Chapter 16: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder

Correct Response: "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 arres

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 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." "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." "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." "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."

The nurse is caring for a child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What action(s) by the nurse should be performed now? Select all that apply. [] Encourage the child to cough and deep breathe to facilitate drainage. [] Check tubing clamps to ensure they are open. [] Check the child's temperature. [] Ensure the tubing is not kinked. [] Ensure the drip chamber is below the child's clavicles.

Correct Response: [x] Check tubing clamps to ensure they are open. [x] Ensure the tubing is not kinked. Explanation: Nursing care of an external ventricular drainage device requires the nurse to ensure all connections are secure and labeled. The amount of drainage requires close observation. If drainage is absent or minimal, the nurse must assess the tubing to make certain it is not clamped or kinked. The level of the drip chamber must be set at the height of the child (at the clavicle). Taking the temperature will be useful to assess for the presence of infection, but that is not currently a concern. Asking the child to cough and deep breathe should not be done. Deep breathing is beneficial for all postoperative clients, but coughing may increase pressures and should be avoided.

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply. [] posture [] eye opening [] fontanels (fontanelles) [] verbal response [] motor response

Correct response: [x] eye opening [x] verbal response [x] motor response Explanation: The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor 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? "Did you use any medications, like aspirin, for the fever?" "What type of fluids did your child take when he had a fever?" "Did you give your child any acetaminophen, such as Tylenol?" "How high did his temperature rise when he was ill?"

Correct response: "Did you use any medications, like aspirin, for the fever?" Explanation: Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

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? "The forceps used during delivery caused this to happen." "It's normal for this to happen, but they don't really know why." "During delivery, your vaginal wall put pressure on the baby's head." "Your baby's head became blocked inside your vagina while you were pushing."

Correct response: "During delivery, your vaginal wall put pressure on the baby's head." Explanation: Caput succedaneum results from pressure from the uterus or vaginal wall during a head-first delivery. The use of forceps is associated with a cephalohematoma. Caput succedaneum is not due to the baby's head becoming blocked inside the vagina. The cause of caput succedaneum is known; it is caused by pressure from the uterus or vaginal wall during a head-first delivery.

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? "The respiratory system matures during this time, so good prenatal care during the first weeks of pregnancy is very important." "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." "Bones begin to harden in the first 5 to 6 weeks of pregnancy, so vitamin D consumption is particularly important."

Correct response: "During the first 3 to 4 weeks of pregnancy, brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma." Explanation: Brain and spinal cord development occur during the first 3 to 4 weeks of gestation. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal central nervous system (CNS) development. Good health before becoming pregnant is important but must continue into the pregnancy. Hardening of bones occurs during 13 to 16 weeks' gestation, and the respiratory system begins maturing around 23 weeks' gestation.

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 this child? "If he vomits again, we will bring him back immediately." "Even if the flashlight bothers him, we will check his eyes." "If he falls asleep, we will wake him up every 15 minutes." "We can give him acetaminophen for a headache, but no aspirin."

Correct response: "Even if the flashlight bothers him, we will check his eyes." Explanation: The child's pupils are checked for reaction to light every 4 hours for 48 hours. If the child falls asleep, he or she should be awakened every 1 to 2 hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The caregiver should observe the child for at least 6 hours for vomiting or a change in the child's level of consciousness. The caregiver should notify the health care provider immediately if the child vomits more than three times, but if the child vomits once, returning to the care provider immediately is not needed.

The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "The child will be placed in the prone position with the nurse holding the child still." "The child will be held by the mother on her lap with his back toward the health care provider." "When positioning the child, the nurse needs to assist the child to a side-lying position and keep his back as flat as much as possible." "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back."

Correct response: "For a lumbar puncture, the child will be placed in a side-lying position with knees bent and neck flexed to assist with arching the back." Explanation: Correct positioning for a lumbar puncture is to place the child on his or her side with the neck flexed and knees bent and drawn up to their chest. This helps to keep the back arched as much as possible. Newborns may be seated upright with their head bent forward. The child is not placed prone; this does not allow the back to be arched.

An infant with a ventriculoperitoneal (VP) shunt in place is brought to the clinic because of being drowsy and less responsive. Which question in the health history would provide information to the nurse indicating that the VP shunt is perhaps infected? "Has your child been eating well the last few days?" "Has your child been sleeping more every day?" "Have you noticed any changes in your child's pupils?" "Has your child been crying more than usual?"

Correct response: "Has your child been eating well the last few days?" Explanation: The major complications for children who have shunts are infection and shunt malfunction. The symptoms a child would exhibit with an infection are poor feeding; increased temperature and heart rate; decreased responsiveness; and localized inflammation along the shunt tract. With a shunt malfunction, the child would have vomiting, drowsiness, and a headache. The nurse would be correct in asking about feeding as a way to indicate infection. Sleeping more and crying, if having a headache, could indicate a shunt malfunction. Pupil changes could indicate increased intracranial pressure. Parents who have children with shunt placements are taught all these symptoms, including pupil checks.

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? "What type of activities was your child doing today?" "Has anyone in your family been sick recently" "Have you checked your child's temperature?" "Is your child up to date on his immunizations?"

Correct response: "Have you checked your child's temperature?" Explanation: In children between the ages of 6 months and 3 years, febrile seizures (seizures resulting from fever) are the most common. Febrile seizures usually occur in the form of a generalized seizure early in the course of a fever. Although an illness in another member of the family might indicate the possibility of an infection or other illness, this would not be the priority question to ask. If the child has had an immunization recently, the child could develop a fever, but asking if the immunizations are up-to-date is not asking about recent immunizations. The child's daily activities would not likely promote seizure activity.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the parent indicates to the nurse that additional teaching is needed? "I always keep phenobarbital with me in case of a fever." "My child will likely outgrow these seizures by age 5." "I have ibuprofen available in case it is needed." "The most likely time for a seizure is when the fever is rising."

Correct response: "I always keep phenobarbital with me in case of a fever." Explanation: Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature before a seizure occurs, which will most likely happen as the temperature rises.

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

Correct response: "I can't take this medication within 2 hours of taking my antacid medication." Explanation: Gabapentin is used in the treatment of seizure disorders. It is rapidly absorbed. It cannot be taken within 2 hours of the administration of antacid medications.

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? "I hate to think that I will need to be worried about my child having seizures for the rest of his life." "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully." "I need to set an alarm to wake up and check his temperature during the night when he is sick." "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."

Correct response: "I hate to think that I will need to be worried about my child having seizures for the rest of his life." Explanation: Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.

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? "This medication may cause him to have trouble sleeping. He may need something else to help him sleep." "I will give the medication to him when I first wake him up in the morning." "I need to watch for any new bruises or bleeding and let my health care provider know about it." "I'm glad to know he will only need this medication for a short time to stop his seizures."

Correct response: "I need to watch for any new bruises or bleeding and let my health care provider know about it." Explanation: Carbamazepine is an antiseizure medication. It can cause bone marrow depression, so parents need to watch for any signs of bruising, bleed, or infection and notify their health care provider if this happens. Administer this medication with food to minimize GI upset. This medication can cause drowsiness, so do not give any sleep-inducing or other sedative type medications. Antiseizure medication does not cure seizures; it only controls the seizures. Lifelong antiseizure medication may be needed.

