Practice Muscular disorder

A nurse is facilitating a group discussion with preschool teachers about child abuse. Which of the following data should the nurse use as a common example of a suggestive finding? A. bruising of both knees with sutures on 1 B. Arm cast for a spiral fracture of the forearm c. Consistent bedwetting at nap time D. Frequent, vague reports of a stomachache or a headache

B

A nurse is caring for a school aged child who had an arm cast applied 8 hrs ago. Which of the following findings should alert the nurse to a complication related to the casting? A. The child reports a pain level of 5 on a scale of 0-10 B. The client's hands are cool bilaterally C. The child reports tightness at the wrist D. The child's grasp is weak

C

A nurse is providing teaching to a school-aged child who just had a fiberglass cast application following a lower extremity fracture. Which of the following instructions should the nurse give child and his parents about care during the first 48 hrs? A. Use a toothbrush to scratch under the cast if your skin itches b. Avoid moving your legs and joints above and below the cast C. Keep the cast above the heart D. Clean soil from the cast with soapy water

C

Through which mechanism is Duchenne muscular dystrophy acquired? virus heredity autoimmune factors environmental toxins

Correct response: heredity Explanation: Muscular dystrophy is hereditary and acquired through a recessive sex-linked trait. Therefore, it isn't caused by viral, autoimmune, or environmental factors.

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? Snip the tuft of hair off close to the skin for hygienic reasons. Move on to other assessments without calling attention to the difference. Record and refer the finding for follow-up to the pediatrician. Inspect for precocious hair growth in the genital and underarm areas.

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

A nurse is providing teaching about home care to the parent of a child who has a newly applied fiberglass leg cast. Which of the following statements should the nurse include? A. Monitor the color of your child's toes every 4 hrs for 24 hrs B. Your child can scratch the skin inside the cast with a small wooden ruler C. Expect cast to remain damp for 72 hrs D. You take your child swimming and giving baths as usual

A

The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? "Itching is common. It's nothing to worry about." "Blowing cool air with a fan or hair dryer may relieve the feeling." "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there." "A small amount of lotion or baby oil can be poured in the cast to moisturize the area."

Correct response: "Blowing cool air with a fan or hair dryer may relieve the feeling." Explanation: Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

An adolescent with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress the adolescent to the treatment goals? "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." "It is important to correct spinal curvature before it gets too bad, causing you problems." "It is important to prevent herniation of a spinal disk, which is painful." "It is important to prevent torticollis."

Correct response: "It is important to wear the brace now to stabilize your spinal alignment, decreasing your symptoms." Explanation: It is important to have the adolescent understand the treatment and how the treatment will benefit him or her. Body bracing helps to hold the spine in alignment and prevent further curvature, decreasing the symptoms. The brace will not correct the problem. Adolescents have a hard time being compliant with the brace due to body image disturbance and peer reaction. The brace can also cause discomfort and be hot to wear. Torticollis is tightened neck muscles causing the head to tilt downward. A herniated disc is related to the disc space between the vertebrae. It has no affect on the curvature of the spine.

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

Correct response: "The cause is unknown and there are many environmental factors that may contribute to it." Explanation: There is no one known cause of spina bifida, but scientists believe that it's linked to hereditary and environmental factors. Neural tube defects, including spina bifida, have been strongly linked to low dietary intake of folic acid. Maternal age doesn't have an impact on spina bifida. An amniocentesis is performed to help diagnose spina bifida in utero but doesn't cause the disorder. Maternal alcohol intake during pregnancy has been linked to intellectual disability, craniofacial defects, and cardiac abnormalities, but not spina bifida.

The caregiver of a child who has had a cast applied to the leg observes the nurse putting adhesive tape strips around the edge of the cast. The caregiver asks the nurse why she is doing this. The best response by the nurse would be: "We put these on so the child will not pull the padding from under the cast." "These will help the cast look more attractive so the child won't feel self-conscious." "These make a smooth edge on the cast so the skin is better protected." "In case the child has an accident and misses the bedpan, these can be changed to keep the area dry."

Correct response: "These make a smooth edge on the cast so the skin is better protected." Explanation: If the cast has no protective edge, it should be petaled with adhesive tape strips. These help keep the skin protected from the rough edge of the cast. If the cast is near the genital area, plastic should be taped around the edge to prevent wetting and soiling of the cast; petaling the cast does not provide protection to keep the cast dry.

The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? "This medication will help to increase bone mineral density." "My child's risk for fractures will hopefully be decreased as by taking this medication." "This medication will cure my child of this disorder." "This medication doesn't prevent fractures from happening."

