C38 Neurologic Disorder

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy is a condition that runs in families." b) "Cerebral palsy means there will be many disabilities." c) "Cerebral palsy is a condition that doesn't get worse." d) "Cerebral palsy occurs because of too much oxygen to the brain."

"Cerebral palsy is a condition that doesn't get worse."

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? a) "Did you use any medications like aspirin for the fever?" b) "What type of fluids did your child take when he had a fever?" c) "How high did his temperature rise when he was ill?" d) "Did you give your child any acetaminophen, such as Tylenol?"

"Did you use any medications like aspirin for the fever?" 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 toddler tells the nurse during a routine well-child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse?

"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." The head of the infant and young child is large in proportion to the body, and is the fastest-growing body part during infancy and continues to grow until the child is 5 years old. In addition, the infant's and child's neck muscles are not well developed. Both of these differences lead to an increased incidence of head injury from falls. The nurse should still let the physician know the mother's concerns in case there is another issue causing the falls.

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? a) "During the first 3 to 4 weeks of pregnancy brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma." b) "The respiratory system matures during this time so good prenatal care during the first weeks of pregnancy is very important." c) "Bones begin to harden in the first 5 to 6 weeks of pregnancy so vitamin D consumption is particularly important." d) "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."

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

"Even if the flashlight bothers him, we will check his eyes."

The nurse is assisting to position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "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." "The child will be held by the mother on her lap with his back towards 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." Explanation: Correct positioning for a lumbar puncture is to place the child on his or her side with their 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.

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

"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

The nurse is collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "He kept smacking his lips and rubbing his hands." b) "He was just staring into space and was totally unaware." c) "He usually is very coordinated, but he couldn't even walk without falling." d) "His arms had jerking movements in his legs and face."

"He was just staring into space and was totally unaware."

An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? "My child will likely outgrow these seizures by age 5." "I have ibuprofen available in case it's needed." "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." 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 because seizures occur 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 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." "This medication will make me extremely hungry."

"I can't take this medication within 2 hours of taking my antacid medication."

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

"I hate to think that I will need to be worried about his 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 need to watch for any new bruises or bleeding and let my health care provider know about it." "I will give the medication to him when I first wake him up in the morning." "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." 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 nurse has just admitted a 17-year-old diagnosed with bacterial meningitis. The parents of the adolescent tell the nurse, "We just don't understand how this could have happened. Our child has always been healthy and also just received a booster vaccine last year?" How should the nurse respond? "Maybe your child's immune system isn't strong enough to fight off the infection, even with having received the vaccine." "Your child was likely exposed to a strain of bacteria not covered with the meningitis vaccine received." "I understand your frustration. Unfortunately immunizations are not 100% effective in preventing the infection." "Are you sure your child received a vaccine for meningitis? Maybe it was a flu vaccine."

"I understand your frustration. Unfortunately immunizations are not 100% effective in preventing the infection." Showing empathy while letting the parents know that vaccines are not 100% effective is the best response. Questioning them about being sure would not be the best response unless there was reason to believe their information was not accurate. There is nothing to lead the nurse to believe that a different strain of bacteria caused the infection, or that the the child'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? "I need to encourage my child to drink at least 1 glass of water after the procedure." "My child may have a headache after the procedure. If she does, she can have something for the pain." "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."

"I will cradle her in my arms after the procedure for at least 30 minutes." Explanation: During the procedure, typically 3 tubes of cerebral spinal fluid (CSF) are removed for testing. After the procedure, the child is encouraged to lay flat for at least 30 minutes.

A nursing instructor has completed a class session on Guillain-Barré syndrome. Which statement by a student indicates a need for further education? "These children may need nutritional support if they are unable to eat." "Children with this disorder may need mechanical ventilation as the disease progresses." "Paralysis peaks at about 3 weeks before recovery, but most do not completely recover from the paralysis." "There is no medication available to treat this disorder."

"Paralysis peaks at about 3 weeks before recovery, but most do not completely recover from the paralysis." Explanation: Despite the length of this disorder, most children recover completely without any residual effects. A small number may have some residual weakness but not necessarily paralysis. The paralysis peaks at about 3 weeks and then slowly reverses. Supportive care such as mechanical ventilation, nutritional support, passive ROM, and every 2 hour turning and repositioning are the focus of care for children with this syndrome. There is no medication specific for this syndrome.

The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status? "She is a pretty happy baby, unless her diaper is wet, then she cries until we change her diaper." "She typically breastfeeds, but lately we have had to supplement with some rice cereal." "She has been irritable for the last hour....seems like she is just upset for some reason." "She always cries when the person holding her has on glasses...I guess glasses scare her."

"She has been irritable for the last hour....seems like she is just upset for some reason." Explanation: Irritability in an infant can be a sign of declining neurological function.

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." "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." 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.

Seven-year-old Isabelle 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 Isabelle 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 best for the nurse to say to this mother?

"This might or might not be a problem. Watch Isabelle 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." 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 three to five 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 arrest.

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 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." "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 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." 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 arrest.

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

"Watch for changes in his behavior or eating patterns." 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.

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

"What happened just before the seizures?" 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.

The nurse is caring for a near-term pregnant woman who has not taken prenatal vitamins or folic acid supplements. Which congenital defect is most likely to occur based on the mother's prenatal history? a) Incomplete myelinization b) Neonatal conjunctivitis c) Facial deformities d) A neural tube defect

A neural tube defect

At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds: 1. Narrow sutures 2. Sunken fontanels 3. A rapid increase in head circumference 4. Increase in weight since last visit

A rapid increase in head circumference

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? Perform a glucose finger stick to determine the child's blood sugar level. Administer lorazepam IV as prescribed. Observe and document the length of time of the seizure and type of movement observed. Administer carbamazepine as prescribed.

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.

What information is most correct regarding the nervous system of the child? a) The child's nervous system is fully developed at birth. b) The child has underdeveloped fine motor skills and well-developed gross motor skills. c) The child has underdeveloped gross motor skills and well-developed fine motor skills. d) As the child grows, the gross and fine motor skills increase.

As the child grows, the gross and fine motor skills increase.

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which intervention would be most important for the nurse to perform? a) Monitor core body temperature. b) Assess the child's level of consciousness. c) Pull up the side rails on the bed. d) Help the child cope with an altered appearance.

Assess the child's level of consciousness

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which intervention would be most important for the nurse to perform?

Assess the child's level of consciousness. Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure client. The child's eyes will correct themselves when ICP is reduced.

The nurse is caring for a child diagnosed with hydrocephalus following ventriculopertoneal shunt placement. The child is currently on a ventilator. Which nursing action is priority? Monitor the client for signs of infection Assess the client's respiratory status Measure the client's head circumference Educate the family on the shunt

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 an airway.

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? Notify the primary health care provider Place the child on fall precaution Assess the level of consciousness (LOC) Place a patch over the client's affected eye

Assess the level of consciousness (LOC) Explanation: Decreased LOC is frequently the first sign of a major neurologic problems after a head trauma.

The nurse is caring for a child who had a seizure, fell to the ground, and hit and injured his face, head, and shoulders. This information indicates the child likely had which type of seizures? a) Myoclonic b) Atonic c) Absence d) Infantile

Atonic Atonic or akinetic seizures cause a sudden momentary loss of consciousness, muscle tone, and postural control and can cause the child to fall. They can result in serious facial, head, or shoulder injuries. In absence seizures the child loses awareness and stares straight ahead but does not fall. 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. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Keep the lights on brightly so that he can see his mother b) Rock the child frequently c) Have the child's 2-year-old brother stay in the room d) Avoid making noise when in the child's room

Avoid making noise when in the child's room

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.

Battle sign. 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.

