ch 22/23 Nursing Care of the Child With an Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder

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

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

Which diagnostic measure is most accurate in detecting neural tube defects?

Significant level of alpha-fetoprotein present in amniotic fluid Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

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 which of the following? a) Spastic hemiplegia b) Athetoid or dyskinetic c) Spastic diplegia d) Ataxic

Spastic hemiplegia Correct Explanation: Spastic hemiplegia involves hypertonicity and permanent contractures on both extremities on one side. Athetoid (dyskinetic) involves abnormal involuntary movements affecting all four extremities and sometimes the face, neck, and tongue. Ataxic affects balance and depth perception. Spastic diplegia affects the lower extremities.

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?

Spica cast 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.

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

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.

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

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

The nurse is caring for a child after an accident in which the child fractured his arm. A cast has been applied to the child's right arm. Which actions should the nurse implement?

• Document any signs of pain. • Monitor the color of the nail beds in the right hand. • Check radial pulse in the both arms. Monitoring for signs of pain, decreased circulation, or change or variation in pulses in the extremity is important for the child in a cast. Pain can indicate serious complications, such as compartment syndrome. Wearing a gown or sterile gloves is unnecessary. Checking posterior pulses would be appropriate when a lower extremity is casted.

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."

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."

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 nurse is caring for a 6-year-old boy with a fractured ulna. He is fearful about the casting process and is resisting treatment. How should the nurse respond?

"Look over there at the neon fish in our aquarium." The best response for a 6-year-old is to use distraction throughout the cast application. He is resisting the application of the cast, so the best approach at this point is distraction. Telling him that application will not hurt is not helpful; nor is asking the child whether he wants pain medication. It is helpful to enlist the cooperation of the child by showing the child cast materials before beginning the procedure; but if he is resisting treatment, distraction would be the best approach.

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) "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." c) "While your child is young, urine leaking from the bladder will not be a problem because diapering is expected." 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." Correct Explanation: Parents need to understand that lack of urinary control is not the greatest problem. The larger threat is of urinary tract infection, which can result in kidney damage. Only one of the responses by the nurse carries the infection message. Continence is important. This along with the infection risk can be managed by clean intermittent catheterization (CIC) or other procedures.

A nurse is providing instructions for home cast care. Which response by the parent indicates a need for further teaching?

"Pale, cool, or blue skin coloration is to be expected." It is very important to teach parents to identify the signs of neurovascular compromise (pale, cool, or blue skin) and tell them to notify the physician immediately. The other statements are correct

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 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 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." 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 mental retardation, craniofacial defects, and cardiac abnormalities, but not spina bifida

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."

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."

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?

"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." The best response would be to remind the boy that there are many children with muscular dystrophy that could be found at the local support group. Teenagers do not like to be told that they "have" to do anything. Telling the boy that he needs to be active or simply suggesting activities does not address his concerns.

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?"

The nurse is caring for a 10-year-old boy who plays on two soccer teams. He practices four days a week and his team travels to tournaments once a month. He has been diagnosed with a stress fracture in one of his vertebrae. Which instruction is most important to emphasize to the boy and his parents?

"You and your coaches need to understand that you cannot play soccer for at least six weeks." A child with an overuse injury needs to avoid the causative activity for six to eight weeks. The other suggestions are also important, but the nurse must emphasize to the boy and his parents that they must tell the coaches "no soccer for six weeks." In some situations, it is helpful to supply a written directive from the nurse or physician to help the parent avoid undue pressure from coaches

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

1 The supplement has 5 mcg of vitamin D in each 0.5 mL. The child is supposed to receive 10 mcg each day of supplemental vitamin D. Desired/Have x Quantity = dose 10 mcg/5 mcg x 0.5 mL = 1.0 mL Ratio/proportion: 0.5 mL/5 micrograms = x/10 micrograms = 1.0 mL

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

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

What methods can a nurse use to evaluate extremity function in an 18-month-old?

• 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. Observing play, eliciting parental descriptions, and looking for symmetry in motion are all developmentally appropriate and effective methods of assessing extremity function in this toddler. Expecting the child to cooperate in squeezing fingers or pushing feet against resistance is not realistic and is likely to cause reluctance to participate in later assessments.

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?

• 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. The parents should call the physician when the following things occur: The child has a temperature greater than 101.5F° (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.

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

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

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.

In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life?

Cartilage During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

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

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

Duchenne's Correct Explanation: Duchenne's accounts for 50% of all cases of muscular dystrophy.

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: a) myotonia. b) limb-girdle. c) Duchenne's. d) facioscapulohumeral.

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

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 finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing?

Head lag when pulled from supine to sitting Head lag in the child requires referral. By 4 to 5 months, the infant should be able to maintain the head in a neutral position. The other assessment findings are normal for age, indicating no need for referral

A 14-year-old girl is diagnosed as having scoliosis. When doing scoliosis screening with her, an important observation would be to note:

Her posterior spine when she bends forward. A lateral curvature of the spine (scoliosis) is best revealed when the child bends forward. Bending to the side would not provide an accurate assessment of the spine nor would assessing the iliac crest or the chest.

