Ped Neuro MCQs
A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure? A. change in level of consciousness B. reduction in heart rate C. increase in heart rate D. decline in respiratory rate
A A change in the level of consciousness is the initial finding in the client who is experiencing an increase in intracranial pressure.
The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem? A. head trauma B. intracranial hemorrhaging C. congenital hydrocephalus D. positional plagiocephaly
A A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma.
A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? A. Positive Kernig sign B. Negative Brudzinski sign C. Positive Chadwick sign D. Negative Kernig sign
A A positive Kernig sign can indicate irritation of the meninges; patient is not able to extend the legs. A positive Brudzinski sign also is indicative of the condition; patient flees the hips when neck is flexed.
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? A. Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention B. Brief, sudden contracture of a muscle or muscle group C. Sudden, momentary loss of muscle tone, with a brief loss of consciousness D. Muscle tone maintained and child frozen in position
A 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 child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse? A. "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." B. "Since the EEG was negative there must be some other cause for the seizures. The lumbar puncture is necessary to determine what the cause is." C. "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." D. "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder."
A Lumbar punctures are performed to analyze cerebrospinal fluid (CSF) to rule out meningitis or encephalitis as a cause of seizures. A normal EEG does not rule out epilepsy because seizure activity rarely occurs during the actual testing time. A 24-hour or longer EEG can help in diagnosing a seizure disorder. Just telling the parents that it needs to be done, to be patient, or it is a routine does not address the parents' concerns.
The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be: A. The child is in status epilepticus. B. The child is having generalized seizures. C. The child's history indicates she has infantile seizures. D. The child may begin to have absence seizures every day.
A Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes, or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.
A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? A. Place the newborn in a prone or lateral position. B. Delay the parents from holding the newborn. C. Place petroleum jelly gauze on the spinal sac to keep it moist. D. Place a urine collection bag on newborn for the continuous leakage.
A The nurse should place the newborn in a prone or lateral position to keep pressure off the spinal sac and avoid newborn injury. Rupture of the sac could be fatal
During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take? A. Report the findings to the pediatric health care provider. B. Reassess the head circumference in 24 hours. C. Document that the infant has microcephaly. D. Tell the parent the infant's brain is underdeveloped.
A These findings are consistent with craniosynostosis, or premature fusion of the cranial sutures. Intervention is needed to prevent damage to the growing brain. Waiting 24 hours to reassess will delay treatment. In microcephaly, the head circumference is small, but the fontanels (fontanelles) and suture line are palpable.
The young child has been diagnosed with bacterial meningitis. Which nursing interventions are appropriate? Select all that apply. Monitor the child for signs and symptoms associated with decreased intracranial pressure. Administer antibiotics as ordered. Identify close contacts of the child who will require post-exposure prophylactic medication. Initiate droplet isolation. Initiate seizure precautions.
A,B,C,E The child with bacterial meningitis should be placed in droplet isolation until 24 hours following the administration of antibiotics. Close contacts of the child should receive antibiotics to prevent them from developing the infection. The nurse should administer antibiotics and initiate seizure precautions. Children with bacterial meningitis have an increased risk of developing problems associated with increased intracranial pressure.
The nurse will teach parents of children with myelomeningocele to maintain an environment free of what element? A. alcohol gel B. latex C. peanuts D. cat dander
B A latex-free environment is important because research shows that up to ~70% of children with repeated surgeries for spina bifida are sensitive to latex. Those with known sensitivity must be managed in a latex-free environment in the health care setting and in the home, in the school, and beyond. Children at risk for latex sensitivity should wear medical alert identification.
A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question? "Did you give your child any acetaminophen, such as Tylenol?" "Did you use any medications, like aspirin, for the fever?" "What type of fluids did your child take when he had a fever?" "How high did his temperature rise when he was ill?"
B Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.
A child was just brought into the emergency department after falling off a skateboard. The parents report that their child lost consciousness briefly and they noticed watery drainage coming from the nose. What action should the nurse take first? A. Collect a sample of the nasal drainage and send the specimen to the laboratory. B. Notify the emergency department health care provider of the information the parents reported. C. Perform a thorough physical assessment. D. Perform a complete neurological assessment.
B The health care provider should be notified immediately if clear liquid fluid is noted draining from the ears or nose following a traumatic accident. Nasal drainage can be tested for glucose at the bedside. If the fluid tests positive for glucose, this is indicative of leakage of cerebrospinal fluid. The other assessments can continue after notifying the health care provider of these findings.
The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele? A. There is protrusion of the spinal cord and meninges, with nerve roots embedded. B. The spinal meninges protrude through the bony defect and form a cystic sac. C. There is no protrusion of the spinal cord, only soft-tissue inflammation occurs. D. There is a bony defect that occurs without soft-tissue involvement
B When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta.
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? A. Take vital signs every 4 hours B. Monitor temperature every 4 hours C. Decrease environmental stimulation D. Encourage the parents to hold the child
C A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? A. Onset and character of fever B. Degree and extent of nuchal rigidity C. Signs of increased intracranial pressure (ICP) D. Occurrence of urine and fecal contamination
C 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.
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? A. "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully." B. "I need to set an alarm to wake up and check his temperature during the night when he is sick." C. "I hate to think that I will need to be worried about my child having seizures for the rest of his life." D. "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."
C 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 generally 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.
A nurse is teaching the parents of a child who has been diagnosed with spina bifida. Which statement by the nurse would be the most accurate description of spina bifida? A. "It has little influence on the intellectual and perceptual abilities of the child." B. "It's a simple neurologic defect that's completely corrected surgically within 1 to 2 days after birth." C. "Its presence indicates that many areas of the central nervous system (CNS) may not develop or function adequately." D. "It's a complex neurologic disability that involves a collaborative health team effort for the entire first year of life."
C When a spinal cord lesion exists at birth, it commonly leads to altered development or function of other areas of the CNS. Spina bifida is a complex neurologic defect that heavily impacts the physical, cognitive, and psychosocial development of the child and involves collaborative, lifelong management due to the chronicity and multiplicity of the problems involved.
The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught? "Call the doctor if he gets a headache." "Limit the amount of television he watches." "Always keep his head raised 30 degrees." "Watch for changes in his behavior or eating patterns."
D Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed.
