Neuro-Pedi NURS 201
The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and flexes his neck, the nurse notes that he flexes his knees and hips. This is referred to as: 1) Brudzinski sign 2) Cushing triad 3) Kernig sign 4) Nuchal rigidity
1 Rationale: Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees.
A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely a/an: 1. Absence seizure 2. Akinetic seizure 3. Non-epileptic seizure 4. Simple spasm seizure
1. Rationale: Absence seizures occur frequently and last less than 30 seconds. The child experiences a brief loss of consciousness during which she may have a change in activity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming.
A preschooler has been having periods during which he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse's best response. 1. "Have the parents follow up with his pediatrician as this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life, as it could be attention-seeking behavior." 3. "Have the parents follow up with his pediatrician as this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him, and see if it continues."
1. Rationale: An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.
A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first? 1. Administer blow-by oxygen and call for additional help 2. Reassure the parents that seizures are common in children with meningitis 3. Call a code and ask the parents to leave the room 4. Assess the child's temperature and blood pressure
1. Rationale: The child experiencing a seizure usually requires more oxygen as the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help.
Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) placed? 1) Semi-Fowler in an infant seat 2) Flat in the crib 3) Trendelenburg 4) In the crib with the head elevated to 90 degrees.
2 Rationale: Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates.
The nurse is aware that cloudy CSF most likely indicates: 1) Viral meningitis 2) Bacterial meningitis 3) No infection, as CSF is usually cloudy 4) Sepsis
2 The CSF in bacterial meningitis is usually cloudy
The nurse is caring for a 3-year-old with an altered state of consciousness . The nurse determines that the child is oriented by asking the child to: 1) Name the president of the United States 2) Identify her parents and state her own name 3) State her full name and phone number 4) Identify the current month but to the date
2) Rationale: Asking the 3-year-old to identify her parents and state her name is a developmentally appropriate way to assess orientation
The parents of a child with altered consciousness ask if they can stay during the morning assessment. Select the nurse's best response: 1) "Your child is more likely to answer questions and cooperate with any procedures if you are not present." 2) "Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside." 3) "It is policy to ask parents to leave during the first assessment of the shift." 4) "Many children fear that their parents will be disappointed if they do not well with procedures, so we recommend that no parents be present at this time."
2) Rationale: Parent should be encouraged to stay with their children for mutual comfort
Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele. SATA 1) Skull x-rays 2) Daily head circumference measurements 3) MRI scan 4) VS q6h 5) Holding to breastfeed
2, 3 Rationale: Daily head circumference measurements are done to assess for hydrocephalus Diagnostic tests include MRI scan, CT scan, U/S, and myelography
Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. Maintain isolation precautions until 24 hours after receiving IV antibiotics 2. IV fluids at 1 1/2 times regular maintenance 3. Neurological checks every hour 4. Administer acetaminophen for temperature higher than 38 degrees C (100.4 degrees F)
2. Rationale: IV fluids at 1 1/2 times regular maintenance could cause fluid overload and lead to IICP
Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with a roommate who also has bacterial meningitis. 2. Semiprivate room with a roommate who has bacterial meningitis but has received IV antibiotics for more than 24 hours. 3. Private room that is dark and quiet with minimal stimulation. 4. Private room that is bright and colorful and has developmentally appropriate activities available.
3 Rationale: A quiet private room with minimal stimulation is ideal as the child with meningitis should be in a quiet environment to avoid cerebral irritation.
The nurse is caring for a child who has been in a motor vehicle accident (MVA). The child falls asleep unless her name is called or she is gently shaken. This state of consciousness is referred to as: 1) Coma 2) Delirium 3) Obtunded 4) Confusion
3) Obtunded Describes a state of consciousness in which the child has a limited response to the environment and can be aroused verbal or tactile stimulation
Which signs best indicate increased intracranial pressure (ICP) in an infant? SATA 1. Sunken anterior fontanel 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.
3, 5 Rationale: A high-pitched cry is often indicative of IICP in infants The infant may be sleeping more than usual due to IICP
To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? 1. Lasix 2. Insulin 3. Glucose 4. Morphine
3. Rationale: A common manifestation is hypoglycemia, which is treated with the administration of IV glucose
A child with Reye syndrome is described in the nurse's notes as follows: 1200-comatose with sluggish pupils; when stimulated, demonstrates decerebrate posturing. 1400-unchanged except that now demonstrates decorticate posturing when stimulated. The nurse concludes that the child's condition is: 1. Worsening and progressing to a more advanced stage of Reye syndrome. 2. Worsening, and the child may likely experience cardiac and respiratory failure. 3. Improving and progressing to a less advanced stage of Reye syndrome. 4. Improving as the child's posturing reflexes are similar.
3. Rationale: Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child's condition
The nurse knows further education is needed about Reye syndrome when a mother states 1. " I will have my children immunized against varicella and influenza." 2. "I will make sure not to give my child any products containing aspirin." 3. "I will give aspirin to my child to treat a headache." 4. "Children with Reye syndrome are admitted to the hospital."
3. Rationale: The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. A headache can be the first sign of a viral illness followed by other symptoms. It is best not to use aspirin or aspirin-containing products in children.
The nurse is caring for a 1-year-old who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted to the hospital. Select the nurse's best response. 1. "Your child will likely he sent home because encephalitis is usually caused by a virus and not bacteria." 2. "Your child will likely be admitted to the pediatric floor for IV antibiotics and observation." 3. "Your child will likely be admitted to the PICU for close monitoring and observation." 4. "Your child will likely be sent home because she is only 1 year old. We see fewer complications and a shorter disease process in the younger child."
3. Rationale: The young child with encephalitis should be admitted to a PICU where close observation and monitoring are available. The child should be observed for signs of IICP and for cardiac and respiratory compromise.
A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first: 1) Administration of IV antibiotic 2) Administration of maintenance IV fluids 3) Placement of a Foley catheter 4) Send the spinal fluid and blood samples to the lab for cultures
4 Rationale: Cultures of spinal fluid and blood should be obtained, followed by administration of IV antibiotics
A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. SATA 1) "Give her some acetaminophen, and see if her symptoms improve. If they do not improve, bring her to the pediatrician's office." 2) "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3) "You are probably worried that she is having a problem with her shunt. This is very unlikely as it has been working well for 9 years." 4) "You should immediately take her to the ER as these may be symptoms of shunt malfunction."
4 Rationale: These are symptoms of shunt malfunction and should be evaluated immediately
The mother of an unconscious child has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response. 1) "I think your daughter hears you, and she is attempting to reach out to you." 2) " Your child is responding to you; please continue trying to stimulate her." 3) "It appears that your child is having a seizure." 4) "Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."
4) Rationale: Posturing is a reflex that often indicates that the child is receiving too much stimulation