Pediatric Cerebral Dysfunction

The nurse who is concerned about increased intracranial pressure in an infant should assess for: A. irritability B. photophobia. C. pulsating anterior fontanel. D. vomiting and diarrhea.

A. irritability Irritability is one of the changes that may indicate increased intracranial pressure. Photophobia does not indicate increased intracranial pressure in infants. Frequently pulsations are visible in the anterior fontanel. It is not an indication of increased intracranial pressure. Vomiting is one of the signs in children but, when present with diarrhea, indicates a gastrointestinal disturbance.

Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain? a. "Your head will be restrained during the procedure." b. "You will have to drink a special fluid before the test." c. "You will have to lie flat after the test is finished." d. "You will have electrodes placed on your head with glue."

a. "Your head will be restrained during the procedure." To reduce fear and enhance cooperation during the MRI, the child should be made aware that the head will be restricted to obtain accurate information. Drinking fluids is usually done for neurologic procedures. A child should lie flat after a lumbar puncture, not after an MRI. Electrodes are attached to the head for an electroencephalogram.

Postoperatively, for placement of a shunt for hydrocephalus, the nurse should place a child in which of the following positions? 1. Elevated 45 degrees in a supine position 2. Flat and lying on the unoperated side 3. Flat and lying on the operated side 4. Elevated 30 degrees and prone

2. A child who has had a shunt revision for hydrocephalus should be placed flat in bed, lying on the unoperated side. The head-elevated position may cause the cerebrospinal fluid to drain too quickly from the ventricles. Lying on the operated side can cause injury to the shunt, and the prone position may cause interference with respiration.

The nurse assesses a child who cries, withdraws from painful stimuli, and opens the eyes to pain to have a Glasgow Coma Scale score of 3. 6. 9. 12.

9 Crying to painful stimuli is a 3, withdrawing from pain is a 4, and opening the eyes to painful stimuli is a 2 on the Glasgow Coma Scale. This gives a total score of 9. A score of 3 means there is neither a verbal nor a motor response to painful stimuli. A score of 12 indicates the child opens the eyes on command, withdraws at simple touch, and has an irritable cry to painful stimuli. A score of 6 is a minimal response to all of the categories, but still a response.

For a male client with suspected increased intracranial pressure (ICP), a most appropriate respiratory goal is to: a. prevent respiratory alkalosis. b. lower arterial pH. c. promote carbon dioxide elimination. d. maintain partial pressure of arterial oxygen (PaO2) above 80 mm Hg

C. The goal of treatment is to prevent acidemia by eliminating carbon dioxide. That is because an acid environment in the brain causes cerebral vessels to dilate and therefore increases ICP. Preventing respiratory alkalosis and lowering arterial pH may bring about acidosis, an undesirable condition in this case. It isn't necessary to maintain a PaO2 as high as 80 mm Hg; 60 mm Hg will adequately oxygenate most clients.

What nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? A. Suctioning child frequently B. Providing environmental stimulation C. Turning head side to side every hour D. Avoiding activities that cause pain or crying

D. Avoiding activities that cause pain or crying Suctioning is a distressing procedure. In addition, the resultant decrease in carbon dioxide can increase ICP. Environmental stimulation should be minimized. The child's head should not be turned side to side. If the jugular vein is compressed, ICP can rise. Nursing interventions should focus on assessment and interventions to minimize pain. These activities can cause intracranial pressure to increase.

The nurse has received report on four children. Which child should the nurse assess first? a. A school-age child in a coma with stable vital signs b. A preschool child with a head injury and decreasing level of consciousness c. An adolescent admitted after a motor vehicle accident who is oriented to person and place d. A toddler in a persistent vegetative state with a low-grade fever

b. A preschool child with a head injury and decreasing level of consciousness The nurse should assess the child with a head injury and decreasing level of consciousness (LOC) first. Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status. The next child the nurse should assess is a toddler in a persistent vegetative state with a low-grade fever. The school-age child in a coma with stable vital signs and the adolescent admitted to the hospital who is oriented to his or her surroundings would be of least worry to the nurse.

