Neurological Questions

14. Which clinical manifestations would lead the nurse to suspect an infant ha hydrocephaly? Select all that apply a. Depressed fontanelle b. Headache c. Vomiting d. low-pitched cry e. irritability f. pupillary changes g. bulging fontanelle

- This disease is a block in the flow of cerebral spinal fluid. This results in increased intracrantial pressure. Vomiting, irritability, buldgin​​g frontanelle, and pupilary​ ​changes are all signs of increased ICP. A depressed fontanelle could be an indication of dehydration, not increased intracranial pressure. Headache may be present in an infant with ICP; however, the infant has no way of communicating this to the nurse or parent. A high pitched cry is an indications of infants with ICP

43. Which assessment would be ** most ** important for the nurse to make initially in a school-age child being seen in the patient who has a sore throat, muscle tenderness, arms feeling weak, and generally is not feeling well?

1. the child is exhibiting symptoms associated with GB syndrome infectious polyneuritis. Most children with sore thra​​t​ have some difficulty swallowing so it is important for the nurse to determine the extent of difficulty to aid in determining what action is necessary. Typically, a sore throat proceeds the paralysis in clients with Guillian Barre syndrome. Muscle tenderness is an intital symptom. Distal muscle weakess​ follows proximal muscle weakness, ultimately progressing to paralysis. Diet history and difficulty urinating will not contribute to assessment of the cause of a sore throat or difficulty swallowing. After determining the extent of difficulty swalling​,​ the nurse can obtain information about exposure to illness.

28. After teaching the parents of a child with febrile seizures aboutmethods to lower temperature other than using medicatji​o​ns which statment ​indicatates sucessful​ teaching?

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 resulting increase in body temp) by increasing the room temp or the temperature of the immediate child enviorment ( such as blankets ) until the shivering stops. Then, attempts are made to lower the temperature more slowly. Shivering does not necessairly correlate with being cold. Alcohol, a toxic substance can be absorbed through the skin. Its use is to be avoided

44. Which action should the be the ** priority** when caring for a school-age child admitted to the pediatric unit with the diagnosis of Guillian - Barre syndrome?

2. With Guillian Barre syndrome, progressive ascending paralysis occurs. Therefore , the nurse should asses the child's muscle strength bilaterally to determine the extent of involvement and prgession o​f the illness. Assessing the child's ability to follow simple comands ​​evaluates brain function. Range of motion exercises are an important part of treatment, but they are not a priority initially. Although the child may need diversional activities later, they also are not an intiti​al priority

39. A hospitalized preschooler with meningitis who is to be discharged becomes angry when the discharge is delayed. Which play activities would be ** most ** appropriate at the time?

3 The child is angry and needs a positive outlet for expression of feelings. An emotionally tense child with pent-up hostilities needs a physical activity that will relases energy and frustration. Pounding on a pegboard offers this opportunity. Listening to a story does not allow the ​​the child to express emotions. It also places the child in a passive role and does not allow the child to deal with feelings in a helathy​ and psitive ​way. Activities such as painting and staging a tower of blocks requires concentration and fine movements, which could add to frustration. However, if the child then knocks the tower over, doing so may help to dispel some of the anger.

35. A preschooler with pneumococcal meningitis is recieving​ intavenous​ antibiotic therapy. When discontining​ the intraceneo​us therapy, the nurse allows the child to apply a dressing to the area where the cathert​er is removed. The nurse rationale for doing so is based on the interpretation that a child in this age group has a need to accomplish with goal?

3. Preschool-age children worry about having an intact body and become fearful of any threat to required care helps protect of any threat to participate in body integrity. Allowing the child to participate in required care helps protect her image of an intact body. Devlopment of trust is the task typically associated with infancy. Additionally, allowing the child to apply a dressing over the intravenous insertionsite ​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 tolddle​r​s than in preschoolers.

17. A nurse evaluates discharge teaching as successful when the parents of a school-age child with a ventriculoperitoneal shunt insertion identify which signs as signaling a blocked shunt?

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

47. A 9 year old child with GB syndrome requires mehanical ventilation. Which action should the nurse take?

4. Even in the absence of respiratory problems or distress, the child must be turned frequently to prevent the cardiopulmonary complications associated with immobility, such as atelectasis and pneumonia. Maintaing the child in a supine position is unnecessary. Doing so does not prevent unnecessary nerve stimulation. In addition, maintaing a​ supine position may lead to stasis of secretions, placing the child at risk for pneumonia. Transferring the child to a chair will not prevent postural hyptension.​ however, doing so will increase vascular tone and help prevent respiratory and skin complications. During the acute disease phase, vigorous physiotherapy is contrainidicate​​d because the child may experiene ​muscle pain and can be hypersensitive to touch. Careful and gentle handling is essential

27. Which statement obtained from the nursing history of a toddler should alert the nurse to suspect that the child has had a febrile seizure?

