Found on quizlet CH27 The Child with Cerebral Dysfunction, CH 30 The Child with Neuromuscular or Muscular Dysfunction

What measure is important in managing hypercalcemia in a child who is immobilized? a. Provide adequate hydration. b. Change position frequently. c. Encourage a diet high in calcium. d. Provide a diet high in calories for healing.

A Vigorous hydration is indicated to prevent problems with hypercalcemia. Suggested intake for an adolescent is 3000 to 4000 ml/day of fluids. Diuretics are used to promote the removal of calcium. Changing position is important for skin and respiratory concerns. Calcium in the diet is restricted when possible. A high-protein diet served as frequent snacks with favored foods is recommended.

The health care provider has prescribed neostigmine (Prostigmin) 0.04 mg/kg/per dose SC q 4 to 6 hrs PRN for a child with myasthenia gravis. The child weighs 77 lb. The nurse is preparing to administer a dose. Calculate the dose the nurse should administer in milligrams. Record your answer below using one decimal place.

ANS: 1.4 The correct calculation is: 77 lb/2.2 kg = 35 kg Dose of Prostigmin is 0.04 mg/kg/dose 0.04 mg ´ 35 = 1.4 mg

The health care provider has prescribed oxybutynin (Ditropan) 0.2 mg/kg/day divided bid for a child with myelomeningocele. The child weighs 33 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below using one decimal place.

ANS: 1.5 The correct calculation is: 33 lb/2.2 kg = 15 kg Dose of Ditropan is 0.2 mg/kg/day divided bid 0.2 mg ´ 15 = 3 mg 3 mg/2 = 1.5 mg

The health care provider has prescribed diazepam (Valium) 0.8 mg/kg/day PO divided q 6 hours for a child with cerebral palsy. The child weighs 110 lb. The nurse is preparing to administer the 1200 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 10 The correct calculation is: 110 lb/2.2 kg = 50 kg Dose of Valium is 30 mg/kg/day divided q 6 hours 0.8 mg ´ 50 = 40 mg/day 40 mg/4 = 10 mg for one dose

The health care provider has prescribed dantrolene sodium (Dantrium) 0.5 mg/kg PO once a day for a child with cerebral palsy. The child weighs 55 lb. Calculate the dose the nurse should administer in milligrams. Record your answer below using one decimal place.

ANS: 12.5 The correct calculation is: 55 lb/2.2 kg = 25 kg Dose of Dantrium is 0.5 mg/kg given once a day 0.5 mg ´ 25 = 12.5 mg

The health care provider has prescribed valproic acid (Depakene) 30 mg/kg/day divided bid for a child with cerebral palsy having seizures. The child weighs 22 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 165 The correct calculation is: 22 lb/2.2 kg = 11 kg Dose of Depakene is 30 mg/kg/day divided bid 30 mg ´ 11 = 330 mg 330 mg/2 = 165 mg for one dose

The health care provider has prescribed carbamazepine (Tegretol) 20 mg/kg/day divided bid for a child with cerebral palsy having seizures. The child weighs 44 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 200 The correct calculation is: 44 lb/2.2 kg = 20 kg Dose of Tegretol is 20 mg/kg/day divided bid 20 mg ´ 20 = 400 mg 400 mg/2 = 200 mg

The health care provider has prescribed gabapentin (Neurontin) 30 mg/kg/day divided q 8 hours for a child with cerebral palsy having seizures. The child weighs 110 lb. The nurse is preparing to administer the 1200 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.

ANS: 500 The correct calculation is: 110 lb/2.2 kg = 50 kg Dose of Neurontin is 30 mg/kg/day divided every 8 hours 30 mg ´ 50 = 1500 mg/day 1500 mg/3 = 500 mg for one dose

What test is used to screen for carbohydrate malabsorption? a. Stool pH b. Urine ketones c. C urea breath test d. ELISA stool assay

ANS: A The anticipated pH of a stool specimen is 7.0. A stool pH of less than 5.0 is indicative of carbohydrate malabsorption. The bacterial fermentation of carbohydrates in the colon produces short-chain fatty acids, which lower the stool pH. Urine ketones detect the presence of ketones in the urine, which indicates the use of alternative sources of energy to glucose. The C urea breath test measures the amount of carbon dioxide exhaled. It is used to determine the presence of Helicobacter pylori. ELISA (enzyme-linked immunosorbent assay) detects the presence of antigens and antibodies. It is not useful for disorders of metabolism.

A lumbar puncture (LP) is being done on an infant with suspected meningitis. The nurse expects which results for the cerebrospinal fluid that can confirm the diagnosis of meningitis? a. ↑WBCs; ↓glucose b. ↑RBCs; normal WBCs c. ↑glucose; normal RBCs d. Normal RBCs; normal glucose

ANS: A A lumbar puncture is the definitive diagnostic test. The fluid pressure is measured and samples are obtained for culture, Gram stain, blood cell count, and determination of glucose and protein content. The findings are usually diagnostic. The patient generally has an elevated white blood cell count, often predominantly polymorphonuclear leukocytes. The glucose level is reduced, generally in proportion to the duration and severity of the infection.

What type of seizure may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

ANS: A Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure. Generalized, simple partial, and complex partial all have clinical manifestations that are observable.

A 12-year-old child with Guillain-Barré syndrome (GBS) is admitted to the pediatric intensive care unit. She tells you that yesterday her legs were weak and that this morning she was unable to walk. After the nurse determines the current level of paralysis, which should the next priority assessment be? a.Swallowing ability b.Parental involvement c.Level of consciousness d.Antecedent viral infections

ANS: A Assessment of swallowing is essential. Both pharyngeal involvement and respiratory function are usually involved at the same time. The child may require ventilatory support. The inability to swallow also contributes to aspiration pneumonia.

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. What is the most appropriate initial action by the school nurse? a. Stay with child and have someone else call emergency medical services (EMS). b. Notify the parent and regular practitioner. c. Notify the parent that the child should go home. d. Stay with the child, offering calm reassurance.

ANS: A Because this is the child's first seizure and it lasted more than 5 minutes, EMS should be called to transport the child, and evaluation should be performed as soon as possible. The nurse should stay with the recovering child while someone else notifies EMS.

A young child's parents call the nurse after their child is bitten by a raccoon in the woods. The nurse's recommendation should be based on what knowledge? a. Antirabies prophylaxis must be initiated immediately. b. The child should be hospitalized for close observation. c. No treatment is necessary if thorough wound cleaning is done. d. Antirabies prophylaxis must be initiated as soon as clinical manifestations appear.

ANS: A Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immunoglobulin (HRIG) as soon as possible.

The nurse is preparing a school-age child for computed tomography (CT) scan to assess cerebral function. The nurse should include what statement in preparing the child? a. "The scan will not hurt." b. "Pain medication will be given." c. "You will be able to move once the equipment is in place." d. "Unfortunately no one can remain in the room with you during the test."

