Neurological Disorders

33. A 2-month-old infant is brought to the emergency department after experiencing a seizure. The infant appears lethargic with very irregular respirations and periods of apnea. The parents report the baby is no longer interested in feeding and, before the seizure, rolled off the couch. What additional testing should the nurse immediately prepare for? 1. Computed tomography (CT) scan of the head and dilation of the eyes. 2. Computed tomography (CT) scan of the head and electroencephalogram (EEG). 3. X-rays of the head. 4. X-rays of all long bones.

1 (1. A computed tomography (CT) scan of the head will reveal trauma. Dilating the eyes is performed to check for retinal hemorrhages that are seen in an infant who has experienced shaken baby syndrome (SBS). 2. An EEG is not usually done as a priority test in an infant displaying symptoms of SBS. 3. X-rays of the head will show fractures, but CT and pupil examinations are the priority for this child. 4. X-rays of all long bones may be performed to rule out any old or new fractures, but CT and pupil examinations are the priority for this child.)

31. The nurse is caring for a child with a skull fracture who is unconscious and has severely increased intracranial pressure (ICP). The nurse notes the child ' s temperature to be 104°F (40°C). Which should the nurse do fi rst? 1. Place a cooling blanket on the child. 2. Administer acetaminophen (Tylenol) via nasogastric tube. 3. Administer acetaminophen (Tylenol) rectally. 4. Place ice packs in the child ' s axillary areas.

1 (1. A cooling blanket will help cool the child quickly and at a controlled temperature. 2. Acetaminophen (Tylenol) should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed. 3. Acetaminophen (Tylenol) should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed. 4. Ice packs will cause the child to shiver, which will increase oxygen consumption and possibly increase ICP. Shivering can also cause the child to experience a rebound increase in temperature.)

19. A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. This is most likely a/an: 1. Absence seizure. 2. Akinetic seizure. 3. Non-epileptic seizure. 4. Simple spasm seizure.

1 (1. Absence seizures occur frequently and last less than 30 seconds. The child experiences a brief loss of consciousness during which she may have a change in activity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming. 2. Akinetic seizures occur when the young child experiences a brief loss of consciousness and postural tone and falls to the ground. The child quickly regains consciousness. 3. A non-epileptic seizure is a seizure that occurs secondary to another disorder, such as a fever or increased ICP. 4. A simple spasm seizure is not a diagnosis.)

20. A preschooler has been having periods during which he suddenly falls and appears to be weak for a short time after the event. The preschool teacher asks what she should do. Select the nurse ' s best response. 1. "Have the parents follow up with his health-care provider because this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life because it could be attention-seeking behavior." 3. "Have the parents follow up with his health-care provider because this is likely an absence seizure." 4. "The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him and see if it continues."

1 (1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground. 2. It is important to evaluate the child for life stressors, but suspected seizure activity needs immediate evaluation. 3. An absence seizure is characterized by a change in activity whereby the child appears to be daydreaming or staring straight ahead. The child usually continues basic simple movements but loses an awareness of surroundings. 4. The preschool years are a not a time of rapid growth. Many children in this age-group appear clumsy, but suspected seizure activity needs immediate evaluation.)

36. Which is the nurse ' s best response to the parents of a neonate with a meningocele who ask what can they expect? 1. "After initial surgery to close the defect, most children experience no neurological dysfunction." 2. "Surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft." 3. "After the initial surgery to close the defect, the child will likely have motor and sensory defi cits." 4. "After the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence."

1 (1. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction. 2. Corrective surgery is done as soon as possible to minimize the risk of infection. 3. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction. 4. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction.)

11. The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and fl exes his neck, the nurse notes he fl exes his knees and hips. This is referred to as: 1. Brudzinski sign. 2. Cushing triad. 3. Kernig sign. 4. Nuchal rigidity.

1 (1. Brudzinski sign occurs when the child responds to a fl exed neck with an involuntary fl exion of the hips and/or knees. 2. Cushing triad is a sign of increased ICP and is manifested with an increase in systolic blood pressure, decreased heart rate, and irregular respirations. 3. Kernig sign occurs when there is resistance or pain in response to raising the child ' s fl exed leg. 4. Nuchal rigidity occurs when there is a resistance to neck fl exion.)

29. The nurse is caring for an unconscious 6-year-old who has had a severe closed-head injury and notes the following changes: Heart rate has dropped from 120 to 55, blood pressure has increased from 110/44 to 195/62, and respirations are becoming more irregular. Which should the nurse do fi rst after calling the physician? 1. Call for additional help and prepare to administer mannitol (Osmitrol). 2. Continue to monitor the patient ' s vital signs and prepare to administer a bolus of isotonic fl uids. 3. Call for additional help and prepare to administer an antihypertensive. 4. Continue to monitor the patient and administer supplemental oxygen.

1 (1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respirations. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP. 2. The child ' s vital signs need to be monitored, but a fl uid bolus will increase the circulating volume and lead to an increase in the child ' s ICP. Fluid boluses are necessary in cases of shock but must be administered carefully and the child closely observed. 3. An antihypertensive will not help decrease the ICP. 4. The child will benefi t from supplemental oxygen, but it will not help decrease the ICP.)

21. The diet that produces anticonvulsant effects from ketosis consists of: 1. High-fat and low-carbohydrate foods. 2. High-fat and high-carbohydrate foods. 3. Low-fat and low-carbohydrate foods. 4. Low-fat and high-carbohydrate foods

1 (1. High fat and low carbohydrates are the components of the ketogenic diet. 2. High fat and low carbohydrates are the components of the ketogenic diet. 3. High fat and low carbohydrates are the components of the ketogenic diet. 4. High fat and low carbohydrates are the components of the ketogenic diet.)

