PEDS Neurological questions
A nurse is caring for a child who has Cerebral palsy. Which of the following medications should the nurse expect to administer to treat painful muscle spasma? SATA
1. Baclofen 2. Diazepam 3. Oxybutynin 4. Methotrexate 5. Prednisone Answer: 1, 2
The pediatric unit charge nurse is working with a newly graduated RN who has been on orientation in the unit for 2 months. Which patient should the charge nurse assign to the new RN?
1. a 2 year old patient with a ventricular septal defect for whom digoxin 90 mcg by mouth has been prescribed 2. A 4 year old patient who had a pulmonary artery banding and has just been transferred in from the ICU 3. a 9 year old with mitral valve endocarditis whose parents need teaching about IV antibiotic administration 4. A 16 year old patient with a heart transplant who was admitted with a low grade fever and tachycardia Answer: 1
After getting change of shift report, which patient should the nurse assess first?
1. an 18 month old patient with coarctation of the aorta who has decreased pedal pulses 2. a 3 year old patient with rheumatic fever who reports severe knee pain 3. a 5 year old patient with endocarditis who has crackles audible throughout both lungs 4. an 8 year old patient with Kawasaki disease who has a temp of 102.2 Answer: 3
A nurse is caring for an infant who has a myelomeningocele. Which of the following actions should the nurse include in the preoperative plan of care?
1. assist the mother with cuddling the infant 2. assess the infants temp rectally 3. place the infant in a supine postition 4. apply a sterile, moist, dressing on the sac Answer: 4
The nurse is caring for a newborn with a myelomeningocele who is awaiting surgical closure of the defect. Which assessment finding is of most concern?
1. bulging of the sac when the infant cries 2. oozing of stool from the anal sphincter 3. flaccid paralysis of both legs 4. temperature of 101.8 Answer: 4
A nurse is caring for a school age child who has juvenile idiopathic arthritis. which of the following home care instructions should the nurse include in the teaching? SATA
1. provide extra time for completing ADLs 2. Use cold compresses for joint pain 3. take ibuprofen on an empty stomach 4. remain home during periods of exacerbation 5. perform ROM exercises Answer: 1, 5
A nurse is caring for a child who has muscular dystrophy. for which of the following findings should the nurse assess? SATA
1. purposeless, involuntary, abnormal movements 2. spinal defect and sac-like protrusion 3. muscular weakness in lower extremities 4. unsteady, wide based or waddling gait 5. upward slant to the eyes Answer: 3, 4
A nurse is developing a plan of care for a toddler who has cerebral palsy. Which of the following actions should the nurse include?
1. structure interventions according to the toddler's chronological age 2. Evaluate the toddler's need for an evaluation of hearing ability 3. monitor the toddlers pain level routinely using a numeric rating scale 4. provide total care for daily hygiene activities Answer: 2
The nurse obtains this information when assessing a 3 year old patient with uncorrected tetralogy of fallot who is crying. Which findings requires immediate action?
1. the apical pulse rate is 118 2. a loud systolic murmur is heard in the pulmonic area 3. there is marked clubbing of the child nail beds 4 the lips and oral mucosa are dusky in color Answer: 4
The nurse is obtaining the history and physical information for a child who is recovering from Kawasaki disease and receives aspirin therapy. Which information concerns the nurse the most?
1. the child attends a day care center 5 days a week 2. the childs fingers have areas of peeling skin 3. the child is very irritable and cries frequently 4. the child has not received any immunization Answer: 4
A 6 year old girl arrives at the ER with her parents. She hit her head when she fell from the jungle gym in the school playground. Which questions are appropriate fro the nurse to ask to assess the child's neurologic status? SATA
1. what is your home address 2. what time does your family eat dinner 3. what grade are you in 4. what is your teachers name 5. what time did you fall 6. what is the name of your school Answer: 1, 3, 4, 6
The nurse notes that an infant with the diagnosis of hydrocephalus has a head that is heavier than that of the average infant. The nurse should determine that special safety precautions are needed when moving the infant with hydrocephalus. Which statement should the nurse plan to include in the discharge teaching with the parents to reflect this safety need?
