Neuro/Gas/Gen worksheet Peds

Asking specific questions will give the nurse the information needed to determine the level of care for the child

. 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

A dark, quiet environment and minimal stimulation will decrease oxygen consumption and ICP.

. 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

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

. Which child is at increased risk for cerebral palsy (CP)?

The helmet is worn 23 hours every day and removed only for bathing Most children gain some improvement from a helmet

A 6-month-old male has been diagnosed with positional brachycephaly. The nurse is providing teaching about the use of a helmet for his therapy. Which statement indicates that the parents understand the education? Select all that apply

. The child experiencing a seizure usually requires more oxygen because the seizure increases the body ' s metabolic rate and demand for oxygen. The seizure may also affect the child ' s airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help

A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first

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

A child has been diagnosed with a midline brain tumor. In addition to showing signs of increased intracranial pressure (ICP), she has been voiding large amounts of very dilute urine. Which medication does the nurse expect to administer

Pain medication promotes comfort and ultimately decreases ICP

A child in the PICU with a head injury is comatose and unresponsive. The parent asks if he needs pain medication. Select the nurse ' best response

All forms of spinal stabilization should be continued while methylprednisolone (Medrol) and ranitidine (Zantac) are administered

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 find in the child ' plan of care

Cultures of spinal fluid and blood should be obtained, followed by administration of intravenous antibiotics.

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first

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

A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen?

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

A child with Reye syndrome is described in the nurse ' s notes as follows: 1200— comatose with sluggish pupils; when stimulated, demonstrates decerebrate posturing. 1400—unchanged except that now demonstrates decorticate posturing when stimulated. The nurse concludes that the child ' condition is

Absence seizures occur frequently and last less than 30 seconds. The child experiences a brief loss of consciousness during which she may have a change in activity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming.

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

These are symptoms of a shunt malfunction and should be evaluated immediately.

A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse best response

CP can manifest in different ways as the child grows. It does not progress, but its clinical manifestations may change

A child with cerebral palsy (CP) has been fitted for braces and is beginning physical therapy to assist with ambulation. The parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse ' best response

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

Brain damage in a child who sustained a closed-head injury can be caused by which factor

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

The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP) due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurse ' best response

Asking the 3-year-old to identify her parents and state her name is a developmentally appropriate way to assess orientation

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:

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

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

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

The nurse is caring for a child receiving radiation therapy for a brain tumor. The parents ask if their child will likely have any learning disabilities. Select the nurse ' s best answer.

"Obtunded" describes a state of consciousness in which the child has a limited response to the environment and can be aroused by verbal or tactile stimulation

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

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

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 first

An open-ended question will encourage family members to share what they know and potentially clear up any misconceptions

The nurse is caring for a child with cerebral palsy (CP) whose weight is in the fi fth percentile and who has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube placed. Which would be the nurse ' best response

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

The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby ' s head circumference. Select the nurse ' s best response

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

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 first after calling the physician

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

The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarification is needed when the mother says

The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. A headache can be the first sign of a viral illness followed by other symptoms. It is best not to use aspirin or aspirincontaining products in children

The nurse knows further education is needed about Reye syndrome when a mother states

Insuffi cient musculoskeletal support and a disproportionate head size place the infant at risk because the head cannot be supported during a shaking episode

The nurse knows that young infants are at risk for injury from shaken baby syndrome (SBS) because

Baclofen is given to help control the spasms associated with CP

The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child ' s parents ask what the medication is for. Select the nurse ' s best response

The incidence of CP has increased, partly as a result of the increased survival rate of extreme low-birth-weight and premature infants

The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the incidence of CP has

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

The parent of a child with neuroblastoma asks the nurse what the typical signs and symptoms are at first. Select the nurse ' best answer

Infants younger than 1 year have the best prognosis.

