PEDS CHAPTER 28 (PREP U LEVEL 8)
The nurse is providing education for the parents of a child with muscular dystrophy about nutrition. Which statement by the parent requires further follow up by the nurse? "Becoming overweight is not a concern; I should encourage high-calorie foods whenever possible." "Long-term use of glucocorticoids may increase hunger." "Swallowing and nutrient absorption may become impaired." "A feeding tube may be required later in my child's care."
"Becoming overweight is not a concern; I should encourage high-calorie foods whenever possible." Explanation: The statement, "Becoming overweight is not a concern; I should encourage high-calorie foods whenever possible," is inaccurate and requires further follow up by the nurse. Although malnutrition and weight loss are of concern, inactivity and glucocorticoid use make the child with muscular dystrophy prone to obesity. The statements, "Long-term use of glucocorticoids may increase hunger," "Swallowing and nutrient absorption may become impaired," and "A feeding tube may be required later in my child's care," are accurate with regard to nutrition and muscular dystrophy and do not require further follow up by the nurse.
The nurse is assessing a 3-year-old child at a clinic visit. On reviewing the child's history, the nurse notes that a small pigmented lesion of the lower spine was identified during infancy. Which question would the nurse likely ask the parents? "Have you noticed any joint problems in your child?" "Is your child having any trouble with urinating or bowel movements?" "Have you seen any jerk-like leg movements?" "Does your child's head seem to be getting bigger?"
"Is your child having any trouble with urinating or bowel movements?" Explanation: On physical exam, an infant with a closed neural tube defect (NTD) may have a dimple or pit, patch of hair, or a pigmented lesion anywhere along the spine, but most commonly in the lower spine. Signs and symptoms suggestive of a closed NTD include leg weakness, muscular atrophy of the legs, and bowel or bladder difficulties. Therefore, the question about urinating and bowel movements would be appropriate. Joint problems, jerky limb movements, or larger head size are not associated with closed NTD.
The parents of a infant born with an abnormality on the back are told by the neonatologist that their child has a myelomeningocele. They ask the nurse what exactly that means. Which would be the nurse's best reply? "It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." "The contents of the sac you see only has fluid in it and should cause the child no problem." "Your child's defect involves only the nerves to the bladder and bowel and can be easily repaired." "The sac is a very small cyst and should resolve within the first year of life."
"It is a herniation through the skin of the back of your child with both the spinal cord and nerve roots involved." Explanation: A myelomeningocele is the more severe form of spina bifida cystica, in which the spinal cord and nerve roots herniate into the sac through an opening in the spine, compromising the meninges and usually resulting in neurological impairment. A meningocele includes the meninges and spinal fluid only. A myelomeningocele usually contains the bowel and bladder innervation but involves many more nerves also. A myelomeningocele is not just a cyst that resolves within a year.
The nurse is conducting a presentation for a group of parents of adolescents at a local high school about spinal cord injury. One of the parents asks, "What is the most common cause of this type of injury?" Which response by the nurse would be most appropriate? "There is no one primary cause of this type of injury." "Sports-related injuries account for most spinal cord injuries." "Motor vehicle accidents cause over 50% of these injuries." "Firearms are highest on the list as a cause of injury."
"Motor vehicle accidents cause over 50% of these injuries." Explanation: Motor vehicle accidents (both vehicle and pedestrian) are the cause of greater than 50% of spinal cord injuries. Firearms, sports-related injuries, falls, and abuse are other less-frequent potential causes of spinal cord injury.
The nurse is providing education to the parents of a child with spinal muscular atrophy (SMA) regarding the use of chest physiotherapy. Which statement by the parents indicates an understanding of the teaching? "This will help facilitate drainage and airway clearance." "This will allow our child to maintain an upright sitting position." "This will help strengthen the swallowing muscles." "This will slow the progression of the curvature of the spine."
"This will help facilitate drainage and airway clearance." Explanation: The statement, "This will help facilitate drainage and airway clearance," indicates an understanding of the purpose of chest physiotherapy, which includes percussion, vibration, and positioning. The statement, "This will allow our child to maintain an upright sitting position," describes the purpose of rigid trunk braces that can be used to support a sitting position, but not chest physiotherapy. Although children with SMA often have difficulty swallowing, "This will help strengthen the swallowing muscles," is not a statement that indicates an understanding of chest physiotherapy, as the focus of the therapy is on respiratory function. Similarly, children with SMA frequently have scoliosis, which is fixed by surgical correction, and not with chest physiotherapy. Therefore, "This will slow the progression of the curvature of the spine," is not a statement that indicates understanding of the teaching.
