[PEDIATRIC] Chapter 16, Nursing Care of Child With an Alteration in Intercranial Regulation/Neurologic Disorder

The healthcare provider has ordered rectal diazepam for a 2-year-old boy with status epilepticus. Which instruction is essential for the nurse to teach the parents? a. Monitor their child's level of sedation b. Watch for fever indicating infection c. Gradually reduce the dosage as seizures stop d. Monitor for an allergic reaction to the medication

a. Monitor their child's level of sedation

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? a. On her side with the head flexed forward and knees flexed to the abdomen b. Sitting upright with the head flexed forward to the chest c. Supine with arms and legs pronated and extended d. Prone with the arms flexed under the chest

a. On her side with the head flexed forward and knees flexed to the abdomen

A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands the need for this treatment is based on what? a. PaCO2 levels decrease, causing vasoconstriction. b. Drainage of cerebrospinal fluid occurs. c. Activity is controlled via a stimulator. d. Hyperexcitability of the nerves is reduced.

a. PaCO2 levels decrease, causing vasoconstriction.

The nurse is caring for a 19-month-old boy who has been admitted to the emergency department with a skull fracture. The parents state that the child fell down when running through the house and hit his head on the floor. Based on normal characteristics of skull fractures, what should be the initial focus of the assessment? a. Possible physical abuse b. Possible bone cancer c. Possible chronic neurologic disease d. Possible developmental delay

a. Possible physical abuse

A nurse is preparing a presentation for a local health fair about meningitis and has developed a display that lists the following causes: Streptococcus group B Haemophilus influenzae type B Streptococcus pneumoniae Neisseria meningitidis What would the nurse highlight as the most common cause of meningitis in newborns? a. Streptococcus group B b. Haemophilus influenzae type B c. Streptococcus pneumoniae d. Neisseria meningitides

a. Streptococcus group B

The community health nurse has just completed a presentation to a group of parents regarding drowning prevention. Which statements by the parents indicate understanding of the teaching? Select all that apply. a. "I am so glad our 6-year-old child had swim lessons. We really can't afford a fence around our pool." b. "Since we have a 16-year-old I am really concerned about supervision when our child is swimming in the ocean." c. "We always make sure our babysitter keeps her CPR training up to date." d. "It is scary to think that we have a pool and drowning is the second leading cause of accidental death in children." e. "We make sure to keep our bathroom door closed when our 10-month-old is walking around the house since the door handle is too high to reach."

b. "Since we have a 16-year-old I am really concerned about supervision when our child is swimming in the ocean." c. "We always make sure our babysitter keeps her CPR training up to date." d. "It is scary to think that we have a pool and drowning is the second leading cause of accidental death in children." e. "We make sure to keep our bathroom door closed when our 10-month-old is walking around the house since the door handle is too high to reach."

A child is brought to the emergency department after sustaining a concussion. The child is to be discharged home with his parents. What would the nurse include in the child's discharge instructions? a. "Expect his headache to get worse initially and then disappear." b. "Wake him every 2 to 4 hours to check his movement and responses." c. "Call your medical provider if he vomits more than five times." d. "Any watery fluid draining from his ears is normal."

b. "Wake him every 2 to 4 hours to check his movement and responses."

The nurse knows that children have larger heads in relation to the body and a higher center of gravity. When developing a teaching plan for parents, the nurse includes information about an increased risk for which problem? a. Febrile seizures b. Head trauma c. Caput succedaneum d. Posterior plagiocephaly

b. Head trauma

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. The nurse documents this finding as: a. Confusion b. Obtunded c. Stupor d. Coma

b. Obtunded

A 10-year-old boy is seen in the emergency department after falling down a flight of stairs and hitting his head. The child will be monitored overnight for complications. Which occurrence in the coming hours will warrant further assessment? a. The child reports a backache. b. The child is increasingly irritable with his mother and caregivers. c. The child refuses offers of snacks. d. The child reports his stomach is upset.

b. The child is increasingly irritable with his mother and caregivers.

During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The nurse is assessing which cranial nerve? a. Olfactory b. Trigeminal c. Facial d. Accessory

b. Trigeminal

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they make what statement? a. "Having the shunt put in decreases his risk for developmental problems." b. "If he doesn't get an infection in the first week, the risk is greatly reduced." c. "He will need more surgeries to replace the shunt as he grows." d. "The shunt will help to prevent any further complications from his disease."

c. "He will need more surgeries to replace the shunt as he grows."

