Neuro-PEDS

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

1. A cooling blanket will help cool the child quickly and at a controlled temperature. 2. Acetaminophen (Tylenol) should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed. 3. Acetaminophen (Tylenol) should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed. 4. Ice packs will cause the child to shiver, which will increase oxygen consumption and possibly increase ICP. Shivering can also cause the child to experience a rebound increase in temperature. TEST-TAKING HINT: The test taker should consider the cause of the increased temperature and how to cool the child quickly. Answer 4 should be eliminated because ice packs are no longer recommended to treat increased temperatures.

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

1. Brudzinski sign occurs when the child responds to a flexed neck with an involuntary flexion of the hips and/or knees. 2. Cushing triad is a sign of increased ICP and is manifested with an increase in systolic blood pressure, decreased heart rate, and irregular respirations. 3. Kernig sign occurs when there is resistance or pain in response to raising the child's flexed leg. 4. Nuchal rigidity occurs when there is a resistance to neck flexion. TEST-TAKING HINT: The test taker should be familiar with terms used to describe meningeal irritation.

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

1. Children who experience a febrile seizure are likely to experience another febrile seizure. 2. Most children over the age of 5 years do not have febrile seizures. 3. Antipyretics are administered to prevent the child's temperature from rising too rapidly. 4. Most children are not prescribed anticonvulsant medication after experiencing a febrile seizure. TEST-TAKING HINT: There is an increased risk in siblings, but the 7-year-old child is above the usual age of febrile seizures.

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

1. Decorticate posturing is seen with a less advanced stage of Reye syndrome and likely indicates that the child's condition is improving. 2. The child's condition is improving; therefore, cardiac and respiratory failure is less likely. 3. Progressing from decerebrate to decorticate posturing usually indicates an improvement in the child's condition. 4. Decorticate posturing is associated with inflammation above the brain stem, whereas decerebrate posturing is associated with inflammation in the brain stem. TEST-TAKING HINT: The test taker needs to be familiar with posturing reflexes and their significance.

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

1. High fat and low carbohydrates are the components of the ketogenic diet. 2. High fat and low carbohydrates are the components of the ketogenic diet. 3. High fat and low carbohydrates are the components of the ketogenic diet. 4. High fat and low carbohydrates are the components of the ketogenic diet. TEST-TAKING HINT: The test taker needs to be familiar with the components of a ketogenic diet.

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

1. Meningocele is a sac that contains a portion of the meninges and cerebrospinal fluid. 2. A myelomeningocele is a sac that contains a portion of the meninges, the CSF, and the nerve roots. 3. Spina bifida occulta is the mildest form of spina bifida in which one or more vertebrae are malformed. The child usually has no symptoms, and in most cases, no one knows there is a spinal defect. 4. Anencephaly is a neural tube defect in which the bones of the skull and head do not form correctly. Infants are missing large parts of their brain and skull. TEST-TAKING HINT: The test taker would need to know the definition of myelomeningocele to answer this question.

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

1. Red blood cells will be needed to increase the red blood cell count. 2. The child should not be around groups of people because of the potential of exposure to infection. 3. Blood thinners are not given to the child with a decreased platelet count. 4. Fresh fruits and vegetables should be avoided because they may contain microorganisms that can lead to infection in the child with a low white blood cell count. TEST-TAKING HINT: The test taker should consider all components of pancytopenia and select the answer that will not harm the child. Answers 2 and 4 should be immediately eliminated because they both increase the risk of infection.

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

1. Swimming does not need to be avoided as long as there is someone else present to call for help in the event of an emergency. 2. The rhythmic reflection of other car lights can trigger a seizure in some children. 3. There is no reason to avoid strenuous activity. 4. It is important for adolescents to be with their peers in order to reach developmental milestones. TEST-TAKING HINT: The test taker should consider the answers that can lead to a seizure. Answer 2 is the only answer that includes a common trigger.

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

1. The CSF in viral meningitis is usually clear. 2. The CSF in bacterial meningitis is usually cloudy. 3. The CSF in healthy children is usually clear. 4. Sepsis is an infection of the bloodstream. TEST-TAKING HINT: The test taker can eliminate answer 4 because an infection of the bloodstream would not be detected in the CSF.