ANS: A For CT scans, the child must be immobilized. It is important to emphasize to the child that at no time is the procedure painful.

A child has been admitted with status epilepticus. An emergency medication has been ordered. What medication should the nurse expect to be prescribed? a. Lorazepam (Ativan) b. Phenytoin (Dilantin) c. Topiramate (Topamax) d. Ethosuximide (Zarontin)

ANS: A For in-hospital management of status epilepticus, intravenous diazepam or lorazepam (Ativan) is the first-line drug of choice. Lorazepam is the preferred agent because of its rapid onset (2-5 minutes) and long half-life (12-24 hours) with few side effects.

An 18-month-old child is brought to the emergency department after being found unconscious in the family pool. What does the nurse identify as the primary problem in drowning incidents? a. Hypoxia b. Aspiration c. Hypothermia d. Electrolyte imbalance

ANS: A Hypoxia is the primary problem because it results in global cell damage, with different cells tolerating variable lengths of anoxia. Neurons sustain irreversible damage after 4 to 6 minutes of submersion. Severe neurologic damage occurs from hypoxia in 3 to 6 minutes.

What intervention is contraindicated in a suspected case of appendicitis? a.Enemas b.Palpating the abdomen c.Administration of antibiotics d.Administration of antipyretics for fever

ANS: A In any instance in which severe abdominal pain is observed and appendicitis is suspected, the nurse must be aware of the danger of administering laxatives or enemas.

An injury to which part of the brain will cause a coma? a. Brainstem b. Cerebrum c. Cerebellum d. Occipital lobe

ANS: A Injury to brainstem =stupor and coma. Cerebrum are specific to the involved area. Frontal lobe= impaired memory, personality changes, or altered intellectual funct. Cerebellum =difficulties w/coordination of muscle mvmnts, including ataxia & nystagmus. Occipital lobe=Impaired vision and functional blindness

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

ANS: A Moro, tonic neck, and withdrawal reflexes are three reflexes that are present in a healthy 2-month-old infant and are expected in this age group.

The nurse is caring for a 10-year-old child who has an acute head injury, has a pediatric Glasgow Coma Scale score of 9, and is unconscious. What intervention should the nurse include in the child's care plan? a. Elevate the head of the bed 15 to 30 degrees with the head maintained in midline. b. Maintain an active, stimulating environment. c. Perform chest percussion and suctioning every 1 to 2 hours. d. Perform active range of motion and nontherapeutic touch every 8 hours.

ANS: A Nursing activities for children with head trauma and increased intracranial pressure (ICP) include elevating the head of the bed 15 to 30 degrees and maintaining the head in a midline position. The nurse should try to maintain a quiet, nonstimulating environment for a child with increased ICP.

The clinic nurse is assessing infant reflexes. What assessment indicates a persistence of primitive reflexes? a.Tonic neck reflex at 8 months of age b.Palmar grasp at 4 months of age c.Plantar grasp at 9 months of age d.Rooting reflex at 3 months of age

ANS: A Persistence of primitive reflexes is one of the earliest clues to CP (e.g., obligatory tonic neck reflex at any age or nonobligatory persistence beyond 6 months of age and the persistence or even hyperactivity of the Moro, plantar, and palmar grasp reflexes).

The nurse is teaching the family of an infant with cerebral palsy how to administer a diazepam (Valium) pill by gastrostomy tube. What should the nurse include in the teaching session? a.The pill should be crushed and mixed with a small amount of water. b.The pill should be crushed and mixed with the infant's formula. c.After administering the medication, flush the tube with air. d.Before administering the medication, check the placement of the tube.

ANS: A Pills may be crushed and mixed with small amounts of water but not other liquids, such as formula or elixir medications, because these may act together to form a sludge that can interfere with gastrostomy tube function. When crushed pills or tablets are administered, flush the feeding tube with more water after instilling the dissolved pill in water.

An adolescent whose leg was crushed when she fell off a horse is admitted to the emergency department. She has completed the tetanus immunization series, receiving the last tetanus toxoid booster 8 years ago. What care is necessary for therapeutic management of this adolescent to prevent tetanus? a.Tetanus toxoid booster is needed because of the type of injury. b.Human tetanus immunoglobulin is indicated for immediate prophylaxis. c.Concurrent administration of both tetanus immunoglobulin and tetanus antitoxin is needed. d.No additional tetanus prophylaxis is indicated. The tetanus toxoid booster is protective for 10 years.

ANS: A Protective levels of antibody are maintained for at least 10 years. Children with serious "tetanus-prone" wounds, including contaminated, crush, puncture, or burn wounds, should receive a tetanus toxoid booster prophylactically as soon as possible. This adolescent has circulating antibodies. The immunoglobulin is not indicated.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. What is the most appropriate way to position and feed this neonate? a.Prone with the head turned to the side b.On the side c.Supine in an infant carrier d.Supine, with defect supported with rolled blankets

ANS: A The prone position with the head turned to the side for feeding is the optimum position for the infant. It protects the spinal sac and allows the infant to be fed without trauma. The side-lying position is avoided preoperatively.

The nurse is planning care for a school-age child with bacterial meningitis. What intervention should be included? a. Keep environmental stimuli to a minimum. b. Have the child move her head from side to side at least every 2 hours. c. Avoid giving pain medications that could dull sensorium. d. Measure head circumference to assess developing complications.

ANS: A The room is kept as quiet as possible and environmental stimuli are kept to a minimum. Most children with meningitis are sensitive to noise, bright lights, and other external stimuli. The nuchal rigidity associated with meningitis would make moving the head from side to side a painful intervention. If pain is present, the child should be treated appropriately. Failure to treat can cause increased intracranial pressure.

Neuropathic bladder disorders are common among children with which disorder? a.Plagiocephaly b.Meningocele c.Craniosynostosis d.Myelomeningocele

ANS: D Myelomeningocele is one of the most common causes of neuropathic bladder dysfunction among children. Plagiocephaly is the flattening of a side of the child's head. This is not associated with neuropathic bladder. Children with meningocele usually do not have neuropathic bladder.

A child develops syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a complication to meningitis. What action should be verified before implementing? a. Forcing fluids b. Daily weights with strict input and output (I and O) c. Strict monitoring of urine volume and specific gravity d. Close observation for signs of increasing cerebral edema

ANS: A The treatment of SIADH consists of fluid restriction until serum electrolytes and osmolality return to normal levels. SIADH often occurs in children who have meningitis. Monitoring weights, keeping I and O and specific gravity of urine, and observing for signs of increasing cerebral edema are all part of the nursing care for a child with SIADH.

A 4-month-old with significant head lag meets the criteria for floppy infant syndrome. A diagnosis of progressive infantile spinal muscular atrophy (Werdnig-Hoffmann disease) is made. What should be included in the nursing care for this child? a.Infant stimulation program b.Stretching exercises to decrease contractures c.Limited physical contact to minimize seizures d.Encouraging parents to have additional children

ANS: A Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). An infant stimulation program is essential. Frequent position changes, including changes in environment, provide the child with more physical contacts. Verbal, tactile, and auditory stimulation are also included.

