Nokea
An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident. The parents keep asking the nurse, How bad is it? The nurses response should be based on which knowledge?
- A. Families adjust better to life-threatening injuries when information is given over time.
- B. Immediate loss of function is indicative of the long-term consequences of the injury.
- C. Extent and severity of damage cannot be determined for several weeks or even months.
- D. Numerous diagnostic tests will be done immediately to determine extent and severity of damage.
Correct Answer: C
Rationale: Spinal cord injury extent and severity are unclear initially due to physiologic responses, with improvement possible over weeks or months. Immediate loss doesn?t predict long-term outcomes, and while tests are done, prognosis requires time. Gradual information helps, but extent is the key issue.
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What is the most common cause of cerebral palsy (CP)?
- A. Central nervous system (CNS) diseases
- B. Birth asphyxia
- C. Cerebral trauma
- D. Neonatal encephalopathy
Correct Answer: D
Rationale: Neonatal encephalopathy, often from unknown prenatal causes, is implicated in about 80% of CP cases, particularly in term and preterm infants. CNS diseases, birth asphyxia, and cerebral trauma contribute but are less common causes.
What functional ability should the nurse expect in a child with a spinal cord lesion at C7?
- A. Complete respiratory paralysis
- B. No voluntary function of upper extremities
- C. Inability to roll over or attain sitting position
- D. Almost complete independence within limitations of wheelchair
Correct Answer: D
Rationale: A C7 spinal cord lesion allows significant independence with wheelchair use, with some assistance for transfers and dressing. Respiratory paralysis occurs at C3 or higher, upper extremity function is preserved, and rolling over or sitting is possible.
The parents of a child with spastic cerebral palsy (CP) state that their child seems to have significant pain. In addition to systemic pharmacologic management, the nurse includes which teaching?
- A. Patterning
- B. Positions to reduce spasticity
- C. Stretching exercises after meals
- D. Topical analgesics for muscle spasms
Correct Answer: B
Rationale: Teaching positions to reduce spasticity, such as specific sitting or lying postures, helps manage pain in spastic CP. Patterning is ineffective, stretching requires prior analgesia, and topical analgesics are not effective for CP spasms.
The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment. The nurses response should be based on which knowledge?
- A. Affected children have some degree of cognitive impairment.
- B. Around 20% of affected children have normal intelligence.
- C. About 45% of affected children have normal intelligence.
- D. Cognitive impairment is expected if motor and sensory deficits are severe.
Correct Answer: C
Rationale: Approximately 40% to 50% of children with CP have normal intelligence, with a wide range of cognitive outcomes. Severe physical impairment does not necessarily correlate with cognitive deficits, and many have minimal intellectual compromise.
A recommendation to prevent neural tube defects (NTDs) is the supplementation of what?
- A. Vitamin A throughout pregnancy
- B. Folic acid for all women of childbearing age
- C. Folic acid during the first and second trimesters of pregnancy
- D. Multivitamin preparations as soon as pregnancy is suspected
Correct Answer: B
Rationale: Folic acid supplementation for women of childbearing age, especially preconceptionally, reduces NTD incidence significantly, as defects occur early (3-5 weeks). Vitamin A is unrelated, and supplementation only during pregnancy or with multivitamins is less effective.