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

Heredity

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

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

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.

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

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

Increased lumbar lordosis Correct Explanation: An increased lumbar lordosis would be seen in a child suffering from muscular dystrophy secondary to paralysis of lower lumbar postural muscles. Increased lower extremity support may also be seen. Hypertonia isn't seen in this disease. Upper extremity spasticity isn't seen because this disease isn't caused by upper motor neuron lesions. Hyperactive reflexes aren't indications of muscular dystrophy.

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

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.

The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element?

Latex 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

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

The child diagnosed with muscular dystrophy often exhibits a forward curvature of the lumbar spine. This description is accurate regarding what condition?

Lordosis Lordosis, a forward curvature of the lumbar spine or swayback, is seen by school age in the child with muscular dystrophy.

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 : 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.

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

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test? a) Muscle biopsy b) EEG c) Assessment of ambulation d) X-ray

Muscle biopsy Correct Explanation: A muscle biopsy shows the degeneration of muscle fibers and infiltration of fatty tissue. It's used for diagnostic confirmation of muscular dystrophy. 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.

Which statement about cerebral palsy would be accurate?

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

The 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?

"In most cases treatment is not necessary, only observation." The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

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."

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."

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:

"These make a smooth edge on the cast so the skin is better protected." 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 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."

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."

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?

"Would you please describe the weakness you are seeing in your son?" The nurse needs to obtain a clear description of weakness. This open-ended question would most likely elicit specific examples of weakness and shed light on whether the boy is simply fatigued. The other questions would most likely elicit a yes or no answer rather than any specific details about his weakness or development.

A group of students are reviewing information about bone healing in children. The students demonstrate understanding of this information when they state:

A child's bones heal more quickly than those of an adult. Bone healing occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.

The nurse is teaching a group of peers regarding different types of fractures seen in children. Which statement best describes a complete fracture?

A fracture in which the bone breaks into two pieces. A fracture in which the bone breaks into two pieces is called a complete fracture. A fracture in which the bone bends without breaking is called a plastic or bowing deformity. A fracture in which the the bone buckles rather than breaks is called a buckle fracture. An incomplete fracture of the bone is called a greenstick fracture.

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

A group of students are reviewing information about the skeletal development in children. The students demonstrate understanding of the information when they identify that ossification is complete by what age?

Adolescence Ossification and conversion of cartilage to bone continue throughout childhood and are complete at adolescence.

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?

Assuming the usual feeding position will be difficult. 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.

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. Correct 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.

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

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) Botulin toxin b) Prednisone c) Lorazepam d) Baclofen

Baclofen Correct Explanation: Baclofen is a centrally acting skeletal muscle relaxant used to treat painful spasms and decrease spasticity in children with motor neuron lesions. Prednisone is a corticosteroid that is used to help slow the progression of Duchenne muscular dystrophy. Lorazepam is a benzodiazepine used for adjunctive relief of skeletal muscle spasm associated with cerebral palsy. Botulin toxin is a neurotoxin used to relieve spasticity in cerebral palsy.

A child is born with a talipes disorder. The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg?

Check the infant's toes for coldness or blueness. Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. The other answers are other interventions pertaining to caring for a child with a talipes disorder but are not associated specifically with ensuring good circulation.

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

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

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 caring for a client in a body cast knows that immobility can cause contractures, loss of muscle tone, or fixation of joints. Which nursing interdisciplinary intervention is recommended to help prevent these adverse conditions?

Encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The nurse should turn the client and encourage active and passive range-of-motion activities to prevent ineffective tissue perfusion. The client should be instructed to cough and breathe deeply to prevent respiratory complications. Normal capillary refill is 1 to 3 seconds. The client should be given small, frequent meals with increased fiber, protein, and vitamin C to prevent malnutrition.

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 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 to 0.4 mg/day b) Ascorbic acid to 4 mg/day c) Folic acid above 0.4 mg/day d) Ascorbic acid to 0.4 mg/day

Folic acid above 0.4 mg/day Correct Explanation: The American Academy of Pediatrics recommends that a woman who has had a child with a neural tube defect increase her intake of folic acid to above 0.4 mg per day 1 month before becoming pregnant and continue this regimen through the first trimester. A woman who has no family history of neural tube defects should take 0.4 mg/day. All women of childbearing age should be encouraged to take a folic acid supplement because the majority of pregnancies in the United States are unplanned. Ascorbic acid hasn't been shown to have any effect on preventing neural tube defects.

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

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

Gene mutation Correct Explanation: Muscular dystrophy is a result of a gene mutation. It isn't from a chromosome aberration or environmental factors. It's genetic and there's a known origin of the disease.

