Deck 32: The Child with Neuromuscular or Muscular Dysfunction

Question 1

How much folic acid is recommended for women of childbearing age?

A)1.0 mg
B)0.4 mg
C)1.5 mg
D)2.0 mg

Answer 1

0.4 mg

Question 2

The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1).Which signs and symptoms are associated with this disease?

A)Spinal muscular atrophy
B)Neural atrophy of muscles
C)Progressive weakness and wasting of skeletal muscle
D)Pseudohypertrophy of certain muscle groups

Answer 2

Progressive weakness and wasting of skeletal muscle

Question 3

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?

A)Place the adolescent in a flat right side-lying position.
B)Place a cool washcloth on the adolescent's forehead and continue to monitor the blood pressure.
C)Implement a standing prescription to empty the bladder with a sterile in and out Foley catheter.
D)Take a full set of vital signs and notify the health care provider.

Answer 3

Implement a standing prescription to empty the bladder with a sterile in and out Foley catheter.

Question 4

The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their child's spasticity.The nurse's response should be based on which statement?

A)Anticonvulsant medications are sometimes useful for controlling spasticity.
B)Medications that would be useful in reducing spasticity are too toxic for use with children.
C)Many different medications can be highly effective in controlling spasticity.
D)Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

Question 5

The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery.Which describes this newborn's defect?

A)Fissure in the spinal column that leaves the meninges and the spinal cord exposed
B)Herniation of the brain and meninges through a defect in the skull
C)Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements
D)Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

Question 6

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning.Which interventions should the nurse plan for the care of the myelomeningocele sac?

A)Open to air
B)Covered with a sterile moist nonadherent dressing
C)Reinforcement of the original dressing if drainage noted
D)A diaper secured over the dressing

Question 7

The nurse is planning a staff in-service on childhood spastic cerebral palsy.Spastic cerebral palsy is characterized by:

A)hypertonicity and poor control of posture, balance, and coordinated motion.
B)athetosis and dystonic movements.
C)wide-based gait and poor performance of rapid, repetitive movements.
D)tremors and lack of active movement.

Question 8

The nurse is caring for a neonate born with a myelomeningocele.Surgery to repair the defect is scheduled the next day.The most appropriate way to position and feed this neonate is which position?

A)Prone and tube-fed
B)Prone, head turned to side, and nipple-fed
C)Supine in an infant carrier and nipple-fed
D)Supine, with defect supported with rolled blankets, and nipple-fed

Question 9

Which clinical manifestations in an infant would be suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)?

A)Hyperactive deep tendon reflexes
B)Hypertonicity
C)Lying in the frog position
D)Motor deficits on one side of body

Question 10

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)? (Select all that apply.)

A)Monitoring and maintaining systemic blood pressure
B)Administering corticosteroids
C)Minimizing environmental stimuli
D)Discussing long-term care issues with the family
E)Monitoring for respiratory complications

Question 11

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?

A)"My child will have an allergic reaction if he comes in contact with yeast products."
B)"My child may have an upset stomach if he eats a food made with wheat or barley."
C)"My child will probably develop an allergy to peanuts."
D)"My child should not eat bananas or kiwis."

Question 12

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?

A)Tonic neck reflex at 5 months of age
B)Absent Moro reflex at 8 months of age
C)Moro reflex at 3 months of age
D)Extensor reflex at 7 months of age

Question 13

The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS).Which is a priority in the care for this child?

A)Monitoring intake and output
B)Assessing respiratory efforts
C)Placing on a telemetry monitor
D)Obtaining laboratory studies

Question 14

Therapeutic management of a child with tetanus includes the administration of:

A)nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation.
B)muscle stimulants to counteract muscle weakness.
C)bronchodilators to prevent respiratory complications.
D)tetanus immunoglobulin therapy.

Question 15

The nurse is conducting a staff in-service on common problems associated with myelomeningocele.Which common problem is associated with this defect?

A)Hydrocephalus
B)Craniosynostosis
C)Biliary atresia
D)Esophageal atresia

Question 16

A 4-year-old child has just been diagnosed with pseudohypertrophic (Duchenne)muscular dystrophy.The management plan should include which action?

A)Recommend genetic counseling.
B)Explain that the disease is easily treated.
C)Suggest ways to limit use of muscles.
D)Assist family in finding a nursing facility to provide his care.

Question 17

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?

A)Neurogenic bladder
B)Mental retardation
C)Respiratory compromise
D)Cranioschisis

Question 18

Latex allergy is suspected in a child with spina bifida.Appropriate nursing interventions include which action?

A)Avoid using any latex product.
B)Use only nonallergenic latex products.
C)Administer medication for long-term desensitization.
D)Teach family about long-term management of asthma.

Question 19

The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit.Which health care provider prescriptions should the nurse clarify with the health care provider before implementing?

A)Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time.
B)Provide total parenteral nutrition (TPN) at 25 ml/hr intravenously.
C)Titrate oxygen to keep pulse oximetry saturations greater than 92.
D)Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

Question 20

The nurse is reviewing prenatal vitamin supplements with an expectant client.Which supplement should be included in the teaching?

A)Vitamin A throughout pregnancy
B)Multivitamin preparations as soon as pregnancy is suspected
C)Folic acid for all women of childbearing age
D)Folic acid during the first and second trimesters of pregnancy

Question 21

Which assessment findings should the nurse note in a school-age child with Duchenne muscular dystrophy (DMD)? (Select all that apply.)

A)Lordosis
B)Gower sign
C)Kyphosis
D)Scoliosis
E)Waddling gait

Question 22

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? (Select all that apply.)

A)Temperature instability
B)Irritability
C)Lethargy
D)Bradycardia
E)Hypertension

Question 23

Which should the nurse expect to find in the cerebral spinal fluid (CSF)results of a child with Guillain-Barré syndrome (GBS)? (Select all that apply.)

A)Decreased protein concentration
B)Normal glucose
C)Fewer than 10 white blood cells (WBCs/mm3)
D)Elevated red blood cell (RBC) count

Question 24

A toddler is admitted to the hospital with a possible diagnosis of tetanus.The health care provider has prescribed lorazepam (Ativan)intravenously 0.05 mg/kg/dose every 6 hours prn as a muscle relaxant.The child weighs 22 lb.How many milligrams of Ativan should the nurse administer per dose? (Record your answer using one decimal place.)

Question 25

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? (Select all that apply.)

A)Continue to perform the clean intermittent catheterizations (CIC) at home.
B)Administer the oxybutynin chloride (Ditropan) as prescribed.
C)Reduce fluid intake in the afternoon and evening hours.
D)Monitor for signs of a recurrent urinary tract infection.
E)Administer furosemide (Lasix) as prescribed.