NR328 UPDATED 2026/2027 EXAM SCRIPT QUESTIONS
AND ANSWERS RATED A+
✔✔cerebral palsy symptoms - ✔✔Chronic, static impairment of muscles
from birth
-Limb spasticity, weakness, paralysis (MC)
-Ataxia (loss of control of movements)
-Dystonia
Often with:
-seizures
-mental retardation
-speech problems
-vision problems
-hearing problems
-tight muscles
-abnormal posture
-stiff joints
-eating problems
-learning disability
✔✔Cerebral Palsy
Treatment - ✔✔-support because non curable
-Specialist such as neurologist , occupational , speech, physical therapist
-Muscle relaxant
baclofen :iv or po
-Pain Meds
dantrolene
diazepam
-Physical therapy to prevent atrophy or contractures
-Mobilization devices
-botox :can be used to paralyze salivary gland to reduce drooling
-Surgury to loosen muscles , straighten bones ,cut nerves to reduce
movements/spasms
,✔✔In children Cerebral Palsy patient may show - ✔✔-Poor head control after the age of
3 months
-Stiff or rigid limbs
-asymetrical crawl
-Arching back /Pushing away
-Floppy tone
-Unable to sit without support at the age of 8 months
-Clenched fist after the age of 3 months
*Preterm birth of ELBW
( extremely low birth weight )
✔✔Possible Behavior signs of Cerebral Palsy - ✔✔-Excessive irritability
-No smiling by age 3 months
-feeding difficulties
*Persistent tongue thrushing
*Frequent gagging or choking with feeds
✔✔Cerebral palsy diagnostic test - ✔✔Complete neurological assessment
Metabolic and genetic testing
MRI
General Movement assessment
✔✔muscle dystrophy - ✔✔one of a group of inherited diseases involving progressive
muscle degeneration, weakness, and atrophy
✔✔Duchenne Muscular Dystrophy (DMD) - ✔✔most common form of muscular
dystrophy; affects primarily boys with onset between the ages of 3 and 5 years; the
disorder progresses rapidly so that most of these boys are unable to walk by age 12
and later need a respirator to breathe
✔✔Duchenne Muscular Dystrophy clinical manifestation - ✔✔-Waddling gait ,frequent
fall
,-Gower sign
-Lordosis
-enlarged muscle especially calves ,thighs and upper arms ,followed by muscle atrophy
-Mental Deficiency
✔✔DMD (Duchenne Muscular Dystrophy) diagnostic - ✔✔-Clinical experience
-EMG
-Muscle biopsy
-serum enzyme measurement
-Gower sign when rising from fall
✔✔Duchenne Muscular Dystrophy (DMD) therapeutic management - ✔✔-Maintain
function in unaffected muscles as long as possible
-ROM, bracing ,performance of ADLs ,surgical release of contractures PRN
-Support
✔✔Spina bifida - ✔✔a congenital defect that occurs during early pregnancy when the
spinal canal fails to close completely around the spinal cord to protect it
✔✔neural tube defects - ✔✔congenital deformities of the brain and spinal cord caused
by incomplete development of the neural tube, the embryonic structure that forms the
nervous system
✔✔spina bifida occulta - ✔✔most common and least severe form of spina bifida without
protrusion of the spinal cord or meninges
✔✔spinal bifida cystica - ✔✔meninges and spinal cord protruding through the absent
vertebral arch and having the appearance of a cyst
✔✔meningocele spina bifida - ✔✔involves an extensive spinal opening with an exposed
pouch of cerebrospinal fluid and the meninges
✔✔Myelomeningocele (spina bifida) - ✔✔Congenital disorder where the spinal cord
does not close before birth and the sac contain spinal fluid , meninges and nerves
, **associated with hydrocephalus
***chiari malformation brain herniates down into the brain stem
urine dribbling or overflow
poor anal sphincter tone
orthopedic deformities
bowel control-incontinent
✔✔Spina bifida risk factors - ✔✔-medication/substances taken during pregnancy
-maternal malnutrition
-insufficient folic acid intake during pregnancy
✔✔Spina Bifida
Physical assessment - ✔✔-protuding sac (cystica)
-port wine angioma(occulta)
-dark hair tufts (occulta)
-subcutaneous lipoma (occulta)
✔✔Spina bifida lab results - ✔✔Increased Alfa FetoProtein in amniotic fluid/maternal
serum
✔✔spina bifida dx - ✔✔In Uterus
* Amniocentesis
* Increase alpha-fetoprotein
*ultrasound
✔✔Spina Bifida-Nursing Considerations - ✔✔*Close monitoring for latex allergy/
*infection
*Aviod bananas ,kiwi, avocados ,chestnuts
*Skin assessment/Assess sac
*repositioning
*Elimination program for urinary and *bowel
*Physical therapy