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

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) Motorized wheelchair c) Walker d) Long leg braces

Long leg braces Correct Explanation: Long leg braces are functional assistive devices that provide increased independence and increased use of upper and lower body strength. Wheelchairs, both motorized and manual, provide less independence and less use of upper and lower body strength. Walkers are functional assistive devices that provide less independence than braces.

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

You meet a child with a slipped capital femoral epiphysis. In what type of child does this usually occur?

Obese adolescent boys A slipped capital epiphyseal femur injury most typically occurs in overweight preadolescent or adolescent boys. Stress increases the risk. A thin child would not have an increased risk, and the age range is past preadolescent and school age. (less)

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.

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

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.

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.

The nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. Of the following nursing interventions, which would be most important for the nurse to include in working with this child and the child's caregivers?

The nurse should help the caregivers to understand and the child to effectively use the corrective devices. Nursing care focuses on helping the child and caregivers to manage the corrective device and on the importance of compliance to promote healing and to avoid long-term disability.

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

Idiopathic scoliosis is the most common form that occurs.

True Idiopathic scoliosis, with the majority of cases occurring during adolescence, is the most common scoliosis.

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 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 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."

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

A transfer technique Correct Explanation: Gowers' sign is a description of a transfer technique present during some phases of muscular dystrophy. The child turns on the side or abdomen, extends the knees, and pushes on the torso to an upright position by walking his hands up the legs. The child's gait is unrelated to the presence of Gowers' sign. Muscle twitching present after a quick stretch is described as clonus.

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.

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

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 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

Which characteristic is true of cerebral palsy? a) It results in mental retardation. b) It's progressive. c) It's reversible. 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. Correct Explanation: Cerebral palsy is an irreversible, nonprogressive disorder that results from damage to the developing brain during the prenatal, perinatal, or postnatal period. Although some children with cerebral palsy are mentally retarded, many have normal intelligence.

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) Loss of strength in ankle dorsiflexion c) Pseudohypertrophy of the calves d) Loss of strength in hip extension

Pectus excavatum Explanation: 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 is associated with Duchenne muscular dystrophy. Loss of strength in hip extension is associated with Duchenne muscular dystrophy. Loss of strength in ankle dorsiflexion is associated with Duchenne muscular dystrophy.

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. Correct Explanation: To protect the myelomeningocele, the child must always be placed in the prone position. Special attention to the infant's legs needs to occur when positioning them. Using a folded diaper in between the legs can help reduce pressure and friction from the legs rubbing together. Placing a pad beneath the diaper area helps to keep the child clean. Using a special care mattress helps to reduce pressure. Using sheepskin under the infant's chest reduces friction on the chest area but not the legs.

The nurse is caring for a 10-year-old child in traction. After performing a skin assessment, she notices that the skin over the calcaneus appears slightly red and irritated. What should be the first intervention?

Reposition the child's foot on a pressure-reducing device. The nurse's first action is to remove continuous pressure from this area. The other actions can help decrease potential for skin breakdown, but the pressure must be relieved first.

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

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

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.

A neonatal nurse examines an infant and notes decreased hip motion that causes pain upon movement. This nurse suspects Legg-Calvé-Perthes disease, a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity.

True Legg-Calvé-Perthes disease is a common pediatric hip disorder that causes pain and decreased hip motion, possibly leading to a femoral head deformity. It has an incidence of 1 per 1,200 live births, with some hereditary factors influencing incidence.

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

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

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy is a condition that doesn't get worse." b) "Cerebral palsy is a condition that runs in families." c) "Cerebral palsy occurs because of too much oxygen to the brain." d) "Cerebral palsy means there will be many disabilities."

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

The 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) "In most cases treatment is not necessary, only observation." b) "Was this from pressure resulting from forceps?" c) "Have you seen any signs of improvement?" d) "This is the most common facial nerve palsy."

"In most cases treatment is not necessary, only observation." Correct Explanation: The nurse should reassure the mother by reminding her that in most cases treatment is not necessary, only observation. Asking about signs of improvement might alarm the mother because in some cases it can take many months for the palsy to resolve. Asking whether this was a result of pressure from forceps does not address the mother's concerns about the child's prognosis. The mother may not understand or know why the condition occurred. Telling the mother that this is the most common facial nerve palsy does not address the mother's concerns about the child's prognosis.

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." Parents need to understand that lack of urinary control is not the greatest problem. The larger threat is of urinary tract infection, which can result in kidney damage. Only one of the responses by the nurse carries the infection message. Continence is important. This along with the infection risk can be managed by clean intermittent catheterization (CIC) or other procedures.

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

Brisk deep tendon Correct Explanation: 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.

