Nokea
An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department. She has completed the tetanus immunization series, receiving the last tetanus toxoid booster 8 years ago. What care is necessary for therapeutic management of this adolescent to prevent tetanus?
- A. Tetanus toxoid booster is needed because of the type of injury.
- B. Human tetanus immunoglobulin is indicated for immediate prophylaxis.
- C. Concurrent administration of both tetanus immunoglobulin and tetanus antitoxin is needed.
- D. No additional tetanus prophylaxis is indicated. The tetanus toxoid booster is protective for 10 years.
Correct Answer: A
Rationale: A tetanus toxoid booster is required for tetanus-prone wounds like crush injuries, despite a booster 8 years ago, as prophylaxis is needed for such injuries. Immunoglobulin isn?t needed with prior immunization, and boosters are protective for 10 years in clean wounds.
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Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care?
- A. High-carbohydrate diet
- B. Meticulous dental hygiene
- C. Minimum use of fluoride
- D. Avoidance of medications that contribute to gingivitis
Correct Answer: B
Rationale: Meticulous dental hygiene prevents gingivitis in CP, countering enamel defects, high-carbohydrate diets, and spasticity-related oral care challenges. Fluoride use is encouraged, and medications like phenytoin may require hygiene adjustments, not avoidance.
A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child?
- A. Infant stimulation program
- B. Stretching exercises to decrease contractures
- C. Limited physical contact to minimize seizures
- D. Encouraging parents to have additional children
Correct Answer: A
Rationale: An infant stimulation program with frequent position changes and sensory input is vital for Werdnig-Hoffmann disease to support development. Contractures are not a concern due to muscle atrophy, sensation is normal, and genetic counseling is needed, not encouragement for more children.
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.
What is a major goal of therapy for children with cerebral palsy (CP)?
- A. Cure the underlying defect causing the disorder.
- B. Reverse the degenerative processes that have occurred.
- C. Prevent the spread to individuals in close contact with the child.
- D. Recognize the disorder early and promote optimum development.
Correct Answer: D
Rationale: Early recognition and promoting optimal development are key CP therapy goals, maximizing potential within physical limits. CP is permanent, not curable or reversible, and is not contagious.