What is important to incorporate in the plan of care for a child who is experiencing a seizure? a. Describe and record the seizure activity observed. b. Suction the child during a seizure to prevent aspiration. c. Place a tongue blade between the teeth if they become clenched. d. Restrain the child when seizures occur to prevent bodily harm.

ANS: A When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity. The child is not suctioned during the seizure. If possible, the child should be placed on the side, facilitating drainage to prevent aspiration.

The nurse is preparing to admit a 10-year-old child with appendicitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a.Fever b.Vomiting c.Tachycardia d.Flushed face e.Hyperactive bowel sounds

ANS: A, B, C Clinical manifestations of appendicitis include fever, vomiting, and tachycardia. Pallor is seen, not a flushed face, and the bowel sounds are hypoactive or absent, not hyperactive.

What functional goal should the nurse expect for a child who has a T1 to T10 spinal cord injury? (Select all that apply.) a.May be braced for standing b.Able to drive automobile with hand controls c.Can manage adapted public transportation d.Some able to use regular public transportation e.Ambulates well, often with short leg braces with or without cane

ANS: A, B, C A child with a T1 to T10 spinal cord injury may be braced for standing, is able to drive an automobile with hand controls, and can manage adapted public transportation. The ability to use regular public transportation and ambulation with bilateral long braces using four-point or swing-through crutch gait are functional goals for individuals with a T10 to L2 injury.

The nurse is teaching the family with a child with cerebral palsy (CP) strategies to prevent constipation. What should the nurse include in the teaching session? (Select all that apply.) a.Increase fluid intake. b.Increase fiber in the diet. c.Administer stool softeners daily as prescribed. d.Increase the amount of dairy products in the diet. e.Allow the child to decide when to try to have a bowel movement.

ANS: A, B, C A variety of factors, including decreased mobility, decreased fluid intake, a fear of toileting, poor positioning on the toilet, and lack of fiber intake may be responsible for constipation for a child with CP. Stool softeners, laxatives, and a bowel management program may be required to prevent chronic constipation. The child should be placed on the toilet or encouraged to have a bowel movement at the same time each day.

The nurse is preparing to admit a 2-year-old child with spina bifida occulta. What clinical manifestations of spina bifida occulta should the nurse expect to observe? (Select all that apply.) a.Dark tufts of hair b.Skin depression or dimple c.Port-wine angiomatous nevi d.Soft, subcutaneous lipomas e.Bladder and sphincter paralysis

ANS: A, B, C, D Clinical manifestations of spina bifida occulta include dark tufts of hair; skin depression or dimple; port-wine angiomatous nevi; and soft, subcutaneous lipomas. Bladder and sphincter paralysis are present with spina bifida cystica but not occulta.

What are some of the associated disabilities seen with cerebral palsy? (Select all that apply.) a.Visual impairment b.Hearing impairment c.Speech difficulties d.Intellectual impairment e.Associated heart defects

ANS: A, B, C, D Some of the disabilities associated with CP are visual impairment, hearing impairment, behavioral problems, communication and speech difficulties, seizures, and intellectual impairment. Additional sensory deficits such as hypersensitivity, hyposensitivity, and balance difficulties may occur in children with CP.

The nurse is preparing to admit a 7-year-old child with ataxic cerebral palsy. What clinical manifestations of ataxic cerebral palsy should the nurse expect to observe? (Select all that apply.) a.Wide-based gait b.Rapid, repetitive movements performed poorly c.Slow, twisting movements of the trunk or extremities d.Hypertonicity with poor control of posture, balance, and coordinated motion e.Disintegration of movements of the upper extremities when the child reaches for objects

ANS: A, B, E Clinical manifestations of ataxic cerebral palsy include a wide-based gait; rapid, repetitive movements performed poorly; and disintegration of movements of the upper extremities when the child reaches for objects. Slow, twisting movements of the trunk are seen with dyskinetic cerebral palsy, and hypertonicity with poor control of posture, balance, and coordinated motion are seen with spastic cerebral palsy.

The nurse is preparing to admit a 5-year-old child with a lower motor neuron syndrome. What clinical manifestations of a lower motor neuron syndrome should the nurse expect to observe? (Select all that apply.) a.Loss of hair b.Babinski reflex present c.Skin and tissue changes d.Marked atrophy of atonic muscle e.Hyperreflexia with tendon reflexes exaggerated

ANS: A, C, D Clinical manifestations of a lower motor neuron syndrome include loss of hair, skin and tissue changes, and marked atrophy of atonic muscle. Babinski reflex present and hyperreflexia with tendon reflexes exaggerated are manifestations of an upper motor neuron syndrome.

The nurse is preparing to admit a 10-year-old child with Duchenne muscular dystrophy. What clinical features of Duchenne muscular dystrophy should the nurse recognize? (Select all that apply.) a.Calf muscle hypertrophy b.Late onset, usually between 6 and 8 years of age c.Progressive muscular weakness, wasting, and contractures d.Loss of independent ambulation by 9 to 12 years of age e.Slowly progressive, generalized weakness during adolescence

ANS: A, C, D, E Clinical features of Duchenne muscular dystrophy include calf muscle hypertrophy; progressive muscular weakness; wasting and contractures; loss of independent ambulation by 9 to 12 years of age; and slowly progressive, generalized weakness during adolescence. The onset is early, not late, usually between 3 and 5 years of age.

A child, age 3 years, has cerebral palsy (CP) and is hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. He is slightly underweight for his height. What is the most appropriate nursing action related to feeding this child? a.Bottle or tube feed him a specialized formula until he gains sufficient weight. b.Stabilize his jaw with caregiver's hand (either from a front or side position) to facilitate swallowing. c.Place him in a well-supported, semireclining position. d.Place him in a sitting position with his neck hyperextended to make use of gravity flow.

ANS: B Jaw control is compromised in many children with CP. More normal control is achieved if the feeder stabilizes the oral mechanisms from the front or side of the face. Bottle or tube feeding will not improve feeding without jaw support. The semireclining position and hyperextended neck position increase the chances of aspiration.

What is the rationale for orthopedic surgery for a child with cerebral palsy? a.To cure spasticity b.To improve function c.For cosmetic purposes d.To prevent the need of physical therapy

ANS: B Orthopedic surgery is used primarily to improve function rather than for cosmetic purposes and is followed by physical therapy. It will not cure spasticity.

A goal for children with spina bifida is to reduce the chance of allergy development. What is a priority nursing intervention? a.Recommend allergy testing. b.Provide a latex-free environment. c.Use only powder-free latex gloves. d.Limit use of latex products as much as possible.