The nurse is performing a Glasgow Coma Scale (GCS) on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record? a. 8 b. 13 c. 11 d. 15

d. 15 The GCS consists of a three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patient's level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. The child who opens eyes spontaneously, obeys commands, and is oriented is scored at a 15.

What action may be beneficial in reducing the risk of Reye's syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza

d. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza Although the etiology of Reye's syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye's syndrome; thus use of aspirin is avoided. No immunization currently exists for Reye's syndrome. Reye's syndrome is not correlated with head injuries or bacterial meningitis.

Which of the following values is considered normal for ICP? 1. 0 to 15 mm Hg 2. 25 mm Hg 3. 35 to 45 mm Hg 4. 120/80 mm Hg

1 Normal ICP is 0-15 mm Hg.

When caring for a child with meningitis, it is essential that the nurse evaluate for a positive Brudzinski's sign, which would indicate1. increased intracranial pressure.2. meningeal irritation.3. encephalitis.4. intraventricular hemorrhage.

2. Brudzinski's sign, when the legs flex at both hips and knees in response to flexing the head and neck, indicates meningeal irritation.

The nurse is caring for a toddler who has had surgery for a brain tumor. During an assessment, the nurse notes that the child is becoming irritable and pupils are unequal and sluggish. The MOST appropriate nursing action is to: A. notify the health care provider immediately. B. document level of consciousness. C. observe closely for signs of increased intracranial pressure (ICP). D. administer pain medication and assess for response.

A. notify the health care provider immediately. The worsening of symptoms may indicate that the ICP is increasing. The practitioner should be notified immediately. The health care provider should be notified first before documenting. The nurse is already noting signs of potentially increased ICP. Pain medication should not be given. Consultation with the practitioner should occur first.

The most common problem of children born with a myelomeningocele is a. Neurogenic bladder b. Intellectual impairment c. Respiratory compromise d. Cranioschisis

ANS: A Feedback A Myelomeningocele is one of the most common causes of neuropathic(neurogenic) bladder dysfunction among children. B Risk of intellectual impairment is minimized through early intervention and management of hydrocephalus. C Respiratory compromise is not a common problem in myelomeningocele. D Cranioschisis is a skull defect through which various tissues protrude. It is not associated with myelomeningocele.

A recommendation to prevent neural tube defects is the supplementation of a. Vitamin A throughout pregnancy b. Multivitamin preparations as soon as pregnancy is suspected c. Folic acid for all women of childbearing age d. Folic acid during the first and second trimesters of pregnancy

ANS: C Feedback A Vitamin A does not have a relation to the prevention of spina bifida. B Folic acid supplementation is recommended for the preconceptual period, as well as during the pregnancy C The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida significantly. D Folic acid supplementation is recommended for the preconceptual period, as well as during the pregnancy.

The parents of a 2-year-old toddler who has cerebral palsy notice the child does not sit up alone. They ask the nurse whether the child will be able to learn to walk alone or with crutches. Which of the following is the appropriate response by the nurse? 1. "Your child will most likely not be able to walk alone or with crutches." 2. "The chances of your child walking without crutches is good, but it is unlikely that your child will walk alone." 3. "It is very difficult to say because every child is different." 4. "Your child will most probably be able to walk alone and without the use of crutches."

1. If a child cannot sit up by the age of 2, there is every indication that the child has cerebral palsy affecting voluntary motor control. As a result, the child will not be able to walk with or without crutches.

The nurse is caring for the client with increased intracranial pressure. The nurse would note which of the following trends in vital signs if the ICP is rising? 1. Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure. 2. Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure. 3. Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure. 4. Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure.

2 A change in vital signs may be a late sign of increased intracranial pressure. Trends include increasing temperature and blood pressure and decreasing pulse and respirations. Respiratory irregularities also may arise.

Which of the following signs and symptoms of increased ICP after head trauma would appear first? 1. Bradycardia 2. Large amounts of very dilute urine 3. Restlessness and confusion 4. Widened pulse pressure

3 The earliest symptom of elevated ICP is a change in mental status. Bradycardia, widened pulse pressure, and bradypnea occur later. The client may void large amounts of very dilute urine if there's damage to the posterior pituitary.

The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain: A. cannot occur if the child is comatose. B. may occur if the child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with the child.

