Pediatric Disorders 3

The nurse caring for a child with suspected absence seizures is collecting data from the parents on how to manage the disorder. Which statement, if made by the parents, indicates the presence of signs congruent with this disorder?

"My child's teacher mentioned that they seem to daydream a lot."

The nurse has provided instructions to the parent of a child with sickle cell disease regarding measures that will prevent a sickle cell crisis. Which statement by the parent indicates an understanding of these measures?

"My child needs to avoid situations that may lead to an infection." The child needs to avoid infections, which can increase metabolic demands and cause dehydration, precipitating a sickle cell crisis.

The nurse is performing an assessment of a 7-year-old child who is suspected of having episodes of absence seizures. Which assessment question to the parent will assist in providing information that will identify the symptoms associated with this type of seizure?

"Does the child have a blank expression during these episodes?" Rationale : Absence seizures are brief episodes of altered awareness or momentary loss of consciousness. No muscle activity occurs except eyelid fluttering or twitching. The child has a blank facial expression. These seizures last only 5 to 10 seconds, but they may occur one after another several times a day.

An adolescent client is diagnosed with conjunctivitis, and the nurse provides information to the client about the use of contact lenses. Which client statement indicates the need for further information?

"My contact lenses can be worn if they are cleaned as directed." Rationale: If the adolescent wears contact lenses, the adolescent needs to be instructed to discontinue wearing them until the infection has cleared completely. Obtaining new contact lenses would eliminate the chance of reinfection from contaminated contact lenses and would lessen the risk of a corneal ulceration.

The nurse is performing an admission assessment on a child with a seizure disorder. The nurse is interviewing the child's parents to determine their adjustment to their child's chronic illness. Which statement, if made by the parents, would indicate a need for further teaching?

"Our child is involved in a swim program with neighbors and friends." Rationale: Parents are especially concerned about seizures that might go undetected during the night. The nurse needs to decrease parental overprotection and would suggest the use of a baby monitor at night. Involvement in a swim program and knowing CPR identify parental understanding of the disorder. Worrying about injuries when a child has a seizure is a common concern. The parents need to be reminded that as the child grows, they cannot always observe their child, but their knowledge of seizure activity and care is appropriate to minimize complications.

A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The parent of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. The nurse would plan to make which best response?

"Sometimes age has to do with the decision for radiation therapy." Rationale: Radiation therapy is usually delayed, whenever possible, until a child is 8 years old to prevent retardation of bone growth and soft tissue development.

The nurse is providing home care instructions to the parents of a child with a seizure disorder. Which statement indicates to the nurse that the teaching regarding seizure disorders has been effective?

"We will make appointments for follow-up blood work and care as directed." Rationale: Antiseizure medications are continued for a prolonged time even if seizures are controlled. Periodic reevaluation of the child is important to assess the continued effectiveness of the medication, to check serum medication levels, and to determine the need to alter the dosage if indicated. Antiseizure medications have potential side effects, and parents would be informed of such effects specific to the medication the child will be taking. Withdrawal of medication follows a predesigned protocol, usually begun when the child has been seizure free for at least 2 years. When a medication is discontinued, the dosage would be reduced gradually over 1 to 2 weeks.

The nurse notes that an infant with the diagnosis of hydrocephalus has a head that is heavier than that of the average infant. The nurse would determine that special safety precautions are needed when moving the infant with hydrocephalus. Which statement would the nurse plan to include in the discharge teaching with the parents to reflect this safety need?

"When picking up your infant, support the infant's neck and head with the open palm of your hand."

The nurse caring for an infant with a diagnosis of hydrocephalus would monitor the infant for which sign of increased intracranial pressure?

A bulging anterior fontanel

The nurse is preparing to perform an assessment on a child being admitted to the hospital with a diagnosis of sickle cell crisis, vasocclusive crisis. Which findings would the nurse expect to note on assessment of the child? Select all that apply.

Abdominal pain Joint swelling Pallor Fever Rationale: Sickle cell crises are acute exacerbations of the disease. Vaso-occlusive crisis is caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction. Manifestations include pallor; fever; painful swelling of hands, feet, and joints; and abdominal pain.

