PrepU Chapter 49 Neurologic Disorders

Question: Put the following events of a generalized epileptic seizure in correct order: 1 Tonic stage 2 Postictal period 3 Prodromal period 4 Clonic stage

1 Prodromal period 2 Tonic stage 3 Clonic stage 4 Postictal period A tonic-clonic seizure is characterized by the following events: 1) prodromal period, 2) tonic stage, 3) clonic stage, and 4) postictal period.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the well-child clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a) "I always keep phenobarbital with me in case of a fever." b) "I have ibuprofen available in case it's needed." c) "The most likely time for a seizure is when the fever is rising." d) "My child will likely outgrow these seizures by age 5."

a) "I always keep phenobarbital with me in case of a fever." Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.

Seven-year-old Isabelle has been complaining of headache, coughing, and an aching chest. The care provider makes a diagnosis of a viral infection. The child's mother tells the nurse that when Isabelle first said she had a headache, the child's father gave her half of an adult aspirin. The mother has heard of Reye syndrome and asks the nurse if her child could get this. Which statement would be best for the nurse to say to this mother? a) "This might or might not be a problem. Watch Isabelle for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." b) "This is unlikely to be a problem. Half an aspirin is not enough to cause harm. Reye syndrome generally only develops from prolonged use of aspirin in connection with a virus." c) "This might or might not be a problem. Watch Isabelle for signs of nasal discharge, sneezing, itching of the nose, or dark circles under the eyes. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." d) "This is a serious problem. Aspirin is likely to cause Reye syndrome, and Isabelle should be admitted to the hospital for observation as a precaution."

a) "This might or might not be a problem. Watch Isabelle for signs of lethargy, unusual irritability, confusion, or vomiting. If you notice any of these, bring her to the emergency room immediately so she can be checked for Reye syndrome." Reye syndrome usually occurs after a viral illness, particularly after an upper respiratory infection or varicella (chickenpox). Administration of aspirin during the viral illness has been implicated as a contributing factor. As a result, the American Academy of Pediatrics recommends that aspirin or aspirin compounds not be given to children with viral infections. The symptoms appear within three to five days after the initial illness: The child is recuperating unremarkably when symptoms of severe vomiting, irritability, lethargy, and confusion occur. Immediate intervention is needed to prevent serious insult to the brain including respiratory arrest.

The nurse is caring for a child who had a seizure, fell to the ground, and hit and injured his face, head, and shoulders. This information indicates the child likely had which type of seizures? a) Atonic b) Absence c) Myoclonic d) Infantile

a) Atonic Atonic or akinetic seizures cause a sudden momentary loss of consciousness, muscle tone, and postural control and can cause the child to fall. They can result in serious facial, head, or shoulder injuries. In absence seizures the child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes.

What finding is consistent with increased ICP in the child? a) Bulging fontanel b) Emotional lability c) Increased appetite d) Narcolepsy

a) Bulging fontanel Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2° F(39° C). What is the nurse's highest priority? a) Institute safety precautions. b) Provide family teaching related to the child's history. c) Encourage the child to do his or her own self-care. d) Offer age-appropriate activities.

a) Institute safety precautions. A child with an elevated temperature is at high risk for having seizures, and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

In caring for the child with meningitis, the nurse recognizes that which nursing diagnosis would be the most important to include in this child's plan of care? a) Risk for injury related to seizure activity b) Ineffective airway clearance related to history of seizures c) Risk for acute pain related to surgical procedure d) Delayed growth and development related to physical restrictions

a) Risk for injury related to seizure activity The child's risk for injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and the history of seizures does not impact the airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

In understanding the nervous system, the nurse recognizes that the central nervous system is made up of: a) the brain and spinal cord. b) fluid that flows through the brain. c) nerves throughout the upper body. d) a protective cushion for nerve cells.

a) the brain and spinal cord. The central nervous system is made up of the brain and spinal cord. The peripheral nervous system is made up of nerves throughout the body. A fluid known as cerebrospinal fluid (CSF) flows through the chambers of the brain and through the spinal cord, serving as a cushion and protective mechanism for nerve cells.

