Pediatric Nursing - Chapter 13

The nurse is doing health promotion education with a group of young women. Because of the risk of neural tube defects, the nurse should stress the importance of taking which supplement daily while of childbearing age? 1. Calcium 2. Magnesium 3. Folic acid 4. Iron

Answer 3 3. Because neural tube closure occurs before most women even know they are pregnant, it is important to teach adolescent girls to begin taking folic acid supplements of at least 0.4 mg per day before pregnancy occurs.

A child with 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 nurses best response. 1. "Give her some APAP, and see if the symptoms improve. If they do not improve bring her to the pediatricians office" 2. "It is common for girls to have these symptoms. especially prior to their menstrual period, 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 as it has been working well for 9 years" 4. "You should immediately take her to the ER as these may be symptoms of a shunt malfunction."

ANSWER 4 4. These are symptoms that the shunt malfunctioned and should be evaluated immediately.

An infant is born with a sac protruding through the spine, containing 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

Answer 2. 2. A myelomeningocele is a sac that contains a portion of the meninges, the CSF, and the nerve roots

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-ray 2. Daily head circumference measurements 3. MRI scan 4. Vital signs every 6 hours 5. Holding to breasfeed

ANSWER: 2, 3 2. Daily head circumference to assess for hydrocephalus 3. Diagnostic tests include MRI, CT, ultrasound, and myelography.

Select the best room assignment for a newly admitted child with bacterial meningitis. 1. Semiprivate room with roommate who also has bacterial meningitis. 2 Semiprivate room with roommate who has bacterial meningitis but has received IV antibiotics for > 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.

Answer: 3 3. A quiet private room with minimal stimulation is ideal as the child with meningitis should be in a quiet environment to avoid cerebral irritation.

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

Answer: 3, 5 Both answers indicate increased ICP

A 2-month-old infant is brought to the ER 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 cough. What additional testing should the nurse prepare for? 1. CT scan of the head and dilation of the pupils 2. CT scan of the head and EEG 3. X-ray of the head 4. X-ray of all long bones

Answer 1 1. A 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 experienced SBS.

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 febrile seizure 3. I'll give my child APAP when ill to prevent the fever from rising to high to fast. 4. Most children with febrile seizures do not require seizure medication

Answer: 2 2. Most children over the age of 5 do not have febrile seizures.

To treat a common manifestation of Reye syndrome, which medication would the nurse expect to have readily available? 1. Lasix 2. Insulin 3. Glucose 4. Mso4

Answer: 3 3. A common manifestation is hypoglycemia, which is treated with IV glucose.

The nurse is giving medications to an adolescent with cerebral palsy (CP). What symptom(s) do a majority of the CP medications target? 1. Decreased cardiac output 2. Muscle spasm and spasticity 3. Respiratory compromise 4. Muscle atrophy

Answer 2 2. About 70% of children affected with cerebral palsy have the spastic type. Most medications target those symptoms.

The nurse prepares to administer baclofen to a child with CP who just had her hamstring surgically released. The parents ask what its for 1. Will help to decrease pain after surgery 2. Will prevent her from having seizures 3. Will help control her spasms. 4. Will help with bladder control

Answer 3 3. Baclofen is given to help control spasms associated with CP

A child with seizure d/o 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

Answer 1 1. Absence seizures occur frequently and last < 30 seconds. The child experiences brief LOC 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.

A preschooler has been having periods during which he suddenly falls and appears to be weak for a short time after the event. The teacher asks what should she do? 1. Have the parents f/u with his pediatrician as this is likely an atonic seizure. 2. Find out if there have been any new stressors in his life as it could be attention seeking behavior 3. Have the parents f/u with his pediatrician as this is likely an absence seizure 4. The preschool years are a time of rapid growth, and many children appear clumsy. Watch him and see if it continues.

Answer 1 1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall on the ground

The nurse notes that a client with cerebral palsy has difficulty with balance and illegible writing. For which type of cerebral palsy should the nurse plan care for this client? 1. Ataxic 2. Mixed 3. Spastic 4. Athetoid

Answer 1 1. Ataxic cerebral palsy causes problems with balance and coordination, especially with purposeful movements like writing or reaching for objects.

Which is the nurse's best response to the parents of a neonate with meningocele who ask what they can 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 initial surgery the child will likely have motor and sensory deficits 4. After initial surgery the child will likely have problems with urinary and bowel continence

Answer 1 1. Because a meningocele does not contain nerve endings most children experience no neurological problems after surgical correction.

