pediatric success neurological disorders chapter 5

8. The nurse is working in the PICU caring for an infant who has just returned from having a ventriculoperitoneal shunt placed. Which position initially will be most beneficial for this child? 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. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates.

15. The nurse is providing education concerning Reye syndrome to a mothers' group. She knows that further education is needed 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 when my child is ill." 3. "Because I do not give my child aspirin, my child will probably never get Reye syndrome, but if that happens, it will be a very mild case." 4. "Children with Reye syndrome are admitted to the hospital."

2. The administration of aspirin or products containing aspirin have been associated with the development of Reye syndrome.

45. The nurse is caring for several children. She knows that which of the following children is at increased risk for CP? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with sepsis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.

2. Any infection of the central nervous system increases the infant's risk of CP.

2. The nurse is caring for a 3-year-old female 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 not the date.

2. Asking the 3-year-old to identify her parents and state her name is a devel opmentally appropriate way to assess orientation.

54. The nurse is caring for a 4-month-old infant who was diagnosed with a neuroblastoma. The nurse knows that this particular child's prognosis is: 1. Excellent, as a neuroblastoma is always cured. 2. Excellent, as infants with a neuroblastoma have the best prognosis. 3. Poor, as infants with a neuroblastoma rarely survive. 4. Variable, depending on where the site of origin is.

2. Infants younger than 1 year have the best prognosis.

13. The nurse is caring for a child who has just been admitted to the pediatric floor with a diagnosis of bacterial meningitis. When reviewing the child's plan of care, which of the following orders would the nurse question? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fluids at 11/2 times regular maintenance. 3. Neurological checks every 4 hours. 4. Administer acetaminophen for temperatures higher than 38°C (100.4°F).

2. Intravenous fluids at 11/2 times regular maintenance could cause fluid overload and lead to increased ICP.

23. The nurse is providing discharge teaching to the parents of a toddler who has experienced a febrile seizure. The nurse knows that clarification is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child's 7-year-old brother is also at high risk for a febrile seizure." 3. "I'll give my child acetaminophen when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2. Most children over the age of 5 years do not have febrile seizures.

29. The emergency room nurse is caring for an unconscious 6-year-old girl who has had a severe closed-head injury and notes the following changes in her vital signs. Her heart rate has dropped from 120 to 55, her blood pressure has increased from 110/44 to 195/62, and her respirations are becoming more irregular. After calling the physi cian, which of the following should the nurse expect to do? 1. Call for additional help, and prepare to administer mannitol. 2. Continue to monitor the patient's vital signs, and prepare to administer a bolus of isotonic fluids. 3. Call for additional help, and prepare to administer an antihypertensive. 4. Continue to monitor the patient, and administer supplemental oxygen.

29. 1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respira tions. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP.

31. The nurse is caring for a 6-year-old female with a skull fracture who is unconscious and has severely increased ICP. The nurse notes the child's temperature to be 104°F (40°C). Which of the following should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer Tylenol via nasogastric tube. 3. Administer Tylenol rectally. 4. Place ice packs in the child's axillary areas.

31. 1. A cooling blanket will help cool the child quickly and at a controlled temperature.

33. A 2-month-old infant is brought to the emergency room after experiencing a seizure. The nurse notes that the infant appears lethargic with very irregular respirations and periods of apnea. The parents report that the child is no longer interested in feeding and that, prior to the seizure, the infant rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography scan of the head and dilation of the eyes. 2. Computed tomography scan of the head and EEG. 3. Close monitoring of vital signs. 4. X-rays of all long bones.

33. 1. A computed tomography scan of the head will reveal trauma. Dilating the eyes is performed to check for retinal hemorrhages that are seen in an infant who has experienced SBS.

11. The nurse is caring for a 6-month-old infant diagnosed with meningitis. When she places the infant in the supine position and flexes his neck, she notes that the infant flexes his knees and hips. The nurse knows that this is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

11. 1. Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees.

18. The nurse is caring for a child with meningitis. The parents call for the nurse as "something is wrong." When the nurse arrives, she notes that the child is having a generalized tonic-clonic seizure. Which of the following 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.

