Chapter 44: Musculoskeletal Disorders Flashcards
- The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which response from his mother indicates a need for further teaching?
A. “He needs to get a medical alert identification.”
B. “I will need to discuss this with his caregivers.”
C. “A product’s label indicates whether it is latex-free.”
D. “He must avoid all contact with latex.”
Answer: C
Rationale: The Food and Drug Administration (FDA) requires that all medical supplies be labeled if they contain latex, but this is not the case with consumer products. The mother must be familiar with products that contain latex. The Spina Bifida Association of America maintains an updated list of latex- containing products. Getting a medical alert identification, talking with his caregivers, and avoiding all
contact with latex are correct.
- The nurse is providing postoperative care for a 14-month-old girl who has undergone a myelomeningocele repair. The girl’s mother is extremely anxious and tells the nurse she is afraid she will never learn how to care for her daughter at home. Which response by the nurse would be most
appropriate?
A. “I will help you become comfortable in caring for your daughter.”
B. “You must learn how to care for your daughter at home.”
C. “You will need to learn to collaborate with all the caregivers.”
D. “There is a lot to learn, and you need a positive attitude.”
Answer: A
Rationale: The nurse needs to empower families to become the experts on their child’s needs and conditions via education and participation in care. The most positive approach is to let the mother know the nurse will support her and help her become an expert on her daughter’s care. Telling the mother that she must learn how to care for her daughter or that she must have a positive attitude is not helpful. Telling her that she needs to collaborate with the caregivers is true, but does not address her fears.
- The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion?
A. Deep-breathing exercises
B. Upright positioning
C. Coughing
D. Chest percussion
Answer: B
Rationale: The nurse should emphasize that the child’s position should be arranged to promote maximum chest expansion. This is usually in the upright position. Deep-breathing exercises are for strengthening/maintaining respiratory muscles. Coughing helps clear the airways. Chest percussion helps loosen secretions in lungs.
- A 6-year-old child with cerebral palsy has been admitted to the hospital for some tests. The child’s condition is stable. A parent remains with the child, but the parent is obviously exhausted and stressed. Which response by the nurse would be most appropriate?
A. “Would you like me to bring you a blanket and pillow?”
B. “You are doing such a wonderful job with your child.”
C. “Your child is in good hands; consider going home to get some sleep.”
D. “Are you planning to spend the night or to go home?”
Answer: C
Rationale: Providing daily, intense care can be quite demanding and tiring. When a child with cerebral palsy is admitted to the hospital, this may serve as a time of respite for family and primary caregivers. The nurse should remind the parent that the child is in good hands and urge the parent to go home. Asking whether the parent is planning to stay might make the parent feel obligated to stay. Asking if
the parent wants a blanket or pillow does not encourage the parent to leave the hospital. Telling the parent he or she is doing a good job is nice, but does not encourage the parent to take a break.
- A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action?
A. Monitoring for a decrease in spasticity
B. Observing for signs of meningeal irritation
C. Assessing motor function
D. Observing for mental confusion or hallucinations
Answer: B
Rationale: Following myelography, the nurse should carefully observe for signs of meningeal irritation because of what is involved in this procedure. Monitoring for a decrease in muscle spasticity, assessing motor function, and observing for mental confusion or hallucinations is appropriate following an intrathecal test dose of baclofen.
- The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury?
A. Recommend the bed’s side rails be raised throughout the day and night.
B. Suggest a caregiver be present continuously to prevent falls from bed.
C. Encourage a loose restraint to be used when he is in bed.
D. Recommend raising the bed’s side rails when a caregiver is not present.
Answer: D
Rationale: The nurse should recommend that side rails on the bed be elevated when a caregiver is not present. The use of restraints should be avoided if at all possible. Suggesting that a caregiver be present at all times places undue stress on the family. Close observation is more appropriate. Recommending side rails be elevated at all times may be upsetting to the child and make him feel like a “baby.”
- The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. What word would the nurse use when documenting these observations?
A. Spastic
B. Athetoid
C. Ataxic
D. Mixed
Answer: B
Rationale: Athetoid cerebral palsy is characterized by abnormal, involuntary movement. It affects all four extremities with possible involvement of the face, neck, and tongue. The movements increase in periods of stress. Dysarthria and drooling may be present as well. Spastic cerebral palsy is characterized by poor control of posture, balance, and movement; exaggeration of deep tendon reflexes; and hypertonicity of affected extremities. Ataxic is characterized by poor coordination, unsteady gait, and wide-based gait.
- The nurse is teaching a group of students about myelinization in a child. Which statement by the
students indicates that the teaching was successful?
