Neurocognitive Disorders (Exam 2)

Which child requires continued follow up because of behaviors of CP? A. A 1 month old who demonstrates the startle reflex when a loud noise is heard B. A 6 month old who always reaches for toys with the right hand C. A 14 month old who has not begun to walk D. A 2 y/o who has not yet achieved bladder control during waking hours

B

Which is the best action for the nurse to take during a child's seizure? A. Administer the child's rescue dose of oral diazepam (Valium) B. Loosen the child's clothing and call for help C. Place a tongue blade in the child's mouth to prevent aspiration D. Carry the child to the infirmary to call 911 and start an IV

B

Which medication should the nurse anticipate administering first to a child in status epilepticus? A. Establish an IV line and administer IV lorazepam (Ativan) B. Administer rectal diazepam (Valium) C. Administer oral glucose to the side of the child's mouth D. Administer oral diazepam (Valium)

B

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? A. Maintain isolation precautions until 24 hours after receiving IV antibiotics B. IV fluids at 1.5x regular maintenance C. Neurological checks every hour D. Administer Tylenol for temps higher than 38C (110.4F)

B

Which should the nurse tell the parent of an infant with spina bifida? A. "Bone growth will be more than that of babies who are not sick because your baby will be less active" B. "Physical and occupational therapy will be helpful to stimulate the sense and improve cognitive skills" C. "Nutritional needs for your infant will be calculated based on activity level" D. "Fine motor skills will be delayed because of the disability"

B

A parent of a newborn diagnosed with myelomeningocele asks what is/are common long term complications? The nurse's best response is which of the following? Select all that apply. A. Learning disabilities B. UTIs C. Hydrocephalus D. Decubitus ulcers and skin breakdown E. Nutrition issues F. Attention deficit disorders

B, C

Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele? Select all that apply. A. Skull x-rays B. Daily head circumference measurements C. MRI scan D. Vital signs Q6 E. Holding the breastfeed

B, C

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 the now demonstrates decorticate posturing when stimulated. The nurse concludes that the child's condition is: A. Worsening and progressing to a more advanced stage of Reye syndrome. B. Worsening, and the child may likely experience cardiac and respiratory failure. C. Improving and progressing to a less advanced stage of Reye syndrome. D. Improving as the child's posturing reflexes are similar.

C

A newborn with a repaired myelomeningocele is assessed for hydrocephalus. Which would the nurse expect in an infant with hydrocephalus? A. Low pitched cry and depressed fontanel B. Low pitched cry and bulging fontanel C. Bulging fontanel and downwardly rotated eyes D. Depressed fontanel and upwardly rotated eyes

C

Select the best room assignment for a newly admitted child with bacterial meningitis. A. Semiprivate room with a roommate who also has bacterial meningitis B. Semiprivate room with a roommate who has bacterial meningitis but has received IV antibiotics for more than 24 hours C. Private room that is dark and quiet with minimal stimulation D. Private room that is bright and colorful and has developmentally appropriate activities available

C

The parents of a child with meningitis and multiple seizures ask if the child will develop CP. Select the nurse's best response. A. "When your child is stable, she'll undergo CT and MRI. The physicians will be able to let you know if she has CP" B. "Most children do not develop CP at this late age" C. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis" D. "Most children who have had complications following meningitis develop some amount of CP"

C

The nurse is assisting with testing on a child suspected of having a neural tube defect. Which diagnostic test would be used to confirm this condition? A. Ultrasound B. Electroencephalogram C. Fluoroscopy D. Computed tomography (CT)

D

The diet that produces anticonvulsant effects from ketosis consist of: A. High fat and low carbohydrate foods B. High fat and high carbohydrate foods C. Low fat and low carbohydrate foods D. Low fat and high carbohydrate foods

A

Which child is at an increased risk for CP? A. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes B. A 17 day old infant with group B Streptococcus meningitis C. A 24 month old child who has experienced a febrile seizure D. A 5 y/o with a closed head injury after falling off a bike

B

Which priority item should be placed at the bedside of a newborn with myelomeningocele? Select all that apply. A. A bottle of normal saline B. A rectal thermometer C. Extra blankets D. A blood pressure cuff E. Latex-free gloves

