Chapter 38: Nursing Care of the Child With an Alteration in Intracranial Regulation/Neurologic Disorder

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

"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 newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate? "During delivery, your vaginal wall put pressure on the baby's head." "It's normal for this to happen, but they don't really know why." "The forceps used during delivery caused this to happen." "Your baby's head became blocked inside your vagina while you were pushing."

"During delivery, your vaginal wall put pressure on the baby's head." 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 helps position a child for a lumbar puncture. Which statement describes the correct positioning for this procedure? "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." "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 held by the mother on her lap with his back toward the health care provider." SUBMIT ANSWER

"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." Correct positioning for a lumbar puncture is to place the child on his or her side with the 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 parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond? "Meningococcal conjugate vaccine covers only two types of bacterial meningitis." "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received." "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine." SUBMIT ANSWER

"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. Meningococcal conjugate vaccine protects against four types of meningitis. There is nothing in the scenario to lead the nurse to believe that a different strain of bacteria caused the infection, or that the adolescent's immune system is compromised.

The nurse is educating a child and his family about what to expect during the child's electroencephalogram (EEG) exam. Which statement by a parent suggests a need for further education? "I will make sure my child goes to bed early the night before the exam." "If my child can't stay still during the procedure, they may have to give him medication to help him be still." "The procedure will determine the electrical patterns of his brain." "The room will be dark during the procedure."

"I will make sure my child goes to bed early the night before the exam." During an EEG, the client needs to be cooperative and quiet. Typically, parents are asked to keep their child up later the night before so that the child will fall asleep during the procedure. The room is also darkened to help them rest. If the child is unable to remain still, sedation may be used. The EEG reflects the electrical patterns of the brain.

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." Irritability in an infant can be a sign of declining neurological function. Because infants are not able to answer questions pertaining to person, place and time, their neurological assessment must be catered to their level of development. The other responses would be typical and normal for an infant.

The parent of a 12-year-old child with Reye syndrome approaches the nurse wanting to know how this happened to the child, saying, "I never give my children aspirin!" What could the nurse say to begin educating the parent? "Sometimes it is hard to tell what products may contain aspirin." "Do not worry; you are in good hands. We have it under control now." "Aspirin in combination with the virus will make the brain swell and the liver fail." "Do you think that maybe your child took aspirin on his or her own?"

"Sometimes it is hard to tell what products may contain aspirin." Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. Two common medications containing salicylates are bismuth subsalicylate and effervescent heartburn relief antiacid. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. The nurse should not state the obvious, but also should not minimize the situation. Encouraging the parent to ask for information and offering explanations in terms the parent will understand are important, but this response does not address the parent's assertion. Telling the parent not to worry is offering platitudes and false reassurance. Giving the description of what complications could happen with the disease would be inappropriate. This would only exacerbate the parent's concern, and it does not address how the child ingested salicylates.

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

"The surgery was successful. Do you have any questions?" Often what parents need most is someone to listen to their concerns. Although this is a good time for education, the parents are more concerned about the success of the surgery than their infant's appearance. Watching the hemoglobin, hematocrit and swelling are important nursing functions but they do not address the parents' psychosocial needs. The parents do not need to be taught statistics about their infant's condition. They more than likely know this from health care provider visits, the Internet, and parent support groups. Following surgery, this knowledge is not what parents are concerned about. Parents want to know their infant is safe and well.

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

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

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. 9-year-old child who was diagnosed with diabetes when he was 7 years old 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti 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 8-year-old child who is in good health 12-year-old child with asthma

9-year-old child who was diagnosed with diabetes when he was 7 years old 5-year-old child who routinely travels in the summer with her parents on mission trips to Haiti 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 The following people have an increased risk of becoming infected with meningococcal meningitis: college freshman living in dormitories, children 11 years old or older, children who travel to high risk areas, and children with chronic health conditions.

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

Assess the client's respiratory status. 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 a patent airway.

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the child's ear. This would be documented as: Battle sign. rhinorrhea. otorrhea. raccoon eyes.

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.

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

Cloudy appearance 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? Admission to the nursing unit Initiation of IV therapy Identification of the causative organism Collection of cerebrospinal fluid (CSF) and blood for culture

Collection of cerebrospinal fluid (CSF) and blood for culture 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 IV therapy aren't, by themselves, appropriate times to begin antibiotic therapy.

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? Encourage the parents to hold the child Monitor temperature every 4 hours Take vital signs every 4 hours Decrease environmental stimulation

Decrease environmental stimulation 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 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? Administer dexamethasone, dosage determined by the pharmacist. Initiate an IV of 0.9% NS to run at 250 ml/hr. 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. Rapid administration of IV fluids may increase ICP. An IV rate of 250 ml/hr of normal saline 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.

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

Institute droplet precautions in addition to standard precautions. 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 once the initial infection has been controlled. Palpating the fontanels (fontanelles) is used to assess for hydrocephalus.

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

Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention 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.

The nurse is performing a neurological assessment on a child. The previous examination noted the child to be alert but answering questions inappropriately. In this exam, the child only responds to vigorous stimuli. Which action should the nurse take first? Document the findings on the hourly assessment tool. Have another nurse verify the results. Notify the health care provider. Reassess in 1 hour.