ANS: B A latex-free environment is the goal. This includes eliminating the use of latex gloves and other medical devices containing latex. Allergy testing would provide information about whether the allergy has developed. It will not reduce the chances of developing the allergy.

What statement best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

ANS: B A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space. An epidural hemorrhage occurs between the dura and the skull, is usually arterial with rapid brain concussion, and occurs most often in the parietotemporal region.

The nurse is caring for a family whose infant was just born with anencephaly. What is the most important nursing intervention? a.Implement measures to facilitate the attachment process. b.Help the family cope with the birth of an infant with a fatal defect. c.Prepare the family for extensive surgical procedures that will be needed. d.Provide emotional support so the family can adjust to the birth of an infant with problems.

ANS: B Anencephaly is the most serious neural tube defect. The infants have an intact brainstem and, if born alive, may be able to maintain vital functions for a few hours to several weeks. The family requires emotional support and counseling to cope with the birth of an infant with a fatal defect. The parents should be encouraged to hold their infant and provide comfort measures.

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy will begin when? a. After the diagnosis is confirmed b. When the medication is received from the pharmacy c. After the child's fluid and electrolyte balance is stabilized d. As soon as the practitioner is notified of the culture results

ANS: B Antimicrobial therapy is begun as soon as a presumptive diagnosis is made. The choice of drug is based on the most likely infective agent. Drug choice may be adjusted when the culture results are obtained. Waiting for culture results to begin therapy increases the risk of neurologic damage.

What clinical manifestations suggest hydrocephalus in an infant? a. Closed fontanel and high-pitched cry b. Bulging fontanel and dilated scalp veins c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

ANS: B Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates.

The nurse is preparing a staff education in-service session for a group of new graduate nurses who will be working in a long-term care facility for children; many of the children have cerebral palsy (CP). What statement should the nurse include in the training? a.Children with dyskinetic CP have a wide-based gait and repetitive movements. b.Children with spastic pyramidal CP have a positive Babinski sign and ankle clonus. c.Children with hemiplegia CP have mouth muscles and one lower limb affected. d.Children with ataxic CP have involvement of pharyngeal and oral muscles with dysarthria.

ANS: B CP has a variety of clinical classifications. Spastic pyramidal CP includes manifestations such as a positive Babinski sign and ankle clonus; ataxic CP has a wide-based gait and repetitive movements; hemiplegia CP is characterized by motor dysfunction on one side of the body with upper extremity more affected than lower limbs; and dyskinetic CP involves the pharyngeal and oral muscles, causing drooling and dysarthria.

A child is on phenytoin (Dilantin). What should the nurse encourage? a. Fluid restriction b. Good dental hygiene c. A decrease in vitamin D intake d. Taking the medication with milk

ANS: B Chronic treatment with phenytoin may cause gum hypertrophy. Children taking phenobarbital or phenytoin should receive adequate vitamin D and folic acid because deficiencies of both have been associated with these drugs.

The nurse should suspect a child has cerebral palsy (CP) if the parent says what? a."My 6-month-old baby is rolling from back to prone now." b."My 4-month-old doesn't lift his head when on his tummy." c."My 8-month-old can sit without support." d."My 10-month-old is not walking."

ANS: B Delayed gross motor development is a universal manifestation of CP. The child shows a delay in all motor accomplishments, and the discrepancy between motor ability and expected achievement tends to increase with successive developmental milestones as growth advances. The infant who does not lift his head when on the tummy is showing a gross motor delay, as that is seen at 0 to 3 months.

A 2-year-old child starts to have a tonic-clonic seizure. The child's jaws are clamped. What is the most important nursing action at this time? a. Place a padded tongue blade between the child's jaws. b. Stay with the child and observe his respiratory status. c. Prepare the suction equipment. d. Restrain the child to prevent injury.

ANS: B It is impossible to halt a seizure once it has begun, and no attempt should be made to do so. The nurse must remain calm, stay with the child, and prevent the child from sustaining any harm during the seizure.

Gingivitis is a common problem in children with cerebral palsy (CP). What preventive measure should be included in the plan of care? a.High-carbohydrate diet b.Meticulous dental hygiene c.Minimum use of fluoride d.Avoidance of medications that contribute to gingivitis

ANS: B Meticulous oral hygiene is essential. Many children with CP have congenital enamel defects, high-carbohydrate diets, poor nutritional intake, and difficulty closing their mouths. These, coupled with the child's spasticity or clonic movements, make oral hygiene difficult. Children with CP have high carbohydrate intake and retention, which contribute to dental caries.

The parents of a child with spastic cerebral palsy (CP) state that their child seems to have significant pain. In addition to systemic pharmacologic management, the nurse includes which teaching? a.Patterning b.Positions to reduce spasticity c.Stretching exercises after meals d.Topical analgesics for muscle spasms

ANS: B Parents and children are taught positions to assume while sitting and recumbent that reduce spasticity. The American Academy of Pediatrics has stated that patterning should not be used for neurologically disabled children.

What type of cerebral palsy (CP) is the most common type? a.Ataxic b.Spastic c.Dyskinetic d.Mixed type

ANS: B Spastic CP is the most common clinical type. Early manifestations are usually generalized hypotonia, or decreased tone that lasts for a few weeks or may extend for months or as long as 1 year. It is replaced by increased stretch reflexes, increased muscle tone, and weakness. Ataxic, dyskinetic, and mixed type are less common forms of CP.

What term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a. Coma b. Stupor c. Obtundation d. Persistent vegetative state

ANS: B Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Coma is the state in which no motor or verbal response occurs to noxious (painful) stimuli. Obtundation describes a level of consciousness in which the child is arousable with stimulation. Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

What test is never performed on a child who is awake? a. Doll's head maneuver b. Oculovestibular response c. Assessment of pyramidal tract lesions d. Funduscopic examination for papilledema

ANS: B The oculovestibular response (caloric test) involves the instillation of ice water into the ear of a comatose child. The caloric test is painful and is never performed on an awake child or one who has a ruptured tympanic membrane. The doll's head maneuver, assessment of pyramidal tract lesions, and funduscopic examination for papilledema are not considered painful.

What signs or symptoms are most commonly associated with the prodromal phase of acute viral hepatitis? a.Bruising and lethargy b.Anorexia and malaise c.Fatigability and jaundice d.Dark urine and pale stools

ANS: B The signs and symptoms most common in the prodromal phase are anorexia, malaise, lethargy, and easy fatigability.

The most important nursing intervention when caring for an infant with myelomeningocele in the preoperative stage is which? a.Take vital signs every hour. b.Place the infant on the side to decrease pressure on the spinal sac. c.Watch for signs that might indicate developing hydrocephalus. d.Apply a heat lamp to facilitate drying and toughening of the sac.

ANS: B The spinal sac is protected from damage until surgery is performed. Early surgical closure is recommended to prevent local trauma and infection. Monitoring vital signs and watching for signs that might indicate developing hydrocephalus are important interventions, but preventing trauma to the sac is a priority. The sac is kept moist until surgical intervention is done.

