Peds NGN, pediatric success neurological disorders chapter 5, Peds - Chapter 16: Nursing Care of the Child With a Neurologic Disorder, Peds Ch 38, Ricci Ch 38 - Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disord...

A group of students are reviewing information about head injuries in children. The students demonstrate understanding of this information when they identify which of the following as the most common type of skull fracture in children? A) Linear B) Depressed C) Diastatic D) Basilar

A) Linear

After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify this as a neural tube defect. a) Anencephaly b) Spina bifida occulta c) Arnold-Chiari malformation d) Encephalocele

Arnold-Chiari malformation

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? a) "Did you use any medications like aspirin for the fever?" b) "Did you give your child any acetaminophen, such as Tylenol?" c) "What type of fluids did your child take when he had a fever?" d) "How high did his temperature rise when he was ill?"

"Did you use any medications like aspirin for the fever?"

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. When I came back, I found her." Which of the following assessments would be the priority? A) Airway, breathing, and circulation B) Level of consciousness C) Vital signs D) Pupillary response

A) Airway, breathing, and circulation

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy is a condition that runs in families." b) "Cerebral palsy means there will be many disabilities." c) "Cerebral palsy is a condition that doesn't get worse." d) "Cerebral palsy occurs because of too much oxygen to the brain."

"Cerebral palsy is a condition that doesn't get worse."

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor for hemorrhagic stroke? a) Sickle cell disease b) Meningitis c) Congenital heart defect d) Arteriovenous malformations (AVMs)

Arteriovenous malformations (AVMs)

A pregnant client asks if there is any danger to the development of her fetus in the first few weeks of her pregnancy. How should the nurse respond? a) "During the first 3 to 4 weeks of pregnancy brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma." b) "The respiratory system matures during this time so good prenatal care during the first weeks of pregnancy is very important." c) "Bones begin to harden in the first 5 to 6 weeks of pregnancy so vitamin D consumption is particularly important." d) "As long as you were taking good care of your health before becoming pregnant, your fetus should be fine during the first few weeks of pregnancy."

"During the first 3 to 4 weeks of pregnancy brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma."

The nurse is reinforcing teaching with the caregivers of a child who has had a head injury and is being discharged. Which statement made by the caregiver indicates an accurate understanding of the follow-up care for their child? a) "Even if the flashlight bothers him, we will check his eyes." b) "If he vomits again, we will bring him back immediately." c) "We can give him Tylenol for a headache, but no aspirin." d) "If he falls asleep, we will wake him up every 15 minutes."

"Even if the flashlight bothers him, we will check his eyes."

The nurse is collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "He kept smacking his lips and rubbing his hands." b) "He was just staring into space and was totally unaware." c) "He usually is very coordinated, but he couldn't even walk without falling." d) "His arms had jerking movements in his legs and face."

"He was just staring into space and was totally unaware."

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they make what statement? A) "Having the shunt put in decreases his risk for developmental problems." B) "If he doesn't get an infection in the first week, the risk is greatly reduced." C) "He will need more surgeries to replace the shunt as he grows." D) "The shunt will help to prevent any further complications from his disease."

"He will need more surgeries to replace the shunt as he grows." Parents need to know that hydrocephalus is a chronic illness that requires lifelong follow-up and regular evaluations, including future surgeries as the child grows. The risk for infection is ever present, but is most common 1 to 2 months after shunt placement. The child with a shunt and hydrocephalus is at risk for potential growth and developmental disabilities as well as complications such as infection and malfunction of the shunt.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the wellchild clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a) "I always keep phenobarbital with me in case of a fever." b) "My child will likely outgrow these seizures by age 5." c) "The most likely time for a seizure is when the fever is rising." d) "I have ibuprofen available in case it's needed."

"I always keep phenobarbital with me in case of a fever." (Phenobarbital is used for prolonged seizures or neurologic abnormalities)

The physician has ordered rectal diazepam (Valium) for a 2-year-old boy with status epilepticus. Which of the following instructions is essential for the nurse to teach the parents? A) Monitor their child's level of sedation. B) Watch for fever indicating infection. C) Gradually reduce the dosage as seizures stop. D) Monitor for an allergic reaction to the medication.

A) Monitor their child's level of sedation.

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? a) "Small increments in dosage lead to sharp increases in plasma drug levels." b) "The capacity to metabolize the drug becomes overwhelmed over time." c) "A drop in the plasma drug level will lead to a toxic state." d) "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."

"Small increments in dosage lead to sharp increases in plasma drug levels."

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" What could the nurse say to begin educating the woman? a) "Aspirin in combination with the virus will make the brain swell and the liver fail." b) "Sometimes it's hard to tell what products may contain aspirin." c) "Don't worry; you're in good hands. We have it under control now." d) "Do you think that maybe your child took aspirin on his own?"

"Sometimes it's hard to tell what products may contain aspirin."

The nurse is educating parents of a male infant with Chiari type II malformation. Which of the following statements about their child's condition is most accurate? a) "Take your time feeding your baby." b) "You'll see a big difference after the surgery." c) "Lay him down after feeding." d) "You won't need to change diapers often."

"Take your time feeding your baby."

Seven-year old Isabelle has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when Isabelle first complained of a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which of the following statements would be best for the nurse to say to this mother? a) "This is a serious problem. Aspirin is likely to cause Reye syndrome, and Isabelle should be admitted to the hospital for observation as a precaution." b) "This might or might not be a problem. Watch Isabelle for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." c) "This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus." d) "This might or might not be a problem. Watch Isabelle for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."

"This might or might not be a problem. Watch Isabelle for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome."

The nurse is educating the family of a 7-year-old epilepsy patient about care and safety for this child. Which of the following comments will be most valuable in helping the parent and the child cope? a) "You'll always need a monitor in his room." b) "Use this information to teach family and friends." c) "If he is out of bed, the helmet's on the head." d) "Bike riding and swimming are just too dangerous."

"Use this information to teach family and friends."

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. What would the nurse include in the child's discharge instructions? A) "Expect his headache to get worse initially and then disappear." B) "Wake him every 2 hours to check his movement and responses." C) "Call your medical provider if he vomits more than five times." D) "Any watery fluid draining from his ears is normal."

"Wake him every 2 hours to check his movement and responses." The nurse should instruct the parents to wake the child every 2 hours to ensure that he moves normally and wakes enough to recognize and respond appropriately to them. The parents should be instructed to call the physician or nurse practitioner or bring the child back to the emergency department if he experiences a constant headache that gets worse, vomits more than two times, or has oozing of blood or watery fluid from his ears or nose.

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? a) "Limit the amount of television he watches." b) "Call the doctor if he gets a headache." c) "Watch for changes in his behavior or eating patterns." d) "Always keep his head raised 30 degrees."

"Watch for changes in his behavior or eating patterns."

The emergency room nurse is taking a history of a 1-year-old child whose parent said that she had a "fit" at home. Which inquiry would be best to start with? a) "How did you treat the child afterwards?" b) "Were there any jerky movements?" c) "Was the child unconscious?" d) "What happened just before the seizures?"

"What happened just before the seizures?"

The nurse is providing education to the parents of a 3-year-old girl with hydrocephalus who has just had an external ventricular drainage system placed. Which question is best to begin the teaching session? a) "Do you understand why you clamp the drain before she sits up?" b) "What questions or concerns do you have about this device?" c) "What do you know about her autoregulation mechanism failing?" d) "Why do you always keep her head raised 30 degrees?"

"What questions or concerns do you have about this device?"

A mother attends the pediatric clinic with her 10-year-old daughter who has diabetes mellitus. After completing a diabetic teaching session, the nurse evaluates learning. Which statement by the mother indicates a satisfactory understanding of DM? 1. "I worry about my daughter maintaining control since children with diabetes have more complications than adults do." 2. "My daughter should drink vanilla milkshakes to maintain a high caloric intake." 3. "Complications from diabetes could include cataracts and kidney stones." 4. "My child won't need a mid-afternoon snack since she takes a gym class in the afternoon."

1. "I worry about my daughter maintaining control since children with diabetes have more complications than adults do."

A 4-year-old boy has a febrile seizure during a well-child visit. Which of the following would be a priority? A) Hyperextending the child's head while placing him on his side B) Using a tongue blade to pry open the child's jaw C) Loosening the child's clothing to ensure a patent airway D) Protecting the child from harm during the seizure

D) Protecting the child from harm during the seizure

A 13-year-old boy is being evaluated for delayed puberty. He has had an examination with a pediatric endocrinologist. who states that the child has a constitutional delay. How would the nurse best reinforce the health care provider's explanation of the diagnosis? 1. "You hormone levels are normal, so no medication is needed at this time. If you want to talk about it, I am happy to discuss it with you." 2. "I am worried about your stature. I think you should get another opinion." 3. "Your father's stature doesn't matter. We just look at your height." 4. "If you want testosterone shots, I will speak to others so we can arrange for them to be given."

1. "You hormone levels are normal, so no medication is needed at this time. If you want to talk about it, I am happy to discuss it with you."

A 10-year-old girl visits the school nurse after recess. This is the child's first day back in school after hospitalization, where she was diagnosed with diabetes mellitus. The child reports she took the dose of insulin as instructed at the hospital, but feels sweaty and sleepy. After noting pallor and hand tremors as additional signs, the nurse suspects which problem? 1. Exercise-induced hypoglycemia 2. Hyperglycemia caused by increased intake at lunch 3. Ketoacidosis caused by an infection 4. The child is embarrassed about having DM upon return to school

1. Exercise-induced hypoglycemia

Mothers in the waiting room of the endocrine clinic are discussing their children's illnesses. The nurse determines that the mothers of children with phenylketonuria (PKU) and congenital hypothyroidism recognize a common goal in the early treatment of their children when they state they are hoping to avoid which complication? 1. Mental retardation 2. Secondary liver disease 3. Obesity 4. Premature cataract development

1. Mental retardation

A new mother of an infant diagnosed with phenylketonuria (PKU) has been informed that PKU follows autosomal recessive inheritance. The mother states that this is a relief since she now knows her next baby will not have the disease. What additional information should the nurse provide? 1. With autosomal recessive inheritance, each baby has a 25% chance of having the disease. 2. Only female babies will have PKU. 3. The mother passes the gene only to male offspring. 4. Since this baby has the disease, the next baby will probably be a carrier for the disease.

1. With autosomal recessive inheritance, each baby has a 25% chance of having the disease.

An adolescent with diabetes mellitus has had several episodes demonstrating lack of diabetic control. Which statement would the nurse include when reviewing information about how to self-monitor control of DM? 1. "Check your urine glucose three times a week." 2. "Check the glycosylated hemoglobin every three months and then every six months when stable." 3. "Check the blood glucose twice a day and the glycosylated hemoglobin every three months." 4. "Do not check anything as long as you feel well."

2. "Check the glycosylated hemoglobin every three months and then every six months when stable."

A 12-year-old boy was just diagnosed with type 1 diabetes mellitus. As the nurse teaches him about insulin injections, he asks why he can't take the diabetic pills that his aunt takes. What would be the best response by the nurse? 1. "You will be able to take the pills once you reach adult height." 2. "You have a different type of diabetes where the pill won't work." 3.. "We have to test you to see if you can take the diabetic pills." 4. "You might be able to switch between taking the pills and insulin."

2. "You have a different type of diabetes where the pill won't work."

A child has demonstrated a sudden onset of thyrotoxicosis. The nurse anticipates that, besides anti-thyroid therapy, the child is likely also to receive which type of drug? 1. Antacid 2. Beta-adrenergic blocker 3. Muscle relaxant 4. Cardiac glycoside

2. Beta-adrenergic blocker

A 10-year-old diabetic client visits the school nurse after recess and reports feeling sweaty and jittery. What should be the nurse's recommendation to the child? 1. Take an extra injection of regular insulin. 2. Drink six ounces of orange juice. 3. Skip the next dose of insulin. 4. Sit quietly in class after exercising.

2. Drink six ounces of orange juice.

A mother of a 4-month-old tells the nurse that her child has been diagnosed with hypothyroidism. The mother asks the nurse what symptoms led to the diagnosis. The nurse explains that which symptoms are consistent with this diagnosis? SATA 1. High-pitched, shrill cry 2. Prolonged jaundice at birth 3. Less than expected motor activity 4. Constipation 5. Tall for gestation age at birth

2. Prolonged jaundice at birth 3. Less than expected motor activity 4. Constipation

A 2-month-old infant arrives at the pediatric clinic. Upon assessment, the baby exhibits the following characteristics. Which characteristics does the nurse relate to a diagnosis of congenital hypothyroidism? SATA 1. Open fontanels 2. Protruding tongue 3. Tachycardia 4. Hypertonia 5. Hypotonia

2. Protruding tongue 5. Hypotonia

An infant was born 24 hours ago. The nurse has been instructed to collect blood by heel stick for neonatal screening for congenital hypothyroidism before the baby is discharged. The nurse explains to the mother that a follow-up test will likely be needed for which reason? 1. At 24 hours, the T4 level will be extremely low 2. There is an immediate rise in the TSH after birth 3. The baby needs to digest formula before a blood sample can be taken 4. A thyroid scan should be done first

2. There is an immediate rise in the TSH after birth

A 4-month-old infant who has been diagnosed with phenylketonuria (PKU) has eczema and sensitivity to sunlight. The mother asks the nurse why her child's skin is so sensitive. What is an appropriate explanation by the nurse? 1. "Some children just have sensitive skin. There is no reason to be excessively concerned." 2. "Your child will outgrow his sensitivity when he is 5 years old. Just use sunscreen for now." 3. "Your child has a deficiency in melanin because of decreased tyrosine. You will always have to take special care of his skin." 4. The phenylketones in your baby's blood concentrate the sun's rays, making burning more likely. Children with PKU can never be in the sun."