C. requires astute nursing assessment and management. Pain can occur in the comatose child. The child can be in pain while comatose. Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must be focused on physiologic and behavioral manifestations. The family can provide insight into different responses, but the nurse should be monitoring physiologic and behavioral manifestations.

A 3-year-old child is status post-shunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? Select all that apply A. Personality change B. Bulging anterior fontanel C. Vomiting D. Dizziness E. Fever

A. Personality change C. Vomiting E. Fever Personality change can be a sign of shunt malformation related to increased intracranial pressure. Vomiting can be a sign of shunt malformation related to increased intracranial pressure. Fever can be a sign of shunt malformation and is a very serious complication. The anterior fontanel closes between 12 and 18 months old. Dizziness is difficult to assess in a 3-year-old and is not necessarily a sign of shunt malformation.

The nurse is doing a neurologic assessment on a 2-month-old infant following a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest: A. neurologic health. B. severe brain damage. C. decorticate posturing. D. decerebrate posturing.

A. neurologic health. The Moro, tonic neck, and withdrawing reflexes are usually present in infants under 3 to 4 months of age. Therefore, the presence of these reflexes indicates neurologic health. These are expected reflexes in a 2-month-old. Decorticate posturing indicates severe dysfunction of the cerebral cortex. Decerebrate posturing indicates dysfunction at the level of the midbrain

When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with observable distended scalp veins, the nurse recognizes these signs as indicative of a. Hydrocephalus b. Syndrome of inappropriate antidiuretic hormone (SIADH) c. Cerebral palsy d. Reye's syndrome

ANS: A Feedback A The combination of signs is strongly suggestive of hydrocephalus. B SIADH would not manifest in this way. The child would have decreased urination, hypertension, weight gain, fluid retention, hyponatremia, and increased urine specific gravity. C The manifestations of cerebral palsy vary but may include persistence of primitive reflexes, delayed gross motor development, and lack of progression through developmental milestones. D Reye's syndrome is associated with an antecedent viral infection with symptoms of malaise, nausea, and vomiting. Progressive neurologic deterioration occurs.

What finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? a. Tremulous movements at rest and with activity b. Sudden jerking movement caused by stimuli c. Writhing, uncontrolled, involuntary movements d. Clumsy, uncoordinated movements

ANS: B Feedback A Tremulous movements are characteristic of rigid/tremor/atonic cerebral palsy. B Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The child's muscles are very tight and any stimuli may cause a sudden jerking movement. C Slow, writhing, uncontrolled, involuntary movements occur with athetoid or dyskinetic cerebral palsy. D Clumsy movements, loss of coordination, equilibrium, and kinesthetic sense occur in ataxic cerebral palsy.

Nursing care of the infant who has had a myelomeningocele repair should include a. Securely fastening the diaper b. Measurement of pupil size c. Measurement of head circumference d. Administration of seizure medications

ANS: C Feedback A A diaper should be placed under the infant but not fastened. Keeping the diaper open facilitates frequent cleaning and decreases the risk for skin breakdown. B Pupil size measurement is usually not necessary. C Head circumference measurement is essential because hydrocephalus can develop in these infants. D Seizure medications are not routinely given to infants who do not have seizures.

Which clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

a. Bulging fontanel and dilated scalp veins Bulging fontanel, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates. Closed fontanel and high-pitched cry, constant low-pitched cry and restlessness, and depressed fontanel and decreased blood pressure are not clinical manifestations of hydrocephalus, but all should be referred for evaluation.

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? Select all that apply a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

a. Observe closely for signs of infection. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention. Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus. Pumping the shunt reservoir, administering sedation, and maintaining Trendelenburg position are not interventions associated with this condition.

The nurse is preparing a school-age child for a computed tomography (CT) scan to assess cerebral function. When preparing the child for the scan, which statement should the nurse include? a. "Pain medication will be given." b. "The scan will not hurt." c. "You will be able to move once the equipment is in place." d. "Unfortunately no one can remain in the room with you during the test."

b. "The scan will not hurt." For CT scans, the child will not be allowed to move and must be immobilized. It is important to emphasize to the child that at no time is the procedure painful. Pain medication is not required; however, sedation is sometimes necessary. Someone is able to remain with the child during the procedure.

