Exam 1: Cerebral Palsy Questions
When planning long-term care for a 2-year-old child with cerebral palsy (CP), what is it important for the nurse to consider? 1. CP is not progressively degenerative. 2. The effects of CP are unpredictable. 3. The child probably has some degree of cognitive impairment (CI). 4. The child should have genetic counseling before planning a family.
1 rationale: CP is a nonprogressive chronic condition, and its effects are predictable. Although CI may be present in some children with CP, all children with this disorder have CI. A variety of prenatal, perinatal, and postnatal factors contribute to the development of CP. It is estimated that the cause of CP is unknown in as many as 80% of people with the disorder.
The hypertonicity of the muscles in an infant with cerebral palsy causes scissoring of the legs. The nurse teaches the mother that the preferred way to carry the infant is in a sitting position in what way? 1. astride one of her hips 2. strapped in an infant seat 3. wrapped tightly in a blanket 4. under the arm in a football hold
1 rationale: Carrying the infant astride the parent's hip prevents scissoring by keeping the infant's legs abducted. An infant seat will not prevent scissoring. Tight wrapping maintains the infant's legs in a scissored position. When the football hold is used, the infant is carried in a supine position with the legs adducted, which promotes scissoring.
What safety instruction should a nurse teach a 10-year-old child with diminished sensation in the legs because of cerebral palsy? 1. Test the temperature of the water before a bath. 2. Tighten brace straps securely before ambulating. 3. Set the clock twice during the night to change position. 4. Look down at the legs when crutch-walking to check how they are positioned.
1 rationale: Individuals whose thermoreceptive senses are impaired are unable to detect changes or degrees of temperature. They must be taught to first test the temperature in any water-related activity to prevent scalding and burning. Overtightening of brace straps may lead to circulatory impairment or skin breakdown. The child with cerebral palsy has uncontrolled movement of voluntary muscles and does not need to change positions at night to prevent skin breakdown. Looking down at the legs when crutch-walking is dangerous because this action alters the center of gravity; with practice the child will be able to place the legs in the appropriate position for walking without looking down.
An orthopedic surgeon plans to have a school-aged child with cerebral palsy walk with crutches. What should the nurse determine before preparing this child for crutch-walking? 1. Weight-bearing ability of the child's four extremities 2. The power in the child's trunk to drag the legs forward when the child is erect 3. Whether the child's circulation can tolerate the body's being placed in an erect position 4. The ability of the child's shoulder girdle to support the body's weight when it leaves the floor
1 rationale: The choice of gait is based on the weight-bearing capabilities of each of the four extremities. Assessment of the extremities takes priority over assessment of the trunk. The child with cerebral palsy uses upper-extremity strength for crutch control and lower-extremity strength to facilitate some movement. The child with cerebral palsy is unlikely to have orthostatic circulatory impairment. Because of decreased muscle control, it is unlikely that the child is able to use a gait involving complete support of body weight off the floor.
A 7-year-old child with cerebral palsy who wears leg braces has a slight sensory loss in the lower extremities. What is the most essential information for the nurse to teach the child and parents? 1. Examine the skin for evidence of pressure points. 2. Keep the braces in good repair and pad them well. 3. Select shoes that have heels that are wide and low. 4. Check that the brace joints are aligned with body joints.
1 rationale: When sensory perception is impaired, with resultant lack of effective specific motor responses, the child will be more vulnerable to skin irritation and trauma. Although it is important for the braces to be usable and well padded, the skin must be assessed daily when there is a sensory loss. Pressure may still occur even if the braces are well padded. Although this type of shoe will facilitate balance, assessing the skin for breakdown is the priority. Although alignment of brace joints to body joints is important in facilitating joint mobility, assessment for skin breakdown takes priority.
An 8-year-old child with cerebral palsy is admitted to the hospital for a tendon-lengthening procedure. After the surgery the parents ask a nurse why their child must wear braces and shoes for at least 12 hours a day, even while in bed. What is the best response by the nurse? 1. "Ambulation should be encouraged as soon as possible." 2. "They maintain body alignment and help prevent foot drop." 3. "They stretch your child's ligaments and strengthen muscle tone." 4. "It helps your child accept the physical constraints of the condition."
