PEDS Neurological Conditions
11. Misty is a 5 year old who has lost her vision one year ago in a motor vehicle accident as a passenger when the airbag deployed. She is being admitted for more reconstructive cosmetic surgery. Which of the following should the nurse do when obtaining her assessment: a. Explain to Misty everything that she will be doing including what body parts she will be touching and how it will feel. b. Enter the room and call Misty's name in a loud manner c. Gently touch Misty's arm so that Misty knows the nurse is near d. Give Misty details about what to expect during her hospital stay including how she will feel after the surgery
A
17. The nurse is working in the ED, when an ambulance arrives with a 10 yr old child who is having a generalized seizure. The EMT tells the nurse that Bobbi has been having a seizure for 35 mins. They were unable to establish an IV line Which of the following should the nurse do first? a. Administer rectal Diastat b. Ask for assistance to hold Bobbi's arm still and attempt to place IV so that anti-epileptics can be given emergently. c. Gather and prepare intubation equipment d. Observe and record Bobbi's seizure
A
18. The nurse is caring for a 6 month old infant with increased intracranial pressure. When reviewing the chart, the nurse would have likely found which of the following: a. Irritability b. Vomiting without complaints of nausea c. Blurred vision d. Headache
A
19. The nurse is caring for 2 year old Raymond with altered consciousness and increased intracranial pressure. When the nurse checks on Raymond's vital signs, she finds that his vital signs have changed immediately calls the physician. Which of the following can indicate a medical emergency in the child with increased intracranial pressure? a. Increased BP, decreased pulse, and decreased RR b. Decreased BP, decreased pulse, and decreased RR c. Increased BP, decreased pulse, and increased RR d. Decreased BP, increased pulse, and decreased RR
A
2. A neonate born within the past 24 hours with myelomeningocele is schedule for corrective surgery. Postoperatively, what is the most important nursing goal? a. Preventing infection b. Ensuring adequate hydration c. Providing adequate nutrition d. Preventing contracture deformity
A
20. Gracie has been diagnosed with hydrocephalus. When the nurse reviews the chart, she learns that the cause of Gracie's hydrocephalus is due to an abnormality in the absorption of the cerebral spinal fluid in the arachnoid space. This type of hydrocephalus is also called: a. Communicating hydrocephalus b. Non-communicating hydrocephalus c. Arnold Chiari malformation d. Hydrocephalus insipidus
A
23. Brandie is a 7 year old admitted to the pediatric intensive care unit with a VP shunt infection. She has surgery to externalize her shunt. The nurse would expect her drainage bag to keep aligned with which of the following a. Her ear b. Her eyebrow c. Her jaw d. Her axilla
A
24. The nurse is caring for Jessie, a 4 year old being evaluated for meningitis. While assisting with the lumbar puncture (LP), the physician comments that Jessie most likely has meningitis. Which of the following signs are often seen in the cerebral spinal fluid (CFS) obtained for the LP in a child with meningitis. a. Increased pressure when the CSF sample is obtained b. CSF that is clear and foul smelling c. CSF that contains a decreased protein count d. CSF that contains an increased glucose count
A
26. Tyler is a 10 year old admitted with a head injury. The radiologist's report of the CT scan states that the bleeding is located between the dura mater and the skull. The nurse knows that this type of head injury is called a: a. Epidural bleed b. Subdural hematoma c. Intraventricular hemorrhage d. Skull fracture
A
30. The nurse is caring for 6 year old Ben diagnosed with Reye syndrome. The nurse would expect Ben's plan of care to include all of the following except: a. Promote hydration through maintenance and bolus IV fluids b. Monitor liver function test results c. Prepare for a CT scan d. Provide education to Ben's parents regarding the avoidance of aspirin in children under 16 years of age.
A
32. The clinic nurse is caring for a teenager who has been taking Phenobarbital for a few years. The nurse recognized this medication as a barbiturate and expects the vital signs to be affected in which of the following ways? a. Decreased RR, heart rate, BP, and body temperature b. Decreased RR and heart rate, increased BP, and body temperature c. Decreased RR, heart rate, BP, and no effect on body temperature d. Increased RR and heart rate, and decreased BP and body temperature
A
33. Sam is a 6 year old male with new onset seizures. He is being place on Phenobarbital and the nurse is providing education to Sam and his parents. The nurse includes all of the following gin her teaching plan except: a. Sam should avoid sunlight as much as possible b. Phenobarbital may cause Sam to act more hyper c. Sam may develop a decreased attention span d. Sam may complain of joint pain.
