Seizure Pediatric Practice Questions (Test #2, Fall 2020)

A hospitalized preschooler with meningitis who is to be discharged becomes angry when the discharge is delayed. Which of the following play activities would be most appropriate at this time? 1.Reading the child a story. 2.Painting with watercolors. 3.Pounding on a pegboard. 4.Stacking a tower of blocks.

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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.

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Which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation? 1.Hemorrhagic skin rash. 2.Edema. 3.Cyanosis. 4.Dyspnea on exertion.

1 Disseminated intravascular coagulation is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues. An abnormal coagulation phenomenon causes the condition. Heparin therapy is often used to interrupt the clotting process. Edema would suggest a fluid volume excess. Cyanosis would indicate decreased tissue oxygenation. Dyspnea on exertion would suggest respiratory problems, such as pulmonary edema.

A 3-month-old infant with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority? 1.Instituting droplet precautions. 2.Administering acetaminophen (Tylenol). 3.Obtaining history information from the parents. 4.Orienting the parents to the pediatric unit"

1 Instituting droplet precautions is the priority for a newly admitted infant with meningococcal meningitis. Acetaminophen may be ordered, but administering it does not take priority over instituting droplet precautions. Obtaining history information and orienting the parents to the unit do not take priority

Which of the following statements obtained from the nursing history of a toddler should alert the nurse to suspect that the child has had a febrile seizure? 1.The child has had a low-grade fever for several weeks. 2.The family history is negative for convulsions. 3.The seizure resulted in respiratory arrest. 4.The seizure occurred when the child had a respiratory infection.

4. Most febrile seizures occur in the presence of an upper respiratory infection, otitis media, or tonsillitis. Febrile seizures typically occur during a temperature rise rather than after prolonged fever. There appears to be increased susceptibility to febrile seizures within families. Infrequently, febrile seizures may lead to respiratory arrest.

Nursing care management of the child with bacterial meningitis includes which of the following? Select all that apply. 1.Administration of IV antibiotics. 2.Intravenous fluids at 1 ½ times maintenance. 3.Decrease environmental stimuli. 4.Neurologic checks every 1 hour. 5.Administration of IV anticonvulsants.

1,3,4 Antibiotics are indicated for the treatment of bacterial meningitis. Clients with bacterial meningitis often have increased ICP. It is necessary to maintain adequate hydration. However, infusing fluids at 1 ½ maintenance can increase ICP, further risking neurologic damage due to cerebral edema. Most children with meningitis are sensitive to sound, light, and stimulation. Decreasing environmental stimuli and keeping the room dim and quiet are essential. Frequent neurologic checks are necessary to monitor any changes in the child's level of consciousness. Anticonvulsants are not indicated unless the child experiences seizures as a result of the meningitis

The nurse is monitoring an infant with meningitis for signs of increased intracranial pressure (ICP). The nurse should assess the infant for which symptoms? Select all that apply. 1.Irritability. 2.Headache. 3.Mood swings. 4.Bulging fontanel. 5.Emesis.

1,4,5. Irritability, bulging fontanel, and emesis are all signs of increased ICP in an infant. A headache may be present in an infant with increased ICP; however, the infant has no way of communicating this to the parent. A headache is an indication of increased ICP in a verbal child. An infant cannot exhibit mood swings; this is indicative of increased ICP in a child or adolescent

The parents of a child with occasional generalized seizures want to send the child to summer camp. The parents contact the nurse for advice on planning for the camping experience. Which of the following activities should the nurse and family decide the child should avoid? 1.Rock climbing. 2.Hiking. 3.Swimming. 4.Tennis.

1. A child who has generalized seizures should not participate in activities that are potentially hazardous. Even if accompanied by a responsible adult, the child could be seriously injured if a seizure were to occur during rock climbing. Someone also should accompany the child during activities in the water. At summer camps, hiking and swimming would occur most commonly as group activities, so someone should be with the child. Tennis would be considered an appropriate, nonhazardous activity for a child with generalized seizures.

A 2-month-old infant is brought to the emergency department after experiencing a seizure. The infant appears lethargic with very irregular respirations and periods of apnea. The parents report the baby is no longer interested in feeding and, before the seizure, rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography (CT) scan of the head and dilation of the eyes. 2. Computed tomography (CT) scan of the head and electroencephalogram (EEG). 3. X-rays of the head. 4. X-rays of all long bones.