When caring for an infant who is hospitalized with Haemophilus influenzae meningitis, an important nursing intervention for the child would be for the nurse to a) Place the child in a side-lying position and keep position using pillows b) Check the child's neurological status every two hours c) Monitor intake and output and increase fluid intake every four hours d) Restrain the child before and during a seizure

b) Check the child's neurological status every two hours The nursing interventions for the child with meningitis are related to the goals for this child, which include monitoring for complications related to neurologic compromise, preventing aspiration, keeping the child safe from injury during a seizure, and monitoring fluid balance. During a seizure, stay with the child, protect the child from injury, but do not restrain him or her. To prevent aspiration, position the child in a side-lying position, watch for and remove excessive mucus as much as possible, and use suction sparingly. Every two hours, observe the child for seizure activity, vital signs, neurologic changes, and change in level of consciousness. The child is placed on fluid restrictions if he or she has decreased urinary output, hyponatremia, increased weight, nausea, and irritability.

The nurse is caring for a 12-month-old infant diagnosed with Haemophilus influenzae meningitis. Which of the following clinical manifestations would likely have been noted in this child? a) Shaking the head and pulling the ear b) High-pitched cry and nuchal rigidity c) Body stiffening and loss of consciousness d) Severe vomiting and confusion

b) High-pitched cry and nuchal rigidity Children with meningitis may have a characteristic high-pitched cry, fever, and irritability. Other symptoms include headache, nuchal rigidity (stiff neck) that may progress to opisthotonos (arching of the back), and delirium.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which intervention should the nurse take initially? a) Palpate the child's fontanels. b) Institute droplet precautions in addition to standard precautions. c) Encourage the mother to hold and comfort the infant. d) Educate the family about preventing bacterial meningitis.

b) Institute droplet precautions in addition to standard precautions. Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.

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

b) Sunlight is "too bright" Photophobia, or intolerance of light, is another symptom of bacterial meningitis. Fixed and dilated pupils are a symptom of head trauma and warrant prompt intervention. Frequent urination is a symptom of a type I Arnold-Chiari malformation. Sunset eyes indicate increased intracranial pressure typical of hydrocephalus.

In caring for a child with a seizure disorder, the primary goal of treatment is: a) The family will understand seizure precautions. b) The child will be free from injury during a seizure. c) The child will have an understanding of the disorder. d) The family caregivers anxiety will be reduced.

b) The child will be free from injury during a seizure. Keeping the child free from injury is the highest priority goal. The other choices are important, but keeping the child safe is higher than the anxiety or knowledge deficit concerns. The physical always is a priority over the psychological.

The best way to evaluate a child's level of consciousness is through conversation. a) False b) True

b) True The best way to evaluate a child's level of consciousness is through conversation. Note any drowsiness or lethargy. Allow the child to answer questions without prompting, and listen carefully to be certain the answer is appropriate to the question.

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question? a) "How high did his temperature rise when he was ill?" b) "What type of fluids did your child take when he had a fever?" c) "Did you use any medications like aspirin for the fever?" d) "Did you give your child any acetaminophen, such as Tylenol?"

c) "Did you use any medications like aspirin for the fever?" Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Cardiogenic shock b) Renal failure c) Cerebral edema d) Left-sided heart failure

c) Cerebral edema The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of I.V. therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.

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) A presence of protein in the urine b) A decrease in the liver enzymes c) Indications of increased intracranial pressure d) An increase in the blood glucose level

c) Indications of increased intracranial pressure Reye syndrome is characterized by brain swelling, liver failure, and death in hours if treatment is not initiated. Therefore, increased intracranial pressure could occur. Liver enzyme levels typically increase. Blood glucose levels and protein in the urine are not characteristic of this illness.

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) Watch for fever indicating infection. b) Monitor for an allergic reaction to the medication. c) Monitor their child's level of sedation. d) Gradually reduce the dosage as seizures stop.

c) Monitor their child's level of sedation. Diazepam is useful for home management of prolonged seizures and requires that the parents be educated on its proper administration. Monitoring the child's level of sedation is key when giving diazepam because it slows the central nervous system. Parents need to monitor the overall health of the child, including temperature when needed, but that has nothing to do with the diazepam. When the use of an anticonvulsant is stopped, gradual reduction of the dosage is necessary to prevent seizures or status epilepticus. This is not done without a physician's order. Monitoring for allergic reactions is necessary when any medications have been prescribed, but is not specific to diazepam.