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? "Meningococcal conjugate vaccine covers only two types of bacterial meningitis." "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received." "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine."

Correct response: "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." Explanation: Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised.

While caring for a child who will be undergoing a lumbar puncture, the nurse explains the procedure to the infant's mother. Which statement by the mother would indicate a need for further education? "My child may have a headache after the procedure. If she does, she can have something for the pain." "During the test, the health care provider will most likely take 3 tubes of spinal fluid to test for several things." "I need to encourage my child to drink at least 1 glass of water after the procedure." "I will cradle her in my arms after the procedure for at least 30 minutes."

Correct response: "I will cradle her in my arms after the procedure for at least 30 minutes." Explanation: During the procedure, typically 3 tubes of cerebrospinal fluid (CSF) are removed for testing. After the procedure, the child is encouraged to lay flat for at least 30 minutes. During that time, the child is also encouraged to drink a glass of water to help prevent cerebral irritation. Even when all proper procedures are followed, some children develop a headache following the test. An analgesic may be given for pain relief.

The nurse is educating a child and his family about what to expect during the child's electroencephalogram (EEG) exam. Which statement by a parent suggests a need for further education? "If my child can't stay still during the procedure, they may have to give him medication to help him be still." "The room will be dark during the procedure." "I will make sure my child goes to bed early the night before the exam." "The procedure will determine the electrical patterns of his brain."

Correct response: "I will make sure my child goes to bed early the night before the exam." Explanation: During an EEG, the client needs to be cooperative and quiet. Typically, parents are asked to keep their child up later the night before so that the child will fall asleep during the procedure. The room is also darkened to help them rest. If the child is unable to remain still, sedation may be used. The EEG reflects the electrical patterns of the brain.

A child with a seizure disorder has been prescribed phenytoin to control the seizures. While providing teaching about the medication, what dietary instructions should the nurse provide the parent? "Increase your child's intake of yogurt and broccoli." "Increase your child's intake of whole milk and orange juice." "Increase your child's intake of eggs and beans." "Increase your child's intake of cheese and spinach."

Correct response: "Increase your child's intake of whole milk and orange juice." Explanation: Phenytoin is a drug used to control seizures. There are several things a parent needs to be taught about the drug. One fact is that it requires a correct therapeutic level, so laboratory tests will be necessary. Another is that it can cause gingival hyperplasia, so good mouth care and oral hygiene are essential. The third thing is that it interferes with vitamin D, so an intake of food containing vitamin D is essential in the diet. The foods that have the highest amount of vitamin D are fatty fish such as salmon. The most common foods a child could eat to increase vitamin D are whole milk, orange juice, yogurt, cheese, and eggs. Spinach and broccoli are both high in vitamin C, not vitamin D. Beans contain no vitamin D. They are high in iron, B6, and magnesium.

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? "The capacity to metabolize the drug becomes overwhelmed over time." "A drop in the plasma drug level will lead to a toxic state." "Large increments in dosage lead to a more rapid stabilizing therapeutic effect." "Small increments in dosage lead to sharp increases in plasma drug levels."

Correct response: "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.

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

Correct response: "Sometimes it is hard to tell what products may contain aspirin." Explanation: Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. Two common medications containing salicylates are bismuth subsalicylate and effervescent heartburn relief antiacid. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. The nurse should not state the obvious, but also should not minimize the situation. Encouraging the parent to ask for information and offering explanations in terms the parent will understand are important, but this response does not address the parent's assertion. Telling the parent not to worry is offering platitudes and false reassurance. Giving the description of what complications could happen with the disease would be inappropriate. This would only exacerbate the parent's concern, and it does not address how the child ingested salicylates. Note: Reye's Syndrome- Acute condition that causes swelling in the brain(encephalopathy) and liver (hepatitis)

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 lumbar puncture is a routine test that is performed anytime someone has a seizure disorder." "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." "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."

Correct response: "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." Explanation: Lumbar punctures are performed to analyze cerebrospinal fluid (CSF) to rule out meningitis or encephalitis as a cause of seizures. A normal EEG does not rule out epilepsy because seizure activity rarely occurs during the actual testing time. A 24-hour or longer EEG can help in diagnosing a seizure disorder. Just telling the parents that it needs to be done, to be patient, or it is a routine does not address the parents' concerns.

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

Correct response: "The surgery was successful. Do you have any questions?" Explanation: Often what parents need most is someone to listen to their concerns. Although this is a good time for education, the parents are more concerned about the success of the surgery than their infant's appearance. Watching the hemoglobin, hematocrit and swelling are important nursing functions but they do not address the parents' psychosocial needs. The parents do not need to be taught statistics about their infant's condition. They more than likely know this from health care provider visits, the Internet, and parent support groups. Following surgery, this knowledge is not what parents are concerned about. Parents want to know their infant is safe and well.

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? "The VP shunt will help drain fluid from my baby's brain." "This shunt is the only surgery my baby will need." "My baby's cerebrospinal fluid is increasing intracranial pressure." "I will watch my baby for irritability and difficulty feeding."

Correct response: "This shunt is the only surgery my baby will need." Explanation: Hydrocephalus results from an imbalance in the production and absorption of CSF. In hydrocephalus, CSF accumulates within the ventricular system and causes the ventricles to enlarge, and increases in ICP subsequently occur. A VP shunt can be used to drain excess CSF, but it will need to be replaced as the child grows, requiring shunt revision surgery at various times during the client's life. The parent should be taught to monitor for signs and symptoms of increased ICP, which include irritability and vomiting. Increased ICP indicates the shunt is not functioning properly.

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? "Use this information to teach family and friends." "If he is out of bed, the helmet's on the head." "You'll always need a monitor in his room." "Bike riding and swimming are just too dangerous."

Correct response: "Use this information to teach family and friends." Explanation: Families need and want information they can share with relatives, child care providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The child may be able to bike ride and swim with proper precautions.

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

Correct response: "Watch for changes in his behavior or eating patterns." Explanation: Changes in behavior or in eating patterns can suggest a problem with his shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed.

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? "Was the child unconscious?" "What happened just before the seizures?" "How did you treat the child afterwards?" "Were there any jerky movements?"

Correct response: "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. Cyanotic breath holding can be accompanied by clinical movements, as can seizures. Both types of events render the child unconscious. One would expect concerned, caring treatment from the parents regardless of the cause.

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? "Do you understand why you clamp the drain before she sits up?" "What questions or concerns do you have about this device?" "What do you know about her autoregulation mechanism failing?" "Why do you always keep her head raised 30 degrees?"

Correct response: "What questions or concerns do you have about this device?" Explanation: Always start by assessing the family's knowledge. Ask them what they need to know. Knowing when to clamp the drain is important, but they might not be listening if they have another question on their minds. Autoregulation is too technical. Teaching should be based on the parents' level of understanding. Keeping her head elevated is not part of the information which would be taught regarding the drainage system.

