Prep U QC: Neuro/ Infection

A child is brought to the emergency center after sustaining a seizure at home. When taking the child's history, which question(s) would the nurse ask the parents? Select all that apply.

"Can you describe to me the movements your child experienced?" "Did your child stop breathing during the seizure?" "Did your child lose bladder or bowel control?" "What time did the seizure occur?" "How long did the seizure last?

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?

"What happened just before the seizures?" (Explanation: Asking what happened just before the seizure will suggest whether the episode was a seizure or a breath-holding event, which is frequently precipitated by an expression of anger or frustration.)

The nursing is caring for a hospitalized child diagnosed with varicella-zoster virus. The child's parents ask how to prevent the child's siblings from contracting the virus. Which response by the nurse is best?

"We will place your child on contact and airborne precautions. It is best for the other children not to visit." (Explanation: The causative agent for chickenpox is the varicella-zoster virus, which is spread through contact and airborne methods. The client should be placed on precautions and limit visitors who are at risk.)

The mother of an 8-year-old boy with mumps tells the nurse that she does not understand how her son could have gotten mumps since he was immunized according to her physician's recommendations. What is the best response by the nurse?

"While immunizations are highly effective they aren't 100% effective at preventing infectious diseases."

What information is most correct regarding the nervous system of the child?

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

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves:

Bacteria (Explanation: Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa {e.g., Toxoplasma gondii}. However, bacteria are typically the culprits.)

Antibiotic therapy to treat meningitis should be instituted immediately after which event?

Collection of cerebrospinal fluid (CSF) and blood for culture (Explanation: Antibiotic therapy should always begin immediately after the collection of CSF and blood cultures. After the specific organism is identified, bacteria-specific antibiotics can be administered if the initial choice of antibiotic therapy isn't appropriate. Admission and initiation of I.V. therapy aren't, by themselves, appropriate times to begin antibiotic therapy.)

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse will be correct in telling the parent which information in regard to seizures?

Convulsive activity often occurs in seizures.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed?

Dramatic increase in head circumference

During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take?

Report the findings to the pediatric health care provider. (Explanation: These findings are consistent with craniosynostosis, or premature fusion of the cranial sutures. Intervention is needed to prevent damage to the growing brain. Waiting 24 hours to reassess will delay treatment. In microcephaly, the head circumference is small, but the fontanels and suture line are palpable.)

A child is brought to the emergency department after experiencing a series of continuous seizures. The nurse is reviewing the orders for care and treatment. Which order would be of the highest priority?

Serum glucose level

The most common complication of varicella is:

secondary bacterial infections. (Explanation: The most common complication of varicella is secondary bacterial infection caused by the child scratching the lesions. Other complications include pneumonia, scarring, and encephalitis.)

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):

steroid. (Explanation: A steroid may be prescribed to reduce inflammation and pressure on vital centers.)

The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?

"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy." (Explanation: Antibiotics are only used for bacterial infections, not viral infections unless a secondary bacterial infection develops from the virus. Treatment for viral infections is aimed at treating the client's symptoms.)

The school football team has developed an outbreak of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). The school nurse is talking with the team to discuss how to stop the spread among the team members. Which fact(s) should the nurse teach these athletes? Select all that apply. ("Keep from touching surfaces in the locker room as much as possible." "Wash your sports clothes in hot water." "Do not borrow deodorant or a hairbrush from each other." "Cover your mouth when coughing." "Clean any cut or abrasion and cover with a dry bandage.")

"Do not borrow deodorant or a hairbrush from each other." "Clean any cut or abrasion and cover with a dry bandage." "Cover your mouth when coughing." "Keep from touching surfaces in the locker room as much as possible." (Explanation: Community-acquired methicillin-resistant Staphylococcus aureus {CAMRSA} is a staphylococcal infection that is resistant to certain antibiotics. The nurse should teach the athletes that transmission occurs through direct person-to-person contact; respiratory droplets; blood; or sharing personal items, such as hairbrushes, towels, and sports equipment; and touching surfaces or items contaminated with MRSA. The barriers to preventing CAMRSA are intact skin and hand hygiene. Students should clean and cover any open cut or abrasion, cover their mouths while coughing, and not share personal items. They should avoid touching surfaces that could be contaminated. It is not necessary to wash the clothes in hot water.)

When providing care for a child with herpes zoster (shingles), the parents ask the nurse how the child contracted this infectious disorder. Which response by the nurse is most appropriate?