The nurse is reviewing the record of a child with a head injury with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. Which assessment finding would the nurse expect if this type of posturing is present?

Abnormal extension of the upper and lower extremities with some internal rotation.

A nursing student is assisting a school nurse in performing scoliosis screening on the children in the school. The nurse assesses the student's preparation for conducting the screening. The nurse determines that the student demonstrates understanding of the disorder when the student states that scoliosis is characterized by which finding?

Abnormal lateral curvature of the spine. Rationale: Scoliosis is defined as an abnormal lateral curvature in any area of the spine. The region of the spine most commonly affected is the right thoracic area, where it results in rib prominence.

A child is admitted to the hospital with a diagnosis of acute bacterial meningitis. In reviewing the primary health care provider's prescriptions, which would the nurse question as appropriate for a child with this diagnosis?

Administer an oral antibiotic.

The nursing student is writing a plan of care for a child who presents with an acute head injury. The nursing instructor reviews the plan of care and praises the student for identifying which assessment as a priority?

Airway and breathing. Rationale: The first step in the emergency treatment of a child with an acute head injury includes an assessment of the ABCs—airway, breathing, and circulation.

The nurse is creating a plan of care for a newborn infant with spina bifida (myelomeningocele type). The nurse includes assessment measures in the plan to monitor for increased intracranial pressure. Which assessment technique would be performed that will best detect the presence of an increase in intracranial pressure?

Assess anterior fontanel for bulging. Rationale: A bulging or taut anterior fontanel would indicate the presence of increased intracranial pressure.

The nurse is providing instructions to the parents of an infant with a ventriculoperitoneal shunt. The nurse would include which instruction?

Call the primary health care provider if the infant has a high-pitched cry.

The nurse caring for a child who has sustained a head injury in an automobile crash is monitoring the child for signs of increased intracranial pressure (ICP). For which early sign of increased ICP would the nurse monitor?

Changes in level of consciousness.

The nurse is providing home care instructions to the parent of a child who is recovering from Reye's syndrome. Which instruction would the nurse provide to the parent?

Check the skin and eyes every day for a yellow discoloration.

A school-age child with Down's syndrome is brought to the ambulatory care center by the parent. The child has bruising all over the body. To work most effectively with this child, the nurse first addresses which complication associated with Down's syndrome?

Children with Down's syndrome are more likely to develop acute leukemia than the average child. Rationale: Children with Down's syndrome have an increased risk for developing leukemia compared with the average child. T

The nurse is caring for a client diagnosed with a hydrocephalus. Which would the nurse anticipate as being the cause of this disorder?

Closure of cranial sutures. Rationale: The closure of cranial sutures during childhood prevents expansion of the cranial vault as the child grows. This leads to increased neurological changes.

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis?

Cloudy CSF, elevated protein, and decreased glucose levels. Meningitis is diagnosed by testing CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure; turbid or cloudy CSF; and elevated leukocyte, elevated protein, and decreased glucose levels.

The nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which is the most appropriate activity for this child?

Crayons and a coloring book Rationale: In the preschooler, play is simple and imaginative, and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh.

The nurse is performing an assessment on a child with a head injury. The nurse notes an abnormal flexion of the upper extremities and an extension of the lower extremities. What would the nurse document that the child is experiencing?

Decorticate posturing. Rationale: Decorticate posturing is an abnormal flexion of the upper extremities and an extension of the lower extremities with possible plantar flexion of the feet. Decerebrate posturing is an abnormal extension of the upper extremities with internal rotation of the upper arms and wrists and an extension of the lower extremities with some internal rotation.

The nurse is assessing a child with increased intracranial pressure. On assessment, the nurse notes that the child is now exhibiting decerebrate posturing. The nurse would modify the client's plan of care based on which interpretation of the client's change?

Deteriorating neurological function Rationale: The progression from decorticate to decerebrate posturing usually indicates deteriorating neurological function and warrants health care provider notification. The remaining options are inaccurate interpretations

The nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit. The nurse prepares for the child's arrival and plans to implement which type of precautions?

Droplet.

The nurse is caring for a child after surgical removal of a brain tumor. The nurse would assess the child for which sign that would indicate that brainstem involvement occurred during the surgical procedure?