A recommendation to prevent neural tube defects (NTDs) is the supplementation of what? a.Vitamin A throughout pregnancy b.Folic acid for all women of childbearing age c.Folic acid during the first and second trimesters of pregnancy d.Multivitamin preparations as soon as pregnancy is suspected

ANS: B The widespread use of folic acid among women of childbearing age has decreased the incidence NTDs. In the United States, the rates of NTDs have declined from 1.3 per 1000 births in 1990 to 0.3 per 1000 after the introduction of mandatory folic acid supplementation in food in 1998. Vitamin A is not related to the prevention of NTDs. Folic acid supplementation is recommended for the preconceptual period, as well as during the pregnancy. The NTD is a failure of neural tube closure during early development, the first 3 to 5 weeks.

What functional goal should the nurse expect for a child who has a C7 spinal cord injury? (Select all that apply.) a.Able to drive automobile with hand controls b.Complete independence within limitations of a wheelchair c.Can roll over in bed, sit up in bed, and eat independently d.Requires some assistance in transfer and lower extremity dressing e.Ambulation with bilateral long braces using four-point or swing-through crutch gait

ANS: B, C, D A child with a C7 spinal cord injury can expect to be completely independent within the limitations of a wheelchair, can roll over in bed, sit up in bed, and eat independently, and will require some assistance in transfer and lower extremity dressing. The ability to drive an automobile with hand controls is a functional goal for a T1 to T10 spinal cord injury. Ambulation with bilateral long braces using four-point or swing-through crutch gait is a functional goal for a T10 to L2 injury.

What findings should the nurse expect to observe in a 7-month-old infant with Werdnig-Hoffman disease? (Select all that apply.) a.Noticeable scoliosis b.Absent deep tendon reflexes c.Abnormal tongue movements d.Failure to thrive e.Prominent pectus excavatum f.Significant leg involvement

ANS: B, C, D Clinical manifestations of Werdnig-Hoffman disease in an infant include absent deep tendon reflexes, abnormal tongue movements, and failure to thrive. Scoliosis, prominent pectus excavatum, and significant leg involvement are findings observed in a child with intermediate spinal muscular atrophy.

The nurse is preparing to admit a 7-year-old child with an upper motor neuron syndrome. What clinical manifestations of an upper motor neuron syndrome should the nurse expect to observe? (Select all that apply.) a.No flexor spasms bBabinski reflex present c.No wasting of muscle mass d.Marked atrophy of atonic muscle e.Hyperreflexia with tendon reflexes exaggerated

ANS: B, C, E Clinical manifestations of an upper motor neuron syndrome include Babinski reflex present, no wasting of muscle mass, and hyperreflexia with tendon reflexes exaggerated. No flexor spasms and marked atrophy of atonic muscle are manifestations of a lower motor neuron syndrome.

The nurse is preparing to admit a 5-year-old with spina bifida cystica that was below the second lumbar vertebra. What clinical manifestations of spina bifida cystica below the second lumbar vertebra should the nurse expect to observe? (Select all that apply.) a.No motor impairment b.Lack of bowel control c.Soft, subcutaneous lipomas d.Flaccid, partial paralysis of lower extremities e.Overflow incontinence with constant dribbling of urine

ANS: B, D, E The clinical manifestations of spina bifida cystica below the second lumbar vertebra include lack of bowel control, flaccid, partial paralysis of lower extremities, and overflow incontinence with constant dribbling of urine. No motor impairment occurs with spina bifida cystica that was below the third lumbar vertebra, and soft, subcutaneous lipomas occur with spina bifida occulta.

What statement is descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur. c. It is a transient and reversible neuronal dysfunction. d. It is a slight lesion that develops remote from the site of trauma.

ANS: C A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head. Petechial hemorrhages on the superficial aspects of the brain along the point of impact are a type of contusion but are not necessarily associated with amnesia.

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. What is the most appropriate nursing action? a. Explain that analgesia is contraindicated with a head injury. b. Have the parents describe the child's previous experiences with pain. c. Consult with a practitioner about what analgesia can be safely administered. d. Teach the parents that analgesia is unnecessary when the child is not fully awake and alert.

ANS: C A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and to promote comfort and relieve anxiety. Analgesia can be safely used in individuals who have sustained head injuries.

A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. How should the nurse respond? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A step-wise approach will be used to reduce the dosage gradually. d. Seizure disorders are a lifelong problem. Medications cannot be discontinued.

ANS: C A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure free for 2 years. Medications must be gradually reduced to minimize the recurrence of seizures. The risk of recurrence is greatest within 6 months after discontinuation.

A toddler with spastic cerebral palsy needs to be transported to the radiology department. What transportation method should the nurse use to take the toddler to the radiology department? a.A stretcher b.A wheelchair c.A wagon with pillows d.Carried in the nurse's arms

ANS: C A wagon with pillows would support the child with spastic cerebral palsy better than a stretcher or wheelchair. A wagon would give the child a "wheelchair" experience, so the nurse should not carry the child.

A 10-year-old boy on a bicycle has been hit by a car in front of a school. The school nurse immediately assesses airway, breathing, and circulation. What should be the next nursing action? a. Place the child on his side. b. Take the child's blood pressure. c. Stabilize the child's neck and spine. d. Check the child's scalp and back for bleeding.

ANS: C After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma. The child's position should not be changed until the neck and spine are stabilized. Blood pressure is a later assessment.

A mother tells the clinic nurse that she often puts honey on her infant's pacifier to soothe the infant. What response should the nurse make to the mother? a.That is a good way to soothe your baby." b.Honey does not have any soothing effects." c.There is still a risk for infant botulism from honey." d.Honey is OK, but it should not be put on the pacifier."

ANS: C Although the precise source of Clostridium botulinum spores has not been identified as originating from honey in many cases of infant botulism in the United States, it is still recommended that honey not be given to infants younger than 12 months

The parents of an infant with cerebral palsy (CP) ask the nurse if their child will have cognitive impairment. The nurse's response should be based on which knowledge? a.Affected children have some degree of cognitive impairment. b.Around 20% of affected children have normal intelligence. c.About 45% of affected children have normal intelligence. d.Cognitive impairment is expected if motor and sensory deficits are severe.

ANS: C Children with CP have a wide range of intelligence, and 40% to 50% are within normal limits. A large percentage of children with CP do not have mental impairment. Many individuals who have severely limiting physical impairment have the least amount of intellectual compromise.

What term refers to seizures that involve both hemispheres of the brain? a. Absence b. Acquired c. Generalized d. Complex partial

ANS: C Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres. Absence seizures have a sudden onset and are characterized by a brief loss of consciousness, a blank stare, and automatisms.

