A nurse is collecting data from a child who has spina bifida occulta. Which of the following findings should the nurse expect?
Flaccid paralysis of lower extremities
Hip dislocation
Hydrocephalus
Dimple in sacral area
The Correct Answer is D
A. Flaccid paralysis of lower extremities:
Flaccid paralysis refers to a weakness or loss of muscle tone in the affected muscles, leading to decreased or absent movement. This finding is not typically associated with spina bifida occulta. Instead, it is more commonly seen in more severe forms of spina bifida, such as myelomeningocele, where there is significant involvement of the spinal cord and nerves.
B. Hip dislocation:
Hip dislocation can occur in individuals with myelomeningocele due to muscle weakness, abnormal muscle tone, and joint deformities associated with spinal cord defects. However, it is not typically associated with spina bifida occulta, which usually presents with less severe spinal cord involvement.
C. Hydrocephalus:
Hydrocephalus, characterized by the accumulation of cerebrospinal fluid within the brain, is a common complication of myelomeningocele due to disturbances in the flow and absorption of cerebrospinal fluid caused by the spinal defect. It is less commonly associated with spina bifida occulta, which typically involves a less severe spinal cord defect.
D. Dimple in sacral area:
This is the correct choice. A dimple, patch of hair, or birthmark in the lower back or sacral area is a common finding in spina bifida occulta. It occurs due to the incomplete closure of the spinal column during fetal development, leading to a small defect in the vertebrae. This is often a subtle manifestation of spina bifida occulta and may not cause significant symptoms or functional impairment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. A room with a toddler who has pneumonia.
This option is not ideal because both RSV and pneumonia are respiratory infections that can spread to other patients. Placing these two patients together could increase the risk of cross-infection.
B. A private room with reverse isolation.
Reverse isolation is typically used to protect immunocompromised patients from acquiring infections from others. However, in the case of RSV, reverse isolation is not necessary because RSV primarily affects infants and young children who are generally not immunocompromised. Therefore, this option is not appropriate for an infant with RSV.
C. A private room with contact/droplet precautions.
This option is the most appropriate. RSV is primarily spread through respiratory droplets and direct contact with respiratory secretions. Placing the infant in a private room with contact/droplet precautions helps to minimize the risk of transmission to other patients. Healthcare workers and visitors entering the room should adhere to appropriate precautions, including wearing personal protective equipment (PPE) such as masks, gloves, and gowns.
D. A room with an infant who has croup.
Placing an infant with RSV in the same room as an infant with croup is not ideal because both conditions involve respiratory symptoms and may increase the risk of cross-infection.
Correct Answer is B
Explanation
A. Onlooker play:
Onlooker play is when a child observes others playing without actively participating themselves. This type of play typically involves watching others engage in activities or play without joining in. It does not directly involve role-playing or hands-on activities to prepare a child for surgery.
B. Therapeutic play:
This is the correct answer. Therapeutic play involves using play activities to help children express their feelings, fears, and concerns about medical procedures or hospitalization. It often includes role-playing and hands-on activities such as practicing medical procedures on dolls or stuffed animals. Therapeutic play helps children become familiar with medical equipment and procedures in a non-threatening environment, reducing anxiety and promoting coping skills.
C. Cooperative play:
Cooperative play involves children playing together, interacting, and collaborating in shared activities. While cooperative play can be beneficial for social development, it does not necessarily involve role-playing or hands-on activities specific to preparing a child for surgery.
D. Play therapy:
Play therapy is a form of psychotherapy that uses play to communicate with and help children express their thoughts and emotions. While play therapy can be therapeutic for children dealing with various issues, including medical procedures, it is typically facilitated by a trained therapist rather than being directly utilized to prepare a child for surgery through role-playing or hands-on activities.
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