57. Which child would likely have experienced a delay in the diagnosis of a brain tumor? 1. A 3-month-old, because signs and symptoms would not have been readily apparent. 2. A 5-month-old, because signs and symptoms would not have been readily suspected. 3. School-age child, because signs and symptoms could have been misinterpreted. 4. Adolescent, because signs and symptoms could have been ignored and denied

1 (1. In infants, signs and symptoms may not be readily apparent because the open fontanel allows for expansion. 2. Although brain tumors are not suspected in infants, a delay in diagnosis is most likely because of the open fontanel, allowing some expansion to go unnoticed. 3. Signs and symptoms may be misinterpreted, but increased ICP will become apparent. 4. Signs and symptoms may be denied, but increased ICP will become apparent.)

55. Which should be included in the plan of care for a child who has a neuroblastoma with metastasis to the bone marrow and pancytopenia? 1. Administer red blood cells. 2. Limit school attendance to less than 4 hours daily. 3. Administer warfarin (Coumadin). 4. Encourage a diet high in fresh fruits and vegetables.

1 (1. Red blood cells will be needed to increase the red blood cell count. 2. The child should not be around groups of people because of the potential of exposure to infection. 3. Blood thinners are not given to the child with a decreased platelet count. 4. Fresh fruits and vegetables should be avoided because they may contain microorganisms that can lead to infection in the child with a low white blood cell count.)

51. The parents of a 12-month-old with cerebral palsy (CP) ask the nurse if they should teach their child sign language because he has not begun to vocalize. The nurse bases the response on the knowledge that sign language: 1. May be a very benefi cial way to help children with CP communicate. 2. May cause confusion and further delay vocalization. 3. Is diffi cult to learn for most children with CP. 4. Is benefi cial to learn, but it would be best to wait until the child is older.

1 (1. Sign language may help the child with CP communicate and ultimately decrease frustration. Children with CP may have diffi culty verbalizing because of weak tongue and jaw muscles. They may be able to have suffi cient motor skills to communicate with their hands 2. Sign language does not cause confusion and may help reinforce vocabulary and vocalization. 3. CP is manifested differently in all children; therefore, generalizations cannot be made. 4. The earlier sign language is taught, the more it will be benefi cial.)

18. A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do fi rst? 1. Administer blow-by oxygen and call for additional help. 2. Reassure the parents that seizures are common in children with meningitis. 3. Call a code and ask the parents to leave the room. 4. Assess the child ' s temperature and blood pressure.

1 (1. The child experiencing a seizure usually requires more oxygen because the seizure increases the body ' s metabolic rate and demand for oxygen. The seizure may also affect the child ' s airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help. 2. It is important to reassure the parents, but giving the child oxygen and calling for additional support is the priority of care. 3. It is not necessary to call a code unless the child experiences a cardiac or respiratory arrest. Research indicates that encouraging parents to remain with the child in emergency situations benefi ts both the child and family. 4. It is important to monitor and observe the child during a seizure, but it is very diffi cult to obtain a blood pressure from a seizing child. The priority of care involves administering oxygen and calling for additional help.)

52. The parents of a child with cerebral palsy (CP) are learning how to feed their child and avoid aspiration. The nurse would question which of the following when reviewing the teaching plan? 1. Place the food on the tip of the tongue. 2. Place the child in an upright position during feedings. 3. Feed the child soft and blended foods. 4. Feed the child slowly.

1 (1. The food should be placed far back in the mouth to avoid tongue thrust. 2. The child should be placed in an upright position. 3. Soft and blended foods minimize the risk of aspiration. 4. Allowing the child time to feed minimizes the risk of aspiration.)

44. The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the incidence of CP has: 1. Increased. 2. Decreased. 3. Remained the same. 4. Has decreased because of early misdiagnosis.

1 (1. The incidence of CP has increased, partly as a result of the increased survival rate of extreme low-birth-weight and premature infants. 2. The incidence of CP has increased since the 1960s. 3. The incidence of CP has increased since the 1960s. 4. There is no evidence to suggest that CP has been diagnosed erroneously.)

61. Which has the potential to alter a child ' s level of consciousness? Select all that apply. 1. Metabolic disorders. 2. Trauma. 3. Hypoxic episode. 4. Dehydration. 5. Endocrine disorders.

1, 2, 3, 4, 5. (1. Many metabolic disorders are associated with hypoglycemia. The hypoglycemic child experiences a decreased level of consciousness because the brain does not have stores of glucose. 2. Trauma can lead to generalized brain swelling with resultant increased ICP. 3. Hypoxemia leads to a decreased level of consciousness because the brain is intolerant to the lack of oxygen. 4. Dehydration can lead to inadequate perfusion to the brain, which can result in a decreased level of consciousness. 5. Endocrine disorders often result in a decreased level of consciousness because they can lead to hypoglycemia, which is poorly tolerated by the brain.)

8. Which position initially is most benefi cial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed? 1. Semi-Fowler in an infant seat. 2. Flat in the crib. 3. Trendelenburg. 4. In the crib with the head elevated to 90 degrees.

2 (1. A semi-Fowler position in an infant seat may allow the ventricles to drain too rapidly in the immediate postoperative period. 2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates. 3. The Trendelenburg position is not used immediately after ventriculoperitoneal shunt placement because it would increase ICP. 4. The head elevated to 90 degrees will allow the ventricle of the brain to drain too quickly.)