*neurological check
AND ANSWERS RATED A+
✔✔cerebral palsy symptoms - ✔✔Chronic, static impairment of muscles
from birth
-Limb spasticity, weakness, paralysis (MC)
-Ataxia (loss of control of movements)
-Dystonia
Often with:
-seizures
-mental retardation
-speech problems
-vision problems
-hearing problems
-tight muscles
-abnormal posture
-stiff joints
-eating problems
-learning disability
✔✔Cerebral Palsy
Treatment - ✔✔-support because non curable
-Specialist such as neurologist , occupational , speech, physical therapist
-Muscle relaxant
baclofen :iv or po
-Pain Meds
dantrolene
diazepam
-Physical therapy to prevent atrophy or contractures
-Mobilization devices
-botox :can be used to paralyze salivary gland to reduce drooling
-Surgury to loosen muscles , straighten bones ,cut nerves to reduce
movements/spasms
,✔✔In children Cerebral Palsy patient may show - ✔✔-Poor head control after the age of
3 months
-Stiff or rigid limbs
-asymetrical crawl
-Arching back /Pushing away
-Floppy tone
-Unable to sit without support at the age of 8 months
-Clenched fist after the age of 3 months
*Preterm birth of ELBW
( extremely low birth weight )
✔✔Possible Behavior signs of Cerebral Palsy - ✔✔-Excessive irritability
-No smiling by age 3 months
-feeding difficulties
*Persistent tongue thrushing
*Frequent gagging or choking with feeds
✔✔Cerebral palsy diagnostic test - ✔✔Complete neurological assessment
Metabolic and genetic testing
MRI
General Movement assessment
✔✔muscle dystrophy - ✔✔one of a group of inherited diseases involving progressive
muscle degeneration, weakness, and atrophy
✔✔Duchenne Muscular Dystrophy (DMD) - ✔✔most common form of muscular
dystrophy; affects primarily boys with onset between the ages of 3 and 5 years; the
disorder progresses rapidly so that most of these boys are unable to walk by age 12
and later need a respirator to breathe
✔✔Duchenne Muscular Dystrophy clinical manifestation - ✔✔-Waddling gait ,frequent
fall
,-Gower sign
-Lordosis
-enlarged muscle especially calves ,thighs and upper arms ,followed by muscle atrophy
-Mental Deficiency
✔✔DMD (Duchenne Muscular Dystrophy) diagnostic - ✔✔-Clinical experience
-EMG
-Muscle biopsy
-serum enzyme measurement
-Gower sign when rising from fall
✔✔Duchenne Muscular Dystrophy (DMD) therapeutic management - ✔✔-Maintain
function in unaffected muscles as long as possible
-ROM, bracing ,performance of ADLs ,surgical release of contractures PRN
-Support
✔✔Spina bifida - ✔✔a congenital defect that occurs during early pregnancy when the
spinal canal fails to close completely around the spinal cord to protect it
✔✔neural tube defects - ✔✔congenital deformities of the brain and spinal cord caused
by incomplete development of the neural tube, the embryonic structure that forms the
nervous system
✔✔spina bifida occulta - ✔✔most common and least severe form of spina bifida without
protrusion of the spinal cord or meninges
✔✔spinal bifida cystica - ✔✔meninges and spinal cord protruding through the absent
vertebral arch and having the appearance of a cyst
✔✔meningocele spina bifida - ✔✔involves an extensive spinal opening with an exposed
pouch of cerebrospinal fluid and the meninges
✔✔Myelomeningocele (spina bifida) - ✔✔Congenital disorder where the spinal cord
does not close before birth and the sac contain spinal fluid , meninges and nerves
, **associated with hydrocephalus
***chiari malformation brain herniates down into the brain stem
urine dribbling or overflow
poor anal sphincter tone
orthopedic deformities
bowel control-incontinent
✔✔Spina bifida risk factors - ✔✔-medication/substances taken during pregnancy
-maternal malnutrition
-insufficient folic acid intake during pregnancy
✔✔Spina Bifida
Physical assessment - ✔✔-protuding sac (cystica)
-port wine angioma(occulta)
-dark hair tufts (occulta)
-subcutaneous lipoma (occulta)
✔✔Spina bifida lab results - ✔✔Increased Alfa FetoProtein in amniotic fluid/maternal
serum
✔✔spina bifida dx - ✔✔In Uterus
* Amniocentesis
* Increase alpha-fetoprotein
*ultrasound
✔✔Spina Bifida-Nursing Considerations - ✔✔*Close monitoring for latex allergy/
*infection
*Aviod bananas ,kiwi, avocados ,chestnuts
*Skin assessment/Assess sac
*repositioning
*Elimination program for urinary and *bowel
*Physical therapy
*neurological check
