You are a nurse caring for a 10-year-old child diagnosed with Duchenne Muscular Dystrophy (DMD). The child is experiencing difficulty with walking and frequent falls.
What is the most appropriate nursing intervention to promote mobility and prevent falls for this patient?
Advise the use of a wheelchair at all times to prevent falls.
Encourage regular physical therapy sessions focusing on strengthening exercises.
Increase calcium and vitamin D intake to improve muscle strength.
Limit physical activity to prevent muscle fatigue and protect from injury.
The Correct Answer is B
Choice A rationale
While wheelchairs offer mobility assistance, their continuous use can lead to muscle atrophy and further deconditioning in individuals with Duchenne Muscular Dystrophy. Promoting some level of independent movement, even with assistive devices, is crucial for maintaining existing muscle function and delaying disease progression. Over-reliance on a wheelchair might prematurely reduce weight-bearing activities vital for bone health and circulation.
Choice B rationale
Regular physical therapy, specifically focusing on strengthening exercises adapted for Duchenne Muscular Dystrophy, is paramount. This helps maintain existing muscle strength, slow the progression of muscle weakness, improve joint flexibility, and enhance overall functional mobility. Tailored exercises can also address compensatory movements and improve balance, thereby reducing the risk of falls and promoting ambulation for as long as possible.
Choice C rationale
While calcium and vitamin D are essential for bone health, their direct impact on improving muscle strength in the context of Duchenne Muscular Dystrophy is limited. DMD is a genetic disorder characterized by the absence of dystrophin, a protein vital for muscle fiber integrity. Supplementation may support bone density, but it does not address the underlying muscular dystrophy pathology or directly enhance muscle contractility.
Choice D rationale
Limiting physical activity excessively in Duchenne Muscular Dystrophy can lead to disuse atrophy, contractures, and a more rapid decline in mobility. A balanced approach is necessary, encouraging appropriate levels of activity to maintain muscle function without causing excessive fatigue or injury. Over-restriction can negatively impact both physical and psychological well-being, accelerating the progression of immobility.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
A weight gain of 25 to 35 pounds is the general recommendation for women who begin pregnancy with a normal body mass index (BMI) of 18.5 to 24.9. Since the client has a BMI of 26.5, she falls into the overweight category, and her recommended weight gain range is different to optimize maternal and fetal outcomes.
Choice B rationale
For pregnant individuals who are classified as overweight, defined by a BMI of 25.0 to 29.9, the recommended total weight gain during pregnancy is 15 to 25 pounds (approximately 6.8 to 11.3 kg). This guideline aims to minimize risks such as gestational diabetes, preeclampsia, and macrosomia while ensuring adequate fetal growth.
Choice C rationale
A weight gain of 11 to 20 pounds is the recommendation for pregnant individuals who are classified as obese, with a BMI of 30.0 or greater. This client's BMI of 26.5 places her in the overweight category, not obese, necessitating a different target range for gestational weight gain to promote healthy outcomes.
Choice D rationale
While a healthy diet is crucial during pregnancy, the exact amount of weight gained does matter for both maternal and fetal health outcomes. Excessive or insufficient weight gain can lead to various complications, including gestational diabetes, preeclampsia, preterm birth, and abnormal fetal growth, thus specific weight gain targets are important.
Correct Answer is D
Explanation
Choice A rationale
Performing fundal massage is indicated for a boggy or displaced fundus, which suggests uterine atony and a risk of hemorrhage. In this scenario, the fundus is described as firm and midline at the umbilicus, indicating appropriate uterine involution and contraction. Therefore, fundal massage is not necessary.
Choice B rationale
Increasing the rate of IV fluids is typically done to expand circulating blood volume in cases of hypovolemia or hemorrhage. Given the small amount of lochia rubra and a firm, midline fundus, there is no indication of excessive blood loss or hypovolemia that would warrant an increase in IV fluid rate.
Choice C rationale
Assisting the client to ambulate is generally encouraged in the postpartum period to promote circulation and prevent complications like deep vein thrombosis. However, in the context of assessing for potential concealed hemorrhage, ambulation is not the most immediate or appropriate action; the priority is to rule out hidden blood loss.
Choice D rationale
A small amount of lochia rubra with a firm, midline fundus is a normal finding. However, checking for blood under the client's buttock is crucial to rule out concealed hemorrhage, as blood can pool unnoticed beneath the client, masking significant blood loss despite a firm fundus. This ensures a comprehensive assessment of blood loss.
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