Ch. 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder - ML6

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) Monitor temperature every 4 hours d) Encourage the parents to hold the child

a) 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) drinking three cans of diet cola b) swimming twice a week c) 11 p.m. bedtime; 6:30 a.m. wake-up d) use of nonaccented soap

a) drinking three cans of diet cola

The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction? a) "The VP shunt will help drain fluid from my baby's brain." b) "This shunt is the only surgery my baby will need." c) "My baby's cerebrospinal fluid is increasing intracranial pressure." d) "I will watch my baby for irritability and difficulty feeding."

b) "This shunt is the only surgery my baby will need."

Absence seizures are marked by what clinical manifestation? a) Brief, sudden onset of increased tone of the extensor muscle b) Loss of motor activity accompanied by a blank stare c) Sudden, brief jerks of a muscle group d) Loss of muscle tone and loss of consciousness

b) Loss of motor activity accompanied by a blank stare

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as: a) raccoon eyes. b) rhinorrhea. c) Battle sign. d) otorrhea.

c) Battle sign.

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

c) Positive Kernig sign

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 parents call the doctor if the child vomits more than twice. 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 child sleep without a pillow under his head.

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

The nurse is assessing a toddler for motor function. Which activity will be the most valuable? a) Ask the child to kick the ball forward. b) Have the child catch a ball. c) Let the child look at a picture book. d) Watch the child reach for a toy.

d) Watch the child reach for a toy.

The nurse is collecting data on an 18-month-old child admitted with a diagnosis of possible seizures. When interviewing the caregivers, which questions would be most important for the nurse to ask? a) "Have you checked your child's temperature?" b) "Is your child up to date on his immunizations?" c) "What type of activities was your child doing today?" d) "Has anyone in your family been sick recently"

a) "Have you checked your child's temperature?"

Gabapentin has been prescribed for a pediatric client. Which statement by the client indicates an understanding of teaching related to the medication? a) "I can't take this medication within 2 hours of taking my antacid medication." b) "This medication will make me extremely hungry." c) "This medication should be taken in the evening before I go to bed." d) "This medication can be sprinkled on my food."

a) "I can't take this medication within 2 hours of taking my antacid medication."

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

a) "Use this information to teach family and friends."

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) Understanding the side effects of medications b) Instructing her teacher how to respond to a seizure c) Treating the child as though she did not have epilepsy d) Placing the child on her side on the floor

a) Understanding the side effects of medications

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)? a) While assessing the child's pupils, there is no change in diameter in response to a light. b) While turning the child's head to the left, the eyes turn to the right. c) While stimulating the child's foot, the big toe points upward and other toes fan outward. d) While calling the child's name, the child stares straight ahead and does not turn to the sound.

a) While assessing the child's pupils, there is no change in diameter in response to a light.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem? a) head trauma b) positional plagiocephaly c) intracranial hemorrhaging d) congenital hydrocephalus

a) head trauma

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) congenital heart defect b) arteriovenous malformations (AVMs) c) meningitis d) sickle cell disease

b) arteriovenous malformations (AVMs)

The nurse is caring for a child diagnosed with hydrocephalus following ventriculoperitoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority? a) Monitor the client for signs of infection. b) Measure the client's head circumference. c) Assess the client's respiratory status. d) Educate the family on the shunt.

c) Assess the client's respiratory status.

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) Palpate the child's fontanels (fontanelles). b) Encourage the mother to hold and comfort the infant. c) Institute droplet precautions in addition to standard precautions. d) Educate the family about preventing bacterial meningitis.

c) Institute droplet precautions in addition to standard precautions.

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? a) The caregivers will be prepared to care for the child at home. b) The family will understand seizure precautions. c) The child will remain free from injury during a seizure. d) The child will have an understanding of the disorder.

c) The child will remain free from injury during a seizure.

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

d) steroid.

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? a) "I hate to think that I will need to be worried about my child having seizures for the rest of his life." b) "I need to set an alarm to wake up and check his temperature during the night when he is sick." c) "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever." d) "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully."

a) "I hate to think that I will need to be worried about my child having seizures for the rest of his life."

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.

a) ensuring the parents know how to properly give antibiotics.

The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP? a) hyperthermia b) poor handwriting c) tachypnea d) hypertension

a) hyperthermia

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

a) moving the infant's head every 2 hours

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? a) "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever." b) "I hate to think that I will need to be worried about my child having seizures for the rest of his life." c) "I need to set an alarm to wake up and check his temperature during the night when he is sick." d) "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully."

b) "I hate to think that I will need to be worried about my child having seizures for the rest of his life."

A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse? a) "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." b) "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." c) "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder." d) "Since the EEG was negative there must be some other cause for the seizures. The lumbar puncture is necessary to determine what the cause is."

b) "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."

