Chapter 44: Alteration in Mobility/Neuromuscular or Musculoskeletal Disorder NCLEX

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.

A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? A) Oral B) Subcutaneous injection C) Intramuscular injection D) Intravenous infusion

C) Intramuscular injection

Which of the following would the nurse expect to find initially in a child with Guillain-Barré syndrome? A) Symmetric flaccid weakness B) Ataxia C) Sensory disturbances D) Lower extremity pain

D) Lower extremity pain

The nurse is developing a teaching plan for the parents of a child with a myelomeningocele who will require clean intermittent catheterization. Which of the following would the nurse include? A) Applying petroleum jelly to lubricate the catheter B) Cleaning the reusable catheter with peroxide after each use C) Storing the reusable cleaned catheter in a brown paper bag D) Soaking the catheter in a vinegar and water solution to sterilize

D) Soaking the catheter in a vinegar and water solution to sterilize

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

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

Diazepam

The nurse is concerned that a preschool-age child is demonstrating signs of Duchenne muscular dystrophy. What did the nurse assess in this child?

Gower sign

A home health-care nurse is visiting a child with Duchenne's muscular dystrophy (MD). The child has a new cough, poor appetite, and a reddened area on his coccyx from sitting in his wheelchair all day. What intervention by the nurse takes priority?

Notify the health care provider and request antibiotics

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

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

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

The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding?

idiopathic scoliosis

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

skeletal traction.

A 6-year-old boy with cerebral palsy has been admitted to the hospital for some tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A) "Would you like me to bring you a blanket and pillow?" B) "You are doing such a wonderful job with your son." C) "He's in good hands; consider going home to get some sleep." D) "Are you planning to spend the night or to go home?"

C) "He's in good hands; consider going home to get some sleep."

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

Complete

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

Muscular dystrophy is a result of which cause?

Gene mutation

The child diagnosed with muscular dystrophy uses a method of rising from the floor which is referred to as which of the following?

Gowers sign

The nurse is doing client teaching with a child who has been placed in a brace to treat scoliosis. Which statement made by the child indicates an understanding of the treatment?

"At least when I take a shower I have a few minutes out of this brace."

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."

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."

An adolescent client who has scoliosis and is wearing a Milwaukee brace tells the nurse that she is ugly and cannot wear the same clothing as her friends. Which response by the nurse best addresses this client's altered self-image?

"Let's look at some clothing that you can wear with the brace that will look like everyone else's clothes but cover it."

A mother is angry about her son's diagnosis of osteosarcoma. She is telling him that if he had not played football last year and broken his leg, this would not have happened. What is the nurse's best response to the mother's statement?

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."

The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse?

"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."

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."

The nurse is caring for a child with a spinal cord injury and providing instruction to the parents on promoting skin integrity. Which response from the mother indicates a need for further teaching? A) "I need to monitor his skin at least twice a week." B) "I must monitor skin affected by his adaptive equipment." C) "He must change positions frequently." D) "We must avoid harsh cleaning products."

A) "I need to monitor his skin at least twice a week."

The nurse is assessing the neuromusculoskeletal system of a newborn. Which of the following would the nurse identify as an abnormal finding? A) Sluggish deep tendon reflexes B) Full range of motion in extremities C) Absence of hypotonia D) Lack of purposeful muscular control

A) Sluggish deep tendon reflexes

A child with myasthenia gravis is brought to the emergency department by his parents. The parents have noticed a sudden increase in respiratory difficulty. The nurse suspects myasthenic crisis based on which statement by the parents? A) "We gave him an extra dose of his medication earlier today." B) "He was coughing and had a slight fever yesterday and today." C) "Things have been pretty stress-free lately." D) "He's been resting when he gets tired."

B) "He was coughing and had a slight fever yesterday and today."

The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. Which of the following would the nurse use when documenting these observations? A) Spastic B) Athetoid C) Ataxic D) Mixed

B) Athetoid

The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which of the following responses from his mother indicates a need for further teaching? A) "He needs to get a medical alert identification." B) "I will need to discuss this with his caregivers." C) "A product's label indicates whether it is latex-free." D) "He must avoid all contact with latex."

C) "A product's label indicates whether it is latex-free."

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.

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?

Creatine kinase

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

Creatine kinase

A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which of the following would the nurse include when teaching the parents about caring for their child? A) Waiting 48 hours before allowing the child to take a tub bath B) Not allowing the child to sleep on his side for about 4 weeks C) Calling the physician if the child's temperature is over 100.5°F D) Discouraging the child from stretching or bending forward for 4 weeks

D) Discouraging the child from stretching or bending forward for 4 weeks

The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? A) Recommend the bed's side rails be raised throughout the day and night. B) Suggest a caregiver be present continuously to prevent falls from bed. C) Encourage a loose restraint to be used when he is in bed. D) Recommend raising the bed's side rails when a caregiver is not present.

D) Recommend raising the bed's side rails when a caregiver is not present.

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

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

Duchenne.

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.

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

The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy?

Gowers sign

The type of fracture often seen in young children is one in which there is not complete ossification of the bone, and the bone bends and just partially breaks. What type of fracture is this?

Greenstick

The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client?

Impaired physical mobility related to a cast on the leg

An adolescent girl with scoliosis is refusing to wear the prescribed body brace. Which instruction is best to progress her to the treatment goals?