1. A computed tomography (CT) 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 shaken baby syndrome (SBS). 2. An EEG is not usually done as a priority test in an infant displaying symptoms of SBS. 3. X-rays of the head will show fractures, but CT and pupil examinations are the priority for this child. 4. X-rays of all long bones may be performed to rule out any old or new fractures, but CT and pupil examinations are the priority for this child. TEST-TAKING HINT: The test taker should consider child abuse (SBS), because the story does not match the injury. The pupils are always dilated to rule out SBS.

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 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 see fewer complications and a shorter disease process in the younger child."

1. Although encephalitis is usually caused by a viral infection, the child is usually admitted for close observation. 2. Intravenous antibiotics are not given to the child with viral encephalitis. 3. 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 increased ICP and for cardiac and respiratory compromise. 4. The child would not be discharged because observation for complications is necessary. As a general rule, younger children tend to have more complications and require a PICU admission. TEST-TAKING HINT: The test taker should be familiar with the diagnosis and treatment of encephalitis. The test taker should not be influenced by the word "viral" but should realize that the sequelae of encephalitis require close monitoring in an ICU environment.

A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type 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.

1. Although many children with epilepsy require more than one medication to achieve seizure control, it is recommended that only one medication be started at a time so that the child's reaction to the specific medication can be observed. 2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels. 3. Rectal gels are used to stop a seizure once it has begun; they are not used to prevent seizures. 4. The route of choice for the prevention of seizures is oral. There is no reason to assume that compliance will be an issue prior to beginning anticonvulsant therapy. TEST-TAKING HINT: The test taker should eliminate answer 4 because IV medications are not included in the initial home medication regimen.

The nurse is caring for an adolescent who remains unconscious 24 hours after sustaining a closed-head injury in a motor vehicle accident (MVA). She responds to deep, painful stimulation with decorticate posturing and has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the teens peers to visit and talk to her about school and other pertinent events. 2. Encourage the teens 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 teen 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.

1. Although peers play an important role in the adolescent's development, this particular patient is at risk for increased ICP and should have decreased stimulation. 2. Loud talking may cause the child's ICP to increase. 3. A bright, lively environment may lead to increased ICP. 4. A dark, quiet environment and minimal stimulation will decrease oxygen consumption and ICP. TEST-TAKING HINT: The test taker should consider the causes of ICP and select answers that will not increase ICP. Answers 1, 2, and 3 cause an increase in ICP and should be eliminated

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 nurses best response. 1. "Have the parents follow up with his health-care provider because this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life because it could be attention-seeking behavior." 3. "Have the parents follow up with his health-care provider because 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. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground. 2. It is important to evaluate the child for life stressors, but suspected seizure activity needs immediate evaluation. 3. An absence seizure is characterized by a change in activity whereby the child appears to be daydreaming or staring straight ahead. The child usually continues basic simple movements but loses an awareness of surroundings. 4. The preschool years are a not a time of rapid growth. Many children in this age-group appear clumsy, but suspected seizure activity needs immediate evaluation. TEST-TAKING HINT: The test taker should recognize the description as seizure activity and, therefore, could immediately eliminate answers 3 and 4.

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 he flexes his knees and hips. This is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

1. Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees. 2. Cushing triad is a sign of increased ICP and is manifested with an increase in systolic blood pressure, decreased heart rate, and irregular respirations. 3. Kernig sign occurs when there is resistance or pain in response to raising the childs flexed leg. 4. Nuchal rigidity occurs when there is a resistance to neck flexion. TEST-TAKING HINT: The test taker should be familiar with terms used to describe meningeal irritation

The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows 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 (Tylenol) when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

1. Children who experience a febrile seizure are likely to experience another febrile seizure. 2. Most children over the age of 5 years do not have febrile seizures. 3. Antipyretics are administered to prevent the child's temperature from rising too rapidly. 4. Most children are not prescribed anticonvulsant medication after experiencing a febrile seizure. TEST-TAKING HINT: There is an increased risk in siblings, but the 7-year-old child is above the usual age of febrile seizures

The nurse is caring for an unconscious 6-year-old who has had a severe closed-head injury and notes the following changes: Heart rate has dropped from 120 to 55, blood pressure has increased from 110/44 to 195/62, and respirations are becoming more irregular. Which should the nurse do first after calling the physician? 1. Call for additional help and prepare to administer mannitol (Osmitrol). 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.

