A nurse is collecting data from a child who has spina bifida occulta. Which of the following findings should the nurse expect?

Choice A rationale Hip dislocation is more commonly associated with overt forms of spina bifida, particularly meningocele or myelomeningocele, which involve neurological deficits causing muscle imbalances and subsequent joint deformities. Spina bifida occulta, characterized by a bony defect in the vertebral arch without protrusion of the spinal cord or meninges, typically does not involve the severe neurological or musculoskeletal deficits required to cause hip dislocation. Choice B rationale Hydrocephalus (excess cerebrospinal fluid in the brain ventricles) is a significant complication frequently seen in myelomeningocele due to the associated Chiari II malformation, which obstructs cerebrospinal fluid flow. In spina bifida occulta, the neural structures are generally intact and the spinal cord is not involved, so the complex pathophysiology leading to hydrocephalus is absent, and thus, it is not an expected finding. Choice C rationale A dimple in the sacral area (a localized skin abnormality over the defect) is a classic, though not always present, external sign of spina bifida occulta, often accompanied by a tuft of hair or a birthmark (e.g., hemangioma). This finding is a cutaneous marker indicating the underlying failure of the posterior vertebral arches to fuse completely, forming the bony defect. Choice D rationale Flaccid paralysis of the lower extremities is indicative of severe lower motor neuron damage, which occurs when the spinal cord or nerve roots are significantly involved, as in myelomeningocele. Spina bifida occulta is distinguished by its occult (hidden) nature, as the spinal cord and meninges are typically covered by skin and often remain structurally and neurologically intact, thus not causing paralysis.