Chapter 38 prep u
A 10-year-old boy has been experiencing complex partial seizures and has not responded well to medication. Surgery is planned to remove brain tissue at the seizure foci. Which diagnostic test would be the most accurate in identifying the seizure foci? Echoencephalography Brain scan Positron emission tomography (PET) Myelography
Positron emission tomography (PET) The diagnostic technique of positron emission tomography (PET) involves imaging after injection of positron-emitting radiopharmaceuticals into the brain. These radioactive substances accumulate at diseased areas of the brain or spinal cord. PET is extremely accurate in identifying seizure foci. Brain scans identify possible tumor, subdural hematoma, abscess, or encephalitis. Echoencephalography is often used in neonatal ICUs to monitor intraventricular hemorrhages and other problems frequently encountered by preterm infants. Myelography is the x-ray study of the spinal cord following the introduction of a contrast material into the CSF by lumbar puncture to reveal the presence of space-occupying lesions of the spinal cord.
After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify which condition as a neural tube defect? spina bifida occulta hydrocephalus encephalocele anencephaly
hydrocephalus Hydrocephalus results from an imbalance in the production and absorption of cerebrospinal fluid. In hydrocephalus, cerebrospinal fluid accumulates within the ventricular system and causes the ventricles to enlarge and increases in intracranial pressure. Anencephaly, encephalocele and spina bifida occulta are all neural tube defects.
The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for? Negative Kernig sign Irritability, fever, and vomiting Flat fontanel (fontanelle) Jaundice, drowsiness, and refusal to eat
Irritability, fever, and vomiting Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels (fontanelles) would be bulging as intracranial pressure rises, and Kernig sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis.
A 1-year-old infant has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents? "The surgery was successful. Do you have any questions?" "I will be watching hemoglobin and hematocrit closely." "This only happens in 1 out of 2,000 births." "I told you yesterday there would be facial swelling."
"The surgery was successful. Do you have any questions?" Often what parents need most is someone to listen to their concerns. Although this is a good time for education, the parents are more concerned about the success of the surgery than their infant's appearance. Watching the hemoglobin, hematocrit and swelling are important nursing functions but they do not address the parents' psychosocial needs. The parents do not need to be taught statistics about their infant's condition. They more than likely know this from health care provider visits, the Internet, and parent support groups. Following surgery, this knowledge is not what parents are concerned about. Parents want to know their infant is safe and well.
While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority? Discuss dietary therapy with the client's caregivers. Protect the child from hitting the arms against the bed. Refer the client to a neurologist. Administer lorazepam rectally to the client.
Protect the child from hitting the arms against the bed. Keeping the child safe during a seizure is the highest priority. The nurse will protect the child from hitting the arms on the bed or other nearby objects. If the seizure continues, lorazepam may be indicated to stop the seizure. The client would be referred to a neurologist for follow-up care; however, this is not a priority. Dietary therapy is considered for clients with chronic seizure disorders who do not respond to medication therapy.
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? Occurrence of urine and fecal contamination Degree and extent of nuchal rigidity Signs of increased intracranial pressure (ICP) Onset and character of fever
Signs of increased intracranial pressure (ICP) Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.
Which of these age groups has the highest actual rate of death from drowning? preschool children toddlers school-aged children infants
toddlers Toddlers and older adolescents have the highest actual rate of death from drowning.
The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "The child will be held by the mother on her lap with his back toward the health care provider." "The child will be placed in the prone position with the nurse holding the child still." "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." "When positioning the child, the nurse needs to assist the child to a side-lying position and keep his back as flat as much as possible."
"For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." Correct positioning for a lumbar puncture is to place the child on his or her side with the neck flexed and knees bent and drawn up to their chest. This helps to keep the back arched as much as possible. Newborns may be seated upright with their head bent forward. The child is not placed prone; this does not allow the back to be arched.
The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status? "She always cries when the person holding her has on glasses...I guess glasses scare her." "She has been irritable for the last hour....seems like she is just upset for some reason." "She typically breastfeeds, but lately we have had to supplement with some oat cereal." "She is a pretty happy baby, unless her diaper is wet, then she cries until we change her diaper."
"She has been irritable for the last hour....seems like she is just upset for some reason." Irritability in an infant can be a sign of declining neurological function. Because infants are not able to answer questions pertaining to person, place and time, their neurological assessment must be catered to their level of development. The other responses would be typical and normal for an infant.
The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope? "Use this information to teach family and friends." "You'll always need a monitor in his room." "Bike riding and swimming are just too dangerous." "If he is out of bed, the helmet's on the head."
"Use this information to teach family and friends." Families need and want information they can share with relatives, child care providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The child may be able to bike ride and swim with proper precautions.
A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement? "My stomach is upset. I feel like I might throw up." "You look funny. Well, both of you do. I see two of you." "I am glad that my headache is getting better." "It will be nice when you will let me take a long nap. I am sleepy."
"You look funny. Well, both of you do. I see two of you." The caregiver should notify the health care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling nauseated is not a reason to notify the provider.
A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as: otorrhea. raccoon eyes. Battle sign. rhinorrhea.
Battle sign. Two signs of basilar skull fracture include Battle sign (bruising or ecchymosis behind the ear) and "raccoon eyes" (blood leaking into the frontal sinuses causing an edematous and bruised periorbital area). Rhinorrhea is CSF leakage from the nose. Otorrhea is CSF leaking from the ear.