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a) Degree and extent of nuchal rigidity b) Onset and character of fever c) Signs of increased intracranial pressure (ICP) d) Occurrence of urine and fecal contamination

c) Signs of increased intracranial pressure (ICP) Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Sitting up, with the back straight b) Lying prone, with the feet higher than the head c) Lying prone, with the neck flexed d) Lying on one side, with the back curved

d) Lying on one side, with the back curved Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate? a) Review the signs of increased intracranial pressure with parents. b) Have the parents call the doctor if the child vomits more than twice. c) Have the child sleep without a pillow under his head. d) Teach the child and his parents to keep a headache diary.

d) Teach the child and his parents to keep a headache diary. A headache diary can help identify any triggers so that the child can avoid them. Triggers can include foods eaten, amount of sleep the night before, or activities at home or school that might be causing stress. Reviewing signs of increased intracranial pressure would be inappropriate because increased intracranial pressure is not associated with headaches. Having the child sleep without a pillow is an intervention to reduce pain from meningitis. Vomiting more than twice is an indication that the parents should notify the physician or nurse practitioner when the child has a head injury.

The nurse is educating the family of a 7-year-old with epilepsy about care and safety for this child. What comment will be most valuable in helping the parent and the child cope? a) "Use this information to teach family and friends." b) "If he is out of bed, the helmet's on the head." c) "Bike riding and swimming are just too dangerous." d) "You'll always need a monitor in his room."

a) "Use this information to teach family and friends." Families need and want information they can share with relatives, childcare providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The boy may be able to bike ride and swim with proper precautions.

An 8-year-old boy has just been diagnosed with Sturge-Weber syndrome. Which of the following symptoms should the nurse expect to see in this client? (Select all that apply.) a) Intractable seizures b) A port-wine birthmark on his upper face c) Unexplained development of subcutaneous tumors d) Cognitive challenge e) Numbness on the side of the face that the lesion is on f) Blindness caused by glaucoma

a) Intractable seizures b) A port-wine birthmark on his upper face d) Cognitive challenge f) Blindness caused by glaucoma A child with Sturge-Weber syndrome (encephalofacial angiomatosis) has a congenital port-wine birthmark on the skin of the upper part of the face that follows the distribution of the first division of the fifth cranial nerve (trigeminal nerve). The child will develop symptoms of hemiparesis (numbness) on the side opposite the lesion from destruction of motor neurons. Intractable seizures, a cognitive challenge, or blindness caused by glaucoma may also be present. The unexplained development of subcutaneous tumors is associated with neurofibromatosis, not with Sturge-Weber syndrome.

Absence seizures are marked by what clinical manifestation? a) Loss of motor activity accompanied by a blank stare b) Loss of muscle tone and loss of consciousness c) Sudden, brief jerks of a muscle group d) Brief, sudden onset of increased tone of the extensor muscle

a) Loss of motor activity accompanied by a blank stare An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? a) Monitor temperature every 4 hours b) Decrease environmental stimulation c) Encourage the parents to hold the child d) Take vital signs every 4 hours

b) Decrease environmental stimulation A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.

The nurse caring for a child with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. a) True b) False

b) False Antibiotics or antivirals are used to treat infectious disease processes. Glucocorticoids and diuretics are used to reduce cerebral edema.

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

b) Protecting the child from harm during the seizure During a seizure, the child should not be held down in a specific position. Protecting the child's head and body during the seizure is the priority. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing or hyperextending his head. The child should be placed on his side and nothing should be inserted into his mouth to forcibly open the jaw.

The mother of a child newly diagnosed with mental retardation tells the nurse that her partner disagrees with the diagnosis and believes that the child is perfectly normal. The mother shares with the nurse that she finds this reaction frustrating and confusing. Which of the following would be appropriate in supporting this mother? The nurse should a) Offer to speak with the partner to explain how the diagnosis was reached b) Suggest that the couple get a second opinion about the child's condition c) Reassure the mother that her partner's reaction is a normal stage in the grieving process d) Recommend that the couple consider placing the child in foster care until they adjust to the diagnosis

c) Reassure the mother that her partner's reaction is a normal stage in the grieving process The family's first reaction to learning that the child may have cognitive impairment is grief because this is not the perfect child of their dreams. A parent may feel shame, assuming that he or she cannot produce a perfect child. Some rejection of the child is almost inevitable at least in the initial stages, but this must be worked through for the family to cope.