37. The nurse is caring for an infant with a myelomeningocele. The parents ask the nurse why the nurse keeps measuring the baby ' s head circumference. Select the nurse ' s best response: 1. "Babies ' heads are measured to ensure growth is on track." 2. "Babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size." 3. "Because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size." 4. "Many infants with myelomeningocele have microcephaly, which can show up as a decrease in head size."

2 (1. Although it is important to measure the head circumference of all babies, children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference. 2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference. 3. Although a defect in the spine can be a portal of entry for infection, children with myelomeningocele often have hydrocephalus as well. 4. Children with myelomeningocele are not at risk for microcephaly.)

24. A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen? 1. Two to three oral anticonvulsant medications so that dosing can be low and side effects minimized. 2. One oral anticonvulsant medication to observe effectiveness and minimize side effects. 3. One rectal gel to be administered in the event of a seizure. 4. A combination of oral and intravenous anticonvulsant medications to ensure compliance.

2 (1. Although many children with epilepsy require more than one medication to achieve seizure control, it is recommended that only one medication be started at a time so that the child ' s reaction to the specifi c medication can be observed. 2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels. 3. Rectal gels are used to stop a seizure once it has begun; they are not used to prevent seizures. 4. The route of choice for the prevention of seizures is oral. There is no reason to assume that compliance will be an issue prior to beginning anticonvulsant therapy)

42. A 6-month-old infant was just diagnosed with craniosynostosis. The infant ' s father asks the nurse for more information about reconstructive surgery. Select the nurse ' s best response. 1. "The surgery is done for cosmetic reasons and is without many complications." 2. "The surgery is important to allow the brain to grow properly. Although most children do well, serious complications can occur, so your child will be closely observed in the intensive care unit." 3. "The surgery is important to allow the brain to grow properly. Most surgeons wait until the child is 18 months old to minimize potential complications." 4. "The surgery is mainly done for cosmetic reasons, and most surgeons wait until the child is 3 years old because the head has fi nished growing at that time."

2 (1. Although there is a cosmetic benefi t, the surgery is done to reconstruct the skull to allow the brain to grow properly. There are potential complications associated with this surgery, such as increased ICP. 2. The surgery is done to reconstruct the skull to allow the brain to grow properly. Because there are potential complications associated with this surgery, such as increased ICP, the child is usually closely observed in the PICU. 3. The surgery is not usually postponed but instead done in early infancy. 4. The surgery is not usually postponed because it will allow for brain growth.)

34. The nurse knows that young infants are at risk for injury from shaken baby syndrome (SBS) because: 1. The anterior fontanel is open. 2. They have insuffi cient musculoskeletal support and a disproportionate head-tobody ratio. 3. They have an immature vascular system with veins and arteries that are more superfi cial. 4. There is immature myelination of the nervous system in a young infant.

2 (1. An open anterior fontanel allows for swelling, therefore decreasing the risk of injury. 2. Insuffi cient musculoskeletal support and a disproportionate head size place the infant at risk because the head cannot be supported during a shaking episode. 3. Superfi cial veins and arteries do not place the infant at a higher risk for injury. 4. Although the myelination is immature, the immature musculoskeletal support places the infant at risk.)

50. A child with cerebral palsy (CP) has been fi tted for braces and is beginning physical therapy to assist with ambulation. The parents ask why he needs the braces when he was crawling without any assistive devices. Select the nurse ' s best response. 1. "The CP has progressed, and he now needs more assistance to ambulate." 2. "As your child grows, different muscle groups may need more assistance." 3. "Most children with CP need braces to help with ambulation." 4. "We have found that when children with CP use braces, they are less likely to fall."

2 (1. CP is a nonprogressive disorder. 2. CP can manifest in different ways as the child grows. It does not progress, but its clinical manifestations may change. 3. Children with CP have different abilities and needs. CP can result in mild to severe motor defi cits; therefore, one treatment regimen cannot be used or recommended for all children. 4. Although braces may assist some children with ambulation, they will not be useful in all cases.)

23. The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarifi cation is needed when the mother says: 1. "My child will likely have another seizure." 2. "My child ' s 7-year-old brother is also at high risk for a febrile seizure." 3. "I ' ll give my child acetaminophen (Tylenol) when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2 (1. Children who experience a febrile seizure are likely to experience another febrile seizure. 2. Most children over the age of 5 years do not have febrile seizures. 3. Antipyretics are administered to prevent the child ' s temperature from rising too rapidly. 4. Most children are not prescribed anticonvulsant medication after experiencing a febrile seizure.)

13. Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. Maintain isolation precautions until 24 hours after receiving intravenous antibiotics. 2. Intravenous fl uids at 1½ times regular maintenance. 3. Neurological checks every hour. 4. Administer acetaminophen (Tylenol) for temperatures higher than 38°C (100.4°F).

2 (1. Isolation precautions must be maintained for at least the fi rst 24 hours of intravenous antibiotic therapy. 2. Intravenous fl uids at 1½ times regular maintenance could cause fl uid overload and lead to increased ICP. 3. Neurological checks are usually made at least every hour. 4. Acetaminophen (Tylenol) is usually administered when the child has a fever, as increased temperature can lead to increased ICP.)

22. Which medication should the nurse anticipate administering fi rst to a child in status epilepticus? 1. Establish an intravenous line and administer intravenous lorazepam (Ativan). 2. Administer rectal diazepam (Valium). 3. Administer an oral glucose gel to the side of the child ' s mouth. 4. Administer oral diazepam (Valium).

2 (1. It is very diffi cult and time consuming to establish an intravenous line in a child who is experiencing a generalized seizure. Rectal diazepam (Valium) is fi rst administered in an attempt to stop the seizure long enough to establish a line, and then medication is administered intravenously. 2. Rectal diazepam (Valium) is fi rst administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered. 3. Although the child may become hypoglycemic due to increased metabolic demands, stopping the seizure with rectal diazepam (Valium) is the fi rst priority. Medication is not placed in the mouth of a child experiencing a generalized seizure because it increases the risk of injury and aspiration. 4. Stopping the seizure with rectal diazepam (Valium) takes priority. Nothing should be administered orally to a patient who is unconscious.)

35. An infant is born with a sac protruding through the spine, containing cerebrospinal fl uid (CSF), a portion of the meninges, and nerve roots. This condition is referred to as: 1. Meningocele. 2. Myelomeningocele. 3. Spina bifi da occulta. 4. Anencephaly.

2 (1. Meningocele is a sac that contains a portion of the meninges and cerebrospinal fl uid. 2. A myelomeningocele is a sac that contains a portion of the meninges, the CSF, and the nerve roots. 3. Spina bifi da occulta is the mildest form of spina bifi da in which one or more vertebrae are malformed. The child usually has no symptoms, and in most cases, no one knows there is a spinal defect. 4. Anencephaly is a neural tube defect in which the bones of the skull and head do not form correctly. Infants are missing large parts of their brain and skull.)

2. The nurse is caring for a 3-year-old with an altered state of consciousness. The nurse determines that the child is oriented by asking the child to: 1. Name the president of the United States. 2. Identify her parents and state her own name. 3. State her full name and phone number. 4. Identify the current month but not the date.

2 (1. Most 3-year-olds are not capable of naming the president. 2. Asking the 3-year-old to identify her parents and state her name is a developmentally appropriate way to assess orientation. 3. Many 3-year-olds are not familiar with their phone number or may not be able to share this information during a stressful time, such as hospitalization. 4. Many 3-year-olds do not know the current month.)

54. The parent of an infant diagnosed with a neuroblastoma asks the nurse what the prognosis is. The nurse ' s best response is: 1. Excellent, because a neuroblastoma is always cured. 2. Excellent, because infants with a neuroblastoma have the best prognosis. 3. Poor, because infants with a neuroblastoma rarely survive. 4. Variable, depending on the site of origin.

2 (1. Neuroblastoma is not always cured and can be fatal depending on the stage at diagnosis, site of origin, and the age of the child. 2. Infants younger than 1 year have the best prognosis. 3. Infants younger than 1 year have the best prognosis. 4. Although the prognosis varies with the site of origin, infants have the most favorable outcome.)

26. Which is the best action for the nurse to take during a child ' s seizure? 1. Administer the child ' s rescue dose of oral diazepam (Valium). 2. Loosen the child ' s clothing, and call for help. 3. Place a tongue blade in the child ' s mouth to prevent aspiration. 4. Carry the child to the infi rmary to call 911 and start an intravenous line.

2 (1. Nothing should be placed in the child ' s mouth because he is at risk for aspiration. Rescue Valium is usually administered rectally. 2. The nurse should remain with the child and observe the seizure. The child should be protected from his environment, and clothing should be loosened. 3. A tongue blade should never be placed in the child ' s mouth because it can cause injury or increase the risk of aspiration. 4. The nurse should remain with the child and call for help. A child can be injured if carried during a seizure.)

3. The parents of a child with altered consciousness ask if they can stay during the morning assessment. Select the nurse ' s best response. 1. "Your child is more likely to answer questions and cooperate with any procedures if you are not present." 2. "Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside." 3. "It is our policy to ask parents to leave during the fi rst assessment of the shift." 4. "Many children fear that their parents will be disappointed if they do not do well with procedures, so we recommend that no parents be present at this time."

2 (1. School-age children feel more comfortable when parents are present and are more likely to cooperate with a neurological assessment. 2. Parents should be encouraged to remain with their child for mutual comfort. 3. Describing a policy is not suffi cient and does not give the parents enough information. 4. School-age children feel more comfortable when parents are present and are more likely to cooperate with a neurological assessment.)

25. Which activity should an adolescent just diagnosed with epilepsy avoid? 1. Swimming, even with a friend. 2. Being in a car at night. 3. Participating in any strenuous activities. 4. Returning to school right away.

2 (1. Swimming does not need to be avoided as long as there is someone else present to call for help in the event of an emergency. 2. The rhythmic refl ection of other car lights can trigger a seizure in some children. 3. There is no reason to avoid strenuous activity. 4. It is important for adolescents to be with their peers in order to reach developmental milestones.)

9. The nurse is aware that cloudy cerebrospinal fl uid (CSF) most likely indicates: 1. Viral meningitis. 2. Bacterial meningitis. 3. No infection, because CSF is usually cloudy. 4. Sepsis.

2 (1. The CSF in viral meningitis is usually clear. 2. The CSF in bacterial meningitis is usually cloudy. 3. The CSF in healthy children is usually clear. 4. Sepsis is an infection of the bloodstream.)

