practice questions ch 27&28- cerebral & endocrine dysfunction

.A child has been admitted with status epilepticus. An emergency medication has been ordered. What medication should the nurse expect to be prescribed? 1. Lorazepam (Ativan) 2. Phenytoin (Dilantin) 3. Topiramate (Topamax) 4. Ethosuximide (Zarontin)

1

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. What is the most appropriate initial action by the school nurse? 1. Stay with child and have someone else call emergency medical services (EMS). 2. Notify the parent and regular practitioner. 3. Notify the parent that the child should go home. 4. Stay with the child, offering calm reassurance.

1

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program? 1. Essential information is presented initially. 2. Teaching should take place in the childs semiprivate room. 3. Education is focused toward the parents because the child is too young. 4. All information needed for self-management of diabetes is taught at once.

1

A child develops syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a complication to meningitis. What action should be verified before implementing? 1. Forcing fluids 2. Daily weights with strict input and output (I and O) 3. Strict monitoring of urine volume and specific gravity 4. Close observation for signs of increasing cerebral edema

1

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? 1. At bedtime 2. After meals 3. Before meals 4. After arising in morning

1

A lumbar puncture (LP) is being done on an infant with suspected meningitis. The nurse expects which results for the cerebrospinal fluid that can confirm the diagnosis of meningitis? 1. WBCs; glucose 2. RBCs; normal WBCs 3. glucose; normal RBCs 4. Normal RBCs; normal glucose

1

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when? 1. Lunch and dinner 2. Breakfast and lunch 3. 0830 to his midmorning snack 4. Bedtime and breakfast the next morning

1

An injury to which part of the brain will cause a coma? 1. brainstem 2. cerebrum 3. cerebellum 4. occipital lobe

1

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? 1. food intake 2. risk of hyperglycemia 3. risk of insulin reaction

1

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test? 1. Hypotension 2. Tachycardia 3. Hypoglycemia 4. Nausea and vomiting

1

The nurse is caring for a 10-year-old child who has an acute head injury, has a pediatric Glasgow Coma Scale score of 9, and is unconscious. What intervention should the nurse include in the childs care plan? 1. Elevate the head of the bed 15 to 30 degrees with the head maintained in midline. 2. Maintain an active, stimulating environment. 3. Perform chest percussion and suctioning every 1 to 2 hours. 4. Perform active range of motion and nontherapeutic touch every 8 hours.

1

The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. How should the nurse interpret these findings? 1. neurologic health 2. severe brain damage 3. decorticae posturing 4. decerebrate posturing

1

The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included? 1. Encourage the child to wear medical identification. 2. Discuss with the child and family ways to limit fluid intake. 3. Teach the child and family how to do required urine testing. 4. Reassure the child and family that this is usually not a chronic or life-threatening illness.

1

The nurse is planning care for a school-age child with bacterial meningitis. What intervention should be included? 1. Keep environmental stimuli to a minimum. 2. Have the child move her head from side to side at least every 2 hours. 3. Avoid giving pain medications that could dull sensorium. 4. Measure head circumference to assess developing complications.

1

The nurse is preparing a school-age child for computed tomography (CT) scan to assess cerebral function. The nurse should include what statement in preparing the child? 1. the scan will not hurt 2. pain meds will be given 3. you will be able to move once equipment is in place 4. unfortunately no one is allowed in the room with you during the procedure

1

What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency? 1. Type 1 diabetes 2. Type 2 diabetes 3. Gestational diabetes 4. Maturity-onset diabetes of the young (MODY)

1

What is important to incorporate in the plan of care for a child who is experiencing a seizure? 1. Describe and record the seizure activity observed. 2. Suction the child during a seizure to prevent aspiration. 3. Place a tongue blade between the teeth if they become clenched. d. 4. Restrain the child when seizures occur to prevent bodily harm.

1

What type of seizure may be difficult to detect? 1. Absence 2. Generalized 3. Simple partial 4. Complex partial

1

The nurse is preparing a community outreach program for adolescents about the characteristic differences between type 1 and type 2 diabetes mellitus (DM). What concepts should the nurse include? (Select all that apply.) 1. Type 1 DM has an abrupt onset. 2. Type 1 DM is often controlled with oral glucose agents. 3. Type 1 DM occurs primarily in whites. 4. Type 2 DM always requires insulin therapy. 5. Type 2 DM frequently has a familial history. 6. Type 2 DM occurs in people who are overweight.

1, 3, 5, 6

A 2-year-old child starts to have a tonic-clonic seizure. The childs jaws are clamped. What is the most important nursing action at this time? 1. Place a padded tongue blade between the childs jaws. 2. Stay with the child and observe his respiratory status. 3. Prepare the suction equipment. 4. Restrain the child to prevent injury.