It is important to wear the brace now to improve your spinal alignment, decreasing your symptoms.

In understanding the function of the musculoskeletal system, the nurse recognizes that which of the following allows for movement of the body parts?

Joints

An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care?

Keeping the buttocks slightly elevated

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

Latex

A school-age child is scheduled for a muscle biopsy. What should the nurse teach the client about the procedure?

Medication will be given so pain is minimized.

The nurse is caring for a child who had a cast on his lower leg placed two hours ago. When assessing the child's foot, the nurse notes that the toes are cool and the child reports extreme pain. What is the best action by the nurse?

Notify the health care provider of the findings immediately.

The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom?

Paresthesia

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 nurse is caring for a child diagnosed with Legg-Calvé-Perthes disease. What is the most important nursing intervention for the nurse to include in working with this child and his caregivers?

The nurse should help the caregivers to understand and help the child to effectively use the corrective devices.

In caring for a child in traction, which intervention is the highest priority for the nurse?

The nurse should monitor for decreased circulation every 4 hours.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unhooking a weight while providing pin care

A nurse is preparing a program for a group of parents about injury prevention. Which of the following would the nurse include as an important contributing factor for cervical spine injury in a child? A) Exposure to teratogens while in utero B) Immaturity of the central nervous system C) Increased mobility of the spine D) Incomplete myelinization

C) Increased mobility of the spine

A nurse is preparing a plan of care for an infant who has undergone surgery to repair a myelomeningocele. The nurse would include placing the infant in which positions postoperatively? Select all that apply.

- Prone - Right side lying - Left side lying

The nurse is assessing a child who is suspected of having Guillain-Barré syndrome. Which assessment findings would the nurse correlate as supporting this diagnosis? Select all answers that apply. A) Recent cytomegalovirus infection B) Hyperactive deep tendon reflexes C) Numbness in the lower extremities D) Sustained clonus E) Difficulty swallowing

A) Recent cytomegalovirus infection C) Numbness in the lower extremities D) Sustained clonus

When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A) Skeletal traction B) Physical therapy C) Orthotics D) Occupational therapy

A) Skeletal traction

The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply.

- The boy 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 nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply.

- Color - Sensation - Pulse - Capillary refill

A preschool-aged client is in an external fixator for a fractured pelvis and the mother is frightened of performing pin site care for the child. How would the nurse help this parent learn to care for her child? Select all that apply.

- Have the mother do a return demonstration of cleaning the pins. - Observe for any signs of inflammation such as odor or drainage.

Which of the following would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A) Positioning supine with a pillow under the buttocks B) Covering the sac with saline-soaked nonadhesive gauze C) Wrapping the infant snugly in a blanket D) Applying a diaper to prevent fecal soiling of the sac

B) Covering the sac with saline-soaked nonadhesive gauze

The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A) Deep-breathing exercises B) Upright positioning C) Coughing D) Chest percussion

B) Upright positioning

A nursing instructor is preparing for a class discussion on spinal muscular atrophy (SMA). When describing type 2 SMA, which of the following would the instructor include? Select all answers that apply. A) Onset before 6 months of age B) Weakness most severe in shoulders and hips C) Difficulty with swallowing D) Slowly progressing condition E) Genetic disease with autosomal recessive inheritance

B) Weakness most severe in shoulders and hips D) Slowly progressing condition E) Genetic disease with autosomal recessive inheritance

A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child's parents about this drug, which statement by the parents indicates the need for additional teaching? A) "We should give this drug before he eats anything." B) "We need to keep a close eye for possible infection." C) "The drug should not be stopped suddenly." D) "He might gain some weight with this drug."

A) "We should give this drug before he eats anything."

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.

The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl's mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most appropriate? A) "I will help you become comfortable in caring for your daughter." B) "You must learn how to care for your daughter at home." C) "You will need to learn to collaborate with all the caregivers." D) "There is a lot to learn, and you need a positive attitude."

A) "I will help you become comfortable in caring for your daughter."

A nurse is caring for a 14-year-old girl following myelography. Which of the following would be the priority nursing action? A) Monitoring for a decrease in spasticity B) Observing for signs of meningeal irritation C) Assessing motor function D) Observing for mental confusion or hallucinations

B) Observing for signs of meningeal irritation

The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve? A) Optic B) Facial C) Acoustic D) Trigeminal

B) Facial

A group of students are reviewing information about neuromuscular disorders. The students demonstrate understanding of the information when they identify which of the following as examples of autoimmune neuromuscular disorders? Select all answers that apply. A) Cerebral palsy B) Guillain-Barré syndrome C) Myasthenia gravis D) Spinal muscular atrophy E) Dermatomyositis

B) Guillain-Barré syndrome C) Myasthenia gravis E) Dermatomyositis

After teaching a class of nursing students about muscular dystrophy, the instructor determines that the teaching was successful when the students identify which type of muscular dystrophy as demonstrating an X-linked recessive pattern of inheritance? A) Limb-girdle B) Myotonic C) Distal D) Duchenne

D) Duchenne

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? A) Myelinization is completed by 4 years of age. B) The process occurs in a head-to-toe fashion. C) The speed of nerve impulses slows as myelinization occurs. D) Nerve impulses become less specific in focus with myelinization.

B) The process occurs in a head-to-toe fashion.