Chapter 38 and 39 PrepU Questions
"What happened just before the seizures?"
The emergency room nurse is taking a history of a 1-year-old child whose parent said that she had a "fit" at home. Which inquiry would be best to start with?
brain stem dysfunction
The nurse assesses a child and finds that the child's pupils are pinpoint. What does this finding indicate?
ensuring the parents know how to properly give antibiotics.
The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is:
"I will need to apply heat to the eye four times a day."
The nurse in the emergency department is caring for a child who has a simple contusion of the right eye following a motor vehicle accident. Upon discharge to home, which response by the parents requires further clarification?
"I always keep phenobarbital with me in case of a fever."
An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done?
being of Black race
The nurse is taking a health history for a 9-year-old girl. Which finding would alert the nurse to a possible risk factor specifically associated with visual impairment?
Astigmatism
The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is:
"Small increments in dosage lead to sharp increases in plasma drug levels."
The parents of a child with a history of seizures who has been taking phenytoin ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate?
Staphylococcus aureus
A group of students are reviewing the various causes of bacterial conjunctivitis in children. The students demonstrate understanding of this condition when they identify what as the most common cause?
Diazepam Lorazepam Fosphenytoin
A nurse is providing care to a child with status epilepticus. Which medications would the nurse identify as appropriate for administration? Select all that apply.
Place ice on the eye for 20 minutes/off the eye for 20 minutes for 24 hours.
A parent calls the nurse triage line to say the child accidentally got hit in the eye and the parent believes the child will have a black eye. Which instruction is important for the nurse to provide this parent?
sensorineural hearing loss
The nurse in the neonatal intensive care unit places earplugs in the premature infant's ears. What type of hearing loss is the nurse trying to prevent?
scleral hemorrhage.
The nurse is assessing a 13-year-old boy with an eye injury. The nurse determines that evaluating pupillary response to light and accommodation is not appropriate based on the suspicion of a:
The infant does not imitate facial expressions.
The nurse is assessing a 5-month-old infant. What would cause the nurse to be concerned about a possible visual impairment?
obtunded
The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's level of consciousness?
While assessing the child's pupils, there is no change in diameter in response to a light.
The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)?
brain stem
The nurse is caring for an adolescent who suffered an injury during a diving accident. During assessment the client is demonstrating the posturing in the figure. The nurse is aware that this type of posturing is the result of injury to what area?
learning to use facial expressions
The nurse is teaching the parents of a visually impaired infant about development for their child. What education would the nurse add to the standard education on development milestones?
Initiate droplet isolation. Identify close contacts of the child who will require post-exposure prophylactic medication. Administer antibiotics as ordered. Initiate seizure precautions.
The young child has been diagnosed with bacterial meningitis. Which nursing interventions are appropriate? Select all that apply.
"I need to watch for any new bruises or bleeding and let my health care provider know about it."
The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching?
"Even if the flashlight bothers him, we will check his eyes."
The nurse is reinforcing teaching with the caregivers of a child who has had a head injury and is being discharged. Which statement made by the caregiver indicates an accurate understanding of the follow-up care for this child?
Only the right eye is involved. The drainage is yellow and thick.
The pediatric office nurse notes that several of the young children that are waiting to see the physician may have conjunctivitis. Which findings are consistent with bacterial conjunctivitis? Select all that apply.
Children will not have 20/20 vision until they are school age. Infants experience blurry vision due to the immaturity of their eye structures. Your baby can see about 8 to 10 inches
The mother of a 4-week-old infant is discussing her baby's vision with the nurse. What information should be included? Select all that apply.
Children will not have 20/20 vision until they are school age. Infants experience blurry vision due to the immaturity of their eye structures. Your baby can see about 8 to 10 inches.
The mother of a 4-week-old infant is discussing her baby's vision with the nurse. What information should be included? Select all that apply.
placing the infant in an infant car seat after feeding the infant
The nurse is caring for an infant with increased intracranial pressure. The mother is preparing to feed the child. What action by the mother indicates an understanding of the proper care of this infant?
"Use this information to teach family and friends."
The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope?
Understanding the side effects of medications
The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures?
"I am excited to see if our child starts talking more after the tubes are placed." "We live on a lake and often swim with our child. We will be sure to use earplugs when swimming." "Our surgeon may require the use of earplugs when bathing our child."
The nurse is preparing a toddler for surgery for insertion of pressure-equalizing (PE) tubes. The nurse is ensuring the parents understand the procedure. Which comments by the parents demonstrate to the nurse that they understand the procedure? Select all that apply.
"I hate to think that I will need to be worried about my child having seizures for the rest of his life."
The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education?
verbal response eye opening motor response
The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply.