"Herpes zoster is a reactivation of a previous varicella zoster infection." (Explanation: Herpes zoster {shingles} is reactivation of the latent varicella zoster {chicken pox} infection that occurs during times of immunosuppression and aging. Although it is possible to contract the varicella zoster virus from a person with herpes zoster or varicella zoster, a child diagnosed with herpes zoster has already been exposed to varicella zoster. Handwashing will not directly prevent herpes zoster.)

A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent?

"Your child may return to school when all of the lesions have crusted over." (Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by the direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district.)

What is the leading cause of neonatal sepsis and death?

Group B streptococcus (Explanation: Group B streptococcus is the leading cause of neonatal sepsis and death.)

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 neural tube defect

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room?

A private room near the nurses' station

The rash in roseola is pruritic. Which measure would you teach the parent to provide comfort?

Apply cool compresses to the skin to stop local itching. (Explanation: Rashes can be uncomfortable and irritating. Parents need to be educated on ways to relieve discomfort and to protect and maintain skin integrity. Cool compresses or cool baths will help to relieve the itching associated with the rash. Antipuretics may be necessary also to help with itching. To protect the skin the child should be instructed not to scratch the skin to alleviate itching. The child's fingernails should be kept short. Keeping the child dressed warmly will not bring out the rash any sooner. Being warm will, however, cause an increased temperature and intensify the itching. Aspirin should not be used in children as an antipyretic. There is an increased risk of developing Reye's syndrome.)

The nurse is caring for a child whose family recently emigrated from a developing country. While completing the admission history, the parents report all the child's immunizations are up to date. Which nursing action is most appropriate?

Ask parents which immunizations have been given. (Explanation: When caring for a child recently immigrated from a developing country, the nurse should be aware that WHO recommended vaccinations and U.S. recommended vaccinations may be different. The most appropriate action is for the nurse to determine which vaccinations have been given to decide if additional immunizations may be needed.)

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as:

Battle sign. (Explanation: Two signs of basilar skull fracture include Battle sign {bruising or ecchymosis behind the ear} and "raccoon eyes" blood leaking into the frontal sinuses causing an edematous and bruised periorbital area)

The nurse is caring for an adolescent who suffered an injury during a diving accident. During assessment the client is demonstrating the posturing in the figure. The nurse is aware that this type of posturing is the result of injury to what area?

Brain stem (Explanation: Decerbrate posturing is seen with injuries occurring at the level of the brain stem. Decorticate posturing occurs with damage of the cerebral cortex. Both types of posturing are characterized by extremely rigid muscle tone. Injuries to the frontal lobe of the brain and the mid-cervical spine would not cause these types of posturing.)

A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them. (Low-grade fever Macular rash Papular rash Vesicle formation Crusting)

Low-grade fever Macular rash Papular rash Vesicle formation Crusting

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?

Red, strawberry tongue (Explanation: The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis.)

The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session?

Tell me your concerns about your child's shunt. (Explanation: Always start by assessing the family's knowledge. Ask them what they feel they need to know. Knowing when to call the doctor and how to raise the child's head are important, but they might not be listening if they have another question on their minds. "Autoregulation" is too technical—base information on the parents' level of understanding.)

The nurse is preparing discharge education for the caregivers of a child with a seizure disorder. Which goal of treatment is priority for this client?

The child will remain free from injury during a seizure.

A chief danger of scarlet fever is that children may develop:

acute glomerulonephritis. (Explanation: Because this is a streptococci-based infection, there is a chance the child will develop rheumatic fever or glomerulonephritis following the illness.)

The nurse is caring for a hospitalized, 1-week-old infant who appears very ill. Which assessment finding(s) will the nurse report to the health care provider? Select all that apply. petechiae respiratory rate 60 breaths/min heart rate 100 beats/min characteristics of crying axillary temperature 97.6°F (36.5°C)

petechiae heart rate 100 beats/min respiratory rate 60 breaths/min axillary temperature 97.6°F (36.5°C) characteristics of crying (Explanation: Sepsis is suspected in any infant under 3 months of age until laboratory findings return. In an infant, the most important findings are hypothermia, bradycardia, and apnea. Tachypnea can be present in both infants and children. The nurse would be concerned with the infant's weak cry, lethargy, and increased work of breathing (such as rate, nasal flaring, grunting, and retractions). The child with sepsis generally has an elevated temperature, but hypothermia is seen in infants. The nurse should perform a good skin assessment. If petechiae are present, it is indicative of a very serious infection caused by Neisseria meningitidis.)

