San Jacinto College - RNSG 2201

Chapter 30: The Child with Neuromuscular or Muscular Dysfunction Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)The nurse is planning a staff in-service on childhood spastic cerebral palsy. What characterizes spastic cerebral palsy?

1. 1. Hypertonicity and poor control of posture, balance, and coordinated motion
   2. Athetosis and dystonic movements
   3. Wide-based gait and poor performance of rapid, repetitive movements
   4. Tremors and lack of active movement

2. The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their child’s spasticity. The nurse’s respNoUnRsSeIsNhGoTuBld.CbOeMbased on which statement?
   1. Anticonvulsant medications are sometimes useful for controlling spasticity.
   2. Medications that would be useful in reducing spasticity are too toxic for use with children.
   3. Many different medications can be highly effective in controlling spasticity.
   4. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

3. The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn’s defect?
   1. Fissure in the spinal column that leaves the meninges and the spinal cord exposed
   2. Herniation of the brain and meninges through a defect in the skull
   3. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural

elements

1. 4. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

4. The nurse is conducting a staff in-service on common problems associated with myelomeningocele. Which common problem is associated with this defect?
   1. Hydrocephalus
   2. Craniostenosis
   3. Biliary atresia
   4. Esophageal atresia

5. The nurse is teaching a group of nursing students about newborns born with the congenital defect of myelomeningocele. Which common problem is associated with this defect?
   1. Neurogenic bladder
   2. Cognitive impairment
   3. Respiratory compromise
   4. Cranioschisis

6. The nurse is reviewing prenatal vitamin supplements with an expectant client. Which supplement should be included in the teaching?
   1. Vitamin A throughout pregnancy
   2. Multivitamin preparations as soon as pregnancy is suspected
   3. Folic acid for all women of childbearing age
   4. Folic acid during the first and second trimesters of pregnancy

7. How much folic acid is recommended for women of childbearing age?
   1. 1.0 mg
   2. 0.4 mg
   3. 1.5 mg
   4. 2.0 mg

8. The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. Which describes the most appropriate way to position and feed this neonate?
   1. Prone and tube-fed
   2. Prone, head turned to side, and nipple-fed
   3. Supine in an infant carrier and nipple-fed
   4. Supine, with defect supported with rolled blankets, and nipple-fed

9. The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching?
   1. “My child will have an allergic reaction if he comes in contact with yeast products.”
   2. “My child may have an upset stomach if he eats a food made with wheat or barley.”
   3. “My child will probably develop an allergy to peanuts.”
   4. “My child should not eat bananas or kiwis.”

10. Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which action?
    1. Avoid using any latex product.
    2. Use only nonallergenic latex products.
    3. Administer medication for long-term desensitization.
    4. Teach family about long-term management of asthma.

11. The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease?
    1. Spinal muscular atrophy
    2. Neural atrophy of muscles
    3. Progressive weakness and wasting of skeletal muscle
    4. Pseudohypertrophy of certain muscle groups

12. Which clinical manifestations in an infant would be suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)?
    1. Hyperactive deep tendon reflexes
    2. Hypertonicity
    3. Lying in the frog position
    4. Motor deficits on one side of body

13. A 4-year-old child has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. The management plan should include which action?
    1. Recommend genetic counseling.
    2. Explain that the disease is easily treated.
    3. Suggest ways to limit use of muscles.
    4. Assist family in finding a nursing facility to provide child’s care.

14. What should be administered to a child with tetanus?
    1. Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation.
    2. Muscle stimulants to counteract muscle weakness.
    3. Bronchodilators to prevent respiratory complications.
    4. Tetanus immunoglobulin therapy.

15. The nurse is conducting reflex testing on infants at a well-child clinic. Which reflex finding should be reported as abnormal and considered as a possible sign of cerebral palsy?
    1. Tonic neck reflex at 5 months of age
    2. Absent Moro reflex at 8 month of age
    3. Moro reflex at 3 months of age
    4. Extensor reflex at 7 months of age

16. The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which intervention should the nurse plan for the care of the myelomeningocele sac?
    1. Open to air
    2. Covered with a sterile, moist, nonadherent dressing
    3. Reinforcement of the original dressing if drainage noted
    4. A diaper secured over the dressing

17. The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which is a priority in the care for this child?
    1. Monitoring intake and output
    2. Assessing respiratory efforts
    3. Placing on a telemetry monitor
    4. Obtaining laboratory studies

18. The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescription should the nurse clarify with the health care provider before implementing?
    1. Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time.
    2. Provide total parenteral nutrition (TPN) at 25 ml/hr intravenously.
    3. Titrate oxygen to keep pulse oximetry saturations greater than 92.
    4. Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

19. A home care nurse is caring for an adolescent with a T1 spinal cord injury. The adolescent suddenly becomes flushed, hypertensive, and diaphoretic. Which intervention should the nurse perform first?
    1. Place the adolescent in a flat right side-lying position.
    2. Place a cool washcloth on the adolescent’s forehead and continue to monitor the blood pressure.
    3. Implement a standing prescription to empty the bladder with a sterile in and out Foley catheter.
    4. Take a full set of vital signs anNdUnRoStIiNfyGTthBe.ChOeMalth care provider.

20. A child steps on a nail and sustains a puncture wound of the foot. Which is the most appropriate method for cleansing this wound?
    1. Wash wound thoroughly with chlorhexidine.
    2. Wash wound thoroughly with povidone-iodine.

1. 3. Soak foot in warm water and soap.
   4. Soak foot in solution of 50% hydrogen peroxide and 50% water.

MULTIPLE RESPONSE

1. A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Nursing care for this child includes which action(s)?
   1. Monitoring and maintaining systemic blood pressure
   2. Administering corticosteroids
   3. Minimizing environmental stimuli
   4. Discussing long-term care issues with the family
   5. Monitoring for respiratory complications

2. Which assessment findings should the nurse note in a school-age child with Duchenne muscular dystrophy (DMD)?
   1. Lordosis
   2. Gower sign
   3. Kyphosis
   4. Scoliosis
   5. Waddling gait

3. The nurse is conducting discharge teaching to parents of a preschool child with myelomeningocele, repaired at birth, being discharged from the hospital after a urinary tract infection (UTI). Which should the nurse include in the discharge instructions related to management of the child’s genitourinary function?
   1. Continue to perform the clean intermittent catheterizations (CIC) at home.
   2. Administer the oxybutynin chloride (Ditropan) as prescribed.
   3. Reduce fluid intake in the afternoon and evening hours.
   4. Monitor for signs of a recurrent urinary tract infection.
   5. Administer furosemide (Lasix) as prescribed.

4. Which should the nurse expect to find in the cerebral spinal fluid (CSF) results of a child with Guillain-Barré syndrome (GBS)?
   1. Decreased protein concentration
   2. Normal glucose
   3. Fewer than 10 white blood cells (WBCs/mm³)
   4. Elevated red blood cell (RBC) count

5. The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant?
   1. Temperature instability
   2. Irritability