Correct response: "This medication will cure my child of this disorder." Explanation: Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening

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

Correct response: Assuming the usual feeding position will be difficult. Explanation: Because the repaired area will need to be protected, having to use an alternate feeding position is likely. The infant may need to be fed prone with the head turned to the side and may not be able to be held. Being able to provide food for the infant is central to parenting the child. Difficulty nurturing a child can be very stressful. Little pain will be experienced and should easily be controlled owing to loss of sensation in the area. The sucking reflex should not be affected by the myelomeningocele or its repair. Nausea and vomiting are unlikely after recovery from the anesthetic.

A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client? Traction Exercise Surgery Bracing

Correct response: Bracing Explanation: For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.

The nurse is caring for a child who fractured the arm in an accident. A cast has been applied to the child's right arm. Which action(s) should the nurse implement? Select all that apply. Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand. Wear a protective gown when moving the child's arm. Wear sterile gloves when removing or touching the cast.

Correct response: Document any signs of pain. Check capillary refill time in the both arms. Monitor the color of the nail beds in the right hand. Explanation: The most important function for the nurse in caring for a child in a cast is frequent neurovascular checks. The nurse should monitor for increased pain and edema, a pale or blue color to the extremities, skin coolness, numbness or tingling, poor capillary refill, and decreased pulse strength. Increased pain, especially unrelieved with pain medications, can indicate serious complications such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary as the cast is not sterile.

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

Correct response: Duchenne muscular dystrophy causes progressive muscular weakness that ends in death. Explanation: Duchenne muscular dystrophy is the most common of several muscular dystrophies and is a progressive, fatal disorder. It involves mainly skeletal muscles, but other muscles are affected over time. Onset occurs in early childhood. The disorder is X-linked recessive. An enzyme is lacking that is necessary for the maintenance of muscle cells. No structural abnormalities of the spinal cord or peripheral nerves are noted.

The nurse receives a report on a child admitted with severe muscular dystrophy. The nurse suspects the child has been diagnosed with the most severe form of the disease, known as: Duchenne. facioscapulohumeral. limb-girdle. myotonia.

Correct response: Duchenne. Explanation: Studies have shown that Duchenne is the most severe form of muscular dystrophy. Myotonia isn't a form of the disease; it's a symptom.

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 appearance of smaller than normal calf muscles indications of hydrocephalus lordosis

Correct response: Gowers sign Explanation: A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.

The nurse is caring for a child who has just had a plaster cast applied to the arm. The nurse is correct in performing which action with this child? Handling the cast with open palms when moving the arm. Using only a draw sheet to move the casted arm. Keeping a clove-hitch restraint gently tied on the hand to stabilize the arm. Encouraging the child to move the arm slowly up and down to help the cast dry.

Correct response: Handling the cast with open palms when moving the arm. Explanation: A wet plaster cast should be handled only with open palms because fingertips can cause indentations and result in pressure points. There is no reason the arm should be restrained or the arm moved to aid in the drying process.

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? Impaired physical mobility related to a cast on the leg Deficient diversional activities related to a need for imposed activity restriction for 6 weeks Situational low self-esteem related to the use of a walker Pain related to chronic inflammation of the lower leg

Correct response: Impaired physical mobility related to a cast on the leg Explanation: Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

The nurse is assessing a preadolescent client reporting pain and swelling just below the knee. The client states it hurts worse after running. What treatment would the nurse expect to be prescribed for this client? NSAIDs, ice, and limiting exercise ice alternating with ankle and knee-strengthening exercises alternating applications of 15 to 30 minutes of heat and ice rest, elevation of the leg, treatment of pain with acetaminophen

Correct response: NSAIDs, ice, and limiting exercise Explanation: The child's symptoms suggest Osgood-Schlatter disease, which is a thickening and enlargement of the tibial tuberosity probably from overuse. Treatment includes administration of NSAIDS, ice, and limiting strenuous activity. Ankle and knee strengthening exercises, applications of ice, and use of acetaminophen is not indicated for this disorder.

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse? Notify the health care provider of the findings immediately. Administer prescribed pain medication. Reposition the leg on pillows so that it is above the level of the child's heart. Apply ice bags to the child's foot and ankle.