Complications associated with bleeding most often involve joints and muscles. Adjunct measures to control bleeding include:

Compression Complications associated with bleeding most often involve joints and muscles. Adjunct measures include rest, ice, compression, and elevation (RICE). In addition, corticosteroids such as prednisone may be used to reduce inflammation in the joint

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) Electromyogram b) Creatine kinase c) Muscle biopsy d) Nerve conduction velocity

Creatine kinase Correct Explanation: The sample for creatine kinase must be obtained before the electromyogram or muscle biopsy because those tests may lead to a release of creatine kinase and provide false results. Nerve conduction velocity tests could be done at anytime.

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) Dietary b) Pharmacy c) Orthotics d) Surgery

Dietary Explanation: No dietary interventions are known to reduce spasticity in the child with cerebral palsy. However, dietitians are essential in helping to meet the nutritional needs of children with cerebral palsy, who may have chewing and swallowing disorders. All the other disciplines have interventions that may be helpful to the child in reducing spasticity, thereby increasing function and/or mobility.

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

Risk for infection Correct Explanation: All of these diagnoses are important for a child with a myelomeningocele. However, during the first 12 hours of life, the most life-threatening event would be an infection. The other diagnoses will be addressed as the child develops.

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

The type of traction in which a pin, wire, tongs, or other device is surgically inserted through a bone is:

Skeletal traction Skeletal traction exerts pull directly on skeletal structures by means of a pin, wire, tongs, or other device surgically inserted through a bone. Skin traction applies pull on tape, rubber, or a plastic material attached to the skin, which indirectly exerts pull on the musculoskeletal system. Examples of skin traction are Bryant traction, Buck extension traction, and Russell traction

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

Spina bifida occulta Correct Explanation: Spina bifida occulta usually is benign and is estimated to affect 20% of the population. It is a defect in the vertebral body without protrusion of the spinal cord or its coverings. Spina bifida is a general term that is often used to refer to all neural tube disorders of the spinal cord. Meningocele and myelomenigocele do involve protrusion of elements of the spinal portion of the central nervous system and require treatment.

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

Tachycardia Correct Explanation: Tachycardia is a sign of myasthenic crisis. Bradycardia is a sign of cholinergic crisis. Sweating is a sign of cholinergic crisis. Increased salivation is a sign of cholinergic crisis.

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?

Wheelchair belt This client has poor trunk control; a belt will prevent him from falling out of the wheelchair. Antitip devices, head rest supports, and extended breaks are all important options but aren't the most important options in this situation.

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.

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 caring for an 11-year-old presenting with tenderness in the shoulder. He is the pitcher for his baseball team and reports shoulder pain with active internal rotation but is able to continue past the pain with full range of motion. Based on these reported symptoms, the nurse is aware that the disorder is most likely to be:

Epiphysiolysis of the proximal humerus. Epiphysiolysis of the proximal humerus is an overuse disorder that occurs with rigorous upper extremity activity such as pitching and causes tenderness in the shoulder. Osgood-Schlatter disease causes knee pain and painful swelling or prominence of the anterior portion of the tibial tubercle. Sever disease causes pain over the posterior aspect of the calcaneus. Epiphysiolysis of the distal radius is an overuse disorder that causes wrist pain. It is common in gymnasts.

Through which mechanism is Duchenne muscular dystrophy acquired?

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

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) Helping with specialized equipment b) Consoling parents c) Teaching children self-care d) Coordinating care by specialists

Coordinating care by specialists Correct Explanation: Being part of a multidisciplinary team and coordinating the care the child usually needs from a variety of specialists is an essential and major role. The other nursing activities are important as well, but many children/families require individual interventions.

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?

• Left side lying • Right side lying • Prone

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."

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

A nurse is caring for an 11-year-old with an Ilizarov fixator and is providing teaching regarding pin care. The nurse should provide which instruction?

"Cleansing by showering should be sufficient." The Ilizarov fixator uses wires that are thinner than ordinary pins, so simply cleansing by showering is usually sufficient to keep the pin site clean.

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

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

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

The nurse is working with a group of caregivers of school-age children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be:

Complete If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

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) Lesions of the brain cortex b) A demyelinating disease c) Degeneration of muscle fibers d) Upper motor neuron lesions

Degeneration of muscle fibers Correct Explanation: Degeneration of muscle fibers with progressive weakness and wasting best describes muscular dystrophy. Demyelination of myelin sheaths is a description of multiple sclerosis. Lesions within the brain cortex and the upper motor neurons suggest a neurologic, not a muscular, disease.

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) Inadequate sucking b) Drooping eyelids c) Diminished gag reflex d) Floppy extremities

Diminished gag reflex Correct Explanation: A diminished gag reflex is indicative of botulism and not typically associated with other conditions. The other symptoms could be indicative of a number of neuromuscular diseases. Botulism is a rare disease and is difficult to diagnose since its symptoms are similar to those of other neuromuscular diseases.

