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Exam 3 (Peds) - Neuromuscular/Diabetes

Total questions: 100

Worksheet time: 53mins

Name
Class
Date
1.

Which of the following is NOT a neuromuscular diagnostic tool?

a)

nerve conduction velocity EMG

b)

muscle biopsy

c)

serum creatinine phosphokinase measurement

d)

laparoscopic endoscopy

2.

Fill in the blank: The most common type of cerebral palsy is _________.

a)

Spastic

b)

Ataxic

c)

Dyskinetic

d)

Hypotonic

3.

Which type of cerebral palsy is characterized by slow, wormlike movements of extremities, trunk, face, and tongue?

a)

Spastic

b)

Athetoid/diskinetic

c)

Ataxic

d)

Mixed/dystonic

4.

Which of the following is a symptom of ataxic cerebral palsy?

a)

Drooling speech problems

b)

Rapid repetitive movements

c)

Combination of spastic and athetosis

d)

Presents as hypotonia

5.

Fill in the blank: Mixed/dystonic cerebral palsy is a combination of ________ and ________.

a)

spastic and athetosis

b)

flaccid and ataxia

c)

rigid and tremor

d)

chorea and myoclonus

6.

Which type of cerebral palsy presents as hypotonia most often, and is considered the most common clinical type?

a)

Spastic

b)

Athetoid/diskinetic

c)

Ataxic

d)

Mixed/dystonic

7.

Fill in the blank: Diplegia affects ________ or ________.

a)

both arms or both legs

b)

the heart or lungs

c)

the eyes or ears

d)

the liver or kidneys

8.

In regards to cerebral palsy, what does Triplegia refer to?

a)

2 extremities affected

b)

3 extremities affected

c)

4 extremities affected

d)

1 extremity affected

9.

Which of the following is NOT a characteristic of Quadriparesis/Tetraparesis?

a)

A) Four extremities involved/severe disability

b)

B) Speech and swallowing difficulties

c)

C) Incomplete tongue protrusion

d)

D) Only lower limbs involved

10.

What is the definition of cerebral palsy (CP)?

a)

Progressive motor dysfunction due to brain damage

b)

Non-progressive motor dysfunction due to brain damage

c)

Non-progressive sensory dysfunction due to brain damage

d)

Progressive sensory dysfunction due to brain damage

11.

SATA: Which of the following is affected by CP?

a)

Cognition

b)

Posture

c)

Muscle tone

d)

Sensory perception

e)

Motion

12.

There is routine postnatal screening for cerebral palsy.

a)

True

b)

False

13.

SATA: Which of the following is a possible motor sign of CP?

a)

Floppy tone

b)

Stiff or rigid limbs

c)

Unable to sit without support at age 8 months

d)

Poor head control after age 3 months

e)

Arching back/pushing away

14.

A child unable to sit without support at age 8 months may have which condition?

a)

Cerebral Palsy

b)

Anencephaly

c)

Spina Bifida

d)

Tetanus

15.

SATA: What are common feeding difficulties in patients with cerebral palsy (CP)?

a)

Persistent tongue thrusting

b)

Excessive drooling

c)

Difficulty swallowing liquids , but not solids

d)

All of the above

e)

Frequent gagging or choking with feeds

16.

Fill in the blank: Strategies to decrease _______ deliveries can help reduce the risk of cerebral palsy (CP).

a)

premature

b)

cesarean

c)

term

d)

multiple

17.

Fill in the blank: Avoidance and prevention of prenatal _______ injuries (injuries where the fetal brain is deprived of oxygen for prolonged periods) is important in preventing CP.

a)

anoxic

b)

toxic

c)

mechanical

d)

chemical

e)

hypotonic

18.

Fill in the blank: Orthotic devices are used to support _______ and prevent contractures in CP management.

a)

alignment

b)

strength

c)

movement

d)

vision

19.

Which of the following is a mobility aid for CP patients?

a)

Standers

b)

Seating systems

c)

Wheelchairs

d)

All of the above

20.

