NURS 232 - EXAM 3: 3/21/2022

The nurse is caring for a child with leukemia. The nurse should be aware that the children treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection 3. Bleeding tendencies 4. Bone deformities 5. Polycythemia

1. 2. 3. Rationale: Anemia is caused by decreased production of RBCs, infection risk in leukemia is secondary to neutropenia, bleeding tendencies are from decreased platelet production. No bone deformities in leukemia, but there is bone pain from proliferation of the cells of the bone marrow, and polycythemia is an increase in RBCs

Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed? 1. Apply pressure to the nose for at least 10 mins 2. Have the child lie supine and quiet 3. Avoid packing of the nostrils. 4. Encourage the child to swallow frequently

1. Rationale: Apply pressure to the nose may stop the bleeding. In vWD there is an increased tendency to bleed from mucus membranes, leading to nosebleeds commonly from the anterior part of the nasal septum. Child should sit up and lead forward, not swallowing to prevent aspiration of blood. Packing with cotton may stop the bleeding, but when removed can dislodge the clot.

List 5 sources of lead for children.

1. Lead paint (Remember what particular year of homes built before in particular?) 2. Lead pipes supplying water to home or lead faucets 3. Old painted toys and furniture 4. On clothing of parents who work in battery or cable manufacturing

A 10 y/o with severe factor VIII deficiency falls, injures an elbow, and is Brough to the ED. The nurse should prepare which of the following? 1. An IM injection of factor VIII 2. An IV infusion of factor VIII 3. An injection of desmopressin 4. An IV infusion of platelets

2. Rationale: Factor VIII is not given via IM injection , only IV infusion to replace the factor the child is missing to stop the bleeding. Desmopressin is given to stimulate the factor VIII production, an it also is given IV. Platelets don't do nothing for hemophilia, they ain't effective because the platelets function normally, the factor is the thing that's wack in hemophilia.

A child is hospitalized diagnosed with bacterial meningitis. What can the nurse anticipate will be included in the plan of care and treatment? (Select all that apply.) A. Antibiotic therapy B. Ice packs to the back of the neck and feet to reduce body temperature C. Antiviral medications D. Administering tepid baths as needed E. Acetaminophen

A D E Rationale: Bacterial meningitis involves a multifaceted plan of care and treatment. Ice packs will sharply reduce temperature and should not be used. Measures that promote shivering should be avoided as they will increase the metabolic rate. Acetaminophen will be prescribed in effort to reduce the body temperature. Tepid baths can be instituted as needed to reduce body temperature. Antibiotic therapy will be initiated to eradicate the pathogens. Antiviral medications are not indicated as this is not a viral infection.

Benzodiazepines exert their effect primarily on which neurotransmitter? A. GABA B. Serotonin C. Norepinephrine D. Both A and B

A. Rationale: It potentiates effects of GABA, an inhibitory neurotransmitter that stabilizes nerve cell membrane. Muscle relaxation is one result.

A pediatric patient is taking Phenytoin for treatment of seizures. Which statement by the patient/caregiver requires you to re-educate the patient about this medication? A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

A. Rationale: This medication should NOT be taken with milk products or antacids because it affects absorption. All the other options are correct.

Tatiana has a seizure disorder; which of the following would be the lowest priority when caring for her? A. Assessing for signs and symptoms of increased intracranial pressure (ICP). B. Educating the family about anticonvulsant therapy. C. Observing and taking down data on all seizures. D. Assuring safety and protection from injury.

A. Rationale: Option A - Signs and symptoms of increased intracranial pressure (ICP) are not associated with seizure activity and therefore would be the lowest priority. Option B - Improper administration of and incomplete compliance with anticonvulsant therapy can lead to status epilepticus; thus education is a priority. Option C - Careful observation and documentation of seizures provide valuable information to aid prevention and treatment. Option D - Safety is always a priority in the care of a child with a seizure disorder because seizures may occur at any given time.