The nurse is observing a 3-year-old boy who is sitting and playing in the waiting area of his pediatrician's office. The nurse calls the boy and his mother back for the boy's appointment. The boy rolls onto his stomach and pushes himself to his knees. Then he presses his hands against his ankles, knees, and thighs, walking up the front of his body, to stand. Which condition should the nurse suspect in this client?

Duchenne muscular dystrophy By age 3, children with Duchenne muscular dystrophy can rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they "walk up their front"); this is a Gower sign. Symptoms of facioscapulohumeral muscular dystrophy begin after the child is 10 years old, and the primary symptom is facial weakness. The child becomes unable to wrinkle the forehead and cannot whistle. Congenital myotonic dystrophy begins in utero and typically leads to death before age 1 year because of inability to sustain respiratory function. The symptoms of juvenile arthritis are primarily stiff and painful joints.

Fracture of the femur typically occurs when a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step.

False If a small child is lifted by one hand, as happens when a parent pulls on one arm to lift the child over a curb or up a step, the head of the radius may escape the ligament surrounding it and become dislocated (nursemaid's elbow). Fracture of the femur is rare and is typically caused by an automobile accident, a fall from a considerable height, or child maltreatment.

A type of traction sometimes used in the treatment of the child with scoliosis is called:

Halo traction. When a child has a severe spinal curvature or cervical instability, a form of traction known as halo traction may be used to reduce spinal curves and straighten the spine. Halo traction is achieved by using stainless steel pins inserted into the skull while counter-traction is applied by using pins inserted into the femur. Weights are increased gradually to promote correction

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

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

A young female has been prescribed corticosteroids for dermatomyositis. Which statements by her mother indicates the need for further education?

• "I give it to her first thing in the morning before breakfast." • "We are taking her to Disney in the summer." Corticosteroids should be given with food to minimize gastric upset. Corticosteroids can mask infection. This child should avoid large crowds to prevent exposure to infectious organisms. The other parent responses are correct regarding corticosteroids and dermatomyositis

The school nurse cares for children with overuse injuries and refers them for treatment. Which statements accurately describe conservative interventions to prevent or care for these types of injuries?

• Encourage 1 to 2 days off per week of competitive athletics. • Apply ice to the injured area to reduce inflammation. • Perform appropriate stretching during a 20-to 30-minute warmup. Conservative treatment methods for the child with an overuse injury include encouraging 1 to 2 days off per week of competitive athletics, performing appropriate stretching during a 20-to 30-minute warmup, and applying ice to the injured area to reduce the inflammation and irritation. NSAIDs (ibuprofen) are used for inflammation and pain control. The physical therapist institutes a stretching and strengthening program for the appropriate muscle groups. Parents and coaches may not understand that the level of activity that causes overuse symptoms varies from child to child. Notes or telephone conversations from the physician or nurse to the child's coach can clarify any misconceptions about what is expected during the recovery and recuperative periods

The nurse caring for an infant with myelomeningocele before surgical intervention will prioritize care in what way?

Cover the sac with a saline-moistened dressing Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided

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

Creatine kinase Serum creatine kinase levels are elevated early in the disorder, when significant muscle wasting is actively occurring. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? a) Creatinine b) Serum potassium c) Sodium d) Bilirubin

Creatinine Correct Explanation: Creatinine is a by-product of muscle metabolism as the muscle hypertrophies. Bilirubin is a by-product of liver function. Potassium and sodium levels can change due to various factors and aren't indicators of muscular dystrophy.

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) Deficient knowledge related to diagnosis and condition b) Ineffective coping related to diagnosis of chronic condition c) Impaired physical mobility related to spinal cord defect d) Risk for injury related to lack of muscle control

Deficient knowledge related to diagnosis and condition Correct Explanation: The parents' statement indicates a lack of understanding about the condition. Spina bifida is a term that is often used to refer to all neural tube disorders that affect the spinal cord. This can be confusing and a cause of concern for parents. There are well-defined degrees of spinal cord involvement, and it is important for healthcare professionals to use the correct terminology. Spina bifida occulta is a defect of the vertebral bodies without protrusion of the spinal cord or meninges. This defect is not visible externally and in most cases has no adverse affects. In most cases, spina bifida occulta is benign and asymptomatic and produces no neurologic signs; it may be considered a normal variant. Mobility typically is not impaired with spina bifida occulta. The child is at no greater risk for injury as any other child. The parents demonstrate a lack of knowledge, not problems with coping.

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

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

Development of gross motor movement Correct Explanation: Physical therapy focuses on assisting in the development of gross motor movements such as walking and positioning and helps the child develop independent movement. Occupational therapy assists in the development of fine motor skills and fashioning orthotics and splints. Occupational therapy assists the child in performing optimal self-care ability by working on skills such as activities of daily living. Speech therapy assists with feeding techniques for the child who has swallowing problems.

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?

Folic acid It is recommended that all women of childbearing age ingest 0.4 mg of folic acid daily. Ascorbic acid is vitamin C, niacin is a B vitamin, and calcium is a mineral, not a vitamin.