An infant is brought to the emergency department after falling off the parents' bed and hitting the head. The infant is diagnosed with a concussion and is safe to return home. Which instruction(s) does the nurse provide the parents for home care of this infant? Select all that apply. ("Return to the emergency department if you notice your infant's pupils are different sizes." "Wake your infant every 6 hours. Your infant should respond normally to waking." "Have someone in the home with your infant for the next 24 hours." "Return to the emergency department if your infant vomits more than 2 times." "Administer acetaminophen every 4 hours for head pain.")

"Return to the emergency department if you notice your infant's pupils are different sizes." "Have someone in the home with your infant for the next 24 hours." "Return to the emergency department if your infant vomits more than 2 times."

The parents of a child with a history of seizures who has been taking phenytoin ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate?

"Small increments in dosage lead to sharp increases in plasma drug levels." (Explanation: Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity.)

A 7-year-old client 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 she first said she had 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 statement would be the best response by the nurse?

"This might or might not be a problem. Watch your daughter 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." (Explanation: Reye syndrome usually occurs after a viral illness, particularly after an upper respiratory infection or varicella (chickenpox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children with viral infections. The symptoms appear within 3 to 5 days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, and confusion occur. Immediate intervention is needed to prevent serious insult to the brain, including respiratory arrest.)

The nurse is caring for a school-aged child hospitalized with an infectious disease. The child is placed on transmission-based precautions. What would the nurse include in the plan of care? Select all that apply.

- Allow the child to view the staff's face through the door window before entering the room. - Encourage the parents to contact friends and classmates so cards can be sent and displayed. - Monitor the child for changes in mood or level of aggression. - Provide the child with age-appropriate games and toys for his or her room. - Plan for extra time to visit the child throughout the shift between assessments and procedures.

Which collaborative intervention will the nurse provide when caring for an infant diagnosed with pertussis? Select all that apply.

- Have suction available in the room. - Encourage small, frequent feedings. - Administer erythromycin for 10 days. - Utilize droplet and standard precautions. (Explanation: Infants with pertussis are generally admitted to the hospital for at least 48 hours to see how the disease course is progressing. Droplet precautions are used until 5 days after a child starts antibiotic therapy, and visitors may be restricted during this time {5 days}. Standard precautions will be used throughout the hospitalization. Frequent small meals are vomited less than larger meals, making it easier for the infant to maintain nutritional status. A full 10-day course of erythromycin or azithromycin may be prescribed because these drugs have the potential to shorten the period of communicability and may shorten the duration of symptoms. Infants with pertussis may need airway suction for thick secretions.)

A nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite? Select all that apply.

- Lyme disease. - Rocky Mountain spotted fever. (Explanation: Infectious diseases caused by tick bites include Lyme disease and Rocky Mountain spotted fever. Psittacosis is transmitted to children by birds. Ascariasis is a roundworm infection. Scabies is a parasitic infection caused by a female mite.)

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. (Stupor Coma Obtundation Disorientation Oriented to person, place, and time)

- Oriented to person, place, and time - Disorientation - Obtundation - Stupor - Coma (Explanation: Levels of consciousness in order from most alert to least alert are orientated to person, place, and time {full consciousness}; confusion {disorientation}; obtundation; stupor; and finally coma)

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.

- 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.

A nurse is assessing a child with a tick-borne disease. What finding would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain spotted fever?

Absence of rash (Explanation: Both Rocky Mountain spotted fever and ehrlichiosis are manifested by fever, headache, and malaise. However, there is rarely a rash with ehrlichiosis, which helps to differentiate it from Rocky Mountain spotted fever.)

When caring for a child diagnosed with West Nile virus, the nurse will question which prescription from the primary health care provider?

Amoxicillin 40 mg/kg/day orally every 8 hours (Explanation: West Nile virus is transmitted to humans primarily through the bite of infected mosquitoes and manifestations include: fever, weakness, fatigue, balance problems, memory impairment, headache, myocarditis, hepatitis, myositis and orchitis, and rhabdomyolysis. Treatment is symptomatic. Since this is a viral illness, antibiotics would not be given and the nurse would question such prescriptions. It is appropriate to give acetaminophen for the fever or pain; place on fall precautions due to fatigue, balance problems, and weakness; and monitor the cardiac status for the development of myocarditis.)