A. Myelinization is completed by 4 years of age.
B. The process occurs in a head-to-toe fashion.
C. The speed of nerve impulses slows as myelinization occurs.
D. Nerve impulses become less specific in focus with myelinization.
Answer: B
Rationale: Myelinization occurs in a cephalocaudal, proximodistal manner and is completed by 2 years
of age. As myelinization proceeds, nerve impulses become fast and more accurate.
- When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely?
A. Skeletal traction
B. Physical therapy
C. Orthotics
D. Occupational therapy
Answer: A
Rationale: Skeletal traction would be the least likely treatment for a child with cerebral palsy. Physical therapy, orthotics and braces, and occupational therapy are all common treatments used for cerebral palsy.
- A nurse is preparing a program for a group of parents about injury prevention. What would the nurse include as an important contributing factor for cervical spine injury in a child?
A. Exposure to teratogens while in utero
B. Immaturity of the central nervous system
C. Increased mobility of the spine
D. Incomplete myelinization
Answer: C
Rationale: Compared to the adult, a child’s spine is very mobile, especially in the cervical spine region, resulting in a higher risk for cervical spine injury. Exposure to teratogens in utero may lead to altered growth and development of the brain or spinal cord. Immaturity of the central nervous system places the infant at risk for insults that may result in delayed motor skill attainment or cerebral palsy. Incomplete myelinization reflects the lack of motor control.
- A child with Duchenne muscular dystrophy is to receive prednisone as part of his treatment plan. After teaching the child’s parents about this drug, which statement by the parents indicates the need for additional teaching?
A. “We should give this drug before he eats anything.”
B. “We need to watch carefully for possible infection.”
C. “The drug should not be stopped suddenly.”
D. “He might gain some weight with this drug.”
Answer: A
Rationale: Corticosteroids such as prednisone can cause gastric upset so the medication should be given with food to reduce this risk. The drug may mask the signs of infection, so the parents need to monitor the child closely for any changes. Treatment with this drug should not be stopped abruptly due to the risk for acute adrenal insufficiency. Common side effects of this drug include weight gain, osteoporosis, and mood changes.
- What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele?
A. Positioning supine with a pillow under the buttocks
B. Covering the sac with saline-soaked nonadhesive gauze
C. Wrapping the infant snugly in a blanket
D. Applying a diaper to prevent fecal soiling of the sac
Answer: B
Rationale: For the infant with a myelomeningocele, saline-soaked nonadhesive gauze or antibiotic-soaked gauze is used to keep the sac moist. The infant is positioned prone, with a folded towel under the abdomen, so that the urine and feces flow away from the sac. A warmer or isolette is used to keep the infant warm. Blankets are avoided because they could place excess pressure on the sac. Diapering may be contraindicated to avoid placing pressure on the sac.
- The nurse is assessing a newborn who was delivered after a prolonged labor due to an abnormal presentation. The newborn sustained a cranial nerve injury. The nurse would most likely expect to assess deficits related to which cranial nerve?
A. Optic
B. Facial
C. Acoustic
D. Trigeminal
Answer: B
Rationale: The most common cranial nerve injury occurring during birth trauma involves facial nerve palsy. The optic, acoustic, and trigeminal nerves are not typically injured during birth trauma.
- A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route?
A. Oral
B. Subcutaneous injection
C. Intramuscular injection
D. Intravenous infusion
Answer: C
Rationale: Botulin toxin is administered by injection into the muscle. It may cause dry mouth. It is not administered orally, by subcutaneous injection, or by intravenous infusion.
- The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding?
A. Sluggish deep tendon reflexes
B. Full range of motion in extremities
C. Absence of hypotonia
D. Lack of purposeful muscular control
Answer: A
Rationale: Deep tendon reflexes are present at birth and are initially brisk in the newborn and progress to average over the first few months. Sluggish deep tendon reflexes indicate an abnormality. The newborn is capable of spontaneous movement but lacks purposeful control. Full range of motion is present at birth. Healthy infants and children demonstrate normal muscle tone; hypertonia or hypotonia is an abnormal finding.
- A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which instruction would the nurse include when teaching the parents about caring for their child?
A. Wait 48 hours before allowing the child to take a tub bath.
B. Do not allow the child to sleep on the left side for about 4 weeks.
C. Call the health care provider if the child’s temperature is over 100.5°F (38°C).
D. Discourage the child from stretching or bending forward for 4 weeks.
Answer: D
Rationale: After insertion of a baclofen pump, the parents should discourage any twisting at the waist, reaching high overhead, stretching, or bending forward or backward for 4 weeks. The child would avoid tub baths for about 2 weeks and avoid sleeping on the stomach for 4 weeks. The parents should notify the health care provider if the child’s temperature is greater than 101.5°F (38.6°C).