A Child's lead levels at 1 year of age are 8 mcg/dL. Which of the following would be the most appropriate nursing action to do? a. Repeat the lead level in 1 year. b. Educate the parents on ways to decrease lead exposure for their child. c. Confirm the level with a repeat test in 2 weeks d. Notify HCP for consideration of starting chelation therapy

B.

Which of the following would most reduce a child's exposure to lead in their homes? a. Only use bottled water in cooking b. Remove old paint from the home c. Only allow the child to play with plastic toys d. Ensure the child drinks plenty of water every day

B.

Which of the following nutrients should be increased in a child's diet to decrease the absorption of lead by the body? (Select all that apply). a. Na b. Ca c. K d. Mg e. Fe (Iron) f. Vitamin C (ascorbic acid)

B. E. F.

A 6-month-old infant is admitted with suspected bacterial meningitis. The infant is crying, irritable, and lying in the opisthotonic position. Which priority intervention the nurse should take? A. Palpate the child's fontanels. B. Institute droplet precautions in addition to standard precautions. C. Encourage the parent to hold and comfort the infant. D. Educate the family about preventing bacterial meningitis.

B. Rationale: Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the parent 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.

The nurse overhears the parent of a critically injured child who is praying at the child's bedside say, "I will stop drinking and smoking." The nurse understands that the parent is in which stage of the grieving process? Denial Acceptance Bargaining Anger

Bargaining

Which test provides a definitive diagnosis of aplastic anemia? CBC w/ differential? Bone Marrow Aspiration? Serum IgG levels? Basic metabolic panel?

Bone marrow aspiration Rationale: Definitive diagnosis is determined from a bone marrow aspiration, which demonstrates the conversion of red bone marrow to yellow, fatty bone marrow.

According to the American Academy of Pediatrics, risk assessments for lead exposure should begin at what age? a. 6 years b. 18 months c. 6 months d. 4 years e. 12 months

C.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for what problem? A. Positional plagiocephaly B. Intracranial hemorrhaging C. Head trauma D. Congenital hydrocephalus

C. Rationale: A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

A patient on Dilantin began showing bruises and signs of active infection. The nurse would be right to anticipate that these manifestations give clue to ________________. A. Drug underdosage B. Hypersensitivity reactions C. Cellular toxicity D. None of the above

C. Rationale: It is characterized by severe liver toxicity, bone marrow suppression, gingival hyperplasia, and serious dermatological reaction (e.g. hirsutism, Steven-Johnson syndrome).

A 10-year-old child is admitted to the hospital due to a 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? A. Prevention of injury by removing the child from his bed B. Prevention of injury by placing a tongue blade in the Child's mouth C. Prevention of injury by restraining the child D. Prevention of injury by placing the child on his side and opening his airway

D.

A 7-year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure? A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence

D. Rationale: This is an absence seizure and is most common in children. The hallmark of it is staring that appears to be like a daydreaming state. It is very short and the post ictus stage of this type of seizure is immediate.

Which anti-seizure agents are used in treating absence seizures only? A. Hydantoins B. Benzodiazepines C. Barbiturates D. Succinimides

D. Succinimides = Ethosuximide (Zarontin)

A nurse is giving discharge instructions to a client who will be taking phenobarbital (Luminal). The nurse would educate the client in which of the following that directly correlates with the safety of the client? A. Take the medication with meals only. B. Decrease the dosage once with symptoms of dizziness and lightheadedness. C. Take the medication at the same time each day. D. Avoid using sleep aids while taking the medication.

D. Rationale: Option D- Phenobarbital (Luminal) is an anticonvulsant and hypnotic drug; the client should avoid the use of medicines that may cause drowsiness (eg, sleep aids, muscle relaxers). Option A - The medication is taken without regard to meals. Option B - Decreasing the dosage is not done without the approval of the physician. Option C - Taking the medication at the same time daily improves compliance and maintains more stable blood levels of the medication.