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. Kerning sign 4. Nuchal rigidity

Answer 1 1. Brudzinski sign occurs when the child responds to a flexed neck with involuntary flexion of the hips and/or knees

The nurse is caring for an unconscious 6-year-old who has had a severe closed-head injury and notes the following changes. HR dropped from 120 to 55, B/P increased from 110/44 to 195/62, respirations are more irregular. Which should the nurse do after calling the physician? 1. Call for additional help, and prepare to administer mannitol 2. Continue to monitor V/S and prepare to administer a bolus of isotonic fluid 3. Call for additional help, and prepare to administer antihypertensive 4. Continue to monitor and administer supplemental o2

Answer 1 1. Cushing's triad is characterized by a decrease in HR, and increase in BP, and changes in respirations. This is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease ICP

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.

Answer 1 1. High fat and low carb are the components of a ketogenic diet

The nurse tells a family of a child with cerebral palsy that since the 1960's the incidence of CP has? 1. Increased 2. Decreased 3. Remained the same 4. Has decreased d/t early misdiagnosis.

Answer 1 1. Incidence has increased partly d/t increased survival of extreme low-birth-weight and premature infants.

The parents of a 12 month old with 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 vocalize 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

Answer 1 1. Sign language may help the child with CP communicate and decrease frustration. These children have difficulty due to weak jaw and tongue muscles, but they may have sufficient motor skills to communicate with their hands.

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, Asses the child's temperature and blood pressure

Answer 1 1. The child experiencing a seizure generally requires more o2 as the seizure increases the metabolic rate and demand for o2. The seizure may also affect the child's airway, causing hypoxia. It is always appropriate to give the child blow-by-oxygen immediately. The nurse should remain with the patient and call for additional help

The parents of a child with 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. Feeds the child slowly

Answer 1 1. The food should be placed far back in the mouth to avoid tongue thrust.

The school nurse is being consulted by a teacher with concerns about a student who is doing poorly in class. The student stares off into space regularly and is unable to recall information that was just discussed. What disorder should the nurse suspect? 1. Myoclonic seizures 2. Absence seizures 3. Febrile seizures 4. Tonic-clonic seizures

Answer 2 2. Absence seizures used to be called "petit mal" seizures and are characterized by loss of awareness but no tonic-clonic movements. The child appears to be staring into space or daydreaming. Sometimes small movements may be present with absence seizures. The child may have problems with learning because he or she misses information in school when seizures occur.

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

Answer 2 2. Any infection of the CNS increases risk for CP

A child with CP has been fitted for braces and is beginning PT to assist with ambulation. The parents ask why he needs the braces when he was crawling without any assistive devices. Best reply 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 races to help with ambulation 4. We have found that when children with CP use braces. they are less likely to fall.

Answer 2 2. CP can manifest in different ways as the child grows, it does not progress but its manifestations may change

The nurse is caring for an infant with myelomeningocele. The parents ask why the nurse keeps measuring the babies head circumference. Select the best response. 1. Babies heads are measure to ensure growth is on track 2. Babies with 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 should up as increased head size 4. Many infants with myelomeningocele have microcephaly, which can show up as a decreased head size

Answer 2 2. Children with myelomeningocele are at increased risk for hydrocephalus which = increased head size.

A nurse in the emergency department (ED) is assessing a pre-school age client who had a febrile seizure at home. The parent is very concerned and asks the nurse if this is very serious. How should the nurse respond? 1. "Yes, the child is likely to get brain damage when a fever gets too high." 2. "Generally they are not. But it is best to treat a fever when it starts." 3. "No, they don't cause any issues." 4. "Yes, you should consider this a medical emergency any time something like this occurs."

Answer 2 2. Febrile seizures are convulsions triggered by a rise in body temperature. These seizures are common in children of ages 3 months to 5 years and are twice as common in boys as in girls. These seizures are infrequent, last less than 5 minutes, and typically do not cause brain injury or increase the risk of epilepsy. Parent/caregiver education should include treating a fever at its beginning.

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

Answer 2 2. Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates

Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis 1. Maintain isolation precaution until 24 hours after receiving IV abx 2 IV fluids at 1.5 times regular maintenance 3. Neurological checks every hour 4. Administer APAP for temperature > 100.4

Answer 2 2. IV fluid at 1.5 times regular could cause fluid overload and lead to increased ICP

A parent with a newborn diagnosed with myelomeningocele asks what is a common long-term complication? The nurses best response is: 1. Learning disabilities 2. Urinary tract infections 3. Hydrocephalus 4. Decubitus ulcers and skin breakdown

Answer 2 2. Nearly all children with myelomeningocele have neurogenic bladder that leads to incomplete emptying of the bladder and subsequent UTI

A child recently diagnosed with epilepsy is being evaluated for anticonvulsant med therapy. The child will likely be placed on which type of regimen? 1. Two to three oral anticonvulsants so that dosing can be low and s/e minimal 2. One oral anticonvulsant to observe effectiveness and minimize s/e 3. one rectal gel to be administered in the event of a seizure. 4. A combination of oral and IV anticonvulsants to ensure compliance

Answer 2 2. One medication is the preferred way to achieve seizure control. The child is monitored for s/e and drug levels.

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

Answer 2 2. Rectal diazepam is 1st administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.