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased ICP in an infant? Select all that apply a. Tachycardia b. Alteration in pupil size and reactivity c. Increased motor response d. Extension or flexion posturing e. Cheyne-Stokes respirations

b. Alteration in pupil size and reactivity d. Extension or flexion posturing e. Cheyne-Stokes respirations Late signs of ICP in an infant or child include bradycardia, alteration in pupil size and reactivity, decreased motor response, extension or flexion posturing, and Cheyne-Stokes respirations.

The Glasgow Coma Scale consists of an assessment of: a. Pupil reactivity and motor response. b. Eye opening and verbal and motor responses. c. Level of consciousness and verbal response. d. Intracranial pressure (ICP) and level of consciousness.

b. Eye opening and verbal and motor responses. The Glasgow Coma Scale assesses eye opening and verbal and motor responses. Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the pediatric coma scale. Level of consciousness and ICP are not part of the Glasgow Coma Scale.

Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a. Coma b. Stupor c. Obtundation d. Persistent vegetative state

b. Stupor Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Coma is the state in which no motor or verbal response occurs to noxious (painful) stimuli. Obtundation describes a level of consciousness in which the child can be aroused with stimulation. Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? Select all that apply a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone

c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone Assessment findings in a neonate with meningitis include bulging anterior fontanel, weak cry, and poor muscle tone. Headache and photophobia are signs seen in an older child

An appropriate nursing intervention when caring for an unconscious child should be to: a. Change the child's position infrequently to minimize the chance of increased intracranial pressure (ICP). b. Avoid using narcotics or sedatives to provide comfort and pain relief. c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. Give tepid sponge baths to reduce fever because antipyretics are contraindicated.

c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema. The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown. Narcotics and sedatives should be used as necessary to reduce pain and discomfort, which can increase ICP. Antipyretics are the method of choice for fever reduction.

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of the nursing assessment to detect early signs of a worsening condition is: a. Posturing. b. Focal neurologic signs. c. Vital signs. d. Level of consciousness.

d. Level of consciousness. The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing indicates neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. The PRIORITY of nursing care is to: A. initiate isolation precautions as soon as the diagnosis is confirmed. B. initiate isolation precautions as soon as the causative agent is identified. C. administer antibiotic therapy as soon as it is ordered. D. administer sedatives/analgesics on a preventive schedule to manage pain.

C. administer antibiotic therapy as soon as it is ordered. Isolation should be instituted as soon as diagnosis is anticipated. Isolation should be instituted as soon as diagnosis is anticipated. This is the priority action. Antibiotics are begun as soon as possible to prevent death and avoid resultant disabilities. Antibiotics are the priority function; pain should be managed if it occurs.

A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective? 1. Urine output increases 2. Pupils are 8 mm and nonreactive 3. Systolic blood pressure remains at 150 mm Hg 4. BUN and creatinine levels return to normal

1 Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubes. Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage. No information is given about abnormal BUN and creatinine levels or that mannitol is being given for renal dysfunction or blood pressure maintenance.

The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits: 1. A positive Brudzinski's sign 2. A negative Kernig's sign 3. Absence of nuchal rigidity 4. A Glascow Coma Scale score of 15

1 Signs of meningeal irritation compatible with meningitis include nuchal rigidity, positive Brudzinski's sign, and positive Kernig's sign. Nuchal rigidity is characterized by a stiff neck and soreness, which is especially noticeable when the neck is fixed. Kernig's sign is positive when the client feels pain and spasm of the hamstring muscles when the knee and thigh are extended from a flexed-right angle position. Brudzinski's sign is positive when the client flexes the hips and knees in response to the nurse gently flexing the head and neck onto the chest. A Glascow Coma Scale of 15 is a perfect score and indicates the client is awake and alert with no neurological deficits.

The nurse should monitor a child for which of the following clinical manifestations of meningeal irritation? Select all that apply: 1. Nuchal rigidity 2. Nausea and vomiting 3. Anxiousness 4. Heightened sense of environment 5. Headache 6. Decreased resistance to pain and extension of the leg

1. 2. 5. Clinical manifestations of meningeal irritation are nuchal rigidity, positive Kernig's sign (resistance to pain and extension of the leg), positive Brudzinski's sign, severe headache, loss of consciousness, photophobia, nausea, vomiting, fever, and convulsions.