2

A child is on phenytoin (Dilantin). What should the nurse encourage? 1. Fluid restriction 2. good dental hygiene 3. A decrease in vitamin D intake 4. Taking the medication with milk

2

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed? 1. Carbohydrates in the diet need to be replaced with protein. 2. Additional snacks are needed to compensate for increased activity. 3. The child needs to decrease his activity level to minimize episodes of hypoglycemia. 4. Insulin dosage should be increased to compensate for a change in activity level.

2

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy will begin when? 1. After the diagnosis is confirmed 2. When the medication is received from the pharmacy 3. After the childs fluid and electrolyte balance is stabilized 4. As soon as the practitioner is notified of the culture results

2

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by which gland? 1. Thyroid gland 2. Adrenal cortex 3. Anterior pituitary 4. Parathyroid glands

2

Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition? 1. Hypopituitarism 2. Diabetes insipidus (DI) 3. Syndrome of inappropriate antidiuretic hormone (SIADH) 4. Acute adrenocortical insufficiency

2

The nurse is teaching the parent of a preschool child how to administer the childs insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught? 1. Draw the insulin in separate syringes. 2. Draw the regular insulin first and then the NPH into the same syringe. 3. Draw the NPH insulin first and then the regular into the same syringe. 4. Check blood sugar first, and if below 120, hold the regular insulin and give the NPH.

2

What statement best describes a subdural hematoma? 1. Bleeding occurs between the dura and the skull. 2. Bleeding occurs between the dura and the cerebrum. 3. Bleeding is generally arterial, and brain compression occurs rapidly. 4. The hematoma commonly occurs in the parietotemporal region.

2

What term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? 1. coma 2. stupor 3. obtundation 4. persistent vegetative state

2

What test is never performed on a child who is awake? 1. dolls head maneuver 2. oculovestibular response 3. assessment of pyrimidial tract lesions 4. fundoscopic examination for papilledema

2

The nurse is preparing to admit a 9-year-old child with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should the nurse include in the childs care plan? (Select all that apply.) 1. Provide a low-sodium, low-fat diet. 2. Initiate seizure precautions. 3. Weigh daily at the same time each day. 4. Encourage intake of 1 l of fluid per day. 5. Measure intake and output hourly.

2, 3, 5

A 10-year-old boy on a bicycle has been hit by a car in front of a school. The school nurse immediately assesses airway, breathing, and circulation. What should be the next nursing action? 1. Place the child on his side. 2. Take the childs blood pressure. 3. Stabilize the childs neck and spine. 4. Check the childs scalp and back for bleeding.

3

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician? 1. Weigh on admission and daily. 2. Replace fluid volume deficit over 48 hours. 3. Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride. 4. Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.

3

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. How should the nurse respond? 1. Medications can be discontinued at this time. 2. The child will need to take the drugs for 5 years after the last seizure. 3. A step-wise approach will be used to reduce the dosage gradually. 4. Seizure disorders are a lifelong problem. Medications cannot be discontinued.

3

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The childs level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. What is the most appropriate nursing action? 1. explain that analgesia is contraindicated with a head injury 2. have parents describe the childs previous experiences w/ pain 3. consult w/ practitioner about what analgesia can be given 4. teach parents analgesia is unnecessary when child is not awake

3

After a tonic-clonic seizure, what symptoms should the nurse expect the child to experience? 1. Diarrhea and abdominal discomfort 2. Irritability and hunger 3. Lethargy and confusion 4. Nervousness and excitability

3

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner? 1. PPP results from a central nervous system (CNS) insult. 2. PPP occurs more frequently in girls. 3. PPP may be viewed as a variation in sexual development. 4. PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn- RH).

3

The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic-clonic seizures. What statement by the parent should indicate a correct understanding of the teaching? 1. I should attempt to restrain my child during a seizure. 2. My child will need to avoid contact sports until adulthood. 3. I should place a pillow under my childs head during a seizure. 4. My child will need to be taken to the emergency department [ED] after each seizure.

3

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic? 1. Exercise increases blood glucose. 2. Extra insulin is required during exercise. 3. Additional snacks are needed before exercise. 4. Excessive physical activity should be restricted.

3

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence? 1. Desire to be unique 2. Preoccupation with the future 3. Need to be perfect and similar to peers 4. Awareness of peers that diabetes is a severe disease

3

What are quick, jerky, grossly uncoordinated, irregular movements that may disappear on relaxation called? 1. twitching 2. spasticity 3. choreiform movements 4. associated movements

3

What finding is a clinical manifestation of increased intracranial pressure (ICP) in children? 1. low pitchcry 2. sunken fontanel 3. diplopia, blurred vision 4. increased blood pressure

3

What is a common clinical manifestation of juvenile hypothyroidism? 1. Insomnia 2. Diarrhea 3. Dry skin 4. Rapid growth

3

What is the initial clinical manifestation of generalized seizures? 1. Confusion 2. Feeling frightened 3. Loss of consciousness 4. Seeing flashing lights

3

What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? 1. Maintain the child NPO (nothing by mouth). 2. Turn the child frequently. 3. Restrict fluids. 4. Encourage fluids.