The nurse is assessing the leg strength of a 2-year-old child by asking the child to extend the legs while resisting the movement. Instead of extending the legs, the child produces a small flicker of movement. How will the nurse grade the strength on the 5-point scale? 0 1 2 3 4 5
1 Explanation: A small flicker of movement should be graded as 1 out of 5. A grade of 0 would be documented for no muscle movement. A grade of 2 would be documented for movement with gravity eliminated. Movement against gravity would be documented as grade 3. Movement against gravity and with some external force applied would be documented as grade 4. A grade of 5 would be documented for movement against gravity and with good external force applied.
A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? 9-month-old infant who can pull self up to a standing position 14-month-old toddler who walks with a parent's assistance 24-month-old toddler who engages in parallel play 3-year-old preschool-aged child who goes up stairs on hands and knees
3-year-old preschool-aged child who goes up stairs on hands and knees Explanation: At 3 years of age, a child should be able to climb the stairs one step up at a time or using alternating feet. If the child can only go up on hands and knees, further evaluation is needed. At 9 months of age, an infant can pull oneself up to a standing position and sometimes is able to cruise around furniture or even walk. Toddlers begin to walk between 9 and 18 months of age. Toddler at 24 months of age engage in parallel play rather than cooperative play.
The nurse is preparing to administer enalapril to a 10-year-old child with muscular dystrophy who is asymptomatic of cardiac dysfunction. What action(s) will the nurse take? Select all that apply. Advise parents that the medication may cause the child to cough. Monitor blood pressure for hypotension. Instruct the parents to speak with the health care provider before beginning over-the-counter medications. Contact the health care provider about the erroneous prescription. Check the apical pulse prior to administration.
Advise parents that the medication may cause the child to cough. Monitor blood pressure for hypotension. Instruct the parents to speak with the health care provider before beginning over-the-counter medications. Explanation: The nurse will advise the parents that the medication may cause the child to cough, because this is an adverse effect of enalapril. The medication may cause hypotension, so the nurse will monitor the child's blood pressure. Enalapril may interact with over-the-counter medications; therefore, the nurse will instruct the parents to speak with the health care provider before beginning these medications. Enalapril is often given even if the child is asymptomatic by the age of 10; therefore, this is not an erroneous prescription. Checking the apical pulse prior to administration is performed for carvedilol.
The nurse is caring for an infant with spina bifida and an open lesion at T4. The infant begins to exhibit signs of respiratory insufficiency and requires intubation. What action(s) will the nurse include in the plan of care? Select all that apply. Assess for anal wink reflex. Keep the infant in a side-lying position during suctioning, drying, and assessment until intubation is performed. Make accommodations to prevent pressure on the lesion while infant is supine after intubation. Monitor urinary output. Cover the lesion with sterile, nonpermeable gauze soaked in chilled normal saline.
Assess for anal wink reflex. Keep the infant in a side-lying position during suctioning, drying, and assessment until intubation is performed. Make accommodations to prevent pressure on the lesion while infant is supine after intubation. Monitor urinary output. Explanation: The nurse will assess for the anal wink reflex, because the infant may have a neurogenic bladder due to neurologic impairment below the level of the lesion; the absence of the anal wink reflex may indicate dysfunction of the bladder. For the same reason, the nurse should carefully monitor urinary output and for signs of urinary retention. Keeping the infant in a side-lying position during suctioning, drying, and assessment until intubation is performed protects the open lesion at T4. The nurse should also take measures to prevent pressure on the lesion while the infant is supine after intubation. The lesion should be covered with sterile, nonpermeable gauze, but should be soaked in warm normal saline, not chilled normal saline. An open lesion allows for increased heat and fluid loss and using warm saline in this intervention reduces the risk of related complications.
The nurse is assessing the moro reflex of a 3-month-old infant. What action will the nurse perform? Gently lift the infant off the bed by the arms, and let go when the shoulders are off the bed. With the infant supine and calm, turn the infant's head to one side. With the infant prone, stroke along the spine on one side. Place a finger in the palm of the infant's hand.