A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons? 1. To reduce intraocular pressure 2. To prevent acute tubular necrosis 3. To promote osmotic diuresis to decrease ICP 4. To draw water into the vascular system to increase blood pressure

3 Mannitol promotes osmotic diuresis by increasing the pressure gradient, drawing fluid from intracellular to intravascular spaces. Although mannitol is used for all the reasons described, the reduction of ICP in this client is a concern.

A nurse is providing discharge instructions to the parents of a child who suffered a head injury 6 hours ago. Which statement by the parents indicates additional teaching is needed? 1. "We will call the doctor immediately if vomiting occurs." 2. "We won't give anything stronger than Tylenol for headache." 3. "We will provide for uninterrupted sleep when we get home." 4. "We know continued amnesia regarding the events of the injury is expected."

3. Waking children to check neurological status following a head injury is important, no matter the time of day. Vomiting could indicate increased intracranial pressure requiring further evaluation. Narcotics should be avoided after a head injury. Amnesia following a head injury is not uncommon.

The nurse is assigned to administer bismuth subsalicylate (Pepto-Bismol) to a 10-year-old child who has Reye's syndrome and is experiencing gastrointestinal clinical manifestations. Which of the following is the priority action for the nurse to take? 1. Administer the prescribed dose of 1 tablet 2. Inform the child and parents that stools will be dark in appearance 3. Instruct the child to chew the tablet thoroughly 4. Question the physician's order

4. Bismuth subsalicylate (Pepto-Bismol) contains aspirin, and there is a suspected link between aspirin and the etiology of Reye's syndrome. It is a priority to question the order for Pepto-Bismol to be given to this child. One tablet is appropriate for a child 10 years of age. Chewing the tablet and informing the child and parents that the stool will be dark in appearance are all appropriate interventions in the plan of care for a child taking Pepto-Bismol, but not for a child with Reye's syndrome.

What is the priority nursing intervention when a child is unconscious after a fall? a. Establish an adequate airway b. Perform neurologic assessment c. Monitor intercranial pressure d. Determine whether a neck injury is present

a. Establish an adequate airway (Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishing an adequate airway is always the first priority. A neurologic assessment and determination of neck injury are performed after breathing and circulation are stabilized. Intracranial, not intercranial, pressure is monitored if indicated after airway, breathing, and circulation are maintained.)

Which drug would be used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema? a. Mannitol b. Atropine sulfate c. Epinephrine hydrochloride d. Sodium bicarbonate

a. Mannitol For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction. Epinephrine, atropine sulfate, and sodium bicarbonate are not used to decrease ICP.

How should the nurse explain positioning for a lumbar puncture to a 5-year-old child? a. "You will be on your knees with your head down on the table." b. "You will be able to sit up with your chin against your chest." c. "You will be on your side with the head of your bed slightly raised." d. "You will lie on your side and bend your knees so that they touch your chin."

d. "You will lie on your side and bend your knees so that they touch your chin." The child should lie on his or her side with knees bent and chin tucked into the knees. This position exposes the area of the back for the lumbar puncture. The knee-chest position is not appropriate for a lumbar puncture. An infant can be placed in a sitting position with the infant facing the nurse and the head steadied against the nurse's body. A side-lying position with the head of the bed elevated is not appropriate for a lumbar puncture.

The mother of a 1-month-old infant tells the nurse that she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on knowing that: a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children

d. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children. H. influenzae type B meningitis has virtually been eradicated in areas of the world where the vaccine is administered routinely. Bacterial meningitis remains a serious illness in children. It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases. The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms. Meningitis is an extension of a variety of bacterial infections. No genetic predisposition exists. Vaccinations are not available for all of the potential causative organisms.

When taking the history of a child hospitalized with Reye's syndrome, the nurse should not be surprised that a week ago the child had recovered from: a. Measles. b. Varicella. c. Meningitis. d. Hepatitis.

b. Varicella. Most cases of Reye's syndrome follow a common viral illness such as varicella or influenza. Measles, meningitis, and hepatitis are not associated with Reye's syndrome.