Notify the health care provider. The level of consciousness is the earliest indicator of improvement or deterioration of the neurological status. Consciousness includes alertness, the ability to respond to stimuli, and cognition. If the child is alert but responding to questions inappropriately, then the child is said to be in a confused state. When the child only responds to vigorous stimuli, then the child is in a state of stupor. The change indicates a worsening state of consciousness. The health care provider should be notified of the change. The nurse can have a second nurse assess the child, but this does not get the child much needed help or intervention. The nurse would certainly document the findings, but only after calling the health care provider. The nurse should be alert to the changes and not wait to reassess.

During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take? Document that the infant has microcephaly. Reassess the head circumference in 24 hours. Report the findings to the pediatric health care provider. Tell the parent the infant's brain is underdeveloped.

Report the findings to the pediatric health care provider. These findings are consistent with craniosynostosis, or premature fusion of the cranial sutures. Intervention is needed to prevent damage to the growing brain. Waiting 24 hours to reassess will delay treatment. In microcephaly, the head circumference is small, but the fontanels (fontanelles) and suture line are palpable.

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

Signs of increased intracranial pressure (ICP) 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.

The nurse is providing education to the parents of a female toddler with hydrocephalus who has just had a shunt placed. Which statement is the best to make during a teaching session? Her autoregulation mechanism to absorb spinal fluid has failed. Call the doctor if she gets a persistent headache. Tell me your concerns about your child's shunt. Always keep her head raised 30º.

Tell me your concerns about your child's shunt. 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.

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? change in level of consciousness decline in respiratory rate increase in heart rate reduction in heart rate

change in level of consciousness 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 using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply. posture eye opening verbal response motor response fontanels (fontanelles)

eye opening verbal response motor response The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response.

Which of these age groups has the highest actual rate of death from drowning? toddlers school-aged children preschool children infants

toddlers Toddlers and older adolescents have the highest actual rate of death from drowning.

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? cerebral angiography computed tomography lumbar puncture video electroencephalogram

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.

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? "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder." "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." "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." SUBMIT ANSWER

"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.

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

A private room near the nurses' station A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until he or she has received IV 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 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 as a risk factor for hemorrhagic stroke? congenital heart defect sickle cell disease meningitis 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.

The nurse assesses a child and finds that the child's pupils are pinpoint. What does this finding indicate? seizure activity brain stem dysfunction intracranial mass brain stem herniation

brain stem dysfunction Pinpoint pupils are commonly observed in poisonings, brain stem dysfunction, and opiate use. Dilated but reactive pupils are seen after seizures. Fixed and dilated pupils are associated with brain stem herniation. A single dilated but reactive pupil is associated with an intracranial mass.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger? drinking three cans of diet cola 11 p.m. bedtime; 6:30 a.m. wake-up use of nonaccented soap swimming twice a week

drinking three cans of diet cola 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.

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 hate to think that I will need to be worried about my child having seizures for the rest of his life." "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 my child having seizures for the rest of his life." 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.

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. Assess child's skin for the development of distinctive rash every 4 hours. Request order for anticonvulsant. Request order for an antiemetic. Assess intake and output every shift. 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. This child likely has Reye syndrome and may require an antiemetic 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 to an increased intracranial pressure that may induce seizures. A distinctive rash is associated with the development of meningococcal meningitis. The nurse should monitor the laboratory values of the child with Reye syndrome for indications that the liver is not functioning well.

The nurse is caring for a child with a suspected head injury. The nurse observes for what response to the child's eye reflex examination that would indicate potential increased intracranial pressure (ICP)? While turning the child's head to the left, the eyes turn to the right. While stimulating the child's foot, the big toe points upward and other toes fan outward. While calling the child's name, the child stares straight ahead and does not turn to the sound. While assessing the child's pupils, there is no change in diameter in response to a light.

While assessing the child's pupils, there is no change in diameter in response to a light. To perform the child's eye reflex examination, the nurse will shine a penlight into the eyes and observe if the pupils constrict, which is a normal response. Lack of pupillary light reflex can indicate increased intracranial pressure (ICP). To perform the "doll's eye" reflex examination, the nurse will place the child in a supine position and move the head gently but rapidly to one side. During this movement, it is normal for the child's eye to move to the opposite side. If the child has increased ICP, this response will be absent. While the other options are potential signs of increased ICP, they do not demonstrate the child's eye reflex examination.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem? intracranial hemorrhaging head trauma congenital hydrocephalus positional plagiocephaly

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.

The nurse caring for an infant with craniosynostosis, specifically positional plagiocephaly, should prioritize which activity? moving the infant's head every 2 hours giving the infant small feedings whenever he is fussy measuring the intake and output every shift massaging the scalp gently every 4 hours

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 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. tongue blade padding for side rails smelling salts oxygen gauge and tubing suction at bedside

padding for side rails oxygen gauge and tubing suction at bedside 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.

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 prone in the crib after feeding the infant placing the infant in an infant car seat after feeding the infant placing the infant in a Sims position in the crib after feeding the infant placing the infant supine in the crib after feeding the infant

placing the infant in an infant car seat after feeding the infant Placing a child or infant in the semi-Fowler position can help reduce cerebral edema and pressure. Using an infant child seat helps to simulate the raised head of the bed. In the supine position, the client is completely flat on his or her spine. Prone is face down and flat. Sims is a side-lying position with one leg flexed. All of the described positions place the client flat, not with the head raised; that would be in the semi-Fowler position.

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? difficulty concentrating vomiting bleeding from the ear trouble focusing when reading

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 nurse cares for a 7-year-old child with new-onset seizure disorder. Which prescription will the nurse anticipate for this client? frequent temperature assessment ketogenic diet use of anticonvulsant medications vagus nerve stimulation

use of anticonvulsant medications 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.