The Child with Neuromuscular or Muscular DysfunctionHockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition
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NURSING
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NURSING
The nurse is planning a staff in-service on childhood spastic cerebral palsy. What
characterizes 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...
the child with neuromuscular or muscular dysfunctionhockenberry wong’s essentials of pediatric nursing
the child with neuromuscular or muscular dysfunctionhockenberry
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Chapter 30: The Child with Neuromuscular
or Muscular Dysfunction Hockenberry:
Wong’s Essentials of Pediatric Nursing, 10th
Edition
MULTIPLE CHOICE
1. The nurse is planning a staff in-service on childhood spastic cerebral palsy. What
characterizes 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 and 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 neurologic disorders.
DIF: Cognitive Level: Understand REF: p. 978
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
2. The parents of a child with cerebral palsy ask the nurse whether any drugs can decrease their
child’s spasticity. The nurse’s respNoUnRsSeIsNhGoTuBld.CbOeMbased on which statement?
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. 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.
DIF: Cognitive Level: Understand REF: p. 979
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive
care nursery. Which describes this newborn’s defect?
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
ANS: D
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.
DIF: Cognitive Level: Understand REF: p. 984
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
4. The nurse is conducting a staff in-service on common problems associated with
myelomeningocele. Which common problem is associated with this defect?
a. Hydrocephalus
b. Craniostenosis
c. Biliary atresia
d. Esophageal atresia
ANS: A
Hydrocephalus is a frequently associated anomaly in 80% to 90% of children. Craniostenosis
is the preterm closing of the cranial sutures and is not associated with myelomeningocele.
Biliary and esophageal atresia is nNoUt R
asSsIoNcGiaTtBe.dCO
wMith myelomeningocele.
DIF: Cognitive Level: Understand REF: p. 984
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
5. 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. Neurogenic bladder
b. Cognitive impairment
c. Respiratory compromise
d. Cranioschisis
ANS: A
Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder
dysfunction among children. Risk of cognitive impairment 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.
DIF: Cognitive Level: Understand REF: p. 987
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
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