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

1. A common manifestation is increased ICP, which is treated with an osmotic diuretic. Furosemide (Lasix) is a loop diuretic. 2. A common manifestation is hypoglycemia. Insulin does not treat hypoglycemia, but decreases the blood sugar instead. 3. A common manifestation is hypoglycemia, which is treated with the administration of intravenous glucose. 4. Morphine is a narcotic used for pain relief. It should be used with caution because it can lead to respiratory depression. TEST-TAKING HINT: The test taker needs to be aware that increased ICP is a very common manifestation of Reye syndrome and should therefore eliminate any answers that do not treat increased ICP. The test taker can also eliminate answers 2 and 4 because they do not treat hypoglycemia, which is another common manifestation of Reye syndrome.

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

1. A semi-Fowler position in an infant seat may allow the ventricles to drain too rapidly in the immediate postoperative period. 2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates. 3. The Trendelenburg position is not used immediately after ventriculoperitoneal shunt placement because it would increase ICP. 4. The head elevated to 90 degrees will allow the ventricle of the brain to drain too quickly. TEST-TAKING HINT: The test taker should note the word "initially" and consider why the position would be immediately beneficial. Answer 3 can be eliminated because that position could increase ICP.

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

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

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

1. Although there is a cosmetic benefit, the surgery is done to reconstruct the skull to allow the brain to grow properly. There are potential complications associated with this surgery, such as increased ICP. 2. The surgery is done to reconstruct the skull to allow the brain to grow properly. Because there are potential complications associated with this surgery, such as increased ICP, the child is usually closely observed in the PICU. 3. The surgery is not usually postponed but instead done in early infancy. 4. The surgery is not usually postponed because it will allow for brain growth. TEST-TAKING HINT: The test taker should consider the importance of allowing room for brain growth. Answers 3 and 4 can be eliminated because the surgery is performed in early infancy.

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

1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground. 2. It is important to evaluate the child for life stressors, but suspected seizure activity needs immediate evaluation. 3. An absence seizure is characterized by a change in activity whereby the child appears to be daydreaming or staring straight ahead. The child usually continues basic simple movements but loses an awareness of surroundings. 4. The preschool years are a not a time of rapid growth. Many children in this age-group appear clumsy, but suspected seizure activity needs immediate evaluation. TEST-TAKING HINT: The test taker should recognize the description as seizure activity and, therefore, could immediately eliminate answers 3 and 4.

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

1. Baclofen is not given for postoperative pain control. 2. Baclofen is not given for seizures. 3. Baclofen is given to help control the spasms associated with CP. 4. Baclofen is not given for bladder control. TEST-TAKING HINT: The test taker needs to be familiar with the medication baclofen.

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

1. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction. 2. Corrective surgery is done as soon as possible to minimize the risk of infection. 3. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction. 4. Because a meningocele does not contain any nerve endings, most children experience no neurological problems after surgical correction. TEST-TAKING HINT: The test taker should consider the risks of infection and immediately eliminate answer 2 because the surgery is not postponed but performed as soon as possible.

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

1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respirations. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP. 2. The child's vital signs need to be monitored, but a fluid bolus will increase the circulating volume and lead to an increase in the child's ICP. Fluid boluses are necessary in cases of shock but must be administered carefully and the child closely observed. 3. An antihypertensive will not help decrease the ICP. 4. The child will benefit from supplemental oxygen, but it will not help decrease the ICP. TEST-TAKING HINT: The test taker should recognize the signs of Cushing triad. If not recognized, the child's condition should at least be seen as deteriorating and emergent. Answers 2 and 4 can be eliminated because they are only partially correct.

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

1. Having a child immunized helps prevent viral illnesses from occurring, thereby decreasing the likelihood of Reye syndrome. 2. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. 3. The administration of aspirin or products containing aspirin has been associated with the development of Reye syndrome. A headache can be the first sign of a viral illness followed by other symptoms. It is best not to use aspirin or aspirin containing products in children. 4. Children with Reye syndrome are always admitted to the hospital because there is a strong possibility for complications and rapid deterioration. TEST-TAKING HINT: The test taker should be aware that aspirin administration in children with viral infections has been linked to Reye syndrome.

