Ped Neuro Prep U
The parents of a child with a history of seizures who has been taking phenytoin ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? "A drop in the plasma drug level will lead to a toxic state." "The capacity to metabolize the drug becomes overwhelmed over time." "Small increments in dosage lead to sharp increases in plasma drug levels." "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."
"Small increments in dosage lead to sharp increases in plasma drug levels."
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?" "Did you give your child any acetaminophen, such as Tylenol?" "What type of fluids did your child take when he had a fever?" "How high did his temperature rise when he was ill?"
"Did you use any medications, like aspirin, for the fever?"
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."
"Watch for changes in his behavior or eating patterns."
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? Educate the family on the shunt. Monitor the client for signs of infection. Assess the client's respiratory status. Measure the client's head circumference.
Assess the client's respiratory status.
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Sudden, momentary loss of muscle tone, with a brief loss of consciousness Muscle tone maintained and child frozen in position Brief, sudden contracture of a muscle or muscle group Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
The nurse helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "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." "The child will be placed in the prone position with the nurse holding the child still." "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."
"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."
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 have ibuprofen available in case it is needed." "My child will likely outgrow these seizures by age 5." "I always keep phenobarbital with me in case of a fever." "The most likely time for a seizure is when the fever is rising."
"I always keep phenobarbital with me in case of a fever."
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? "I will cradle her in my arms after the procedure for at least 30 minutes." "During the test, the health care provider will most likely take 3 tubes of spinal fluid to test for several things." "My child may have a headache after the procedure. If she does, she can have something for the pain." "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."
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? "I will make sure my child goes to bed early the night before the exam." "The room will be dark during the procedure." "If my child can't stay still during the procedure, they may have to give him medication to help him be still." "The procedure will determine the electrical patterns of his brain."
"I will make sure my child goes to bed early the night before the exam."
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? 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. Notify the health care provider and request a prescription for an antihypertensive. Place a fan pointing toward the adolescent's face to help reduce flushing.
Assess the adolescent's indwelling urinary catheter to see if it is obstructed.
A 9-year-old client who suffered a head injury has strabismus. The nurse assesses the client for intracranial pressure (ICP). Which additional intervention is most important for the nurse to perform? Assess the level of consciousness (LOC). Notify the primary health care provider. Place the child on fall precaution. Place a patch over the client's affected eye.
Assess the level of consciousness (LOC).
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? Cerebral edema Renal failure Left-sided heart failure Cardiogenic shock
Cerebral edema
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 Monitor temperature every 4 hours Decrease environmental stimulation Encourage the parents to hold the child
Decrease environmental stimulation
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? Institute droplet precautions in addition to standard precautions. Encourage the mother to hold and comfort the infant. Educate the family about preventing bacterial meningitis. Palpate the child's fontanels (fontanelles).
Institute droplet precautions in addition to standard precautions.
The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session? Tell me your concerns about your child's shunt. Call the doctor if she gets a persistent headache. Her autoregulation mechanism to absorb spinal fluid has failed. Always keep her head raised 30º.
Tell me your concerns about your child's shunt.
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? Understanding the side effects of medications Treating the child as though she did not have epilepsy Placing the child on her side on the floor Instructing her teacher how to respond to a seizure
Understanding the side effects of medications
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. Increase intake of citrus foods to promote absorption. Use a soft toothbrush. Avoid excessive sunlight.
Use a soft toothbrush.
The nurse is educating parents of a male infant with Chiari type II malformation. Which statement about their child's condition is most accurate? "Take your time feeding your baby." "Lay him down after feeding." "You'll see a big difference after the surgery." "You won't need to change diapers often."
"Take your time feeding your baby."
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? "If he is out of bed, the helmet's on the head." "Bike riding and swimming are just too dangerous." "Use this information to teach family and friends." "You'll always need a monitor in his room."
"Use this information to teach family and friends."
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? Administer intravenous antibiotics as prescribed. Pad and raise the rails on the child's bed. Educate the parents about seizure precautions. Prepare a menu with the child's favorite foods.
Administer intravenous antibiotics as prescribed
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? Onset and character of fever Degree and extent of nuchal rigidity Signs of increased intracranial pressure (ICP) Occurrence of urine and fecal contamination
Signs of increased intracranial pressure (ICP)
The parents of a 10-month-old child bring the infant to the emergency department after finding the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone." Which assessments are priority for the nurse to complete? Select all that apply. airway respiratory status level of consciousness vital signs circulation pupillary response sgns of child abuse (child mistreatment)
airway respiratory status circulation
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 no response to verbal statements arms adducted and extended with pronation of wrists with fingers flexed arms adducted and flexed on the chest with hands fisted
arms adducted and extended with pronation of wrists with fingers flexed
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? arteriovenous malformations (AVMs) sickle cell disease congenital heart defect meningitis
arteriovenous malformations (AVMs)
The nurse is caring for an adolescent who suffered an injury during a diving accident. During assessment the client is demonstrating the decerebrate 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
brain stem
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.
ensuring the parents know how to properly give antibiotics.
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? "I will give the medication to him when I first wake him up in the morning." "This medication may cause him to have trouble sleeping. He may need something else to help him sleep." "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."
"I need to watch for any new bruises or bleeding and let my health care provider know about it."
The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority? Risk for delayed development Risk for injury Risk for ineffective tissue perfusion: cerebral Risk for self-care deficit: bathing and dressing
Risk for injury
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. eye opening verbal response motor response fontanels (fontanelles) posture
eye opening verbal response motor response
The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem? head trauma intracranial hemorrhaging congenital hydrocephalus positional plagiocephaly
head trauma
Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem? moderate closed-head injury early closure of the fontanels (fontanelles) congenital hydrocephalus intracranial hemorrhaging
intracranial hemorrhaging
The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity? moving the infant's head every 2 hours measuring the intake and output every shift massaging the scalp gently every 4 hours giving the infant small feedings whenever he is fussy
moving the infant's head every 2 hours
Any individual taking phenobarbital for a seizure disorder should be taught: to brush his or her teeth four times a day. never to discontinue the drug abruptly. never to go swimming. to avoid foods containing caffeine.
never to discontinue the drug abruptly.
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? semi-Fowler position with a parent at the bedside supine on a parent's lap 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
Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n): diuretic. antihistamine. anticonvulsant. steroid.
steroid.
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.
their child should maintain an active lifestyle.
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. "I am afraid that our 10-year-old will start having febrile seizures." "It is so scary to think that our child will likely develop epilepsy now." "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." "I am thankful that our child won't have to be on anti-seizure medication."
"I am afraid that our 10-year-old will start having febrile seizures." "It is so scary to think that our child will likely develop epilepsy now."
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? "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." "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." "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine."
"I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."
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? "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." "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder."
"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."
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. Assess intake and output every shift. Assess child's skin for the development of distinctive rash every 4 hours. Request order for anticonvulsant. Monitor the child's laboratory values related to pancreatic function.
Request order for an antiemetic. Assess intake and output every shift. Request order for anticonvulsant.
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? "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." "I hate to think that I will need to be worried about my child having seizures for the rest of his life." "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."
"I hate to think that I will need to be worried about my child having seizures for the rest of his life."
A 7-year-old client has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when she first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be the best response by the nurse? "This might or might not be a problem. Watch your daughter for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." "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 is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only de
"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."
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.
The child was rubbing the hands and smacking the lips.