True or False: A patient who is experiencing a tonic-clonic seizure is experiencing a focal (partial) seizure.

False Rationale: A patient who is experiencing a tonic-clonic seizure is experiencing a GENERALIZED seizure. This type of seizure affects both sides of the brain.

Discuss 3 teaching points for an infant who has just been prescribed ferrous sulfate to treat iron deficiency anemia.

Iron supplements for infants are often dark brown-orange in color in the liquid form, this is due to the irons natural pigmentation, place the drops behind the infants teeth to prevent stain formation from forming on the most visible teeth. Accurate measurement of the iron by the caregiver is important, use the dropper, syringe, or spoon the iron comes with and not another measuring device. Iron can be constipating, if this does occur, discuss options with provider, if appropriate increasing fiber and fluid intake may help, or decreasing the iron dose.

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? 1. "How high did his temperature rise when he was ill?" 2. "Did you use any medications like aspirin for the fever?" 3. "What type of fluids did your child take when he had a fever?" 4. "Did you give your child any acetaminophen, such as Tylenol?"

Rationale: 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.

What is a safe lead level?

Zero, None, Na-da, zip, big nope....

A 6-year-old child has been receiving chemotherapy. She is also receiving TPN via a central line. Which of the following concepts would be the priority to monitor for this patient? A. Nutrition B. Infection C. Functional Ability D. Fluids and electrolytes

B. Rationale: Although all of the concepts would require monitoring, infection or the risk for infection would be a priority due to the immunosuppression from chemotherapy, having a central line and receiving TPN through that central line.

The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby? A. Narcan B. Flumazenil C. Calcium Chloride D. Idarucizumab

B. Rationale: Flumazenil is the reversal agent for Lorazepam, which is a benzodiazepine.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. 1. Immobilize the extremity 2. Elevate the extremity 3. Warm, moist compresses applied to decrease pain 4. Passive ROM exercises to the extremity 5. Factor VIII should be administered

1. 2. 5. Rationale: Measures are needed to induce vasoconstriction and stop bleeding: Immobilization, elevation. Treatment should in include application of cold compression, not warmth to promote vasoconstriction. Hemophilia A is a deficiency in factor VIII, which causes a delay in clotting. Giving a dose of factor VIII concentrate will assist the clotting process.

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming 2. Golf 3. Hiking 4. Fishing 5. Soccer

1. 2. 3. 4. Rationale: Children with hemophilia should be encourage to take part in non-contact activities that allow for social, psychosocial, and physical growth, such as swimming, golf, hiking, and fishing. Contact sports such as soccer should be discouraged.

Which of the following can be a manifestation of leukemia in a child? Select all that apply 1. Leg pain 2. Fever 3. Excessive weight gain 4. Bruising 5. Enlarged lymph nodes

1. 2. 4. 5. Rationale: The proliferation of cells in bone marrow can cause leg pain. Fever is the result of neutropenia. A decrease in platelets causes bruising. The lymph nodes are enlarged by the infiltration of leukemic cells. There is usually a decrease in weight because the child will feel sick and not as hungry.

A nurse is caring for a 5-year-old who has terminal cancer. Which of the following statements are true? (Select all that apply). 1. The parents may be at different stages in dealing with the child's death. 2. The child is thinking about the future and knows he may not be able to participate. 3. The dying child may become clingy and act like a toddler. 4. Whispering in the room will help the child to cope. 5. The death of a child may have long term disruptive effects on a family. 6. The child doesn't fully understand the concept of death.

1. 3. 5. 6. Rationale: Everyone goes through the grieving process at their own pace and may go back and forth through the stages of grieving. Death of a child is very difficult for families and may have many long lasting psychological, social, economic and other impacts upon the family. Children under stress often will regress in their behaviors. A 5-year-old does not understand the concept of death fully. They may still experience magical thinking and may not understand that death is permanent but also that they may have caused their illness and ultimate death. Whispering may also cause increase anxiety and imagined thoughts from the child. Thinking about the future would aligns with adolescents, not preschoolers.