18. 1. 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 air way, 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.

35. An infant is born with a sac protruding through the spine. The sac contains CSF, a portion of the meninges, and nerve roots. The nurse knows that this is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly.

2. A myelomeningocele is a sac that con tains a portion of the meninges, the CSF, and the nerve roots.

60. The nurse is working in the emergency room caring for a 10-year-old who was in an MVA. The child is currently on a backboard with a cervical collar in place. The child is diagnosed with a cervical fracture. Which of the following would the nurse expect to find in the child's plan of care? 1. Remove the cervical collar, keep the backboard in place, and administer high dose methlyprednisolone. 2. Continue with all forms of spinal stabilization, and administer high-dose methylprednisolone and ranitidine. 3. Remove the backboard and cervical collar, and prepare for halo traction placement. 4. Remove the cervical collar and backboard, place the child on spinal precautions, and administer high-dose methylprednisolone and ranitidine.

2. All forms of spinal stabilization should be continued while methylprednisolone and Zantac are administered.

37. The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response: 1. "We measure all babies' heads to ensure that their growth is on track." 2. "Babies with myelomeningocele are at risk for hydrocephalus, which can show up with an increase in head circumference." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up with an increase in head circumference." 4. "Many infants with myelomeningocele have microcephaly, which can show up with a decrease in head circumference."

2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an in crease in head circumference.

24. The nurse is caring for a 5-year-old female recently diagnosed with epilepsy. She is being evaluated for anticonvulsant medication therapy. The nurse knows that the child will likely be placed on which kind of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensure compliance.

2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels.

3. The nurse is preparing to assess a 6-year-old male with altered consciousness in the PICU. His parents ask if they can stay during his 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 our 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 do well with procedures, so we recommend that no parents be present at this time."

2. Parents should be encouraged to remain with their child for mutual comfort.

22. The nurse is working in the emergency room when an ambulance arrives with a 9-year-old male who has been having a generalized seizure for 35 minutes. The paramedics have provided blow-by oxygen and monitored vital signs. The patient does not have intravenous access yet. Which of the following medications should the nurse anticipate administering first? 1. Establish an intravenous line, and administer intravenous lorazepam. 2. Administer rectal diazepam. 3. Administer an oral glucose gel to the side of the child's mouth. 4. Place a nasogastric tube, and administer oral diazepam.

2. Rectal diazepam is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.

9. A child is being evaluated in the emergency room for a possible diagnosis of meningitis. The nurse is assisting with the lumbar puncture and notes that the CSF is cloudy. The nurse is aware that cloudy CSF most likely means: 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.

58. A 5-year-old female has been diagnosed with a midline brain tumor. In addition to showing signs of increased ICP, she has been voiding large amounts of very dilute urine. Which of the following medications does the nurse expect to administer? 1. Mannitol. 2. Vasopressin. 3. Lasix. 4. Dopamine.

2. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Vasopressin is a hormone that is used to help the body retain water.

26. An 8-year-old child is attending a Cub Scout camp picnic. He has a history of epilepsy and has had generalized seizures since the age of 3. The child falls to the ground and has a generalized seizure. Which of the following is the best action for the nurse to take during the child's seizure? 1. Administer the child's rescue dose of oral valium. 2. Loosen the child's clothing, and call for help. 3. Place an oral tongue blade in the child's mouth to prevent aspiration. 4. Carry the child to the infirmary to call 911 and start an intravenous line.

2. The nurse should remain with the child and observe the seizure. The child should be protected from his environ ment, and clothing should be loosened.

38. The most common complication associated with myelomeningocele is: 1. Learning disability. 2. Urinary tract infection. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown.

2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neuro genic bladder that leads to incomplete emptying of the bladder and subse quent urinary tract infections. Fre quent catheterization also increases the risk of urinary tract infection.

17. The nurse is caring for a child with Reye syndrome stage III. The child is comatose with sluggish pupils. The child is currently maintaining his own respirations, and all vital signs are within normal range. In order to treat a common manifestation, what medication would the nurse expect to have readily available? 1. Lasix. 2. Insulin. 3. Glucose. 4. Morphine.

3. A common manifestation is hypo glycemia, which is treated with the ad ministration of intravenous glucose.

5. The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. Which of the following signs best indicates increased ICP in this child? 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite.

3. A high-pitched cry is often indicative of increased ICP in infants.

28. The emergency room nurse is caring for a 5-year-old child who fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which of the following statements is a priority for the nurse at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"

3. Asking specific questions will give the nurse the information needed to deter mine the level of care for the child.

49. The nurse is giving morning medications to a 4-year-old female who has just had a surgical procedure to release her hamstrings. The child has a history of CP. When the nurse prepares to administer baclofen, the child's parents ask what the medication is for. Select the nurse's best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

3. Baclofen is given to help control the spasms associated with CP.

1. The nurse is caring for a child who has been in an MVA. The child continues to fall asleep unless her name is called or she is gently shaken. The nurse knows that this state of consciousness is referred to as: 1. Coma. 2. Delirium. 3. Obtunded. 4. Confusion.

3. Obtunded describes a state of conscious ness in which the child has a limited re sponse to the environment and can be aroused by verbal or tactile stimulation.

30. The nurse is caring for a 2-year-old male in the PICU with a head injury. The child is comatose and unresponsive at this time. The parents ask if he needs pain medication. Select the nurse's best response. 1. "Pain medication is not necessary as he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." 3. "Pain medication is necessary to promote comfort." 4. "Although pain medication is necessary for comfort, we use it cautiously as it increases the demand for oxygen."

3. Pain medication promotes comfort and ultimately decreases ICP.

43. A 6-month-old male has been diagnosed with positional brachycephaly. The nurse is providing teaching about the use of a helmet for his therapy. Which of the following statements indicate that his parents understand the education? 1. "We will keep the helmet on him when he is awake and remove it only for bathing and sleeping." 2. "He will start wearing the helmet when he is closer to 12 months, as he will be more upright and mobile." 3. "He will wear the helmet 23 hours every day." 4. "Most children need to wear the helmet for 6 to 12 months."

3. The helmet is worn 23 hours every day and removed only for bathing.

32. The nurse is caring for a 16-year-old female who remains unconscious 24 hours after sustaining a closed-head injury in an MVA. She responds to deep painful stimulation with decorticate posturing. The child has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the child's peers to visit and talk to the child about school and other pertinent events. 2. Encourage the child's parents to hold her hand and speak loudly to her in an attempt to help her regain consciousness. 3. Attempt to keep a normal day/night pattern by keeping the child in a bright lively environment during the day and dark quiet environment at night. 4. Attempt to keep the environment dark and quiet, and encourage minimal stimulation.

4. A dark, quiet environment and minimal stimulation will decrease oxygen con sumption and ICP.

40. The parents of a 12-month-old female with a neurogenic bladder ask the nurse if their child will always have to be catheterized. Select the nurse's best response. 1. "Your child will never feel when her bladder is full, so she will always have to be catheterized. Because she is female, she will always need assistance." 2. "As your child ages, she will likely be able to sense when her bladder is full and will be able to empty it on her own." 3. "Although your child will not be able to feel when her bladder is full, she can learn to urinate every 4 to 6 hours and therefore not require catheterizations." 4. "Your child will never be able to completely empty her bladder spontaneously, but there are other options to traditional catheterization. An opening can be made surgically through the abdomen, thus allowing the parents and child to be able to place a catheter into the opening."

4. A vesicostomy is an example of an op tion for children with myelomeningo celes where alternatives to traditional catheterizations are created.

10. The nurse is caring for a child who is being admitted with a diagnosis of meningitis. The child's plan of care includes the following: administration of intravenous antibi otics, administration of maintenance intravenous fluids, placement of a Foley catheter, and obtaining cultures of spinal fluid and blood. Select the procedure the nurse should do first. 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fluids. 3. Placement of a Foley catheter. 4. Send the spinal fluid and blood cultures to the laboratory.