60. A child involved in a motor vehicle accident (MVA) is currently on a backboard with a cervical collar in place. The child is diagnosed with a cervical fracture. Which would the nurse expect to fi nd in the child ' s plan of care? 1. Remove the cervical collar, keep the backboard in place, and administer highdose methylprednisolone (Medrol). 2. Continue with all forms of spinal stabilization and administer high-dose methylprednisolone (Medrol) and ranitidine (Zantac). 3. Remove the backboard and cervical collar and prepare for halo traction placement. 4. Remove the cervical collar and backboard, place the child on spinal precautions, and administer high-dose methylprednisolone (Medrol) and ranitidine (Zantac).

2 (1. The cervical collar should not be removed. In addition to the methylprednisolone (Medrol), ranitidine (Zantac) should be administered to prevent gastric ulcer formation. 2. All forms of spinal stabilization should be continued while methylprednisolone (Medrol) and ranitidine (Zantac) are administered. 3. The backboard and cervical collar should not be removed until after the halo traction has been applied. 4. The cervical collar should not be removed.)

58. A child has been diagnosed with a midline brain tumor. In addition to showing signs of increased intracranial pressure (ICP), she has been voiding large amounts of very dilute urine. Which medication does the nurse expect to administer? 1. Mannitol (Osmitrol). 2. Vasopressin. 3. Furosemide (Lasix). 4. Dopamine (Intropin).

2 (1. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Mannitol (Osmitrol) is an osmotic diuretic that will not treat diabetes insipidus. 2. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Vasopressin is a hormone that is used to help the body retain water. 3. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Furosemide (Lasix) is a diuretic that will not treat diabetes insipidus. 4. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Dopamine (Intropin) is a beta-adrenergic agonist that is not used to treat diabetes insipidus..)

46. Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)? 1. A 1-month-old who demonstrates the startle refl ex when a loud noise is heard. 2. A 6-month-old who always reaches for toys with the right hand. 3. A 14-month-old who has not begun to walk. 4. A 2-year-old who has not yet achieved bladder control during waking hours.

2 (1. The startle refl ex is expected in an infant 1-month-old. 2. The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP. 3. Although many children walk before the age of 14 months, it is not considered a motor delay not to have achieved this milestone at this point. 4. Many 2-year-olds have not achieved bladder control)

45. Which child is at increased risk for cerebral palsy (CP)? 1. An infant born at 34 weeks with an Apgar score of 6 at 5 minutes. 2. A 17-day-old infant with group B Streptococcus meningitis. 3. A 24-month-old child who has experienced a febrile seizure. 4. A 5-year-old with a closed-head injury after falling off a bike.

2 (1. There is an increased incidence of CP when the infant has an Apgar score of 3 or less at 5 minutes. 2. Any infection of the central nervous system increases the infant ' s risk of CP. 3. A febrile seizure does not increase the risk of CP. 4. Although head trauma can increase the risk of CP, the school-age child is not likely to develop CP from falling off a bike.)

6. Which of the following would be included in the plan of care for a hospitalized newborn following surgical repair of a myelomeningocele? Select all that apply. 1. Skull x-rays. 2. Daily head circumference measurements. 3. MRI scan. 4. Vital signs every 6 hours. 5. Holding to breastfeed

2, 3. (1. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography. These tests give much more needed information than do skull x-rays. 2. Daily head circumference measurements are done to assess for hydrocephalus. 3. Diagnostic tests include MRI scan, CT scan, ultrasound, and myelography. 4. Vital signs should be taken at least every 4 hours. 5. Infants with repaired myelomeningocele are kept prone to prevent pressure on the surgical site.)

38. A parent of a newborn diagnosed with myelomeningocele asks what is/are common long-term complication(s)? The nurse ' s best response is which of the following? Select all that apply. 1. Learning disabilities. 2. Urinary tract infections. 3. Hydrocephalus. 4. Decubitus ulcers and skin breakdown. 5. Nutrition issues. 6. Attention defi cit disorders

2, 3. (1. Some children with myelomeningocele experience learning disabilities, but it is not the most common complication. 2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection. 3. About 90% to 95% of children with myelomeningocele experience hydrocephalus. 4. Children with myelomeningocele are at risk for skin breakdown and decubitus ulcers, but they are not the most common complications. 5. Nutrition issues can occur, but are not the most common complication. 6. Attention defi cit disorders can occur, but are not the most common complications.)

1. The nurse is caring for a child who has been in a motor vehicle accident (MVA). The child falls asleep unless her name is called or she is gently shaken. This state of consciousness is referred to as: 1. Coma. 2. Delirium. 3. Obtunded. 4. Confusion.

3 (1. "Coma" describes a state of consciousness in which the child is not responsive to any stimulation, including painful stimulation. 2. "Delirium" describes a state of consciousness in which the child is extremely confused and anxious. 3. "Obtunded" describes a state of consciousness in which the child has a limited response to the environment and can be aroused by verbal or tactile stimulation. 4. "Confusion" describes a state of consciousness in which the child is not oriented to person, place, and time.)

17. To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? 1. Furosemide (Lasix). 2. Insulin. 3. Glucose. 4. Morphine.

3 (1. A common manifestation is increased ICP, which is treated with an osmotic diuretic. Furosemide (Lasix) is a loop diuretic. 2. A common manifestation is hypoglycemia. Insulin does not treat hypoglycemia, but decreases the blood sugar instead. 3. A common manifestation is hypoglycemia, which is treated with the administration of intravenous glucose. 4. Morphine is a narcotic used for pain relief. It should be used with caution because it can lead to respiratory depression.)