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) Hyperventilation therapy to counteract the periods of decreased oxygenation b) Physical, occupational, and speech therapy to maximize his potential c) Support for maintaining self-esteem because of his altered lifestyle d) Multiple corrective surgeries to slowly remove diseased parts of his brain

c) Support for maintaining self-esteem because of his altered lifestyle The effects of living with a seizure disorder can be devastating, and it is essential for the child to receive support to maintain self-esteem. While corrective surgery is possible, it would only be performed once. Physical, occupational, speech, and hyperventilation therapy are not indicated for treatment of epilepsy.

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) Facial b) Olfactory c) Trigeminal d) Accessory

c) Trigeminal To test the trigeminal nerve, the nurse would note the strength of the infant's suck on a pacifier, thumb, or bottle. The olfactory nerve is not assessed in infants and young children. The facial nerve is assessed by noting the symmetry of facial expressions. For the infant, this would be assessed during spontaneous crying or smiling. The accessory nerve is assessed when the infant is in the sitting position and symmetry of the head position is noted.

A nurse is performing a complete neurological examination of a 7-year-old boy. She will now test his cerebellar function. Which of the following tests would be appropriate for this purpose? a) Ask the boy to touch each finger on one hand with the thumb that hand in rapid succession b) Ask the boy to close his eyes and then touch his skin with a cotton wisp; ask him to point to where he was touched c) Measure the circumference of the calves and thighs with a tape measure d) Ask the boy who he is, where he is, and what day it is

a) Ask the boy to touch each finger on one hand with the thumb that hand in rapid succession Tests for cerebellar function are tests for balance and coordination, such as asking the child to touch each finger on one hand with the thumb of that hand in rapid succession. Motor function is measured by evaluating muscle size, strength, and tone. Begin by comparing the size and symmetry of extremities. If in doubt about either of these, measure the circumference of the calves and thighs or upper and lower arms with a tape measure. If children's sensory systems are intact, they should be able to distinguish light touch, pain, vibration, hot, and cold. Have a child close his eyes and then ask him to point to the spot where you touch him with an object. Orientation, which is one measure of cerebral function, refers to whether children are aware of who they are, where they are, and what day it is (person, place, and time).

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? a) Positive Kernig sign b) Negative Kernig sign c) Positive Chadwick sign d) Negative Brudzinski sign

a) Positive Kernig sign A positive Kernig sign can indicate irritation of the meninges. A positive Brudzinski sign also is indicative of the condition. A positive Chadwick sign is a bluish discoloration of the cervix indicating pregnancy.

Haemophilus Influenzae Meningitis is usually spread by which of the following methods of transmission? a) Contact b) Droplet c) Intravenous d) Fecal

b) Droplet Transmission of H. influenzae meningitis is by means of droplet infection from an infected person; other forms of meningitis are contracted by invasion of the meninges via the bloodstream from an infection elsewhere. Fecal and contact transmission is not how H. influenzae meningitis is spread or tranmitted.

A 9-year-old girl who is suspected of having an infection of the central nervous system is undergoing a lumbar puncture to withdraw cerebrospinal fluid for analysis. The nurse knows that the needle will be introduced into the subarachnoid space at the level of which of the following vertebrae? a) C1 or C2 b) L4 or L5 c) T3 or T4 d) L1 or L2

b) L4 or L5 Lumbar puncture, the introduction of a needle into the subarachnoid space (under the arachnoid membrane) at the level of L4 or L5 to withdraw CSF for analysis, is used most frequently with children to diagnose hemorrhage or infection in the CNS or to diagnose an obstruction of CSF flow.

The treatment for children with seizures disorders is most often: a) Strict exercise regimen b) Use of anticonvulsant medications c) Restricted fat diet d) Surgical intervention

b) Use of anticonvulsant medications Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. A few children may be candidates for surgical intervention but, in most cases, surgery is not the treatment. Ketogenic diets (high in fat and low in carbohydrates and protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Exercise is not a treatment for seizure disorders.