4. Cultures of spinal fluid and blood should be obtained, followed by admin istration of intravenous antibiotics.

27. The nurse is caring for a child who has sustained a closed-head injury. The nurse knows that brain damage can be caused by which of the following factors? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4. Decreased perfusion of the brain and increased metabolic needs of the brain.

6. The nurse is preparing to give preoperative teaching to the parents of an infant with hydrocephalus. The nurse knows that the most common treatment for hydrocephalus includes the surgical placement of a shunt connecting which of the following? 1. The ventricle of the brain to the peritoneum. 2. The ventricle of the brain to the right atrium of the heart. 3. The ventricle of the brain to the lower esophagus. 4. The ventricle of the brain to the small intestine.

6. 1. The ventriculoperitoneal is the most common shunt used to treat hydrocephalus.

4. The nurse is caring for a 9-year-old female who is unconscious in the PICU. The child's mother 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. Posturing is a reflex that often indicates that the child is receiving too much stimulation.

7. The nurse receives a phone call from the parents of a 9-year-old female who is com plaining of a headache and blurry vision. The child has been healthy but has a history of hydrocephalus and received a ventriculoperitoneal shunt at the age of 1 month. The parents also state that she is not acting like herself, is irritable, and sleeps more than she used to. They ask the nurse what they should do. Select the nurse's best response. 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 bring her to the emergency room as these may be symptoms of a shunt malfunction."

4. These are symptoms of a shunt malfunc tion and should be evaluated immediately.

51. The parents of a 12-month-old with CP ask the nurse if they should teach their child sign language because he has not begun any vocalization yet. The nurse bases her response on which of the following? 1. Sign language may be a very beneficial way to help children with CP communicate. 2. Sign language may cause confusion and further delay verbalization. 3. Most children with CP will have great difficulty learning sign language. 4. Sign language may be beneficial, but it would be best to wait until the child is closer to the preschool age.

51. 1. Sign language may help the child with CP communicate and ultimately de crease frustration. Children with CP may have difficulty verbalizing because of weak tongue and jaw muscles. They may be able to have sufficient motor skills to communicate with their hands.

52. The parents of a 2-year-old with CP are learning how to feed their child and avoid aspiration. When reviewing the teaching plan, the nurse should question which of the following? 1. Place the food on the tip of the tongue, as the child will be less likely to choke. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

52. 1. The food should be placed far back in the mouth to avoid tongue thrust.

55. The nurse is caring for a 6-year-old female with a neuroblastoma. The girl has metastasis to the bone marrow and has been diagnosed with pancytopenia. Which of the following should be included in her care? 1. Administration of red blood cells. 2. Limit school attendance to less than 4 hours daily. 3. Administration of Coumadin. 4. Encourage a diet high in fresh fruits and vegetables.

55. 1. Red blood cells will be needed to increase the red blood cell count.

19. A 5-year-old female has been diagnosed with a seizure disorder. Her teacher noticed that she has been having episodes where she drops her pencil and simply appears to be daydreaming. This is most likely called: 1. An absence seizure. 2. An akinetic seizure. 3. A non-epileptic seizure. 4. A simple spasm seizure.

19. 1. Absence seizures occur frequently and last less than 30 seconds. The child ex periences a brief loss of consciousness where she may have a change in activ ity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming.

50. A 3-year-old male with CP has just been fitted for braces and is beginning physical therapy to assist with ambulation. His parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse's best response: 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child ages and grows, the CP can manifest in different ways, and different muscle groups can need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

2. CP can be manifested in different ways as the child grows. It does not progress,

34. The nurse knows that young infants are at risk for injury from SBS because: 1. Anterior fontanel is open. 2. Insufficient musculoskeletal support and a disproportionate head-to-body ratio. 3. Immature vascular system with veins and arteries that are more superficial. 4. Immature myelination of the nervous system.

2. Insufficient musculoskeletal support and a disproportionate head places the infant at risk because the head cannot be supported during a shaking episode.