Correct response: Notify the health care provider of the findings immediately. Explanation: Cool fingers or toes, extreme pain, and impaired movement are symptoms of compartment syndrome. Compartment syndrome can severely decrease blood flow to the area causing damage and necrosis to the surrounding area. If compartment syndrome occurs, the cast needs to be released immediately; therefore, the health care provider must be notified of these assessment findings immediately. Administration of pain medication, positioning, and ice are interventions that may be prescribed after a cast is placed, but they are not the first treatment for compartment syndrome.

The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? Internal fixation device External fixation device Spica cast Stockinette

Correct response: Spica cast Explanation: The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. The boy experiences mild pain when wiggling his toes. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. New drainage is seeping out from under the cast. The outside of the boy's cast got wet and had to be dried using a hair dryer. The boy's toes are light blue and very swollen.

Correct response: The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. New drainage is seeping out from under the cast. The boy's toes are light blue and very swollen. Explanation: The parents should call the physician when the following things occur: The child has a temperature greater than 101.5° F (38.7° C) for more than 24 hours, there is drainage from the casted site, the site distal to the casted extremity is cyanotic, or severe edema is present.

The nurse is caring for a 10-year-old girl in traction. The girl is experiencing muscle spasms associated with the traction. What would the nurse expect to administer if ordered? diazepam opioid analgesics alendronate pamidronate

Correct response: diazepam Explanation: Diazepam is an antianxiety drug that also has the effect of skeletal muscle relaxation; it is used for the treatment of muscle spasm associated with traction or casting. Opioid analgesics are used for pain relief. Alendronate increases bone mineral density for children with osteogenesis imperfecta. Pamidronate increases bone mineral density for children with osteogenesis imperfecta.

An infant has been born and diagnosed with a meningocele. Which action will the nurse incorporate into each contact with this infant? inspection of the cystic sac on the child's back for leakage auscultation for bowel sounds listening for a shrill cry careful supine positioning

Correct response: inspection of the cystic sac on the child's back for leakage Explanation: Leakage from the cystic area indicates loss of cerebrospinal fluid (CSF) and risk of infection of the central nervous system. Prompt intervention is needed, probably surgical. Listening for bowel sounds confirms intestinal peristalsis but is not necessary with each infant contact. A shrill cry may indicate increased intracranial pressure (ICP). This is important to note yet is not as pressing as being aware of leakage. The baby would be positioned prone, not supine, to protect the sac.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? alcohol gel latex peanuts cat dander

Correct response: latex Explanation: A latex-free environment is important because research shows that up to 73% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification. The other options may present risks to individual children but are not a threat to those with spina bifida as a group.

The nurse is caring for a child with rickets. Which diagnostic test result would the nurse expect to find in the child's medical record? low serum calcium levels low alkaline phosphate levels high serum phosphate levels x-ray confirmation of adequate bone shape

Correct response: low serum calcium levels Explanation: With rickets, serum calcium and phosphate levels are low and alkaline phosphate levels are elevated. Radiographs show changes in the shape and structure of the bone.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? X-ray muscle biopsy EEG assessment of ambulation

Correct response: muscle biopsy Explanation: Muscle biopsy provides definitive diagnosis of muscular dystrophy demonstrating the absence of dystrophin. X-ray is best for identifying an osseous deformity. Ambulation assessment alone wouldn't confirm diagnosis of this client's disorder. EEG wouldn't be appropriate in this case.

The nurse is caring for a child with a broken wrist that has just been placed in a cast. The nurse would elevate the arm to: promote healing. prevent edema. discourage infection. ensure proper bone alignment.

Correct response: prevent edema. Explanation: Edema tends to be dependent. Elevating the arm, therefore, would reduce swelling from the injury. Elevation of the arm would not promote healing or discourage infection. The cast will maintain proper bone alignment.

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. prone right side lying left side lying semi-Fowler supine

Correct response: prone right side lying left side lying Explanation: Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates? a normal spinal closure spina bifida with meningocele spina bifida occulta spina bifida with myelomeningocele

Correct response: spina bifida occulta Explanation: Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arouse suspicion of its presence, or it may be overlooked entirely.

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

Correct response: standing Explanation: 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 child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment? the presence of a waddling gait and difficulty climbing stairs a short heel cord caused by walking on the toes meeting motor milestones such as sitting, walking, and standing but at a later age than the average child when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand

Correct response: when on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand Explanation: A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

A nurse is assessing an adolescent who has sustained a broken tibia. Following the application of fiberglass cast, the adolescent reports pain and a tingling feeling in the limb. Which of the following actions should the nurse take first? A. give the adolescent ibuprofen B. Elevate the adolescent's leg on pillows C. Place an ice pack on the cast D. Assess for manifestation of circulatory impairment

D