A nurse in the emergency department (ED) is assessing a 2-year-old male child. The parents state the child "has been very feverish the past few days, and today the child developed a purple rash on the chest. The child is now very sleepy." Click to highlight the findings that will require immediate follow-up. The assessment reveals the child is lethargic but opens eyes and answers yes and no to questions. The child is unable to lie with hips flexed and straighten the leg out , and states their neck hurts when trying to move it. Vital signs: temperature, 102.4°F (39.1°C) ; heart rate, 120 beats/min; blood pressure, 78/45 mm Hg; respirations, 28 breaths/min ; oxygen saturation, 92% on room air .

Correct response: -lethargic -unable to lie with hips flexed and straighten the leg out -neck hurts -102.4°F (39.1°C) (NOT WRONG BUT NOT RIGHT) --blood pressure, 78/45 mm Hg; respirations, 28 breaths/min -92% on room air' Explanation: The client's temperature of 102.4°F (39.1°C) indicates a fever. This will require the nurse to follow up to determine the underlying cause for the fever. A purple (purpuric) rash appearing during a febrile state requires follow-up, because it may indicate meningitis. The child reporting a stiff neck may indicate meningeal irritation. The child's inability to straighten the leg when lying flat with hips flexed indicates meningeal irritation; it is referred to as a positive Kernig sign. Lethargy indicates decreased level of consciousness; the nurse should closely monitor the child's level of consciousness. The child's oxygen saturation of 92% on room air indicates decreased oxygen levels. ** The child's blood pressure of 78/45 mm Hg and respiratory rate of 28 breaths/min are within normal range for a 2-year-old child.

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. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down IN THE ORDER using the arrows to the left. 1-Disorientation 2-Oriented to person, place, and time 3-Obtundation 4-Stupor 5-Coma

Correct response: 1-Oriented to person, place, and time 2-Disorientation 3-Obtundation 4-Stupor 5-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 nurse is assessing the neurological functioning of a preschool child. What actions will best review functioning of cranial nerve III? The nurse talks softly to the child to note the ability to hear. The nurse observes facial features and expressions for symmetry. A bright-colored toy is moved in the child's visual fields. The nurse allows the child to smell objects and describe them.

Correct response: A bright-colored toy is moved in the child's visual fields. Explanation: Cranial nerve III, the oculomotor nerve, is assessed by using a brightly colored object to assess the child's ability to watch its movement. Cranial nerve I (olfactory nerve) controls the sense of smell. Asking the child to smell objects would be an assessment of this cranial nerve. Cranial nerve VII (facial nerve) is assessed by monitoring symmetry of facial movements. Cranial nerve VIII (acoustic nerve) is assessed by whispering.

A 6-year-old child with hydrocephalus had a ventriculoperitoneal (VP) shunt placed 6 weeks ago and now has experienced a seizure, vomiting, and loss of appetite. Which intervention will target the child's priority need? Educate the parents about seizure precautions. Pad and raise the rails on the child's bed. Prepare a menu with the child's favorite foods. Administer intravenous antibiotics as prescribed.

Correct response: Administer intravenous antibiotics as prescribed. Explanation: The major complications associated with shunts are infection and malfunction. When a shunt malfunctions the child experiences vomiting, drowsiness, and headache. When infection has occurred the child experiences increased vital signs, poor feeding, vomiting, decreased responsiveness, seizure activity and signs of local inflammation along the shunt tract. When an infection occurs the priority of care is to treat the infection with IV antibiotics. The seizures and the poor eating will resolve once the infection is cleared. The parents can be taught about seizure precautions and the bed can be padded but these are not the priority of care. Reference:

The nurse is caring for a school-age child who has been having a continuous seizure for the last 40 minutes. What is the priority action by the nurse? Administer lorazepam IV as prescribed. Perform a glucose finger stick to determine the child's blood sugar level. Administer carbamazepine as prescribed. Observe and document the length of time of the seizure and type of movement observed.

Correct response: Administer lorazepam IV as prescribed. Explanation: A seizure lasting longer than 30 minutes is considered status epilepticus and is an emergency situation. An IV benzodiazepine such as lorazepam is administered to help stop the seizure. Checking blood glucose levels, monitoring length and type of seizure, and administration of anti-seizure medication such as carbamazepine all are correct interventions for clients with seizures, but these are not the priority action.

The nurse is caring for an adolescent who suffered a thoracic spinal cord injury 8 weeks ago. While assessing the adolescent, the nurse notes a blood pressure of 185/95 mm Hg, heart rate of 130 beats/minute, flushed face, and a report of a severe headache. What is the priority action by the nurse? Notify the health care provider and request a prescription for an antihypertensive. Place the adolescent in a high-Fowler position to reduce intracranial pressure. Assess the adolescent's indwelling urinary catheter to see if it is obstructed. Place a fan pointing toward the adolescent's face to help reduce flushing.

Correct response: Assess the adolescent's indwelling urinary catheter to see if it is obstructed. Explanation: Autonomic dysreflexia is an emergent situation that is caused by a full bladder in a child with a spinal cord injury. It is characterized by extreme hypertension, tachycardia, flushed face and severe occipital headache. Assessing and emptying the bladder is the first action in treating this disorder. Placing the child in high-Fowler and providing a fan does not address the underlying cause of the autonomic dysreflexia. The nurse will need to notify the health care provider but should do this after assessing the client's bladder and indwelling bladder catheter.

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? Assess the client's respiratory status. Measure the client's head circumference. Educate the family on the shunt. Monitor the client for signs of infection.

Correct response: Assess the client's respiratory status. Explanation: The nurse would place priority on monitoring the client's respiratory status since the client is on a ventilator and at risk for intracranial pressure. The nurse would educate the family on the shunt, monitor for infection, and measure head circumference; however, these actions are not priority over ensuring the client maintains a patent airway.

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

Correct response: 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). Rhinorrhea is CSF leakage from the nose. Otorrhea is CSF leaking from the ear.

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? Renal failure Cerebral edema Cardiogenic shock Left-sided heart failure

Correct response: Cerebral edema Explanation: The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of IV therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.

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

Correct response: 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 IV therapy aren't, by themselves, appropriate times to begin antibiotic therapy.

The nurse is assigned an infant with a possible neurological disorder. Which assessment finding would the nurse communicate to the health care provider as a late sign of increased intracranial pressure? Decorticate posturing and fixed and dilated pupils Headache and sunset eyes Dizziness and irritability Decreased pupil reaction and decreased respiration.

Correct response: Decorticate posturing and fixed and dilated pupils Explanation: Decerebrate or decorticate posturing and fixed and dilated pupils are late signs of increased intracranial pressure. Decreased pupil reaction, decreased respirations, headache, sunset eyes, dizziness, and irritability are early signs of increased intracranial pressure.

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? Take vital signs every 4 hours Decrease environmental stimulation Monitor temperature every 4 hours Encourage the parents to hold the child

Correct response: Decrease environmental stimulation Explanation: A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed? Pupil of one eye dilated and reactive Vertical nystagmus Dramatic increase in head circumference Posterior fontanel (fontanelle) is closed

Correct response: Dramatic increase in head circumference Explanation: A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel (fontanelle) would be frequently seen by this age.

