What characteristic manifestation does the nurse caring for a child with Duchenne's muscular dystrophy document?

Exhibits atrophy of the calf muscles.

Has delayed fine-motor development.

Falls frequently and is clumsy.

Ambulates by holding onto furniture.

Answer and Explanation

The Correct Answer is C

C. Muscle weakness and lack of coordination contribute to difficulties with balance and coordination, leading to frequent falls and clumsiness in children with DMD.

A. DMD typically presents with symptoms such as difficulty climbing stairs, a waddling gait, and calf muscle hypertrophy, rather than atrophy.

B. Delayed fine-motor development is not a typical manifestation of Duchenne muscular dystrophy. DMD primarily affects muscle strength and function rather than fine motor skills.

D. Ambulating by holding onto furniture is not typical in Duchenne muscular dystrophy. As the disease progresses, children with DMD typically experience difficulty walking and may eventually require the use of assistive devices such as wheelchairs or orthoses for mobility.

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Correct Answer is B

Explanation

B. Reye's syndrome is characterized by swelling of the brain (cerebral edema), which can lead to increased intracranial pressure (ICP). Monitoring for signs of increased ICP, such as changes in level of consciousness, headache, vomiting, and altered pupil size and reactivity, is crucial for early detection and intervention to prevent neurological deterioration.

A. Reye's syndrome primarily affects the liver and brain, leading to liver dysfunction and encephalopathy. While renal involvement can occur in some cases, the priority complication typically relates to liver dysfunction and neurological manifestations rather than renal impairment.

C. Hyperglycemia may be present due to liver dysfunction and altered glucose metabolism, but it is not the primary concern compared to neurological complications and hepatic failure.

D. Reye's syndrome is not caused by a bacterial infection; it is typically associated with viral illnesses, particularly influenza and varicella (chickenpox).

A. Extreme fatigue B. An airway obstruction C. The presence of dehydration D. The presence of pain

Correct Answer is B

Explanation

B. Leaning forward with the chin thrust out, often described as the "sniffing position," is a classic sign of airway obstruction, particularly in cases of epiglottitis. This positioning helps to maximize airway patency by opening the airway and reducing the risk of further obstruction.

A. Leaning forward with the chin thrust out is not typically associated with extreme fatigue. Instead, it is a specific positioning often seen in individuals with epiglottitis to help alleviate airway obstruction and facilitate breathing.

C. Leaning forward with the chin thrust out is not indicative of dehydration. Dehydration may present with other signs and symptoms such as dry mucous membranes, decreased urine output, sunken fontanelle (in infants), and poor skin turgor.

D. Pain may be present in a child with epiglottitis but leaning forward with the chin thrust out is not primarily indicative of pain. This positioning is primarily a compensatory mechanism to alleviate airway obstruction rather than a response to pain.

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What characteristic manifestation does the nurse caring for a child with Duchenne's muscular dystrophy document?

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Naxlex Comprehensive Predictor Exams

The nurse reviews the plan of care for a child with Reye's syndrome. The nurse plans to monitor for which priority complication of this syndrome?

Correct Answer is B

Explanation

The nurse employed in an emergency department is instructed to monitor a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. The nurse interprets this observation as indicating which finding?

Correct Answer is B

Explanation

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