A
37. The nurse would expect which of the following as an early symptom seen in a toddler with lead intoxication a. Hyperactivity b. Mental retardation c. Diarrhea and dehydration d. Dyspnea
A
39. The first symptom seen in a toddler lead intoxication might be: a. Poor coordination b. Mental retardation c. Diarrhea and hydration d. Dyspnea
A
31. The nurse is teaching a health maintenance class to a group of parents when someone asks about lead poisoning. The nurse knows that regarding lead poisoning which of the following is true: a. Lead poisoning is defined as the presence of blood lead levels greater than 18 micrograms/dL (greater than 10) b. Lead is only excreted through the bile c. Constipation can be a sign of lead poisoning d. Lead screening should begin at the age of 3
C
21. Levi is a 4 week old infant who has been diagnosed with hydrocephalus. While reviewing his history and assessing the infant, the nurse would expect to find all of the following except: a. Head circumference greater than 95th percentile b. A dull cry when stimulated c. Sunset sign d. Large bulging fontanel
B
25. The nurse receives a call from the admitting nurse in the ED. Toby, a 6 year old with bacterial meningitis is being admitted to the pediatric floor. In order to care for Toby, which of the following types of precautions will be necessary? a. Gloves and gown only b. Gloves, gown and mask (Droplet precaution) c. Gloves and mask only d. Mask and gown only
B
27. The nurse is caring for Luke, an 11 year old with a head injury. He opens his eyes to painful stimulation, grunts in response to questions, and withdraws his hand in response to the pain. Which of the following would best represent his Glasgow Coma Scale score? a. 6 b. 8 (2, 2, 4) c. 10 d. 12
B
38. Lead poisoning is suspected in 21 month old Hannah. What might be the source of her lead ingestion? a. She lives near a paint factory b. She teethed on her 35 year old crib c. Her home has asbestos ceiling in poor repair d. She ingested a crayon at age 19 months
B
5. What is the most important nursing intervention immediately following post-operative placement of a ventriculoperitoneal shunt? a. Place the child in reverse Trendelenburg position b. Place the child on his non-operative side c. Keep the child in a sitting position to assist drainage d. Pump the shunt intermittently for 8 hours
B
7. The nurse is testing the reflexes of 6 week old Timothy. She records in the chart that he has a positive fencing reflex. Which of the following describes the fencing reflex? a. When the cheek is stoked, the infant will turn his head toward the stimuli and begin to suck. b. When the infant is lying on his back w/ his head turned to one side, the infant will flex the opposite arm & leg & extend the arm & leg on the side the infant is facing c. When the infant is held upright with his feet touching a hard surface he will move his legs and feet as if walking d. The infant will react to loud noises or sudden movement by extending his arms and legs and then retracting them
B
8. Brian, an eighteen month old toddler is being evaluated in the developmental clinic. When the sole of the foot is stroked upward from the heel to the ball of the foot. Brian's toes hyperextend. Brain's father asks what this means. Which of the following is the nurse's best response? a. Brian seems very ticklish, it's not something to worry about. b. Brian has a positive Babinski reflex which is expected at this age group c. Brian has a reflex that usually disappears at a younger age. We'll need to evaluate him a little more to see how he's developing d. Brian has a strong reflex in his foot tell me more about his birth.
B
35. You are the nurse performing discharge teaching for 8 year old Sarah who has epilepsy and her parents. You know that an important component of your discharge teaching are the side effects of Dilantin (phenytoin) including: a. Respiratory acidosis b. Tachycardia c. Gum hyperplasia d. Hearing loss
C
40. The most detrimental long-term effects of lead intoxication are caused by: a. Myocardial ischemia b. Hepatic necrosis c. Neurotoxicity d. Renal calculi
C
1. An infant undergoes surgery to repair a myelomeningocele. To detect increased intracranial pressure (ICP) as early as possible, the nurse should stay alert for which post-operative finding? a. Decreased urine output b. Increased heart rate c. Bulging fontanel d. Sunken eyeballs
C
10. Alex, a 4 year old has been diagnosed with amblyopia in the left eye. His parents are very concerned and ask what will be don't to treat his condition. Select the nurse's best response. a. Alex's eye condition will be treated with prescription glasses, we should encourage him to help select the glasses he likes the most. b. Alex will most likely outgrow this condition, we will evaluate him again before he starts school c. Alex will need to wear a patch on his right eye. d. Alex will need to wear a patch on his left eye.