The mother of an infant reports that her child is frequently choking when breastfeeding or taking a bottle. The nurse plans on assessing which cranial nerve when addressing the mother's concerns? VI VII VIII IX

Correct response: IX Explanation: Cranial nerve IX (glossopharyngeal) would be assessed to test the swallowing and gag reflex. Cranial nerve VIII is the acoustic nerve which is involved in hearing. Cranial nerve VII is the facial nerve and controls facial muscles, salivation and taste. Cranial nerve VI is the abducens nerve and controls and is related to eye movements.

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

Correct response: Institute droplet precautions in addition to standard precautions. Explanation: Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one; the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels (fontanelles) is used to assess for hydrocephalus.

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

Correct response: Irritability, fever, and vomiting Explanation: Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels (fontanelles) would be bulging as intracranial pressure rises, and Kernig sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis.

hat is a true statement regarding status epilepticus? Children over the age of 3 are more likely to develop status epilepticus. The most common cause is flashing lights. It is a common neurologic emergency in children. Seizure activity lasts less than 30 minutes.

Correct response: It is a common neurologic emergency in children. Explanation: Status epilepticus is a common neurological emergency in children. Children younger than 3 years of age are most likely to develop status epilepticus. The most common cause of status epilepticus in children is febrile seizures. Status epilepticus occurs when seizures last longer than 30 minutes or recur without return of consciousness between seizures.

A child was just brought into the emergency department after falling off a skateboard. The parents report that their child lost consciousness briefly and they noticed watery drainage coming from the nose. What action should the nurse take first? Perform a complete neurological assessment. Notify the emergency department health care provider of the information the parents reported. Perform a thorough physical assessment. Collect a sample of the nasal drainage and send the specimen to the laboratory.

Correct response: Notify the emergency department health care provider of the information the parents reported. Explanation: The health care provider should be notified immediately if clear liquid fluid is noted draining from the ears or nose following a traumatic accident. Nasal drainage can be tested for glucose at the bedside. If the fluid tests positive for glucose, this is indicative of leakage of cerebrospinal fluid. The other assessments can continue after notifying the health care provider of these findings.

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

Correct response: Positive Kernig sign Explanation: A positive Kernig sign can indicate irritation of the meninges. A positive Brudzinski sign also is indicative of the condition. A positive Chadwick sign is a bluish discoloration of the cervix indicating pregnancy.

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? Echoencephalography Positron emission tomography (PET) Brain scan Myelography

Correct response: 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 is caring for a preschooler who has developed a high fever and has just had a seizure. What is the best action by the nurse? Place the child in a bathtub filled with cool water. Apply ice packs to the child's axillary and groin area. Administer acetaminophen by mouth as prescribed. Remove any blankets or heavy clothing and replace with a thin sheet

Correct response: Remove any blankets or heavy clothing and replace with a thin sheet Explanation: The child should not have any blankets or clothing that would elevate the temperature further. Removing them is helpful in allowing the heat to dissipate. The child should not be placed in a bathtub because he or she may suffer another seizure and slip underwater. Using ice packs or alcohol can be a shock to an immature nervous system. Antipyretics should be administered as a suppository rather than PO to reduce the risk of aspiration while the child is in the postictal or drowsy state following the seizure.

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? Risk for injury related to seizure activity Delayed growth and development related to physical restrictions Risk for acute pain related to surgical procedure Ineffective airway clearance related to history of seizures

Correct response: Risk for injury related to seizure activity Explanation: The child's risk for injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and if the child has a history of seizures, it would specifically impact airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

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

Correct response: Teach the child and his parents to keep a headache diary. Explanation: A headache diary can help identify any triggers so that the child can avoid them. Triggers can include foods eaten, amount of sleep the night before, or activities at home or school that might be causing stress. Reviewing signs of increased intracranial pressure would be inappropriate because increased intracranial pressure is not associated with headaches. Having the child sleep without a pillow is an intervention to reduce pain from meningitis. Vomiting more than twice is an indication that the parents should notify the physician or nurse practitioner when the child has a head injury.

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

Correct response: 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 caring for a child admitted with focal onset motor seizures (simple partial motor seizures). Which clinical manifestation would likely have been noted in the child with this diagnosis? The child had shaking movements on one side of the body. The child was dizzy and had decreased coordination. The child was rubbing the hands and smacking the lips. The child had jerking movements in the legs and facial muscles.

Correct response: The child had shaking movements on one side of the body. Explanation: Focal onset aware seizures (formerly called simple partial seizures) can either have motor or sensory symptoms. A focal onset motor seizure causes a localized motor activity such as shaking of an arm, leg, or other body part. A focal onset sensory seizure may include sensory symptoms called an aura, which signals an impending attack. 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. Complex partial seizures may cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

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? The child has vomited and has bruising behind her ear. The child is bleeding from the ear and draining fluid from the nose. The child is easily distracted and can't concentrate. The child is weak and has blurry vision.

Correct response: The child is easily distracted and can't concentrate. Explanation: A child with a concussion will be distracted and unable to concentrate. Signs and symptoms of contusions include disturbances to vision, strength, and sensation. Vomiting and bruising behind the ear are signs of a subdural hematoma. Bleeding from the ear and otorrhea are signs of a basilar skull fracture.

During the trial period to determine the efficacy of an anticonvulsant drug, which caution should be explained to the parents? 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 Drug dosage will be adjusted depending on the frequency of seizure activity Plasma levels of the drug will be monitored on a daily basis

Correct response: The child shouldn't participate in activities that could be hazardous if a seizure occurs Explanation: Until seizure control is certain, clients shouldn't participate in activities (such as riding a bicycle) that could be hazardous if a seizure were to occur. Plasma levels need to be monitored periodically over the course of drug therapy; daily monitoring isn't necessary. Dosage changes are usually based on plasma drug levels as well as seizure control. Anticonvulsant drugs should be withdrawn over a period of 6 weeks to several months, never immediately, as doing so could precipitate status epilepticus.

The nurse is caring for a child admitted with focal onset impaired awareness seizure (complex partial seizure). Which clinical manifestation would likely have been noted in the child with this diagnosis? The child had jerking movements and then the extremities stiffened. The child had shaking movements on one side of the body. The child was rubbing the hands and smacking the lips. The child was dizzy and had decreased coordination.

Correct response: The child was rubbing the hands and smacking the lips. Explanation: With the focal onset impaired awareness seizure, formerly called complex partial seizure, the child is confused or their awareness is affected during the seizure. The seizure begins in a small area of the brain and changes or alters consciousness. These seizures can have motor and non-motor symptoms. They cause memory loss and staring and nonpurposeful movements, such as hand rubbing, lip smacking, arm dropping, and swallowing. In the tonic phase of tonic-clonic seizures, the child's muscles contract, the child may fall, and the child's extremities may stiffen. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.Focal onset aware seizures (formerly called simple partial seizures) can either have motor or sensory symptoms. A focal onset motor seizure causes a localized motor activity such as shaking of an arm, leg, or other body part.