2 months of age
The nurse recognizes that if the infant is following normal development, the infant will be able to focus and follow an object with the eyes by what age?
Decrease environmental stimulation
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan?
use of anticonvulsant medications
The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client?
Infantile glaucoma
A 1-year-old comes to the clinic for a routine visit. The eye examination reveals an enlarged, edematous, and hazy cornea. The child appears sensitive to light. What should the nurse suspect?
Infants have horizontally placed Eustachian tubes.
A 1-year-old female has been diagnosed with her fourth ear infection since birth. The nurse understands that children are more susceptible to ear infections than adults because of which anatomical difference?
"The surgery was successful. Do you have any questions?"
A 1-year-old infant has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents?
Use a soft toothbrush.
A 12-year-old child has been prescribed phenytoin. What information should be included in discussion about this medication?
moving the infant's head every 2 hours
The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?
steroid.
Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):
Absence of the red reflex
During physical assessment of a 2-year-old child, the nurse becomes concerned that the child may have a cataract in one eye. Which sign or symptom suggests the child has a cataract?
The child shouldn't participate in activities that could be hazardous if a seizure occurs
During the trial period to determine the efficacy of an anticonvulsant drug, which caution should be explained to the parents?
"A child's vision is not completely developed by this age. Your child might outgrow this nearsightedness."
The nurse is talking with the mother of a 4-year-old boy who will soon be going to a pre-kindergarten program. The child has had the Snellen vision test done at home, and he was unable to distinguish the pictures at the distance that would indicate his vision is normal. The child's mother asks the nurse if he will need glasses. Which statement made by the nurse would be mostappropriate regarding the child's vision?
Administer intravenous antibiotics as prescribed.
A 6-year-old child with hydrocephalus had a ventriculoperitoneal (VP) shunt placed 6 weeks ago and now has experienced a seizure, vomiting, and loss of appetite. Which intervention will target the child's priority need?
"Did you use any medications, like aspirin, for the fever?"
A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question?
Most of these conditions will spontaneously resolve.
A 4-month-old infant is seen at the ambulatory care clinic and diagnosed with nasolacrimal duct obstruction. The mother asks what can be done. What information should be included in the information provided to the parent?
Institute droplet precautions in addition to standard precautions.
A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially?
Battle sign.
A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as:
improvement of the child's language and speech development
The nurse is caring for a child who has had persistent otitis media effusions and is scheduled to have pressure equalizing tubes placed in 3 days. What should the parents observe after the tubes have been placed?
Place a cap or similar covering on the newborn's head.
A nurse is caring for a newborn with anencephaly. Which intervention will the nurse use?
The child had shaking movements on one side of the body.
The nurse is caring for a child admitted with focal onset motor seizures (simple partial motor seizures). Which clinical manifestation would likely have been noted in the child with this diagnosis?
Assess the client's respiratory status.
The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority?
Reddened conjunctiva
The nurse is assessing a child with an eye problem. Which symptom, if present, would rule out a hordeolum?
Interference with hearing Interference with vision
A nursing student is doing a clinical rotation on a pediatric floor and is learning about normal growth and development. What can impact normal growth and development? Select all that apply.
Amblyopia
The nurse is screening a 4-year-old girl for vision problems. What problem could result in loss of vision?
hypertension
The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP?
Remove any blankets or heavy clothing and replace with a thin sheet
The nurse is caring for a preschooler who has developed a high fever and has just had a seizure. What is the best action by the nurse?
"Hearing loss after the tubes are placed may be permanent."
The nurse is caring for a toddler who is scheduled to have myringotomy tubes placed. Which statement by the child's parents indicates a lack of understanding?
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure?
The child is in status epilepticus.
The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be:
Oriented to person, place, and time Disorientation Obtundation Stupor Coma
A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression.
semi-Fowler position with a parent at the bedside
A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure?
shouting
A nurse is preparing a presentation for a group of parents who have children with significant visual impairment. Which action would the nurse be least likely to include as an example of a self-stimulatory action?
serum glucose level
A child is brought to the emergency department after experiencing a series of continuous seizures. The nurse is reviewing the orders for care and treatment. Which order would be of the highest priority?
importance of patching as prescribed.
The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the:
prevention and treatment of otitis media
The nurse is educating the parents of a 6-year-old child about preventing hearing loss. Which topic will be included in the discussion?
Positron emission tomography (PET)
A 10-year-old boy has been experiencing complex partial seizures and has not responded well to medication. Surgery is planned to remove brain tissue at the seizure foci. Which diagnostic test would be the most accurate in identifying the seizure foci?
Use analgesics as prescribed.