2 rationale: Braces are worn to enable the spastic child to control movement. They also prevent deformities that can occur as a result of misalignment. Early ambulation is promoted by maintaining muscle strength and tone, but it is not the reason for applying braces. Exercises, not braces, are used to stretch ligaments and improve muscle strength and tone. Promoting acceptance is not the purpose of braces and shoes. The child is in Erikson's stage of industry versus inferiority, and the braces and shoes will promote independence.
The nurse anticipates that the family of a child with cerebral palsy is at risk for difficult parenting issues. What does the nurse conclude is the probable basis for this difficulty? 1. lack of social support 2. unrealistic expectations 3. loss of the expected healthy child 4. having a child with cognitive impairment
3 rationale: All parents initially grieve over the loss of a healthy child, what could have been, and what may never be. Many families have support systems. Unrealistic expectations may be true of some, but not all, parents. Not all children with cerebral palsy are cognitively impaired; approximately 30% to 50% of children with cerebral palsy are mentally challenged.
A nurse is teaching the parents of an infant with cerebral palsy how to provide optimal care. What should the nurse include in the teaching? 1. focusing on cognitive rather than motor skills 2. maintaining immobility of the limbs with splints 3. preserving muscle tone to prevent joint contractures 4. continuing to offer a special formula to limit gagging
3 rationale: Children with cerebral palsy are especially prone to muscle tone disorders, including spasticity, which can lead to joint contractures. The therapy program must be balanced to promote progress in all areas of growth and development. Splinting of limbs is contraindicated because immobility promotes the development of joint contractures. Although these infants tend to gag and choke during feedings, a special formula is not necessary unless the child is allergic to dairy products.
A nurse is planning to teach the four-point alternate crutch gait to a 9-year-old child with cerebral palsy. How does the nurse explain this choice to the parents? 1. The child has minimal step ability in the lower extremities. 2. It provides for two points of support on the floor at all times. 3. It provides for equal but partial weight bearing on each limb. 4. The child has more power in the upper extremities than in the lower extremities.
3 rationale: The four-point alternate crutch gait is a simple, slow, stable gait because there are always three points of support on the floor, with equal but partial weight bearing on each limb. The child has the ability to move, but the movement in the lower extremities is uncoordinated. The four-point gait provides for three points of support, not two, at all times. A four-point gait divides weight bearing equally among the limbs.
A nurse is concerned about helping the parents of an infant with cerebral palsy set long-term goals for the family. What is most important to understand when setting long-term goals? 1. cognitive impairments require special education 2. progressive deterioration requires future institutionaliztion 3. unknown extent of the disability requires continual adjustments 4. diminished immune responses require protection from infection
3 rationale: The infant is too young for specific long-term plans; different problems may manifest as the child grows older. Children with cerebral palsy may or may not have cognitive impairments. Cerebral palsy does not get progressively worse; placement outside the home depends on the child's needs and the parents' abilities and desires. There is no relationship between cerebral palsy and a lowered immune response.
While working in a neuromuscular clinic the nurse monitors infants for symptoms of cerebral palsy. Which statements by infants' mothers indicate the need for further evaluation for cerebral palsy? Select all that apply. 1. my baby doesn't make eye contact 2. my baby seems to have a voracious appetite 3. my baby was able to turn from front to back by 2 months of age 4. i've noticed that this baby clings to me more than other children of the same age 5. all of my other children were sitting alone by this age. this baby doesn't seem to be anywhere near sitting alone
3, 5 rationale: An infant that turns from front to back at an early age will often be found to have spastic cerebral palsy; it is the spasticity that causes an unintentional turn from front to back. Cerebral palsy is a neurologic problem and is commonly recognized when the child fails to meet developmental norms. Failure to make eye contact is often associated with eye issues or autism. Neither anorexia nor a voracious appetite are associated with cerebral palsy. Personality traits are not related to a diagnosis of cerebral palsy.