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 Development of gastrointestinal organs in the fetus Reproductive organ development in the fetus Solid bone formation in the fetus Brain development in the fetus

Brain development in the fetus Spinal cord 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 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? a) Brain stem herniation b) Brain stem dysfunction c) Intracranial mass d) Seizure activity

Brain stem Decerbrate 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? a) Intracranial mass b) Seizure activity c) Brain stem herniation d) Brain stem dysfunction

Brain stem dysfunction

What finding is consistent with increased ICP in the child?

Bulging fontanel Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping.

A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure? Reduction in heart rate Change in level of consciousness Increase in heart rate Decline in respiratory rate

Change in level of consciousness Explanation: A change in the level of consciousness is the initial finding in the client who is experiencing an increase in intracranial pressure.

The nurse is in the room when a child with a seizure disorder is having a seizure. The child is having generalized jerking muscle movement, and the nurse notes the bed appears to be wet with urine. The child is in which stage of the generalized seizure? a) Clonic b) Tonic c) Prodromal d) Postictal

Clonic

The nurse is in the room when a child with a seizure disorder is having a seizure. The child is having generalized jerking muscle movement, and the nurse notes the bed appears to be wet with urine. The child is in which stage of the generalized seizure? a) Tonic b) Postictal c) Prodromal d) Clonic

Clonic

The father of a 7-year-old boy reports to the nurse that two or three times over the past weeks he has observed his son seemingly staring into space and rubbing his hands. The behavior lasts for a minute or so, followed by an inability of the child to understand what's being said to him. When the nurse asks the child about his experience, he says he doesn't know what his father is talking about. What type of seizure do these symptoms indicate the child is experiencing? a) Complex partial seizures b) Simple partial sensory seizures c) Simple partial motor seizures d) Absence seizures

Complex partial seizures

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) Convulsive activity occurs. b) The EEG is normal. c) Cyanosis occurs at the onset of the seizure. d) The patient is bradycardiac.

Convulsive activity occurs. During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent what information in regard to seizures? The EEG is normal. The child is bradycardiac. Cyanosis occurs at the onset of the seizure. Convulsive activity often occurs.

Convulsive activity occurs. During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

The nurse caring for a child with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. a) True b) False

False Glucocorticoids and diuretics are used to reduce cerebral edema.

The nurse caring for a child with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema.

False Antibiotics or antivirals are used to treat infectious disease processes. Glucocorticoids and diuretics are used to reduce cerebral edema.

The nurse is preparing a room for a child being admitted with meningitis. What is the appropriate action by the nurse? Gather appropriate equipment and signage for respiratory isolation precautions. Provide information regarding policies of the unit's playroom for the parents to review. Place multiple pillows in the room to assist with propping the child's head up. Ensure that lights and televisions work properly to provide stimulation while the child is hospitalized.

Gather appropriate equipment and signage for respiratory isolation precautions. Explanation: Children with meningitis are placed on respiratory precautions for 24 hours after the start of antibiotic therapy to prevent transmission of the infection to other family members or health care providers. While a child is on respiratory isolation, they will typically not be allowed out of their rooms to play. Due to pain when their neck is flexed, most children are most comfortable without a pillow. Reducing stimulation can help to promote rest for the child.

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

Head trauma 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.

During physical assessment of a 2-month-old infant, the nurse suspects the child may have a lesion on the brain stem. Which symptom was observed? a) Sudden increase in head circumference b) Closed posterior fontanel c) Only one eye is dilated and reactive d) Horizontal nystagmus

Horizontal nystagmus

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? VIII VII IX VI

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.

The nurse is caring for a hospitalized infant at risk for developing increased intracranial pressure. Which assessment finding(s) would the nurse communicate to the health care provider for further intervention? Select all that apply. Vomitting Increased head circumference Parent states, "My infant does not act right." Pulse rate of 60 beats/min and regular Blood pressure decreased from baseline

Increased head circumference Pulse rate of 60 beats/min and regular Vomitting Parent states, "My infant does not act right." Explanation: Signs of increased intracranial pressure include buldging fontanelle (increased head circumference), decreased pulse, vomiting, increased blood pressure and behavior changes. The nurse must listen to the parents if concerns about behavior are mentioned. The blood pressure would increase, not decrease. The nurse would alert the health care provider immediatley of these signs so intervention can be started if needed.

The nurse is caring for a child who has suffered a head injury and has had an ICP monitor placed. Which prescription by the health care provider would the nurse question? Place in an indwelling urinary catheter. Administer mannitol IV, dosage determined by the pharmacist. Initiate an IV of 0.9% NS to run at 250 mL/hr. Administer dexamethasone, dosage determined by the pharmacist.

Initiate an IV of 0.9% NS to run at 250 mL/hr. Explanation: Rapid administration of IV fluids may increase ICP. An IV rate of 250 mL/hr can be considered a rapid infusion. Corticosteroids such as dexamethasone can reduce cerebral edema. Osmotic diuretics, such as mannitol, can reduce pressure. Because of the administration of the osmotic diuretic, indwelling urinary catheters are typically inserted.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2° F(39° C). What is the nurse's highest priority? a) Institute safety precautions. b) Provide family teaching related to the child's history. c) Offer age-appropriate activities. d) Encourage the child to do his or her own self-care.

Institute safety precautions.

Preterm infants have more fragile capillaries in the periventricular area than term infants. Which problem does this put these infants at risk for? a) Moderate closed-head injury b) Congenital hydrocephalus c) Early closure of the fontanels d) Intracranial hemorrhaging

Intracranial hemorrhaging

Preterm infants have more fragile capillaries in the periventricular area than term infants. This put these infants at risk for which problem? Congenital hydrocephalus Intracranial hemorrhaging Moderate closed-head injury Early closure of the fontanels

Intracranial hemorrhaging Explanation: Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage.

What 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. Seizure activity lasts less than 30 minutes. It is a common neurologic emergency in children.

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.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Lying prone, with the feet higher than the head b) Lying on one side, with the back curved c) Lying prone, with the neck flexed d) Sitting up, with the back straight

Lying on one side, with the back curved

The nurse is collecting data from a child who may have a seizure disorder. Which is a description of an absence seizure? a) Brief, sudden contracture of a muscle or muscle group b) Minimal or no alteration in muscle tone, with a brief loss of consciousness c) Sudden, momentary loss of muscle tone, with a brief loss of consciousness d) Muscle tone maintained and child frozen in position

Minimal or no alteration in muscle tone, with a brief loss of consciousness

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 Giving the infant small feedings whenever he is fussy Measuring the intake and output every shift

Moving the infant's head every 2 hours 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.

A client presents reporting headache that she describes as "throbbing pain on the left side of my head and sensitivity to light and motion." The nurse asks the client to describe the sequence of events before the onset of the headache. Which signs and symptoms described by the client are characteristic of the prodrome phase of a migraine headache? Select all that apply. Seeing flashing lights Neck stiffness Loss of appetite Fatigue Frequent yawning

Neck stiffness Frequent yawning Loss of appetite Explanation: The prodrome phase includes experiencing signs and symptoms that occur hours or days before the onset of the headache. Stiffness of the neck muscles, frequent yawning, or loss of appetite are common during the prodrome (or preheadache) phase. Seeing flashing lights is an aura, which is a warning sign of the impending onset of a migraine headache. Fatigue is common during the postdrome portion of a migraine.

At 36 weeks' gestation a client is scheduled for a biophysical profile. Before the client has the ultrasound examination, which component of the biophysical profile does the nurse complete? Fetal movement evaluation Contraction stress test Doppler flow study Nonstress test

Nonstress test Explanation: A nonstress test is the one component of a biophysical profile not performed during the ultrasound examination. Fetal movement evaluation is performed by the client, at home on a daily basis. A contraction stress test involved the induction of uterine contractions and is not part of a biophysical profile. Doppler flow studies are performed during an ultrasound examination, but are not part of a biophysical profile.