A school-aged child with seizures is prescribed phenytoin sodium, 75 mg four times per day. What instruction would the nurse give the parents regarding this medication? Watching television while taking the drug may cause seizures Even small doses may cause noticeable dizziness Numbness of the fingers is common while taking this drug The child will have to adhere to good tooth brushing

Correct response: The child will have to adhere to good tooth brushing Explanation: A side effect of phenytoin sodium is gingival hyperplasia. Good tooth brushing helps prevent inflammation under the hypertrophied tissue. Dizziness and tingling and numbness of the fingers are not side effects of this drug. Television watching will not elicit a seizure in a child with a known seizure disorder. A seizure occurs as an electrical interference in the brain.

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 [Select]. -suction the client's airway -insert an airway into the client's mouth -ensure proper oxygenation -ensure proper oxygenation followed by [Select] -administer intravenous (IV) or intramuscular (IM) benzodiazepine -administer an antiepileptic by mouth (PO) -do not allow the client to sleep once the seizure has ended

Correct response: The nurse should first [Select]. -ensure proper oxygenation followed by [Select] -administer intravenous (IV) or intramuscular (IM) benzodiazepine. Explanation: The nurse first ensures a patent airway and proper oxygenation using a blow-by method.The nurse then administers an antiepileptic medication such as benzodiazepines intravenously or intramuscularly for prolonged seizure activity. Nothing should be inserted into the child's airway when the child is seizing, not even suction. The nurse can place the child in a side-lying position to prevent the tongue from occluding the airway and help with secretions that may pool up in the back of the throat.The child should not receive anything orally when the child is seizing. The nurse should administer medications via intravenous push (IVP) or intramuscular (IM) during prolonged seizure activity.It is appropriate for the nurse to allow the child to sleep once the seizure has ended. The child should be placed in the left lateral recumbent recovery position.

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

Correct response: Understanding the side effects of medications Explanation: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.

A 12-year-old child has been prescribed phenytoin. What information should be included in discussion about this medication? Take medication on an empty stomach. Use a soft toothbrush. Avoid excessive sunlight. Increase intake of citrus foods to promote absorption.

Correct response: Use a soft toothbrush. Explanation: Phenytoin is an anticonvulsant medication. It can be used in the management of seizure disorders. This medication is associated with gingival hyperplasia. This may result in tender and bleeding gums. The use of a soft toothbrush will reduce pain, bleeding and discomfort. There is no need to take this medication on an empty stomach or with citrus foods and beverages. The medication does not make an individual photosensitive.

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

Correct response: Watch the child reach for a toy. Explanation: Watching the child reach for a toy would be most valuable for assessing motor function because the infant should be able to extend extremities to a normal stretch. Catching a ball or kicking a ball forward is too advanced for a toddler to accomplish. Looking at a picture book would help assess visual acuity and eye movement.

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)? While turning the child's head to the left, the eyes turn to the right. While calling the child's name, the child stares straight ahead and does not turn to the sound. While stimulating the child's foot, the big toe points upward and other toes fan outward. While assessing the child's pupils, there is no change in diameter in response to a light.

Correct response: While assessing the child's pupils, there is no change in diameter in response to a light. Explanation: To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination.

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 preschool-age child sitting on the lap of a caregiver in the back seat of a car [] an infant in a car seat [] a child riding a scooter with elbow and knee pads [] a child wearing a helmet while ice skating [] a child wearing a helmet, knee pads, and elbow pads while riding a skateboard

Correct response: [] an infant in a car seat [] a child wearing a helmet while ice skating [] a child wearing a helmet, knee pads, and elbow pads while riding a skateboard Explanation: Seat belts and child restraints such as car seats should always be used. Children should never ride on the lap of someone else in a car. Helmets should be worn while the child is riding or using anything that can move faster than the child can run. Examples of these are scooters, roller skates, ice skates, and skateboards.

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. [] "Did your child lose bladder or bowel control?" [] "How long did the seizure last?" [] "Did you give your child any fever medicine prior to the seizure?" [] "What time did the seizure occur?" [] "Did your child stop breathing during the seizure?" [] "Can you describe to me the movements your child experienced?"

Correct response: [x] "Did your child lose bladder or bowel control?" [x] "How long did the seizure last?" [x] "What time did the seizure occur?" [x] "Did your child stop breathing during the seizure?" [x] "Can you describe to me the movements your child experienced?" Explanation: There are many types of seizures. After a child has experienced a seizure, it is helpful to know the details as much as possible so these can aid in the diagnosis. The health history becomes very important to gather this information. The nurse would obtain information from the parents as to the time the seizure occurred and note how long the seizure lasted. The parents could supply a description of the child's behavior during the seizure. This would include a description of the child's movements, any loss of bowel or bladder control, if the child became cyanotic, or any other characteristics the parents observed. The nurse would also ask the parents about any precipitating events before the seizure occurred such as a fever, a fall, anxiety, or exposure to strong stimuli. Giving an antipyretic medication to the child would not interfere with the seizure.

Upon assessment of an infant the nurse suspects the infant has positional plagiocephaly. What question(s) should the nurse ask the parents to help confirm if this is correct? Select all that apply. [] "Do you change the position of your infant at night when the child is sleeping?" [] "How much tummy time do you plan each day for your infant?" [] "Do you rock your infant to sleep or lay the infant in the crib or bassinet to fall asleep?" [] "Besides transporting your infant in the car, how much time do you place your infant in the car seat every day?" [] "Do you follow the recommended guidelines of placing your infant on their back to sleep rather than the abdomen?"

Correct response: [x] "How much tummy time do you plan each day for your infant?" [x] "Besides transporting your infant in the car, how much time do you place your infant in the car seat every day?" [x] "Do you follow the recommended guidelines of placing your infant on their back to sleep rather than the abdomen?" Explanation: Positional plagiocephaly refers to asymmetry in head shape without fused sutures. It results from gravitational force exertion on the developing cranium and has increased in incidence since the inception of the "back to sleep" programs to prevent sudden unexplained infant death. Placing the infant on the abdomen (tummy time) occasionally during the day, position changes when the infant is awake, and not leaving the infant in the car seat other than for automobile transport can prevent positional plagiocephaly from occurring. The infant's position does not need to be adjusted during the night, and whether the infant is rocked to sleep is irrelevant.

The nurse is caring for a 3-year-old child who experienced a febrile seizure for the first time. What statements by the parents of the child should the nurse address further? Select all that apply. [] "It's important to manage fevers in the future in order to decrease the risk of febrile seizures." [] "We have never had anyone in our family have a febrile seizure so I was so surprised when this happened." [] "It is so scary to think that our child will likely develop epilepsy now." [] "I am afraid that our 10-year-old will start having febrile seizures." [] "I am thankful that our child won't have to be on anti-seizure medication."