1."Feed your infant in a side-lying position." 2."Place a helmet on your infant when in bed." 3."Hyperextend your infant's head with a rolled blanket under the neck area." 4."When picking up your infant, support the infant's neck and head with the open palm of your hand." Answer: 4
A nursing student is assisting a school nurse in performing scoliosis screening on the children in the school. The nurse assesses the student's preparation for conducting the screening. The nurse determines that the student demonstrates understanding of the disorder when the student states that scoliosis is characterized by which finding?
1.Abnormal lateral curvature of the spine 2.Abnormal anterior curvature of the lumbar spine 3.Excessive posterior curvature of the thoracic spine 4.Abnormal curvature of the spine caused by inflammation Answer: 1
A child is admitted to the hospital with a diagnosis of acute bacterial meningitis. In reviewing the health care provider's prescriptions, which would the nurse question as appropriate for a child with this diagnosis?
1.Administer an oral antibiotic. 2.Maintain strict intake and output. 3.Draw blood for a culture and sensitivity. 4.Place the child on droplet precautions in a private room. Answer: 1 Administered IV route, not orally
The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysiological process?
1.An infectious disease of the central nervous system 2.An inflammation of the brain as a result of a viral illness 3.A chronic disability characterized by impaired muscle movement and posture 4.A congenital condition that results in moderate to severe intellectual disabilities Answer: 3
The nurse is assessing a child with increased intracranial pressure. On assessment, the nurse notes that the child is now exhibiting decerebrate posturing. The nurse should modify the client's plan of care based on which interpretation of the client's change?
1.An insignificant finding 2.An improvement in condition 3.Decreasing intracranial pressure 4.Deteriorating neurological function Answer: 4
A child is diagnosed with Reye's syndrome. The nurse creates a nursing care plan for the child and should include which intervention in the plan?
1.Assessing hearing loss 2.Monitoring urine output 3.Changing body position every 2 hours 4.Providing a quiet atmosphere with dimmed lighting Answer: 4
The nurse is creating a plan of care for a newborn infant with spina bifida (myelomeningocele type). The nurse includes assessment measures in the plan to monitor for increased intracranial pressure. Which assessment technique should be performed that will best detect the presence of an increase in intracranial pressure?
1.Check urine for specific gravity. 2.Monitor for signs of dehydration. 3.Assess anterior fontanel for bulging. 4.Assess blood pressure for signs of hypotension. Answer: 3
A lumbar puncture is performed on a child suspected to have bacterial meningitis, and cerebrospinal fluid (CSF) is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis?
1.Clear CSF, decreased pressure, and elevated protein level 2.Clear CSF, elevated protein, and decreased glucose levels 3.Cloudy CSF, elevated protein, and decreased glucose levels 4.Cloudy CSF, decreased protein, and decreased glucose levels Answer: 3
The nurse is caring for an infant with spina bifida (myelomeningocele type) who had the sac on the back containing cerebrospinal fluid, the meninges, and the nerves (gibbus) surgically removed. The nursing plan of care for the postoperative period should include which action to maintain the infant's safety?
1.Covering the back dressing with a binder 2.Placing the infant in a head-down position 3.Strapping the infant in a baby seat sitting up 4.Elevating the head with the infant in the prone position Answer: 4
The nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit. The nurse prepares for the child's arrival and plans to implement which type of precautions?
1.Enteric 2.Contact 3.Droplet 4. Neutropenic Answer: 3
The nurse is providing instructions to the parents of an infant with a ventriculoperitoneal shunt. The nurse should include which instruction?
1.Expect an increased urine output from the shunt. 2.Notify the health care provider if the infant is fussy. 3.Call the health care provider if the infant has a high-pitched cry. 4.Position the infant on the side of the shunt when the infant is put to bed. Answer: 3
The nurse is assigned to care for a child with a brain injury who has a temporal lobe herniation and increasing intracranial pressure. Which signs should the nurse identify as indicative of this type of injury? Select all that apply.
1.Flaccid paralysis 2.Pupil response to light 3.Ipsilateral pupil dilation 4.Compression of the sixth cranial nerve 5.Shifting of the temporal lobe laterally across the tentorial notch Answer: 1, 3, 5 Temporal lobe herniation or uncal herniation refers to a shifting of the temporal lobe laterally across the tentorial notch. This produces compression of the third cranial nerve and ipsilateral pupil dilation. If pressure continues to rise, flaccid paralysis, pupil fixation, and death will result.
The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing?
