Peds success ch.11 Neuromuscular Disorders
the nurse is planning care for a child with a T12 spinal cord injury. which lifelong complication should the child and family know about? (select all that apply) a. compromised skin integrity b. incontinence c. loss of large and small motor activity d. loss of voice e. spasticity
a, b, c, e
the mother of a child with duchenne MD asks the nurse who in the family should have genetic screening. who should the nurse say must be tested? (select all that apply) a. mother b. sister c. brother d. aunts and all female cousins e. uncles and all male cousins
a, b, d
which will help a school age child with MD stay active longer? (select all that apply) a. normal activities, such as swimming b. using a treadmill every day c. several periods of rest every day d. using a wheelchair upon getting tired e. sleeping as late as needed
a, c, d
which would the nurse expect a child with spastic CP to demonstrate? (select all that apply) a. increased deep tendon reflexes b. decreased muscle tone c. scoliosis d. contractures e. scissoring f. good control of posture g. good fine motor skills
a, c, d, e
the nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for MD is which of the following? a. electromyelogram b. nerve conduction velocity c. muscle biopsy d. creatinine kinase level
c
the parent of an infant with CP asks the nurse if the infant will be mentally retarded. which is the nurse's best response? a. "children with CP have some amount of mental retardation" b. "approximately 20% of children with CP have normal intelligence" c. "many children with CP have normal intelligence" d. "mental retardation is expected if motor and sensory deficits are severe"
c
which should the nurse tell the parent of an infant with spina bifida? a. "bone growth will be more than that of babies who are not sick because your baby will be less active" b. "physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills" c. "nutritional needs for your infant will be calculated on the basis of activity level" d. "fine motor skills will be delayed because of the disability"
b
when assessing the neurological status of an 8 month old, the nurse should check for which of the following? (select all that apply) a. clarity of speech b. interaction with staff c. vision test d. romberg test e. ability to roll over and sit independently
b and e
cause of autonomic dysreflexia include which of the following? (select all that apply) a. decrease in blood pressure b. abdominal distention c. bladder distention d. diarrhea e. tight clothing f. hyperthermia
b, c, e
A child with GBS has had lots of oral fluids but has not urinated for 8 hours. Which is the nurse's first action? a. check the child's serum blood-urea-nitrogen level. b. check the child's complete blood count. c. catheterize the child in and out. d. run water in the bathroom to stimulate urination.
c
A child with spastic CP had an intrathecal dose of baclofen in the early afternoon. What is the expected result 31/2 hours post dose that suggests the child would benefit from a baclofen pump? a. the ability to self-feed. b. the ability to walk with little assistance. c. if the spasticity were decreased. d. if the spasticity were increased.
c
A newborn with a repaired myelomeningocele is assessed for hydrocephalus. What would the nurse expect if the infant has hydrocephalus? a. low-pitched cry and depressed fontanel. b. low-pitched cry and bulging fontanel. c. bulging fontanel and downwardly rotated eyes. d. depressed fontanel and upwardly rotated eyes.
c
The parent of a young child with CP brings the child to the clinic for a checkup. Which of the parent's following statements indicates an understanding of the child's long-term needs? a. "my child will need all my attention for the next 10 years." b. "once in school, my child will catch up and be like the other children." c. "my child will grow up and need to learn to do things independently." d. "I'm the one who knows the most about my child and can do the most for my child."
