Neuro

A 12-month-old infant has been prescribed lumbar puncture to confirm the diagnosis of meningitis. The nurse is teaching the parents of the child about the rationale behind the procedure. The nurse incorporates in the teaching that a lumbar puncture is used to do what? a. Determine the causative agent b. Identify the presence of blood c. Reduce the intracranial pressure d. Measure the glucose level

A

A 3-week-old infant is receiving treatment for meningitis. The nurse is assessing the infant for complications. What observation made by the nurse suggests a complication? a. A tense and nonpulsatile anterior fontanel on the head b. A lack of coordination between eye and muscle movement c. A larger head circumference than chest circumference d. An inability to support the head in the prone position

A

A 6-year-old girl born with a myelomeningocele has a neurogenic bladder disorder. Her parents have been performing clean intermittent catheterization. What is the nurse's most appropriate action? a. Teach the child to do self-catheterization. b. Teach the child appropriate bladder control. c. Continue having parents do catheterization. d. Encourage the family to consider urinary diversion.

A

A child has been admitted to the emergency department after falling off a horse. The first responders stabilized the child using a rigid cervical collar with supportive blocks on a rigid backboard. What is the most appropriate explanation for the nursing team to give regarding why the child was stabilized in this manner? a. "It immobilizes the entire spine." b. "It prevents the spread of infection." c. "It provides psychological reassurance." d. "It promotes cognitive development."

A

A ventriculoperitoneal (VP) shunt has been placed in an infant with hydrocephalus. What does the nurse include in the assessment to determine if the VP shunt is functioning properly? a. Palpate the anterior fontanel. b. Check for periorbital edema. c. Determine the frequency of voiding. d. Observe for symmetry of the Moro reflex.

A

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and pupils are unequal and sluggish. What is the mostappropriate nursing action? a. Notify the health care provider immediately. b. Document level of consciousness. c. Observe closely for signs of increased intracranial pressure (ICP). d. Administer pain medication and assess for response.

A

The nurse is doing a neurologic assessment on a 2-month-old infant following a car accident. Moro, tonic neck, and withdrawal reflexes are present. What should the nurse recognize that these reflexes suggest? a. Neurologic health b. Severe brain damage c. Decorticate posturing d. Decerebrate posturing

A

The nurse is performing an assessment of a 14-month-old infant with meningitis. The nurse finds that the baby cannot extend the knee more than 135 degrees and cries when in the supine position with the hip and knee flexed at 90 degrees. What is an appropriate interpretation by the nurse? a. Kernig sign b. Babinski reflex c. Chvostek sign d. Cremasteric reflex

A

The nurse who is concerned about increased intracranial pressure in an infant should assess for what? a. Irritability b. Photophobia c. Pulsating anterior fontanel d. Vomiting and diarrhea

A

Which action does the nurse take when there is reduced urinary output in a comatose child? a. Evaluates tests for syndrome of inappropriate antidiuretic hormone secretion (SIADH) b. Obtains a prescription from the primary health care provider to increase fluids c. Obtains a prescription to increase the child's feedings using bolus feedings d. Positions the child in a side-lying position and elevates the bed slightly

A

Which measurement scale does the nurse use to assess the level of consciousness (LOC) in a child? a. GCS b. Doll's head maneuver c. Caloric test d. Oculovestibular response

A

The nursing instructor is explaining Duchenne muscular dystrophy (DMD) to parents. Which statements does the nurse include in the explanation? Select all that apply. a. "It is inherited as an X-linked recessive trait, and it is a single-gene defect." b. "It is an autosomal recessive, autosomal dominant, or X-linked recessive trait." c. "The female carriers are completely healthy without any symptoms of the illness." d. "About 10% of female carriers develop cardiomyopathy with elevated creatine kinase." e. "In about 30% of cases it is a new mutation, and in 65% of cases it is a positive family history."

A, D, E

A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. What is a priority nursing intervention? a. Recommend allergy testing. b. Provide a latex-free environment. c. Use only powder-free latex gloves. d. Limit use of latex products as much as possible.

B

The nurse is caring for an infant with myelomeningocele and needs to keep the infant in the prone position. Which is the mostappropriate way to keep the infant in the prone position while minimizing tension in the sac? a. Hips extended with the legs in abduction and the child lying with back down b. Hips kept slightly flexed with the legs in abduction and the child lying chest down c. Legs kept well separated, thighs acutely flexed on the abdomen, and the child lying on the back d. Child lying on the left side with the left thigh slightly flexed and the right thigh acutely flexed on the abdomen

B

The nurse tells the mother of an infant, "Do not give your child honey until the child turns 1." What is the rationale for this statement? a. Honey often carries tetani spores. b. Honey often carries botulinum spores. c. Honey has a high percentage of fat and protein value, which can adversely affect the child. d. Consumption of honey can lead to a diabetic condition.