56. The parent of a child with neuroblastoma asks the nurse what the typical signs and symptoms are at fi rst. Select the nurse ' s best answer. 1. "Most children complain of abdominal fullness and diffi culty urinating." 2. "Many children in the early stages of a neuroblastoma have joint pain and walk with a limp." 3. "The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue." 4. "The signs and symptoms are fairly consistent regardless of the location of the tumor. They include fatigue, hunger, weight gain, and abdominal fullness."

3 (1. Although abdominal fullness is often seen, diffi culty urinating is not a common symptom. 2. Bone manifestations are a sign of bone metastasis, which is not seen in the early stages of neuroblastoma. 3. The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue. 4. The signs and symptoms vary according to the location of the tumor. Generally, hunger and weight gain are not seen.)

14. The nurse is caring for a 1-year-old who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted to the hospital. Select the nurse ' s best response. 1. "Your child will likely be sent home because encephalitis is usually caused by a virus and not bacteria." 2. "Your child will likely be admitted to the pediatric fl oor for intravenous antibiotics and observation." 3. "Your child will likely be admitted to the PICU for close monitoring and observation." 4. "Your child will likely be sent home because she is only 1 year old. We see fewer complications and a shorter disease process in the younger child."

3 (1. Although encephalitis is usually caused by a viral infection, the child is usually admitted for close observation. 2. Intravenous antibiotics are not given to the child with viral encephalitis. 3. The young child with encephalitis should be admitted to a PICU where close observation and monitoring are available. The child should be observed for signs of increased ICP and for cardiac and respiratory compromise. 4. The child would not be discharged because observation for complications is necessary. As a general rule, younger children tend to have more complications and require a PICU admission.)

49. The nurse prepares baclofen for a child with cerebral palsy (CP) who just had her hamstrings surgically released. The child ' s parents ask what the medication is for. Select the nurse ' s best response. 1. "It is a medication that will help decrease the pain from her surgery." 2. "It is a medication that will prevent her from having seizures." 3. "It is a medication that will help control her spasms." 4. "It is a medication that will help with bladder control."

3 (1. Baclofen is not given for postoperative pain control. 2. Baclofen is not given for seizures. 3. Baclofen is given to help control the spasms associated with CP. 4. Baclofen is not given for bladder control.)

47. The parents of a child with meningitis and multiple seizures ask if the child will likely develop cerebral palsy (CP). Select the nurse ' s best response. 1. "When your child is stable, she ' ll undergo computed tomography (CT) and magnetic resolution imaging (MRI). The physicians will be able to let you know if she has CP." 2. "Most children do not develop CP at this late age." 3. "Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis." 4. "Most children who have had complications following meningitis develop some amount of CP."

3 (1. CP is diagnosed based on clinical characteristics and developmental fi ndings. It is not diagnosed with any type of radiological examination. 2. Although most cases of CP occur in the neonatal period, some children can develop CP at a later age. 3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made. 4. Although many children develop CP after having complications of meningitis, many do not. Although the parents should not be given false hope, they should not be led to lose hope for a complete recovery.)

41. Which does the nurse include in the postoperative plan of care for a child with myelomeningocele following ligament release? 1. Encourage the child to resume a regular diet, beginning slowly with bland foods that are easily digested, such as bananas. 2. Encourage the child to blow balloons to increase deep breathing and avoid postoperative pneumonia. 3. Assist the child to change positions to avoid skin breakdown. 4. Provide education on dietary requirements to prevent obesity and skin breakdown.

3 (1. Children with myelomeningocele are prone to latex allergies and therefore should not eat bananas. 2. Children with myelomeningocele are prone to latex allergies and therefore should not be exposed to balloons. 3. Preventing skin breakdown is important in the child with myelomeningocele because pressure points are not felt easily. 4. It is always important to provide education on dietary needs, but it is not the priority in the immediate postoperative period.)

16. A child with Reye syndrome is described in the nurse ' s notes as follows: 1200— comatose with sluggish pupils; when stimulated, demonstrates decerebrate posturing. 1400—unchanged except that now demonstrates decorticate posturing when stimulated. The nurse concludes that the child ' s condition is: 1. Worsening and progressing to a more advanced stage of Reye syndrome. 2. Worsening, and the child may likely experience cardiac and respiratory failure. 3. Improving and progressing to a less advanced stage of Reye syndrome. 4. Improving because the child ' s posturing refl exes are similar.

3 (1. Decorticate posturing is seen with a less advanced stage of Reye syndrome and likely indicates that the child ' s condition is improving. 2. The child ' s condition is improving; therefore, cardiac and respiratory failure is less likely. 3. Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child ' s condition. 4. Decorticate posturing is associated with infl ammation above the brain stem, whereas decerebrate posturing is associated with infl ammation in the brain stem.)

30. A child in the PICU with a head injury is comatose and unresponsive. The parent asks if he needs pain medication. Select the nurse ' s best response. 1. "Pain medication is not necessary because he is unresponsive and cannot feel pain." 2. "Pain medication may interfere with his ability to respond and may mask any signs of improvement." 3. "Pain medication is necessary to make him comfortable." 4. "Pain medication is necessary for comfort, but we use it cautiously because it increases the demand for oxygen."

3 (1. Even if the child is unresponsive, the child can still feel pain. 2. If pain medication is administered cautiously, the child can still be monitored and signs of improvement will be evident. 3. Pain medication promotes comfort and ultimately decreases ICP. 4. Pain medication decreases the demand for oxygen)

15. The nurse knows further education is needed about Reye syndrome when a mother states: 1. "I will have my children immunized against varicella and infl uenza." 2. "I will make sure not to give my child any products containing aspirin." 3. "I will give aspirin to my child to treat a headache." 4. "Children with Reye syndrome are admitted to the hospital."