1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respirations. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP. 2. The child's vital signs need to be monitored, but a fluid bolus will increase the circulating volume and lead to an increase in the child's ICP. Fluid boluses are necessary in cases of shock but must be administered carefully and the child closely observed. 3. An antihypertensive will not help decrease the ICP. 4. The child will benefit from supplemental oxygen, but it will not help decrease the ICP. TEST-TAKING HINT: The test taker should recognize the signs of Cushing triad. If not recognized, the child's condition should at least be seen as deteriorating and emergent. Answers 2 and 4 can be eliminated because they are only partially correct.

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 intravenous antibiotics. 2. Intravenous fluids at 1½ times regular maintenance. 3. Neurological checks every hour. 4. Administer acetaminophen (Tylenol) for temperatures higher than 38°C (100.4°F)

1. Isolation precautions must be maintained for at least the first 24 hours of intravenous antibiotic therapy. 2. Intravenous fluids at 1½ times regular maintenance could cause fluid overload and lead to increased ICP. 3. Neurological checks are usually made at least every hour. 4. Acetaminophen (Tylenol) is usually administered when the child has a fever, as increased temperature can lead to increased ICP. TEST-TAKING HINT: The test taker should consider the answers and eliminate those that may increase ICP. Intravenous fluids are often given at less than maintenance unless the child is hemodynamically unstable.

A child 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 is a priority for the triage nurse to say 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?"

1. It is not a priority of care to find out if anyone else was injured. 2. Although open-ended questions are important, the nurse needs specific information, and the anxious parent may need to be guided during triage assessment. 3. Asking specific questions will give the nurse the information needed to determine the level of care for the child. 4. Although it is important to provide safety education, this information should be given in a nonjudgmental manner at a point when the parent and child are less stressed. TEST-TAKING HINT: The test taker needs to consider the role of a triage nurse to obtain specific information quickly. Answer 4 can be eliminated because it implies judgment and does not help the current situation.

Which is the best action for the nurse to take during a child 's seizure? 1. Administer the child's rescue dose of oral diazepam (Valium). 2. Loosen the child's clothing, and call for help. 3. Place a 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

1. Nothing should be placed in the child's mouth because he is at risk for aspiration. Rescue Valium is usually administered rectally. 2. The nurse should remain with the child and observe the seizure. The child should be protected from his environment, and clothing should be loosened. 3. A tongue blade should never be placed in the child's mouth because it can cause injury or increase the risk of aspiration. 4. The nurse should remain with the child and call for help. A child can be injured if carried during a seizure. TEST-TAKING HINT: The test taker should eliminate answers 1 and 3 because nothing should ever be placed in the mouth of a child having a seizure.

Which activity should an adolescent just diagnosed with epilepsy avoid? 1. Swimming, even with a friend. 2. Being in a car at night. 3. Participating in any strenuous activities. 4. Returning to school right away.

1. Swimming does not need to be avoided as long as there is someone else present to call for help in the event of an emergency. 2. The rhythmic reflection of other car lights can trigger a seizure in some children. 3. There is no reason to avoid strenuous activity. 4. It is important for adolescents to be with their peers in order to reach developmental milestones. TEST-TAKING HINT: The test taker should consider the answers that can lead to a seizure. Answer 2 is the only answer that includes a common trigger

The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, because CSF is usually cloudy. 4. Sepsis.

1. The CSF in viral meningitis is usually clear. 2. The CSF in bacterial meningitis is usually cloudy. 3. The CSF in healthy children is usually clear. 4. Sepsis is an infection of the bloodstream. TEST-TAKING HINT: The test taker can eliminate answer 4 because an infection of the bloodstream would not be detected in the CSF.

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.

1. The anterior fontanel is usually raised and bulging in infants with increased ICP. 2. The infant is not able to comprehend blurred vision or make any statements. 3. A high-pitched cry is often indicative of increased ICP in infants. 4. The infant with increased ICP usually has a poor appetite and does not feed well. 5. The infant may be sleeping more than usual because of increased ICP. TEST-TAKING HINT: The test taker needs to be familiar with hydrocephalus and how increased ICP is manifested in infants. Answer 2 can be eliminated because an infant cannot specifi cally verbalize.