The nurse identifies which of the following as warning signs in a 12-month-old with cerebral palsy? Select all that apply:• 1. Weak or absent sucking• 2. Hypotonia• 3. Toe walking but unable to stand alone• 4. Absent or weak primitive reflex responses• 5. Toe walking while held, but unable to stand alone• 6. Athetoid (irregular, twisting) movement

3. 5. 6. Warning signs for cerebral palsy in a 12-month-old include toe walking while being held because the child is unable to stand alone. When crawling occurs, it is abnormal because only the arms may be used and it may be athetoid, which refers to irregular, twisting movements. Weak or absent sucking reflex and absent or weak primitive reflex responses are present in the neonate. Hypertonia is present in a 6-month-old.

The parents of a child with cerebral palsy ask the nurse what the most common cause of cerebral palsy is. The most appropriate response by the nurse is which of the following? 1. "It results when the cord gets wrapped around the neck in the birth canal." 2. "It is the result of a forceps delivery." 3. "It is the result of a premature birth or very low birth weight." 4. "It is the result of preeclampsia in the mother."

3. Although the cord getting wrapped around the neck in the birth canal, a forceps delivery, and preeclampsia in the mother all place a child at risk for cerebral palsy, children born prematurely or those who have very low birth weights are the most at risk.

The nurse is planning care for a school-age child with bacterial meningitis. The plan should include: A. keeping environmental stimuli at a minimum. B. avoiding giving pain medications that could dull sensorium. C. measuring head circumference to assess developing complications. D. having child move head side to side at least every 2 hours.

A. keeping environmental stimuli at a minimum. Children with meningitis are sensitive to noise, bright lights, and other external stimuli. The nurse should keep the room as quiet as possible, with a minimum of external stimuli. After consultation with the practitioner, pain medications can be used if necessary. A school-age child will have closed sutures. Head circumference should not change. The child is placed in a side-lying position with the head of the bed slightly elevated. The nurse should avoid measures such as lifting the child's head that would increase discomfort.

What is a sign of increased intracranial pressure (ICP) in a 10-year-old child? a. Headache b. Bulging fontanel c. Tachypnea d. Increase in head circumference

ANS: A Feedback A Headaches are a clinical manifestation of increased ICP in children. A change in the child's normal behavior pattern may be an important early sign of increased ICP. B This is a manifestation of increased ICP in infants. A 10-year-old child would have a closed fontanel. C A change in respiratory pattern is a late sign of increased ICP. Cheyne-Stokes respiration may be evident. This refers to a pattern of increasing rate and depth of respirations followed by a decreasing rate and depth with a pause of variable length. D By 10 years of age, cranial sutures have fused so that head circumference will not increase in the presence of increased ICP.

A nurse should expect which cerebrospinal fluid (CSF) laboratory results on a child diagnosed with bacterial meningitis? Select all that apply a. Elevated white blood cell (WBC) count b. Decreased protein c. Decreased glucose d. Cloudy in color e. Increase in red blood cells (RBCs)

a. Elevated white blood cell (WBC) count c. Decreased glucose d. Cloudy in color The CSF laboratory results for bacterial meningitis include elevated WBC counts, cloudy or milky in color, and decreased glucose. The protein is elevated and there should be no RBCs present. RBCs are present when the tap was traumatic.

When caring for the child with Reye's syndrome, the priority nursing intervention is to: a. Monitor intake and output. b. Observe for petechiae. c. Prevent skin breakdown. d. Do range-of-motion (ROM) exercises.

a. Monitor intake and output. Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema. Preventing skin breakdown, observing for petechiae, and doing ROM exercises are important interventions in the care of a critically ill or comatose child. Careful monitoring of intake and output is a priority.