4. Most febrile seizures occur in the presence of an upper respiratory infection, otitis media, or tonsilitis. Febrile seizures typically ocur during 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.

36. A child with meningitis is to receive 1,000mL of dextrose 5% in normal salien over 12 hours. At what rate in mililiters per hour should the nurse set the pump? Round your answer to the nearest whole number

1000mL divided by 12 hours = 83 mL/h

30. When teaching an adolescent with a seizure disorder who is recieving​ calproi​c acid, which signs or symptom should the nurse instuct​ the patient ***immediately** to repost to the healthcare provider?

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

25. A nurse is developing a plan of care with the parents of a 6year old girl diagnosed with a seizures disorder. To promote growth and development, the nurse should instruct the parents that:

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 abilitie sas any other child. Activity limitation is not needed. Learning disabilities are not associated with seizures. The child is able to attent​d public school, and social stigma is a rarity

29. An adolescent girl with a seizure disorder control wit​h phyenyt​oin and carabamazepi​ne asks the nurse about getting married and having children. Which response by the nurse would be **most** important?

3. Phenytoin sodium is known teratogenic agent, causing numerous fetal problems, Therefore the adolescent should be advised to talk to the health care provider to see if changing the medication is possible. Additionally, anticonvulsant requiremnts usually increase during pregnancy. Seizures can be controlled but cannot be cured. there is a familiar tendency for seizure disorders. Seizure disorders and infertility are not related.

13. Before placement of ventriculoperitoneal shunt for hydrocephalus, and infant is irritable, lethargic, and difficult to feed. To maintain the infant's nutritional status. Which actions should be *** MOST ** appropriate?

- Small, frequent feedings given at times when the infant is relaxed and call are tolerated best an infant with this disorder is difficult to feed because of poor sucking, lethargy, and vomiting, which asre associated with increased intracranial pressure. Wrong: Feedign an infant before any procedure is inappropriate because the stress of the procedure am​y lead to vomiting. Ideally, the infant should be held to in a slightly vertical position when feeding to prevent backflow of formula into the eustachian tubes and subsequent development of ear infections. Giving, large, less fequent ​feelings allows for the rest but typically rusults in more vomiting

38. The nurse is monitoring an infant with meningitis for signs and increased intracraninal pressure ( ICP). The patient should assess the infant for which signs and symptoms? Select all that apply. 1. Irritability 2. Headache 3. Mood swings 4. Bulging fontanelle 5. emesis

1, 4, 5. Irritability, buldging fontanelle, 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 communication 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

37. Nursing management of the child with bacterial meningitis includes which interventions? Select all that apply 1. Administation of IV antibiotics 2. Intravenous fluids at 1 1/2 times maintenance 3. Decreaing enviormental​ stimuli 4. Neurologic checks every 4 hours 5. Administration of IV anticonculsant​​s

1,3,4 Antibiotics are indicated for the treatment of bacterial meningitis. Clients with baterial meningitis have often increased ICP. It is necessary to maintain adequate hydration. However infusint gluids at 1 1/2 maintenanc ca​n increase ICP, further risking neurological damage due to verbral ​​​edema. Most children with meningitis are sensitive to sound, light, and stimulation. Decreasing enviormental ​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 consiousness.​ Anticonvulsants are not indicated unless the child experiences seizures as a result of the meningitis.

26. 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 type of activity should the nurse and family decide the child should avoid?

1. A child who has generalized seizures should not participate in activites 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 activies, ​so someone should be with the child. Tenis would be considered an appropriate nonhazardous activity for a child with generalized seizure.

33. Which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation?

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 cuases the condition. Heparin therapy is often used to inturupt​​ the clotting process. Edema would suggest a fluid volume excess. Cyanosis would indicate decreased tissur​​e oxygenation. Dyspnea on exertion would suggest respiratory problems, such as pulmonary edema

15. The nurse is proving postoperative care for an infant who had a ventriculoperioneal shunt placed to correct hydrocephalus. Which clinical finding warrants immediate interventions?

1. Abdominal distention in a pediatric patient with a venticuloperitoneal shunt can be an indicatio ​of pertonitis and requires intervention. Lethargy may be present for several days following surgery for a ventriculoperitoneal shunt. Facial and eye edema is common during the posterperativ​e process to the eyes. Infants commonly have pain in the postoperative period that should be treated with analgesics; however, infants cannot conver​y that they are specifically having a headache.

31. A 3 month old infant with meningoccal ​meningitis has just been admitted to the pediatric unit. When nursing interventions ahs the *** highest priority***?

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

41. The nurse is caring for a lethargic 4-year old who is a cictim of a near-drowning accident. The nurse should *** first***?

