetic testing indicates the presence of a gene associated with spinal muscular atrophy. b) Serum creatine kinase levels are elevated. c) The child is unable to rise easily into a standing position when placed on the floor. d) A muscle biopsy shows an absence of dystrophin. e) An electromyogram demonstrates the problem is within the nerves, not the muscles.

• Serum creatine kinase levels are elevated. • An electromyogram demonstrates the problem is within the nerves, not the muscles. • The child is unable to rise easily into a standing position when placed on the floor.