3. "Your child has a deficiency in melanin because of decreased tyrosine. You will always have to take special care of his skin."

17. The nurse is caring for a child with Reye syndrome stage III. The child is comatose with sluggish pupils. The child is currently maintaining his own respirations, and all vital signs are within normal range. In order to treat a common manifestation, what medication would the nurse expect to have readily available? 1. Lasix. 2. Insulin. 3. Glucose. 4. Morphine.

3. A common manifestation is hypo glycemia, which is treated with the ad ministration of intravenous glucose.

5. The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. Which of the following signs best indicates increased ICP in this child? 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite.

3. A high-pitched cry is often indicative of increased ICP in infants.

The nurse has completed family teaching on dietary restrictions necessary for a child with phenylketonuria. The parents are given sample menus to choose a meal for their child. Which menu choice best indicates an understanding of the dietary instructions? 1. A hamburger and a diet soda sweetened with aspartane. 2. Steak and mashed potatoes with orange juice. 3. A large bowl of dry cereal with strawberries and apple juice. 4. Milkshakes and grilled cheese sandwich.

3. A large bowl of dry cereal with strawberries and apple juice.

A teenage mother arrives at the clinic with her new baby who was recently diagnosed with congenital hypothyroidism. When instructing the mother about administering levothyroxine medication, what information should the nurse include? 1. Crush the medication and place it in a full bottle of formula or juice to disguise the taste. 2. Administer the medication every third day. 3. Give the crushed medication in a syringe or in the nipple mixed with a small amount of formula. 4. Understand that the medication will not be needed after age 5.

3. Give the crushed medication in a syringe or in the nipple mixed with a small amount of formula.

After being diagnosed with Graves' disease, a teenager begins taking methimazole (Tapazole) for treatment of the disease. What symptom would indicate to the nurse that the dose may be too high? 1. Weight loss 2. Polyphagia 3. Lethargy 4. Difficulty attending to school work

3. Lethargy

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which of the following? Select all answers that apply. A) Complaints of stiff neck B) Photophobia C) Absent headache D) Negative Brudzinski sign E) Vomiting

A) Complaints of stiff neck B) Photophobia E) Vomiting

43. A 6-month-old male has been diagnosed with positional brachycephaly. The nurse is providing teaching about the use of a helmet for his therapy. Which of the following statements indicate that his parents understand the education? 1. "We will keep the helmet on him when he is awake and remove it only for bathing and sleeping." 2. "He will start wearing the helmet when he is closer to 12 months, as he will be more upright and mobile." 3. "He will wear the helmet 23 hours every day." 4. "Most children need to wear the helmet for 6 to 12 months."

3. The helmet is worn 23 hours every day and removed only for bathing.

56. The nurse is caring for a 3-year-old with neuroblastoma. The child's parents ask the nurse what the typical signs and symptoms are at first. Select the nurse's best answer. 1. "Most children complain of abdominal fullness and difficulty urinating." 2. "Many children in the early stages of a neuroblastoma have joint pain and walk with a limp." 3. "The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue." 4. "The signs and symptoms are fairly consistent regardless of the location of the tumor. They include fatigue, hunger, weight gain, and abdominal fullness."

3. The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue.

14. The nurse is caring for a 1-year-old female who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted. 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 tend to see fewer complications and a shorter disease process in the younger child."

3. The young child with encephalitis should be admitted to a PICU where close observation and monitoring are available. The child should be ob served for signs of increased ICP and for cardiac and respiratory compromise.

The nurse is administering propylthiouracil (PTU) to a 12-year-old recently diagnosed with Graves' disease. The child has been receiving the drug three times a day for three weeks. She suddenly reports onset of a severe sore throat. What would be the appropriate nursing action? 1. Continue to give the medication or she will continue to exhibit signs of Graves' disease 2. Offer lozenges for the relief of a sore throat. 3. Withhold the dose and report this to the physician. 4. Question whether she is trying to avoid doing assigned schoolwork while in the hospital.

3. Withhold the dose and report this to the physician.

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which of the following food selections would be most appropriate for his lunch? A) Fried eggs, bacon, and iced tea B) A hamburger on a bun, French fries, and milk C) Spaghetti with meatballs, garlic bread, and a cola drink D) A grilled cheese sandwich, potato chips, and a milkshake

A) Fried eggs, bacon, and iced tea

32. The nurse is caring for a 16-year-old female who remains unconscious 24 hours after sustaining a closed-head injury in an MVA. She responds to deep painful stimulation with decorticate posturing. The child has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the child's peers to visit and talk to the child about school and other pertinent events. 2. Encourage the child's 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 child 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.

4. A dark, quiet environment and minimal stimulation will decrease oxygen con sumption and ICP.

40. The parents of a 12-month-old female with a neurogenic bladder ask the nurse if their child will always have to be catheterized. Select the nurse's best response. 1. "Your child will never feel when her bladder is full, so she will always have to be catheterized. Because she is female, she will always need assistance." 2. "As your child ages, she will likely be able to sense when her bladder is full and will be able to empty it on her own." 3. "Although your child will not be able to feel when her bladder is full, she can learn to urinate every 4 to 6 hours and therefore not require catheterizations." 4. "Your child will never be able to completely empty her bladder spontaneously, but there are other options to traditional catheterization. An opening can be made surgically through the abdomen, thus allowing the parents and child to be able to place a catheter into the opening."

4. A vesicostomy is an example of an op tion for children with myelomeningo celes where alternatives to traditional catheterizations are created.

Considering a child's developmental level in diabetic care is essential. The nurse should include which information in teaching the parents of a recently diagnosed toddler with diabetes? SATA 1. Allow the toddler to assist with the daily insulin injections. 2. Prepare meat, vegetables, and potatoes for each dinner. The toddler should not be allowed many choices in food selection. 3. Test the toddler's blood glucose each time he or she goes outside to play. 4. Allow the toddler to assist with cleaning off a finger before blood glucose monitoring. 5. Allow the toddler to choose food selections from options offered.

4. Allow the toddler to assist with cleaning off a finger before blood glucose monitoring. 5. Allow the toddler to choose food selections from options offered.

Four newborns have blood drawn for the Guthrie test for phenylketonuria (PKU). The nurse would question the results for which infant? 1. An infant whose test is performed at 48 hours of age 2. An infant who was breastfed for the 24 hours before the test 3. An infant who was fed glucose water followed by formula for 30 hours 4. An infant who was tested immediately after birth

4. An infant who was tested immediately after birth

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for which of the following? A) Indications of increased intracranial pressure B) An increase in the blood glucose level C) A decrease in the liver enzymes D) A presence of protein in the urine

A) Indications of increased intracranial pressure

The nurse is teaching a 15-year-old client about the different types of insulin. The client takes NPH insulin at 8:00 am. The nurse interprets that the adolescent understands this type of insulin when the child states that which of the following would be the most likely time for a hypoglycemic reaction? SATA 1. While in gym class at 9:00 am 2. While taking a test at 10:00 am 3. While eating lunch at noon 4. While golfing after school at 2:15 pm 5. While waiting for an early supper at 4:00 pm

4. While golfing after school at 2:15 pm 5. While waiting for an early supper at 4:00 pm

6. The nurse is preparing to give preoperative teaching to the parents of an infant with hydrocephalus. The nurse knows that the most common treatment for hydrocephalus includes the surgical placement of a shunt connecting which of the following? 1. The ventricle of the brain to the peritoneum. 2. The ventricle of the brain to the right atrium of the heart. 3. The ventricle of the brain to the lower esophagus. 4. The ventricle of the brain to the small intestine.

6. 1. The ventriculoperitoneal is the most common shunt used to treat hydrocephalus.

The nurse is caring for a near-term pregnant woman who has not taken prenatal vitamins or folic acid supplements. Which congenital defect is most likely to occur based on the mother's prenatal history? a) Incomplete myelinization b) Neonatal conjunctivitis c) Facial deformities d) A neural tube defect

A neural tube defect

At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds: 1. Narrow sutures 2. Sunken fontanels 3. A rapid increase in head circumference 4. Increase in weight since last visit

A rapid increase in head circumference

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? A) On her side with the head flexed forward and knees flexed to the abdomen B) Sitting upright with the head flexed forward to the chest C) Supine with arms and legs pronated and extended D) Prone with the arms flexed under the chest

A) On her side with the head flexed forward and knees flexed to the abdomen

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands the need for this treatment is based on which of the following? A) PaCO2 levels decrease, causing vasoconstriction. B) Drainage of cerebrospinal fluid occurs. C) Activity is controlled via a stimulator. D) Hyperexcitability of the nerves is reduced.

A) PaCO2 levels decrease, causing vasoconstriction.

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: Streptococcus group B Haemophilus influenzae type B Streptococcus pneumoniae Neisseria meningitidis Which of these would the nurse highlight as the most common cause of meningitis in newborns? A) Streptococcus group B B) Haemophilus influenzae type B C) Streptococcus pneumoniae D) Neisseria meningitides

A) Streptococcus group B

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply. A) Complaints of stiff neck B) Photophobia C) Absent headache D) Negative Brudzinski sign E) Vomiting

A, B, E In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomiting.

9. A goiter is an enlargement or hypertrophy of which gland? a. Thyroid c. Anterior pituitary b. Adrenal d. Posterior pituitary

ANS: A A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenals or the anterior and posterior pituitaries.

34. The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

ANS: A All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes (sodium, potassium, chloride, phosphate, and magnesium). The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitors after the rehydrating solution has been initiated.

2. A child with growth hormone (GH) deficiency is receiving GH therapy. The best time for the GH to be administered is: a. At bedtime. c. Before meals. b. After meals. d. On arising in the morning.

ANS: A Injections are best given at bedtime to more closely approximate the physiologic release of GH. Before or after meals and on arising in the morning are times that do not mimic the physiologic release of the hormone.

39. The nurse should expect to assess which clinical manifestations in an adolescent with Cushing's syndrome (Select all that apply)? a. Hyperglycemia b. Hyperkalemia c. Hypotension d. Cushingoid features e. Susceptibility to infections

ANS: A, D, E In Cushing's syndrome, physiologic disturbances seen are cushingoid features, hyperglycemia, susceptibility to infection, hypertension, and hypokalemia.

36. Nursing care of a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) should include (Select all that apply): a. Weigh daily. b. Encourage fluids. c. Turn frequently. d. Maintain nothing by mouth. e. Restrict fluids.

ANS: A, E Increased secretion of ADH causes the kidney to resorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids, turning frequently, and maintaining nothing by mouth are not associated with SIADH.

26. What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

ANS: B A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.

14. Chronic adrenocortical insufficiency is also referred to as: a. Graves' disease. c. Cushing's syndrome. b. Addison's disease. d. Hashimoto's disease.

ANS: B Addison's disease is chronic adrenocortical insufficiency. Graves' and Hashimoto's diseases involve the thyroid gland. Cushing's syndrome is a result of excessive circulation of free cortisol.

18. What is the most appropriate intervention for the parents of a 6-year-old girl with precocious puberty? a. Advise the parents to consider birth control for their daughter. b. Explain the importance of having the child foster relationships with same-age peers. c. Assure the child's parents that there is no increased risk for sexual abuse because of her appearance. d. Counsel parents that there is no treatment currently available for this disorder.

ANS: B Despite the child's appearance, the child needs to be treated according to her chronologic age and to interact with children in the same age-group. An expected outcome is that the child will adjust socially by exhibiting age-appropriate behaviors and social interactions. Advising the parents of a 6-year-old to put their daughter on birth control is not appropriate and will not reverse the effects of precocious puberty. Parents need to be aware that there is an increased risk of sexual abuse for a child with precocious puberty. Treatment for precocious puberty is the administration of gonadotropin-releasing hormone blocker, which slows or reverses the development of secondary sexual characteristics and slows rapid growth and bone aging.

29. An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? a. There is a lack of growth hormone (GH) being produced. b. There is excess GH after closure of the epiphyseal plates. c. There is an excess of GH before the closure of the epiphyseal plates. d. There is a lack of thyroid hormone being produced.

ANS: B Excess GH after closure of the epiphyseal plates results in acromegaly. A lack of growth hormone results in delayed growth or even dwarfism. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates. Cretinism is associated with hypothyroidism.

10. Exophthalmos (protruding eyeballs) may occur in children with: a. Hypothyroidism. c. Hypoparathyroidism. b. Hyperthyroidism. d. Hyperparathyroidism.