B

The parents find that their son has X-linked Duchenne muscular dystrophy (DMD). They also have a daughter and are concerned about their daughter's well-being. Neither parent has muscular dystrophy. Their daughter has not shown any symptoms. Which are the most appropriate statements to address their concerns? Select all that apply. a. "Your daughter is surely a carrier of the disease." b. "It can be a new mutation, and the mother need not be a carrier." c. "Your daughter may be a carrier and could develop cardiomyopathy." d. "It is a genetic disease caused by mutation of the gene that encodes dystrophin." e. "Your son has inherited the disease from both parents."

B, C, D

A 12-month-old child presents with symptoms of bacterial meningitis. The child undergoes lumbar puncture and the nurse notes that the cerebrospinal fluid is cloudy. How does the nurse interpret this finding? a. The CSF is healthy b. The glucose level has increased c. The WBC count has risen d. The count of RBCs has risen

C

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. The nurse should recognize that this is what? a. An absence seizure b. A generalized seizure c. Status epilepticus d. A simple partial seizure

C

The child is scheduled to undergo a computed tomography (CT) scan and magnetic resonance imaging (MRI) after falling down a flight of stairs. The child is showing signs of concussion and impairment in some of the reflex actions. The child's parents ask the nurse about the importance of diagnostic testing. What is the most appropriate response by the nurse? a. "They can provide insight into the cognitive development of the child." b. "They will accurately assess your child's airway, breathing, and circulation." c. "They will assess your child's neurologic function and help rule out spinal cord injury." d. "The primary health care provider wants to assess your child's psychological development."

C

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. What is the priority of nursing care? a. Initiate isolation precautions as soon as the diagnosis is confirmed. b. Initiate isolation precautions as soon as the causative agent is identified. c. Administer antibiotic therapy as soon as it is ordered. d. Administer sedatives/analgesics on a preventive schedule to manage pain.

C

The nurse is assessing a 9-year-old child for the presence of Reye's syndrome (RS). What information about the child is most useful for the nurse during the assessment? a. The child reports having a rash recently. b. The child had an episode of acute tonsillitis. c. The child reports having a recent viral infection. d. The child has had a fractured radius and ulna.

C

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. In the discussion, what should the nurse include? a. Parental protection is essential until the child reaches adulthood. b. Cognitive impairment is to be expected with hydrocephalus. c. Shunt malfunction or infection requires immediate treatment. d. Most usual childhood activities must be restricted.

C

What most accurately describes bowel function in children born with a myelomeningocele? a. Incontinence cannot be prevented. b. Enemas and laxatives are contraindicated. c. Some degree of fecal continence can usually be achieved. d. Colostomy is usually required by the time the child reaches adolescence.

C

Which is a priority nursing intervention for a child, who is administered intravenous lorazepam (Ativan) for the treatment of status epilepticus? a. Monitoring fluid and electrolyte balance b. Monitoring infusion of midazolam (Dormicum) c. Monitoring for alterations in vital signs d. Monitoring hematocrit frequently

C

Which is the most important nursing intervention while providing care for a child with endotracheal intubation who is in a deep comatose state? a. Ask family members to be always present b. Monitor hematocrit often c. Assess respiratory effectiveness d. Perform suctioning every day

C

Which medication helps reduce intracranial pressure (ICP) elevations greater than 20 to 25 mm Hg in a child? a. Phenytoin (Dilantin) b. Rectal diazepam (Valium) c. Mannitol (Osmitrol) d. Ibuprofen (Motrin)

C

Which statement best describes pseudohypertrophic (Duchenne) muscular dystrophy? a. It is inherited as an autosomal dominant disorder. b. It is characterized by weakness of proximal muscles of both pelvic and shoulder girdles. c. It is characterized by muscle weakness usually beginning about 3 years old. d. Onset occurs in later childhood and adolescence.

C

Which test is used to understand the staging criteria for Reye's syndrome in a child? a. MRI b. CT scan c. Liver biopsy d. EEG

C

An 8-year-old female child is diagnosed with moderate cerebral palsy (CP). She recently began participation in a regular classroom for part of the day. Her mother asks the school nurse about having her daughter join the after-school Girl Scout troop. On what knowledge should the nurse's response be based? a. Most activities such as Girl Scouts cannot be adapted for children with CP. b. After-school activities usually result in extreme fatigue for children with CP. c. Trying to participate in activities such as Girl Scouts leads to lowered self-esteem in children with CP. d. After-school activities often provide children with CP opportunities for socialization and recreation.

D

The nurse is admitting a 12-year-old female patient with severe muscle weakness and a differential diagnosis of Guillain-Barré. Upon interviewing the mother regarding the child's recent injuries and illnesses, which finding would be most important? a. A significant fall from her bicycle b. A family trip to the Caribbean c. Contact with a classmate who has chickenpox d. A flu-like illness

D

The nurse is caring for a patient with Guillain-Barré syndrome (GBS). The nurse asks the child's parents to communicate with the child and attempt to make eye contact and physical contact. Which statement by the nurse best explains the rationale for this? a. "This is advised by the primary health care provider." b. "It is a useful motor function stimulus for your child." c. "This will stimulate the sensory functions of your child." d. "Active cognitive abilities allow your child to relate to you."