46. The nurse is working in the pediatric developmental clinic. Which of the children requires continued follow-up because of behaviors suspicious of CP? 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

2. The clinical characteristic of hemiple gia can be manifested by the early pref erence of one hand. This may be an early sign of CP.

25. The nurse is providing discharge instructions to the parents of a 13-year-old girl who has been diagnosed with epilepsy. Her parents ask if there are any activities that she should avoid. Select the nurse's best response. 1. "She should avoid swimming, even with a friend." 2. "She should avoid being in a car at night." 3. "She should avoid any strenuous activities." 4. "She should not return to school right away as her peers will likely cause her to feel inadequate."

2. The rhythmic reflection of other car lights can trigger a seizure in some children.

42. A 6-month-old infant male has just been diagnosed with craniosynostosis. He is being evaluated for reconstructive surgery. The infant's father asks the nurse for more information about the surgery. Select the nurse's best response. 1. "The surgery is done for cosmetic reasons and is without many complications." 2. "The surgery is important to allow the brain to grow properly. Although most children do well, serious complications can occur, so your child will be closely observed in the intensive care unit." 3. "The surgery is important to allow the brain to grow properly. Most surgeons wait until the child is 3 years old to minimize potential complications." 4. "The surgery is mainly done for cosmetic reasons, and most surgeons wait until the child is 3 years old as the head has finished growing at that time."

2. The surgery is done to reconstruct the skull to allow the brain to grow prop erly. Because there are potential com plications associated with this surgery, such as increased ICP, the child is usually closely observed in the PICU.

21. The nurse is discussing a ketogenic diet with a family. The nurse knows that this diet is sometimes used with children who have had little success with anticonvulsant med ication. The diet that produces anticonvulsant effects from ketosis consists of: 1. High fat and low carbohydrates. 2. High fat and high carbohydrates. 3. Low fat and low carbohydrates. 4. Low fat and high carbohydrates.

21. 1. High fat and low carbohydrates are the components of the ketogenic diet.

59. The nurse is caring for a 30-month-old female receiving radiation therapy for a brain tumor. The parents ask if their child will likely have any learning disabilities in the future. Select the nurse's best answer. 1. "All children who receive radiation have some amount of learning disability. As long as they receive extra tutoring, they usually do well in school." 2. "Because your daughter is so young, she will likely do well and have no problems in the future." 3. "Response varies with each child, but younger children who receive radiation tend to have some amount of learning disability later in life." 4. "Response varies with each child, but younger children who receive radiation tend to have fewer problems later in life than older children."

3. Although variable, younger children tend to experience more learning difficulties than older children.

48. The nurse is caring for a 2-month-old male infant who is at risk for CP due to extreme low birth weight and prematurity. There is a multidisciplinary team caring for him. His parents ask why there is a speech therapist involved in his care. Select the nurse's best response. 1. "Your child is likely to have speech problems because of his early birth. Involving the speech therapist at this point will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "It is the hospital routine to involve as many members of the health-care team in your child's care so that we will know if he has any unmet needs."

3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements.

47. The nurse is caring for a 13-month-old with meningitis. The child has experienced increased ICP and multiple seizures. The child's parents ask if the child is likely to develop CP. Select the nurse's best response. 1. "When your daughter is stable, she'll undergo computed tomography and magnetic resolution imaging. The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications of meningitis develop some amount of CP."

3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made.

56. The nurse is caring for a 3-year-old with neuroblastoma. The child's parents ask the nurse what the typical signs and symptoms are at first. Select the nurse's best answer. 1. "Most children complain of abdominal fullness and difficulty urinating." 2. "Many children in the early stages of a neuroblastoma have joint pain and walk with a limp." 3. "The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue." 4. "The signs and symptoms are fairly consistent regardless of the location of the tumor. They include fatigue, hunger, weight gain, and abdominal fullness."

3. The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue.

14. The nurse is caring for a 1-year-old female who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted. Select the nurse's best response. 1. "Your child will likely be 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 intravenous 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 tend to see fewer complications and a shorter disease process in the younger child."