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? Obtain a detailed family and body systems health history Perform a thorough physical assessment Perform a complete neurological assessment Notify the emergency department physician of the information the parents reported

Notify the emergency department physician of the information the parents reported If clear liquid fluid is noted draining from the ears or nose, the physician should be notified immediately. If the fluid tests positive for glucose, this is indicative of leaking. The other assessments can continue after notifying the physician of these findings.

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. Observation of level of consciousness Administration of intravenous fluids Rest Assessment of serum electrolyte levels Strict monitoring of intake and output

Observation of level of consciousness Rest Explanation: The 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 reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in a roller skating accident. What should the caregivers be instructed to do? Select all that apply. Observe and report any vomiting that occurs within 6 hours. Administer acetaminophen for headache. Check the pupil reaction to light every 15 minutes for 12 hours. Wake the child every 1 to 2 hours to check level of consciousness. Observe for and report to provider any double or blurred vision.

Observe and report any vomiting that occurs within 6 hours. Observe for and report to provider any double or blurred vision. Wake the child every 1 to 2 hours to check level of consciousness. The caregiver should observe the child for at least 6 hours for vomiting or a change in the child's level of consciousness. 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 child's pupils are checked for reaction to light every 4 hours for 48 hours.

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? Stupor Obtunded Fully conscious Decreased level of consciousness

Obtunded 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 neurological 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.

A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the following in the order that reflects this progression. Coma Disorientation Oriented to person, place, and time Obtundation Stupor

Oriented to person, place, and time Disorientation Obtundation Stupor Coma 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.

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. Suction at bedside Padding for side rails Smelling salts. Oxygen gauge and tubing Tongue blade

Oxygen gauge and tubing Suction at bedside Padding for side rails

A nurse is caring for a newborn with anencephaly. Which intervention will the nurse use? Place a cap or similar covering on the newborn's head. Closely monitor neurologic status. Monitor for increased intracranial pressure (ICP). Refer the family to an agency to assist with long-term care.

Place a cap or similar covering on the infant's head. Using an infant cap can help parents deal with the malformed appearance of their child. Because the child was born with a small or missing brain, the baby will likely die within hours or days. Monitoring for increased intracranial pressure (ICP) or neurologic status are not necessary interventions.

A nurse is caring for a newborn with anencephaly. Which of the following interventions will the nurse use? a) Monitor for increased intracranial pressure (ICP). b) Closely monitor neurologic status. c) Refer the family to an agency to assist with long-term care. d) Place a cap or similar covering on the infant's head.

Place a cap or similar covering on the infant's head. Correct Explanation: Using an infant cap can help parents deal with the malformed appearance of their child. Because the child was born with a small or missing brain, the baby will likely die within hours or days. Monitoring for increased intracranial pressure (ICP) or neurologic status are not necessary interventions.

Which intervention prevents a 17-month-old child with spastic cerebral palsy from going into a scissoring position? a) Keeping the child in leg braces 23 hours per day b) Letting the child lie down as much as possible c) Trying to keep the child as quiet as possible d) Placing the child on your hip

Placing the child on your hip

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

Positive Kernig sign 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? a) Brain scan b) Echoencephalography c) Positron emission tomography (PET) d) Myelography

Positron emission tomography (PET) 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.

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? Apply ice packs to the child's axillary and groin area. Administer acetaminophen by mouth as prescribed. Place the child in a bathtub filled with cool water. Remove any blankets or heavy clothing and replace with a thin sheet

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.

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 injury Risk for self-care deficit: bathing and dressing Risk for delayed development Risk for ineffective tissue perfusion: cerebral

Risk for injury A seizure disorder is caused by a disruption in the electrical impulses in the brain. Tonic-clonic seizures is the most dramatic seizure disorder. It is characterized by a loss of consciousness, along with the entire body experiencing tonic contractions followed by rhythmic clonic contractions alternating with relaxation of all muscle groups. Cyanosis may be noted due to apnea, and saliva may collect in the mouth due to inability to swallow. All of these symptoms would make Risk for injury the highest priority.

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? Urinalysis Hemoglobin level White blood cell count Serum glucose level

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

A nurse is performing a neurologic examination of a 5-year-old child. She asks the boy to close his eyes, and then she places a crayon in his hand and asks him to identify it. Which type of ability is the nurse testing for in this boy? a) Orientation b) Stereognosis c) Kinesthesia d) Graphesthesia

Stereognosis

The nurse is caring for a child admitted with simple partial motor seizures. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child had jerking movements in the legs and facial muscles. b) The child was rubbing the hands and smacking the lips. c) The child had shaking movements on one side of the body. d) The child was dizzy and had decreased coordination.

The child had shaking movements on one side of the body. Simple partial motor seizures cause a localized motor activity, such as shaking of an arm, leg, or other part of the body. These may be limited to one side of the body. 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? a) The child has vomited and has bruising behind her ear. b) The child is weak and has blurry vision. c) The child is easily distracted and can't concentrate. d) The child is bleeding from the ear and draining fluid from the nose.

The child is easily distracted and can't concentrate 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..

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be: a) The child is having generalized seizures. b) The child's history indicates she has infantile seizures. c) The child may begin to have absence seizures every day. d) The child is in status epilepticus.

The child is in status epilepticus.

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be:

The child is in status epilepticus. Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which symptom indicates that the shunt is infected? a) The child has a high-pitched cry. b) The child is not responding or eating well. c) The child's pupil reaction time is rapid and uneven. d) The fontanels are bulging or tense.

The child is not responding or eating well. Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract.A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction.Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure.Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure.

During the trial period to determine the efficacy of an anticonvulsant drug, which caution should be explained to the parents? a) The child shouldn't participate in activities that could be hazardous if a seizure occurs b) Plasma levels of the drug will be monitored on a daily basis c) Drug dosage will be adjusted depending on the frequency of seizure activity d) 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 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 complex partial seizures. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child was dizzy and had decreased coordination. b) The child had shaking movements on one side of the body. c) The child was rubbing the hands and smacking the lips. d) The child had jerking movements and then the extremities stiffened.

The child was rubbing the hands and smacking the lips. Complex partial seizures, also called psychomotor seizures, change or alter consciousness. They cause memory loss and staring and nonpurposeful movements, such as hand rubbing, lip smacking, arm dropping, and swallowing.

In caring for a child with a seizure disorder, the primary goal of treatment is:

The child will be free from injury during a seizure. Keeping the child free from injury is the highest priority goal. The other choices are important, but keeping the child safe is higher than the anxiety or knowledge deficit concerns. The physical always is a priority over the psychological.

Which of these age groups has the highest actual rate of death from drowning? Infants Toddlers Preschool children School-aged children

Toddlers 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? a) Vomiting b) Trouble focusing when reading c) Difficulty concentrating d) Bleeding from the ear

Trouble focusing when reading

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?

Trouble focusing when reading 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 best way to evaluate a child's level of consciousness is through conversation. a) False b) True

True

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. 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 treatment for children with seizures disorders is most often which of the following? a) Restricted fat diet b) Use of anticonvulsant medications c) Surgical intervention d) Strict exercise regimen

Use of anticonvulsant medications

The nurse caares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client? Vagus nerve stimulation Use of anticonvulsant medications Ketogenic diet Frequent temperature assessment

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? a) Video electroencephalogram b) Computed tomography c) Cerebral angiography d) Lumbar puncture

Video electroencephalogram 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 assessing a toddler for motor function. Which of the following activities will be most valuable? a) Watch the child reach for a toy. b) Give the child some potato chips. c) Have the child catch a ball. d) Let the child look at a picture book.

Watch the child reach for a toy.

A nurse is performing a neurological examination of a preschool girl. She is testing her remote memory. Which of the following would be an appropriate type of memory to ask the girl to recall? a) What the girl had for dinner last night b) A string of three digits that the nurse has just spoken to her c) The name of an object that the nurse showed her 5 minutes ago d) Where the girl and her family went on vacation last year

What the girl had for dinner last night

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

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.

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. 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 is in regards to 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.