Correct response: [x] "It is so scary to think that our child will likely develop epilepsy now." [x] "I am afraid that our 10-year-old will start having febrile seizures." Explanation: It is very unlikely that the 10-year-old child will develop febrile seizures. Febrile seizures usually affect children who are younger than 5 years of age, with the peak incidence occurring in children between 12 and 18 months old; it is rare to see febrile seizures in children younger than 6 months and older than 5 years of age. Children who experience one or more simple febrile seizures have a slightly greater risk of developing epilepsy than the general population, so it is not "likely" that the child will develop epilepsy.

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." [] "Administer acetaminophen every 4 hours for head pain." [] "Return to the emergency department if your infant vomits more than 2 times." [] "Have someone in the home with your infant for the next 24 hours."

Correct response: [x] "Return to the emergency department if you notice your infant's pupils are different sizes." [x] "Return to the emergency department if your infant vomits more than 2 times." [x] "Have someone in the home with your infant for the next 24 hours." Explanation: Falls are the most common cause of head injuries in infants. A concussion is a type of closed head injury. It results in disruption or malfunction of the electrical activities of the brain. After diagnostic testing and physical assessment have ruled out a serious injury, the infant can be sent home. The parents are taught how to monitor for more serious neurological signs. They, or someone, should be with the infant for the first 24 hours after injury to monitor or respond to an emergent situation. The infant should be awakened every 2 to 4 hours during the first 24 hours. The infant should be able to respond appropriately from waking. The parents would be taught to return to the emergency department if the child vomits more than twice, has increased irritability, unequal pupil sizes, or has a seizure. Acetaminophen would not be administered because it can mask the symptoms.

The nurse has performed discharge teaching for parents of a child diagnosed with epilepsy. The child has been prescribed Zonegran (zonisamide). Which comments by the parents indicate the need for further discharge teaching regarding this medication? Select all that apply. [] "Since our child also takes Dilantin (phenytoin), the dosages will likely be adjusted since it increases the metabolism of the Zonegran (zonisamide)." [] "We need to watch our child's gums for swelling since this commonly happens with this medicine." [] "This medication can make our child very sedated so we need to monitor for this side effect." [] "We may need to add B-complex vitamin supplementation to our child's medications because this can help mange side effects." [] "I hope this medicine doesn't upset our child's stomach when taking it since the medication should be given on an empty stomach."

Correct response: [x] "We need to watch our child's gums for swelling since this commonly happens with this medicine." [x] "This medication can make our child very sedated so we need to monitor for this side effect." [x] "We may need to add B-complex vitamin supplementation to our child's medications because this can help mange side effects." Explanation: Presence of food will delay absorption of the medication so it should not be administered with food. Phenytoin, phenobarbital, and carbamazepine all increase the metabolism of this drug. A side effect of phenobarbital is excessive sedation and gingival hyperplasia. B-complex vitamin supplementation can help manage side effects of levetiracetam

The nurse is providing discharge teaching to the parents of a child recently diagnosed with a seizure disorder. The nurse determines learning has occurred with which statement(s) by the parents? Select all that apply. [] "We will be sure to hold our child snugly during the seizure so no injuries occur." [] "We will be sure to keep the area safe and turn our child on the side during seizure activity." [] "We will keep an oral airway on hand and insert it into our child's mouth to maintain an open airway even if the teeth are clenched." [] "We should time the seizure and write down what happens during the seizure." [] "We will activate EMS immediately when a seizure begins."

Correct response: [x] "We will be sure to keep the area safe and turn our child on the side during seizure activity." [x] "We should time the seizure and write down what happens during the seizure." Explanation: The area should be made safe so injury does not occur during the seizure, and turning the child on the side helps maintain an open airway. Documentation of the seizure should be kept so the health care provider can review what occurred during the seizure. The child should not be restrained, because this will more likely lead to injury. Emergency medical services (EMS) only needs to be contacted if the child stops breathing; if any injury has occurred; if the seizure lasts for more than 5 minutes; or if the child is unresponsive to painful stimuli after the seizure. The other time EMS should be activated is if a child has a seizure for the first time, which does not apply to this case. The child's jaws should never be forced open.

The nurse is preparing a care plan for a toddler diagnosed with cerebral palsy (CP). Which intervention would be appropriate for the nursing diagnosis of Risk for disuse syndrome related to spasticity of muscle groups? Select all that apply. [] Administer carbidopa/levodopa as prescribed. [] Educate the child's parents that CP is a single name for a wide variety of disorders. [] Teach parents exercises and games to help prevent contractures. [] Encourage the parents to participate in speech therapy sessions to assist with speech development. [] Administer benzodiazepines as prescribed.

Correct response: [x] Administer carbidopa/levodopa as prescribed. [x] Teach parents exercises and games to help prevent contractures. [x] Administer benzodiazepines as prescribed. Explanation: Dopaminergic drugs such as carbidopa/levodopa can help to reduce muscle rigidity and spasticity. Benzodiazepines also help with smoother muscle movement and reduce spasticity. Exercises and games, done daily, can help to prevent contractures from disuse. Interventions such as education about the disease and speech therapy are appropriate for clients with cerebral palsy but are not appropriate for the nursing diagnosis of Risk for disuse syndrome related to spasticity of muscle groups.

The nurse caring for a 3-year-old child with a history of seizures observes the child having a seizure. What information should the nurse document concerning the event? Select all that apply. [] Incontinence of urine or stool [] Number of seizures child has had in the last 48 hours [] Factors present before seizure started [] Persons in attendance during seizure [] Time the seizure started [] Eye position and movement

Correct response: [x] Incontinence of urine or stool [x] Factors present before seizure started [x] Time the seizure started [x] Eye position and movement Explanation: Following a seizure, the nurse documents the following: time the seizure started; what the child was doing when the seizure began; any factor present just before the seizure (bright light, noise); part of the body where seizure activity began; movement and parts of the body involved; any cyanosis; eye position and movement; incontinence of urine or stool; time seizure ended; and child's activity after the seizure. Who was with the child or the number of seizures the child has had are not relevant to document regarding observation of this seizure.

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. [] Request order for an antiemetic. [] Request order for anticonvulsant. [] Monitor the child's laboratory values related to pancreatic function. [] Assess child's skin for the development of distinctive rash every 4 hours. [] Assess intake and output every shift.

Correct response: [x] Request order for an antiemetic. [x] Request order for anticonvulsant. [x] Assess intake and output every shift. Explanation: This child likely has Reye syndrome and may require an antiemetic for severe vomiting. The nurse should monitor the child's intake and output every shift for the development of fluid imbalance. The child may require an anticonvulsant due to an increased intracranial pressure that may induce seizures. A distinctive rash is associated with the development of meningococcal meningitis. The nurse should monitor the laboratory values of the child with Reye syndrome for indications that the liver is not functioning well.

The parents of a 10-month-old infant 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 assessment(s) is the priority for the nurse to complete? Select all that apply. [] vital signs [] level of consciousness [] pupillary response [] signs of child abuse (child mistreatment) [] circulation [] airway [] respiratory status

Correct response: [x] airway [x] respiratory status [x] circulation Explanation: With a submersion injury, hypoxia is the primary problem. Therefore, assessment of the airway, breathing, and circulation (ABCs) are the primary assessments the nurse will complete. These guide implementation of resuscitative measures. Other assessments such as level of consciousness, vital signs, and pupillary response would be done once the infant is stable. The nurse would also perform a complete assessment, looking for signs of child abuse (child mistreatment) once the infant is stable.