The parent of an infant diagnosed with a neuroblastoma asks the nurse what the prognosis is. The nurse best response

A vesicostomy is an example of an option for children with myelomeningocele in which alternatives to traditional catheterizations are created

The parents of a 12-month-old with a neurogenic bladder ask the nurse if their child will always have to be catheterized. Select the nurse ' best response

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

The parents of a 12-month-old with cerebral palsy (CP) ask the nurse if they should teach their child sign language because he has not begun to vocalize. The nurse bases the response on the knowledge that sign language

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

The parents of a child with altered consciousness ask if they can stay during the morning assessment. Select the nurse best response

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

The parents of a child with cerebral palsy (CP) are learning how to feed their child and avoid aspiration. The nurse would question which of the following when reviewing the teaching plan

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

The parents of a child with meningitis and multiple seizures ask if the child will likely develop cerebral palsy (CP). Select the nurse best response

A common manifestation is hypoglycemia, which is treated with the administration of intravenous glucose

To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available

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

Which activity should an adolescent just diagnosed with epilepsy avoid

The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP.

Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)?

In infants, signs and symptoms may not be readily apparent because the open fontanel allows for expansion

Which child would likely have experienced a delay in the diagnosis of a brain tumor?

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

Which does the nurse include in the postoperative plan of care for a child with myelomeningocele following ligament release

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

A 6-month-old infant was just diagnosed with craniosynostosis. The infant ' s father asks the nurse for more information about reconstructive surgery. Select the nurse ' s best response

A computed tomography (CT) scan of the head will reveal trauma. Dilating the eyes is performed to check for retinal hemorrhages that are seen in an infant who has experienced shaken baby syndrome (SBS

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

Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection. About 90% to 95% of children with myelomeningocele experience hydrocephalus.

A parent of a newborn diagnosed with myelomeningocele asks what is/are common long-term complication(s)? The nurse ' s best response is which of the following? Select all that apply

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

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 ' best response

A myelomeningocele is a sac that contains a portion of the meninges, the CSF, and the nerve roots

An infant is born with a sac protruding through the spine, containing cerebrospinal fluid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as:

A quiet private room with minimal stimulation is ideal because the child with meningitis should be in a quiet environment to avoid cerebral irritation

Select the best room assignment for a newly admitted child with bacterial meningitis

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

The diet that produces anticonvulsant effects from ketosis consist of

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

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 flexing her arms and wrists while bringing her arms closer to the midline of her body. The child ' s mother asks, "What is going on?" Select the nurse ' s best response.

The CSF in bacterial meningitis is usually cloudy.

The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates

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

The nurse is caring for a 1-year-old who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted to the hospital. Select the nurse best repsonse

Many metabolic disorders are associated with hypoglycemia. The hypoglycemic child experiences a decreased level of consciousness because the brain does not have stores of glucose. Trauma can lead to generalized brain swelling with resultant increased ICP. Hypoxemia leads to a decreased level of consciousness because the brain is intolerant to the lack of oxygen. Dehydration can lead to inadequate perfusion to the brain, which can result in a decreased level of consciousness. Endocrine disorders often result in a decreased level of consciousness because they can lead to hypoglycemia, which is poorly tolerated by the brain

Which has the potential to alter a child ' s level of consciousness? Select all that apply

The child is placed in the prone position to avoid any pressure on the defect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fluids are begun to prevent dehydration.

Which is included in the plan of care for a newborn who has a myelomeningocele

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

Which is the best action for the nurse to take during a child ' s seizure

Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction

Which is the nurse ' s best response to the parents of a neonate with a meningocele who ask what can they expect

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

Which medication should the nurse anticipate administering first to a child in status epilepticus

Daily head circumference measurements are done to assess for hydrocephalus. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography

Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele? Select all that apply

Intravenous fluids at 1½ times regular maintenance could cause fluid overload and lead to increased ICP

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis

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

Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed

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

Which should be included in the plan of care for a child who has a neuroblastoma with metastasis to the bone marrow and pancytopenia

A high-pitched cry is often indicative of increased ICP in infants. The infant may be sleeping more than usual because of increased ICP.

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply.