Neuromuscular or Muscular Conditions PDF

Stuvia.com - The Marketplace to Buy and Sell your Study Material Chapter 54: Neuromuscular or Muscular Conditions Keenan-Lindsay: Perry’s Maternal Child Nursing Care in Canada, 3rd Edition MULTIPLE CHOICE 1. Which set of symptoms are characteristic of spastic cerebral palsy? a. Hypertonici...

Stuvia.com - The Marketplace to Buy and Sell your Study Material Chapter 54: Neuromuscular or Muscular Conditions Keenan-Lindsay: Perry’s Maternal Child Nursing Care in Canada, 3rd Edition MULTIPLE CHOICE 1. Which set of symptoms are characteristic of spastic cerebral palsy? 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 ANS: A 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 neurological disorders. DIF: Cognitive Level: Comprehension OBJ: 1 KEY: Nursing Process: Assessment 2. The parents of a child with cerebral palsy ask the nurse if any medications can decrease their child’s spasticity. What knowledge is the basis of the nurses’ response? a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use in children. c. Many different medications can be highly effective in controlling spasticity. d. A pump can be implanted that delivers medication into the intrathecal space to decrease spasticity. ANS: D Baclofen given intrathecally is best suited for children with severe spasticity that interferes with activities of daily living and ambulation. Anticonvulsant medications are used when seizures occur in children with cerebral palsy. The intrathecal route decreases the adverse effects of the drugs that reduce spasticity. Few medications are presently available for the control of spasticity. DIF: Cognitive Level: Analysis OBJ: 2 KEY: Nursing Process: Implementation 3. What term is used for 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? a. Rachischisis b. Encephalocele c. Meningocele d. Myelomeningocele ANS: D Downloaded by: shawnma | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material A myelomeningocele is 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 spinal cord exposed. Encephalocele is a herniation of the 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. DIF: Cognitive Level: Comprehension OBJ: 2 KEY: Nursing Process: Assessment 4. Which problem is most often associated with a myelomeningocele? a. Hydrocephalus b. Craniosynostosis c. Biliary atresia d. Esophageal atresia ANS: A Hydrocephalus is a frequently associated anomaly in 80% to 90% of children with myelomeningocele. Craniosynostosis is the premature closing of the cranial sutures and is not associated with myelomeningocele. Biliary and esophageal atresias are not associated with myelomeningocele. DIF: Cognitive Level: Comprehension OBJ: 2 KEY: Nursing Process: Planning 5. Which interventions should a nurse include in the plan of care for the infant awaiting surgical closure of a 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 ANS: B Before surgical closure, the myelomeningocele is prevented from drying by the application of a sterile, moist, nonadherent dressing over the defect. The moistening solution is usually sterile normal saline. Dressings are changed frequently (every 2 to 4 hours), and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The sac must be carefully cleansed if it becomes soiled or contaminated. The original dressing would not be reinforced but changed as needed. A diaper is not placed over the dressing because stool contamination can occur. DIF: Cognitive Level: Application OBJ: 2 KEY: Nursing Process: Implementation 6. Which supplement is recommended to prevent neural tube defects? a. Vitamin A throughout pregnancy b. Multivitamin preparations as soon as pregnancy is suspected c. Folic acid for all women of child-bearing age d. Folic acid during the first and second trimesters of pregnancy ANS: C Downloaded by: shawnma | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material The widespread use of folic acid among persons 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 preconception period and during the pregnancy. DIF: Cognitive Level: Analysis OBJ: N/A KEY: Nursing Process: Planning 7. Which signs and symptoms are associated with Werdnig-Hoffmann disease? a. Spinal muscular atrophy b. Neural atrophy of muscles c. Progressive weakness and wasting of skeletal muscle d. Pseudohypertrophy of certain muscle groups ANS: C Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). It is characterized by progressive weakness and wasting of skeletal muscle caused by degeneration of anterior horn cells. Kugelberg-Welander syndrome is a juvenile spinal muscular atrophy with a later onset. Charcot-Marie-Tooth disease is a form of progressive neural atrophy of muscles supplied by the peroneal nerves. Progressive weakness of the distal muscles of the arms and feet is found. Duchenne’s muscular dystrophy is characterized by muscles, especially in the calves, thighs, and upper arms that become enlarged from fatty infiltration and feel unusually firm or woody on palpation. The term pseudohypertrophy is derived from this muscular enlargement. DIF: Cognitive Level: Comprehension OBJ: 3 KEY: Nursing Process: Assessment 8. The nurse is caring for an infant born with a myelomeningocele. Surgery to repair the defect is