What statement best describes Duchenne (pseudohypertrophic) muscular dystrophy (DMD)? a.It has an autosomal dominant inheritance pattern. b.Onset occurs in later childhood and adolescence. c.It is characterized by presence of Gower sign, a waddling gait, and lordosis. d.Disease stabilizes during adolescence, allowing for life expectancy to approximately age 40 years.

ANS: C DMD is characterized by a waddling gait and lordosis. Gower sign is a characteristic way of rising from a squatting or sitting position on the floor. DMD is inherited as an X-linked recessive gene. Genetic counseling. Onset occurs usually between ages 3 and 5 years. DMD has a progressive and relentless loss of muscle function until death by respiratory or cardiac failure.

What finding is a clinical manifestation of increased intracranial pressure (ICP) in children? a. Low-pitched cry b. Sunken fontanel c. Diplopia, blurred vision d. Increased blood pressure

ANS: C Diplopia and blurred vision are signs of increased ICP in children. A high-pitched cry and a tense or bulging fontanel are characteristic of increased ICP. Increased blood pressure, common in adults, is rarely seen in children.

An adolescent with a spinal cord injury is admitted to a rehabilitation center. Her parents describe her as being angry, hostile, and uncooperative. The nurse should recognize that this is suggestive of which psychosocial state? a.Normal phase of adolescent development b.Severe depression that will require long-term counseling c.Normal response to her situation that can be redirected in a healthy way d.Denial response to her situation that makes rehabilitative efforts more difficult

ANS: C During the rehabilitation phase, it is desirable for adolescents to begin to express negative feelings toward the situation. The rehabilitation team can redirect the negative energy toward learning a new way of life. The injury has interrupted the normal adolescent process of achieving independence, triggering these negative behaviors. Severe depression can occur, but it indicates that the child is no longer in denial.

A feeding technique the nurse can teach to parents of a child with cerebral palsy to improve use of the lips and the tongue to facilitate speech is which? a.Feeding pureed foods b.Placing food on the tongue c.Placing food at the side of the tongue d.Placing food directly into the mouth with a spoon

ANS: C Feeding techniques such as forcing the child to use the lips and tongue in eating facilitate speech. An example of this technique is placing food at the side of the tongue, first one side and then the other, and making the child use the lips to take food from a spoon rather than placing it directly on the tongue.

A pregnant woman asks about prenatal diagnosis of hydrocephalus. The nurse's response should be based on which knowledge? a. It can be diagnosed only after birth. b. It can be diagnosed by chromosome studies. c. It can be diagnosed with fetal ultrasonography. d. It can be diagnosed by measuring the lecithin-to-sphingomyelin ratio.

ANS: C Hydrocephalus can be diagnosed by fetal ultrasonography as early as 14 weeks of gestation. Most incidents of hydrocephalus are not chromosomal in origin. The lecithin-to-sphingomyelin ratio can be used to determine fetal lung maturity.

Spastic cerebral palsy (CP) is characterized by which clinical manifestations? a.Athetosis, dystonic movements b.Tremors, lack of active movement c.Hypertonicity; poor control of posture, balance, and coordinated motion d.Wide-based gait; poor performance of rapid, repetitive movements

ANS: C Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic CP. Athetosis and dystonic movements are part of the classification of dyskinetic or athetoid CP. Tremors and lack of active movement may indicate other neurologic disorders. A wide-based gait and poor performance of rapid, repetitive movements are part of the classification of ataxic CP.

After a tonic-clonic seizure, what symptoms should the nurse expect the child to experience? a. Diarrhea and abdominal discomfort b. Irritability and hunger c. Lethargy and confusion d. Nervousness and excitability

ANS: C In the postictal phase, after a tonic-clonic seizure, the child may remain semiconscious and difficult to arouse. The average duration of the postictal phase is usually 30 minutes. The child may remain confused or sleep for several hours. He or she may have mild impairment of fine motor movements. The child may have visual and speech difficulties and may vomit or complain of headache.

The nurse is caring for a 4-year-old child with cerebral palsy (CP). The child, developmentally, is at an infant stage. Appropriate developmental stimulation for this child should be what? a.Playing "pat-a-cake" with the child b.None so the child does not become overstimulated c.Putting a colorful mobile with music on the bed d.Giving the child a coloring book and crayons

ANS: C Incorporating play into the therapeutic program for a child with CP often requires great ingenuity and inventiveness from those involved in the child's care. Objects and toys are chosen for the child's developmental stage to provide needed sensory input using a variety of shapes, forms, and textures. Nurses can help parents integrate therapy into play activities in natural ways.

During a well-child visit, the mother tells the nurse that her 4-month-old infant is constipated, is less active than usual, and has a weak-sounding cry. The nurse suspects botulism and questions the mother about the child's diet. What factor should support this diagnosis? a.Breastfeeding b.Commercial formula c.Infant cereal with honey d.Improperly sterilized bottles

ANS: C Ingestion of honey is a risk factor for infant botulism in the United States. Honey should not be given to children younger than the age of 1 year. Botulism is not found with the use of commercial infant cereals. Inadequate sterilization of home-canned foods can contribute to botulism.

What is the initial clinical manifestation of generalized seizures? a. Confusion b. Feeling frightened c. Loss of consciousness d. Seeing flashing lights

ANS: C Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation. Being confused, feeling frightened, and seeing flashing lights are clinical manifestations of a complex partial seizure.

What term is used to describe a child's level of consciousness when the child is arousable with stimulation? a. Stupor b. Confusion c. Obtundation d. Disorientation

ANS: C Obtundation describes a level of consciousness in which the child is arousable with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.

What nursing intervention is appropriate when caring for an unconscious child? a. Avoid using narcotics or sedatives to provide comfort and pain relief. b. Change the child's position infrequently to minimize the chance of increased intracranial pressure (ICP). c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. Give tepid sponge baths to reduce fevers above 38.3° C (101° F) because antipyretics are contraindicated.

ANS: C Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. Narcotics and sedatives should be used as necessary to reduce pain and anxiety, which can increase ICP. The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown. Antipyretics are the method of choice for fever reduction.

The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic-clonic seizures. What statement by the parent should indicate a correct understanding of the teaching? a. "I should attempt to restrain my child during a seizure." b. "My child will need to avoid contact sports until adulthood." c. "I should place a pillow under my child's head during a seizure." d. "My child will need to be taken to the emergency department [ED] after each seizure."

ANS: C Parents should try to place a pillow or folded blanket under the child's head for protection. The parent should not try to restrain the child during the seizure. The child does not need to go to the ED with each seizures; the nurse can teach parents certain criteria for when their child would need to be seen. Discussing what will happen in adulthood is not appropriate at this time.

What are quick, jerky, grossly uncoordinated, irregular movements that may disappear on relaxation called? a. Twitching b. Spasticity c. Choreiform movements d. Associated movements

ANS: C Quick, jerky, grossly uncoordinated, irregular movements that may disappear on relaxation are called choreiform movements. Twitching is defined as spasmodic movements of short duration. Spasticity is prolonged and steady contraction of muscle characterized by clonus (alternating relaxation and contraction of the muscle) and exaggerated reflexes.

