Chapter 32 - The Child With Neuromuscular or Muscular Dysfunction

Hockenberry & Wilson: Wongs Essentials of Pediatric Nursing,
8th Edition
Pub Review
Chapter 32: The Child with Neuromuscular or Muscular Dysfunction
MULTIPLE CHOICE
1. Spastic cerebral palsy is characterized by which of the following?

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 and poor control of posture, balance, and coordinated motion are part of
the classification of spastic cerebral palsy.
DIF: Cognitive Level: Comprehension REF: Page 1146

TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
2. The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their
childs spasticity. The nurses response should be based on which of the following?
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.
ANS: D
Baclofen, given intrathecally, is best suited for children with severe spasticity that
interferes with activities of daily living and ambulation.
DIF: Cognitive Level: Analysis REF: Page 1148

TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral
Therapy
3. Which of the following 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?
a Rachischisis
.
b Encephalocele
.
c Meningocele
.
d Myelomeningocele
.
ANS: D
A myelomeningocele has a visible defect with an external saclike protrusion, containing
meninges, spinal fluid, and nerves.

4. Which of the following problems is most often associated with 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.

5. Which of the following is the most common problem of children born with a
myelomeningocele?
a Neurogenic bladder
.
b Mental retardation
.
c Respiratory compromise
.
d Cranioschisis
.
ANS: A
Myelomeningocele is one of the most common causes of neuropathic (neurogenic)
bladder dysfunction among children.

TOP: Integrated Process: Nursing Process: Problem Identification
6. A recommendation to prevent neural tube defects is the supplementation of which of the

following?
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
.
ANS: C
The widespread use of folic acid among women of childbearing age has decreased the
incidence of spina bifida significantly.

TOP: Integrated Process: Nursing Process: Implementation
Therapy
7. 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
.
ANS: B
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.

Therapy
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 to place him:
a prone 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 is turned to one side for
feeding.
DIF: Cognitive Level: Application REF: Page 1158

MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort
9. The nurse is talking to a parent with a child who has a latex allergy. Which of the
following statements 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.
.
ANS: D
There are cross-reactions between latex allergies and a number of foods such as bananas,
avocados, kiwi, and chestnuts.

TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
10. Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions
include which of the following?
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.
.
ANS: A
Care must be taken 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.

TOP: Integrated Process: Nursing Process: Intervention
11. Which of the following is a progressive infantile spinal muscular atrophy and the most
common paralytic form of the floppy infant syndrome?
a Kugelberg-Welander disease
.
b Charcot-Marie-Tooth disease
.
c Werdnig-Hoffmann disease
.
d Duchenne muscular dystrophy
.
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.

12. Which of the following 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
.
ANS: C
The infant lies in the frog position with the legs externally rotated, abducted, and flexed
at knees.

13. A young boy has just been diagnosed with pseudohypertrophic (Duchenne) muscular
dystrophy. The management plan should include which of the following?
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.
.
ANS: A
Pseudohypertrophic (Duchenne) muscular dystrophy is inherited as an X-linked recessive
gene. Genetic counseling is recommended for parents, female siblings, maternal aunts,
and their female offspring.

14. Therapeutic management of a child with tetanus includes the administration of which of
the following?
a Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation
.
b Muscle stimulants to counteract muscle weakness
.
c Bronchodilators to prevent respiratory complications
.
d Antibiotics to control bacterial proliferation at site of injury
.
ANS: D
Antibiotics are administered to control the proliferation of the vegetative forms of the
organism at the site of infection.
DIF: Cognitive Level: Application REF: Page 1167 | Page 1168

Therapy
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 of the following? (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 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.

Chapter 32 - The Child With Neuromuscular or Muscular Dysfunction

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 32 - The Child With Neuromuscular or Muscular Dysfunction

Uploaded by

Copyright:

Available Formats

Hockenberry & Wilson: Wongs Essentials of Pediatric Nursing,

Chapter 32: The Child with Neuromuscular or Muscular Dysfunction

1. Spastic cerebral palsy is characterized by which of the following?

DIF: Cognitive Level: Comprehension REF: Page 1146

DIF: Cognitive Level: Analysis REF: Page 1148

DIF: Cognitive Level: Comprehension REF: Page 1154

4. Which of the following problems is most often associated with myelomeningocele?

DIF: Cognitive Level: Comprehension REF: Page 1154

DIF: Cognitive Level: Comprehension REF: Page 1156

6. A recommendation to prevent neural tube defects is the supplementation of which of the

DIF: Cognitive Level: Analysis REF: Page 1157

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

DIF: Cognitive Level: Comprehension REF: Page 1157

DIF: Cognitive Level: Application REF: Page 1158

DIF: Cognitive Level: Analysis REF: Page 1159

DIF: Cognitive Level: Application REF: Page 1159

DIF: Cognitive Level: Comprehension REF: Page 1161

DIF: Cognitive Level: Comprehension REF: Page 1161

DIF: Cognitive Level: Application REF: Page 1162

DIF: Cognitive Level: Application REF: Page 1167 | Page 1168

You might also like