A mother whose infant was found to have cerebral palsy at 6 months of age asks why she was not told that her baby had cerebral palsy when the infant was born. How should the nurse respond? 1. the neurological lesions changed as your baby matured 2. joint deformities don't appear until after 6 months of age 3. the staff members didn't want to alarm you until it was necessary 4. until there's control of voluntary movement, a diagnosis can't be confirmed
4 rationale: Cortical control of voluntary muscles occurs between 2 and 4 months of age. The neurological lesions are fixed and will neither progress nor regress. Cerebral palsy is not diagnosed on the basis of the presence of joint deformities; these may develop later because of spastic muscle imbalance. Parents have a right to be informed of their child's diagnosis as soon as possible.
A nurse notes that a child is exhibiting signs of cerebral palsy. At what age are these signs usually first noticeable? 1. 2 years 2. 3 years 3. 3 months 4. 12 months
4 rationale: Early diagnosis of cerebral palsy may be made as early as 6 months of age, but usually the condition is diagnosed closer to 12 months of age, as motor control is established. The diagnosis usually is established before 2 years of age as the child's movements and behaviors are observed. Differences in muscle tone, gait, posture, and mobility are apparent before 3 years of age in children with cerebral palsy. Although motor dysfunction may be apparent during the first 3 months in severely affected infants, cerebral palsy is most frequently diagnosed by the end of the first year of life.
nurse in the pediatric clinic should be most observant for signs of cerebral palsy in a 6-month-old infant in which instance? 1. has a 40-year-old mother 2. was born exhibiting the moro reflex 3. was delivered by elective cesarean birth 4. was born during the 32nd week of gestation
4 rationale: Studies indicate that a large percentage of children with cerebral palsy had preterm births and weighed less than 3 lb 5 oz (1500 g) at birth. Studies do not indicate a greater incidence of cerebral palsy in children born to older women. There is no greater incidence of cerebral palsy in children born in cesarean births that are not performed because of fetal distress. The Moro reflex is expected at birth.
An infant is found to have cerebral palsy (CP) several months after birth. When the infant is 10 months old the mother comes to the pediatric clinic because the child has begun to exhibit slow writhing movements. The nurse explains that these movements are characteristically associated with what type of CP? 1. ataxic 2. spastic 3. dystonic 4. athetoid
4 rationale: The athetoid type of CP consists of slow, wormlike, writhing movements. The ataxic type of CP is characterized by rapid, repetitive movements. The spastic type of CP is characterized by hypertonicity of muscles. The dystonic type of CP is a combination of the spastic and athetoid types.
A 9-year-old child who has cerebral palsy and scoliosis also is mentally challenged and blind. The child is incontinent, has contractures of the elbows and wrists, and sits in a customized wheelchair most of the day. One goal of nursing care is for the child's skin integrity to remain intact. Which nursing action will best achieve this goal? 1. padding the child's lower extremities 2. repositioning the child every 4 hours 3. replacing the bed linens with sterile linens 4. changing disposable diapers every 2-3 hours
4 rationale: The buttocks are at greatest risk for excoriation because the child sits in a wheelchair most of the day. For skin integrity to be maintained, the diaper area must be kept dry; disposable diapers keep moisture away from the skin. Because the child is in a wheelchair, there is no pressure on the child's legs. The child should be repositioned every 1 to 2 hours. Replacing the bed linens is unnecessary; freshly laundered linens will not prevent the development of a pressure ulcer.
A 9-year-old child with cerebral palsy is to be taught the four-point alternate crutch gait. The parents ask why this gait was chosen. How should the nurse respond? 1. "Your child has more power in the arms than in the legs." 2. "Your child doesn't have power or step ability in the legs." 3. "It provides two points of support on the floor between steps." 4. "It provides for equal but partial weight-bearing on each limb."
4 rationale: The four-point alternate crutch gait is a simple and slow but stable gait because there are always three points of support on the floor, with equal but partial weight-bearing on each limb. Telling the parent that their child has more power in the arms than in the legs may or may not be true; the data are insufficient to justify this conclusion. Some power and step ability is required to use the four-point alternate crutch gait. The child has uncoordinated movement in the legs because of the cerebral palsy.