A, E

A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first? A. Administer blow-by oxygen and call for additional help B. Reassure the parents that seizures are common in children with meningitis C. Call a code and ask the parents to leave the room D. Assess the child's temperature and BP

A

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: A. Absence seizure B. Akinetic seizure C. Non-epileptic seizure D. Simple spasm seizure

A

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 nurse's best response: A. "Have the parents follow up with his HCP because this is likely an atonic seizure" B. "Find out if there have been any new stressors in his life because it could be attention-seeking behavior" C. "Have the parents follow up with his HCP because this is likely an absence seizure" D. "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"

A

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 that he flexes his knees and hips. This is referred to as: A. Brudzinski sign B. Cushing triad C. Kernig sign D. Nuchal rigidity

A

The nurse tells a family of a child with CP that since the 1960s the incidence of CP has: A. Increased B. Decreased C. Remained the same D. Has decreased because of early misdiagnosis

A

The parents of a 12 month old with CP as the nurse if they should teach their child sign language because he has not begun to vocalize. The nurse bases the response on the knowledge that sign language: A. May be a very beneficial way to help children with CP communicate B. May cause confusion and further delay in vocalization C. Is difficult to learn for most children with CP D. Is beneficial to learn, but it would be best to wait until the child is older

A

The parents of a child with CP are learning how to feed their child and avoid aspiration. The nurse would question which of the following when reviewing the teaching plan? A. Place the food on the tip of the tongue B. Place the child in an upright position during feeding C. Feed the child soft and blended foods D. Feed the child slowly

A

Which intervention should be included in the plan of care for a newborn with a newly repaired myelomeningocele? A. Offer formula/breast milk Q3 hrs B. Turn the infant back to front Q2 hrs C. Place a wet dressing on the sac D. Provide pain medication Q4 hrs

A

Which is the nurse's best response to the parents of a neonate with a meningocele who ask what they can expect? A. "After initial surgery to close the defect, most children experience no neurological dysfunction" B. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft" C. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits" D. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence"

A

Which has the potential to alter a child's level of consciousness? Select all that apply. A. Metabolic disorders B. Trauma C. Hypoxic episode D. Dehydration E. Endocrine disorders

A, B, C, D, E

Which activity should an adolescent just diagnosed with epilepsy avoid? A. Swimming, even with a friend B. Being in a car at night C. Participating in any strenuous activities D. Returning to school right away

B

A child with CP has been fitted for braces and is beginning physical therapy to assist with ambulation. The parents ask why he needs braces when he was crawling perfect without any assistance devices. The nurse's best response is: A. "The CP has progressed and now he needs more assistance to ambulate" B. "As your child grows, different muscle groups may need more assistance" C. "Most children with CP need braces to help with ambulation" D. We have found that when children with CP use braces, they are less likely to fall"

B

An infant is born with a sac protruding through the spine, containing CSF, a portion of the meninges, and nerve roots. This condition is referred to as: A. Meningocele B. Myelomeningocele C. Spina bifida occutla D. Anencephaly

B

The nurse is aware that cloudy CSF most likely indicates: A. Viral meningitis B. Bacterial meningitis C. No infection, because CSF is always cloudy D. Sepsis

B

The nurse is caring for a 3 y/o with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: A. Name the president of the US B. Identify her parents and then state her own name C. State her full name and phone number D. identify the current month but not the date

B

The nurse is caring for an infant with myelomeningocele. The parents ask the nurse why the nurse keeps measure the baby's head circumference. Select the nurse's best response. A. "Babies' heads are measured to ensure growth is on track" B. "Babies will a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size" C. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size" D. "Many infants with myelomeningocele have microcephaly, which can show up as a decrease in head size"

B

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: A. "My child will likely have another seizure" B. "My child's 7 y/o brother is also at high risk for a febrile seizure" C. "I'll give my child Tylenol when ill to prevent the fever from rising too high and too rapidly" D. "Most children with febrile seizures do not require seizure medication"

B

The nurse observes a child for neurologic disorders. What is the earliest indicator of improvement or deterioration of neurologic status? A. Vital signs B. Level of consciousness C. Motor function D. Reflexes