A newborn develops tetany and has a seizure prior to discharge from the nursery. The newborn is diagnosed with hypocalcemia secondary to hypoparathyroidism and is started on calcium and vitamin D. Which information would be most important for the nurse to teach the parents? 1. They should observe the baby for signs of tetany and seizures. 2. They should observe for weakness, nausea, vomiting, and diarrhea. 3. They should administer the calcium and vitamin D daily as prescribed. 4. They should call the clinic if they have any questions about care of the newborn.

1. The baby has hypocalcemia and is being treated for this condition by the team. This should be reviewed with the family. 2. Vitamin D toxicity (weakness, nausea, vomiting, and diarrhea) is a serious consequence of therapy and should be the top priority in teaching. 3. Reminding the family to give the medication as prescribed is helpful and should be a basic part of discharge care, but it is not the most important information. 4. Giving the family the phone number for calling the clinic is part of basic care for discharge to home, but it is not the most important information. TEST-TAKING HINT: Going over the side effects and risks of vitamin D treatment educates the family about what to watch for when giving the new medications.

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. The child experiencing a seizure usually requires more oxygen because the seizure increases the bodys 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. 2. It is important to reassure the parents, but giving the child oxygen and calling for additional support is the priority of care. 3. It is not necessary to call a code unless the child experiences a cardiac or respiratory arrest. Research indicates that encouraging parents to remain with the child in emergency situations benefits both the child and family. 4. It is important to monitor and observe the child during a seizure, but it is very difficult to obtain a blood pressure from a seizing child. The priority of care involves administering oxygen and calling for additional help. TEST-TAKING HINT: The test taker needs to prioritize care and choose answer 1 because it will help maintain the airway. Answer 3 could immediately be eliminated because the child is having a seizure, not a cardiac arrest.

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 intravenous 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.

1. The child with bacterial meningitis should be placed in a private room isolated from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other. 2. The child with bacterial meningitis should be placed in a private room isolated from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other. 3. A quiet private room with minimal stimulation is ideal because the child with meningitis should be in a quiet environment to avoid cerebral irritation. 4. A bright room with developmental activities may cause irritation and increase ICP. TEST-TAKING HINT: The test taker should consider what contributes to cerebral irritation and should not be infl uenced by the developmental requirements of a healthy child.

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. Select the nurse 's best response. 1. "Give her some acetaminophen (Tylenol), and see if her symptoms improve. If they do not improve, bring her to the health-care provider '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 because it has been working well for 9 years." 4. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

1. These are symptoms of a shunt malfunction and should be evaluated immediately. 2. Although these symptoms may be associated with the start of a girls menstrual cycle, they are symptoms of a shunt malfunction and require immediate evaluation. 3. A shunt can malfunction at any point and should be evaluated when signs of increased ICP are evident. 4. These are symptoms of a shunt malfunction and should be evaluated immediately. TEST-TAKING HINT: The test taker should recognize these symptoms as signs of a shunt malfunction and can eliminate answers 1, 2, and 3 because they do not address the situation as an emergency

Which clinical assessment of a neonate with bacterial meningitis would warrant immediate intervention? 1. Irritability. 2. Rectal temperature of 100.6°F (38.1°C). 3. Quieter than usual. 4. Respiratory rate of 24 breaths per minute.

1. With the diagnosis of suspected bacterial meningitis, the neonate is expected to be irritable, which frequently accompanies increased intracranial pressure. 2. A rectal temperature of 38.1°C or 100.6°F indicates a low-grade fever and is not as concerning as the slower-than-normal respiratory rate of 24. 3. The fact the infant is quieter than normal is in response to the slow respiratory rate and sepsis the neonate is experiencing. 4. A normal neonate's respiratory rate is 30 to 60 breaths per minute. Neonates respiratory systems are immature, and the rate may initially double in response to illness. If no immediate interventions are begun when there is respiratory distress, a neonate's respiratory rate will slow down, respiratory distress will worsen, and, eventually, respiratory arrest will occur. Neonates with slower or faster-than-normal respiratory rates are true emergency cases; they require identification of the cause of distress. TEST-TAKING HINT: The test taker needs to know the normal range of vital signs and when to be concerned to help answer the question.