ANS: B Exophthalmos is a clinical manifestation of hyperthyroidism. Hypothyroidism, hypoparathyroidism, and hyperparathyroidism are not associated with exophthalmos.

24. The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

ANS: B School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.

27. Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones c. Elevated serum carbon dioxide b. Low arterial pH d. Elevated serum phosphorus

ANS: B Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.

35. A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism. Which results are consistent with this condition? a. Decreased serum phosphorus c. Increased serum glucose b. Decreased serum calcium d. Decreased serum cortisol

ANS: B The diagnosis of hypoparathyroidism is made on the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus. Decreased serum phosphorus would be seen in hyperparathyroidism, elevated glucose in diabetes, and decreased serum cortisol in adrenocortical insufficiency (Addison's disease).

15. A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. Vitamin D. c. Stool softeners. b. Cortisone. d. Calcium carbonate.

ANS: B The most common biochemical defect with congenital adrenal hyperplasia is partial or complete 21-hydroxylase deficiency. With complete deficiency, insufficient amounts of aldosterone and cortisol are produced, so circulatory collapse occurs without immediate replacement. Vitamin D, stool softeners, and calcium carbonate have no role in the therapy of adrenogenital hyperplasia.

6. Diabetes insipidus is a disorder of the: a. Anterior pituitary. c. Adrenal cortex. b. Posterior pituitary. d. Adrenal medulla.

ANS: B The principal disorder of posterior pituitary hypofunction is diabetes insipidus. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone. The adrenal cortex produces aldosterone, sex hormones, and glucocorticoids. The adrenal medulla produces catecholamines.

37. Which children admitted to the pediatric unit would the nurse monitor closely for development of syndrome of inappropriate antidiuretic hormone (SIADH) (Select all that apply)? a. A newly diagnosed preschooler with type 1 diabetes b. A school-age child returning from surgery for removal of a brain tumor c. An infant with suspected meningitis d. An adolescent with blunt abdominal trauma following a car accident e. A school-age child with head trauma

ANS: B, C, E Childhood SIADH usually is caused by disorders affecting the central nervous system, such as infections (meningitis), head trauma, and brain tumors. Type 1 diabetes and blunt abdominal trauma are not likely to cause SIADH.

38. A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism (Select all that apply)? a. Weight loss b. Fatigue c. Diarrhea d. Dry, thick skin e. Cold intolerance

ANS: B, D, E A child with hypothyroidism will display fatigue; dry, thick skin; and cold intolerance. Weight loss and diarrhea are signs of hyperthyroidism.

28. A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which of the following? a. Treatment is most successful if it is started during adolescence. b. Treatment is considered successful if children attain full stature by adulthood. c. Replacement therapy requires daily subcutaneous injections. d. Replacement therapy will be required throughout the child's lifetime.

ANS: C Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers. Replacement therapy is not needed after attaining final height. They are no longer GH deficient.

33. To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions

ANS: C Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes. The peer group would focus on the differences.

20. A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on knowing that: a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.

ANS: C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.

11. The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves' disease). Which statement made by the parent indicates a correct understanding of the teaching? a. "I would expect my child to gain weight while taking this medication." b. "I would expect my child to experience episodes of ear pain while taking this medication." c. "If my child develops a sore throat and fever, I should contact the physician immediately." d. "If my child develops the stomach flu, my child will need to be hospitalized."

ANS: C Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Weight gain, episodes of ear pain, and stomach flu are not usually associated with leukopenia.

30. The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia c. Dry skin b. Diarrhea d. Accelerated growth

ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.

8. A common clinical manifestation of juvenile hypothyroidism is: a. Insomnia. c. Dry skin. b. Diarrhea. d. Accelerated growth.

ANS: C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.

21. The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

ANS: C Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged and not restricted unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.

1. Which statement best describes hypopituitarism? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.

ANS: C In children with hypopituitarism, the skeletal proportions are normal. Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism.

41. The nurse is caring for a school-age child with hyperthyroidism (Graves' disease). Which clinical manifestations should the nurse monitor that may indicate a thyroid storm (Select all that apply)? a. Constipation b. Hypotension c. Hyperthermia d. Tachycardia e. Vomiting

ANS: C, D, E A child with a thyroid storm will have severe irritability and restlessness, vomiting, diarrhea, hyperthermia, hypertension, severe tachycardia, and prostration.

3. What is the priority nursing goal for a 14-year-old with Graves' disease? a. Relieving constipation b. Allowing the adolescent to make decisions about whether or not to take medication c. Verbalizing the importance of adherence to the medication regimen d. Developing alternative educational goals

ANS: C In order to adhere to the medication schedule, children need to understand that the medication must be taken two or three times per day. The adolescent with Graves' disease is not likely to be constipated. Adherence to the medication schedule is important to ensure optimal health and wellness. Medications should not be skipped and dose regimens should not be tapered by the child without consultation with the child's medical provider. The management of Graves' disease does not interfere with school attendance and does not require alternative educational plans.

4. At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years c. Boys, 9 years; girls, 8 years b. Boys, 12 years; girls, 10 years d. Boys, 10 years; girls, 9.5 years

ANS: C Manifestations of sexual development before age 9 in boys and age 8 in girls are considered precocious and should be investigated. Boys older than 9 years of age and girls older than 8 years of age fall within the expected range of pubertal onset.

16. What is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 18 years. d. Oral agents are often effective for treatment.

ANS: C The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Peak incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with oral agents are more consistent with type 2 diabetes.

13. Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the: a. Thyroid gland. c. Adrenal cortex. b. Parathyroid glands. d. Anterior pituitary.

ANS: C These hormones are secreted by the adrenal cortex. The thyroid gland produces thyroid hormone and thyrocalcitonin. The parathyroid glands produce parathyroid hormone. The anterior pituitary produces hormones such as growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, gonadotropin, prolactin, and melanocyte-stimulating hormone.

12. A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity? a. Headache and seizures b. Physical restlessness and voracious appetite without weight gain c. Weakness and lassitude d. Anorexia and insomnia

ANS: C Vitamin D toxicity can be a serious consequence of therapy. Parents are advised to watch for signs including weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia. Headaches may be a sign of vitamin D toxicity, but seizures are not. Physical restlessness and a voracious appetite with weight loss are manifestations of hyperthyroidism. Anorexia and insomnia are not characteristic of vitamin D toxicity.

40. A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting (Select all that apply)? a. Novolin N b. Lantus c. NovoLog d. Novolin R

ANS: C, D Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin peaks 30 to 90 minutes later and may last as long as 5 hours. Short-acting (regular) insulin (e.g., Novolin R) usually reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. Long-acting insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.

7. The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would she or he expect to observe? a. Oliguria c. Nausea and vomiting b. Glycosuria d. Polyuria and polydipsia

ANS: D Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate. Oliguria is decreased urine production and is not associated with diabetes insipidus. Glycosuria is associated with diabetes mellitus. Nausea and vomiting are associated with inappropriate antidiuretic hormone secretion.

17. Which symptom is considered a cardinal sign of diabetes mellitus? a. Nausea c. Impaired vision b. Seizures d. Frequent urination

ANS: D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

31. Which clinical manifestation may occur in the child who is receiving too much methimazole (Tapazole) for the treatment of hyperthyroidism (Graves' disease)? a. Seizures c. Pancreatitis or cholecystitis b. Enlargement of all lymph glands d. Lethargy and somnolence

ANS: D Parents should be aware of the signs of hypothyroidism that can occur from overdosage of the drug. The most common manifestations are lethargy and somnolence. Seizures and pancreatitis are not associated with the administration of Tapazole. Enlargement of the salivary and cervical lymph glands occurs.

19. Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin c. Fluid overload b. Weight gain d. Poor wound healing

ANS: D Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

5. A child will start treatment for precocious puberty. This involves injections of synthetic: a. Thyrotropin. b. Gonadotropins. c. Somatotropic hormone. d. Luteinizing hormone-releasing hormone.

ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone. Thyrotropin, gonadotropin, and somatotropic hormone are not appropriate therapies for precocious puberty.

23. Manifestations of hypoglycemia include: a. Lethargy. c. Nausea and vomiting. b. Thirst. d. Shaky feeling and dizziness.

ANS: D Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.

22. A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. Saturated and unsaturated fat. c. Several glasses of water. b. Fruit juice. d. Complex carbohydrate and protein.

ANS: D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood sugar.

25. The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption? a. Arm c. Buttock b. Leg d. Abdomen

ANS: D The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.

32. The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.

ANS: D Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample.

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. When I came back, I found her." Which assessment would be the priority? A) Airway, breathing, and circulation B) Level of consciousness C) Vital signs D) Pupillary response

Airway, breathing, and circulation With a submersion injury, hypoxia is the primary problem. Therefore, assessment of airway, breathing, and circulation are the priority assessments for which the nurse would institute resuscitative measures. Other assessments such as level of consciousness, vital signs, and papillary response would be done once the child's airway, breathing, and circulation are assessed and emergency interventions are instituted.

An emergency department nurse is caring for a 5-year-old child who was just brought in by ambulance with partial-thickness (second-degree) and full-thickness (third-degree) burns to their face, neck, and chest. The client is awake and alert. Vital signs: temperature, 97.2°F (36.2°C); heart rate, 148 beats/min; blood pressure, 68/39 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 90% on 2 liters by nasal cannula. Apply oxygen to maintain oxygen saturations 95% or greater. Administer 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hour. The nurse receives prescriptions for the client. Click to highlight the prescription(s) that requires immediate implementation. Initiate fluid resuscitation per Lund and Browder chart using Parkland formula with 0.9% saline.

Apply oxygen to maintain oxygen saturations 95% or greater. Administer 100 mcg/kg morphine via intravenous push (IVP) for pain prn q4 hour. Initiate fluid resuscitation per Lund and Browder chart using Parkland formula with 0.9% saline.

What information is most correct regarding the nervous system of the child? a) The child's nervous system is fully developed at birth. b) The child has underdeveloped fine motor skills and well-developed gross motor skills. c) The child has underdeveloped gross motor skills and well-developed fine motor skills. d) As the child grows, the gross and fine motor skills increase.

As the child grows, the gross and fine motor skills increase.

A nurse is performing a complete neurological examination of a 7-year-old boy. She will now test his cerebellar function. Which of the following tests would be appropriate for this purpose? a) Ask the boy to close his eyes and then touch his skin with a cotton wisp; ask him to point to where he was touched b) Measure the circumference of the calves and thighs with a tape measure c) Ask the boy who he is, where he is, and what day it is d) Ask the boy to touch each finger on one hand with the thumb that hand in rapid succession

Ask the boy to touch each finger on one hand with the thumb that hand in rapid succession

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which intervention would be most important for the nurse to perform? a) Monitor core body temperature. b) Assess the child's level of consciousness. c) Pull up the side rails on the bed. d) Help the child cope with an altered appearance.

Assess the child's level of consciousness

The nurse is caring for a child who had a seizure, fell to the ground, and hit and injured his face, head, and shoulders. This information indicates the child likely had which type of seizures? a) Myoclonic b) Atonic c) Absence d) Infantile

Atonic Atonic or akinetic seizures cause a sudden momentary loss of consciousness, muscle tone, and postural control and can cause the child to fall. They can result in serious facial, head, or shoulder injuries. In absence seizures the child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes.

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. Which of the following would the nurse include in the child's discharge instructions? A) "Expect his headache to get worse initially and then disappear." B) "Wake him every 2 hours to check his movement and responses." C) "Call your medical provider if he vomits more than five times." D) "Any watery fluid draining from his ears is normal."

B) "Wake him every 2 hours to check his movement and responses."

The nurse knows that children have larger heads in relation to the body and a higher center of gravity. When developing a teaching plan for parents, the nurse includes information about an increased risk for which of the following problems? A) Febrile seizures B) Head trauma C) Caput succedaneum D) Posterior plagiocephaly

B) Head trauma

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: A) Confusion B) Obtunded C) Stupor D) Coma

B) Obtunded

During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? A) Olfactory B) Trigeminal C) Facial D) Accessory

B) Trigeminal

During class, a student states, "I didn't think children could have strokes. I thought this only occurred in older adults." When responding to the student, which of the following would be most important for the instructor to integrate into the response? A) Strokes in children often have an identifiable cause. B) The signs and symptoms in children are different from an adult. C) Research has identified specific treatments for children. D) Ischemic strokes are more common than hemorrhagic strokes.

D) Ischemic strokes are more common than hemorrhagic strokes.

The community health nurse has just completed a presentation to a group of parents regarding drowning prevention. Which statements by the parents indicate understanding of the teaching? Select all that apply. A) "I am so glad our 6-year-old child had swim lessons. We really can't afford a fence around our pool." B) "Since we have a 16-year-old I am really concerned about supervision when our child is swimming in the ocean." C) "We always make sure our babysitter keeps her CPR training up to date." D) "It is scary to think that we have a pool and drowning is the second leading cause of accidental death in children." E) "We make sure to keep our bathroom door closed when our 10-month-old is walking around the house since the door handle is too high to reach."