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. [] padding for side rails [] suction at bedside [] oxygen gauge and tubing [] tongue blade [] smelling salts

Correct response: [x] padding for side rails [x] suction at bedside [x] oxygen gauge and tubing Explanation: When planning the client's environment it is imperative that both safety items and those to manage the seizure are present. The side rails should be padded to prevent injury during seizure activity. Oxygen setup should be provided. Suction may be needed. Tongue blades and smelling salts are not employed.

A 12-year-old child has suffered a concussion after being in an automobile accident. What will be included in the plan of care/treatment? Select all that apply. [] rest [] observation of level of consciousness [] assessment of serum electrolyte levels [] administration of intravenous fluids [] strict monitoring of intake and output

Correct response: [x] rest [x] observation of level of consciousness Explanation: A concussion is a common head injury. The injury is caused by a bump, blow, jolt, jarring, or shaking and results in disruption or malfunction of the electrical activities of the brain. Treatment includes rest and monitoring for neurologic changes that could indicate a more severe injury.

The nurse is completing a nursing history on a female client who has just found out she is 6 weeks' pregnant. She reports that over the last 2 months she has been drinking excessive amounts of alcohol every weekend and smokes a half-pack of cigarettes per day. What is the nurse concerned with given this information? Select all that apply. [] spinal cord development in the fetus [] brain development in the fetus [] reproductive organ development in the fetus [] development of gastrointestinal organs in the fetus [] solid bone formation in the fetus

Correct response: [x] spinal cord development in the fetus [x] brain development in the fetus Explanation: The brain and spinal cord make up the central nervous system (CNS). Development of these structures begins in the first 3 to 4 weeks of gestation from the neural tube. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal CNS development.

The nurse is assessing a child who has suffered a head injury. Which assessment finding would indicate loss of midbrain functioning? loss of deep tendon reflexes arms adducted and flexed on the chest with hands fisted no response to verbal statements arms adducted and extended with pronation of wrists with fingers flexed

Correct response: arms adducted and extended with pronation of wrists with fingers flexed Explanation: Decerebrate posturing, rigid extension, and adduction of the arms and pronation of the wrists with flexed fingers occurs when the midbrain is not functional. Cerebral loss is shown mainly by decorticate posturing (the child's arms are adducted and flexed on the chest with wrists flexed, hands fisted). Deep tendon reflexes decrease with level of consciousness, but this does not specifically indicate lack of midbrain functioning. No response to verbal statements may indicate a decreased level of consciousness, but it does not indicate lack of midbrain functioning.

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? congenital heart defect arteriovenous malformations (AVMs) meningitis sickle cell disease

Correct response: arteriovenous malformations (AVMs) Explanation: Vascular malformations such as intracranial AVMs are a risk factor for hemorrhagic stroke. Sickle cell disease is a risk factor for ischemic stroke. Congenital heart defects are risk factors for ischemic stroke. Meningitis or other infection is a risk factor for ischemic stroke.

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 cerebral cortex frontal lobe mid-cervical

Correct response: brain stem Explanation: Decerebrate 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.

The nurse assesses a child and finds that the child's pupils are pinpoint. What does this finding indicate? brain stem dysfunction seizure activity brain stem herniation intracranial mass

Correct response: brain stem dysfunction Explanation: Pinpoint pupils are commonly observed in poisonings, brain stem dysfunction, and opiate use. Dilated but reactive pupils are seen after seizures. Fixed and dilated pupils are associated with brain stem herniation. A single dilated but reactive pupil is associated with an intracranial mass.

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

Correct response: drinking three cans of diet cola Explanation: Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

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: maintaining effective cerebral perfusion. ensuring the parents know how to properly give antibiotics. establishing seizure precautions for the child. encouraging development of motor skills.

Correct response: ensuring the parents know how to properly give antibiotics. Explanation: Educating parents how to properly give the antibiotics would be the priority intervention because the child's shunt has become infected. Maintaining cerebral perfusion is important for a child with hydrocephalus, but the priority intervention for the parents at this time concerns the infection. Establishing seizure precautions is an intervention for a child with a seizure disorder. Encouraging development of motor skills would be appropriate for a microcephalic child.

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: group B streptococcus. enterovirus. Haemophilus influenzae type B. Escherichia coli.

Correct response: enterovirus. Explanation: Aseptic meningitis is the most common type of meningitis, and if a causative organism can be identified, it is usually a virus such as enterovirus. E. coli is a cause of bacterial meningitis. H. influenzae type B is a cause of bacterial meningitis. Group B streptococcus is a cause of bacterial meningitis.

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

Correct response: head trauma Explanation: A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify which condition as a neural tube defect? hydrocephalus anencephaly encephaloceles pina bifida occulta

Correct response: hydrocephalus Explanation: Hydrocephalus results from an imbalance in the production and absorption of cerebrospinal fluid. In hydrocephalus, cerebrospinal fluid accumulates within the ventricular system and causes the ventricles to enlarge and increases in intracranial pressure. Anencephaly, encephalocele and spina bifida occulta are all neural tube defects.

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

Correct response: hypertension Explanation: Symptoms of increased intracranial pressure include slowing of both pulse and respirations, increasing blood pressure, and the development of hypothermia. All of these symptoms result from the increased ICP putting pressure on the cranial vessels and the hypothalamus. Double vision, or diplopia, also occurs as a result of increasing ICP.

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

Correct response: moving the infant's head every 2 hours Explanation: 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. Measuring the intake and output is important but has no effect on the skull bones. Small feedings are indicated whenever an infant has increased intracranial pressure, but feeding an infant each time he fusses is inappropriate care.

After experiencing a head injury the child keeps falling asleep when no one is rousing him. When documenting this in the medical record which term is most appropriate? lethargic obtunded stupor unconscious

Correct response: obtunded Explanation: Obtunded is defined as a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Stupor exists when the child only responds to vigorous stimulation. Lethargic refers to being without energy and relaxed.

The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's level of consciousness? decreased level of consciousness stupor fully conscious obtunded

Correct response: obtunded Explanation: Obtunded is defined as a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Fully conscious describes a child who has no neurologic changes. Stupor exists when the child only responds to vigorous stimulation. Decreased level of consciousness is a vague term that does not describe the assessment findings.

The nurse is caring for an infant with increased intracranial pressure. The mother is preparing to feed the child. What action by the mother indicates an understanding of the proper care of this infant? placing the infant in an infant car seat after feeding the infant placing the infant supine in the crib after feeding the infant placing the infant prone in the crib after feeding the infant placing the infant in a Sims position in the crib after feeding the infant

Correct response: placing the infant in an infant car seat after feeding the infant Explanation: Placing a child or infant in the semi-Fowler position can help reduce cerebral edema and pressure. Using an infant child seat helps to simulate the raised head of the bed. In the supine position, the client is completely flat on his or her spine. Prone is face down and flat. Sims is a side-lying position with one leg flexed. All of the described positions place the client flat, not with the head raised; that would be in the semi-Fowler position.