What is the purpose of botulinum toxin in the treatment of CP?

a)

Localized spasticity management

b)

Systemic spasticity management

c)

Reduction of lower extremity ataxia

d)

None of the above

21.

Fill in the blank: Deep brain stimulation is used for severe _______ disorders in CP.

a)

movement

b)

alignment

c)

visual

d)

hearing

22.

What percentage of CP patients have normal IQs?

a)

10-20%

b)

30-40%

c)

50-60%

d)

80-90%

23.

Rigid, atonic, and quadriparetic CP patients have the highest incidence of ________ impairment.

a)

profound

b)

mild

c)

single-limb

d)

auditory

24.

Which of the following is a pharmacologic intervention to decrease CP spasticity?

a)

Botox

b)

Haldol

c)

Morphine

d)

Diphenhydramine

25.

Baclofen can be administered orally or via an implanted pump for ________ administration.

a)

intrathecal

b)

subcutaneous

c)

intravenous

d)

intradermal

26.

Which of the following is NOT a pharmacologic intervention to decrease CP spasticity?

a)

Baclofen

b)

Dantrolene sodium

c)

Diazepam

d)

Propofol

27.

Neural tube defects (NTDs) are the largest group of congenital anomalies with ________ inheritance.

a)

multifactorial

b)

autosomal dominant

c)

mitochondrial

d)

X-linked recessive

e)

autosomal recessive

28.

The incidence of neural tube defects is higher in ____.

a)

girls

b)

boys

29.

A decline in NTDs is attributed to the addition of ________ to the diet.

a)

folic acid

b)

vitamin C

c)

calcium

d)

iron

30.

Which neural tube defect is the most serious and incompatible with life?

a)

Spina bifida occulta

b)

Spina bifida cystica

c)

Anencephaly

d)

Hydrocephalus

31.

Spina bifida occulta is ________ visible externally.

a)

not

b)

always

c)

sometimes

d)

clearly

32.

Spina bifida cystica is visible with an external ________ protrusion.

a)

saclike

b)

bony

c)

muscular

d)

cartilaginous

33.

Fill in the blank: Neurologic deficit occurs in varying degrees with _________

a)

myelomeningocele

b)

hydrocephalus

c)

encephalocele

d)

spina bifida occulta

34.

Myelomeningocele most frequently occurs during which period of pregnancy?

a)

First trimester

b)

Second trimester

c)

Third trimester

d)

First month

e)

First two months

35.

What percentage of myelomeningocele cases occur in the lumbar area?

a)

75%

b)

30%

c)

50%

d)

90%

36.

Which anomaly is most frequently associated with myelomeningocele?

a)

Hydrocephalus

b)

Spina bifida occulta

c)

Scoliosis

d)

Clubfoot

37.

Which of the following is NOT an etiology of myelomeningocele?

a)

Genetic predisposition

b)

Maternal radiation

c)

Maternal viral infection

d)

Maternal substance abuse

e)

Maternal malnutrition

38.

Fill in the blank: An obvious physical defect readily apparent on inspection is a clinical manifestation of ___________.

a)

myelomeningocele

b)

spina bifida occulta

c)

meningitis

d)

pruritiis

39.

There is a high prevalence of latex allergy in patients exposed to latex products during surgery and/or numerous bladder catheterizations.

a)

True

b)

False

40.

Kugelberg-Welander Syndrome Type 3 is also known as ________.

a)

juvenile spinal muscular atrophy

b)

Duchenne muscular dystrophy

c)

amyotrophic lateral sclerosis

d)

Friedreich's ataxia

41.

Kugelberg-Welander Syndrome can have a possible onset all the way up until adulthood. However, what is the usual onset period for Kugelberg-Welander Syndrome Type 3?

a)

First year of life

b)

Second year of life

c)

Fifth year of life

d)

Third year of life

42.

Which muscles are weak in Kugelberg-Welander Syndrome Type 3?

a)

Foot and calf muscles

b)

Thigh and hip muscles

c)

Facial and neck muscles

d)

Hand and arm muscles

43.

All patients with Kugelberg-Welander Syndrome Type 3 will eventually learn to walk.

a)

True

b)

False

44.

What is the life expectancy for individuals with Kugelberg-Welander Syndrome Type 3?

a)

Shortened

b)

Normal

c)

Unknown

d)

Severely reduced

45.

SATA: Guillain-Barre Syndrome (GBS) is characterized by symmetrical paralysis that causes problems with which of the following?

a)

Respiration

b)

Talking

c)

Swallowing

d)

Vision

e)

Hearing

46.

In Guillain-Barre Syndrome, paralysis begins in the ______ extremities and ______ bilaterally.

a)

lower, ascends

b)

upper, descends

c)

distal, descends

d)

proximal, ascends

47.

Guillain-Barre Syndrome has some associations to swine flu immunizations.

a)

True

b)

False

48.

Guillain-Barre Syndrome is frequently preceded by a mild _____ or intestinal infection.

a)

respiratory

b)

cardiac

c)

hepatic

d)

renal

49.

Which of the following best describes the progression of Guillain-Barre Syndrome?

a)

Begins as weakness, progresses to ataxia, then bilateral paresthesia, and finally paralysis

b)

Begins as ataxia, progresses to weakness, then bilateral paresthesia, and finally paralysis

c)

Begins as weakness, progresses to ataxia, then bilateral paralysis, and finally paresthesia

d)

Begins as ataxia, progresses to weakness, then bilateral paralysis, and finally paresthesia

50.

What is the main cause of death in Guillain-Barre Syndrome?

a)

Heart failure

b)

Respiratory failure

c)

Kidney failure

d)

Liver failure

51.

Tetanus is also known as ________.

a)

lockjaw

b)

measles

c)

chickenpox

d)

mumps

52.

Which of the following is NOT a manifestation of tetanus?

a)

Irritability, tonic spasms

b)

Headache, difficulty swallowing, sore throat

c)

Lack of sweat, lethargy, loss of reflexes

d)

Facial spasms: fixed smile, elevated eyebrows

e)

Fever, chills, restlessness

53.

SATA: What are some treatments that the RN can administer to a child AFTER they have been exposed to and contracted tetanus?

a)

tetanus antitoxin

b)

tetanus immune globulin

c)

pancuronium

d)

antibiotics

e)

muscle relaxants

54.

Fill in the blank: Food poisoning resulting from ingestion of toxin produced by the anaerobic bacillus ________ causes botulism.

a)

Clostridium botulinum

b)

Escherichia coli

c)

Staphylococcus aureus

d)

Salmonella typhi

55.

SATA: What are the sources of botulism in infants?

a)

Honey

b)

Unpasteurized milk

c)

Raw eggs

d)

Contaminated water

e)

Corn syrup

56.

What is a common source of botulism in older children?

a)

Fresh fruits

b)

Improperly sterilized home-canned foods

c)

Pasteurized cheese

d)

Bottled honey

57.

SATA: Symptoms of botulism include:

a)

double or blurry vision

b)

slurred speech

c)

difficulty swallowing

d)

dry mouth

e)

muscle weakness

58.

Which of the following is NOT a symptom of botulism?

a)

Slurred speech

b)

Difficulty swallowing

c)

Dry mouth

d)

High fever

59.

Muscle weakness in botulism starts in the ________ and then ________ through the body.

a)

shoulders, descends

b)

legs, ascends

c)

hands, spreads

d)

feet, radiates

60.

CNS symptoms of botulism appear abruptly _____ hours after ingestion of Clostridium botulinum.

a)

12-36

b)

12-24

c)

24-48

d)

48-72

61.

Which of the following is a general sign of botulism?

a)

Weakness

b)

Dizziness

c)

Headache

d)

All of the above

62.

What is often the presenting symptom of botulism?

a)

Constipation

b)

Fever

c)

Blurry vision

d)

Muscle weakness

e)

Dysphagia

63.

Which medications are used to treat botulism?

a)

BabyBIG, trivalent equine antitoxin and bivalent antitoxin

b)

isoniazid and rifampin

c)

acyclovir and ribavirin

d)

None of the above

64.

