The nurse is providing care for a child with Duchenne muscular dystrophy.
What characteristic manifestation should the nurse expect to observe?
Lateral curvature of the spine.
Joint inflammation.
Progressive muscle weakness.
Bone deformities.
The Correct Answer is C
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
GTPAL stands for Gravida, Term, Preterm, Abortions, Living Children. Gravida (G) is the total number of pregnancies, including the current one. This client has had three children plus one miscarriage, and is currently pregnant, making G = 5. Term (T) refers to pregnancies delivered at 37 weeks 0 days gestation or beyond. The client has two full-term children, so T = 2. Preterm (P) refers to pregnancies delivered between 20 weeks 0 days and 36 weeks 6 days gestation. The client had one child born prematurely at 34 weeks, so P = 1. Abortions (A) includes miscarriages and induced abortions before 20 weeks gestation. The client has a history of one miscarriage, so A = 1. Living (L) refers to the number of living children. The client has three children living at home, so L = 3. Therefore, the correct GTPAL is G5 T2 P1 A1 L3.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Explanation
The nurse should determine that the FHR pattern represents Early decelerations due to Fetal head compression during contractions.
Rationale for correct answers:
Early decelerations are a gradual decrease and return to baseline of the fetal heart rate (FHR) associated with uterine contractions. They mirror contractions, beginning and ending with the contraction. This pattern is physiologic and typically benign.
Fetal head compression during contractions causes a vagal response leading to early decelerations. At a station of +4 and full dilation, fetal descent is significant, making head compression the most likely cause.
Rationale for incorrect Response 1 Options:
Late decelerations occur after the peak of the contraction and are due to uteroplacental insufficiency. These are non-reassuring and do not mirror contractions, unlike what is noted in the case.
Variable decelerations are abrupt drops in FHR and vary in timing, shape, and duration. They are not mirror images and are often associated with cord compression, which is not supported by this case’s findings.
Prolonged decelerations last >2 minutes and <10 minutes. The decelerations in this case are transient (to 105 bpm) and resolve before the end of the contractions, ruling out prolonged patterns.
Rationale for incorrect Response 2 Options:
Umbilical cord compression leads to variable decelerations, which are abrupt and not aligned with contraction timing, unlike the current pattern.
Uteroplacental insufficiency results in late decelerations, which occur after the contraction ends. These are non-reassuring and not consistent with the current findings.
Maternal hypotension due to epidural could cause late decelerations from reduced placental perfusion. However, despite a BP drop at 0900 (100/52 mm Hg), the FHR deceleration pattern does not match.
Take home points:
- Early decelerations are benign and typically reflect fetal head compression during contractions.
- Differentiate early from late decelerations based on timing relative to contractions—early mirrors, late lags.
- Variable decelerations are abrupt and typically linked to umbilical cord compression, not head compression.
- Maternal hypotension from epidural requires close monitoring, but it leads to uteroplacental insufficiency and late decelerations, not early.
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