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) Ascorbic acid b) Calcium c) Niacin d) Folic acid

Folic acid Correct Explanation: It is recommended that all women of childbearing age ingest 0.4 mg of folic acid daily. Ascorbic acid is vitamin C, niacin is a B vitamin, and calcium is a mineral, not a vitamin.

A nurse who is discussing Duchenne muscular dystrophy characterizes it correctly using which descriptors? a) Duchenne muscular dystrophy is diagnosed in boys who develop gait changes during the late school-age years. b) Duchenne muscular dystrophy is a progressive disease of muscles and nerves that affects males and females equally. 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.

Folic acid supplementation Correct Explanation: Strong evidence exists that folic acid supplementation by the mother before conception decreases the incidence of neural tube defects by 50%. Ultrasound screening at 16 to 18 weeks' gestation can help identify fetuses at risk, but this would not prevent neural tube defects. Screening of maternal serum α-fetoprotein levels can help identify fetuses at risk, but this would not prevent neural tube defects. Neural tube defects are not related to genetic dysfunction, so genetic testing would be of no value.

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

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

Inspection of the cystic sac on the child's back for leakage Correct 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? a) Latex b) Cat dander c) Alcohol gel d) Peanuts

Latex Correct 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.

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

Record and refer the finding for follow-up to the pediatrician Correct Explanation: Dimpling and hair growth may signal spina bifida occulta, which usually is benign. However, some complications can be associated, and further investigation is warranted to prevent possible damage to the spinal cord. Magnetic resonance imaging (MRI) is often the diagnostic tool used. No hygienic concerns need prevail. These findings do not suggest development of precocious puberty or any other hormonal problem. The dimpling and hair tuft must be clearly explained to the parents.

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) Ptosis or altered eye movements b) Tenting of skin 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 Correct Explanation: The nurse would expect to find a rash involving the upper eyelids and extensor surfaces of the knuckles, elbows, and knees. Tenting of the skin would suggest dehydration. Ptosis or altered eye movements are more commonly seen with other forms of paralysis, like myasthenia gravis. Delayed capillary refill is associated with dehydration or problems involving circulation.

In caring for the child with Guillain-Barré syndrome, the nurse will provide much supportive care while watching carefully for signs of deterioration in which body system? a) Urinary b) Integumentary c) Cardiovascular d) Respiratory

Respiratory Correct Explanation: Guillain-Barré is a life-threatening disease; the greatest risk occurs during the acute stage, when respiratory failure may occur. The child with this syndrome will be ill and will have limited mobility for an extended time. All body systems will be stressed, requiring supportive care.

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 skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

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

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

When startled, a strong Moro reflex is noted. Explanation: The Moro reflex is a primitive one that should have disappeared around 4 months of age. Persistence of this reflex may occur in children with cerebral palsy. Older children with cerebral palsy often drool owing to the inability to control oral muscles. Drooling in an 8-month-old is developmentally normal, as is sitting independently with the back straight. It fits developmentally that the 8-month-old does not yet crawl.

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 position postoperatively? Select all that apply. a) Right side lying b) Left side lying c) Semi-Fowler d) Supine e) Prone

• Right side lying • Left side lying • Prone Correct Explanation: Postoperatively, the nurse would position the infant in the prone or side-lying position to allow the incision to heal.

While an adolescent wears a body brace for scoliosis, you would teach her:

To continue with age-appropriate activities. Wearing a body brace should not interfere with normal activities, which are necessary to maintain adolescent self-esteem. Sex changes continue with or without bracing; the provider will determine the length of time for wearing the brace each day

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

• Poor control of balance • Exaggerated deep tendon reflexes • Hypertonicity • Hemiplegia Correct Explanation: Spastic cerebral palsy is associated with exaggerated deep tendon reflexes; poor control of posture, balance, and movement; hypertonicity of the affected extremities; and hemiplegia, quadriplegia, or diplegia, based on the limbs affected. Drooling and dysarthria are associated with athetoid cerebral palsy.

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 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 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) "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." b) "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." c) "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life." d) "It has little influence on the intellectual and perceptual abilities of the child."

"Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." Correct Explanation: When a spinal cord lesion exists at birth, it commonly leads to altered development or function of other areas of the CNS. Spina bifida is a complex neurologic defect that heavily impacts the physical, cognitive, and psychosocial development of the child and involves collaborative, lifelong management due to the chronicity and multiplicity of the problems involved.

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) "I need to figure out his usual pattern for passing stool." c) "He must have an adequate amount of fluid." d) "My son's activity is too limited to stimulate his bowels."

"My son's activity is too limited to stimulate his bowels." Correct Explanation: The nurse needs to point out to the mother that even minimal activity increases peristalsis. Together they can come up with appropriate activities within the child's limits or restrictions to promote peristalsis. It is important to determine the usual pattern for passing stool so that the mother and nurse can determine the best program. Palpating the abdomen can reveal distention suggesting constipation. Adequate fluid is necessary to stimulate peristalsis.