As a result of seizure activity, a computed tomography (CT) scan was performed and indicated that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, what would the nurse expect to implement actions to prevent? a. Drug interactions b. Developmental disabilities c. Hemorrhagic stroke d. Respiratory paralysis

c. Hemorrhagic stroke

When providing care to a newborn infant who was born at 29 weeks' gestation, the nurse integrates knowledge of potential complications, being alert for signs and symptoms of what priority condition? a. Neonatal conjunctivitis b. Facial deformities c. Intracranial hemorrhage d. Incomplete myelinization

c. Intracranial hemorrhage

Hydrocephalus is suspected in a 4-month-old infant. Which would the nurse expect to assess? a. Sunken fontanels b. Diminished reflexes c. Lower extremity spasticity d. Skull symmetry

c. Lower extremity spasticity

The nurse is caring for an 8-year-old boy who has chronic epilepsy. What would be most important to address when teaching the child and parents about living with this condition? a. Multiple corrective surgeries to slowly remove diseased parts of his brain b. Physical, occupational, and speech therapy to maximize his potential c. Support for maintaining altered lifestyle d. Hyperventilation therapy to counteract the periods of decreased oxygenation

c. Support for maintaining altered lifestyle

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion? a. The child's risk for cognitive problems is greatly increased. b. Structural damage occurs with febrile seizure. c. The child's risk for epilepsy is now increased. d. Febrile seizures are benign in nature.

d. Febrile seizures are benign in nature.

A nurse is preparing a presentation for an expectant parent group about neural tube defects and how to prevent them. Which would the nurse emphasize? a. Smoking cessation b. Aerobic exercise c. Increased calcium intake d. Folic acid supplementation

d. Folic acid supplementation

During class, a student states, "I did not think children could have strokes. I thought this only occurred in older adults." When responding to the student, what would be most important for the instructor to integrate into the response? a. Strokes in children often have an identifiable cause. b. The signs and symptoms in children are different from an adult. c. Research has identified specific treatments for children. d. Ischemic strokes are more common than hemorrhagic strokes.

d. Ischemic strokes are more common than hemorrhagic strokes.

A group of nursing students are reviewing information related to seizures that occur in infants and children. The students demonstrate a need for additional review when they identify which type as common in neonates? a. Tonic b. Focal clonic c. Multifocal clonic d. Myoclonic

d. Myoclonic

What finding would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure? a. Bradycardia b. Cheyne-Stokes respirations c. Fixed, dilated pupils d. Projectile vomiting

d. Projectile vomiting

A 4-year-old boy has a febrile seizure during a well-child visit. What action would be a priority? a. Hyperextending the child's head while placing him on his side b. Using a tongue blade to pry open the child's jaw c. Loosening the child's clothing to ensure a patent airway d. Protecting the child from harm during the seizure

d. Protecting the child from harm during the seizure

The nurse has developed a teaching plan for the family of a 2-year-old boy who holds his breath when he gets frustrated. What will be most important to include in this plan? a. Provide cuddle time whenever the child begins to act out. b. Explain the child's behavior to the parents. c. Encourage the parents to interact more with the child. d. Stay close to prevent injury when he gets frustrated.

d. Stay close to prevent injury when he gets frustrated.

A 16-year-old boy reports to the school nurse reporting headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis? a. Fixed and dilated pupils b. Frequent urination c. Sunset eyes d. Sunlight is "too bright"

d. Sunlight is "too bright"

The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as: a. Decorticate posturing b. Nystagmus c. Doll's eye d. Sunsetting

d. Sunsetting

A group of students are reviewing information about head injuries in children. The students demonstrate understanding of this information when they identify what as the most common type of skull fracture in children? a. Linear b. Depressed c. Diastatic d. Basilar

a. Linear

A 10-month-old is brought to the emergency department by her parents after they found her face down in the bathtub. The mother said, "I just left the bathroom to answer the phone. When I came back, I found her." Which assessment would be the priority? a. Airway, breathing, and circulation b. Level of consciousness c. Vital signs d. Pupillary response

a. Airway, breathing, and circulation

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply. a. Complaints of stiff neck b. Photophobia c. Absent headache d. Negative Brudzinski sign e. Vomiting

a. Complaints of stiff neck b. Photophobia e. Vomiting

A 4-year-old boy has a history of seizures and has been started on a ketogenic diet. Which food selection would be most appropriate for his lunch? a. Fried eggs, bacon, and iced tea b. A hamburger on a bun, French fries, and milk c. Spaghetti with meatballs, garlic bread, and a cola drink d. A grilled cheese sandwich, potato chips, and a milkshake

a. Fried eggs, bacon, and iced tea

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for what finding? a. Indications of increased intracranial pressure b. An increase in the blood glucose level c. A decrease in the liver enzymes d. A presence of protein in the urine

a. Indications of increased intracranial pressure