B, C, D, E In children older than 15 years of age, most drownings occur in natural water settings, such as oceans or lakes. Most incidents of drowning are accidental and result from inadequately supervising children of any age. It is important for any caregivers of children to be current on CPR in case of any accident. Children younger than 1 year old most often drown in bathtubs, buckets, or toilets, so keeping the bathroom door closed helps decrease the risk of drowning.

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the patient's ear. This would be documented as which of the following? a) Battle sign b) Otorrhea c) Rhinorrhea d) Raccoon eyes

Battle sign

The nurse assesses a child and finds that the child's pupils are pinpoint. What does this finding indicate? a) Intracranial mass b) Seizure activity c) Brain stem herniation d) Brain stem dysfunction

Brain stem dysfunction

A group of nursing students are reviewing information related to seizures that occur in infants and children. The students demonstrate a need for additional review when they identify which type as common in neonates? A) Tonic B) Focal clonic C) Multifocal clonic D) Myoclonic

D) Myoclonic

Which of the following is consistent with increased ICP in the child? a) Increased appetite b) Bulging fontanel c) Emotional lability d) Narcolepsy

Bulging fontanel

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they state which of the following? A) "Having the shunt put in decreases his risk for developmental problems." B) "If he doesn't get an infection in the first week, the risk is greatly reduced." C) "He will need more surgeries to replace the shunt as he grows." D) "The shunt will help to prevent any further complications from his disease."

C) "He will need more surgeries to replace the shunt as he grows."

As a result of seizure activity, a computed tomography (CT) scan was performed and showed that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, the nurse would expect to implement actions to prevent which of the following? A) Drug interactions B) Developmental disabilities C) Hemorrhagic stroke D) Respiratory paralysis

C) Hemorrhagic stroke

When providing care to a newborn infant who was born at 29 weeks' gestation, the nurse integrates knowledge of potential complications, being alert for signs and symptoms of which of the following? A) Neonatal conjunctivitis B) Facial deformities C) Intracranial hemorrhage D) Incomplete myelinization

C) Intracranial hemorrhage

Hydrocephalus is suspected in a 4-month-old infant. Which of the following would the nurse expect to assess? A) Sunken fontanels B) Diminished reflexes C) Lower extremity spasticity D) Skull symmetry

C) Lower extremity spasticity

The nurse is caring for an 8-year-old boy who has chronic epilepsy. Which of the following would be most important to address when teaching the child and parents about living with this condition? A) Multiple corrective surgeries to slowly remove diseased parts of his brain B) Physical, occupational, and speech therapy to maximize his potential C) Support for maintaining self-esteem because of his altered lifestyle D) Hyperventilation therapy to counteract the periods of decreased oxygenation

C) Support for maintaining self-esteem because of his altered lifestyle

To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Cerebral edema b) Cardiogenic shock c) Left-sided heart failure d) Renal failure

Cerebral edema

Which of the following would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? A) Bradycardia B) Cheyne-Stokes respirations C) Fixed, dilated pupils D) Projectile vomiting

D) Projectile vomiting

The nurse is in the room when a child with a seizure disorder is having a seizure. The child is having generalized jerking muscle movement, and the nurse notes the bed appears to be wet with urine. The child is in which stage of the generalized seizure? a) Clonic b) Tonic c) Prodromal d) Postictal

Clonic

The nurse is in the room when a child with a seizure disorder is having a seizure. The child is having generalized jerking muscle movement, and the nurse notes the bed appears to be wet with urine. The child is in which stage of the generalized seizure? a) Tonic b) Postictal c) Prodromal d) Clonic

Clonic

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Cloudy appearance b) Elevated sugar c) Decreased pressure d) Decreased leukocytes

Cloudy appearance

Antibiotic therapy to treat meningitis should be instituted immediately after which event? a) Identification of the causative organism b) Initiation of I.V. therapy c) Admission to the nursing unit d) Collection of cerebrospinal fluid (CSF) and blood for culture

Collection of cerebrospinal fluid (CSF) and blood for culture

The father of a 7-year-old boy reports to the nurse that two or three times over the past weeks he has observed his son seemingly staring into space and rubbing his hands. The behavior lasts for a minute or so, followed by an inability of the child to understand what's being said to him. When the nurse asks the child about his experience, he says he doesn't know what his father is talking about. What type of seizure do these symptoms indicate the child is experiencing? a) Complex partial seizures b) Simple partial sensory seizures c) Simple partial motor seizures d) Absence seizures

Complex partial seizures

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) Convulsive activity occurs. b) The EEG is normal. c) Cyanosis occurs at the onset of the seizure. d) The patient is bradycardiac.

Convulsive activity occurs.

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of which of the following into the discussion? A) The child's risk for cognitive problems is greatly increased. B) Structural damage occurs with febrile seizure. C) The child's risk for epilepsy is now increased. D) Febrile seizures are benign in nature.

D) Febrile seizures are benign in nature.

A nurse is preparing a presentation for an expectant parent group about neural tube defects and prevention. Which of the following would the nurse emphasize? A) Smoking cessation B) Aerobic exercise C) Increased calcium intake D) Folic acid supplementation

D) Folic acid supplementation

The nurse has developed a teaching plan for the family of a 2-year-old boy who holds his breath when he gets frustrated. Which of the following will be most important to include in this plan? A) Provide cuddle time whenever the child begins to act out. B) Explain the child's behavior to the parents. C) Encourage the parents to interact more with the child. D) Stay close to prevent injury when he gets frustrated.

D) Stay close to prevent injury when he gets frustrated.

A 16-year-old boy complains to the school nurse of headaches and a stiff neck. Which of the following signs and symptoms would alert the nurse that the child may have bacterial meningitis? A) Fixed and dilated pupils B) Frequent urination C) Sunset eyes D) Sunlight is "too bright"

D) Sunlight is "too bright"

The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: A) Decorticate posturing B) Nystagmus C) Doll's eye D) Sunsetting

D) Sunsetting

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) Decrease environmental stimulation b) Take vital signs every 4 hours c) Encourage the parents to hold the child d) Monitor temperature every 4 hours

Decrease environmental stimulation

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? a) Swimming twice a week b) 11 p.m. bedtime; 6:30 a.m. wake-up c) Drinking three cans of diet cola d) Use of nonscented soap

Drinking three cans of diet cola

A nurse is preparing a presentation for an expectant parent group about neural tube defects and prevention. Which would the nurse emphasize? A) Smoking cessation B) Aerobic exercise C) Increased calcium intake D) Folic acid supplementation

Folic acid supplementation The cause of neural tube defects is unknown, but there is strong evidence to support the use of folic acid supplementation for prevention. Smoking cessation and aerobic exercise are general health recommendations unrelated to neural tube defects. Increased calcium intake is important for fetal growth and development, but it is not linked to preventing neural tube defects.

A doctor orders the placement of an ICP monitor in a patient with cerebral edema. The nurse is aware that this surgery will take place in the infratentorial region of the brain. a) True b) False

False

The nurse caring for a patient with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. a) False b) True

False

The nurse caring for a child with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. a) True b) False

False Glucocorticoids and diuretics are used to reduce cerebral edema.

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion? A) The child's risk for cognitive problems is greatly increased. B) Structural damage occurs with febrile seizure. C) The child's risk for epilepsy is now increased. D) Febrile seizures are benign in nature.

Febrile seizures are benign in nature. Parents need reassurance that febrile seizures, although frightening, are benign in nature. Children who experience one or more febrile seizures are at no greater risk of developing epilepsy than the general population. No evidence exists that febrile seizures cause structural damage or cognitive declines.

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which food selection would be most appropriate for his lunch? A) Fried eggs, bacon, and iced tea B) A hamburger on a bun, French fries, and milk C) Spaghetti with meatballs, garlic bread, and a cola drink D) A grilled cheese sandwich, potato chips, and a milkshake

Fried eggs, bacon, and iced tea The ketogenic diet involves a high intake of fats, adequate protein intake, and a very low intake of carbohydrates, resulting in a state of ketosis. The child is kept in a mild state of dehydration. Eggs and bacon are high in fat; the tea does not contain any carbohydrates. Therefore, this is the best choice. The hamburger is fat and protein, the bun is a carbohydrate, and the French fries and the milk both contain fat and protein, but both contain a lot of carbohydrates. The pasta and the sauce for the spaghetti are carbohydrates, the meatballs are protein, and the garlic bread is a carbohydrate, as is the cola drink. The grilled cheese sandwich has the fat and protein from the cheese, but the bread and chips are primarily carbohydrates, and the milkshake has fat, protein, and carbohydrates. Only the selection in A contains a ketogenic meal.

The nurse knows that children have larger heads in relation to the body and a higher center of gravity. When developing a teaching plan for parents, the nurse includes information about an increased risk for which problem? A) Febrile seizures B) Head trauma C) Caput succedaneum D) Posterior plagiocephaly

Head trauma The larger head size in relation to the body, coupled with a higher center of gravity, causes children to hit their head more readily when involved in motor vehicle accidents, bicycle accidents, and falls. Febrile seizures are not related to anatomy or physiology. Caput succedaneum is an edematous area on the scalp caused by pressure of the uterus or vagina during head-first delivery. Posterior plagiocephaly is caused by early closure of the lamboid suture.

As a result of seizure activity, a computed tomography (CT) scan was performed and showed that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, what would the nurse expect to implement actions to prevent? A) Drug interactions B) Developmental disabilities C) Hemorrhagic stroke D) Respiratory paralysis

Hemorrhagic stroke Intracranial hemorrhage or hemorrhagic stroke is a risk for children with intracranial arteriovenous malformation. Drug interactions are a risk for children who are treated with combinations of anticonvulsants for epilepsy. Children with hydrocephalus are at an increased risk for developmental disabilities. Respiratory paralysis is a risk of botulism that typically affects infants younger than 6 months of age.

During physical assessment of a 2-month-old infant, the nurse suspects the child may have a lesion on the brain stem. Which symptom was observed? a) Sudden increase in head circumference b) Closed posterior fontanel c) Only one eye is dilated and reactive d) Horizontal nystagmus

Horizontal nystagmus

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for what finding? A) Indications of increased intracranial pressure B) An increase in the blood glucose level C) A decrease in the liver enzymes D) A presence of protein in the urine

Indications of increased intracranial pressure Reye syndrome is characterized by brain swelling, liver failure, and death in hours if treatment is not initiated. Therefore, increased intracranial pressure could occur. Liver enzyme levels typically increase. Blood glucose levels and protein in the urine are not characteristic of this illness.

A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be: 1. Educate the family on ways to prevent bacterial meningitis. 2. Initiate appropriate isolation precautions and begin intravenous antibiotics. 3. Assess the infant's fontanels. 4. Encourage the mother to hold the infant and feed her.

Initiate appropriate isolation precautions and begin intravenous antibiotics.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially? a) Institute droplet precautions in addition to standard precautions. b) Educate the family about preventing bacterial meningitis. c) Encourage the mother to hold and comfort the infant. d) Palpate the child's fontanels.

Institute droplet precautions in addition to standard precautions.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2° F(39° C). What is the nurse's highest priority? a) Institute safety precautions. b) Provide family teaching related to the child's history. c) Offer age-appropriate activities. d) Encourage the child to do his or her own self-care.

Institute safety precautions.

When providing care to a newborn infant who was born at 29 weeks' gestation, the nurse integrates knowledge of potential complications, being alert for signs and symptoms of what condition? A) Neonatal conjunctivitis B) Facial deformities C) Intracranial hemorrhage D) Incomplete myelinization

Intracranial hemorrhage Premature infants have more fragile capillaries in the periventricular area than term infants, which puts them at greater risk for intracranial hemorrhage. Neonatal conjunctivitis can occur in any newborn during birth and is caused by viruses, bacteria, or chemicals. Facial deformities are typical of babies of alcoholic mothers. Incomplete myelinization is present in all newborns.

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem? a) Congenital hydrocephalus b) Early closure of the fontanels c) Moderate closed-head injury d) Intracranial hemorrhaging

Intracranial hemorrhaging

Preterm infants have more fragile capillaries in the periventricular area than term infants. Which problem does this put these infants at risk for? a) Moderate closed-head injury b) Congenital hydrocephalus c) Early closure of the fontanels d) Intracranial hemorrhaging

Intracranial hemorrhaging

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for? a) Irritability, fever, and vomiting b) Negative Kernig's sign c) Flat fontanel d) Jaundice, drowsiness, and refusal to eat

Irritability, fever, and vomiting

During class, a student states, "I didn't think children could have strokes. I thought this only occurred in older adults." When responding to the student, what would be most important for the instructor to integrate into the response? A) Strokes in children often have an identifiable cause. B) The signs and symptoms in children are different from an adult. C) Research has identified specific treatments for children. D) Ischemic strokes are more common than hemorrhagic strokes.

Ischemic strokes are more common than hemorrhagic strokes. In children, ischemic strokes are more common than hemorrhagic strokes. However, the cause of the stroke in many children remains unidentified. Signs and symptoms are similar to those in adults and will vary based on age; underlying cause, if known; and location of the stroke. Historically, children have been excluded from adult stroke studies and thus, many treatments used have had to be adapted from adult studies.