What should be part of the nurse's teaching plan for a child with epilepsy being discharged on a regimen of phenytoin (Dilantin)? 1.Drinking plenty of fluids. 2.Brushing teeth after each meal. 3.Having someone be with the child during waking hours. 4.Reporting signs of infection.

2. Phenytoin (Dilantin) can cause gingival hyperplasia. Children taking Dilantin should brush their teeth after every meal and at bedtime, and visit their dentist on a regular basis. Drinking plenty of fluids is not required while taking Dilantin. A child on Dilantin does not need to be observed during waking hours because the seizures should be under control. Infections do not occur with an increased incidence in clients receiving Dilantin.

When teaching an adolescent with a seizure disorder who is receiving valproic acid (Depakene), which sign or symptom should the nurse instruct the client to report to the health care provider? 1.Three episodes of diarrhea. 2.Loss of appetite. 3.Jaundice. 4.Sore throat.

3. A toxic effect of valproic acid (Depakene) is liver toxicity, which may manifest with jaundice and abdominal pain. If jaundice occurs, the client needs to notify the health care provider as soon as possible. Diarrhea and sore throat are not common side effects of this drug. Increased appetite is common with this drug

A nurse evaluates discharge teaching as successful when the parents of a school-age child with a ventriculoperitoneal shunt insertion identify which sign as signaling a blocked shunt? 1.Decreased urine output with stable intake. 2.Tense fontanel and increased head circumference. 3.Elevated temperature and reddened incisional site. 4.Irritability and increasing difficulty with eating.

4. In a school-age child, irritability, lethargy, vomiting, difficulty with eating, and decreased level of consciousness are signs of increased intracranial pressure caused by a blocked shunt. Decreased urine output with stable fluid intake indicates fluid loss from a source other than the kidneys. A tense fontanel and increased head circumference would be signs of a blocked shunt in an infant. Elevated temperature and redness around incisions might suggest an infection.

To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? 1. Furosemide (Lasix). 2. Insulin. 3. Glucose. 4. Morphine.

1. A common manifestation is increased ICP, which is treated with an osmotic diuretic. Furosemide (Lasix) is a loop diuretic. 2. A common manifestation is hypoglycemia. Insulin does not treat hypoglycemia, but decreases the blood sugar instead. 3. A common manifestation is hypoglycemia, which is treated with the administration of intravenous glucose. 4. Morphine is a narcotic used for pain relief. It should be used with caution because it can lead to respiratory depression. TEST-TAKING HINT: The test taker needs to be aware that increased ICP is a very common manifestation of Reye syndrome and should therefore eliminate any answers that do not treat increased ICP. The test taker can also eliminate answers 2 and 4 because they do not treat hypoglycemia, which is another common manifestation of Reye syndrome.

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

1. A cooling blanket will help cool the child quickly and at a controlled temperature. 2. Acetaminophen (Tylenol) should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed. 3. Acetaminophen (Tylenol) should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed. 4. Ice packs will cause the child to shiver, which will increase oxygen consumption and possibly increase ICP. Shivering can also cause the child to experience a rebound increase in temperature. TEST-TAKING HINT: The test taker should consider the cause of the increased temperature and how to cool the child quickly. Answer 4 should be eliminated because ice packs are no longer recommended to treat increased temperatures.

Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt 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.

1. A semi-Fowler position in an infant seat may allow the ventricles to drain too rapidly in the immediate postoperative period. 2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates. 3. The Trendelenburg position is not used immediately after ventriculoperitoneal shunt placement because it would increase ICP. 4. The head elevated to 90 degrees will allow the ventricle of the brain to drain too quickly. TEST-TAKING HINT: The test taker should note the word "initially" and consider why the position would be immediately benefi cial. Answer 3 can be eliminated because that position could increase ICP.

A child is being admitted with the diagnosis of meningitis. 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 samples to the laboratory for cultures.

1. Administration of intravenous antibiotics should not be started until after all cultures have been obtained. 2. Administration of maintenance IV fluids can wait until after the cultures have been obtained. 3. Placement of a Foley catheter is not a priority procedure. 4. Cultures of spinal fluid and blood should be obtained, followed by administration of intravenous antibiotics. TEST-TAKING HINT: The test taker needs to think about priority of care. Answer 3 can be immediately eliminated because it is not a priority. Answer 4 should be considered a priority because antibiotics should not be started before the samples have been obtained and sent for culturing

A 6-month-old infant was just diagnosed with craniosynostosis. The infants father asks the nurse for more information about reconstructive surgery. Select the nurses 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 18 months 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 because the head has finished growing at that time."

