Peds Ch 38 TB and end of chapter questions

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 meningitidis

ANS: A

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to st 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

ANS: A

Phenytoin IV has been prescribed by health care provider for a child who has experienced a seizure. Before administering the drug what should the nurse do? A. Determine the IV fluid infusing is normal saline B. Assess the child's vital signs C. Monitor the electrolyte levels D. Start another IV with a large bore needle

ANS: A

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

ANS: A

The physician 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.

ANS: A

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

ANS: A, B, E

A hospitalized child is scheduled for magnetic resonance imaging (MRI) with contrast. What nursing intervention(s) will the nurse complete to ensure safety during the examination? Select all that apply. A. Place child in clothing with no metal B. Connect the child to a heart monitor C. Assess the IV site for patency D. Review any prescriptions for sedation E. Assess for a latex allergy

ANS: A, C, D

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 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."

ANS: B

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

ANS: B

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. What is the child's level of consciousness? A. Confusion B. Obtunded C. Stupor D. Coma

ANS: B

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

ANS: B

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"

ANS: C

As a result of seizure activity, a computed tomography (CT) scan was performed and showed 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

ANS: C

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

ANS: C

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 self-esteem because of his altered lifestyle D. Hyperventilation therapy to counteract the periods of decreased ooxygenation

ANS: C

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 condition? A. Neonatal conjunctivitis B. Facial deformities C. Intracranial hemorrhage D. Incomplete myelinization

ANS: C

A 16-year-old boy reports to the school nurse with 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"

ANS: D

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

ANS: D

A group of nursing students are reviewing information related to seizures that occur in st 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

ANS: D

A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would st 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

ANS: D

During class, a student states, "I didn't 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.

ANS: D

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.

ANS: D

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

ANS: D

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

ANS: D

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

ANS: A

1- When compared with adults, why are infants and children at an increased risk of head trauma? 1. The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed. 2. The development of the nervous system is complete at birth but remains immature. 3. The spine is very immobile in infants and young children. 4. The skull is more flexible due to the presence of sutures and fontanels.

ANS: 1- The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed

4- A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be 1. Educate the family on ways to prevent bacterial meningitis. 2. Initiate appropriate isolation precautions and begin intravenous antibiotics. 3. Assess the infant's fontanels. 4. Encourage the mother to hold the infant and feed her.

ANS: 2- Initiate appropriate isolation precautions and begin intravenous antibiotics.

2- At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds 1. Narrow sutures 2. Sunken fontanels 3. A rapid increase in head circumference 4. Increase in weight since last visit

ANS: 3- A rapid increase in head circumference

3- A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention? 1. Prevention of injury by removing the child from his bed 2. Prevention of injury by placing a tongue blade in the child's mouth 3. Prevention of injury by restraining the child 4. Prevention of injury by placing the child on his side and opening his airway

ANS: 4- Prevention of injury by placing the child on his side and opening his airway

A 10-month-old infant is brought to the emergency department by his parents after they found the infant face down in the bathtub. The parent states, "I just left the bathroom to answer the phone. When I came back, I found my infant." Which nursing action is priority? A. Assess the client's respiratory rate B. Start cardiopulmonary resusitative measures C. Determine how long the client was face down in the water D. Apply a heart monitor to the client

ANS: A

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

ANS: A

A child is in the emergency department with a head injury obtained in a motor vehicle crash. The glascow coma scale assessment is rated at 10 (3 eye opening, 3 motor, 4 verbal). How should the nurse interpret these findings? A. The child's eyes open to verbal stimuli, is confused and flexes with painful stimuli B. The child's eyes open spontaneously, able to localize pain and uses inappropriate words C. The child's eyes open to speech, is able to obey commands but is confused D. The child's eyes open to pain, opens to extension and says incomprehensible words

ANS: A

A child with a seizure disorder will be discharged home from the hospital on the drug levetiracetam. What discharge instruction is the most important for the nurse to provide the parent? A. Notify the health care provider if child experiences poor coordination B. Notify the health care provider if the number of seizures increases after 4 weeks C. Return to the clinic in 3 weeks for laboratory test to determine therapeutic level of the drug D. Do not to take two doses together if one dose is missed

ANS: A

A child with increased intracranial pressure is being treated with hyperentilation. The nurse understands that after this treatment: A. PaCO levels decrease, causing vasoconstriction. B. drainage of cerebrospinal fluid occurs. C. activity is controlled via a stimulator. D. hyperexcitability of the nerves is reduced.

ANS: A