Chapter 38: Nursing Care of the Child with an Alteration in Intracranial Regulation/Neurologic Disorder

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they make what statement?

"He will need more surgeries to replace the shunt as he grows."

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. What would the nurse include in the child's discharge instructions?

"Wake him every 2 hours to check his movement and responses."

A 10-month-old infant is brought to the emergency department by the parents after they found the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone. When I came back, I found my infant." Which nursing action is priority?

Assess the client's respiratory rate

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply.

Complaints of stiff neck Photophobia Vomiting

Phenytoin IV has been prescribed by health care provider for a child who has experienced a seizure. Before administering the drug what should the nurse do?

Determine the IV fluid infusing is normal saline

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion?

Febrile seizures are benign in nature.

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which food selection would be most appropriate for his lunch?

Fried eggs, bacon, and iced tea

The nurse knows that children have larger heads in relation to the body and a higher center of gravity. When developing a teaching plan for parents, the nurse includes information about an increased risk for which problem?

Head trauma

As a result of seizure activity, a computed tomography (CT) scan was performed and showed that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, what would the nurse expect to implement actions to prevent?

Hemorrhagic stroke

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for what finding?

Indications of increased intracranial pressure

When providing care to a newborn infant who was born at 29 weeks' gestation, the nurse integrates knowledge of potential complications, being alert for signs and symptoms of what condition?

Intracranial hemorrhage

During class, a student states, "I didn't think children could have strokes. I thought this only occurred in older adults." When responding to the student, what would be most important for the instructor to integrate into the response?

Ischemic strokes are more common than hemorrhagic strokes.

A group of students are reviewing information about head injuries in children. The students demonstrate understanding of this information when they identify what as the most common type of skull fracture in children?

Linear

Hydrocephalus is suspected in a 4-month-old infant. Which would the nurse expect to assess?

Lower extremity spasticity

The physician has ordered rectal diazepam for a 2-year-old boy with status epilepticus. Which instruction is essential for the nurse to teach the parents?

Monitor their child's level of sedation.

A group of nursing students are reviewing information related to seizures that occur in infants and children. The students demonstrate a need for additional review when they identify which type as common in neonates?

Myoclonic

A child with a seizure disorder will be discharged home from the hospital on the drug levetiracetam. What discharge instruction is the most important for the nurse to provide the parent?

Notify the health care provider if child experiences poor coordination

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. What is the child's level of consciousness?

Obtunded

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner?

On her side with the head flexed forward and knees flexed to the abdomen

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands that after this treatment:

PaCO2 levels decrease, causing vasoconstriction.

A hospitalized child is scheduled for magnetic resonance imaging (MRI) with contrast. What nursing intervention(s) will the nurse complete to ensure safety during the examination? Select all that apply.

Place child in clothing with no metal Assess the IV site for patency Review any prescriptions for sedation

What finding would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure?

Projectile vomiting

A 4-year-old boy has a febrile seizure during a well-child visit. What action would be a priority?

Protecting the child from harm during the seizure

The nurse has developed a teaching plan for the family of a 2-year-old boy who holds his breath when he gets frustrated. What will be most important to include in this plan?

Stay close to prevent injury when he gets frustrated.

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: Streptococcus group B Haemophilus influenzae type B Streptococcus pneumoniae Neisseria meningitidis What would the nurse highlight as the most common cause of meningitis in newborns?

Streptococcus group B

A 16-year-old boy reports to the school nurse with headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis?

Sunlight is "too bright"

The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as:

Sunsetting

The nurse is caring for an 8-year-old boy who has chronic epilepsy. What would be most important to address when teaching the child and parents about living with this condition?

Support for maintaining self-esteem because of his altered lifestyle

A child is in the emergency department with a head injury obtained in a motor vehicle crash. The glascow coma scale assessment is rated at 10 (3 eye opening, 3 motor, 4 verbal). How should the nurse interpret these findings?

The child's eyes open to verbal stimuli, is confused and flexes with painful stimuli

During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve?

Trigeminal