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 When a lumbar puncture is performed on a child, the child is placed on his or her side with the head flexed forward and knees flexed to the abdomen. An infant would be positioned sitting upright with the head flexed forward. A supine position with the arms and legs pronated and extended suggests decerebrate posturing. A prone position is not used for a lumbar puncture.

The premise behind using plasmapheresis in patient diagnosed with Guillain-Barré syndrome includes which of the following? a) Prevention of demyelination b) Prevention of joint contractures c) Prevention of skin breakdown d) Prevention of deep vein thrombosis

a) Prevention of demyelination The immune basis for GBS suggests use of intravenous immune globulins or plasmapheresis to prevent demyelination. Plasmapheresis does not prevent joint contractures, skin breakdown, or deep vein thrombosis.

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) Sunsetting b) Decorticate posturing c) Doll's eye d) Nystagmus

a) Sunsetting Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate posturing includes adduction of the arms, flexion at the elbows with the arms held over the chest, and flexion of the wrists with both hands fisted and the lower extremities adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye movements. Doll's eye is a maneuver that tests for symmetric eye movement to the opposite side when the head is turned in the other direction.

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be: a) The child may begin to have absence seizures every day. b) The child is in status epilepticus. c) The child is having generalized seizures. d) The child's history indicates she has infantile seizures.

b) The child is in status epileptics. Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

The nurse is observing a group of children diagnosed with various types of cerebral palsy. One of the children has an awkward and wide-based gait. The nurse recognizes this characteristic as common in which type of cerebral palsy? a) Ataxic cerebral palsy b) Rigidity cerebral palsy c) Spastic cerebral palsy d) Athetoid cerebral palsy

a) Ataxic cerebral palsy Ataxic cerebral palsy is essentially a lack of coordination caused by disturbances in the kinesthetic and balance senses; it is characterized by an awkward and wide-based gait. Athetoid cerebral palsy is marked by involuntary, uncoordinated motion with varying degrees of muscle tension. Children with this disorder are constantly in motion; the whole body is in a state of slow, writhing muscle contractions whenever voluntary movement is attempted. Rigidity cerebral palsy is uncommon and is characterized by rigid postures and lack of active movement. Spastic cerebral palsy is characterized by scissoring caused by severe hip adduction.

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? a) "Small increments in dosage lead to sharp increases in plasma drug levels." b) "The capacity to metabolize the drug becomes overwhelmed over time." c) "Large increments in dosage lead to a more rapid stabilizing therapeutic effect." d) "A drop in the plasma drug level will lead to a toxic state."

a) "Small increments in dosage lead to sharp increases in plasma drug levels." Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity.

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) Negative Brudzinski sign b) Photophobia c) Vomiting d) Complaints of stiff neck e) Absent headache

b) Photophobia c) Vomiting d) Complaints of stiff neck In addition to the adolescent's complaints and history, other findings suggesting bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive Brudzinski sign, and vomiting.

The caregivers of a child who has had difficulty learning to walk notice that when the child attempts to pull himself up to stand, he can't seem to get his legs uncrossed and beside each other. When he is in a standing position, he stays up on his toes. This is different from what they saw with their older children and they are concerned. Further diagnostic tests indicate the child has cerebral palsy. Which type of cerebral palsy do these symptoms indicate? The child has a) Athetoid cerebral palsy b) Ataxic cerebral palsy c) Spastic cerebral palsy d) Rigidity cerebral palsy

c) Spastic cerebral palsy Among other things, spastic cerebral palsy is characterized by scissoring caused by severe hip adduction. When scissoring is present, the child's legs are crossed and the toes are pointed down. When standing, the child is on her or his toes. It is difficult for this child to walk on the heels or run. Ataxic cerebral palsy is essentially a lack of coordination caused by disturbances in the kinesthetic and balance senses; it is characterized by an awkward and wide-based gait. Athetoid cerebral palsy is marked by involuntary, uncoordinated motion with varying degrees of muscle tension. Children with this disorder are constantly in motion; the whole body is in a state of slow, writhing muscle contractions whenever voluntary movement is attempted. Rigidity cerebral palsy is uncommon and is characterized by rigid postures and lack of active movement.