Nokea
The nurse is preparing a staff education in-service session for a group of new graduate nurses who will be working in a long-term care facility for children; many of the children have cerebral palsy (CP). What statement should the nurse include in the training?
- A. Children with dyskinetic CP have a wide-based gait and repetitive movements.
- B. Children with spastic pyramidal CP have a positive Babinski sign and ankle clonus.
- C. Children with hemiplegia CP have mouth muscles and one lower limb affected.
- D. Children with ataxic CP have involvement of pharyngeal and oral muscles with dysarthria.
Correct Answer: B
Rationale: Spastic pyramidal CP is characterized by a positive Babinski sign and ankle clonus due to hypertonicity. Dyskinetic CP involves oral muscles and dysarthria, hemiplegia affects one side with upper limbs more impacted, and ataxic CP features a wide-based gait.
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What type of cerebral palsy (CP) is the most common type?
- A. Ataxic
- B. Spastic
- C. Dyskinetic
- D. Mixed type
Correct Answer: B
Rationale: Spastic CP, marked by initial hypotonia transitioning to hypertonicity, is the most common type. Ataxic, dyskinetic, and mixed types are less frequent, with spastic CP showing increased stretch reflexes and weakness.
An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents describe her as being angry, hostile, and uncooperative. The nurse should recognize that this is suggestive of which psychosocial state?
- A. Normal phase of adolescent development
- B. Severe depression that will require long-term counseling
- C. Normal response to her situation that can be redirected in a healthy way
- D. Denial response to her situation that makes rehabilitative efforts more difficult
Correct Answer: C
Rationale: Anger, hostility, and uncooperativeness in a spinal cord injury adolescent reflect a normal response to disrupted independence, which can be redirected positively during rehabilitation. This isn?t typical adolescent behavior, severe depression, or denial, but an adaptive phase.
What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)?
- A. It has an autosomal dominant inheritance pattern.
- B. Onset occurs in later childhood and adolescence.
- C. It is characterized by presence of Gower sign, a waddling gait, and lordosis.
- D. Disease stabilizes during adolescence, allowing for life expectancy to approximately age 40 years.
Correct Answer: C
Rationale: DMD features Gower sign, waddling gait, and lordosis due to progressive muscle weakness starting at ages 3-5. It?s X-linked recessive, not autosomal dominant, and relentlessly progresses, leading to death by respiratory or cardiac failure, not stabilization.
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.
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.