A 9-year-old girl who is suspected of having an infection of the central nervous system is undergoing a lumbar puncture to withdraw cerebrospinal fluid for analysis. The nurse knows that the needle will be introduced into the subarachnoid space at the level of which of the following vertebrae? a) T3 or T4 b) L1 or L2 c) C1 or C2 d) L4 or L5

L4 or L5

An 8-year-old child is admitted to a medical-surgical unit with a diagnosis of syndrome of inappropriate antidiuretic syndrome (SIADH). Drag words from the choices below to fill in each blank in the following sentence. The nurse will closely monitor the client's .... , .... , .....

LOC, fluid balance, glucose

A group of students are reviewing information about head injuries in children. The students demonstrate understanding of this information when they identify what as the most common type of skull fracture in children? A) Linear B) Depressed C) Diastatic D) Basilar

Linear The most common type of skull fracture in children is a linear skull fracture, which can result from minor head injuries. Other, less common types of skull fractures in children include depressed, diastatic, and basilar.

Hydrocephalus is suspected in a 4-month-old infant. Which would the nurse expect to assess? A) Sunken fontanels B) Diminished reflexes C) Lower extremity spasticity D) Skull symmetry

Lower extremity spasticity Hydrocephalus is manifested by spasticity of lower extremities, bulging fontanels, brisk reflexes, and skull asymmetry.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Lying prone, with the feet higher than the head b) Lying on one side, with the back curved c) Lying prone, with the neck flexed d) Sitting up, with the back straight

Lying on one side, with the back curved

The nurse is collecting data from a child who may have a seizure disorder. Which is a description of an absence seizure? a) Brief, sudden contracture of a muscle or muscle group b) Minimal or no alteration in muscle tone, with a brief loss of consciousness c) Sudden, momentary loss of muscle tone, with a brief loss of consciousness d) Muscle tone maintained and child frozen in position

Minimal or no alteration in muscle tone, with a brief loss of consciousness

The physician has ordered rectal diazepam for a 2-year-old boy with status epilepticus. Which instruction is essential for the nurse to teach the parents? A) Monitor their child's level of sedation. B) Watch for fever indicating infection. C) Gradually reduce the dosage as seizures stop. D) Monitor for an allergic reaction to the medication.

Monitor their child's level of sedation. Diazepam is useful for home management of prolonged seizures and requires that the parents be educated on its proper administration. Monitoring the child's level of sedation is key when giving diazepam because it slows the central nervous system. Parents need to monitor the overall health of the child, including temperature when needed, but that has nothing to do with the diazepam. When the use of an anticonvulsant is stopped, gradual reduction of the dosage is necessary to prevent seizures or status epilepticus. This is not done without a physician's order. Monitoring for allergic reactions is necessary when any medications have been prescribed, but is not specific to diazepam.

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity? a) Massaging the scalp gently every 4 hours b) Giving the infant small feedings whenever he is fussy c) Moving the infant's head every 2 hours d) Measuring the intake and output every shift

Moving the infant's head every 2 hours

A group of nursing students are reviewing information related to seizures that occur in infants and children. The students demonstrate a need for additional review when they identify which type as common in neonates? A) Tonic B) Focal clonic C) Multifocal clonic D) Myoclonic

Myoclonic Five major types of seizures have been recognized in the neonatal period: subtle, tonic, focal clonic, multifocal clonic, and myoclonic. Of these, myoclonic seizures rarely occur during the neonatal period. Subtle seizures affect preterm and full-term neonates. Tonic seizures primarily occur in preterm neonates. Focal clonic and multifocal clonic are more common in full-term neonates.

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: A) Confusion B) Obtunded C) Stupor D) Coma

Obtunded Obtunded is a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Confusion involves disorientation; the child may be alert but responds inappropriately to questions. Stupor exists when the child responds only to vigorous stimulation. Coma is a state in which the child cannot be aroused even with painful stimuli.

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? A) On her side with the head flexed forward and knees flexed to the abdomen B) Sitting upright with the head flexed forward to the chest C) Supine with arms and legs pronated and extended D) Prone with the arms flexed under the chest

On her side with the head flexed forward and knees flexed to the abdomen When a lumbar puncture is performed on a child, the child is placed on his or her side with the head flexed forward and knees flexed to the abdomen. An infant would be positioned sitting upright with the head flexed forward. A supine position with the arms and legs pronated and extended suggests decerebrate posturing. A prone position is not used for a lumbar puncture.

Question: A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression. 1 Oriented to person, place, and time 2 Stupor 3 Disorientation 4 Obtundation 5 Coma

Oriented to person, place, and time Disorientation Obtundation Stupor Coma

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands the need for this treatment is based on what? A) PaCO2 levels decrease, causing vasoconstriction. B) Drainage of cerebrospinal fluid occurs. C) Activity is controlled via a stimulator. D) Hyperexcitability of the nerves is reduced.

PaCO2 levels decrease, causing vasoconstriction. Hyperventilation decreases PaCO2, which results in vasoconstriction and therefore decreases intracranial pressure. A shunt would allow for drainage of cerebrospinal fluid. A vagal nerve stimulator is used to provide an appropriate dose of stimulation to manage seizure activity. Anticonvulsants decrease the hyperexcitability of nerves.

A nurse is caring for a newborn with anencephaly. Which of the following interventions will the nurse use? a) Place a cap or similar covering on the infant's head. b) Closely monitor neurologic status. c) Monitor for increased intracranial pressure (ICP). d) Refer the family to an agency to assist with long-term care.

Place a cap or similar covering on the infant's head.

Which intervention prevents a 17-month-old child with spastic cerebral palsy from going into a scissoring position? a) Keeping the child in leg braces 23 hours per day b) Letting the child lie down as much as possible c) Trying to keep the child as quiet as possible d) Placing the child on your hip

Placing the child on your hip

A nurse is caring for a 3-year-old girl with microcephaly. Which of the following actions is appropriate for the nurse to take? a) Playfully ask the child to touch her nose. b) Administer antipyretics as ordered. c) Prepare the child for the experience of cranial surgery. d) Teach the parents about ventriculoperitoneal (VP) shunts.

Playfully ask the child to touch her nose

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? a) Negative Brudzinski's sign b) Positive Homans' sign c) Negative Kernig's sign d) Positive Kernig's sign

Positive Kernig's sign

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? a) Brain scan b) Echoencephalography c) Positron emission tomography (PET) d) Myelography

Positron emission tomography (PET)

The nurse is caring for a 19-month-old boy who has been admitted to the emergency department with a skull fracture. The parents state that the child fell down when running through the house and hit his head on the floor. Based on normal characteristics of skull fractures, what should be the initial focus of the assessment? A) Possible physical abuse B) Possible bone cancer C) Possible chronic neurological disease D) Possible developmental delay

Possible physical abuse Physical abuse must be investigated first because it takes a great deal of force to produce a skull fracture in infants and children younger than 2 years old. Due to the flexibility of the immature skull, it is able to withstand a great degree of deformation before a fracture will occur.

Question: Put the following events of a generalized epileptic seizure in correct order: 1 Prodromal period 2 Tonic stage 3 Postictal period 4 Clonic stage

Prodromal period Tonic stage Clonic stage Postictal period

What finding would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? A) Bradycardia B) Cheyne-Stokes respirations C) Fixed, dilated pupils D) Projectile vomiting

Projectile vomiting Projectile vomiting is an early sign of increased intracranial pressure. Bradycardia, Cheyne-Stokes respirations, and fixed dilated pupils are late signs of increased intracranial pressure.

A 4-year-old boy has a febrile seizure during a well-child visit. What action would be a priority? A) Hyperextending the child's head while placing him on his side B) Using a tongue blade to pry open the child's jaw C) Loosening the child's clothing to ensure a patent airway D) Protecting the child from harm during the seizure

Protecting the child from harm during the seizure During a seizure, the child should not be held down in a specific position. Protecting the child's head and body during the seizure is the priority. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing or hyperextending his head. The child should be placed on his side and nothing should be inserted into his mouth to forcibly open the jaw.

In caring for the child with meningitis, the nurse recognizes that which of the following nursing diagnoses would be the most important to include in this child's plan of care? a) Delayed growth and development related to physical restrictions b) Risk for acute pain related to surgical procedure c) Ineffective airway clearance related to history of seizures d) Risk for injury related to seizure activity

Risk for injury related to seizure activity

The nurse has developed a teaching plan for the family of a 2-year-old boy who holds his breath when he gets frustrated. What will be most important to include in this plan? A) Provide cuddle time whenever the child begins to act out. B) Explain the child's behavior to the parents. C) Encourage the parents to interact more with the child. D) Stay close to prevent injury when he gets frustrated.

Stay close to prevent injury when he gets frustrated. Encourage the parents to maintain a safe environment when an episode is occurring, but to avoid giving extra attention to the child after the event since this could encourage repetition of the behavior. It is important for the parents to understand what is happening, but rewarding the child with cuddle time when he is misbehaving provides incorrect reinforcement of behaviors. Encouraging the parents to interact more with the child may be helpful, but the priority is safety for the child.

A nurse is performing a neurologic examination of a 5-year-old child. She asks the boy to close his eyes, and then she places a crayon in his hand and asks him to identify it. Which type of ability is the nurse testing for in this boy? a) Orientation b) Stereognosis c) Kinesthesia d) Graphesthesia

Stereognosis

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: Streptococcus group B Haemophilus influenzae type B Streptococcus pneumoniae Neisseria meningitidis What would the nurse highlight as the most common cause of meningitis in newborns? A) Streptococcus group B B) Haemophilus influenzae type B C) Streptococcus pneumoniae D) Neisseria meningitides

Streptococcus group B Meningitis due to Streptococcus group B along with Escherichia coli is most common in newborns and infants. H. influenzae type B is a common cause in infants between the ages of 6 and 9 months. S. pneumoniae and N. meningitides are common causes in children older than 3 months and in adults.

A 16-year-old boy reports to the school nurse of headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis? A) Fixed and dilated pupils B) Frequent urination C) Sunset eyes D) Sunlight is "too bright"

Sunlight is "too bright" Photophobia, or intolerance of light, is another symptom of bacterial meningitis. Fixed and dilated pupils are a symptom of head trauma and warrant prompt intervention. Frequent urination is a symptom of a type I Arnold-Chiari malformation. Sunset eyes indicate increased intracranial pressure typical of hydrocephalus.

The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: A) Decorticate posturing B) Nystagmus C) Doll's eye D) Sunsetting

Sunsetting Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate posturing includes adduction of the arms, flexion at the elbows with the arms held over the chest, and flexion of the wrists with both hands fisted and the lower extremities adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye movements. Doll's eye is a maneuver that tests for symmetric eye movement to the opposite side when the head is turned in the other direction.

The nurse is caring for an 8-year-old boy who has chronic epilepsy. What would be most important to address when teaching the child and parents about living with this condition? A) Multiple corrective surgeries to slowly remove diseased parts of his brain B) Physical, occupational, and speech therapy to maximize his potential C) Support for maintaining self-esteem because of his altered lifestyle D) Hyperventilation therapy to counteract the periods of decreased oxygenation

Support for maintaining self-esteem because of his altered lifestyle The effects of living with a seizure disorder can be devastating, and it is essential for the child to receive support to maintain self-esteem. While corrective surgery is possible, it would only be performed once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy.

After a difficult birth, the nurse observes that a newborn has swelling on part of his head. Which sign suggests cephalohematoma? a) Swelling crosses the midline of the infant's scalp. b) Infant had a low birth weight when born at 37 weeks. c) Infant has facial abnormalities. d) Swelling does not cross the suture lines.

Swelling does not cross the suture lines.

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? a) Have the child sleep without a pillow under his head. b) Review the signs of increased intracranial pressure with parents. c) Teach the child and his parents to keep a headache diary. d) Have the parents call the doctor if the child vomits more than twice.

Teach the child and his parents to keep a headache diary.

The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which of the following statements is the best to use for a teaching session? a) Tell me your concerns about your child's shunt. b) Her autoregulation mechanism to absorb spinal fluid has failed. c) Call the doctor if she gets a persistent headache. d) Always keep her head raised 30º.

Tell me your concerns about your child's shunt.

The nurse is caring for an 8-year-old girl who was in a car accident. What would lead the nurse to suspect a concussion? a) The child has vomited and has bruising behind her ear. b) The child is weak and has blurry vision. c) The child is easily distracted and can't concentrate. d) The child is bleeding from the ear and draining fluid from the nose.

The child is easily distracted and can't concentrate.

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 having generalized seizures. b) The child's history indicates she has infantile seizures. c) The child may begin to have absence seizures every day. d) The child is in status epilepticus.

The child is in status epilepticus.

A 10-year-old boy is seen in the emergency department after falling down a flight of stairs and hitting his head. The child will be monitored overnight for complications. Which occurrence in the coming hours will warrant further assessment? A) The child reports a backache. B) The child is increasingly irritable with his mother and caregivers. C) The child refuses offers of snacks. D) The child reports his stomach is upset.