scheduled for the next day. What is the most appropriate way to position and feed this newborn? a. Left lateral and tube feed b. Prone, turn head to side, and nipple feed c. Supine in infant carrier and nipple feed d. Supine, with defect supported with rolled blankets, and nipple feed ANS: B In the prone position, feeding is a problem. The infant’s head must be turned to one side for feeding. If the child is able to nipple feed (or breastfeed), there is no indication for tube feeding. Before surgery, the infant should be kept in the prone position to minimize tension on the sac and risk of trauma. DIF: Cognitive Level: Application OBJ: 2 KEY: Nursing Process: Implementation 9. The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent indicates they correctly understand the teaching? a. “My child will have an allergic reaction if they comes in contact with yeast products.” b. “My child may have an upset stomach if they eat foods made with wheat or barley.” c. “My child will probably develop an allergy to peanuts.” Downloaded by: shawnma | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material d. “My child should not eat bananas or kiwis.” ANS: D There are cross-reactions between latex allergies and a number of foods, such as bananas, avocados, kiwis, and chestnuts. Although yeast products, wheat and barley, and peanuts are potential allergens, they are currently not known to cross-react with latex. DIF: Cognitive Level: Analysis OBJ: 2 KEY: Nursing Process: Evaluation 10. A latex allergy is suspected in a child with spina bifida. Which is an appropriate nursing intervention? a. Avoid using any latex product. b. Use only nonallergenic latex products. c. Administer medication for long-term desensitization. d. Teach the family about long-term management of asthma. ANS: A Care must be taken so that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment. There are no nonallergic latex products. At this time, desensitization is not an option. The child does not have asthma. The parents must be taught about allergy and the risk of anaphylaxis. DIF: Cognitive Level: Application OBJ: 2 KEY: Nursing Process: Implementation 11. What clinical manifestation is suggestive of spinal muscular atrophy (Werdnig-Hoffmann disease) in an infant? a. Hyperactive deep tendon reflexes b. Hypertonicity c. Lying in the frog position d. Motor deficits on one side of body ANS: C The infant lies in the frog position with the legs externally rotated, abducted, and flexed at knees. Deep tendon reflexes are absent. The child has hypotonia and inactivity as the most prominent features. Motor deficits are bilateral. DIF: Cognitive Level: Comprehension OBJ: 3 KEY: Nursing Process: Assessment 12. A young boy has just been diagnosed with Duchenne muscular dystrophy. What should the management plan include? a. Recommend genetic counselling. b. Explain that the disease is easily treated. c. Suggest ways to limit the use of his muscles. d. Assist the family in finding a nursing facility to provide his care. ANS: A Downloaded by: shawnma | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Duchenne muscular dystrophy is inherited as an X-linked recessive gene. Genetic counselling 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 they possibly can are able to avoid wheelchair confinement for a longer time. Assisting the family in finding a nursing facility for the boy 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. DIF: Cognitive Level: Application OBJ: 3 KEY: Nursing Process: Implementation 13. A 14-year-old girl is in the critical care unit after a spinal cord injury 2 days ago. Which should be included in nursing care for this child? a. Avoiding the use of diazepam b. Administering methylprednisolone c. Minimizing environmental stimuli d. Discussing long-term care issues with the family ANS: B Corticosteroids are administered to minimize the inflammation present at the injury site. Patients with spinal cord injury are physiologically labile, so close monitoring is required. Diazepam is the medication of choice for seizure control and muscle relaxation; therefore, it should not be avoided. Minimizing environmental stimuli and discussing long-term care issues with the family actions do not apply to providing care for this patient. DIF: Cognitive Level: Analysis OBJ: 5 KEY: Nursing Process: Implementation 14. A nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which nursing intervention 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 ANS: B Treatment of GBS is primarily supportive. In the acute phase, patients are hospitalized because respiratory and pharyngeal involvement may require assisted ventilation, sometimes with a temporary tracheotomy. Treatment modalities include aggressive ventilatory support in the event of respiratory compromise, administration of intravenous immunoglobulin (IVIG), and sometimes steroids; plasmapheresis and immunosuppressive drugs may also be used. Monitoring intake and output, telemetry monitoring, and obtaining laboratory studies may be part of the plan of care but are not the priority. DIF: Cognitive Level: Analysis OBJ: N/A KEY: Nursing Process: Implementation 15. Which finding should cause a nurse to suspect a diagnosis of spastic cerebral