Peds Success: Neurological

A preschooler has been having periods during which he suddenly falls and appears to be weak for a short period of time after the event. The preschool teacher asks what she should do. Select the nurses best response. 1. "Have the parents follow-up with this health-care provider because this is likely an atonic seizure." 2. "Find out if there have been any new stressors in his life because it could be attention-seeking behavior." 3. "Have the parents follow up with his health-care provider because 4. "The preschool years are time of rapid growth, and many children appear clumsy. It would be best to watch him and see if it continues."

1. "Have the parents follow-up with this health-care provider because this is likely an atonic seizure." An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.

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: 1. Absence seizure. 2. Akinetic seizure. 3. Non-epileptic seizure. 4. Simple spasm seizure.

1. Absence seizure. Absence seizures occur frequently and last less than 30 seconds. The child experiences a brief loss of consciousness 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 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. Assess the child's temperature and blood pressure

1. Administer blow-by oxygen and call for additional help The child experiencing a seizure usually requires more oxygen because the seizure increases the body's metabolic rate and demand for oxygen. The seizure may also affect the child's airway, causing the child to be hypoxic. It is always appropriate to give the child blow-by oxygen immediately. The nurse should remain with the child and call for additional help.

A 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. Kernig sign 4. Nuchal rigidity

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

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.

1. High-fat and low-carbohydrate foods. High fat and low carbohydrates are the components of the ketogenic diet.

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 a febrile seizure." 3. "I'll give my child acetaminophen (Tylenol) when ill to prevent the fever from rising too high too rapidly." 4. "Most children with febrile seizures do not require seizure medicine."

2. "My child's 7-year-old brother is also at high risk for a febrile seizure." Most children over the age of 5 years do not have febrile seizures

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

2. Administer rectal diazepam (Valium) Rectal diazepam is first 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 CSF indicates: 1. Viral meningitis 2. Bacterial meningitis 3. No infections, because CSF is usually cloudy 4. Sepsis

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

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

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

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

2. Daily head circumference measurements 3. MRI scan Daily head circumference measurements are done to assess for hydrocephalus. Diagnostic tests include MRI scan, CT scan, ultrasound and myelography

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

2. Flat in the crib Flat in the rib 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 precautions until 24 hours after receiving IV antibiotics. 2. IV fluids at 1 1/2 times regular maintenance 3. Neurological checks every hour 4. Administer acetaminophen (Tylenol) for temperatures higher than 38degrees C (100.4degreesF)

2. IV fluids at 1 1/2 times regular maintenance IV fluids at 1 1/2 times regular maintenance could cause fluid overload and lead to increased ICP

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

2. One oral anticonvulsant medication to observe effectiveness and minimize side effects One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels.

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

3. High-pitched cry. 5. Sleeping more than usual. A high-pitched cry is often indicative of increased ICP in infants. The infant may be sleeping

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

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

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

4. Send the spinal fluid and blood samples to the laboratory for cultures. Cultures of spinal fluid and blood should be obtained, followed by administration of IV antibiotics

A child with a VP shunt complains of HA and blurry vision and now experiences irritability and sleeping more than usual. The parent ask the nurse what they should do. Select the nurse's best response. A. Give her some acetaminophen, and see if her symptoms improve. If they do not improve, bring her into the ped office. B. It is common for girls to have these symptoms, especially prior to beginning their menstrual cycle. Give her a few days and see if she improves. C. 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. D. You should immediately take her to the ED as these may be symptoms of a shunt malfunction.

D. You should immediately take her to the ED as these may be symptoms of a shunt malfunction. These are symptoms of a shunt malfunction and should be evaluated immediately.