c
a child presents with a history of having an upper respiratory tract infection 2 weeks ago; complains of symmetrical lower extremity weakness, back pain, muscle tenderness; and has absent deep tendon reflexes in the lower extremities. which is important regarding this condition? a. the disease process if probably bacterial b. the recent upper respiratory infection is not important information c. this may be an acute inflammatory demyelinating neuropathy d. CN involvement is rare
c
the mother of an infant diagnosed with werdnig-hoffmann disease asks the nurse what she could have done during her first pregnancy to prevent his. the nurse explains that the cause of werdnig-hoffmann is which of the following? a. unknown b. restricted movement in utero c. inherited as an autosomal recessive trait d. inherited as an autosomal dominant trait
c
the nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. which would be a priority nursing diagnosis before surgery? a. alteration in parent infant bonding b. altered growth and development c. risk of infection d. risk for weight loss
c
the nurse is developing a plan of care for a child who has been recently diagnosed with CP. which should be the nurse's priority goal? a. ensure the ingestion of sufficient calories for growth b. decrease intracranial pressure c. teach appropriate parenting strategies for a child with special needs d. ensure that the child reaches full potential
c
the nurse is planning care for a child who was recently admitted with GBS. which is a priority nursing diagnosis? a. risk for constipation related to immobility b. chronic sorrow related to presence of chronic disability c. impaired skin integrity related to infectious disease process d. activity intolerance related to ineffective cardiac muscle function
c
treatment of an adolescent who has MG consists of? a. long term corticosteroids b. genatmycin for infections c. pyridostigmine (mestinon) d. encourage strenuous activities
c
which is the priority nursing intervention for a child with tetanus? a. quiet environment b. monitoring the feeding tube c. respiratory assessment d. emotional support
c
the nurse judges teaching as successful when the parent of a child with MG states which of the following? (select all that apply) a. "my child should play on the school's basketball team" b. "my child should meditate every day" c. "my child should be allowed to do what other kids do" d. "my child should be watched carefully for signs of illness" e. "my child should sleep in my room so that I can watch him better"
c and d
the nurse should tell the parents of a child with duchenne (pseudohypertrophic) MD that some of the progressive complications include which of the following? (select all that apply) a. dry skin and hair, hirsutism, protruding tongue, and mental retardation b. anorexia, gingival hyperplasia, dry skin and hair c. contractures, obesity, and pulmonary infections d. trembling, frequent loss of consciousness, and slurred speech e. increasing difficulty swallowing and shallow breathing
c and e
which should the nurse expect as an intervention in a child in the recovery phase of GBS? (select all that apply) a. assist with self feeding skills b. assist with grooming and dressing c. arrange for in home schooling d. begin testing to determine what school grade the child should be in e. begin an active PT program
c and e
which should the nurse in the ED be prepared for in a child with a possible spinal cord injury? (select all that apply) a. severe pain b. elevated temperature c. respiratory depression d. increased intracranial pressure e. multiple sites of injury
c and e
which should the nurse expect in a 2 week old with a brachial plexus injury? (select all that apply) a. history of a normal vaginal delivery b. small infant c. absent moro reflex on one side d. no sensory loss e. associated clavicle fracture
c, d, e
an adolescent presents with sudden-onset unilateral facial weakness with drooping of one side of the mouth. the teen is unable to close the eye on the affected side but has no other symptoms and otherwise feels well. the nurse could summarize the condition by which of the following? a. the prognosis is poor b. this may be a CVA c. it is the fifth CN palsy d. this is paralysis of the facial nerve
d
the nurse evaluates teaching of parents of a child newly diagnosed with CP as successful when the parents state that CP is which of the following? a. inability to speak and uncontrolled drooling b. involuntary movements of lower extremities only c. involuntary movements of upper extremities only d. an increase in muscle tone and deep tendon reflexes
d
the nurse is caring for a school age child with duchenne MD in the elementary school. which would be an appropriate nursing diagnosis? a. anticipatory guidance b. anxiety reduction c. increased pain d. activity intolerance
d
the parent of an infant asks the nurse what to watch for to determine whether the infant has CP. which is the nurse's best response? a. "whether the infant cannot sit up without support before 8 months" b. "whether the infant demonstrates tongue thrust before 4 months" c. "whether the infant has poor head control after 2 months" d. "whether the infant has clenched fists after 3 months"
d
which can elicit the gower sign? (select all that apply) a. close the eyes and touch the nose with alternating index fingers b. hop on one foot and then the other c. bend from the waist to touch the toes d. walk like a duck and rise from a squatting position
d