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

1. In infants, signs and symptoms may not be readily apparent because the open fontanel allows for expansion. 2. Although brain tumors are not suspected in infants, a delay in diagnosis is most likely because of the open fontanel, allowing some expansion to go unnoticed. 3. Signs and symptoms may be misinterpreted, but increased ICP will become apparent. 4. Signs and symptoms may be denied, but increased ICP will become apparent. TEST-TAKING HINT: The test taker should consider growth and development in answering this question. The anterior fontanel allows for brain expansion, therefore delaying the discovery of signs and symptoms of a brain tumor.

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

1. It is very difficult and time consuming to establish an intravenous line in a child who is experiencing a generalized seizure. Rectal diazepam (Valium) is first administered in an attempt to stop the seizure long enough to establish a line, and then medication is administered intravenously. 2. Rectal diazepam (Valium) is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered. 3. Although the child may become hypoglycemic due to increased metabolic demands, stopping the seizure with rectal diazepam (Valium) is the first priority. Medication is not placed in the mouth of a child experiencing a generalized seizure because it increases the risk of injury and aspiration. 4. Stopping the seizure with rectal diazepam (Valium) takes priority. Nothing should be administered orally to a patient who is unconscious. TEST-TAKING HINT: The test taker needs to consider the current situation and the level of difficulty in establishing intravenous access in a child experiencing a generalized seizure.

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

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

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

1. The cervical collar should not be removed. In addition to the methylprednisolone (Medrol), ranitidine (Zantac) should be administered to prevent gastric ulcer formation. 2. All forms of spinal stabilization should be continued while methylprednisolone (Medrol) and ranitidine (Zantac) are administered. 3. The backboard and cervical collar should not be removed until after the halo traction has been applied. 4. The cervical collar should not be removed. TEST-TAKING HINT: The test taker should be familiar with spinal cord injuries. The test taker should eliminate any answer stating the cervical collar be removed, such as 1, 3, and 4.

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

1. The child experiencing a seizure usually requires more oxygen because the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help. 2. It is important to reassure the parents, but giving the child oxygen and calling for additional support is the priority of care. 3. It is not necessary to call a code unless the child experiences a cardiac or respiratory arrest. Research indicates that encouraging parents to remain with the child in emergency situations benefits both the child and family. 4. It is important to monitor and observe the child during a seizure, but it is very difficult to obtain a blood pressure from a seizing child. The priority of care involves administering oxygen and calling for additional help. TEST-TAKING HINT: The test taker needs to prioritize care and choose answer 1 because it will help maintain the airway. Answer 3 could immediately be eliminated because the child is having a seizure, not a cardiac arrest.

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

1. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Mannitol (Osmitrol) is an osmotic diuretic that will not treat diabetes insipidus. 2. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Vasopressin is a hormone that is used to help the body retain water. 3. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Furosemide (Lasix) is a diuretic that will not treat diabetes insipidus. 4. The child is experiencing diabetes insipidus, a common occurrence in children with midline brain tumors. Dopamine (Intropin) is a beta-adrenergic agonist that is not used to treat diabetes insipidus. TEST-TAKING HINT: The test taker should be familiar with diabetes insipidus. The question describes its symptoms. Diabetes insipidus commonly occurs in children with midline brain tumors. The test taker can eliminate answers 1 and 3 because they increase diuresis, which needs to be avoided.

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

1. The incidence of CP has increased, partly as a result of the increased survival rate of extreme low-birth-weight and premature infants. 2. The incidence of CP has increased since the 1960s. 3. The incidence of CP has increased since the 1960s. 4. There is no evidence to suggest that CP has been diagnosed erroneously. TEST-TAKING HINT: The test taker should consider the causes of CP and be led to answer 1 because technology has increased the survival rate of low-birth-weight and premature infants. The test taker should resist the temptation to select answer 2 because it has not decreased as have many disorders.

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

1.Although many children with epilepsy require more than one medication to achieve seizure control, it is recommended that only one medication be started at a time so that the child's reaction to the specific medication can be observed. 2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels. 3. Rectal gels are used to stop a seizure once it has begun; they are not used to prevent seizures. 4. The route of choice for the prevention of seizures is oral. There is no reason to assume that compliance will be an issue prior to beginning anticonvulsant therapy. TEST-TAKING HINT: The test taker should eliminate answer 4 because IV medications are not included in the initial home medication regimen.