C
12. Allie is a 9 year old who has been complaining of itching and burning both eyelids. The nurse notes that her eyes are red with yellow discharge. Allie is diagnosed with bacterial conjunctivitis to both eyes. Which of the following should be included in Allie's plan of care? a. Keep Allie away from other children until there is no longer discharge b. Apply prescription eye antibiotic from outer to inner canthus c. Encourage Allie to wear sunglasses when outside d. Keep Allie away from other children for at least 48 hours
C
29. The nurse is caring for 8 year old Jacob who has been admitted with diagnosis of Reye syndrome. When obtaining his history, Jacob's mom stated that she gave him aspirin while he was sick. The nurse inquires as to what type of illness Jacob had and expects Jacob's mom to reply with which of the following a. Strep throat b. Pink eye c. Influenza d. Rocky Mountain Spotted fever
C
6. The nurse should watch David void prior to surgery to repair her myelomeningocele in order to determine whether: a. Fluid has been adequate to meet the metabolic needs b. Restricted mobility has produced urinary stasis c. Nervous control of the bladder has been impaired d. There is concurrent hypospadias
C
15. Sallie is a 10 year old with epilepsy. She has been taking Dilantin for several years. Sallie complains to the nurse that she wishes that she didn't have to take the dumb medicine because of the side effects. Which of the following side effects would Sallie most likely complain of? a. Alopecia b. Halitosis c. Difficulty falling asleep d. Hirsutism
D
16. The nurse is teaching a class to a group of parents when one father asks for information about febrile seizures. The nurse should include all of the following except: a. There tends to be a family pattern to febrile seizures b. Once a child has a febrile seizure, there is an increased risk for that child to have an additional seizure c. Febrile seizures tend to occur as the temperature is rapidly rising d. Febrile seizures are more common in children under the age of 8. (under age of 5)
D
13. The nurse is caring for a child with cerebral palsy (CP). Which of the following statements is correct? a. CP is a progressive disorder characterized by abnormal coordination and muscle tone. b. The majority of children with CP have some degree of intellectual disability c. CP is always caused by trauma that occurs at birth d. Children with CP often have speech, vision, or hearing difficulties (non-progressive disorder)
D
14. The nurse is caring for 2 year old Cameron when his mom calls out, "someone come quick, something's wrong with my baby" When the nurse enters the room, she sees that Cameron is lying in her crib having a generalized seizure. Which of the following should the nurse do? a. Administer Cameron's scheduled dose of oral Dilantin b. Turn Cameron on his side and suction his mouth c. Ensure that the crib rolls are up and go get additional help d. Observe the seizure and call for help if necessary!
D
22. Brock is a 12 year old who has a ventriculoperitoneal shunt (VP shunt). After playing basketball, Brock complains of a headache and photophobia. He goes to his room to lie down. His mother calls the nurse and asks her what to do. Which of the following is the nurse's best response? a. Give Brock Tylenol and see if he feels better in a few hours b. Give Brock Aspirin and see if he feels better in a few hours c. Brock was probably over stimulated, see if he feels better when he wakes up. d. You need to bring Brock to the ED to be evaluated.
D
28. The nurse is caring for Jason, a 3 year old who was injured in a motor vehicle accident. He is being observed on the pediatric unit with a diagnosis of a closed head injury. Which of the following should be included in Jason's plan of care? a. Assess ear and nose drainage for low glucose counts b. Monitor vital signs every shift c. Assess level of consciousness every 4 hours while awake (every 2 hours) d. Promote bed rest and limit unnecessary movements
D
3. Following the repair of myelomeningocele, the nurse watches for symptoms of hydrocephalus. What symptoms indicate increased intracranial pressure? a. Sunset sign, increased pulse, lethargy b. High shrill cry, decreased pulse, positive Ortolani sign c. Vomiting, increased pulse, bulging fontanels d. Bulging fontanels, decreased pulse, irritability (sunset sign is a late sign)
D
34. Abigail is a 3 year old who has had 4 febrile seizures in the past few months. The use of Phenobarbital has been discussed. Which of the following represents the most effective way to use Phenobarbital in managing febrile seizures a. Administer an oral dose of Phenobarbital as soon as Abigail seizures b. Administer an oral dose of Phenobarbital as soon as Abigail develops a fever c. Administer an oral dose of Phenobarbital as soon as Abigail has a seizure d. Administer a prophylactic daily dose of Phenobarbital
D
36. Twenty-one month old Luke is being treated with a lead chelating agent. The following would be the most appropriate information to include in your patient-family education regarding its mechanism of action a. Alters the acid-base balance in the GI system b. Alters the neurological damage done by the lead c. Combines with hemoglobin in the liver d. Aids in eliminating the lead
D
4. David is born with a myelomeningocele in his lumbar area. What pre-operative nursing care should you provide? a. Position him in a supine position b. Apply lotion and gently massage the meningocele c. Exercise his legs and arms to prevent atrophy of the muscles d. Place him in a prone position with a light sterile dressing on the meningocele
D
41. You are caring for a 22 month old recently diagnosed with lead poisoning. His blood lead level is 70. Which of the following would you expect for his course of treatment? a. Administer oral lead chelation and follow up for serum blood levels through his primary care provider b. Administer both oral and intramuscular injectable lead chelation therapy and follow up for serum blood lead levels through his primary care provider c. If asymptomatic, treat as an outpatient with oral and intramuscular lead chelation. d. Hospitalize immediately for inpatient lead chelation therapy.
D
9. The mother of an infant tells the nurse that her baby used to hold onto her finger whenever she touched her hand and that she stopped doing this a few weeks ago. Based on this information, the nurse knows that the baby is most likely how old? a. 4 weeks b. 8 weeks c. 3 months d. 4 months
D