When caring for a child with probable appendicitis, the nurse should be alert to recognize which sign or symptom as a manifestation of perforation? a.Anorexia b.Bradycardia c.Sudden relief from pain d.Decreased abdominal distention

ANS: C Signs of peritonitis, in addition to fever, include sudden relief from pain after perforation. Anorexia is already a clinical manifestation of appendicitis. Tachycardia, not bradycardia, is a manifestation of peritonitis.

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. What nursing intervention is a priority for this child? a.Minimizing environmental stimuli b.Administering immunoglobulin c.Monitoring and maintaining systemic blood pressure d.Discussing long-term care issues with the family

ANS: C Spinal cord injury patients are physiologically labile, and close monitoring is required. They may be unstable for the first few weeks after the injury. Increased blood pressure may be an indication of autonomic dysreflexia.

What is a priority of care when a child has an external ventricular drain (EVD)? a. Irrigation of drain to maintain flow b. As-needed dressing changes if dressing becomes wet c. Frequent assessment of amount and color of drainage d. Maintaining the EVD below the level of the child's head

ANS: C The EVD is inserted into the child's ventricle. Frequent assessment is necessary to determine amount of drainage and whether an infection is present. The EVD is a closed system and is not opened for irrigation. Antibiotics may be administered through the drain, but this is usually done by the neuropractitioner. The dressing is not changed. If it becomes wet, then the practitioner should be notified that cerebrospinal fluid (CSF) may be leaking.

The nurse is caring for a child admitted with acute abdominal pain and possible appendicitis. What intervention is appropriate to relieve the abdominal discomfort during the evaluation? a.Place in the Trendelenburg position. b.Apply moist heat to the abdomen. c.Allow the child to assume a position of comfort. d.Administer a saline enema to cleanse the bowel.

ANS: C The child should be allowed to take a position of comfort, usually with the legs flexed. The Trendelenburg position will not help If appendicitis is a possibility, administering laxative or enemas or applying heat to the area is dangerous. Such measures stimulate bowel motility and increase the risk of perforation.

An adolescent has just been brought to the emergency department with a spinal cord injury and paralysis from a diving accident. The parents keep asking the nurse, "How bad is it?" The nurse's response should be based on which knowledge? a.Families adjust better to life-threatening injuries when information is given over time. b.Immediate loss of function is indicative of the long-term consequences of the injury. c.Extent and severity of damage cannot be determined for several weeks or even months. d.Numerous diagnostic tests will be done immediately to determine extent and severity of damage.

ANS: C The extent and severity of damage cannot be determined initially. The immediate loss of function is caused by anatomic and impaired physiologic function, and improvement may not be evident for weeks or months. It is essential to provide information about the adolescent's status to the parents. Immediate treatment information should be provided.

A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. What sign or symptom is considered a manifestation of postconcussion syndrome and does not necessitate medical attention? a. Vomiting b. Blurred vision c. Behavioral changes d. Temporary loss of consciousness

ANS: C The parents are advised of probable posttraumatic symptoms that may be expected. These include behavioral changes, sleep disturbances, emotional lability, and alterations in school performance. If the child is vomiting, has blurred vision, or has temporary loss of consciousness, she should be seen for evaluation.

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

ANS: C With a combination of dietary modification, regular toilet habits, and prevention of constipation and impaction, some degree of fecal continence can usually be achieved. Incontinence can be minimized with the development of a regular bowel training program.

What refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column? a.Rachischisis b.Meningocele c.Encephalocele d.Myelomeningocele

ANS: D A myelomeningocele has a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves. Rachischisis is a fissure in the spinal column that leaves the meninges and the spinal cord exposed. Meningocele is a hernial protrusion of a saclike cyst of meninges with spinal fluid but no neural elements. Encephalocele is a herniation of brain and meninges through a defect in the skull, producing a fluid-filled sac.

An 8-year-old girl with moderate cerebral palsy (CP) recently began joining a regular classroom for part of the day. Her mother asks the school nurse about joining the after-school Girl Scout troop. The nurse's response should be based on which knowledge? a.Most activities such as Girl Scouts cannot be adapted for children with CP. b.After-school activities usually result in extreme fatigue for children with CP. c.Trying to participate in activities such as Girl Scouts leads to lowered self-esteem in children with CP. d.Recreational activities often provide children with CP with opportunities for socialization and recreation.

ANS: D After-school and recreational activities serve to stimulate children's interest and curiosity. They help the children adjust to their disability, improve their functional ability, and build self-esteem. Increasing numbers of programs are adapted for children with physical limitations. Almost all activities can be adapted. The child should participate to her level of energy. Self-esteem increases as a result of the positive feedback the child receives from participation.

A child has a seizure disorder. What test should be done to gather the most specific information about the type of seizure the child is having? a. Sleep study b. Skull radiography c. Serum electrolytes d. Electroencephalogram (EEG)

ANS: D An EEG is obtained for all children with seizures and is the most useful tool for evaluating a seizure disorder. The EEG confirms the presence of abnormal electrical discharges and provides information on the seizure type and the focus.

A child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What is a common reason for elective revision of this shunt? a. Meningitis b. Gastrointestinal upset c. Hydrocephalus resolution d. Growth of the child since the initial shunting

ANS: D An elective revision of a ventriculoperitoneal shunt would most likely be done to accommodate the child's growth. Meningitis would require an emergent replacement or revision of the shunt. Gastrointestinal upset alone would not indicate the need for shunt revision.

The nurse is caring for a child with myasthenia gravis (MG). What health care prescription should the nurse verify before administering? a.Ceftizoxime (Cefizox) b.Cefotaxime (Claforan) c.Ceftriaxone (Rocephin) d.Garamycin (gentamicin)

ANS: D Avoid aminoglycoside antibiotics such as gentamicin because they potentiate MG symptoms. Cefizox, Claforan, and Rocephin are cephalosporin antibiotics.

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt. What issues should be addressed? a. Most childhood activities must be restricted. b. Cognitive impairment is to be expected with hydrocephalus. c. Wearing head protection is essential until the child reaches adulthood. d. Shunt malfunction or infection requires immediate treatment.

ANS: D Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions. Cognitive impairment depends on the extent of damage before the shunt was placed.

What is the antiepileptic medication that requires monitoring of vitamin D and folic acid? a. Topiramate (Topamax) b. Valproic acid (Depakene) c. Gabapentin (Neurontin) d. Phenobarbital (Luminal)

ANS: D Children taking phenobarbital or phenytoin should receive adequate vitamin D and folic acid because deficiencies of both have been associated with these drugs.

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the child's younger brother had when he was an infant. The nurse should base a response on which information? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.

ANS: D H. influenzae type B meningitis has been virtually eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms.