Autonomic Dysreflexia is also known as spinal cord injury at ______ or higher.

a)

T6

b)

T12

c)

L1

d)

C7

65.

What are some causes of autonomic dysreflexia?

a)

Full bladder, UTI, fecal impaction

b)

Low blood sugar, dehydration, hyperventilation

c)

Asthma, allergic rhinitis, eczema

d)

Migraine, tension headache, sinusitis

66.

Which of the following is NOT a symptom of vasodilation ABOVE the level of injury?

a)

Severely increased BP

b)

Flushed face and headache

c)

Distended neck veins

d)

Pale, cool skin

67.

In autonomic dysreflexia, ______ occurs above the level of the injury, and ______ occurs below the level of the injury.

a)

hemodilution, hemostasis

b)

constipation, incontinence

c)

vasodilation, vasoconstriction

d)

hypotension, hypertension

68.

What is the largest group of muscular diseases in children?

a)

Muscular dystrophies

b)

Myasthenia gravis

c)

Cerebral palsies

d)

Congenital myopathies

69.

All muscular dystrophies have genetic origin with gradual degeneration of muscle fibers, progressive weakness, and wasting of skeletal muscles.

a)

True

b)

False

70.

What is the most severe and most common muscular dystrophy in childhood?

a)

Duchenne Muscular Dystrophy (DMD)

b)

Becker Muscular Dystrophy (BMD)

c)

Facioscapulohumeral Muscular Dystrophy (FSHD)

d)

Limb-Girdle Muscular Dystrophy (LGMD)

71.

Duchenne Muscular Dystrophy (DMD) is also known as ________.

a)

pseudohypertrophic muscular dystrophy

b)

myasthenia gravis

c)

Becker muscular dystrophy

d)

polymyositis

72.

Which of the following is NOT a characteristic of Duchenne Muscular Dystrophy (DMD)?

a)

Onset between 3-5 years

b)

Progressive muscle weakness, wasting, and contractures

c)

Calf muscles hypertrophy in most patients

d)

Y-linked inheritance pattern

73.

Fill in the blank: Duchenne Muscular Dystrophy (DMD) is suspected based on ________.

a)

clinical appearance

b)

blood pressure measurement

c)

hearing test

d)

vision screening

74.

Fill in the blank: Confirmation of DMD is done by EMG, muscle biopsy, and ________ measurement.

a)

serum enzyme

b)

blood pressure

c)

urine glucose

d)

CSF protein

75.

In a child with DMD, serum CPK and AST levels are high in the first 2 years of life, before onset of weakness. Levels ________ as muscle deterioration continues.

a)

diminish

b)

increase

c)

remain unchanged

d)

fluctuate

76.

SATA: Which of the following are clinical manifestations of DMD?

a)

Waddling gait

b)

Gower's sign

c)

Pelvic girdle instability

d)

Saclike protrusion

e)

Overflow incontinence

77.

Fill in the blank: In DMD, ________ is a common spinal abnormality.

a)

lordosis

b)

scoliosis

c)

kyphosis

d)

spina bifida

78.

Fill in the blank: DMD is characterized by enlarged muscles, especially ________ and upper arms.

a)

thighs

b)

calves

c)

shoulders

d)

chest

79.

Fill in the blank: Profound muscular ________ occurs in later stages of DMD.

a)

atrophy

b)

hypertrophy

c)

spasm

d)

regeneration

80.

Steroids are used to reduce inflammation in DMD. What is another type of drug therapy used for DMD?

a)

Gene therapy

b)

Mineralocorticoid replacement therapy

c)

Antiviral and antifungal therapy

d)

DMARD therapy

81.

Chorea is a symptom of diskinetic cerebral palsy and manifests as _____, involuntary movements that worsen with ____ stress.

a)

jerky, emotional

b)

wormlike, physical

c)

tonic-clonic, cardiac

d)

ataxic, psychological

82.