which should the nurse prepare the parents of an infant for following surgical repair and closure of a myelomeningocele shortly after birth? the infant will: a. not need any long term management and should be considered cured b. not be at risk for urinary tract infections or movement problems c. have continual drainage of cerebrospinal fluid, needing frequent dressing changes d. need lifelong management of urinary, orthopedic, and neurological problems
d
which foods would be best for a child with duchenne MD? (select all that apply) a. high carbohydrate, high protein foods b. no special food combinations c. extra protein to help strengthen muscles d. low calorie foods to prevent weight gain e. thickened liquids and smaller portions that are cut up
d and e
an adolescent with a T4 spinal cord injury suddenly becomes dangerously hypertensive and bradycardic. which intervention is appropriate? a. call the neurosurgeon immediately, as this sounds like sudden intracranial hypertension b. check to be certain that the client's bladder is not distended c. administer diazoxide (hyperstat) to treat the blood pressure d. administer atropine for bradycardia
b
over the past week, an infant with a repaired meylomeningocele has had a high pitched cry and has been irritable. length, weight, and head circumference have been at the 50th percentile. today, length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. the nurse should do which of the following? a. tell the parent this is normal for an infant with a repaired myelomeningocele b. tell the parent this might mean the baby has increased intracranial pressure c. suspect the baby's intracranial pressure is low because of a leak d. refer the baby to the neurologist for follow up care
b
the most common type of tetanus presents with which early symptom? a. muscle pain b. progressive stiffness of the neck muscles c. progressive involvement of the trunk muscles d. pneumonia
b
the mother of a toddler diagnosed with werdnig-hoffmann disease ask the nurse what they can feed their child that would be quality food. which would be good choices for the nurse to recommend? a. a hit dog and chips b. chicken and broccoli c. a banana and almonds d. a milkshake and a hamburger
b
the nurse evaluates the teaching as successful when a parent states that which of the following can cause autonomic dysreflexia? a. exposure to cold temperatures b. distended bowel or bladder c. bradycardia d. headache
b
the nurse knows that teaching was successful when a parent states which of the following are early signs of MD? a. increased muscle strength b. difficulty climbing stairs c. high fevers and tiredness d. respiratory infections and obesity
b
the nurse us doing a follow up assessment of a 9 month old. the infant rolls both ways, sits with some support, pushes food out of the mouth, and pushes away when help. the parent asks about the infant's development. the nurse responds by saying which of the following? a. "your child is developing normally" b. "your child needs to see the primary care provider" c. "you need to help your child learn to sit unassisted" d. "push the food back when your child pushes the food out"
b
the parent of a child diagnosed with werdnig-hoffmann disease notes times of not being able to hear the child breathing. which should the nurse do first? a. check pulse ox on the child b. count the child's respirations c. listen to the child's lung sounds
b
the parent of a toddler newly diagnosed with CP asks the nurse what caused it. the nurse should answer with which of the following? a. most cases are caused by unknown prenatal factors b. it is commonly caused by perinatal factors c. the exact cause is not known d. the exact cause is known in every instance
b
which should be the primary nursing diagnosis for a 12 hour old newborn with a myelomeningocele at L2? a. altered bowel elimination related to neurological deficits b. potential for infection related to the physical defect c. altered nutrition related to neurological deficit d. disturbance in self concept related to physical disability
b
which should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? a. weigh diapers for 24 hour urine output b. measure head circumference c. offer clear fluids d. assess for infection
b
A child with a repaired myelomeningocele is in the clinic for a regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which should the nurse tell the parent? a. tethered cord is a post-surgical complication. b. tethered cord occurs during times of slow growth. c. release of the tethered cord will be necessary only once. d. offering laxatives and acetaminophen daily will help control these problems.
a
a school age child is admitted to the unit preoperatively for bladder reconstruction. the child is latex sensitive. which intervention should the nurse implement? a. post a sign on the door and note in the chart that the child is latex allergic b. use powder free latex gloves when giving care c. keep personal items such as stuffed animals in a plastic bag to avoid latex contamination d. use a disposable plastic covered blood pressure cuff that will stay in the child's room
a
after spinal cord surgery, an adolescent suddenly complains of a severe headache. which should be the nurse's first action? a. check the blood pressure b. check for a full bladder c. ask if pain is present somewhere else d. ask if other symptoms are present
b
parents bring their 2 month old into the clinic with concerns that the baby seems "floppy". the parents say the baby seems to be working hard to breath, eats very slowly, and seems to fatigue quickly. the nurse assesses intercostal retractions, although the baby is otherwise in no distress. the parents add there was a cousin whose baby had similar symptoms. the nurse would be concerned with which possible complication? a. respiratory compromise b. dehydration c. need for emotional support for the family d. feeding intolerance
