Question 1

Which clinical manifestation in an infant is suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease)?&#10;A)Hyperactive deep tendon reflexes&#10;B)Hypertonicity&#10;C)Lying in the frog position&#10;D)Motor deficits on one side of body

Accepted Answer

The infant lies in the frog position with the legs externally rotated abducted and flexed at knees. The deep tendon reflexes are absent. The child has hypotonia and inactivity as the most prominent features. The motor deficits are bilateral.

Question 2

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 (choose all that apply):&#10;A)Monitoring and maintaining systemic blood pressure.&#10;B)Administering corticosteroids.&#10;C)Minimizing environmental stimuli.&#10;D)Discussing long-term care issues with the family.&#10;E)Monitoring for respiratory complications.

Accepted Answer

Spinal cord injury patients are physiologically labile,and close monitoring is required. They may be unstable for the first few weeks after the injury. Corticosteroids are administered to minimize the inflammation present with the injury. Minimizing environmental stimuli and discussing long-term care issues with the family actions do not apply to providing care for this patient.

Question 3

Therapeutic management of a child with tetanus includes the administration of:&#10;A)Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation.&#10;B)Muscle stimulants to counteract muscle weakness.&#10;C)Bronchodilators to prevent respiratory complications.&#10;D)Antibiotics to control bacterial proliferation at the site of injury.

Accepted Answer

Antibiotics are administered to control the proliferation of the vegetative forms of the organism at the site of infection. Tetanus toxin acts at the myoneural junction to produce muscular stiffness and lowers the threshold for reflex excitability. NSAIDs are not routinely used. Sedatives or muscle relaxants are used to help reduce titanic spasm and prevent seizures. Respiratory status is carefully evaluated for any signs of distress because muscle relaxants,opioids,and sedatives that may be prescribed may cause respiratory depression. Bronchodilators would not be used unless specifically indicated.

Question 4

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?&#10;A)&#34;My child will have an allergic reaction if he comes in contact with yeast products.&#34;&#10;B)&#34;My child may have an upset stomach if he eats a food made with wheat or barley.&#34;&#10;C)&#34;My child will probably develop an allergy to peanuts.&#34;&#10;D)&#34;My child should not eat bananas or kiwis.&#34;

Accepted Answer

There are cross-reactions between latex allergies and a number of foods such as bananas,avocados,kiwi,and chestnuts. Although yeast products,wheat and barley,and peanuts are potential allergens,they are currently not known to cross-react with latex.

Question 5

Which problem is most often associated with myelomeningocele?&#10;A)Hydrocephalus&#10;B)Craniosynostosis&#10;C)Biliary atresia&#10;D)Esophageal atresia

Accepted Answer

Hydrocephalus is a frequently associated anomaly in 80% to 90% of children. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresias are not associated with myelomeningocele.

Question 6

What refers to a hernial protrusion of a saclike cyst of meninges,spinal fluid,and a portion of the spinal cord with its nerves through a defect in the vertebral column?&#10;A)Rachischisis&#10;B)Encephalocele&#10;C)Meningocele&#10;D)Myelomeningocele

Accepted Answer

A myelomeningocele has a visible defect with an external saclike protrusion containing meninges,spinal fluid,and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Encephalocele is a herniation of brain and meninges through a defect in the skull,producing a fluid-filled sac. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements.

Question 7

Spastic cerebral palsy is characterized by:&#10;A)Hypertonicity and poor control of posture,balance,and coordinated motion.&#10;B)Athetosis and dystonic movements.&#10;C)Wide-based gait and poor performance of rapid,repetitive movements.&#10;D)Tremors and lack of active movement.

Accepted Answer

Hypertonicity,poor control of posture,balance,and coordinated motion are part of the classification of spastic cerebral palsy. Athetosis and dystonic movements are part of the classification of dyskinetic/athetoid cerebral palsy. Wide-based gait and poor performance of rapid,repetitive movements are part of the classification of ataxic cerebral palsy. Tremors and lack of active movement may indicate other neurologic disorders.

Question 8

How much folic acid is recommended for women of childbearing age?&#10;A)0.1 mg&#10;B)0.4 mg&#10;C)1.5 mg&#10;D)2 mg

Accepted Answer

It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of cases of neural tube defects. 0.1 mg is too low a dose. 1.5 mg and 2 mg are not recommended dosages of folic acid.

Question 9

A recommendation to prevent neural tube defects is the supplementation of:&#10;A)Vitamin A throughout pregnancy.&#10;B)Multivitamin preparations as soon as pregnancy is suspected.&#10;C)Folic acid for all women of childbearing age.&#10;D)Folic acid during the first and second trimesters of pregnancy.

Accepted Answer

The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. Vitamin A does not have a relation to the prevention of spina bifida. Folic acid supplementation is recommended for the preconceptual period and during the pregnancy. Only 42% of women actually follow these guidelines.

Question 10

A young boy has just been diagnosed with pseudohypertrophic (Duchenne) muscular dystrophy. The management plan should include:&#10;A)Recommending genetic counseling.&#10;B)Explaining that the disease is easily treated.&#10;C)Suggesting ways to limit the use of muscles.&#10;D)Assisting the family in finding a nursing facility to provide his care.

Accepted Answer

Pseudohypertrophic (Duchenne's) muscular dystrophy is inherited as an X-linked recessive gene. Genetic counseling is recommended for parents,female siblings,maternal aunts,and their female offspring. No effective treatment exists at this time for childhood muscular dystrophy. Maintaining optimal function of all muscles for as long as possible is the primary goal. It has been found that children who remain as active as possible are able to avoid wheelchair confinement for a longer time. Assisting the family in finding a nursing facility is inappropriate at the time of diagnosis. When the child becomes increasingly incapacitated,the family may consider home-based care,a skilled nursing facility,or respite care to provide the necessary care.

Question 11

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 to place him:&#10;A)Prone and tube feed.&#10;B)Prone,turn head to side,and nipple feed.&#10;C)Supine in infant carrier and nipple feed.&#10;D)Supine,with defect supported with rolled blankets,and nipple feed.

Accepted Answer

The answer of The nurse is caring for a neonate...

Question 12

The most common problem of children born with a myelomeningocele is:&#10;A)Neurogenic bladder.&#10;B)Cognitive impairment.&#10;C)Respiratory compromise.&#10;D)Cranioschisis.

Accepted Answer

The answer of The most common problem of children born...

Question 13

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include:&#10;A)Avoiding using any latex product.&#10;B)Using only nonallergenic latex products.&#10;C)Administering medication for long-term desensitization.&#10;D)Teaching the family about long-term management of asthma.

Accepted Answer

The answer of Latex allergy is suspected in a child...

Question 14

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on knowing that:&#10;A)Anticonvulsant medications are sometimes useful for controlling spasticity.&#10;B)Medications that would be useful in reducing spasticity are too toxic for use with children.&#10;C)Many different medications can be highly effective in controlling spasticity.&#10;D)Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

Accepted Answer

The answer of The parents of a child with cerebral...

Deck 55: Neuromuscular or Muscular Dysfunction