Elevated temperature Special attention is given to the child's temperature, which may be elevated because of hypothalamic or brainstem involvement during surgery. A cooling blanket needs to be in place on the bed or readily available if the child becomes hyperthermic.

The nurse is caring for an infant with spina bifida (myelomeningocele type) who had the sac on the back containing cerebrospinal fluid, the meninges, and the nerves (gibbus) surgically removed. The nursing plan of care for the postoperative period would include which action to maintain the infant's safety?

Elevating the head with the infant in the prone position Rationale: Elevating the head will decrease the chance that cerebrospinal fluid will accumulate in the cranial cavity. The infant needs to be prone or side-lying to decrease the pressure on the surgical site on the back. Binders and a baby seat would not be used because of the pressure they would exert on the surgical site.

The nurse is assigned to care for a child with a brain injury who has a temporal lobe herniation and increasing intracranial pressure. Which signs would the nurse identify as indicative of this type of injury? Select all that apply.

Flaccid paralysis. Ipsilateral pupil dilation. Shifting of the temporal lobe laterally across the tentorial notch Rationale: Temporal lobe herniation or uncal herniation refers to a shifting of the temporal lobe laterally across the tentorial notch. This produces compression of the third cranial nerve and ipsilateral pupil dilation. If pressure continues to rise, flaccid paralysis, pupil fixation, and death will result.

The nurse would plan to place a child who had a medulloblastoma brain tumor (infratentorial) removed in which position postoperatively?

Flat, on either side Rationale: If an infratentorial tumor has been removed, the child is positioned flat on either side. The pillow is placed behind the child's back for comfort and for maintaining the position.

The nurse is caring for a child who sustained a head injury after falling from a tree. On assessment of the child, the nurse notes the presence of a watery discharge from the child's nose. The nurse would immediately test the discharge for the presence of which substance?

Glucose. On noting watery discharge from the child's nose, the nurse would test the drainage for glucose using an agency-approved reagent strip. If the results are positive, the nurse will contact the primary health care provider.

The nurse is monitoring a child with a brain tumor for complications associated with increased intracranial pressure. Which finding, if noted by the nurse, would indicate the presence of diabetes insipidus?

High urine output. A high urine output would be indicative of DI. Diabetes insipidus (DI) can occur in a child with increased intracranial pressure.

The nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled for surgical closure of the sac. In the preoperative period, which is the priority problem?

Infection. Rationale : The newborn with spina bifida is at risk for infection before the closure of the sac, which is done soon after birth. Initial care of the newborn with myelomeningocele involves prevention of infection. A sterile normal saline dressing is placed over the sac to maintain moisture of the sac and its contents and to prevent tearing or breakdown of the skin integrity at the site. Any opening in the sac greatly increases the risk of infection of the central nervous system.

The nurse is preparing a plan of care for a child with sickle cell crisis who will be admitted to the nursing unit. The nurse would include which intervention as a priority in the plan of care for the child?

Initiate an intravenous (IV) line for the administration of fluids. Rationale: The priorities in management of sickle cell crisis are hydration therapy and pain relief. To achieve this, the child is given IV fluids to promote hydration and reverse the agglutination of sickled cells in small blood vessels.

The nurse is assessing a client with fragile X syndrome. The nurse anticipates noting which physical assessment finding?

Long, narrow face with a prominent jaw. Rationale: Fragile X syndrome is a genetic condition that causes developmental problems, including learning disabilities and cognitive impairment. Physical assessment findings of fragile X syndrome include long, wide, and/or protruding ears; a long, narrow face with a prominent jaw; and large testes. Therefore, the descriptions in the remaining options are incorrect.

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention would be included in the plan of care?

Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics. Rationale: A major priority of nursing care for a child suspected to have meningitis is to administer the antibiotic as soon as it is prescribed. The child also is placed on respiratory isolation precautions for at least 24 hours while culture results are obtained and the antibiotic is having an effect.

The nurse is caring for a child diagnosed with Down's syndrome. Which explanation of this syndrome would the nurse provide the parents?

Moderate to severe intellectual disability and linkage to an extra chromosome 21, group G Rationale: Down's syndrome is a congenital condition that results in moderate to severe intellectual disability. Most cases are attributable to an extra chromosome (group G)—hence the name trisomy 21. The characteristics in the remaining options are incorrect characteristics of this syndrome.

The nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle crash for signs of increased intracranial pressure (ICP). The nurse would assess the child frequently for which early sign of increased ICP?

Nausea

The nurse is reviewing a chart for a child with a head injury. The nurse notes that the level of consciousness has been documented as obtunded. Which finding would the nurse expect to note on assessment of the child?

Not easily arousable and limited interaction. Obtunded indicates that the child sleeps unless aroused and once aroused has limited interaction with the environment.

The nurse is monitoring an infant for signs of increased intracranial pressure. On assessment of the fontanelles, the nurse notes that the anterior fontanelle bulges when the infant is sleeping. Based on this finding, which is the priority nursing action?

Notify the primary health care provider (PHCP).

The nurse is caring for a child with a head injury. The nurse observes decerebrate posturing. What is the nurse's best action?

Notify the primary health care provider. Decerebrate posturing indicates damage in the diencephalon, midbrain, or pons. The progression from flexion to extension posturing usually indicates deteriorating neurological function, not improvement, and warrants primary health care provider notification. A focused neurological examination is priority at this time.

The nurse is assessing for Kernig's sign in a child with a suspected diagnosis of meningitis. Which action would the nurse perform for this test?

Raise the child's leg with the knee flexed and then extend the leg at the knee and assess for pain. Rationale: To test for Kernig's sign, the leg is raised with the knee flexed and then extended at the knee. If any resistance is noted or pain is felt, the result is a positive Kernig's sign. This is a common finding in meningitis. Chvostek's sign, seen in tetany, is a spasm of the facial muscles elicited by tapping the facial nerve in the region of the parotid gland. Trousseau's sign is a sign for tetany in which carpal spasm can be elicited by compressing the upper arm and causing ischemia to the nerves distally. Brudzinski's sign occurs when flexion of the head causes flexion of the hips and knees.

A child who is playing in the playroom experiences a tonic-clonic seizure. During the seizure, the nurse would take which actions? Select all that apply.

Remain calm. Time the seizure. Ease the child to the floor. Loosen restrictive clothing.

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period?

Reposition the infant frequently. Rationale : In infants with hydrocephalus, the head grows at an abnormal rate, and if the infant is not repositioned frequently, pressure ulcers can occur on the back and side of the head. An egg crate mattress under the head is also a nursing intervention that can help to prevent skin breakdown.

The community health nurse is providing information to parents of children in a local school regarding the signs of meningitis. The nurse informs the parents that the classic signs/symptoms of meningitis include which findings?

Severe headache, fever, stiff neck, and a change in the level of consciousness. Rationale: The classic signs/symptoms of meningitis include severe headache, fever, stiff neck, and a change in the level of consciousness. Photophobia also may be a prominent early manifestation and is thought to be related to meningeal irritation.

The nurse develops a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) needs to be placed at the child's bedside?

Suctioning equipment and oxygen. Because increased oral secretions and apnea can occur during and after the seizure, oxygen and suctioning equipment are placed at the bedside.

The nurse creates a plan of care for a child with Reye's syndrome. Which priority intervention would the nurse include in the plan of care?

Teach the parents the signs and symptoms of a bacterial infection.

A 10-year-old child has been diagnosed with type 1 diabetes mellitus, and the nurse prepares to educate the family. The child is very active socially and often is away from the parents. Which is the best focus of the nurse's teaching for this client?

The child is taught how to monitor insulin requirements and how to self-administer the insulin. Rationale: Most children 9 years of age and older can understand the principles of monitoring their own insulin requirements. They usually are responsible enough to determine the appropriate intervention needed to maintain their health.

Which nursing actions apply to the care of a child who is having a seizure? Select all that apply.

Time the seizure. Stay with the child. Loosen clothing around the child's neck. Place the child in a lateral side-lying position.

The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply.

Time the seizure. Stay with the child. Move furniture away from the child.

The nurse enters a child's room and discovers that the child is having a seizure. Which actions would the nurse take? Select all that apply.

Turn the child on the side. Loosen any restrictive clothing. Check the child's respiratory status.