Gently lift the infant off the bed by the arms, and let go when the shoulders are off the bed. Explanation: The nurse should start with the infant supine, then gently lift the infant off the bed by the arms. When the shoulders are off the bed but the majority of the head is still on the bed, the nurse should let go of the arms. The infant should "startle," with arms flaring outward and abducting. Turning the infant's head to one side with the infant supine and calm tests the infant's asymmetric tonic neck reflex. Stroking the spine along one side with the infant prone tests the trunk incurvation reflex. Placing a finger in the palm of the infant's hand tests the palmar grasp reflex.
The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? Gowers sign appearance of smaller than normal calf muscles indications of hydrocephalus lordosis
Gowers sign Explanation: A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.
The nurse is caring for a 4-year-old child with cerebral palsy who is experiencing painful spasms. The nurse reviews the chart note above from the previous shift. Based on the chart note, what nonpharmacologic intervention(s) will the nurse perform? Select all that apply. Minimize interruptions. Allow the child to have comfort items such as toys and blankets. Encourage caregiver to let child rest in bed. Turn off music. Provide a well-lit environment.
Minimize interruptions. Allow the child to have comfort items such as toys and blankets. Explanation: The nurse should minimize interruptions and allow the child to have comfort items such as toys and blankets as nonpharmacologic interventions for pain management. Allowing the caregiver to hold the child is important for pain management, as well as playing soft music and keeping the lights in the examination room dimmed, as appropriate.
A nurse is providing care to parents whose infant has been diagnosed with spinal muscular atrophy (SMA) type 1. The parents ask the nurse to explain what this diagnosis means for their child long term. Which statement should the nurse include in the explanation? This is an autosomal dominant disorder that affects motor and cognitive development. The slow progression of the disorder will allow the infant to have a fairly normal childhood. Muscular wasting results in generalized immobility and difficulty feeding and breathing. Intense physical therapy can aide the infant in learning to sit and walk independently.
Muscular wasting results in generalized immobility and difficulty feeding and breathing. Explanation: SMA type 1 is the most severe form of spinal muscle atrophy that results in muscle wasting, generalized immobility and difficulty feeding. This is an autosomal recessive genetic disorder that affects motor but not cognitive development. SMA type 1 has a rapid progression; these infants do not usually live past 2 years of age. Infants diagnosed with SMA type 1 will not sit unassisted and will not walk. Physical therapy is beneficial in strengthening some muscles, especially in those with the less severe SMA types 2, 3 or 4.
The nurse is assessing the vestibulocochlear nerve function of an infant. How will the nurse proceed with the assessment? Observe the infant's ability to startle to loud noises. Check hearing by rubbing fingers together near the infant's ears. Observe the strength and quality of the infant's cry. Evaluate for the presence of the gag reflex.
Observe the infant's ability to startle to loud noises. Explanation: The nurse will observe the infant's ability to startle to loud noises as part of assessing the vestibulocochlear nerve function of an infant. Checking the hearing by rubbing the fingers together near the infant's ears is part of assessing the vestibulocochlear nerve function in an adult. Observing the strength and quality of the infant's cry, and evaluating for the presence of the gag reflex, are part of assessing the vagus nerve function.
The nurse is caring for a 7-year-old child with cerebral palsy. What intervention(s) will the nurse perform to support adequate nutrition for the child? Select all that apply. Offer high-calorie foods when the child is most hungry. Facilitate the opportunity to eat with family or friends. Offer choices when possible. Place child in upright position while feeding. Maintain strict mealtimes.
Offer high-calorie foods when the child is most hungry. Facilitate the opportunity to eat with family or friends. Offer choices when possible. Place child in upright position while feeding. Explanation: The nurse will offer high-calorie foods when the child is most hungry to ensure the child consumes an adequate amount of calories. Facilitating the opportunity to eat with family or friends may improve the child's appetite. Offering food choices when possible increases the likelihood that the child will eat. Placing the child in an upright position while feeding reduces the risk for aspiration. Maintaining strict mealtimes may cause the child to feel pressured or rushed to consume food, which does not support adequate nutrition for the child.
The nurse is assessing the moro (startle) reflex of a 2-month-old infant. Place the steps in the order in which the nurse will proceed. Use all options.
Place the infant in the supine position. Gently lift the infant off the surface by the arms. Continue lifting until the shoulders are off the bed but the majority of the head is still on the bed. . Let go of the arms. Observe for the arms flaring outward and abducting. Explanation: To assess the moro (startle) reflex, the nurse should place the infant in the supine position, gently lift the infant off the surface by the arms, continue lifting until the shoulders are off the bed but the majority of the head is still on the bed, let go of the arms, and then observe for the arms flaring outward and abducting.
The nurse is caring for a newborn with spina bifida and a myelomeningocele who was born approximately 1 hour ago. What action will the nurse anticipate in the plan of care for the child? Prepare the infant for spinal surgery. Assess the infant for Gower sign. Administer IV furosemide as prescribed. Monitor for signs of autonomic dysreflexia.
Prepare the infant for spinal surgery. Explanation: The nurse will anticipate preparing the infant for spinal surgery, because this is typically done for newborns with spina bifida within 24 to 36 hours of birth. Gower sign is a finding associated with muscular dystrophy, and furosemide may be given to treat cardiac dysfunction in a child with muscular dystrophy. Autonomic dysreflexia is a complication of spinal cord injury.
A parent brings an 18-month-old child to the pediatrician's office for a well-child visit. The child has mild cerebral palsy that affects the child's gait. The nurse wants to assess the child's neuromuscular system. What is the best way for the nurse to make that assessment? Quietly observe the child at play while interviewing the parent. Ask the parent to describe the child's development. Get down to the child's level and interact with the child. Review the child's health history to determine if the child is on track developmentally.
Quietly observe the child at play while interviewing the parent. Explanation: The best way to assess a young child's neuromuscular system is to observe the child from a distance. Observing the child at play will allow the nurse to assess the child's gross and fine motor skills, as well as cognitive abilities. Asking the parent to describe the child's motor development may be appropriate in some cases such as the ability to feed. Getting down to the child's level may help assess the child's social development but observing the child play at a distance is best to assess a child's fine and gross motor development. Reviewing the child's history will give the nurse a sense of the child's past developmental level but will not give information about the child's current status.
Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site? Peripheral neurovascular dysfunction Disorganized infant behavior Risk for activity intolerance 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 is assessing a 1-month-old infant's ability to feed during the neurologic assessment. What action will the nurse perform? Stroke the infant's cheek. Place a finger below the infant's toes on the plantar surface. With the infant prone, stroke along the spine on one side. With the infant held in an upright position with the infant's back to the nurse, quickly move the infant forward, as if falling suddenly.
Stroke the infant's cheek. Explanation: The nurse should assess the infant's rooting reflex, and this reflex is related to the infant's ability to feed. To assess the rooting reflex of the infant, the nurse will stroke the infant's cheek. The infant should turn to that side and make sucking movements. Placing a finger below the infant's toes on the plantar surface tests the plantar reflex. Stroking the spine on one side with the infant prone assesses the trunk incurvation reflex. Quickly moving the infant forward, as if falling suddenly, while the infant is held in an upright position with the infant's back to the nurse, assesses the parachute reflex.
The nurse is assessing a 6-year-old child. The nurse instructs the child, "Let me see all of your pretty white teeth." Which cranial nerve is the nurse assessing? VII II IV VI
VII Explanation: The nurse is testing if cranial nerve VII was intact. The cranial nerve VII is the facial nerve and can be assessed by asking to see a child's teeth, having them smile, or lift an eyebrow. In infants facial symmetry would be assessed. Cranial nerve II is assessed by testing visual fields and visual acuity. Cranial nerve IV is tested by having the child move eyes downward and inward. Cranial nerve VI is assessed by checking for the ability of the eyes to move laterally.
The nurse is conducting a physical examination of a 10-year-old child. The nurse whispers the child's name from behind the child so that the child does not see the nurse's lips moving. Which cranial nerve is the nurse assessing? V IV III VIII
VIII Explanation: Testing a child's hearing by observing a response to a whisper without a visual clue assesses cranial nerve VIII, the acoustic nerve. Nerve V is the trigeminal nerve and is tested by having the child bite down and by evaluating the corneal reflex and also sensory response with a cotton wisp. Cranial nerve IV is the trochlear and is tested by having the child move the eyes downward and inward. Cranial nerve III is the oculomotor nerve and is testing by evaluating pupil reactivity and the six cardinal positions of gaze.
A 10-year-old child is brought to the emergency department by the parents. Based on the documented findings above, the nurse suspects Guillain-Barré syndrome, which is later confirmed by diagnostic testing. When developing the child's plan of care, which treatment would the nurse anticipate as the priority? administration of intravenous immune globulin (IVIG) intensive physical therapy measures institution of plasmapheresis use of opioids for pain management
administration of intravenous immune globulin (IVIG) Explanation: Therapeutic interventions for Guillain-Barré syndrome include treatment with immune globulin, plasmapheresis, pain management, and physical therapy. Treatment with intravenous immune globulin (IVIG) is the preferred clinical therapy for Guillain-Barré syndrome. If IVIG is ineffective or the child cannot receive IVIG, plasmapheresis is an alternative treatment. Pain management is highly individualized. Opioids would be avoided if the child experiences respiratory dysfunction.
The nurse is assessing for bladder and bowel function in a newborn with spina bifida at the level of the lumbar spine. Which reflex test would the nurse use to assess this function? anal wink cremasteric Achilles gag
anal wink Explanation: Because the infant likely has neurological impairment below the level of the lesion, neurogenic bladder and/or bowel is of concern. Although it is difficult to assess for neurogenic bowel in a newborn, assessment of the anal wink is a good predictor of functional bladder control. To elicit the anal wink, the nurse would gently stoke the skin near the anus and observe for a contraction of the anal sphincter muscle. If contraction does not occur, bladder and/or bowel function is likely impaired. None of the other reflex tests would provide information about bowel or bladder control.
The nurse is reviewing the history of a 3-year-old child diagnosed with cerebral palsy as an infant. Which factor from the child's health history would the nurse identify as placing this child at risk for this condition? birth at 26 weeks' gestation birth weight 7 lb 2 oz (3,231 g) singleton birth paternal history of seizure disorder
birth at 26 weeks' gestation Explanation: The child was premature at birth, which is a risk factor for cerebral palsy. Other factors that increase the risk for cerebral palsy include low birth weight, multiple births, and maternal history of seizure disorder.
A nurse is caring for an infant with a meningocele. Which finding alerts the nurse that the lesion is increasing in size? leaking cerebrospinal fluid increasing ICP constipation and bladder dysfunction increasing head circumference
constipation and bladder dysfunction Explanation: Symptoms of constipation and bladder dysfunction may result due to an increasing size of the lesion. Increasing ICP and head circumference would point to hydrocephalus. Leaking cerebrospinal fluid would indicate the sac is leaking.
The nurse caring for a client diagnosed with muscular dystrophy would expect which laboratory values to be most abnormal? bilirubin creatine kinase serum potassium sodium
creatine kinase Explanation: 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 parents of a 4-year-old child bring the child to the provider's office for an evaluation. The parents are concerned about the child's weakness and problems with stair climbing. The nurse assesses the child and documents the findings. Based on the findings, the nurse suspects Duchenne muscular dystrophy (DMD). When discussing the findings with the primary care provider, the nurse anticipates which laboratory test being prescribed to provide additional information? white blood cell count creatinine kinase (CK) prothrombin time (PT) alkaline phosphatase
creatinine kinase (CK) Explanation: In light of the child's assessment findings, the nurse would anticipate the need for a creatinine kinase (CK) level. An elevated creatinine kinase (CK) level further raises the suspicion for DMD and should prompt a referral to a genetic specialist. A normal CK level all but eliminates the possibility for DMD, and alternative diagnoses should be investigated. White blood cell count, prothrombin time, or alkaline phosphatase would be inappropriate and shed no further light on the child's possible diagnosis.
The nurse is planning to teach the parents of a child with newly diagnosed muscular dystrophy about the disease. Which definition should the nurse use to best describe this condition? a demyelinating disease lesions of the brain cortex upper motor neuron lesions degeneration of muscle fibers
degeneration of muscle fibers 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.
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? pharmacy surgery orthotics dietary
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.