A client is admitted to the neurological ICU following a craniotomy. The nurse and the medical staff have established a goal to maintain the client's intracranial pressure (ICP)within normal range. Which of the following should the nurse do? Select all that apply. 1. Assure the head of the bed is elevated 15to 30 degrees. 2. Encourage the client to cough and breathe deeply often. 3. Monitor the client's neurological status using the Glasgow Coma Scale (GCS). 4. Notify the healthcare provider if the ICP is greater than 20 mm Hg. 5. Stimulate the client with the use of active range-of-motion exercises. a. 2, 5 b. 1, 3, 4 c. 3, 4, 5 d. 2, 3, 4, 5

b. 1, 3, 4 The client should maintain the head of the bed between 15 and 30 degrees (1). Monitoring neurological status using the GCS is correct (3). An ICP greater than 20 mm Hg indicates increased ICP, and the nurse should notify the healthcare provider immediately if this occurs (4). Choices a, c, and d are incorrect. The nurse should not encourage the client to cough (2) nor engage in range-of-motion exercises (5), as these will increase ICP and should be avoided in the early postoperative stages.

The vector reservoir for agents causing viral encephalitis in the United States is: a. Tarantula spiders. b. Mosquitoes and ticks. c. Carnivorous wild animals. d. Domestic and wild animals.

b. Mosquitoes and ticks. Viral encephalitis, not attributable to a childhood viral disease, is usually transmitted by mosquitoes and ticks. The vector reservoir for most agents pathogenic for humans and detected in the United States are mosquitoes and ticks; therefore, most cases of encephalitis appear during the hot summer months. Tarantulas, carnivorous wild animals, and domestic animals are not reservoirs for the agents that cause viral encephalitis.

The nurse is caring for a client with a head injury. The client has clear drainage from the nose and ears. How can the nurse determine if the drainage is cerebrospinal fluid (CSF)? a. Measure the pH of the fluid. b. Measure the specific gravity of the fluid. c. Test the fluid for glucose. d. Test the fluid for chloride.

c. CSF is positive for glucose; thus the drainage should be tested for the presence of glucose. Choice a is incorrect. Testing the fluid's pH will not confirm CSF. Choices b and dare incorrect. The fluid should be tested for glucose.

Clinical manifestations of increased intracranial pressure (ICP) in infants are: SATA a. Low-pitched cry. b. Sunken fontanel. c. Diplopia and blurred vision. d. Irritability. e. Distended scalp veins. f. Increased blood pressure.

c. Diplopia and blurred vision. d. Irritability. e. Distended scalp veins. Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants. Low-pitched cry, sunken fontanel, and increased blood pressure are not clinical manifestations associated with ICP in infants.

Which term is used to describe a child's level of consciousness when the child can be aroused with stimulation? a. Stupor b. Confusion c. Obtundation d. Disorientation

c. Obtundation Obtundation describes a level of consciousness in which the child can be aroused with stimulation. Stupor is a state in which the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Confusion is impaired decision making. Disorientation is confusion regarding time and place.

What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? a. "One of the parents carries a defective gene that causes myelomeningocele." b. "A deficiency in folic acid in the father is the most likely cause." c. "Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele." d. "There may be no definitive cause identified."

ANS: D Feedback A The exact cause of most cases of neural tube defects is unknown. There may be a genetic predisposition, but no pattern has been identified. B Folic acid deficiency in the mother has been linked to neural tube defect. C There is no evidence that children who have parents with spinal problems are at greater risk for neural tube defects. D The etiology of most neural tube defects is unknown in most cases. There maybe a genetic predisposition or a viral origin, and the disorder has been linked to maternal folic acid deficiency; however, the actual cause has not been determined.

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. In the discussion the nurse should include that: A. parental protection is essential until the child reaches adulthood. B. cognitive impairment is to be expected with hydrocephalus. C. shunt malfunction or infection requires immediate treatment. D. most usual childhood activities must be restricted

C. shunt malfunction or infection requires immediate treatment. Limits should be appropriate to the developmental age of the child. Except for contact sports, the child will have few restrictions. Cognitive impairment depends on the extent of damage before the shunt was placed. Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the developmental age of the child. Except for contact sports, the child will have few restrictions.

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as: a. Eye trauma. b. Neurosurgical emergency. c. Severe brainstem damage. d. Indication of brain death.

b. Neurosurgical emergency. The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding. Although a dilated pupil may be associated with eye trauma, this child has experienced a neurologic insult. Pinpoint pupils or fixed, bilateral pupils for more than 5 minutes are indicative of brainstem damage. The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain. One fixed and dilated pupil is not suggestive of brain death.