A 12-year-old recently began bedwetting after parental divorce.
The physical exam is unremarkable. What should the nurse do next?

Choice A rationale

Lateral curvature of the spine, known as scoliosis, can occur in Duchenne muscular dystrophy (DMD) as a secondary complication due to progressive muscle weakness affecting the spinal support. However, it is not the primary or initial characteristic manifestation of the disease. The fundamental pathology of DMD is direct muscle fiber degeneration leading to weakness.

Choice B rationale

Joint inflammation is characteristic of inflammatory arthropathies, such as juvenile idiopathic arthritis. Duchenne muscular dystrophy is a primary myopathy, a disorder of muscle tissue itself, not a condition primarily involving inflammation of the joints. While secondary musculoskeletal issues can arise, joint inflammation is not a hallmark feature of the disease.

Choice C rationale

Duchenne muscular dystrophy is an X-linked recessive disorder characterized by the absence of dystrophin, a crucial protein for maintaining muscle fiber integrity. This leads to progressive degeneration of skeletal muscle fibers, resulting in escalating muscle weakness. This weakness typically manifests in early childhood, starting in the proximal muscles and gradually spreading, leading to loss of ambulation.

Choice D rationale

While severe muscle weakness in Duchenne muscular dystrophy can indirectly lead to some skeletal deformities over time, such as contractures and kyphoscoliosis, these are typically secondary consequences rather than primary manifestations. The direct and defining characteristic of the disease is the progressive degeneration and weakness of the muscles themselves.

Choice A rationale

Ensuring the car seat is securely installed and properly buckled is paramount for infant safety. Correct installation prevents excessive movement of the car seat during a collision, and proper buckling ensures the infant is restrained effectively, reducing the risk of ejection or injury from impact forces.

Choice B rationale

Using an expired car seat or one that has been involved in a previous accident is highly dangerous. Over time, materials degrade, and the structural integrity of a car seat can be compromised after an accident, even if there are no visible signs of damage. Expired seats may not meet current safety standards.

Choice C rationale

Always placing the car seat in the front seat, facing forward, is incorrect and extremely dangerous. The front passenger airbag can deploy with significant force, causing severe or fatal injuries to an infant in a car seat. Infants and young children should always be in the back seat to mitigate this risk.

Choice D rationale

Placing the car seat in the middle of the back seat, facing forward, is incorrect for infants. Infants should always be in a rear-facing car seat until they meet the maximum height or weight limits for their rear-facing car seat, typically around 2 years of age or older. The middle back seat is generally safest for placement due to optimal crash protection.