The nurse is caring for a 1-year-old child who was diagnosed with cerebral palsy during a well-child examination after a series of screening and diagnostic testing. What will the nurse plan to include in the child's care? facilitating referral to a developmental health care provider surgical correction of the spinal lesion serial head circumference measurements assessment for Gower sign
facilitating referral to a developmental health care provider Explanation: The nurse will plan to facilitate a referral to a developmental health care provider. Surgical correction of a spinal lesion and serial head circumference measurements are both part of the care of children with spina bifida. Assessment for Gower sign is part of screening for muscular dystrophy.
The nurse is performing an assessment of a 3-year-old child during a well-child visit and documents the findings shown in the chart above. Based on the chart, which finding(s) requires further follow up by the nurse? Select all that apply. gait posture calf muscle hypertrophy standing from lying position Inability to hop on one foot
gait posture calf muscle hypertrophy standing from lying position Explanation: Walking with weight shifted to the toes, lordotic posture, calf muscle hypertrophy, and relying on arm strength to stand from a lying position are all findings that are consistent with muscular dystrophy and require further follow up by the nurse. The inability to hop on one foot is an expected finding for a 3-year-old child, because children typically develop this ability around the age of 4 years.
The nurse is assessing the coordination of a 2-year-old child at a well-child visit. For what will the nurse observe? gait while walking attempts to touch the caregiver's face heel-to-toe walking ability ability to walk only on the heels, then only on the toes
gait while walking Explanation: The nurse will observe the gait while walking for a 2-year-old child, because this is a developmentally appropriate approach to assessing the child's coordination based on the child's age. Attempts to touch the caregiver's face would be an appropriate part of the coordination assessment for an infant of about 2 months old. The heel-to-toe walking ability is appropriate for assessing coordination in a child of about 3 to 4 years, whereas walking on the heels and then only on the toes may be used to assess the coordination of school-age and older children.
Muscular dystrophy is a result of which cause? gene mutation chromosomal aberration unknown nongenetic origin genetic and environmental factors
gene mutation 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 is a known origin of the disease.
A 7-year-old child with cerebral palsy comes to the clinic for an evaluation. The child is prescribed medications to address muscle spasticity and seizures. When assessing the child's mouth, which condition would the nurse associate with the child's medication regimen? malocclusion enamel erosion gingival hyperplasia multiple dental caries
gingival hyperplasia Explanation: Although enamel defects and malocclusion are common dental problems in children with cerebral palsy, the child is receiving anticonvulsant therapy, which can lead to gingival hyperplasia. Dental caries are unrelated to the child's diagnosis or medication therapy.
A 3-month-old infant is seen in the pediatric clinic. The infant's parent expresses concern that the child has developed cerebral palsy. The nurse assesses the infant. Which assessment finding indicates to the nurse that the parent's concern is valid? hypertonia in the upper extremities exhibits Gower sign unable to sit without support turns head toward sounds
hypertonia in the upper extremities Explanation: Cerebral palsy manifests as hyper- or hypotonia, and cognitive and developmental delays. Gower sign is a manifestation of muscular dystrophy not cerebral palsy. A 3-month-old infant should be developmentally able to turn toward a voice or sound but is too young to sit without support.
A nurse is providing care to a pediatric client hospitalized with a diagnosis of Duchenne muscular dystrophy (DMD). The nurse is reviewing the above laboratory results. Which laboratory result will have the greatest impact on the client's condition? creatinine calcium glucose potassium
potassium Explanation: The potassium level is low and will have the greatest impact on the client's condition. Children diagnosed with DMD often have issues with cardiac and respiratory function and are often on antihypertensive and diuretic medications. They will also be prescribed glucocorticoids to manage the neuromuscular effects of the disorder. The glucose level is elevated slightly and will need to be monitored (especially with the use of glucocorticoids) but the potassium level requires immediate intervention. The creatinine and calcium levels are within normal limits.
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 symmetrical spontaneous movement absence of Moro reflex absence of tonic neck reflex presence of Moro reflex
presence of Moro reflex Explanation: The persistence of a primitive reflex in a 9-month-old would warrant further evaluation. Symmetrical spontaneous movement and absence of the Moro and tonic neck reflexes are expected in a normally developing 9-month-old child.