1.Flaccid paralysis of all extremities 2.Adduction of the arms at the shoulders 3.Rigid extension and pronation of the arms and legs 4.Abnormal flexion of the upper extremities and extension and adduction of the lower extremities Answer: 3
The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. Which assessment finding should the nurse expect if this type of posturing is present?
1.Flexion of the upper extremities and extension of the lower extremities. 2.Unilateral or bilateral postural change in which the extremities are rigid. 3.Abnormal extension of the upper and lower extremities with some internal rotation. 4.Arms are adducted with fists clenched, and the legs are flaccid with external rotation. Answer: 3
The nurse is monitoring an infant for signs of increased intracranial pressure. On assessment of the fontanelles, the nurse notes that the anterior fontanelle bulges when the infant is sleeping. Based on this finding, which is the priority nursing action?
1.Increase oral fluids. 2.Document the finding. 3.Notify the health care provider. 4.Place the infant supine in a side-lying position. Answer: 3
The nurse is providing home care instructions to the mother of a child who is recovering from Reye's syndrome. Which instruction should the nurse provide to the mother?
1.Increase stimuli in the home environment. 2.Avoid daytime naps so that the child will sleep at night. 3.Give the child frequent small meals, if vomiting occurs. 4.Check the skin and eyes every day for a yellow discoloration. Answer: 4 Checking for jaundice will assist in identifying the presence of liver complications, which are characteristic of Reye's syndrome. Decreasing stimuli and providing rest decrease stress on the brain tissue. If vomiting occurs in Reye's syndrome, it is caused by cerebral edema and is a sign of intracranial pressure.
The nurse caring for a child who has sustained a head injury in an automobile crash is monitoring the child for signs of increased intracranial pressure (ICP). For which early sign of increased ICP should the nurse monitor?
1.Increased systolic blood pressure 2.Abnormal posturing of extremities 3.Significant widening pulse pressure 4.Changes in level of consciousness Answer: 4
The nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled for surgical closure of the sac. In the preoperative period, which is the priority problem?
1.Infection 2.Choking 3.Inability to tolerate stimulation 4.Delayed growth and development Answer: 1
The nurse assists a health care provider in performing a lumbar puncture on a 3-year-old child with leukemia in whom central nervous system disease is suspected. In which position will the nurse place the child during this procedure?
1.Lithotomy position 2.Modified Sims' position 3.Lateral recumbent position with the knees flexed and chin resting on the chest 4.Prone with knees flexed to the abdomen and head bent with chin resting on the chest Answer: 3
The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care?
1.Maintain enteric precautions. 2.Maintain neutropenic precautions. 3.No precautions are required as long as antibiotics have been started. 4.Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics. Answer: 4
The nurse notes documentation that a child is exhibiting an inability to flex the leg when the thigh is flexed anteriorly at the hip. Which condition does the nurse suspect? 1.
1.Meningitis 2.Spinal cord injury 3.Intracranial bleeding 4.Decreased cerebral blood flow Answer: 1
The nurse creates a plan of care for a child with Reye's syndrome. Which priority intervention should the nurse include in the plan of care?
1.Monitor for signs of increased intracranial pressure. 2.Immediately check the presence of protein in the urine. 3.Reassure the parents hyperglycemia is a common symptom. 4.Teach the parents signs and symptoms of a bacterial infection. Answer: 1
A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP?
1.Nausea 2.Irritability 3.Headache 4.Bradycardia Answer: 4
The nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle crash for signs of increased intracranial pressure (ICP). The nurse should assess the child frequently for which early sign of increased ICP?
1.Nausea 2.Papilledema 3.Decerebrate posturing 4.Alterations in pupil size Answer: 1
The community health nurse is providing information to parents of children in a local school regarding the signs of meningitis. The nurse informs the parents that the classic signs/symptoms of meningitis include which findings?
1.Nausea, delirium, and fever 2.Severe headache and back pain 3.Photophobia, fever, and confusion 4.Severe headache, fever, and a change in the level of consciousness Answer: 4
The nurse is reviewing a chart for a child with a head injury. The nurse notes that the level of consciousness has been documented as obtunded. Which finding should the nurse expect to note on assessment of the child?
1.Not easily arousable and limited interaction 2.Loss of the ability to think clearly and rapidly 3.Loss of the ability to recognize place or person 4.Awake, alert, interacting with the environment Answer: 1
The nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the health care provider's (HCP's) prescriptions and should contact the HCP to question which prescription?