1. An open anterior fontanel allows for swelling, therefore decreasing the risk of injury. 2. Insufficient musculoskeletal support and a disproportionate head size place the infant at risk because the head cannot be supported during a shaking episode. 3. Superficial veins and arteries do not place the infant at a higher risk for injury. 4. Although the myelination is immature, the immature musculoskeletal support places the infant at risk. TEST-TAKING HINT: Answer 3 should be eliminated because superficial vessels do not lead to SBS.

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 because the childs posturing reflexes are similar.

1. Decorticate posturing is seen with a less advanced stage of Reye syndrome and likely indicates that the child s condition is improving. 2. The childs condition is improving; therefore, cardiac and respiratory failure is less likely 3. Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child s condition. 4. Decorticate posturing is associated with inflammation above the brain stem, whereas decerebrate posturing is associated with inflammation in the brain stem. TEST-TAKING HINT: The test taker needs to be familiar with posturing reflexes and their significance.

A child in the PICU with a head injury is comatose and unresponsive. The parent asks if he needs pain medication. Select the nurse's best response. 1. "Pain medication is not necessary because 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 make him comfortable." 4. "Pain medication is necessary for comfort, but we use it cautiously because it increases the demand for oxygen."

1. Even if the child is unresponsive, the child can still feel pain. 2. If pain medication is administered cautiously, the child can still be monitored and signs of improvement will be evident. 3. Pain medication promotes comfort and ultimately decreases ICP. 4. Pain medication decreases the demand for oxygen.

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."

1. Having a child immunized helps prevent viral illnesses from occurring, thereby decreasing the likelihood of Reye syndrome. 2. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. 3. 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. 4. Children with Reye syndrome are always admitted to the hospital because there is a strong possibility for complications and rapid deterioration. TEST-TAKING HINT: The test taker should be aware that aspirin administration in children with viral infections has been linked to Reye syndrome.

The diet that produces anticonvulsant effects from ketosis consists of: 1. High-fat and low-carbohydrate foods. 2. High-fat and high-carbohydrate foods. 3. Low-fat and low-carbohydrate foods. 4. Low-fat and high-carbohydrate foods.

1. High fat and low carbohydrates are the components of the ketogenic diet. 2. High fat and low carbohydrates are the components of the ketogenic diet. 3. High fat and low carbohydrates are the components of the ketogenic diet. 4. High fat and low carbohydrates are the components of the ketogenic diet. TEST-TAKING HINT: The test taker needs to be familiar with the components of a ketogenic diet.

Which medication should the nurse anticipate administering first to a child in status epilepticus? 1. Establish an intravenous line and administer intravenous lorazepam (Ativan). 2. Administer rectal diazepam (Valium). 3. Administer an oral glucose gel to the side of the childs mouth. 4. Administer oral diazepam (Valium).

1. It is very difficult and time consuming to establish an intravenous line in a child who is experiencing a generalized seizure. Rectal diazepam (Valium) is first administered in an attempt to stop the seizure long enough to establish a line, and then medication is administered intravenously. 2. Rectal diazepam (Valium) is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered. 3. Although the child may become hypoglycemic due to increased metabolic demands, stopping the seizure with rectal diazepam (Valium) is the first priority. Medication is not placed in the mouth of a child experiencing a generalized seizure because it increases the risk of injury and aspiration. 4. Stopping the seizure with rectal diazepam (Valium) takes priority. Nothing should be administered orally to a patient who is unconscious. TEST-TAKING HINT: The test taker needs to consider the current situation and the level of difficulty in establishing intravenous access in a child experiencing a generalized seizure

A child is to receive phenytoin (Dilantin) 100 mg IV for seizure prophylaxis. Which intervention is appropriate when administering this drug? 1. Mix it in dextrose 5% in water and give over 1 hour. 2. Administer no faster than 2 mg/kg/min. 3. Do not use an inline filter. 4. Monitor temperature prior to and after administration.