a
the mother of a newborn relates that this is her first child; the baby seems to sleep a lot and does not cry much. which question would the nurse ask the mother? a. "how many ounces of formula does your baby take at each feeding" b. "how many bowel movements does your baby have in a day" c. "how much sleep do you get every night" d. "how long does the baby stay awake at each feeding
a
which developmental milestone should the nurse be concerned about if a 10 month old cannot do it? a. crawl b. cruise c. walk d. have a pincer grasp
a
which gross motor skills should the nurse assess in a 3 month old with spina bifida? a. head control b. pincer grasp c. sitting alone d. rolling over
a
which if the best advice to offer the parent of a 6 month old with werdnig-hoffmann disease on how to treat the infant's constipation? a. offer extra water every day b. add corn syrup to two bottles a day c. give the infant a glycerin suppository today d. let the infant go 3 days without a stool before intervening
a
which intervention should be included in the plan of care for a newborn with a newly repaired myelomeningocele? a. offer formula/breast milk every 3 hours b. turn the infant back to front every 2 hours c. place a wet dressing on the sac d. provide pain medication every 4 hours
a
which should the nurse do for a 7 year old living in a rural area who is missing school shots and who has sustained a puncture wound? a. administer Tdap vaccine b. start the child on an antibiotic c. clean the wound with hydrogen peroxide d. send the child to the ED
a
why does spinal cord injury without radiographic abnormality sometimes occur in children? a. children can suffer momentary severe subluxation and trauma to the spinal cord b. the immature spinal column in children does not allow for quality films c. the hemorrhaging that occurs with injury obscures radiographic abnormalities d. radiographic abnormalities are not evident because of incomplete ossification of the vertebrae
a
A child has a provisional diagnosis of MG. which should the nurse expect in this child? (select all that apply) a. double vision, ptosis b. tremors and seizures c. coughing and choking d. ascending paralysis e. sensory disturbance
a and c
the parents of a preschooler diagnosed with MD are asking questions about the course of their child's disease. which should the nurse tell them? (select all that apply) a. "MD usually results in progressive weakness" b. "the weakness that your child is having will probably not increase" c. "your child will be able to function normally and not need any special accommodations" d. "the extent of weakness depends on doing daily PT" e. "your child may have pain in his legs with muscle weakness"
a and e
which priority item should be placed at the bedside of a newborn with unrepaired myelomeningocele? (select all that apply) a. a bottle of normal saline b. a rectal thermometer c. extra blankets d. a blood pressure cuff e. latex free gloves
a and e
which symptoms will a child suffering from complete spinal cord injury experience? (select all that apply) a. loss of motor or sensory function below the level of the injury b. loss of interest in normal activities c. extreme pain below the level of the injury d. loss of some function, with sparing of function below the level of the injury e. loss of bowel and bladder control
a and e
which of the following are causes of botulism? (select all that apply) a. man made materials b. contaminated words c. improperly cooked canned food d. honey if given to an infant less than 12 months of age e. wound sustained by a teen in a large city
a, b, c, d
a 5 year old has been diagnosed with pseudohypertrophic MD. which nursing intervention(s) would be appropriate? (select all that apply) a. discuss with the parents the potential need for respiratory support b. explain that this disease is easily treated with medication c. suggest low impact exercises that limit stress placed on the muscles and prevent fatigue d. assist the parents in finding a nursing facility for future care e. encourage the parents to contact the school to develop an IEP
a, c, e
which should the nurse include when teaching sexuality education to an adolescent with a spinal cord injury? (select all that apply) a. "you can enjoy a healthy sex life and most likely conceive children" b. "you will never be able to conceive if you have no genital sensation" c. "development of secondary sex characteristics is delayed" d. "a few females have regular menstrual periods after injury" e. "you can get the same sexually transmitted infections that those without spinal cord injuries get"
a, d, e
a 10 year old sustained a puncture wound to the foot while playing in the back yard. his immunizations are up to date. which of the following should be administered? a. tetanus toxoid b. Tdap c. tetanus immunoglobulin d. DTaP
b
a 15 year old with spina bifida is seen in the clinic for a well child checkup. the teen uses leg braces and crutches to ambulate. which nursing diagnosis takes priority? a. potential for infection b. alteration in mobility c. alteration in elimination d. potential body image disturbance
b
a 3 year old with CP is admitted for dehydration following an episode of diarrhea. the nurse's assessment follows: awake; pale, thin child lying in bed; multiple contractures; drooling; coughing spells noted when parent feeds. T 97.8F (36.5C), P 75, RR 25, weight 7.2 kg, no diarrheal stool for 48 hours. which nursing diagnosis is most important? a. potential for skin breakdown; lying in one position b. alteration in nutrition; less than body requirements c. potential for impaired social support; parent sole caretaker d. alteration in elimination; diarrhea
b