The nurse is caring for a child with tetanus during the acute phase. What should the nurse plan in the care for this child? a.Playing music on a radio b.Giving frequent back rubs c.Providing bright lighting in the room d.Clustering nursing care to limit distractions

ANS: D In caring for a child with tetanus during the acute phase, every effort should be made to control or eliminate stimulation from sound, light, and touch.

A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What sign or symptom does the child have that indicates a revision is necessary? a. Tachycardia b. Gastrointestinal upset c. Hypotension d. Alteration in level of consciousness

ANS: D In older children, who are usually admitted to the hospital for elective or emergency shunt revision, the most valuable indicators of increasing intracranial pressure are an alteration in the child's level of consciousness, complaint of headache, and changes in interaction with the environment.

What functional ability should the nurse expect in a child with a spinal cord lesion at C7? a.Complete respiratory paralysis b.No voluntary function of upper extremities c.Inability to roll over or attain sitting position d.Almost complete independence within limitations of wheelchair

ANS: D Individuals who sustain injuries at the C7 level are able to achieve a significant level of independence. Some assistance is needed with transfers and lower extremity dressing. Patients are able to roll over in bed and to sit and eat independently.

A 23-month-old child is admitted to the hospital with a diagnosis of meningitis. She is lethargic and very irritable with a temperature of 102° F. What should the nurse's care plan include? a. Observing the child's voluntary movement b. Checking the Babinski reflex every 4 hours c. Checking the Brudzinski reflex every 1 hour d. Assessing the level of consciousness (LOC) and vital signs every 2 hours

ANS: D Observation of vital signs, neurologic signs, LOC, urinary output, and other pertinent data is carried out at frequent intervals on a child with meningitis. The nurse should avoid actions that cause pain or increase discomfort, such as lifting the child's head, so the Brudzinski reflex should not be checked hourly. Checking the Babinski reflex or child's voluntary movements will not help with assessing the child's status.

What clinical manifestation should be the most suggestive of acute appendicitis? a.Rebound tenderness b.Bright red or dark red rectal bleeding c.Abdominal pain that is relieved by eating d.Colicky, cramping, abdominal pain around the umbilicus

ANS: D Pain is the cardinal feature. It is initially generalized, usually periumbilical. The pain becomes constant and may shift to the right lower quadrant. Rebound tenderness is not a reliable sign and is extremely painful to the child.

The nurse is caring for a child with severe head trauma after a car accident. What is an ominous sign that often precedes death? a. Delirium b. Papilledema c. Flexion posturing d. Periodic or irregular breathing

ANS: D Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Delirium is a state of mental confusion and excitement marked by disorientation for time and place. Papilledema is edema and inflammation of the optic nerve. It is commonly a sign of increased intracranial pressure. Flexion posturing is seen with severe dysfunction of the cerebral cortex or of the corticospinal tracts above the brainstem.

An 8-year-old child is hospitalized with infectious polyneuritis (Guillain-Barré syndrome [GBS]). When explaining this disease process to the parents, what should the nurse consider? a.Paralysis is progressive with little hope for recovery. b.Disease is inherited as an autosomal, sex-linked, recessive gene. c.Disease results from an apparently toxic reaction to certain medications. d.Muscle strength slowly returns, and most children recover.

ANS: D Recovery usually begins within 2 to 3 weeks, and most patients regain full muscle strength. The paralysis is progressive with proximal muscle weakness occurring before distal weakness. The recovery of muscle strength occurs in the reverse order of onset of paralysis. Most individuals regain full muscle strength. GBS is an immune-mediated disease.

A young adolescent experiences infrequent migraine episodes. What pharmacologic intervention is most likely to be prescribed? a. Opioid b. Lorazepam c. Ergotamine d. Sumatriptan

ANS: D Sumatriptan is a serotonin agonist at specific vascular serotonin receptor sites and causes vasoconstriction in large intracranial arteries. Opioids are used infrequently because they rarely work on the mechanism of pain. Lorazepam is a benzodiazepine that acts as an anxiolytic and sedative. It is not indicated for treatment of migraine episodes.

What is a major goal of therapy for children with cerebral palsy (CP)? a.Cure the underlying defect causing the disorder. b.Reverse the degenerative processes that have occurred. c.Prevent the spread to individuals in close contact with the child. d.Recognize the disorder early and promote optimum development.

ANS: D The goals of therapy include early recognition and promotion of an optimum developmental course to enable affected children to attain their potential within the limits of their dysfunction. The disorder is permanent, and therapy is chiefly symptomatic and preventive.

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What clinical manifestation is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

ANS: D The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of an injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing is indicative of neurologic damage.

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. How should the nurse interpret this? a. Eye trauma b. Brain death c. Severe brainstem damage d. Neurosurgical emergency

ANS: D The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding. Although a dilated pupil may be associated with eye trauma, this child has experienced a neurologic insult. One fixed and dilated pupil is not suggestive of brain death. Pinpoint pupils or fixed, bilateral pupils for more than 5 minutes are indicative of brainstem damage. The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain.

When a child develops latex allergy, which food may also cause an allergic reaction? a.Yeast b.Wheat c.Peanuts d.Bananas

ANS: D There are cross-reactions between allergies to latex and to a number of foods such as bananas, avocados, kiwi, and chestnuts. Although yeast, wheat, and peanuts are potential allergens, currently they are not known to cross-react with latex allergy.

A woman who is 6 weeks pregnant tells the nurse that she is worried that, even though she is taking folic acid supplements, the baby might have spina bifida because of a family history. The nurse's response should be based on what? a.Prenatal detection is not possible yet. b.There is no genetic basis for the defect. c.Chromosome studies done on amniotic fluid can diagnose the defect prenatally. d.Open neural tube defects (NTDs) result in elevated concentrations of a-fetoprotein in amniotic fluid.

ANS: D Ultrasound scanning and measurement of a-fetoprotein may indicate the presence of anencephaly or myelomeningocele. The optimum time for performing this analyzing is between 16 and 18 weeks. Prenatal diagnosis is possible through amniocentesis. A multifactorial origin is suspected, including drugs, radiation, maternal malnutrition, chemicals, and possibly a genetic mutation. Chromosome abnormalities are not present in NTDs.

What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP) in an unconscious child? a. Suction the child frequently. b. Turn the child's head side to side every hour. c. Provide environmental stimulation. d. Avoid activities that cause pain or crying.

ANS: D Unrelieved pain, crying, and emotional stress all contribute to increasing the ICP. Disturbing procedures should be carried out at the same time as therapies that reduce ICP, such as sedation. Suctioning is poorly tolerated by children.

What side effect commonly occurs with corticosteroid (prednisone) therapy? a. Alopecia b. Anorexia c. Nausea and vomiting d. Susceptibility to infection

D Corticosteroids have immunosuppressive effects. Children who are taking prednisone are susceptible to infections. Hair loss is not a side effect of corticosteroid therapy. Children taking corticosteroids have increased appetites.