NUR 366 chapters 37, 45, & 49
c
A child has been seizure-free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which intervention in the response? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A stepwise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.
c
A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is: a. "Epilepsy is easily treated." b. "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."
c
A current recommendation to prevent neural tube defects is the supplementation of: a. Vitamin A throughout pregnancy. b. Multivitamin preparations as soon as pregnancy is suspected. c. Folic acid for all women of childbearing age. d. Folic acid during the first and second trimesters of pregnancy.
b
A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of: a. Microcephaly. b. Down syndrome. c. Cerebral palsy. d. Fragile X syndrome.
d
A young child with hydrocephalus is admitted to the Peds unit following the placement of a ventriculoperitoneal shunt. Which of the following is a necessary nursing intervention? a. daily x-rays to evaluate the shunt b. measure head circumference daily c. palpate fontanels frequently d. keep child prone
a
An important nursing intervention when caring for a child who is experiencing a seizure is to: a. Describe and record the seizure activity observed. b. Restrain the child when seizure occurs to prevent bodily harm. c. Place a tongue blade between the teeth if they become clenched. d. Suction the child during a seizure to prevent aspiration.
a e f
An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care (Select all that apply)? a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.
b
Brian, 4 weeks old is returned to his room after a CT scan to evaluate a seizure episode. Upon examination you find a sleepy infant who is arousable with vigorous stimulation and has pale, dusky colored skin and mucous membranes. (T=35.8*, P=110, R=30, BP= 82/40, O2 sat= 89-90%, wt= 5kg). He received 500mg of chloral hydrate earlier plus an additional 200mg before leaving the CT. What is the best intervention at this time? a. monitor vital signs and cover the infant b. administer oxygen, place a radiant warmer over the infant, and notify the physician c. fill out a medication error report d. allow infant to sleep
a
Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include: a. Avoiding using any latex product. b. Using only nonallergenic latex products. c. Administering medication for long-term desensitization. d. Teaching the family about long-term management of asthma.
b
Mark, a 9-year-old with Down syndrome, is mainstreamed into a regular third-grade class for part of the school day. His mother asks the school nurse about programs such as Cub Scouts that he might join. The nurse's recommendation should be based on knowing that: a. Programs such as Cub Scouts are inappropriate for children who are cognitively impaired. b. Children with Down syndrome have the same need for socialization as other children. c. Children with Down syndrome socialize better with children who have similar disabilities. d. Parents of children with Down syndrome encourage programs such as scouting because they deny that their children have disabilities.
d
Since age 2, Jan Little has had epilepsy that is well controlled with medication. However, now that she has begun elementary school, her seizures have returned. On they way home Jan frequently has a seizure on the bus, however, on weekends and holidays she is seizure free. As the school nurse, you advise Jan's parents to: a. take her for medication reevaulation b. increase her antiepilectic medication c. drive her home from school d. ride with her on the school bus
a
Spastic cerebral palsy is characterized by: a. Hypertonicity and poor control of posture, balance, and coordinated motion. b. Athetosis and dystonic movements. c. Wide-based gait and poor performance of rapid, repetitive movements. d. Tremors and lack of active movement.
c
The child with Down syndrome should be evaluated for what characteristic before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfield's spots)
c
The initial clinical manifestation of generalized seizures is: a. Being confused. b. Feeling frightened. c. Losing consciousness. d. Seeing flashing lights.
a
The most common problem of children born with a myelomeningocele is: a. Neurogenic bladder. b. Intellectual impairment. c. Respiratory compromise. d. Cranioschisis.
a b c
The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant (Select all that apply)? a. Temperature instability b. Irritability c. Lethargy d. Bradycardia e. Hypertension
b
The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him: a. Prone and tube feed. b. Prone, turn head to side, and nipple feed. c. Supine in infant carrier and nipple feed. d. Supine, with defect supported with rolled blankets, and nipple feed.
b
The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac? a. Open to air b. Covered with a sterile, moist, nonadherent dressing c. Reinforcement of the original dressing if drainage noted d. A diaper secured over the dressing
a b d
The nurse is conducting discharge teaching with parents of a preschool child with myelomeningocele, repaired at birth, who is being discharged from the hospital after a urinary tract infection (UTI). Which should the nurse include in the discharge instructions related to management of the child's genitourinary function (Select all that apply)? a. Continue to perform the clean intermittent catheterizations (CIC) at home. b. Administer the oxybutynin chloride (Ditropan) as prescribed. c. Reduce fluid intake in the afternoon and evening hours. d. Monitor for signs of a recurrent UTI. e. Administer furosemide (Lasix) as prescribed.
d
The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect? a. Fissure in the spinal column that leaves the meninges and the spinal cord exposed b. Herniation of the brain and meninges through a defect in the skull c. Hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements d. Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves
d
The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on knowing that: a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.
d
The priority nursing diagnosis for a baby just born with a myelomeningocele is: a. alteration in nutrition related to NPO status b. alteration in neurological status related to neuromuscular defect c. body image disturbances related to congenital defect d. risk for infection related to exposed sac
b
The priority nursing intervention for a school aged child in status epilepticus is: a. educate the parents on the cause of status epilepticus b. maintain a patent airway c. protect the child from injury d. obtain a blood pressure
d
What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? a. "One of the parents carries a defective gene that causes myelomeningocele." b. "A deficiency in folic acid in the father is the most likely cause." c. "Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele." d. "There may be no definitive cause identified."
c
When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: a. Hypospadias. b. Pyloric stenosis. c. Congenital heart disease. d. Congenital hip dysplasia.
c
Which action is contraindicated when a child with Down syndrome is hospitalized? a. Determine the child's vocabulary for specific body functions. b. Assess the child's hearing and visual capabilities. c. Encourage parents to leave the child alone for extended periods of time. d. Have meals served at the child's usual mealtimes.
a b d
Which assessment findings indicate to the nurse a child has Down syndrome (select all that apply)? a. High-arched, narrow palate b. Protruding tongue c. Long, slender fingers d. Transverse palmar crease e. Hypertonic muscle tone
a
Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure
b
Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? a. Tremulous movements at rest and with activity b. Sudden jerking movement caused by stimuli c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements
a
Which problem is most often associated with myelomeningocele? a. Hydrocephalus b. Craniosynostosis c. Biliary atresia d. Esophageal atresia
c
Which type of seizure involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired
a
Which type of seizure may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial
