Which assessment findings should the nurse note in a school-age child with Duchenne muscular dystrophy (DMD)? (Select all that apply)
Waddling gait
Kyphosis
Lordosis
Scoliosis
Gower sign
Correct Answer : A,B,C,D,E
The correct answer is
A. Waddling gait
B. Kyphosis
C. Lordosis
D. Scoliosis
E. Gower sign
Choice A reason
Waddling gait: Children with Duchenne muscular dystrophy (DMD) often exhibit a waddling gait due to progressive muscle weakness, particularly in the pelvic girdle muscles. This gait pattern is a compensatory mechanism to maintain balance and mobility despite weakened muscles. The waddling gait is one of the early signs of DMD and typically becomes noticeable between the ages of 2 and 6 years.
Choice B Reason
Kyphosis: Kyphosis, an excessive outward curvature of the spine, can develop in children with DMD as the disease progresses. Muscle weakness and imbalance, particularly in the back muscles, contribute to this spinal deformity. Kyphosis can lead to discomfort, respiratory issues, and further mobility challenges, necessitating close monitoring and intervention.
Choice C Reason
Lordosis: Lordosis, an exaggerated inward curvature of the lower spine, is another common finding in children with DMD. This condition often develops as a compensatory mechanism to maintain an upright posture despite weakened hip and thigh muscles. Lordosis can cause lower back pain and impact overall posture and gait.
Choice D Reason
Scoliosis: Scoliosis, a lateral curvature of the spine, frequently occurs in children with DMD due to progressive muscle weakness and imbalance. As the disease advances, scoliosis can become more pronounced, leading to discomfort, respiratory complications, and further functional limitations. Early detection and management are crucial to mitigate these effects.
Choice E Reason
Gower sign: The Gower sign is a classic clinical indicator of DMD. It refers to the maneuver children with DMD use to rise from the floor, involving the use of their hands to “walk” up their legs due to proximal muscle weakness. This sign is typically observed in early childhood and is a key diagnostic feature of DMD1.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
The correct answer is a) Positive Ortolani click, b) Unequal gluteal folds, c) Trendelenburg sign, and e) Telescoping of the affected limb.
Choice A reason:
A positive Ortolani click is a clinical manifestation of developmental dysplasia of the hip (DDH). The Ortolani maneuver is used to detect hip dislocation or subluxation in infants. When the hip is abducted and gentle pressure is applied to the proximal thigh from behind, a palpable “clunk” is noticed as the femoral head relocates into the acetabulum. This indicates hip instability, which is a characteristic of DDH.
Choice B reason:
Unequal gluteal folds are another clinical manifestation of DDH. Asymmetrical gluteal creases can suggest hip dysplasia in infants. This is because the dislocation or subluxation of the hip can cause one leg to appear shorter than the other, leading to uneven gluteal folds.
Choice C reason:
The Trendelenburg sign is a clinical test used to assess the integrity and strength of the hip abductor muscles, particularly the gluteus medius and gluteus minimus. A positive Trendelenburg sign usually indicates weakness in these muscles, which can be associated with hip abnormalities such as congenital hip dislocation3. In DDH, the hip instability can lead to a positive Trendelenburg sign.
Choice D reason:
A negative Babinski sign is not a clinical manifestation of DDH. The Babinski reflex is a normal reflex in infants up to 2 years old, where the big toe moves upward and the other toes fan out when the sole of the foot is stroked. A negative Babinski sign would indicate the absence of this reflex, which is not related to DDH.
Choice E reason:
Telescoping of the affected limb is a clinical manifestation of DDH. In a child with DDH, the hip socket is shallow, and the head of the femur may slip in and out, leading to a telescoping effect. This means the femoral head can move further out of the socket, causing the limb to appear shorter or longer depending on the position.
Correct Answer is B
Explanation
The correct answer is b. 25%.
Choice A: 50%
If both parents are heterozygous for the sickle cell trait (carriers), each child has a 50% chance of inheriting one sickle cell gene from one parent and a normal gene from the other parent. This would make the child a carrier of the sickle cell trait, not someone with sickle cell anemia. Therefore, the chance of having sickle cell anemia is not 50%.
Choice B: 25%
When both parents are carriers of the sickle cell trait (heterozygous), there is a 25% chance that their child will inherit two sickle cell genes (one from each parent), resulting in sickle cell anemia. This is because each parent has one normal hemoglobin gene (A) and one sickle cell gene (S). The possible combinations for their children are AA (normal), AS (carrier), SA (carrier), and SS (sickle cell anemia). The probability of the SS combination is 25%.
Choice C: 75%
A 75% chance is not accurate in this scenario. The 75% figure might be mistakenly considered if one were to add the probabilities of being a carrier (50%) and having sickle cell anemia (25%). However, these probabilities are distinct and should not be combined in this manner.
Choice D: 100%
A 100% chance would imply that every child of the couple would have sickle cell anemia, which is not the case. Since each parent is a carrier, there is only a 25% chance for each child to have sickle cell anemia. The remaining 75% of the time, the child will either be a carrier or have normal hemoglobin.
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