A child is born with anencephaly. What should the L&D RN do next?

a)

Prepare the child for immediate craniotomy

b)

Provide pediatric cardiopulmonary resuscitation

c)

Provide comfort care for the infant

d)

Prepare the child for immediate skull reconstructive surgery

83.

Which is more severe, and actually has a portion of the neural tube inside the saclike protrusion?

a)

meningocele

b)

myelomeningocele

c)

hydrocephaly

d)

spina bifida oculta

84.

SATA: Besides the saclike protrusion, what are some other clinical manifestations of myelomeningocele?

a)

overflow incontinence

b)

urine dribbling

c)

poor anal sphincter tone

d)

orthopedic deformities

e)

respiratory complications

85.

The most dangerous complication of botulism is progressive and life threatening _______ paralysis.

a)

respiratory

b)

cardiac

c)

gastrointestinal

d)

upper extremity

86.

SATA: What are some clinical manifestations of botulism in INFANTS?

a)

loss of head control

b)

feeding difficulty

c)

weak cry

d)

diminished gag reflex

e)

hypotonia

87.

The life expectancy for a child with DMD is _____ years.

a)

less than 40 years

b)

less than 10 years

c)

less than 20 years

d)

less than 5 years

88.

SATA: What are the hallmark "3 Ps" of diabetes?

a)

Polyuria

b)

Proteinuria

c)

Polydipsia

d)

Pruritis

e)

Polyphagia

89.

A child with diabetes has a(n) ______ risk of infection.

a)

increased

b)

decreased

90.

SATA: Select of the criteria for diabetic ketoacidosis.

a)

BG level over 200 mg/dL

b)

Blood pH lower than 7.3

c)

Blood pH higher than 7.6

d)

Serum bicarbonate level lower than 15 mEq/L

e)

Positive anion gap

91.

What are Kussmal's respirations?

a)

hyperventilation to eliminate excess CO2

b)

hypoventilation to eliminate excess CO2

c)

hyperventilation to acquire more CO2

d)

hypoventilation to acquire more CO2

92.

What is the FIRST thing the RN should prepare to do when treating a child presenting with DKA?

a)

check blood glucose

b)

administer insulin

c)

draw CBC and BMP

d)

begin fluid resuscitation

93.

The initial volume expansion treatment for children with DKA is _______ ml/kg of an isotonic solution (NS or LR) over the first hour.

a)

20-40

b)

10-20

c)

5-10

d)

40-80

94.

A continuous insulin drip for a pediatric DKA patient should be set to:

a)

10 U/kg/hr

b)

1 U/kg/hr

c)

0.1 U/kg/hr

d)

0.01 U/kg/hr

95.

A child is on an insulin drip for DKA. How much should their BG level drop per HOUR?

a)

50-100 mg/dL

b)

100-200 mg/dL

c)

5-10 mg/dL

d)

200-500 mg/dL

96.

A child is receiving treatment for DKA. What should the RN be MOST concerned about with this child?

a)

hypoglycemia

b)

hypokalemia

c)

cerebral edema

d)

pitting edema

e)

hyponatremia

97.

SATA: If a hypoglycemic child can drink and swallow, the Rule of 15 should be used to boost their BG. If a hypoglycemic child CANNOT swallow, what should the RN do?

a)

50% dextrose IVP based on age

b)

50% dextrose IVP based on weight

c)

1 mg glucagon IM

d)

1 mg glucagon SQ

e)

1 mg glucagon IVP

98.

A child with diabetes is presenting to the ED with signs of acute illness. How often should their urine be checked for the presence of ketones?

a)

every hour

b)

every 3 hours

c)

every 6 hours

d)

every 12 hours

99.

Insulin glargine (Lantus) peaks at 30-90 minutes after administration.

a)

True

b)

False

100.

A RN used the Rule of 15 to bring a child's blood sugar above 70 mg/dL. Now that this target level is reached, what should the RN do next?

a)

give child another simple carbohydrate

b)

give child a complex carbohydrate

c)

administer insulin as ordered

d)

administer 50% dextrose IVP as ordered

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