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

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

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

1, 2, 3, 4, 5. 1. Many metabolic disorders are associated with hypoglycemia. The hypoglycemic child experiences a decreased level of consciousness because the brain does not have stores of glucose. 2. Trauma can lead to generalized brain swelling with resultant increased ICP. 3. Hypoxemia leads to a decreased level of consciousness because the brain is intolerant to the lack of oxygen. 4. Dehydration can lead to inadequate perfusion to the brain, which can result in a decreased level of consciousness. 5. Endocrine disorders often result in a decreased level of consciousness because they can lead to hypoglycemia, which is poorly tolerated by the brain. TEST-TAKING HINT: Metabolic disorders, trauma, hypoxic episodes, dehydration, and endocrine disorders are examples of disorders that can alter a child's level of consciousness by either increasing ICP or decreasing the perfusion of blood to the brain.

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

1. "Coma" describes a state of consciousness in which the child is not responsive to any stimulation, including painful stimulation. 2. "Delirium" describes a state of consciousness in which the child is extremely confused and anxious. 3. "Obtunded" describes a state of consciousness in which the child has a limited response to the environment and can be aroused by verbal or tactile stimulation. 4. "Confusion" describes a state of consciousness in which the child is not oriented to person, place, and time. TEST-TAKING HINT: The test taker needs to be familiar with terms describing states of consciousness.

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

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

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

1. Administration of intravenous antibiotics should not be started until after all cultures have been obtained. 2. Administration of maintenance IV fluids can wait until after the cultures have been obtained. 3. Placement of a Foley catheter is not a priority procedure. 4. Cultures of spinal fluid and blood should be obtained, followed by administration of intravenous antibiotics. TEST-TAKING HINT: The test taker needs to think about priority of care. Answer 3 can be immediately eliminated because it is not a priority. Answer 4 should be considered a priority because antibiotics should not be started before the samples have been obtained and sent for culturing.

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

1. Although abdominal fullness is often seen, difficulty urinating is not a common symptom. 2. Bone manifestations are a sign of bone metastasis, which is not seen in the early stages of neuroblastoma. 3. The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue. 4. The signs and symptoms vary according to the location of the tumor. Generally, hunger and weight gain are not seen. TEST-TAKING HINT: The test taker should eliminate answer 2 because bone metastases are a late sign, and the test taker is looking for initial signs.

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

1. Although encephalitis is usually caused by a viral infection, the child is usually admitted for close observation. 2. Intravenous antibiotics are not given to the child with viral encephalitis. 3. The young child with encephalitis should be admitted to a PICU where close observation and monitoring are available. The child should be observed for signs of increased ICP and for cardiac and respiratory compromise. 4. The child would not be discharged because observation for complications is necessary. As a general rule, younger children tend to have more complications and require a PICU admission. TEST-TAKING HINT: The test taker should be familiar with the diagnosis and treatment of encephalitis. The test taker should not be influenced by the word "viral" but should realize that the sequelae of encephalitis require close monitoring in an ICU environment.

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

1. Although it is important to measure the head circumference of all babies, children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference. 2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference. 3. Although a defect in the spine can be a portal of entry for infection, children with myelomeningocele often have hydrocephalus as well. 4. Children with myelomeningocele are not at risk for microcephaly. TEST-TAKING HINT: The test taker should consider the diagnosis and choose a response that best fits the current diagnosis.

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

1. Although peers play an important role in the adolescent's development, this particular patient is at risk for increased ICP and should have decreased stimulation. 2. Loud talking may cause the child's ICP to increase. 3. A bright, lively environment may lead to increased ICP. 4. A dark, quiet environment and minimal stimulation will decrease oxygen consumption and ICP. TEST-TAKING HINT: The test taker should consider the causes of ICP and select answers that will not increase ICP. Answers 1, 2, and 3 cause an increase in ICP and should be eliminated.