A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a clinical manifestation of von Willebrand disease? Select all that apply 1. The child bruises easily 2. Excessive menstruation 3. The child has frequent nose bleeds 4. Elevated creatinine levels 5. Elevated blood pressure

1. 2. 3. Rationale: vWD is a hereditary bleeding disorder chracterized by deficiency of or defect in a protein. The disorder causes adherence of platelets to damaged epithelium and a mild deficiency of factor VIII. One of the manifestations is bleeding of the mucus membranes. Excessive menstruation may be a manifestation of this disease. Frequent nosebleeds are common. There is no increase in BP/Cr.

Which of the following measures should the nurse implement to help with N/V caused by chemotherapy? Select all that apply 1. Give antiemetic 30 mins prior to start of therapy 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete 3. Remove food that has a lot of odor 4. Keep the child on a NPO status 5. Wait until the nausea begins to start the antiemetic

1. 2. 3. Rationale: The first dose should be given 30 mins prior, then administered around the clock until 24 hours after completion of therapy. It is also helpful to remove noxious odors. The child should be allowed to take food and fluids if tolerated. Antiemetics are most beneficial if given beforehand.

A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression. Coma Disorientation Oriented to person, place, and time Obtundation Stupor

1. Oriented to person, place, and time 2. Disorientation 3. Obtundation 4. Stupor 5. Coma Rationale: Levels of consciousness in order from most alert to least alert are orientated to person, place, and time (full consciousness); confusion (disorientation); obtundation; stupor; and finally coma.

Which of the following describes ITP? Select all that apply 1. ITP is a congenital hematology disorder 2. ITP causes excessive destruction of platelets 3. Children with ITP have normal bone marrow 4. Platelets are small in ITP 5. Petechia is common in ITP

2. 3. 5. Rationale: ITP is characterized by destruction of platelets, and purpura (petechia, bruises) the bone marrow is normal in ITP, and platelets are large not small in ITP.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of RBCs 4. To prevent sickle cell crisis.

2. Rationale: Splenic sequestration is life threatening in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration, or has this in the past, the spleen will be removed.

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply 1. Rule out meningitis 2. Assess the CNS for infiltration 3. Determine ICP 5. Stage the leukemia

2. 3. Rationale: There is no need to perform a spinal tap to rule out meningitis unless the patient has s/s of meningitis. A lumbar puncture is done to determine whether cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. Chemotherapy can also be given through a LP. ICP would be considered if s/s of ICP were present. Leukemia is not staged this way.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply 1. Position the child for comfort 2. Apply hot packs to painful areas 3. Give meperidine (Demerol) 25 mg IV q 4 hours as needed for pain. 4. Restrict oral fluids 5. Apply oxygen per nasal cannula to keep oxygen saturation above 94%

3. 4. 5. Rationale: Medical treatment of sickle cell vasoconstriction-occlusive crises is directed toward preventing hypoxia. Tissue hypoxia is very painful, so placing the child in a position of comfort is important. Hot packs help prevent pain due to vasodilation properties, this allows the blood to flow and decreases hypoxia. Tissue hypoxia is very painful, narcotics such as morphine are usually given for pain in a crisis. Meperidine (demerol) should be avoided because of the risk of Demerol induced seizures. Oxygen is of little value unless the tissue is hypoxic.

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol) 2. Aspirin 3. Morphine 4. Behavior techniques 5. Acetaminophen (Tylenol) w/ codeine

3. 4. 5. Rationale: Demerol (Meperidine) potentiates seizures and should not be used. Aspirin in children leads to Reyes syndrome, big nope (except for certain conditions such as Kawasaki disease....) Morphine is the drug of choice my dudes, and usually the child is started orally on Tylenol w/ Codeine. When that is not sufficient to alleviate pain, stronger narcotics are prescribed. Behavioral techniques such as positive self-talk, relaxation, distraction etc, are helpful when pain is occurring.