palsy? a. Tremulous movements at rest and with activity Downloaded by: shawnma | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material b. Positive Babinski reflex c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements ANS: B Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with persistent primitive reflexes, positive Babinski reflex, ankle clonus, exaggerated stretch reflexes, and eventual development of contractures. The child’s muscles are very tight and any stimuli may cause a sudden jerking movement. Tremulous movements are characteristic of rigid/tremor/atonic cerebral palsy. Slow, writhing, uncontrolled, involuntary movements occur with athetoid or dyskinetic cerebral palsy. Clumsy movements, loss of coordination, equilibrium, and kinesthetic sense occur in ataxic cerebral palsy. DIF: Cognitive Level: Application OBJ: 1 KEY: Nursing Process: Assessment 16. What is the most appropriate nursing response to a parent of a newborn infant with myelomeningocele who asks about the cause of this condition? a. “One of the parents carries a defective gene that causes myelomeningocele.” b. “A deficiency in folic acid in the father is the most likely cause.” c. “Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele.” d. “There may be a variety of different causes.” ANS: D The etiology of most neural tube defects is likely multifactorial. There may be a genetic predisposition or a viral origin, and the disorder has been linked to maternal folic acid deficiency; however, the actual cause has not been determined. There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects. DIF: Cognitive Level: Application OBJ: 2 KEY: Nursing Process: Implementation 17. Which statement best describes a myelomeningocele? 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 sac-like cyst of meninges with spinal fluid but no neural elements. d. Visible defect with an external sac-like protrusion containing meninges, spinal fluid, and nerves. ANS: D A myelomeningocele is a visible defect with an external sac-like 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 sac-like cyst of meninges with spinal fluid, but no neural elements. DIF: Cognitive Level: Comprehension OBJ: 2 KEY: Nursing Process: Assessment Downloaded by: shawnma | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material MULTIPLE RESPONSE 1. A 14 year old is in the intensive care unit after a spinal cord injury 2 days ago. Which nursing care interventions are needed for this child? (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 ANS: A, B, E Spinal cord injury patients are physiologically labile, and close monitoring of blood pressure and respirations 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 do not apply to providing care for this patient. DIF: Cognitive Level: Application OBJ: 5 KEY: Nursing Process: Implementation 2. Which assessment findings should the nurse note in a school-age child diagnosed with Duchenne muscular dystrophy (DMD)? (Select all that apply.) a. Lordosis b. Gower sign c. Kyphosis d. Scoliosis e. Waddling gait ANS: A, B, E Difficulties in running, riding a bicycle, and climbing stairs are usually the first symptoms noted in DMD. Typically, affected boys have a waddling gait and lordosis, fall frequently, and develop a characteristic manner of rising from a squatting or sitting position on the floor (Gower sign). Lordosis occurs as a result of weakened pelvic muscles, and the waddling gait is a result of weakness in the gluteus medius and maximus muscles. Kyphosis and scoliosis are not assessment findings with DMD. DIF: Cognitive Level: Application OBJ: 3 KEY: Nursing Process: Assessment 3. A nurse is conducting discharge teaching with parents of a preschool child with a myelomeningocele, repaired at birth, who is 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 as prescribed. c. Reduce fluid intake in the afternoon and evening hours. d. Monitor for signs of a recurrent UTI. e. Administer furosemide as prescribed. ANS: A, B, D Downloaded by: shawnma | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Discharge teaching to prevent renal complications in a child with myelomeningocele include: (1) regular urological care with prompt and vigorous treatment of infections; (2) a method of regular emptying of the bladder, such as clean intermittent catheterization (CIC) taught to and performed by parents and self-catheterization taught to children; and (3) medications to improve bladder storage and continence, such as oxybutynin chloride and tolterodine. Fluids should not be limited, and furosemide is not used to improve renal function for children with myelomeningocele. DIF: Cognitive Level: Application OBJ: 2 KEY: Nursing Process: Implementation 4. A nurse is caring for an infant with myelomeningocele who is 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 ANS: A, B, C The nurse should observe an infant with unrepaired myelomeningocele for early signs of infection, such as temperature instability (axillary), irritability, and lethargy. Bradycardia and hypertension are not early signs of infection in infants. DIF: Cognitive Level: Comprehension OBJ: 2 KEY: Nursing Process: Assessment Downloaded by: shawnma | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?