1. Near drowning victims typically suffer hypoxia and mixed acidosis. the priority is to resore oxygenation and prevent further hypoxia. here the patient has blunted sensorium but is not unconscious; therefore, delivery of supplemental tocols and fluid resucitation ​will most likely be needed to help correct acidosis, but these interventions are secondary to oxygen administration. Intubation is required if the child is comatose, shows signs of airway compromise, or does not respond adequately to more conservative therapies.

32. During the acute stage of meningitis, a 3 year old child is resless​ and irratable. Which interventions would be *** most*** appropriate to institue?​

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, gentale, reassuring voice. the child needs gentle and calm bathing. Because the acuteness fo the infection sponge baths would be more appropriate than tub baths. Although treatments need to be completed 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.

46. Assessment of a school-age child with G.B syndrome revels absent gag and cough reflex. Which problem should recieve the ** highest priority ** during the acute phase?

2. An ineffective breathing pattern cause day the ascending paralysis of the disorder interfereres with the child's ability to maintain an adequate oxygen supply. Therefore this nursing diagnosis takes precedence. Aditionally, as the neurologic impairment process, it will probably have an effect on the child's ability to maintain respirations. An increased risk for infection related to an altered immune system is not associated with Guillian - barre syndrome. Although impaired swallowing and incontence may occur with the ascending paralysis of theis disorder, oxygenation is the priority

42. The parents of a child tell the nurse that they feel guilty because their hild almost drowned. Which remark by the nurse would be ** most*** appropriate?

2. Guilt is a common parental response. the parents need to be allowed to express their feelings openly in a nonthreatening, nonjudgemental atmosphere. Telling the parents that these things happen does not allow them to verbalize their feelings. telling the parents that they should not have taken their eyes off the child blames them, possibly further contributing to their guilt. Telling the parents that they shoud not feel guilty denies the aprents' feelings of guilt and is inappropriate. Telling the parents that they are lucky that the child will be okay does not remove the feelings of guilt.

40. The nurse is admitting a toddler with the diagnosis of near -drwning in a neighbor's heated swimming pool to the emerceny ​​department. The nurse should assess the child for?

2. Hypoxia is the primary problem because it results in brain cell damage. Irreversible brain damage occurs after 4 to 6 minutes of submersion. Hypothermia occurs rapidly in infants and children because of their large body surface area. Hypothermia is more of a problem when the child is in cold water. Although fluid aspiration occurs in most drownings and results in atelectasis and plumonary​ edema, further aggravating hypoxia, hypoxia is the primary problem. Cutaneous cappillar​y paralysis is not a problem.

34. When interviewing the parents of a 2 year old child, a sitor​y of which illness should lead the nurse to suspect pneumoccal ​meningitis?

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

23. What should be part of the nurse teaching plan for a child with epilepsy being discharged on a regimen of phenytoin?

2. Phenytoin can cause gingival hyperplasia. Children taking phenytoin 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 phenytoin. A child on phenytoin does no need to be observed during walking hours because the seizures should be under control. Infections do not occur with an increased incidence in patients receiving phenytoin

48. The parent brings a child to the clinic after discharge fromt the hospital for GB syndrome. Which statemet ​by the parent indications that discharge paln​ is being followed?

3. Developmentally appropriate activities and therapeutic play should be used as rehabilitation modalitis. Taking the child to the pool to exercise with other cildren ​indicated that the child is participating in exercise as well as engaging with other children, thus fostering development. Arguring with the sister does not address the discharge plan. Inappropriate rewars ​or threats should not be used to corc​e a child into complicace. Although the mother is attempting to comply with the discharge plan, bribery is an inappropriate technique to foster compliance. Missing therapy sessions delays recovery. The parents need to help set the child's schedua​​l​e to ensure that she gets adequate rest to be able to follow her treatment plan.

24. After the nurse instructs a group of school-teachers about seizures, the teachers role-play a senario involving a child experiencing a generalized tonic-clonic seizure. Which action when performed ***first***, indicates the nurse's teaching has been successful?

3. During a generalized tonic-clonic seizure, the first priority is to keep the child safe and protect the child by removing any neraby 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 provindi​​n​g privacy is important, the child's safety is the priority. During a seizure, nothing should be forced into the patient's mouth because this can cause severe damage to the teeth and mouth

45. The nurse asks a school age child with the child's speech for decreased volume and clarity. The underlying rationale for these assesments​ is to determine which finding?

3. In a child with gillian barre syndrome, decreased colume​ and clarity of speech and decreased ability to courgh​t voluntai​ri​l​y indicate ascending progression of neural inflammation, speacifical​l​y affecting the cranial nerves

16. What action should the nurse take when providing postoperative nursign care to a child after insertion of a ventriculoperitoneal shunt?

3. Monitoring the temperature allows the nurse to assess for infection, the most common and most hazardous post -operative comlicaiton afte ventriculoperitoneal shunt placement. Typically pain after ininsertion of V.Shunt is mild, requireing the use of mild anaggesics. Usually, narcotics are not considered