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

placing the infant in an infant car seat after feeding the infant Explanation: Placing a child or infant in the semi-Fowler's position can help reduce cerebral edema and pressure. Using an infant child seat helps to simulate the raised head of the bed.

When assisting a child while she is having a tonic-clonic seizure, it would be important to a) place a tongue blade between the child's teeth. b) restrain the child from all movement. c) turn the child onto her back and observe her. d) protect the child from hitting her arms against furniture.

protect the child from hitting her arms against furniture.

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's position while sitting on the parent's lap supine on a parent's lap semi-Fowler's position with a parent at the bedside

semi-Fowler's 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's 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's position is contraindicated immediately after this procedure.

In understanding the nervous system, the nurse recognizes that the central nervous system is made up of: a) the brain and spinal cord. b) fluid that flows through the brain. c) a protective cushion for nerve cells. d) nerves throughout the upper body.

the brain and spinal cord.

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

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.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction you would want to give her parents regarding this is a) their child will have to practice good tooth brushing. b) even small doses may cause noticeable dizziness. c) watching television while taking the drug may cause seizures. d) numbness of the fingers is common while taking this drug.

their child will have to practice good tooth brushing. A side effect of phenytoin sodium is hypertrophy of the gumline. Good tooth brushing helps prevent inflammation under the hypertrophied tissue.

An 8-year-old girl is diagnosed as having tonic-clonic seizures. You would want to teach her parents that: a) their daughter should be kept quiet late in the day when she is most likely to have a seizure. b) if their daughter shows symptoms of beginning a seizure, immediately give her medication. c) their daughter should maintain an active lifestyle. d) their daughter should carry a padded tongue blade with her at all times.

their daughter should maintain an active lifestyle.

The meningococcal vaccine should be offered to high-risk populations. If never vaccinated, who has an increased risk of becoming infected with meningococcal meningitis? Select all that apply. a) 18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates b) 12-year-old child with asthma c) 8-year-old child who is in good health d) 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti e) 9-year-old child who was diagnosed with diabetes mellitus when he was 7 years old

• 18-year-old student who is preparing for college in the fall and has signed up to live in a dormitory with two other suite mates • 12-year-old child with asthma • 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti • 9-year-old child who was diagnosed with diabetes mellitus when he was 7 years old

The nurse is caring for a 6-year-old child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What actions by the nurse are indicated?

• Check tubing clamps to ensure they are open. • Ensure the tubing is not kinked. Nursing care of an external ventricular drainage device requires the nurse 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.

A 9-year-old diagnosed with neurofibromatosis is being evaluated for the presence of a brain tumor. What tests may be ordered to diagnose this condition? Select all that apply. a) Radiology b) Lumbar puncture c) Positron emission tomography d) Computed tomography e) Magnetic resonance imaging f) Electroencephalogram

• Computed tomography • Magnetic resonance imaging

A 9-year-old diagnosed with neurofibromatosis is being evaluated for the presence of a brain tumor. What tests may be ordered to diagnose this condition?

• Computed tomography • Magnetic resonance imaging Computed tomography is used for visualization of tumors, ventricles, brain tissue, CSF, hematomas, and cysts. Magnetic resonance imaging is also useful in tumor identification. Lumbar puncture is used to measure CSF pressure and collect CSF samples for laboratory tests. Electroencephalograms detect and locate abnormal electrical discharges produced in the brain. Radiology identifies the presence of fractures, widened skull sutures, calcifications, bone erosion, or skeletal anomalies

A nurse is providing care to a child with status epilepticus. Which medications would the nurse identify as appropriate to give in this situation? Select all that apply. a) Lorazepam b) Gabapentin c) Fosphenytoin d) Carbamazepine e) Diazepam

• Diazepam (Valuim) • Lorazepam (Ativan) • Fosphenytoin treating status epilepticus include lorazepam, diazepam, and fosphenytoin. Gabapentin and carbamazepine are anticonvulsants used to treat and prevent seizures in general.

A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included?

• Oxygen gauge and tubing • Suction at bedside • Padding for side rails 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.

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. a) Assess child's skin for the development of distinctive rash every 4 hours b) Assess intake and output every shift c) Request order for an antiemetic d) Request order for anticonvulsant e) 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

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?

• Request order for an antiemetic • Assess intake and output every shift • Request order for anticonvulsant This child likely has Reye syndrome and may require an anti-emetic 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 an increased intracranial pressure that may induce seizures. A distinctive rash is associated with the development of meningococcal meningitis. The nurse should monitor the Reye's syndrome child's laboratory values for indications that the liver is not functioning well

When assessing a neonate for seizures, what would the nurse expect to find? Select all that apply. a) Ocular deviation b) Jitteriness c) Tonic-clonic contractions d) Elevated blood pressure e) Tachycardia

• Tachycardia • Elevated blood pressure • Jitteriness • Ocular deviation

When assessing a neonate for seizures, what would the nurse expect to find?

• Tachycardia • Elevated blood pressure • Jitteriness • Ocular deviation Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic-clonic contractions typically are more common in older children.

The young boy was involved in a motor vehicle accident and was admitted to the pediatric intensive care unit with changes in level of consciousness and a high-pitched cry. Which are late signs of increased intracranial pressure? Select all that apply. a) The sclera of the eyes is visible above the iris. b) The child's pupils are fixed and dilated. c) The child's toes are pointed downward, his head and neck are arched backwards, and his arms and legs are extended. d) The child's heart rate is 56 beats per minute. e) The child states that he feels a little "dizzy."

• The child's toes are pointed downward, his head and neck are arched backwards, and his arms and legs are extended. • The child's heart rate is 56 beats per minute. • The child's pupils are fixed and dilated.

When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply. a) The nurse positions the child on the side during a seizure. b) The nurse has oxygen available to use during a seizure. c) The nurse pads the crib or side rails before a seizure. d) The nurse teaches the caregivers regarding seizure precautions. e) The nurse places a washcloth in the mouth to prevent injury during seizure. f) The nurse goes for help as soon as a seizure begins.

• The nurse pads the crib or side rails before a seizure. • The nurse positions the child on the side during a seizure. • The nurse goes for help as soon as a seizure begins. • The nurse has oxygen available to use during a seizure. • The nurse teaches the caregivers regarding seizure precautions.

hen caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply. a) The nurse positions the child on the side during a seizure. b) The nurse has oxygen available to use during a seizure. c) The nurse pads the crib or side rails before a seizure. d) The nurse teaches the caregivers regarding seizure precautions. e) The nurse places a washcloth in the mouth to prevent injury during seizure. f) The nurse goes for help as soon as a seizure begins.

• The nurse pads the crib or side rails before a seizure. • The nurse positions the child on the side during a seizure. • The nurse goes for help as soon as a seizure begins. • The nurse has oxygen available to use during a seizure. • The nurse teaches the caregivers regarding seizure precautions.

A nurse is providing information to the parents of a child diagnosed with absence seizures. What information would the nurse expect to include when describing this type of seizure? Select all that apply. a) You might have mistaken this type of seizure for lack of attention. b) This type of seizure is more common in girls than it is in boys. c) The child will commonly report a strange odor or sensation before the seizure. d) This type of seizure is usually short, lasting for no more than 30 seconds. e) You might see a blank facial expression after a sudden stoppage of speech. f) Your child will probably sleep deeply for ½ to 2 hours after the seizure.

• This type of seizure is more common in girls than it is in boys. • You might see a blank facial expression after a sudden stoppage of speech. • This type of seizure is usually short, lasting for no more than 30 seconds. • You might have mistaken this type of seizure for lack of attention.

The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. Which of the following would the nurse assess? Select all that apply. a) Verbal response b) Motor response c) Posture d) Eye opening e) Fontanels

• Verbal response • Motor response • Eye opening Correct Explanation: The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response.

