Question 1

Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy?

Accepted Answer

A) Tremulous movements at rest and with activity 
B) Sudden jerking movement caused by stimuli 
C) Writhing, uncontrolled, involuntary movements 
D) Clumsy, uncoordinated movements 
A) Tremulous movements at rest and with activity 
B) Sudden jerking movement caused by stimuli 
C) Writhing, uncontrolled, involuntary movements 
D) Clumsy, uncoordinated movements B

Question 2

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?

Accepted Answer

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. 
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. C

Question 3

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)?

Accepted Answer

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

Question 4

A 14-year-old girl 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)?

Accepted Answer

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. 
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 5

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

Accepted Answer

A) 0.1 mg 
B) 0.4 mg 
C) 1.5 mg 
D) 2 mg 
A) 0.1 mg 
B) 0.4 mg 
C) 1.5 mg 
D) 2 mg

Question 6

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

Accepted Answer

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 the site of injury. 
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 the site of injury.

Question 7

The 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?

Accepted Answer

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

Question 8

Spastic cerebral palsy is characterized by:

Accepted Answer

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. 
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 9

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:

Accepted Answer

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. 
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.

Question 10

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?

Accepted Answer

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." 
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 11

The most common problem of children born with a myelomeningocele is:

Accepted Answer

A) Neurogenic bladder. 
B) Intellectual impairment. 
C) Respiratory compromise. 
D) Cranioschisis. 
A) Neurogenic bladder. 
B) Intellectual impairment. 
C) Respiratory compromise. 
D) Cranioschisis.

Question 12

Which problem is most often associated with myelomeningocele?

Accepted Answer

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

Question 13

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

Accepted Answer

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 
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 14

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

Accepted Answer

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

Question 15

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 lbs.How many milligrams of Ativan should the nurse administer per dose? _____ Record your answer using one decimal place.

Accepted Answer

0.5
Find the child's weight in

Question 16

The nurse is conducting discharge teaching with parents of a preschool child with 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)?

Accepted Answer

A) Continue to perform the clean intermittent catheterizations (CI
C)  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 UTI. 
E) Administer furosemide (Lasix) as prescribed. 
A) Continue to perform the clean intermittent catheterizations (CI
C)  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 UTI. 
E) Administer furosemide (Lasix) as prescribed.

Question 17

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?

Accepted Answer

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 
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 18

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:

Accepted Answer

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. 
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 19

A current recommendation to prevent neural tube defects is the supplementation of:

Accepted Answer

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. 
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 20

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

Accepted Answer

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

Exam 49: Neuromuscular or Muscular Dysfunction

Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy?

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?

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 14-year-old girl 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)?

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

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

The 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?

Spastic cerebral palsy is characterized by:

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:

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?

The most common problem of children born with a myelomeningocele is:

Which problem is most often associated with myelomeningocele?

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

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

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?

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:

A current recommendation to prevent neural tube defects is the supplementation of:

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

21st Century Maternity Nursing

Community Care: the Family and Culture

Assessment and Health Promotion

Reproductive System Concerns

Infertility,contraception,and Abortion

Genetics, conception, and Fetal Development

Anatomy and Physiology of Pregnancy

Nursing Care of the Family During Pregnancy

Maternal and Fetal Nutrition

Assessment of High Risk Pregnancy

Pregnancy at Risk: Preexisting Conditions

Pregnancy at Risk: Gestational Conditions

Labor and Birth Processes

Pain Management

Fetal Assessment During Labor

Nursing Care of the Family During Labor and Birth

Labor and Birth Complications

Maternal Physiologic Changes

Nursing Care of the Family During the Postpartum Period

Transition to Parenthood

Postpartum Complications

Physiologic and Behavioral Adaptations of the Newborn

Nursing Care of the Newborn and Family

Newborn Nutrition and Feeding

The High Risk Newborn

21st Century Pediatric Nursing

Family, social, cultural, and Religious Influences on Child Health Promotion

Developmental and Genetic Influences on Child Health Promotion

Communication, history, and Physical Assessment

Pain Assessment and Management in Children

The Infant and Family

The Toddler and Family

The Preschooler and Family

The School-Age Child and Family

The Adolescent and Family

Chronic Illness, disability, and End-Of-Life Care

Impact of Cognitive or Sensory Impairment on the Child and Family

Family-Centered Care of the Child During Illness and Hospitalization

Pediatric Variations of Nursing Interventions

Respiratory Dysfunction

Gastrointestinal Dysfunction

Cardiovascular Dysfunction

Hematologic and Immunologic Dysfunction

Genitourinary Dysfunction

Cerebral Dysfunction

Endocrine Dysfunction

Integumentary Dysfunction

Musculoskeletal or Articular Dysfunction

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