The nurse is caring for a school-age child diagnosed with Duchenne muscular dystrophy who is receiving glucocorticoid therapy. When teaching the parents about this therapy, the nurse would emphasize which aspect? importance of yearly cardiac exams safety measures for injury prevention steps for active and passive range-of-motion exercises techniques for assisted coughing
safety measures for injury prevention Explanation: Although annual cardiac exams, active and passive range-of-motion exercises, and assisted coughing techniques are important components of care for a child with Duchenne muscular dystrophy (DMD), safety measures for injury prevention would be critical for this child because of the use of glucocorticoids. This therapy has been shown to improve neuromuscular outcomes but it is also associated with adverse effects on bone health. Long-term use predisposes the child to osteoporosis. Coupled with the fact that children with DMD have progressively weakening muscles, the risk of osteoporosis is compounded. Both vertebral fractures and fractures of the long bones are common even in low-level trauma. Therefore, safety would be the priority.
A newborn is diagnosed with spina bifida. What initial reactions might the nurse expect to observe in the parents of the newborn? Select all that apply. shock disbelief denial elation acceptance
shock disbelief denial Explanation: When family caregivers learn of a child's diagnosis, their first reactions may be shock, disbelief, and denial. These reactions last for varied times, from days to months. The initial response may be of mourning for the "perfect" child lost, combined with guilt, blame, and rationalization.
Which type of spinal neural tube defect does the nurse recognize as common and usually benign? myelomeningocele spina bifida meningocele spina bifida occulta
spina bifida occulta Explanation: Spina bifida occulta usually is benign and is estimated to affect 10% to 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 myelomeningocele do involve protrusion of elements of the spinal portion of the central nervous system and require treatment.
Based on knowledge of the progression of muscular dystrophy, which activity would a nurse anticipate the client having difficulty with first? breathing sitting standing swallowing
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 parent brings a 12-month-old child diagnosed with congenital cerebral palsy to the clinic. The nurse completes an assessment. Which assessment finding requires immediate intervention by the nurse? spastic movements of the extremities suspected failure to thrive babbling speech sits with assistance
suspected failure to thrive Explanation: The finding that requires the nurse's immediate attention is the suspicion of failure to thrive (FTT). FTT refers to inadequate growth in infants and children. Children diagnosed with cerebral palsy (CP) often have difficulty maintaining adequate nutrition due to muscle spasticity and difficulty chewing and swallowing. The nurse who suspects FTT in a child with CP should refer the child to a dietitian and/or speech therapist. Parents should also be taught the most effective way to feed their child. Spastic movements are common findings in CP and in this case do not require immediate intervention by the nurse. Babbling speech may also be found in the infant diagnosed with CP. The infant should be referred to a speech therapist but in this case does not require immediate intervention. A 12-month-old child with CP may need assistance to sit related to muscle spasticity.
The nurse is assessing the spine of an infant. Which finding requires further follow up by the nurse? tuft of hair present on the lower back no lateral curvature mild curvature from anterior to posterior skin is free of dimples.
tuft of hair present on the lower back Explanation: A tuft of hair on the lower back is an abnormal finding that requires further follow up by the nurse, because this finding may indicate the presence of occult spina bifida. No lateral curvature, mild curvature from anterior to posterior, and the skin being free of dimples are expected findings that require no follow up by the nurse.
The nurse is preparing to perform a neurologic assessment on a 2-year-old child at a well-child visit. How will the nurse begin the assessment? while the child is in the caregiver's lap with the child seated at rest on the examination table by picking up the child from the caregiver's lap offering a variety of toys of the child to play with
while the child is in the caregiver's lap Explanation: The nurse will perform the assessment while the child is in the caregiver's lap, because young children are often more comfortable in this setting. While some children may be eager to show off gross and fine motor skills during play, some may shy away from the nurse, especially if the child is separated from the caregiver.
The nurse is assessing an infant with spina bifida for hydrocephalus. Which finding(s) requires further follow up by the nurse? Select all that apply. widening sutures on the head sunset eyes vomiting awake and alert flat fontanels
widening sutures on the head sunset eyes vomiting Explanation: The findings of widening sutures on the head, the border of the pupil covered by the lower eyelid (sunset eyes), and vomiting are all signs of hydrocephalus and require further follow up by the nurse. Being awake and alert and having flat fontanels are expected findings that do not require further follow up by the nurse.
