C HAPTER 28: A LTERATIONS IN
N EUROMUSCULAR F UNCTION
MULTIPLE CHOICE
1. After a tonic-clonic seizure, it would not be unusual for a child to display which
symptom?
a. Irritability and hunger
b. Lethargy and confusion
c. Nausea and vomiting
d. Nervousness and excitability
ANS: B
In the period after a tonic-clonic seizure, the child may be confused and
lethargic. Some children may sleep for a period of time. Neither irritability
nor hunger is typical of the period after a tonic-clonic seizure. Nausea and
vomiting are not expected reactions in the postictal period. The child will
more likely be confused and lethargic after a tonic-clonic seizure.
2. What should the nurse teach parents when the child is taking phenytoin (Dilantin)
to control seizures?
a. The child should use a soft toothbrush and floss his teeth after every meal.
b. The child will require monitoring of his liver function while taking this
medication.
c. Dilantin should be taken with food because it causes gastrointestinal
distress.
d. The medication can be stopped when the child has been seizure free for 1
, month.
ANS: A
A side effect of Dilantin is gingival hyperplasia. Good oral hygiene will
minimize this adverse effect. The child receiving Depakene (valproic acid)
should have liver function studies because this anticonvulsant may cause
hepatic dysfunction. Dilantin has not been found to cause gastrointestinal
upset. The medication can be taken without food. Anticonvulsants should
never be stopped suddenly or without consulting the physician. Such a ction
could result in seizure activity.
3. What is the most appropriate nursing response to the father of a newborn infant
with myelomeningocele who asks about the cause of this condition?
a. One of the parents carries a defective gene that causes myelomeningoc ele.
b. A deficiency in folic acid in the father is the most likely cause.
c. Offspring of parents who have a spinal abnormality are at greater risk for
myelomeningocele.
d. There may be no definitive cause identified.
ANS: D
The etiology of most neural tube defects is unknown in most cases. There may
be a genetic predisposition or a viral origin, and the disorder has been linked
to maternal folic acid deficiency; however, the actual cause has not been
determined. The exact cause of most cases of neural tube defe cts is unknown.
There may be a genetic predisposition, but no pattern has been identified.
Folic acid deficiency in the mother has been linked to neural tube defect.
There is no evidence that children who have parents with spinal problems are
at greater risk for neural tube defects.
, 4. Which assessment noted in an infant 1 day after placement of a
ventriculoperitoneal shunt is indicative of surgical complications?
a. Hypoactive bowel sounds
b. Congestion in upper airways
c. Increasing lethargy
d. Mild incisional pain
ANS: C
A decreasing level of consciousness indicates a problem with shunt function
and should be reported immediately to the neurosurgeon. Peristalsis is
depressed during surgery. Hypoactive bowel sounds may be evident after
surgery as peristalsis returns to its preoperative function. Congestion in the
upper airways may be evident after surgery. Mild incisional pain is a normal
finding in the postoperative period.
5. Which change in vital signs should alert the nurse to increased intracranial
pressure (ICP) in a child with a head injury?
a. Rapid, shallow breathing
b. Irregular, rapid heart rate
c. Increased diastolic pressure with narrowing pulse pressure
d. Confusion and altered mental status
ANS: D
The child with a head injury may have confusion and altered mental status, a
change in vital signs, retinal hemorrhage, hemiparesis, and papilledema.
Respiratory changes occur with increased intracranial pressure. One pattern
that may be evident is Cheyne-Stokes respiration. This pattern of breathing is
N EUROMUSCULAR F UNCTION
MULTIPLE CHOICE
1. After a tonic-clonic seizure, it would not be unusual for a child to display which
symptom?
a. Irritability and hunger
b. Lethargy and confusion
c. Nausea and vomiting
d. Nervousness and excitability
ANS: B
In the period after a tonic-clonic seizure, the child may be confused and
lethargic. Some children may sleep for a period of time. Neither irritability
nor hunger is typical of the period after a tonic-clonic seizure. Nausea and
vomiting are not expected reactions in the postictal period. The child will
more likely be confused and lethargic after a tonic-clonic seizure.
2. What should the nurse teach parents when the child is taking phenytoin (Dilantin)
to control seizures?
a. The child should use a soft toothbrush and floss his teeth after every meal.
b. The child will require monitoring of his liver function while taking this
medication.
c. Dilantin should be taken with food because it causes gastrointestinal
distress.
d. The medication can be stopped when the child has been seizure free for 1
, month.
ANS: A
A side effect of Dilantin is gingival hyperplasia. Good oral hygiene will
minimize this adverse effect. The child receiving Depakene (valproic acid)
should have liver function studies because this anticonvulsant may cause
hepatic dysfunction. Dilantin has not been found to cause gastrointestinal
upset. The medication can be taken without food. Anticonvulsants should
never be stopped suddenly or without consulting the physician. Such a ction
could result in seizure activity.
3. What is the most appropriate nursing response to the father of a newborn infant
with myelomeningocele who asks about the cause of this condition?
a. One of the parents carries a defective gene that causes myelomeningoc ele.
b. A deficiency in folic acid in the father is the most likely cause.
c. Offspring of parents who have a spinal abnormality are at greater risk for
myelomeningocele.
d. There may be no definitive cause identified.
ANS: D
The etiology of most neural tube defects is unknown in most cases. There may
be a genetic predisposition or a viral origin, and the disorder has been linked
to maternal folic acid deficiency; however, the actual cause has not been
determined. The exact cause of most cases of neural tube defe cts is unknown.
There may be a genetic predisposition, but no pattern has been identified.
Folic acid deficiency in the mother has been linked to neural tube defect.
There is no evidence that children who have parents with spinal problems are
at greater risk for neural tube defects.
, 4. Which assessment noted in an infant 1 day after placement of a
ventriculoperitoneal shunt is indicative of surgical complications?
a. Hypoactive bowel sounds
b. Congestion in upper airways
c. Increasing lethargy
d. Mild incisional pain
ANS: C
A decreasing level of consciousness indicates a problem with shunt function
and should be reported immediately to the neurosurgeon. Peristalsis is
depressed during surgery. Hypoactive bowel sounds may be evident after
surgery as peristalsis returns to its preoperative function. Congestion in the
upper airways may be evident after surgery. Mild incisional pain is a normal
finding in the postoperative period.
5. Which change in vital signs should alert the nurse to increased intracranial
pressure (ICP) in a child with a head injury?
a. Rapid, shallow breathing
b. Irregular, rapid heart rate
c. Increased diastolic pressure with narrowing pulse pressure
d. Confusion and altered mental status
ANS: D
The child with a head injury may have confusion and altered mental status, a
change in vital signs, retinal hemorrhage, hemiparesis, and papilledema.
Respiratory changes occur with increased intracranial pressure. One pattern
that may be evident is Cheyne-Stokes respiration. This pattern of breathing is
