CHapter 27: The Child with Cerebral Dysfunction (wongs Pediatrics)

The nurse recognizes that which of the following should be included in the postoperative care of a patient with a shunt? a. positioning the patient in a head-up position b. continuous pumping of the shunt to assess function c. monitor for abdominal or peritoneal distention d. positioning the child on the side of the operative site to facilitate drainage

c

18. A child diagnosed with meningitis is having a generalized tonic-clonic seizure. Which should the nurse do first? 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

A nurse is caring for a child who has ICP. Which of the following actions should the nurse take? SATA A. Suction the endotracheal tube every 2 hours B. Maintain a quiet environment C. Use two pillows to elevate the head D. Administer a stool softener E. Maintain body alignment

B,C,E

You are caring for a child with hydrocephalus who is postoperative from a shunt revision. Which assessment finding is your priority for increased intercranial pressure? A. Nausea and refusal to eat postoperatively B. Complaint of a headache C. Irritability and wanting to sleep D. Decrease in heart rate over the last hour

D

You are the nurse assigned to care for a child with a basilar skull fracture. Your most important nursing observation is change in level of consciousness. You will be highly alert for: A. Alterations in vital signs that often appear before alterations in consciousness or focal neurologic signs B. Bleeding from the ear, which is indicative of an anterior basal skull fracture C. Seizures that are relatively uncommon in children at the time of head injury D. Changes in posturing, such as any signs of extension or flexion posturing, unusual response to stimuli, and random versus purposeful movement

D

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

9. 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

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

The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? SATA 1. time the seizure 2. restrain the child 3. stay with the child 4. place the child in a prone position 5. move furniture away from the child 6. insert a padded tongue blade in the child's mouth

1,3,5

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

2

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

2

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

22. Which medication should the nurse anticipate administering first 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

23. The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure. The nurse knows clarification 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

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 infirmary to call 911 and start an intravenous line.

2

8. Which position initially is most beneficial 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

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period? 1. test the urine for protein 2. reposition the infant frequently 3. provide a stimulating environment 4. assess blood pressure every 15 minutes

2. In an infant with hydrocephalus, the head grows at an abnormal rate, and if the infant is not repositioned frequently, pressure ulcers can form in the back and side of the head

The nurse is reviewing the record of a child with increased ICP pressure and notes that the child has exhibited signs of decorticate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing. 1. Flaccid paralysis of all extremities 2. Adduction of the arms at the shoulders 3. Rigid extension and pronation of the arms and legs 4. Abnormal flexion of the upper extremities and extension and adduction of the lower extremities

3. Decorticate think "to the core" or pronation of the arms and legs inward

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 office." 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

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

A nurse is caring for a child who just experienced a generalized seizure. Which of the following is the priority action for the nurse to take? A. Position the child to a side-lying position B. Try to determine the seizure trigger C. reorient the child to the environment D. Note the time of the postictal period

A

The nurse creates a plan of care for a child at risk for tonic-colonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the childs bedside. 1. Emergency cart 2. Tracheotomy set 3. Padded tongue blade 4. Suctioning equipment and oxygen

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

A mother arrives at the ED with her 5-year old child and states that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and asses the child for early and late signs of increased ICP. Which is a late sign of increased ICP? 1. Nausea 2. Irritability 3. Headache 4. Bradycardia

4. Bradycardia; late signs of ICP include a significant decrease in LOC, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity

A nurse is caring for a child who just experienced a generalized seizure. Which of the following findings should the nurse expect? SATA a. Loss of consciousness b. Appearance of daydreaming c. Dropping held objects d. falling on the floor e. having a piercing cry

A,B,C

A nurse is teaching a group of caregivers about the risk factors for seizures. Which of the following factors should the nurse include in the teaching? SATA A. febrile episode B. Hypoglycemia C. sodium imbalances D. low blood lead levels E. presence of diphtheria

A,B,C

You are working with a family that brought their child into the pediatric clinic. The mother describes what may be a type of seizure. What subjective data will help you determine the type? Select all that apply. A. The presence or absence of an aura B. If the child appeared disoriented after the seizure C. Presence of vomiting after the seizure D. The duration of the seizure E. If the seizure was related to certain foods or occurred after a certain activity

A,B,D

As the nurse assigned to a child diagnosed with bacterial meningitis, you know that: A. The child will not need to be placed in isolation because antibiotics have been started B. Enteric precautions will remain in place for up to 48 hours C. Respiratory isolation will remain in place for 24 hours after antibiotics are started D. Due to headache, the child will want the head of the bed elevated with two pillows

C

ICP monitoring has been found to be useful in the pediatric critical care to: a. provide quick and effective relief of increased pressure b. evaluate children with Glascow coma scale less than 8 c. maintain PaCO2 at 25 to 30mmHg d. prevent herniation

b

Which of the following indicators is best to use to determine the depth of the comatose state? a. motor activity b. level of consciousness c. reflexes d. vital signs

b

In most children who have a febrile seizure, the factors that trigger the seizures tends to be: a. rapidity of the temperature elevation b. duration of the temperature elevation c. height of the temperature elevation d. any of the above

c

The infant with hydrocephalus has which of the following clinical manifestations? a. upward eye slanting b. strabismus c. setting sun-sign d. decreased head circumference

c

Which of the following signs is used to evaluate increased ICP in the infant but not in the older child? a. projectile vomiting b. headache c. tense or bulging fontanel d. fatigue

c