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in an in-line skating accident. What should the caregivers be instructed to do? Select all that apply. a) Observe and report any vomiting that occurs within six hours. b) Check the pupil reaction to light every 15 minutes for two hours. c) Wake the child every one to two hours to check level of consciousness. d) Observe for and report to provider any double or blurred vision. e) Administer acetaminophen for headache.

• Wake the child every one to two hours to check level of consciousness. • Observe and report any vomiting that occurs within six hours. • Observe for and report to provider any double or blurred vision.

The nurse is reinforcing teaching with the caregivers of a child being discharged from the urgent care setting following a mild head injury that occurred in an in-line skating accident. The caregiver should be instructed to do which of the following? Select all that apply. a) Administer acetaminophen for headache. b) Observe for and report to provider any double or blurred vision. c) Check the pupil reaction to light every 15 minutes for two hours. d) Wake the child every one to two hours to check level of consciousness. e) Observe and report any vomiting that occurs within six hours.

• Wake the child every one to two hours to check level of consciousness. • Observe and report any vomiting that occurs within six hours. • Observe for and report to provider any double or blurred vision. Explanation: The caregiver should observe the child for at least six hours for vomiting or a change in the child's level of consciousness. If the child falls asleep, he or she should be awakened every one to two hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The child's pupils are checked for reaction to light every four hours for 48 hours.

A nurse is providing information to the parents of a child diagnosed with absence seizures. Which of the following would the nurse expect to include when describing this type of seizure? Select all that apply. a) You might have mistaken this type of seizure for lack of attention. b) This type of seizure is more common in girls than it is in boys. c) This type of seizure is usually short, lasting usually for no more than 30 seconds. d) Your child will probably sleep deeply for ½ to 2 hours after the seizure. e) You might see a blank facial expression after a sudden stoppage of speech. f) The child will commonly report a strange odor or sensation before the seizure.

• You might have mistaken this type of seizure for lack of attention. • This type of seizure is more common in girls than it is in boys. • This type of seizure is usually short, lasting usually for no more than 30 seconds. • You might see a blank facial expression after a sudden stoppage of speech. Correct Explanation: Absence seizures are more common in girls than boys and are characterized by a sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. This type of seizure lasts less than 30 seconds and may have been mistaken for inattentiveness because of the subtle changes. Absence seizures are not associated with a postictal state.

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy means there will be many disabilities." b) "Cerebral palsy is a condition that doesn't get worse." c) "Cerebral palsy is a condition that runs in families." d) "Cerebral palsy occurs because of too much oxygen to the brain."

"Cerebral palsy is a condition that doesn't get worse." Correct Explanation: By definition, cerebral palsy is a nonprogressive neuromuscular disorder. It can be mild or quite severe and is believed to be the result of a hypoxic event during pregnancy or the birth process and doesn't run in families.

A 6-year-old has had a viral infection for the past 5 days and is now having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which of the following questions? a) "How high did his temperature rise when he was ill?" b) "Did you use any medications like aspirin for the fever?" c) "Did you give your child any acetaminophen, such as Tylenol?" d) "What type of fluids did your child take when he had a fever?"

"Did you use any medications like aspirin for the fever?" Correct 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 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? a) "It's normal for this to happen, but they don't really know why." b) "During delivery, your vaginal wall put pressure on the baby's head." c) "Your baby's head became blocked inside your vagina while you were pushing." d) "The forceps used during delivery caused this to happen."

"During delivery, your vaginal wall put pressure on the baby's head." Correct 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.

The nurse is reinforcing teaching with the caregivers of a child who has had a head injury and is being discharged. Which of the following statements made by the caregiver indicate an accurate understanding of the follow-up care for their child? a) "We can give him Tylenol for a headache, but no aspirin." b) "Even if the flashlight bothers him, we will check his eyes." c) "If he vomits again, we will bring him back immediately." d) "If he falls asleep, we will wake him up every 15 minutes."

"Even if the flashlight bothers him, we will check his eyes." Explanation: The child's pupils are checked for reaction to light every four hours for 48 hours. If the child falls asleep, he or she should be awakened every one to two 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 six 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 is collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "He kept smacking his lips and rubbing his hands." b) "His arms had jerking movements in his legs and face." c) "He was just staring into space and was totally unaware." d) "He usually is very coordinated, but he couldn't even walk without falling."

"He was just staring into space and was totally unaware." Correct Explanation: Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. 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 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.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the wellchild clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a) "I have ibuprofen available in case it's needed." b) "The most likely time for a seizure is when the fever is rising." c) "My child will likely outgrow these seizures by age 5." d) "I always keep phenobarbital with me in case of a fever."

"I always keep phenobarbital with me in case of a fever." Correct Explanation: Antiepileptics, such as phenobarbital (Luminal), 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 because seizures occur as the temperature rises.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the wellchild clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a) "I always keep phenobarbital with me in case of a fever." b) "My child will likely outgrow these seizures by age 5." c) "The most likely time for a seizure is when the fever is rising." d) "I have ibuprofen available in case it's needed."

"I always keep phenobarbital with me in case of a fever." (Phenobarbital is used for prolonged seizures or neurologic abnormalities)

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) 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) "A drop in the plasma drug level will lead to a toxic state." b) "Large increments in dosage lead to a more rapid stabilizing therapeutic effect." c) "The capacity to metabolize the drug becomes overwhelmed over time." d) "Small increments in dosage lead to sharp increases in plasma drug levels."

"Small increments in dosage lead to sharp increases in plasma drug levels." 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 mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" What could the nurse say to begin educating the woman? a) "Sometimes it's hard to tell what products may contain aspirin." b) "Don't worry; you're in good hands. We have it under control now." c) "Aspirin in combination with the virus will make the brain swell and the liver fail." d) "Do you think that maybe your child took aspirin on his own?"

"Sometimes it's hard to tell what products may contain aspirin." Correct Explanation: Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. Don't state the obvious, but also don't minimize the situation. Encouraging the mother to ask for information and offering explanations in terms she will understand are important, but this response does not address the mother's assertion.

The nurse is educating parents of a male infant with Chiari type II malformation. Which of the following statements about their child's condition is most accurate? a) "You won't need to change diapers often." b) "Lay him down after feeding." c) "Take your time feeding your baby." d) "You'll see a big difference after the surgery."

"Take your time feeding your baby." Explanation: One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms, rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.

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

"The surgery was successful. Do you have any questions?" Correct Explanation: Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.

Seven-year old Isabelle 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 Isabelle first complained of 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 of the following statements would be best for the nurse to say to this mother? a) "This is a serious problem. Aspirin is likely to cause Reye syndrome, and Isabelle should be admitted to the hospital for observation as a precaution." b) "This might or might not be a problem. Watch Isabelle 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." c) "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." d) "This might or might not be a problem. Watch Isabelle 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."

"This might or might not be a problem. Watch Isabelle 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."

Seven-year old Isabelle 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 Isabelle first complained of 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 of the following statements would be best for the nurse to say to this mother? a) "This might or might not be a problem. Watch Isabelle 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." b) "This might or might not be a problem. Watch Isabelle 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." c) "This is a serious problem. Aspirin is likely to cause Reye syndrome, and Isabelle should be admitted to the hospital for observation as a precaution." d) "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 might or might not be a problem. Watch Isabelle 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." Correct 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 three to five 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 arrest.

The nurse is educating the family of a 7-year-old epilepsy patient about care and safety for this child. Which of the following comments will be most valuable in helping the parent and the child cope? a) "Use this information to teach family and friends." b) "If he is out of bed, the helmet's on the head." c) "You'll always need a monitor in his room." d) "Bike riding and swimming are just too dangerous."

"Use this information to teach family and friends." Explanation: Families need and want information they can share with relatives, childcare 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 boy may be able to bike ride and swim with proper precautions.

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 of the following inquiries would suggest what has happened? a) "Was the child unconscious?" b) "Were there any jerky movements?" c) "What happened just before the seizures?" d) "How did you treat the child afterwards?"