A 16-year-old child has experienced a small corneal abrasion. What will be included in the plan of treatment?
Using a hair dryer on cool to dry the ears.
A 10-year-old client has just been treated for external otitis (acute otitis externa or swimmer's ear) and now the nurse is teaching the boy and his parents about prevention. Which recommendation should the nurse include?
oxygen gauge and tubing suction at bedside padding for side rails
A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply.
Decorticate posturing and fixed and dilated pupils
The nurse is assigned an infant with a possible neurological disorder. Which assessment finding would the nurse communicate to the health care provider as a late sign of increased intracranial pressure?
administering antibiotics as soon as they're available
The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement?
video electroencephalogram
The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain?
"He was just staring into space and was totally unaware."
The nurse is collecting data from the caregivers of a child admitted with seizures. Which statement indicates the child most likely had an absence seizure?
corneal light reflex test
The nurse is explaining information to the parents of a 3-year-old boy who may have strabismus. The nurse should explain that which examinations will be performed first to find out if he has strabismus?
Gather appropriate equipment and signage for respiratory isolation precautions.
The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse?
Notify the emergency department health care provider of the information the parents reported.
A child was just brought into the emergency department after falling off a skateboard. The parents report that their child lost consciousness briefly and they noticed watery drainage coming from the nose. What action should the nurse take first?
"It's an overgrowth of retinal blood vessels."
The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided?
"I can't imagine how difficult this must be. When you're ready I would be happy to arrange a meeting with a support group of other parents with children who have hearing loss."
The parents of a toddler have just learned that their child has profound hearing loss. The parents are very upset and state to the nurse, "It just isn't fair. We did everything right during our pregnancy all the way to this point." How should the nurse respond?
"I am afraid that our 10-year-old will start having febrile seizures." "It is so scary to think that our child will likely develop epilepsy now."
The nurse is caring for a 3-year-old child who experienced a febrile seizure for the first time. What statements by the parents of the child should the nurse address further? Select all that apply.
"A brief hearing loss after the infection is an abnormal development."
The nurse is providing teaching to the parent of a 4-year-old child being treated for otitis media. When discussing the condition, the parent indicates an understanding of the information provided when making which statement?
It is a common neurologic emergency in children.
What is a true statement regarding status epilepticus?
Instill a few drops of a topical anesthetic into the affected eye
An 8-year-old boy comes to the emergency room with an eye injury after having a glass bottle shatter near his face. Which intervention should the nurse do first while assisting this client?
their child should maintain an active lifestyle.
An 8-year-old child is diagnosed as having tonic-clonic seizures. The nurse would want to teach the parents that:
A preoperative injection of atropine
An infant is born with congenital glaucoma. The infant is scheduled for surgery to relieve this condition at age 2 days. Which prescription should the nurse question for the infant?
"Have you checked your child's temperature?"
The nurse is collecting data on an 18-month-old child admitted with a diagnosis of possible seizures. When interviewing the caregivers, which questions would be most important for the nurse to ask?
Recently helped clean the basement
The nurse is taking a health history for a 9-year-old child with conjunctivitis. Which finding would suggest that this is allergic conjunctivitis?
"We should use ice intermittently for the first 24 hours." "When we apply ice to the eye, it should only be for about 20 minutes at a time." "It will likely take about 3 weeks or so for all of that bruising to go away."
A school-age child was admitted to the emergency department following a simple contusion to the eye from playing baseball. The nurse has given discharge instructions to the parents. Which comment(s) by the parents indicate they understood the discharge teaching? Select all that apply.
The child will have to adhere to good tooth brushing
A school-aged child with seizures is prescribed phenytoin sodium, 75 mg four times per day. What instruction would the nurse give the parents regarding this medication?
how to administer the ear drops
A toddler is diagnosed with acute otitis media and prescribed antipyretics and numbing ear drops. Which instruction is most important to teach the parents about treatment?
"This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."
A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse?
Teach the child and his parents to keep a headache diary.
A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate?
"Our child can go back to school in 4 hours, after that thick yellow drainage is gone." "I will continue to use eye drops until the redness is gone."
A child has been diagnosed with bacterial conjunctivitis. Which statement(s) by the child's parent indicates the need for further education? Select all that apply.
enterovirus.
A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother based on the understanding that this disorder is most likely caused by
"You look funny. Well, both of you do. I see two of you."
A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement?
"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."
A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse?
"Increase your child's intake of whole milk and orange juice."
A child with a seizure disorder has been prescribed phenytoin to control the seizures. While providing teaching about the medication, what dietary instructions should the nurse provide the parent?
arteriovenous malformations (AVMs)
A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke?
hydrocephalus
After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify which condition as a neural tube defect?