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

Cover the sac with a saline-moistened dressing Correct Explanation: Protection of exposed neural tissue is of high priority. Keeping the cystic mass moist prevents damage to neural elements from drying. Blankets may cause trauma to the sac. An Isolette can be used for warmth, but much attention will have to be directed toward keeping the sac moist. Side-to-side hourly position changes increase the risk of damage to protruding nervous tissue. Unnecessary handling should be avoided.

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 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 weakeness. 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 caring for a toddler immediately after a fall from a grocery cart will avoid moving which body area as the child is examined? a) Head and neck b) Lower extremities c) Clavicle d) Torso

Head and neck Correct Explanation: The head and neck should remain immobilized until cervical spine injury is ruled out. Motion in this area could damage the spinal cord. The rest of the child's body should be examined carefully so as not to aggravate an unsuspected injury. The clavicle is the bone most frequently fractured during childhood.

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 Correct Explanation: Screening for significant levels of alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

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

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. 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 arms. The child states that it is difficult to move his legs.

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. Correct Explanation: Guillain-Barré syndrome paresthesias and muscle weakness. Classically it initially affects the lower extremities and progresses in an ascending manner to upper extremities and then the facial muscles. Progression is usually complete in 2 to 4 weeks, followed by a stable period leading to the recovery phase

What methods can a nurse use to evaluate extremity function in an 18-month-old? Select all that apply. a) Ask the child to squeeze the nurse's fingers simultaneously. b) Have the child push against resistance with both feet. c) Look for symmetric motion in the arms and legs. d) Elicit from the parent a description of fine and gross motor activities. e) Observe the child in developmentally appropriate play.

• Look for symmetric motion in the arms and legs. • Elicit from the parent a description of fine and gross motor activities. • Observe the child in developmentally appropriate play. Correct Explanation: Observing play, eliciting parental descriptions, and looking for symmetry in motion are all developmentally appropriate and effective methods of assessing extremity function in this toddler. Expecting the child to cooperate in squeezing fingers or pushing feet against resistance is not realistic and is likely to cause reluctance to participate in later assessments.

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?

"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." Studies have shown that boys treated with prednisone have improved muscle strength and function. This is thought to be due to the protection that prednisone provides to muscle fibers. Calcium is needed to prevent osteoporosis, which is a side effect of prednisone that also occurs when weight bearing is limited. Respiratory infection is a risk in that those muscles weaken with progression of the disease, but reactive airway disease is not a particular risk. No peripheral nerve involvement is observed in Duchenne muscular dystrophy. Side effects of prednisone include weight gain and appetite stimulation, but these are not the reasons for the prednisone therapy. Calcium does augment dietary intake of the mineral and is important for tooth development, and it may play a role in prevention of muscle cramps, but these are not the main reasons for taking the calcium supplement

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 will protect against nerve inflammation in his hips and legs. Calcium is necessary should dietary intake be insufficient to meet growth needs." d) "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."

"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." Explanation: Studies have shown that boys treated with prednisone have improved muscle strength and function. This is thought to be due to the protection that prednisone provides to muscle fibers. Calcium is needed to prevent osteoporosis, which is a side effect of prednisone that also occurs when weight bearing is limited. Respiratory infection is a risk in that those muscles weaken with progression of the disease, but reactive airway disease is not a particular risk. No peripheral nerve involvement is observed in Duchenne muscular dystrophy. Side effects of prednisone include weight gain and appetite stimulation, but these are not the reasons for the prednisone therapy. Calcium does augment dietary intake of the mineral and is important for tooth development, and it may play a role in prevention of muscle cramps, but these are not the main reasons for taking the calcium supplement.

A nurse is caring for an infant with spinal muscle atrophy (SMA) type 1. What will the nurse note when assessing the child? a) Enlarged head with low-set ears b) Lusty cry with voracious appetite c) Narrow chest and protuberant abdomen d) Spastic upper and lower extremities

Narrow chest and protuberant abdomen Correct Explanation: SMA type 1 is also known as Werdnig-Hoffman disease and infantile SMA. It is the most severe of the three types. This disease is autosomal recessive and affects the ability of spinal nerves to communicate with muscle, eventually leading to atrophy. The infantile form progresses rapidly to early childhood death, usually from respiratory complications. The narrow chest and large abdomen are characteristic. Over time, the chest develops pectus excavatum, which restricts respiration further when combined with muscle weakness. Extremities would not be spastic but hypotonic. Head size and ear placement are normal in the infant with SMA type 1. Difficulties in sucking and swallowing are common, and a lusty cry is not found.

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) Extended breaks c) Wheelchair belt d) Headrest support

Wheelchair belt Correct Explanation: This client has poor trunk control; a belt will prevent him from falling out of the wheelchair. Antitip devices, head rest supports, and extended breaks are all important options but aren't the most important options in this situation.

