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Flashcards in Chapter 32 Deck (15):
1

Cerebral palsy (CP) may result from a variety of causes. It is now known that the most common cause of CP is
a. birth asphyxia
b. neonatal diseases
c. cerebral trauma
d. prenatal brain abnormalities

Ans: D
The most common currently identifiable cause of CP is existing brain abnormalities during the prenatal period.
Birth asphyxia had previously been thought of as a factor in the development of CP.
Neonatal diseases have previously been thought of as factors in the development of CP.
Cerebral trauma has previously been thought of as a factor in the development of CP.

2

The major goal of therapy for children with cerebral palsy (CP) is
a. reversing degenerative processes that have occurred.
b. curing the underlying defect causing the disorder.
c. preventing spread to individuals in close contact with the children.
d. recognizing the disorder early and promoting optimal development.

Ans: D
Because CP is currently a permanent disorder, the goal of therapy is to promote optimal development. This is done through early recognition and beginning of therapy.
It is difficult to reverse the degenerative processes associated with CP.
The underlying defect(s) associated with the development of CP cannot be cured.
CP is not contagious.

3

A 3-year-old has cerebral palsy (CP) and is hospitalized for orthopedic surgery. The child’s mother states the child has difficulty swallowing and cannot hold a utensil to self-feed. The child is slightly underweight for height. What is the most appropriate nursing action related to feeding?
a. Bottle-feed or tube-feed the child with a specialized formula until sufficient weight is gained.
b. Stabilize the child’s jaw with one hand (either from a front or side position) to facilitate swallowing.
c. Place the child in a well-supported, semireclining position to make use of gravity flow.
d. Place the child in a sitting position with the neck hyperextended to make use of gravity flow.

Ans: B
Because the jaw is compromised, more normal control can be achieved if the feeder provides stability. Manual jaw controls assist with head control, correction of neck and trunk hyperextension, and jaw stabilization.
The child is too old to be bottle-fed. The neuromuscular compromise of the jaw interferes with the child's ability to eat.
The child should be sitting up for meals to prevent aspiration.
For swallowing, the neck should not be hyperextended.

4

An 8-year-old has been diagnosed with moderate cerebral palsy (CP). The child recently began participation in a regular classroom for part of the day. The child’s mother asks the school nurse about joining the after-school Scout troop. The nurse's response should be based on knowledge that
a. most activities such as Scouts cannot be adapted for children with CP.
b. after-school activities usually result in extreme fatigue for children with CP.
c. trying to participate in activities such as Scouts leads to lowered self-esteem in children with CP.
d. after-school activities often provide children with CP with opportunities for socialization and recreation.

Ans: D
Recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs in order to promote socialization opportunities.
Most activities can be adapted for children with CP.
The child, family, and activity director should assess the degree of activity to ensure it matches the child's capabilities.
A supportive environment associated with after-school activities will add to the child's self-esteem.

5

A neural tube defect that is not visible externally in the lumbosacral area would be called
a. meningocele.
b. myelomeningocele.
c. spina bifida cystica.
d. spina bifida occulta.

Ans: D
Spina bifida occulta is completely enclosed. Often, this disorder will not be noticed. A clue to the presence of this internal disorder will be a dimple or tuft of hair on the lumbosacral area.
A meningocele contains meninges and spinal fluid but no neural tissue and is evident at birth as a sac in the lumbosacral area. Transillumination of light will be present.
A myelomeningocele is a neural tube defect that contains meninges, spinal fluid, and nerves and is evident at birth as a sac in the lumbosacral area. Transillumination of light will not be present.
Spina bifida cystica is a cystic formation with an external saclike protrusion.

6

A woman who is 6 weeks pregnant tells the nurse that she is worried her baby might have spina bifida because of a family history. What should the nurse's response be based on?
a. There is no genetic basis for the defect.
b. Prenatal detection is not possible yet.
c. Chromosomal studies done on amniotic fluid can diagnose the defect prenatally.
d. The concentration of α-fetoprotein in amniotic fluid can potentially indicate the presence of the defect prenatally.

Ans: D
Fetal ultrasound and elevated concentrations of α-fetoprotein in amniotic fluid many indicate the presence of anencephaly, myelomeningocele, or other neural tube defects.
The origin of neural tube defects is unknown but appears to have a multifactorial inheritance pattern.
Prenatal detection is possible through amniotic fluid or chorionic villi sampling.
There are no chromosomal studies currently that can diagnose spina bifida prenatally.

7

A 6-year-old child born with a myelomeningocele has a neurogenic bladder. The parents have been performing clean intermittent catheterization. What should the nurse recommend?
a. Teach the child to do self-catheterization.
b. Teach the child appropriate bladder control.
c. Continue having the parents do the catheterization.
d. Encourage the family to consider urinary diversion.

Ans: A
At 6 years of age, this child should have the dexterity to perform the intermittent catheterization. This will give the child more control and mastery over the disability.
Bladder control cannot be taught in a child with a neurogenic bladder.
School-age children, even as young as 6 years, should be able to begin self-catheterization.
A urinary diversion is not necessary for a neurogenic bladder.

8

What most accurately describes bowel function in children born with a myelomeningocele?
a. Incontinence cannot be prevented.
b. Enemas and laxatives are contraindicated.
c. Some degree of fecal continence can usually be achieved.
d. A colostomy is usually required by the time the child reaches adolescence.