The child is increasingly irritable with his mother and caregivers. After a head injury the patient should be closely observed for neurological changes. Behavioral changes such as lethargy and irritability should be evaluated for the potential development of complications.

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which symptom indicates that the shunt is infected? a) The child has a high-pitched cry. b) The child is not responding or eating well. c) The child's pupil reaction time is rapid and uneven. d) The fontanels are bulging or tense.

The child is not responding or eating well.

During the trial period to determine the efficacy of an anticonvulsant drug, which caution should be explained to the parents? a) The child shouldn't participate in activities that could be hazardous if a seizure occurs b) Plasma levels of the drug will be monitored on a daily basis c) Drug dosage will be adjusted depending on the frequency of seizure activity d) The drug must be discontinued immediately if even the slightest problem occurs

The child shouldn't participate in activities that could be hazardous if a seizure occurs

The nurse is caring for a child admitted with complex partial seizures. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child was dizzy and had decreased coordination. b) The child had shaking movements on one side of the body. c) The child was rubbing the hands and smacking the lips. d) The child had jerking movements and then the extremities stiffened.

The child was rubbing the hands and smacking the lips.

In caring for a child with a seizure disorder, the highest priority goal is which of the following? a) The child will have an understanding of the disorder. b) The child will be free from injury during a seizure. c) The family will understand seizure precautions. d) The family caregivers anxiety will be reduced.

The child will be free from injury during a seizure.

When compared with adults, why are infants and children at an increased risk of head trauma? 1. The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. 2. The development of the nervous system is complete at birth but remains immature. 3. The spine is very immobile in infants and young children. 4. The skull is more flexible due to the presence of sutures and fontanels.

The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed.

The nurse is caring for a premature infant diagnosed with intraventricular hemorrhage (IVH). Which of the following interventions best serves the needs of this client? a) Using a squeak toy to attract the child's gaze b) Stroking the child's cheek with a finger c) Placing the crib in a room by itself d) Removing toys from the crib when not in use

Using a squeak toy to attract the child's gaze

After a difficult birth, the nurse observes that a newborn has swelling on part of his head. The nurse suspects caput succedaneum based on what evidence? a) The swelling crosses the midline of the infant's scalp. b) The infant had low-set ears and facial abnormalities. c) The swelling is limited to one small area without crossing the sagittal suture. d) The infant had a low birthweight when born at term.

The swelling crosses the midline of the infant's scalp.

Which of the following age groups of children have the highest actual rate of death from drowning? a) School-age children b) Toddlers c) Preschool children d) Infants

Toddlers

During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? A) Olfactory B) Trigeminal C) Facial D) Accessory

Trigeminal To test the trigeminal nerve, the nurse would note the strength of the infant's suck on a pacifier, thumb, or bottle. The olfactory nerve is not assessed in infants and young children. The facial nerve is assessed by noting the symmetry of facial expressions. For the infant, this would be assessed during spontaneous crying or smiling. The accessory nerve is assessed when the infant is in the sitting position and symmetry of the head position is noted.

The nurse is caring for an 8-year-old girl who was in a car accident. Which symptom suggests the child has a cerebral contusion? a) Vomiting b) Trouble focusing when reading c) Difficulty concentrating d) Bleeding from the ear

Trouble focusing when reading

The best way to evaluate a child's level of consciousness is through conversation. a) False b) True

True

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? a) Treating the child as though she did not have epilepsy b) Understanding the side effects of medications c) Instructing her teacher how to respond to a seizure d) Placing the child on her side on the floor

Understanding the side effects of medications

The treatment for children with seizures disorders is most often which of the following? a) Restricted fat diet b) Use of anticonvulsant medications c) Surgical intervention d) Strict exercise regimen

Use of anticonvulsant medications

The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain? a) Video electroencephalogram b) Computed tomography c) Cerebral angiography d) Lumbar puncture

Video electroencephalogram

The nurse is assessing a toddler for motor function. Which of the following activities will be most valuable? a) Watch the child reach for a toy. b) Give the child some potato chips. c) Have the child catch a ball. d) Let the child look at a picture book.

Watch the child reach for a toy.

A nurse is performing a neurological examination of a preschool girl. She is testing her remote memory. Which of the following would be an appropriate type of memory to ask the girl to recall? a) What the girl had for dinner last night b) A string of three digits that the nurse has just spoken to her c) The name of an object that the nurse showed her 5 minutes ago d) Where the girl and her family went on vacation last year

What the girl had for dinner last night

The nurse is assigned an infant with a possible neurological disorder. Which of the following assessment findings should you communicate to the physician as a late sign of increased intracranial pressure? a) headache and sunset eyes. b) dizziness and irritability. c) decorticate posturing and fixed and dilated pupils d) decreased pupil reaction and decreased respiration.

decorticate posturing and fixed and dilated pupils

A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. Complete the following sentence(s) by choosing from the lists of options. The nurse should first...then.....

ensure proper oxygenation then administer intravenous (IV) or intramuscular (IM) benzodiazepine

A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. Complete the following sentence(s) by choosing from the lists of options. The nurse should first .... , .....

ensure proper oxygenation, administer intravenous (IV) or intramuscular (IM) benzodiazepine

The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is: a) ensuring the parents know how to properly give antibiotics. b) encouraging development of motor skills. c) establishing seizure precautions for the child. d) maintaining effective cerebral perfusion.

ensuring the parents know how to properly give antibiotics.

A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother based on the understanding that this disorder is most likely caused by: a) Escherichia coli. b) Haemophilus influenza type B. c) enterovirus. d) Streptococcus group B.

enterovirus

The parent of a newborn diagnosed with Turner syndrome asks the nurse about the treatment that will be required for their newborn. Complete the following sentence(s) by choosing from the lists of options. The nurse should educate the parents on the primary treatments used in the treatment of Turner syndrome, which includes ... , .....

growth hormones, estrogen therapy

The nurse is caring for a 6-year-old male child who was brought to the pediatrician's office by the parent for a fever for the past few days. Click to highlight the findings that will require follow-up. Assessment reveals the client has also been experiencing increased urinary frequency , dysuria , and costovertebral pain . Vital signs: temperature, 101.2°F (38.4°C) ; heart rate, 110 beats/min ; blood pressure, 88/48 mm Hg; respiratory rate, 22 breaths/min ; oxygen saturation, 98% room air. Laboratory results: urinalysis, positive for leukocytes; white blood cell (WBC) count, 12 × 103/mm3 (12 × 109/l)

increased urinary frequency, dysuria, and costovertebral pain. 101.2 temp. RR of 22/min. Laboratory results: urinalysis, positive for leukocytes; white blood cell (WBC) count, 12 × 103/mm3 (12 × 109/l)

While observing a child, the nurse notes that the child's arms and legs are extended and pronated. The nurse interprets this as indicating damage to the: a) midbrain. b) cerebral cortex. c) meninges. d) cranial nerves.

midbrain

When assisting a child while she is having a tonic-clonic seizure, it would be important to a) place a tongue blade between the child's teeth. b) restrain the child from all movement. c) turn the child onto her back and observe her. d) protect the child from hitting her arms against furniture.

protect the child from hitting her arms against furniture.

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n) a) steroid. b) diuretic. c) antihistamine. d) anticonvulsant.

steroid

In understanding the nervous system, the nurse recognizes that the central nervous system is made up of: a) the brain and spinal cord. b) fluid that flows through the brain. c) a protective cushion for nerve cells. d) nerves throughout the upper body.

the brain and spinal cord.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction you would want to give her parents regarding this is a) even small doses may cause noticeable dizziness. b) watching television while taking the drug may cause seizures. c) numbness of the fingers is common while taking this drug. d) their child will have to practice good tooth brushing.

their child will have to practice good tooth brushing.

An 8-year-old girl is diagnosed as having tonic-clonic seizures. You would want to teach her parents that: a) their daughter should be kept quiet late in the day when she is most likely to have a seizure. b) if their daughter shows symptoms of beginning a seizure, immediately give her medication. c) their daughter should maintain an active lifestyle. d) their daughter should carry a padded tongue blade with her at all times.

their daughter should maintain an active lifestyle.

The meningococcal vaccine should be offered to high-risk populations. If never vaccinated, who has an increased risk of becoming infected with meningococcal meningitis? Select all that apply. a) 18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates b) 12-year-old child with asthma c) 8-year-old child who is in good health d) 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti e) 9-year-old child who was diagnosed with diabetes mellitus when he was 7 years old

• 18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates • 12-year-old child with asthma • 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti • 9-year-old child who was diagnosed with diabetes mellitus when he was 7 years old

The nurse determines that a child is experiencing late signs of increased intracranial pressure based on which assessment findings? Select all that apply. a) Sunset eyes b) Irregular respirations c) Increased blood pressure d) Fixed dilated pupils e) Bradycardia

• Bradycardia • Fixed dilated pupils • Irregular respirations

A 9-year-old diagnosed with neurofibromatosis is being evaluated for the presence of a brain tumor. What tests may be ordered to diagnose this condition? Select all that apply. a) Radiology b) Lumbar puncture c) Positron emission tomography d) Computed tomography e) Magnetic resonance imaging f) Electroencephalogram

• Computed tomography • Magnetic resonance imaging

A nurse is providing care to a child with status epilepticus. Which medications would the nurse identify as appropriate to give in this situation? Select all that apply. a) Lorazepam b) Gabapentin c) Fosphenytoin d) Carbamazepine e) Diazepam

• Diazepam (Valuim) • Lorazepam (Ativan) • Fosphenytoin treating status epilepticus include lorazepam, diazepam, and fosphenytoin. Gabapentin and carbamazepine are anticonvulsants used to treat and prevent seizures in general.

An 11-year-old child was recently diagnosed with chickenpox. His parents gave him aspirin for a fever and the child is now hospitalized. Which nursing interventions are appropriate for this child? Select all that apply. a) Assess child's skin for the development of distinctive rash every 4 hours b) Assess intake and output every shift c) Request order for an antiemetic d) Request order for anticonvulsant e) Monitor the child's laboratory values related to pancreatic function

• Request order for an antiemetic • Assess intake and output every shift • Request order for anticonvulsant

When assessing a neonate for seizures, what would the nurse expect to find? Select all that apply. a) Ocular deviation b) Jitteriness c) Tonic-clonic contractions d) Elevated blood pressure e) Tachycardia

• Tachycardia • Elevated blood pressure • Jitteriness • Ocular deviation

The young boy was involved in a motor vehicle accident and was admitted to the pediatric intensive care unit with changes in level of consciousness and a high-pitched cry. Which are late signs of increased intracranial pressure? Select all that apply. a) The sclera of the eyes is visible above the iris. b) The child's pupils are fixed and dilated. c) The child's toes are pointed downward, his head and neck are arched backwards, and his arms and legs are extended. d) The child's heart rate is 56 beats per minute. e) The child states that he feels a little "dizzy."

• The child's toes are pointed downward, his head and neck are arched backwards, and his arms and legs are extended. • The child's heart rate is 56 beats per minute. • The child's pupils are fixed and dilated.

When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply. a) The nurse positions the child on the side during a seizure. b) The nurse has oxygen available to use during a seizure. c) The nurse pads the crib or side rails before a seizure. d) The nurse teaches the caregivers regarding seizure precautions. e) The nurse places a washcloth in the mouth to prevent injury during seizure. f) The nurse goes for help as soon as a seizure begins.

• The nurse pads the crib or side rails before a seizure. • The nurse positions the child on the side during a seizure. • The nurse goes for help as soon as a seizure begins. • The nurse has oxygen available to use during a seizure. • The nurse teaches the caregivers regarding seizure precautions.

A nurse is providing information to the parents of a child diagnosed with absence seizures. What information would the nurse expect to include when describing this type of seizure? Select all that apply. a) You might have mistaken this type of seizure for lack of attention. b) This type of seizure is more common in girls than it is in boys. c) The child will commonly report a strange odor or sensation before the seizure. d) This type of seizure is usually short, lasting for no more than 30 seconds. e) You might see a blank facial expression after a sudden stoppage of speech. f) Your child will probably sleep deeply for ½ to 2 hours after the seizure.

• This type of seizure is more common in girls than it is in boys. • You might see a blank facial expression after a sudden stoppage of speech. • This type of seizure is usually short, lasting for no more than 30 seconds. • You might have mistaken this type of seizure for lack of attention.

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in an in-line skating accident. What should the caregivers be instructed to do? Select all that apply. a) Observe and report any vomiting that occurs within six hours. b) Check the pupil reaction to light every 15 minutes for two hours. c) Wake the child every one to two hours to check level of consciousness. d) Observe for and report to provider any double or blurred vision. e) Administer acetaminophen for headache.

• Wake the child every one to two hours to check level of consciousness. • Observe and report any vomiting that occurs within six hours. • Observe for and report to provider any double or blurred vision.

46. The nurse is working in the pediatric developmental clinic. Which of the children requires continued follow-up because of behaviors suspicious of CP? 1. A 1-month-old who demonstrates the startle reflex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

2. The clinical characteristic of hemiple gia can be manifested by the early pref erence of one hand. This may be an early sign of CP.