1. Mix intravenous doses in normal saline as mixtures precipitate with dextrose 5% in water. 2. Phenytoin (Dilantin) should be given slowly (1-2 mg/kg/min) via pump. Rapid infusion may cause hypotension, arrhythmias, and circulatory collapse. 3. An inline filter is recommended. 4. Continuous monitoring of electrocardiogram, blood pressure, and respiratory status is essential because of potential side effects. TEST-TAKING HINT: The test taker must know both the side effects of the drug and how to administer it safely.

Brain damage in a child who sustained a closed-head injury can be caused by which factor? 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.

1. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 2. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 3. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 4. Decreased perfusion of the brain and increased metabolic needs of the brain TEST-TAKING HINT: The test taker needs to be familiar with the mechanics of a head injury.

During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which of the following would be most appropriate to institute? 1.Limiting conversation with the child. 2.Keeping extraneous noise to a minimum. 3.Allowing the child to play in the bathtub. 4.Performing treatments quickly

2 A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent overstressing the child, they should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing intracranial pressure.

When interviewing the parents of a 2-year-old child, a history of which of the following illnesses should lead the nurse to suspect pneumococcal meningitis? 1.Bladder infection. 2.Middle ear infection. 3.Fractured clavicle. 4.Septic arthritis.

2 Organisms that cause bacterial meningitis, such as pneumococci or meningococci, are commonly spread in the body by vascular dissemination from a middle ear infection. The meningitis may also be a direct extension from the paranasal and mastoid sinuses. The causative organism is a pneumococcus. A chronically draining ear is also frequently found. Bladder infections commonly are caused by Escherichia coli, unrelated to the development of pneumococcal meningitis. Pneumococcal meningitis is unrelated to a fractured clavicle or to septic arthritis, which is commonly caused by Staphylococcus aureus, group A streptococci, or Haemophilus influenz

Before placement of a ventriculoperitoneal shunt for hydrocephalus, an infant is irritable, lethargic, and difficult to feed. To maintain the infant's nutritional status, which of the following actions would be most appropriate? 1.Feeding the infant just before doing any procedures. 2.Giving the infant small, frequent feedings. 3.Feeding the infant in a horizontal position. 4.Scheduling the feedings for every 6 hours.

2. An infant with hydrocephalus is difficult to feed because of poor sucking, lethargy, and vomiting, which are associated with increased intracranial pressure. Small, frequent feedings given at times when the infant is relaxed and calm are tolerated best. Feeding an infant before any procedure is inappropriate because the stress of the procedure may lead to vomiting. Ideally, the infant should be held in a slightly vertical position when feeding to prevent backflow of formula into the eustachian tubes and subsequent development of ear infections. Most infants are fed on demand every 3 to 4 hours

After teaching the parents of a child with febrile seizures about methods to lower temperature other than using medication, which of the following statements indicates successful teaching? 1."We'll add extra blankets when he says he is cold." 2."We'll wrap him in a blanket if he starts shivering." 3."We'll make the bath water cold enough to make him shiver." 4."We'll use a solution of half alcohol and half water when sponging him.

2. Shivering, the body's defense against rapid temperature decrease, results in an increase in body temperature. Therefore, the parents need to take measures to stop the shivering (and the resulting increase in body temperature) by increasing the room temperature or the temperature of the child's immediate environment (such as with blankets) until the shivering stops. Then, attempts are made to lower the temperature more slowly. Shivering does not necessarily correlate with being cold. Alcohol, a toxic substance, can be absorbed through the skin. Its use is to be avoided.

An adolescent girl with a seizure disorder controlled with phenytoin (Dilantin) and carbamazepine (Tegretol) asks the nurse about getting married and having children. Which of the following responses by the nurse would be most appropriate? 1."You probably shouldn't consider having children until your seizures are cured." 2."Your children won't necessarily have an increased risk of seizure disorder." 3."When you decide to have children, talk to the doctor about changing your medication." 4."Women who have seizure disorders commonly have a difficult time conceiving.

3. Phenytoin sodium (Dilantin) is a known teratogenic agent, causing numerous fetal problems. Therefore, the adolescent should be advised to talk to the doctor about changing the medication. Additionally, anticonvulsant requirements usually increase during pregnancy. Seizures can be controlled but cannot be cured. There is a familial tendency for seizure disorders. Seizure disorders and infertility are not related.