A nurse is caring for an infant who has just undergone a ventricular tap. In what position should the nurse place the infant immediately after the procedure? prone on the bed with a parent or caregiver on either side of the bed high-Fowler position while sitting on the parent's lap semi-Fowler position with a parent at the bedside supine on a parent's lap

Correct response: semi-Fowler position with a parent at the bedside Explanation: Proper positioning for an infant after a ventricular tap is to place the child in a semi-Fowler position to prevent additional drainage from the puncture site. Allow the parents or caregivers to comfort the child. Placing the child in the prone or supine position could allow for additional drainage from the puncture site. High-Fowler position is contraindicated immediately after this procedure.

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 hemoglobin level white blood cell count urinalysis

Correct response: serum glucose level Explanation: Status epilepticus is the occurrence of repetitive seizures in an individual. This is a neurological emergency. The events of the repetitive seizures greatly expend energy. This will result in rapid drops in serum glucose level, making this the priority laboratory value to review.

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

Correct response: steroid. Explanation: Increased intracranial pressure (ICP) may be caused by several factors: head trauma, birth trauma, hydrocephalus, infection, and/or tumors. Whatever the reason, the brain swells and becomes inflamed. Dexamethasone is a steroid. A steroid may be prescribed to reduce inflammation and pressure on vital centers of the brain. The diuretic mannitol may be used to decrease edema. An anticonvulsant is used with increased ICP to prevent seizures. An antihistamine would not be warranted for the treatment of a head injury.

While observing a child, the nurse notes that the child's arms and legs are extended and pronated. During shift hand-off, the nurse reports potential damage to: the cerebral cortex. the cranial nerves. the midbrain. the meninges.

Correct response: the midbrain. Explanation: The observations indicate decerebrate posturing, which occurs with damage to the midbrain. Decorticate posturing as evidenced by arm adduction, elbow flexion with arms over the chest, and wrist flexion with fisted hands indicates damage to the cerebral cortex. Damage to the cranial nerves would be manifested by defects in motor and/or sensory function, depending on the cranial nerves affected. Meningeal irritation, as with bacterial meningitis, is manifested by opisthotonos in an infant. With this position, the head and neck are hyperextended to relieve discomfort.

An 8-year-old child is diagnosed as having tonic-clonic seizures. The nurse would want to teach the parents that: their child should maintain an active lifestyle. they should immediately give medication if their child shows symptoms of beginning a seizure. their child should carry a padded tongue blade at all times. their child should be kept quiet late in the day when he or she is most likely to have a seizure.

Correct response: their child should maintain an active lifestyle. Explanation: Having a child with a chronic seizure disorder can place stress and anxiety on the family. The nurse should encourage the family to be involved in the care of the child. The child's caregivers, such as the school nurse, should also be involved in the care of the child. Children with seizure disorders who are treated no differently than any other child develop a positive self-image and increased self-esteem. Any needed activity restrictions are based on the type, frequency, and severity of the child's seizures. Padded tongue blades should not be used when a seizure is occurring. There is too much potential to damage bone structure or occlude the airway. The child should take seizure medications on a regular basis to develop a therapeutic level to prevent the seizure. Seizures can occur at any time during the day or night so keeping the child resting late in the day is not necessary.

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

Correct response: toddlers Explanation: Toddlers and older adolescents have the highest actual rate of death from drowning.

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? bleeding from the ear trouble focusing when reading vomiting difficulty concentrating

Correct response: trouble focusing when reading Explanation: Signs and symptoms for cerebral contusions include disturbances to vision, strength, and sensation. A child suffering a concussion will be distracted and unable to concentrate. Vomiting is a sign of a subdural hematoma. Bleeding from the ear is a sign of a basilar skull fracture.

The nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client? use of anticonvulsant medications vagus nerve stimulation ketogenic diet frequent temperature assessment

Correct response: use of anticonvulsant medications Explanation: Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. These medications are typically used first as treatment for seizure disorders. Frequent temperature assessment would only be useful in febrile seizures. Ketogenic diets (high in fat, low in carbohydrates, and adequate in protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Diet is generally used when medications cannot control a child's seizure activity. Stimulating the left vagus nerve intermittently with electrical pulses may reduce seizure frequency. This requires surgically implanting a stimulator under the skin and is approved for children 12 and older.

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? video electroencephalogram computed tomography cerebral angiography lumbar puncture

Correct response: video electroencephalogram Explanation: A video electroencephalogram can determine the precise localization of the seizure area in the brain. Cerebral angiography is used to diagnose vessel defects or space-occupying lesions. Lumbar puncture is used to diagnose hemorrhage, infection, or obstruction in the spinal canal. Computed tomography is used to diagnose congenital abnormalities such as neural tube defects.

The nurse is talking with a teen and her parents about triggers for her frequent headaches. Which statements indicate an understanding? Select all that apply. [] "I may experience headaches during certain periods in my menstrual cycle." [] "Chocolate may trigger my headaches." [] "Giving up cola may be beneficial to helping me avoid headaches." [] "Change in weather can trigger my headaches." [] "Spicy foods are associated with headaches."

The nurse is talking with a teen and her parents about triggers for her frequent headaches. Which statements indicate an understanding? Select all that apply. [x] "I may experience headaches during certain periods in my menstrual cycle." [x] "Chocolate may trigger my headaches." [x] "Giving up cola may be beneficial to helping me avoid headaches." [x] "Change in weather can trigger my headaches." Explanation: Teaching about headaches should include a discussion about possible triggers. Foods containing chocolate and caffeine should be restricted in the diet as they may trigger headache pain. Changes in the menstrual cycle may also be tied to headaches. Spicy foods are not tied to headaches.

When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply. [] The nurse pads the crib or side rails before a seizure. [] The nurse stays with the child and calls for help when a seizure begins. [] The nurse places a washcloth in the mouth to prevent injury during seizure. [] The nurse positions the child on the side during a seizure. [] The nurse has oxygen available to use during a seizure. [] The nurse teaches the caregivers regarding seizure precautions.

[x] The nurse pads the crib or side rails before a seizure. [x] The nurse stays with the child and calls for help when a seizure begins. [x] The nurse positions the child on the side during a seizure. [x] The nurse has oxygen available to use during a seizure. [x] The nurse teaches the caregivers regarding seizure precautions. Explanation: The nurse should pad the crib sides and keep sharp or hard items out of the crib. The nurse should also position the child to one side to prevent aspiration of saliva or vomitus and have oxygen and suction equipment readily available for emergency use. The nurse should teach family caregivers seizure precautions so they can handle a seizure that occurs at home. The nurse should not put anything in the child's mouth; doing so could cause injury to the child or to the nurse. It is important for the nurse to promptly inform other members of the care team when a child is experiencing seizure activity, but leaving the bedside to do so would be unsafe.