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

"What questions or concerns do you have about this device?"

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "It will be nice when you will let me take a long nap. I am sleepy." b) "I am glad that my headache is getting better." c) "My stomach is upset. I feel like I might throw up." d) "You look funny. Well, both of you do. I see two of you."

"You look funny. Well, both of you do. I see two of you." Correct Explanation: The caregiver should notify the health-care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling naueauted is not a reason to notify the provider.

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? a) A room with an 8-month-old infant with failure to thrive b) A private room near the nurses' station c) A room with a 12-month-old infant with a urinary tract infection d) A two-bed room in the middle of the hall

A private room near the nurses' station Correct Explanation: A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until that child has received I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.

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 of the following interventions will target the child's most pressing need? a) Prepare a menu with the child's favorite foods. b) Pad and raise the rails on the child's bed. c) Administer intravenous antibiotics as ordered. d) Educate the parents about seizure precautions.

Administer intravenous antibiotics as ordered. Explanation: It is likely the child's VP shunt has become infected. Intravenous antibiotics are required. The symptoms of seizures and vomiting should diminish once the infection is brought under control. Eradicating the likely central nervous system infection takes precedence over poor appetite.

After teaching a group of students about neural tube disorders, the instructor determines that additional teaching is needed when the students identify which of the following as a neural tube defect? a) Anencephaly b) Encephalocele c) Arnold-Chiari malformation d) Spina bifida occulta

Arnold-Chiari malformation Arnold-Chiari malformation is a deformity of the cerebellar tonsils being displaced into the upper cervical canal. Anencephaly is a neural tube defect. Encephalocele is a neural tube defect Spina bifida occulta is a neural tube defect.

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 of the following as a risk factor for hemorrhagic stroke? a) Meningitis b) Congenital heart defect c) Sickle cell disease d) Arteriovenous malformations (AVMs)

Arteriovenous malformations (AVMs) 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.

A nurse is performing a complete neurological examination of a 7-year-old boy. She will now test his cerebellar function. Which of the following tests would be appropriate for this purpose? a) Ask the boy to close his eyes and then touch his skin with a cotton wisp; ask him to point to where he was touched b) Measure the circumference of the calves and thighs with a tape measure c) Ask the boy who he is, where he is, and what day it is d) Ask the boy to touch each finger on one hand with the thumb that hand in rapid succession

Ask the boy to touch each finger on one hand with the thumb that hand in rapid succession

A nurse is performing a complete neurological examination of a 7-year-old boy. She will now test his cerebellar function. Which of the following tests would be appropriate for this purpose? a) Ask the boy to close his eyes and then touch his skin with a cotton wisp; ask him to point to where he was touched b) Ask the boy who he is, where he is, and what day it is c) Measure the circumference of the calves and thighs with a tape measure d) Ask the boy to touch each finger on one hand with the thumb that hand in rapid succession

Ask the boy to touch each finger on one hand with the thumb that hand in rapid succession Correct Explanation: Tests for cerebellar function are tests for balance and coordination, such as asking the child to touch each finger on one hand with the thumb of that hand in rapid succession. Motor function is measured by evaluating muscle size, strength, and tone. Begin by comparing the size and symmetry of extremities. If in doubt about either of these, measure the circumference of the calves and thighs or upper and lower arms with a tape measure. If children's sensory systems are intact, they should be able to distinguish light touch, pain, vibration, hot, and cold. Have a child close his eyes and then ask him to point to the spot where you touch him with an object. Orientation, which is one measure of cerebral function, refers to whether children are aware of who they are, where they are, and what day it is (person, place, and time).

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which of the following interventions would be most important for the nurse to perform? a) Pull up the side rails on the bed. b) Monitor core body temperature. c) Assess the child's level of consciousness. d) Help the child cope with an altered appearance.

Assess the child's level of consciousness. Correct Explanation: Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure patient. The child's eyes will correct themselves when ICP is reduced.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Avoid making noise when in the child's room b) Keep the lights on brightly so that he can see his mother c) Rock the child frequently d) Have the child's 2-year-old brother stay in the room

Avoid making noise when in the child's room Correct Explanation: Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the patient's ear. This would be documented as which of the following? a) Battle sign b) Otorrhea c) Rhinorrhea d) Raccoon eyes

Battle sign

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the patient's ear. This would be documented as which of the following? a) Raccoon eyes b) Otorrhea c) Battle sign d) Rhinorrhea

Battle sign Correct 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.

Which of the following is consistent with increased ICP in the child? a) Increased appetite b) Bulging fontanel c) Emotional lability d) Narcolepsy

Bulging fontanel

Which of the following is consistent with increased ICP in the child? a) Increased appetite b) Emotional lability c) Bulging fontanel d) Narcolepsy

Bulging fontanel Correct Explanation: Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping.

To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Cerebral edema b) Cardiogenic shock c) Left-sided heart failure d) Renal failure

Cerebral edema

To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Cerebral edema b) Renal failure c) Left-sided heart failure d) Cardiogenic shock

Cerebral edema Correct 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 I.V. therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.

The nurse is in the room when a child with a seizure disorder is having a seizure. The child is having generalized jerking muscle movement, and the nurse notes the bed appears to be wet with urine. The child is in which stage of the generalized seizure? a) Postictal b) Tonic c) Prodromal d) Clonic

Clonic Explanation: The initial rigidity of the tonic phase changes rapidly to generalized jerking muscle movements in the clonic phase. The child may bite the tongue or lose control of bladder and bowel functions. The jerking movements gradually diminish and then disappear, and the child relaxes.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for which of the following? a) Intracranial hemorrhaging b) Congenital hydrocephalus c) Positional plagiocephaly d) Closed head injury

Closed head injury Correct 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 closed head injury. 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.

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Cloudy appearance b) Elevated sugar c) Decreased leukocytes d) Decreased pressure

Cloudy appearance Correct Explanation: In the CSF of clients diagnosed with bacterial meningitis, the pressure is elevated, the appearance is cloudy, and the leukocytes are elevated. A decreased sugar content is noted.

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

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 I.V. therapy aren't, by themselves, appropriate times to begin antibiotic therapy.

The father of a 7-year-old boy reports to the nurse that two or three times over the past weeks he has observed his son seemingly staring into space and rubbing his hands. The behavior lasts for a minute or so, followed by an inability of the child to understand what's being said to him. When the nurse asks the child about his experience, he says he doesn't know what his father is talking about. The symptoms this child is exhibiting might indicate the child is having a) Absence seizures b) Complex partial seizures c) Simple partial motor seizures d) Simple partial sensory seizures

Complex partial seizures Explanation: Complex partial seizures, also called psychomotor seizures, begin in a small area of the brain and change or alter consciousness. They cause memory loss and staring. Nonpurposeful movements such as hand rubbing, lip smacking, arm dropping, and swallowing may occur. Following the seizure the child may sleep or be confused for a few minutes. The child is often unaware of the seizure. Simple partial sensory seizures may include sensory symptoms called an aura (a sensation that signals an impending attack) involving sight, sound, taste, smell, touch, or emotions (a feeling of fear, for example). The child may also have numbness, tingling, paresthesia, or pain. Simple partial motor seizures cause a localized motor activity such as shaking of an arm, leg, or other part of the body. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. The child may have blinking or twitching of the mouth or an extremity along with the staring. Immediately after the seizure, the child is alert and continues conversation but does not know what was said or done during the episode.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) The EEG is normal. b) Cyanosis occurs at the onset of the seizure. c) The patient is bradycardiac. d) Convulsive activity occurs.

Convulsive activity occurs. Explanation: During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

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? a) Take vital signs every 4 hours b) Encourage the parents to hold the child c) Monitor temperature every 4 hours d) Decrease environmental stimulation

Decrease environmental stimulation Correct 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.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. Which of the following would the nurse identify as a possible trigger? a) Swimming twice a week b) 11 p.m. bedtime; 6:30 a.m. wake-up c) Use of nonscented soap d) Drinking three cans of diet cola

Drinking three cans of diet cola Correct 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.