After teaching a group of school teachers about seizures, the teachers role-play a scenario involving a child experiencing a generalized tonic-clonic seizure. Which of the following actions, when performed first, indicates that the nurse's teaching has been successful? 1.Asking the other children what happened before the seizure. 2.Moving the child to the nurse's office for privacy. 3.Removing any nearby objects that could harm the child. 4.Placing a padded tongue blade between the child's teeth

3. During a generalized tonic-clonic seizure, the first priority is to keep the child safe and protect the child by removing any nearby objects that could cause injury. Although obtaining information about events surrounding the seizure is important, this information can be obtained later, once the child's safety is ensured. During a seizure, the child should not be moved. Although providing privacy is important, the child's safety is the priority. During a seizure, nothing should be forced into the client's mouth because this can cause severe damage to the teeth and mouth."

Which action should the nurse take when providing postoperative nursing care to a child after insertion of a ventriculoperitoneal shunt? 1.Administer narcotics for pain control. 2.Check the urine for glucose and protein. 3.Monitoring for increased temperature. 4.Test cerebrospinal fluid leakage for protein.

3. Monitoring the temperature allows the nurse to assess for infection, the most common and the most hazardous postoperative complication after ventroperitoneal shunt placement. Typically, pain after insertion of a ventriculoperitoneal shunt is mild, requiring the use of mild analgesics. Usually narcotics are not administered because they alter the level of consciousness, making assessment of cerebral function difficult. Neither proteinuria nor glycosuria is associated with shunt placement. Cerebrospinal fluid leakage commonly occurs with head injury. It is not usually associated with shunt placement.

A nurse is developing a plan of care with the parents of a 6-year-old girl diagnosed with a seizure disorder. To promote growth and development, the nurse should instruct the parents that: 1.The child will need activity limitation and will be unable to perform as well as her peers. 2.There is potential for a learning disability and the child may need tutoring to reach her grade level. 3.The child will likely have normal intelligence and be able to attend regular school. 4.There will be problems associated with social stigma and parents should consider home schooling.

3. Most children who develop seizures after infancy are intellectually normal. A child with a seizure disorder needs the same experiences and opportunities to develop intellectual, emotional, and social abilities as any other child. Activity limitation is not needed. Learning disabilities are not associated with seizures. The child is able to attend public school, and social stigma is a rarity.

A preschooler with pneumonococci meningitis is receiving intravenous antibiotic therapy. When discontinuing the intravenous therapy, the nurse allows the child to apply a dressing to the area where the needle is removed. The nurse's rationale for doing so is based on the interpretation that a child in this age group has a need to accomplish which of the following? 1.Trust those caring for her. 2.Find diversional activities. 3.Protect the image of an intact body. 4.Relieve the anxiety of separation from home.

3. Preschool-age children worry about having an intact body and become fearful of any threat to body integrity. Allowing the child to participate in required care helps protect her image of an intact body. Development of trust is the task typically associated with infancy. Additionally, allowing the child to apply a dressing over the intravenous insertion site is unrelated to the development of trust. Finding diversional activities is not a priority need for a child in this age group. Separation anxiety is more common in toddlers than in preschoolers.

A 4-year-old child with hydrocephalus is scheduled to have a ventroperitoneal shunt in the right side of the head. When developing the child's postoperative plan of care, the nurse should place the preschooler in which of the following positions immediately after surgery? 1.On the right side, with the foot of the bed elevated. 2.On the left side, with the head of the bed elevated. 3.Prone, with the head of the bed elevated. 4.Supine, with the head of the bed flat.

4. For at least the first 24 hours after insertion of a ventriculoperitoneal shunt, the child is positioned supine with the head of the bed flat to prevent too rapid a decrease in cerebrospinal fluid pressure. Although elevating the head increases cerebrospinal fluid drainage and reduces intracranial pressure, a rapid reduction in the size of the ventricles can cause subdural hematoma. Positioning on the operative or right side is avoided because it places pressure on the shunt valve, possibly blocking desired drainage of the cerebrospinal fluid. Elevating the foot of the bed could increase intracranial pressure. With continued increased intracranial pressure, the child would be positioned with the head of the bed elevated to allow gravity to aid drainage. The child should be kept off the nonoperative side (side opposite the shunt), or the left side, to help prevent rapid decompression leading to a cerebral hematoma.