"Have someone in the home with your infant for the next 24 hours." "Return to the emergency department if your infant vomits more than 2 times." "Return to the emergency department if you notice your infant's pupils are different sizes."
An infant is brought to the emergency department after falling off the parents' bed and hitting the head. The infant is diagnosed with a concussion and is safe to return home. Which instruction(s) does the nurse provide the parents for home care of this infant? Select all that apply.
Collection of cerebrospinal fluid (CSF) and blood for culture
Antibiotic therapy to treat meningitis should be instituted immediately after which event?
Risk for injury related to seizure activity
In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be most important to include in this child's plan of care?
Lack of depth perception (stereopsis)
In examining the vision of a 9-year-old girl, the nurse notices that she frequently reaches either too far or not far enough when attempting to take an object from the nurse's hand. Which condition does the nurse suspect?
Apply hot, moist compresses to the affected area.
The 12-year-old child has developed a stye. Which may be included in the child's care?
"Now I know why when she is working on puzzles she says her eye is sleepy."
The caregiver of a 2-year-old child tells the nurse, "They told me my daughter has an eye disorder called hyperopia." Which statement made by the mother indicates she has an understanding of this child's current condition?
a child wearing a helmet while ice skating an infant in a car seat a child wearing a helmet, knee pads, and elbow pads while riding a skateboard
The community health nurse is preparing a presentation on safety measures to prevent injuries in children. Which example of proper safety guidelines should the nurse include? Select all that apply.
18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates 12-year-old child with asthma 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti 9-year-old child who was diagnosed with diabetes when he was 7 years old
The meningococcal vaccine should be offered to high-risk populations. If never vaccinated, who has an increased risk of becoming infected with meningococcal meningitis? Select all that apply.
spinal cord development in the fetus brain development in the fetus
The nurse is completing a nursing history on a female client who has just found out she is 6 weeks' pregnant. She reports that over the last 2 months she has been drinking excessive amounts of alcohol every weekend and smokes a half-pack of cigarettes per day. What is the nurse concerned with given this information? Select all that apply.
The eustachian tube in the infant is straighter and wider than in the adult.
The nurse is discussing the ears and hearing in a child with a group of peers. Which statement is most accurate related to this topic?
"I will make sure my child goes to bed early the night before the exam."
The nurse is educating a child and his family about what to expect during the child's electroencephalogram (EEG) exam. Which statement by a parent suggests a need for further education?
This may signal a connective tissue disorder.
The nurse is performing an assessment on a child who is 6 months of age. When assessing the eyes, the nurse notes the presence of a bluish tinge to the sclerae. What can the nurse infer about this finding?
Delayed growth and development Impaired verbal communication Risk for injury
The nurse is preparing a care plan for the school-age child with a congenital hearing loss of 60 to 80 dB. Which nursing diagnoses should the nurse include on the care plan for this child? Select all that apply.
"Watch for changes in his behavior or eating patterns."
The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?
Tell me your concerns about your child's shunt.
The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?
ensuring the protective eye patch is securely in place
The nurse is providing immediate postoperative care for a 3-month-old who had a cataract removed. Which intervention would be the priority?
The nurse positions the child on the side during a seizure. The nurse stays with the child and calls for help when a seizure begins. The nurse pads the crib or side rails before a seizure. The nurse teaches the caregivers regarding seizure precautions.
When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply.
Ensuring that the child's environment is familiar and secure Encouraging activities to stimulate development Using touch and tone of voice to demonstrate affection
When developing the plan of care for a child with a visual impairment, what would the nurse include? Select all that apply.
"I will cradle her in my arms after the procedure for at least 30 minutes."
While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education?
Request order for an antiemetic. Assess intake and output every shift. Request order for anticonvulsant.
An 11-year-old child was recently diagnosed with chickenpox. His parents gave him aspirin for a fever and the child is now hospitalized. Which nursing interventions are appropriate for this child? Select all that apply.
Encourage the parents to apply ice to the area for 20 minutes at a time for the first 24 hours.
A child is being prepared for discharge after sustaining a simple contusion of the eye. Which advice would the nurse expect to include in the discharge instructions?
IX
The mother of an infant reports that her child is frequently choking when breastfeeding or taking a bottle. The nurse plans on assessing which cranial nerve when addressing the mother's concerns?
Initiate an IV of 0.9% NS to run at 250 ml/hr.
The nurse is caring for a child who has suffered a head injury and has had an ICP monitor placed. Which prescription by the health care provider would the nurse question?
Administer lorazepam IV as prescribed.
The nurse is caring for a school-age child who has been having a continuous seizure for the last 40 minutes. What is the priority action by the nurse?
