Neurological Disorders

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:

Identify her parents and state her own name.

The nurse knows that young infants are at risk for injury from shaken baby syndrome (SBS) because:

They have insufficient musculoskeletal support and a disproportionate head-to-body ratio.

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.

Urinary tract infections. Hydrocephalus.

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:

"My child's 7-year-old brother is also at high risk for a febrile seizure."

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.

"The signs and symptoms vary depending on where the tumor is located, but typical symptoms include weight loss, abdominal distention, and fatigue."

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.

Daily head circumference measurements. MRI scan.

Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed?

Flat in the crib.

Select the best room assignment for a newly admitted child with bacterial meningitis.

Private room that is dark and quiet with minimal stimulation.

The nurse knows further education is needed about Reye syndrome when a mother states:

"I will give aspirin to my child to treat a headache."

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:

Improving and progressing to a less advanced stage of Reye syndrome.

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:

Obtunded

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.

Attempt to keep the environment dark and quiet and encourage minimal stimulation.

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?

Continue with all forms of spinal stabilization and administer high-dose methylprednisolone (Medrol) and ranitidine (Zantac).

To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available?

Glucose.

The diet that produces anticonvulsant effects from ketosis consists of:

High-fat and low-carbohydrate foods.

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply.

High-pitched cry. Sleeping more than usual.

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.

"It is a medication that will help control her spasms."

The parents of a child with altered consciousness ask if they can stay during the morning assessment. Select the nurse's best response.

"Most children feel more at ease when parents are present, so you are more than welcome to stay at the bedside."

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.

"Response varies with each child, but younger children who receive radiation tend to have some amount of learning disability later in life."

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?

"Tell me your thoughts about G-tubes."

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.

"The speech therapist will help with tongue and jaw movements to assist with feeding."

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:

Absence seizure.

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

Administer blow-by oxygen and call for additional help.

Which medication should the nurse anticipate administering first to a child in status epilepticus?

Administer rectal diazepam (Valium).

Which should be included in the plan of care for a child who has a neuroblastoma with metastasis to the bone marrow and pancytopenia?

Administer red blood cells.

A child recently diagnosed with epilepsy is being evaluated for anticonvulsant medication therapy. The child will likely be placed on which type of regimen?

One oral anticonvulsant medication to observe effectiveness and minimize side effects.

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?

Place a cooling blanket on the child.

Which is included in the plan of care for a newborn who has a myelomeningocele?

Place the child in the prone position with a sterile moist dressing over the defect. Begin intravenous fluids to prevent dehydration.

A child is being admitted with the diagnosis of meningitis. Select the procedure the nurse should do first:

Send the spinal fluid and blood samples to the laboratory for cultures.

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.

"He will wear the helmet 23 hours every day." "Most children gain some improvement."

Which is the nurse's best response to the parents of a neonate with a meningocele who ask what can they expect?

"After initial surgery to close the defect, most children experience no neurological dysfunction."

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.

"As your child grows, different muscle groups may need more assistance."

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:

"Babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size."

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?

"Did he vomit, have a seizure, or display any other behavior that was unusual when he woke up?"

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.

"Have the parents follow up with his health-care provider because this is likely an atonic seizure."

Which child is at increased risk for cerebral palsy (CP)?

A 17-day-old infant with group B Streptococcus meningitis.

Which child would likely have experienced a delay in the diagnosis of a brain tumor?

A 3-month-old, because signs and symptoms would not have been readily apparent.

Which child requires continued follow-up because of behaviors suspicious of cerebral palsy (CP)?

A 6-month-old who always reaches for toys with the right hand.

Which does the nurse include in the postoperative plan of care for a child with myelomeningocele following ligament release?

Assist the child to change positions to avoid skin breakdown.

The nurse is aware that cloudy cerebrospinal fluid (CSF) most likely indicates:

Bacterial meningitis.

Which activity should an adolescent just diagnosed with epilepsy avoid?

Being in a car at night.

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:

Brudzinski sign.

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?

Call for additional help and prepare to administer mannitol (Osmitrol).

Brain damage in a child who sustained a closed-head injury can be caused by which factor?

Decreased perfusion of the brain and increased metabolic needs of the brain.

The parent of an infant diagnosed with a neuroblastoma asks the nurse what the prognosis is. The nurse's best response is:

Excellent, because infants with a neuroblastoma have the best prognosis.

The nurse tells a family of a child with cerebral palsy (CP) that since the 1960s the incidence of CP has:

Increased.

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis?

Intravenous fluids at 1½ times regular maintenance.

Which is the best action for the nurse to take during a child's seizure?

Loosen the child's clothing, and call for help.

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:

May be a very beneficial way to help children with CP communicate.

Which has the potential to alter a child's level of consciousness? Select all that apply.

Metabolic disorders. Trauma. Hypoxic episode. Dehydration. Endocrine disorders.

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:

Myelomeningocele.

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?

Computed tomography (CT) scan of the head and dilation of the eyes.

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?

Vasopressin.

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.

"Pain medication is necessary to make him comfortable."

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.

"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."

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.

"You should immediately take her to the emergency department because these may be symptoms of a shunt malfunction."

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.

"Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving."

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.

"Your child will be closely monitored after discharge, and a developmental specialist will be able to make the diagnosis."

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.

"Your child will likely be admitted to the PICU for close monitoring and observation."

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.

"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."

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?

Place the food on the tip of the tongue.