1.Obtain daily weight. 2.Provide clear liquid intake. 3.Nasotracheal suction as needed. 4.Maintain a patent intravenous line. Answer: 3
The nurse is caring for a child who sustained a head injury after falling from a tree. On assessment of the child, the nurse notes the presence of a watery discharge from the child's nose. The nurse should immediately test the discharge for the presence of which substance?
1.Protein 2.Glucose 3.Neutrophils 4.White blood cells Answer: 2
The nurse caring for an infant with a diagnosis of hydrocephalus should monitor the infant for which sign of increased intracranial pressure?
1.Proteinuria 2.Bradycardia 3.A drop in blood pressure 4.A bulging anterior fontanel Answer: 4
The nurse is assessing for Kernig's sign in a child with a suspected diagnosis of meningitis. Which action should the nurse perform for this test?
1.Tap the child's facial nerve and assess for spasm. 2.Compress the child's upper arm and assess for tetany. 3.Bend the child's head toward the knees and hips and assess for pain. 4.Raise the child's leg with the knee flexed and then extend the leg at the knee and assess for pain. Answer: 4
An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period?
1.Test the urine for protein. 2.Reposition the infant frequently. 3.Provide a stimulating environment. 4.Assess blood pressure every 15 minutes. Answer: 2
Cerebral palsy (CP) is suspected in a child and the parents ask the nurse about the potential warning signs of CP. The nurse should provide which information? Select all that apply.
1.The infant's arms or legs are stiff or rigid. 2.A high risk factor for CP is very low birth weight. 3.By 8 months of age, the infant can sit without support. 4.The infant has strong head control but a limp body posture. 5.The infant has feeding difficulties, such as poor sucking and swallowing. 6.If the infant is able to crawl, only one side is used to propel himself or herself. Answer: 1, 2, 5, 6 Cerebral palsy (CP) is a term applied to a disorder that impairs movement and posture. The effects on perception, language, and intellect are determined by the type that is diagnosed. Stiff, rigid arms and legs, low birth weight, poor sucking and swallowing, and inability to crawl properly are potential warning signs of CP. By 8 months of age, if the infant cannot sit up without support, this would be considered a potential warning sign, because this developmental task should be completed by this time. The infant with a potential diagnosis of CP has poor head control by 3 months of age, when head control should be strong.
The nurse is monitoring a child with a brain tumor for complications associated with increased intracranial pressure. Which finding, if noted by the nurse, would indicate the presence of diabetes insipidus?
1.Weight gain 2.Hypertension 3.High urine output 4.Urine specific gravity greater than 1.030 Answer: 3
A 7-month-old male infant diagnosed with spastic cerebral palsy is seen by the nurse in the clinic. Which statement by the parent warrants immediate intervention by the nurse?
A. "My son often chokes while I am feeding him." B. "Is it normal for my child's legs to cross each other?" C. "He gets stiff when I pull him up to a sitting position." D. "My 4-year-old son is jealous of his little brother." Answer: A Airway obstruction is always a priority when caring for any client. Options B and C are characteristics of spastic cerebral palsy and may involve one or both sides. These children have difficulty with fine motor skills, and attempts at motion increase abnormal postures. Option D is an expected behavior and may need to be addressed, but it is not a priority over choking.
The nurse is examining a male child experiencing an exacerbation of juvenile rheumatoid arthritis (JRA) and notes that his mobility is greatly reduced. What is the most likely cause of the child's impaired mobility?
A. Pathologic fractures B. Poor alignment of joints C. Dyspnea on exertion D. Joint inflammation Answer: D Joint inflammation and pain are the typical manifestations of an exacerbation of JRA. Options A, B, and C are not specifically related to JRA.
The nurse assigns an unlicensed assistive personnel (UAP) to provide morning care to a newly admitted child with bacterial meningitis. What is the most important instruction for the nurse to review with the UAP?
A. Use designated isolation precautions. B. Keep the lighting in the room dim. C. Allow the parents to assist with care. D. Report any pain that the child experiences. Answer: A All these are important measures to review with the UAP, but the most important is option A. Improper use of isolation precautions can place other staff and clients at risk for infection. Options B, C, and D promote client comfort and reduce anxiety but are of a lower priority than option A.