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 which of the following? a) Haemophilus influenza type B b) Escherichia coli c) Streptococcus group B d) Enterovirus

Enterovirus 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. influenza type B is a cause of bacterial meningitis. Streptococcus group B is a cause of bacterial meningitis.

The nurse caring for a patient with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. a) False b) True

False

A doctor orders the placement of an ICP monitor in a patient with cerebral edema. The nurse is aware that this surgery will take place in the infratentorial region of the brain. a) True b) False

False Explanation: Surgical procedures in the infratentorial region are usually indicated for tumor or cyst resection. Most surgical procedures in the supratentorial region of the brain are indicated for resection of epileptogenic cortex (seizure foci), placement of ventricular catheters to drain CSF, draining collected blood following head injury, placement of ICP monitors, and also resection or biopsy of tumors or cysts

A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be: 1. Educate the family on ways to prevent bacterial meningitis. 2. Initiate appropriate isolation precautions and begin intravenous antibiotics. 3. Assess the infant's fontanels. 4. Encourage the mother to hold the infant and feed her.

Initiate appropriate isolation precautions and begin intravenous antibiotics.

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

Institute droplet precautions in addition to standard precautions.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which of the following interventions should the nurse take initially? a) Institute droplet precautions in addition to standard precautions. b) Palpate the child's fontanels. c) Encourage the mother to hold and comfort the infant. d) Educate the family about preventing bacterial meningitis.

Institute droplet precautions in addition to standard precautions. Correct 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 on once the initial infection has been controlled. Palpating the fontanels 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? a) Irritability, fever, and vomiting b) Negative Kernig's sign c) Flat fontanel d) Jaundice, drowsiness, and refusal to eat

Irritability, fever, and vomiting

A 9-year-old girl who is suspected of having an infection of the central nervous system is undergoing a lumbar puncture to withdraw cerebrospinal fluid for analysis. The nurse knows that the needle will be introduced into the subarachnoid space at the level of which of the following vertebrae? a) L1 or L2 b) L4 or L5 c) T3 or T4 d) C1 or C2

L4 or L5 Correct Explanation: Lumbar puncture, the introduction of a needle into the subarachnoid space (under the arachnoid membrane) at the level of L4 or L5 to withdraw CSF for analysis, is used most frequently with children to diagnose hemorrhage or infection in the CNS or to diagnose an obstruction of CSF flow.

Absence seizures are marked by which of the following clinical manifestations? a) Loss of muscle tone and loss of consciousness b) Brief, sudden onset of increased tone of the extensor muscle c) Sudden, brief jerks of a muscle group d) Loss of motor activity accompanied by a blank stare

Loss of motor activity accompanied by a blank stare Correct Explanation: An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Lying prone, with the neck flexed b) Sitting up, with the back straight c) Lying on one side, with the back curved d) Lying prone, with the feet higher than the head

Lying on one side, with the back curved Correct Explanation: Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

While observing a child, the nurse notes that the child's arms and legs are extended and pronated. The nurse interprets this as indicating damage to which of the following? a) Midbrain b) Meninges c) Cerebral cortex d) Cranial nerves

Midbrain 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 opisthotonus in an infant. With this position, the head and neck are hyperextended to relieve discomfort.

The nurse is collecting data from a child who may have a seizure disorder. Which of the following is a description of an absence seizure? a) Sudden, momentary loss of muscle tone, with a brief loss of consciousness b) Muscle tone maintained and child frozen in position c) Brief, sudden contracture of a muscle or muscle group d) Minimal or no alteration in muscle tone, with a brief loss of consciousness

Minimal or no alteration in muscle tone, with a brief loss of consciousness Explanation: Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.

A nurse is caring for a newborn with anencephaly. Which of the following interventions will the nurse use? a) Place a cap or similar covering on the infant's head. b) Closely monitor neurologic status. c) Monitor for increased intracranial pressure (ICP). d) Refer the family to an agency to assist with long-term care.

Place a cap or similar covering on the infant's head.

A nurse is caring for a 3-year-old girl with microcephaly. Which of the following actions is appropriate for the nurse to take? a) Playfully ask the child to touch her nose. b) Administer antipyretics as ordered. c) Prepare the child for the experience of cranial surgery. d) Teach the parents about ventriculoperitoneal (VP) shunts.

Playfully ask the child to touch her nose

A nurse is caring for a 3-year-old girl with microcephaly. Which of the following actions is appropriate for the nurse to take? a) Playfully ask the child to touch her nose. b) Teach the parents about ventriculoperitoneal (VP) shunts. c) Administer antipyretics as ordered. d) Prepare the child for the experience of cranial surgery.

Playfully ask the child to touch her nose. Correct Explanation: Having the child touch her nose will assist the nurse in assessing probable neurologic and cognitive deficits. A VP shunt may be necessary for hydrocephaly, not this disorder. Surgery is often an intervention for craniosynostosis but cannot correct microcephaly. Hyperthermia is not a complication with microcephaly.

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? a) Negative Brudzinski's sign b) Positive Homans' sign c) Negative Kernig's sign d) Positive Kernig's sign

Positive Kernig's sign

A nurse is assessing a 3-year-old child with nuchal rigidity. Which sign would be documented on the chart to support this condition? a) Positive Homans' sign b) Positive Kernig's sign c) Negative Kernig's sign d) Negative Brudzinski's sign

Positive Kernig's sign Correct Explanation: A positive Kernig's sign indicates nuchal rigidity, caused by an irritative lesion of the subarachnoid space. A positive Brudzinski's sign also is indicative of the condition. A positive Homans' sign may indicate venous inflammation of the lower leg.

A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention? 1. Prevention of injury by removing the child from his bed 2. Prevention of injury by placing a tongue blade in the child's mouth 3. Prevention of injury by restraining the child 4. Prevention of injury by placing the child on his side and opening his airway

Prevention of injury by placing the child on his side and opening his airway

Question: Put the following events of a generalized epileptic seizure in correct order: 1 Prodromal period 2 Tonic stage 3 Postictal period 4 Clonic stage

Prodromal period Tonic stage Clonic stage Postictal period

Put the following events of a generalized epileptic seizure in correct order: Tonic stage Prodromal period Clonic stage Postictal period

Prodromal period Tonic stage Clonic stage Postictal period Correct Explanation: A tonic-clonic seizure is characterized by the following events: 1) prodromal period, 2) tonic stage, 3) clonic stage, and 4) postictal period.

In caring for the child with meningitis, the nurse recognizes that which of the following nursing diagnoses would be the most important to include in this child's plan of care? a) Risk for injury related to seizure activity b) Risk for acute pain related to surgical procedure c) Delayed growth and development related to physical restrictions d) Ineffective airway clearance related to history of seizures

Risk for injury related to seizure activity Keeping the child free of injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and the history of seizures does not impact the airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a) Occurrence of urine and fecal contamination b) Degree and extent of nuchal rigidity c) Onset and character of fever d) Signs of increased intracranial pressure (ICP)

Signs of increased intracranial pressure (ICP) Correct Explanation: Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.

A nurse is examining a boy with cerebral palsy. He has hypertonic muscles and abnormal clonus in his legs and walks on his toes. Which of the following is the type of cerebral palsy that this boy is demonstrating? a) Spastic b) Ataxic c) Athetoid d) Dyskinetic

Spastic

After a difficult birth, the nurse observes that a newborn has swelling on part of his head. Which sign suggests cephalohematoma? a) Swelling crosses the midline of the infant's scalp. b) Infant had a low birth weight when born at 37 weeks. c) Infant has facial abnormalities. d) Swelling does not cross the suture lines.

Swelling does not cross the suture lines.

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

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.