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

1. An open anterior fontanel allows for swelling, therefore decreasing the risk of injury. 2. Insufficient musculoskeletal support and a disproportionate head size place the infant at risk because the head cannot be supported during a shaking episode. 3. Superficial veins and arteries do not place the infant at a higher risk for injury. 4. Although the myelination is immature, the immature musculoskeletal support places the infant at risk. TEST-TAKING HINT: Answer 3 should be eliminated because superficial vessels do not lead to SBS.

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

1. CP is a nonprogressive disorder. 2. CP can manifest in different ways as the child grows. It does not progress, but its clinical manifestations may change. 3. Children with CP have different abilities and needs. CP can result in mild to severe motor deficits; therefore, one treatment regimen cannot be used or recommended for all children. 4. Although braces may assist some children with ambulation, they will not be useful in all cases. TEST-TAKING HINT: The test taker can eliminate answers 3 and 4 because generalizations cannot be made regarding CP. Each child has different abilities and disabilities.

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

1. CP is diagnosed based on clinical characteristics and developmental findings. It is not diagnosed with any type of radiological examination. 2. Although most cases of CP occur in the neonatal period, some children can develop CP at a later age. 3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made. 4. Although many children develop CP after having complications of meningitis, many do not. Although the parents should not be given false hope, they should not be led to lose hope for a complete recovery. TEST-TAKING HINT: The test taker should be led to answer 3 because it explains the process and does not state that the child definitely will or will not develop CP.

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

1. Children with myelomeningocele are prone to latex allergies and therefore should not eat bananas. 2. Children with myelomeningocele are prone to latex allergies and therefore should not be exposed to balloons. 3. Preventing skin breakdown is important in the child with myelomeningocele because pressure points are not felt easily. 4. It is always important to provide education on dietary needs, but it is not the priority in the immediate postoperative period. TEST-TAKING HINT: The test taker should consider that children with myelomeningocele are prone to latex allergies and therefore should eliminate answers 1 and 2.

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

1. Even if the child is unresponsive, the child can still feel pain. 2. If pain medication is administered cautiously, the child can still be monitored and signs of improvement will be evident. 3. Pain medication promotes comfort and ultimately decreases ICP. 4. Pain medication decreases the demand for oxygen. TEST-TAKING HINT: The test taker needs to consider the presence and significance of pain in the unresponsive child. Answer 1 can be immediately eliminated because the unresponsive child does feel pain.

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

1. Isolation precautions must be maintained for at least the first 24 hours of intravenous antibiotic therapy. 2. Intravenous fluids at 1½ times regular maintenance could cause fluid overload and lead to increased ICP. 3. Neurological checks are usually made at least every hour. 4. Acetaminophen (Tylenol) is usually administered when the child has a fever, as increased temperature can lead to increased ICP. TEST-TAKING HINT: The test taker should consider the answers and eliminate those that may increase ICP. Intravenous fluids are often given at less than maintenance unless the child is hemodynamically unstable.

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

1. It is not a priority of care to find out if anyone else was injured. 2. Although open-ended questions are important, the nurse needs specific information, and the anxious parent may need to be guided during triage assessment. 3. Asking specific questions will give the nurse the information needed to determine the level of care for the child. 4. Although it is important to provide safety education, this information should be given in a nonjudgmental manner at a point when the parent and child are less stressed. TEST-TAKING HINT: The test taker needs to consider the role of a triage nurse to obtain specific information quickly. Answer 4 can be eliminated because it implies judgment and does not help the current situation.

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

1. Most 3-year-olds are not capable of naming the president. 2. Asking the 3-year-old to identify her parents and state her name is a developmentally appropriate way to assess orientation. 3. Many 3-year-olds are not familiar with their phone number or may not be able to share this information during a stressful time, such as hospitalization. 4. Many 3-year-olds do not know the current month. TEST-TAKING HINT: The test taker needs to be familiar with the concept of consciousness and applying normal developmental-specific age-groups.

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

1. Neuroblastoma is not always cured and can be fatal depending on the stage at diagnosis, site of origin, and the age of the child. 2. Infants younger than 1 year have the best prognosis. 3. Infants younger than 1 year have the best prognosis. 4. Although the prognosis varies with the site of origin, infants have the most favorable outcome. TEST-TAKING HINT: The question requires the test taker to be familiar with the prognosis of neuroblastoma.