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia 2. Hemarthrosis 3. Aplastic crisis 4. Thrombocytopenia 5. Vaso-occlusive crisis

3. 5. Rationale: Aplastic crisis, temporary cessation of RBC production, is associated with sickle cell disease. Vaso-occlusive crisis is the most common problem in children with sickle cell disease. Polycythemia is seen in children with chronic hypoxia, such as with cyanotic heart disease. Hemarthrosis, bleeding into a joint is commonly seen in children with hemophilia. Thrombocytopenia is associated with ITP, high altitude, medication side effects, and pregnancy.

Which of the following will be abnormal in a child with a diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level 3. White blood cell count 4. Partial thromboplastin time (PTT)

4. Rationale: The platelet function is normal in hemophilia. There is no change to Hgb, the Hgb will drop with bleeding. WBC is not affected with hemophilia. PTT abnormalities are expected, and related to the decreased clotting factor (function), PTT is prolonged.

Which of the following are signs and symptoms of lead poisoning? (select all that apply). a. Growth delays b. Difficulty concentrating c. Clumsiness d. Hypoglycemia e. Headaches f. Seizures

A B C E F

When assessing a neonate for seizures, what would the nurse expect to find? (Select all that apply.) A. Tachycardia B. Elevated blood pressure C. Jitteriness D. Tonic--clonic contractions E. Ocular deviation

A. B. C. E. Rationale: Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic--clonic contractions typically are more common in older children.

A nurse is providing information to the parents of a child diagnosed with absence seizures. What information would the nurse expect to include when describing this type of seizure? (Select all that apply.) A. The child will commonly report a strange odor or sensation before the seizure. B. This type of seizure is more common in girls than it is in boys. C. This type of seizure is usually short, lasting for no more than 30 seconds. D. Your child will probably sleep deeply for ½ to 2 hours after the seizure. E. You might see a blank facial expression after a sudden stoppage of speech. F. You might have mistaken this type of seizure for lack of attention.

A. B. D. E. Rationale: Absence seizures are more common in girls than boys and are characterized by a sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. This type of seizure lasts less than 30 seconds and may have been mistaken for inattentiveness because of the subtle changes. Absence seizures are not associated with a postictal state.

The nurse is caring for a 3-year-old child who experienced a febrile seizure for the first time. What statements by the parents of the child should the nurse address further? (Select all that apply.) A. "I am afraid that our 10-year-old will start having febrile seizures." B. "It is so scary to think that our child will likely develop epilepsy now." "I am thankful that our child won't have to be on anti-seizure medication." "We have never had anyone in our family have a febrile seizure so I was so surprised when this happened." "It's important to manage fevers in the future in order to decrease the risk of febrile seizures."

A. B. Rationale: It is very unlikely that the parents' 10-year-old child will develop febrile seizures. Febrile seizures usually affect children who are younger than 5 years of age, with the peak incidence occurring in children between 12 and 18 months old; it is rare to see febrile seizures in children younger than 6 months and older than 5 years of age. Children who experience one or more simple febrile seizures have a slightly greater risk of developing epilepsy than the general population, so it is not "likely" that the child will develop epilepsy.

The nurse is teaching the family of a child with sickle cell anemia about triggers that may cause a pain crisis. Which of the following would be included in the teaching? (Select all that apply). A. Infection B. Over-hydration C. A hot, humid day D. Stress at school E. Being outside on a cold winter day F. Oxygen saturation of 96%

A. C. D. E.

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During the administration of this drug, it is important the nurse monitors for: Select all that apply A. Respiratory depression B. Hypertension C. Disseminated intravascular clotting D. Hypotension E. Fever

A. D. Rationale: This medication stimulates the GABA receptors and helps with inhibitory neurotransmission. It can lead to respiratory depression and hypotension, therefore, it is very important the nurse monitors the patient for this.