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

Teach the child and his parents to keep a headache diary. Correct 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 of the following statements is the best to use for a teaching session? a) Tell me your concerns about your child's shunt. b) Always keep her head raised 30º. c) Her autoregulation mechanism to absorb spinal fluid has failed. d) Call the doctor if she gets a persistent headache.

Tell me your concerns about your child's shunt. Correct 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 interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be which of the following? a) The child may begin to have absence seizures every day. b) The child is having generalized seizures. c) The child is in status epilepticus. d) The child's history indicates she has infantile seizures.

The child is in status epilepticus. Correct Explanation: Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which of the following symptoms indicate that the shunt is infected? a) The fontanels are bulging or tense. b) The child is not responding or eating well. c) The child's pupil reaction time is rapid and uneven. d) The child has a high-pitched cry.

The child is not responding or eating well. Correct Explanation: Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract. Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure. A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction. Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure.

In caring for a child with a seizure disorder, the highest priority goal is which of the following? a) The child will have an understanding of the disorder. b) The child will be free from injury during a seizure. c) The family will understand seizure precautions. d) The family caregivers anxiety will be reduced.

The child will be free from injury during a seizure.

When compared with adults, why are infants and children at an increased risk of head trauma? 1. The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. 2. The development of the nervous system is complete at birth but remains immature. 3. The spine is very immobile in infants and young children. 4. The skull is more flexible due to the presence of sutures and fontanels.

The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed.

After a difficult birth, the nurse observes that a newborn has swelling on part of his head. The nurse suspects caput succedaneum based on which of the following? a) The infant had a low birthweight when born at term. b) The infant had low-set ears and facial abnormalities. c) The swelling crosses the midline of the infant's scalp. d) The swelling is limited to one small area without crossing the sagittal suture.

The swelling crosses the midline of the infant's scalp. The fact that the swelling crosses the midline of the infant's scalp indicates caput succedaneum. If the swelling is limited and does not cross the midline or suture lines, it would suggest cephalohematoma. Low birthweight does not suggest caput succedaneum. Low-set ears may be seen in infants with chromosomal abnormalities. Facial abnormalities may accompany encephalocele.

Which of the following age groups of children have the highest actual rate of death from drowning? a) School-age children b) Toddlers c) Preschool children d) Infants

Toddlers

Which of the following age groups of children have the highest actual rate of death from drowning? a) School-age children b) Infants c) Preschool children d) Toddlers

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

The best way to evaluate a child's level of consciousness is through conversation. a) True b) False

True Correct Explanation: The best way to evaluate a child's level of consciousness is through conversation. Note any drowsiness or lethargy. Allow the child to answer questions without prompting, and listen carefully to be certain the answer is appropriate to the question.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which of the following interventions is most effective for eliminating breakthrough seizures? a) Instructing her teacher how to respond to a seizure b) Understanding the side effects of medications c) Placing the child on her side on the floor d) Treating the child as though she did not have epilepsy

Understanding the side effects of medications 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.

The treatment for children with seizures disorders is most often which of the following? a) Use of anticonvulsant medications b) Surgical intervention c) Strict exercise regimen d) Restricted fat diet

Use of anticonvulsant medications Correct Explanation: Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. A few children may be candidates for surgical intervention but, in most cases, surgery is not the treatment. Ketogenic diets (high in fat and low in carbohydrates and protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Exercise is not a treatment for seizure disorders.

The nurse is caring for a premature infant diagnosed with intraventricular hemorrhage (IVH). Which of the following interventions best serves the needs of this client? a) Using a squeak toy to attract the child's gaze b) Stroking the child's cheek with a finger c) Placing the crib in a room by itself d) Removing toys from the crib when not in use

Using a squeak toy to attract the child's gaze Explanation: Assessing neurological changes is part of a care plan for intraventricular hemorrhage (IVH). The squeak toy will check for normal reactions from the child. There is no need to remove toys (as a precaution for seizures), check sensory function, or isolate the child.

The nurse is assessing a toddler for motor function. Which of the following activities will be most valuable? a) Give the child some potato chips. b) Watch the child playing with a pull-toy. c) Let the child look at a picture book. d) Have the child catch a ball.

Watch the child playing with a pull-toy. Correct Explanation: Watching the child playing with a pull-toy would be most valuable for assessing motor function. Catching a ball is too advanced for a toddler to accomplish. Looking at a picture book would help assess visual acuity and eye movement. Eating potato chips would help assess sensor function for taste.

A nurse is performing a neurological examination of a preschool girl. She is testing her remote memory. Which of the following would be an appropriate type of memory to ask the girl to recall? a) Where the girl and her family went on vacation last year b) What the girl had for dinner last night c) A string of three digits that the nurse has just spoken to her d) The name of an object that the nurse showed her 5 minutes ago

What the girl had for dinner last night Explanation: Immediate recall is the ability to retain a concept for a short time such as being able to remember a series of numbers and repeat them (a child of 4 years can usually repeat three digits; a child older than 6 years can repeat five digits). Recent memory covers a slightly longer period of time. To measure this, show the preschool child an object such as a key and ask him to remember it, because later you will ask him to tell you what it was. After about 5 minutes, ask whether he remembers what object you showed him. Ask older children what they ate for breakfast to test recent memory. Remote memory is long-term recall. Ask preschoolers what they ate for breakfast that morning, or dinner the night before as, for them, that was a long time ago; ask older children what was the name of their first-grade teacher as most people remember that their whole life.

The nurse is assigned an infant with a possible neurological disorder. Which of the following assessment findings should you communicate to the physician as a late sign of increased intracranial pressure? a) headache and sunset eyes. b) dizziness and irritability. c) decorticate posturing and fixed and dilated pupils d) decreased pupil reaction and decreased respiration.

decorticate posturing and fixed and dilated pupils

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

ensuring the parents know how to properly give antibiotics.

Any individual taking phenobarbital for a seizure disorder should be taught a) never to go swimming. b) never to discontinue the drug abruptly. c) to brush his or her teeth four times a day. d) to avoid foods containing caffeine.

never to discontinue the drug abruptly. Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

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

steroid

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

steroid. Correct Explanation: A steroid may be prescribed to reduce inflammation and pressure on vital centers.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction you would want to give her parents regarding this is a) their child will have to practice good tooth brushing. b) even small doses may cause noticeable dizziness. c) watching television while taking the drug may cause seizures. d) numbness of the fingers is common while taking this drug.

their child will have to practice good tooth brushing. A side effect of phenytoin sodium is hypertrophy of the gumline. Good tooth brushing helps prevent inflammation under the hypertrophied tissue.

The nurse determines that a child is experiencing late signs of increased intracranial pressure based on assessment of which of the following? Select all that apply. a) Bradycardia b) Fixed dilated pupils c) Increased blood pressure d) Irregular respirations e) Sunset eyes

• Bradycardia • Fixed dilated pupils • Irregular respirations Late signs of increased intracranial pressure include bradycardia, fixed and dilated pupils, and irregular respirations. Increased blood pressure and sunset eyes are early signs of increased intracranial pressure.

The young child has been diagnosed with bacterial meningitis. Which nursing interventions are appropriate? Select all that apply. a) Identify close contacts of the child who will require post-exposure prophylactic medication b) Initiate seizure precautions c) Monitor the child for signs and symptoms associated with decreased intracranial pressure d) Administer antibiotics as ordered e) Initiate droplet isolation

• Initiate droplet isolation • Identify close contacts of the child who will require post-exposure prophylactic medication • Administer antibiotics as ordered • Initiate seizure precautions

When assessing a neonate for seizures, which of the following would the nurse expect to find? Select all that apply. a) Tonic-clonic contractions b) Tachycardia c) Ocular deviation d) Elevated blood pressure e) Jitteriness

• Tachycardia • Ocular deviation • Elevated blood pressure • Jitteriness Correct Explanation: Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic-clonic contractions typically are more common in older children.