The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse? a) Provide information regarding policies of the unit's playroom for the parents to review. b) Gather appropriate equipment and signage for respiratory isolation precautions. c) Place multiple pillows in the room to assist with propping the child's head up. d) Ensure that lights and televisions work properly to provide stimulation while the child is hospitalized.

b) Gather appropriate equipment and signage for respiratory isolation precautions.

The nurse is assessing a child and notes horizontal nystagmus. Which question would the nurse ask the parent first? a) "Has your child reached developmental milestones?" b) "Have you noticed rapid or rhythmic eye movements in your child?" c) "Does your child take phenytoin?" d) "Has your child had any type of head injury?"

c) "Does your child take phenytoin?"

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) Instructing her teacher how to respond to a seizure b) Placing the child on her side on the floor c) Understanding the side effects of medications d) Treating the child as though she did not have epilepsy

c) Understanding the side effects of medications

A 1-year-old infant has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents? a) "The surgery was successful. Do you have any questions?" b) "I told you yesterday there would be facial swelling." c) "This only happens in 1 out of 2,000 births." d) "I will be watching hemoglobin and hematocrit closely."

a) "The surgery was successful. Do you have any questions?"

The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond? A) "Meningococcal conjugate vaccine covers only two types of bacterial meningitis." B) "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine." C) "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received." D) "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."

D) "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."

The community health nurse is preparing a presentation on safety measures to prevent injuries in children. Which example of proper safety guidelines should the nurse include? Select all that apply. a) a child wearing a helmet while ice skating b) a child riding a scooter with elbow and knee pads c) a preschool-age child sitting on the lap of a caregiver in the back seat of a car d) an infant in a car seat e) a child wearing a helmet, knee pads, and elbow pads while riding a skateboard

a) a child wearing a helmet while ice skating d) an infant in a car seat e) a child wearing a helmet, knee pads, and elbow pads while riding a skateboard

Which of these age groups has the highest actual rate of death from drowning? a) toddlers b) infants c) preschool children d) school-aged children

a) toddlers

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

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

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching? a) "I'm glad to know he will only need this medication for a short time to stop his seizures." b) "I need to watch for any new bruises or bleeding and let my health care provider know about it." c) "I will give the medication to him when I first wake him up in the morning." d) "This medication may cause him to have trouble sleeping. He may need something else to help him sleep."

b) "I need to watch for any new bruises or bleeding and let my health care provider know about it."

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? a) urinalysis b) serum glucose level c) hemoglobin level d) white blood cell count

b) serum glucose level

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) bleeding from the ear b) trouble focusing when reading c) difficulty concentrating d) vomiting

b) trouble focusing when reading

A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply. a) tongue blade b) smelling salts c) padding for side rails d) suction at bedside e) oxygen gauge and tubing

c) padding for side rails d) suction at bedside e) oxygen gauge and tubing

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? a) "Large increments in dosage lead to a more rapid stabilizing therapeutic effect." 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) "Small increments in dosage lead to sharp increases in plasma drug levels."

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

A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement? a) "I am glad that my headache is getting better." b) "My stomach is upset. I feel like I might throw up." c) "It will be nice when you will let me take a long nap. I am sleepy." d) "You look funny. Well, both of you do. I see two of you."

d) "You look funny. Well, both of you do. I see two of you."

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

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

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

d) Cerebral edema

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) computed tomography b) cerebral angiography c) lumbar puncture d) video electroencephalogram

d) video electroencephalogram

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? a) Always keep her head raised 30º. b) Tell me your concerns about your child's shunt. c) Call the doctor if she gets a persistent headache. d) Her autoregulation mechanism to absorb spinal fluid has failed.

b) Tell me your concerns about your child's shunt.

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 (decerebrate posturing). The nurse is aware that this type of posturing is the result of injury to what area? a) mid-cervical b) frontal lobe c) cerebral cortex d) brain stem

d) brain stem

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

b) Risk for injury related to seizure activity

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest 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 responsiveness or attention c) Muscle tone maintained and child frozen in position d) Sudden, momentary loss of muscle tone, with a brief loss of consciousness

b) Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? a) A room with an 8-month-old infant with failure to thrive b) A two-bed room in the middle of the hall c) A room with a 12-month-old infant with a urinary tract infection d) A private room near the nurses' station

d) A private room near the nurses' station

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

b) Signs of increased intracranial pressure (ICP)

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? a) "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." b) "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." c) "This might or might not be a problem. Watch your daughter 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." d) "This is a serious problem. Aspirin is likely to cause Reye syndrome, and she should be admitted to the hospital for observation as a precaution."

b) "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."