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.) A. Motor response B. Posture C. Fontanels D. Eye opening E. Verbal response

A. D. E. Rationale: The pediatric Glasgow Coma Scale assesses level of consciousness using three parts: eye opening, verbal response, and motor response.

The nurse determines that a child is experiencing late signs of increased intracranial pressure based on which assessment findings? (Select all that apply.) A. Irregular respirations B. Sunset eyes C. Increased blood pressure D. Fixed dilated pupils E. Bradycardia

A. D. E. Rationale: Late signs of increased intracranial pressure include bradycardia, fixed and dilated pupils, and irregular respirations. Increased blood pressure and sunset eyes are early signs of increased intracranial pressure.

The nurse is caring for a child receiving chemotherapy. The nurse should be aware that the child may experience which of the following side effects? (Select all that apply). a. Anemia b. Weight-gain c. Polycythemia d. Mucositis e. Leukocytosis f. Thrombocytopenia

A. D. F. Rationale: Many of the side effects of chemotherapy are due to bone marrow suppression and destruction of normal cells along with the abnormal cells. These side effects would include mouth sores (mucositis), neutropenia, thrombocytopenia, anemia, weight loss.

You have a patient who has a brain tumor and is at risk for seizures. In the patient's plan of care you incorporate seizure precautions. Select below all the proper steps to take in initiating seizure precautions: A. Oxygen and suction at bedside B. Bed in highest position C. Remove all pillows from the patient's head D. Have restraints on stand-by E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access

A. E. F. G. Rationale: The bed needs to be in the LOWEST position possible, a pillow should be underneath the patient's head to protect it from injury, AVOID using restraints (this can cause musculoskeletal damage).

The nurse is assigned to a child with acute lymphoblastic leukemia (ALL) who has a platelet count of 35,000 (normal 140,000-400,000). The nurse should implement which of the following interventions? A. Provide a soft toothbrush for mouth care. B. Isolation precautions should be started immediately. C. The child's VS, including BP, should be monitored every 4 hours. D. All visitors should be discouraged from coming to the hospital.

A. Rationale: The platelet count is significantly low, increasing the risk of bleeding. Using a soft toothbrush would decrease the risk of oral bleeding. The child may have an increased risk from infection from neutropenia but not as a result of thrombocytopenia.

You're assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure? A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."

A. The patient will experience an alternation in consciousness (hence the name focal IMPAIRED awareness) AND will perform an action without knowing they are doing it called automatism like lip-smacking, rubbing the hands together etc. With a focal onset AWARE seizure (also called partial simple seizure) the patient is aware and will remember what happens (like vision changes etc.).

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. A. The child needs to be taken to a physician when sick. B. The parent should make sure the child sleeps in an air-conditioned room. C. Emotional stress should be avoided. D. It is important to keep the child well hydrated. E. It is important to make sure the child gets adequate nutrition.

A. C. D. E. Rationale: Seek medical attention for illness to prevent the child from going into a crisis. A cold environment causes vasoconstriction, which needs to be prevented to promote good perfusion. Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. The child needs good hydration and nutrition to maintain good health, as well as prevent dehydration.

Which of the following would indicate an increased risk for lead poisoning? (Select all that apply) a. Eating a diet containing iron-rich foods. b. Exposure to water that is supplied through lead pipes. c. Children playing with older painted toys d. Having a parent who works in a battery manufacturing plant e. Living in a home built in 1999

B. C. D.

A child with hemophilia fell during gym class at school. He has an abrasion on his right knee that is painful, swollen, and bleeding. What would be the priority action of the nurse? A. Complete a neurological assessment. B. Apply pressure to the right knee C. Call EMS. D. Apply an ice pack.

B. Rationale: Because he is experiencing active bleeding, you would want to apply pressure first. He will likely need an infusion of factor to help control the bleeding. Ice may also be helpful in controlling the pressure; however applying pressure would be the priority.

The nurse is providing education to the parents of a 2-year-old child with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught? A. "Limit the amount of television your child watches." B. "Watch for changes in your child's behavior or eating patterns." C. "Call the healthcare provider if your child gets a headache." D. "Always keep your child's head raised 30 degrees."

B. Rationale: Changes in behavior or in eating patterns can suggest a problem with the shunt, such as infection or blockage. Irritability, lack of appetite, increased crying, or inability to settle down may indicate increased intracranial pressure. Any headache needs to be monitored, but if it goes away quickly, such as after eating, it probably isn't a problem. It is not necessary to keep the child's head raised 30 degrees. The child's shunt will not be affected by the amount of television viewed.

The nurse assesses a child and finds that the child's pupils are pinpoint. What does this finding indicate? A. Intracranial mass B. Brain stem dysfunction C. Brain stem herniation D. Seizure activity

B. Rationale: Pinpoint pupils are commonly observed in poisonings, brain stem dysfunction, and opiate use. Dilated but reactive pupils are seen after seizures. Fixed and dilated pupils are associated with brain stem herniation. A single dilated but reactive pupil is associated with an intracranial mass.

While observing a child, the nurse notes that the child's arms and legs are extended and pronated. The nurse interprets this as indicating damage to the: A. cerebral cortex. B. midbrain. C. meninges. D. cranial nerves.

B. Rationale: The observations indicate decerebrate posturing, which occurs with damage to the midbrain. Decorticate posturing as evidenced by arm adduction, elbow flexion with arms over the chest, and wrist flexion with fisted hands indicates damage to the cerebral cortex. Damage to the cranial nerves would be manifested by defects in motor and/or sensory function depending on the cranial nerves affected. Meningeal irritation, as with bacterial meningitis, is manifested by opisthotonus in an infant. With this position, the head and neck are hyperextended to relieve discomfort.

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will?* A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

B. A normal Phenytoin level is 10 to 20 mcg/mL. The patient's level is low; therefore, the patient is at risk for seizures. The nurse should initiate seizure precautions. Remember a patient being under medicated is a trigger for developing a seizure.

You're developing discharge instructions to the parents of a child who experiences atonic seizures. What information below is important to include in the teaching? A. "This type of seizure is hard to detect because the child may appear like he or she is daydreaming." B. "Be sure your child wears a helmet daily." C. "It is common for the child to feel extremely tired after experiencing this type of seizure." D. "Avoid high fat and low carbohydrate diets."

B. Rationale: This type of seizure leads to a sudden loss of muscle tone. The patient will go limp and fall, which when this happens the head is usually the first part of the body to hit the floor or an object nearby. It is important the child wears a helmet daily to protect their head from injury. Option A is a characteristic of an absence seizure. Option C is a characteristic of a tonic-clonic seizure during the post ictus stage. And option D is wrong because some patients benefit from this type of diet known as the ketogenic diet.

The nurse determines that a child is experiencing early signs of increased intracranial pressure based on which assessment findings? (Select all that apply.) A. Irregular respirations B. Sunset eyes C. Increased blood pressure D. Fixed dilated pupils E. Bradycardia

B. C. Rationale: Late signs of increased intracranial pressure include bradycardia, fixed and dilated pupils, and irregular respirations. Increased blood pressure and sunset eyes are early signs of increased intracranial pressure.

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which as a risk factor(s) for ischemic stroke? Select all that apply. A. Arteriovenous malformations (AVMs) B. Meningitis C. Sickle cell disease D. Congenital heart defect

B. C. D. Vascular malformations such as intracranial AVMs are a risk factor for hemorrhagic stroke. Sickle cell disease is a risk factor for ischemic stroke. Congenital heart defects are risk factors for ischemic stroke. Meningitis or other infection is a risk factor for ischemic stroke.