3. The young child with encephalitis should be admitted to a PICU where close observation and monitoring are available. The child should be ob served for signs of increased ICP and for cardiac and respiratory compromise.

36. The nurse is caring for a neonate who has just been diagnosed with a meningocele. The parents ask what to expect. Which of the following is the nurse's best response? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

36. 1. Because a meningocele does not con tain any nerve endings, most children experience no neurological problems after surgical correction.

53. The nurse is caring for a 5-year-old male with CP. His weight is in the fifth percentile, and he has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube put in. Which of the following would be the nurse's best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4. An open-ended question will encour age family members to share what they know and potentially clear any misconceptions.

44. The nurse is caring for a child with CP. The nurse knows that since the 1960s the incidence of CP has: 1. Increased. 2. Decreased. 3. Remained the same. 4. Has decreased due to early misdiagnosis.

44. 1. The incidence of CP has increased partly due to the increased survival of extreme low-birth-weight and premature infants.

20. The school nurse is called to the preschool classroom to evaluate a child. He has been noted to have periods where 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."

20. 1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.

12. A toddler is being admitted to the hospital with a diagnosis of bacterial meningitis. Select the best room assignment for the patient. 1. A semiprivate room with a roommate who also has bacterial meningitis. 2. A semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. A private room that is dark and quiet with minimal stimulation. 4. A private room that is bright and colorful and has developmentally appropriate activities available.

3. A quiet private room with minimal stimulation is ideal as the child with meningitis should be in a quiet envi ronment to avoid cerebral irritation.

41. The nurse is caring for a 9-year-old with myelomeningocele who has just had surgery to release a tight ligament to the lower extremity. Which of the following does the nurse include in the child's postoperative plan of care? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.

3. Preventing skin breakdown is important in the child with myelomeningocele, as pressure points are not felt easily.

16. The nurse is caring for a child with Reye syndrome in the PICU. At noon, the nurse notes that the child is comatose with sluggish pupils. When stimulated, the child demonstrates decerebrate posturing. At 2 p.m., the nurse notes that the child remains unchanged except that the child now demonstrates decorticate posturing when stimulated. The nurse concludes that: 1. The child's condition is worsening and progressing to a more advanced stage of Reye syndrome. 2. The child's condition is worsening, and the child may likely experience cardiac and respiratory failure. 3. The child's condition is improving and progressing to a less advanced stage of Reye syndrome. 4. The child's condition remains unchanged as posturing reflexes are similar.

3. Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child's condition.

39. The nurse is caring for a newborn infant who has just been diagnosed with a myelomeningocele. Which of the following is included in the child's plan of care? 1. Place the child in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the child in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the child in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

4. The child is placed in the prone posi tion to avoid any pressure on the de fect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fluids are begun after the surgery.

57. The nurse is working in the pediatric cancer center caring for a group of children with brain tumors. Which of the following children would have likely experienced a delay in diagnosis? 1. A 3-month-old, as signs and symptoms would not have been readily apparent. 2. A 5-month-old, as signs and symptoms would not have been readily suspected. 3. A school-age child, as signs and symptoms could have been misinterpreted. 4. An adolescent, as signs and symptoms could have been ignored and denied.

57. 1. In infants, signs and symptoms may not be readily apparent as the open fontanel allows for expansion.

61. Which of the following has the potential to alter a child's level of consciousness? Select all that apply. 1. Metabolic disorders. 2. Trauma. 3. Hypoxic episode. 4. Dehydration. 5. Endocrine disorders.

61. 1, 2, 3, 4, 5. 1. Many metabolic disorders are associ ated with hypoglycemia. The hypo glycemic child experiences a decreased level of consciousness as the brain does not have stores of glucose. 2. Trauma can lead to generalized brain swelling with resultant increased ICP. 3. Hypoxemia leads to a decreased level of consciousness as the brain is intoler ant to the lack of oxygen. 4. Dehydration can lead to inadequate perfusion to the brain, which can result in a decreased level of consciousness. 5. Endocrine disorders often result in a decreased level of consciousness as they can lead to hypoglycemia, which is poorly tolerated by the brain.