D

What do the major goals of therapy for children with cerebral palsy include? a. Reversing degenerative processes that have occurred b. Curing underlying defect causing the disorder c. Preventing spread to individuals in close contact with the child d. Recognizing the disorder early and promoting optimal development

D

What is an important nursing intervention when caring for a child with myelomeningocele in the postoperative stage? a. Place child on his or her side to decrease pressure on the spinal cord. b. Apply a heat lamp to facilitate drying and toughening of the sac. c. Keep skin clean and dry to prevent irritation from diarrheal stools. d. Measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.

D

Which diet does the nurse recommend for a child for management of epilepsy? a. Low-fat diet b. High-fiber diet c. Liquid diet d. Ketogenic diet

D

Which neurologic condition is indicated if a child's pupils are fixed bilaterally for more than 5 minutes? a. Seizures b. Eye trauma c. Hypothermia d. Brainstem damage

D

Which nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? a. Suctioning child frequently b. Providing environmental stimulation c. Turning head side to side every hour d. Avoiding activities that cause pain or crying

D

Why are infants particularly vulnerable to acceleration-deceleration head injuries? a. The anterior fontanel is not yet closed. b. The nervous tissue is not well developed. c. The scalp of the head has extensive vascularity. d. Musculoskeletal support of head is insufficient.

D

Which interventions does the nurse implement in the plan of care for a child with bacterial meningitis? Select all that apply. a. Ensuring a quiet environment in the room b. Ensuring maximum exposure to sunlight c. Placing the child in a side-lying position d. Using a pillow to lift the child's head e. Assessing whether the child is febrile

A, C, E

Which posttraumatic syndromes does the nurse assess for in a child after a head injury? Select all that apply. a. Postconcussion syndrome b. Posttraumatic seizures c. Neuroblastoma d. Hydrocephalus e. Bacterial meningitis

A, B, D

The parents of a child with cerebral palsy (CP) report that the child frequently chokes and aspirates during feedings. What advice does the nurse provide to the parents? Select all that apply. a. "Assess the child's chewing and swallowing ability." b. "Use jaw support, and control the jaw during feedings." c. "Use baclofen (Lioresal) therapy with an implanted pump." d. "Position your child on the cradle of your arm during feedings." e. "Position your child in a semiupright position during and after feedings."

A, B, E

What are the areas of nursing care for a child with Guillain-Barré syndrome (GBS)? Select all that apply. a. Monitor paralysis and prevent aspiration and ventilator-associated pneumonia (VAP). b. Prevent atelectasis, deep vein thrombosis (DVT), and autonomic dysfunction. c. Apply dressing and prescribe intravenous administration of immunoglobulin (IVIG). d. Prescribe and administer a low-molecular-weight heparin and other medicines. e. Manage fear and neuropathic pain in the child as well as monitor the respiratory function.

A, B, E

A child with cerebral palsy (CP) is experiencing repeated muscle contractures. What advice does the nurse convey to the family to prevent this condition? Select all that apply. a. "Perform stretching exercises on the affected muscles of the child." b. "Teach activities of daily living (ADLs) and encourage self-help skills." c. "Use assistive devices, such as wrist splits and ankle-foot orthoses." d. "Use jaw control during and after feeding, and remove thick carpeting." e. "Avoid throw rugs and thick carpeting, and use padded furniture."

A, C

Which constituents of the cranium should remain the same at all times to maintain a constant intracranial pressure (ICP)? Select all that apply. a. Brain b. Meninges c. CSF d. Blood e. Dura mater

A, C, D

Which interventions does the nurse implement to prevent the elevation of intracranial pressure (ICP) in an unconscious child? Select all that apply. a. Provides dim lights in the room b. Asks many relatives to visit often c. Prevents sudden movements in the child d. Administers prescribed pain medications e. Monitors the child's temperature frequently

A, C, D, E

What areas of initial care does the nurse provide for a newborn with spina bifida (SB)? Select all that apply. a. Prevention of infection b. Dental care techniques c. Neurologic assessment d. Impact of the anomaly on the family e. Tetanus immunoglobulin f. Anomalies of spinal bifida

A, C, D, F

The pediatric clinic nurse completes an assessment on a 4-month-old infant brought in because the parents are concerned that something is "just not right" with their baby. To which assessment findings should the nurse alert the health care provider? Select all that apply. a. Inability to sit up without support b. Poor head control and clenched fists c. Inability to crawl d. Failure to smile e. Extreme irritability

B, D, E

A patient who is 6 weeks pregnant tells the nurse that she is worried that the baby might have spina bifida because of a family history. What is the nurse's best response? a. "There is no genetic basis for the defect." b. "Prenatal detection is not possible yet." c. "Chromosome studies done on amniotic fluid can diagnose the defect prenatally." d. "The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally."

D