3 (1. Having a child immunized helps prevent viral illnesses from occurring, thereby decreasing the likelihood of Reye syndrome. 2. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. 3. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. A headache can be the fi rst sign of a viral illness followed by other symptoms. It is best not to use aspirin or aspirincontaining products in children. 4. Children with Reye syndrome are always admitted to the hospital because there is a strong possibility for complications and rapid deterioration.)

28. A child fell off his bike and sustained a closed-head injury. The child is currently awake and alert, but his mother states that he "passed out" for approximately 2 minutes. The mother appears highly anxious and is very tearful. The child was not wearing a helmet. Which is a priority for the triage nurse to say at this time? 1. "Was anyone else injured in the accident?" 2. "Tell me more about the accident." 3. "Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?" 4. "Why was he not wearing a helmet?"

3 (1. It is not a priority of care to fi nd out if anyone else was injured. 2. Although open-ended questions are important, the nurse needs specifi c information, and the anxious parent may need to be guided during triage assessment. 3. Asking specifi c questions will give the nurse the information needed to determine the level of care for the child. 4. Although it is important to provide safety education, this information should be given in a nonjudgmental manner at a point when the parent and child are less stressed.)

59. The nurse is caring for a child receiving radiation therapy for a brain tumor. The parents ask if their child will likely have any learning disabilities. Select the nurse ' s best answer. 1. "All children who receive radiation have some amount of learning disability. As long as they receive extra tutoring, they usually do well in school." 2. "Because your child is so young, she will likely do well and have no problems in the future." 3. "Response varies with each child, but younger children who receive radiation tend to have some amount of learning disability later in life." 4. "Response varies with each child, but younger children who receive radiation tend to have fewer problems later in life than older children."

3 (1. Not all children who receive radiation experience learning disabilities. 2. Younger children tend to experience more learning diffi culties than do older children. 3. Although variable, younger children tend to experience more learning diffi culties than do older children. 4. Although variable, younger children tend to experience more learning diffi culties than do older children.)

12. Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with a roommate who also has bacterial meningitis. 2. Semiprivate room with a roommate who has bacterial meningitis but has received intravenous antibiotics for more than 24 hours. 3. Private room that is dark and quiet with minimal stimulation. 4. Private room that is bright and colorful and has developmentally appropriate activities available.

3 (1. The child with bacterial meningitis should be placed in a private room isolated from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other. 2. The child with bacterial meningitis should be placed in a private room isolated from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other. 3. A quiet private room with minimal stimulation is ideal because the child with meningitis should be in a quiet environment to avoid cerebral irritation. 4. A bright room with developmental activities may cause irritation and increase ICP.)

48. The nurse is caring for a 2-month-old infant who is at risk for cerebral palsy (CP) due to extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the nurse ' s best response. 1. "Your baby is likely to have speech problems because of his early birth. Involving the speech therapist now will ensure vocalization at a developmentally appropriate age." 2. "The speech therapist will help with tongue and jaw movements to assist with babbling." 3. "The speech therapist will help with tongue and jaw movements to assist with feeding." 4. "Many members of the health-care team are involved in your child ' s care so that we will know if there are any unmet needs."

3 (1. The nurse cannot assume that the child will have speech diffi culties. Speech therapy does not guarantee vocalization at a developmentally appropriate age. 2. Although speech therapy will assist with babbling at a later age, its primary purpose is to assist with feeding. 3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements. 4. Members of a multidisciplinary team become involved in a child ' s care based on specifi c needs, not hospital routine.)

5. Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual

3, 5. (1. The anterior fontanel is usually raised and bulging in infants with increased ICP. 2. The infant is not able to comprehend blurred vision or make any statements. 3. A high-pitched cry is often indicative of increased ICP in infants. 4. The infant with increased ICP usually has a poor appetite and does not feed well. 5. The infant may be sleeping more than usual because of increased ICP.)

43. A 6-month-old male has been diagnosed with positional brachycephaly. The nurse is providing teaching about the use of a helmet for his therapy. Which statement indicates that the parents understand the education? Select all that apply. 1. "We will keep the helmet on him when he is awake and remove it only for bathing and sleeping." 2. "He will start wearing the helmet when he is closer to 9 months because he will be more upright and mobile." 3. "He will wear the helmet 23 hours every day." 4. "Most children need to wear the helmet for 6 to 12 months." 5. "Most children gain some improvement."

3, 5. (1. The infant needs to wear the helmet 23 hours daily. It is removed for bathing but not sleeping. 2. The helmet is most effective when the child is younger because the bones in the skull are more malleable. The child is less likely to need the helmet when upright and mobile because there is less pressure in one area. 3. The helmet is worn 23 hours every day and removed only for bathing. 4. Most children wear the helmet for 3 months. 5. Most children gain some improvement from a helmet.)

10. A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do fi rst: 1. Administration of intravenous antibiotics. 2. Administration of maintenance intravenous fl uids. 3. Placement of a Foley catheter. 4. Send the spinal fl uid and blood samples to the laboratory for cultures.

4 (1. Administration of intravenous antibiotics should not be started until after all cultures have been obtained. 2. Administration of maintenance IV fl uids can wait until after the cultures have been obtained. 3. Placement of a Foley catheter is not a priority procedure. 4. Cultures of spinal fl uid and blood should be obtained, followed by administration of intravenous antibiotics.)