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

1. Not all children who receive radiation experience learning disabilities. 2. Younger children tend to experience more learning difficulties than do older children. 3. Although variable, younger children tend to experience more learning difficulties than do older children. 4. Although variable, younger children tend to experience more learning difficulties than do older children. In infants, signs and symptoms may not be readily apparent because the open fontanel allows for expansion. TEST-TAKING HINT: The test taker should be familiar with radiation therapy. The test taker should be led to answers 3 and 4 because they both state that difficulties are variable.

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

1. Placing the child in the prone position is correct. A dry dressing may adhere to the defect, causing irritation. 2. A dry dressing may adhere to the defect, causing irritation. 3. Oral gastric feedings are not usually started unless there is going to be a delay in surgery. The defect is usually corrected within 24 hours to avoid infection. 4. The child is placed in the prone position to avoid any pressure on the defect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fluids are begun to prevent dehydration. TEST-TAKING HINT: The test taker can eliminate answer 2 because a dry dressing could cause irritation and stick to the sac.

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

1. School-age children feel more comfortable when parents are present and are more likely to cooperate with a neurological assessment. 2. Parents should be encouraged to remain with their child for mutual comfort. 3. Describing a policy is not sufficient and does not give the parents enough information. 4. School-age children feel more comfortable when parents are present and are more likely to cooperate with a neurological assessment. TEST-TAKING HINT: The test taker needs to be familiar with growth and development of children and applying theories to specific clinical situations.

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

1. Sharing information may not be helpful if the family is not ready to listen. 2. Sharing information may not be helpful if the family is not ready to listen. 3. The family may have other concerns that would be communicated through an openended question. 4. An open-ended question will encourage family members to share what they know and potentially clear up any misconceptions. TEST-TAKING HINT: The test taker should consider the principles of therapeutic communication. Answer 4 is an openended question that will not be perceived as judgmental and should elicit the most information.

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

1. Sign language may help the child with CP communicate and ultimately decrease frustration. Children with CP may have difficulty verbalizing because of weak tongue and jaw muscles. They may be able to have sufficient motor skills to communicate with their hands. 2. Sign language does not cause confusion and may help reinforce vocabulary and vocalization. 3. CP is manifested differently in all children; therefore, generalizations cannot be made. 4. The earlier sign language is taught, the more it will be beneficial. TEST-TAKING HINT: The test taker can immediately eliminate answer 3 because it makes a generalization. All forms of language are beneficial and well tolerated by children, especially young children.

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

1. The child is demonstrating a reflex called posturing. The parent should not be given any false hope that the child is responding at a higher level than is truly occurring. 2. The posturing reflex often indicates irritability, and the child should not continue to receive stimulation. 3. Posturing is a reflex, not a seizure. 4. Posturing is a reflex that often indicates that the child is receiving too much stimulation. TEST-TAKING HINT: The test taker needs to be familiar with caring for the comatose child and what causes posturing.

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

1. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 2. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 3. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to ischemia and brain damage. 4. Decreased perfusion of the brain and increased metabolic needs of the brain. TEST-TAKING HINT: The test taker needs to be familiar with the mechanics of a head injury.

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

1. The child with a neurogenic bladder will never be able to spontaneously empty it completely. Most children learn to self catheterize at a young age. 2. The child with a neurogenic bladder will never be able to spontaneously empty it completely. 3. Placing the child with a neurogenic bladder on a bladder training program is not helpful, because the child will never be able to spontaneously empty it completely. 4. A vesicostomy is an example of an option for children with myelomeningocele in which alternatives to traditional catheterizations are created. TEST-TAKING HINT: The test taker should recognize that the neurogenic bladder in a child with myelomeningocele is irreversible, and answers 2 and 3 should be eliminated.

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

1. The child with bacterial meningitis should be placed in a private room isolated from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other. 2. The child with bacterial meningitis should be placed in a private room isolated from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other. 3. A quiet private room with minimal stimulation is ideal because the child with meningitis should be in a quiet environment to avoid cerebral irritation. 4. A bright room with developmental activities may cause irritation and increase ICP. TEST-TAKING HINT: The test taker should consider what contributes to cerebral irritation and should not be influenced by the developmental requirements of a healthy child.