A 9-year-old female child was brought to the emergency department after experiencing wheezing and shortness of breath while playing soccer. The parents administered two puffs of albuterol metered dose inhaler (MDI) with little effect, and 911 was notified. Paramedics applied oxygen 2 liters by nasal cannula for oxygen saturation of 90% on room air, and administered an albuterol nebulizer treatment. Audible wheezing was heard, and a 20-gauge intravenous (IV) catheter was inserted. Vital signs upon arrival at the emergency room: temperature, 98.8°F (37.1°C); heart rate, 125 beats/min; blood pressure, 88/50 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 92% on simple face mask. Child appears anxious. Complete the following sentence(s) by choosing from the lists of options. The emergency room nurse should first ... , .....

assess airway, give IV methylprednisolone

A nurse is caring for a newborn with Down syndrome. The nurse educates the parents regarding potential complications that their newborn is at higher risk for developing such as .... , .... , and .....

autoimmune disorder, endocrine disorders and spinal problems

A nurse in a pediatrician's office is assessing a 4-year-old child. What assessment techniques will the nurse use with a preschool-age child?

involve child in assessment and to play with safe medical equipment

A school nurse is called to the school cafeteria after a 13-year-old child is reported to have sudden difficulty breathing. The child has a history of asthma and allergies to peanuts. The focused nursing assessment reveals difficulty breathing, inspiratory and expiratory wheezing, swelling of lips, and a rash on the face. The child reports feeling nauseated, having chest tightness, and feeling faint. Complete the following sentence(s) by choosing from the lists of options. The nurse should first address the child's....then.....

wheezing then lip swelling

The young child has been diagnosed with bacterial meningitis. Which nursing interventions are appropriate? Select all that apply. a) Identify close contacts of the child who will require post-exposure prophylactic medication b) Initiate seizure precautions c) Monitor the child for signs and symptoms associated with decreased intracranial pressure d) Administer antibiotics as ordered e) Initiate droplet isolation

• Initiate droplet isolation • Identify close contacts of the child who will require post-exposure prophylactic medication • Administer antibiotics as ordered • Initiate seizure precautions

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all answers that apply. a) Motor response b) Posture c) Eye opening d) Verbal response e) Fontanels

• Motor response • Eye opening • Verbal response

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? a) "Did you use any medications like aspirin for the fever?" b) "What type of fluids did your child take when he had a fever?" c) "How high did his temperature rise when he was ill?" d) "Did you give your child any acetaminophen, such as Tylenol?"

"Did you use any medications like aspirin for the fever?"

The mother of a newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate? a) "Your baby's head became blocked inside your vagina while you were pushing." b) "It's normal for this to happen, but they don't really know why." c) "The forceps used during delivery caused this to happen." d) "During delivery, your vaginal wall put pressure on the baby's head."

"During delivery, your vaginal wall put pressure on the baby's head."

1. The nurse is caring for a child who has been in an MVA. The child continues to fall asleep unless her name is called or she is gently shaken. The nurse knows that this state of consciousness is referred to as: 1. Coma. 2. Delirium. 3. Obtunded. 4. Confusion.

3. Obtunded describes a state of conscious ness in which the child has a limited re sponse to the environment and can be aroused by verbal or tactile stimulation.

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "I am glad that my headache is getting better." b) "My stomach is upset. I feel like I might throw up." c) "You look funny. Well, both of you do. I see two of you." d) "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."

11. The nurse is caring for a 6-month-old infant diagnosed with meningitis. When she places the infant in the supine position and flexes his neck, she notes that the infant flexes his knees and hips. The nurse knows that this is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

11. 1. Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees.

18. The nurse is caring for a child with meningitis. The parents call for the nurse as "something is wrong." When the nurse arrives, she notes that the child is having a generalized tonic-clonic seizure. Which of the following 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.

18. 1. The child experiencing a seizure usually requires more oxygen as the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's air way, 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.

19. A 5-year-old female has been diagnosed with a seizure disorder. Her teacher noticed that she has been having episodes where she drops her pencil and simply appears to be daydreaming. This is most likely called: 1. An absence seizure. 2. An akinetic seizure. 3. A non-epileptic seizure. 4. A simple spasm seizure.

19. 1. Absence seizures occur frequently and last less than 30 seconds. The child ex periences a brief loss of consciousness where she may have a change in activ ity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming.

13. The nurse is caring for a child who has just been admitted to the pediatric floor with a diagnosis of bacterial meningitis. When reviewing the child's plan of care, which of the following orders would the nurse question? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fluids at 11/2 times regular maintenance. 3. Neurological checks every 4 hours. 4. Administer acetaminophen for temperatures higher than 38°C (100.4°F).

2. Intravenous fluids at 11/2 times regular maintenance could cause fluid overload and lead to increased ICP.

35. An infant is born with a sac protruding through the spine. The sac contains CSF, a portion of the meninges, and nerve roots. The nurse knows that this is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifida occulta. 4. Anencephaly.

2. A myelomeningocele is a sac that con tains a portion of the meninges, the CSF, and the nerve roots.

60. The nurse is working in the emergency room caring for a 10-year-old who was in an MVA. The child is currently on a backboard with a cervical collar in place. The child is diagnosed with a cervical fracture. Which of the following would the nurse expect to find in the child's plan of care? 1. Remove the cervical collar, keep the backboard in place, and administer high dose methlyprednisolone. 2. Continue with all forms of spinal stabilization, and administer high-dose methylprednisolone and ranitidine. 3. Remove the backboard and cervical collar, and prepare for halo traction placement. 4. Remove the cervical collar and backboard, place the child on spinal precautions, and administer high-dose methylprednisolone and ranitidine.

2. All forms of spinal stabilization should be continued while methylprednisolone and Zantac are administered.

45. The nurse is caring for several children. She knows that which of the following children is at increased risk for CP? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with sepsis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.

2. Any infection of the central nervous system increases the infant's risk of CP.

2. The nurse is caring for a 3-year-old female with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: 1. Name the president of the United States. 2. Identify her parents and state her own name. 3. State her full name and phone number. 4. Identify the current month but not the date.

2. Asking the 3-year-old to identify her parents and state her name is a devel opmentally appropriate way to assess orientation.

50. A 3-year-old male with CP has just been fitted for braces and is beginning physical therapy to assist with ambulation. His parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse's best response: 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child ages and grows, the CP can manifest in different ways, and different muscle groups can need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

2. CP can be manifested in different ways as the child grows. It does not progress,

37. The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby's head circumference. Select the nurse's best response: 1. "We measure all babies' heads to ensure that their growth is on track." 2. "Babies with myelomeningocele are at risk for hydrocephalus, which can show up with an increase in head circumference." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up with an increase in head circumference." 4. "Many infants with myelomeningocele have microcephaly, which can show up with a decrease in head circumference."

2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an in crease in head circumference.

8. The nurse is working in the PICU caring for an infant who has just returned from having a ventriculoperitoneal shunt placed. Which position initially will be most beneficial for this child? 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.

2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates.

54. The nurse is caring for a 4-month-old infant who was diagnosed with a neuroblastoma. The nurse knows that this particular child's prognosis is: 1. Excellent, as a neuroblastoma is always cured. 2. Excellent, as infants with a neuroblastoma have the best prognosis. 3. Poor, as infants with a neuroblastoma rarely survive. 4. Variable, depending on where the site of origin is.

2. Infants younger than 1 year have the best prognosis.

34. The nurse knows that young infants are at risk for injury from SBS because: 1. Anterior fontanel is open. 2. Insufficient musculoskeletal support and a disproportionate head-to-body ratio. 3. Immature vascular system with veins and arteries that are more superficial. 4. Immature myelination of the nervous system.

2. Insufficient musculoskeletal support and a disproportionate head places the infant at risk because the head cannot be supported during a shaking episode.

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

2. Most children over the age of 5 years do not have febrile seizures.

24. The nurse is caring for a 5-year-old female recently diagnosed with epilepsy. She is being evaluated for anticonvulsant medication therapy. The nurse knows that the child will likely be placed on which kind 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.

2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels.

3. The nurse is preparing to assess a 6-year-old male with altered consciousness in the PICU. His parents ask if they can stay during his morning assessment. Select the nurse's best response. 1. "Your child is more likely to answer questions and cooperate with any procedures if you are not present." 2. "Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside." 3. "It is our policy to ask parents to leave during the first assessment of the shift." 4. "Many children fear that their parents will be disappointed if they do not do well with procedures, so we recommend that no parents be present at this time."

2. Parents should be encouraged to remain with their child for mutual comfort.

22. The nurse is working in the emergency room when an ambulance arrives with a 9-year-old male who has been having a generalized seizure for 35 minutes. The paramedics have provided blow-by oxygen and monitored vital signs. The patient does not have intravenous access yet. Which of the following medications should the nurse anticipate administering first? 1. Establish an intravenous line, and administer intravenous lorazepam. 2. Administer rectal diazepam. 3. Administer an oral glucose gel to the side of the child's mouth. 4. Place a nasogastric tube, and administer oral diazepam.

2. Rectal diazepam is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.

9. A child is being evaluated in the emergency room for a possible diagnosis of meningitis. The nurse is assisting with the lumbar puncture and notes that the CSF is cloudy. The nurse is aware that cloudy CSF most likely means: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, as CSF is usually cloudy. 4. Sepsis.

2. The CSF in bacterial meningitis is usually cloudy.

15. The nurse is providing education concerning Reye syndrome to a mothers' group. She knows that further education is needed 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 when my child is ill." 3. "Because I do not give my child aspirin, my child will probably never get Reye syndrome, but if that happens, it will be a very mild case." 4. "Children with Reye syndrome are admitted to the hospital."

2. The administration of aspirin or products containing aspirin have been associated with the development of Reye syndrome.

58. A 5-year-old female has been diagnosed with a midline brain tumor. In addition to showing signs of increased ICP, she has been voiding large amounts of very dilute urine. Which of the following medications does the nurse expect to administer? 1. Mannitol. 2. Vasopressin. 3. Lasix. 4. Dopamine.

2. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Vasopressin is a hormone that is used to help the body retain water.

26. An 8-year-old child is attending a Cub Scout camp picnic. He has a history of epilepsy and has had generalized seizures since the age of 3. The child falls to the ground and has a generalized seizure. Which of the following is the best action for the nurse to take during the child's seizure? 1. Administer the child's rescue dose of oral valium. 2. Loosen the child's clothing, and call for help. 3. Place an oral 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.

2. The nurse should remain with the child and observe the seizure. The child should be protected from his environ ment, and clothing should be loosened.

25. The nurse is providing discharge instructions to the parents of a 13-year-old girl who has been diagnosed with epilepsy. Her parents ask if there are any activities that she should avoid. Select the nurse's best response. 1. "She should avoid swimming, even with a friend." 2. "She should avoid being in a car at night." 3. "She should avoid any strenuous activities." 4. "She should not return to school right away as her peers will likely cause her to feel inadequate."

2. The rhythmic reflection of other car lights can trigger a seizure in some children.

42. A 6-month-old infant male has just been diagnosed with craniosynostosis. He is being evaluated for reconstructive surgery. The infant's father asks the nurse for more information about the surgery. Select the nurse's 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 3 years 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 as the head has finished growing at that time."

2. The surgery is done to reconstruct the skull to allow the brain to grow prop erly. Because there are potential com plications associated with this surgery, such as increased ICP, the child is usually closely observed in the PICU.

38. The most common complication associated with myelomeningocele is: 1. Learning disability. 2. Urinary tract infection. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown.

2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neuro genic bladder that leads to incomplete emptying of the bladder and subse quent urinary tract infections. Fre quent catheterization also increases the risk of urinary tract infection.

20. The school nurse is called to the preschool classroom to evaluate a child. He has been noted to have periods where 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. 1. "Have the parents follow up with his pediatrician as this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life, as it could be attention-seeking behavior." 3. "Have the parents follow up with his pediatrician as 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."

20. 1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.

21. The nurse is discussing a ketogenic diet with a family. The nurse knows that this diet is sometimes used with children who have had little success with anticonvulsant med ication. The diet that produces anticonvulsant effects from ketosis consists of: 1. High fat and low carbohydrates. 2. High fat and high carbohydrates. 3. Low fat and low carbohydrates. 4. Low fat and high carbohydrates.

21. 1. High fat and low carbohydrates are the components of the ketogenic diet.

29. The emergency room nurse is caring for an unconscious 6-year-old girl who has had a severe closed-head injury and notes the following changes in her vital signs. Her heart rate has dropped from 120 to 55, her blood pressure has increased from 110/44 to 195/62, and her respirations are becoming more irregular. After calling the physi cian, which of the following should the nurse expect to do? 1. Call for additional help, and prepare to administer mannitol. 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.

29. 1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respira tions. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP.

12. A toddler is being admitted to the hospital with a diagnosis of bacterial meningitis. Select the best room assignment for the patient. 1. A semiprivate room with a roommate who also has bacterial meningitis. 2. A semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. A private room that is dark and quiet with minimal stimulation. 4. A private room that is bright and colorful and has developmentally appropriate activities available.