The nurse is aware that cloudy cerebrospinal fluid most likely indicates 1. Viral meningitis 2. Bacterial meningitis 3. No infections, as CSF is usually cloudy 4. Sepsis

Answer 2 2. The CSF in bacterial meningitis is usually cloudy

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

Answer 2 2. The clinical characteristic of hemiplegia can be manifested by the early preference of one hand. This may be an early sign of CP

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 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 IV line

Answer 2 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.

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

Answer 2 2. The rhythmic reflection of other car lights can trigger a seizure in some children

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 and products containing ASA 3. I will give ASA to my child to treat a headache 4. Children with Reye syndrome are admitted to the hospital.

Answer 3 3. Giving ASA has been associated with development of Reye syndrome. HA can be the 1st sign of a viral illness followed by other symptoms.

The nurse in the emergency department (ED) is assessing a school-age child with a new ventriculoperitoneal (VP) shunt. The child is being seen for lethargy, irritability, vomiting, severe headache, and a fever of 102.4°. What initial action should the nurse expect would be taken? 1. An admission to the hospital for IV fluids and monitoring 2. Give mannitol for increased intracranial pressure. 3. Obtain a CT scan of the brain with X-rays of the chest and abdomen. 4. A surgical intervention for hydrocephalus

Answer 3 3. If a child has an implanted (VP) shunt but develops symptoms of hydrocephalus or a shunt failure, a CT scan of the brain with X-rays of the chest and abdomen must be performed to assess the patency and function of the shunt catheters.

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

Answer 3 3. Prevention of skin breakdown is important as pressure points are not easily felt

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 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 advance stage of Reye syndrome 4. Improving as the child's posturing reflexes are similar

Answer 3 3. Progression from decerebrate to decorticate posturing usually indicates an improvement in the child's condition

The parents of a child with meningitis and multiple seizures as if the child will likely develop CP, select the nurses best reply. 1. When your child is stable, she'll undergo a CT and MRI, the physician will be able to tell you if she has CP 2. Most children do not develop cerebral palsy at this late age 3. Your child will be closely monitored after discharge, a developmental specialist will be able to make the diagnosis 4. Most children who have had complications following meningitis develop some amount of CP

Answer 3 3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made

A preschool-age client begins to experience a tonic-clonic seizure. What action should the nurse take first? 1. Apply oxygen. 2. Support the head. 3. Position the client on the side. 4. Place a padded tongue blade in the mouth.

Answer 3 3. The client should be turned to on the side when experiencing a seizure to help the airway remain open and allow fluids or emesis to drain from the mouth.

The nurse is caring for a 2 month old infant who is at risk for CP d/t extreme low birth weight and prematurity. His parents ask why a speech therapist is involved in his care. Select the best response. 1. Your child 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.

Answer 3 3. The infant with CP may have weakened and uncoordinated tongue and jaw movements. ST can help strengthen these

The nurse is visiting the home of a school-age child who is recovering from shunt placement for hydrocephalus. Which assessment finding indicates that the shunt is draining too aggressively? 1. Fever 2. Lethargy 3. Dizziness 4. Severe headache

Answer 3 3. The nurse should monitor for signs that the shunt is draining the ventricles too aggressively. Symptoms of too much drainage include headache, nausea, and dizziness.

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 best response. 1. Your child will likely be sent home b/c encephalitis is usually caused by a virus and not bacteria. 2. Your child will likely be admitted to the peds floor for IV abx 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 b/c she is only 1. We see fewer complications and a shorter disease process in the younger child

Answer 3. 3. The young child with encephalitis should be admitted to a PICU to be observed for s/s of increased ICP and for cardiac and respiratory compromise

The nurse is caring for a child with CP whose weight is in the fifth percentile and who has been hospitalized for aspiration PNA. His parents are anxious and state that they do not want a g-tube place. What is the nurses best response? 1. A g-tube will help your son gain weight and reduce his risk for future hospitalization d/t PNA 2. G-tubes are very easy to care for and will make feeding time easier for you and 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.

Answer 4 4. An open-ended question will encourage family members to share what they know and potentially clear any misconceptions.

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

Answer 4 4. Cultures of spinal fluid and blood should be obtained , followed by administration of IV abx

Which is included in the plan of care for a newborn who has myelomeningocele? 1. Child in prone position, sterile dry dressing over defect, slowly begin oral gastric feedings to prevent necrotizing enterocolitis 2. Child in prone position, sterile dry dressing over defect, begin IV fluids to prevent dehydration 3. Child in prone position, sterile moist dressing over defect, slowly begin oral gastric feeding to prevent necrotizing enterocolitis 4. Child in prone position, sterile moist dressing over defect, begin IV fluids to prevent dehyrdration

Answer 4 4. Prone to avoid pressure on defect, sterile moist dressing to keep defect as clean as possible, IVF to prevent dehydration