A nurse is assessing a pediatric client. Which finding would alert the nurse to the possibility of Spinal Muscular Atrophy Type I?

Spinal nerve fibers exposed in a lesion

The patient has ineffective airway clearance related to weak respiratory muscles.

Frequent seizures, impacting daily function

The patient is immunocompromised.

Answer and Explanation

The Correct Answer is B

A. Spinal nerve fibers exposed in a lesion: Exposed spinal nerve tissue is characteristic of neural tube defects such as myelomeningocele, not spinal muscular atrophy. SMA is a genetic neuromuscular disorder affecting motor neurons without structural spinal lesions.

B. The patient has ineffective airway clearance related to weak respiratory muscles: Spinal Muscular Atrophy Type I (Werdnig–Hoffmann disease) causes profound hypotonia and progressive weakness, including the intercostal and bulbar muscles. Respiratory muscle weakness leads to poor cough effort and ineffective airway clearance, making this a hallmark clinical concern.

C. Frequent seizures, impacting daily function: Seizures are not a typical manifestation of SMA Type I, as the disorder primarily affects lower motor neurons and does not directly involve cortical brain function.

D. The patient is immunocompromised: Immunodeficiency is not a defining feature of SMA. While recurrent infections may occur secondary to poor airway clearance, the immune system itself is not intrinsically impaired.

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Correct Answer is B

Explanation

A. The toddler is coughing intermittently without respiratory distress: Intermittent coughing without additional concerning signs is typical of viral bronchitis and does not usually require imaging. Supportive care is often sufficient in these cases.

B. The toddler has a persistent high fever and audible crackles on lung auscultation: Persistent high fever and crackles may indicate a bacterial infection or pneumonia rather than simple bronchitis. A chest x-ray is warranted to evaluate for lung consolidation or other complications and guide treatment.

C. The toddler has a normal oxygen saturation and clear lung sounds: Normal oxygen levels and clear lungs suggest mild illness that does not necessitate imaging. Routine bronchitis is often managed without a chest x-ray in this scenario.

D. The toddler has mild nasal congestion and occasional wheezing: These findings are common in viral respiratory infections and mild bronchitis. They are not indications for a chest x-ray unless symptoms worsen or fail to improve.

A. The tumor originated in the adrenal glands. B. The tumor has not spread to other areas of the child's body. C. The tumor came from malformation of astrocyte glial brain cells. D. The tumor is located in the lower back of the brain in the midline posterior fossa.

Correct Answer is A

Explanation

A. The tumor originated in the adrenal glands: Neuroblastoma is a malignancy of the sympathetic nervous system, most commonly arising in the adrenal medulla. It can also develop along the sympathetic chain in the neck, chest, or abdomen. Adrenal origin accounts for approximately 40% of cases in children.

B. The tumor has not spread to other areas of the child's body: Neuroblastoma is often metastatic at diagnosis, commonly spreading to bones, bone marrow, lymph nodes, liver, and skin. Localized tumors are less common, and assuming no spread is inaccurate.

C. The tumor came from malformation of astrocyte glial brain cells: Tumors of astrocytes are classified as astrocytomas or gliomas, which are primary brain tumors. Neuroblastoma arises from neural crest cells, not glial cells.

D. The tumor is located in the lower back of the brain in the midline posterior fossa: This description is characteristic of medulloblastoma, a central nervous system tumor. Neuroblastoma originates in peripheral sympathetic tissue, not the posterior fossa of the brain.

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A nurse is assessing a pediatric client. Which finding would alert the nurse to the possibility of Spinal Muscular Atrophy Type I?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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