A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure?

Change in level of consciousness

A child who developed parotid gland swelling on March 5 was diagnosed with mumps. The nurse determines that the child will no longer be contagious at which time?

March 14 (Explanation: Children with mumps are no longer considered contagious 9 days following the onset of parotid swelling.)

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity?

Moving the infant's head every 2 hours (Positional plagiocephaly can occur because the infant's head is allowed to stay in one position for too long. Because the bones of the skull are soft and moldable, they can become flattened if the head is allowed to remain in the same position for a long period of time. Massaging the scalp will not affect the skull.)

The nurse is assessing a child who presents with a history of fever, malaise, fatigue, and headache. The nurse notes a bulls-eye rash on the child's right leg. Which action will the nurse take?

Notify the primary health care provider (Explanation: The nurse would suspect the child has Lyme disease and notify the health care provider for additional testing and potential antibiotic therapy. Precautions are not indicated for clients with Lyme disease. An ECG would only be needed if cardic symptoms were noted. It is recommended to clean the site of the tick bite with rubbing alcohol when the tick is removed, not at a later time.)

A nursing instructor is teaching students about the chain of infection. What does the instructor tell students is responsible for allowing the pathogen to enter? (Portal of exit Portal of entry Reservoir Means of transmission)

Portal of entry (Explanation: The chain of infection is the process by which organisms are spread. An infectious agent is any organism capable of causing an infection. It can be bacteria, viruses, or fungi. The reservoir is the place where these organisms thrive and reproduce. After reproduction, the organism must leave the reservoir. This area is the portal of exit. Pathogens can be transmitted via either direct or indirect methods. Direct method would be close contact with the infected person. Indirect transmission occurs with things like droplets in the air {e.g., sneeze, cough}. The portal of entry is the way for a pathogen to enter the body. It can be through inhalation, ingestion, or breaks in the skin. Any person who cannot resist the pathogen is the susceptible host.)

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?

Positron emission tomography (PET) (Explanation: The diagnostic technique of positron emission tomography (PET) involves imaging after injection of positron-emitting radiopharmaceuticals into the brain. These radioactive substances accumulate at diseased areas of the brain or spinal cord. PET is extremely accurate in identifying seizure foci. Brain scans identify possible tumor, subdural hematoma, abscess, or encephalitis. Echoencephalography is often used in neonatal ICUs to monitor intraventricular hemorrhages and other problems frequently encountered by preterm infants. Myelography is the x-ray study of the spinal cord following the introduction of a contrast material into the CSF by lumbar puncture to reveal the presence of space-occupying lesions of the spinal cord.)

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used?

Puncturing a vein on the dorsal side of the hand (Explanation: The usual sites for obtaining blood specimens are veins on the dorsal side of the hand or the antecubital fossa. Administration of sucrose prior to beginning helps control pain for young infants. Accessing an indwelling venous access device may be appropriate if the child is in an acute care setting. An automatic lancet device is used for capillary puncture of an infant's heel.)

What information should be included in the teaching plan for a child with varicella?

Remind the child not to scratch the lesions. (Explanation: Varicella lesions appear first on the scalp. They spread to the face, the trunk, and to the extremities. There may be various stages of the lesions present at any one time. The lesions are intensely pruritic. The teaching plan for varicella should include that the child not scratch the lesions. Opening the lesions gives access for secondary infection to occur and causes scarring. Acetaminophen, not aspirin, should be administered for fever due to the link with Reye syndrome. The best treatment for skin discomfort is a cool bath with soothing colloidal oatmeal every 3 to 4 hours for the first few days. Warm baths cause more itching and dry the skin.)

The parents of a 10-month-old child bring the infant to the emergency department after finding the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone." Which assessments are priority for the nurse to complete? Select all that apply. vital signs pupillary response circulation airway respiratory status signs of child abuse (child mistreatment) level of consciousness

circulation airway respiratory status

The nurse is caring for a hospitalized infant at risk for developing increased intracranial pressure. Which assessment finding(s) would the nurse communicate to the health care provider for further intervention? Select all that apply. (- parent states, "My infant does not act right." - vomiting - blood pressure decreased from baseline - pulse rate of 60 beats/min and regular - increased head circumference)

increased head circumference pulse rate of 60 beats/min and regular vomiting parent states, "My infant does not act right."