Neuro

A child fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which is a priority for the triage nurse to say at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"

3

A child in the PICU with a head injury is comatose and unresponsive. The parent asks if he needs pain medication. Select the nurse ' s best response. 1. "Pain medication is not necessary because he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." 3. "Pain medication is necessary to make him comfortable." 4. "Pain medication is necessary for comfort, but we use it cautiously because it increases the demand for oxygen."

3

Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with a roommate who also has bacterial meningitis. 2. Semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. Private room that is dark and quiet with minimal stimulation. 4. Private room that is bright and colorful and has developmentally appropriate activities available.

3

The nurse is caring for a child who has been in a motor vehicle accident (MVA). The child falls asleep unless her name is called or she is gently shaken. This state of consciousness is referred to as: 1. Coma. 2. Delirium. 3. Obtunded. 4. Confusion.

3

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

3

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do fi rst: 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fl uids. 3. Placement of a Foley catheter. 4. Send the spinal fl uid and blood samples to the laboratory for cultures.

4

Brain damage in a child who sustained a closed-head injury can be caused by which factor? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4

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

4

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.

3, 5

A 2-month-old infant is brought to the emergency department after experiencing a seizure. The infant appears lethargic with very irregular respirations and periods of apnea. The parents report the baby is no longer interested in feeding and, before the seizure, rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography (CT) scan of the head and dilation of the eyes. 2. Computed tomography (CT) scan of the head and electroencephalogram (EEG). 3. X-rays of the head. 4. X-rays of all long bones.

1

A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do fi rst? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child ' s temperature and blood pressure.

1

A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely a/an: 1. Absence seizure. 2. Akinetic seizure. 3. Non-epileptic seizure. 4. Simple spasm seizure.

1

A preschooler has been having periods during which he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse ' s best response. 1. "Have the parents follow up with his health-care provider because this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life because it could be attention-seeking behavior." 3. "Have the parents follow up with his health-care provider because this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him and see if it continues."

1

The diet that produces anticonvulsant effects from ketosis consists of: 1. High-fat and low-carbohydrate foods. 2. High-fat and high-carbohydrate foods. 3. Low-fat and low-carbohydrate foods. 4. Low-fat and high-carbohydrate foods.

1

The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and fl exes his neck, the nurse notes he fl exes his knees and hips. This is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

1

The nurse is caring for an unconscious 6-year-old who has had a severe closed-head injury and notes the following changes: Heart rate has dropped from 120 to 55, blood pressure has increased from 110/44 to 195/62, and respirations are becoming more irregular. Which should the nurse do fi rst after calling the physician? 1. Call for additional help and prepare to administer mannitol (Osmitrol). 2. Continue to monitor the patient ' s vital signs and prepare to administer a bolus of isotonic fl uids. 3. Call for additional help and prepare to administer an antihypertensive. 4. Continue to monitor the patient and administer supplemental oxygen.

1

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

1, 2, 3, 4, 5

A child involved in a motor vehicle accident (MVA) is currently on a backboard with a cervical collar in place. The child is diagnosed with a cervical fracture. Which would the nurse expect to fi nd in the child ' s plan of care? 1. Remove the cervical collar, keep the backboard in place, and administer high- dose methylprednisolone (Medrol). 2. Continue with all forms of spinal stabilization and administer high-dose methylprednisolone (Medrol) and ranitidine (Zantac). 3. Remove the backboard and cervical collar and prepare for halo traction placement. 4. Remove the cervical collar and backboard, place the child on spinal precautions, and administer high-dose methylprednisolone (Medrol) and ranitidine (Zantac).

2

A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensure compliance.

2

The nurse is caring for a child with a skull fracture who is unconscious and has severely increased intracranial pressure (ICP). The nurse notes the child ' s temperature to be 104°F (40°C). Which should the nurse do fi rst? 1. Place a cooling blanket on the child. 2. Administer acetaminophen (Tylenol) via nasogastric tube. 3. Administer acetaminophen (Tylenol) rectally. 4. Place ice packs in the child ' s axillary areas.

1

The nurse is aware that cloudy cerebrospinal fl uid (CSF) most likely indicates: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, because CSF is usually cloudy. 4. Sepsis.

2

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

2

The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarifi cation is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child ' s 7-year-old brother is also at high risk for a febrile seizure." 3. "I ' ll give my child acetaminophen (Tylenol) when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2

The nurse knows that young infants are at risk for injury from shaken baby syndrome (SBS) because: 1. The anterior fontanel is open. 2. They have insuffi cient musculoskeletal support and a disproportionate head-to- body ratio. 3. They have an immature vascular system with veins and arteries that are more superfi cial. 4. There is immature myelination of the nervous system in a young infant.

2

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

2

Which activity should an adolescent just diagnosed with epilepsy avoid? 1. Swimming, even with a friend. 2. Being in a car at night. 3. Participating in any strenuous activities. 4. Returning to school right away.

2

Which is the best action for the nurse to take during a child ' s seizure? 1. Administer the child ' s rescue dose of oral diazepam (Valium). 2. Loosen the child ' s clothing, and call for help. 3. Place a tongue blade in the child ' s mouth to prevent aspiration. 4. Carry the child to the infi rmary to call 911 and start an intravenous line.

2

Which medication should the nurse anticipate administering first to a child in status epilepticus? 1. Establish an intravenous line and administer intravenous lorazepam (Ativan). 2. Administer rectal diazepam (Valium). 3. Administer an oral glucose gel to the side of the child ' s mouth. 4. Administer oral diazepam (Valium).

2

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fl uids at 11⁄2 times regular maintenance. 3. Neurological checks every hour. 4. Administer acetaminophen (Tylenol) for temperatures higher than 38°C (100.4°F).

2

The nurse is caring for an adolescent who remains unconscious 24 hours after sustaining a closed-head injury in a motor vehicle accident (MVA). She responds to deep, painful stimulation with decorticate posturing and has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the teen ' s peers to visit and talk to her about school and other pertinent events. 2. Encourage the teen ' s parents to hold her hand and speak loudly to her in an attempt to help her regain consciousness. 3. Attempt to keep a normal day/night pattern by keeping the teen in a bright, lively environment during the day and dark quiet environment at night. 4. Attempt to keep the environment dark and quiet and encourage minimal stimulation.

4