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?

Degeneration of muscle fibers Degeneration of muscle fibers with progressive weakness and wasting best describes muscular dystrophy. Demyelination of myelin sheaths is a description of multiple sclerosis. Lesions within the brain cortex and the upper motor neurons suggest a neurologic, not a muscular, disease.

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?

Folic acid above 0.4 mg/day The American Academy of Pediatrics recommends that a woman who has had a child with a neural tube defect increase her intake of folic acid to above 0.4 mg per day 1 month before becoming pregnant and continue this regimen through the first trimester. A woman who has no family history of neural tube defects should take 0.4 mg/day. All women of childbearing age should be encouraged to take a folic acid supplement because the majority of pregnancies in the United States are unplanned. Ascorbic acid hasn't been shown to have any effect on preventing neural tube defects.

Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing? a) Equal withdrawal of lower extremities from pain b) Head lag when pulled from supine to sitting c) Bilaterally open rather than closed hands d) Supporting own weight when placed in standing position

Head lag when pulled from supine to sitting Explanation: Head lag in the child requires referral. By 4 to 5 months, the infant should be able to maintain the head in a neutral position. The other assessment findings are normal for age, indicating no need for referral.

The nurse caring for a client with suspected muscular dystrophy would prepare her client for which diagnostic test?

Muscle biopsy 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

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 Correct Explanation: Positional muscles of the hip and shoulder are affected first. Progression later advances to muscles of the foot and hand. Involuntary muscles, such as the muscles of respiration, are affected last.

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 reflex are expected in a normally developing 9-month-old child.

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

Risk for impaired skin integrity Explanation: The skin of the infant's knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs.

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

Thymectomy Correct Explanation: Myasthenia gravis is an autoimmune disease that can be treated in several ways. Thymectomy can be used for children who have reached puberty. Cholecystectomy is removal of the gallbladder. Thyroidectomy removes the thyroid gland, and splenectomy removes the spleen.

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

"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 mental retardation, craniofacial defects, and cardiac abnormalities, but not spina bifida.

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

• How to administer anticholinergic drugs • Establishment of plans for rest periods • Signs and symptoms of infection • Stress management techniques Explanation: The teaching plan for a child with myasthenia gravis should include instructions about administering anticholinergic agents, usually 30 to 45 minutes before meals, on time and exactly as ordered; measures to allow for rest periods for energy conservation; signs and symptoms of infection and the need to notify the physician because infection can precipitate a myasthenic crisis; stress management techniques because stress can precipitate a myasthenic crisis; and ways to maintain the child's environmental temperature because exposure to extreme temperatures can precipitate a myasthenic crisis.

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 which of the following? 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." Correct Explanation: When the urine stops flowing, the parents should press on the lower abdomen or have the child lean forward to tense the abdominals to ensure that no more urine is in the bladder. For a female, the catheter is inserted about 2 to 3 inches. For a male, the catheter is inserted about 4 to 6 inches. Before the catheter is inserted, the labia is cleaned with a washcloth or disposable wipe from front to back. A generous amount of water-soluble lubricant, not petroleum jelly, is applied to the catheter. There is no need to apply the lubricant to the labia.

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) Provide accommodations for both parents to room-in with their teen b) Assume responsibility for the teen's daily care while accepting input from parents and the 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 Explanation: The parents have probably been caring daily for their son for longer than 10 years while his condition has deteriorated and his care has become more complex. They may use this hospitalization as an opportunity to be relieved briefly of some of this responsibility (respite). Chest PT and rooming-in are important but do not address the need for respite.

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

Folic acid supplementation Correct Explanation: Strong evidence exists that folic acid supplementation by the mother before conception decreases the incidence of neural tube defects by 50%. Ultrasound screening at 16 to 18 weeks' gestation can help identify fetuses at risk, but this would not prevent neural tube defects. Screening of maternal serum α-fetoprotein levels can help identify fetuses at risk, but this would not prevent neural tube defects. Neural tube defects are not related to genetic dysfunction, so genetic testing would be of no value.

The pediatric nurse practioner (PNP) records "positive Gowers' sign" after finishing the assessment of a young boy. How will the student nurse reading the PNP's note interpret this? a) Severe lordosis is evident in the lumbar spine. b) The boy rises from the floor by walking his hands up his legs. c) The head is held tilted with limited side-to-side motion. d) The boy has a large tan skin lesion on his torso.

The boy rises from the floor by walking his hands up his legs. Correct Explanation: Gowers' sign is a hallmark finding of Duchenne muscular dystrophy as muscles weaken. The boy cannot rise from the floor in the usual way and needs to turn to hands and knees, move feet under the body, and "walk" hands up his legs to stand. The other options do not describe Gowers' sign, although lordosis is often a manifestation of Duchenne muscular dystrophy.