32. The nurse is caring for an adolescent who remains unconscious 24 hours after sustaining a closed-head injury in a motor vehicle accident (MVA). She responds to deep, painful stimulation with decorticate posturing and has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable. Select the most appropriate nursing action. 1. Encourage the teen ' s peers to visit and talk to her about school and other pertinent events. 2. Encourage the teen ' s parents to hold her hand and speak loudly to her in an attempt to help her regain consciousness. 3. Attempt to keep a normal day/night pattern by keeping the teen in a bright, lively environment during the day and dark quiet environment at night. 4. Attempt to keep the environment dark and quiet and encourage minimal stimulation.

4 (1. Although peers play an important role in the adolescent ' s development, this particular patient is at risk for increased ICP and should have decreased stimulation. 2. Loud talking may cause the child ' s ICP to increase. 3. A bright, lively environment may lead to increased ICP. 4. A dark, quiet environment and minimal stimulation will decrease oxygen consumption and ICP.)

39. Which is included in the plan of care for a newborn who has a myelomeningocele? 1. Place the infant in the prone position with a sterile dry dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 2. Place the infant in the prone position with a sterile dry dressing over the defect. Begin intravenous fl uids to prevent dehydration. 3. Place the infant in the prone position with a sterile moist dressing over the defect. Slowly begin oral gastric feeds to prevent the development of necrotizing enterocolitis. 4. Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fl uids to prevent dehydration.

4 (1. Placing the child in the prone position is correct. A dry dressing may adhere to the defect, causing irritation. 2. A dry dressing may adhere to the defect, causing irritation. 3. Oral gastric feedings are not usually started unless there is going to be a delay in surgery. The defect is usually corrected within 24 hours to avoid infection. 4. The child is placed in the prone position to avoid any pressure on the defect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fl uids are begun to prevent dehydration.)

53. The nurse is caring for a child with cerebral palsy (CP) whose weight is in the fi fth percentile and who has been hospitalized for aspiration pneumonia. His parents are anxious and state that they do not want a G-tube placed. Which would be the nurse ' s best response? 1. "A G-tube will help your son gain weight and reduce his risk for future hospitalizations due to pneumonia." 2. "G-tubes are very easy to care for and will make feeding time easier for your family." 3. "Are you concerned that you will not be able to care for his G-tube?" 4. "Tell me your thoughts about G-tubes."

4 (1. Sharing information may not be helpful if the family is not ready to listen. 2. Sharing information may not be helpful if the family is not ready to listen. 3. The family may have other concerns that would be communicated through an openended question. 4. An open-ended question will encourage family members to share what they know and potentially clear up any misconceptions.)

4. The mother of an unconscious child has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is fl exing her arms and wrists while bringing her arms closer to the midline of her body. The child ' s mother asks, "What is going on?" Select the nurse ' s best response. 1. "I think your daughter hears you, and she is attempting to reach out to you." 2. "Your child is responding to you; please continue trying to stimulate her." 3. "It appears that your child is having a seizure." 4. "Your child is demonstrating a refl ex that indicates she is overwhelmed with the stimulation she is receiving."

4 (1. The child is demonstrating a refl ex called posturing. The parent should not be given any false hope that the child is responding at a higher level than is truly occurring. 2. The posturing refl ex often indicates irritability, and the child should not continue to receive stimulation. 3. Posturing is a refl ex, not a seizure. 4. Posturing is a refl ex that often indicates that the child is receiving too much stimulation.)

27. Brain damage in a child who sustained a closed-head injury can be caused by which factor? 1. Increased perfusion to the brain and increased metabolic needs of the brain. 2. Decreased perfusion to the brain and decreased metabolic needs of the brain. 3. Increased perfusion to the brain and decreased metabolic needs of the brain. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.

4 (1. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 2. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 3. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 4. Decreased perfusion of the brain and increased metabolic needs of the brain.)

40. The parents of a 12-month-old with a neurogenic bladder ask the nurse if their child will always have to be catheterized. Select the nurse ' s best response. 1. "Your child will never feel when her bladder is full, so she will always have to be catheterized. Because she is female, she will always need assistance." 2. "As your child ages, she will likely be able to sense when her bladder is full and will be able to empty it on her own." 3. "Although your child will not be able to feel when her bladder is full, she can learn to urinate every 4 to 6 hours and therefore not require catheterizations." 4. "Your child will never be able to completely empty her bladder spontaneously, but there are other options to traditional catheterization. An opening can be made surgically through the abdomen, allowing a catheter to be placed into the opening."

4 (1. The child with a neurogenic bladder will never be able to spontaneously empty it completely. Most children learn to selfcatheterize at a young age. 2. The child with a neurogenic bladder will never be able to spontaneously empty it completely. 3. Placing the child with a neurogenic bladder on a bladder training program is not helpful, because the child will never be able to spontaneously empty it completely. 4. A vesicostomy is an example of an option for children with myelomeningocele in which alternatives to traditional catheterizations are created.)

7. A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse ' s best response. 1. "Give her some acetaminophen (Tylenol), and see if her symptoms improve. If they do not improve, bring her to the health-care provider ' s offi ce." 2. "It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves." 3. "You are probably worried that she is having a problem with her shunt. This is very unlikely because it has been working well for 9 years." 4. "You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

4 (1. These are symptoms of a shunt malfunction and should be evaluated immediately. 2. Although these symptoms may be associated with the start of a girl ' s menstrual cycle, they are symptoms of a shunt malfunction and require immediate evaluation. 3. A shunt can malfunction at any point and should be evaluated when signs of increased ICP are evident. 4. These are symptoms of a shunt malfunction and should be evaluated immediately.)