Ans: C
With diet modification and regular toilet habits (bowel training) to prevent constipation and impaction, some degree of fecal continence can be achieved.
Although a lengthy process, continence can be achieved with modification of diet, use of stool softeners, and/or enemas.
Enemas and stool softeners are part of the strategy to achieve continence. Laxatives should be used only as a last resort, although they may be used in some instances.
A colostomy is not indicated for the child with myelomeningocele.

9

What is important when caring for a child with myelomeningocele in the preoperative stage?
a. Place the child on one side to decrease pressure on the spinal cord.
b. Apply a heat lamp to facilitate drying and toughening of the sac.
c. Keep the skin clean and dry to prevent irritation from diarrheal stools.
d. Measure the head circumference and examine the fontanels for signs that might indicate developing hydrocephalus.

Ans: D
Obstructive hydrocephalus is frequently associated with myelomeningocele. Assessment of the fontanels and daily measurements of the head circumference will aid in early detection of associated increased intracranial pressure.
Preoperatively, the child is kept in a prone position to decrease tension on the sac and reduce the risk of trauma or sac tearing.
The sac must be kept moist. Sterile, moist, nonadherent dressings are placed over the sac as prescribed by the physician.
Most infants do not have diarrheal stools. The sac area, though, should be kept clean and dry and out of contact with urine and stools.

10

A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. A priority nursing intervention is to
a. recommend allergy testing.
b. provide a latex-free environment.
c. use only powder-free latex gloves.
d. limit the use of latex products as much as possible.

Ans: B
The most important nursing intervention is to provide a latex-free environment. From birth on, limitation of exposure to latex is essential in an attempt to minimize sensitization. Latex-free catheters for self-catheterization are available.

Allergy testing may expose the child to the allergen and, therefore, is not recommended.
The gloves contain latex and will contribute to sensitization. No latex products should be used with children who have latex allergies.
Latex products should be avoided at all times.

11

Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy (DMD)?
a. DMD is inherited as an autosomal dominant disorder.
b. DMD is characterized by weakness of the proximal muscles of both the pelvic and shoulder girdles.
c. DMD is characterized by muscle weakness, usually beginning at about age 3 years.
d. The onset of DMD occurs in later childhood and adolescence.

Ans: C
Usually, children with DMD reach the early developmental milestones, but the muscular weakness is usually observed in the third year of life.
DMD is inherited as an X-linked recessive disorder.
Weakness in a child with DMD is usually first noted in walking. Progressive muscle weakness in other muscle groups then follows.
DMD usually develops in the third year of life.

12

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome). When explaining this disease process to the parents, what should the nurse consider?
a. Paralysis is progressive, with little hope for recovery.
b. Muscle function will gradually return, and recovery is possible in most children.
c. Guillain-Barré syndrome results from an apparently toxic reaction to certain medications.
d. Guillain-Barré syndrome is inherited as an autosomal recessive, sex-linked gene.

Ans: B
Most patients regain full muscle strength following recovery from Guillain-Barré syndrome. The return of function is in reverse order of onset. Onset occurs as ascending paralysis; recovery occurs as descending return of function.
The paralysis is progressive in Guillain-Barré syndrome, but most children have full recovery. Supportive nursing care is essential.
Guillain-Barré syndrome is an immune-mediated disease most often associated with viral infections. During the history, the parents should be asked about the child's having a cold or viral infection within the past 2 weeks.
Guillain-Barré syndrome is an immune-mediated disease most often associated with viral infections.

13

Which statement is most accurate in describing tetanus?
a. Acute infectious disease caused by an exotoxin produced by an anaerobic, gram-positive bacillus
b. Inflammatory disease that causes extreme, localized muscle spasm
c. Acute infection that causes meningeal inflammation, resulting in symptoms of generalized muscle spasm
d. Disease affecting the salivary gland with resultant stiffness of the jaw

Ans: A
Tetanus is an acute, preventable disease caused by an exotoxin produced by an anaerobic spore-forming, gram-positive bacillus, Clostridium tetani.
Tetanus is caused by the effect of the exotoxins becoming fixed on nerve cells and is not an inflammatory disorder that causes muscle spasms.
Tetanus is not an acute infection that leads to generalized muscle spasms.
Tetanus is not a disease that affects the salivary glands, with resultant stiffness of the jaw.

14

What is associated with infant botulism?
a. Contaminated soil
b. Honey and corn syrup
c. Commercial infant cereals
d. Improperly sterilized bottles

Ans: B
Unlike adult botulism, infant botulism is caused by ingesting spores of Clostridium botulinum, with the subsequent release of the toxin. The bacterium has been found in honey and corn syrup that were fed to affected infants.
Contaminated soil is not associated with infants who develop infant botulism.
Commercial infant cereals are not associated with the development of infant botulism.
Improperly sterilized bottles are not associated with the development of infant botulism.

15

A 15 year-old is admitted to the intensive care unit (ICU) with a spinal cord injury. The most appropriate nursing interventions for this adolescent are (select all that apply)
a. monitoring neurologic status.
b. administering corticosteroids.
c. monitoring for respiratory complications.
d. discussing long-term care issues with the family.
e. monitoring and maintaining hemodynamic status.

Ans: A, B, C, E