Which medication is commonly used to treat juvenile idiopathic arthritis (JIA)?

Choice A rationale

Duchenne muscular dystrophy (DMD) is a progressive genetic disorder characterized by muscle degeneration and weakness. Individuals with DMD experience significant muscle weakness, particularly in the lower limbs, leading to an increased risk of falls due to impaired balance and gait instability. Decreased muscle strength directly compromises postural control.

Choice B rationale

Rapid cognitive development is not a typical characteristic of Duchenne muscular dystrophy. While DMD primarily affects skeletal muscles, some individuals may experience cognitive impairments, ranging from mild learning difficulties to more significant intellectual disabilities. The disease is linked to dystrophin deficiency in brain tissue, which can impact neurological function.

Choice C rationale

Increased muscle strength is antithetical to the pathology of Duchenne muscular dystrophy. The hallmark of DMD is progressive muscle weakness caused by the absence or malfunction of dystrophin, a protein vital for maintaining muscle fiber integrity. This leads to chronic muscle damage, inflammation, and eventual replacement of muscle tissue with fat and fibrous tissue.

Choice D rationale

Wheelchair dependence is a common and almost inevitable outcome for individuals with Duchenne muscular dystrophy. Due to the progressive muscle weakness affecting ambulation, most individuals with DMD lose the ability to walk independently between ages 7 and 13, necessitating the use of a wheelchair for mobility as the disease progresses and leg muscles deteriorate.

Choice A rationale

Repositioning the client to a left lateral position aims to improve uteroplacental perfusion by alleviating compression of the inferior vena cava by the gravid uterus. This enhances venous return to the mother's heart, increasing cardiac output and ultimately improving blood flow and oxygen delivery to the placenta and fetus, which can resolve late decelerations caused by uteroplacental insufficiency.

Choice B rationale

Documenting findings is a crucial nursing responsibility, but it is not the immediate intervention for addressing late decelerations. Scientific principles dictate that physiological stabilization takes precedence over documentation when fetal well-being is compromised. Documentation would follow after initial interventions are implemented to improve the fetal status.

Choice C rationale

Adjusting fetal monitor sensors might be necessary if the tracing is poor quality, but it does not directly address the physiological cause of late decelerations. Late decelerations reflect uteroplacental insufficiency, not merely a monitoring artifact. Addressing the underlying physiological compromise is the priority before troubleshooting equipment.

Choice D rationale

Inserting a fetal scalp electrode provides a more accurate assessment of fetal heart rate by directly monitoring the fetus. However, this is an invasive procedure and is typically considered after initial conservative measures, such as maternal repositioning and oxygen administration, have been attempted without resolution of the late decelerations.