Neuro & Masculo Unit: BB Wong Neuromuscular Quiz

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1

The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their child’s spasticity. The nurse’s response should be based on which statement?

a. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.
b. Medications that would be useful in reducing spasticity are too toxic for use with children.
c. Anticonvulsant medications are sometimes useful for controlling spasticity.
d. Many different medications can be highly effective in controlling spasticity.

a.Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available

-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 side effects of the drugs that reduce spasticity. Few medications are currently available for the control of spasticity.

2

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

a. Herniation of the brain and meninges through a defect in the skull
b. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements
c. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves
d. Fissure in the spinal column that leaves the meninges and the spinal cord exposed

c. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

-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 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.

3

The nurse is teaching a group of nursing students about newborns born with the congenital defect of myelomeningocele. Which common problem is associated with this defect?

a. Respiratory compromise
b. Cognitive impairment
c. Cranioschisis
d. Neurogenic bladder

d.Neurogenic bladder

-Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children. Risk of mental retardation is minimized through early intervention and management of hydrocephalus. Respiratory compromise is not a common problem in myelomeningocele. Cranioschisis is a skull defect through which various tissues protrude. It is not associated with myelomeningocele.

4

The nurse is reviewing prenatal vitamin supplements with an expectant client. Which supplement should be included in the teaching?

a. Folic acid during the first and second trimesters of pregnancy
b. Multivitamin preparations as soon as pregnancy is suspected
c. Folic acid for all women of childbearing age
d. Vitamin A throughout pregnancy

c. Folic acid for all women of childbearing age

-The widespread use of folic acid among women of childbearing age has decreased the incidence of spina bifida significantly. Vitamin A is not related to the prevention of spina bifida. Folic acid supplementation is recommended for the preconception period and during the pregnancy. Only 42% of women actually follow these guidelines.

5

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?

a. “My child will probably develop an allergy to peanuts.”
b. “My child will have an allergic reaction if he comes in contact with yeast products.”
c. “My child should not eat bananas or kiwis.”
d. “My child may have an upset stomach if he eats a food made with wheat or barley.”

c. “My child should not eat bananas or kiwis.”

-There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts. Children with a latex allergy will not develop allergies to other food products such as yeast, wheat, barley, or peanuts.

6

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which action?

a. Administer medication for long-term desensitization.
b. Avoid using any latex product.
c. Use only nonallergenic latex products.
d. Teach family about long-term management of asthma.

b. Avoid using any latex product.

-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. There are no nonallergenic 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.

7

What should be administered to a child with tetanus?

a. Bronchodilators to prevent respiratory complications.
b. Tetanus immunoglobulin therapy.
c. Muscle stimulants to counteract muscle weakness.
d. Nonsteroidal antiinflammatory drugs (NSAIDs) to reduce inflammation.

b.Tetanus immunoglobulin therapy.

-Tetanus immunoglobulin therapy, to neutralize toxins, is the most specific therapy for tetanus. 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.

8

The nurse is conducting reflex testing on infants at a well-child clinic. Which reflex finding should be reported as abnormal and considered as a possible sign of cerebral palsy?

a. Tonic neck reflex at 5 months of age
b. Moro reflex at 3 months of age
c. Extensor reflex at 7 months of age
d. Absent Moro reflex at 8 months of age

c.Extensor reflex at 7 months of age

-Establishing a diagnosis of cerebral palsy (CP) may be confirmed with the persistence of primitive reflexes: (1) either the asymmetric tonic neck reflex or persistent Moro reflex (beyond 4 months of age) and (2) the crossed extensor reflex. The tonic neck reflex normally disappears between 4 and 6 months of age. The crossed extensor reflex, which normally disappears by 4 months, is elicited by applying a noxious stimulus to the sole of one foot with the knee extended. Normally, the contralateral foot responds with extensor, abduction, and then adduction movements. The possibility of CP is suggested if these reflexes occur after 4 months.

9

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which intervention should the nurse plan for the care of the myelomeningocele sac?

a. Covered with a sterile, moist, nonadherent dressing
b. Reinforcement of the original dressing if drainage noted
c. A diaper secured over the dressing
d. Open to air

a.Covered with a sterile, moist, nonadherent dressing

-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.

10

The nurse is admitting a school-age child with suspected Guillain-Barré syndrome (GBS). Which is a priority in the care for this child?

a. Obtaining laboratory studies
b. Placing on a telemetry monitor
c. Monitoring intake and output
d. Assessing respiratory efforts

d.Assessing respiratory efforts

-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, intravenous (IV) administration of immunoglobulin (IVIG), and sometimes steroids; plasmapheresis and immunosuppressive drugs may also be used. Intake and output, telemetry monitoring and obtaining laboratory studies may be part of the plan of care but are not the priority.

11

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?

a. Implement a standing prescription to empty the bladder with a sterile in and out Foley catheter.
b. Take a full set of vital signs and notify the health care provider.
c. Place the adolescent in a flat right side-lying position.
d. Place a cool washcloth on the adolescent’s forehead and continue to monitor the blood pressure.

a. Implement a standing prescription to empty the bladder with a sterile in and out Foley catheter.

-The adolescent is experiencing an autonomic dysreflexia episode. The paralytic nature of autonomic function is replaced by autonomic dysreflexia, especially when the lesions are above the mid-thoracic level. This autonomic phenomenon is caused by visceral distention or irritation, particularly of the bowel or bladder. Sensory impulses are triggered and travel to the cord lesion, where they are blocked, which causes activation of sympathetic reflex action with disturbed central inhibitory control. Excessive sympathetic activity is manifested by a flushing face, sweating forehead, pupillary constriction, marked hypertension, headache, and bradycardia. The precipitating stimulus may be merely a full bladder or rectum or other internal or external sensory input. It can be a catastrophic event unless the irritation is relieved. Placing a cool washcloth on the adolescent's forehead, continuing to monitor blood pressure and vital signs, and notifying the healthcare provider would not reverse the sympathetic reflex situation.

12

A child steps on a nail and sustains a puncture wound of the foot. Which is the most appropriate method for cleansing this wound?

a. Wash wound thoroughly with povidone-iodine.
b. Soak foot in warm water and soap.
c. Soak foot in solution of 50% hydrogen peroxide and 50% water.
d. Wash wound thoroughly with chlorhexidine.

b.Soak foot in warm water and soap.

-Puncture wounds should be cleansed by soaking the foot in warm water and soap. Chlorhexidine, hydrogen peroxide, and povidone-iodine should not be used because they have a cytotoxic effect on healthy cells and minimal effect on controlling infection.

13

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 action(s)? (Select all that apply.)

a. Monitoring for respiratory complications
b. Discussing long-term care issues with the family
c. Administering corticosteroids
d. Monitoring and maintaining systemic blood pressure
e. Minimizing environmental stimuli

a. Monitoring for respiratory complications
c. Administering corticosteroids
d. Monitoring and maintaining systemic blood pressure

-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. It is not necessary to minimize environmental stimuli for this type of injury. Discussing long-term care issues with the family is inappropriate. The family is focusing on the recovery of their child. It will not be known until the rehabilitation period how much function the child may recover.

14

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. Hypertension
b. Bradycardia
c. Lethargy
d. Irritability
e. Temperature instability

c. Lethargy
d. Irritability
e. Temperature instability

-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.

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

0.5 mg

-Find the child’s weight in kilograms by dividing 22 by 2.2 = 22/2.2 = 10 kg. Multiply the 0.05 mg dose by 10 = 0.05 mg × 10 kg = 0.5 mg per dose.