course point part 2
The mother of a newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate? "During delivery, your vaginal wall put pressure on the baby's head." "The forceps used during delivery caused this to happen." "Your baby's head became blocked inside your vagina while you were pushing." "It's normal for this to happen, but they don't really know why."
"During delivery, your vaginal wall put pressure on the baby's head." Caput succedaneum results from pressure from the uterus or vaginal wall during a head-first delivery. The use of forceps is associated with a cephalohematoma. Caput succedaneum is not due to the baby's head becoming blocked inside the vagina. The cause of caput succedaneum is known; it is caused by pressure from the uterus or vaginal wall during a head-first delivery. pg. 1420
Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? Onset and character of fever Degree and extent of nuchal rigidity Signs of increased intracranial pressure (ICP) Occurrence of urine and fecal contamination
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. pg. 1388
The treatment for children with seizures disorders is most often: Surgical intervention Use of anticonvulsant medications Restricted fat diet Strict exercise regimen
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. pg. 1393
The mother of a toddler tells the nurse during a routine well-child appointment that she is concerned because, "It seems like my son is falling and hitting his head all of the time." What is the best response by the nurse? "You probably don't have anything to worry about. It is common for toddlers to fall." "I understand your concern, but toddlers fall and hit their heads a lot since they are not very coordinated yet." "Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." "Most mothers are concerned because their toddlers fall a lot. As long as your child seems to be developmentally normal it shouldn't be a concern."
"Due to the size of their heads and immature neck muscles falling is common, but I will let the physician know your concerns." The head of the infant and young child is large in proportion to the body, and is the fastest-growing body part during infancy and continues to grow until the child is 5 years old. In addition, the infant's and child's neck muscles are not well developed. Both of these differences lead to an increased incidence of head injury from falls. The nurse should still let the physician know the mother's concerns in case there is another issue causing the falls. pg. 1381
The nurse is educating parents of a male infant with Chiari type II malformation. Which statement about their child's condition is most accurate? "Take your time feeding your baby." "Lay him down after feeding." "You'll see a big difference after the surgery." "You won't need to change diapers often."
"Take your time feeding your baby." One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms, rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations. pg. 1402
A 1-year-old has just undergone surgery to correct craniosynostosis. Which comment is the best psychosocial intervention for the parents? "The surgery was successful. Do you have any questions?" "This only happens in 1 out of 2,000 births." "I told you yesterday there would be facial swelling." "I'll be watching hemoglobin and hematocrit closely."
"The surgery was successful. Do you have any questions?" Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.
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? "If he is out of bed, the helmet's on the head." "Bike riding and swimming are just too dangerous." "Use this information to teach family and friends." "You'll always need a monitor in his room."
"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. pg. 1392
During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed? Dramatic increase in head circumference Pupil of one eye dilated and reactive Vertical nystagmus Posterior fontanel is closed
Dramatic increase in head circumference A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age. pg. 1386
The nurse caring for a child with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. True False
False Antibiotics or antivirals are used to treat infectious disease processes. Glucocorticoids and diuretics are used to reduce cerebral edema. pg. 1384
Absence seizures are marked by what clinical manifestation? Brief, sudden onset of increased tone of the extensor muscle Loss of motor activity accompanied by a blank stare Sudden, brief jerks of a muscle group Loss of muscle tone and loss of consciousness
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. pg. 1393
Which of these age groups has the highest actual rate of death from drowning? Infants Toddlers Preschool children School-aged children
Toddlers Toddlers and older adolescents have the highest actual rate of death from drowning. pg. 1419
Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n): diuretic antihistamine anticonvulsant steroid.
steroid. A steroid may be prescribed to reduce inflammation and pressure on vital centers. pg. 1384
A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse? "The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." "Since the EEG was negative there must be some other cause for the seizures. The lumbar puncture is necessary to determine what the cause is." "I know it must be frustrating not having a diagnosis yet, but you have to be patient. Seizure disorders are difficult to diagnose." "A lumbar puncture is a routine test that is performed anytime someone has a seizure disorder."
"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures." Lumbar punctures are performed to analyze cerebrospinal fluid (CSF) to rule out meningitis or encephalitis as a cause of seizures. A normal EEG does not rule out epilepsy because seizure activity rarely occurs during the actual testing time. A 24-hour or longer EEG can help in diagnosing a seizure disorder. Just telling the parents that it needs to be done, to be patient, or it is a routine does not address the parents' concerns. pg. 1389
What information is most correct regarding the nervous system of the child? The child's nervous system is fully developed at birth. As the child grows, the gross and fine motor skills increase. The child has underdeveloped fine motor skills and well-developed gross motor skills. The child has underdeveloped gross motor skills and well-developed fine motor skills.
As the child grows, the gross and fine motor skills increase. As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills. pg. 1381
Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? Avoid making noise when in the child's room. Rock the child frequently. Have the child's 2-year-old brother stay in the room. Keep the lights on brightly so that he can see his mother.
Avoid making noise when in the child's room. Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation. pg. 1410
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? Cerebral edema Renal failure Left-sided heart failure Cardiogenic shock
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. pg. 1384
The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent what information in regard to seizures? Cyanosis occurs at the onset of the seizure. Convulsive activity occurs. The child is bradycardiac. The EEG is normal.
Convulsive activity occurs. During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal. pg. 1423
The nurse is using the pediatric Glasgow Coma Scale to assess a child's level of consciousness. What would the nurse assess? Select all that apply. Eye opening Verbal response Motor response Fontanels Posture
Eye opening Verbal response Motor response The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response. pg. 1385
A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? Positive Kernig sign Negative Brudzinski sign Positive Chadwick sign Negative Kernig sign
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. pg. 1409
In caring for a child with a seizure disorder, the primary goal of treatment is: the family caregivers' anxiety will be reduced. the child will have an understanding of the disorder. the family will understand seizure precautions. the child will be free from injury during a seizure.
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. pg. 1397