3. A quiet private room with minimal stimulation is ideal as the child with meningitis should be in a quiet envi ronment to avoid cerebral irritation.

59. The nurse is caring for a 30-month-old female receiving radiation therapy for a brain tumor. The parents ask if their child will likely have any learning disabilities in the future. Select the nurse's best answer. 1. "All children who receive radiation have some amount of learning disability. As long as they receive extra tutoring, they usually do well in school." 2. "Because your daughter is so young, she will likely do well and have no problems in the future." 3. "Response varies with each child, but younger children who receive radiation tend to have some amount of learning disability later in life." 4. "Response varies with each child, but younger children who receive radiation tend to have fewer problems later in life than older children."

3. Although variable, younger children tend to experience more learning difficulties than older children.

28. The emergency room nurse is caring for a 5-year-old child who 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 of the following statements is a priority for the nurse 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?"

3. Asking specific questions will give the nurse the information needed to deter mine the level of care for the child.

49. The nurse is giving morning medications to a 4-year-old female who has just had a surgical procedure to release her hamstrings. The child has a history of CP. When the nurse prepares to administer baclofen, the child's parents ask what the medication is for. Select the nurse's best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

3. Baclofen is given to help control the spasms associated with CP.

48. The nurse is caring for a 2-month-old male infant who is at risk for CP due to extreme low birth weight and prematurity. There is a multidisciplinary team caring for him. His parents ask why there is a speech therapist involved in his care. Select the nurse's best response. 1. "Your child is likely to have speech problems because of his early birth. Involving the speech therapist at this point will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "It is the hospital routine to involve as many members of the health-care team in your child's care so that we will know if he has any unmet needs."

3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements.

30. The nurse is caring for a 2-year-old male in the PICU with a head injury. The child is comatose and unresponsive at this time. The parents ask if he needs pain medication. Select the nurse's best response. 1. "Pain medication is not necessary as 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 promote comfort." 4. "Although pain medication is necessary for comfort, we use it cautiously as it increases the demand for oxygen."

3. Pain medication promotes comfort and ultimately decreases ICP.

41. The nurse is caring for a 9-year-old with myelomeningocele who has just had surgery to release a tight ligament to the lower extremity. Which of the following does the nurse include in the child's postoperative plan of care? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.

3. Preventing skin breakdown is important in the child with myelomeningocele, as pressure points are not felt easily.

16. The nurse is caring for a child with Reye syndrome in the PICU. At noon, the nurse notes that the child is comatose with sluggish pupils. When stimulated, the child demonstrates decerebrate posturing. At 2 p.m., the nurse notes that the child remains unchanged except that the child now demonstrates decorticate posturing when stimulated. The nurse concludes that: 1. The child's condition is worsening and progressing to a more advanced stage of Reye syndrome. 2. The child's condition is worsening, and the child may likely experience cardiac and respiratory failure. 3. The child's condition is improving and progressing to a less advanced stage of Reye syndrome. 4. The child's condition remains unchanged as posturing reflexes are similar.

3. Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child's condition.

47. The nurse is caring for a 13-month-old with meningitis. The child has experienced increased ICP and multiple seizures. The child's parents ask if the child is likely to develop CP. Select the nurse's best response. 1. "When your daughter is stable, she'll undergo computed tomography and magnetic resolution imaging. The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications of meningitis develop some amount of CP."

3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made.

31. The nurse is caring for a 6-year-old female with a skull fracture who is unconscious and has severely increased ICP. The nurse notes the child's temperature to be 104°F (40°C). Which of the following should the nurse do first? 1. Place a cooling blanket on the child. 2. Administer Tylenol via nasogastric tube. 3. Administer Tylenol rectally. 4. Place ice packs in the child's axillary areas.

31. 1. A cooling blanket will help cool the child quickly and at a controlled temperature.

33. A 2-month-old infant is brought to the emergency room after experiencing a seizure. The nurse notes that the infant appears lethargic with very irregular respirations and periods of apnea. The parents report that the child is no longer interested in feeding and that, prior to the seizure, the infant rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography scan of the head and dilation of the eyes. 2. Computed tomography scan of the head and EEG. 3. Close monitoring of vital signs. 4. X-rays of all long bones.

33. 1. A computed tomography 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 SBS.

36. The nurse is caring for a neonate who has just been diagnosed with a meningocele. The parents ask what to expect. Which of the following is the nurse's best response? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory deficits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

36. 1. Because a meningocele does not con tain any nerve endings, most children experience no neurological problems after surgical correction.

53. The nurse is caring for a 5-year-old male with CP. His weight is in the fifth percentile, and he has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube put in. Which of the following would be the nurse's best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4. An open-ended question will encour age family members to share what they know and potentially clear any misconceptions.

10. The nurse is caring for a child who is being admitted with a diagnosis of meningitis. The child's plan of care includes the following: administration of intravenous antibi otics, administration of maintenance intravenous fluids, placement of a Foley catheter, and obtaining cultures of spinal fluid and blood. 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 cultures to the laboratory.

4. Cultures of spinal fluid and blood should be obtained, followed by admin istration of intravenous antibiotics.

27. The nurse is caring for a child who has sustained a closed-head injury. The nurse knows that brain damage can be caused by which of the following factors? 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.

4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4. The nurse is caring for a 9-year-old female who is unconscious in the PICU. The child's mother has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response. 1. "I think your daughter hears you, and she is attempting to reach out to you." 2. "Your child is responding to you; please continue trying to stimulate her." 3. "It appears that your child is having a seizure." 4. "Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."

4. Posturing is a reflex that often indicates that the child is receiving too much stimulation.

39. The nurse is caring for a newborn infant who has just been diagnosed with a myelomeningocele. Which of the following is included in the child's plan of care? 1. Place the child in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the child in the prone position with a sterile dry dressing over the defect. Begin intravenous fluids to prevent dehydration. 3. Place the child in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

4. The child is placed in the prone posi tion to avoid any pressure on the de fect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fluids are begun after the surgery.

7. The nurse receives a phone call from the parents of a 9-year-old female who is com plaining of a headache and blurry vision. The child has been healthy but has a history of hydrocephalus and received a ventriculoperitoneal shunt at the age of 1 month. The parents also state that she is not acting like herself, is irritable, and sleeps more than she used to. They ask the nurse what they should do. Select the nurse's best response. 1. "Give her some acetaminophen, and see if her symptoms improve. If they do not improve, bring her to the pediatrician'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 as it has been working well for 9 years." 4. "You should immediately bring her to the emergency room as these may be symptoms of a shunt malfunction."

4. These are symptoms of a shunt malfunc tion and should be evaluated immediately.

44. The nurse is caring for a child with CP. The nurse knows that since the 1960s the incidence of CP has: 1. Increased. 2. Decreased. 3. Remained the same. 4. Has decreased due to early misdiagnosis.

44. 1. The incidence of CP has increased partly due to the increased survival of extreme low-birth-weight and premature infants.

51. The parents of a 12-month-old with CP ask the nurse if they should teach their child sign language because he has not begun any vocalization yet. The nurse bases her response on which of the following? 1. Sign language may be a very beneficial way to help children with CP communicate. 2. Sign language may cause confusion and further delay verbalization. 3. Most children with CP will have great difficulty learning sign language. 4. Sign language may be beneficial, but it would be best to wait until the child is closer to the preschool age.

51. 1. Sign language may help the child with CP communicate and ultimately de crease frustration. Children with CP may have difficulty verbalizing because of weak tongue and jaw muscles. They may be able to have sufficient motor skills to communicate with their hands.

52. The parents of a 2-year-old with CP are learning how to feed their child and avoid aspiration. When reviewing the teaching plan, the nurse should question which of the following? 1. Place the food on the tip of the tongue, as the child will be less likely to choke. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

52. 1. The food should be placed far back in the mouth to avoid tongue thrust.

55. The nurse is caring for a 6-year-old female with a neuroblastoma. The girl has metastasis to the bone marrow and has been diagnosed with pancytopenia. Which of the following should be included in her care? 1. Administration of red blood cells. 2. Limit school attendance to less than 4 hours daily. 3. Administration of Coumadin. 4. Encourage a diet high in fresh fruits and vegetables.

55. 1. Red blood cells will be needed to increase the red blood cell count.

57. The nurse is working in the pediatric cancer center caring for a group of children with brain tumors. Which of the following children would have likely experienced a delay in diagnosis? 1. A 3-month-old, as signs and symptoms would not have been readily apparent. 2. A 5-month-old, as signs and symptoms would not have been readily suspected. 3. A school-age child, as signs and symptoms could have been misinterpreted. 4. An adolescent, as signs and symptoms could have been ignored and denied.

57. 1. In infants, signs and symptoms may not be readily apparent as the open fontanel allows for expansion.

61. Which of the following has the potential to alter a child's level of consciousness? Select all that apply. 1. Metabolic disorders. 2. Trauma. 3. Hypoxic episode. 4. Dehydration. 5. Endocrine disorders.

61. 1, 2, 3, 4, 5. 1. Many metabolic disorders are associ ated with hypoglycemia. The hypo glycemic child experiences a decreased level of consciousness as the brain does not have stores of glucose. 2. Trauma can lead to generalized brain swelling with resultant increased ICP. 3. Hypoxemia leads to a decreased level of consciousness as the brain is intoler ant to the lack of oxygen. 4. Dehydration can lead to inadequate perfusion to the brain, which can result in a decreased level of consciousness. 5. Endocrine disorders often result in a decreased level of consciousness as they can lead to hypoglycemia, which is poorly tolerated by the brain.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Keep the lights on brightly so that he can see his mother b) Rock the child frequently c) Have the child's 2-year-old brother stay in the room d) Avoid making noise when in the child's room

Avoid making noise when in the child's room

A parent brings their 4-year-old male child to the pediatrician's office for a scheduled wellness appointment. The assessment reveals weight loss since the last visit. The client looks malnourished and pale, with dry lips and mucous membranes. The client appears lethargic. The parent reports numerous liquid stools and abdominal cramping daily. Complete the following sentence(s) by choosing the best answers from the lists of options. The nurse suspects that the client may have .... AEB ... , ....

Crohn disease AEB malnutrition lethargy, loos stools and dry mucus membranes

A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention? 1. Prevention of injury by removing the child from his bed 2. Prevention of injury by placing a tongue blade in the child's mouth 3. Prevention of injury by restraining the child 4. Prevention of injury by placing the child on his side and opening his airway

Prevention of injury by placing the child on his side and opening his airway

A 15-year-old female adolescent visits the school nurse. The client appears anxious and states they have been dating a couple of different friends. The client states that they went to a party the other night and does not remember the entire night. The client states "I woke up and some of my clothes were missing. Now I have been experiencing some pain when I pee and there is yellow, green drainage that smells awful." Complete the following sentence(s) by choosing from the lists of options. The nurse suspects the client has.... AEB ....

STI AEB discharge

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a) Degree and extent of nuchal rigidity b) Signs of increased intracranial pressure (ICP) c) Occurrence of urine and fecal contamination d) Onset and character of fever

Signs of increased intracranial pressure (ICP)

A nurse is examining a boy with cerebral palsy. He has hypertonic muscles and abnormal clonus in his legs and walks on his toes. Which of the following is the type of cerebral palsy that this boy is demonstrating? a) Spastic b) Ataxic c) Athetoid d) Dyskinetic

Spastic

A nurse on a pediatric unit finds a 3-year-old child unconscious. The child does not respond to stimuli. The nurse calls a code and starts to perform cardiopulmonary resuscitation (CPR). Complete the following sentence(s) by choosing from the lists of options. The nurse should first address the child's....then....then....

airway, breathing, perfusion

A nurse is caring for a 4-year-old male child brought to the emergency department (ED) for symptoms of influenza. The parents state the child has "had high fevers for the past 3 days even though we have been giving our child acetaminophen and they do not really want to eat or drink anything and has been very sleepy." Client opens eyes to voice, follows simple commands, and skin is very warm, ruddy, and dry. Vital signs: 101.5°F (38.6°C); heart rate, 138 beats/min; oxygen saturation, 95% on room air. Laboratory values: white blood cell (WBC) count, 43 × 103 cells/mm3 (43 × 109/l); hemoglobin, 10 mg/dl (100 g/l); hematocrit, 32% (0.32); platelets, 20,000/ml (20 × 109/l); neutrophil bands, 48/mcl (0.05 × 109/l); lymphoblasts, 33 (NA). Complete the following sentence(s) by choosing from the lists of options. The nurse should first address .... , .....

bleeding/perfusion risk, nonrebreather mask

A nurse is assessing a 6-year-old male child brought to the pediatrician's office for sore throat and fever. Assessment reveals lethargy; dry, warm skin; capillary refill time <3 seconds; lungs clear to auscultation. Vital signs: temperature, 100.1°F (37.8°C); heart rate, 128 beats/min; respiratory rate, 28 breaths/min. The nurse performs a throat culture, which is positive for group A streptococcus (GAS). Urine sample results: dark concentrated urine; urine specific gravity 1.04. Complete the following sentence(s) by choosing from the lists of options. The child is at highest risk for developing .... AEB .....

carditis pneumonia ABE group A streptococcus