Chapter 35: The Child with Neuromuscular or Muscular Dysfunction

Chapter 35: The Child with Neuromuscular or Muscular Dysfunction

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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

 

 

ANS:  D

Approximately 80% of CP is caused by unknown prenatal causes. Neonatal encephalopathy in term and preterm infants is believed to play a significant role in the development of CP. CNS diseases such as meningitis or encephalitis can result in CP. Birth asphyxia does contribute to some cases of CP. Cerebral trauma, including shaken baby syndrome, can result in CP.

 

DIF:    Cognitive Level: Understanding       REF:   p. 1632

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Physiological Integrity

 

2. Spastic cerebral palsy (CP) is characterized by which clinical manifestations?

a.	Athetosis, dystonic movements
b.	Tremors, lack of active movement
c.	Hypertonicity; poor control of posture, balance, and coordinated motion
d.	Wide-based gait; poor performance of rapid, repetitive movements

 

 

ANS:  C

Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic CP. Athetosis and dystonic movements are part of the classification of dyskinetic or athetoid CP. Tremors and lack of active movement may indicate other neurologic disorders. A wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic CP.

 

DIF:    Cognitive Level: Understanding       REF:   p. 1619

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Physiological Integrity

 

3. What type of cerebral palsy (CP) is the most common type?

a.	Ataxic
b.	Spastic
c.	Dyskinetic
d.	Mixed type

 

 

ANS:  B

Spastic CP is the most common clinical type. Early manifestations are usually generalized hypotonia, or decreased tone that lasts for a few weeks or may extend for months or as long as 1 year. It is replaced by increased stretch reflexes, increased muscle tone, and weakness. Ataxic, dyskinetic, and mixed type are less common forms of CP.

 

DIF:    Cognitive Level: Understanding       REF:   p. 1619

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Physiological Integrity

 

4. The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment. The nurse’s 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.

 

 

ANS:  C

Children with CP have a wide range of intelligence, and 40% to 50% are within normal limits. A large percentage of children with CP do not have mental impairment. Many individuals who have severely limiting physical impairment have the least amount of intellectual compromise.

 

DIF:    Cognitive Level: Applying               REF:   p. 1620

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity

 

5. 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

 

 

ANS:  B

Meticulous oral hygiene is essential. Many children with CP have congenital enamel defects, high-carbohydrate diets, poor nutritional intake, and difficulty closing their mouths. These, coupled with the child’s spasticity or clonic movements, make oral hygiene difficult. Children with CP have high carbohydrate intake and retention, which contribute to dental caries. Use of fluoride should be encouraged through fluoridated water or supplements and toothpaste. Certain medications such as phenytoin do contribute to gingival hyperplasia. If that is the drug of choice, then meticulous oral hygiene must be used.

 

DIF:    Cognitive Level: Applying               REF:   p. 1621

TOP:    Nursing Process: Implementation          MSC:   Client Needs: Physiological Integrity