An 8-year-old child, who is not responding to anti-seizure medications, is prescribed to start a ketogenic diet. This diet will include: A. High carbohydrates and high fat B. Low fat, high salt, and high carbohydrates C. High fat and low carbohydrates D. High glucose, high fat, and low carbohydrates

C. Rationale: This is a type of diet used in the pediatric population with epilepsy whose seizures cannot be controlled by medication. It is a high fat and low carb diet.

A nurse is providing care to a child with status epilepticus. Which medications would the nurse identify as appropriate to give in this situation? (Select all that apply.) A. Carbamazepine B. Gabapentin C. Fosphenytoin D. Lorazepam E. Diazepam

C. D. E. Rationale: Commonly used medications for treating status epilepticus include lorazepam, diazepam, and fosphenytoin. Gabapentin and carbamazepine are anticonvulsants used to treat and prevent seizures in general.

The nurse is educating the parents of a 7-year-old child with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? A. Treating the child as though the child did not have epilepsy B. Instructing the child's teacher how to respond to a seizure C. Understanding the side effects of medications D. Placing the child on the side on the floor

C. Rationale: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though the child did not have epilepsy helps improve the child's self-image and self-esteem. Placing the child on the side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed? A. Vertical nystagmus B. Posterior fontanel is closed C. Dramatic increase in head circumference D. Pupil of one eye dilated and reactive

C. Rationale: 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.

While observing the infant, the nurse notes that the child is in an opisthotonus position. The nurse interprets this as indicating damage to the: A. cerebral cortex. B. midbrain. C. meninges. D. cranial nerves.

C. Meningeal irritation, as with bacterial meningitis, is manifested by opisthotonus in an infant. With this position, the head and neck are hyperextended to relieve discomfort.

Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to? A. Continue assisting the patient to the restroom and let them sit down. B. Initiate the emergency response system. C. Lay the patient down on their side with a pillow underneath the head. D. Assess the patient's medication history.

C. Rationale: The patient is reporting signs and symptoms of an aura (this is a warning sign before a seizure event). Lay the patient down on their side with a pillow underneath the head and remove any restrictive clothing. Also, time the seizure. If the seizure lasts more than 5 minutes or if the patient starts to have seizures back-to-back activate the emergency response system.

A child is diagnosed with aseptic meningitis. The child's parent states, "I don't know where my child would have picked this up." The nurse prepares to respond to the parent based on the understanding that this disorder is most likely caused by: A. Escherichia coli. B. Streptococcus group B. C. enterovirus. D. Haemophilus influenza type B.

C. Rationale: Aseptic meningitis is the most common type of meningitis, and if a causative organism can be identified, it is usually a virus such as enterovirus. E. coli is a cause of bacterial meningitis. H. influenza type B is a cause of bacterial meningitis. Streptococcus group B is a cause of bacterial meningitis.

A parent has brought their 5-month-old child to the clinic because the child has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which symptom indicates that the shunt is infected? A. The child's pupil reaction time is rapid and uneven. B. The child has a high-pitched cry. C. The fontanels are bulging or tense. D. The child is not responding or eating well.

D. Rationale: Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract. Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure. A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction. Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure.

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

D. Rationale: 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 healthcare provider when the child has a head injury.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. What activity would the nurse identify as a possible trigger? A. Use of non-scented soap B. Swimming twice a week C. 11 PM bedtime; 6:30 AM wake-up D. Drinking three cans of diet cola

D. Rationale: Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

At what lead level would the HCP consider the initiation of chelation therapy? a. < 5 mcg/dL b. 5-14 mcg/dL c. 15-44 mcg/dL d. > than 44 mcg/dL

D. Wtf is chelation therapy anyway? You may ask.... *Chelation therapy involves weekly IV treatments of ethylenediaminetetraacetic acid (EDTA). Each treatment lasts about 30 minutes. In general, the medication seeks out and sticks to metals and minerals in the bloodstream, creating a compound that the body removes when urinating.