B

The parent of a toddler with newly diagnosed CP asks the nurse what caused it. The nurse should answer with which of the following? A. Most cases are caused by unknown prenatal factors B. It is commonly caused by perinatal factors C. the exact cause is not known D. The exact cause is known in every instance

B

The nurse is caring for a 1 y/o 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. A. "Your child will likely be sent home because encephalitis is usually caused by a virus and not a bacteria" B. "Your child will likely be admitted to the pediatric floor for IV antibiotics and observation" C. "Your child will likely be admitted to the PICU for close monitoring and observation" D. "Your child will likely be sent home because she is only 1 y/o. We see fewer complications and a shorter disease process in the younger child"

C

The nurse is caring for a 2 month old who is at risk for CP due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurse's best response. A. "Your baby is likely to have speech problems because of his early birth. Involving the speech therapist now will ensure vocalization at a developmentally appropriate age" B. "The speech therpist will help with tongue and jaw movements to assist with babbling" C. "The speech therapist will help with tongue and jaw movements to assist with feeding" D. "Many members of the health-care team are involved with your child's care so that we will know if there are any unmet needs"

C

The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which would be a priority nursing diagnosis before surgery? A. Alteration in parent-infant bonding B. Altered growth and development C. Risk of infection D. Risk for weight loss

C

The nurse knows further education is needed about Reye syndrome when a mother states: A. "I will have my children immunized against varicella and influenza" B. "I will make sure not to give my child any products containing aspirin" C. "I will give aspirin to my child to treat a headache" D. "Children with Reye syndrome are admitted to the hospital"

C

The parent of an infant with CP asks the nurse if the infant will be mentally retarded. Which is the nurse's best response? A. "Children with CP have some amount of mental retardation" B. "Approximately 20% of children with CP have normal intelligence" C. "Many children with CP have normal intelligence" D. "Mental retardation is expected if motor and sensory deficits are severe"

C

Which signs best indicated increased ICP in an infant? Select all that apply. A. Sunken anterior fontanel B. Complaints of blurry vision C. High-pitched cry D. Increased appetite E. Sleeping more than usual

C, E

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first: A. Administration of IV antibiotics B. Administration of maintenance IV fluids C. Placement of foley catheter D. Send the spinal fluid and blood samples to the lab for cultures

D

A child with a 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. A. "Give her some Tylenol and see if her symptoms improve. If they do not improve, bring her to the HCP's office." B. "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" C. "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" D. "You should immediately take her to the ED because these may be symptoms of shunt malfunction"

D

The mother of an unconscious child has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that she is felxing her arms and wrists while bringing her arms cloers to the midline of her body. The child's mother asks, "what is going on?" Select the nurse's best response. A. "I think your daughter hears you, and she is attempting to reach out to you" B. "Your child is responding to you; please continue trying to stimulate her" C. "It appears that your child is having a seizure" D. "Your child is demonstrating a reflect that indicates she is overwhelmed with the stimulation she is receiving"

D

The nurse evaluates teaching of parents of a child newly diagnosed with CP as successful when the parents state that CP is which of the following? A. Inability to speak and uncontrolled drooling B. Involuntary movements in lower extremities only C. Involuntary movements of upper extremities only D. An increase in muscle tone and deep tendon reflexes

D

The nurse is caring for a child with CP whose weight is in the 5th percentile and who has been hospitalized for aspiration pneumonia. His parents are anxious and state they they do not want a G-tube placed. Which would be the nurse's best response? A. "The G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia" B. "G-tubes are very easy to care for and will make feeding time easier for your family" C. "Are you concerned that you will not be able to care for his G-tube?" D. "Tell me your thoughts about G-tubes"

D

Which is included in the plan of care for a newborn who has myelomeningocele? A. Place the infant in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis B. Place the infant in the prone position with a sterile dry dressing over the defect. Begin IV fluids to prevent dehydration C. Place the infant in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis D. Place the child in the prone position with a sterile moist dressing over the defect. Begin IV fluids to prevent dehydration

D

Which should the nurse prepare the parents of an infant for following surgical repair and closure of myelomeningocele shortly after birth? The infant will: A. Not need any long-term management and should be considered cured B. Not be at risk for UTIs or movement problems C. Have continual drainage of CSF, needing frequent dressing changes D. Need lifelong management of urinary, orthopedic, and neurological problems

D