The nurse is caring for a child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What action(s) by the nurse should be performed now? Select all that apply. Ensure the drip chamber is below the child's clavicles. Ensure the tubing is not kinked. Check the child's temperature. Check tubing clamps to ensure they are open. Encourage the child to cough and deep breathe to facilitate drainage.
Check the child's temperature. Check tubing clamps to ensure they are open. Ensure the tubing is not kinked Nursing care of an external ventricular drainage device requires the nurse to ensure all connections are secure and labeled. The amount of drainage requires close observation. If drainage is absent or minimal, the nurse must assess the tubing to make certain it is not clamped or kinked. The level of the drip chamber must be set at the height of the child (at the clavicle). Taking the temperature will be useful to assess for the presence of infection, but that is not currently a concern. Asking the child to cough and deep breathe should not be done. Deep breathing is beneficial for all postoperative clients, but coughing may increase pressures and should be avoided.
Absence seizures are marked by what clinical manifestation? Sudden, brief jerks of a muscle group Loss of muscle tone and loss of consciousness Loss of motor activity accompanied by a blank stare Brief, sudden onset of increased tone of the extensor muscle
Loss of motor activity accompanied by a blank stare An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Brief, sudden contracture of a muscle or muscle group Sudden, momentary loss of muscle tone, with a brief loss of consciousness Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Muscle tone maintained and child frozen in position
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.
The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority? Risk for delayed development Risk for ineffective tissue perfusion: cerebral Risk for injury Risk for self-care deficit: bathing and dressing
Risk for injury
The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger? swimming twice a week 11 p.m. bedtime; 6:30 a.m. wake-up use of nonaccented soap drinking three cans of diet cola
drinking three cans of diet cola Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.
The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client? vagus nerve stimulation ketogenic diet use of anticonvulsant medications frequent temperature assessment
use of anticonvulsant medications Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. These medications are typically used first as treatment for seizure disorders. Frequent temperature assessment would only be useful in febrile seizures. Ketogenic diets (high in fat, low in carbohydrates, and adequate in protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Diet is generally used when medications cannot control a child's seizure activity. Stimulating the left vagus nerve intermittently with electrical pulses may reduce seizure frequency. This requires surgically implanting a stimulator under the skin and is approved for children 12 and older.
The mother of a toddler tells the nurse during a routine well-child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse? "Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." "I understand your concern, but toddlers fall and hit their heads a lot since they are not very coordinated yet." "Most mothers are concerned because their toddlers fall a lot. As long as your child seems to be developmentally normal it shouldn't be a concern." "You probably don't have anything to worry about. It is common for toddlers to fall."
"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." The head of the infant and young child is large in proportion to the body, and is the fastest-growing body part during infancy and continues to grow until the child is 5 years old. In addition, the infant's and child's neck muscles are not well developed. Both of these differences lead to an increased incidence of head injury from falls. The nurse should still let the physician know the mother's concerns in case there is another issue causing the falls.
The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? "I hate to think that I will need to be worried about my child having seizures for the rest of his life." "I need to set an alarm to wake up and check his temperature during the night when he is sick." "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever." "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully."
"I hate to think that I will need to be worried about my child having seizures for the rest of his life." Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.
The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond? "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received." "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine." "Meningococcal conjugate vaccine covers only two types of bacterial meningitis." "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."
"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised.
The nurse is educating parents of a male infant with Chiari type II malformation. Which statement about their child's condition is most accurate? "Lay him down after feeding." "Take your time feeding your baby." "You'll see a big difference after the surgery." "You won't need to change diapers often."
"Take your time feeding your baby." One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms, rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.
The nurse has performed discharge teaching for parents of a child diagnosed with epilepsy. The child has been prescribed Zonegran (zonisamide). Which comments by the parents indicate the need for further discharge teaching regarding this medication? Select all that apply. "I hope this medicine doesn't upset our child's stomach when taking it since the medication should be given on an empty stomach." "Since our child also takes Dilantin (phenytoin), the dosages will likely be adjusted since it increases the metabolism of the Zonegran (zonisamide)." "This medication can make our child very sedated so we need to monitor for this side effect." "We need to watch our child's gums for swelling since this commonly happens with this medicine." "We may need to add B-complex vitamin supplementation to our child's medications because this can help mange side effects.
"This medication can make our child very sedated so we need to monitor for this side effect." "We need to watch our child's gums for swelling since this commonly happens with this medicine." "We may need to add B-complex vitamin supplementation to our child's medications because this can help mange side effects." Presence of food will delay absorption of the medication so it should not be administered with food. Phenytoin, phenobarbital, and carbamazepine all increase the metabolism of this drug. A side effect of phenobarbital is excessive sedation and gingival hyperplasia. B-complex vitamin supplementation can help manage side effects of levetiracetam.
A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure.The nurse should first ________________ followed by ________________
ensure proper oxygenation followed by administer intravenous (IV) or intramuscular (IM) benzodiazepine The nurse first ensures a patent airway and proper oxygenation using a blow-by method.The nurse then administers an antiepileptic medication such as benzodiazepines intravenously or intramuscularly for prolonged seizure activity. Nothing should be inserted into the child's airway when the child is seizing, not even suction. The nurse can place the child in a side-lying position to prevent the tongue from occluding the airway and help with secretions that may pool up in the back of the throat.The child should not receive anything orally when the child is seizing. The nurse should administer medications via intravenous push (IVP) or intramuscular (IM) during prolonged seizure activity.It is appropriate for the nurse to allow the child to sleep once the seizure has ended. The child should be placed in the left lateral recumbent recovery position.