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

1. The food should be placed far back in the mouth to avoid tongue thrust. 2. The child should be placed in an upright position. 3. Soft and blended foods minimize the risk of aspiration. 4. Allowing the child time to feed minimizes the risk of aspiration. TEST-TAKING HINT: The test taker should consider which methods will decrease the risk of aspiration. Answers 2, 3, and 4 all decrease the risk of choking and should be eliminated.

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

1. The nurse cannot assume that the child will have speech difficulties. Speech therapy does not guarantee vocalization at a developmentally appropriate age. 2. Although speech therapy will assist with babbling at a later age, its primary purpose is to assist with feeding. 3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements. 4. Members of a multidisciplinary team become involved in a child's care based on specific needs, not hospital routine. TEST-TAKING HINT: The test taker should immediately eliminate answer 4 because it does not consider the child's individual needs.

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

1. The startle reflex is expected in an infant 1-month-old. 2. The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP. 3. Although many children walk before the age of 14 months, it is not considered a motor delay not to have achieved this milestone at this point. 4. Many 2-year-olds have not achieved bladder control. TEST-TAKING HINT: The test taker should be familiar with normal developmental milestones and eliminate answers 1, 3, and 4 because they are all developmentally appropriate.

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

1. There is an increased incidence of CP when the infant has an Apgar score of 3 or less at 5 minutes. 2. Any infection of the central nervous system increases the infant's risk of CP. 3. A febrile seizure does not increase the risk of CP. 4. Although head trauma can increase the risk of CP, the school-age child is not likely to develop CP from falling off a bike. TEST-TAKING HINT: The test taker should consider the risks for CP. Answers 3 and 4 should be eliminated because these symptoms are least likely to lead to CP.

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

1. These are symptoms of a shunt malfunction and should be evaluated immediately. 2. Although these symptoms may be associated with the start of a girl's menstrual cycle, they are symptoms of a shunt malfunction and require immediate evaluation. 3. A shunt can malfunction at any point and should be evaluated when signs of increased ICP are evident. 4. These are symptoms of a shunt malfunction and should be evaluated immediately. TEST-TAKING HINT: The test taker should recognize these symptoms as signs of a shunt malfunction and can eliminate answers 1, 2, and 3 because they do not address the situation as an emergency.

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

2, 3. 1. Some children with myelomeningocele experience learning disabilities, but it is not the most common complication. 2. Urinary tract infections are the most common complication of myelomeningocele. Nearly all children with myelomeningocele have a neurogenic bladder that leads to incomplete emptying of the bladder and subsequent urinary tract infections. Frequent catheterization also increases the risk of urinary tract infection. 3. About 90% to 95% of children with myelomeningocele experience hydrocephalus. 4. Children with myelomeningocele are at risk for skin breakdown and decubitus ulcers, but they are not the most common complications. 5. Nutrition issues can occur, but are not the most common complication. 6. Attention deficit disorders can occur, but are not the most common complications. TEST-TAKING HINT: The test taker needs to be familiar with the complications of myelomeningocele. Neurogenic bladder and hydrocephalus are the most common complications, so the test taker should be led to select answers 2 and 3.

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

3, 5. 1. The anterior fontanel is usually raised and bulging in infants with increased ICP. 2. The infant is not able to comprehend blurred vision or make any statements. 3. A high-pitched cry is often indicative of increased ICP in infants. 4. The infant with increased ICP usually has a poor appetite and does not feed well. 5. The infant may be sleeping more than usual because of increased ICP. TEST-TAKING HINT: The test taker needs to be familiar with hydrocephalus and how increased ICP is manifested in infants. Answer 2 can be eliminated because an infant cannot specifically verbalize.

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

3, 5. 1. The infant needs to wear the helmet 23 hours daily. It is removed for bathing but not sleeping. 2. The helmet is most effective when the child is younger because the bones in the skull are more malleable. The child is less likely to need the helmet when upright and mobile because there is less pressure in one area. 3. The helmet is worn 23 hours every day and removed only for bathing. 4. Most children wear the helmet for 3 months. 5. Most children gain some improvement from a helmet. TEST-TAKING HINT: The test taker should recognize that the helmet is worn 23 hours daily and can eliminate answer 1.