3

What nursing intervention is appropriate when caring for an unconscious child? 1. Avoid using narcotics or sedatives to provide comfort and pain relief. 2. Change the childs position infrequently to minimize the chance of increased intracranial pressure (ICP). 3. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. 4. Give tepid sponge baths to reduce fevers above 38.3 C (101 F) because antipyretics are contraindicated.

3

What statement is characteristic of type 1 diabetes mellitus? 1. Onset is usually gradual. 2. Ketoacidosis is infrequent. 3. Peak age incidence is 10 to 15 years. 4. Oral agents are available for treatment.

3

What term is used to describe a childs level of consciousness when the child is arousable with stimulation? 1. stupor 2. confusion 3. obtundation 4. disorientation

3

What term refers to seizures that involve both hemispheres of the brain? 1. Absence 2. Acquired 3. Generalized 4. Complex partial

3

. What clinical manifestation occurs with hypoglycemia? 1. Lethargy 2. Confusion 3. Nausea and vomiting 4. Weakness and dizziness

4

A 23-month-old child is admitted to the hospital with a diagnosis of meningitis. She is lethargic and very irritable with a temperature of 102 F. What should the nurses care plan include? 1. Observing the childs voluntary movement 2. Checking the Babinski reflex every 4 hours 3. Checking the Brudzinski reflex every 1 hour 4. Assessing the level of consciousness (LOC) and vital signs every 2 hours

4

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention? 1. Sports drink and fruit 2. Glucose tabs and protein 3. Glass of water and crackers 4. Milk and peanut butter on bread

4

A child has a seizure disorder. What test should be done to gather the most specific information about the type of seizure the child is having? 1. Sleep study 2. Skull radiography 3. Serum electrolytesd. 4.Electroencephalogram (EEG)

4

A child will start treatment for central precocious puberty. What synthetic hormone will be injected? 1. Thyrotropin 2. Gonadotropins 3. Somatotropic hormone 4. Luteinizing hormonereleasing hormone

4

A young adolescent experiences infrequent migraine episodes. What pharmacologic intervention is most likely to be prescribed? 1.Opioid 2. Lorazepam 3. Ergotamine 4. Sumatriptan

4

Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved? 1. Central 2. Skeletal 3. Peripheral 4. Autonomic

4

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the childs younger brother had when he was an infant. The nurse should base a response on which information? 1. Meningitis rarely occurs during infancy. 2. Often a genetic predisposition to meningitis is found. 3. Vaccination to prevent all types of meningitis is now available. 4. Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.

4

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What clinical manifestation is the most essential part of the nursing assessment to detect early signs of a worsening condition? 1. Posturing 2. Vital signs 3. Focal neurologic signs 4. Level of consciousness

4

The nurse is caring for a child with severe head trauma after a car accident. What is an ominous sign that often precedes death? 1. delirium 2. papilledema 3. flexion posturing 4. periodic or irregular breathing

4

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption? 1. Arm 2. Leg 3. Buttock 4. Abdomen

4

The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe? 1. Mix the medication with sterile water. 2. Mix the medication with sterile normal saline. 3. Have another nurse double-check the medication dose. 4. Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.

4

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurses response should be based on which knowledge? 1. It is unsafe. 1. It is acceptable for up to 24 hours. 3. It is acceptable for families with very limited resources. 4. It is suitable for up to 3 days if stored in the refrigerator.

4

What blood glucose measurement is most likely associated with diabetic ketoacidosis? 1. 185 mg/dl 2. 220 mg/dl 3. 280 mg/dl 4. 330 mg/dl

4

What clinical manifestation is considered a cardinal sign of diabetes mellitus? 1. Nausea 2. Seizures 3. Impaired vision 4. Frequent urination

4

What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP) in an unconscious child? 1. suction freqeuntly 2. turn childs head side to side every hour 3. provide environmental stimuli 4. avoid activities tht cause pain or crying

4

What statement applies to the current focus of the dietary management of children with diabetes? 1. Measurement of all servings of food is vital for control. 2. Daily calculate specific amounts of carbohydrates, fats, and proteins. 3. The number of calories for carbohydrates remains constant on a daily basis; protein and fat calories are liberal. 4. The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

4

the nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. How should the nurse interpret this? 1. eye trauma 2. brain death 3. severe brainstem damage 4. neurosurgical emergency

4