The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations would the nurse expect to observe? (Select all that apply.)
Positive Ortolani click
Unequal gluteal folds
Trendelenburg sign
Negative Babinski sign
Telescoping of the affected limb
Correct Answer : A,B,C,E
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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
A low protein diet is not a therapeutic treatment for Hirschsprung disease. Hirschsprung disease is a congenital condition characterized by the absence of ganglion cells in the distal colon, leading to a lack of peristalsis and functional obstruction. Dietary modifications, such as a low protein diet, do not address the underlying issue of the absence of nerve cells in the bowel. Therefore, this choice is incorrect.
Choice B reason:
Surgical removal of the affected section of the bowel is the primary treatment for Hirschsprung disease. This procedure, known as a pull-through surgery, involves removing the aganglionic segment of the colon and connecting the healthy part of the intestine to the anus. This surgery restores normal bowel function by allowing the passage of stool through the healthy, innervated portion of the intestine. The pull-through procedure can be performed using minimally invasive techniques, resulting in shorter recovery times and fewer complications.
Choice C reason:
A permanent colostomy is not typically the first-line treatment for Hirschsprung disease. While a temporary colostomy may be performed in some cases to allow the bowel to heal before a pull-through surgery, a permanent colostomy is usually reserved for more severe cases or when other surgical options are not feasible. The goal of treatment is to restore normal bowel function, and a permanent colostomy is generally considered a last resort.
Choice D reason:
Daily enemas are not a definitive treatment for Hirschsprung disease. While enemas may be used temporarily to relieve symptoms and manage bowel movements, they do not address the underlying cause of the condition. The absence of ganglion cells in the bowel requires surgical intervention to restore normal bowel function. Therefore, daily enemas are not a long-term solution for Hirschsprung disease.
Correct Answer is A
Explanation
Choice A reason:
Cardiac arrhythmia is a primary clinical manifestation of hyperkalemia. Hyperkalemia, defined as an elevated level of potassium in the blood, can significantly affect the electrical activity of the heart. This can lead to various types of arrhythmias, including bradycardia, ventricular tachycardia, and even cardiac arrest1. The presence of arrhythmias is a critical indicator of hyperkalemia and requires immediate medical attention to prevent life-threatening complications.
Choice B reason:
Seizures are not typically associated with hyperkalemia2. While severe electrolyte imbalances can potentially lead to neurological symptoms, seizures are more commonly linked to conditions such as hyponatremia (low sodium levels) or hypocalcemia (low calcium levels). Therefore, seizures are not a primary sign of hyperkalemia.
Choice C reason:
Dyspnea, or difficulty breathing, can occur in various medical conditions, including heart failure and respiratory disorders. While hyperkalemia can lead to muscle weakness and fatigue, which might indirectly affect breathing, dyspnea is not a primary clinical manifestation of hyperkalemia. The main concern with hyperkalemia is its effect on cardiac function.
Choice D reason:
Oliguria, or reduced urine output, is a symptom of acute renal failure but not specifically indicative of hyperkalemia. While acute renal failure can lead to hyperkalemia due to the kidneys’ inability to excrete potassium, oliguria itself is not a direct sign of hyperkalemia. The focus should be on the cardiac effects of elevated potassium levels
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